Department of pathology, St. John Hospital & Medical Center, 22101, Moross Road, Detroit, MI 48236, USA.
Eur Ann Otorhinolaryngol Head Neck Dis. 2012 Dec;129(6):331-3. doi: 10.1016/j.anorl.2012.01.001. Epub 2012 Sep 13.
Schwannoma rarely involves the phrenic nerve. We report a unique case of schwannoma as a cause of chronic hiccups due to the involvement of phrenic nerve.
A 72-year-old male presented with 20-year history of hiccups. He underwent multiple esophagogastroduodenoscopy procedures, all of which were negative. A computed tomography (CT-scan) of soft tissue of the neck was remarkable for left retrosternal mass with central calcification, located adjacent to the thyroid gland. He underwent surgery and this mass was found to be originating from the left phrenic nerve. Resection of the portion of phrenic nerve with mass was performed. Grossly, the specimen was a pale-tan piece of soft tissue, 4.8 cm in maximum dimension with an attached portion of nerve. Microscopically, it showed a well-circumscribed spindle cell lesion with hypercellular and hypocellular areas and multiple Verocay bodies. There was no atypia or significant mitotic activity. On immunohistochemical staining, the spindle cells were positive for S-100, supporting the diagnosis of schwannoma.
Postoperatively, the patient showed marked improvement in his symptoms and the hiccups were almost completely resolved. Although they are very rare, schwannomas of the phrenic nerve should be considered in the differential diagnosis of chronic hiccups.
神经鞘瘤很少累及膈神经。我们报告了一例因膈神经受累而导致慢性呃逆的神经鞘瘤的罕见病例。
一名 72 岁男性因呃逆 20 年就诊。他曾多次接受食管胃十二指肠镜检查，但均为阴性。颈部软组织的计算机断层扫描（CT 扫描）显示左胸骨后有一个肿块，伴中央钙化，位于甲状腺旁边。他接受了手术，发现这个肿块来源于左侧膈神经。膈神经与肿块的部分被切除。大体上，标本为 4.8 厘米最大尺寸的淡褐色软组织，附有一部分神经。显微镜下，显示边界清楚的梭形细胞病变，有细胞丰富区和细胞稀疏区，并有多个 Verocay 小体。没有非典型性或显著的有丝分裂活动。免疫组织化学染色显示，梭形细胞 S-100 阳性，支持神经鞘瘤的诊断。
术后，患者的症状明显改善，呃逆几乎完全缓解。虽然非常罕见，但膈神经的神经鞘瘤在慢性呃逆的鉴别诊断中应予以考虑。
