Intrathoracic Multiple Schwannomas of a Single Intercostal Nerve

Incidental ancient schwannoma of the posterior mediastinum in a young male: a rare scenario

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.

Chest Wall Schwannoma: Case Report and a Review of Imaging Findings

A chest wall schwannoma arises from peripheral nerve sheath Schwann cells of the intercostal nerves. We describe the presentation and imaging findings of a patient who presented with a chest wall swelling. The imaging findings were highly suspicious for a chest wall schwannoma and the histopathology confirmed the diagnosis following surgical excision. Imaging findings are reviewed in detail.

Giant intercostal nerve schwannoma in a patient with neurofibromatosis type 2

PURPOSE

To describe a case of giant intercostal nerve schwannoma successfully resected in a patient with neurofibromatosis type 2.

METHODS

A 44-year-old woman, with a history of neurofibromatosis type 2, presented with chest discomfort and mild dyspnea. She had undergone a recent resection of a large frontal parasagittal benign meningioma. Radiologic examinations showed a large lesion (9×12×9 cm) of the left hemithorax causing a complete atelectasis of left upper lobe. Bronchoscopy did not show any endobronchial alterations, apart from an ab estriseco compression of the left upper bronchial tree. A transthoracic needle biopsy was then performed and microscopic examination revealed a mesenchymal tumor composed of spindle-like cells.

RESULTS

A video-assisted thoracoscopic surgery procedure was proposed. The tumor mass appeared to be tenaciously adherent to the parietal pleura in its anterolateral aspect, confirming the radiologic appearance. No invasion of the lung parenchyma or parietal pleural metastases were visible. Therefore, a left posterolateral thoracotomy at the fifth intercostal space was performed and a macroscopic complete resection was carried out. The recovery was uneventful and the patient was discharged on postoperative day 5. The histologic examination revealed a moderate cellular proliferation of spindle-shaped and oval to polygonal cells with frequent Verocay bodies; mitotic figures were rare. The tumor cells were strongly S-100 positive. The microscopic features were consistent with benign intercostal schwannoma. Eight years later, the patient is disease-free and asymptomatic.

CONCLUSIONS

An unusual case of giant intercostal nerve schwannoma successfully resected in a patient with neurofibromatosis type 2 is described.

Chest wall schwannoma presenting as a solitary malignant lesion: a case report

Background

Chest wall schwannomas are rare tumors arising from the intercostals nerves. Schwannomas are lobulated, encapsulated spherical masses, different from neurofibromas in that matter. Men and women are equally affected in their third and fourth decades.

Case presentation

A 42 year old female presented with a 6 month history of progressively worsening pain over the right shoulder and chest wall, aggravated by movement and with associated right arm oedema and paraesthesia. She believed mild symptoms began 2 years prior to presentation. The histopathological examination revealed a benign lesion; a schwannoma with degenerative changes. The section revealed a benign nerve sheath tumor characterized by a proliferation of band spindle cells arranged in fascicles and variable cellularity and associated with dilated and think walled blood vessels.

Conclusion

Chest wall schwannomas are rare; they mimic chest wall malignant lesions.

Human pulmonary dirofilariasis coexisting with intercostal neurilemmoma: a case report and literature review

Human pulmonary dirofilariasis (HPD) is a rare zoonotic infection caused by Dirofilaria immitis. Dogs are the definite hosts and humans are infected occasionally via a vector, generally a mosquito. Most thoracic neurilemmoma arise in the mediastinum and fewer tumors originate peripherally from the intercostal nerves. Most patients with HPD or thoracic neurilemmoma are asymptomatic and these diseases are often discovered incidentally. We present a 53-year-old female who was found to have a pulmonary nodule and a chest wall nodule during a routine health examination. She underwent a video-assisted thoracoscopic surgery (VATS) with partial lung resection and local excision of the chest wall. The pathological examination revealed a coiled, degenerating Dirofilariasis immitis worm surrounded by granulomatous inflammation with caseous necrosis and a neurilemmoma composed of S-100 protein immunoreactive but smooth muscle actin negative spindle cells. Because these diseases are self-limiting and make further treatment unnecessary, video-assisted thoracoscopic surgery (VATS) is considered preferable and less invasive for definitive diagnosis and management.

Unusual presentation of mediastinal neurogenic tumours

Mediastinal neurogenic tumours generally arise as single benign lesions and their typical location is the costovertebral sulcus. In about 10% of cases mediastinal neurogenic tumours may extend to the spinal canal; occasionally they may extend to the cervical region and, more rarely, may be multiple or associated with other synchronous mediastinal lesions. The treatment of choice is surgical resection. This report describes three cases of unusual presentation of mediastinal benign schwannomas successfully treated at our Hospital. In the first case multiple simultaneous paravertebral lesions were resected through a posterior approach. In the second case a tumour of the posterior mediastinum extending to the cervical region was excised through a one-stage combined supraclavicular incision followed by left mini-invasive video-assisted thoracoscopic surgical techniques. The third case describes a patient with a posterior neurogenic mediastinal tumour with a synchronous parathyroid adenoma of the anterior mediastinum, which were both successfully resected by video-assisted thoracoscopic surgery.

Tandem intercostal thoracic schwannomas resected using a thoracoscopic nerve-sparing technique: case report

BACKGROUND AND IMPORTANCE

To describe a novel nerve-sparing technique for the resection of intercostal nerve schwannomas. This case demonstrates that intercostal neuralgia can be caused by intercostal schwannomas and that it can be relieved by their removal.

CLINICAL PRESENTATION

A young woman with schwannomatosis had progressively worsening intercostal neuralgia caused by compression of the intercostal nerve against the rib by tandem intercostal schwannomas. After the tumors were removed, her symptoms were completely relieved. A thoracoscopic technique was used to define the involved fascicles and to facilitate removal of the tumors while sparing the uninvolved nerve.

CONCLUSION

The patient's radicular pain was relieved completely by the tumor resection. Thoracoscopic surgery offers a safe and minimally invasive technique for removal of intercostal schwannomas and is a valid alternative to open thoracotomy. Removal of thoracic schwannomas can relieve intercostal neuralgia.

Multiple schwannomas in a single costal interval: report of two cases

Schwannomas of the intercostal nerve, typically, are solitary and rarely originate from the mediastinum. Here, we describe two cases of multiple schwannomas occurring within a single costal interval. Both patients were misdiagnosed prior to surgery, and the correct diagnosis was made by pathological examination following surgery. Upon retrospective review of the preoperative radiographic examination, we found that such misdiagnoses may be avoided by performing 3-dimensional reconstruction.

Schwannomatosis of a single intercostal nerve: a case report

Schwannomatosis is a rare form of neurofibromatosis and is characterized by more than one schwannoma without any sign of neurofibromatosis. We report a case of a 60-year-old male patient admitted with progressive chest discomfort who was found to have six encapsulated tumors along the seventh intercostal space with a maximum tumor size of 3x2x1 cm.