EURORAD ESR

Case 15643

Primary intra-osseous psammomatous melanotic schwannoma of the sacrum

Author(s)
Gavin A. McKenzie
Benjamin M. Howe
Caterina Giannini
Peter S. Rose
Doris E. Wenger

200 1st St SW 55905 Rochester; Email:mckenzie.gavin@mayo.edu
 
Patient
female, 60 year(s)
 
 
  • Figure 1
    Axial non-enhanced CT
     

    Non-contrast CT demonstrates a lytic heterogeneous sacral mass with internal calcifications (arrowhead, B) and macroscopic fat (arrow, A) involving the first three sacral segments with a small focus of soft tissue...

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: CT; Procedure: Education; Special Focus: Neoplasia;

    Non-contrast CT demonstrates a lytic heterogeneous sacral mass with internal calcifications (arrowhead, B) and macroscopic fat (arrow, A) involving the first three sacral segments with a small focus of soft tissue...

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: CT; Procedure: Education; Special Focus: Neoplasia;

    Non-contrast CT demonstrates a lytic heterogeneous sacral mass with internal calcifications (arrowhead, B) and macroscopic fat (arrow, A) involving the first three sacral segments with a small focus of soft tissue...

     
    Area of Interest: Education; Imaging Technique: CT; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 2
    Axial MRI Images
     

    Axial T1 (A) MRI sequence demonstrate inhomogenous T1 hyperintensity with superimposed dominant T1 hyperintense focus (arrows) which can be seen with fat, melanotic, hemorrhagic, proteinaceous or maybe mineralized...

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;

    Axial T1 fat sat non contrast MRI sequence demonstrates inhomogenous T1 hyperintensity which can be seen with melanotic, hemorrhagic, proteinaceous or maybe mineralized lesions.

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 3
    MRI with and without gadolinium
     

    Axial T2-weighted fat saturated (A) and SPGR post gadolinium (B) sequences, demonstrate a T2 heterogeneous peripherally enhancing lesion. Sagittal SPGR post gadolinium sequence (C) demonstrates the small soft tissue...

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;

    Axial T2-weighted fat saturated (A) and SPGR post gadolinium (B) sequences, demonstrate a T2 heterogeneous peripherally enhancing lesion. Sagittal SPGR post gadolinium sequence (C) demonstrates the small soft tissue...

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;

    Axial T2-weighted fat saturated (A) and SPGR post gadolinium (B) sequences, demonstrate a T2 heterogeneous peripherally enhancing lesion. Sagittal SPGR post gadolinium sequence (C) demonstrates the small soft tissue...

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 4
    Coronal Oblique MRI

    Coronal oblique T1-weighted sequence in plane with the neuroforamen demonstrate the nerve sparing nature of the mass with overall preservation of the S1-S4 nerves (arrows), most consistent with primary intra-osseous...

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;
     
     
  • Figure 5
    Histopathology and Immunohistochemical stains

    H&E sections (A, B) demonstrate tumor cells immersed in adipose tissue (A), and psammomatous calcification (B). Immunohistochemical stains show S100 (schwanninan marker positivity (C)) and HMB45 (immature melanosomes...

     
    Area of Interest: Musculoskeletal bone; Imaging Technique: MR; Procedure: Education; Special Focus: Neoplasia;
     
     
Non-contrast CT demonstrates a lytic heterogeneous sacral mass with internal calcifications (arrowhead, B) and macroscopic fat (arrow, A) involving the first three sacral segments with a small focus of soft tissue breakthrough anteriorly (arrow, C).
 
Non-contrast CT demonstrates a lytic heterogeneous sacral mass with internal calcifications (arrowhead, B) and macroscopic fat (arrow, A) involving the first three sacral segments with a small focus of soft tissue breakthrough anteriorly (arrow, C).
 
Non-contrast CT demonstrates a lytic heterogeneous sacral mass with internal calcifications (arrowhead, B) and macroscopic fat (arrow, A) involving the first three sacral segments with a small focus of soft tissue breakthrough anteriorly (arrow, C).
 
Axial T1 (A) MRI sequence demonstrate inhomogenous T1 hyperintensity with superimposed dominant T1 hyperintense focus (arrows) which can be seen with fat, melanotic, hemorrhagic, proteinaceous or maybe mineralized lesions.
 
Axial T1 fat sat non contrast MRI sequence demonstrates inhomogenous T1 hyperintensity which can be seen with melanotic, hemorrhagic, proteinaceous or maybe mineralized lesions.
 
Axial T2-weighted fat saturated (A) and SPGR post gadolinium (B) sequences, demonstrate a T2 heterogeneous peripherally enhancing lesion. Sagittal SPGR post gadolinium sequence (C) demonstrates the small soft tissue focus with cortical breakthrough
 
Axial T2-weighted fat saturated (A) and SPGR post gadolinium (B) sequences, demonstrate a T2 heterogeneous peripherally enhancing lesion. Sagittal SPGR post gadolinium sequence (C) demonstrates the small soft tissue focus with cortical breakthrough
 
Axial T2-weighted fat saturated (A) and SPGR post gadolinium (B) sequences, demonstrate a T2 heterogeneous peripherally enhancing lesion. Sagittal SPGR post gadolinium sequence (C) demonstrates the small soft tissue focus with cortical breakthrough
 
Coronal oblique T1-weighted sequence in plane with the neuroforamen demonstrate the nerve sparing nature of the mass with overall preservation of the S1-S4 nerves (arrows), most consistent with primary intra-osseous origin.
 
H&E sections (A, B) demonstrate tumor cells immersed in adipose tissue (A), and psammomatous calcification (B). Immunohistochemical stains show S100 (schwanninan marker positivity (C)) and HMB45 (immature melanosomes (D)), supporting a psammomatous melanotic schwannoma.
 
 
 
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