Cargando…

Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases

BACKGROUND: Migratory disc herniations can mimic neoplasms clinically and on imaging. Far lateral lumbar disc herniations usually compress the exiting nerve root and can be challenging to distinguish from a nerve sheath tumor due to the proximity of the nerve and characteristics on magnetic resonanc...

Descripción completa

Detalles Bibliográficos
Autores principales: Uy, Benjamin R., Sun, Matthew Z., Muftuoglu, Yagmur, Cheng, Megan, Kim, Wi Jin, Magaki, Shino, Yoo, Brian Y., Salehi, Banafsheh, Beckett, Joel S., Macyszyn, Luke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Association of Neurological Surgeons 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10555549/
https://www.ncbi.nlm.nih.gov/pubmed/37014005
http://dx.doi.org/10.3171/CASE22552
_version_ 1785116679374635008
author Uy, Benjamin R.
Sun, Matthew Z.
Muftuoglu, Yagmur
Cheng, Megan
Kim, Wi Jin
Magaki, Shino
Yoo, Brian Y.
Salehi, Banafsheh
Beckett, Joel S.
Macyszyn, Luke
author_facet Uy, Benjamin R.
Sun, Matthew Z.
Muftuoglu, Yagmur
Cheng, Megan
Kim, Wi Jin
Magaki, Shino
Yoo, Brian Y.
Salehi, Banafsheh
Beckett, Joel S.
Macyszyn, Luke
author_sort Uy, Benjamin R.
collection PubMed
description BACKGROUND: Migratory disc herniations can mimic neoplasms clinically and on imaging. Far lateral lumbar disc herniations usually compress the exiting nerve root and can be challenging to distinguish from a nerve sheath tumor due to the proximity of the nerve and characteristics on magnetic resonance imaging (MRI). These lesions can occasionally present in the upper lumbar spine region at the L1–2 and L2–3 levels. OBSERVATIONS: The authors describe 2 extraforaminal lesions in the far lateral space at the L1–2 and L2–3 levels, respectively. On MRI, both lesions tracked along the corresponding exiting nerve roots with avid postcontrast rim enhancement and edema in the adjacent muscle tissue. Thus, they were initially concerning for peripheral nerve sheath tumors. One patient underwent fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) screening and demonstrated moderate FDG uptake on PET-CT scan. In both cases, intraoperative and postoperative pathology revealed fibrocartilage disc fragments. LESSONS: Differential diagnosis for lumbar far lateral lesions that are peripherally enhancing on MRI should include migratory disc herniation, regardless of the level of the disc herniations. Accurate preoperative diagnosis can aid in decision making for management, surgical approach, and resection.
format Online
Article
Text
id pubmed-10555549
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher American Association of Neurological Surgeons
record_format MEDLINE/PubMed
spelling pubmed-105555492023-10-07 Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases Uy, Benjamin R. Sun, Matthew Z. Muftuoglu, Yagmur Cheng, Megan Kim, Wi Jin Magaki, Shino Yoo, Brian Y. Salehi, Banafsheh Beckett, Joel S. Macyszyn, Luke J Neurosurg Case Lessons Case Lesson BACKGROUND: Migratory disc herniations can mimic neoplasms clinically and on imaging. Far lateral lumbar disc herniations usually compress the exiting nerve root and can be challenging to distinguish from a nerve sheath tumor due to the proximity of the nerve and characteristics on magnetic resonance imaging (MRI). These lesions can occasionally present in the upper lumbar spine region at the L1–2 and L2–3 levels. OBSERVATIONS: The authors describe 2 extraforaminal lesions in the far lateral space at the L1–2 and L2–3 levels, respectively. On MRI, both lesions tracked along the corresponding exiting nerve roots with avid postcontrast rim enhancement and edema in the adjacent muscle tissue. Thus, they were initially concerning for peripheral nerve sheath tumors. One patient underwent fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) screening and demonstrated moderate FDG uptake on PET-CT scan. In both cases, intraoperative and postoperative pathology revealed fibrocartilage disc fragments. LESSONS: Differential diagnosis for lumbar far lateral lesions that are peripherally enhancing on MRI should include migratory disc herniation, regardless of the level of the disc herniations. Accurate preoperative diagnosis can aid in decision making for management, surgical approach, and resection. American Association of Neurological Surgeons 2023-04-03 /pmc/articles/PMC10555549/ /pubmed/37014005 http://dx.doi.org/10.3171/CASE22552 Text en © 2023 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Case Lesson
Uy, Benjamin R.
Sun, Matthew Z.
Muftuoglu, Yagmur
Cheng, Megan
Kim, Wi Jin
Magaki, Shino
Yoo, Brian Y.
Salehi, Banafsheh
Beckett, Joel S.
Macyszyn, Luke
Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases
title Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases
title_full Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases
title_fullStr Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases
title_full_unstemmed Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases
title_short Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases
title_sort upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases
topic Case Lesson
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10555549/
https://www.ncbi.nlm.nih.gov/pubmed/37014005
http://dx.doi.org/10.3171/CASE22552
work_keys_str_mv AT uybenjaminr upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases
AT sunmatthewz upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases
AT muftuogluyagmur upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases
AT chengmegan upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases
AT kimwijin upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases
AT magakishino upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases
AT yoobriany upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases
AT salehibanafsheh upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases
AT beckettjoels upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases
AT macyszynluke upperlumbarspinefarlateraldischerniationsmasqueradingasperipheralnervesheathtumorsillustrativecases