Shoaib Daania, Zahir Muhammad N, Khan Saqib R, Jabbar Adnan A, Rashid Yasmin A
Internal Medicine, Aga Khan University Hospital, Karachi, PAK.
Medical Oncology, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2021 Aug 27;13(8):e17511. doi: 10.7759/cureus.17511. eCollection 2021 Aug.
Schwannoma is a rare tumor that arises from the Schwann cells, which are specialized, myelin-producing cells of the peripheral nerve sheaths. As anatomic logic would dictate, these masses commonly occur in the skull base, cerebellopontine angle, and posterior spinal roots. Of this already rare entity, rarer still are the pleural schwannomas, representing approximately 1-2% of thoracic tumors. These tumors commonly affect adults with a propensity for the third and sixth decades of life and a comparative male predilection. Schwannomas are benign, indolent, and follow an asymptomatic course. As such, they often come to light incidentally. Here we report a case of primary pleural schwannomas in a 68-year-old female, found incidentally on a CT scan of the chest. To the best of our knowledge and literature review, no other similar case has been reported in our country, Pakistan. Around three weeks before her presentation, she was diagnosed with COVID-19. Her infection had run a mild course with quick recovery without the need for any hospitalization. Therefore, the manifestation of shortness of breath after resolution of all other symptoms prompted a further workup. Radiographic chest x-ray revealed an incidental finding of a large right upper lobe lung mass, slightly impinging on the trachea. This was followed by a chest CT scan at our radiological imaging facility, which showed a large, well-encapsulated, right upper lobe lung mass in the paraspinal apical location. She then underwent an image-guided biopsy of the aforementioned mass, pathological analysis of which was suggestive of a benign peripheral nerve sheath tumor (PNST) arising from the pleura (pleural schwannoma). She underwent right posterolateral thoracotomy with uneventful complete surgical removal of the pleural-based lung mass. Postoperative investigations included a chest x-ray that showed interval complete resection of the mass. Currently, she is asymptomatic and her clinical condition has improved with the successful resumption of her daily routine. Physicians thus need to keep pleural schwannomas in mind as a probable diagnosis of intrathoracic tumors. Indolent and asymptomatic, they are very amenable to surgical resection with little to no chances of recurrence in the long term. However, these patients should be closely followed with repeat imaging studies when symptomatic.
施万细胞瘤是一种罕见的肿瘤，起源于施万细胞，施万细胞是周围神经鞘中专门产生髓磷脂的细胞。按照解剖学逻辑，这些肿块通常发生在颅底、桥小脑角和后脊髓神经根。在这种本就罕见的肿瘤类型中，胸膜施万细胞瘤更为罕见，约占胸部肿瘤的1% - 2%。这些肿瘤通常影响成年人，好发于30至60岁，男性略多。施万细胞瘤是良性的，生长缓慢，通常无症状。因此，它们常常是偶然被发现。在此，我们报告一例68岁女性原发性胸膜施万细胞瘤，该肿瘤在胸部CT扫描时偶然发现。据我们所知及文献检索，在我们国家巴基斯坦，尚未有其他类似病例报道。在她就诊前三周左右，她被诊断为新冠肺炎。她的感染过程较轻，恢复迅速，无需住院治疗。因此，在所有其他症状缓解后出现的气短症状促使进一步检查。胸部X线片偶然发现右肺上叶有一个大肿块，对气管略有压迫。随后在我们的放射影像科进行了胸部CT扫描，显示在脊柱旁尖部位置有一个大的、边界清晰的右肺上叶肿块。然后她接受了对上述肿块的影像引导下活检，病理分析提示为起源于胸膜的良性周围神经鞘瘤（胸膜施万细胞瘤）。她接受了右后外侧开胸手术，顺利完整切除了胸膜源性肺肿块。术后检查包括胸部X线片，显示肿块已完整切除。目前，她无症状，随着日常活动的成功恢复，临床状况有所改善。因此，医生需要将胸膜施万细胞瘤作为胸内肿瘤的一种可能诊断加以考虑。因其生长缓慢且无症状，非常适合手术切除，长期复发几率很小或几乎没有。然而，这些患者出现症状时应通过重复影像学检查密切随访。
