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Doan L, Cassarino DS. A rare case of cutaneous pseudoglandular schwannoma. J Cutan Pathol 2023; 50:798-800. [PMID: 37312417 DOI: 10.1111/cup.14477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/15/2023]
Abstract
Schwannomas are benign tumors that arise from the peripheral nerve sheath. Many variants of schwannomas exist, including plexiform, epithelioid, cellular, glandular, and ancient. The pseudoglandular subtype is extremely rare, as fewer than five cases of cutaneous pseudoglandular schwannomas have been reported based on our literature review. Herein, we report a case of a 64-year-old female who presented with a skin-colored nodule on her right arm for several years. Histopathology showed a superficial and deep dermal nodulocystic neoplasm composed of epithelioid and spindle cells surrounded by a fibrous stroma. The epithelioid cells surrounded multiple spaces suggestive of glandular differentiation, although many of these spaces also contained serum and red blood cells, raising consideration for vascular differentiation. Multiple epithelial markers, including pancytokeratin and epithelial membrane antigen, were all negative, providing no support for an epithelial tumor with true ductal/glandular differentiation. In addition, CD31, CD34, smooth muscle actin, and desmin stains were negative in these spaces, making a vascular neoplasm or smooth muscle tumor unlikely. However, SOX10 and S-100 stains were positive, including in cells lining the pseudoglandular spaces, supporting the diagnosis of pseudoglandular schwannoma. Complete excision was recommended. This case highlights an extremely rare presentation of the pseudoglandular variant of schwannoma.
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Affiliation(s)
- Leandra Doan
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - David S Cassarino
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
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A rare case of pseudoglandular schwannoma. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.947348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chen YL, He DQ, Yang HX, Dou Y. Multiple schwannomas with pseudoglandular element synchronously occurring under the tongue: A case report. World J Clin Cases 2020; 8:5611-5617. [PMID: 33344551 PMCID: PMC7716331 DOI: 10.12998/wjcc.v8.i22.5611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/19/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Schwannoma is a rare benign, encapsulated tumor of the nerve sheath under the tongue, mostly occurring as solitary tumors with classical histological pattern and several common morphological variants. To our knowledge, multiple schwannomas with pseudoglandular element synchronously occurring under the tongue are rare; we report herein the first such case.
CASE SUMMARY A 53-year-old man had first noticed an isolated asymptomatic mass under the tongue, and as the mass grew, the tongue was elevated. Physical examination showed multiple oval neoplasms, and the overlying mucosa was normal. Computed tomography showed three low-density oval neoplasms under the tongue, which were cystic-solid with unclear boundary. The patient has no cutaneous tumors, VIII nerve tumors, or lens opacities and no history of neurofibromatosis 2 or confirmed schwannomatosis in any first-degree relative. Magnetic resonance imaging showed no evidence of vestibular schwannoma. The preoperative diagnosis was mucoepidermoid carcinoma. During hospitalization, all neoplasms were completely excised by surgeons through an intraoral approach under general anesthesia. The diagnosis of the multiple schwannomas with pseudoglandular element was made by histopathology after surgery. At the 15-mo follow-up visit, the patient had no sign of recurrence or development of other peripheral nerve tumors.
CONCLUSION Although rare, multiple schwannomas with pseudoglandular element do exist in patients presenting with masses under the tongue. Oral surgeons should be aware of the existence of multiple schwannomas with pseudoglandular element when considering masses under the tongue due to the different prognosis between multiple schwannomas with pseudoglandular element and mucoepidermoid carcinoma.
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Affiliation(s)
- Yong-Lin Chen
- Department of Pathology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Deng-Qi He
- Department of Oral Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Hai-Xia Yang
- Department of Pathology, Gansu General Hospital of Armed Police, Lanzhou 730030, Gansu Province, China
| | - Yu Dou
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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Saggini A, Di Prete M, D'Amico F, Lora V, Orlandi A. Glandular Schwannoma: An Uncommon Variant of Schwannoma with Controversial Histogenesis. Dermatopathology (Basel) 2019; 6:206-212. [PMID: 31828061 DOI: 10.1159/000503599] [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] [Received: 07/22/2019] [Accepted: 09/23/2019] [Indexed: 11/19/2022] Open
Abstract
Schwannomas are benign, encapsulated nerve sheath tumors arising from Schwann cells; several histologic variants of schwannoma have been described, including the exceedingly rare glandular schwannoma (GS). The histogenesis of the glands in GS (as well as in other peripheral nerve sheath tumors with a glandular component) remains unclear; no consensus exists as to whether glands should be interpreted as metaplastic elements or entrapped reactive glands. We report a case of GS with detailed immunohistochemical analysis of the epithelial component. We believe that our findings raise further questions regarding the histogenesis of glands in GS, casting doubts on the traditional distinction between true metaplasia and glandular entrapment. Further research is warranted in this regard.
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Affiliation(s)
- Andrea Saggini
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Monia Di Prete
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federico D'Amico
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Viviana Lora
- Division of Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Chandra SR, Karim F, Rawal YB. Divergent Schwannoma-Like Phenotype in a Pleomorphic Adenoma. Head Neck Pathol 2017; 11:567-574. [PMID: 28439689 PMCID: PMC5677055 DOI: 10.1007/s12105-017-0817-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
The schwannoma-like pleomorphic adenoma is a rare histopathological variant of the pleomorphic adenoma. Five previous reports with seven cases exist in English language literature. These tumors present in the parotid gland most commonly. Intraparotid schwannomas of the facial nerve and schwannomas with glandular differentiation have also been reported. A 60-year-old male presented with an asymptomatic swelling over the left angle of the mandible. The swelling had been present for about 12 years with a recent increase in size. CT imaging showed a hyperdense circumscribed mass of the superficial lobe of the parotid. The working diagnosis was that of a benign tumor of salivary gland or soft tissue origin. The mass was excised with careful preservation of the facial nerve. The 3.5 cm mass was submitted for histopathological examination. The well-circumscribed, encapsulated mass showed a predominant sheet-like proliferation of Antoni type A-like tissue, Foci of glandular differentiation with duct-like structures were also seen. Cytological atypia or mitotic activity were not seen. Nuclei of lesional cells diffusely and strongly expressed reactivity to p63. The final diagnosis was a schwannoma-like pleomorphic adenoma. No recurrence has been reported in the 15 months since the removal. Facial nerve function is unimpaired with a House Brackmann facial nerve function score of one. The potential for misdiagnosis in fine needle aspirate and incisional biopsies is real in cases of schwannoma-like pleomorphic adenoma. The diagnostic pitfalls include the schwannoma and leiomyoma. Schwannomas with glandular differentiation have also been reported and therefore a misdiagnosis may potentially occur in excised specimens. Careful application of immunohistochemistry may help in the differentiation of these lesions.
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Affiliation(s)
- Srinivasa R. Chandra
- 0000 0004 0433 5561grid.412618.8Oral Maxillofacial – Head & Neck Oncologic & Reconstructive Microvascular Surgery, Harborview Medical Center, Seattle, WA USA
| | - Farah Karim
- 0000000122986657grid.34477.33School of Dentistry, University of Washington, Seattle, WA USA
| | - Yeshwant B. Rawal
- 0000000122986657grid.34477.33Department of Oral & Maxillofacial Surgery, School of Dentistry, University of Washington, B-204 Magnuson Health Sciences Center, 1959 NE Pacific Street, Box 357133, Seattle, WA 98195 USA
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Abstract
Cellular schwannoma and pseudoglandular schwannoma are both previously described rare variants of schwannoma. The authors present an unusual case of a cellular spindle cell neoplasm with prominent gland-like structures, having features of both variants. The nature of this lesion was confirmed by histology and immunohistochemistry, with diffuse and strong S100 and membranous collagen type IV staining. The gland-like structures were lined by S100 + cells and contained proteinaceous, mucicarmine-negative material, supporting a degenerative, not true glandular, phenomenon. This is the first case of a cutaneous schwannoma demonstrating both marked cellularity and pseudoglandular formation, which the authors have designated cutaneous cellular pseudoglandular schwannoma. Recognition of this extremely rare variant will help avoid diagnostic confusion and overtreatment of this benign entity.
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Ud Din N, Ahmad Z, Ahmed A. Schwannomas with pseudoglandular elements: clinicopathologic study of 61 cases. Ann Diagn Pathol 2015; 20:24-8. [PMID: 26626208 DOI: 10.1016/j.anndiagpath.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/12/2015] [Accepted: 10/12/2015] [Indexed: 02/06/2023]
Abstract
Schwannomas are benign neoplasms of peripheral nerve sheath. A number of morphologic variants of schwannoma have been described. The pseudoglandular variant is very rare. We retrieved and reviewed hematoxylin and eosin slides of all cases of schwannoma reported between 2007 and 2014 to look for pseudoglandular elements. Pseudoglandular cystic spaces were seen in 61 (6.3%) of 971 schwannomas diagnosed during the study period. Of these 61 cases, 56 (91.8%) were located in the spinal nerve roots. The majority (60.6%) were male. Mean age in these 61 cases was 41 years. Mean tumor size was 3.5 cm. All 61 cases showed typical Antoni A and Antoni B areas with multiple pseudoglandular cystic spaces scattered throughout. These areas were lined by flat to cuboidal cells which showed positivity for immunohistochemical stain S-100 and were negative for epithelial membrane antigen. An average of 7 pseudoglandular cystic spaces was noted per case. In conclusion, pseudoglandular cystic spaces are lined by Schwann cells and most likely represent degenerative changes in schwannoma probably degenerated Verocay bodies. They are rare albeit well-defined features seen in a significant though small number of schwannomas. It is important not to mistake them for other neoplasms. Larger studies are required to determine predilection of these changes in spinal nerve root schwannomas as seen in our series.
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Affiliation(s)
- Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi Pakistan.
| | - Zubair Ahmad
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi Pakistan.
| | - Arsalan Ahmed
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi Pakistan.
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Gómez-Mateo MDC, Compañ-Quilis A, Monteagudo C. Microcystic pseudoglandular plexiform cutaneous neurofibroma. J Cutan Pathol 2015; 42:884-8. [PMID: 26269328 DOI: 10.1111/cup.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 07/15/2012] [Accepted: 08/19/2012] [Indexed: 12/01/2022]
Abstract
Glandular structures are well documented to appear in peripheral nerve sheath tumors. These epithelial elements are usually present in malignant peripheral nerve sheath tumors although a few cases of glandular benign peripheral nerve sheath tumors have also been described, most of them being schwannomas. A neurofibroma with glands is considered to be a rare type of divergent differentiation, but a neurofibroma containing gland-like or pseudoglandular structures have not, to our knowledge, been described. We report a 33-year-old patient with a well-demarcated dermal neoplasm, composed of neoplastic Schwann cells, perineurial-like cells and fibroblasts in a matrix with collagen fibers and myxoid areas. A part of the tumor consisted of microcystic gland-like spaces lined by flat cells. These cells were either S100 positive or negative, with no epithelial membrane antigen, cytokeratin or CD31 immunostaining. Recognition of the presence of pseudoglandular elements in neurofibromas is important to distinguish them from other tumoral lesions, some of them with malignant potential.
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Affiliation(s)
| | | | - Carlos Monteagudo
- Department of Pathology, University Clinic Hospital, Valencia, Spain.,Department of Pathology, University of Valencia, Valencia, Spain
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Cutaneous pseudoglandular schwannoma: a case report of an unusual histopathologic variant. Am J Dermatopathol 2011; 33:e63-5. [PMID: 21478728 DOI: 10.1097/dad.0b013e3181f86879] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multiple morphologic variants of schwannomas have been described, including plexiform, cellular, epithelioid, ancient, and glandular schwannomas. Very rare variants of schwannoma contain gland-like structures formed by neoplastic Schwann cells. The differential diagnosis in these cases can be challenging and includes adnexal neoplasms, neurothekeoma, and vascular neoplasms. We present a case of a well-circumscribed dermal-based neoplasm, which consisted of microcystic gland-like spaces lined by flat to cuboidal cells. A small focus of spindle cells with features resembling that of the Antoni A area typical of schwannoma was present. By immunohistochemistry, the cells lining the cystic spaces and the rest of the tumor were consistent with Schwann cells. In conjunction with this case report, we shall review the concept of the glandular structures in schwannoma.
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Abstract
A unique intraparotid location of a rare pseudoglandular schwannoma is described. Although the diagnosis of schwannoma could readily be substantiated, accurate subtyping was initially mislabeled. The pitfall was in failing to acknowledge the presence of multiple well-formed gland-like structures, which is instantly thought to be cystically dilated salivary ducts. Immunohistochemically, epithelial-appearing cells lining the duct-like spaces proved to be schwannian in nature. Interpretation of an immediately recognizable gland-like architecture is more problematic when a pseudoglandular variant originates from a nerve coursing through the gland, as here.
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Affiliation(s)
- F Ide
- Department of Pathology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan.
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