Acoustic schwannoma - cystic

Case contributed by Jack Ren

Presentation

Sensory hearing neural loss

Patient Data

Age: 54 years
Gender: Male
CT

There is a left extraaxial mass measuring approximately 2.7 x 2.5 cm in transverse diameter, which causes distortion upon the left middle cerebellar peduncle and fourth ventricle.

There is no evidence of supratentorial hydrocephalus. The mass demonstrates foci of increased density within the central aspect of the lesion.

The left internal auditory canal is enlarged measuring approximately 11 mm (on the right it measures 6 mm).

The facial nerve canal is symmetric (3mm).

Normal symmetric mastoid air cells and middle ear cavity.

Left mastoid air cells and anterior middle ear cavity demonstrate fluid/mucus.

Normal grey white matter differentiation with no evidence of acute infarct.

Likely co dominant transverse sinuses.

Conclusion:

Left extra axial mass with distortion upon the left middle cerebellar peduncle and fourth ventricle.

No evidence of supratentorial hydrocephalus.

There is widening of the left internal auditory canal and in association with the incorporated MRI, the findings are likely consistent with an acoustic neuroma. Given the cystic appearance on MRI a meningioma is thought less likely.

MRI

No report data found

MICROSCOPIC DESCRIPTION:

The sections show a moderately cellular schwannoma. It mainly contains Antoni A areas with fascicles of spindle cells. There is focal palisading with Verocay body formation. The tumour cells show focal ancient change with moderate nuclear enlargement and smudged chromatin. Mitoses are inconspicuous. Scattered foamy macrophages are noted. There is no evidence of necrosis. No evidence of malignancy is identified.

DIAGNOSIS:

Brain tumour: Schwannoma.

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Case information

rID: 29487
Case created: 30th May 2014
Last edited: 6th Oct 2015
Inclusion in quiz mode: Included

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