Gangliocytic paraganglioma of the spine

Paragangliomas are rare, encapsulated, benign neuroendocrine tumors that can arise from the adrenal medulla or extra-adrenal paraganglia. Extra-adrenal paragangliomas may develop a gangliocytic component with ganglion cells (Gangliocytic paragangliomas). Nearly 25%of cauda equina paragangliomas are gangliocytic paragangliomas. Here, we describe the case of a 35-year-old male who presented with weakness of both lower limbs over the last two months. Radiological findings were suggestive of myxopapillary ependymoma. However, the histopathological examination revealed a tumor with cells arranged in sheets, papillae, lobules, and around vessels forming pseudo rosettes. Ganglion cells were seen in small groups and, also singly. Tumor cells were immunopositive for chromogranin, synaptophysin, and S-100. Ganglion cells were immunopositive for synaptophysin, NSE, and NFP. A final histological diagnosis of Gangliocytic paraganglioma (WHO grade I) was made. To date, only nine gangliocytic paraganglioma cases have been previously reported, and to the best of our knowledge, this is the largest gangliocytic paraganglioma.

Two new mixed-ligand coordination polymers based on multi-N chelating ligand inhibit YAP expression and induce caspase-mediated spinal tumor cell apoptosis

Two new coordination polymers [Zn (bdc)(bpybzimH2)](DMF)0.5 (1, H2bdc=1,4-dicarboxybenzene, bpybzimH2=6,6′-bis-(1H-benzoimidazol-2-yl)-2,2′-bipyridine, DMF=N,N-dimethylformamide) and [Co (bpybzimH2)(sbc)]H2O (2, H2sbc=4-mercaptobenzoic acid) have been successfully prepared under solvothermal conditions using the multi-N chelating organic ligand bpybzimH2 as the foundational building block. In addition, the Cell Counting Kit-8 assay was conducted to evaluate the anti-proliferation activity of compounds 1 and 2 against human spinal tumor cells OPM-2. The cell viability curves showed that the two compounds have anti-proliferation activity on spinal tumor cells, and the activity of compound 1 is higher than compound 2. The annexin V-FITC/PI assay and western blot were used to detect the apoptotic percentage of OPM-2 cells incubated with compounds 1 and 2. The YAP protein expression and its role in cell apoptosis were further studied with qRT-PCR, immunoblotting, and flow cytometer.

Spinal tumors in children / Tumores de coluna em crianças

Summary Introduction: Spinal tumors are rare in the pediatric population, presenting many specific peculiarities when compared to adults. We have performed a broad narrative review to describe the most common spinal tumors in children, discussing their main characteristics and management options. Method: The authors have performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results: Multimodality radiological studies (plain films, 3D computed tomography scan and magnetic resonance imaging) are necessary for proper evaluation and differential diagnosis of spinal tumors in children. In selected cases nuclear medicine imaging is used to improve the chances of a more accurate diagnosis. As a general rule, a fine needle biopsy is recommended after radiological evaluation to confirm the tumor's histology. Primary bone tumors can be divided into benign bone tumors, mostly represented by vertebral hemangiomas, osteoid osteomas, osteoblastomas, aneurismal bone cysts, and eosinophilic granulomas, and malign or aggressive tumors, such as Ewing's or osteogenic sarcomas. Secondary bone tumors (spinal metastases) comprise different tumor histologies, and treatment is mainly based on tumor's radiosensitivity. The characteristics and treatment options of the main spinal tumors are discussed in details. Conclusion: Spinal tumors in children are rare lesions that demand a thorough understanding of their main characteristics for their proper management. Understanding the nuances of spinal tumors in children is of paramount importance for improving outcomes and chances of cure.

Resumo Introdução: Os tumores de coluna em crianças são raros, apresentando peculiaridades únicas quando comparados com os da população adulta. Método: Dada a escassez de trabalhos que avaliem o tema, realizou-se extensa revisão de literatura objetivando descrever os tumores de coluna que acometem a população pediátrica, discutindo características e opções de manejo. Resultados: A utilização de exames radiológicos combinados (radiografias, tomografia computadorizada com reconstrução em 3D e ressonância magnética) é necessária para avaliação adequada e diagnóstico diferencial dessas lesões. Em casos selecionados, exames de medicina nuclear aumentam as chances do diagnóstico preciso. Como regra geral, biópsia por agulha é recomendada para confirmação da histologia tumoral e tratamento subsequente. As lesões primárias de coluna podem ser benignas, representadas principalmente pelos hemangiomas, osteomas osteoides, osteoblastomas, cistos ósseos aneurismáticos e granulomas eosinofílicos, enquanto as lesões malignas são geralmente representadas por tumores agressivos, como o sarcoma de Ewing ou os sarcomas osteogênicos. Metástases de coluna podem ter diferentes etiologias, sendo o tratamento dependente principalmente da radiossensibilidade do tumor de origem. As opções de tratamento dessas lesões são descritas em detalhes. Conclusão: Tumores de coluna em crianças são raros e o seu manejo requer um conhecimento amplo e variado das diferentes possibilidades diagnósticas. Conhecer os nuances envolvidos no tratamento dessas lesões e os sintomas iniciais é fundamental para melhorar o prognóstico e as chances de cura.

Tokuhashi Scoring System has limited applicability in the majority of patients with spinal cord compression secondary to vertebral metastasis / A Escala de Tokuhashi possui aplicabilidade limitada na maioria dos pacientes com compressao medular secundaria a metastase vertebral

Spine is the primary bone site affected by systemic metastasis. Although there are scales that attempt to manage these patients, their real applicability is unknown. The Tokuhashi Scoring System (TSS) is a widely used prognostic tool. At the time of treatment, the data necessary to complete TSS may be incomplete, making its application impossible. Objective To evaluate the number of TSS scores completed by the time the clinical therapeutic decision was made. Methods From July 2010 to January 2012, we selected patients who were diagnosed with spinal metastases. Results Sixty spinal metastasis patients (21 female, 39 male) were evaluated between July 2010 and January 2012. At the time of the treatment decision, only 25% of the patients had completed the TSS items. Conclusion In the majority of patients with vertebral metastasis, TSS variables cannot be applied. .

A coluna vertebral é o sítio ósseo mais acometido na doença neoplásica metastática. Embora haja escalas que buscam normatizar o tratamento destes pacientes, sua real aplicabilidade é incerta. A Escala de Tokuhashi (TSS) é uma ferramenta prognóstica vastamente empregada. No momento do tratamento, os dados necessários ao preenchimento da escala podem estar incompletos, tornando sua aplicação inviável. Objetivo Avaliar o número de TSS completos até a tomada de decisão terapêutica. Métodos De Julho de 2010 a Janeiro de 2012, selecionamos pacientes diagnosticados com metástases espinhais. Resultados Sessenta pacientes foram avaliados durante o período; destes, 21 eram mulheres e 39, homens. Até a tomada de decisão, foi possível completar os itens da TSS em apenas 25% dos pacientes. Conclusão Na maioria dos pacientes com metástases espinhais, a TSS não pôde ser aplicada. .

Abordaje combinado en columna toracolumbar para los tumores / Approach combined in thoracolumbar spine for tumors

Introducción: el progreso de la imaginología, la supervivencia del paciente oncológico y el desarrollo de instrumentaciones cortas, aumentó el interés por el uso de abordajes combinados. Objetivo: exponer la experiencia del servicio de ortopedia del Hospital Clínico Quirúrgico Hermanos Ameijeiras en abordaje combinado de columna toracolumbar. Descripción: se presentaron 5 casos con procesos tumorales del segmento toracolumbar en los que se empleó abordaje combinado, operados en el servicio de ortopedia desde febrero de 2007 hasta mayo de 2011; se reflejó edad, sexo, tipo de tumor. Se evaluó el dolor (por la escala Denis) y el estado neurológico (por la escala Frankel) preoperatorio y posoperatorio, así como las complicaciones. Resultados: en los pacientes menores de 50 años predominó el sexo femenino y los tumores primarios; 4 pacientes tenían en el preoperatorio un estado Frankel C y en todos se logró pasar a E. En cuanto al dolor por la escala Denis que era entre 3 y 4, pasaron a 0 y 1. Como complicaciones se presentó una luxación del injerto con sepsis profunda, así como 2 desgarros del saco dural. Conclusiones: el abordaje combinado se presenta como opción ventajosa y recomendable de tratamiento quirúrgico en los tumores espinales

Introduction: the progress of imaging, the survival of oncology patient and the development of short instrumentations increased the interest by the use of combined approaches. Objective: to expose the experience of the Orthopedics service of Hermanos Ameijeiras Clinical Surgical Hospital in the combined approach of thoracolumbar spine. Description: authors present 5 cases presenting with tumoral processes of thoracolumbar segment using a combined approach, operated on above mentioned service from February, 2007 to May, 2011. Following variables were included: age, sex, and type of tumor. Pain was assessed (Denis) and the preoperative and postoperative neurologic status (Frankel), as well as the complications. Results: in patients aged under 50 there was predominance of female sex and of primary tumors: in preoperative period 4 patients had a C Frankel and in all of them it was possible to move to E. As regards the Denis pain between 3 and 4 moving to 0 and 1. Complications included graft luxation with a deep sepsis, as well as two dural sac tears. Conclusions: the combined approach is an advantageous and recommendable option for surgical treatment in spinal tumors

Frequency of central nervous system tumors in delta region, Egypt.

Introduction and Aim of Work: Central nervous system (CNS) tumors represent a major public health problem, and their epidemiological data in Egypt have been rather incomplete except for some regional reports. There are no available frequency-based data on CNS tumors in our locality. The objective of this study was to estimate the frequency of CNS tumors in east delta region, Egypt. Materials and Methods: The data were collected during the 8-year period from January 1999 to December 2007 from Pathology Department, Mansoura University, and other referred pathology labs. Examination of HandE stained sections from retrieved paraffin blocks were done in all cases for histopathologic categorization of C.N.S. tumors. Immunohistochemical studies were applied to confirm final histopathologic diagnosis in problematic cases. Results: Intracranial tumors represented 86.7% of cases in comparison to only 13.3% for spinal tumors. Gliomas were the CNS tumors of the highest frequency (35.2%), followed by meningioma (25.6%), pituitary adenoma (11.6%) and nerve sheath tumors (6.6%). 10.25% of tumors were of children <15 years. Conclusion: This study provides the largest series of the relative frequency of CNS tumors in Delta region in Egypt till now and may help to give insight into the epidemiology of CNS tumors in our locality.

Dynamic Contrast Enhanced Magnetic Resonance Imaging of Diffuse Spinal Bone Marrow Infiltration in Patients with Hematological Malignancies

OBJECTIVE: To investigate the significance of the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) parameters of diffuse spinal bone marrow infiltration in patients with hematological malignancies. MATERIALS AND METHODS: Dynamic gadolinium-enhanced MR imaging of the lumbar spine was performed in 26 patients with histologically proven diffuse bone marrow infiltration, including multiple myeloma (n = 6), acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 5), chronic myeloid leukemia (n = 7), and non-Hodgkin lymphoma (n = 2). Twenty subjects whose spinal MRI was normal, made up the control group. Peak enhancement percentage (Emax), enhancement slope (ES), and time to peak (TTP) were determined from a time-intensity curve (TIC) of lumbar vertebral bone marrow. A comparison between baseline and follow-up MR images and its histological correlation were evaluated in 10 patients. The infiltration grade of hematopoietic marrow with plasma cells was evaluated by a histological assessment of bone marrow. RESULTS: Differences in Emax, ES, and TTP values between the control group and the patients with diffuse bone marrow infiltration were significant (t = -11.51, -9.81 and 3.91, respectively, p 0.05). A positive correlation was found between Emax, ES values and the histological grade of bone marrow infiltration (r = 0.86 and 0.84 respectively, p < 0.01). A negative correlation was found between the TTP values and bone marrow infiltration histological grade (r = -0.54, p < 0.01). A decrease in the Emax and ES values was observed with increased TTP values after treatment in all of the 10 patients who responded to treatment (t = -7.92, -4.55, and 5.12, respectively, p < 0.01). CONCLUSION: DCE-MRI of spine can be a useful tool in detecting diffuse marrow infiltration of hematological malignancies, while its parameters including Emax, ES, and TTP can reflect the malignancies' histological grade.

Epithelioid Hemangioma Involving Three Contiguous Bones: a Case Report with a Review of the Literature

An epithelioid hemangioma involving three contiguous bones in continuity has, to the best of our knowledge, not been reported in the literature. A case of a 48-year-old man presented with radiating pain to the lower thoracic region for two years. A radiograph and CT scan revealed both permeative osteolytic and multiple trabeculated lesions involving the left posterior part of the 10th rib as well as the 9th and 10th vertebral bodies in continuity and was misled as a malignant or infectious lesion. The histopathology and immuno-histochemistry of the lesion confirmed the diagnosis of an epithelioid hemangioma. The lesion was still stable as of three years after surgery.

Hemangioma vertebral del arco posterior con extensión extraósea y sintomatología neurológica: informe de un caso y revisión de la literatura / Vertebral hemangioma of the posterior arch with subsequent extraosseous extension and neurological symptoms: case report and literature review

Introducción: El hemangioma vertebral es el tumor más común de la columna vertebral, se identifica hasta en 11 % de las autopsias. Es tipificado como una malformación benigna vascular de crecimiento lento; en ocasiones involucra los elementos posteriores, asociándose a compromiso neurológico. Por lo general es asintomático, encontrándose de forma incidental al estudiar el dolor de origen espinal en busca de otra patología; ocasionalmente produce manifestación neurológica. La extensión extraósea intrarraquídea con compromiso neurológico ha sido poco informada y representa un reto terapéutico. Caso clínico: Adolescente femenina con hemangioma vertebral de tamaño inusual del arco posterior con extensión hacia el conducto raquídeo que ocasionó manifestaciones neurológicas y ameritó tratamiento quirúrgico para su resección y fijación transpedicular. Conclusiones: El hemangioma vertebral es una lesión asintomática que no requiere tratamiento específico. Solo en algunos casos es necesario el tratamiento quirúrgico, que debe llevarse a cabo oportunamente cuando hay compresión neurológica, para evitar secuelas permanentes. El crecimiento extraóseo intrarraquídeo con deterioro neurológico es una presentación inusitada.

BACKGROUND: Vertebral hemangioma is the most common benign spinal tumor and is found in 11% of postmortem studies as a slow-growing benign vascular malformation. It usually involves the vertebral body and sometimes the posterior vertebral elements. When the posterior elements are involved, spinal cord compression with neurological symptoms are seen more often. Vertebral hemangiomas exist as a continuum of manifestations and lesions ranging from the common asymptomatic forms to the rare compression lesion. Extraosseous extension of vertebral hemangioma with cord compression and neurological symptoms is a rare condition and represents a treatment challenge. Surgical options are open resection, embolization or vertebroplasty. CLINICAL CASE: We report a case of a vertebral hemangioma with extraosseous extension to the spinal canal with an unusual size and osseous component in the posterior elements. This tumor caused neurological manifestations and was surgically treated with posterior decompression and stabilization with transpedicular screws and rods. Clinical outcome was good. CONCLUSIONS: Vertebral hemangioma is normally an asymptomatic benign lesion not requiring specific treatment. Only in a few cases is surgical treatment required. When neurological compromise is present, early treatment should be carried out before the presence of permanent paralysis.

Una rara complicación de la anestesia epidural y subaracnoidea. Tumores epidermoideos espinales / A rare complication of epidural and subarachnoid anesthesia iatrogenic spinal epidermoid tumors

Los tumores epidermoideos espinales son tumores muy poco frecuentes, que pueden tener un origen congénito o iatrogénico. Los tumores de origen iatrogénico pueden formarse a partir de la implantación de fragmentos de piel dentro del espacio epidural o subaracnoideo, que posteriormente crecen. El arrastre de células epidérmicas se puede producir por un "efecto de biopsia" durante las punciones lumbares, por una inadecuada adaptación del mandril dentro de la aguja. El tiempo de latencia hasta la aparición de los primeros síntomas neurológicos puede estar entre los 2 y 10 años. Se localizan, principalmente, en la columna lumbar. Los signos y los síntomas varían según la situación, el sitio y la dimensión del tumor. Las manifestaciones clínicas tienen relación con su efecto compresivo y aparecen cuando este tumor adquiere un tamaño de 1,5 a 3 cm. y comienza a ejercer presión sobre las raíces nerviosas de la cola de caballo. El diagnóstico presuntivo se establece por el antecedente de alguna punción lumbar practicada en años anteriores, en un paciente que presenta la clínica antes mencionada, sumado al informe radiológico del hallazgo de una imagen con diferente densidad dentro del canal medular, de localización extramedular y próxima a la zona de la punción lumbar. El pronóstico es bueno por su benignidad anatomopatológica y el tratamiento es quirúrgico.

Spinal epidermoid tumors are very rare and their origin may be either congenital or iatrogenic. Iatrogenic tumors may originate from the implant of skin fragments within the epidural or subarachnoid space and later grow. The dragging of epidermic cells may occur from a "biopsy effect" during lumbar punctures due to an inadequate placement of the mandrel inside the needle. The time of latency until the appearance of the first neurological symptoms may be between 2 to 10 years. They are mainly located in the lumbar spine. Signs and symptoms vary according to the situation, site and size of the tumor. Clinical manifestations are related to their compression effect and appear when the tumor reaches a size of 1.5 to 3 cm and begins to exert pressure on the nerve roots of the horsetail. Presumptive diagnosis is based on the history of a lumbar puncture of some years back in a patient with the above-mentioned background of compressive symptoms added to the radiological report of an image with a different density within the medullar canal, located extra-medularly and near the area of the lumbar puncture. Treatment is surgical and it has a good prognosis due to it being anatomo-pathologically benign.

Os tumores epidermóides espinhais sao raros. Podem ser congenitos ou iatrogenicos. Os iatrogenicos originam-se da implantação de fragmentos de pele dentro do espaço epidural ou subaracnóideo que posteriormente cresce. O arrasto de células epidérmicas pode ocorrer por "efeito de biópsia" durante punções lombares com agulhas com mandril inadaptados. O tempo de latencia até o aparecimento dos primeiros sintomas neurológicos varia entre 2 e 10 anos. Os tumores se localizam, principalmente, na coluna lombar. Os sinais e sintomas variam conforme a situação, o sítio e a dimensao do tumor. As manifestaçoes clínicas associam-se a seu efeito compressivo e aparecem quando o tamanho do tumor atinge 1,5 a 3 cm e começa a comprimir as raízes nervosas da cauda eqüina. O diagnóstico presuntivo é estabelecido pelo antecedente de alguma punção lombar praticada em anos anteriores, em um paciente que apresenta o quadro clínico antes mencionado, além de um relatório radiológico do achado de uma imagem com diferente densidade dentro do canal medular, de localização extramedular e próxima da região da punção lombar. Por sua benignidade anatomopatológica, o prognóstico é bom, e o tratamento é cirúrgico.

Regression of a cervical spinal mass following highly active antiretroviral therapy (HAART) in child with advanced human immunodeficiency virus (HIV) disease.

This report documents a case of infiltrating cervical spinal mass, most likely a spinal tumor, in a girl with HIV infection that regressed following HAART and without treatment of the tumor or any anti-infectives.

Primary spinal paragangliomas: a clinicopathological and immunohistochemical study of six cases.

Spinal paragangliomas are uncommon neoplasms and subject of much debate regarding the factors governing their biological behaviour. We describe the clinicopathological and immunohistochemical (IHC) features of six cases of spinal paraganglioma. The mean age of patients was 40 years (range 20-60 years) with a male to female ratio of (2:1). Majority presented with low backache, sphincter disturbances and sensory symptoms. All tumors were intradural in the cauda region one of them extending to the filum. Only one showed focal extradural extension on microscopy. Gross total resection of tumors was possible in all cases. Histologically four showed classical 'zell-ballen' pattern and two revealed an ependymal morphology. On immunohistochemistry, in all the six cases the chief cells were intensely labeled by antibody to chromogranin but not for GFAP while staining for synaptophysin was less intense and variable in five. Sustentacular cells in all cases showed strong expression for S-100 protein and chief cells were stained light in three cases. Low MIB-1 labeling index of 0.01-2% was noted in five cases and in the sixth it was 5%. None of the tumours recurred. Immunohistochemistry assisted in differentiating these relatively benign neural crest tumours from the more aggressive spinal ependymomas.

Oncologic progression of bone plasmacytomas to multiple myeloma

OBJETIVO: Avaliar os aspectos clínicos, diagnósticos, fatores de prognóstico e porcentagem de evolução dos casos de plasmocitoma para mieloma múltiplo. MATERIAS E MÉTODOS: Foram levantados 103 prontuários do Hospital das Clínicas da FMUSP, entre os anos de 1950 e 1998. Destes, 73 não foram utilizados por perda de seguimento ou por apresentarem diagnóstico diferente de plasmocitoma. RESULTADOS: Concluímos que a idade dos pacientes que evoluíram para mieloma múltiplo é inferior a dos pacientes que não evoluíram. A média do primeiro grupo foi de 52,3 ± 2,6 anos e a do segundo 62,6 ± 3,4 anos (média ± SEM; p=0,02). Não houve diferença estatística quanto ao sexo. Analisando pacientes com plasmocitoma que evoluiu para mieloma múltiplo, foi observada uma incidência maior de recidivas múltiplas (75%, p=0,049). Em ambos os grupos houve predominância de lesões da coluna vertebral. Não houve nenhuma diferença significativa entre os grupos com relação ao tempo de doença (desde o aparecimento dos sintomas até o diagnóstico) (p=0,20) e à sobrevida (p=0,34). Quanto ao tempo de evolução de plasmocitoma para mieloma, a média foi de 41 meses (DP=38,8), com uma taxa de evolução aproximadamente igual a 57%. CONCLUSÃO: Os pacientes que evoluíram para mieloma múltiplo são mais jovens. Não houve diferença significativa entre os dois grupos quanto ao sexo, tempo de doença e tempo de sobrevida. Em ambos os grupos a localização anatômica mais acometida foi a coluna vertebral. O tempo médio de evolução para mieloma múltiplo foi de 41 meses. Não foi possível calcular os fatores que influem na sobrevida dos pacientes com plasmocitoma e dos pacientes com plasmocitoma que evoluiu para mieloma múltiplo.

Cervical Ewing's sarcoma presenting as neurinoma

Considering their usual bone localisation, Ewing's sarcomas of soft tissues are rare. We report a case of a 19-year-old patient who had been suffering from cervico-brachial neuralgia followed by symptoms of progressive spinal cord compression. Magnetic resonance imaging detected a tumour at the C [7] level in the antero-lateral part of the spinal canal with an intracanal extension via an enlarged inter vertebral foramen, mimicking a neurinoma. The patient underwent an incomplete tumoural exeresis. The pathological examination yielded typical findings of Ewing's sarcoma. The patient underwent chemotherapy followed by complementary tumoural exeresis and radiotherapy. Literature review denotes the exceptional feature of the presentation. Correct and definitive diagnosis is made by pathological examination. Management of Ewing's sarcoma with the three main modalities: surgery, radiotherapy and chemotherapy increase the patient's survival

Osteoblastoma of the spine

To identify the factors that are associated with the development of scoliosis and its manifestations. Summary of the background data: Painful scoliosis is a well-recognized presentation of osteoblastoma but as a result of small number of previous reports, the outcome and habits of tumor in spine is not well-known. Ten factors were assessed including; age, sex, duration of symptoms, site of the lesion, site of lesion in individual, Cobs angle at presentation, chief complaint at presentation, neurological involvement, type of treatment, recurrence of tumor. Result: Fifty% of patients had scoliosis. All of the lesions typically were present on the concave side of the curve. In the thoracic and lumber spine 80% had scoliosis, but no scoliosis was seen on cervical and sacral regions. All the patients were under 30 years. The mean time to diagnose at our center was 18.4 months. All of the patients with cervical involvement [2 patients] had deformity [Cock Robin] and restriction in range of motion. The lesion was in posterior elements in all of the cases and localized in only one side of the spine. Chief complaint was pain in 67%, deformity in 16% and both [pain and deformity] in 17%. Radiological exam was diagnostic in 58% of the cases. Conclusions: Findings support the concept that scoliosis is secondary to asymmetric muscle spasm. The most common complaint is pain and then deformity. In the cervical spins deformity and restriction of motion are chief complaints. In children, spastic pain was more obvious than deformity. Treatment is curettage as wide as possible. There was no recurrence

C-1 Root Schwannoma with Aggressive Lateral Mass Invasion

Schwannomas are relatively common, benign tumors that are thought to arise from the nerve sheath cell. Schwannomas of the C1 root are extremely rare and seldom invade lateral masses because they gradually increase in size and can extend through the wide space behind the lateral mass instead of the intervertebral foramen. We present here an unusual case of a benign schwannoma that aggressively invaded the lateral mass of C-1.