PMC9593123_01
Computed tomography examination, with enhanced contrast: (A) Coronal image presenting a well-circumscribed, homogenous tissue mass, with modest contrast enhancement, of 2.5x4.5 cm, in the right lateral-cervical area, displacing ventrally the carotid artery; (B) Axial image of the same tumor mass; (C) Sagittal image of the same tumor mass
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F1
Cervical computed tomography (CT) examination revealed a well-circumscribed, homogenous tissue mass, with modest contrast enhancement, 2.5x4.5 cm in size, localized side of right lateral-cervical vascular package, which imprints and moves the internal carotid artery to the ventral part of the neck (Figure 1A,1B,1C).
Intraoperative aspect of the intranodal schwannoma showing a solid, well delimited mass
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F2
Intraoperative, the tumor was completely removed, without any complications (Figure 2), with a favorable short and long-term postoperative evolution.
Morphological examination: residual lymph node tissue at the periphery of the tumor and part of the lymph node capsule [Hematoxylin-Eosin (HE) staining, x40]
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F3
The morphological examination revealed the structure of a lymph node, with rare peripheral lymphoid tissue (Figure 3).
Morphological examination: nodular mesenchymal proliferation, with elongated cells, arranged in palisade (HE staining, x200)
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F4
The mass proliferation does not exceed the lymph node capsule, with normal architecture being replaced by a nodular mesenchymal proliferation, with elongated cells, with indistinct limits (Figure 4), eosinophilic cytoplasm, euchromatic nuclei, with round, elongated or slightly wavy form and reduced pleomorphism, rare degenerative nuclear atypia, and no mitotic activity nor necrosis.
Immunohistochemistry (IHC) analysis (x200): tumor cells with increased expression of S100 protein
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F5
In addition, immunohistochemistry (IHC) showed expression of S100 protein - useful for establishing a positive diagnosis (Figure 5), with negative results for smooth muscle actin (SMA) and desmin (Figure 6, A and B).
IHC analysis (x200): tumor cells with negative results for smooth muscle actin (SMA) (A) and desmin (B)
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F6
In addition, immunohistochemistry (IHC) showed expression of S100 protein - useful for establishing a positive diagnosis (Figure 5), with negative results for smooth muscle actin (SMA) and desmin (Figure 6, A and B).
IHC analysis (x200): the cellular proliferation index (Ki67) was around 5%
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F7
The cellular proliferation index (Ki67) was low (5%) (Figure 7).