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Hattab RM, Jarrar Z, Al Sharie S, Al-Hussaini M, Obeidat M. Intraventricular schwannomas: A case report and a literature review. Rare Tumors 2024; 16:20363613241267740. [PMID: 39070741 PMCID: PMC11273710 DOI: 10.1177/20363613241267740] [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: 05/06/2024] [Revised: 06/30/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024] Open
Abstract
Intraventricular schwannomas are extremely rare, typically benign tumors originating from Schwann cells, which are not normally found within the ventricular system. Their presence challenges conventional understanding of tumor origins and complicates diagnosis and management. We report the case of a 19-year-old female presenting with a drop attack and headache, with no significant medical history. MRI revealed a heterogeneously enhancing lesion in the right lateral ventricle. Differential diagnoses included malignant tumors; however, histopathological examination post-surgical resection confirmed an intraventricular schwannoma. Postoperative outcomes were favorable, with successful CSF diversion via a right occipital ventriculoperitoneal shunt for isolated right temporal hydrocephalus. This case is notable for its atypical presentation in a young patient, challenging the conventional understanding that intraventricular schwannomas primarily affect older individuals. In addition, the correct diagnosis and successful management of a rare intraventricular schwannoma underscores the importance of considering this rare diagnosis in patients with nonspecific neurological symptoms and intraventricular lesions. This case, alongside the literature review, enriches the body of evidence on intraventricular schwannomas, highlighting the critical role of surgical intervention and the need for a comprehensive diagnostic approach.
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Affiliation(s)
| | - Zeid Jarrar
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | | | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mouness Obeidat
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
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2
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Bobkova S, Oldham EP, Shendrik I. A Unique Case of Cutaneous Schwannoma With Coexistent Masson's Hemangioma. Cureus 2024; 16:e63600. [PMID: 39087170 PMCID: PMC11290594 DOI: 10.7759/cureus.63600] [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] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Schwannomas (SCHs) are benign neural tumors originating from Schwann cells of the peripheral nerve sheaths. These neoplasms typically exhibit hyalinized vessels with impaired vascular permeability; however, angioma-like features are rare. We report an intriguing case of a cutaneous SCH with unusual vascular changes in a 60-year-old female who presented with a tender nodular lesion on her lower back. Histopathological examination of the excised lesion revealed a schwannoma with a central area of thrombosis and a vascular proliferative lesion consistent with Masson's hemangioma (MH). MH, also known as intravascular papillary endothelial hyperplasia (IPEH), is a rare benign vascular lesion characterized by papillary endothelial hyperplasia and obliterative changes within vascular lumens. Immunohistochemical staining confirmed S100 positivity in the SCH component and highlighted the papillary endothelial lining by ERG (erythroblast transformation-specific regulated gene 1). To our knowledge, this is the first report of a schwannoma harboring MH. This unique case underscores the potential for rare vascular proliferation to arise within otherwise typical SCHs.
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Affiliation(s)
- Svetlana Bobkova
- School of Biomedical Sciences, Oklahoma State University Center for Health Sciences, Tulsa, USA
| | - Eli P Oldham
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, USA
| | - Igor Shendrik
- Dermatopathology Section, Regional Medical Laboratory, Inc., Tulsa, USA
- Dermatopathology Section, Pathology Laboratory Associates, Inc., Tulsa, USA
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3
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Lee L, Dawood E, Vorona G, Richard H, Manzoor NF. Pediatric progressive facial nerve palsy with associated intratemporal mass. Am J Otolaryngol 2024; 45:104279. [PMID: 38604104 DOI: 10.1016/j.amjoto.2024.104279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Lawrance Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Emaan Dawood
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gregory Vorona
- Department of Radiology, Children's Hospital of Richmond, at VCU, 1101 E. Marshall St., Room 4-052, Richmond, VA, USA
| | - Hope Richard
- Department of Pathology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
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Mak YH, Ho G. Multicompartmental cystic trigeminal schwannoma as an uncommon differential diagnosis of cerebellopontine angle tumors. Radiol Case Rep 2024; 19:2552-2557. [PMID: 38596177 PMCID: PMC11001620 DOI: 10.1016/j.radcr.2024.03.013] [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: 12/02/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
Trigeminal schwannoma is the second most common intracranial schwannoma yet accounts for less than 0.5% intracranial tumors [1]. Cystic degeneration is uncommon. We would like to report a pathologically proven multicompartmental cystic trigeminal schwannoma in a young adult presenting with chronic headache. A literature review on the imaging features of trigeminal schwannoma is performed to assist radiologists in accurate disease localization and prioritizing differential diagnosis in challenging cases. Confident preoperative radiological diagnosis would directly affect management strategies.
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Affiliation(s)
- Yuen Hei Mak
- Department of Radiology, Queen Mary Hospital, Hong Kong SAR, China, 102 Pokfulam Road, Hong Kong SAR, China
| | - Grace Ho
- Department of Radiology, Queen Mary Hospital, Hong Kong SAR, China, 102 Pokfulam Road, Hong Kong SAR, China
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Terrapon APR, Stienen MN, Veeravagu A, Fehlings M, Bozinov O, Hejrati N. Intradural cystic schwannomas of the spine: A case-based systematic review of an unusual tumor. BRAIN & SPINE 2024; 4:102843. [PMID: 38947985 PMCID: PMC11214289 DOI: 10.1016/j.bas.2024.102843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/15/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024]
Abstract
Introduction Cystic schwannomas have only been reported in a few case reports/series. As a result, they may be misdiagnosed and a standardized management approach remains challenging to establish. Research question The aim of this study was to compile all reported cases of cystic schwannomas and analyze the perioperative course based on a systematic review of the literature with an additional two cases from the authors' experience. Material and methods We conducted a search of MEDLINE and CENTRAL databases for spinal intradural extramedullary cystic schwannomas, in accordance to the PRISMA statement. All title/abstracts were screened, and a full-text review of the remaining articles was conducted. The results were compiled in tables and summarized using means and standard deviation (SD), median and interquartile range, and percentage and 95% confidence intervals. Results We identified 263 articles, of which 35, which reported 54 cases, were included. Including our case-reports (n = 56), patients had a mean age of 47.7 years (SD ± 13.0 years) at presentation, 57% were males, and most lesions were lumbar (43%). The most common symptoms were pain (82%) and muscle weakness (68%) with 84% of patients showing neurological findings. 70% of patients showed a complete relief of symptoms after surgery and 96% reported improvement. Only four complications were reported. Discussion and conclusion Schwannomas should be considered in the differential diagnosis of intradural extramedullary cystic lesions. Patients typically present with subacute to chronic pain and/or neurologic changes. Surgical resection is the primary therapeutic modality and usually has a good to excellent outcome.
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Affiliation(s)
- Alexis Paul Romain Terrapon
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
- Department of Neurosurgery, Bern University Hospital, Rosenbühlgasse 25, 3010 Bern, Switzerland
| | - Martin N. Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
| | - Anand Veeravagu
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Oliver Bozinov
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
| | - Nader Hejrati
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen & Medical School of St.Gallen, St.Gallen, Switzerland
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Nickl V, Ziebolz D, Rumpel C, Klein D, Nickl R, Rampeltshammer E, Monoranu CM, Ernestus RI, Matthies C, Löhr M, Hagemann C, Breun M. Analysis of tumor microenvironment composition in vestibular schwannomas: insights into NF2-associated and sporadic variations and their clinical correlations. Front Oncol 2024; 14:1340184. [PMID: 38817895 PMCID: PMC11137168 DOI: 10.3389/fonc.2024.1340184] [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: 11/17/2023] [Accepted: 04/09/2024] [Indexed: 06/01/2024] Open
Abstract
Objective Vestibular schwannomas (VS), benign tumors stemming from the eighth cranial nerve's Schwann cells, are associated with Merlin gene mutations, inflammation, and the tumor microenvironment (TME), influencing tumor initiation, maintenance, and potential neural dysfunction. Understanding TME composition holds promise for systemic therapeutic interventions, particularly for NF2-related schwannomatosis. Methodology A retrospective analysis of paraffin-embedded tissue from 40 patients (2013-2020), evenly divided by neurofibromatosis type 2 status, with further stratification based on magnetic resonance imaging (MRI) progression and hearing function. Immunohistochemistry assessed TME components, including T-cell markers (CD4, CD8, CD25), NK cells (CD7), and macrophages (CD14, CD68, CD163, CCR2). Fiji software facilitated image analysis. Results T-cell markers (CD4, CD8, CD7) exhibited low expression in VS, with no significant NF2-associated vs. sporadic distinctions. Macrophage-related markers (CD14, CD68, CD163, CCR2) showed significantly higher expression (CD14: p = 0.0187, CD68: p < 0.0001, CD163: p = 0.0006, CCR2: p < 0.0001). CCR2 and CD163 significantly differed between NF2-associated and sporadic VS. iNOS, an M1-macrophage marker, was downregulated. CD25, a regulatory T-cell marker, correlated significantly with tumor growth dynamics (p = 0.016). Discussion Immune cells, notably monocytes and macrophages, crucially contribute to VS pathogenesis in both NF2-associated and sporadic cases. Significant differences in CCR2 and CD163 expression suggest distinct immune responses. Regulatory T-cells may serve as growth dynamic markers. These findings highlight immune cells as potential biomarkers and therapeutic targets for managing VS.
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Affiliation(s)
- Vera Nickl
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - David Ziebolz
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Charlotte Rumpel
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Dennis Klein
- Department of Neurology, Developmental Neurobiology, University Hospital Würzburg, Würzburg, Germany
| | - Robert Nickl
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Eva Rampeltshammer
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Camelia M. Monoranu
- Institute of Pathology, Department of Neuropathology, University Würzburg, Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Cordula Matthies
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Mario Löhr
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Carsten Hagemann
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Maria Breun
- Department of Neurosurgery, Section Experimental Neurosurgery, University Hospital Würzburg, Würzburg, Germany
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Derka S, Ebeling M, Pietzka S, Vairaktari G, Stavrianos S, Schramm A, Sakkas A. Extracranial Hypoglossal Schwannoma: Case Report and Literature Review. In Vivo 2024; 38:1489-1497. [PMID: 38688631 PMCID: PMC11059859 DOI: 10.21873/invivo.13596] [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: 01/17/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Schwannomas are solitary neurogenic tumors originating from the myelin sheath of peripheral nerves. Extracranial hypoglossal schwannomas comprise <5% of all head and neck schwannomas and can mimic submandibular salivary gland tumors. CASE REPORT We report the diagnostic imaging, surgical treatment, and histopathological findings of a rare case of extracranial schwannoma of the hypoglossal nerve in a 73-year-old female, presented with an asymptomatic swelling in the left submandibular region that had been persisted for approximately three years. CONCLUSION Accurate diagnosis of this rare clinical entity requires comprehensive diagnostics. The optimal therapeutic strategy is nerve-sparing surgical excision, although it can be challenging.
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Affiliation(s)
- Spyridoula Derka
- Department of Oral and Maxillofacial Surgery, Attikon General University Hospital of Athens, Athens, Greece
| | - Marcel Ebeling
- Department of Oral and Plastic Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Ulm, Germany
| | - Sebastian Pietzka
- Department of Oral and Plastic Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Ulm, Germany
| | - Georgia Vairaktari
- Department of Oral and Maxillofacial Surgery, Attikon General University Hospital of Athens, Athens, Greece
| | - Spyridon Stavrianos
- Plastic Surgery Department, St. Savvas Cancer Hospital of Athens, Athens, Greece
| | - Alexander Schramm
- Department of Oral and Plastic Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Ulm, Germany
| | - Andreas Sakkas
- Department of Oral and Plastic Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany;
- Department of Oral and Plastic Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital of the University of Ulm, Ulm, Germany
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8
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Sorial V, Khan AS, Welsh T, Zhang L, Fayek SA. Gastric Schwannoma in an Octogenarian: A Case Report and Review of the Literature. Cureus 2024; 16:e58857. [PMID: 38800239 PMCID: PMC11116083 DOI: 10.7759/cureus.58857] [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] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Gastric schwannomas are an exceedingly rare tumor arising from the myenteric plexus of the gastrointestinal enteric nervous system. These schwannomas are most commonly benign and reported to occur in female patients with a mean age of 58 at presentation. They are most often discovered incidentally, but can occasionally present with abdominal discomfort, obstructive symptoms, or GI bleeding. Frequently, the initial clinical consideration is for a gastrointestinal stromal tumor, which is much more common. A definitive diagnosis is made with microscopic imaging and immunohistochemical staining. Complete surgical resection, typically performed laparoscopically, is the most definitive and usually curative treatment, requiring no further follow-up. Herein, we present the first and only case of gastric schwannoma in an octogenarian and discuss an update on current diagnostic and therapeutic options.
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Affiliation(s)
- Verena Sorial
- Surgery, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Aramish S Khan
- Surgery, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Terry Welsh
- Pathology, Parkview Community Hospital Medical Center, Riverside, USA
| | - Lei Zhang
- Pathology, Parkview Community Hospital Medical Center, Riverside, USA
| | - Sameh A Fayek
- Surgery, University of California Riverside, Riverside, USA
- Surgery, Faculty of Medicine, Cairo, EGY
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Li X, Hu X, Wang P, Cai J. 18F-FDG PET/CT revealed sporadic schwannomatosis involving the lumbar spinal canal and both lower limbs: a case report. Front Med (Lausanne) 2024; 11:1346647. [PMID: 38576707 PMCID: PMC10993731 DOI: 10.3389/fmed.2024.1346647] [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: 11/29/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Schwannomatosis is a rare autosomal dominant hereditary syndrome disease characterized by multiple schwannomas throughout the body, without bilateral vestibular schwannoma or dermal schwannoma. The most common location of schwannomatosis is the head and neck, as well as the limbs, while multiple schwannomas in the lumbosacral canal and lower extremities are relatively rare. In this study, we report a 79-year-old woman diagnosed with schwannomatosis. MRI and contrast-enhanced imaging revealed multiple schwannomas in both lower extremities. An 18F-FDG PET/CT examination revealed that in addition to multiple tumors with increased 18F-FDG uptake in both lower extremities, there was also an increased 18F-FDG uptake in a mass in the lumbosacral canal. These masses were confirmed to be schwannomas by pathology after surgery or biopsy. 18F-FDG PET/CT findings of schwannomas were correlated with MRI and pathological components. Antoni A area rich in tumor cells showed significant enhancement on contrast-enhanced T1WI, and PET/CT showed increased uptake of 18F-FDG in the corresponding area, while Antoni B region rich in mucus showed low enhancement on contrast-enhanced T1WI, accompanied by a mildly increased 18F-FDG uptake.
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Affiliation(s)
- Xiaotian Li
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Nuclear Medicine, People’s Hospital of Qianxinan Buyi and Miao Minority Autonomous Prefecture, Xingyi, China
| | - Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Pan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jiong Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Huang CY, Peng SJ, Yang HC, Wu HM, Chen CJ, Wang MC, Hu YS, Lin CJ, Shiau CY, Guo WY, Chung WY, Pan DHC, Lee CC. Association Between Pseudoprogression of Vestibular Schwannoma After Radiosurgery and Radiological Features of Solid and Cystic Components. Neurosurgery 2023; 93:1383-1392. [PMID: 37432016 DOI: 10.1227/neu.0000000000002599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The pathophysiology of vestibular schwannoma (VS) pseudoprogression after Gamma Knife radiosurgery (GKRS) remains unclear. Radiological features in pretreatment magnetic resonance images may help predict VS pseudoprogression. This study used VS radiological features quantified using an automated segmentation algorithm to predict pseudoprogression after GKRS treatment. METHODS This is a retrospective study comprising 330 patients with VS who received GKRS. After image preprocessing and T2W/contrast-enhanced T1-weighted image (CET1W) image generation, with fuzzy C-means clustering, VSs were segmented into solid and cystic components and classified as solid and cystic. Relevant radiological features were then extracted. The response to GKRS was classified into "nonpseudoprogression" and "pseudoprogression/fluctuation". The Z test for two proportions was used to compare solid and cystic VS for the likelihood of pseudoprogression/fluctuation. Logistic regression was used to assess the correlation between clinical variables and radiological features and response to GKRS. RESULTS The likelihood of pseudoprogression/fluctuation after GKRS was significantly higher for solid VS compared with cystic VS (55% vs 31%, P < .001). For the entire VS cohort, multivariable logistic regression revealed that a lower mean tumor signal intensity (SI) in T2W/CET1W images was associated with pseudoprogression/fluctuation after GKRS ( P = .001). For the solid VS subgroup, a lower mean tumor SI in T2W/CET1W images ( P = .035) was associated with pseudoprogression/fluctuation after GKRS. For the cystic VS subgroup, a lower mean SI of the cystic component in T2W/CET1W images ( P = .040) was associated with pseudoprogression/fluctuation after GKRS. CONCLUSION Pseudoprogression is more likely to occur in solid VS compared with cystic VS. Quantitative radiological features in pretreatment magnetic resonance images were associated with pseudoprogression after GKRS. In T2W/CET1W images, solid VS with a lower mean tumor SI and cystic VS with a lower mean SI of cystic component were more likely to have pseudoprogression after GKRS. These radiological features can help predict the likelihood of pseudoprogression after GKRS.
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Affiliation(s)
- Chih-Ying Huang
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei , Taiwan
| | - Huai-Che Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston , Texas , USA
| | - Mao-Che Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei , Taiwan
| | - Yong-Sin Hu
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Cheng-Ying Shiau
- Cancer Center, Taipei Veterans General Hospital, Taipei , Taiwan
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei , Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
| | - Wen-Yuh Chung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei , Taiwan
| | - David Hung-Chi Pan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei , Taiwan
| | - Cheng-Chia Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei , Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei , Taiwan
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11
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Chelepy W, Yousif S, Nichols PR. Intraosseous Schwannoma of the Frontal Bone: A Case Report and Review of the Literature. Int Med Case Rep J 2023; 16:767-773. [PMID: 38020582 PMCID: PMC10674691 DOI: 10.2147/imcrj.s428579] [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: 07/31/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Intraosseous schwannoma is a rare diagnosis, particularly so in the skull. Accordingly, little data exists to unify common features of this disease. Here, we present the fourth known case of a primary intraosseous schwannoma of the frontal bone: a 46-year-old male with severe, progressive headache and an osteolytic frontal bone lesion. Gross total resection of the lesion was performed with excellent clinical outcome. Histological analysis confirmed the diagnosis. The limited existing literature on this topic was reviewed to identify emerging trends surrounding presenting symptoms and treatment. Early literature suggests symptoms are often nonspecific, except for lesions of the petrous apex. No cases of recurrence have been demonstrated after gross total resection, though incomplete resection has been associated with recurrence. This diagnosis appears to be becoming a more often-considered differential for osteolytic, expansile skull lesions.
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Affiliation(s)
- William Chelepy
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Saif Yousif
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Paul Robert Nichols
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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12
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Halalmeh DR, Asad MY, Atallah OA, Sbeih AI, Alrashdan M, Richardson AM, Moisi MD, Sbeih IA. Predictors of Surgical Outcomes in Patients with Abducens Nerve Schwannoma: A Comprehensive Systematic Review and a Case Report. World Neurosurg 2023; 179:204-215.e4. [PMID: 37652133 DOI: 10.1016/j.wneu.2023.08.100] [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: 07/17/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Abducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined. OBJECTIVE To characterize clinical features of AN schwannomas and predictors of surgical outcomes. METHODS PRISMA-guided systematic review of the literature on AN schwannomas was performed. Subsequently, univariate and multivariate regression analyses were performed to identify the predictive value of variables that influence postoperative outcomes. RESULTS A total of 42 studies with 55 patients were evaluated. The mean age at presentation was 43.9 ± 14.6 years. The most common presenting symptom was cranial nerve VI palsy (69.1%). Cavernous sinus (49.1%) and prepontine cistern (36.3%) were the most commonly involved locations. Complete recovery after surgery was seen in 36.3% at a median follow-up of 28.4 ± 25.8 months. Preoperative AN palsy (P < 0.001), suboccipital approach (P = 0.007), and subtotal resection of tumor (P = 0.044) were significant protective factors for postoperative complications. Prepontine location and postoperative complications were poor prognostic indicators of AN recovery (odds ratio [OR], 0.10, P = 0.030 and OR, 0.10, P = 0.028, respectively). Subtotal resection was significantly correlated with higher odds of AN recovery (OR, 6.06; P = 0.040). CONCLUSIONS AN schwannomas are rare but serious tumors that can cause significant morbidity, with only approximately one third of patients showing complete recovery after surgery. The suboccipital approach was a protective factor for postoperative complications, especially when combined with subtotal resection. Knowledge of these factors along with tumor characteristics helps optimize surgical planning and preoperative counseling.
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Affiliation(s)
- Dia R Halalmeh
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA.
| | - Mahmoud Y Asad
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Omar A Atallah
- Department of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | | | | | - Angela M Richardson
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marc D Moisi
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
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13
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Kunimatsu N, Kunimatsu A, Miura K, Mori I, Kiryu S. Differentiation between pleomorphic adenoma and schwannoma in the parapharyngeal space: histogram analysis of apparent diffusion coefficient. Dentomaxillofac Radiol 2023; 52:20230140. [PMID: 37665011 PMCID: PMC10552127 DOI: 10.1259/dmfr.20230140] [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: 03/26/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES To elucidate the differences between pleomorphic adenomas and schwannomas occurring in the parapharyngeal space by histogram analyses of apparent diffusion coefficient (ADC) values measured with diffusion-weighted MRI. METHODS This retrospective study included 29 patients with pleomorphic adenoma and 22 patients with schwannoma arising in the parapharyngeal space or extending into the parapharyngeal space from the parotid region. Using pre-operative MR images, ADC values of tumor lesions showing the maximum diameter were measured. The regions of interest for ADC measurement were placed by contouring the tumor margin, and the histogram metrics of ADC values were compared between pleomorphic adenomas and schwannomas regarding the mean, skewness, and kurtosis by Wilcoxon's rank sum test. Subsequent to the primary analysis which included all lesions, we performed two subgroup analyses regarding b-values and magnetic field strength used for MRI. RESULTS The mean ADC values did not show significant differences between pleomorphic adenomas and schwannomas for the primary and subgroup analyses. Schwannomas showed higher skewness (p = 0.0001) and lower kurtosis (p = 0.003) of ADC histograms compared with pleomorphic adenomas in the primary analysis. Skewness was significantly higher in schwannomas in all the subgroup analyses. Kurtosis was consistently lower in schwannomas but did not reach statistical significance in one subgroup analysis. CONCLUSIONS Skewness and kurtosis showed significant differences between pleomorphic adenomas and schwannomas occupying the parapharyngeal space, but the mean ADC values did not. Our results suggest that the skewness and kurtosis of ADC histograms may be useful in differentiating these two parapharyngeal tumors.
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Affiliation(s)
| | - Akira Kunimatsu
- Department of Radiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Koki Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | | | - Shigeru Kiryu
- Department of Radiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
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14
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de Paiva JLR, Sabino JV, Pereira FV, Okuda PA, Villarinho LDL, Queiroz LDS, França MC, Reis F. The Role of MRI in the Diagnosis of Spinal Cord Tumors. Semin Ultrasound CT MR 2023; 44:436-451. [PMID: 37555685 DOI: 10.1053/j.sult.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Spinal cord tumors are uncommon, and its multiple representatives not always have pathognomonic characteristics, which poses a challenge for both patients and caring physicians. The radiologist performs an important role in recognizing these tumors, as well as in differentiating between neoplastic and non-neoplastic processes, supporting clinical and surgical decision-making in patients with spinal cord injury. Magnetic Resonance Imaging (MRI) assessment, paired with a deep understanding of the various patterns of cord involvement allied to detailed clinical data can provide a diagnosis or significantly limit the differential diagnosis in most cases. In this article, we aim to review the most common and noteworthy intramedullary and extramedullary spinal tumors, as well as some other tumoral mimics, with an emphasis on their MRI morphologic characteristics.
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Affiliation(s)
- Jean L R de Paiva
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - João V Sabino
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fernanda V Pereira
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Paulo A Okuda
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | - Marcondes C França
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, University of Campinas (UNICAMP), Campinas, Brazil.
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15
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Corrêa DG, Hygino da Cruz LC, Freddi TDAL. The Vestibulocochlear Nerve: Anatomy and Pathology. Semin Ultrasound CT MR 2023; 44:81-94. [PMID: 37055143 DOI: 10.1053/j.sult.2023.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
The vestibulocochlear nerve is the eighth cranial nerve, entering the brainstem in the medullopontine sulcus after crossing the internal auditory canal and cerebellopontine angle cistern. It is a purely sensitive nerve, originating from the Scarpa's and spiral ganglions, responsible for balance and hearing. It has 6 nuclei located in the lower pons. Magnetic resonance imaging (MRI) is useful for evaluating the vestibulocochlear nerve, although computed tomography may have a complementary role in assessing bone lesions. A heavily T2-weighted sequence, such as fast imaging employing steady-state acquisition (FIESTA) or constructive interference steady state (CISS), is crucial in imaging exams to depict the canalicular and cisternal segments of the vestibulocochlear nerve, as well as the fluid signal intensity in the membranous labyrinth. The vestibulocochlear nerve can be affected by several diseases, such as congenital malformations, trauma, inflammatory or infectious diseases, vascular disorders, and neoplasms. The purpose of this article is to review the vestibulocochlear nerve anatomy, discuss the best MRI techniques to evaluate this nerve and demonstrate the imaging aspect of the main diseases that affect it.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil.; Department of Radiology, Federal Fluminense University, Niterói, RJ, Brazil..
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16
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Chiasson-MacKenzie C, Vitte J, Liu CH, Wright EA, Flynn EA, Stott SL, Giovannini M, McClatchey AI. Cellular mechanisms of heterogeneity in NF2-mutant schwannoma. Nat Commun 2023; 14:1559. [PMID: 36944680 PMCID: PMC10030849 DOI: 10.1038/s41467-023-37226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
Schwannomas are common sporadic tumors and hallmarks of familial neurofibromatosis type 2 (NF2) that develop predominantly on cranial and spinal nerves. Virtually all schwannomas result from inactivation of the NF2 tumor suppressor gene with few, if any, cooperating mutations. Despite their genetic uniformity schwannomas exhibit remarkable clinical and therapeutic heterogeneity, which has impeded successful treatment. How heterogeneity develops in NF2-mutant schwannomas is unknown. We have found that loss of the membrane:cytoskeleton-associated NF2 tumor suppressor, merlin, yields unstable intrinsic polarity and enables Nf2-/- Schwann cells to adopt distinct programs of ErbB ligand production and polarized signaling, suggesting a self-generated model of schwannoma heterogeneity. We validated the heterogeneous distribution of biomarkers of these programs in human schwannoma and exploited the synchronous development of lesions in a mouse model to establish a quantitative pipeline for studying how schwannoma heterogeneity evolves. Our studies highlight the importance of intrinsic mechanisms of heterogeneity across human cancers.
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Affiliation(s)
- Christine Chiasson-MacKenzie
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jeremie Vitte
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA and Jonsson Comprehensive Cancer Center (JCCC), University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Ching-Hui Liu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Emily A Wright
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Elizabeth A Flynn
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
| | - Shannon L Stott
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Center for Engineering in Medicine and BioMEMS Resource Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, USA
| | - Marco Giovannini
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA and Jonsson Comprehensive Cancer Center (JCCC), University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Andrea I McClatchey
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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17
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Constanzo F, Teixeira BCDA, Sens P, Smaili H, Escuissato DL, Ramina R. Perfusion-weighted imaging in vestibular schwannoma: the influence that cystic status and tumor size have on perfusion profiles. Radiol Bras 2023; 56:67-74. [PMID: 37168041 PMCID: PMC10165972 DOI: 10.1590/0100-3984.2022.0035] [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: 03/21/2022] [Accepted: 09/12/2022] [Indexed: 05/13/2023] Open
Abstract
Objective The perfusion profile of vestibular schwannomas (VSs) and the factors that influence it have yet to be determined. Materials and Methods Twenty patients with sporadic VS were analyzed by calculating parameters related to the extravascular extracellular space (EES)-the volume transfer constant between a vessel and the EES (Ktrans); the EES volume per unit of tissue volume (Ve); and the rate transfer constant between EES and blood plasma (Kep)-as well as the relative cerebral blood volume (rCBV), and by correlating those parameters with the size of the tumor and its structure (solid, cystic, or heterogeneous). Results Although Ktrans, Ve, and Kep were measurable in all tumors, rCBV was measurable only in large tumors. We detected a positive correlation between Ktrans and rCBV (r = 0.62, p = 0.031), a negative correlation between Ve and Kep (r = -0.51, p = 0.021), and a positive correlation between Ktrans and Ve only in solid VSs (r = 0.64, p = 0.048). Comparing the means for small and large VSs, we found that the former showed lower Ktrans (0.13 vs. 0.029, p < 0.001), higher Kep (0.68 vs. 0.46, p = 0.037), and lower Ve (0.45 vs. 0.83, p < 0.001). The mean Ktrans was lower in the cystic portions of cystic VSs than in their solid portions (0.14 vs. 0.32, p < 0.001), as was the mean Ve (0.37 vs. 0.78, p < 0.001). There were positive correlations between the solid and cystic portions for Ktrans (r = 0.71, p = 0.048) and Kep (r = 0.74, p = 0.037). Conclusion In VS, tumor size appears to be consistently associated with perfusion values. In cystic VS, the cystic portions seem to have lower Ktrans and Ve than do the solid portions.
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Affiliation(s)
- Felipe Constanzo
- Clínica Biobío, Concepción, Chile
- Hospital Clínico Regional de Concepción, Concepción,
Chile
| | | | - Patricia Sens
- Instituto de Neurologia de Curitiba (INC), Curitiba, PR, Brazil
| | - Hamzah Smaili
- Instituto de Neurologia de Curitiba (INC), Curitiba, PR, Brazil
| | | | - Ricardo Ramina
- Instituto de Neurologia de Curitiba (INC), Curitiba, PR, Brazil
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18
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Pennacchi A, Marchi F, Delù G, Caprioli S, Peretti G. Schwannoma of the Mylohyoid Nerve: A Case Report and Review of Literature of Sublingual Schwannomas. J Maxillofac Oral Surg 2023. [DOI: 10.1007/s12663-023-01867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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19
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Naser PV, Haux-Nettesheim D, Rahmanzade R, Lenga P, Reuss D, Unterberg AW, Beynon C. Accessory nerve schwannoma extending into the fourth ventricle: case report and review of literature. Br J Neurosurg 2023:1-4. [PMID: 36799128 DOI: 10.1080/02688697.2023.2179598] [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: 09/22/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
Accessory nerve schwannoma is a rare entity in patients presenting with cranial nerve (CN) deficits. Most of these tumours arise from the cisternal segment of the eleventh CN and extend caudally. Herein, we report the third case of an accessory schwannoma extending cranially into the fourth ventricle. A 61-year-old female presented with a history of variable headaches. Cerebral magnetic resonance imaging (cMRI) revealed a large inhomogeneous contrast-enhancing lesion at the craniocervical junction extending through the foramen of Magendi and concomitant hydrocephalus due to obstruction of the foramina of Luschkae. Microsurgical tumour resection was performed in the half-sitting position. Intraoperatively, the tumour arose from a vestigial fascicle of the spinal accessory nerve. At three month follow-up, neither radiological tumour recurrence nor neurological deficits were observed.
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Affiliation(s)
| | | | - Ramin Rahmanzade
- Department of Neuropathology, Heidelberg University, Heidelberg, Germany
| | - Pavlina Lenga
- Department of Neurosurgery, Heidelberg University, Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, Heidelberg University, Heidelberg, Germany
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20
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Noureldine MHA, Shimony N, Jallo GI. Benign Spinal Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:583-606. [PMID: 37452955 DOI: 10.1007/978-3-031-23705-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Benign spinal intradural tumors are relatively rare and include intramedullary tumors with a favorable histology such as low-grade astrocytomas and ependymomas, as well as intradural extramedullary tumors such as meningiomas and schwannomas. The effect on the neural tissue is usually a combination of mass effect and neuronal involvement in cases of infiltrative tumors. The new understanding of molecular profiling of different tumors allowed us to better define central nervous system tumors and tailor treatment accordingly. The mainstay of management of many intradural spinal tumors is maximal safe surgical resection. This goal is more achievable with intradural extramedullary tumors; yet, with a meticulous surgical approach, many of the intramedullary tumors are amenable for safe gross-total or near-total resection. The nature of these tumors is benign; hence, a different way to measure outcome success is pursued and usually depends on functional rather than oncological or survival outcomes.
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Affiliation(s)
- Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Nir Shimony
- Institute of Neuroscience, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, PA, USA
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Department of Surgery, St Jude Children's Research Hospital, Memphis, USA
| | - George I Jallo
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA.
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21
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Tumor Biology and Microenvironment of Vestibular Schwannoma-Relation to Tumor Growth and Hearing Loss. Biomedicines 2022; 11:biomedicines11010032. [PMID: 36672540 PMCID: PMC9856152 DOI: 10.3390/biomedicines11010032] [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: 10/30/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
Vestibular schwannoma is the most common benign neoplasm of the cerebellopontine angle. It arises from Schwann cells of the vestibular nerve. The first symptoms of vestibular schwannoma include hearing loss, tinnitus, and vestibular symptoms. In the event of further growth, cerebellar and brainstem symptoms, along with palsy of the adjacent cranial nerves, may be present. Although hearing impairment is present in 95% of patients diagnosed with vestibular schwannoma, most tumors do not progress in size or have low growth rates. However, the clinical picture has unpredictable dynamics, and there are currently no reliable predictors of the tumor's behavior. The etiology of the hearing loss in patients with vestibular schwannoma is unclear. Given the presence of hearing loss in patients with non-growing tumors, a purely mechanistic approach is insufficient. A possible explanation for this may be that the function of the auditory system may be affected by the paracrine activity of the tumor. Moreover, initiation of the development and growth progression of vestibular schwannomas is not yet clearly understood. Biallelic loss of the NF2 gene does not explain the occurrence in all patients; therefore, detection of gene expression abnormalities in cases of progressive growth is required. As in other areas of cancer research, the tumor microenvironment is coming to the forefront, also in vestibular schwannomas. In the paradigm of the tumor microenvironment, the stroma of the tumor actively influences the tumor's behavior. However, research in the area of vestibular schwannomas is at an early stage. Thus, knowledge of the molecular mechanisms of tumorigenesis and interactions between cells present within the tumor is crucial for the diagnosis, prediction of tumor behavior, and targeted therapeutic interventions. In this review, we provide an overview of the current knowledge in the field of molecular biology and tumor microenvironment of vestibular schwannomas, as well as their relationship to tumor growth and hearing loss.
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22
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Mendpara V, Sahu S, Shah DN, Parmar S, Shaik TA, Sedhai S, Pancholi M. Retroperitoneal Ancient Neurilemmoma: A Nervous Rarity. Cureus 2022; 14:e28940. [PMID: 36237786 PMCID: PMC9547614 DOI: 10.7759/cureus.28940] [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] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
Neurilemmomas are tumors of neural origin that comprise Schwann cell proliferation in a characteristic pattern. They are benign in nature. Ancient neurilemmomas are usually longstanding growths that exhibit degenerative features that could be mistaken for malignancy. We report a case of ancient neurilemmoma in a 70-year-old male patient in the retroperitoneal area. Retroperitoneal schwannomas are extremely uncommon along with ancient neurilemmoma features making it worth reporting.
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23
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Lin C, Liang A, Liang S, Wang X, Meng L, Chen M. Laparoscopic surgery combined with the double-J tube implantation for the rare cystic-solid schwannoma of seminal vesicle: A Case Report and Literature Review. Medicine (Baltimore) 2022; 101:e29352. [PMID: 35839059 PMCID: PMC11132320 DOI: 10.1097/md.0000000000029352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Schwannoma is common in young and middle-aged people and occurs in the head, neck, posterior mediastinum, and retroperitoneal. Schwannoma, on the other hand, is a rare occurrence in the seminal vesicle. Early diagnosis and treatment are crucial since the disease can cause lower abdominal pain, nocturia, frequent urination, blood sperm, and other symptoms. There is no standard diagnostic or treatment guideline for seminal vesicle schwannomas currently. Therefore, the treatment experience relies on the few cases reported throughout the world. PATIENT CONCERNS A 45-year-old male patient discovered that the tumor beside the right side spermatophore is bigger than 3 years ago. DIAGNOSIS Schwannoma of seminal vesicle. INTERVENTIONS Ureter double-J tube implantation and laparoscopic surgery for schwannoma of seminal vesicle. OUTCOMES The operation process went smoothly. And the patient was no discomfort after half a year. CONCLUSION Schwannoma of the seminal vesicle is very rare in the clinic, and the imaging examination was not conclusive. The diagnosis mainly depends on pathological results. Surgical resection is the best treatment method for schwannoma. In surgery for schwannoma of seminal vesicle, combined with the ureter double-J tube implantation are many benefits. This case is an excellent example of the seminal vesicle schwannomas.
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Affiliation(s)
- Canbin Lin
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Aidi Liang
- Department of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Shulin Liang
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Xiao Wang
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Lei Meng
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Ming Chen
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
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24
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Primary Benign Tumors of the Spinal Canal. World Neurosurg 2022; 164:178-198. [PMID: 35552036 DOI: 10.1016/j.wneu.2022.04.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022]
Abstract
Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and schwannomas) account for 60%-70% of all primary spinal tumors. Benign spinal canal tumors provoke nonspecific clinical manifestations, mostly related to the affected level of the spinal cord. These tumors present a challenge for the patient and healthcare professionals, for they are often difficult to diagnose and the high frequency of posttreatment complications. In this review, we describe the epidemiology, risk factors, clinical features, diagnosis, histopathology, molecular biology, and treatment of extramedullary benign meningiomas, osteoid osteomas, osteoblastomas, aneurysmal bone cysts, osteochondromas, neurofibromas, giant cell tumors of the bone, eosinophilic granulomas, hemangiomas, lipomas, and schwannomas located in the spine, as well as possible future targets that could lead to an improvement in their management.
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25
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Huang CY, Peng SJ, Wu HM, Yang HC, Chen CJ, Wang MC, Hu YS, Chen YW, Lin CJ, Guo WY, Pan DHC, Chung WY, Lee CC. Quantification of tumor response of cystic vestibular schwannoma to Gamma Knife radiosurgery by using artificial intelligence. J Neurosurg 2022; 136:1298-1306. [PMID: 34598136 DOI: 10.3171/2021.4.jns203700] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gamma Knife radiosurgery (GKRS) is a common treatment modality for vestibular schwannoma (VS). The ability to predict treatment response is important in patient counseling and decision-making. The authors developed an algorithm that can automatically segment and differentiate cystic and solid tumor components of VS. They also investigated associations between the quantified radiological features of each component and tumor response after GKRS. METHODS This is a retrospective study comprising 323 patients with VS treated with GKRS. After preprocessing and generation of pretreatment T2-weighted (T2W)/T1-weighted with contrast (T1WC) images, the authors segmented VSs into cystic and solid components by using fuzzy C-means clustering. Quantitative radiological features of the entire tumor and its cystic and solid components were extracted. Linear regression models were implemented to correlate clinical variables and radiological features with the specific growth rate (SGR) of VS after GKRS. RESULTS A multivariable linear regression model of radiological features of the entire tumor demonstrated that a higher tumor mean signal intensity (SI) on T2W/T1WC images (p < 0.001) was associated with a lower SGR after GKRS. Similarly, a multivariable linear regression model using radiological features of cystic and solid tumor components demonstrated that a higher solid component mean SI (p = 0.039) and a higher cystic component mean SI (p = 0.004) on T2W/T1WC images were associated with a lower SGR after GKRS. A larger cystic component proportion (p = 0.085) was associated with a trend toward a lower SGR after GKRS. CONCLUSIONS Radiological features of VSs on pretreatment MRI that were quantified using fuzzy C-means were associated with tumor response after GKRS. Tumors with a higher tumor mean SI, a higher solid component mean SI, and a higher cystic component mean SI on T2W/T1WC images were more likely to regress in volume after GKRS. Those with a larger cystic component proportion also trended toward regression after GKRS. Further refinement of the algorithm may allow direct prediction of tumor response.
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Affiliation(s)
- Chih-Ying Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
| | - Syu-Jyun Peng
- 2Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University
| | - Hsiu-Mei Wu
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 4Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ching-Jen Chen
- 5Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mao-Che Wang
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 6Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital
| | - Yong-Sin Hu
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 4Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Wei Chen
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 4Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Jung Lin
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 4Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Yuo Guo
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 4Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - David Hung-Chi Pan
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 7Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University; and
| | - Wen-Yuh Chung
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Cheng-Chia Lee
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 8Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Partially intraosseous schwannoma of the distal humerus with increased enhancement after biopsy: Radiologic-pathologic correlation. Radiol Case Rep 2022; 17:1194-1200. [PMID: 35169427 PMCID: PMC8829534 DOI: 10.1016/j.radcr.2021.12.050] [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: 12/12/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/20/2022] Open
Abstract
Intraosseous schwannomas are rare benign tumors that most often occur at the mandible or sacrum. We present an unusual case of a bilobed schwannoma of the distal humerus with both intraosseous and extraosseous components. The extraosseous component was non-enhancing on initial MRI and enhanced on a subsequent MRI obtained after biopsy. We hypothesize that this change was attributable to decreased intra-tumoral pressure secondary to biopsy-related disruption of the tumor capsule.
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27
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Rogala B, Khan ZA, Jackson-Boeters L, Darling MR. Investigation of the Molecular Profile of Granular Cell Tumours and Schwannomas of the Oral Cavity. Dent J (Basel) 2022; 10:dj10030038. [PMID: 35323240 PMCID: PMC8946879 DOI: 10.3390/dj10030038] [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: 12/29/2021] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Granular cell tumours (GCTs) are rare submucosal lesions, thought to develop from Schwann cells, characterised by large polygonal cells with abundant lysosomes. The objectives of this study are to investigate whether GCTs have an antigen-presenting cell (APC) phenotype or a neural crest phenotype using immunohistochemistry and to compare expression profiles with Schwannomas. Immunoreactivity to CD68, HLA-DR, CD163, CD40 and CD11c (APC phenotype) and markers of neural crest cell (NCC) origin S100, SOX10, NSE and GAP43 in 23 cases of GCTs and 10 cases of Schwannomas were evaluated. RT-qPCR was used to identify a possible NCC developmental phenotype in 6 cases of GCTs. GAP43 was identified as a new NCC marker for GCTs, and some evidence was found for an APC phenotype from CD68 and HLA-DR immunoreactivity. RT-qPCR failed to identify an NCC developmental phenotype of GCTs, likely due to technical issues.
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28
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Hung ND, Dung LT, Huyen DK, Duy NQ, He DV, Duc NM. The value of quantitative magnetic resonance imaging signal intensity in distinguishing between spinal meningiomas and schwannomas. Int J Med Sci 2022; 19:1110-1117. [PMID: 35919813 PMCID: PMC9339414 DOI: 10.7150/ijms.73319] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Prior studies have suggested a number of the subjective visual characteristics that help distinguish between spinal meningiomas and schwannomas on magnetic resonance imaging and computed tomography; however, objective quantification of the signal intensity can be useful information. This study assessed whether quantitative magnetic resonance imaging (MRI) signal intensity (SI) measurements could distinguish intradural-extramedullary schwannomas from meningiomas. Methods: From July 2019 to September 2021, 54 patients with intradural-extramedullary tumors (37 meningiomas and 17 schwannomas) underwent surgery, and tumors were verified pathologically. Defined regions of interest were used to quantify SI values on T1- (T1W) and T2-weighted images (T2W). Receiver operating characteristic curve analysis was used to obtain cutoff values and calculate the area under the curve (AUC), sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV). Results: Both Maximum (T2max) and mean (T2mean) T2W SI values demonstrated outstanding (AUC: 0.91) abilities to differentiate meningiomas from schwannomas with Se, Sp, PPV, and NPV values of 94.6%, 70.6%, 87.5%, and 85.7%, respectively, for T2max and 81.1%, 88.2%, 93.8%, and 68.2% for T2mean. The maximum SI value on contrast-enhanced T1W (T1CEmax) and the T2W tumor: fat SI ratio (rTF) demonstrated acceptable abilities (AUC: 0.73 and 0.79, respectively) to differentiate meningiomas from schwannomas with Se, Sp, PPV, and NPV values of 94.6%, 70.6%, 87.5%, and 85.7%, respectively, for T1CEmax and 81.1%, 88.2%, 93.8%, and 68.2% for rTF. Conclusions: Quantitative SI values (T2max, T2mean, T2min, T1CEmax, rTF) can be used to differentiate intradural-extramedullary schwannomas from meningiomas.
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Affiliation(s)
- Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam.,Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
| | - Le Thanh Dung
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam.,Department of Radiology, VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Dang Khanh Huyen
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ngo Quang Duy
- Department of Radiology, Ha Giang General Hospital, Ha Giang, Vietnam
| | - Dong-Van He
- Department of Neurosurgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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29
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Pak KY, Pun S, Cassarino DS. Case of Symptomatic Dermal Neurofibroma With Microcystic Features. Am J Dermatopathol 2021; 43:e290-e292. [PMID: 33989218 DOI: 10.1097/dad.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A neurofibroma is a benign neural tumor arising within a peripheral nerve sheath composed of Schwann cells, fibroblasts, and immune cells involved in the nerve. Microcystic elements have been rarely described in these tumors. Neurofibromas are classically described as unencapsulated tumors of interspersed spindle cells and mast cells in a hypocellular, myxoid stroma. These tumors are most commonly dermal and seen in almost all patients with neurofibromatosis type 1; however, they may also occur sporadically, as seen in our case here. We report a 23-year-old patient with no significant medical history who presented with a dome-shaped papule on her cheek. This slow-growing mass had been present for multiple years and was soft, inflamed, and painful. Shave biopsy was collected and sent for evaluation. The shave biopsy diagnosed a benign neural tumor with features of a rare microcystic neurofibroma. This unencapsulated tumor consisted of microcystic spaces lined by oval-shaped to spindle-shaped cells in a matrix of myxoid to collagenous-like areas. Scattered lymphocytes and mast cells were noted, with few true vessels enclosing red blood cells. The stromal cells and cells lining the microcystic spaces stained S100 and SOX-10 positive. These cells had limited CD34 staining; however, most microcystic spaces were negative. Only the few true vessels stained CD31 positive. It is important to distinguish the prominent microcystic features in neurofibromas versus schwannomas by the lack of encapsulation or Antoni A features with Verocay bodies, which are typical of the latter. Further differentiating neurofibromas versus malignant peripheral nerve sheath tumors is required, where the latter should exhibit much greater nuclear atypic, higher cellularity, necrosis, hemorrhage, and increased mitotic activity. Excision of this benign microcystic neurofibroma was not deemed necessary because of lack of clinical concern and recurrent lesions.
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Affiliation(s)
- Kaitlynne Y Pak
- Wright State University Boonshoft School of Medicine, Dayton, OH; and
| | - Stacey Pun
- Departments of Dermatology and Pathology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - David S Cassarino
- Departments of Dermatology and Pathology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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30
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Domènech M, Hernández A, Plaja A, Martínez-Balibrea E, Balañà C. Hypoxia: The Cornerstone of Glioblastoma. Int J Mol Sci 2021; 22:12608. [PMID: 34830491 PMCID: PMC8620858 DOI: 10.3390/ijms222212608] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022] Open
Abstract
Glioblastoma is the most aggressive form of brain tumor in adults and is characterized by the presence of hypervascularization and necrosis, both caused by a hypoxic microenvironment. In this review, we highlight that hypoxia-induced factor 1 (HIF-1), the main factor activated by hypoxia, is an important driver of tumor progression in GB patients. HIF-1α is a transcription factor regulated by the presence or absence of O2. The expression of HIF-1 has been related to high-grade gliomas and aggressive tumor behavior. HIF-1 promotes tumor progression via the activation of angiogenesis, immunosuppression, and metabolic reprogramming, promoting cell invasion and survival. Moreover, in GB, HIF-1 is not solely modulated by oxygen but also by oncogenic signaling pathways, such as MAPK/ERK, p53, and PI3K/PTEN. Therefore, the inhibition of the hypoxia pathway could represent an important treatment alternative in a disease with very few therapy options. Here, we review the roles of HIF-1 in GB progression and the inhibitors that have been studied thus far, with the aim of shedding light on this devastating disease.
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Affiliation(s)
- Marta Domènech
- B·ARGO (Badalona Applied Research Group of Oncology) Medical Oncology Department, Catalan Institute of Oncology Badalona, 08916 Badalona, Spain; (M.D.); (A.H.); (A.P.)
| | - Ainhoa Hernández
- B·ARGO (Badalona Applied Research Group of Oncology) Medical Oncology Department, Catalan Institute of Oncology Badalona, 08916 Badalona, Spain; (M.D.); (A.H.); (A.P.)
| | - Andrea Plaja
- B·ARGO (Badalona Applied Research Group of Oncology) Medical Oncology Department, Catalan Institute of Oncology Badalona, 08916 Badalona, Spain; (M.D.); (A.H.); (A.P.)
| | - Eva Martínez-Balibrea
- Germans Trias i Pujol Research Institute (IGTP), ProCURE Program, Catalan Institute of Oncology, 08916 Badalona, Spain;
| | - Carmen Balañà
- B·ARGO (Badalona Applied Research Group of Oncology) Medical Oncology Department, Catalan Institute of Oncology Badalona, 08916 Badalona, Spain; (M.D.); (A.H.); (A.P.)
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31
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Muramatsu K, Tani Y, Seto T, Iwanaga R, Mihara A, Ihara K, Sakai T. Schwannoma in the extremity: clinical features and microscopic intra-capsular enucleation. J Rural Med 2021; 16:184-190. [PMID: 34707726 PMCID: PMC8527622 DOI: 10.2185/jrm.2021-020] [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: 04/16/2021] [Accepted: 05/31/2021] [Indexed: 11/27/2022] Open
Abstract
Objective: Schwannomas are the most common type of neoplasm of the
peripheral nerves. Enucleation is a standard surgical procedure; however, it occasionally
results in iatrogenic nerve injury, even with atraumatic procedures. Herein, we present
the clinical characteristics of schwannoma arising in the extremities and discuss the
clinical outcomes of extra- and intra-capsular
enucleation. Patients and Methods: We reviewed 122 schwannomas treated at our institute.
Schwannomas arising from the minor nerve (n=30) or intramuscularly (n=15) were operated
using the extra-capsular technique. Of the 77 major nerve schwannomas, 62 schwannomas were
treated using the intra-capsular technique and 15 schwannomas using the extra-capsular
technique. Results: Neurological deficits following enucleation were significantly
lower using the intra-capsular technique than with the extra-capsular technique. The
patient age, duration of symptoms, maximum tumor diameter, and site of occurrence were not
associated with subsequent neurological deficits. With both techniques, no tumor
recurrence was observed at the final follow-up. Conclusion: These results support the use of intra-capsular
micro-enucleation as a safe and reliable treatment for every type of schwannoma. To
minimize the risk of nerve injury, en bloc resection should not be used because the main
purpose of schwannoma surgery is the relief of symptoms, not tumor resection.
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Affiliation(s)
- Keiichi Muramatsu
- Department of Hand and Microsurgery, Nagato General Hospital, Japan.,Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan
| | - Yasuhiro Tani
- Department of Hand and Microsurgery, Nagato General Hospital, Japan
| | - Tetsuya Seto
- Department of Hand and Microsurgery, Nagato General Hospital, Japan
| | - Ryuta Iwanaga
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan
| | - Atsushi Mihara
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan
| | - Koichiro Ihara
- Department of Orthopedic Surgery, Kanmon Medical Center, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Japan
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32
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Buechner S, Capone L. Ice Pack Test Eased Ptosis in a Patient Presenting with a Possible Oculomotor Nerve Schwannoma: A Case Report. Neurol Int 2021; 13:510-516. [PMID: 34698277 PMCID: PMC8544292 DOI: 10.3390/neurolint13040050] [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: 06/08/2021] [Revised: 08/15/2021] [Accepted: 09/10/2021] [Indexed: 11/21/2022] Open
Abstract
A 32-year-old man presented with complete third nerve palsy. Brain magnetic resonance imaging revealed a possible sporadic oculomotor nerve schwannoma in the left cavernous sinus. Interestingly, the patient’s ptosis was fluctuating and eased immediately after application of ice over his eyelid. The ice pack test (IPT) is a simple and fast method that can help diagnose myasthenia gravis (MG) in patients with ptosis. Additional diagnostic investigations (antibody assays and repetitive stimulation) excluded associated MG in the patient. Tumor treatment with Gamma Knife radiosurgery was planned. This case highlights the finding that IPT can also be positive in neurogenic (non-myasthenic) ptosis, but its usefulness in other disorders associated with muscle weakness and fatigability remains questionable.
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33
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Halawani AM, Tohyama S, Hung PSP, Behan B, Bernstein M, Kalia S, Zadeh G, Cusimano M, Schwartz M, Gentili F, Mikulis DJ, Laperriere NJ, Hodaie M. Correlation between Cranial Nerve Microstructural Characteristics and Vestibular Schwannoma Tumor Volume. AJNR. AMERICAN JOURNAL OF NEURORADIOLOGY 2021; 42:1853-1858. [PMID: 34615646 DOI: 10.3174/ajnr.a7257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 05/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vestibular schwannomas are common cerebellopontine angle tumors arising from the vestibulocochlear nerve and can result in cranial nerve dysfunction. Conventional MR imaging does not provide information that could correlate with cranial nerve compression symptoms of hearing loss or imbalance. We used multitensor tractography to evaluate the relationship between the WM microstructural properties of cranial nerves and tumor volume in a cohort of patients with vestibular schwannomas. MATERIALS AND METHODS A retrospective study was performed in 258 patients with vestibular schwannomas treated at the Gamma Knife clinic at Toronto Western Hospital between 2014 and 2018. 3T MR images were analyzed in 160 surgically naïve patients with unilateral vestibular schwannomas. Multitensor tractography was used to extract DTI-derived metrics (fractional anisotropy and radial, axial, and mean diffusivities of the bilateral facial and vestibulocochlear nerves [cranial nerves VII/VIII]). ROIs were placed in the transition between cisternal and intracanalicular segments, and images were analyzed using the eXtended Streamline Tractography reconstruction method. Diffusion metrics were correlated with 3D tumor volume derived from the Gamma Knife clinic. RESULTS DTI analyses revealed significantly higher fractional anisotropy values and a reduction in axial diffusivity, radial diffusivity, and mean diffusivity (all P < .001) within the affected cranial nerves VII and VIII compared with unaffected side. All specific diffusivities (axial, radial, and mean diffusivity) demonstrated an inverse correlation with tumor volume (axial, radial, and mean diffusivity, P < .01). CONCLUSIONS Multitensor tractography allows the quantification of cranial nerve VII and VIII WM microstructural alterations in patients with vestibular schwannomas. Our findings support the hypothesis that tumor volume may cause microstructural alterations of the affected cranial nerves VII and VIII. This type of advanced imaging may represent a possible avenue to correlate diffusivities with cranial nerve function.
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Affiliation(s)
- A M Halawani
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Medical Imaging (A.M.H., D.J.M.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology (A.M.H., D.J.M.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - S Tohyama
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, (S.T., P.S.-P.H., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - P S-P Hung
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, (S.T., P.S.-P.H., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B Behan
- Ontario Brain Institute (B.B.), Toronto, Ontario, Canada
| | - M Bernstein
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.B., S.K., F.G., M.H.), Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - S Kalia
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.B., S.K., F.G., M.H.), Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - G Zadeh
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre (G.Z.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - M Cusimano
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.C.), Saint Michael's Hospital, Toronto, Ontario, Canada
| | - M Schwartz
- Division of Neurosurgery (M.S.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - F Gentili
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.B., S.K., F.G., M.H.), Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - D J Mikulis
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Medical Imaging (A.M.H., D.J.M.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology (A.M.H., D.J.M.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - N J Laperriere
- Department of Radiation Oncology (N.J.L.), University of Toronto, Toronto, Ontario, Canada.,Division of Radiation Oncology (N.J.L.), Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - M Hodaie
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada .,Institute of Medical Science, (S.T., P.S.-P.H., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.B., S.K., F.G., M.H.), Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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34
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Pancreatic/peripancreatic neurogenic tumor; little known masses not to be missed. Pancreatology 2021; 21:1386-1394. [PMID: 34446337 DOI: 10.1016/j.pan.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Retroperitoneal neurogenic tumors are extremely rare pathological entities; therefore, few clinical features and natural courses, especially originating from the pancreatic/peripancreatic regions, have been reported. This study aimed to investigate the clinicopathological features of pancreatic and peripancreatic neurogenic tumors and assess the diagnostic value of computed tomography (CT) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). METHODS Between 2006 and 2018, patients who were diagnosed with neurogenic tumors were included. In total, 90 histologically confirmed cases of neurogenic tumors located in the pancreatic/peripancreatic regions were selected for analysis. RESULTS The mean age was 49.2 ± 13.1 years. There were no differences in sex distribution of the tumors. Schwannomas (44.4%) and paragangliomas (41.1%) were the most common neurogenic tumors. The sensitivity of CT was 62.2% in 90 cases. EUS-FNB was performed in 30 cases and the sensitivity of it was 83.3%. The diagnosis of neurogenic tumors with EUS-FNB or CT was not significantly associated with tumor location and size. Surgical resection was performed in 78 cases. Of the 12 patients who did not undergo surgery, 10 cases were followed-up without any increase in tumor size. CONCLUSIONS Through the present study, we verified radiological, pathological, and clinical aspects of the pancreatic/peripancreatic neurogenic tumors which little known before, therefore, this study can serve as the basis for research to present an optimal diagnosis and treatment of neurogenic tumors. In addition, EUS-FNB is useful in the diagnosis of pancreatic/peripancreatic neurogenic tumors with relatively high sensitivity and can help establish therapeutic plans before the surgery.
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35
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Popovici RM, Cărăuleanu A, Costea CF, Florea ID, Scripcariu DV, Mogoş RA, Cheaito A, Tănase AE, Haba RM, Grigore M. Rare retroperitoneal conditions that mimic uterine myoma. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:7-14. [PMID: 32747890 PMCID: PMC7728116 DOI: 10.47162/rjme.61.1.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The most frequent tumoral condition of the uterus is represented by uterine myoma. The diagnosis, in most cases, is established by clinical examination and ultrasound scan. Nevertheless, there are rare cases, in which the surgical findings reveal a retroperitoneal tumor instead of a uterine myoma. These could be represented by schwannomas or Castleman disease. The schwannomas are rarely malignant and arise from the Schwann cells of nerve fibers. These tumors are frequently found at the level of the head, neck and mediastinum and rarely in the pelvis. Generally, schwannomas localized at retroperitoneal level are asymptomatic and with a very slow growth rate. The treatment consists in complete surgical resection. The recurrence rate is low and, generally, the prognosis is good. The Castleman disease is considered a rare entity, but it should be always taken into consideration when it comes to a differential diagnosis in a young patient who presents a retroperitoneal mass at imagery exams. The condition affects the lymphatic system and is characterized by a hyperplasia of the lymph nodes, sometimes associated with herpes virus infection. The clinical picture is often non-specific; the pain may be the only symptom. The imaging methods are not always conclusive for the final positive diagnosis and the histopathological examination is always necessary. Pelvic Castleman disease can be misdiagnosed as myoma or an adnexal tumor. In this article, we review the present knowledge regarding the pathogenesis, pathology and management of these rare retroperitoneal tumors. Both conditions, when located in pelvis must be taken into consideration in the differential diagnosis of uterine myomas, especially in the pedunculated form.
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Affiliation(s)
- Răzvan Mihai Popovici
- Department of Ophthalmology, Department of Obstetrics and Gynecology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; ,
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36
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Lee CW, Grammatopoulou V, Bagwan I, Sunkaraneni V. Schwannoma of the sinonasal tract: case report with review of the literature. Ann R Coll Surg Engl 2021; 103:e216-e222. [PMID: 34019433 DOI: 10.1308/rcsann.2020.7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Schwannomas of the sinonasal tract are rare, accounting for <4% of head and neck schwannomas. We report the case of a 61-year-old male who presented with unilateral nasal symptoms. Examination and imaging revealed a unilateral polyp at the level of the middle turbinate, with an initial biopsy suggestive of an inflammatory polyp. Due to the persistence of the patient's symptoms and his polyp despite medical therapy, endoscopic nasal polypectomy was performed. The histology surprisingly showed a schwannoma. No further interventions were carried out, and the patient remains disease-free 6 months postoperatively. A review of the literature comprising 60 cases is included. An optimal clinical approach to the investigation and management of schwannomas of the sinonasal tract is subsequently discussed.
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Affiliation(s)
- C W Lee
- Royal Surrey County Hospital, UK
| | | | - I Bagwan
- Royal Surrey County Hospital, UK
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37
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Malla SR, Bhalla AS, Manchanda S, Kandasamy D, Kumar R, Agarwal S, Shamim SA, Kakkar A. Dynamic contrast-enhanced magnetic resonance imaging for differentiating head and neck paraganglioma and schwannoma. Head Neck 2021; 43:2611-2622. [PMID: 33938085 DOI: 10.1002/hed.26732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/27/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Morphological assessment with conventional magnetic resonance imaging (MRI) sequences has limited specificity to distinguish between paragangliomas and schwannomas. Assessing the differences in microvascular properties through pharmacokinetic parameters of dynamic contrast-enhanced (DCE)-MRI can provide additional information to aid in this differentiation. MATERIALS AND METHODS A prospective study on MR characterization of neck masses was performed between January 2017 and March 2019 in our department, out of which 40 patients with head and neck paragangliomas (HNPGLs) (33 lesions) and schwannomas (15 lesions) were included in this analysis. MR perfusion using dynamic axial T1WI fat suppressed fast spoiled gradient recalled sequence with parallel imaging was performed in all the patients, in addition to single-shot turbo spin-echo axial diffusion weighted imaging (DWI) and routine MRI. ROI-based method was used to obtain signal-time curves, permeability measurements, and mean apparent diffusion coefficient (ADC) to differentiate paragangliomas from schwannomas. Statistical analysis was done to assess the significance and establish a cutoff to distinguish between the two entities. The available images of DOTANOC PET/CT (34 lesions) were analyzed retrospectively. Correlations between the perfusion, diffusion, and molecular PET/CT parameters were done. RESULTS Paragangliomas had a higher wash-in rate, wash-out rate, Ktrans, Kep , and Vp (p < 0.001); while schwannomas had a higher relative enhancement (p < 0.012), time to peak, time of onset, brevity of enhancement, and Ve (p < 0.001). Among the perfusion parameters, Kep (area under curve (AUC) 0.994) and Vp (AUC 0.992) were found to have the highest diagnostic value. In diffusion-weighted imaging, paragangliomas had a lower mean ADC compared to schwannomas (p < 0.001). The SUVmax and SUVmean were significantly associated with Ktrans , Kep , and Vp in paragangliomas. CONCLUSION DCE-MRI in addition to DWI-MRI can accurately distinguish HNPGL from schwannoma and may replace the need for any additional imaging and preoperative biopsy in most cases.
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Affiliation(s)
- Soumya Ranjan Malla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rakesh Kumar
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine & PET, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Dewey BJ, Howe BM, Spinner RJ, Johnson GB, Nathan MA, Wenger DE, Broski SM. FDG PET/CT and MRI Features of Pathologically Proven Schwannomas. Clin Nucl Med 2021; 46:289-296. [PMID: 33443952 DOI: 10.1097/rlu.0000000000003485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The aim of this study was to examine the MRI and FDG PET/CT imaging features of pathologically proven schwannomas. PATIENTS AND METHODS This institutional review board-approved retrospective study examined biopsy-proven schwannomas that underwent FDG PET/CT and/or MRI at our institution between January 1, 2002, and April 1, 2018. PET/CT features analyzed included SUVmax, metabolic ratios, volumetric metabolic measures, presence of calcification, and pattern of FDG activity. MRI features included T1/T2 signal, enhancement pattern, margins, perilesional edema, presence of muscular denervation, and size. RESULTS Ninety-five biopsy-proven schwannomas were identified (40 with both PET and MRI, 35 with PET only, and 20 with MRI only), 46 females and 49 males, average age of 57.7 ± 15.3 years. The average largest dimension was 4.6 ± 2.7 cm, the average SUVmax was 5.4 ± 2.7, and lesion SUVmax/liver SUVmean was 2.2 ± 1.2. Eleven (15%) of 75 lesions had SUVmax greater than 8.1, 26/75 (35%) had SUVmax greater than 6.1, and 14/75 (19%) had lesion SUVmax/liver SUVmean greater than 3.0. On MRI, 29/53 (55%) demonstrated internal nonenhancing areas. Twenty-eight (70%) of 40 lesions with both MRI and PET demonstrated at least 1 imaging feature concerning for malignant peripheral nerve sheath tumor (irregular margins, internal nonenhancement, perilesional edema, heterogeneous FDG uptake, or SUVmax >8.1). Lesions with heterogeneous FDG activity had higher SUVmax (6.5 ± 0.5 vs 4.7 ± 0.4, P = 0.0031) and more frequent internal nonenhancement on MRI (P = 0.0218). CONCLUSIONS Schwannomas may be large, be intensely FDG avid, and demonstrate significant heterogeneity, features typically associated with malignant peripheral nerve sheath tumors. A significant proportion exhibit FDG activity above cutoff levels previously thought useful in differentiating malignant from benign peripheral nerve sheath tumors.
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Ardeleanu V, Pirici D, Sava A, Folescu R, Motoc AGM. Cystic schwannoma of the distal forearm. Case presentation. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:911-916. [PMID: 33817733 PMCID: PMC8112778 DOI: 10.47162/rjme.61.3.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Schwannomas are well-encapsulated, benign tumors arising from Schwann cell constituting the nerve sheaths. We report a case of a cystic conventional schwannoma, measuring 2.5×3 cm, located in the distal forearm of a 33-year-old female patient with no sign of neurofibromatosis type 2 or type 3. The mass was painless, but Tinel’s sign was positive. Ultrasonography showed a soft tissue cystic mass diagnosed as being synovial cyst in the left distal forearm. Surgical resection was performed without any complications. Histopathological examinations oriented the diagnosis to a schwannoma, but immunohistochemical stainings proved the tumor origin in Schwann cells and made the differential diagnosis with other pathologies, like neurofibroma, leiomyoma, epithelial cyst, synovial cyst, or ganglion cyst.
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Affiliation(s)
- Valeriu Ardeleanu
- Department of Morpho-Functional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania;
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40
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Utomo SA, Bajamal AH, Faris M, Ardiansyah D, Lunardhi JH. Long Completely Cystic Sciatic Schwannoma: A Rare Case. Case Rep Oncol 2021; 14:561-567. [PMID: 33976634 PMCID: PMC8077366 DOI: 10.1159/000514633] [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: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/19/2022] Open
Abstract
Schwannomas are the most common peripheral nerve sheath tumors. Benign schwannomas with malignant transformation are rarely reported. Most common schwannomas occur in the head and neck region. Sciatic schwannomas are rare, as are completely cystic schwannomas. Sciatic nerve schwannomas represent less than 1% of all schwannomas. Benign tumors in the sciatic nerve consist of 60% neurofibromas and 38% schwannomas. In general, a schwannoma induces chronic symptoms. It can be misleading, sometimes mimicking degenerative spinal pathology due to disc herniation. Schwannoma involving the sciatic nerve can be asymptomatic or may present with sciatica or neurological deficits. Most schwannomas are solid or heterogeneous tumors, and completely cystic schwannomas are rare. The differential diagnoses of nondiscogenic sciatica include lumbar disc herniation, tumor, abscess, hematoma, facet syndrome, lumbar instability, sacroiliitis, piriformis syndrome, and sciatic neuritis. We report a rare case of a long completely cystic sciatic schwannoma in the left foraminal L5–S1 zone extending to the left ischial groove with chronic sciatica that was diagnosed radiologically with a combination of conventional MRI and MR neurography and confirmed histopathologically by surgical resection. The patient previously had conservative therapy, but the complaints were not reduced. Nonsurgical therapy is considered the first choice, and surgical therapy is indicated in cases that do not respond to conservative therapy, with recurrent cysts, severe pain, or neurological deficits.
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Affiliation(s)
- Sri Andreani Utomo
- Doctoral Program Health Science, Airlangga University, Surabaya, Indonesia.,Radiology Department, Airlangga University, Surabaya, Indonesia
| | | | - Muhammad Faris
- Neurosurgery Department, Airlangga University, Surabaya, Indonesia
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Pajazetovic A, Dahukey A. A Case of Schwannoma of the Lateral Aspect of the Superficial Peroneal Nerve. J Am Podiatr Med Assoc 2021; 111:464170. [PMID: 33872363 DOI: 10.7547/20-079] [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 benign tumor with a neurogenic origin that affects peripheral nerves. It arises from the neural sheath of the peripheral nerves. We present a case of a 54-year-old woman who presented to our clinic with a painful schwannoma of her superficial peroneal nerve at the level of the ankle. The patient was treated with surgical excision, and diagnosis was confirmed with pathologic analysis.
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42
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Wang CY, Yin HL, Lee KT, Kuo KK. Extremely rare case of retroperitoneal "ancient" schwannoma with significant cystic change embedded in the psoas muscle. Kaohsiung J Med Sci 2021; 37:632-633. [PMID: 33611807 DOI: 10.1002/kjm2.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Che-Yuan Wang
- School of Post-Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsin-Ling Yin
- College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - King-Teh Lee
- College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Kung-Kai Kuo
- College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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43
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Ahmed G, Sheikh U, Dawson T, Sonwalker H. Rare Case of Multiple Intradural Extramedullary Spinal Schwannomas With Intramedullary Extension. Cureus 2021; 13:e13228. [PMID: 33728178 PMCID: PMC7946570 DOI: 10.7759/cureus.13228] [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] [Indexed: 11/29/2022] Open
Abstract
Spinal schwannomas are benign WHO grade I nerve sheath tumors that account for nearly 30% of all spinal neoplasm. Typically, these lesions are intradural extramedullary in location and are composed entirely of well-differentiated eosinophilic Schwann cells. Intramedullary schwannomas, however, are extremely rare due to the lack of Schwan cells in the normal spinal cord and represent 1% of all the spinal schwannoma population. The presence of such an intramedullary component makes diagnosis challenging as imaging features may resemble other intramedullary neoplastic entities. Here, we describe a case of a 56-year-old male patient who presented with an 18-month history of intermittent right-sided mid-thoracic pain secondary to multiple intradural extramedullary spinal schwannoma with intramedullary extensions. We also review the literature pertaining to the condition.
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Affiliation(s)
- Gasim Ahmed
- Radiology, The Christie Hospital NHS Foundation Trust, Manchester, GBR
| | - Usman Sheikh
- Radiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, GBR
| | - Timothy Dawson
- Pathology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, GBR
| | - Hemant Sonwalker
- Radiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, GBR
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Bălaşa AF, Hurghiş CI, Tămaş F, Şerban GM, Kövecsi A, Florian IA, Chinezu R. Gross-total versus near-total resection of large vestibular schwannomas. An institutional experience. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:485-492. [PMID: 33544800 PMCID: PMC7864290 DOI: 10.47162/rjme.61.2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE We will report our experience of the surgical treatment of large vestibular schwannomas (VSs). PATIENTS, MATERIALS AND METHODS We conducted a retrospective study of patients operated on for Koos grade IV VS between 2007 and 2015 at the Department of Neurosurgery, Emergency County Hospital, Târgu Mureş, Romania. We studied the general preoperatory clinical data, the preoperative and postoperative facial nerve status, preoperative hearing on the affected side, and any postoperative complications, including death. RESULTS Sixty-six cases were included in our study. The mean age was 52.95 years and 66.7% (n=44) of the sample were female. All patients had suffered from tinnitus and this had been followed by loss of serviceable hearing on the affected side in 89.4% (n=59) of cases. Preoperative facial palsy was found in 53% (n=35) of patients. The mean tumor size was 40.35 mm. Gross-total resection (GTR) was achieved in 24 (36.36%) cases, while near-total resection (NTR) was obtained in 42 (63.64%) cases. New-onset facial palsy or degradation of the preoperative facial deficit occurred in 12 (18.18%) cases, most of whom were patients with a GTR (n=9, 37.5%). This was statistically significant. There were no significant postoperative differences between the GTR and NTR groups. There was one death in the GTR group. CONCLUSIONS We conclude that near-total tumor removal provides good surgical results and better postsurgical quality of life for patients when compared to gross-total tumor resection. Therefore, this should be the end goal of the resection of large VSs.
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Affiliation(s)
- Adrian Florian Bălaşa
- Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Romania;
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Gonçalves VM, Suhm EM, Ries V, Skardelly M, Tabatabai G, Tatagiba M, Schittenhelm J, Behling F. Macrophage and Lymphocyte Infiltration Is Associated with Volumetric Tumor Size but Not with Volumetric Growth in the Tübingen Schwannoma Cohort. Cancers (Basel) 2021; 13:cancers13030466. [PMID: 33530441 PMCID: PMC7865601 DOI: 10.3390/cancers13030466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 01/22/2023] Open
Abstract
Most patients with vestibular schwannomas can be cured with microsurgical resection, or tumor growth can be stabilized by radiotherapy in certain cases. Recurrence is rare but usually difficult to treat. Treatment alternatives to local therapies are not established. There is growing evidence of the role of inflammatory processes in schwannomas, which may be exploitable by targeted innovative therapies. To further define the impact of inflammation with tumor growth in vestibular schwannoma, we performed immunohistochemical analyses of CD3, CD8, CD68 and CD163 to assess lymphocyte and macrophage infiltration in 923 tumor tissue samples of surgically resected vestibular schwannomas. An inflammatory score was compared with tumor size and volumetric growth. We observed a significantly larger preoperative tumor size with increased expression rates of CD3, CD8, CD68 and CD163 (p < 0.0001, p < 0.0001, p = 0.0015 and p < 0.0001, respectively), but no differences in percentual volumetric tumor growth. When all four markers were combined as an inflammatory score, tumors with high inflammatory infiltration showed slower percentual growth in a multivariate analysis, including MIB1 expression (p = 0.0249). We conclude that inflammatory cell infiltration increases with larger tumor size but is associated with slower percentual volumetric tumor growth.
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Affiliation(s)
- Vítor Moura Gonçalves
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (V.M.G.); (E.-M.S.); (V.R.); (M.S.); (G.T.); (M.T.)
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Elisa-Maria Suhm
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (V.M.G.); (E.-M.S.); (V.R.); (M.S.); (G.T.); (M.T.)
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen -Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany;
| | - Vanessa Ries
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (V.M.G.); (E.-M.S.); (V.R.); (M.S.); (G.T.); (M.T.)
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen -Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany;
| | - Marco Skardelly
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (V.M.G.); (E.-M.S.); (V.R.); (M.S.); (G.T.); (M.T.)
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen -Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany;
| | - Ghazaleh Tabatabai
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (V.M.G.); (E.-M.S.); (V.R.); (M.S.); (G.T.); (M.T.)
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen -Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany;
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK), DKFZ Partner Site Tübingen, 72076 Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (V.M.G.); (E.-M.S.); (V.R.); (M.S.); (G.T.); (M.T.)
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen -Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany;
| | - Jens Schittenhelm
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen -Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany;
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany
| | - Felix Behling
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany; (V.M.G.); (E.-M.S.); (V.R.); (M.S.); (G.T.); (M.T.)
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen -Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, 72076 Tübingen, Germany;
- Correspondence:
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Chowdhary S, Thangavel S, Ganesan S, Alexander A. Extratemporal intraparotid facial nerve schwannoma. BMJ Case Rep 2021; 14:14/1/e239407. [PMID: 33431474 PMCID: PMC7802682 DOI: 10.1136/bcr-2020-239407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Schwannomas of the eighth nerve are common, usually found in syndromic association with neurofibromatosis-2. The occurrence of seventh nerve schwannoma, especially in its extratemporal course, is very rare. Here, we present a case report of an extratemporal facial nerve schwannoma diagnosed preoperatively with cytopathology and postoperative histopathologic confirmation. Histopathology provides the confirmatory diagnosis in such cases. An atypical diagnosis of neural schwannomas should be kept in mind when facial palsy is clinically encountered in the absence of any other aetiological factors.
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Affiliation(s)
- Stuti Chowdhary
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Saranya Thangavel
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sivaraman Ganesan
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Arun Alexander
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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de Graaf P, Erb-Eigner K. Imaging in Orbital Pathology. Clin Neuroradiol 2021. [DOI: 10.1007/978-3-319-61423-6_91-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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48
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Abstract
A 55-year-old woman underwent FDG PET/CT to evaluate a pancreatic mass. The images showed elevated FDG activity in the uncinated process of the pancreas, suggestive of malignancy. However, pathological examination from the resected lesion demonstrated pancreatic schwannoma.
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Yang HC, Wu CC, Lee CC, Huang HE, Lee WK, Chung WY, Wu HM, Guo WY, Wu YT, Lu CF. Prediction of pseudoprogression and long-term outcome of vestibular schwannoma after Gamma Knife radiosurgery based on preradiosurgical MR radiomics. Radiother Oncol 2020; 155:123-130. [PMID: 33161011 DOI: 10.1016/j.radonc.2020.10.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE Gamma Knife radiosurgery (GKRS) is a safe and effective treatment modality with a long-term tumor control rate over 90% for vestibular schwannoma (VS). However, numerous tumors may undergo a transient pseudoprogression during 6-18 months after GKRS followed by a long-term volume reduction. The aim of this study is to determine whether the radiomics analysis based on preradiosurgical MRI data could predict the pseudoprogression and long-term outcome of VS after GKRS. MATERIALS AND METHODS A longitudinal dataset of patients with VS treated by single GKRS were retrospectively collected. Overall 336 patients with no previous craniotomy for tumor removal and a median of 65-month follow-up period after radiosurgery were finally included in this study. In total 1763 radiomic features were extracted from the multiparameteric MRI data before GKRS followed by the machine-learning classification. RESULTS We constructed a two-level machine-learning model to predict the long-term outcome and the occurrence of transient pseudoprogression after GKRS separately. The prediction of long-term outcome achieved an accuracy of 88.4% based on five radiomic features describing the variation of T2-weighted intensity and inhomogeneity of contrast enhancement in tumor. The prediction of transient pseudoprogression achieved an accuracy of 85.0% based on another five radiomic features associated with the inhomogeneous hypointensity pattern of contrast enhancement and the variation of T2-weighted intensity. CONCLUSION The proposed machine-learning model based on the preradiosurgical MR radiomics provides a potential to predict the pseudoprogression and long-term outcome of VS after GKRS, which can benefit the treatment strategy in clinical practice.
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Affiliation(s)
- Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Chun Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Huai-En Huang
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Department of Medical Imaging, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Wei-Kai Lee
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Yuh Chung
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Mei Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taiwan
| | - Wan-Yuo Guo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taiwan
| | - Yu-Te Wu
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.
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50
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Geethapriya S, Govindaraj J, Raghavan B, Ramakrishnan B, Arafath R, Vishwanathan S, Krishna M. Cranial nerve schwannoma - A pictorial essay. Indian J Radiol Imaging 2020; 30:116-125. [PMID: 33100678 PMCID: PMC7546302 DOI: 10.4103/ijri.ijri_17_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/13/2020] [Accepted: 04/09/2020] [Indexed: 01/25/2023] Open
Abstract
Schwannomas are peripheral nerve sheath tumours arising from cranial, spinal or peripheral nerves. Most of the schwannomas are benign with the rare possibility of malignant transformation. Cranial nerve schwannomas can be seen along the course of any cranial nerve in the intracranial region or head and neck location. Although a majority are solitary sporadic lesions, multiple schwannomas can be seen in syndromes like neurofibromatosis type 2 and rarely in type 1. Since intracranial schwannomas are slow-growing, clinical presentation varies between no symptoms to cranial nerve palsy. Most of the times, the symptoms are due to mass effect over the adjacent structures, foraminal widening, compression of other cranial nerves, denervation injury or hydrocephalus. Familiarity with the course of the cranial nerves, imaging appearances and clinical presentation of schwannomas helps in accurate diagnosis and possible differential diagnosis, especially in uncommon clinical and radiological appearances. In this pictorial review, we illustrate relevant anatomy of cranial nerves, imaging features of schwannomas of most of the cranial nerves, clinical presentation and differential diagnosis.
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Affiliation(s)
- Sivaramalingam Geethapriya
- Department of Radiology, Apollo Cancer Institutes, Padma Complex, Anna Salai, Chennai, Tamil Nadu, India
| | - Jayaraj Govindaraj
- Department of Radiology, Apollo Cancer Institutes, Padma Complex, Anna Salai, Chennai, Tamil Nadu, India
| | - Bagyam Raghavan
- Department of Radiology, Apollo Cancer Institutes, Padma Complex, Anna Salai, Chennai, Tamil Nadu, India
| | - Banupriya Ramakrishnan
- Department of Radiology, Apollo Cancer Institutes, Padma Complex, Anna Salai, Chennai, Tamil Nadu, India
| | - Rasheed Arafath
- Department of Radiology, Apollo Cancer Institutes, Padma Complex, Anna Salai, Chennai, Tamil Nadu, India
| | - Sathyashree Vishwanathan
- Department of Radiology, Apollo Cancer Institutes, Padma Complex, Anna Salai, Chennai, Tamil Nadu, India
| | - Murali Krishna
- Department of Radiology, Apollo Cancer Institutes, Padma Complex, Anna Salai, Chennai, Tamil Nadu, India
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