Acoustic neuroma pathophysiology: Difference between revisions
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{{Acoustic neuroma}} | {{Acoustic neuroma}} | ||
{{CMG}} | |||
==Overview== | {{CMG}}{{AE}}{{Simrat}} {{M.B}} {{Sab}} | ||
On microscopic histopathological | ==Overview== | ||
Acoustic neuroma arises from [[Schwann cells]], which are the [[Cell (biology)|cells]] involved in the conduction of [[Nervous system|nervous]] impulses along [[axons]], [[nerve]] development and [[Nerve regeneration|regeneration]]. On [[microscopic]] [[histopathological]] analysis, acoustic neuroma may display two types of growth patterns: Antoni type A and Antoni type B. Antoni type A growth pattern is composed of elongated [[Cell (biology)|cells]] with [[Cytoplasm|cytoplasmic]] processes arranged in [[Fascicle|fascicles]], little [[stromal]] [[matrix]] and verocay bodies. Antoni type B growth pattern is composed of loose meshwork of [[Cell (biology)|cells]], less dense [[Cell (biology)|cellular]] [[matrix]], microcysts and myxoid change. | |||
==Pathophysiology== | ==Pathophysiology== | ||
Acoustic | * Acoustic neuromas are [[benign]] [[Tumor|tumors]] ([[WHO]] [[Grading (tumors)|grade]] 1), usually arising from the intracanalicular segment of the vestibular portion of the [[Vestibulocochlear nerve|vestibulocochlear nerve (CN VIII)]], near the transition point between [[Glial cell|glial]] and [[Schwann cell|Schwann cells]] (Obersteiner-Redlich zone). | ||
* An acoustic neuroma arises from a type of [[Cell (biology)|cell]] known as the [[Schwann cell]]. These [[Cell (biology)|cells]] form an insulating layer over all [[Nerve|nerves]] of the [[peripheral nervous system]] (i.e., [[Nerve|nerves]] outside of the [[central nervous system]]) including the [[Vestibulocochlear nerve|eighth cranial nerve]]. | |||
=== | * Most acoustic neuromas are found along the [[Vestibular nerve|vestibular]] portion of the [[Vestibulocochlear nerve|eighth cranial nerve]]. | ||
* As these [[Tumor|tumors]] are made up of [[Schwann cells]], and usually located along the [[Vestibular nerve|vestibular]] portion of the [[Vestibulocochlear nerve|eighth cranial nerve]], many [[Physician|physicians]] prefer to use the term, "[[Acoustic neuroma|vestibular schwannoma]]". However, the term acoustic neuroma is still used more often in the [[medical literature]].<ref name="radio">Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015</ref> | |||
* | * Acoustic neuromas are well circumscribed encapsulated [[Mass|masses]], which unlike neuromas, arise from but are separate from [[nerve]] fibers. | ||
** | |||
** | == Genetic == | ||
* One the most common causes of acoustic neuroma is [[Neurofibromatosis type II|neurofibromatosis type 2 (NF2)]], an [[Dominance relationship|autosomal dominant]] disease caused by loss of function [[Mutation|mutation]]. | |||
* [[Genetics|Genetic]] studies have linked both sporadic and [[Neurofibromatosis type II|NF2]]-associated acoustic neuromas to a single [[gene]], the NF2 [[gene]], located on [[chromosome 22]] band q11–13.1. | |||
* | |||
** | == Associated Conditions == | ||
* | *Acoustic neuroma is strongly associated with [[Neurofibromatosis type II|neurofibromatosis type 2 (NF2)]].<ref>{{Cite journal | ||
| author = [[M. M. Eibl]], [[R. Ahmad]], [[H. M. Wolf]], [[Y. Linnau]], [[E. Gotz]] & [[J. W. Mannhalter]] | |||
| title = A component of factor VIII preparations which can be separated from factor VIII activity down modulates human monocyte functions | |||
| journal = [[Blood]] | |||
| volume = 69 | |||
| issue = 4 | |||
| pages = 1153–1160 | |||
| year = 1987 | |||
| month = April | |||
| pmid = 3030465 | |||
}}</ref> | |||
== Gross Pathology == | |||
On [[gross pathology]], following are the characteristic findings of acoustic neuroma: | |||
* Rubbery-firm with a pale, gray color<ref>{{Cite journal | |||
| author = [[Joshua Greene]] & [[Mohammed A.. Al-Dhahir]] | |||
| title = Acoustic Neuroma (Vestibular Schwannoma) | |||
| year = 2019 | |||
| month = January | |||
| pmid = 29262098 | |||
}}</ref> | |||
* Well-defined capsule | |||
* Different degrees of [[vascularity]] | |||
==== On Cut Section ==== | |||
* Pale gray and firm<ref>{{Cite journal | |||
| author = [[Joshua Greene]] & [[Mohammed A.. Al-Dhahir]] | |||
| title = Acoustic Neuroma (Vestibular Schwannoma) | |||
| year = 2019 | |||
| month = January | |||
| pmid = 29262098 | |||
}}</ref> | |||
* Fine trabeculated appearance | |||
* [[Cyst|Cystic]] degeneration | |||
* [[Bleeding|Hemorrhage]] | |||
* [[Calcification]] | |||
* Xanthomatous changes | |||
==Microscopic Pathology== | |||
===On Light Microscopy=== | |||
*The [[tumor]] is made up of [[Spindle neuron|spindle cells]] with elongated [[Cell nucleus|nuclei]] and fibrillary [[cytoplasm]].<ref>{{Cite journal | |||
| author = [[Joshua Greene]] & [[Mohammed A.. Al-Dhahir]] | |||
| title = Acoustic Neuroma (Vestibular Schwannoma) | |||
| year = 2019 | |||
| month = January | |||
| pmid = 29262098 | |||
}}</ref> | |||
*The [[Spindle neuron|spindle cells]] are arranged in two ways: | |||
'''1. Antoni A''' | |||
*Antoni A [[Tissue (biology)|tissue]] is small with organized and interwoven course of elongated [[Bipolar cell|bipolar cells]].<ref>{{Cite journal | |||
| author = [[Joshua Greene]] & [[Mohammed A.. Al-Dhahir]] | |||
| title = Acoustic Neuroma (Vestibular Schwannoma) | |||
| year = 2019 | |||
| month = January | |||
| pmid = 29262098 | |||
}}</ref> | |||
*The spiral framework, formed by the arrangement of the [[Cell nucleus|nuclei]] and fibers, can resemble a [[meningioma]]. | |||
*Verocay bodies can also be seen.<ref name="WippoldLubner2007">{{cite journal|last1=Wippold|first1=F.J.|last2=Lubner|first2=M.|last3=Perrin|first3=R.J.|last4=Lammle|first4=M.|last5=Perry|first5=A.|title=Neuropathology for the Neuroradiologist: Antoni A and Antoni B Tissue Patterns|journal=American Journal of Neuroradiology|volume=28|issue=9|year=2007|pages=1633–1638|issn=0195-6108|doi=10.3174/ajnr.A0682}}</ref> | |||
'''2. Antoni B''' | |||
*It is represented by a random grouping of [[Cell (biology)|cells]] around foci of [[necrosis]], [[Cyst|cystic]] change, [[Bleeding|hemorrhage]], and [[Blood vessel|blood vessels]].<ref>{{Cite journal | |||
| author = [[Joshua Greene]] & [[Mohammed A.. Al-Dhahir]] | |||
| title = Acoustic Neuroma (Vestibular Schwannoma) | |||
| year = 2019 | |||
| month = January | |||
| pmid = 29262098 | |||
}}</ref> | |||
*This [[Tissue (biology)|tissue]] can also have a variable amount of [[Lymphocyte|lymphocytic]] infiltration. | |||
===On Electron Microscopy=== | |||
The following findings on [[Electron microscope|electron microscopy]] are characteristic of an acoustic neuroma: | |||
*Characteristic [[basement membrane]] of the [[Schwann cell|schwann cells]].<ref>{{Cite journal | |||
| author = [[Joshua Greene]] & [[Mohammed A.. Al-Dhahir]] | |||
| title = Acoustic Neuroma (Vestibular Schwannoma) | |||
| year = 2019 | |||
| month = January | |||
| pmid = 29262098 | |||
}}</ref><ref>{{Cite journal | |||
| author = [[Lukas D. Landegger]], [[Jessica E. Sagers]], [[Sonam Dilwali]], [[Takeshi Fujita]], [[Mehmet I. Sahin]] & [[Konstantina M. Stankovic]] | |||
| title = A Unified Methodological Framework for Vestibular Schwannoma Research | |||
| journal = [[Journal of visualized experiments : JoVE]] | |||
| issue = 124 | |||
| year = 2017 | |||
| month = June | |||
| doi = 10.3791/55827 | |||
| pmid = 28654042 | |||
}}</ref> | |||
*Wide-spaced [[collagen]]. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Latest revision as of 16:18, 23 April 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Mohsen Basiri M.D. Sabawoon Mirwais, M.B.B.S, M.D.[3]
Overview
Acoustic neuroma arises from Schwann cells, which are the cells involved in the conduction of nervous impulses along axons, nerve development and regeneration. On microscopic histopathological analysis, acoustic neuroma may display two types of growth patterns: Antoni type A and Antoni type B. Antoni type A growth pattern is composed of elongated cells with cytoplasmic processes arranged in fascicles, little stromal matrix and verocay bodies. Antoni type B growth pattern is composed of loose meshwork of cells, less dense cellular matrix, microcysts and myxoid change.
Pathophysiology
- Acoustic neuromas are benign tumors (WHO grade 1), usually arising from the intracanalicular segment of the vestibular portion of the vestibulocochlear nerve (CN VIII), near the transition point between glial and Schwann cells (Obersteiner-Redlich zone).
- An acoustic neuroma arises from a type of cell known as the Schwann cell. These cells form an insulating layer over all nerves of the peripheral nervous system (i.e., nerves outside of the central nervous system) including the eighth cranial nerve.
- Most acoustic neuromas are found along the vestibular portion of the eighth cranial nerve.
- As these tumors are made up of Schwann cells, and usually located along the vestibular portion of the eighth cranial nerve, many physicians prefer to use the term, "vestibular schwannoma". However, the term acoustic neuroma is still used more often in the medical literature.[1]
- Acoustic neuromas are well circumscribed encapsulated masses, which unlike neuromas, arise from but are separate from nerve fibers.
Genetic
- One the most common causes of acoustic neuroma is neurofibromatosis type 2 (NF2), an autosomal dominant disease caused by loss of function mutation.
- Genetic studies have linked both sporadic and NF2-associated acoustic neuromas to a single gene, the NF2 gene, located on chromosome 22 band q11–13.1.
Associated Conditions
- Acoustic neuroma is strongly associated with neurofibromatosis type 2 (NF2).[2]
Gross Pathology
On gross pathology, following are the characteristic findings of acoustic neuroma:
- Rubbery-firm with a pale, gray color[3]
- Well-defined capsule
- Different degrees of vascularity
On Cut Section
- Pale gray and firm[4]
- Fine trabeculated appearance
- Cystic degeneration
- Hemorrhage
- Calcification
- Xanthomatous changes
Microscopic Pathology
On Light Microscopy
- The tumor is made up of spindle cells with elongated nuclei and fibrillary cytoplasm.[5]
- The spindle cells are arranged in two ways:
1. Antoni A
- Antoni A tissue is small with organized and interwoven course of elongated bipolar cells.[6]
- The spiral framework, formed by the arrangement of the nuclei and fibers, can resemble a meningioma.
- Verocay bodies can also be seen.[7]
2. Antoni B
- It is represented by a random grouping of cells around foci of necrosis, cystic change, hemorrhage, and blood vessels.[8]
- This tissue can also have a variable amount of lymphocytic infiltration.
On Electron Microscopy
The following findings on electron microscopy are characteristic of an acoustic neuroma:
- Characteristic basement membrane of the schwann cells.[9][10]
- Wide-spaced collagen.
References
- ↑ Acoustic Schwannoma. Radiopedia(2015) http://radiopaedia.org/articles/acoustic-schwannoma Accessed on October 2 2015
- ↑ M. M. Eibl, R. Ahmad, H. M. Wolf, Y. Linnau, E. Gotz & J. W. Mannhalter (1987). "A component of factor VIII preparations which can be separated from factor VIII activity down modulates human monocyte functions". Blood. 69 (4): 1153–1160. PMID 3030465. Unknown parameter
|month=
ignored (help) - ↑ Joshua Greene & Mohammed A.. Al-Dhahir (2019). "Acoustic Neuroma (Vestibular Schwannoma)". PMID 29262098. Unknown parameter
|month=
ignored (help) - ↑ Joshua Greene & Mohammed A.. Al-Dhahir (2019). "Acoustic Neuroma (Vestibular Schwannoma)". PMID 29262098. Unknown parameter
|month=
ignored (help) - ↑ Joshua Greene & Mohammed A.. Al-Dhahir (2019). "Acoustic Neuroma (Vestibular Schwannoma)". PMID 29262098. Unknown parameter
|month=
ignored (help) - ↑ Joshua Greene & Mohammed A.. Al-Dhahir (2019). "Acoustic Neuroma (Vestibular Schwannoma)". PMID 29262098. Unknown parameter
|month=
ignored (help) - ↑ Wippold, F.J.; Lubner, M.; Perrin, R.J.; Lammle, M.; Perry, A. (2007). "Neuropathology for the Neuroradiologist: Antoni A and Antoni B Tissue Patterns". American Journal of Neuroradiology. 28 (9): 1633–1638. doi:10.3174/ajnr.A0682. ISSN 0195-6108.
- ↑ Joshua Greene & Mohammed A.. Al-Dhahir (2019). "Acoustic Neuroma (Vestibular Schwannoma)". PMID 29262098. Unknown parameter
|month=
ignored (help) - ↑ Joshua Greene & Mohammed A.. Al-Dhahir (2019). "Acoustic Neuroma (Vestibular Schwannoma)". PMID 29262098. Unknown parameter
|month=
ignored (help) - ↑ Lukas D. Landegger, Jessica E. Sagers, Sonam Dilwali, Takeshi Fujita, Mehmet I. Sahin & Konstantina M. Stankovic (2017). "A Unified Methodological Framework for Vestibular Schwannoma Research". Journal of visualized experiments : JoVE (124). doi:10.3791/55827. PMID 28654042. Unknown parameter
|month=
ignored (help)