1
|
Wong CE, Huang CC, Chuang MT, Lee PH, Chen LY, Hsu HH, Huang CY, Wang LC, Lee JS. Quantification of vessel separation using the carotid-jugular angle to predict the nerve origin of neck peripheral nerve sheath tumours: a pooled analysis of cases from the literature and a single-center cohort. Int J Surg 2023; 109:2704-2713. [PMID: 37204443 PMCID: PMC10498853 DOI: 10.1097/js9.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Postoperative nerve palsy is a major complication following resection of neck peripheral nerve sheath tumours (PNSTs). Accurate preoperative identification of the nerve origin (NO) can improve surgical outcomes and patient counselling. MATERIAL AND METHODS This study was a retrospective cohort and quantitative analysis of the literature. The authors introduced a parameter, the carotid-jugular angle (CJA), to differentiate the NO. A literature review of neck PNST cases from 2010 to 2022 was conducted. The CJA was measured from eligible imaging data, and quantitative analysis was performed to evaluate the ability of the CJA to predict the NO. External validation was performed using a single-centre cohort from 2008 to 2021. RESULTS In total, 17 patients from our single-centre cohort and 88 patients from the literature were analyzed. Among them, 53, 45, and 7 patients had sympathetic, vagus, and cervical nerve PNSTs, respectively. Vagus nerve tumours had the largest CJA, followed by sympathetic tumours, whereas cervical nerve tumours had the smallest CJA ( P <0.001). Multivariate logistic regression identified a larger CJA as a predictor of vagus NO ( P <0.001), and receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.907 (0.831-0.951) for the CJA to predict vagus NO ( P <0.001). External validation showed an AUC of 0.928 (0.727-0.988) ( P <0.001). Compared with the AUC of the previously proposed qualitative method (AUC=0.764, 0.673-0.839), that of the CJA was greater ( P =0.011). The cut-off value identified to predict vagus NO was greater than or equal to 100°. Receiver operating characteristic analysis showed an AUC of 0.909 (0.837-0.956) for the CJA to predict cervical NO ( P <0.001), with a cut-off value less than 38.5°. CONCLUSIONS A CJA greater than or equal to 100° predicted a vagus NO and a CJA less than 100° predicted a non-vagus NO. Moreover, a CJA less than 38.5 was associated with an increased likelihood of cervical NO.
Collapse
Affiliation(s)
- Chia-En Wong
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital
| | - Chi-Chen Huang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital
| | | | - Po-Hsuan Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital
| | - Liang-Yi Chen
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital
| | - Hao-Hsiang Hsu
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital
| | - Chih-Yuan Huang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital
| | - Liang-Chao Wang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital
| | - Jung-Shun Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital
- Cell Biology and Anatomy
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
2
|
Hammad RM. Malignant Melanotic Nerve Sheath Tumors: A Review of Clinicopathologic and Molecular Characteristics. J Microsc Ultrastruct 2023; 11:125-129. [PMID: 38025185 PMCID: PMC10679827 DOI: 10.4103/jmau.jmau_5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 11/04/2022] Open
Abstract
Malignant melanotic nerve sheath tumor (MMNST) which was formerly known as melanocytic schwannoma, is an uncommon aggressive type of nerve sheath tumor. It originates from nerve roots with clonal Schwann cell proliferation and melanin pigment production. MMNST which was once thought to be a benign tumor is now considered a malignant disease based on the latest 2020 World Health Organization classification of soft tissue tumors. Interestingly, despite the histologic features appearing benign with a low proliferation index, the clinical course of this tumor is malignant, which was demonstrated in case series with high rate of recurrences and metastasis. This tumor can occur sporadically or in patients with an underlying familial predisposition syndrome called, Carney's complex. Affected patients will often harbor a germline mutation in the PRKAR1A gene. MMNST can be histologically difficult to distinguish from malignant melanoma, other melanocytic tumors, and Schwannoma. Having a better understanding of its clinic pathologic characteristics and associated conditions is essential in properly diagnosing and managing affected individuals. This includes the possible need for genetic testing to detect germline mutations, genetic counseling, and surveillance according to published recommendations. In this article, we summarize the clinic pathologic and molecular features of MMNST and discuss what is known about its molecular biology and its associations with predisposing conditions. The review was conducted through an extensive PubMed search using keywords then relevant publications were selected.
Collapse
Affiliation(s)
- Rawan M. Hammad
- Department of Haematology, Division of Paediatric Haematology and Oncology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
3
|
Wang H, Shi L, Tian T, Xian H, Song Z, Cong R, Zhao R. Case report: A rare case of massive peripheral nerve melanotic schwannoma and review of the literature. Front Neurol 2023; 14:1103604. [PMID: 36779049 PMCID: PMC9909008 DOI: 10.3389/fneur.2023.1103604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023] Open
Abstract
Melanotic schwannoma is a rare tumor with indeterminate biologic behavior and varying treatment recommendations. Just about 200 cases have been reported worldwide, in which occurred in peripheral nerves has even less reported. Due to the lack of cognition of melanotic schwannoma, it is easy to be misdiagnosed and mistreatment in primary hospitals. Herein, we presented a case of massive melanotic schwannoma growing in the brachial plexus of an elderly male patient. First, the patient underwent a left forearm tumor resection in the local primary hospital because a painless lump was found there in 2017, of which details remain unclear. After this operation, the patient developed the symptoms of left median nerve injury. Thus, he came to our hospital and underwent a second operation. During this operation, we found that a part of the median nerve was absent at the left forearm, and the remanent median nerve, from the broken end to the elbow, was totally turned black, which was accompanied by petroleum-like exudate. Losing the opportunity for nerve repair, the black nerve was removed extensively and thoroughly. Postoperative pathological diagnosis revealed that the tumor was melanotic schwannoma. Then 4 years later, the tumor recurrence again, which led to the paralysis of the whole left arm and severe nerve pain, and the pulmonary metastasis of the tumor was detected at the same time. The black nerve was resected again in our hospital, and the nerve pain was partially relieved after the operation. To the best of our knowledge, it is the first time to report a melanotic schwannoma case that happened in the peripheral nerve trunk and then spread to the whole brachial plexus. There were many questions that worthy of discussion could be invited from this case, and we analyzed and discussed them based on the relevant literature. In conclusion, we reported a rare case of melanotic schwannoma that happened in the brachial plexus and illustrated the problems of the diagnosis and treatment of it based on the analysis of the relevant literature, which is helpful for the cognition of this rare nerve tumor.
Collapse
Affiliation(s)
- Han Wang
- Department of Orthopedics, Air Force Medical Center, Beijing, China
| | - Lin Shi
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Tong Tian
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Hang Xian
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Zhao Song
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Rui Cong
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, China,*Correspondence: Rui Cong
| | - Rui Zhao
- Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, China,Rui Zhao
| |
Collapse
|
4
|
Bonomo G, Gans A, Mazzapicchi E, Rubiu E, Alimonti P, Eoli M, Paterra R, Pollo B, Iess G, Restelli F, Falco J, Acerbi F, Schiariti MP, Ferroli P, Broggi M. Sporadic spinal psammomatous malignant melanotic nerve sheath tumor: A case report and literature review. Front Oncol 2023; 13:1100532. [PMID: 36910634 PMCID: PMC9998981 DOI: 10.3389/fonc.2023.1100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Background Sporadic Spinal Psammomatous Malignant Melanotic Nerve Sheath Tumor (SSP-MMNST) is a rare subgroup of peripheral nerve sheath tumors arising along the spine. Only a few reports of SSP-MMNST have been described. In this paper, we review the literature on SSP-MMNST focusing on clinical, and diagnostic features, as well as investigating possible pathogenetic mechanisms to better implement therapeutic strategies. We also report an illustrative case of a young female presenting with cervicobrachial pain due to two SSP-MMNSTs arising from C5-6 right spinal roots. Case description We report a case of a 28-year-old woman presenting with right arm weakness and dysesthesia. Clinical examination and neuroimaging were performed, and, following surgical removal of both lesions, a histological diagnosis of SSP-MMNST was obtained. Results The literature review identified 21 eligible studies assessing 23 patients with SSP-MMNST, with a mean onset age of 41 years and a slight male gender preference. The lumbar district was the most involved spinal segment. Gross-total resection (GTR) was the treatment of choice in all amenable cases, followed in selected cases with residual tumor by adjuvant radiotherapy or chemotherapy. The metastatic and recurrence rates were 31.58% and 36.8%, respectively. Conclusion Differently from common schwannomas, MMNST represents a rare disease with known recurrence and metastatization propensity. As reported in our review, SSP-MMNST has a greater recurrence rate when compared to other forms of spinal MMNST, raising questions about the greater aggressiveness of the former. We also found that residual disease is related to a higher risk of systemic disease spreading. This metastatic potential, usually associated with primary lumbar localization, is characterized by a slight male prevalence. Indeed, whenever GTR is unachievable, considering the higher recurrence rate, adjuvant radiation therapy should be taken into consideration.
Collapse
Affiliation(s)
- Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy.,Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Catania, Italy
| | - Alessandro Gans
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Emanuele Rubiu
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Paolo Alimonti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marica Eoli
- Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Rosina Paterra
- Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Guglielmo Iess
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marco Paolo Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| |
Collapse
|
5
|
Yan X, Wang K, Lin N, Huang X, Fu Y, Ye Z. A Rare Case of Melanotic Schwannoma Occurred Intraosseous of Sacrum: A Literature Review. Orthop Surg 2022; 15:655-662. [PMID: 36453472 PMCID: PMC9891983 DOI: 10.1111/os.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Melanotic schwannoma is a rare tumor when it occurs in the sacrum. Though it is mostly classified as benign, the prognosis is unpredictable due to the possibility of recurrence and metastasis. Here, we reported a case of intraosseous of sacrum with good results and reviewed the literature. CASE PRESENTATION A 33-year-old male patient complained of low back pain and was discovered to have an obstruction at S2. Following the necessary imaging diagnosis, we treated the patient with piecemeal excision in conjunction with extended curettage, and the frozen biopsy revealed that the tumor was melanotic schwannoma. The intraosseous portion of the lesion was curettaged using high-speed drill to enlarge the edge of curettage, and piecemeal excision for lesion within the sacral canal. After surgery, the patient received total 56Gy radiotherapy and frequent follow-up. After 15 months follow-up, there was no evidence of recurrence, and the nerve function was normal. CONCLUSION Melanotic schwannoma that occurs intraosseous of the sacrum is extremely rare and lacks typical clinical manifestations; however it can be identified through careful pathological and imaging diagnosis. Intralesional extended curettage combined with radiotherapy can achieve a good local control with a satisfactory clinical effect in this rare disease.
Collapse
Affiliation(s)
- Xiaobo Yan
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Zhejiang UniversityHangzhouChina,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang ProvinceHangzhouChina
| | - Keyi Wang
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Zhejiang UniversityHangzhouChina,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang ProvinceHangzhouChina
| | - Nong Lin
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Zhejiang UniversityHangzhouChina,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang ProvinceHangzhouChina
| | - Xin Huang
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Zhejiang UniversityHangzhouChina,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang ProvinceHangzhouChina
| | - YanBiao Fu
- Department of PathologyThe Second Affiliated Hospital of Zhejiang UniversityHangzhouChina
| | - Zhaoming Ye
- Department of Orthopedic OncologyThe Second Affiliated Hospital of Zhejiang UniversityHangzhouChina,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang ProvinceHangzhouChina
| |
Collapse
|
6
|
Benson JC, Marais MD, Flanigan PM, Bydon M, Giannini C, Spinner RJ, Folpe AL. Malignant Melanotic Nerve Sheath Tumor. AJNR Am J Neuroradiol 2022; 43:1696-1699. [PMID: 36302602 DOI: 10.3174/ajnr.a7691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/30/2022] [Indexed: 02/01/2023]
Abstract
Malignant melanotic nerve sheath tumors are uncommon pigmented tumors of Schwann cell origin, most often found along the spinal nerves. Although well-described in the literature, the tumors are quite rare, making up <1% of nerve sheath tumors. Physicians are, therefore, often unfamiliar with both the appearance and the optimal treatment of such tumors. Morphologically, many imaging features overlap with schwannomas and neurofibromas. Nevertheless, the malignant melanotic nerve sheath tumors are crucial to identify. They can be extremely aggressive, and the management of these tumors is considerably different from their benign counterparts. In this radiology-pathology review, we will highlight the imaging appearance, histologic features, surgical resection, and subsequent therapeutic strategies in a patient with a lumbar malignant melanotic nerve sheath tumor.
Collapse
Affiliation(s)
- J C Benson
- From the Department of Radiology (J.C.B., M.D.M.)
| | - M D Marais
- From the Department of Radiology (J.C.B., M.D.M.)
| | | | - M Bydon
- Neurologic Surgery (P.M.F., M.B.)
| | - C Giannini
- Laboratory Medicine and Pathology (C.G., R.J.S., A.L.F.), Mayo Clinic, Rochester, Minnesota
| | - R J Spinner
- Laboratory Medicine and Pathology (C.G., R.J.S., A.L.F.), Mayo Clinic, Rochester, Minnesota
| | - A L Folpe
- Laboratory Medicine and Pathology (C.G., R.J.S., A.L.F.), Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
7
|
Yeom JA, Song YS, Lee IS, Han IH, Choi KU. Malignant melanotic nerve sheath tumors in the spinal canal of psammomatous and non-psammomatous type: Two case reports. World J Clin Cases 2022; 10:8735-8741. [PMID: 36157803 PMCID: PMC9453363 DOI: 10.12998/wjcc.v10.i24.8735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/11/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A malignant melanotic nerve sheath tumor (MMNST), previously known as a melanotic schwannoma, is a rare variant of a peripheral nerve sheath tumor composed of Schwann cells with melanotic differentiation. Only a few reports of spinal MMNST have been reported.
CASE SUMMARY In the first case, a 58-year-old woman presented with a history of low back pain and paresthesia. Magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbar spine revealed an intradural extramedullary mass lesion with amorphous linear calcification. Complete tumor resection was performed and histological examination revealed a psammomatous melanotic schwannoma. In the second case, a 72-year-old man presented with low back pain and paresthesia. MRI of the thoracolumbar spine revealed an intramedullary mass lesion at the T11 vertebral body level. The mass lesion was hypointense on T2WI and hyperintense on T1WI. Tumor resection was performed and the histologic result was melanotic schwannoma.
CONCLUSION MMNST should be considered in the differential diagnosis when calcification or melanin is seen in an intradural spinal tumor.
Collapse
Affiliation(s)
- Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - You Seon Song
- Department of Radiology, Pusan National University Hospital, Busan 49241, South Korea
| | - In Sook Lee
- Department of Radiology, Pusan National University Hospital, Busan 49241, South Korea
| | - In Ho Han
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, South Korea
| | - Kyung Un Choi
- Department of Pathology, Pusan National University Hospital, Busan 49241, South Korea
| |
Collapse
|
8
|
Lin KY, Chen L, Hung SW, Hung SC, Yang CK, Chen CJ, Chiu KY. A para-aortic malignant melanotic nerve sheath tumor mimicking a gastrointestinal stromal tumor: a rare case report and review of literature. BMC Surg 2022; 22:293. [PMID: 35902891 PMCID: PMC9331146 DOI: 10.1186/s12893-022-01727-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Malignant melanotic nerve sheath tumor (MMNST), formerly called melanotic schwannoma, is a rare tumor of neural crest derivation which most frequently arises from the region of spinal or autonomic nerves near the midline. Recent studies have reported malignant behavior of MMNST, and there still has no standard management guidelines. Intra-abdominal MMNST, which has never been reviewed as an entity, is even rarer. In this study, we present a rare case of a cystic MMNST arising from the para-aortic region and mimicking an intra-abdominal gastrointestinal stromal tumor (GIST), and review the literature regarding MMNSTs located in the abdominal cavity. Case presentation A 59-year-old female was incidentally found a tumor located in the left para-aortic area by non-contrast computed tomography. A Magnetic Resonance Imaging showed a cystic mass originated from the inferior mesenteric artery (IMA) territory. A GIST was initially diagnosed. The tumor was resected en bloc by laparoscopic surgery and was found between mesocolon and Gerota’s fascia with blood supply of IMA. Grossly, dark brown materials were noted at the inner surface of the cystic wall. Microscopically, the tumor cells were melanin-containing, and no psammomatous bodies were present. Immunohistochemically, the tumor showed positivity for MART1, HMB45, collagen IV, and SOX10, and negativity for AE1/AE3. MMNST was favored over malignant melanoma, since the tumor was located near ganglia and had cells with less atypical cytology and a low mitotic rate, and subsequent adjuvant radiotherapy was performed. The patient was alive with no evidence of recurrent or metastatic disease 11 months after radiotherapy. Conclusions Our review of abdominal MMNST cases showed a female predominance, with an average age of 54.8 years, and a trend toward being a larger tumor showing cystic or necrotic changes. Local recurrence and metastasis rate were reviewed, and both showed a low rate. Diagnosis of MMNST should combine all the available findings, and complete excision of the tumor should be performed, followed by long-term patient monitoring.
Collapse
Affiliation(s)
- Kuan-Yu Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Lujen Chen
- Department of Pathology and Laboratory Medicine, Taichung Veternas General Hospital, Taichung, Taiwan
| | - Siu-Wan Hung
- Interventional Radiology, Radiology Department, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.,School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Sheng-Chun Hung
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Cheng-Kuang Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Chih-Jung Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.. .,Department of Pathology and Laboratory Medicine, Taichung Veternas General Hospital, Taichung, Taiwan.
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.. .,Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan, R.O.C..
| |
Collapse
|
9
|
Malignant melanocytic schwannian tumor and leptomeningeal disease: A case series with a focus on management. J Neurol Sci 2022; 438:120291. [DOI: 10.1016/j.jns.2022.120291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022]
|
10
|
Hall JC, Chang SD, Wilson TJ, Ganjoo KN, Toland A, Vogel H, Pollom EL, Rahimy E. Post-operative Stereotactic Radiosurgery of Malignant Melanotic Schwannoma. Cureus 2022; 14:e22849. [PMID: 35399431 PMCID: PMC8980252 DOI: 10.7759/cureus.22849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Melanotic schwannoma is an extremely rare schwannoma variant with malignant potential, demonstrating high local and distant recurrence. Given the paucity of data, recommended treatment with localized disease is radical resection, with the unclear benefit of adjuvant therapy. We present a case of an 18-year-old female with no past medical history or genetic syndromes who underwent margin-positive resection of an S1 nerve root melanotic schwannoma followed by adjuvant stereotactic radiosurgery (SRS). SRS was delivered without acute or late toxicity by 2.5 years post-treatment. She remains without evidence of recurrent disease, although longer follow-up is needed given the risk of late recurrence. Our case adds to the limited literature documenting the efficacy of adjuvant radiotherapy in melanotic schwannoma and is the first to describe the successful use of SRS for this rare disease.
Collapse
|
11
|
Shui C, Davey L, Scholsem M. Leptomeningeal dissemination of a malignant melanotic nerve sheath tumor: A case report and review of the literature. Surg Neurol Int 2022; 13:59. [PMID: 35242425 PMCID: PMC8888312 DOI: 10.25259/sni_31_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/24/2022] [Indexed: 01/19/2023] Open
Abstract
Background: Malignant melanotic nerve sheath tumors (MMNSTs) are rare tumors of presumed neural crest origin. Here, we present a 21-year-old female with a left L5/S1 MMNST along with a review of approximately 70 spinal cases reported in the literature, the majority of which were either local recurrences or metastases. Case Description: A 21-year-old female presented with 3 months of severe left L5 distribution radicular leg pain and sensory loss. The MR revealed a dumbbell-shaped, heterogenously enhancing lesion centered on the left L5/S1 foramen; the intracanalicular component displaced the thecal sac to the right, while the extraforaminal portion of tumor extended anteriorly into the retroperitoneal space. Gross total resection was performed after a L5/S1 facetectomy. In the immediate postoperative period there were no complications, and the patient had full lower limb power. Four months later, the patient experienced generalized seizures, headache, and multiple cranial nerve palsies due to local and diffuse CNS dissemination. The MRI of the brain and whole spine revealed diffuse leptomeningeal enhancement along the full length of the spinal cord into the brainstem and cerebrum along with a focally recurrent epidural soft-tissue lesion located posterolaterally on the left at the L4/5 level (i.e., measuring 12 mm × 10 mm). An external ventricular drain and subsequent ventriculoperitoneal shunt were inserted, followed by craniospinal irradiation. She was discharged 3 months later with residual distal lower limb weakness. Conclusion: This case illustrates the rapid disease progression of MMNST despite gross total resection. Further such lesions should be aggressively treated locally, and followed by adjuvant radiotherapy and systemic chemotherapy/immunotherapy.
Collapse
Affiliation(s)
- Cher Shui
- Departments of Neurosurgery, St George Hospital, Kogarah, Australia,
| | - Louella Davey
- Anatomical Pathology, St George Hospital, Kogarah, Australia
| | - Martin Scholsem
- Departments of Neurosurgery, St George Hospital, Kogarah, Australia,
| |
Collapse
|