Igai Hitoshi, Kamiyoshihara Mitsuhiro, Kawatani Natsuko, Ibe Takashi, Shimizu Kimihiro
Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahi-cho, 371-0014, Maebashi, Gunma, Japan.
J Cardiothorac Surg. 2014 Jun 27;9:116. doi: 10.1186/1749-8090-9-116.
The preoperative diagnosis of intraosseous schwannoma is challenging because of its rarity. We report a resected case of sternal intraosseous schwannnoma mimicking late recurrence of breast cancer.A 60-year-old Japanese woman with a history of breast cancer was diagnosed as having a sternal tumor by chest computed tomography (CT) demonstrating a round, well-defined, low-density nodule measuring 3.3 × 2.8 cm, which was located almost at the center of the sternum and associated with bone lysis and erosion. [18 F]Fluorodeoxyglucose positron emission tomography (FDG-PET)/CT demonstrated FDG accumulation in the tumor, suggesting malignancy. Therefore, late isolated recurrence of breast cancer was suspected. Surgical resection was performed for both confirmation of the diagnosis and treatment.Pathological examination revealed that the tumor was composed predominantly of spindle-shaped cells arranged in a typical palisading pattern, being compatible with schwannoma. Although the periosteum was intact, the tumor was found to have destroyed the cortex of the sternum and proceeded forward to the bone marrow. Additionally, immunohistochemical staining revealed that the lesion was diffusely and strongly positive for S-100 protein. Thus metastasis from breast cancer was ruled out on the basis of the features revealed by microscopy.
由于骨内神经鞘瘤罕见，其术前诊断具有挑战性。我们报告一例切除的胸骨骨内神经鞘瘤病例，该病例酷似乳腺癌的晚期复发。一名有乳腺癌病史的60岁日本女性，胸部计算机断层扫描（CT）显示胸骨有一个肿瘤，表现为一个圆形、边界清晰的低密度结节，大小为3.3×2.8厘米，几乎位于胸骨中央，伴有骨质溶解和侵蚀。[18F]氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）/CT显示肿瘤内有FDG聚集，提示为恶性肿瘤。因此，怀疑为乳腺癌的晚期孤立性复发。为明确诊断和进行治疗，实施了手术切除。病理检查显示，肿瘤主要由呈典型栅栏状排列的梭形细胞组成，符合神经鞘瘤。虽然骨膜完整，但发现肿瘤已破坏胸骨皮质并侵入骨髓。此外，免疫组化染色显示该病变S-100蛋白弥漫性强阳性。因此，根据显微镜检查结果排除了乳腺癌转移。
