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Ortega-Merchan MP, Reyes F, Mejía JA, Rivera DM, Galvis JC, Marquez JC. Cystic trigeminal schwannomas. Radiol Case Rep 2019; 14:1513-1517. [PMID: 31660099 PMCID: PMC6807068 DOI: 10.1016/j.radcr.2019.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/22/2019] [Accepted: 09/22/2019] [Indexed: 12/04/2022] Open
Abstract
Trigeminal Schwannomas are less than 1% of intracranial tumors, of which only 7% have a cystic component. We documented 2 cases of males with cystic trigeminal Schwannomas, their symptoms, the diagnosis process and the imaging characteristics. In addition, a review of the literature is performed, with emphasis on the radiological classification of this rare entity, that constitutes a diagnostic challenge for the radiologist, who has an essential role in the approach to the disease and therefore in its management.
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Affiliation(s)
- María P. Ortega-Merchan
- Pontificia Universidad Javeriana- Hospital Universitario San Ignacio, 2do piso Radiología, Cra7 # 40-60, Bogotá, Colombia
| | - Fabian Reyes
- Pontificia Universidad Javeriana- Hospital Universitario San Ignacio, 2do piso Radiología, Cra7 # 40-60, Bogotá, Colombia
| | - Juan A. Mejía
- Pontificia Universidad Javeriana- Hospital Universitario San Ignacio, 2do piso Radiología, Cra7 # 40-60, Bogotá, Colombia
| | - Diego M. Rivera
- Pontificia Universidad Javeriana- Hospital Universitario San Ignacio, 2do piso Radiología, Cra7 # 40-60, Bogotá, Colombia
| | - Juan C. Galvis
- Pontificia Universidad Javeriana- Hospital Universitario San Ignacio, 2do piso Radiología, Cra7 # 40-60, Bogotá, Colombia
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D'Almeida Costa F, Dias TM, Lombardo KA, Raghunathan A, Giannini C, Kenyon L, Saad AG, Gokden M, Burger PC, Montgomery EA, Rodriguez FJ. Intracranial cellular schwannomas: a clinicopathological study of 20 cases. Histopathology 2019; 76:275-282. [PMID: 31379028 DOI: 10.1111/his.13967] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/31/2019] [Indexed: 01/21/2023]
Abstract
AIMS Cellular schwannoma is a specific subtype of schwannoma, prone to misinterpretation as a malignant neoplasm. Involvement of the intracranial compartment by these tumours is extremely rare. We aim to characterise this clinicopathological subgroup. METHODS AND RESULTS We identified a total of 20 cellular schwannomas with predominant intracranial involvement. The mean age of the patients at the time of surgery was 37 years (range = 16-81), with a slight female predominance (1.5:1 ratio). The most common sites were the eighth (n = 8) and fifth (n = 6) cranial nerves. Three tumours involved the anterior cranial fossa/olfactory groove, and a single case involved the glossopharyngeal nerve. All tumours met established criteria for cellular schwannoma, and were composed of interlacing fascicles of spindle cells lacking Verocay bodies with minimal Antoni B pattern and variable chronic inflammation and foamy histiocytes. Rare findings included haemosiderin deposition (n = 6), necrosis (n = 4), brisk mitotic activity (>10 mitoses per 10 high-power fields) (n = 2), focal epithelioid morphology (n = 2), myxoid areas (n = 2), neuroblastoma-like pattern (n = 1) and granular cells (n = 1). Immunohistochemical stains demonstrated expression of Schwann cell markers (S100 protein, SOX10, collagen IV) and preserved H3 K27 trimethylation in all cases tested. Fourteen patients had postoperative follow-up, ranging from 2 months to 21 years (mean = 66 months). In patients with follow-up, local recurrence/persistence developed in six cases; five tumours were initially incompletely resected. No metastatic disease or deaths were reported. CONCLUSIONS Intracranial cellular schwannomas share morphological and immunophenotypical features with cellular schwannomas at others sites may demonstrate locally aggressive growth but appear to lack metastatic potential.
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Affiliation(s)
| | - Tiago M Dias
- Department of Anatomic Pathology, A. C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Kara A Lombardo
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Lawrence Kenyon
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ali G Saad
- Department of Pathology, University of Mississippi, Jackson, MS, USA
| | - Murat Gokden
- Department of Pathology, University of Arkansas, Little Rock, AR, USA
| | - Peter C Burger
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.,The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
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O'Connor KP, Pelargos PE, Palejwala AH, Shi H, Villeneuve L, Glenn CA. Resection of Pediatric Trigeminal Schwannoma Using Minimally Invasive Approach: Case Report, Literature Review, and Operative Video. World Neurosurg 2019; 127:518-524. [DOI: 10.1016/j.wneu.2019.04.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 12/22/2022]
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Longo F, Musumeci G, Ferrara G, Trombatore C, Magro G. Retroperitoneal cellular schwannoma (CS): a potential pitfall of malignancy. Report of a case and review of the literature. Histol Histopathol 2014. [DOI: 10.7243/2055-091x-1-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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MacNally SP, Rutherford SA, Ramsden RT, Evans DG, King AT. Trigeminal schwannomas. Br J Neurosurg 2009; 22:729-38. [DOI: 10.1080/02688690802272172] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ayberk G, Ozveren MF, Uzum N, Tosun O, Akcay EK. CELLULAR SCHWANNOMA OF THE GREATER SUPERFICIAL PETROSAL NERVE PRESENTING WITH ABDUCENS NERVE PALSY AND XEROPHTHALMIA. Neurosurgery 2008; 63:E813-4; discussion E814. [DOI: 10.1227/01.neu.0000325501.75772.fd] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
ABSTRACT
OBJECTIVE
Cellular schwannomas (CS) are rare in the cranial space. This report is the first of a patient with a greater superficial petrosal nerve CS presenting with abducens nerve palsy and xerophthalmia.
CLINICAL PRESENTATION
A 16-year-old female patient presented with a 1-month history of diplopia. Neurological examination was normal except for the presence of right abducens nerve palsy. Schirmer's test revealed decreased tear secretion in the right eye. Computed tomography and magnetic resonance imaging showed a mass in the right petrous apex. It was thought that the schwannoma in our patient originated from the greater superficial petrosal nerve, based on the location of the tumor in addition to the absence of partial Horner's syndrome and a persistent decrease in tear secretion. INTERVENTION: The tumor was exposed with the use of a right subtemporal extradural approach and removed entirely. Pathological evaluation of the tumor revealed a CS.
CONCLUSION
The abducens nerve palsy improved completely in the follow-up period, but the decreased tear secretion did not resolve. CS is one of the subtypes of ordinary schwannomas and exhibits malignant features on microscopic examination, although it has a good clinical prognosis. No adjuvant treatment was applied because of the tumor's benign character. The greater superficial petrosal nerve schwannoma should be considered in the differential diagnosis of the abducens nerve palsy and petrous apex mass.
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Affiliation(s)
- Giyas Ayberk
- Department of Neurosurgery, Ankara Ataturk Training and Research Hospital, Bilkent, Turkey
| | - Mehmet F. Ozveren
- Department of Neurosurgery, Ankara Ataturk Training and Research Hospital, Bilkent, Turkey
| | - Nuket Uzum
- Department of Pathology, School of Medicine, Gazi University, Besevler, Turkey
| | - Ozgur Tosun
- Department of Radiology, Ankara Ataturk Training and Research Hospital, Bilkent, Turkey
| | - Emine K. Akcay
- Department of Ophthalmology, Ankara Ataturk Training and Research Hospital, Bilkent, Turkey
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