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1.
Medicine (Baltimore) ; 99(40): e21433, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019381

RESUMO

INTRODUCTION: Intradural schwannomas can occur at any level of the spine. According to the literature, approximately 8% of intradural schwannomas occur in the atlantoaxial spine, and these tumors are usually located in the posterolateral or lateral spinal cord. In contrast, tumors in the ventral midline of the spinal cord are relatively rare. PATIENT CONCERNS: A 47-year-old female presented with progressively worsening neck pain and paresthesias in both upper and lower limbs for the past 5 years. DIAGNOSIS: Based on Magnetic Resonance Imaging and histopathological findings, she was diagnosed with ventral midline primary schwannoma of the cervical spinal cord. INTERVENTIONS: The patient was treated with surgical resection. OUTCOMES: Follow-up visit at 2 years after the surgery showed that the patient is neurologically intact and free of disease. CONLUSION: In summary, for the tumors in the ventral midline of the atlantoaxial spinal cord, the preferred treatment is complete surgical resection by the posterior approach compared to the anterior approach, which often improves clinical symptoms or achieves a healing effect.


Assuntos
Neurilemoma/patologia , Neoplasias da Medula Espinal/patologia , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia
2.
HNO ; 68(10): 734-748, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32886128

RESUMO

INTRODUCTION: Hearing rehabilitation with cochlear implants has attracted increasing interest also for patients with cochleovestibular schwannoma. The authors report their experience with the surgical management of tumors with rare transmodiolar or transmacular extension and outcomes after cochlear implantation (CI). METHODS: This retrospective case series included nine patients with either primary intralabyrinthine tumors or secondary invasion of the inner ear from the internal auditory canal. The primary endpoint with CI, performed in six patients, was word recognition score at 65 dB SPL (sound pressure level). Secondary endpoints were intra- and postoperative electrophysiological parameters, impedance measures, the presence of a wave V in the electrically evoked (via the CI) auditory brainstem responses, the specifics of postoperative CI programming, and adverse events. RESULTS: Hearing rehabilitation with CI in cases of transmodiolar tumor growth could be achieved only with incomplete tumor removal, whereas tumors with transmacular growth could be completely removed. All six patients with CI had good word recognition scores for numbers in quiet conditions (80-100% at 65 dB SPL, not later than 6 to 12 months post CI activation). Four of these six patients achieved good to very good results for monosyllabic words within 1-36 months (65-85% at 65 dB SPL). The two other patients, however, had low scores for monosyllables at 6 months (25 and 15% at 65 dB SPL, respectively) with worsening of results thereafter. CONCLUSIONS: Cochleovestibular schwannomas with transmodiolar and transmacular extension represent a rare entity with specific management requirements. Hearing rehabilitation with CI is a principal option in these patients.


Assuntos
Implante Coclear , Implantes Cocleares , Neurilemoma , Neuroma Acústico , Humanos , Neurilemoma/terapia , Neuroma Acústico/terapia , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 99(38): e22307, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957393

RESUMO

RATIONALE: Schwannoma is a benign peripheral nerve sheath tumor composed of Schwann cells and caused by genetic mutation or deletion. It rarely occurs in seminal vesicles. The optimal therapic strategy for asymptomatic cases is still unclear. PATIENT CONCERNS: A 42-year-old man presented no clinical symptoms. A mass in his left seminal vesicle was found incidentally in a computed tomography scan and transrectal ultrasound-guided biopsy revealed the mass was schwannoma. DIAGNOSIS: The patient was diagnosed as schwannoma of the seminal vesicle with no significant extension to the surrounding tissues. INTERVENTIONS: The patient underwent computed tomography or magnetic resonance imaging scans periodically to estimate the alteration of the lesion and further strategy. OUTCOMES: After 20-month follow-up, computed tomography scans showed no significant alteration to the lesion and no clinical symptoms were reported by the patient. LESSONS: Conservative strategy might be an effective treatment option for asymptomatic patients with seminal vesical schwannoma. The period of follow-up depends on the size of the tumor.


Assuntos
Tratamento Conservador/métodos , Neoplasias dos Genitais Masculinos/terapia , Neurilemoma/terapia , Adulto , Neoplasias dos Genitais Masculinos/diagnóstico por imagem , Neoplasias dos Genitais Masculinos/patologia , Humanos , Achados Incidentais , Imagem por Ressonância Magnética , Masculino , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Glândulas Seminais/diagnóstico por imagem , Glândulas Seminais/patologia , Tomografia Computadorizada por Raios X
4.
Artigo em Russo | MEDLINE | ID: mdl-32929931

RESUMO

Neurofibromatosis type 2, a rare disease, the most characteristic manifestation of which is the presence of bilateral vestibular schwannomas, less often schwannomas of other cranial, spinal and peripheral nerves. Much less frequent are meningiomas (intracranial, including meningiomas of the optic nerves, and spinal), epindymomas and gliomas. As a rule, in one patient several formations occur simultaneously, which creates a certain difficulty in treatment tactics. The authors present a case of type 2 neurofibromatosis in a 22-year-old female patient with multiple schwannomas of spinal roots and an atypical intraventricular meningioma.


Assuntos
Glioma , Neoplasias Meníngeas , Meningioma , Neurilemoma , Neurofibromatose 2 , Adulto , Feminino , Humanos , Adulto Jovem
5.
Medicine (Baltimore) ; 99(33): e21603, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872015

RESUMO

RATIONALE: Schwannomas of the seminal vesicles are extremely rare, and only cases of single seminal vesicle schwannomas have been reported. Here, we report a case of multiple schwannoma of the seminal vesicle. PATIENT CONCERNS: We report a rare case of multiple schwannoma of the seminal vesicle that occurred in a 48-year-old man during physical examination. Multiple mixed masses in the left region of the seminal vesicle were documented with transrectal ultrasonography and magnetic resonance imaging. The patient presented no clinical symptoms, no family history of the disease and no history of genetic disease. DIAGNOSIS: Postoperative pathology revealed a diagnosis of seminal vesical schwannoma. INTERVENTIONS: The patient underwent robotic-assisted laparoscopic surgery to remove the mass. OUTCOMES: The patient recovered rapidly and the length of hospitalization was 6 days after operation. At present, there is no recurrence in 10 month follow up. LESSONS: Whether benign or malignant, single or multiple, schwannomas still need to be diagnosed by pathology because of the limitations of examination methods. Surgical resection is still the preferred treatment.


Assuntos
Neoplasias dos Genitais Masculinos/patologia , Neurilemoma/patologia , Glândulas Seminais/patologia , Neoplasias dos Genitais Masculinos/diagnóstico por imagem , Neoplasias dos Genitais Masculinos/cirurgia , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Glândulas Seminais/diagnóstico por imagem
6.
Medicine (Baltimore) ; 99(38): e21765, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957306

RESUMO

INTRODUCTION: Neurogenic tumors are the most frequent neoplasms of the lower posterior mediastinum. Traditionally, lower posterior mediastinal tumors are excised by video-assisted thoracic surgery. However, the available robotic treatment for the lower posterior mediastinum tumors to date are rare. Herein, we report a case of a right lower posterior mediastinal tumors successfully treated with retroperitoneal robot-assisted surgery using a transdiaphragmatic approach. PATIENT CONCERNS: A 54-year-old male patient without any symptoms was admitted into our department with a right lower posterior mediastinal paravertebral tumor that was detected during a medical check-up. DIAGNOSIS: A right lower posterior mediastinal paravertebral tumor. INTERVENTIONS: Retroperitoneal robot-assisted resection using a transdiaphragmatic approach was performed. OUTCOMES: The patient was treated with retroperitoneal robot-assisted surgery using a transdiaphragmatic approach and remained disease-free throughout a 6-month follow-up. His postoperative course was uneventful. Histopathological examination revealed a benign schwannoma. CONCLUSION: Our initial experience showed that retroperitoneal robot-assisted resection of a lower posterior mediastinal tumor using a transdiaphragmatic approach is technically feasible and can be considered a potential alternative for either video-assisted thoracic surgery or a thoracotomy.


Assuntos
Neoplasias do Mediastino/cirurgia , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Masculino , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neurilemoma/patologia
7.
Arch. argent. pediatr ; 118(4): e410-e413, agosto 2020. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1118594

RESUMO

El schwannoma es un tumor primario, habitualmente, benigno, procedente de las células de Schwann, productoras de la vaina de mielina que recubre los nervios periféricos. Constituye menos del 10 % de los tumores intracraneales y es infrecuente en la edad pediátrica.Se presenta a un paciente de 6 años y 11 meses de edad, previamente sano, con antecedente de cefalea holocraneana intermitente asociado a proptosis y disminución de la agudeza visual del ojo izquierdo, epífora y estrabismo, con evidencia tomográfica de una masa retroocular. Se realizó la exéresis macroscópicamente completa, con diagnóstico anatomopatológico de schwannoma orbitario


Schwannoma is a usually benign primary tumor. It develops from the Schwann cells, which produce the myelin sheath that surrounds the peripheral nerves. It represents less than 10 % of the intracranial tumors, and it is infrequent in the pediatric age.We hereby present a 6-year-and-11-month-old previously healthy patient, with a history of intermittent generalized cephalea associated with proptosis and a diminished visual acuity of the left eye, epiphora and strabismus, with radiological evidence of retro-ocular mass. A macroscopically complete exeresis was performed, with an anatomopathological diagnosis of orbital schwannoma


Assuntos
Humanos , Masculino , Criança , Células de Schwann , Neurilemoma/diagnóstico por imagem , Órbita/lesões , Exoftalmia , Neoplasias , Neurilemoma/cirurgia
8.
Medicine (Baltimore) ; 99(31): e21527, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756198

RESUMO

RATIONALE: Schwannoma is a tumor of the peripheral nervous system that originated in the Schwann cells of the neural sheath. Esophageal schwannomas are rare esophageal submucosal tumors, comprising approximately 2% of esophageal tumors. Since the symptoms, signs, and images of esophageal schwannoma are not specific, its preoperative diagnosis remains challenging. PATIENT CONCERNS: A 67-year-old woman visited our department with complaints of gradually developed dysphagia and dyspnea for 4 years. A chest computed tomography scan showed a well-demarcated, enhancing homogeneous tumor measuring 61 × 46 × 60 mm in the upper third of the esophagus. Upper gastrointestinal endoscopy revealed a smooth elevated lesion located 19 to 24 cm from the incisor teeth. An endoscopic ultrasound-guided fine-needle aspiration demonstrated the presence of benign spindle cells. DIAGNOSES: Histopathologic examination revealed spindle-shaped cells in a fasciculated and disarrayed architecture. The immunohistochemical study showed positivity for S-100 protein antibody and absence of staining for CD117, CD34, smooth muscle actin, and Desmin. These findings confirmed the diagnosis of benign esophageal schwannoma. INTERVENTIONS: The tumor was considered to be difficult to repair the esophagus by direct anastomosis after tumor resection. Therefore, subtotal esophagectomy and esophagogastrostomy in the right thorax were performed. OUTCOMES: The patient has been doing well with no recurrence at 36 months after the operation. LESSONS: The symptoms and surgical procedures for benign esophageal schwannoma depend on the size and location of the tumor, proper and timely treatment is essential. A definitive diagnosis is confirmed by histology, and complete excision should yield good results.


Assuntos
Neoplasias Esofágicas/patologia , Neurilemoma/patologia , Idoso , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Neurilemoma/cirurgia
9.
Medicine (Baltimore) ; 99(29): e20940, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702833

RESUMO

RATIONALE: Schwannomas are mesenchymal tumors with low malignant potential that originate from Schwann cells. They can occur in most parts of the body, such as the head, neck, and extremities. Schwannoma in the hepatoduodenal ligament is extremely rare, and only four cases have been reported in the literature. PATIENT CONCERNS: Herein, we describe a 58-year-old female who presented with right epigastric pain for 10 days. Preoperative computed tomographic (CT) revealed a 4.5 cm × 3.8 cm tumor in the hepatic hilar area. DIAGNOSES: Schwannoma in the hepatoduodenal ligament with portal vein invasion. INTERVENTIONS: Intraoperative findings revealed that the tumor was identified in the hepatoduodenal ligament, and the left branch of the portal vein was compressed. Complete tumor resection with reparation of the portal vein was performed for the patient. Postoperative pathological examination confirmed the final diagnosis of benign schwannoma, characterized by abundant spindle-shaped cells and positive reactivity for S-100 protein. OUTCOMES: The patient had a good prognosis and had no recurrence after 37 months of follow-up. LESSONS: Our case of schwannoma in the hepatoduodenal ligament is unique owing to the portal vein invasion, aimed at helping recognize the difficulty of preoperative diagnosis.


Assuntos
Ligamentos/patologia , Neurilemoma/patologia , Omento/patologia , Neoplasias Peritoneais/patologia , Veia Porta/patologia , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Ligamentos/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Omento/diagnóstico por imagem , Omento/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Tomografia Computadorizada por Raios X
10.
Zhonghua Wai Ke Za Zhi ; 58(8): 653-656, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727200

RESUMO

Trigeminal schwannomas(TSs) is the second most common intracranial schwannomas next to acoustic neuroma. These uncommon, slow-growing tumors, which prove to originated from Schwann cells of the fifth brain nerve, can achieve their development into various compartments.Previous to the era of microsurgery, the total tumor resection rate was low, and the postoperative neurological function was seriously damaged.With the development of microsurgery and skull base approach, the microsurgery effect of TSs has been improved. Besides, neuroendoscopy is also used in the operation of some types of trigeminal schwannomas. Radiation therapy can be performed to control tumor growth for the patients who cannot tolerate surgery, have small tumor volume, have residual tumor tissue or relapse.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Doenças do Nervo Trigêmeo/cirurgia , Neoplasias dos Nervos Cranianos/radioterapia , Humanos , Microcirurgia , Neurilemoma/radioterapia , Neuroendoscopia , Resultado do Tratamento , Doenças do Nervo Trigêmeo/radioterapia
11.
Medicine (Baltimore) ; 99(25): e20747, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569218

RESUMO

RATIONALE: Optic Schwannoma is rarely observed clinically as optic nerve had anatomically impossibility for the location of Schwannoma. However, several reports described the established cases of optic Schwannoma, of which the locations were in orbit or within optic canal. The occurrence of optic Schwannoma intracranially has been not reported. PATIENT CONCERNS: A 60-year-old female complained of visual impairment in the right eye and the frequent headache and the dizziness over 2 years with unknown reasons. The result of magnetic resonance imaging (MRI) showed a round, well-circumscribed, heterogeneously enhancing signal with cystic change displayed on the right suprasellar cistern. DIAGNOSES: Intracranial optic Schwannomas. INTERVENTIONS: The patient accepted microneurosurgery assisted by endoscopy. We observed a gray and yellow lesion located near the right anterior clinoid process with a mid-sized cyst. And there was a vague boundary between the tumor and the right optic nerve which was compressed by the tumor. Optic chiasm and left optic nerve were also compressed. Meanwhile, the tumor had also adhesion to the right anterior cerebral artery (ACA). OUTCOMES: After the tumor was totally resected, the patient had satisfactory recovery. LESSONS: We reported an intracranial optic Schwannoma removal with the lateral supraorbital keyhole approach assisted by neuroendoscopy. Intracranial optic Schwannoma was rarely seen clinically. Neuroendoscopy imaging suggested the close relationship between the tumor and ACA, supporting vasculature-origin hypothesis for the optic Schwannoma.


Assuntos
Microcirurgia/métodos , Neurilemoma/cirurgia , Neuroendoscopia/métodos , Neoplasias do Nervo Óptico/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/cirurgia , Neoplasias do Nervo Óptico/diagnóstico por imagem
13.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 105-111, mayo-jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-192414

RESUMO

ANTECEDENTES/OBJETIVOS: Los tumores de los nervios periféricos son lesiones poco frecuentes que se categorizan en general dentro de los tumores de partes blandas, por lo que suelen ser manejados por diferentes disciplinas quirúrgicas, como cirugía plástica, cirugía ortopédica y traumatológica, dermatología, cirugía general y neurocirugía. Un conocimiento apropiado en cuanto a la indicación terapéutica y el manejo quirúrgico es fundamental de cara a evitar un déficit neurológico en el paciente. MATERIALES Y MÉTODOS: Estudio restrospectivo donde se presenta la experiencia conjunta de 2 equipos quirúrgicos especializados en la cirugía de los nervios periféricos, 66 lesiones tumorales, en un total de 64 pacientes. RESULTADOS: La localización más frecuente fue el miembro inferior y el miembro superior con 48 lesiones tumorales. El diagnóstico anatomopatológico más frecuente fue el de schwannoma, con un 51,5%. La resección tumoral completa se logró en el 81,8% de las lesiones y siempre con estimulación o monitorización neurofisiológica. La complicación posquirúrgica más frecuente fue el dolor neuropático o un trastorno sensitivo transitorio en el 15% de las cirugías, apareciendo solo un déficit motor persistente en 2 casos que requirieron reconstrucción con injerto nervioso. CONCLUSIONES: Si bien el manejo terapéutico de los tumores benignos como los schwannomas puede considerarse relativamente sencillo aplicando los conceptos básicos en microcirugía de los nervios periféricos, los tumores malignos, si bien son muy infrecuentes, requieren de un manejo multidisciplinar. La opción de la biopsia prequirúrgica a día de hoy sigue siendo un tema controvertido y sin acuerdo entre los diferentes autores; en nuestra opinión, no es necesaria su realización de forma percutánea en la mayoría de los casos


BACKGROUND/OBJECTIVES: Peripheral nerve tumours (PNT) are rare lesions that are generally categorised as soft tissue tumours, so they are usually managed by a range of surgical disciplines such as plastic, orthopaedic and trauma surgery, dermatology, general surgery and neurosurgery. Appropriate knowledge of the therapeutic indication and surgical management are essential in order to avoid neurological deficit. MATERIALS AND METHODS: This is a retrospective study of 66 tumour lesions in 64 patients, acquired from the joint experience of 2 surgical teams specialised in peripheral nerve surgery. RESULTS: The most common location was the lower limb and upper limb with 48 tumour lesions. The most common pathological diagnosis was Schwannoma, accounting for 51.5%. Complete tumour resection was achieved in 81.8% of the lesions and always with neurophysiological stimulation and/or monitoring. The most common postsurgical complication was neuropathic pain and/or a transient sensory disorder in 15% of surgeries, with only one persistent motor deficit appearing in 2cases that required nerve graft reconstruction. CONCLUSIONS: Although the therapeutic management of benign tumours such as Schwannomas can be considered to be relatively simple thanks to the application of the basic concepts of peripheral nerve microsurgery, malignant tumors, despite being very rare, require multidisciplinary management. The option of pre-surgical biopsy remains a controversial issue and no consensus has been reached among the different authors. In our opinion, percutaneous biopsy is not necessary in most cases


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias do Sistema Nervoso Periférico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Estudos Retrospectivos , Neurilemoma/diagnóstico por imagem , Dor Pós-Operatória/complicações , Nervos Periféricos/anatomia & histologia , Nervos Periféricos/patologia
16.
Kyobu Geka ; 73(2): 157-159, 2020 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-32393727

RESUMO

A 18-year-old man was referred to our hospital complaining of chest abnormal shadow of the left upper lung field in mass screening chest X-ray. Although his left anterior chest wall swelled, he did not recognize that. Computed tomography and magnetic resonance imaging demonstrated a dumbbell shaped tumor of the left 1st intercostal space which had grown both inside and outside the thoracic cavity. As a possibility of solitary fibrous tumor or myxoma was not excluded, the patient underwent tumor resection. A solid tumor connected to the 1st intercostal nerve was easily dissected from surrounding tissue. Pathological examination revealed the tumor was consisted of spindle shaped cells without atypia, and diagnosed as neurilemmoma without malignancy. Based on anatomical pathway of intercostal nerves, we speculate that the tumor originated from anterior cutaneous nerve.


Assuntos
Neurilemoma , Parede Torácica , Adolescente , Humanos , Nervos Intercostais , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
17.
Gan To Kagaku Ryoho ; 47(5): 835-837, 2020 May.
Artigo em Japonês | MEDLINE | ID: mdl-32408331

RESUMO

The patient was a 52-year-old woman, who was found to have an abnormality in the upper gastrointestinal(UGI)tract, via a contrast-imaging study; she had no symptoms.Computed tomography(CT)revealed a tumor, measuring approximately 100mm in diameter, in the antrum of the stomach.The tumor was diagnosed as gastric schwannoma using endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA).Preoperative CT revealed multiple lymph adenopathies around the antrum, which led to the suspicion of lymph node metastasis. The patient underwent a laparoscopic partial gastrectomy after the confirmation of the absence of lymph node metastasis by intraoperative rapid diagnosis.


Assuntos
Laparoscopia , Neurilemoma , Neoplasias Gástricas , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Gastrectomia , Humanos , Pessoa de Meia-Idade
18.
S D Med ; 73(4): 150-151, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32445301

RESUMO

INTRODUCTION: Schwannomas are benign neurogenic tumors that make up less than 1 percent of all gastrointestinal tumors. Schwannoma can occur along peripheral nerves anywhere throughout the body. Gastrointestinal schwannoma is relatively rare and most commonly occurs in the stomach, small intestine, and colon, respectively. There have only been a handful of case reports describing appendiceal schwannomas. Approximately 30-50 percent of appendicular tumors show clinical symptoms and signs similar to those of appendicitis. CASE REPORT: A 36-year-old male presented initially for right lower quadrant pain of one day duration. He denied any other associated symptoms. CT imaging of abdomen and pelvis showed a fluid-filled and dilated appendix with fat stranding consistent with appendicitis. He underwent laparoscopic appendectomy without complication. The pathology report showed a well-defined proliferation of bland uniform cells that contained small smooth nuclei and abundant foamy cytoplasm at the tip of the appendix. Scattered eosinophils were noted. These neoplastic cells were positive for S100 and negative for CD68, CD34, and CD117, most consistent with a schwannoma. DISCUSSION: Diagnosing appendiceal schwannoma pre-operatively is a challenging task due to the rare nature of the tumors and the lack of clinical features to separate it from other appendiceal pathology. Appendiceal schwannomas are benign but it is unclear if malignant transformation is possible if left untreated. While there are currently no agreed upon treatment guidelines for appendiceal schwannoma, it is currently thought that complete surgical resection is the best treatment while chemotherapy and radiotherapy are not effective.


Assuntos
Apendicectomia , Apendicite , Laparoscopia , Neurilemoma , Doença Aguda , Adulto , Apendicite/cirurgia , Humanos , Achados Incidentais , Masculino , Neurilemoma/diagnóstico
19.
PLoS One ; 15(5): e0233623, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469953

RESUMO

OBJECTIVES: To retrospectively determine the diagnostic ability of MRI in differentiating between intradural extramedullary spinal schwannomas and meningiomas. METHODS: A total of 199 patients with spinal intradural extramedullary tumors who underwent preoperative contrast-enhanced MRI between January 2012 and December 2018 were included in this study. Two radiologists independently analyzed the presence of cystic change, dural tail sign, and neural foraminal extension. Clinical and MRI features between the two groups were compared by univariable and multivariable analyses using logistic regression. Interobserver agreements were calculated using kappa statistics. RESULTS: Patients with schwannoma showed significantly higher frequency of cystic change (96% vs 24%, P < 0.001), neural foraminal extension (29% vs 3%, P = 0.001), and lumbar location (41% vs 5%, P = 0.008). Patients with meningioma showed significantly higher frequency of dural tail sign (64% vs 1%, P < 0.001), thoracic location (75% vs 31%, P = 0.007), older age (59.7 years vs 47.6 years, P < 0.001), higher female predominance (83% vs 50%, P < 0.001), and smaller size (19.8 cm vs 28.8 cm, P < 0.001). Multivariable analysis showed that cystic change (P < 0.001; odds ratio [OR], 0.02), dural tail sign (P < 0.001; OR, 36.23), age (P = 0.032; OR, 1.06), and lumbar location (P = 0.006; OR, 0.02) were independent factors. Interobserver agreements were almost perfect for all analyses. CONCLUSIONS: MRI features were useful in differentiating between intradural extramedullary schwannomas from meningiomas. The presence of cystic change and dural tail sign were independently significant discriminators.


Assuntos
Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Células de Schwann/patologia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia
20.
World Neurosurg ; 138: 440-443, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251817

RESUMO

BACKGROUND: Spinal schwannomas are benign nerve sheath neoplasms that constitute about 30% of extramedullary spinal cord tumors. They are usually small, well-encapsulated tumors with low mitotic activity and concurrently carry a low risk of recurrence. Here, we report a case of atypical histologic variant of spinal schwannoma that had higher cellular density, nuclear atypia, and lack of encapsulation. To our best knowledge, no such cases of this atypical variant with regards to lumbar spine have been reported in the literature. CASE DESCRIPTION: A 66-year-old male had an incidental left-sided paraspinal mass discovered while undergoing workup for cholecystitis. On examination, the patient was neurologically intact. Imaging revealed the presence of a contrast-enhanced, partially cystic mass arising from the L3-4 intervertebral foramen and causing left psoas muscle displacement. A minimally invasive left L3-4 posterior extracavitary resection was done. Histopathologic examination revealed a partly unencapsulated tumor with higher than usual cellular density and nuclear atypia, resulting in a diagnosis of "atypical schwannoma." Imaging at 6 months' follow-up showed stable postsurgical changes and residual tumor with no evidence of progression/recurrence. CONCLUSIONS: Atypical schwannoma has higher cellular density and nuclear atypia and lacks encapsulation. A review of the literature suggests an increased risk of recurrence when compared with typical variants, and complete tumor removal should be attempted.


Assuntos
Vértebras Lombares/patologia , Neurilemoma/patologia , Neoplasias da Medula Espinal/patologia , Idoso , Colecistite/complicações , Colecistite/diagnóstico por imagem , Forame Magno/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Neoplasias da Bainha Neural/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
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