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MRI of the brain with contrast demonstrates a mass in the right cerebellopontine angle. It is heterogeneous in signal, enhances vividly, and extends a tongue of tissue into the internal acoustic meatus. It appears to be an isolated abnormality.
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This patient went on to have a resection.
MICROSCOPIC DESCRIPTION: The sections show multiple fragments of tumour, comprising spindle cells forming loose fascicles and sheets, with occasional foci of nuclear palisading (Verocay body formation). There are scattered thick-walled vessels, and there are extensive areas of foam cell and lymphocytic infiltration within the tumour. Foci of haemosiderin deposition are also noted. There is no necrosis and mitotic activity is minimal. In some foci, tumour cell nuclei show some hyperchromasia and atypia, (ancient change).
FINAL DIAGNOSIS: Right acoustic schwannoma.
This case illustrates the typical appearances of acoustic schwannomas, including heterogeneity of signal and enhancement - a common feature of larger tumours.