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Shanmugasundaram G, Thangavel P, Venkataraman B, Barathi G. Incidental ancient schwannoma of the posterior mediastinum in a young male: a rare scenario. BMJ Case Rep 2019; 12:12/5/e227497. [PMID: 31079038 DOI: 10.1136/bcr-2018-227497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Ancient schwannoma is a distinctive type of schwannoma occurring mostly in the retroperitoneum. The presentation in the posterior mediastinum is rare. The term 'ancient' represents a group of neurogenic tumours showing degenerative changes with marked nuclear atypia. A 26-year-old man was incidentally detected to have an upper mediastinal mass lesion in the chest X-ray. MRI chest revealed a mixed signal intensity lesion in the left side upper para spinal region of the posterior mediastinum. The patient underwent left posterior thoracotomy and excision of the mass was done. Postoperative period was uneventful. The histopathological feature was typical of Ancient schwannoma. The patient is on regular follow-up and disease free until.
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Affiliation(s)
| | - Periyasamy Thangavel
- Department of Cardiothoracic Surgery, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | | | - Gunabooshanam Barathi
- Department of Pathology, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
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Rosario MS, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Inatani H, Higuchi T, Tsuchiya H. A case of infected schwannoma mimicking malignant tumor. World J Surg Oncol 2016; 14:302. [PMID: 27923374 PMCID: PMC5141643 DOI: 10.1186/s12957-016-1058-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Infected schwannoma has been reported, this being one of the four cases published in the literature. Infected schwannoma has proven to be a tough diagnostic challenge to the treating tumor surgeon, mimicking infectious entities and most essentially, a malignant tumor. CASE PRESENTATION The authors report the case of a 64-year-old male with a soft tissue mass in his right gluteal area that presented initially with right leg pain, then later with signs of inflammation on the tumor area. Magnetic resonance imaging (MRI), computed tomography (CT), and thallium-201 scintigraphy studies confirm the presence of soft tissue mass which had continuity with sciatic nerve, with subsequent serial MRI findings suggesting tumor enlargement with cystic degeneration. Increased level of C-reactive protein (CRP) was observed before surgery. During an open biopsy upon tissue sampling, exudates with necrotic tissue were seen. Increased level of CRP and necrotic change suggested the possibility of malignant tumor. Histopathological diagnosis was schwannoma, and group B Streptococcus was detected by culture. After the confirmation of infected schwannoma, enucleation of the tumor was performed. CONCLUSIONS The report concludes that establishment of a benign pathology is essential when presented with similar clinical findings prior to definitive enucleation of an infected schwannoma.
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Affiliation(s)
- Mamer S. Rosario
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
- Department of Orthopaedics, East Avenue Medical Center, East Avenue, Diliman, Quezon City, 1101 Metro Manila Philippines
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Hiroyuki Inatani
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
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Ben Amar J, Zaibi H, Boudaya S, Ayadi A, Dhahri B, Aouina H. [A thoracic cystic lesion]. Rev Mal Respir 2016; 34:70-73. [PMID: 26782992 DOI: 10.1016/j.rmr.2015.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/01/2015] [Indexed: 11/17/2022]
Affiliation(s)
- J Ben Amar
- Service de pneumologie, hôpital Charles Nicolle, Tunis, Tunisie.
| | - H Zaibi
- Service de pneumologie, hôpital Charles Nicolle, Tunis, Tunisie
| | - S Boudaya
- Service de chirurgie thoracique, hôpital Abderrahman Mami, Tunis, Tunisie
| | - A Ayadi
- Service d'anatomie-pathologie, hôpital Abderrahman Mami, Tunis, Tunisie
| | - B Dhahri
- Service de pneumologie, hôpital Charles Nicolle, Tunis, Tunisie
| | - H Aouina
- Service de pneumologie, hôpital Charles Nicolle, Tunis, Tunisie
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Intrathoracic peripheral nerve sheath tumors-a clinicopathological study of 75 cases. Hum Pathol 2014; 46:419-25. [PMID: 25595633 DOI: 10.1016/j.humpath.2014.11.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/20/2014] [Accepted: 11/26/2014] [Indexed: 11/24/2022]
Abstract
Although peripheral nerve sheath tumors (PNSTs) are common in the posterior mediastinum, they are rare in other mediastinal compartments and in the pleuropulmonary parenchyma. We sought to characterize the clinicopathological features of PNSTs occurring in the lung, pleura, and mediastinum. Diagnoses were confirmed by slide review. Study cases include 21 benign pleuropulmonary PNSTs, 49 benign mediastinal PNSTs, and 5 malignant PNSTs. Benign pleuropulmonary tumors comprised 13 schwannomas, 6 neurofibromas, 1 perineurioma, and 1 ganglioneuroma. Six lesions were endobronchial (3 neurofibromas, 1 schwannoma, 1 perineurioma, 1 ganglioneuroma), whereas the remaining schwannomas and neurofibromas formed parenchymal masses (usually pleural based). Benign mediastinal PNSTs (46 posterior, 2 middle, and 1 anterior) were all schwannomas and showed a female predominance. None of the patients with benign PNSTs experienced recurrence. Of the 5 malignant PNSTs, 4 were pleuropulmonary (3 pleural based) and 1 occurred in the anterior mediastinum. Two of the 5 patients had a history of neurofibromatosis type 1 (aged 27 and 45 years). At last follow-up, 3 of the 5 patients had died of disease, 1 was alive with disease, and 1 was alive with no evidence of disease (41 months). Although rare, a wide histologic range of PNSTs occur in the lung. Although neurofibroma, perineurioma, and ganglioneuroma were observed as endobronchial lesions, most pulmonary schwannomas were pleural-based masses. Mediastinal PNSTs are dominated by posterior mediastinal schwannomas, although schwannomas rarely occur in the other mediastinal compartments as well. Malignant PNSTs are very rare in the thorax, where they show aggressive behavior.
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Tripathi SK, Mishra AK, Verma AK, Prakash V. Posterior mediastinal mass diagnosed as schwanomma with concomittant tuberculosis. BMJ Case Rep 2014; 2014:bcr-2014-205799. [PMID: 25246469 DOI: 10.1136/bcr-2014-205799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 21-year-old non-smoker, non-hypertensive male without diabetes was referred to our pulmonary medicine department with suspected malignant intrathoracic mass. The clinicoradiological evaluation revealed that it could be a posterior mediastinal mass. The same diagnosis was confirmed on performing CT and MRI. Benign posterior mediastinal schwanomma was suspected as it is the most common posterior mediastinal mass. It was completely resected. Histopathological examination confirmed the same. The mass was also sent for culture for mycobacterium which came out to be positive. The patient recovered from the surgery and postoperative X-ray showed complete clearance. He was treated with antitubercular treatment and responded very well.
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Affiliation(s)
- Surya Kant Tripathi
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashwini Kumar Mishra
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar Verma
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ved Prakash
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Videothoracoscopy in the treatment of benign neurogenic tumours of the posterior mediastinum. Wideochir Inne Tech Maloinwazyjne 2014; 9:315-8. [PMID: 25337152 PMCID: PMC4198653 DOI: 10.5114/wiitm.2014.44255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/23/2014] [Accepted: 04/20/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction The indications for videothoracoscopy are very broad and include the treatment of mediastinal tumours. Aim To present our experience of using the minimally invasive technique in treating benign neurogenic tumours. Material and methods Twenty-two patients were treated due to tumours of the posterior mediastinum from 2003 to 2012. The size of the tumours ranged from 2 cm to 25 cm. Tumours up to the size of 6 cm were treated using videothoracoscopy (VT), bigger ones through thoracotomy. Results The videothoracoscopy technique was used in 17 patients, thoracotomy in 5. In 2 cases conversion was required due to adhesions in the pleural cavity preventing VT treatment. Complications related to the procedure were not observed. The average time of hospital stay after VT treatment was 4 days, while after thoracotomy it was 6 days. Histologically, tumours of benign nature were found in all cases. Schwannoma was diagnosed in 15 patients, ganglioneuroma in 3 patients, neurofibroma in 3 patients, and chemodectoma in 1 patient. None of the 3 cases of neurofibroma was associated with Recklinghausen's disease. At a mean follow-up of 60 months no recurrence of the tumour was found. Conclusions In the case of tumours up to 6 cm the best surgical technique is videothoracoscopy. In the case of large tumours the best access is the open technique. The minimally invasive technique allows one to shorten the patient's treatment time, reduce postoperative pain and obtain a good cosmetic effect of the treatment.
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Quartey B, Lenert J, Deb SJ, Henry LR. Giant Posterior Mediastinal Ancient Schwannoma Requiring Thoracoabdominal Resection: A Case Report and Literature Review. World J Oncol 2011; 2:191-194. [PMID: 29147246 PMCID: PMC5649657 DOI: 10.4021/wjon348w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2011] [Indexed: 12/03/2022] Open
Abstract
Posterior mediastinal schwannomas are benign, slow growing nerve sheath tumors and rarely cause symptoms. We present a case of a 47-year-old man who presents with severe mid-back pain and dyspnea on exertion. Chest radiograph and computed topography revealed a large posterior mediastinum mass. Surgical resection required en bloc resection of a portion of the diaphragm, and wedge resection of the left lower lobe of the lung via left thoracoabdominal approach. Pathology was consistent with ancient schwannoma. This case is unique due to the location and size of the mass and the surgical approach required for complete resection.
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Affiliation(s)
- Benjamin Quartey
- National Capital Consortium, National Naval Medical Center, Department of General Surgery, Bethesda, Maryland, 20889, USA
| | - Jeffrey Lenert
- National Capital Consortium, National Naval Medical Center, Department of Surgical Oncology, Bethesda, Maryland, 20889, USA
| | - Subrato J Deb
- National Naval Medical Center, Department of Cardiothoracic Surgery, Bethesda, Maryland, 20889, USA.,Western Maryland Regional Medical Center, Thoracic Surgery Oncology, Cumberland, Maryland, 21502, USA
| | - Leonard R Henry
- Indiana University Health, Goshen Center for Cancer, Goshen, IN 46526, USA
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Abstract
Schwannoma is a well-defined tumor arising from the nerve sheath. It may present as a solitary mass in any part of the body, but is more commonly seen in the head, neck and extremities. We describe a 32-year-old female patient with a small dermal nodule on the forehead, which was 2 cm in diameter, round and of a cystic nature. Microscopic examination revealed that it consisted of compact spindle cells arranged partly in short bundles or a fascicular pattern with outstanding cystic degeneration manifested as a large, unilocular cavity in the center of the tumor tissue. The tumor cells were positive for S-100 protein and negative for epithelial membrane antigen (EMA), while the tumor capsule was positive for EMA. There was no S-100-positive membrane-like structure lining the cyst wall.
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Affiliation(s)
- Yu Sung Choi
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Abstract
A case of adenomatoid tumor presenting as a mass in the anterior mediastinum is described. The patient was a 56-year-old woman with left side chest wall pain who showed a mediastinal mass on chest x-ray and CT scans. Thorough clinical and radiographic examination did not reveal any evidence of tumor elsewhere. At surgery, the tumor was found adjacent to the anterior pericardial reflection. Grossly, the tumor measured 5.5 x 5.5 x 3 cm and showed a homogeneous cut surface with numerous cystic structures that varied from 0.5 to 1.5 cm in greatest diameter. Histologic examination showed numerous cystic spaces lined by flattened or cuboidal epithelial cells. The walls of the cysts showed a proliferation of small canalicular structures lined by round to polygonal epithelioid cells with vacuolated eosinophilic cytoplasm. Immunohistochemical studies showed strong positivity of the epithelioid cells for AE1/AE3 cytokeratin, CK5/CK6, and calretinin. Stains for CK7, CK20, alpha-fetoprotein, CD31, carcinoembryonic antigen, MOC 31, and chromogranin were negative. Electron microscopic examination showed numerous long microvilli on the cell surface and abundant tonofilaments/desmosomal plaques in the tumor cells, characteristic of mesothelial cells. The patient is alive and well and free of recurrence 1 year following surgery. Adenomatoid tumor is a rare neoplasm that should be added in the differential diagnosis of anterior mediastinal masses. Immunohistochemical and ultrastructural studies may be of aid in identifying the characteristic features of mesothelial cells and to avoid mistaking this lesion for more ominous conditions.
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Affiliation(s)
- Jose Antonio Plaza
- Department of Pathology, Division of Anatomic Pathology, Ohio State University, Columbus, Ohio 43210, USA
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Kiryu T, Ohashi N, Hoshi H, Iwata H, Shimokawa K, Kawaguchi S. Mediastinal schwannoma: MR imaging findings of an unusual case presenting as a lobulated mass with internal fibrous septa. Clin Radiol 2003; 58:652-5. [PMID: 12887961 DOI: 10.1016/s0009-9260(03)00140-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Kiryu
- Department of Radiology, Gifu University School of Medicine, Gifu City, Japan.
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Chen SR, Chen MH, Ho DMT, Lin FC, Chang SC. Massive hemoptysis caused by endobronchial schwannoma in a patient with neurofibromatosis 2. Am J Med Sci 2003; 325:299-302. [PMID: 12792252 DOI: 10.1097/00000441-200305000-00010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neurogenic tumor of the lung is very uncommon. To the best of our knowledge, endobronchial schwannoma complicated by massive hemoptysis in a patient with neurofibromatosis 2 has not been reported previously. We report a case of endobronchial schwannoma complicated by massive hemoptysis in an 18-year-old man with neurofibromatosis 2. The diagnosis of neurofibromatosis 2 was established by demonstration of bilateral vestibular schwannomas on magnetic resonance imaging of the brain and pathologic examination of the resected brain tumors. Massive hemoptysis developed after surgical removal of the brain tumors in this patient. Bronchoscopy was done immediately after the first episode of hemoptysis and a tumor protruding from the orifice of the right lower lobe bronchus was found. Despite 2 additional bronchoscopies to stop bleeding and ameliorate airway obstruction in the consecutive 2 days, hemoptysis recurred rapidly and caused profound oxygen desaturation. The patient was subjected to right lower lobectomy and endobronchial schwannoma was evidenced pathologically.
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Affiliation(s)
- Shihn-Rur Chen
- Chest Department, Taipei Veterans General Hospital, Republic of China
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Fierro N, D'ermo G, Di Cola G, Gallinaro LS, Galassi G, Galassi G. Posterior mediastinal schwannoma. Asian Cardiovasc Thorac Ann 2003; 11:72-3. [PMID: 12692029 DOI: 10.1177/021849230301100118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An exceptional case of neurilemmoma in a 33-year-old asymptomatic man is described. Complete excision of an encapsulated 7.2-cm mass was achieved successfully. Pathological findings were consistent with a diagnosis of schwannoma with areas of sclerosis.
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Affiliation(s)
- Nicola Fierro
- Department of Surgical Sciences and Applied Medical Technologies, University of Rome, La Sapienza, Rome, Italy.
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