A rare case of dumbbell shaped ancient schwannoma found inside thoracic spine in a psychologically challenged patient.

Introduction and importance: Ancient schwannoma undergoes a degenerative process leading to hemorrhage, cystic necrosis, and calcification. The head and neck, thorax, and retroperitoneum are the most common locations; the spinal location is extraordinary. Case presentation: A 50-year-old man presented with muscle weakness in his lower limbs following 2 years of lower back pain, tingling sensation and numbness. He suffers from moderate depression that was refractory to treatment and was put on selective serotonin reuptake inhibitor. MRI showed an intradural extramedullary dumbbell-shaped mass at the T11-T12 level with compression of the spinal cord. Furthermore, it was located on the right side of the spinal canal in close relation to the right T12 spinal root. He underwent a T11-T12 laminectomy with complete en bloc resection and the nerve root was sacrificed. Histopathological exam confirmed the final diagnosis. Follow-up showed a rapid improvement of the neurological and psychiatric symptoms. Clinical discussion: Shwannomas are slow growing tumors arising from Schwann cells of the peripheral nerve sheaths. Spinal ancient schwannomas are particularly rare because of the compression of the spinal cord leading to the early presentation of symptoms. The risk of developing depressive disorders is increased by physical diseases; moreover, chronic back pain is strongly associated with depression. Conclusion: Ancient schwannoma is a slow-growing tumor and best pre-operatively diagnosed by MRI. Diagnostic approach in patient with psychiatric disorders presenting with physical symptoms, especially neurological symptoms should be done carefully depending on objective tools such as imaging or detailed neurological examination.