Frontal intraparenchymal schwannoma

Frontal lobe intra-axial schwannoma harboring a CHD7::VGLL3 fusion and heterozygous TSC2 p.F1510del mutation in a young child

BACKGROUND

Brain intraparenchymal schwannoma is a rare clinical entity, generally curable with adequate resection.

METHODS AND RESULTS

We describe a case in a male patient first presenting at 19 months of age, the youngest reported age for this lesion. It also appears to be the first case connected to a germline TSC2 p.1510del mutation in a patient with autism-like symptoms. Although tuberous sclerosis is generally not associated with increased risk of schwannoma, mTORC1 activity, which is inhibited by intact TSC1/TSC2 complex, is involved in schwannoma progression. This patient's tumor also harbored a CHD7::VGLL3 fusion consistent with its genomic DNA methylation classification of CNS Schwannoma, VGLL-fused. The Hippo pathway, mTORC1, and VGLL3 all negatively regulate the YAP1/TEAD cotranscriptional complex. We hypothesize that this schwannoma may have arisen because of increased VGLL3 functional activity from the CHD7::VGLL3 fusion and, perhaps, increased mTORC1 activity due to TSC2 mutation, and their combined effects on the balance between YAP1/TEAD- and VGLL3/TEAD-mediated transcriptional programs.

CONCLUSIONS

We present a frontal lobe intra-axial parenchymal schwannoma containing a CHD7::VGLL3 gene fusion presenting in a 19 month-old male, the youngest patient yet reported for this lesion.

Large Middle Cranial Fossa Schwannoma: A Rare Presentation of Vestibular Schwannoma

Schwannomas are benign tumors composed of neoplastic Schwann cells and rarely occur in the central nervous system. Schwannomas account for approximately 8% of intracranial tumors and most commonly originate from cranial nerve VIII at the cerebellopontine angle in the posterior fossa. Herein, we report two cases of vestibular schwannomas extending in the middle fossa. The first case shows a 51-year-old male who presented with a history of mild headaches for one year associated with acute nausea, vomiting, and word-finding difficulties. Imaging revealed a large multicystic contrast-enhancing lesion in the left middle cranial fossa. The middle fossa lesion was resected with pathology indicating a schwannoma. The second case shows a 63-year-old woman who presented with seizures, right-sided hearing loss, and right-sided facial weakness. On MRI, she is found to have a large right middle fossa lesion originating from the right internal auditory canal and consistent with vestibular schwannoma with a 9 mm leftward midline shift. The histopathologic examination of the excised tumor indicated a schwannoma. Schwannomas most commonly occur in the posterior fossa when they present intracranially. However, in rare occurrences, they may present as middle fossa masses with significant intracranial compression.

CT and MRI findings of intra-parenchymal and intra-ventricular schwannoma: a series of seven cases

Objective

To analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of patients with intra-parenchymal and intra-ventricular schwannoma.

Methods

The CT and MRI features of seven cases with intra-parenchymal and intra-ventricular schwannoma were analyzed retrospectively.

Results

There were four men and three women (median age, 25 years; range, 12–42 years) in this study. The median tumor size was 4.4 cm (range, 3.1–6.5 cm). The mass was, respectively, round in four cases (57.1%), lobulated in two cases (28.6%) and oval in one case (14.3%). All tumors were well-circumscribed. Septa in the mass could be observed in three cases (42.9%), and nodular calcification was observed in two cases (28.6%), which peritumoral edema (n = 3, 42.9%) and hydrocephalus (n = 3, 42.9%) could be observed. Most of these lesions (n = 6) presented iso-hypointensity on T1-weighted images and iso-hyperintensity on T2-weighted images, except one lesion showing low intensity on T2WI. In addition, a fluid–fluid level was observed in one case. After contrast agents’ injection, all masses illustrated heterogeneously moderate to marked enhancement.

Conclusions

A well-defined solid and cystic mass with calcification and moderate to marked delayed enhancement may be an objective account of intra-parenchymal or intra-ventricular schwannoma.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12880-022-00917-z.

Brainstem intraparenchymal schwannoma: A case report and literature review

Background:

Intracranial intraparenchymal schwannomas (IS) are rare tumors that have mainly been described in case reports. Here, we report on a case of a brainstem IS and included a comprehensive literature review.

Case Description:

A 74-year-old man presented with progressive gait disturbances. CT- and MRI-imaging revealed a contrast-enhancing mass accompanied by a cyst in the dorsolateral pons. Hemangioblastoma was suspected and surgery was advised. During surgery, gross total resection of a non-invasive tumor was performed. Postoperative recovery was uneventful. Based on histopathological examination, the intraparenchymal brainstem tumor was diagnosed as schwannoma.

Conclusion:

Our extensive review illustrates that ISs are benign tumors that most often present in relatively young patients. Malignant cases have been described but form an extremely rare entity. Preoperative diagnosis based on radiological features is difficult but should be considered when peritumoral edema, calcifications, and cysts are noted. In benign cases, gross total resection of the lesion is curative. To adequately select this treatment and adjust the surgical strategy accordingly, it is important to include IS in the preoperative differential diagnosis when the abovementioned radiological features are present.

Intraparenchymal schwannoma with calcification of the temporal lobe: Case report and literature review

RATIONALE

Intracranial schwannomas most frequently arise from the trigeminal nerve and the vestibular nerve. Schwannomas within the cerebral parenchyma are exceedingly rare. Additionally, calcification is an uncommon histopathological and radiological characteristic in schwannomas.

PATIENT CONCERNS

A 46-year-old man presented to us with sudden onset epileptic seizure and a 3-month history of intermittent headache. After admission, the physical and neurological examinations were all normal. Brain CT revealed an irregular, well-defined, hyperdense mass in the right temporal lobe. MRI showed a solid mass appearing iso- to hypointensity on T1-weighted imaging and heterogeneous intensity on T2-weighted imaging in the right temporal lobe; after Gd-DTPA administration, the lesion showed heterogeneous enhancement.

DIAGNOSIS

Histopathological examination revealed hyperchromatic nuclei and loose intercellular matrix with calcification. Immunohistochemical analysis demonstrated that the tumor was strongly positive for S100 protein but negative for GFAP and CK, which was consistent with a schwannoma.

INTERVENTIONS AND OUTCOMES

A surgical resection via the right temporal approach was performed. Intraoperatively, we noticed that the tumor was grayish yellow, capsuled, and located entirely within the temporal parenchyma. A gross total resection was achieved. The postoperative course was uneventful, and there was no epileptic seizure.

LESSONS

Intraparenchymal schwannoma with calcification is an uncommon histopathological and radiological characteristic in schwannomas. Intraparenchymal schwannoma with calcification is extremely rare. The early identification and appropriate surgical treatment should be highlighted.

Microcystic/Reticular Schwannoma of the Frontal Lobe: An Unusual Occurrence

Schwannoma is a benign peripheral nerve sheath tumor that typically involves cranial nerves of the head and neck region. Intraparenchymal occurrence of this tumor is uncommon. Even rarer in this site is the microcystic/reticular pattern of schwannoma. This histologic variant, first described in 2008, has a predilection for visceral organs. Herein, we report the first case of microcystic/reticular schwannoma of the frontal lobe.

Supra and infratentorial ectopic schwannoma mimicking a meningioma

We report the case of a supra and infratentorial ectopic schwannoma, mimicking a meningioma, that was surgically resected on a 75-year-old man, with a history of progressive visual loss and headaches. MRI was in favour of an occipital, cystic, tentorial-based meningioma extending to the posterior fossa, with signs of intratumoral haemorrhage. This is a unique case because of the rare type of lesion, in a very atypical location, completely unexpected by the preoperative imaging analysis, and to the best of our knowledge it is the oldest patient reported in the literature with this kind of tumour.

Histologic Evidence for Arteriovenous Malformation-Like Vasculature Occurring within an Intracerebral Schwannoma: A Case Report and Review of the Literature

BACKGROUND

The phenomenon of intracerebral schwannoma is exceedingly rare, and its etiology still a matter of debate. No documented cases of intracerebral schwannoma containing vascular elements consistent with those of an arteriovenous malformation (AVM) have been reported. We describe such a case here.

CASE DESCRIPTION

A left temporal intraparenchymal lesion was discovered incidentally in a 34-year-old man after he suffered a mild trauma. The lesion was resected and found on histologic examination to be an intracerebral schwannoma with AVM-like vasculature. The patient made a full recovery after resection.

CONCLUSIONS

To our knowledge, this is the first case of an intracerebral schwannoma with AVM-like characteristics to be reported in the literature. We hypothesize that the co-occurrence of this rare pathologic entity is caused by an interrelated etiologic process, with the tumor microenvironment of the schwannoma inciting the development of the vascular malformation.

Supratentorial brain schwannomas: an uncommon location for a common tumour

INTRODUCTION

Intracranial schwannomas not related to cranial nerves are uncommon brain tumours. Such tumours account for less than 1% of all surgically treated schwannomas. Only 79 cases have been reported in the literature.

METHODS

We describe two cases treated in our centre. The patients are young women with seizures as a presenting symptom. Both underwent surgery with the presumptive diagnosis of benign brain tumour. Histopathological examination revealed the certain diagnosis of Schwannoma.

RESULTS

Good outcome was achieved with total excision of the tumour. Based on the literature, demographic data, clinical aspects, imaging features and theories on the possible origin of this rare tumour are discussed.

CONCLUSIONS

These tumours should be included in the differential diagnosis of supratentorial benign tumours in young adults. Total excision, whenever possible, is the treatment of choice.

Childhood tumors of the brain: demographic pattern over a ten-year period in the Kashmir Valley

Brain tumors in children represent the second most frequent tumors in this age group after hematologic malignancies. We highlight the demographic pattern after retrospective analysis of brain tumors in children from geographically and ethnically distinct Kashmir Valley managed in our center between 2000 and 2009. We had a total of 248 pediatric patients with brain tumors. The parameters analyzed were age, gender, location of tumors and histopathological subtypes as well as WHO grade of tumor. We also did a comparison between the frequencies of common varieties of tumor in the first and second 5-year periods. We found that 111 tumors (44.75%) were supratentorial, and 137 (55.25%) were infratentorial. The male-to-female ratio was 1.4:1. The proportions of low-grade and high-grade tumors were 60 and 40%, respectively. The most common tumor in our series was astrocytoma. The most common tumors in the supratentorial and infratentorial compartments were craniopharyngioma and medulloblastoma, respectively. Our experience reflects a different demographic profile of pediatric brain tumors as compared with other regions of the world.