Microcystic/reticular schwannoma：clinicopathologic analyses and review of literatures_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LU Ya , HE Xin ,  ZHANG Hongying

Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

ZHANG Hongying, Email: hy_zhang@scu.edu.cn

Keywords：

microcystic/reticular schwannoma; schwannoma; diagnosis

DOI：

10.7507/1007-9424.202002029

Video：

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Objective To summarize the clinicopathological features of microencapsulated/reticular schwannoma.Methods Two cases of microencapsulated/reticular schwannoma treated in West China Hospital of Sichuan University were retrospectively collected. The histological and immunohistochemical features were summarized, and the related literatures were reviewed.Results Two cases of microcystic/reticular neurilemmoma diagnosed and treated in West China Hospital of Sichuan University were male. The clinical manifestations were “dull pain in the right lower abdomen” and “mass of left index finger”. Microscopically, the characteristic reticular or cribriform structures were found in all cases, and lymphocytic sheath was seen in 1 case. Immunohistochemical staining showed S-100, glial fibrillary acidic protein (GFAP) and calretinin positive. By February 2020, only 41 cases were reported in the literatures （there were no cases of this group),there was no significant gender difference, the median age was 55 years (11–93 years), and the median size of the lesion was 2.1 cm (0.4–13.0 cm). Most of them were found by accident, without obvious symptoms and signs, and no history of neurofibromatosis type 1 or 2. Microencapsulated/reticular schwannoma in this patients mainly occurs in the viscera, especially in the gastrointestinal tract (mostly in the the colorectal of lower gastrointestinal tract ), most of them were solitary nodular masses without capsule. Microscopically, the boundary was clear, and the characteristic microcapsules and reticular structures were seen. The tumor cells were diffusely expressing S-100 protein, and GFAP and calretinin were expressed in varying degrees. Electron microscopy showed the characteristics of Schwann cells.Conclusions Microcystic/reticular schwannoma is a rare subtype of schwannoma, which needs to be differ-entiated from multiple benign and malignant neoplasms. The diagnosis of the tumor is a challenge for the pathologist.

Citation： LU Ya, HE Xin, ZHANG Hongying. Microcystic/reticular schwannoma：clinicopathologic analyses and review of literatures. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1200-1206. doi: 10.7507/1007-9424.202002029 Copy

1.	Liegl B, Bennett MW, Fletcher CD. Microcystic/reticular Schwannoma: a distinct variant with predilection for visceral locations. Am J Surg Pathol, 2008, 32(7): 1080-1087.
2.	Tang SX, Sun YH, Zhou XR, <italic>et al</italic>. Bowel mesentery (Meso-Appendix) microcystic/reticular Schwannoma: case report and literature review. World J Gastroenterol, 2014, 20(5): 1371-1376.
3.	Liu C, Yan L, Liu Q, <italic>et al</italic>. Lumbar intraspinal microcystic/reticular Schwannoma: case report and literature review. Medicine (Baltimore), 2018, 97(39): e12474.
4.	Fletcher CDM, Bridge JA, Hogendoorn PCW. WHO classification of tumours of soft tissue and bone. 4th Edition. Lyon, International Agency for Research on Cancer, 2013: 170-172.
5.	Tozbikian G, Shen R, Suster S. Signet ring cell gastric Schwannoma: report of a new distinctive morphological variant. Ann Diagn Pathol, 2008, 12(2): 146-152.
6.	Lee SM, Goldblum J, Kim KM. Microcystic/reticular Schwannoma in the colon. Pathology, 2009, 41(6): 595-596.
7.	Agaimy A, Märkl B, Kitz J, <italic>et al</italic>. Peripheral nerve sheath tumors of the gastrointestinal tract: a multicenter study of 58 patients including NF1-associated gastric Schwannoma and unusual morphologic variants. Virchows Arch, 2010, 456(4): 411-422.
8.	李百周, 王加伟, 魏红权. 微囊性/网状神经鞘瘤的临床病理特点. 中华病理学杂志, 2010, 39(6): 396-399.
9.	Kienemund J, Liegl B, Siebert F, <italic>et al</italic>. Microcystic reticular Schwannoma of the colon. Endoscopy, 2010, 42(Suppl 2): E247.
10.	Chetty R. Reticular and microcystic Schwannoma: a distinctive tumor of the gastrointestinal tract. Ann Diagn Pathol, 2011, 15(3): 198-201.
11.	Liegl B, Bodo K, Martin D, <italic>et al</italic>. Microcystic/reticular Schwannoma of the pancreas: a potential diagnostic pitfall. Pathol Int, 2011, 61(2): 88-92.
12.	Lau PPL, Yau DTW, Lau WH, <italic>et al</italic>. Multinodular reticular Schwannoma in the head and neck region: a potential diagnostic pitfall. Int J Surg Pathol, 2013, 21(1): 54-58.
13.	Pang JM, Mahar A, Shannon K, <italic>et al</italic>. Reticular and microcystic Schwannoma of the parotid gland. Pathology, 2013, 45(1): 96-98.
14.	Trivedi A, Ligato S. Microcystic/reticular Schwannoma of the proximal sigmoid colon: case report with review of literature. Arch Pathol Lab Med, 2013, 137(2): 284-288.
15.	Chaurasia JK, Afroz N, Sahoo B, <italic>et al</italic>. Reticular Schwannoma mimicking myxoid sarcoma. BMJ Case Rep, 2014, 2014: bcr2013202963.
16.	Gong S, Hafez-Khayyata S, Xin W, <italic>et al</italic>. Microcystic/reticular Schwannoma: morphological features causing diagnostic dilemma on fine-needle aspiration cytology. Am J Case Rep, 2014, 15: 538-542.
17.	Gu MJ, Choi JH. Microcystic/reticular Schwannoma of the esophagus: the first case report and a diagnostic pitfall. BMC Gastroenterol, 2014, 14: 193.
18.	沈勤, 王艳芬, 余波, 等. 胰腺微囊/网状型神经鞘瘤临床病理特征. 诊断病理学杂志, 2014, 21(11): 689-692.
19.	Yin Y, Wang T, Cai YP, <italic>et al</italic>. Microcystic/reticular Schwannoma of the mandible first case report and review of the literature. Medicine (Baltimore), 2015, 94(45): e1974.
20.	Zhou J, Zhang D, Wang G, <italic>et al</italic>. Primary adrenal microcystic/reticular Schwannoma: clinicopathological and immunohistochemical studies of an extremely rare case. Int J Clin Exp Pathol, 2015, 8(5): 5808-5811.
21.	Lau RP, Melamed J, Yee-Chang M, <italic>et al</italic>. Microcystic/reticular Schwannoma arising in the submandibular gland: a rare benign entity that mimics more common salivary gland carcinomas. Head Neck Pathol, 2016, 10(3): 374-378.
22.	Luzar B, Tanaka M, Schneider J, <italic>et al</italic>. Cutaneous microcystic/reticular Schwannoma: a poorly recognized entity. J Cutan Pathol, 2016, 43(2): 93-100.
23.	谢军, 王辉, 邓妮. 肾上腺微囊性/网状神经鞘瘤1例报道. 诊断病理学杂志, 2016, 23(8): 626-628.
24.	Pearson L, Akture E, Wonderlick J, <italic>et al</italic>. Microcystic/reticular Schwannoma of the frontal lobe: an unusual occurrence. Case Rep Pathol, 2017, 2017: 4728585.
25.	郭俊召, 张晓文, 杨守京. 硬腭微囊性/网状型神经鞘瘤误诊为多形性腺瘤一例. 中华病理学杂志, 2017, 46(6): 431-432.
26.	Georgescu TA, Dumitru AV, Oproiu AM, <italic>et al</italic>. Cutaneous microcystic/reticular Schwannoma: case report and literature review of an exceedingly rare entity with an unusual presentation. Rom J Morphol Embryol, 2018, 59(1): 303-309.
27.	程羽青, 周晓莉, 顾文贤, 等. 皮肤微囊/网状型神经鞘瘤临床病理特征. 诊断病理学杂志, 2018, 25(7): 489-493.
28.	Bedir R, Semerci O, Fındık Güvendi G. Incidental cutaneous microcystic/reticular Schwannoma in pilonidal sinus. Balkan Med J, 2019, 37(1): 52-53.
29.	Maciel JM, Pereira DV, Simões HF, <italic>et al</italic>. Adrenal microcystic reticular Schwannoma. AACE Clin Case Rep, 2019, 5(4): e250-e254.
30.	Zhou J, Zhang D, Li W, <italic>et al</italic>. Primary adrenal Schwannoma: a series of 31 cases emphasizing their clinicopathologic features and favorable prognosis. Endocrine, 2019, 65(3): 662-674.
31.	王坚, 朱雄增. 软组织肿瘤病理学. 第 2 版. 北京: 人民卫生出版社, 2017: 1027-1053.
32.	Mentzel T, Kutzner H. Reticular and plexiform perineurioma: clinicopathological and immunohistochemical analysis of two cases and review of perineurial neoplasms of skin and soft tissues. Virchows Arch, 2005, 447(4): 677-682.
33.	Folpe AL, Billings SD, McKenney JK, <italic>et al</italic>. Expression of claudin-1, a recently described tight junction-associated protein, distinguishes soft tissue perineurioma from potential mimics. Am J Surg Pathol, 2002, 26(12): 1620-1626.
34.	Song W, Flucke U, Suurmeijer AJH. Myoepithelial tumors of bone. Surg Pathol Clin, 2017, 10(3): 657-674.
35.	Jo VY, Fletcher CDM. Myoepithelial neoplasms of soft tissue: an updated review of the clinicopathologic, immunophenotypic, and genetic features. Head Neck Pathol, 2015, 9(1): 32-38.
36.	Flucke U, Palmedo G, Blankenhorn N, <italic>et al</italic>. EWSR1 gene rearrangement occurs in a subset of cutaneous myoepithelial tumors: a study of 18 cases. Mod Pathol, 2011, 24(11): 1444-1450.

1. Liegl B, Bennett MW, Fletcher CD. Microcystic/reticular Schwannoma: a distinct variant with predilection for visceral locations. Am J Surg Pathol, 2008, 32(7): 1080-1087.
2. Tang SX, Sun YH, Zhou XR, <italic>et al</italic>. Bowel mesentery (Meso-Appendix) microcystic/reticular Schwannoma: case report and literature review. World J Gastroenterol, 2014, 20(5): 1371-1376.
3. Liu C, Yan L, Liu Q, <italic>et al</italic>. Lumbar intraspinal microcystic/reticular Schwannoma: case report and literature review. Medicine (Baltimore), 2018, 97(39): e12474.
4. Fletcher CDM, Bridge JA, Hogendoorn PCW. WHO classification of tumours of soft tissue and bone. 4th Edition. Lyon, International Agency for Research on Cancer, 2013: 170-172.
5. Tozbikian G, Shen R, Suster S. Signet ring cell gastric Schwannoma: report of a new distinctive morphological variant. Ann Diagn Pathol, 2008, 12(2): 146-152.
6. Lee SM, Goldblum J, Kim KM. Microcystic/reticular Schwannoma in the colon. Pathology, 2009, 41(6): 595-596.
7. Agaimy A, Märkl B, Kitz J, <italic>et al</italic>. Peripheral nerve sheath tumors of the gastrointestinal tract: a multicenter study of 58 patients including NF1-associated gastric Schwannoma and unusual morphologic variants. Virchows Arch, 2010, 456(4): 411-422.
8. 李百周, 王加伟, 魏红权. 微囊性/网状神经鞘瘤的临床病理特点. 中华病理学杂志, 2010, 39(6): 396-399.
9. Kienemund J, Liegl B, Siebert F, <italic>et al</italic>. Microcystic reticular Schwannoma of the colon. Endoscopy, 2010, 42(Suppl 2): E247.
10. Chetty R. Reticular and microcystic Schwannoma: a distinctive tumor of the gastrointestinal tract. Ann Diagn Pathol, 2011, 15(3): 198-201.
11. Liegl B, Bodo K, Martin D, <italic>et al</italic>. Microcystic/reticular Schwannoma of the pancreas: a potential diagnostic pitfall. Pathol Int, 2011, 61(2): 88-92.
12. Lau PPL, Yau DTW, Lau WH, <italic>et al</italic>. Multinodular reticular Schwannoma in the head and neck region: a potential diagnostic pitfall. Int J Surg Pathol, 2013, 21(1): 54-58.
13. Pang JM, Mahar A, Shannon K, <italic>et al</italic>. Reticular and microcystic Schwannoma of the parotid gland. Pathology, 2013, 45(1): 96-98.
14. Trivedi A, Ligato S. Microcystic/reticular Schwannoma of the proximal sigmoid colon: case report with review of literature. Arch Pathol Lab Med, 2013, 137(2): 284-288.
15. Chaurasia JK, Afroz N, Sahoo B, <italic>et al</italic>. Reticular Schwannoma mimicking myxoid sarcoma. BMJ Case Rep, 2014, 2014: bcr2013202963.
16. Gong S, Hafez-Khayyata S, Xin W, <italic>et al</italic>. Microcystic/reticular Schwannoma: morphological features causing diagnostic dilemma on fine-needle aspiration cytology. Am J Case Rep, 2014, 15: 538-542.
17. Gu MJ, Choi JH. Microcystic/reticular Schwannoma of the esophagus: the first case report and a diagnostic pitfall. BMC Gastroenterol, 2014, 14: 193.
18. 沈勤, 王艳芬, 余波, 等. 胰腺微囊/网状型神经鞘瘤临床病理特征. 诊断病理学杂志, 2014, 21(11): 689-692.
19. Yin Y, Wang T, Cai YP, <italic>et al</italic>. Microcystic/reticular Schwannoma of the mandible first case report and review of the literature. Medicine (Baltimore), 2015, 94(45): e1974.
20. Zhou J, Zhang D, Wang G, <italic>et al</italic>. Primary adrenal microcystic/reticular Schwannoma: clinicopathological and immunohistochemical studies of an extremely rare case. Int J Clin Exp Pathol, 2015, 8(5): 5808-5811.
21. Lau RP, Melamed J, Yee-Chang M, <italic>et al</italic>. Microcystic/reticular Schwannoma arising in the submandibular gland: a rare benign entity that mimics more common salivary gland carcinomas. Head Neck Pathol, 2016, 10(3): 374-378.
22. Luzar B, Tanaka M, Schneider J, <italic>et al</italic>. Cutaneous microcystic/reticular Schwannoma: a poorly recognized entity. J Cutan Pathol, 2016, 43(2): 93-100.
23. 谢军, 王辉, 邓妮. 肾上腺微囊性/网状神经鞘瘤1例报道. 诊断病理学杂志, 2016, 23(8): 626-628.
24. Pearson L, Akture E, Wonderlick J, <italic>et al</italic>. Microcystic/reticular Schwannoma of the frontal lobe: an unusual occurrence. Case Rep Pathol, 2017, 2017: 4728585.
25. 郭俊召, 张晓文, 杨守京. 硬腭微囊性/网状型神经鞘瘤误诊为多形性腺瘤一例. 中华病理学杂志, 2017, 46(6): 431-432.
26. Georgescu TA, Dumitru AV, Oproiu AM, <italic>et al</italic>. Cutaneous microcystic/reticular Schwannoma: case report and literature review of an exceedingly rare entity with an unusual presentation. Rom J Morphol Embryol, 2018, 59(1): 303-309.
27. 程羽青, 周晓莉, 顾文贤, 等. 皮肤微囊/网状型神经鞘瘤临床病理特征. 诊断病理学杂志, 2018, 25(7): 489-493.
28. Bedir R, Semerci O, Fındık Güvendi G. Incidental cutaneous microcystic/reticular Schwannoma in pilonidal sinus. Balkan Med J, 2019, 37(1): 52-53.
29. Maciel JM, Pereira DV, Simões HF, <italic>et al</italic>. Adrenal microcystic reticular Schwannoma. AACE Clin Case Rep, 2019, 5(4): e250-e254.
30. Zhou J, Zhang D, Li W, <italic>et al</italic>. Primary adrenal Schwannoma: a series of 31 cases emphasizing their clinicopathologic features and favorable prognosis. Endocrine, 2019, 65(3): 662-674.
31. 王坚, 朱雄增. 软组织肿瘤病理学. 第 2 版. 北京: 人民卫生出版社, 2017: 1027-1053.
32. Mentzel T, Kutzner H. Reticular and plexiform perineurioma: clinicopathological and immunohistochemical analysis of two cases and review of perineurial neoplasms of skin and soft tissues. Virchows Arch, 2005, 447(4): 677-682.
33. Folpe AL, Billings SD, McKenney JK, <italic>et al</italic>. Expression of claudin-1, a recently described tight junction-associated protein, distinguishes soft tissue perineurioma from potential mimics. Am J Surg Pathol, 2002, 26(12): 1620-1626.
34. Song W, Flucke U, Suurmeijer AJH. Myoepithelial tumors of bone. Surg Pathol Clin, 2017, 10(3): 657-674.
35. Jo VY, Fletcher CDM. Myoepithelial neoplasms of soft tissue: an updated review of the clinicopathologic, immunophenotypic, and genetic features. Head Neck Pathol, 2015, 9(1): 32-38.
36. Flucke U, Palmedo G, Blankenhorn N, <italic>et al</italic>. EWSR1 gene rearrangement occurs in a subset of cutaneous myoepithelial tumors: a study of 18 cases. Mod Pathol, 2011, 24(11): 1444-1450.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Microcystic/reticular schwannoma：clinicopathologic analyses and review of literatures

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