Intraparenchymal schwannoma with calcification of the temporal lobe

Abstract

Rationale:Intracranial schwannomas most frequently arise from the trigeminal nerve and the vestibular nerve. Schwannomas within the cerebral parenchyma are exceedingly rare. Additionally, calcification is an uncommon histopathological and radiological characteristic in schwannomas.Patient concerns:A 46-year-old man presented to us with sudden onset epileptic seizure and a 3-month history of intermittent headache. After admission, the physical and neurological examinations were all normal. Brain CT revealed an irregular, well-defined, hyperdense mass in the right temporal lobe. MRI showed a solid mass appearing iso- to hypointensity on T1-weighted imaging and heterogeneous intensity on T2-weighted imaging in the right temporal lobe; after Gd-DTPA administration, the lesion showed heterogeneous enhancement.Diagnosis:Histopathological examination revealed hyperchromatic nuclei and loose intercellular matrix with calcification. Immunohistochemical analysis demonstrated that the tumor was strongly positive for S100 protein but negative for GFAP and CK, which was consistent with a schwannoma.Interventions and outcomes:A surgical resection via the right temporal approach was performed. Intraoperatively, we noticed that the tumor was grayish yellow, capsuled, and located entirely within the temporal parenchyma. A gross total resection was achieved. The postoperative course was uneventful, and there was no epileptic seizure.Lessons:Intraparenchymal schwannoma with calcification is an uncommon histopathological and radiological characteristic in schwannomas. Intraparenchymal schwannoma with calcification is extremely rare. The early identification and appropriate surgical treatment should be highlighted.

Brainstem intraparenchymal schwannoma: A case report and literature review

“…[ 15 ] Intracranial schwannomas comprise around 8% of all primary brain tumors, with the vast majority arising from the cranial nerves. [ 2 , 7 ] Less than 1% of intracranial schwannomas are located within the brain parenchyma. [ 1 , 11 ] The first case of intraparenchymal schwannoma (IS) was described by Gibson et al .…”

A rapidly growing intraparenchymal schwannoma in a geriatric patient: a case report and literature review

“…The developmental theory assumes that mesenchymal pial cells in the brain parenchyma transform into Schwann cells. Alternatively, the non-developmental theory assumes that Schwann cells originate from adjacent organs, such as the meningeal branch of the perivascular nerve plexus and anterior ethmoidal and trigeminal nerves, where Schwann cells usually exist [9]. At present, it unclear clear which of these 2 hypotheses prevails.…”

Schwannoma intraparenquimatoso con calcificación focal en lóbulo temporal

“…Son lesiones de lento crecimiento, cuyos síntomas se relacionan directamente con la ubicación de la lesión, siendo la cefalea el síntoma cardinal y las convulsiones cuando la lesión se presenta en el lóbulo temporal. 1 Con respecto al rango etario, es poco común su presencia en pacientes mayores de 30 años, edad en la que sí podríamos encontrar otras patologías como ser meningiomas, metástasis o gliomas primarios de cerebro.9 Lo opuesto ocurre en los schwannomas vestibulares en donde la presencia en la población pediátrica debe obligarnos a descartar la presencia de neurofibromatosis tipo 2. Con respecto a los estudios por imágenes, en la tomografía se suele encontrar una imagen iso/hipodensa y es muy útil en lesiones que se presentan con calcio en su interior.…”

“…El compromiso de cualquier otro par craneal tiene una incidencia mucho menor. 1 Se conoce que la presencia de schwannomas originados dentro del parénquima cerebral es extremadamente rara. El primer caso fue reportado en 1966; y desde entonces menos de 70 casos han sido publicados.…”

“…2 A su vez, la presencia de calcificaciones en estos tumores es poco común: a la fecha sólo se han reportado 16 casos. 1 Si bien existen diversas teorías sobre su origen, el mismo es aún incierto. Estas lesiones suelen ser únicas y en pocos casos se asocian a la presencia de neurofibromatosis.…”