A Rare Case of Primary Intrapulmonary Neurilemmoma Diagnosed in a 43-Year-Old Asymptomatic Man with a Well-defined Intrapulmonary Mass

A grand mimicker of pulmonary malignancy: The massive mediastinal intercostal nerve tumour

Mediastinal mass-like manifestations often cause alarm and instigate a myriad of investigative testing to rule out insidious malignant processes. However, a unique and benign finding, the schwannoma can present either incidentally or while in pursuit of a symptomatic presentation. Given its rarity, limited literature exists on these neurogenic tumours with less than three dozen reported cases. No specific guidelines exist regarding the extent of required advanced imaging or degree of invasive evaluation. Therefore, practitioners confronted with these intrathoracic tumours may find management challenging or delayed. We present a case discussing a large benign tumour causing symptomatic burden, the investigative methods implored and treatment modality. We add to the literature another unique presentation of an intercostal nerve sheath tumour with schwannoma pathology.

Intrapulmonary schwannoma presenting as an asymptomatic lung mass: a case report

BACKGROUND

Schwannomas are solitary well-circumscribed encapsulated benign tumors that exhibit Schwann cell differentiation, and arise directly from myelinated peripheral or central nerves. Although they are usually asymptomatic and found incidentally, schwannomas can cause symptoms due to compression of nearby structures which, depending on the location, can make clinical presentations widely variable. Despite their rarity, schwannomas have been documented in a number of locations including the limbs, cerebellopontine angle, posterior mediastinum, and, far more infrequently, the lungs.

CASE PRESENTATION

In this article, we report an incidental finding of an intrapulmonary schwannoma in a 59-year-old Pakistani woman who was grossly asymptomatic upon presentation to the cardiothoracic surgery clinic. An [18F]fluorodeoxyglucose positron emission tomography/computed tomography scan revealed a lobulated soft-tissue lesion measuring 23 mm × 23 mm in the lower lobe of the right lung. A computed tomography-guided core biopsy of the mass was performed, which revealed a benign spindle cell lesion based on histopathological examination and immunohistochemical staining. The mass was surgically resected via a right lower lobectomy, and subsequently confirmed to be an encapsulated neoplastic lesion composed of well-differentiated Schwann cells. There were no short- or long-term complications, morbidities, or recurrences based on 1-year follow-up.

CONCLUSION

This report underscores the predominantly asymptomatic nature of schwannomas and reemphasizes the efficacy of surgical resection as a safe and curative procedure for a tumor of this nature. Albeit very rare, intrapulmonary schwannomas can be considered a differential diagnosis when encountering solitary asymptomatic pulmonary nodules or masses.

Mediastinal schwannoma: A case report

INTRODUCTION

Mediastinal schwannoma is a rare tumor that develops from a peripheral nerve sheath in the mediastinal.

CASE PRESENTATION

An Indonesian female, 60 years old, complained of breathlessness, left chest pain, and an intermittent cough. A cystic lesion in the left lung was discovered on radiological evaluation and no evidence of malignancy or metastases were found. The patient underwent a thoracotomy and continued therapy, which included cefixime at a dose of 2 × 200 mg/day, ketorolac at a dose of 3 × 30 mg/day, ranitidine at a dose of 2 × 50 mg/day, and wound care. Histopathology examination revealed a mediastinal schwannoma. For 3 months, the patient-controlled dyspnea, left chest pain, and intermittent cough disappeared once a month.

DISCUSSION

If the tumor is large enough, a thoracoscopic procedure is advised. Because mediastinal schwannomas are benign tumors, most do not get radiotherapy, chemotherapy, and recurrence in this case has not been reported.

CONCLUSION

Tissue histopathology is used to determine the diagnosis mediastinal schwannoma, whereas radiological evaluation just confirms the diagnosis. The management is thoracotomy for large masses.

Varied foci of primary benign schwannoma of the thorax: a case series

Schwannomas are the most common tumor of peripheral nerves. It comprises 1 to 2% of total thoracic tumor. Posterior mediastinum is the most common site in thorax. Hereby we are reporting two cases of schwannoma with different sites of origin. The classical presentation of schwannoma is an asymptomatic mass found on chest radiograph. This tumor is usually benign and slow growing. Imaging followed by histopathological examination is key to the diagnosis of this neoplasm. Resection of tumor cures the disease.