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Case of an Intramedullary Ancient Schwannoma of the Brainstem Mimicking Astrocytoma: A Rare Clinical Presentation with a Diagnostic Dilemma
Correspondence Address :
Dr. Prajna Das,
Plot No. 784/786, Lane 3, Jaydev Vihar, Bhubaneswar-751013, Odisha, India.
E-mail: prajnadas68@gmail.com
Schwannomas are common benign tumours arising from the myelin sheath of peripheral nerves. These tumours are usually located in the intradural and extramedullary regions. The common sites are cervical (58%) and thoracic region (32%), followed by the lumbar region (10%). Intramedullary location is rare and if present, is usually associated with neurofibromatosis 1 and 2 (NF-1 and 2). Intramedullary brainstem schwannomas without NF are uncommon, and to the best of the authors’ knowledge, only 19 cases have been reported to date. It was first described by James Watson Kernohan, an Irish-American pathologist, in 1931. The rarity of these tumours in this location is due to the absence of Schwann cells in this area. There are several hypotheses postulating the presence of these tumours in this location. The exact cause is not yet known. The authors here present a case of intramedullary brainstem ancient schwannoma with an unusual clinicoradiological presentation, which raised suspicion of Glioma with the possibility of Astrocytoma. The patient presented with right-sided neck stiffness and shoulder pain for a period of four months. Total excision of the tumour was performed, and the postoperative period was uneventful with clinical improvement in the patient. Histomorphology raised the suspicion of a tumour of glial origin with the possibility of Astrocytoma; Immunohistochemistry (IHC) helped in reaching the definitive diagnosis of Ancient Schwannoma. Thus, a combined approach of clinicoradiological, as well as histomorphology and IHC, is essential for a definitive diagnosis of these tumours. Future multicentric studies are required to elucidate the pathogenesis of the location of these tumours.
Histopathology, Immunohistochemistry, Intradural
DOI: 10.7860/JCDR/2024/67903.19466
Date of Submission: Oct 06, 2023
Date of Peer Review: Dec 23, 2023
Date of Acceptance: Feb 22, 2024
Date of Publishing: Jun 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 06, 2023
• Manual Googling: Dec 26, 2023
• iThenticate Software: Feb 20, 2024 (12%)
ETYMOLOGY: Author Origin
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