title: Atypical and low-grade malignant vestibular schwannomas: clinical implications of proliferative activity.
abstract: OBJECTIVE
  To examine the relationship between histopathology, immunohistochemistry, and clinical behavior in atypical and low-grade malignant vestibular schwannomas.
  
  
  METHODS
  The study design was a retrospective case review in conjunction with a histopathologic and immunohistochemical proliferation marker study of archival specimens.
  
  
  METHODS
  A tertiary referral center's anatomic pathology and vestibular schwannoma computerized databases.
  
  
  METHODS
  The diagnosis of atypical or low-grade malignant vestibular schwannoma was based on the number of mitotic figures present per tumor slide. MIB1 labeling indices were used to compare the proliferative activity of the atypical and low-grade malignant groups with that in an age-matched and size-matched control group.
  
  
  RESULTS
  Eight cases of atypical and six cases of low-grade malignant vestibular schwannoma were diagnosed from 1990 to 1998. In the atypical and low-grade malignant groups, respectively, the average patient age was 54.3 years (range, 38-74 yr) and 50 years (range, 38-72 yr), and the average total tumor size was 1.53 cm (range, 0.7-3.5 cm) and 1.55 cm (range, 1.5-2 cm). Two recurrences were identified from the low-grade malignant group, and there was one postoperative House-Brackmann Grade III facial weakness. There were no recurrences or facial palsies in the atypical group. No distant metastasis or aggressive local invasion was observed in either group. MIB1 labeling indices were significantly (p < or = 0.001) higher in the atypical (4.69%) and low-grade malignant (5.23%) groups than in the control group (1.99%).
  
  
  CONCLUSIONS
  These findings suggest a tendency for recurrence in proliferative tumors; however, the designation of malignancy should be reconsidered.
authors.affiliation: Department of Otolaryngology, Kaplan Comprehensive Cancer Center, New York University School of Medicine, 550 First Avenue, New York, NY 10016, U.S.A.
authors.forename: J P
authors.initials: JP
authors.lastname: Light
authors.forename: J T
authors.initials: JT
authors.lastname: Roland
authors.forename: A
authors.initials: A
authors.lastname: Fishman
authors.forename: D C
authors.initials: DC
authors.lastname: Miller
authors.forename: N L
authors.initials: NL
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000378:metabolism; D002465:Cell Movement / Q000502:physiology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D000911:Antibodies, Monoclonal; D019394:Ki-67 Antigen