SESSION TITLE: Lung Cancer Cases
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 25, 2015 at 10:45 AM - 12:00 PM
INTRODUCTION: Schwannomas are a mostly benign, slow-growing nerve sheath tumors. In 90-95% of cases, pulmonary schwannomas are located in the posterior mediastinum. Patients are usually asymptomatic with an incidental diagnosis made on chest radiograph. Symptoms correspond to rapid growth of the tumor or invasion of surrounding structures. Schwannomas carry a good prognosis after complete surgical resection and seldom recur. We describe a case of a woman with recurrent schwannoma presenting as a right paratracheal mass.
CASE PRESENTATION: A 56 year-old female with a past medical history of hypertension presented for evaluation of a progressive non-productive cough over the past 10 months. Her symptoms were associated with sharp, substernal chest pain that radiated to her back. Of note, patient underwent complete excision of a right paratracheal mass consistent with schwannoma two years prior to presentation. Physical examination revealed clear lungs with no palpable lymphadenopathy. Chest computed tomography revealed 4.8 cm x 4.0 cm mass in the right paratracheal region(image1). The patient underwent endobronchial ultrasound-transbronchial needle aspiration of the mass with mixed sonographic density from fat to solid to liquid. Cytology revealed the presence of spindle cells positive for S100 on immunostaining. The patient was diagnosed with recurrent schwannoma and referred to cardiothoracic surgery for surgical resection.
DISCUSSION: Superior mediastinal masses are most concerning for malignancy including lymphoma or lung cancer. The radiographic appearance of a round, homogenous mass with a sharply defined border should raise suspicion for schwannoma. Occasionally, there is heterogeneity of the mass due to hemorrhage or necrosis. Most cases of schwannomas are benign, however, the distinction between benign and malignant tumors can seldom be made on imaging. Biopsy of the tumor is needed for diagnosis and cytology commonly shows spindle cells with immunostaining positive for S100. Complete surgical resection is the mainstay of treatment with recurrence in less than 1-2% of the cases.
CONCLUSIONS: The literature is limited for cases of schwannoma presenting as a recurrent superior mediastinal mass after complete resection. This case stresses the importance of adding schwannoma to the differential for a recurrent, rapidly growing superior mediastinal mass.
Reference #1: Intrathoracic peripheral nerve sheath tumors-a clinicopathological study of 75 cases. Boland JM, Colby TV, Folpe AL. Hum Pathol. 2015 Mar;46(3):419-25
DISCLOSURE: The following authors have nothing to disclose: Priyanka Rajaram, Christopher Ochoa
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