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Yılmaz MŞ, Ulubay M, Kuru F, Akar ÖS. Multiple Penile and Scrotal Schwannomas in an Adult Patient: A Case Report. Urol Int 2024; 108:259-263. [PMID: 38290475 DOI: 10.1159/000535093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/23/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Schwannomas originate from the peripheral nerve sheaths and are mainly detected in the head, neck, or extremities. They are rarely encountered in the penoscrotal region. CASE PRESENTATION Herein, we present a case of a penoscrotal schwannoma diagnosed and successfully treated in our center. A 40-year-old patient with a history of resection of a dorsal penile schwannoma presented with multiple nodular lesions at the scrotum, penile shaft, and radix, which were first noticed 5 years before his current presentation. He complained about penile pain and dyspareunia. Magnetic resonance imaging was performed for preoperative diagnosis. All nodular lesions were resected while preserving the neurovascular structures. The histopathological examination revealed benign lesions. The patient's complaints were resolved, and there was no recurrence during the 1-year follow-up. CONCLUSION The primary treatment is surgical excision. The patients need close follow-up regarding the risks of recurrence and malignant transformation.
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Affiliation(s)
- Muhammet Şahin Yılmaz
- Department of Urology, Samsun University Samsun Training and Research Hospital, Samsun, Turkey
| | - Mahmut Ulubay
- Department of Urology, Samsun University Samsun Training and Research Hospital, Samsun, Turkey
| | - Fatih Kuru
- Department of Urology, Samsun University Samsun Training and Research Hospital, Samsun, Turkey
| | - Ömer Salih Akar
- Department of Medical Genetics, Ondokuz Mayıs University, Samsun, Turkey
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2
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Kumagai H, Takehana K, Shioi Y, Tono C. Axillary schwannoma mimicking lymph node metastasis-associated breast cancer: a case report. Surg Case Rep 2022; 8:135. [PMID: 35844031 PMCID: PMC9288938 DOI: 10.1186/s40792-022-01493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Axillary schwannoma associated with breast cancer is an extremely rare disease, and previous reports have been limited. In this setting, there is great concern about whether a tumor in the axillary region is lymph node metastasis. Herein, we report a unique case of axillary schwannoma that mimicked lymph node metastasis associated with breast cancer.
Case presentation
A 68-year-old woman who underwent mastectomy and axillary lymph node dissection for right breast cancer over 20 years ago presented to our hospital with numbness and weakness in the right arm for 6 months. Ultrasonography, computed tomography, and magnetic resonance imaging showed a 20-mm well-circumscribed round tumor in the right axillary region. Initially, she was suspected of having lymph node metastasis-associated breast cancer, but the result of the core needle biopsy was a schwannoma. The patient underwent tumor enucleation. The patient has had no recurrence 1 year after the operation.
Conclusion
Axillary schwannomas often mimic lymph node metastasis in patients with a history of malignancy, particularly breast cancer. To select the optimal treatment, the clinicians should make as accurately as possible a diagnosis, with histopathological examinations, when examining patients with cancer who develop tumors in the axillary region.
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3
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Yuan Y, Gao J, Xiong G, Guo L. Diagnostic accuracy of multiparametric ultrasound for peripheral nerve schwannoma. Acta Radiol 2022; 64:1608-1614. [PMID: 36071627 DOI: 10.1177/02841851221125109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ultrasound (US) diagnostic techniques have the advantages of low cost, convenient operation, and high availability. PURPOSE To explore the diagnostic accuracy of multiparametric US in evaluating signs of peripheral schwannoma. MATERIAL AND METHODS This retrospective case-control study included patients with soft-tissue masses on the limbs (divided into the schwannoma and non-schwannoma groups) between January 2017 and November 2020. US features were compared between the two groups, and receiver operating characteristics analysis was used to evaluate the diagnostic efficacy of these features. RESULTS A total of 165 patients were included in this study; of them, 63 (38.2%) were diagnosed with schwannoma. Regular morphology (95.2% vs. 39.2%), cystic degeneration (71.4% vs. 27.5%), target sign on elastography (82.5% vs. 0), and polar blood supply sign (87.3% vs. 14.7%) were more common in schwannomas than in non-schwannoma lesions (all P < 0.001). Combining the four signs for diagnosis of schwannomas, the sensitivity, specificity, and accuracy were 95.24%, 96.08%, and 95.76%, respectively, with an area under the curve (AUC) of 0.987 (95% confidence interval = 0.955-0.998). Entering and exiting nerve sign was observed in 87.3% of schwannomas and in 3.0% of non-schwannoma lesions (P < 0.001), while split-fat sign was similar between the two groups (9.5% vs. 2.0%; P = 0.068). CONCLUSION Polar blood supply sign and target sign on elastography are specific US signs in peripheral schwannomas. The combination of two-dimensional imaging, color flow imaging, and elastography can achieve an excellent diagnostic accuracy in schwannomas.
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Affiliation(s)
- Yu Yuan
- Department of Ultrasound, 74768Tianjin Hospital, Tianjin, PR China
| | - Jinmei Gao
- Department of Ultrasound, 74768Tianjin Hospital, Tianjin, PR China
| | - Guangyi Xiong
- Department of Pathology, 74768Tianjin Hospital, Tianjin, PR China
| | - Lin Guo
- Department of Radiology, 74768Tianjin Hospital, Tianjin, PR China
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Tow CM, Tang J, Chun CM, Chien JLK. A rare case of penile schwannomatosis presenting with painful nocturnal penile tumescence. Basic Clin Androl 2022; 32:4. [PMID: 35313799 PMCID: PMC8935751 DOI: 10.1186/s12610-022-00154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Penile schwannoma is a rare tumor. They commonly present as an asymptomatic, painless and slow growing mass. Other presentations include sexual dysfunction, most commonly dyspareunia, followed by erectile dysfunction, abnormal penile curvature or pain with ejaculation. Case presentation A 26-year-old male presented atypically with painful nocturnal penile tumescence, along with multiple nodules over the dorsal penis. Excision of multiple penile tumors under general anaesthesia was performed and histopathologic examination revealed benign schwannoma. Conclusion Our hypothesis is that the schwannoma lies along the axis of the dorsal penile nerve, and compression of this nerve occurs during his erection causing pain. However, there are limited presentations of painful erections in penile schwannomas, and we hope that future studies can help confirm this theory.
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Affiliation(s)
- Chan Ming Tow
- Department of Urology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
| | - Jonathan Tang
- Department of Pathology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Chan Ming Chun
- Department of Urology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Joe Lee King Chien
- Department of Urology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
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Colonna MR, Costa AL, Mastrojeni C, Rizzo V, Nirta G, Angileri FF, Ieni A, Milone E, Macrì A. Giant sacral schwannoma excised under intraoperative neuromonitoring in an elderly patient: case report. J Surg Case Rep 2021; 2021:rjab460. [PMID: 34733472 PMCID: PMC8560204 DOI: 10.1093/jscr/rjab460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 11/14/2022] Open
Abstract
Schwannomas are mainly benign tumors arising from the Schwann cells of the peripheral nerve sheath. These tumors can often be associated with non-specific symptoms, such as abdominal heaviness. In this article, we present a detailed description of the surgical management of a giant sacral schwannoma in an elderly patient, for which intraoperative neuromonitoring made it possible to distinguish easily the nerves of the sacral plexus from which the tumor originated and to remove it without complications. Treatment of these rare and symptomatic giant tumors is still a challenge for surgeons; to treat adequately these tumors; a multidisciplinary approach is required to ensure an optimal therapeutic approach to reduce the risk of recurrence and, on the other hand, is not associated with unnecessary iatrogenic neurological damage.
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Affiliation(s)
- Michele R Colonna
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
| | - Alfio L Costa
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Messina, Italy
| | - Claudio Mastrojeni
- Unit of Vascular Surgery, CardioVascular and Thoracic Department, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Sperimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Nirta
- U.O.C. Radiodiagnostic, University of Messina, Messina, Italy
| | - Filippo F Angileri
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Antonio Ieni
- Departmant of Human Patology, Messina University Medical School Hospital, Messina, Italy
| | - Erica Milone
- Departmant of Human Patology, Messina University Medical School Hospital, Messina, Italy
| | - Antonio Macrì
- Departmant of Human Patology, Messina University Medical School Hospital, Messina, Italy
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Sturdà C, Pennisi G, D'Alessandris QG, Mattogno P, Fernandez E, Granata G, Gessi M, Lauretti L. Multinodular plexiform tumors of major peripheral nerves: A practical overview. J Clin Neurosci 2021; 93:106-111. [PMID: 34656232 DOI: 10.1016/j.jocn.2021.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Multinodular/plexiform schwannomas and neurofibromas of major nerves are rare: before surgery, differential diagnosis among these two uncommon variants is challenging. For both forms, surgical removal is recommended in case of progressive growth and worsening of neurological symptoms. Surgery has a higher risk of neurological damage than conventional schwannomas or neurofibromas. In literature, a comparison among these rare tumors is usually limited to the pathological aspect while specific surgical and clinical management indications are lacking. Cutaneous tumors of both forms arising from terminal peripheral nerves' branches might be treated by plastic surgeons while tumors of major nerves remain under neurosurgical competence. Here we report our recent neurosurgical experience on the matter, to furnish useful suggestions for the management of these tumors. METHOD We analyzed the clinical, radiological, and pathological data in a consecutive case series of plexiform/multinodular nerve tumors operated at our institution in the last five years. RESULTS In our series, neurofibroma type of plexiform tumors was more frequent than schwannoma type: two sporadic plexiform-multinodular schwannomas (patients 1, and 5) and three multinodular/plexiform Neurofibromatosis familial (Neurofibromatosis 1 / NF-1) (patients 2, 3, and 4). Surgery was complex when major nerves were involved. The early outcome appeared mostly related to the pre-surgical neurological conditions and histological grading. INTERPRETATION Although sharing some features, multinodular-plexiform schwannomas and neurofibromas have consistent differences from the clinical, surgical and pathological points of view.
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Affiliation(s)
- Cosimo Sturdà
- Department of Neuroscience, Section of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Giovanni Pennisi
- Department of Neuroscience, Section of Neurosurgery, Catholic University School of Medicine, Rome, Italy; Neurosurgery Unit, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy.
| | | | - Pierpaolo Mattogno
- Neurosurgery Unit, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Eduardo Fernandez
- Neurosurgery Unit, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Giuseppe Granata
- Unit of Neurology, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Marco Gessi
- Unit of NeuroPathology, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
| | - Liverana Lauretti
- Department of Neuroscience, Section of Neurosurgery, Catholic University School of Medicine, Rome, Italy; Neurosurgery Unit, Fondazione Policlinico Universitario "Agostino Gemelli" - IRCCS, Rome, Italy
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Majumder A, Ahuja A, Chauhan DS, Paliwal P, Bhardwaj M. A clinicopathological study of peripheral schwannomas. Med Pharm Rep 2021; 94:191-196. [PMID: 34013190 PMCID: PMC8118219 DOI: 10.15386/mpr-1708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022] Open
Abstract
Aim and objective Schwannomas are benign neoplasms of neural origin with sporadic or syndromic occurence. They are commonly seen in cranial nerves. Peripheral schwannomas occur rarely and may have unique presentations. The aim of this study is to evaluate the clinico-pathological characteristics of peripheral schwannomas. Methods A retrospective cross sectional study of peripheral schwannomas excluding head neck region was conducted. The study group consisted of 18 cases which were recorded over a period of seven years. The corresponding data were collected from the archives of the Department of Pathology. Results Male to female ratio was 1:1. The average age of the cases was 47 years. The most common site was the upper limbs (55.55%) followed by lower limbs, chest and penis. The lesions mostly presented as painless swellings (62%). Histopathological examination revealed classic features of schwannoma. Secondary changes included cystic degeneration, foam cells, epitheloid cells, hyalinization, microcystic change and collection of plasma cells. All cases were confirmed by positive S100 staining. Conclusion Peripheral schwannomas may be missed due to its rarity and atypical presentations. Both clinicians and pathologists should be aware of this common entity at unusual sites for the proper management of the patients. Surgery is usually the treatment of choice.
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Affiliation(s)
- Ankur Majumder
- Department of Pathology, Atal Bihari Vajpayee Instititute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, Atal Bihari Vajpayee Instititute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - D S Chauhan
- Department of Pathology, Atal Bihari Vajpayee Instititute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Purnima Paliwal
- Department of Pathology, Atal Bihari Vajpayee Instititute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Minakshi Bhardwaj
- Department of Pathology, Atal Bihari Vajpayee Instititute of Medical Sciences (ABVIMS) & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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8
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Leung KCP, Lam NKY, Chan E, Ko TCS. Primary recurrent orbital schwannoma treated with surgical excision and Mitomycin-C. Am J Ophthalmol Case Rep 2020; 19:100784. [PMID: 32613139 PMCID: PMC7315101 DOI: 10.1016/j.ajoc.2020.100784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Primary orbital schwannoma (POS) is a slow growing, benign encapsulated peripheral nerve sheath tumor that occurs infrequently within the orbit. Recurrence of POS is extremely rare. Previous speculations for reasons of recurrence include incomplete excision and tumor seeding. Observations We present the fifth case reported in the literature to date of POS that had 2 episodes of recurrences within 8 years after diagnosis, in which rapid and insidious relapses were observed after initial surgical resection. This is also the first reported recurrent POS in which topical Mitomycin-C (MMC) has been employed during surgical excision with an aim to prevent further recurrences. Conclusions AND IMPORTANCE: Whilst complete surgical excision remained the standard for management for most POS, when there are multiple recurrences and in cases where total excision is not possible, addition of topical MMC may be an option that may bring about tumour regression as demonstrated in our case.
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Affiliation(s)
| | - Nerissa Kei Yen Lam
- Department of Ophthalmology, Tuen Mun Eye Centre, Tuen Mun Hospital, Hong Kong
| | - Edwin Chan
- Department of Ophthalmology, Tung Wah Eastern Hosptial, Causewaybay, Hong Kong
| | - Tak Chuen Simon Ko
- Department of Ophthalmology, Tung Wah Eastern Hosptial, Causewaybay, Hong Kong
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9
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Pundu A, Lehnert B. Schwannoma of the Sural Nerve: A Case Report. J Am Podiatr Med Assoc 2020; 110:441586. [PMID: 32730604 DOI: 10.7547/17-156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A schwannoma is a slow-growing, neurogenic tumor composed of Schwann cells arising from a peripheral nerve sheath. The authors present a rare finding of a schwannoma of the sural nerve that was overlooked in a 51-year-old female with radiating foot pain. This case highlights the clinical implications and important teaching points in recognizing a schwannoma of the foot.
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10
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Murtaza M, Chacko A, Delbaz A, Reshamwala R, Rayfield A, McMonagle B, St John JA, Ekberg JAK. Why are olfactory ensheathing cell tumors so rare? Cancer Cell Int 2019; 19:260. [PMID: 31632194 PMCID: PMC6788004 DOI: 10.1186/s12935-019-0989-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023] Open
Abstract
The glial cells of the primary olfactory nervous system, olfactory ensheathing cells (OECs), are unusual in that they rarely form tumors. Only 11 cases, all of which were benign, have been reported to date. In fact, the existence of OEC tumors has been debated as the tumors closely resemble schwannomas (Schwann cell tumors), and there is no definite method for distinguishing the two tumor types. OEC transplantation is a promising therapeutic approach for nervous system injuries, and the fact that OECs are not prone to tumorigenesis is therefore vital. However, why OECs are so resistant to neoplastic transformation remains unknown. The primary olfactory nervous system is a highly dynamic region which continuously undergoes regeneration and neurogenesis throughout life. OECs have key roles in this process, providing structural and neurotrophic support as well as phagocytosing the axonal debris resulting from turnover of neurons. The olfactory mucosa and underlying tissue is also frequently exposed to infectious agents, and OECs have key innate immune roles preventing microbes from invading the central nervous system. It is possible that the unique biological functions of OECs, as well as the dynamic nature of the primary olfactory nervous system, relate to the low incidence of OEC tumors. Here, we summarize the known case reports of OEC tumors, discuss the difficulties of correctly diagnosing them, and examine the possible reasons for their rare incidence. Understanding why OECs rarely form tumors may open avenues for new strategies to combat tumorigenesis in other regions of the nervous system.
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Affiliation(s)
- Mariyam Murtaza
- 1Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4111 Australia.,2Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222 Australia.,3Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, 4111 Australia
| | - Anu Chacko
- 1Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4111 Australia.,2Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222 Australia.,3Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, 4111 Australia
| | - Ali Delbaz
- 1Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4111 Australia.,2Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222 Australia.,3Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, 4111 Australia
| | - Ronak Reshamwala
- 1Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4111 Australia.,2Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222 Australia.,3Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, 4111 Australia
| | - Andrew Rayfield
- 1Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4111 Australia.,2Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222 Australia.,3Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, 4111 Australia
| | - Brent McMonagle
- 4Department of Otolaryngology-Head and Neck Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD 4215 Australia
| | - James A St John
- 1Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4111 Australia.,2Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222 Australia.,3Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, 4111 Australia
| | - Jenny A K Ekberg
- 1Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4111 Australia.,2Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222 Australia.,3Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Nathan, 4111 Australia
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Bentley E, Ved R, Hayhurst C. Oculomotor schwannoma causing a progressive complete third-nerve palsy. BMJ Case Rep 2019; 12:12/8/e230272. [PMID: 31413058 DOI: 10.1136/bcr-2019-230272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 69-year-old woman presented with an 8-month history of diplopia and examination findings consistent with a right third-nerve palsy. Head MRI identified the presence of a 5.8 mm, nodular, isointense lesion in the suprasellar cistern, which demonstrated enhancement with gadolinium contrast. The lesion did not show any evidence of growth over a 3-month follow-up period. These MRI findings, alongside the clinical features, suggest oculomotor nerve schwannoma. Oculomotor schwannomas are a rare cause of third-nerve palsy. The presenting features and management options for oculomotor schwannomas are discussed to provide a framework for the diagnosis and management of these patients.
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Affiliation(s)
- Emily Bentley
- Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Ronak Ved
- Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Caroline Hayhurst
- Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, UK
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12
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Yoon YJ, Suh MJ, Lee HY, Lee HJ, Choi EH, Moon IS, Song K. Anti-tumor effects of cold atmospheric pressure plasma on vestibular schwannoma demonstrate its feasibility as an intra-operative adjuvant treatment. Free Radic Biol Med 2018; 115:43-56. [PMID: 29138018 DOI: 10.1016/j.freeradbiomed.2017.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 12/12/2022]
Abstract
Vestibular schwannoma (VS), although a benign intracranial tumor, causes morbidities by brainstem compression. Since chemotherapy is not very effective in most Nf2-negative schwannomas, surgical removal or radiation therapy is required. However, depending on the size and site of the tumor, these approaches may cause loss of auditory or vestibular functions, and severely decrease the post-surgical wellbeing. Here, we examined the feasibility of cold atmospheric pressure plasma (CAP) as an intra-operative adjuvant treatment for VS after surgery. Cell death was efficiently induced in both human HEI-193 and mouse SC4 VS cell lines upon exposure to CAP for seven minutes. Interestingly, both apoptosis and necroptosis were simultaneously induced by CAP treatment, and cell death was not completely inhibited by pan-caspase and receptor-interacting serine/threonine-protein kinase 1 (RIK1) inhibitors. Upon CAP exposure, cell death phenotype was similarly observed in patient-derived primary VS cells and tumor mass. In addition, CAP exposure after the surgical removal of primary tumor efficiently inhibited tumor recurrence in SC4-grafted mouse models. Collectively, these results strongly suggest that CAP should be developed as an efficient adjuvant treatment for VS after surgery to eliminate the possible remnant tumor cells, and to minimize the surgical area in the brain for post-surgical wellbeing.
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Affiliation(s)
- Yeo Jun Yoon
- Department of Biochemistry, College of Life Science & Biotechnology, Yonsei University, Seoul 03722, Korea
| | - Michelle J Suh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Seoul 03722, Korea
| | - Hyun Young Lee
- Department of Electrical Engineering, Pusan National University, Pusan 46269, Korea
| | - Hae June Lee
- Department of Electrical Engineering, Pusan National University, Pusan 46269, Korea
| | - Eun Ha Choi
- Plasma Bioscience Research Center and Department of Electrical and Biological Physics, Kwangwoon University, Seoul 01897, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Seoul 03722, Korea.
| | - Kiwon Song
- Department of Biochemistry, College of Life Science & Biotechnology, Yonsei University, Seoul 03722, Korea.
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13
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An X, Zhu M, Zhang N, Lu S, Wei P, Jiang L, Yang X. Schwannoma of the vagina - a common tumor but a rare location: A case report. Mol Clin Oncol 2017; 7:783-786. [PMID: 29181168 PMCID: PMC5700289 DOI: 10.3892/mco.2017.1420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022] Open
Abstract
Schwannomas are nerve sheath tumors arising from Schwann cells. These tumors usually present as benign, relatively slow-growing, solitary, encapsulated, painless masses. Schwannomas rarely occur in the vagina, and have not been fully recognized as gynecological tumors. We herein describe the case of a patient who presented with a schwannoma occurring in the wall of vagina, with non-specific symptoms lasting for ~1 year. The vaginal mass was incidentally detected during a sonographic examination and the patient was referred for surgical resection. The surgery was uncomplicated and the vaginal tumor was diagnosed as benign schwannoma. The immunohistochemical examination revealed positivity for vimentin, S-100 and glial fibrillary acidic protein, whereas discovered on GIST-1, CD117, CD34, desmin, smooth muscle actin and cytokeratin were negative. Tumors occurring in the vagina are common and are of variable histological types, with a wide range of pathological characteristics and complications. Schwannoma should be considered in the differential diagnosis in patients presenting with atypical symptoms from the gynecological tract. Immunohistochemical staining is required for confirmation of the diagnosis of schwannoma, and for distinguishing this entity from other homologous tumors.
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Affiliation(s)
- Xin An
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
| | - Meng Zhu
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Ning Zhang
- Department of Pathology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - Sanjun Lu
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
| | - Pin Wei
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
| | - Linna Jiang
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
| | - Xueli Yang
- Department of Pathology, Handan First Hospital, Handan, Hebei 056002, P.R. China
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Young ED, Ingram D, Metcalf-Doetsch W, Khan D, Al Sannaa G, Le Loarer F, Lazar AJF, Slopis J, Torres KE, Lev D, Pollock RE, McCutcheon IE. Clinicopathological variables of sporadic schwannomas of peripheral nerve in 291 patients and expression of biologically relevant markers. J Neurosurg 2017; 129:805-814. [PMID: 28885122 DOI: 10.3171/2017.2.jns153004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE While sporadic peripheral schwannomas (SPSs) are generally well treated with surgery, their biology is not well understood. Consequently, treatment options are limited. The aim of this study was to provide a comprehensive description of SPS. The authors describe clinicopathological features and treatment outcomes of patients harboring these tumors, and they assess expression of biomarkers using a clinically annotated tissue microarray. Together, these data give new insight into the biology and management of SPS. METHODS Patients presenting with a primary SPS between 1993 and 2011 (n = 291) were selected from an institutional registry to construct a clinical database. All patients underwent follow-up, and short- and long-term outcomes were assessed. Expression of relevant biomarkers was assessed using a new tissue microarray (n = 121). RESULTS SPSs were generally large (mean 5.5 cm) and frequently painful at presentation (55%). Most patients were treated with surgery (80%), the majority of whom experienced complete resolution (52%) or improvement (18%) of their symptoms. Tumors that were completely resected (85%) did not recur. Some patients experienced short-term (16%) and long-term (4%) complications postoperatively. Schwannomas expressed higher levels of platelet-derived growth factor receptor-β (2.1) than malignant peripheral nerve sheath tumors (MPNSTs) (1.5, p = 0.004) and neurofibromas (1.33, p = 0.007). Expression of human epidermal growth factor receptor-2 was greater in SPSs (0.91) than in MPNSTs (0.33, p = 0.002) and neurofibromas (0.33, p = 0.026). Epidermal growth factor receptor was expressed in far fewer SPS cells (10%) than in MPNSTs (58%, p < 0.0001) or neurofibromas (37%, p = 0.007). SPSs more frequently expressed cytoplasmic survivin (66% of tumor cells) than normal nerve (46% of cells), but SPS expressed nuclear survivin in fewer tumor cells than in MPNSTs (24% and 50%, respectively; p = 0.018). CONCLUSIONS Complete resection is curative for SPS. Left untreated, however, these tumors can cause significant morbidity, and not all patients are candidates for resection. SPSs express a pattern of biomarkers consistent with the dysregulation of the tumor suppressor merlin observed in neurofibromatosis Type 2-associated schwannomas, suggesting a shared etiology. This SPS pattern is distinct from that of other tumors of the peripheral nerve sheath.
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Affiliation(s)
- Eric D Young
- 1Department of Cancer Biology, University of Kansas Medical Center, Andover, Kansas
| | - Davis Ingram
- Departments of2Surgical Oncology.,6The Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Dilshad Khan
- 8Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Ghadah Al Sannaa
- 3Pathology and Laboratory Medicine.,6The Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Alexander J F Lazar
- 3Pathology and Laboratory Medicine.,6The Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Keila E Torres
- Departments of2Surgical Oncology.,6The Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dina Lev
- 10Department of Surgery, Sheba Medical Center, Israel; and
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Chick G, Victor J, Hollevoet N. Six cases of sporadic schwannomatosis: Topographic distribution and outcomes of peripheral nerve tumors. HAND SURGERY & REHABILITATION 2017; 36:378-383. [PMID: 28781128 DOI: 10.1016/j.hansur.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022]
Abstract
The diagnosis of schwannomatosis is often overestimated and is based on the existence of multiple peripheral nerve tumors composed exclusively of schwannomas, in the absence of clinical signs of neurofibromatosis type 2 (NF2). Sporadic forms are much more frequent than familial forms. The objective of this study was to describe the distribution of peripheral nerve tumors and investigate the outcomes of schwannomas in the context of sporadic schwannomatosis. We conducted a retrospective study of patients who fulfilled clinical diagnostic criteria for sporadic schwannomatosis. Six patients were reviewed with a mean follow-up of 38.5months (27-60months). Patients' demographic, clinical, radiographic, and pathologic data were extracted. All patients underwent slit-lamp examination, enhanced brain magnetic resonance imaging (MRI) and a spinal MRI. Enucleation that preserved nerve continuity was performed in symptomatic patients. On average, patients were 36years of age at the time of diagnosis with no sex predominance. The topographic distribution of the peripheral nerve tumors was always unilateral and most frequently targeted the upper limb. In four cases, the tumors involved the same peripheral nerve exclusively. The average number of nerve tumors observed per patient was 4.7 (2-8). The outcome after enucleation was marked by the systematic appearance of new tumors. After enucleation, no recurrence or malignant transformation was observed at the final follow-up. There was no transition to a NF2 configuration. The absence of neurofibroma and NF2 criteria makes schwannomatosis a diagnosis of exclusion. While a good prognosis can be expected following enucleation, two risks related to neurofibromatosis type 3 (NF3) are worth monitoring: the transition to NF2, particularly in young patients, and the appearance of new tumors.
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Affiliation(s)
- G Chick
- Department of Hand Surgery and Peripheral Nerve Surgery, hôpital de la Tour, 1, avenue J.D. Maillard, 1217 Meyrin, Geneva, Switzerland.
| | - J Victor
- Ghent University Hospital, Department of Orthopaedic Surgery and Traumatology, De Pintelaan 185, 9000 Gent, Belgium.
| | - N Hollevoet
- Ghent University Hospital, Department of Orthopaedic Surgery and Traumatology, De Pintelaan 185, 9000 Gent, Belgium.
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16
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Yoshizawa K, Yuki M, Kinoshita Y, Emoto Y, Yuri T, Elmore SA, Tsubura A. N-methyl-N-nitrosourea-induced schwannomas in male Sprague-Dawley rats with a literature review of inducible and spontaneous lesions. ACTA ACUST UNITED AC 2016; 68:371-9. [PMID: 27233116 DOI: 10.1016/j.etp.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/03/2016] [Accepted: 05/10/2016] [Indexed: 12/01/2022]
Abstract
N-methyl-N-nitrosourea (MNU) possesses peripheral nervous system carcinogenic activity in rats and induces benign and malignant schwannomas in systemic organs. In this retrospective study, we compared the characteristics of various immunohistochemical markers in MNU-induced schwannomas in male Crj:CD(SD)IGS rats including: vimentin (Vim), S100, p75 nerve growth factor receptor (LNGFR), CD57, pancytokeratin (CK), myoglobin, desmin and α smooth muscle actin (SMA). Single intraperitoneal exposures of 50 or 75mg/kg MNU in male rats at the age of 4 weeks induced schwannomas in 43 surviving and terminated rats up to 30-weeks-old. The incidence rate of neoplastic lesions was 37% (16 of 43 rats). Benign schwannomas (mesentery, pancreas, thymus) and malignant schwannomas (subendocardium, cardiac intramural, thoracic cavity, abdominal cavity, prostate), occurred in nine and seven rats, respectively. All neoplastic lesions were moderately or strongly positive for Vim, S100 and LNGFR proteins. Benign tumors were weakly positive and malignant tumors strongly positive for Ki-67, suggesting a high active proliferation rate of Schwann cell precursors. All lesions were negative for CD57, CK, myoglobin, desmin and SMA. This data may provide useful immunohistochemical information for the investigation of schwannomas in rat chemical carcinogenicity studies.
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Affiliation(s)
- Katsuhiko Yoshizawa
- Department of Pathology II, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan.
| | - Michiko Yuki
- Department of Pathology II, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Yuichi Kinoshita
- Department of Pathology II, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan; Division of Diagnostic Cytopathology and Histopathology, Kansai Medical University Medical Center, Fumizono 10-15, Moriguchi, Osaka 570-8507, Japan
| | - Yuko Emoto
- Department of Pathology II, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Takashi Yuri
- Department of Pathology II, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Susan A Elmore
- Cellular & Molecular Pathology Branch, National Institute of Environmental Health Sciences, 111 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Airo Tsubura
- Department of Pathology II, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan
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18
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Abstract
Merlin, the protein product of NF2 gene, is one of the most versatile tumor suppressors capable of integrating different mechanisms that regulate cell proliferation, motility, survival and signaling pathways underlying and governing those mechanisms. Merlin is considered a member of the band 4.1 families of cytoskeleton-associated proteins also called ERM family and acts as tumor suppressor. The main cause for transformation of Schwann cells into schwannomas is credited to the inactivation of the neurofibromin 2 (NF2) gene and the consecutive loss of its protein merlin. Recent scientific advances improved our understanding of pathogenic mechanisms involving NF2 gene. The present review brings genetic properties of NF2 gene, molecular characteristics of merlin, summarizes mutational spectra and explains merlin's multifunctional roles regarding its involvement in neurofibromatosis associated tumorigenesis.
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Pećina-Slaus N, Zeljko M, Pećina HI, Nikuseva Martić T, Bacić N, Tomas D, Hrasćan R. Frequency of loss of heterozygosity of the NF2 gene in schwannomas from Croatian patients. Croat Med J 2013; 53:321-7. [PMID: 22911524 PMCID: PMC3428820 DOI: 10.3325/cmj.2012.53.321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim To identify gross deletions in the NF2 gene in a panel of schwannomas from Croatian patients in order to establish their frequencies in Croatian population. Methods Changes of the NF2 gene were tested by polymerase chain reaction/loss of heterozygosity (LOH) using two microsatellite markers, D22S444 and D22S929. Results The analysis with both markers demonstrated that 43.75% of schwannomas exhibited LOH of the NF2 gene. The D22S444 region exhibited 45.5% of LOHs and the D22S929 region exhibited 14.3% of LOHs. Four LOHs were found in Antoni B, 2 in Antoni A, and 1 in Antoni A and B type tumors. Conclusion The frequency of changes observed in Croatian patients is broadly similar to that reported in other populations and thus confirms the existing hypothesis regarding the tumorigenesis of schwannomas and contributes to schwannoma genetic profile helping us to better understand its etiology and treatment.
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Affiliation(s)
- Nives Pećina-Slaus
- Laboratory of Neurooncology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Salata 12, HR-10000 Zagreb, Croatia.
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Kron M, Bohnsack BL, Archer SM, McHugh JB, Kahana A. Recurrent orbital schwannomas: clinical course and histopathologic correlation. BMC Ophthalmol 2012; 12:44. [PMID: 22937797 PMCID: PMC3503695 DOI: 10.1186/1471-2415-12-44] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 08/27/2012] [Indexed: 11/22/2022] Open
Abstract
Background Schwannomas are slow-growing typically encapsulated tumors composed of differentiated Schwann cells, the primary class of peripheral glial cells. Complete excision is the treatment of choice for orbital schwannomas that cause pain, disfigurement, diplopia, or optic neuropathy. The presence of multiple schwannomas in a single patient suggests possible association with neurofibromatosis type 2 (NF2) or schwannomatosis. Case presentation We present 2 patients who experienced recurrent orbital schwannoma without evidence for neurofibromatosis. The recurrence in one patient, a 59-year old man, occurred 6 years after complete excision of the initial tumor. This recurrence consisted of 2 independent tumors in the same orbit. The recurrence in the second patient, a 5 year-old girl, occurred multiple times within days to weeks of partial excisions until eventually
a complete excision was performed. Conclusion The clinical history, histopathologic features and particularly the intraoperative findings suggest that the 59 year old man suffers from orbital schwannomatosis, while the rapid recurrence in the second patient correlated with the cellular features of her plexiform schwannoma. Hence, the recurrence in each patient is linked to a different etiology, with implications for treatment and patient counseling given the difficulty in treating orbital schwannomatosis. To our knowledge, this is the first description of isolated orbital schwannomatosis.
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Affiliation(s)
- Michelle Kron
- University of Michigan Medical School, Ann Arbor, MI, USA
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21
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Ammoun S, Schmid MC, Triner J, Manley P, Hanemann CO. Nilotinib alone or in combination with selumetinib is a drug candidate for neurofibromatosis type 2. Neuro Oncol 2011; 13:759-66. [PMID: 21727212 DOI: 10.1093/neuonc/nor056] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Loss of the tumor suppressor merlin is a cause of frequent tumors of the nervous system, such as schwannomas, meningiomas, and ependymomas, which occur spontaneously or as part of neurofibromatosis type 2 (NF2). Because there is medical need for drug therapies for these tumors, our aim is to find therapeutic targets. We have studied the pathobiology of schwannomas, because they are the most common merlin-deficient tumors and are a model for all merlin-deficient tumors. With use of a human schwannoma in vitro model, we previously described strong overexpression/activation of platelet-derived growth factor receptor-β (PDGFR-β) leading to strong, long-lasting activation of extracellular-signal-regulated kinase (ERK1/2) and AKT and increased schwannoma growth, which we successfully inhibited using the PDGFR/Raf inhibitor sorafenib. However, the benign character of schwannomas may require long-term treatment; thus, drug tolerability is an issue. With the use of Western blotting, proliferation assays, viability assays, and a primary human schwannoma cell in vitro model, we tested the PDGFR/c-KIT inhibitors imatinib (Glivec(;) Novartis) and nilotinib (Tasigna(;) Novartis). Imatinib and nilotinib inhibited PDGF-DD-mediated ERK1/2 activation, basal and PDGF-DD-mediated activation of PDGFR-β and AKT, and schwannoma proliferation. Nilotinib is more potent than imatinib, exerting its maximal inhibitory effect at concentrations lower than steady-state trough plasma levels. In addition, nilotinib combined with the MEK1/2 inhibitor selumetinib (AZD6244) at low concentrations displayed stronger efficiency toward tumor growth inhibition, compared with nilotinib alone. We suggest that therapy with nilotinib or combinational therapy that simultaneously inhibits PDGFR and the downstream Raf/MEK1/2/ERK1/2 pathway could represent an effective treatment for schwannomas and other merlin-deficient tumors.
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Affiliation(s)
- Sylwia Ammoun
- Clinical Neurobiology, Peninsula College for Medicine and Dentistry, The John Bull Building, Tamar Science Park, Research Way, Plymouth PL6 8BU, United Kingdom
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Ammoun S, Hanemann CO. Emerging therapeutic targets in schwannomas and other merlin-deficient tumors. Nat Rev Neurol 2011; 7:392-9. [DOI: 10.1038/nrneurol.2011.82] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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23
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Hilton DA, Ristic N, Hanemann CO. Activation of ERK, AKT and JNK signalling pathways in human schwannomasin situ. Histopathology 2009; 55:744-9. [DOI: 10.1111/j.1365-2559.2009.03440.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The ErbB inhibitors trastuzumab and erlotinib inhibit growth of vestibular schwannoma xenografts in nude mice: a preliminary study. Otol Neurotol 2009; 29:846-53. [PMID: 18636037 DOI: 10.1097/mao.0b013e31817f7398] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To analyze the ability of ErbB inhibitors to reduce the growth of vestibular schwannoma (VS) xenografts. METHODS Vestibular schwannoma xenografts were established in the interscapular fat pad in nude mice for 4 weeks. Initially, a small cohort of animals was treated with the ErbB2 inhibitor trastuzumab or saline for 2 weeks. Animals also received bromodeoxyuridine injections to label proliferating cells. In a longer-term experiment, animals were randomized to receive trastuzumab, erlotinib (an ErbB kinase inhibitor), or placebo for 12 weeks. Tumor growth was monitored by magnetic resonance imaging during the treatment period. Cell death was analyzed by terminal deoxynucleotidyl transferase-mediated dUTP-biotin end labeling of fragmented DNA. RESULTS Tumors can be distinguished with T2-weighted magnetic resonance imaging sequences. Trastuzumab significantly reduced the proliferation of VS cells compared with control (p < 0.01) as analyzed by bromodeoxyuridine uptake. Control tumors demonstrated slight growth during the 12-week treatment period. Both trastuzumab and erlotinib significantly reduced the growth of VS xenografts (p < 0.05). Erlotinib, but not trastuzumab, resulted in a significant increase in the percentage of terminal deoxynucleotidyl transferase-mediated dUTP-biotin end labeling of fragmented DNA-positive VS cells (p < 0.01). CONCLUSION In this preliminary study, the ErbB inhibitors trastuzumab and erlotinib decreased growth of VS xenografts in nude mice, raising the possibility of using ErbB inhibitors in the management of patients with schwannomas, particularly those with neurofibromatosis Type 2.
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Flaiz C, Ammoun S, Biebl A, Hanemann CO. Altered adhesive structures and their relation to RhoGTPase activation in merlin-deficient Schwannoma. Brain Pathol 2008; 19:27-38. [PMID: 18445079 DOI: 10.1111/j.1750-3639.2008.00165.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Schwannomas are Schwann cell tumors of the nervous system that occur spontaneously and in patients with neurofibromatosis 2 (NF2) and lack the tumor suppressor merlin. Merlin is known to bind paxillin, beta1 integrin and focal adhesion kinase, members of focal contacts, multi-protein complexes that mediate cell adhesion to the extracellular matrix. Moreover, merlin-deficient Schwannomas show pathological adhesion to the extracellular matrix making the characterization of focal contacts indispensable. Using our Schwannoma in vitro model of human primary Schwann and Schwannoma cells, we here show that Schwannoma cells display an increased number of mature and stable focal contacts. In addition to an involvement of RhoA signaling via the Rho kinase ROCK, Rac1 plays a significant role in the pathological adhesion of Schwannoma cells. The Rac1 guanine exchange factor- beta-Pix, localizes to focal contacts in human primary Schwannoma cells, and we show that part of the Rac1 activation, an effect of merlin-deficiency, occurs at the level of focal contacts in human primary Schwannoma cells. Our results help explaining the pathological adhesion of Schwannoma cells, further strengthen the importance of RhoGTPase signaling in Schwannoma development, and suggest that merlin's role in tumor suppression is linked to focal contacts.
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Affiliation(s)
- Christine Flaiz
- Department of Clinical Neurobiology, Institute of Biomedical and Clinical Science, Peninsula College for Medicine and Dentistry, Plymouth, UK
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Abstract
Schwannomatosis is the most recently recognized form of neurofibromatosis in which patients harbor multiple non-vestibular nerve schwannomas. The diagnosis is contingent on excluding neurofibromatosis Type 2 (NF2), to which it is related. The authors present a case of schwannomatosis diagnosed fortuitously when a preoperative magnetic resonance (MR) image of a pelvic schwannoma was suggestive of a lesion in the lower lumbar canal. Definitive studies confirmed the presence of multiple spinal tumors including a thoracic schwannoma, which was removed during a subsequent procedure. This case emphasizes the need to consider the possibility of multiple tumors in every patient presenting with a schwannoma because the follow-up and genetic counseling are vastly different in those with NF2 and schwannomatosis compared with those harboring sporadic tumors. Details of this case and current considerations in the diagnosis and management of schwannomatosis are discussed.
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Affiliation(s)
- Kimberly Harbaugh
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
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