Axillary schwannoma, preoperative diagnosis on a tru-cut biopsy: Case report and literature review

Axillary Peripheral Nerve Schwannoma: A Rare Occurrence in the Torso

A schwannoma is a benign, solitary, noninvasive, and encapsulated tumor that originates from Schwann cells of the peripheral nerve sheath commonly found in the head and neck. A rare case of a benign schwannoma in the axillary region of a 34-year-old male patient is presented here accompanied by a discussion on the known entities of peripheral nerve schwannoma as well as the clinical and radiological findings coupled with treatment techniques. The patient presented with a left axillary mass of seven years gradually progressing in size which is associated with pain in the left arm. There were no neurological deficits on examination. Ultrasound and soft tissue MRI were performed followed by fine-needle aspiration cytology (FNAC), and a decision was made to take the patient up for an excisional biopsy. Histopathology revealed a tumor composed of hyper- (Antoni A) and hypocellular (Antoni B) areas, while immunohistochemistry was positive for the S-100 protein, thus confirming the diagnosis of left axillary peripheral nerve schwannoma. With such nonspecific presentation and the added challenge of its rarity, an axillary schwannoma may be easily missed and mismanaged. Surgical excision and biopsy are recommended with an aim of preserving neurological function.

Case Report: Upper limb dysfunction may be caused by chest wall mass excision: An enlightenment from a special case

Of all the thoracic surgical procedures, chest wall surgery is probably the lowest-risk type. In fact, it is not so. Clinical work also often has the trap of chest wall surgery. An operation to remove a mass in the axilla may result in upper limb disability on the affected side. Here, we report the case of a 47-year-old female patient with a left chest wall adjacent axillary mass, which was considered an abnormal structural lymph node on color ultrasound examination and chest CT. Otherwise, she felt no discomfort. The left upper limb moved freely without being affected by the mass. A routine resection of the tumor was performed after the preoperative examination was completed. After the operation, the incision recovered well. However, the day after the surgery, she developed numbness and pain in her left little finger and ring finger, pain that often kept her from sleeping. The mass was confirmed to be a schwannoma with cystic degeneration by pathology slicing after the operation. By this time, doctors were alerted to the fact that the removal of the chest wall mass had nearly disabled the left upper limb of the patient, which was a great warning to the thoracic surgeon. In this case report, we hope that all surgeons will be cautious and careful and will not trust the imaging diagnosis too much. It is also hoped that the patient understands that some procedures may lead to unexpected complications.

Two case reports: Breast schwannoma and a rare case of an axillary schwannoma imitating an axillary lymph node metastasis

A 79-year-old woman with a newly detected oval circumscribed lump in subcutaneous location on mammography and ultrasound turned out to be a Schwannoma after ultrasound-guided core needle biopsy. A 72-year-old woman with breast cancer in medical history demonstrated a new axillary mass in follow up, initially regarded as a lymph node metastasis. Core needle biopsy did not lead to a sufficient diagnosis. Pathologic examination after intraoperative sampling revealed a Schwannoma. These 2 case reports illustrate the importance of diagnostic imaging and remind to include Schwannomas in the differential diagnosis of breast and axillary masses.