Abstract
BACKGROUNDLate pathology after vestibular schwannoma radiosurgery is uncommon. The authors presented a case of a resected hemorrhagic mass 13 years after radiosurgery, when no residual tumor was found.OBSERVATIONSA 56-year-old man with multiple comorbidities, including myelodysplastic syndrome cirrhosis, received Gamma Knife surgery for a left vestibular schwannoma. After 11 years of stable imaging assessments, the lesion showed gradual growth until a syncopal event occurred 2 years later, accompanied by progressive facial weakness and evidence of intralesional hemorrhage, which led to resection. However, histopathological analysis of the resected specimen showed hemorrhage and reactive tissue but no definitive residual tumor.LESSONSThis case demonstrated histopathological evidence for the role of radiosurgery in complete elimination of tumor tissue. Radiosurgery for vestibular schwannoma carries a rare risk for intralesional hemorrhage in select patients.
Highlights
Late pathology after vestibular schwannoma radiosurgery is uncommon
We provide details regarding a patient after radiosurgery who developed an intralesional hemorrhage
We describe an unusual case of a vestibular schwannoma that was treated by radiosurgery and developed delayed intralesional hemorrhage, necessitating its resection
Summary
Late pathology after vestibular schwannoma radiosurgery is uncommon. The authors presented a case of a resected hemorrhagic mass 13 years after radiosurgery, when no residual tumor was found. Histopathological analysis of the resected specimen showed hemorrhage and reactive tissue but no definitive residual tumor. LESSONS This case demonstrated histopathological evidence for the role of radiosurgery in complete elimination of tumor tissue. Radiosurgery for vestibular schwannoma carries a rare risk for intralesional hemorrhage in select patients. Pathology almost invariably shows recurrent tumor with reactive changes, including mixed chronic inflammatory effects and abnormal vasculature with focal proliferation.[1,2,3] tumors can show significant tumor regression on high-quality imaging, complete regression of a tumor is rare after radiosurgery. Resection is usually not required; histological or autopsy analyses of post–Gamma Knife surgery tissues are rarely available.[2] Intratumoral hemorrhage is rare and can occur as part of the response to radiosurgery, more frequently in patients with a coagulation disorder. The hemorrhage was resected without evidence of a residual tumor, suggesting that expansion was solely due to the hemorrhage and reactive tissue
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