Case Report

Malignant Intracerebral Nerve Sheath Tumors: A Case Report with Review of the Literature

Table 2

Radiographic and histological features in 15 reported cases of MINST.

Authors reference Radiological findingsTumor size (cm)*Histopathological findings

Ellis et al., 2011[7]MRI: Irregular enhancing lesion8 × 6.5 × 7Spindle and epithelial cells, hypercellular, fascicular pattern, mitotic index >10 mitoses/hpf, interdigitating processes, tight junctions, basal lamina, +S-100, +Bcl2, +PGP 9.5, +BAF47
Barnard et al., 2011 [9]MRI: heterogeneous mass with areas of enhancement, cystic changes, and foci of hemorrhage6.8 (ap) × 5.0 (t) × 4.6 cm (ci)Spindle cells, moderate cellularity and
pleiomorphism, mitotically active, high nuclear : cytoplasmic ratio, fascicular pattern, microcysts, +Vimentin, +S-100
Oztanir et al.,
2009 [10]
MRI: heterogeneous contrast enhancement, central necrosis, calcifications, cystic components, peritumoral edema, isointense (T1 and T2) 8 × 8 × 8Spindle cells, fascicular pattern, geographic necrosis, abundant mitosis, +S-100, +Vimentin
Kozić et al.,
2008 [11]
MRI: Ill-defined mass, inhomogenous, faint contrast enhancement, hyperintense on T23.0 (ap) × 3.2 (ci)Tightly packed cells, arranged in fascicles, +S-100
De Cauwer et al., 2007 [5]MRI: Perilesional edema, Methionine PET: a site of high metabolic activity.NRSpindle cells, hyperchromatic nuclei, prominent nucleoli, rhabdomatoid differentiation, high mitotic activity, necrosis, +S-100, +Desmin, +Vimentin
Beauchesne et al., 2004 [2]MRI: a heterogeneous, peripherally enhancing, centrally necrotic mass2.2Spindle cells, highly cellular, nuclear polymorphism, fascicles pattern, +S-100, +Vimentin
Maiuri et al., 2004 [12]CT: hyperdense; irregular margins, inhomogeneous contrast enhancement.NRFused, pleomorphic cells, hyperchromatic nuclei, some multinucleated cells and epithelioid cells, mitotic index was 4 × 10 HPF, +S-100, +Vimentin, +Leu 7 (CD57)
Bornstein-Quevedo et al., 2003 [4]CT: enhancing mass lesion, multilobulated5.1 × 3.2Spindle cells, rhabdomyoblasts, hypercellular, fascicular pattern, marked pleiomorphism, high mitotic activity (8 mitoses/10 HPF), necrosis, fragmented external lamina, thin cytoplasmic processes, occasional cell junctions, +S-100, +CD57, +desmin, +myoglobin, +Myo-D1
Takahashi et al., 2000 [6]MRI: solid, irregularly enhancing mass; hypointense (T1), hyperintense (T2)3.0 × 4.0 × 3.0Spindle cells, mitotic activity, rhabdomyoblastic component, surrounding basal lamina, desmosomes, +actin,+desmin, +S-100
Tanaka et al.,
2000 [13]
CT: isodense mass, intratumoral calcification, perifocal edema, irregularly shaped septa within multiloculations, MRI: considerable enhancement; hypointense (T1), mixed signal intensity (T2)5.0 × 5.0 × 4.0Hypercellularity, spindle cells, nuclear hyperchormatism, interlacing fascicles, cystic components, high mitotic activity (10/10 HPF), stromal calcification, +S-100, +NSE, +Vimentin, +MIB-1 (10%)
Sharma et al., 1998 [14]MRI: mixed attenuation, disruption of the gray/white matter interface, multiple cysts3.4 × 2.7 × 0.4Moderate-high cellularity, moderate pleomorphic spindle cells, intertwining fascicles, 3 mitoses/10 HPF, +epitheloid cells, +S-100, +MIB-1 (2.3–7.5%), +reticulin
Jung et al., 1995 [15]CT: cystic mass, peripheral edema, heterogeneous enhancement
MRI: considerable enhancement; hypointense (T1), mixed signal intensity (T2)
5.0 × 5.0 × 6.0Spindle cells, interlacing fascicles, frequent mitotic figures, thin cellular processes, distinct external lamina, +reticulin, +S-100, +Vimentin,
Singh et al., 1993 [16]CT: contrast-enhancing, mixed attenuating lesionNRSpindle cells, +foamy/clear cells, many mitotic figures, interwoven fascicles, lobular outgrowths, prominent vessels, cellular processes, poorly developed basal lamina, +necrosis, +pseudoinclusions, +desmosomes, +S-100
Stefanko et al., 1986 [17]CT: ring-enhancing lesion6.2 × 6.2 Bipolar spindle cells, hyperchromatic nuclei, high cellularity, +epithelioid cells, +syncytia, +basal lamina, +cellular processes, +reticulin, +S-100,
Bruner et al., 1984 [18]CT: mass lesionNRSpindle cells, rare mitoses, +collagen, +reticulin, rare basement membranes, occasional cell junctions, MNGCs, +bizzare cytolplasmic processes +S-100, +GFAP
Present caseMRI: hematoma with mass effect resulting in 5 mm midline shift. Nodular areas of enhancement centrally within this mass 4.1 cm × 3.5 cm × 4.1 cm Pleomorphic spindle cells, hyperchromatic nuclei, fascicules, basal lamina, vacuoles and granular changes, anisonucleosis, mitotic figures, MNGC, dystrophic calcification, necrosis foci, +collagen, +desmin, +Vimentin

Tumor size as reported on imaging or pathology; MNGC: multinucleated giant cells; NR: not reported.