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LETTERS TO EDITOR  
Year : 2018  |  Volume : 61  |  Issue : 1  |  Page : 156-157
Suprasellar schwannoma: A rare occurence


1 Department of Lab Medicine, Max Super Speciality Hospital, New Delhi, India
2 Department of Lab Medicine; Department of Pathology, Max Super Speciality Hospital, New Delhi, India

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Date of Web Publication22-Mar-2018
 

How to cite this article:
Mukherjee U, Patil N, Khurana A. Suprasellar schwannoma: A rare occurence. Indian J Pathol Microbiol 2018;61:156-7

How to cite this URL:
Mukherjee U, Patil N, Khurana A. Suprasellar schwannoma: A rare occurence. Indian J Pathol Microbiol [serial online] 2018 [cited 2019 Dec 7];61:156-7. Available from: http://www.ijpmonline.org/text.asp?2018/61/1/156/228197




Editor,

A 32-year-old male was apparently asymptomatic 1 year back, when he developed decreased appetite and significant weight loss of 15 kg. In a present illness of last 3 weeks, he developed recurrent vomiting and memory impairment mainly for the recent events. There was no history of headache, decreased vision, blurring of vision, or visual field defects. His neurological examination and complete blood profile were unremarkable. On radiological investigation, computed tomography scan of the brain was suggestive of suprasellar tumor [Figure 1]a. A preoperative diagnosis of pituitary adenoma was made. Reflexly, his hormonal profile was evaluated which revealed elevated prolactin level (33.32 ng/ml) and the random cortisol was 3.67 (normal). Right frontal craniotomy with a subfrontal–lamina terminalis approach was planned. Tumor was yellowish, soft to firm, nonsuckable, and highly vascular. Material obtained for histopathological examination showed multiple gray-brown soft-tissue bits measuring 2 cm × 1 cm × 0.5 cm. Microscopic examination revealed bland ovoid-to-spindle-shaped cells arranged in sheets and fascicles with occasional nested pattern [Figure 1]b. There were alternating cellular and hypocellular areas. In the cellular areas, the cells appeared palisaded which had eosinophilic cytoplasm and elongated, pointed nuclei. The hypocellular areas showed hyalinization and myxoid matrix. No mitoses or necrosis was noted. No calcification was detected. Immunohistochemical markers were applied. The cells were positive for S-100 [Figure 1]c and negative for Epithelial Membrane Antigen EMA and CD34. Glial Acidic fibrillary protein GFAP was expressed in few cells. A final diagnosis of schwannoma was rendered.
Figure 1: (a) Computed tomography scan image showing well-defined enhancing lesion in the suprasellar cistern. (b) Microphotograph showing spindle cells with wavy nuclei against a fibrillary cytoplasm. (H and E, ×100). (c) S100 protein staining the tumor cell nuclei (DAB, ×400)

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Sellar tumors most commonly arise from adenohypophyses, pituitary adenoma being the most common.[1] Suprasellar schwannoma is the rarest, with a very few cases reported in literature.

As there are no nerves running in the sella turcica, the origin of the schwannoma is unclear.[2] The proposed theory indicates that the schwannomas could arise from sensory nerves around the dura. The dural nerve plexus arising from trigeminal nerve and lateral sellar plexus, could be the possible source of origin.[2] In our case, the schwannoma was seen to abut the floor of the third ventricle and bilateral basal ganglia and posteriorly compressing midbrain and thalami, possibly arising from the optic nerve. Unusual intracranial sites for schwannoma are encountered in neurofibromatosis 2 (NF 2).[2] The clinical features associated with NF 2 were not observed in our case, making this case further unique, arising in a nonsyndromic setting.

Sellar schwannomas cannot be differentiated from pituitary adenomas clinically and radiologically.[3] Though a rare occurrence, a preoperative inclusion of schwannoma as a differential could avoid incomplete excision and revisit intervention, as surgery remains the mainstay of treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mohammed S, Kovacs K, Munoz D, Cusimano MD. A short illustrated review of sellar region schwannomas. Acta Neurochir (Wien) 2010;152:885-91.  Back to cited text no. 1
    
2.
Honegger J, Koerbel A, Psaras T, Petrick M, Mueller K. Primary intrasellar schwannoma: Clinical, aetiopathological and surgical considerations. Br J Neurosurg 2005;19:432-8.  Back to cited text no. 2
    
3.
Park HW, Jung S, Jung TY, Moon KS. Intra-suprasellar schwannoma originating from the diaphragma sellae. J Korean Neurosurg Soc 2009;45:375-7.  Back to cited text no. 3
    

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Correspondence Address:
Nayana Patil
Department of Pathology, Max Super Speciality Hospital, Saket, New Delhi - 110 017
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_819_16

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