Thoracic schwannoma is a rare condition in a pregnant patient. Most tumors are benign and asymptomatic. This case report describes a pregnant patient presenting with symptoms of chest pain and dyspnea.
This 35 year old woman presented at 12 weeks gestation with two weeks of pleuritic pain and dyspnea. There was no history of cough, hemoptysis, constitutional symptoms or tobacco use. Percussion exam of the chest revealed localized dullness over the left posterior thorax. Chest imaging studies identified a left pleural effusion and chest mass. A thoracentesis showed exudative characteristics and non-diagnostic cytology. The patient was transferred to this institution for further diagnosis and management. A MRI of the chest characterized the mass as: 12cm in greatest diameter, extrapleural in location, of heterogeneous appearance, with small calcifications, and vertebral body remodeling. Differential diagnosis included neurogenic tumor, sarcoma, blastoma, teratoma, lymphoma, hamartoma, mesenchymal neoplasm, and bronchogenic carcinoma.The patient underwent a left thoracotomy for resection of the tumor. Histologic examination was consistent with a schwannoma Antoni type A cellular pattern.DISCUSSION: This is the first reported case of a thoracic schwannoma in pregnancy. Thoracic schwannomas comprise about 31% of neurogenic tumors. Mean age of occurrence is 38 years, with a predominance of caucasian females. Greater than 90% are benign. The potential for malignant transformation occurs in 30% of these cases. A posterior mediastinal location and tumor mass spanning at least two intercostal spaces are the most common described features on chest CT. MRI is the imaging study of choice for preoperative evaluation.
Despite rare occurrence, schwannomas are the most common neurogenic tumor of the thorax. Surgical intervention is generally curative in benign tumors and eliminates the risk of malignant transformation. Recurrence of benign tumors is unusual.
I.N. Stumpf-Cabot, None.