Department of Pathology, The Military General Hospital of Beijing PLA, Nanmen Warehouse 5, Dongsishitiao Street, Dongcheng District, Beijing 100700, People's Republic of China.
Diagn Pathol. 2014 Feb 7;9:31. doi: 10.1186/1746-1596-9-31.
Bony schwannoma is a rare benign tumor derived from schwann cells of nerve fibers in the bone. It accounts for less than 1% of bony benign tumor, and prone to occur in the sacrum and mandible, occurrence in scapula is very rare. Here we report a 42-year-old woman with the chief complaint of pain in the left scapula. Imaging examination showed a giant, irregular, swelling lesion with distinct border involving the left scapula, extending into the left shoulder glenoid and pressing the surrounding soft tissues. Needle biopsy showed that the tumor was composed of spindle cells with S-100 protein positive, mimicking a benign neurogenic tumor. Then a complete excision was performed by removing the tumor and the surrounding tissues including partial left shoulder glenoid. Histologically, Antoni type A areas were the predominant microscopic pattern with occasional alternation by Antoni type B areas. Immunohistochemistry found that the neoplastic cells were scatteredly positive for S-100 protein. All these features suggest a diagnosis of an intraosseous schwannoma of the left scapula. Follow-up of the patient for ten months found no recurrence or sign of other tumors following complete tumor resection without any adjuvant therapy. In conclusion, this case of giant intraosseous schwannoma of the scapula is a rare benign bony tumor, and its diagnosis combined with clinical, imaging and pre-operative needle biopsy is important to guide further therapy, and avoid overtreatment.
The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1399352761104042.
骨神经鞘瘤是一种罕见的良性肿瘤，来源于骨神经纤维的施万细胞。它在骨良性肿瘤中不到 1%，易发生于骶骨和下颌骨，肩胛骨发生非常罕见。我们在此报告一例 42 岁女性，以左肩胛骨疼痛为主诉。影像学检查显示左肩胛骨有一个巨大的、不规则的、边界清晰的肿胀病变，延伸至左肩胛骨肩峰并压迫周围软组织。针吸活检显示肿瘤由梭形细胞组成，S-100 蛋白阳性，类似于良性神经源性肿瘤。然后通过切除肿瘤和包括部分左肩胛骨肩峰在内的周围组织进行完全切除。组织学上，以 Antoni A 型区为主，偶尔伴有 Antoni B 型区交替。免疫组化发现肿瘤细胞散在表达 S-100 蛋白。所有这些特征均提示左肩胛骨骨内神经鞘瘤的诊断。患者随访 10 个月，在完全肿瘤切除后无任何辅助治疗，未见复发或其他肿瘤迹象。总之，这种罕见的肩胛骨巨大骨内神经鞘瘤是一种良性骨肿瘤，其诊断结合临床、影像学和术前针吸活检对于指导进一步治疗和避免过度治疗非常重要。
