Haemosiderin cap sign in cervical intramedullary schwannoma mimicking ependymoma: how to differentiate?

  • Sabarish SekarEmail author
  • S Vinayagamani
  • Bejoy Thomas
  • Rajalakshmi Poyuran
  • Chandrasekharan Kesavadas
Short Report


A 37-year-old female presented with gradually progressive asymmetric ascending paraesthesia and weakness involving bilateral upper and lower limbs. The MRI spine images revealed expansile intramedullary, solid cystic, peripherally enhancing lesion with a haemosiderin cap along the lower margin. The lesion extended into the left C5 and C6 nerve root exit zones, along with thickening and enhancement of the nerve roots. She underwent excision of the lesion, which revealed intramedullary schwannoma on histopathological examination. Presence of the cap, an extension of the lesion into the nerve root exit zone, with associated thickening and enhancement of the dorsal nerve roots should alert the radiologist to consider the possibility of intramedullary schwannoma rather than ependymoma.

Schwannoma showing compact Antoni A area with Schwannian whorls and nuclear palisades (A,B) and loose Antoni B area with haemosiderin pigment (C). The tumour exhibits diffuse positivity for S-100 protein (D) and negativity for GFAP (E). [Stain: A-C: Haematoxylin and Eosin; D,E: Immunoperoxidase. Magnification = Scale Bar, A-E: 100μm]


Haemosiderin cap sign  Intramedullary Schwannoma Ependymoma Root exit zone 



No funding was received for this study.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures in this short report involving patient were in accordance with ethical standards of institutional and or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patient.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Imaging Sciences and Interventional RadiologySreechitra Institute of Medical Sciences and TechnologyTrivandrumIndia
  2. 2.Department of PathologySreechitra Institute of Medical Sciences and TechnologyTrivandrumIndia

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