Schwannoma of the uterine cervix: a rare case report

Malignant Peripheral Nerve Sheath Tumour of Uterine Cervix-a Case Report and Review of Literature

Malignant peripheral nerve sheath tumour (MPNST) is a rare variety of sarcoma occurring in the uterine cervix. Only 16 cases have been reported in literature till date. There is no clear consensus on the treatment due to the rarity of the disease. This is primarily managed by surgery. Here, we present a case of MPNST of the cervix who was treated with preoperative radiotherapy followed by radical hysterectomy and bilateral salpingo-oophorectomy.

An unusual histological finding following myomectomy

Ancient schwannomas are benign tumours arising from the neural sheath of peripheral, cranial and autonomic nerves. They are commonly situated in the inner ear and spine with pelvic manifestations being rare. We present the case of a 30-year-old patient, who presented with an abdominal mass. MRI imaging suggested a broad ligament fibroid and open surgery was undertaken to remove it. Subsequent histology confirmed an ancient schwannoma. This case report details the rarity of such a condition and the need for a high index of suspicion as well as outlining management options and surveillance.

Low-Malignant Schwannoma of the Cervix in Pregnancy: A Case Report and Literature Systematic Review

Primary cervical melanocytic schwannomas, arising from the sympathetic chain, are very rare pigmented neural sheath tumors that, both grossly and clinically, are often misdiagnosed with other more frequent lesions of the uterine cervix. Literature review accounts for seventeen published cases of schwannomas of the cervix, ten of which are malignant and seven benign. Pathological examination with immunostaining techniques is essential for the correct diagnosis of these tumors. We report a case of primary cervical schwannoma in a 32-year-old female who was referred to our department at 13 weeks of gestation with a diagnosis of malignant melanoma of the cervix. Pathological review detailed a neoplasm with a myxoid spindle cell component and a minority of small epithelioid cells, with a low-malignant potential proliferation index: morphological and immunocytochemical findings were compatible with the diagnosis of nerve sheath tumor, type schwannoma. The patient underwent a vaginal trachelectomy and a prophylactic Shirodkar's cerclage. Pregnancy was carried on without any negative event. The patient delivered by a caesarean section a healthy female newborn. Placental histology was negative. After 6 years from the first diagnosis, the patient is healthy and disease free.

Histomorphological Spectrum of Cervical Lesions in a Rural Hospital

Background

Pathologically the cervix is affected by infective, inflammatory, and neoplastic diseases. Non‑neoplastic lesions of the cervix are seen often in sexually active women. Inflammatory lesions include chronic granulomatous cervicitis, acute and chronic cervicitis. In India, cervical cancer is a significant health problem. Many factors contribute to the differences in the spectrum of cervical diseases in the rural population compared to urban areas, but the studies in these populations are scarce.

Materials and methods

A retrospective analysis of all gynecological lesions over one year was studied. All case files were manually extracted, and the data was entered in an Excel sheet. The information included was clinical history (symptoms, signs, menstrual history, duration of illness, parity status), physical examination, per vaginal examination, investigations, including pathological diagnosis. The curated data was then analyzed using IBM SPSS for Windows version 22 (IBM Corp., Armonk, NY).

Results

There were 164 women in the study, with a mean age of 46.07 ± 8.17 years. A majority (n = 124, 75.6%) presented with excessive bleeding. Two-thirds of the study population had a normal cervix on examination. Twenty-seven women had squamous metaplasia, six had low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL), and one had malignancy. Excessive bleeding was significantly associated only with LSIL. Among the microscopic findings, only squamous metaplasia (p < 0.001) and dysplasia (p < 0.001) were significantly associated with the final diagnoses, such as LSIL, HSIL, and chronic cervicitis.

Conclusion

Most studies involving rural populations have involved the knowledge, attitude, and practices of the study cohort rather than the histomorphological spectrum of cervical lesions. Since these disorders are also influenced by education, parity, hygiene, and socioeconomic status, it behooves us to be aware of the spectrum of cervical lesions in a rural cohort who differ in these aspects when compared to urban populations. Most of such lesions of the cervix in the population that our medical institution served were benign in nature.

Gastric schwannoma: a diagnosis that should be known in 2019

Gastric schwannoma (GS) is a rare neoplasm of the stomach deriving from Schwann cells of the peripheral nerves in the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing and asymptomatic. Due to its rarity, GS is not widely recognized by clinicians. Preoperatively, GSs are difficult to differentiate from other mesenchymal tumors, such as gastrointestinal stromal tumor (GIST) or leiomyoma, which develop from mesenchymal stem cells. The optimal management of GS is based on the symptoms of the patient, tumor size and histologic grading. Here, we report the case of a GS in a 73-year-old female who underwent a wedge gastric resection following a clinical diagnosis of GIST. A histological and immunohistochemical study was performed excluding the misdiagnosis of GIST. The histomorphological features of the lesion and absence of c-Kit and strong positivity of S100 indicated the diagnosis of GS.