Cervical schwannoma in the early stage of pregnancy: a case report
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CASE REPORT
Cervical schwannoma in the early stage of pregnancy: a case report Koki Kawaguchi1†, Koji Akeda1*† , Norihiko Takegami1, Tatsuya Kurata2, Kuniaki Toriyabe3, Tomoaki Ikeda3 and Akihiro Sudo1
Abstract Background: Although spinal schwannomas generally grow very slowly, it has been reported that these clinical growths and their associated neurological symptoms accelerate during pregnancy. Because these cases are rare, surgical intervention for this tumor during pregnancy poses a significant challenge. The change of pregnancy-related hormones, such as estrogen and progesterone, is considered to have an effect on the clinical symptoms of spinal tumors. Expressions of the receptors for estrogen and progesterone in orbital and vestibular schwannomas have been reported; however, those expressions in spinal schwannomas have not been examined. Case presentation: A 36-year-old woman at 8 weeks’ gestation suffered from developing neck pain and neurological symptoms in the right upper extremity. Magnetic resonance imaging (MRI) confirmed the presence of a cervical intradural extramedullary tumor. Under general anesthesia, using intraoperative neurophysiological monitoring of motor-evoked potentials (MEPs), spinal tumor resection following a hemi-laminoplasty was performed in a prone position at 12 weeks gestation. The pathological diagnosis following surgery was spinal schwannoma. Her neurological symptoms were significantly improved after surgery and she delivered a healthy baby in her 40th week of pregnancy. At a 12-month follow-up, no abnormalities were observed during medical examinations of both mother and child. An immunohistochemical study identified the expression of estrogen receptors, but not progesterone receptors, in the spinal schwannoma. Conclusions: A cervical spinal schwannoma was successfully removed under general anesthesia at 12 weeks gestation by coordination between orthopaedic, obstetric and anesthesia teams. For the first time, an immunohistochemical analysis showed that the expression of estrogen receptors was identified in spinal schwannoma cells, suggesting the possibility that these hormone receptors in spinal schwannoma might contribute to the worsening of neurological symptoms during pregnancy. Keywords: Spinal schwannoma, Pregnancy, Surgery, Estrogen receptor Background Spinal schwannomas are benign nerve within the spinal canal, typically arising cells of dorsal nerve roots. They are the intradural extramedullary spinal tumor
sheath tumors from Schwann most common and represent
*Correspondence: [email protected]‑u.ac.jp † Koki Kawaguchi and Koji Akeda equally contributed to this manuscript 1 Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2‑174 Edobashi, Tsu, Mie 514‑8507, Japan Full list of author information is available at the end of the article
approximately 55% of spinal tumors [1]. Spinal schwannomas during pregnancy are rare and surgical intervention of this tumor during this time poses a significant challenge. Although sp
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