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Chinchilla-Tábora LM, Blázquez BS, Sayagués JM, González MR, González-Rivero J, León JAM, Pérez ABJ, Morais IG, Bueno-Sacristán D, Ludeña MD. Intravascular schwannoma as an extremely unusual cause of vein obstruction: a case report. J Pathol Transl Med 2024; 58:249-254. [PMID: 38952255 PMCID: PMC11424199 DOI: 10.4132/jptm.2024.05.15] [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: 04/08/2024] [Accepted: 05/14/2024] [Indexed: 07/03/2024] Open
Abstract
The blood vessel lumen is an extremely rare location for a benign peripheral nerve sheath tumor like schwannoma. Less than 10 cases have been previously reported. In this report, we present a case of a 68-year-old woman who had a soft tissue nodule at the posterior calf of her left leg during a physical examination. Pathological examination was performed after complete surgical excision. The patient underwent follow-up for 12 months after surgery without evidence of recurrence or any other complication. This is the first case of intravascular schwannoma reported as a cause of vein obstruction. Microscopically, the tumor was composed of Schwann spindle cells that were immunoreactive for S100 protein and SOX10. This tumor was surrounded by a well-defined vascular smooth muscle wall. Prospective series are required to improve the knowledge on the underlying mechanisms of intravascular schwannoma development.
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Affiliation(s)
- Luis Miguel Chinchilla-Tábora
- Pathology Department, University Hospital of Salamanca, Salamanca, Spain
- University of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | - José María Sayagués
- Pathology Department, University Hospital of Salamanca, Salamanca, Spain
- University of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Marta Rodríguez González
- Pathology Department, University Hospital of Salamanca, Salamanca, Spain
- University of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Joaquín González-Rivero
- Pathology Department, University Hospital of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - José Antonio Muñoz León
- Pathology Department, University Hospital of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Andrea Beatriz Jiménez Pérez
- Pathology Department, University Hospital of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | | | - María Dolores Ludeña
- Pathology Department, University Hospital of Salamanca, Salamanca, Spain
- University of Salamanca, Salamanca, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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Dai A, Cai JP. Intravascular schwannoma: A review of a rare diagnosis. J Cutan Pathol 2020; 48:314-317. [PMID: 32623758 DOI: 10.1111/cup.13797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
While schwannoma is one of the most common types of benign peripheral nerve tumors in adults, a very unique and specific variant of schwannoma, the intravascular variant, is exceedingly rare. There have only been three previously published cases of intravascular schwannomas. Here we describe a fourth case of an intravascular schwannoma in a 47-year-old man with an enlarging subcutaneous nodule on his posterior calf. This is the second case of an intravascular schwannoma contained within a vein. Also included is an overview of intravascular schwannomas, including a description and discussion of the histopathological diagnosis, differential diagnoses, and schwannoma variants.
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Affiliation(s)
- Annie Dai
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jian-Ping Cai
- Dermatopathology, Florida Division of Dianon Systems/LabCorp, Tampa, Florida, USA
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3
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Fernandez-Flores A, Saeb-Lima M, Cassarino DS. Intramural schwannoma involving a vein. J Cutan Pathol 2018; 46:211-215. [PMID: 30421509 DOI: 10.1111/cup.13391] [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: 09/29/2018] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 12/01/2022]
Abstract
Schwannoma involving the blood vessels is a rare phenomenon. So far, only three cases of intravascular schwannoma have been described (all of which were intraluminal), and the origin of the schwannoma in such cases is not yet completely understood. Here, we describe a very rare intramural venous schwannoma in the subcutaneous right prepatellar area of a 31-year-old man. The schwannoma grew by enlarging and thickening the blood vessel wall, between two preserved layers of the vein. In some areas, there was erosion of the luminal layer, with fibrin apposed to the tumor. The tumor expressed S100 and was negative for CD31, CD34, desmin, and smooth muscle actin. The expression of p16 was preserved. Endothelial markers such as CD31 and Factor VIII showed the endothelial lining (which was D2-40-negative) above the tumor. Although degenerative atypia was present, there were no mitotic figures or necrosis identified.
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Affiliation(s)
- Angel Fernandez-Flores
- Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain.,Department of the CellCOM-SB Research Group, Biomedical Investigation Institute of A Coruña, A Coruña, Spain.,Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain
| | - Marcela Saeb-Lima
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Dermatopathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David S Cassarino
- Department of Dermatology, Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Los Angeles, California
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Ward RE, Shah JA, Mehregan DR, Ali L. A rare case of intravascular schwannoma. J Cutan Pathol 2018; 45:731-733. [DOI: 10.1111/cup.13328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/28/2018] [Accepted: 07/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Rachel Elizabeth Ward
- Department of Dermatology; Wayne State University School of Medicine; Detroit Michigan
| | - Julia A. Shah
- University of Toledo School of Medicine; Toledo Ohio
| | - Darius R. Mehregan
- Department of Dermatology; Wayne State University School of Medicine; Detroit Michigan
- Pinkus Dermatopathology Laboratory, Aurora Diagnostics; Monroe Michigan
| | - Liaqat Ali
- Department of Dermatology; Wayne State University School of Medicine; Detroit Michigan
- Pinkus Dermatopathology Laboratory, Aurora Diagnostics; Monroe Michigan
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Cornejo A, Lekah A, Kurklinsky AK. Neoplastic zebras of venous thrombosis: Diagnostic challenges in vascular medicine. Phlebology 2014; 30:744-8. [PMID: 25300312 DOI: 10.1177/0268355514555210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Venous thrombosis is a common medical problem. Imaging differentiation of neoplasms and venous clots may prove challenging. We report three cases of "mistaken identities" of venous thrombi and neoplasms on the basis of clinical findings and different imaging modalities: ultrasound, computed tomography, and magnetic resonance imaging. Imaging studies are not always reliable and consideration of clinical features, including pretest probability, is necessary for correct diagnosis. A combination of imaging modalities and biopsies is needed for correct diagnosis in some cases.
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Affiliation(s)
- A Cornejo
- Hospital Metropolitano in Quito, Ecuador
| | - A Lekah
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, USA
| | - A K Kurklinsky
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, USA
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Park J, Lee D. Intraarterial schwannoma in horizontal segment of middle cerebral artery causing subarachnoid hemorrhage. J Neurosurg 2013; 118:1069-71. [DOI: 10.3171/2013.2.jns122103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A spontaneous subarachnoid hemorrhage (SAH) from the middle cerebral artery is most commonly caused by the rupture of saccular aneurysms and rarely by fusiform aneurysms or arterial dissections/dissecting aneurysms. To the authors' knowledge, this is the first report of an intraarterial neoplasm causing an SAH. A 44-year-old woman presented with an SAH in the basal cisterns. Subsequent internal carotid artery angiography demonstrated a small bulge on the superior wall of the horizontal (M1) segment of the middle cerebral artery. However, a pterional craniotomy revealed a well-circumscribed solitary tumor with a diameter of 15 mm involving the superior wall of the M1 segment as the cause of the SAH. Pathological examination demonstrated typical findings of a schwannoma, elongated cells with tapered, spindle-shaped nuclei and indistinct cell borders, and diffuse immunoreactivity for the S100 protein.
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Affiliation(s)
| | - Dakeun Lee
- 2Pathology, Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea
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