Presentation
Hoarseness of voice
Patient Data
There is a moderate sized mildly lobulated hypodense cystic lesion with few thin internal septations in the right CP angle region, extending along the ipsilateral jugular foramen with small extracranial component. There is associated mild to moderate smooth widening of jugular foramen and mass effect on adjacent middle cerebellar peduncle, pons and upper medulla. Few trace hemorrhages are seen within the lesion. No significant enhancement on postcontrast images.
Jugular foramen schwanomma with hemorrhage is the likely possibility.
Histopathology report:
Macroscopic: received grey white soft tissue measuring approximately 3 x 2 x 1 cm.
Microscopic: the tumor shows hypercellular and hypocellular areas composed of fascicles of spindle cells with elongated nuclei. There is nuclear palisading with focal Versace bodies. There is no significant nuclear atypia / increased in mitosis activity or any other evidence of malignancy. Perivascular hyalinisation is noted.
Impression: Schwanomma
Case Discussion
Schwannomas are benign tumors of Schwann cell origin and are the most common tumor of peripheral nerves, including cranial nerves. Most of the cases are sporadic,however, there is an association with neurofibromatosis type 2.
In jugular foramen it is likely to originate from cranial nerves IX, X, XI or XII. In this case mass effect on cranial nerve X is responsible for patient symptom of hoarseness of voice.
Others common differential diagnosis of jugular foramen lesion includes paraganglioma and meningioma.