Corresponding author : Hiba Bettaieb
- Dr. Rim Dhahri: Associate Professor , Rheumatology
department, Military Hospital of Tunis, TunisiaEmail:rimdhahri@ymail.com
- Dr Hiba Bettaieb : Rheumatologist, , Rheumatology department,
Military Hospital of Tunis, TunisiaThe corresponding author+216 56 179 617Adress: 08 Street de la sirène. 2070. Tunis. TunisiaEmail :
hibahera@gmail.com
- Dr Maroua Slouma : University Hospital Assistant,
Rheumatology department, Military Hospital of Tunis, TunisiaEmail:maroua.slouma@gmail.com
- Dr Yasmine Khrifech : Intern, internal medicine department,
Military Hospital of Tunis, TunisiaEmail :
yessminkhrifech@gmail.com
- Dr Youssef Mallat : University Hospital Assistant,
Orthopedics’ department, Military Hospital of Tunis, TunisiaEmail :
dr.youssef.mallat@gmail.com
- Dr Khalil Amri : University Hospital Assistant, Orthopedics’
department, Military Hospital of Tunis, TunisiaEmail :
akhalil.kh@gmail.com
- Dr Ahmed Harbaoui : Associate Professor, Neurosurgery
department, Military Hospital of Tunis, TunisiaEmail:ahmed.harbaoui@gmail.com
- Prof Leila Metoui : Associate Professor, Rheumatology
department, Military Hospital of Tunis, TunisiaEmail:leila.metoui@gnet.tn
- Prof Imene Gharsallah : Professor, head of Rheumatology
department , Military Hospital of Tunis, TunisiaEmail :
imengharsallah@hotmail.fr
- Prof Bassem Louzir : Professor, head of internal medicine
department , Military Hospital of Tunis, TunisiaEmail:louzir.bassem@yahoo.frDeclarations section:
- Consent for publication: Patient was informed and fully
consented to publication.
- Availability of data and material: The datasets used and/or
analyzed during the current study are available from the corresponding
author on reasonable request.
- Competing interests : None to declare
- Funding : None
- Pharmaceutical / industry support: NoneABSTRACT: Neurinomas are tumors of Schwann cells of the peripheral nerve sheath.
Sacral location is rarely reported especially in spondyloarthritis
patients. Herein, we report a case of uncommon pygalgia in a
25-year-old man with history of a non-radiographic axial
spondyloarthritis and in whom the diagnosis of sacral neurinoma was
established.KEY WORDS: Neurinoma; Schwannoma; spondyloarthritis; pygalgiaKEY CLINICAL MESSAGE :
- Neurinoma of peripheral nerve roots is a rare entity.
- Neurinoma and spondyloarthritis is an unusual association
- Differential diagnosis of sacroiliac joint pain is made with S1 nerve
roots tumors such as Neurinoma.PRESENTATION:A 25-year-old man with history of a non-radiographic axial
spondyloarthritis admitted for persistent right buttock pain. The
sacroiliac radiographs showed a slight enlargement of the first right
sacral foramen (Figure A). An MRI of the lumbosacral spine and the
sacroiliacs was done in the background to objectify a sacroiliitis in
flare. However, the MRI had shown a soft tissue mass lateral to the
left S1/S2 foramina. This was consistent with a neurinoma measuring
18mm * 22 mm. The patient was operated on with total resection of the
neuroma. Histological findings have confirmed the diagnosis (Figure
F). The evolution was good with disappearance of pygalgias.DISCUSSION:The incidence of spinal schwannoma, according to recent studies,
varies between 3 and 4 cases / 1,000 000 people per year [1]. MRI
is the gold standard for the diagnosis of spinal schwannoma, it allows
structural and spatial analysis of the lesion [2]. The average age
of the appearance of neurinomas is between 30 and 50 years old. In our
observation, the age was younger than usual. The most clinical signs
are the pain of both the spine and root system reflecting the lesion
syndrome. Surgery is the gold standard of treatment for spinal
schwannoma [3].REFERENCES:[1] Emel E, Abdallah A, Sofuoglu OE, Ofluoglu AE, Gunes M, Guler
B, Bilgic B. Long-term Surgical Outcomes of Spinal Schwannomas:
Retrospective Analysis of 49 Consecutive Cases. Turk Neurosurg.
2017;27(2):217-225. doi: 10.5137/1019-5149.JTN.15678-15.1.
[2] Amezyane T, Pouit B, Bassou D, Lecoules S, Desramé J, Blade
JS, Béchade D, Algayres JP. Une cause rare de lombosciatique [A rare
cause of sciatica]. Rev Med Interne. 2006 ;27(6):494-6. doi:
10.1016/j.revmed.2005.10.001.
[3] Chang, Ung-Kyu, et al. Radiosurgery Using the Cyberknife for
Benign Spinal Tumors: Korea Cancer Center Hospital Experience. Journal
of Neuro-oncology, vol. 101, no. 1, 2011, pp. 91-9.FIGURE’S LEGEND:Figure A: Enlargement of the first right sacral foramen on a pelvic x
ray.
Figure B, C: Frontal T1 and T2 sacroiliac sequences showing targeted
appearance of the mass consistent with neurinoma’ diagnosis.
Figure D, E: Sagittal lumbar spine T1, T2 and STIR weighted sequences
showing high signal soft tissue mass on the right S1 nerve root on T2
and STIR weighted sequences and low signal on T1 weighted sequences.
Figure F: Spindle cell tumor proliferation showing characteristic
nuclear palisades.