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AJNR - American Journal of Neuroradiology

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MR Imaging Features of a Scalp Plexiform Schwannoma

Kazumichi Yamada^a, Mikio Harada^a, Naoko Kunitoku^a, Satoshi Goto^a, Masato Kochi^a and Yukitaka Ushio^a

^a From the Department of Neurosurgery, Kumamoto University School of Medicine and Kumamoto Neurosurgical Hospital, Kumamoto, Japan

View larger version (163K): [in a new window]   FIG 1. Photograph showing a large scalp tumor in the left retroauricular portion. The surface of the skin presents mild discoloration and partial alopecia.

View larger version (57K): [in a new window]   FIG 2. CT scan depicting a left subcutaneous mass exhibiting low isoattenuation (A) and bone image CT (B) showing erosion of the occipitomastoid bones (arrow); no evidence of tumor invasion into the skull is evident.

View larger version (173K): [in a new window]   FIG 3. Axial (A and B) and coronal (C and D) MR images. The mass (4 x 5 cm in diameter) is seated within the subcutaneous adipose tissue. The tumor is heterogeneously hypoisointense and surrounded by a hypointense thin capsule on T1-weighted images (A and C). The multiple, hyperintense nodules are separated by a hypointense, internodular structure on T2-weighted images (B and D).

View larger version (72K): [in a new window]   FIG 4. Gross specimen of the removed tumor. The tumor is covered by smooth fibrous capsule (A) and composed of well-circumscribed, soft to rubbery-firm nodules (B). The cut surface of the tumor is grayish white to yellow and there are scattered macroscopic hemorrhages (B). Scale bars: 1 cm in both A and B.

View larger version (76K): [in a new window]   FIG 5. Photomicrographs of the tumor. A, The constituent cells are spindle-shaped with irregular, generally elongated nuclei and wavy, ill-defined, eosinophilic cytoplasm. (Hematoxylin-eosin, original magnification x100) B, The tumor cells exhibit strong immunoreactivity for S-100 protein. (Original magnification x200)