2013
DOI: 10.1136/bcr-2012-008435
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Cellular schwannoma masquerading as malignant peripheral nerve sheath tumour: a diagnostic dilemma

Abstract: We present a case of a 15-year-old girl with a pulsatile, rapidly enlarging mass at the root of the nose suspected to be malignant. Excisional biopsy showed worrisome histological features; however, a final diagnosis of cellular schwannoma was reached excluding the possibility of malignant peripheral nerve sheath tumour by histological and immunohistochemical attributes. Cellular schwannoma, a pseudosarcomatous entity, is a rare benign neoplasm that may cause bone erosion and may be mistaken for a malignancy, … Show more

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Cited by 5 publications
(9 citation statements)
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“…In our case, the mass had a homogeneous soft-tissue density, probably due to the high level of diffuse high cellularity. Interestingly, the mass had neither cystic areas nor calcifications, which instead are frequently encountered in schwannomas [44,48]. The enhancement pattern of schwannomas depends on the variation in the degree of cellularity; therefore, unlike our case, in which the enhancement refers to a moderately vascularized mass, a low cellularity with a diffuse edematous change may result in a minimal contrast enhancement [47].…”
Section: Discussionmentioning
confidence: 55%
“…In our case, the mass had a homogeneous soft-tissue density, probably due to the high level of diffuse high cellularity. Interestingly, the mass had neither cystic areas nor calcifications, which instead are frequently encountered in schwannomas [44,48]. The enhancement pattern of schwannomas depends on the variation in the degree of cellularity; therefore, unlike our case, in which the enhancement refers to a moderately vascularized mass, a low cellularity with a diffuse edematous change may result in a minimal contrast enhancement [47].…”
Section: Discussionmentioning
confidence: 55%
“…Cellular schwannoma, a rare variant, typically presents as a Schwann cell fascicular proliferation with no Verocay bodies and the presence of high cellularity and increased mitotic figures 9 . Because of this increased mitoses and ability to cause bone erosion, it is often mistaken as a malignant peripheral nerve sheath tumor (MPNST), even though the clinical course is typically benign 22,23 . Diffuse positivity of S100 in schwannomas is helpful in differentiating between a schwannoma and MPNST.…”
Section: Discussionmentioning
confidence: 99%
“…The presence of cellular whorls, perivascular and capsular lymphocytes and histocytes aggregates, and the absence of fascicles tend to the diagnosis of cellular schwannoma, while the presence of perivascular hypercellularity, extensive pleomorphism, high mitotic activity (> 10/10HPF), heterologous elements, and geographic areas of necrosis favor MPNST. [18] Other malignant spindle cell tumour (dermatofibrosarcoma protuerans, leiomyosarcoma, fibrosarcoma, synovial sarcoma, malignant fibrous histiocytoma) should be differentiated from cellular schwannoma. These tumours often present malignant histologic features, such as significant polymorphism, high mitotic activity (> 10/HPF) and necrosis.…”
Section: Discussionmentioning
confidence: 99%