Recurrence of acoustic neurilemoma as a malignant spindle-cell neoplasm

Case report

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✓ A 75-year-old man presented with a right cerebellopontine angle tumor 11 months after complete macroscopic resection of a right acoustic neurilemoma. Histological examination of the recurrent tumor showed a malignant spindle-cell neoplasm with positive staining for S-100 protein. The patient had no stigmata of von Recklinghausen's disease. It is proposed that this recurrence represents progression from a benign to a malignant acoustic nerve-sheath tumor, an event that is extremely rare outside the clinicopathological context of neurofibromatosis.

Article Information

Address reprint requests to: Michael F. Gonzales, M.B.,B.S., F.R.C.P.A., Department of Anatomical Pathology, The Royal Melbourne Hospital, Post Office, Parkville, Victoria 3050, Australia.

© AANS, except where prohibited by US copyright law.

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Figures

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    Computerized tomography scan after contrast enhancement showing the original lesion.

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    T2-weighted magnetic resonance image showing the recurrent tumor with an extra-axial component and invasion of the medulla and inferior cerebellar peduncle.

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    Photomicrographs of the original tumor. Left: Spindle cell Antoni A tissue is evident, admixed with more loosely aggregated Antoni B tissue typical of a neurilemoma. H & E, × 40. Center: An area of increased cellularity includes a single mitosis. H & E, × 20. Right: Immunostaining with antisera against S-100 protein. Positive staining is seen predominantly with an Antoni A tissue. S-100 PAP counterstained with H & E, × 40.

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    Photomicrographs of the recurrent tumor. Left: This view shows a fascicular arrangement of spindle cells and increased cellularity compared with the original tumor. H & E, × 20. Center Enlargement of area within the box shown left highlighting mitotic figures. H & E, × 40. Right: Immunostaining revealed focal positivity of the tumor cells (arrows) with antisera against S-100 protein. S-100 PAP counterstained with H & E, × 40.

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    Coronal sections of the medulla and cerebellum showing infiltration of the medulla and inferior cerebellar peduncle by the recurrent tumor. An area of necrosis (arrow) appears cystic.

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