Cellular schwannoma: a clinicopathologic study of 57 patients and 58 tumors

Article Abstract:

The cellular schwannoma can be a troublesome pathologic diagnosis. Roughly a quarter of cellular schwannomas may receive a diagnosis of malignant from a pathologist, and yet evidence is accumulating to suggest that these tumors are benign. Cellular schwannoma may be confirmed to arise from Schwann cells (which create the sheath of peripheral nerves) by immunocytochemical techniques and by electron microscopy. The cellular schwannoma does not contain, however, the Verocay bodies that are a common feature in the classic schwannoma. (Verocay bodies are groups of fibrils surrounded by palisaded nuclei.) A review of 58 cellular schwannomas in 57 patients revealed that bone erosion, hypercellularity, nuclear polymorphism, and other features usually associated with cancer are common. In the present series, such features led to a diagnosis of cancer in 28 percent of the cases. Nevertheless, not a single patient developed a metastatic tumor or died of tumor. Local recurrence, however, was observed in 3 of 35 patients who were followed for an average of 7 years. The authors indicate that the pathologic distinction between cellular schwannoma and high-grade malignant peripheral nerve sheath tumors is straightforward, since the latter have characteristic features, which include areas of necrosis abruptly rimmed by hyperchromatic (densely stained) and mitotically active anaplastic cells. Although the distinction between a cellular schwannoma and a low-grade malignant nerve sheath tumor is more difficult, the distinction is nonetheless important as a proper diagnosis of cellular schwannoma will save the patient from unnecessary chemotherapy or radiotherapy, and also eliminate the sacrifice of nerve function by the surgical removal of a tumor erroneously thought to be malignant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Nervous system tumors

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Acinic cell carcinoma: clinicopathologic review

Article Abstract:

Acinic cell carcinoma is a cancer of the salivary glands. it is not common, constituting only two to four percent of primary cancers of the salivary gland. Acinic cell carcinoma was originally classed as an adenoma, that is, a tumor with recognizable glandular structures but without the ability to metastasize. It has become clear, however, that this tumor is indeed a cancer and both local recurrence and metastatic spread are well recognized. The authors have gone through case records and histological slides between 1915 and 1978 and have identified 90 cases of acinic cell carcinoma; the major features of these cases are reviewed. Fifty-five females and 35 males were identified; this female predominance is consistent with other reports on the cancer. The peak incidence of acinic cell carcinoma occurs between the fifth and sixth decades of life. In the present series, 31 percent of the patients died of their disease. Recurrence may follow initial presentation by as many as 30 years, and death may follow by as many as 38. In general, local recurrence was already begun when metastases were found and death was usually due to local recurrence. The presence of pain, the gross appearance of tumor invasion, and greater mitotic activity within the cells all correlated with poorer survival. It was also found that the patients who were treated by removal of the salivary gland did significantly better than those who had the tumor alone excised. The authors also found that additional surgical treatment for patients with local recurrence can result in long-term disease survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Mouth cancer, Adenocarcinoma

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