Original Article

Virchows Archiv

, Volume 460, Issue 6, pp 629-636

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Intratumoral hemorrhage, vessel density, and the inflammatory reaction contribute to volume increase of sporadic vestibular schwannomas

  • Maurits de VriesAffiliated withDepartment of Otolaryngology, Leiden University Medical Center
  • , Pancras C. W. HogendoornAffiliated withDepartment of Pathology, Leiden University Medical Center Email author 
  • , Inge Briaire-de BruynAffiliated withDepartment of Pathology, Leiden University Medical Center
  • , Martijn J. A. MalessyAffiliated withDepartment of Neurosurgery, Leiden University Medical Center
  • , Andel G. L. van der MeyAffiliated withDepartment of Otolaryngology, Leiden University Medical Center


Vestibular schwannomas show a large variation in growth rate, making prediction and anticipation of tumor growth difficult. More accurate prediction of clinical behavior requires better understanding of tumor biological factors influencing tumor progression. Biological processes like intratumoral hemorrhage, cell proliferation, microvessel density, and inflammation were analyzed in order to determine their role in vestibular schwannoma development. Tumor specimens of 67 patients surgically treated for a histologically proven unilateral vestibular schwannoma were studied. Preoperative magnetic resonance imaging (MRI) scans were used to determine tumor size and to classify tumors as homogeneous, inhomogeneous, and cystic. Immunohistochemical studies evaluated cell proliferation (histone H3 and Ki-67), microvessel density (CD31), and inflammation (CD45 and CD68). Intratumoral hemorrhage was assessed by hemosiderin deposition. The expression patterns of these markers were compared with tumor size, tumor growth index, MRI appearance, patients’ age, and duration of symptoms. No relation between cell proliferation and clinical signs of tumor volume increase or MRI appearance was found. Intratumoral hemosiderin, microvessel density, and inflammation were significantly positively correlated with tumor size and the tumor growth index. Cystic and inhomogeneous tumors showed significantly more hemosiderin deposition than homogeneous tumors. The microvessel density was significantly higher in tumors with a high number of CD68-positive cells. The volume increase of vestibular schwannomas is not based on cell proliferation alone. Factors like intratumoral bleeding, (neo)vascularization, and intensity of the inflammatory reaction also influence tumor volume.


Vestibular schwannoma Neuropathology Tumor biology