Acoustic schwannoma

Case contributed by Jack Ren

Presentation

3 weeks of nausea and vomiting, unsteady gait

Patient Data

Age: 63 years
Gender: Male
Modality: CT

CT brain has been performed for surgical planning.

Right CP angle mass is again noted which causes mass effect on the adjacent

Right cerebellum and slight distortion of the fourth ventricle but does not occlude it.

No significant ventricular dilation.

Modality: MRI

33 x 26 x 31 mm extraaxial mass in the right cerebellopontine angle.

The lesion has low to intermediate signal on T2 weighted images and intermediate T1 signal.

There is homogeneous enhancement post administration of contrast. There is a possibility of peripheral nonenhancing cystic elements around the more solid enhancing lesion. The lesion bulges into the porus acousticus which appears mildly expanded.

On the high resolution Fiesta images the nerves in the internal acoustic meatus can be seen separately to the mass. The superior aspect of the lesion abuts the undersurface of the tentorium with a possible dural tail in this region.

Laterally the lesion abuts the petrous ridge, extending to the region of the jugular foramen.

There is moderate oedema in the adjacent cerebellar hemisphere and there is moderate mass effect on the right middle cerebral peduncle. Compressed vessels are seen around the lesion. There is distortion of the fourth ventricle and mild hydrocephalus seen involving the lateral and third ventricles.

Conclusion:

Right cerebello pontine angle mass with moderate local mass effect.

The differential diagnosis is between meningioma and vestibular schwannoma, with meningioma slightly favoured on the imaging appearance but both lesions remain in the differential diagnosis.

MICROSCOPIC DESCRIPTION: 

Paraffin sections show fragments of a moderately hypercellular neurilemmoma (Schwannoma) composed of both Antoni-A and B type tissues. Moderately well formed Verocay bodies are noted in Antoni-A areas. Tumour cells have uniform nuclear features. No mitotic figures, densely hypercellular areas or areas of necrosis are identified.

DIAGNOSIS:

Right CP angle tumour: Neurilemmoma (Schwannoma).

PlayAdd to Share

Case Information

rID: 29488
Case created: 30th May 2014
Last edited: 6th Oct 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.