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Ogasawara N, Yamashita S, Yamasaki K, Kawano T, Kawano T, Muta J, Matsumoto F, Watanabe T, Ohta H, Yokogami K, Fukushima T, Sato Y, Takeshima H. Spontaneous malignant transformation of trigeminal schwannoma: consideration of responsible gene alterations for tumorigenesis-a case report. Brain Tumor Pathol 2023; 40:222-229. [PMID: 37515639 DOI: 10.1007/s10014-023-00466-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) arising from the trigeminal nerves are extremely rare (only 45 cases, including the present case, have been published) and have been reported to develop de novo from the peripheral nerve sheath and are not transformed from a schwannoma or neurofibroma. Here, we report a case of MPNSTs of the trigeminal nerve caused by the malignant transformation of a trigeminal schwannoma, with a particular focus on genetic considerations. After undergoing a near-total resection of a histologically typical benign schwannoma, the patient presented with regrowth of the tumor 10 years after the primary excision. Histopathologic and immunochemical examinations confirmed the recurrent tumor to be an MPNST. Comprehensive genomic analyses (FoundationOne panel-based gene assay) showed that only the recurrent MPNST sample, not the initial diagnosis of schwannoma, harbored genetic mutations, including NF1-p.R2637* and TP53-p.Y234H, candidate gene mutations associated with malignant transformation. Moreover, the results of reverse transcription polymerase chain reaction showed that the fusion of SH3PXD2A and HTRA1, which has been reported as one of the responsible genetic aberrations of schwannoma, was detected in the recurrent tumor. Taken together, we could illustrate the accumulation process of gene abnormalities for developing MPNSTs from normal cells via schwannomas.
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Affiliation(s)
- Natsuki Ogasawara
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Shinji Yamashita
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Koji Yamasaki
- Department of Neurosurgery, Miyazaki Prefectural Nichinan Hospital, Miyazaki, Japan
| | - Tomoki Kawano
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Tomohiro Kawano
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Junichiro Muta
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Fumitaka Matsumoto
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takashi Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hajime Ohta
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Kiyotaka Yokogami
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Tsuyoshi Fukushima
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuichiro Sato
- Department of Diagnostic Pathology, Division of Pathology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Hideo Takeshima
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Liang A, Xi B, Zhou C, Yang Y, Zhang J, Gui S, Xu F, Wan D. Malignant Peripheral Nerve Sheath Tumor of the Trigeminal Nerve Involving the Middle and Posterior Cranial Fossa. World Neurosurg 2018; 112:221-226. [PMID: 29408426 DOI: 10.1016/j.wneu.2018.01.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although benign trigeminal schwannomas are uncommon, malignant peripheral nerve sheath tumors (MPNSTs) of the trigeminal nerve are extraordinarily rare. CASE DESCRIPTION A 56-year-old female presented with a 2-month-long history of numbness of the right face and progressive weakness of the left limbs. Preoperative neuroimages indicated a giant tumor involving the middle and posterior cranial fossa with similar radiologic characteristics to benign trigeminal schwannomas. However, histopathologic and immunochemical examinations confirmed the tumor to be an MPNST. A nearly gross total resection was obtained with a combined frontotemporal extradural and subtemporal anterior petrosal approach. The postoperative course was uneventful, and the patient received adjuvant radiotherapy subsequently. There was no recurrence of the tumor with a 6-month-long follow-up. CONCLUSION MPNSTs of the trigeminal nerve are exceedingly rare. This study described the 21st case of MPNSTs of the trigeminal nerve. MPNSTs of the trigeminal nerve showed similar radiologic characteristics to benign trigeminal schwannomas, and accurate diagnosis depended on pathologic and immunochemical examinations. Gross total resection followed by radiotherapy is the usual treatment.
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Affiliation(s)
- Aijun Liang
- Department of Neurosurgery, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Bin Xi
- Department of Neurosurgery, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Chaoyang Zhou
- Department of Neurosurgery, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Yu Yang
- Department of Neurosurgery, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Jianzhong Zhang
- Department of Neurosurgery, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Shaogao Gui
- Department of Medical Imaging, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Fanghua Xu
- Department of Pathology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Dengfeng Wan
- Department of Neurosurgery, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China.
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Malignant trigeminal nerve sheath tumor and anaplastic astrocytoma collision tumor with high proliferative activity and tumor suppressor p53 expression. Case Rep Pathol 2014; 2014:153197. [PMID: 25386378 PMCID: PMC4214048 DOI: 10.1155/2014/153197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
Background. The synchronous development of two primary brain tumors of distinct cell of origin in close proximity or in contact with each other is extremely rare. We present the first case of collision tumor with two histological distinct tumors. Case Presentation. A 54-year-old woman presented with progressive atypical left facial pain and numbness for 8 months. MRI of the brain showed left middle cranial fossa heterogeneous mass extending into the infratemporal fossa. At surgery, a distinct but intermingled intra- and extradural tumor was demonstrated which was completely removed through left orbitozygomatic-temporal craniotomy. Histopathological examination showed that the tumor had two distinct components: malignant nerve sheath tumor of the trigeminal nerve and temporal lobe anaplastic astrocytoma. Proliferative activity and expressed tumor protein 53 (TP53) gene mutations were demonstrated in both tumors. Conclusions. We describe the first case of malignant trigeminal nerve sheath tumor (MTNST) and anaplastic astrocytoma in collision and discuss the possible hypothesis of this rare occurrence. We propose that MTNST, with TP53 mutation, have participated in the formation of anaplastic astrocytoma, or vice versa.
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Schmidt RF, Yick F, Boghani Z, Eloy JA, Liu JK. Malignant peripheral nerve sheath tumors of the trigeminal nerve: a systematic review of 36 cases. Neurosurg Focus 2013; 34:E5. [PMID: 23451818 DOI: 10.3171/2012.11.focus12292] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Malignant peripheral nerve sheath tumors (MPNSTs) are a rare form of malignancy arising from the Schwann cells of peripheral nerves. MPNSTs of the trigeminal nerve are exceptionally rare, with only a handful of reports in the literature. These tumors are typically very aggressive, resulting in significant patient morbidity and a generally grim prognosis. Most current reports suggest that radical resection with radiation therapy offers the best benefit. In this study, the authors systematically reviewed the world English-language literature on MPNSTs of the trigeminal nerve to analyze the presentations, treatment options, and outcomes for patients with this disease. METHODS A literature search for MPNSTs of the trigeminal nerve confined to nonanimal, English-language articles was conducted utilizing the PubMed database, with additional cases chosen from the references of selected articles. Only cases of confirmed MPNSTs of the trigeminal nerve or its peripheral branches, based upon surgical, pathological, or radiological analysis, were included. RESULTS From the literature search, 29 articles discussing 35 cases of MPNSTs of the trigeminal nerve were chosen. With the addition of 1 case from their own institution, the authors analyzed 36 cases of trigeminal MPNSTs. The average age of onset was 44.6 years. These tumors were more commonly seen in male patients (77.1%). The gasserian ganglion was involved in 36.1% of the cases. Of the cases in which the nerve distribution was specified (n = 25), the mandibular branch was most commonly involved (72.0%), followed by the maxillary branch (60.0%) and the ophthalmic branch (32.0%), with 44.0% of patients exhibiting involvement of 2 or more branches. Altered facial sensation and facial pain were the 2 most commonly reported symptoms, found in 63.9% and 52.8% of patients, respectively. Mastication difficulty and diplopia were seen in 22.2% of patients, facial weakness was seen in 19.4%, and hearing loss was present in 16.7%. With regard to the primary treatment strategy, 80.6% underwent resection, 16.7% underwent radiation therapy, and 2.9% received chemotherapy alone. Patients treated with complete resection followed by postoperative radiation therapy had the most favorable outcomes, with no patients showing evidence of disease recurrence with a mean follow-up of 34.6 months. Patients treated with incomplete resection followed by postoperative radiation therapy had more favorable outcomes than patients treated with incomplete resection without radiation therapy or radiation therapy alone. CONCLUSIONS Trigeminal MPNSTs most commonly present as altered facial sensation or facial pain, although they exhibit a number of other clinical manifestations, including the involvement of other cranial nerves. While a variety of treatment options exist, due to their highly infiltrative nature, aggressive resection followed by radiation therapy appears to offer the greatest chance of recurrence-free survival.
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Affiliation(s)
- Richard F Schmidt
- Department of Neurological Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey, USA
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Bowers CA, Taussky P, Duhon BS, Chin SS, Couldwell WT. Malignant peripheral nerve sheath tumour of the trigeminal nerve: case report and literature review. Br J Neurosurg 2011; 25:750-3. [DOI: 10.3109/02688697.2011.562990] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ziadi A, Saliba I. Malignant peripheral nerve sheath tumor of intracranial nerve: a case series review. Auris Nasus Larynx 2010; 37:539-45. [PMID: 20399579 DOI: 10.1016/j.anl.2010.02.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 12/17/2009] [Accepted: 02/02/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The incidence of malignant peripheral nerve sheath tumor (MPNST) is approximately 0.001%. Those involving intracranial nerves are even more exceptional. Little information is available concerning work up and management. Our objective is: (1) to review all cases of intracranial MPNST described in the literature, (2) to highlight the suspicion of intracranial MPNST, (3) to identify the gross pathology, the histopathology, the immunohistochemistry, (4) to discuss the differential diagnosis, the treatment, the recurrence rate, the follow-up, the incidence of metastasis and the prognosis. METHODS We reviewed English, Spanish and French literature published from 1950 to date. We used the following Keywords: "malignant peripheral nerve sheath tumor", "cranial nerve", "neurosarcoma", "malignant schwannoma", "neurofibroma", "malignant neurofibroma" and "nerve tumor". We considered cases where MPNST involved an intracranial cranial nerve. The results yielded 20 relevant studies, in which 31 patient's records were transcribed. We also added our case to this series. RESULTS We identified 32 cases of cranial MPNST including our case. The age ranged from 5 to 75 years old with most patients being in the 5th and 6th decade. Male to female ratio is 2.5:1. Most cases are developed sporadically (50%), 31% arise from a malignant transformation of schwannoma and 19% from a neurofibroma. Imaging findings were not specific. The cranial nerve VIII is the most involved (15/32), followed by the Vth (10/32) and the VIIth (5/32). 4 cases had neurofibromatosis type 1 and 2 had neurofibromatosis type 2. MPNST will strongly express protein S-100 and collagen IV-laminin. 13 cases were treated with radiotherapy for tumor recurrence and metastasis. In these cases the survival rate was better than the cases without radiotherapy. Fatal outcome occurred in 66% of patients whereas 19% were reported alive with or without complications. The seven cases reported to have metastasis were entirely to the spine. The mean time of recurrence or metastasis is 12.2 months. CONCLUSION MPNST of cranial nerves are very rare. In neurofibroma, even though MPNST is mainly associated to type 1, we should keep in mind its association to NF2. Mainstay of treatment is radical resection with adjuvant radiotherapy. Inaccessibility of cranial MPNST may explain the subtotal resection and thus the poor prognosis. Metastasis to the spinal cord is the most frequent one. A close postoperative follow-up is mandatory to eliminate recurrence.
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Affiliation(s)
- Arbia Ziadi
- Department of Otolaryngology - Head and Neck Surgery, Montreal University Hospital Center (CHUM) Notre Dame Hospital, Montreal University, 1560 Sherbrooke East, Montreal, Quebec H2L 4M1, Canada
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Malignant peripheral nerve sheath tumours of the infraorbital nerve: case report and literature review. The Journal of Laryngology & Otology 2009; 123:466-70. [DOI: 10.1017/s002221510800265x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report a case of malignant peripheral nerve sheath tumour seen in our department.Method:We present case reports and a review of the world literature concerning malignant peripheral nerve sheath tumour.Results:A 38-year-old Caucasian woman was diagnosed with malignant peripheral nerve sheath tumour of the infraorbital nerve. She underwent a wide enbloc resection followed by a course of radiotherapy. A five-year post-operative magnetic resonance imaging scan revealed no evidence of recurrence.Conclusion:Malignant peripheral nerve sheath tumours are rare in the head and neck. An awareness of their occurrence is important for early diagnosis. Management involves: accurate histological diagnosis; radiological imaging to define tumour extent and plan resection; wide surgical excision with histologically negative margins; reconstruction of the tissue defect; and post-operative radiotherapy.
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Malignant trigeminal schwannoma extending into the anterior skull base. Acta Neurochir (Wien) 2008; 150:599-604. [PMID: 18473115 DOI: 10.1007/s00701-008-1563-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 02/10/2008] [Indexed: 10/22/2022]
Abstract
Malignant schwannomas are rare tumours that seldom grow in the head and neck and their occurrence is even rarer in patients not affected by neurofibromatosis. The authors report a 40 year old woman with a left trigeminal malignant schwannoma (arising from V2), involving the infratemporal fossa and subsequently extending into the maxillary, sphenoid and ethmoidal sinuses, the orbit, and the intracranial compartment. Given the complex location of this tumour, the patient initially underwent radiation treatment; however due to a poor response to this form of treatment as well as disease progression, surgical resection requiring a combined Neurosurgical, ENT and Plastic Surgery was recommended. The planned operation included sacrificing the internal carotid artery and cavernous sinus, ipsilateral orbit exenteration and reconstruction with a free flap from the latissimus dorsi muscle. In this report, we discuss the sporadic occurrence of these tumours, the histo-pathological features and the management strategy along with a review of the literature.
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Abstract
We report a case of an intracranial epithelioid schwannoma. Epithelioid schwannoma is a low-grade malignant peripheral nerve sheath tumor that occurs most commonly in the limbs and inguinal region. Association with cranial nerves has been reported to be rare and in almost all cases has only involved extracranial distal branches.
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Affiliation(s)
- Tanya Yuen
- Department of Neurosurgery and Surgery, University of Melbourne, Royal Parade, Parkville, 3050, Victoria, Australia.
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Rodríguez JA, Hedges TR, Heilman CB, Strominger MB, Laver NM. Painful sixth cranial nerve palsy caused by a malignant trigeminal nerve sheath tumor. J Neuroophthalmol 2007; 27:29-31. [PMID: 17414869 DOI: 10.1097/wno.0b013e31803311df] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 17-year-old woman developed a sixth cranial nerve palsy from a malignant peripheral nerve sheath tumor of the trigeminal nerve. This case is unusual in that the principal symptom was diplopia stemming from a sixth cranial nerve palsy. Pain was mild, and trigeminal function was preserved. Imaging evidence of rapid growth of the cavernous sinus mass gave rise to an initial impression that the cause might be inflammatory. Treatment with gamma knife stereotactic radiosurgery produced some improvement in sixth cranial nerve function and reduction in tumor size over a follow-up period of 9 months.
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Affiliation(s)
- Julio A Rodríguez
- New England Eye Center, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA
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Ueda R, Saito R, Horiguchi T, Nakamura Y, Ichikizaki K. Malignant Peripheral Nerve Sheath Tumor in the Anterior Skullb Base Associated With Neurofibromatosis Type 1-Case Report-. Neurol Med Chir (Tokyo) 2004; 44:38-42. [PMID: 14959936 DOI: 10.2176/nmc.44.38] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 36-year-old man presented with a tumor in the anterior skull base manifesting as headache and visual disturbance. Neurofibromatosis type 1 (NF-1) was identified in early childhood in the patient, and also in his father. Subtotal excision of the tumor was performed, leaving the portion extending outside of the cranium. The histological diagnosis was malignant peripheral nerve sheath tumor. Local radiotherapy was instituted postoperatively. Facial paralysis and dysphagia appeared 7 months after the first operation. Magnetic resonance imaging revealed new lesions in the lateral ventricle and around the brainstem. These tumors were also subtotally excised, but the patient died 10 months after the first operation. The tumor very likely originated from the meningeal branch of the trigeminal nerve. Treatment of such tumors developing inside the cranium should include the widest resection possible, followed by irradiation of the entire neuraxis including the spinal cord to inhibit dissemination through the cerebrospinal fluid. Treatment should be started as quickly as possible if the tumor is associated with NF-1, because of the poor prognosis associated with this condition.
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Affiliation(s)
- Ryo Ueda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
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Maheshwari GK, Baboo HA, Gopal U, Baiar DB, Shah NM. Malignant schwannoma of the sinonasal tract. Indian J Otolaryngol Head Neck Surg 1999; 51:47-50. [PMID: 23119484 DOI: 10.1007/bf02996845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Malignant Schwannoma of the sinonasal tract is an extremely rare tumour. So far, only 19 cases have been reported in the literature. We report herein a case of malignant schwannoma involving nasal cavity, maxillary antrum and ethmoid sinus in a 60-year-old male patient. The patient was treated with surgery and post-operative radiotherapy. He currently remains free of the disease 15 months after the diagnosis and twelve months after completing therapy.
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Affiliation(s)
- G K Maheshwari
- Dept. of Radiation Oncology, The Gujarat Cancer and Research Institute NCH Campus, 380 016 Asarwa, Ahmedabad, India
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Abstract
Five cases of a rare malignant sinonasal tumour of neurofibromatous nature are described. The term neurogenic sarcoma (or malignant peripheral nerve sheath tumour) is advocated instead of malignant schwannoma. The clinicopathological features of this tumour are described, and the different diagnosis are discussed. The necessity of using immunohistochemistry in the diagnosis of sinonasal tumours of fibromatous nature is emphasized. The clinical management consists of radical surgery and adjuvant radiotherapy. Clinically there seems to be a high-grade and a low-grade type of sinonasal neurogenic sarcoma, however, this could not be distinguished histologically in the present series.
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Affiliation(s)
- H B Hellquist
- Department of Pathology, Orebro Medical Centre Hospital, Sweden
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Horie Y, Akagi S, Taguchi K, Yoshino T, Hayashi K, Takahashi K, Akagi T. Malignant schwannoma arising in the intracranial trigeminal nerve. A report of an autopsy case and a review of the literature. ACTA PATHOLOGICA JAPONICA 1990; 40:219-25. [PMID: 2193485 DOI: 10.1111/j.1440-1827.1990.tb03326.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An autopsy case of malignant schwannoma arising in the intracranial trigeminal nerve is reported. The tumor involved the right cerebellopontine angle of the brain stem in an 18-year-old man. The spindle-shaped tumor cells with eosinophilic cytoplasm proliferated in fascicles and exhibited hypercellularity, pleomorphism, increased mitotic activity and invasive growth. Ultrastructurally, interdigitating cytoplasmic processes and a few fragmented basal lamina-like structures were observed. Immunohistochemically, some tumor cells were reactive with conventional anti-S-100 protein antibody, but negative for beta subunit. Most tumor cells were positive for alpha subunit of S-100 protein. This is the eighth reported case of malignant schwannoma arising in the intracranial trigeminal nerve.
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Affiliation(s)
- Y Horie
- Department of Pathology, Okayama University Hospital, Japan
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