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Acoustic neuroma must be differentiated from [[meningioma]], intracranial epidermoid cyst, [[facial nerve]] [[schwannoma]], [[trigeminal]] [[schwannoma]], [[ependymoma]], leiomyoma, intranodal palisaded myofibroblastoma, [[malignant]] peripheral nerve sheath tumour (MPNST), [[gastrointestinal]] stromal tumor, [[neurofibroma]], [[Meniere's]] disease, and [[Bell's palsy]].<ref>{{Cite web | title =Radiopedia Differential diagnosis of Acoustic Neuroma| url =http://radiopaedia.org/articles/acoustic-schwannoma }}</ref>   
Acoustic neuroma must be differentiated from [[meningioma]], intracranial epidermoid cyst, [[facial nerve]] [[schwannoma]], [[trigeminal]] [[schwannoma]], [[ependymoma]], leiomyoma, intranodal palisaded myofibroblastoma, [[malignant]] peripheral nerve sheath tumour (MPNST), [[gastrointestinal]] stromal tumor, [[neurofibroma]], [[Meniere's]] disease, and [[Bell's palsy]].<ref>{{Cite web | title =Radiopedia Differential diagnosis of Acoustic Neuroma| url =http://radiopaedia.org/articles/acoustic-schwannoma }}</ref>   
==Differential Diagnosis==
==Differential Diagnosis==
The most frequent differential to be considered are:<ref>{{Cite web | title =Radiopedia Differential diagnosis of Acoustic Neuroma| url =http://radiopaedia.org/articles/acoustic-schwannoma }}</ref>
Acoustic neuroma must be differentiated from:<ref>{{Cite web | title =Libre Pathology Differential diagnosis of Acoustic Neuroma| url =http://librepathology.org/wiki/index.php/Schwannoma }}</ref>
*Meningioma
*Intracranial epidermoid cyst
*Facial nerve schwannoma
*Trigeminal schwannoma
*Ependymoma
*[[Metastasis]]
*[[Leiomyoma]]
*Intranodal palisaded myofibroblastoma
*Gastrointestinal stromal tumor
*MPNST - schwannoma with ancient change has no significant [[mitotic]] activity<ref name="pmid17244372">{{cite journal| author=Chan PT, Tripathi S, Low SE, Robinson LQ| title=Case report--ancient schwannoma of the scrotum. | journal=BMC Urol | year= 2007 | volume= 7 | issue=  | pages= 1 | pmid=17244372 | doi=10.1186/1471-2490-7-1 | pmc=PMC1783662 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17244372  }} </ref>
*[[Neurofibroma]]
*[[Meniere's]] disease
*[[Bell's palsy]]
 
Differentiating features of common differential diagnosis are:<ref>{{Cite web | title =Radiopedia Differential diagnosis of Acoustic Neuroma| url =http://radiopaedia.org/articles/acoustic-schwannoma }}</ref>
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Meningioma  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Meningioma  
| style="padding: 5px 5px; background: #F5F5F5;" |Hearing loss is a less prominent  
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |*Usually more homogeneous in appearance: significant signal heterogeneity with cystic or haemorrhagic areas is more typical of vestibular schwannoma than meningiomas (although cystic meningiomas do occur)  
*Hearing loss is a less prominent  
| style="padding: 5px 5px; background: #F5F5F5;" |
*Usually more homogeneous in appearance: significant signal heterogeneity with cystic or haemorrhagic areas is more typical of vestibular schwannoma than meningiomas (although cystic meningiomas do occur)  
*Meningiomas tend to have a broad dural base
*Meningiomas tend to have a broad dural base
*Usually lack trumpet IAM sign
*Usually lack trumpet IAM sign
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |  Intracranial epidermoid cyst
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |  Intracranial epidermoid cyst
| style="padding: 5px 5px; background: #F5F5F5;" |Hearing loss is a less prominent
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |No enhancing component
*Hearing loss is less  
Very high signal on DWI ( Diffusion weighted imaging)  
| style="padding: 5px 5px; background: #F5F5F5;" |
does not widen the IAC (Internal Auditory Canal)
*No enhancing component
*Very high signal on DWI ( [[Diffusion weighted imaging]])  
*Does not widen the IAC ([[Internal auditory canal]])
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Facial nerve Schwannoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Facial nerve schwannoma
| style="padding: 5px 5px; background: #F5F5F5;" |Facial weakness is prominent and occurs early
| style="padding: 5px 5px; background: #F5F5F5;" |
Sometimes associated with neurofibromatosis
*Facial weakness is prominent and occurs early
| style="padding: 5px 5px; background: #F5F5F5;" |CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal
*Sometimes associated with neurofibromatosis
| style="padding: 5px 5px; background: #F5F5F5;" |
*CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Trigeminal Schwannoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Trigeminal schwannoma
| style="padding: 5px 5px; background: #F5F5F5;" |Clinically associated with more prominent facial numbness
| style="padding: 5px 5px; background: #F5F5F5;" |
Hearing loss is also less prominent  
*Clinically associated with more prominent facial numbness
| style="padding: 5px 5px; background: #F5F5F5;" |CT and MRI imaging displays a dumbbell-shaped mass over the petrous apex affecting Meckel cave.
*Hearing loss is also less prominent  
The trigeminal nerve enhancement extends proximal to the tumor and does not extend into the IAM (internal acoustic meatus)
| style="padding: 5px 5px; background: #F5F5F5;" |
*CT and MRI imaging displays a dumbbell-shaped mass over the petrous apex affecting Meckel cave.
*The trigeminal nerve enhancement extends proximal to the tumor and does not extend into the IAM (internal acoustic meatus)
|}
|}
Other Differential diagnosis and their findings include:<ref>{{Cite web | title =Libre Pathology Differential diagnosis of Acoustic Neuroma| url =http://librepathology.org/wiki/index.php/Schwannoma }}</ref>
*Ependymoma
*[[Metastasis]]
*[[Leiomyoma]]
*Intranodal palisaded myofibroblastoma
*Gastrointestinal stromal tumor
*MPNST - schwannoma with ancient change has no significant [[mitotic]] activity<ref name="pmid17244372">{{cite journal| author=Chan PT, Tripathi S, Low SE, Robinson LQ| title=Case report--ancient schwannoma of the scrotum. | journal=BMC Urol | year= 2007 | volume= 7 | issue=  | pages= 1 | pmid=17244372 | doi=10.1186/1471-2490-7-1 | pmc=PMC1783662 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17244372  }} </ref>
*[[Neurofibroma]]
*[[Meniere's]] disease
*[[Bell's palsy]]


==References==
==References==
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[[Category:PNS neoplasia]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Disease]]
[[Category:Disease]]

Revision as of 04:43, 2 October 2015

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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]

Overview

Acoustic neuroma must be differentiated from meningioma, intracranial epidermoid cyst, facial nerve schwannoma, trigeminal schwannoma, ependymoma, leiomyoma, intranodal palisaded myofibroblastoma, malignant peripheral nerve sheath tumour (MPNST), gastrointestinal stromal tumor, neurofibroma, Meniere's disease, and Bell's palsy.[1]

Differential Diagnosis

Acoustic neuroma must be differentiated from:[2]

Differentiating features of common differential diagnosis are:[4]

Disease/Condition Differentiating Signs/Symptoms Findings on CT or MRI
Meningioma
  • Hearing loss is a less prominent
  • Usually more homogeneous in appearance: significant signal heterogeneity with cystic or haemorrhagic areas is more typical of vestibular schwannoma than meningiomas (although cystic meningiomas do occur)
  • Meningiomas tend to have a broad dural base
  • Usually lack trumpet IAM sign
  • Calcification is more common
Intracranial epidermoid cyst
  • Hearing loss is less
Facial nerve schwannoma
  • Facial weakness is prominent and occurs early
  • Sometimes associated with neurofibromatosis
  • CT and MRI imaging results are similar to acoustic neuroma but enhancement extends into the geniculate ganglion of the facial nerve and facial canal
Trigeminal schwannoma
  • Clinically associated with more prominent facial numbness
  • Hearing loss is also less prominent
  • CT and MRI imaging displays a dumbbell-shaped mass over the petrous apex affecting Meckel cave.
  • The trigeminal nerve enhancement extends proximal to the tumor and does not extend into the IAM (internal acoustic meatus)

References

  1. ↑ "Radiopedia Differential diagnosis of Acoustic Neuroma".
  2. ↑ "Libre Pathology Differential diagnosis of Acoustic Neuroma".
  3. ↑ Chan PT, Tripathi S, Low SE, Robinson LQ (2007). "Case report--ancient schwannoma of the scrotum". BMC Urol. 7: 1. doi:10.1186/1471-2490-7-1. PMC 1783662. PMID 17244372.
  4. ↑ "Radiopedia Differential diagnosis of Acoustic Neuroma".

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