1. 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.

2. Case of the Month 23

3. Case of the Month 23

4. Case of the Month 23

5. Case of the Month 23

6. Case of the Month 23
What is your diagnosis ?

8. 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?

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

10. 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

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

12. Case of the Month 23
What is your diagnosis ?

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

14. 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

15. 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