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Lee HS, Jung EJ, Kim JM, Kim JY, Kim IK, Kim JR, Kim TH, Jang JY, Woo JW, Lee J, Park T, Jeong SH, Cho E, Song DH. Schwannoma of the breast presenting as a painful lump: A case report. Medicine (Baltimore) 2021; 100:e27903. [PMID: 34889239 PMCID: PMC8663845 DOI: 10.1097/md.0000000000027903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Schwannoma in the breast parenchyma is very unusual. It usually develops on the head, neck, and extensor surfaces of the upper and lower extremities. PATIENT CONCERNS We report a case of a 60-year-old woman with a palpable and painful mass. Clinically, she experienced neuropathic pain at the mass site. DIAGNOSES The tumor was a 1 cm, well-circumscribed mass, and revealed schwannoma on core needle biopsy. INTERVENTIONS The patient underwent wide excision. OUTCOMES No postoperative complications were observed. A six-month follow-up revealed no recurrence. LESSONS SUBSECTIONS Although breast schwannoma is a very rare tumor, it is a very important consideration in case of a Breast Imaging-Report and Data System 4A lesion with a painful and palpable mass.
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Affiliation(s)
- Han Shin Lee
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Eun Jung Jung
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Myung Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Ju Yeon Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - In Kyeong Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Ri Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Tae Han Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae Yool Jang
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jung Woo Woo
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - JinKwon Lee
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sang Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Eun Cho
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Dae Hyun Song
- Department of Pathology, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
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2
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Breast Shwannoma - Time to explore alternative management strategy? Ann Diagn Pathol 2021; 54:151773. [PMID: 34273600 DOI: 10.1016/j.anndiagpath.2021.151773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022]
Abstract
Schwannoma (SCH) is a benign peripheral nerve sheath neoplasm of Schwann cell origin. It can be observed anywhere whilst the breast is uncommon site. Preliminary investigations are not entirely diagnostic and surgical excision is often required to reach a conclusion. We conducted a retrospective review in two European Breast units to know more about this rare condition. Herein, we provide a comprehensive review and we question whether the surgical approach to management can be changed.
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3
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Aref H, Abizeid GA. Axillary schwannoma, preoperative diagnosis on a tru-cut biopsy: Case report and literature review. Int J Surg Case Rep 2018; 52:49-53. [PMID: 30316135 PMCID: PMC6187017 DOI: 10.1016/j.ijscr.2018.09.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 12/26/2022] Open
Abstract
Although Axillary Schwannoma is a rare condition, physicians should recognize it as a part of their differential diagnosis of an axillary swelling. Preoperative utilization of Tru-cut biopsy in diagnosing this condition will further help surgeons to plan proper surgical treatment. The author recommends utilizing an intraoperative nerve stimulator to facilitate nerve preservation during excision; aiming to provide optimal management and better outcome.
Introduction Schwannoma is a benign encapsulated tumor of the peripheral nervous system which is mainly located in the head and neck. However, axillary Schwannoma is rare. In this article, the author presents an interesting case of a right axillary Schwannoma, where the diagnosis was preoperatively made on a Tru-cut biopsy. Case presentation We report a case of an enlarged right axillary swelling in a sixty-year-old male. Proper radiologic workup was performed. Furthermore, a Tru-cut biopsy was taken which revealed evidence of schwannoma. Having such symptomatic lesion, operative excision was done with the use of a nerve stimulator, which aided in preserving nerve function. Conclusion With such non-specific presentation, axillary Schwannoma may be easily missed and mismanaged. A Tru-cut biopsy may provide great help in expert hands, aiding operative planning; likewise in the case we are presenting. Furthermore, utilizing an intraoperative nerve stimulator will facilitate nerve preservation.
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Affiliation(s)
- Hager Aref
- Department of Surgery, International Medical Center, P.O. Box 1716, Jeddah 21441, Saudi Arabia.
| | - Georges A Abizeid
- Department of Surgery, International Medical Center, P.O. Box 1716, Jeddah 21441, Saudi Arabia.
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4
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Bellezza G, Lombardi T, Panzarola P, Sidoni A, Cavaliere A, Giansanti M. Schwannoma of the Breast: A Case Report and Review of the Literature. TUMORI JOURNAL 2018. [DOI: 10.1177/030089160709300317] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Schwannoma arising within breast parenchyma is very rare. This report describes such a case in a 58-year-old woman. The tumor, which measured 4.4 × 3.5 × 2.1 cm, was painless, mobile and elastic-soft. Mammography showed a well-circumscribed, oval-shaped nodule without microcalcifications. At ultrasonography it appeared as a hypoechoic solid mass. Fine-needle cytology revealed several clusters of spindle cells indicative of a neoplasm of mesenchymal origin. Histological examination evidenced the characteristic morphological appearance of a schwannoma with Antoni A and Antoni B areas. A review of the 23 proven cases of breast schwannoma is included. The main differential diagnostic findings are also discussed.
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Affiliation(s)
- Guido Bellezza
- Institute of Pathologic Anatomy and Histology, Division of Cancer Research, and University of Perugia, Perugia, Italy
| | - Tiziana Lombardi
- Institute of Radiology, Breast Section, Perugia Medic School, University of Perugia, Perugia, Italy
| | - Paola Panzarola
- Institute of Radiology, Breast Section, Perugia Medic School, University of Perugia, Perugia, Italy
| | - Angelo Sidoni
- Institute of Pathologic Anatomy and Histology, Division of Cancer Research, and University of Perugia, Perugia, Italy
| | - Antonio Cavaliere
- Institute of Pathologic Anatomy and Histology, Division of Cancer Research, and University of Perugia, Perugia, Italy
| | - Michele Giansanti
- Institute of Pathologic Anatomy and Histology, Division of Cancer Research, and University of Perugia, Perugia, Italy
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5
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Salihoglu A, Esatoglu SN, Eskazan AE, Halac M, Aydin SO. Breast schwannoma in a patient with diffuse large B-cell lymphoma: a case report. J Med Case Rep 2012; 6:423. [PMID: 23244369 PMCID: PMC3571884 DOI: 10.1186/1752-1947-6-423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/06/2012] [Indexed: 11/15/2022] Open
Abstract
Introduction Schwannomas are mostly benign tumors arising from Schwann cells of the nerve sheaths. Breast schwannomas are very rare and account for only 2.6% of cases. As far as we know this is the first reported case of breast schwannoma discovered in a patient with diffuse large B-cell lymphoma. The breast schwannoma was evaluated with positron emission tomography and it exhibited moderate 18F-fluorodeoxyglucose uptake. Case presentation We present the case of a breast schwannoma in a 63-year-old Caucasian woman who was diagnosed with diffuse large B-cell lymphoma. Conclusion Imaging modalities including positron emission tomography-computed tomography failed to distinguish breast schwannoma from diffuse large B-cell lymphoma involvement of the breast.
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Affiliation(s)
- Ayse Salihoglu
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Kocamustafapasa, Fatih, Istanbul, Turkey.
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6
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Lagha A, Chraiet N, Oueslati I, Krimi S, Ayadi M, Allani B, Rifi H, Raies H, Mezlini A. Schwannoma of the Breast: Presentation of Four Cases and Review of the Literature. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2012.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aymen Lagha
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Nesrine Chraiet
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Imen Oueslati
- Department of Surgical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Sarra Krimi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Mouna Ayadi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Bassem Allani
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Hela Rifi
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Henda Raies
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
| | - Amel Mezlini
- Department of Medical Oncology, Salah Azaiez Institute, Tunis, Tunisia
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Abstract
Schwannomas arise from Schwann cells of the peripheral nerve sheath. The most common locations include the head, neck, and extensor surfaces of the extremities. Intramammary schwannomas are very rare and account for only 2.6% of schwannomas. A review of the English literature reveals 27 such cases of breast schwannoma. In this paper we describe another such rare case.
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8
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Ben Hassouna J, Ben Bachouche W, Bouzid T, Bouzaiene H, Maamouri F, Chargui R, Khomsi F, Mtaalah MH, Dhiab T, Hechiche M, Gamoudi A, Rahal K. Schwannome mammaire bénin: à propos de deux cas. ACTA ACUST UNITED AC 2006; 34:1147-50. [PMID: 17134932 DOI: 10.1016/j.gyobfe.2006.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Accepted: 05/23/2006] [Indexed: 10/23/2022]
Abstract
Schwannoma is a rare nervous tumor developed on schwan cells. Only 22 cases of breast schwannoma have been published since 2005. It usually appears as a breast lump having clinical and radiological characteristics suggestive of kindness. Its diagnosis is histological. Its treatment is surgical. Through two observations and a review of the literature we would try to remind the characteristics of this tumor.
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Affiliation(s)
- J Ben Hassouna
- Service de chirurgie carcinologique, institut Salah-Azaïz, boulevard 9-avril, 1006 Tunis, Tunisie
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9
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Lee EK, Kook SH, Kwag HJ, Park YL, Bae WG. Schwannoma of the breast showing massive exophytic growth: A case report. Breast 2006; 15:562-6. [PMID: 16844378 DOI: 10.1016/j.breast.2005.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 11/08/2005] [Accepted: 11/17/2005] [Indexed: 11/21/2022] Open
Abstract
Schwannoma is a slow-growing tumor that frequently occurs in the extremities, the trunk and the head region. Its occurrence in the breast is rare with only a few cases being reported. We present here the case of breast schwannoma in a 41-year-old woman who presented with a palpable mass in her right breast. This is the first report of breast schwannoma that showed massive exophytic growth with invasion of the skin, and it was initially presumed to be a breast cancer on preoperative mammography, ultrasonography and breast MRI examinations. Complete excision of the mass was done and pathology revealed a plexiform schwannoma.
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Affiliation(s)
- E K Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongro-Ku, Seoul 110-746, Republic of Korea
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10
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Klijanienko J, Caillaud JM, Lagacé R. Cytohistologic correlations in schwannomas (neurilemmomas), including "ancient," cellular, and epithelioid variants. Diagn Cytopathol 2006; 34:517-22. [PMID: 16850489 DOI: 10.1002/dc.20320] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Schwannoma accounts for one of the most common benign mesenchymal neoplasms of soft tissues. Although it is well defined in the cytology literature, particular histologic subtypes such as "ancient," cellular and epithelioid variants could be a source of diagnostic difficulties. We have reviewed cytology aspirates and corresponding histologic sections from 34 schwannomas diagnosed at Institut Curie. Histologically, 24 cases were classic, 5 were "ancient," 4 were cellular, and 1 was epithelioid schwannomas. No example of melanotic schwannoma was recorded. Original cytologic diagnosis was schwannoma in 13 (38.2%) cases, benign soft tissue tumor in 11 (32.4%), pleomorphic adenoma in 2 (6%) cases, angioma in 1 (2.9%) case, nodular fasciitis in 1 (2.9%) case, suspicious in 3 (8.8%) cases, and not satisfactory in 3 (8.8%) cases. There were no major differences between classical, "ancient," cellular, and epithelioid variants on cytology smears. Myxoid stroma, mast cells, and intranuclear inclusions were limited to classical subtype. Similarly, cyto-nuclear atypia was more frequent in classical subtype than in other subtypes. Schwannoma should be differentiated from well-differentiated malignant peripheral nerve sheath tumor, neurofibroma, and pleomorphic adenoma, in the last instance particularly for head and neck lesions.
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11
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Domanski HA, Akerman M, Engellau J, Gustafson P, Mertens F, Rydholm A. Fine-needle aspiration of neurilemoma (schwannoma). A clinicocytopathologic study of 116 patients. Diagn Cytopathol 2006; 34:403-12. [PMID: 16680779 DOI: 10.1002/dc.20449] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The preoperative fine-needle aspiration cytology (FNAC) diagnoses in 116 surgically excised neurilemomas were reviewed and compared with the corresponding histopathologic diagnoses made on surgical specimens and with clinical data. In addition, the utility of adjunctive techniques was analyzed and other spindle-cell lesions in the differential diagnoses were discussed. An unequivocal, benign diagnosis was rendered by FNAC in 80 cases, 67 of which were correctly labelled as neurilemoma in a review of the original cytology reports. There were 6 false-positive malignant diagnoses while 23 smears were considered insufficient and 7 inconclusive as to whether benign or malignant. On reevaluation, the diagnostic smears in most cases contained spindle cells with wavy nuclei embedded in a fibrillar, occasionally collagenous, and/or myxoid matrix and Antoni A/Antoni B tissue fragments. A moderate to abundant admixture of round to oval cells was also frequent. Nuclear palisading was seen in 41 smears with distinctive Verocay bodies in 10. Markedly pleomorphic nuclei were seen in smears from 8 ancient and 6 conventional neurilemomas, and slight to moderate nuclear pleomorphism was observed in 38 additional cases. Thus most neurilemomas have distinct cytomorphologic features that allow correct diagnosis. The major problem in FNAC of neurilemoma is to obtain sufficient material. Furthermore aspirates showing predominantly Antoni A features, nuclear pleomorphism, and/or myxoid changes can easily be confused with other types of benign or malignant soft-tissue tumors.
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Affiliation(s)
- Henryk A Domanski
- Department of Pathology and Cytology, Lund University Hospital, Lund, Sweden.
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12
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Staklenac B, Pauzar B, Pajtler M, Loncar B, Dmitrović B. An unusual tumour of the breast: cytological findings. Cytopathology 2004; 15:160-2. [PMID: 15165273 DOI: 10.1111/j.1365-2303.2004.00131.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B Staklenac
- Department of Clinical Cytology, University Hospital Osijek, Osijek, Croatia.
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13
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Magro G, Michal M, Bisceglia M. Benign spindle cell tumors of the mammary stroma: diagnostic criteria, classification, and histogenesis. Pathol Res Pract 2002; 197:453-66. [PMID: 11482575 DOI: 10.1078/0344-0338-00112] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purely benign mesenchymal spindle cell neoplasms of the breast are currently labeled under various terms in the literature (benign spindle cell tumor, fibroma, spindle cell lipoma, myofibroblastoma, solitary fibrous tumor, myogenic stromal tumor). The lack of strict diagnostic criteria to clearly indicate such mesenchymal neoplasms is the main reason which generated the risk of terming the same lesion under different names or, conversely, of collecting different types under the same term. Although such neoplasms exhibit morphological and immunophenotypical heterogeneity, they actually represent variations of the same tumor entity, likely arising from the uncommitted vimentin+/CD34+ fibroblasts of the mammary stroma, capable of multidirectional mesenchymal differentiation. To cover the entire spectrum of such lesions, the term "benign spindle cell tumors (BSCTs) of the mammary stroma" is advocated. BSCTs can be subtyped into four main groups by light microscopy (LM) and immunocytochemistry (ICC): fibroblastic, myofibroblastic, fibrohistiocytic, and mixed forms. A simple and practical approach to a nosologically correct diagnosis and a list of differential diagnoses are presented. The awareness of the diversity of morphological and immunophenotypical features of BSCTs of the mammary stroma, including uncommon variants, is helpful to avoid confusion with other monomorphic bland-looking benign and malignant spindle cell tumors and tumor-like lesions of the breast.
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Affiliation(s)
- G Magro
- Istituto di Anatomia Patologica, Università di Catania, Italy.
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14
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Jacobson BC, Hirsch MS, Lee JH, Van Dam J, Shoji B, Farraye FA. Multiple asymptomatic plexiform schwannomas of the sigmoid colon: a case report and review. Gastrointest Endosc 2001; 53:801-4. [PMID: 11375596 DOI: 10.1067/mge.2001.115317] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- B C Jacobson
- Division of Gastroenterology and the Division of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA
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15
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Cho KS, Choi HY, Lee SW, Sung SH. Sonographic findings in solitary schwannoma of the breast. JOURNAL OF CLINICAL ULTRASOUND : JCU 2001; 29:99-101. [PMID: 11425095 DOI: 10.1002/1097-0096(200102)29:2<99::aid-jcu1005>3.0.co;2-r] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Solitary schwannoma is a benign neoplasm of Schwann cell origin, most frequently occurring in the extremities and the trunk and head regions. The breast is a very unusual site for this tumor. We report a case of benign schwannoma of the breast in a 76-year-old woman. The palpable mass was localized in the lower outer quadrant of the right breast. This intramammary schwannoma appeared sonographically as a well-circumscribed, hypoechoic, slightly inhomogeneous solid mass. Microscopically, it had a pattern similar to that of schwannoma at other sites.
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Affiliation(s)
- K S Cho
- Department of Radiology, MokDong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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16
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Abstract
Pseudosarcomatous lesions are benign neoplasms of the musculoskeletal system that are likely to be misdiagnosed as malignant, based on clinical and histologic features. These include soft-tissue "tumors" considered reactive or reparative lesions such as nodular fasciitis and myositis ossificans. Also included in the "pseudosarcoma" category are benign neoplasms which show "pseudoanaplastic" cytologic atypia. The latter include lipoma, leiomyoma, angiomyolipoma, and benign peripheral nerve-sheath tumors. These neoplasms, particularly the reparative processes and the nerve sheath tumors, are increasingly being subjected to initial diagnosis by fine-needle aspiration cytology. Even by conventional cytology this group of lesions represents a well-known pitfall for the diagnostic pathologist. We review some cytologic features: repair-like change, cohesion of cellular fragments, and presence of "normal" elements in the aspirate, which may help the cytopathologist avoid misdiagnosis of these notoriously difficult entities.
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Affiliation(s)
- L G Dodd
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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17
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Gupta RK, Naran S, Lallu S, Fauck R. Fine-needle aspiration cytology in neurilemoma (schwannoma) of the breast: report of two cases in a man and a woman. Diagn Cytopathol 2001; 24:76-7. [PMID: 11135474 DOI: 10.1002/1097-0339(200101)24:1<76::aid-dc1013>3.0.co;2-j] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Abstract
A 51-yr-old male presented with an 8-mo history of lower back pain. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) studies showed a 3.5 X 3.0 cm sacral mass within the spinal canal in the region of the left S2 nerve root. A fine-needle aspirate biopsy (FNAB) was performed under CT guidance. The cytologic findings included a spindle-cell population with a fibrillary background arranged in a vaguely streaming pattern, wavy nuclei with mild atypia, wispy cytoplasm, rare intranuclear inclusions, and dilated vascular spaces. Some cells contained a nonrefractile granular brown pigment consistent with melanin. Also identified were calcified concentric laminations typical of psammoma bodies. Immunohistochemically, the neoplastic cells were strongly immunoreactive for S-100 protein and HMB-45. A diagnosis of psammomatous melanotic schwannoma was rendered. No stigmata of Carney's complex were identified on physical examination. The patient has declined the recommendation of surgical excision of the mass. We herein describe a case unequivocally diagnosed as psammomatous melanotic schwannoma by FNAB.
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Affiliation(s)
- T J Cummings
- Department of Pathology and Cytopathology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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19
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Abstract
The term "ancient" schwannoma was proposed for a group of neural tumors showing degenerative changes and marked nuclear atypia. Prior to the realization that the observed atypia was a regressive phenomenon, many of these lesions were erroneously diagnosed as sarcomas. Fine-needle aspiration (FNA) cytologic material from five patients is included in this study. Tissue examined histologically included four resected tumors and 18 gauge core biopsies of one tumor. Aspirates of ancient schwannoma showed many of the same features as FNA of regular schwannoma: aggregates of spindled cells with indistinct cytoplasm and elongate nuclei with blunt point ends. The feature unique to these lesions was nuclear pleomorphism, which was identified in all aspirates. Nuclear inclusions were identified in all but one case. Cystic degeneration, xanthomatous changes, and perivascular sclerosis were identified in excised lesions. Ancient schwannomas show most of the FNA features of benign schwannomas but can demonstrate marked nuclear atypia. The FNA features of ancient schwannoma are important to note because of the potential to confuse this lesion with a more serious one such as sarcoma on FNA.
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Affiliation(s)
- L G Dodd
- Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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20
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Abstract
The cytomorphologic features of 13 neural lesions sampled by fine-needle aspiration (FNA) are reviewed. The frequencies at which various architectural features including Verocay bodies, filamentous background, and vascular arcades were present was recorded, along with the frequencies of cytologic findings including the presence of spindle cells, wavy nuclei, intranuclear inclusions, fishhook nuclei, nuclear pleomorphism, filamentous cytoplasm, and mitotic figures. Verocay bodies were a rare finding, present in only 1 of 11 cases. Vascular arcades were similarly infrequent (1/11 cases). Spindle-shaped cells along with wavy nuclei were the most frequent findings, with fishhook-shaped nuclei and a filamentous background of high frequency (9/11 cases). Our study indicates that some of the characteristic features recorded in the literature are rarely seen in needle aspiration smears, but features such as spindle-shaped cells, wavy and fishhook-shaped nuclei, and a filamentous background are relatively frequent findings.
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Affiliation(s)
- E E Mooney
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
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