impact of intratumoral hemorrhage in producing arrays of morphological features in schwannomas

ABSTRACT

To study and evaluate the impact of intratumoral hemorrhage in producing wide spectrum of morphological features including Antoni A and Antoni B areas in Schwannomas. Observational study. Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad from 1st April 2005 to 31st October 2006. The total number of cases was 30 selected through convenience non-probability method. All diagnosed cases of Schwannomas were included in this study and were later reviewed by a final year FCPS student and a senior pathologist. A criterion was set for examining each slide. Percentage of hypercellular, hypo cellular or mixed areas was estimated in each slide. Verocay bodies were graded as 3 [well formed], 2 [moderately formed] and 1 [Schwann cells aggregates with suggestion of Verocay bodies]. Number of blood vessels was graded as 3, 2 and 1 if these constituted > 50%, 25-50% or < 25% of the area in the slide respectively. Hyalinization of blood vessels was graded as grade 3 for the wall thickness double the lumen diameter, grade 2 for wall thickness equal to the lumen diameter, grade 1 when lumen diameter was greater than wall thickness and 0 when no hyalinization was noted. Number of extravasated RBCs was graded from 3 to 0 depending upon extravasation seen in > 50%, 25-50%, <25% and none respectively. All the data was entered in SPSS version 10 and frequencies calculated. Impact scores of various parameters in predominantly hyper and hypocellular areas were also calculated. There was marked impact of intratumoral hemorrhage in creation of all sorts of morphological pictures in schwannomas. In about 47% cases hemorrhage was mild while in about 43% cases it was quite significant giving rise to dominant hypocellular areas, marked extravasation of red blood cells and hyalinization of blood vessels. Verocay bodies were well formed in 47% cases and these became ill defined with increased severity of hemorrhages. Intratumoral hemorrhages produce wide arrays of morphological changes in Schwannomas that have resulted not only in division of Antoni A and Antoni B areas but also giving bewildering morphological patterns, lack of familiarity of which may cause difficulty in recognition of the entity. On the other hand future research towards elimination or minimization of hemorrhages may help in reducing the bulk of the tumors thus avoiding pressure complications and facilitating their easy removal