Case of the Week 86 Courtesy of Markus Fechler, DC, Heidelberg, Germany 56 year old female, who had been a regular patient in the office of Dr. Fechler for several years, presented in 2007 with excruciating pain down her left leg and numbness along her left lateral and anterior thigh that prevented her from sleeping at night. She had weakness of her left quadriceps and psoas muscles and radicular pain at L3 and L4 on the left. MRIs were ordered.

What are the abnormal findings? What is the likely diagnosis? How should this be treated?

A few more MRI slices to appreciate

Answers Abnormal findings: Abnormal findings: A very large mass is present surrounding the left L3 nerve root, extending into the spinal canal and outside the canal through the intervertebral foramen of L3-4. The mass displaces the left psoas muscle. A very large mass is present surrounding the left L3 nerve root, extending into the spinal canal and outside the canal through the intervertebral foramen of L3-4. The mass displaces the left psoas muscle. Enlargement of the left L3-4 IVF is noted as well as posterior scalloping of the left side of L3 vertebral body from pressure erosion. Enlargement of the left L3-4 IVF is noted as well as posterior scalloping of the left side of L3 vertebral body from pressure erosion. Likely Diagnosis: Likely Diagnosis: This is a benign, slow growing neurogenic tumour as evidenced by the pressure erosions on the adjacent bony structures. The most likely Diagnoses for this ‘dumbbell’ tumour are Neurofibroma or Schwannoma. This is a benign, slow growing neurogenic tumour as evidenced by the pressure erosions on the adjacent bony structures. The most likely Diagnoses for this ‘dumbbell’ tumour are Neurofibroma or Schwannoma. Treatment: Treatment: Surgery is the treatment as she was in excruciating pain with neurological symptoms. Surgery is the treatment as she was in excruciating pain with neurological symptoms. The patient underwent surgery 2 weeks later with a good outcome. The patient underwent surgery 2 weeks later with a good outcome.