| 제목 |
T1 spinal nerve schwannoma presenting as a lung mass : Case Report |
| 소속 |
Soonchunhyang University College of Medicine, Cheonan, Korea, Department of Physical Medicine & Rehabilitation1, Soonchunhyang University College of Medicine, Bucheon, Korea, Department of Physical Medicine & Rehabilitation2, Soonchunhyang University College of Medicine, Seoul, Korea, Department of Physical Medicine & Rehabilitation3 |
| 저자 |
Joung Hyun Doh1*, Yuntae Kim1†, Soo A Kim1, Ki Young Oh1, Jin Young Kim2, Sang Hoon Lee3 |
Introduction
Schwannoma is nerve sheath tumor composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral nerves. Large schwannoma in the spine are relatively rare, usually expand into the mediastinum and retroperitoneum and can reach considerable size before they become symptomatic. The patients mostly complain of nerve compression symptoms during the growth of the mass, with numbness and pain in the corresponding limb. In this case, we present a patient with painless, isolated mass on right mediastinum.
Case presentation
A 33-year-old woman showing suspicious lung mass in chest x-ray was admitted to hospital at pulmonology department for the evaluation. The patient had no specific past medial history and did not show any symptoms. The lung mass was in RUL, and after bronchoscopy and PTNB, the result of immunohistochemical stain showed S-100 protein(+), Ki-67(+), SMA, Desmin, CD34(-), revealed the mass as schwannoma. The mass was 3cm sized, well-marginated extrapleural mass of the pleural wall located in Right upper hemithorax. She was admitted to hospital again at cardiovascular surgery department for ‘Resection of mediastinal mass via VATS’. During the operation the mass was found close to subclavian vessels and had adhesions with small vessels. 1 month after surgery, she complained weakness in hand intrinsic muscles, and hypoesthesia on right upper arm and forearm, and hypohidrosis on right hand, axillar, and face. The follow up chest CT showed remnant post-op. granulation tissue with calcification in right apex, but other than that no abnormality was found. So she was referred to physical medicine and rehabilitation department for evaluation of the symptoms. After close physical examination, weakness was showed in right abductor pollicis brevis and abductor digiti minimi muscles, and hypoesthesia was showed in medial antebrachial cutaneous and medial brachial cutaneous nerve. We performed electromyography on right upper extremity and found out the amplitude of sensory nerve action potential of right medial brachial cutaneous nerve, and abnormal spontaneous activity was showed in abductor pollicis brevis and first dorsal interossei muscles. So we concluded as injury of T1 spinal nerve lesion. Two months after surgery, her symptoms improved and only numbness on right MBC and MABC areas was remained.
Conclusion
We report a case of T1 spinal nerve schwannoma which first presented as a lung mass. Primary benign spinal neoplasm and lung cancer require different surgical strategies and treatment, so we must consider the possibility of malignant neoplasm when confronted by single spinal mass. Large benign schwannomas are rare. But in most cases it can be treated through one surgical approach such as complete resection, and expecting a good postoperative prognosis. Although we should always be aware of the possible recurrence of spinal schwannomas, and a long-term follow-up is recommended. |
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Fig1. X-ray and Chest CT images, showing lung mass in Rt. Apex., coronal / axial/ sagittal view(A, B, C)
Fig2. X-ray image of the chest, 2 weeks after the surgery (A), Chest CT image, 1 month after the removal of mass showing granulation tissue with calcification (B)
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