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+/-peripheral lymphoid cuff (esp. GI tract) | +/-peripheral lymphoid cuff (esp. GI tract) | ||
| Subtypes = conventional schwannoma, cellular schwannoma, plexiform schwannoma, melanotic schwannoma | | Subtypes = conventional schwannoma, cellular schwannoma, plexiform schwannoma, melanotic schwannoma | ||
| LMDDx = [[meningioma]], [[leiomyoma]], [[GIST]], [[intranodal palisaded myofibroblastoma]], [[MPNST]] | | LMDDx = [[meningioma]], [[leiomyoma]], [[GIST]], [[intranodal palisaded myofibroblastoma]], [[MPNST]], [[neurofibroma]], [[biphenotypic sinonasal sarcoma]] | ||
| Stains = | | Stains = | ||
| IHC = S-100 +ve, EMA -ve, CD34 +ve | | IHC = S-100 +ve, EMA -ve, CD34 +ve | ||
| Line 17: | Line 17: | ||
| Site = [[soft tissue lesions|soft tissue]] - [[peripheral nerve sheath tumours]] | | Site = [[soft tissue lesions|soft tissue]] - [[peripheral nerve sheath tumours]] | ||
| Assdx = | | Assdx = | ||
| Syndromes = [[neurofibromatosis type 2]], [[Carney complex]] (psammomatous melanotic schwannoma) | | Syndromes = [[neurofibromatosis type 2]], [[Carney complex]] (psammomatous melanotic schwannoma), schwannomatosis | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Line 27: | Line 27: | ||
| Prognosis = good | | Prognosis = good | ||
| Other = | | Other = | ||
| ClinDDx = [[meningioma]] - esp. at | | ClinDDx = [[meningioma]] - esp. at [[cerebellopontine angle]] | ||
}} | }} | ||
'''Schwannoma''' is a relatively common [[peripheral nerve sheath tumour]]. | '''Schwannoma''' is a relatively common [[peripheral nerve sheath tumour]]. | ||
At the [[cerebellopontine angle|cerebellopontine (CP) angle]], they may be referred to as ''acoustic neuroma'' or ''vestibular schwannoma''. | |||
==General== | ==General== | ||
*A common [[neuropathology]] [[CNS tumours|tumour]] that occasionally shows-up elsewhere. | *A common [[neuropathology]] [[CNS tumours|tumour]] that occasionally shows-up elsewhere. | ||
* | *often encapsulated tumour of tissue surrounding a nerve. | ||
**Axons adjacent to the tumour are normal... but may be compressed. | **Axons adjacent to the tumour are normal... but may be compressed. | ||
*May be a part of [[neurofibromatosis type 2]]. | *May be a part of [[neurofibromatosis type 2]]. | ||
*Occurs at all ages. | |||
==Macro== | |||
*Usu. encapsulated. | |||
*Cystic. | |||
*Yellow patches on white surface. | |||
**Variable lipidization. | |||
==Microscopic== | ==Microscopic== | ||
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*In the GI tract: classically have a ''peripheral lymphoid cuff''.<ref name=pmid15728600>{{cite journal |author=Levy AD, Quiles AM, Miettinen M, Sobin LH |title=Gastrointestinal schwannomas: CT features with clinicopathologic correlation |journal=AJR Am J Roentgenol |volume=184 |issue=3 |pages=797–802 |year=2005 |month=March |pmid=15728600 |doi= |url=http://www.ajronline.org/cgi/content/full/184/3/797}}</ref> | *In the GI tract: classically have a ''peripheral lymphoid cuff''.<ref name=pmid15728600>{{cite journal |author=Levy AD, Quiles AM, Miettinen M, Sobin LH |title=Gastrointestinal schwannomas: CT features with clinicopathologic correlation |journal=AJR Am J Roentgenol |volume=184 |issue=3 |pages=797–802 |year=2005 |month=March |pmid=15728600 |doi= |url=http://www.ajronline.org/cgi/content/full/184/3/797}}</ref> | ||
*+/-Hemosiderin deposition within tumour. | *+/-Hemosiderin deposition within tumour. | ||
*Reticulin stain +ve (around individual cells). | |||
Notes: | Notes: | ||
*Tumour does ''not'' smear well.<ref>MUN. 24 November 2010.</ref> | *Tumour does ''not'' smear well.<ref>MUN. 24 November 2010.</ref> | ||
*Antoni A: may look somewhat like scattered matchsticks. | *Antoni A: may look somewhat like scattered matchsticks. | ||
*Hybrid Schwannoma / [[Neurofibroma]] are overrepresented in hereditary conditions.<ref>{{Cite journal | last1 = Harder | first1 = A. | last2 = Wesemann | first2 = M. | last3 = Hagel | first3 = C. | last4 = Schittenhelm | first4 = J. | last5 = Fischer | first5 = S. | last6 = Tatagiba | first6 = M. | last7 = Nagel | first7 = C. | last8 = Jeibmann | first8 = A. | last9 = Bohring | first9 = A. | title = Hybrid neurofibroma/schwannoma is overrepresented among schwannomatosis and neurofibromatosis patients. | journal = Am J Surg Pathol | volume = 36 | issue = 5 | pages = 702-9 | month = May | year = 2012 | doi = 10.1097/PAS.0b013e31824d3155 | PMID = 22446939 }}</ref> | |||
DDx: | DDx: | ||
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*[[MPNST]] - schwannoma with ancient change has no significant mitotic activity.<ref name=pmid17244372>{{Cite journal | last1 = Chan | first1 = PT. | last2 = Tripathi | first2 = S. | last3 = Low | first3 = SE. | last4 = Robinson | first4 = LQ. | title = Case report--ancient schwannoma of the scrotum. | journal = BMC Urol | volume = 7 | issue = | pages = 1 | month = | year = 2007 | doi = 10.1186/1471-2490-7-1 | PMID = 17244372 }}</ref> | *[[MPNST]] - schwannoma with ancient change has no significant mitotic activity.<ref name=pmid17244372>{{Cite journal | last1 = Chan | first1 = PT. | last2 = Tripathi | first2 = S. | last3 = Low | first3 = SE. | last4 = Robinson | first4 = LQ. | title = Case report--ancient schwannoma of the scrotum. | journal = BMC Urol | volume = 7 | issue = | pages = 1 | month = | year = 2007 | doi = 10.1186/1471-2490-7-1 | PMID = 17244372 }}</ref> | ||
*[[Neurofibroma]]. | *[[Neurofibroma]]. | ||
*[[Biphenotypic sinonasal sarcoma]] - head and neck. | |||
===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
Image:Schwannoma_-_Antoni_A_and_B_-_intermed_mag.jpg | Schwannoma - Antoni A & B - intermed. mag. (WC) | Image:Schwannoma_-_Antoni_A_and_B_-_intermed_mag.jpg | Schwannoma - Antoni A & B - intermed. mag. (WC) | ||
Image:Schwannoma_-_Antoni_A_and_B_-_very_high_mag.jpg | | Image:Schwannoma_-_Antoni_A_and_B_-_very_high_mag.jpg | Schwannoma - Antoni A & B - very high mag. (WC) | ||
File:Antoni a fibers schwannoma.jpg | Antoni-A pattern in cerebelloponine angle schwannoma. (WC/jensflorian) | |||
File:Schwannoma 0023.jpg | Antoni-A pattern in cerebelloponine angle schwannoma.(WC/jensflorian) | |||
Image:Nerve_root_schwannoma_-_intermed_mag.jpg | Nerve root schwannoma - intermed. mag. (WC) | Image:Nerve_root_schwannoma_-_intermed_mag.jpg | Nerve root schwannoma - intermed. mag. (WC) | ||
File:Schwannoma, S-100 Immunostain (5203888371).jpg | S-100 immunostain in schwannoma. (WC/Ed Uthman) | |||
</gallery> | </gallery> | ||
www: | www: | ||
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====Cellular schwannoma==== | ====Cellular schwannoma==== | ||
*May mimic [[MPNST]]. | *May mimic [[MPNST]]. | ||
*Usu. <4 mitoses in 10 HPF (see [[HPFitis]]). | |||
*Absence of Verocay bodies. | |||
*Usu paravertebral location. | |||
Images: | Images: | ||
| Line 110: | Line 128: | ||
Images: | Images: | ||
*[http://path.upmc.edu/cases/case387.html Psammomatous melanotic schwannoma - several images (upmc.edu)]. | *[http://path.upmc.edu/cases/case387.html Psammomatous melanotic schwannoma - several images (upmc.edu)]. | ||
<gallery> | |||
Image:Psammomatous_melanotic_schwannoma_-_high_mag.jpg | Psammomatous melanotic schwannoma - high mag. (WC) | |||
</gallery> | |||
==IHC== | ==IHC== | ||
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*Glut1 +ve. | *Glut1 +ve. | ||
*CD34 +ve. | *CD34 +ve. | ||
*Cytokeratins ~70% +ve.{{ | *Cytokeratins ~70% +ve.<ref>{{Cite journal | last1 = Fanburg-Smith | first1 = JC. | last2 = Majidi | first2 = M. | last3 = Miettinen | first3 = M. | title = Keratin expression in schwannoma; a study of 115 retroperitoneal and 22 peripheral schwannomas. | journal = Mod Pathol | volume = 19 | issue = 1 | pages = 115-21 | month = Jan | year = 2006 | doi = 10.1038/modpathol.3800489 | PMID = 16357842 }}</ref> | ||
*SOX10 +ve.<ref name=pmid18636017>{{cite journal |author=Nonaka D, Chiriboga L, Rubin BP |title=Sox10: a pan-schwannian and melanocytic marker |journal=Am. J. Surg. Pathol. |volume=32 |issue=9 |pages=1291–8 |year=2008 |month=September |pmid=18636017 |doi=10.1097/PAS.0b013e3181658c14 |url=}}</ref> | *SOX10 +ve.<ref name=pmid18636017>{{cite journal |author=Nonaka D, Chiriboga L, Rubin BP |title=Sox10: a pan-schwannian and melanocytic marker |journal=Am. J. Surg. Pathol. |volume=32 |issue=9 |pages=1291–8 |year=2008 |month=September |pmid=18636017 |doi=10.1097/PAS.0b013e3181658c14 |url=}}</ref> | ||
**-ve in [[synovial sarcoma]], [[rhabdomyosarcoma]], [[chondrosarcoma]]. | **-ve in [[synovial sarcoma]], [[rhabdomyosarcoma]], [[chondrosarcoma]]. | ||
| Line 124: | Line 145: | ||
Others: | Others: | ||
*Beta-catenin +ve | *Beta-catenin +ve<ref name=pmid11813884>{{Cite journal | last1 = Hasegawa | first1 = M. | last2 = Muramatsu | first2 = N. | last3 = Tohma | first3 = Y. | last4 = Fukaya | first4 = K. | last5 = Fujisawa | first5 = H. | last6 = Hayashi | first6 = Y. | last7 = Tachibana | first7 = O. | last8 = Kida | first8 = S. | last9 = Yamashita | first9 = J. | title = Expression of E-cadherin-catenin complex in human benign schwannomas. | journal = Histol Histopathol | volume = 17 | issue = 1 | pages = 39-44 | month = Jan | year = 2002 | doi = | PMID = 11813884 }}</ref> -- not nuclear.<ref name=pmid17711447>{{Cite journal | last1 = Carlson | first1 = JW. | last2 = Fletcher | first2 = CD. | title = Immunohistochemistry for beta-catenin in the differential diagnosis of spindle cell lesions: analysis of a series and review of the literature. | journal = Histopathology | volume = 51 | issue = 4 | pages = 509-14 | month = Oct | year = 2007 | doi = 10.1111/j.1365-2559.2007.02794.x | PMID = 17711447 }}</ref> | ||
==Molecular== | |||
Overview: <ref>{{Cite journal | last1 = Agnihotri | first1 = S. | last2 = Jalali | first2 = S. | last3 = Wilson | first3 = MR. | last4 = Danesh | first4 = A. | last5 = Li | first5 = M. | last6 = Klironomos | first6 = G. | last7 = Krieger | first7 = JR. | last8 = Mansouri | first8 = A. | last9 = Khan | first9 = O. | title = The genomic landscape of schwannoma. | journal = Nat Genet | volume = 48 | issue = 11 | pages = 1339-1348 | month = 11 | year = 2016 | doi = 10.1038/ng.3688 | PMID = 27723760 }}</ref> | |||
* Most common: NF2 (in Vestibular Schwannoma up to84%). | |||
* less common: ARID1A, ARID1B, DDR, TSC1, TSC2, CDC27 and USP8. | |||
* SH3PXD2A-HTRA1 fusions (10%). | |||
*INI1 mosaic pattern in familiar schwannomatosis.<ref>{{Cite journal | last1 = Caltabiano | first1 = R. | last2 = Magro | first2 = G. | last3 = Polizzi | first3 = A. | last4 = Praticò | first4 = AD. | last5 = Ortensi | first5 = A. | last6 = D'Orazi | first6 = V. | last7 = Panunzi | first7 = A. | last8 = Milone | first8 = P. | last9 = Maiolino | first9 = L. | title = A mosaic pattern of INI1/SMARCB1 protein expression distinguishes Schwannomatosis and NF2-associated peripheral schwannomas from solitary peripheral schwannomas and NF2-associated vestibular schwannomas. | journal = Childs Nerv Syst | volume = 33 | issue = 6 | pages = 933-940 | month = Jun | year = 2017 | doi = 10.1007/s00381-017-3340-2 | PMID = 28365909 }}</ref> | |||
* LZTR1-associated vestibular schwannomas.<ref>{{Cite journal | last1 = Evans | first1 = DG. | last2 = Bowers | first2 = NL. | last3 = Tobi | first3 = S. | last4 = Hartley | first4 = C. | last5 = Wallace | first5 = AJ. | last6 = King | first6 = AT. | last7 = Lloyd | first7 = SKW. | last8 = Rutherford | first8 = SA. | last9 = Hammerbeck-Ward | first9 = C. | title = Schwannomatosis: a genetic and epidemiological study. | journal = J Neurol Neurosurg Psychiatry | volume = | issue = | pages = | month = Jun | year = 2018 | doi = 10.1136/jnnp-2018-318538 | PMID = 29909380 }}</ref> | |||
Molecular subgroups:<ref>{{Cite journal | last1 = Agnihotri | first1 = S. | last2 = Jalali | first2 = S. | last3 = Wilson | first3 = MR. | last4 = Danesh | first4 = A. | last5 = Li | first5 = M. | last6 = Klironomos | first6 = G. | last7 = Krieger | first7 = JR. | last8 = Mansouri | first8 = A. | last9 = Khan | first9 = O. | title = The genomic landscape of schwannoma. | journal = Nat Genet | volume = 48 | issue = 11 | pages = 1339-1348 | month = 11 | year = 2016 | doi = 10.1038/ng.3688 | PMID = 27723760 }}</ref> | |||
*Group 1: vestibular (has significant higher rate of 22q loss). | |||
*Group 2: spinal. | |||
==Sign out== | ==Sign out== | ||
<pre> | |||
Lesion, Right Ulnar Nerve, Excision: | |||
- Schwannoma. | |||
</pre> | |||
===Block letters=== | |||
<pre> | <pre> | ||
LESION, LEFT ANTERIOR TIBIA, EXCISION: | LESION, LEFT ANTERIOR TIBIA, EXCISION: | ||
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[[Category:Peripheral nerve sheath tumours]] | [[Category:Peripheral nerve sheath tumours]] | ||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Neuropathology tumours]] | |||