|LETTER TO THE EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 182-183
Ovarian schwannoma - Report of a rare case
Lalita Negi1, Kavita Mardi1, Sharab Chhopal2
1 Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Pathology, Shri Lal Bahadur Shastri Medical College, Mandi, Himachal Pradesh, India
|Date of Submission||16-Dec-2021|
|Date of Acceptance||01-Feb-2022|
|Date of Web Publication||24-May-2022|
Dr Kavita Mardi
Set No. 14, Type VI Quarters, IAS Colony, Meheli, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Negi L, Mardi K, Chhopal S. Ovarian schwannoma - Report of a rare case. Indian J Health Sci Biomed Res 2022;15:182-3
Schwannomas are peripheral nerve sheath tumor and commonly occurs on head, neck, and trunk. They are rare in the pelvis and the retroperitoneal areas and account for <0.5% of reported cases. Ovarian schwannomas are extremely rare, few cases have been reported so far. We report an additional case of ovarian schwannoma in a 71-year-old patient who was admitted in the Gynecology Department with history of pain abdomen and postmenopausal bleeding for 2-3 months. On per abdominal examination, a large mass arising from right side pelvis was palpable. On per vaginal examination, also, a mass was felt in right adnexa. Radiological diagnosis on ultrasound and contrast-enhanced computed tomography was suggestive of a large subserosal myoma. Patient underwent hysterectomy and found a large mass in the right ovary. On gross examination, right ovary was converted into a solid, well-circumscribed mass measuring 19 cm × 14 cm × 8 cm, cut section was solid gray white with cystic spaces [Figure 1]. Microscopic examination showed compact hypercellular Antoni A areas and myxoid hypocellular Antoni B areas. Hypercellular area showed intersecting fascicles of spindle cells having elongated, wavy hyperchromatic nuclei with tapered ends with fibrillary eosinophilic cytoplasm interspersed with collagen fibers. Hypocellular area showed that spindled to oval cells in loose myxoid stroma, ill formed verocay bodies, nuclear palisading, and hyalinized blood vessels are seen [Figure 2]. On immunohistochemical studies, spindle cells were positive for S-100 protein [Figure 3]. Final diagnosis of ovarian schwannoma was made.
|Figure 1: Gross specimen revealing right ovary converted in to a well-circumscribed mass with solid grey white cut surface|
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|Figure 2: Photomicrograph showing fascicles of spindle cells having elongated, wavy hyperchromatic nuclei with tapered ends with fibrillary eosinophilic cytoplasm (H and E, ×20)|
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Schwannomas are generally benign tumors arising from Schwann cells which are found in peripheral nerve sheath. They constitute one of the most common types of benign peripheral nerve sheath tumors. These tumors are common in cranial and peripheral nerves but they are rarely seen in the ovary. They occur most commonly between 40 and 60 years of age.
Pelvic schwannomas are misdiagnosed due to the lack of specific symptoms. On gross appearance, schwannomas are solitary, well-circumscribed firm, and smooth surfaced tumors. Cystic degeneration can occur in the lesion resulting from degenerative changes caused by inadequate blood supply to the center of the tumor and complete cystic schwannoma can be seen. Other degenerative changes of the tumor are calcification, hemorrhage, and hyalinization.
Schwannomas are nonaggressive, slow growing, solitary neoplasm with an extremely low possibility of malignant transformation or recurrence after excision. Differential diagnosis of schwannoma includes fibroma, leiomyomas, and solid cystic tumor of ovary. Macroscopically schwannomas are well-circumscribed, encapsulated tumors. Histologically, schwannoma is characterized by the presence of Antoni A and Antoni B areas. Antoni A area represents a disposition in a Verocay body, and Antoni B area is a loose hypocellular myxoid region. Immunohistochemistry is positive for S-100, vimentin, and neuron-specific enolase but negative for SMA and CD117.
As a result of their slow growth rate and anatomic location, pelvic schwannomas remain asymptomatic and are either incidentally discovered during a medical investigation for unrelated symptoms or are discovered as soon as they are sufficiently large to cause a mass effect. This mass effect can lead to pain in the pelvic area and lower back and a sense of heaviness accompanied with urinary and digestive symptoms caused by bladder and bowel compression.,
Retroperitoneal schwannoma localized in the pelvic cavity with complete cystic degeneration, mimicking an ovarian carcinoma, was reported. Schwannomas mimicking ovarian malignancies have also been reported.
Schwannomas are solitary, well-circumscribed, encapsulated tumors and do not invade local tissues. Due to these characteristics they are easily dissected from adjacent tissues. Complete excision of the tumor either laparoscopically or with open abdominal surgery is the treatment of choice. The literature review showed that laparoscopic excision of these neural tumors is the preferred mode of treatment.
In conclusion, although extremely rare, schwannoma should be considered in the differential diagnosis of benign spindle cell lesions of the ovary.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]