Tuberc Respir Dis.  2008 Oct;65(4):318-322.

A Case of Double Primary Neurilemmoma on Both Chest Wall, One of Them is Bulging to Skin from Intercostal Nerve

• Kim C
• Park SM
• Park EJ
• Jung EJ
• Jang WH
• Kim YK
• Lee YM
• Kim KU
• Kim HZ
• Hwang JH
• Jin SY
• Uh ST

Abstract

Neurilemmomas are benign nerve sheath tumors derived from Schwann cells that rarely occur in the chest wall. Neurilemmomas of the chest wall are usually solitary lesions that bulge toward the pleural cavity. Neurilemmomas are confirmed histologically based on the presence of Verocay bodies, Antoni A and Antoni B tissue patterns and S-100 protein. Bilateral neurilemmomas in the chest wall are extremely rare, as are those that grow in the subcutaneous tissue but not the pleural area. We report here a case of bilateral chest wall neurilemmomas in which the tumors bulged out to the skin and were palpable.

Keyword

Bilateral neurilemmomas; Chest wall

MeSH Terms

Intercostal Nerves
Nerve Sheath Neoplasms
Neurilemmoma
Pleural Cavity
S100 Proteins
Schwann Cells
Skin
Subcutaneous Tissue
Thoracic Wall
Thorax
S100 Proteins

Figure

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  Figure 1 Chest PA and left lateral radiographic findings of 62 year old patients who had already known pulmonary nodules. Faint mass like density are found at left 4th intercostal space (white arrow) and soft tissue swelling in right lower chest (black arrow).

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  Figure 2 Chest computed tomography of the presented patients show soft and oval shape homogenous low density mass at the intercostal area, protruding to lung (A). Lower right chest area same density mass are detected in the pleura which is protruded toward subcutaneous tissue (B).

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  Figure 3 Specimens from the patient by surgical extirpation are well encapsulated about 2 cm sized single mass from left chest wall (A), and conglobulated five ovoid soft masses from right, 3 cm, the largest one (B).

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  Figure 4 Microscopic examination from the sectioned specimen, tumor was composed two parts, the compact area (Antoni type A) which was condensed spindle cell clusters and less compact area (Antoni type B) which was less condense and degenerated area. The hyalinized acellular area and the rows of parallel nuclei were specific findings of Verocay body (A) (H&H stain, ×100). Immunohistochemical staining showed positive (brown color) for S-100 protein which is stained melanoma and neuron cells (B) (×100).

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