Epithelioid neurilemmoma of the trigeminal nerve: an immunohistochemical and ultrastructural study

A 50-year-old male presented with facial pain due to an extrinsic intracranial tumour involving pontine nerve roots. Biopsy and subsequent partial surgical excision indicated origin from the trigeminal nerve. Histologically the tumour had features of a neurilemmoma but in addition contained a population of epithelioid cells. Immunohistochemical studies demonstrated S100 protein in the non-epithelioid component but no reaction in the epithelioid cells, whilst vimentin was present in both cell types. Ultrastructurally the epithelioid cells showed features consistent with a Schwann cell nature and may represent a less well differentiated cell population derived from a Schwann cell precursor. The significance of these findings in relation to the cell of origin of neurilemmomas is discussed.