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Intercostal Nerve Schwannoma Encountered during a Rib-Latissimus Dorsi Osteomyocutaneous Flap Operation.

Kim KS, Ji SR, Kim HM, Kwon YJ, Hwang JH, Lee SY - Arch Plast Surg (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.

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Schwannomas are benign, slow-growing tumors that arise from the Schwann cells of peripheral nerve sheaths and are also known as neurilemmomas or neurinomas... They frequently occur in the head and neck or in the extremities... The lesions themselves do not cause an inflammatory reaction, and patients usually present when these lesions compress the associated peripheral nerve and cause sensory or motor issues secondary to neuropathy... Schwannomas of the intercostal nerve are extremely rare with few cases of large or symptomatic lesions reported in the literature... In the operating room, the sternal mass was resected en bloc with a wide surgical margin... In order to restore the resulting chest wall defect, a composite island flap was elevated, including the left tenth rib and the latissimus dorsi muscle... During this process, a 1-cm×1-cm mass was incidentally found along the subcostal groove of the tenth rib (Fig. 1)... However, the preoperative chest computed tomography images did not indicate the presence of the intercostal schwannoma... He did not report any paresthesia or hypoesthesia in the area innervated by the tenth intercostal nerve... The patient was discharged 14 days after the operation without any complications... The patient did not report any subsequent episodes of the pain... While uncommon, schwannomas of the intercostal nerve can grow to compress the nerve against the subcostal groove, causing intercostal neuralgia, including pain, tenderness, paresthesia, and hypoesthesia... Such small intercostal schwannomas are difficult to detect clinically because the intercostal nerve is located deep in the chest wall and may not be apparent in radiologic studies.

No MeSH data available.


Related in: MedlinePlus

Histopathologic images of the specimen. (A) The low-power view shows a biphasic pattern with a cellular Antoni A area (black arrow) and a hypocellular Antoni B area (white arrow) (H&E, ×40). (B) The high-power view shows tumor cells forming nuclear palisades (Verocay bodies) consisting of alternating parallel rows of tumor cell nuclei and their densely packed, aligned cell processes (H&E, ×400).
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Figure 2: Histopathologic images of the specimen. (A) The low-power view shows a biphasic pattern with a cellular Antoni A area (black arrow) and a hypocellular Antoni B area (white arrow) (H&E, ×40). (B) The high-power view shows tumor cells forming nuclear palisades (Verocay bodies) consisting of alternating parallel rows of tumor cell nuclei and their densely packed, aligned cell processes (H&E, ×400).

Mentions: A 58-year-old male patient with a sternal mass underwent excisional biopsy of a sternal lesion. The mass was found to be a chondrosarcoma on histopathology, and the patient subsequently underwent a secondary operation for wide resection and reconstruction of the chest wall defect. In the operating room, the sternal mass was resected en bloc with a wide surgical margin. In order to restore the resulting chest wall defect, a composite island flap was elevated, including the left tenth rib and the latissimus dorsi muscle. During this process, a 1-cm×1-cm mass was incidentally found along the subcostal groove of the tenth rib (Fig. 1). This well demarcated mass was excised. The remainder of the operation was uneventful. The results of the histologic examination of this lesion were consistent with a schwannoma (Fig. 2). Upon inquiry, the patient did report occasional bouts of pain in the area, which was described as sharp stabbing pain that worsened with coughing and exercise. However, the preoperative chest computed tomography images did not indicate the presence of the intercostal schwannoma. He did not report any paresthesia or hypoesthesia in the area innervated by the tenth intercostal nerve. The patient was discharged 14 days after the operation without any complications. The patient did not report any subsequent episodes of the pain.


Intercostal Nerve Schwannoma Encountered during a Rib-Latissimus Dorsi Osteomyocutaneous Flap Operation.

Kim KS, Ji SR, Kim HM, Kwon YJ, Hwang JH, Lee SY - Arch Plast Surg (2015)

Histopathologic images of the specimen. (A) The low-power view shows a biphasic pattern with a cellular Antoni A area (black arrow) and a hypocellular Antoni B area (white arrow) (H&E, ×40). (B) The high-power view shows tumor cells forming nuclear palisades (Verocay bodies) consisting of alternating parallel rows of tumor cell nuclei and their densely packed, aligned cell processes (H&E, ×400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660001&req=5

Figure 2: Histopathologic images of the specimen. (A) The low-power view shows a biphasic pattern with a cellular Antoni A area (black arrow) and a hypocellular Antoni B area (white arrow) (H&E, ×40). (B) The high-power view shows tumor cells forming nuclear palisades (Verocay bodies) consisting of alternating parallel rows of tumor cell nuclei and their densely packed, aligned cell processes (H&E, ×400).
Mentions: A 58-year-old male patient with a sternal mass underwent excisional biopsy of a sternal lesion. The mass was found to be a chondrosarcoma on histopathology, and the patient subsequently underwent a secondary operation for wide resection and reconstruction of the chest wall defect. In the operating room, the sternal mass was resected en bloc with a wide surgical margin. In order to restore the resulting chest wall defect, a composite island flap was elevated, including the left tenth rib and the latissimus dorsi muscle. During this process, a 1-cm×1-cm mass was incidentally found along the subcostal groove of the tenth rib (Fig. 1). This well demarcated mass was excised. The remainder of the operation was uneventful. The results of the histologic examination of this lesion were consistent with a schwannoma (Fig. 2). Upon inquiry, the patient did report occasional bouts of pain in the area, which was described as sharp stabbing pain that worsened with coughing and exercise. However, the preoperative chest computed tomography images did not indicate the presence of the intercostal schwannoma. He did not report any paresthesia or hypoesthesia in the area innervated by the tenth intercostal nerve. The patient was discharged 14 days after the operation without any complications. The patient did not report any subsequent episodes of the pain.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Schwannomas are benign, slow-growing tumors that arise from the Schwann cells of peripheral nerve sheaths and are also known as neurilemmomas or neurinomas... They frequently occur in the head and neck or in the extremities... The lesions themselves do not cause an inflammatory reaction, and patients usually present when these lesions compress the associated peripheral nerve and cause sensory or motor issues secondary to neuropathy... Schwannomas of the intercostal nerve are extremely rare with few cases of large or symptomatic lesions reported in the literature... In the operating room, the sternal mass was resected en bloc with a wide surgical margin... In order to restore the resulting chest wall defect, a composite island flap was elevated, including the left tenth rib and the latissimus dorsi muscle... During this process, a 1-cm×1-cm mass was incidentally found along the subcostal groove of the tenth rib (Fig. 1)... However, the preoperative chest computed tomography images did not indicate the presence of the intercostal schwannoma... He did not report any paresthesia or hypoesthesia in the area innervated by the tenth intercostal nerve... The patient was discharged 14 days after the operation without any complications... The patient did not report any subsequent episodes of the pain... While uncommon, schwannomas of the intercostal nerve can grow to compress the nerve against the subcostal groove, causing intercostal neuralgia, including pain, tenderness, paresthesia, and hypoesthesia... Such small intercostal schwannomas are difficult to detect clinically because the intercostal nerve is located deep in the chest wall and may not be apparent in radiologic studies.

No MeSH data available.


Related in: MedlinePlus