Chest wall mass with double pathology

Abstract

Intrathoracic neurogenic tumors arising from chest wall are generally rare tumors. The benign soft tissue tumors may produce compression effect on the chest wall but are generally free. The presence of unusual adherence raises the suspicion of malignancy. Our case report describes the clinical features of a young male who underwent excision of a left posterosuperior chest wall mass with a portion of the fourth rib. Histopathological examination unexpectedly revealed the existence of two different pathologies. The mass was found to be benign schwannoma and the rib showed features of tuberculous osteomyelitis. Inflammatory response and fibrous reaction mimicked the features of malignancy.

Contrast-Enhanced Ultrasonographically Guided Percutaneous Biopsy in the Diagnosis of Paravertebral Schwannoma

“…4,5 Schwannoma (or neurilemmoma) arises from the Schwann cells of a peripheral nerve sheath, such as the spinal nerve root or intercostal nerve, and is the most common mediastinal neurogenic tumor. 3,4 Histologically, schwannomas consist of compact cellular lesions (Antoni type A tissue) and loose hypocellular myxoid lesions with microcystic spaces (Antoni type B tissue); the cells show intense immunohistochemical staining for S-100 protein, confirming their neuroectodermal origin. 6 Schwannoma is generally a slow-growing benign tumor, but in some cases it can be malignant.…”

“…2,3 Magnetic resonance imaging and CT are the imaging techniques of choice to investigate mediastinal lesions, but their findings can be inconclusive, and not infrequently, patients undergo surgical exploration before a definitive diagnosis is obtained. 2,3 Posterior mediastinal masses can accurately be imaged by endoscopic ultrasonography (EUS), and EUS-guided fineneedle aspiration has successfully been used to diagnose schwannoma of the posterior mediastinum, avoiding more invasive procedures such as mediastinoscopy. 2 However, EUS is available in a limited number of centers, is technically difficult and uncomfortable, and needs conscious sedation of the patient.…”

“…3 We report a case in which contrast-enhanced ultrasonography (CEUS) and CEUSguided needle biopsy played a key role in diagnosing a schwannoma of the chest wall. Medicine (G.G., G.T., A.D.G., F.F.)…”

“…3,4 However, it is often difficult preoperatively to clarify whether they are benign or malignant, 1 and CT-guided needle biopsy can also be nondiagnostic. 3 We report a case in which contrast-enhanced ultrasonography (CEUS) and CEUSguided needle biopsy played a key role in diagnosing a schwannoma of the chest wall.…”

Successful resection of schwannoma from an intercostal nerve causing bloody pleural effusion: Report of a case

“…6 If the patient has Von Recklinghausen's disease or a history of radiation exposure, the risk of malignancy increases to 10%-20%. 6 Approximately 80%-85% of malignant peripheral nerve sheath tumors are spindle cell tumors with fasciculating patterns. 7 Malignancy is suggested by features such as invasion of surrounding tissues, invasion of vascular structures, nuclear pleomorphism, necrosis, and mitotic activity.…”