Ann Rehabil Med.  2013 Dec;37(6):896-900. 10.5535/arm.2013.37.6.896.

Thoracic Outlet Syndrome Caused by Schwannoma of Brachial Plexus

• Yun DH
• Kim HS
• Chon J
• Lee J
• Jung PK

• KMID: 2266571
• DOI: http://doi.org/10.5535/arm.2013.37.6.896

Abstract

Schwannomas are benign, usually slow-growing tumors that originate from Schwann cells surrounding peripheral, cranial, or autonomic nerves. The most common form of these tumors is acoustic neuroma. Schwannomas of the brachial plexus are quite rare, and symptomatic schwannomas of the brachial plexus are even rarer. A 47-year-old woman presented with a 1-year history of dysesthesia, neuropathic pain, and mild weakness of the right upper limb. Results of physical examination and electrodiagnostic studies supported a diagnosis as thoracic outlet syndrome. Conservative treatment did not relieve her symptoms. After 9 months, a soft mass was found at the upper margin of the right clavicle. Magnetic resonance imaging showed a 3.0x1.8x1.7 cm ovoid mass between the inferior trunk and the anterior division of the brachial plexus. Surgical mass excision and biopsy were performed. Pathological findings revealed the presence of schwannoma. After schwannoma removal, the right hand weakness did not progress any further and neuropathic pain gradually reduced. However, dysesthesia at the right C8 and T1 dermatome did not improve.

Keyword

Thoracic outlet syndrome; Brachial plexus; Schwannoma

MeSH Terms

Autonomic Pathways
Biopsy
Brachial Plexus*
Clavicle
Diagnosis
Female
Hand
Humans
Magnetic Resonance Imaging
Middle Aged
Neuralgia
Neurilemmoma*
Neuroma, Acoustic
Paresthesia
Physical Examination
Schwann Cells
Thoracic Outlet Syndrome*
Upper Extremity

Figure

• 

  Fig. 1 A well-defined heterogeneous echoic mass is apparent in the right lower anterior neck. The dimensions were 1.9×1.3×2.1 cm. The deep soft mass was located in the lateral margin of the sternocleidomastoid muscle.

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  Fig. 2 (A) T2 coronal magnetic resonance imaging (MRI) and (B) T2 sagittal MRI right brachial T2 coronal view images indicates an approximately 3.0×1.8×1.7 cm ovoid mass (arrow) between the inferior trunk and the anterior division of the brachial plexus (A). At the lateral arc of the right first rib, the T2 sagittal view also revealed an ovoid mass (arrow).

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  Fig. 3 (A) Hematoxylin and eosin-stained tumor composed of spindle-shaped neoplastic Schwann cells with alternating areas of compact, elongated cells with occasional nuclear palisading (Antoni A region on the left field) and less cellular, loosely textured areas (Antoni B region on the right field) (×100). (B) Immunohistochemical staining (×300 magnification) demonstrated that the tumor cells were positive for S-100 protein.

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