Reticular schwannoma mimicking myxoid sarcoma

Abstract

Reticular/microcystic schwannoma is a recently described rare distinctive variant of schwannoma with a predilection for gastrointestinal tract. Its occurrence in soft tissue is extremely rare. We report a case of reticular/microcystic variant of schwannoma in a 55-year-old Indian woman who presented with a painless slow-growing swelling in the right forearm for the past 6 months. MRI findings suggested myxoid sarcoma. However, histological and immunohistochemical findings in the excised specimen were consistent with reticular/microcystic variant of schwannoma. This case report emphasises that the diagnosis of reticular/microcystic schwannoma should always be considered in cases where myxoid sarcomas are suspected as it can mimic malignant myxoid sarcomas, clinically and radiologically, thereby avoiding aggressive intervention and overtreatment.

Cutaneous microcystic/reticular schwannoma: a poorly recognized entity

“…Microcystic/reticular schwannoma was originally reported by Liegl et al as a distinctive variant of schwannoma showing predilections for the gastrointestinal tract . Nevertheless, similar lesions have infrequently been also reported in the respiratory tract, adrenal gland, deep soft tissue of the face and upper back, cervical spine, parotid gland, pancreas, mesentery and skin . Prior to the present study, only three microcystic/reticular schwannomas occurring in the skin have been described .…”

Diagnostic conundrums of schwannomas: two cases highlighting morphological extremes and diagnostic challenges in biopsy specimens of soft tissue tumors

“…Case 2 revealed extensive myxoid change, particularly within the peripheral aspect of the tumor, and led to a diagnostic dilemma during the intraoperative frozen section. Chaurasia et al [ 6 ] described a reticular schwannoma mimicking a low-grade fibromyxoid sarcoma, and this case also described extensive myxoid change. Many soft tissue tumors can exhibit myxoid change.…”

“…Myxoid change is a well-described phenomenon in schwannomas and often causes diagnostic difficulties [ 6 ]. Case 2 revealed extensive myxoid change, particularly within the peripheral aspect of the tumor, and led to a diagnostic dilemma during the intraoperative frozen section.…”

Microcystic/Reticular Schwannoma of the Frontal Lobe: An Unusual Occurrence

“…In contrast to other variants of schwannomas, MRV lacks a capsule and most importantly has a predilection for visceral locations [29–33]. To the best of our knowledge, this case is the first reported reticular/microcystic variant in an intracerebral location.…”

“…Schwannomas can also occur in the viscera, with the gastrointestinal tract being the most common site. The newly described microcystic/reticular variant (MRV) has a tendency to occur in the viscera [29–34]. …”