Cellular schwannoma

Case contributed by Dr Amr Farouk

Presentation

Temporal mass of few years duration.

Patient Data

Age: 70 years
Gender: Male
CT

A well-defined contour mass is seen filling the left masticator space with medial displacement of the left parapharyngeal fat and posterior displacement of the carotid sheath. Lateral extension into the left infratemporal fossa. Associated destruction of the left pterygoid plates, as well as the posterior and medial boundaries of the left maxillary sinus. Infiltration and destruction of the bony boundaries of the sphenoid and left posterior ethmoid air cells. Superiorly the lesion causes the destruction of the related sphenoid and squamous parts of the left temporal bone with subsequent intra-cranial extension into the middle cranial fossa and upward and posterior displacement of the related temporal lobe. No underlying brain edema.

The sellar component of the lesion is seen displacing the pituitary gland superiorly and encasing the lacerum and cavernous segments of the left internal carotid artery.  A more posterior component is seen extending also into the posterior cranial fossa, filling the left cerebellopontine angle and abutting the related aspect of the pons. Bony destruction of the left lateral orbital wall (the greater wing of the sphenoid) is also noted with the abutment of the left lateral rectus muscle.

Case Discussion

A pathologically proven case of cellular spindle cell tumor, keeping with cellular active schwannoma, ulcerated and inflamed.Such lesion is locally aggressive and biologic tendency for local recurrences.

The microscopic picture revealed tissue fragments formed of cellular growth of bundles of spindle cells with spindle wavy nuclei with focal palisading. Surface ulceration, non-specific inflammation and areas of hemorrhage as well as hyalinized blood vessels. No atypical mitotic figures nor necrosis are seen.

Cellular schwannoma is an unusual benign neoplasm that may cause bone erosion. It is highly cellular nerve-sheath benign tumor. Its radiologic and histologic appearance mimics that of a malignant neoplasm. The outcome is favourable without a metastatic spread. A typical tumor is solitary and at least partially encapsulated 1.

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Case information

rID: 57437
Published: 25th Dec 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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