Presentation
Left-prominent quadriparesis
Patient Data
The mass in the right cerebellar angle broadens the right porus acusticus, measuring about 49 x 42 mm. The mass shows a circumscribed and lobulated appearance, consisting of both tissue and a prominent cyst, with no restricted diffusion. After gadolinium injection, the tissue lesion shows dark on SWI and enhanced. The mass causes edema in the adjacent parenchymal brain and compression of the brainstem and fourth ventricle, resulting in the enlargement of the bilateral lateral ventricles and the third ventricle.
The CT scan was performed after ventriculoperitoneal shunt surgery. Similar to the appearances on MRI images, the mass exhibits two parts with hypo density (suggestive of a cyst) and tissue density.
The patient underwent tumor removal surgery, and here is the pathology result:
I. Gross description:
The specimens, ranging in size from 0.3 cm to 1.4 cm, displayed a mixture of grey-black and gold hues, all consolidated into one cassette.
II. Microscopic description:
On the section made from the received specimen and stained with hematoxylin and eosin: The tissue sections taken from the tumor exhibit regions with alternating cell-rich and cell-poor areas. The tumor cells are spindle-shaped, with pointed and slightly undulating nuclei, arranged in bundles or spirals, forming areas resembling a Verocay body. The edematous stromal tissue shows significant infiltration of small lymphocytes and scattered thick-walled blood vessels. No atypical cells, mitosis, or necrosis were observed.
III. Conclusion:
The histopathological findings are indicative of schwannoma.
Case Discussion
In this case, we might have a differential diagnosis: cystic meningioma. However, the darkness on SWI, heterogeneous enhancement, and particularly the broadening of the right porus acusticus internus indicate a schwannoma.
Unable to process the form. Check for errors and try again.