Clinical picture - The Lancet

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31 Sieweke MH, Bissell MJ. The tumor-promoting effect of ... MECHANISMS OF DISEASE. THE LANCET • Vol 362 • August 16, 2003 • www.thelancet.com. 533.
MECHANISMS OF DISEASE

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Clinical picture Thigh pain due to intraspinal neurilemmoma Kari Laiho, Eero A Belt, Seppo Juvela, Anders Paetau, Irma Soini

A 51-year-old man presented with pain in the right groin and thigh. On examination he had weak right-sided patellar and Achilles reflexes. His right thigh was numb and weak. Axial lumbar spine magnetic resonance imaging (figure) showed a large intraspinal neurilemmoma (black star) at L3-L4, compressing nerve roots to the left and extending to the right nerve root canal. Another large neurilemmoma (white star) was seen on the right displacing the psoas muscle. We did a rightsided hemilaminectomy of L3-L4 and removed the intraspinal neurilemmoma originating from the L4 nerve root while preserving the nerve fibres. The perispinal neurilemmoma originated from L3 and was left intact. Histopathologically the intraspinal tumour showed a typical neurilemmoma. The patient had less pain postoperatively, but mild numbness and mucle weakness in the thigh remained. Rheumatism Foundation Hospital, FIN-18120 Heinola, Finland (K Laiho MD, E A Belt MD, I Soini MD); Departments of Neurosurgery (S Juvela MD) and Pathology (A Paetau MD), Helsinki University Central Hospital

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