Oliveira Rui Caetano, Nogueira Tiago, Sousa Vítor, Carvalho Lina
Department of Pathology, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Hospitais da Universidade de Coimbra Centro de Cirurgia Cardiotoracica, Coimbra, Portugal.
BMJ Case Rep. 2016 Oct 19;2016:bcr2016217300. doi: 10.1136/bcr-2016-217300.
Bronchial schwannomas are very rare pulmonary lesions, but its awareness is important to reach correct diagnosis and decide proper intervention. Clinical and radiological characteristics are mainly unspecific and pathological examination usually provides the definite diagnosis. In small lesions, endoscopic approach may be sufficient, but in large lesions associated with organising pneumonia surgical intervention may be required. Prognosis is typically favourable. We describe a case of a woman, aged 66 years, with productive cough and sporadic haemoptysis, dyspnoea, anorexia, excessive sweating and weight loss with 2 months evolution. CT scan showed a soft tissue dense lesion on the left hilum with 3.75 cm with 18-Fludeoxyglucose uptake. Left upper lobectomy was performed. Gross examination revealed a polypoid mass without necrosis, histologically showing cellular dense (Antoni A) and less dense (Antoni B) areas with Verocay bodies, slightly pleomorphic spindle cells, without mitotic activity and positive for S100 protein on immunohistochemistry.
支气管神经鞘瘤是非常罕见的肺部病变,但认识到这一点对于做出正确诊断和决定适当的干预措施很重要。临床和放射学特征主要是非特异性的,病理检查通常能提供明确诊断。对于小病变,内镜检查可能就足够了,但对于伴有机化性肺炎的大病变,可能需要手术干预。预后通常良好。我们描述了一例66岁女性病例,患者有咳痰和偶发咯血、呼吸困难、厌食、多汗及体重减轻,病程2个月。CT扫描显示左肺门有一个3.75厘米的软组织致密病变,伴有18氟脱氧葡萄糖摄取。实施了左上肺叶切除术。大体检查发现一个无坏死的息肉样肿块,组织学显示有细胞密集区(Antoni A区)和密度较低区(Antoni B区),可见Verocay小体,有轻度多形性的梭形细胞,无有丝分裂活性,免疫组化显示S100蛋白阳性。