Large pre-sacral mass, well circumscribed with high T2 signal. No communication with the bowel or spinal canal.
Case Discussion
The patient underwent a resection.
Histology
Macroscopic appearance
The sectioned surfaces of the larger pieces are solid and variegated with tan and yellow areas in additional to well-circumscribed, shiny white foci of probable calcific areas. Other fragments show a muscular tissue appearance on sectioned surfaces as well as on the outer surface. In other fragments, the cut surfaces are more soft and gelatinous.
Microscopy
Representative sections show characteristic features of Schwannoma. The tumor is composed mostly of hypercellular (Antoni A) areas with some alternating hypocellular (Antoni B) areas. There are subtle Verocay bodies. At low power, there is marked nodularity to this Schwannoma. Areas of hyalinization as well as hyalinized blood vessels are seen. Clusters of reactive lymphocytes are seen. The areas between the nodules of this Schwannoma are made of dense connective tissue. There are no atypical features such as mitotic activity, necrosis, or marked pleomorphism. The tumor cells are immunoreactive for S-100. Neurofilament immunostaining shows scattered nerve twigs between the tumor nodules and occasionally within the tumor. Overall, this tumor represents benign Schwannoma.
Final Diagnosis: Schwannoma.
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