Access Keys:
Skip to content (Access Key - 0)

Schwannoma of Bone

(neurilemmoma)

DEFINITION AND PATHOGENESIS

  • Not of bone origin, but may cause massive bony destruction when of spinal origin, particularly the sacrum

IMPORTANCE

  • An important cause of "scalloping from without" (compared to "scalloping from within" by enchondroma)

CLINICAL FEATURES

  • Pelvic mass
  • ? neurological signs/sxs
  • Long hx of pain

RADIOLOGIC FEATURES

  • MRI reveals extrapinal extent with smooth, round borders, maintainence of fat planes, and encapsulation, ? necrosis

GROSS PATHOLOGY

  • Encapsulated, separable from nerves

HISTOLOGIC FEATURES

  • Composed of alternating Antoni A (cellular) and Antoni B (hypocellular) regions
  • Immunohistochemistry
    • + S-100

DIFFERENTIAL CLINICOPATHOLOGIC DIAGNOSIS

  • Chordoma (when in the sacrum or spine)
  • GCT
  • Osteoblastoma
  • Chondrosarcoma

DISEASE COURSE AND TREATMENT

  • Large tumors can undergo central necrosis, secondary infection has been reported
  • Debulking to gain vascular control, piecemeal excsion with thorough bony curettage
  • Anterior approach when majority of tumor anterior ? omental mobilization

SPECIAL CONSIDERATION

CELLULAR SCHWANNOMA

  • A variant with cellular Antoni A but no Antoni B areas and without hypocellular Verocay bodies which can be mistaken for malignant schwannoma

REFERENCES

Lin PP, Horenstein MG, Healey JH: Sacral mass in a 56-year-old woman. Clin Orthop 344:333-7,41-3,1997.
Mirra, JM: Neurogenous tumors. In Bone Tumors. Clinical, radiologic, and pathologic correlations. JM Mirra (Ed), Lea & Febiger, Philadelphia, 1989, pp 801-867.

Content

Download: PDF | EPUB

Famous Quote
"It seemed to me a matter of course that we should all take our share of the burden of pain which lies upon the world." Albert Schweitzer
Figures
Related Content

Resources for Schwannoma of Bone and related topics on OrthopaedicsOne.