[A case of metastatic intracerebral malignant schwannoma]

A 53 year old male complaining of headache and left hemiparesis was referred to our hospital on November 11, '89. He had no evidence of von Recklinghausen's disease. He had been operated on because of a well circumscribed tumor in the left paravertebral muscle on July 11, '87, and metastasis in the lower lobe of the left lung on April 20, '88. The pathological diagnosis of both the primary and the metastatic lung tumor was malignant peripheral nerve sheath tumor showing peripheral cell differentiation (malignant schwannoma). Contrast enhanced CT demonstrated an irregularly enhanced mass in the right parietal lobe just before admission. On the night of admission November 12, '89, he suddenly had severe headache and this progressed to hemiparesis. Repeat CT examination was done immediately and revealed intratumoral hemorrhage. On November 19, '89, the tumor was totally removed. His symptoms disappeared postoperatively. The pathological findings of the tumor were the same as those made previously. The patient received radiotherapy to the brain (local 50 Gy and whole brain 30 Gy) and chemotherapy with nitrosourea (MCNU 150mg). He was discharged without neurological deficits. However he had two operations to remove metastatic tumors in the soft tissue of the hip on January 12, and August 17, '90. A very rare case of metastatic intracerebral malignant schwannoma is reported, and the literature on this point is reviewed.