Question
QUESTION: Sir,
For the past weeks, I have been experiencing a strange tingling/pressure feeling in the mid thoracic spine. At first, it was no actual pain, but by now it has increased to frank pain (though still relatively mild) every now and then. However, most times it is still a tingling/squeezing/pressure feeling. It happens lying in bed as well. I am pretty sure its a neurological problem since i know nerve related symptoms/paresthesia from my other diseases (which do NOT affect spinal nerves). I am 27 years old, and i have never suffered from back pain before.

I am wondering if i could have a spinal tumor since i may have a condition (genetic esting is going to be done ) which predisposes to the development of a certain type of spinal schwannoma.
I also have been experiencing increasing balance issues.
Thanks so much for your time and help.
Sarah

ANSWER: Hi Sarah,

Sorry to hear about this. You really need a diagnostic workup.

Regarding your balance issue, a vestibular schwannoma, also called an acoustic neuroma, can affect a nerve connecting the inner ear and the brain, and this can cause balance problems. Tinnitus or ringing in the ear may be associated with this.

Regarding your mid back, it is possible. If there is nothing you can relate the pain to; lifting something, working above your head, twisting, yard work or blunt trauma to the area, it may be suspicious, especially with the symptoms at rest.

Schwannomas are tumors of the tissue that surrounds nerves - they are not malignant and do not spread, however, they can grow in size and this can be a problem. It is very, very rare that these types of tumors are malignant. A neurofibrosarcoma would be more concerning. So, it is not possible for me to say yes or no, therefore, it is very important to have a complete diagnostic work-up as soon as possible. With your history, it does not make sense to assume it is just musculoskeletal and treat it a such, without ruling out a possible tumor first.

I hope everything turns out good and this can be managed efficiently and effectively.

All the best.

Dr. Steve

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QUESTION: Thank you very much fr your time and help. Is a neurofibrosarcoma a malignant schwannoma? The terms which are used in the internet seem to be a little confusing.
Do any symotoms suggest rather a malignant over a benign tumor?
Or do neurological symptoms happen irrespective of the nature of the tumor? That is that at this stage one cannot tell without MRI if it could be a tumor and if this tumor could be malignant?
Would a spinal MRI rule out a tumor for sure and could it differentiate between a benign and malignant grwth?
Thanks so much.

ANSWER: Hi Sarah,

Malignant schwannomas are known as Malignant Peripheral Nerve Sheath Tumors (MPNSTs) or "neurofibrosarcomas", which are rare soft tissue sarcomas. In general, it would be difficult to say the difference compared to a non malignant tumor as both would affect the nerve and would depend on what stage it is. Generally, a malignancy would cause fatigue, fever and night pain more than non malignancy. A malignant tumor can also spread to other areas. A far as the method of radiographic diagnosis, I would have to defer to a radiologist. MRI is a possibility, along with CT and Ultrasonography and may include contrasting agents. However, one or more of these methods would show it. Regarding differentiating between malignant and non malignant, there are often signs from imaging studies to indicate this, however, sometimes it is necessary to do a biopsy. Additional information regarding genetic testing can also help with the diagnosis.

Dr. Steve

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QUESTION: Thanks for the additional information. I have a very last question:  could a thoracic spinal or paraspinal  tumor also compress the superior vena cava? Because for some time, i have been experiencing symptoms which are (as i found out today) strongly suggestive of superior vena cava syndrome and i will have a chest MRI tomorrow.

Answer
Hi Sarah,

It is possible that a tumor could cause this, however, I'm not sure it would be related to your mid back pain. Its hard to get an idea of exactly where your pain is, but the superior vena cava lies next to the upper lobe of the right lung. It is possible that lymph nodes could be involved, however, I want to refrain from guessing and I don't know what the symptoms are. Typically, coughing, shortness of breath, sore throat and chest pain. If it is shortness of breath and perhaps some chest pain, it could be anxiety or panic attacks, which would be understandable considering everything your going through. More concerning symptoms would be swelling of the arms and/or facial area, any coughing up blood or swollen veins in the chest or neck area, which can turn the skin a light blue or sometimes red.

In any event, I wish you all the best. I hope there is a benign explanation for all this and an easy solution. I will be thinking about you. As little as I can do, I will be responsive to any questions or concerns you have and, although not an area of expertise for me, I will do my best to help any way possible.

Kind regards and best wishes!

Dr. Steve