Acoustic neuroma

Case contributed by A.Prof Frank Gaillard

Presentation

Sensory neural hearing loss.

Patient Data

Age: 48 years
Gender: Female
MRI

Right cerebellopontine angle mass is seen to extend into the right internal acoustic canal which it enlarges. It demonstrates mass effect and slight distortion on the right middle cerebellar peduncle but no evidence of abnormal T2/FLAIR signal to suggest oedema or gliosis.

The mass is characterised by low T1 signal, intermediate T2 signal with areas of cystic change and demonstrates heterogeneous enhancement.

Small right Meckels cave enhancing lesion likely represents a small right trigeminal nerve schwannoma and measures 6 x 5 x 7 mm (AP x RL x CC).

The left internal acoustic canal is normal with no suggestion of mass.

Conclusion:

1. Right cerebellopontine angle mass demonstrates features characteristic for an acoustic neuroma.

2. Right trigeminal schwannoma.

Presence of two (presumed) schwannomas raises the possibility of NF2 although in the absence of other tumours, and in this age group this is less likely.

Case Discussion

The patient went on to have resection of the presumed acoustic schwannoma, confirming the diagnosis. 

Histology

MICROSCOPIC DESCRIPTION: Paraffin sections show fragments of moderately hypercellular

neurilemmoma (Schwannoma). This is composed of both Antoni A and B type tissues. Well formed Verocay bodies are noted in Antoni A areas.

Moderate numbers of blood vessels with thickened hyalinised walls are also noted. Tumour cells show mild nuclear pleomorphism. No mitotic figures or areas of necrosis are identified.

FINAL DIAGNOSIS: Right acoustic nerve schwannoma

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Case information

rID: 34049
Case created: 3rd Feb 2015
Last edited: 10th Sep 2015
Inclusion in quiz mode: Included

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