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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.

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