Rapid Growth of a Thoracic Cystic Schwannoma Accelerated by Spondylodiscitis

Study Design: A case report. Objectives: This case report highlights the clinical presentation, radiological features, and surgical outcomes of a rapidly growing cystic schwannoma in the thoracic spine, emphasizing its rarity and potential rapid growth influenced by inflammatory conditions. Summary of Literature Review: Spinal schwannomas are the most common intradural extramedullary tumors, usually solid, with cystic variants being rare. Predominantly cystic schwannomas are even less common, with only 22 cases reported between 1981 and 2021. These tumors are more frequent in the lumbar region and must be differentiated from other cystic spinal lesions. Theories on their pathogenesis include ischemic necrosis and mucinous degeneration, and their growth may be accelerated by inflammatory triggers. Materials and Methods: A 76-year-old woman with a history of lumbar fusion for chronic pain presented with worsening backache, leg weakness, and incontinence. She was previously diagnosed with spondylodiscitis and treated with antibiotics. An initial MRI revealed an asymptomatic cystic mass at T11-12. One year later, the mass had significantly enlarged, leading to surgical intervention. A T11 laminectomy and en-bloc resection were performed, and the mass was histopathologically confirmed as a cystic schwannoma. Results: Postoperatively, the patient showed significant neurological improvement. The tumor’s growth rate far exceeded average schwannoma growth rate, potentially linked to the patient's history of spondylodiscitis. Conclusions: Cystic schwannomas, though rare, should be considered in the differential diagnosis of intradural cystic lesions, particularly in cases with rapid progression. This case highlights the potential for accelerated growth of a thoacic cystic schwannoma due to inflammatory conditions, underscoring the need for vigilant monitoring and timely surgical intervention, with complete resection being crucial to prevent recurrence.