A case of malignant schwannoma with overexpression of multidrug resistance gene (MDR1) after chemotherapy.

A 19-year-old:female patient with malignant schwannoma in the right knee was treated by combination chemotherapy including lipophilic anticancer compounds (cyclophosphamide, doxorubicin, vincristine and dacarbazine). The tumor was radically removed after chemotherapy, but metastatic lesions were noted in the right inguinal nodes. The patient died due to the cachexic state six months after surgery. In human neoplasm, P-glycoprotein (P-Gp) encoded by human multidrug resistance gene MDR1 is known to be related with multidrug resistant phenotype. Northern blot analysis revealed apparent MDR1 expression in the metastatic lesion, while the primary lesion showed faint MDR1 expression detected by only reverse transcriptase-polymerase chain reaction. P-Gp positive tumor cells were immunohistochemically detected both in the metastatic lesion and the primary lesion. The P-Gp-positive tumor cells in the metastatic lesion showed anaplastic features with highly atypical nuclei. These results suggest that MDR1 overexpression is related to the multidrug resistance phenomenon in the malignant schwannoma with morphological differences.