Case of the Month 23 May 2017 History: 62-year-old male presented with a rigth upper chest pain since six weeks. An initial chest radiograph was performed.

Case of the Month 23

Case of the Month 23

Case of the Month 23

Case of the Month 23

Case of the Month 23 What is your diagnosis ?

Case of the Month 23 May 2017 History: Question: 62-year-old male presented with a rigth upper chest pain since six weeks. An initial chest radiograph was performed. Question: What are the key findings on the CXR?

Case of the Month 23 Mass most likely attached to the chest wall and in an extra-pulmonary location

Case of the Month 23 At CT, the mass is located in the intercostal space and herniates on both sides of it Solid component but quite low attenuation (35 HU) Second lesion located in the right arm Both show high FDG uptake

Case of the Month 23 The patient underwent biopsy of his right apical mass

Case of the Month 23 What is your diagnosis ?

Authors: D Tack, P Duchatelet Baudour Belgium Case of the Month 23 Multiple Swannomas Authors: D Tack, P Duchatelet Baudour Belgium

Discussion Case of the Month 23 WHO grade 1 90% of schwannomas are solitary and sporadic Transformation to a malignant peripheral nerve sheath tumor is extremely rare May compress or erode nearby structures including bone Neurofibromatosis type 2 (NF2) is an autosomal dominant disease characterized by bilateral vestibular schwannomas May include plexiform schwannomas Other CNS tumors often occur including: schwannomas of other cranial nerves, meningiomas, ependymomas, and gliomas Schwannomatosis (NF3) presents with multiple schwannomas involving skin or soft tissue Often painful May be sporadic or inherited

Discussion Case of the Month 23 Differential Diagnosis Neurofibroma Solitary circumscribed (palisaded encapsulated) neuroma Traumatic Neuroma MPNST Leiomyoma/Leiomyosarcoma Meningioma Plexiform neurofibroma Metastatic melanoma Pigmented neurofibroma http://surgpathcriteria.stanford.edu/peripheral-nerve/schwannoma/