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Hemorrhagic acoustic schwannoma: radiological and histopathological findings
M Schlieter1, S Zoubaa, B Kress
1Division of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, D 69120 Heidelberg, Germany. martin.schlieter@med.uni-heidelberg.de
Abstract:
A 49-year-old man on anticoagulation treatment with phenprocoumon presented with acute right sided 7th and 8th cranial nerve palsy, acute hearing loss, headache, vertigo, and vomiting. CT and MRI revealed a cerebellopontine angle tumor 15mm in diameter and acute intratumoral hematoma. A cellular schwannoma composed predominantly of Antoni A tissue with dilated thin-walled vessels, surrounded by old hemorrhage with hemosiderin-laden macrophages was found histologically.
Insights
A cerebellopontine angle schwannoma with intratumoral hematoma caused acute cranial nerve palsy and hearing loss in a patient on anticoagulation. Histology confirmed a cellular schwannoma with dilated vessels and old hemorrhage.
Area of Science:
- Neuro-oncology
- Neuropathology
- Vascular Neurology
Background:
- Cerebellopontine angle (CPA) tumors can present with diverse neurological deficits.
- Intratumoral hemorrhage is a known, albeit uncommon, complication of CPA tumors.
- Anticoagulation therapy may influence the risk and severity of bleeding within tumors.
Observation:
- A 49-year-old male on phenprocoumon anticoagulation presented with acute onset of right 7th and 8th cranial nerve palsy, hearing loss, vertigo, headache, and vomiting.
- Imaging (CT and MRI) demonstrated a 15mm CPA tumor with evidence of acute intratumoral hematoma.
- The patient's symptoms were attributed to the acute bleeding event within the tumor.
Findings:
- Histopathological examination revealed a cellular schwannoma, predominantly Antoni A type.
- The tumor exhibited dilated, thin-walled vessels.
- Evidence of chronic hemorrhage, characterized by hemosiderin-laden macrophages, surrounded the acute hematoma.
Implications:
- This case highlights the potential for acute intratumoral hemorrhage in CPA schwannomas, particularly in patients on anticoagulation.
- The vascular characteristics of the schwannoma may predispose it to bleeding.
- Prompt diagnosis via advanced imaging is crucial for effective management of such acute neurological events.
