Urakawa T, Kawakita N, Nagahata Y
Department of Surgery, Kobe Rosai Hospital, Japan.
Kobe J Med Sci. 1993 Aug;39(4):123-31.
A fist-sized tumor mainly locating in the right thoracic wall of a 73 year-old woman was found by ultrasonography and computed tomography, although a definitive diagnosis was not obtained because of the tumor extension to the abdominal cavity from the right internal thoracic wall, precluding biopsy. Angiography of the right eleventh intercostal artery demonstrated irregular tumor vessels, indicating malignant nature of the tumor. Therefore en-block resection of the tumor with the right eleventh rib was performed under a thoracotomy. Postoperative histopathological examination showed that the tumor was a benign schwannoma of Antoni type A. Since schwannoma is usually difficult to diagnose preoperatively without histopathological study, it is suggested that patients with schwannoma-like tumors, as represented by the present case, should be treated carefully to avoid excessive surgery including an extensive resection of the surrounding tissue.
超声检查和计算机断层扫描发现,一名73岁女性右胸壁有一个拳头大小的肿瘤,主要位于右胸壁。尽管由于肿瘤从右胸廓内动脉延伸至腹腔,无法进行活检,因而未能获得明确诊断。右第11肋间动脉血管造影显示肿瘤血管不规则,提示肿瘤具有恶性特征。因此,在开胸手术下对肿瘤连同右第11肋进行了整块切除。术后组织病理学检查显示,该肿瘤为Antoni A型良性神经鞘瘤。由于神经鞘瘤通常在没有组织病理学研究的情况下很难在术前诊断,因此建议对以本病例为代表的神经鞘瘤样肿瘤患者进行谨慎治疗,以避免过度手术,包括广泛切除周围组织。