EURORAD ESR

Case 12374

Purely cystic ancient schwannoma

Author(s)
Sergio Savastano1, Houshang Kalamian2, Ilaria Franceschetti3, Antonio Perasole3, Andrea Busolo1, Da Pozzo Stefano1

U.O. Radiologia1,
U.O. Chirugia2 and
U.O. Anatomia e Istocitopatologia3
Ospedale San Bortolo
V.le F. Rodolfi 37
36100 Vicenza, Italy
 
Patient
female, 31 year(s)
 
 
  • Figure 1
    Contrast-enhance CT of the pelvis
     

    A large retroperitoneal cyst displaces the iliopsoas muscle and left iliac vessels on the left side. The cyst is unilocular; neither enhancement nor wall thickening are appreciable. The S1 intervertebral foramen is...

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;

    The cyst at lower level scan.

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
  • Figure 2
    T2-weighted MRI of the pelvis
     

    The cyst is unilocular and circumscribed by a thin well-defined wall hypointense on T2w image; the content is homogeneous.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Sagittal T2w image.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Coronal T2w image.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
  • Figure 3
    Diffusion-weighted MRI

    ADC map: the cystic capsule shows water diffusion restriction whereas its content does not (ADC value 2700/mm2/sec).

     
    Area of Interest: Pelvis; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
  • Figure 4
    T1w 3D-GE sequences with fat suppression
     

    Non-enhanced axial view.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Post-contrast axial view: no enhancement of the cystic wall.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    Post-contrast coronal view: no enhancement of the cystic wall.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;
     
     
  • Figure 5
    Intraoperative finding

    Well-defined, yellowish extraperitonel mass.

     
    Area of Interest: Pelvis; Imaging Technique: Experimental; Procedure: Surgery; Special Focus: Cysts;
     
     
  • Figure 6
    Histology and immunochemistry
     

    At low magnification a thick capsule is appreciable (1.25X EE).

     
    Area of Interest: Pelvis; Imaging Technique: Experimental; Procedure: Diagnostic procedure; Special Focus: Pathology;

    At higher magnification, the Schwann cells are arranged in interweaving fascicles and in rosette-like circles (10X EE).

     
    Area of Interest: Pelvis; Imaging Technique: Experimental; Procedure: Diagnostic procedure; Special Focus: Pathology;

    S100 strong positivity of the neoplastic cells (10X S100).

     
    Area of Interest: Pelvis; Imaging Technique: Experimental; Procedure: Diagnostic procedure; Special Focus: Pathology;
     
     
A large retroperitoneal cyst displaces the iliopsoas muscle and left iliac vessels on the left side. The cyst is unilocular; neither enhancement nor wall thickening are appreciable. The S1 intervertebral foramen is preserved.
 
The cyst at lower level scan.
 
The cyst is unilocular and circumscribed by a thin well-defined wall hypointense on T2w image; the content is homogeneous.
 
Sagittal T2w image.
 
Coronal T2w image.
 
ADC map: the cystic capsule shows water diffusion restriction whereas its content does not (ADC value 2700/mm2/sec).
 
Non-enhanced axial view.
 
Post-contrast axial view: no enhancement of the cystic wall.
 
Post-contrast coronal view: no enhancement of the cystic wall.
 
Well-defined, yellowish extraperitonel mass.
 
At low magnification a thick capsule is appreciable (1.25X EE).
 
At higher magnification, the Schwann cells are arranged in interweaving fascicles and in rosette-like circles (10X EE).
 
S100 strong positivity of the neoplastic cells (10X S100).
 
 
 
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