Abstract
BackgroundScrotal schwannoma is a rare neoplasm and poses a diagnostic challenge to urologists. This article describes a rare case of ancient scrotal schwannoma and reviews the current modality of investigation and treatment of this tumour.Case reportA 28 year old man presented with a 3-month history of an asymptomatic scrotal swelling. Ultrasonography and computer topography revealed an intra-scrotal and extra-testicular mass without local invasion. Surgical excision was undertaken and histology was an ancient schwannoma of the scrotum.ConclusionSchwannoma is a benign encapsulating neoplasm with an overall low incidence, occurring mostly in the head and neck region and seldom in the scrotum. Histology shows two distinctive patterns, Antoni type A and B areas. Variations of schwannoma such as cellular, ancient, glandular and epithelioid are observed based on the appearances. Ancient schwannoma exhibits pleomorphism without mitosis as the result of cellular degeneration, which can lead to an erroneous diagnosis of malignancy. Imaging modalities are non-specific for schwannomas, but can define tumour size, site and extension. The mainstay treatment is complete excision, although local recurrence may occur in large and incompletely excised lesions. Malignant change is exceedingly rare.
Highlights
Scrotal schwannoma is a rare neoplasm and poses a diagnostic challenge to urologists
Histology shows two distinctive patterns, Antoni type A and B areas. Variations of schwannoma such as cellular, ancient, glandular and epithelioid are observed based on the appearances
Ancient schwannoma exhibits pleomorphism without mitosis as the result of cellular degeneration, which can lead to an erroneous diagnosis of malignancy
Summary
A schwannoma is a benign encapsulated neoplasm derived from schwann cells of the nerve sheath. Antoni B areas consist of tumour cells suspended in a myxomatous matrix that may appear microcystic. Several variants of schwannomas based on appearances have been observed, including cellular, glandular, epithelioid and ancient types, and all exhibit benign progression. Ancient schwannomas show bizarre hyperchromatic nuclei without mitoses. Large and incompletely excised lesions are capable of recurrence; malignant change is exceedingly rare [3,10]. This patient will require a prolonged period of surveillance due to the large size of the tumour and the uncertainty of complete excision. MFiigcurorseco3pic appearance of ancient schwannoma Microscopic appearance of ancient schwannoma. a) spindle cells in an Antoni type A area; a red arrow indicates a large bizarre hyperchromatic nucleus b) Antoni B areas consisting of spindle cells within a loose myxoid matrix, c) occasional pleomorphic nuclei within Antoni A areas, and d) positive S100 immunohistochemical staining
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