• Xun-Ze Shen, Wei Wang, and Zhou-Ye Luo.
• PET/CT Center, Shaoxing People's Hospital, the First Affiliated Hospital of Shaoxing University, 568 Zhongxing North Rd, Shaoxing City.
• Medicine (Baltimore). 2021 Feb 26; 100 (8): e24803e24803.

RationaleMelanotic schwannoma (MS) is an unusual variant of a nerve sheath neoplasm that accounts for less than 1% of all primary peripheral nerve sheath tumors. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has unique value in detecting malignant MS lesions. To date, only 4 cases of MS with hepatic metastasis have been reported. Herein, we report the fifth case, which is the first reported patient with MS of Asian ethnicity with hepatic metastasis.Patient ConcernsA 29-year-old woman with a 1-day history of backache was admitted to our hospital. PET/CT showed a paravertebral heterogeneous soft tissue mass along the spinal nerve at the L2-L3 level with strong FDG uptake, and a nodule with increased FDG uptake in the lateral lobe of the left liver.DiagnosisA puncture biopsy of the L3 bony destruction and surrounding soft tissue mass was performed. The final diagnosis was spinal MS with hepatic metastasis.InterventionsThe patient underwent 6 courses of systemic chemotherapy.OutcomesThe patient did not receive further treatment for half a year after the end of chemotherapy and recovered well.LessonsUnlike conventional schwannomas, which are completely benign, MS has an unpredictable prognosis. It is thought to have low malignant potential, and the malignant type tends to metastasize. FDG PET/CT has a unique and important value in the differential diagnosis of benign and malignant lesions, in detecting occult metastases, monitoring the treatment response, and assessing the prognosis of MS.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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