Posterior mediastinal schwannoma

Case contributed by Dr Paul Leong

Presentation

Hx of previous gestational trophoblastic disease

Patient Data

Age: 50
Gender: Female
Modality: X-ray

There is an opacity in the left posterior mediastinum. There is associated widening of the 4th intercostal space posteriorly, with scalloping of the inferior margin of the 4th rib. There is also some coarse calcification within the lesion.  

Modality: CT

There is a soft tissue density lesion within the left posterior mediastinum, in a paravertebral location. The lesion is closely related to the left neural exit foramen, but there is no definite extension into the spinal canal. The lesion does extend into the intercostal space. There is associated bony remodelling, with no bone erosion or destruction.

 

Modality: MRI

Left T4/5 paraspinal mass, which demonstrates heterogenous T2 high signal, small internal low signal foci (calcification) and areas of necrosis. 

There is associated bony remodelling, in keeping with a non-aggressive lesion.

Case Discussion

Imaging appearances were suggestive of a neurogenic tumour. This was confirmed on histopathology (obtained via VATS). 

Histopathology: Sections show a well-circumscribed, partly encapsulated, paucicellular tumour containing thick walled hyalinised vessels, areas of haemorrhage and dystrophic calcification. Tumour cells show mild nuclear atypia with focal Verocay body formation. Tumour cells stain S-100 positive, whilst they are negative for Neu-N, NFP and CD34. Histological and immunohistochemical features are those of an ancient schwannoma

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Case Information

rID: 26625
Case created: 31st Dec 2013
Last edited: 16th Nov 2015
System: Chest
Inclusion in quiz mode: Included

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