A rare case of malignant schwannoma of the diaphragm is presented. The CT and ultrasound findings are described, correlated with the pathologic findings. During surgery, the tumor presented as a dumbbell shaped mass with central disruption of the right diaphragm.
Adult ; *Diaphragm ; Female ; Human ; Neurilemmoma/*diagnosis/radiography/ultrasonography ; Soft Tissue Neoplasms/*diagnosis/radiography/ultrasonography ; *Tomography, X-Ray Computed

Benign esophageal lesions occur in various diseases. Barium studies are useful for the evaluation of mucosal surface lesions but provide little information about the extramucosal extent of disease. Computed tomography and magnetic resonance imaging, on the other hand, permit the assessment of wall thickness, mediastinal involvement, adjacent lymphadenopathy, and distant spread. In diseases such as fibrovascular polyps, duplication cysts, scleroderma, trauma, caustic esophagitis, hiatal hernia, esophageal diverticulum, achalasia, and paraesophageal varices, the findings of imaging studies are specific, obviating the need for further invasive diagnostic work-up. The advent of helical computed tomography and its volume data set allows the acquisition of multiplanar images, and magnetic resonance imaging is useful both for this and for tissue characterization. Thus, multiplanar cross-sectional imaging further extends the role of imaging modalities to the evaluation of benign esophageal lesions. Through an awareness of the multiplanar cross-sectional appearances of various benign esophageal lesions, the radiologist can play an important role in the detection, diagnosis, further diagnostic planning, and treatment of the diseases in which they occur.
Adult ; Aged ; Esophageal Diseases/*pathology/*radiography ; Esophageal Neoplasms/*pathology/*radiography ; Esophagus/*pathology/*radiography ; Female ; Human ; Leiomyoma/*pathology/*radiography ; Magnetic Resonance Imaging ; Male ; Middle Age ; Neurilemmoma/*radiography ; Tomography, X-Ray Computed

We report a case of multiple hematogenous pulmonary metastases from a spinal malignant schwannoma. A 54-year-old woman with a known primary spinal malignant schwannoma presented with a 2-month history of painful neck mass, ptosis, anhidrosis, facial edema and mild chest discomfort. She had had the spinal surgeries two times followed by postoperative radiation therapy. The chest radiograph revealed typical multiple metastatic nodules on the both lung fields. Metastatic malignant schwannoma to the lung was confirmed by fine needle aspiration biopsy using a 22-gauge needle under fluoroscopic gauidance. The result of cytology of the lung mass was malignant spindle cell tumors consistent with malignant schwannoma located in cervical spine. The course of metastases might be hematogenous due to direct vascular invasion of tumor.
Biopsy ; Biopsy, Fine-Needle ; Edema ; Female ; Humans ; Hypohidrosis ; Lung ; Middle Aged ; Neck ; Needles ; Neoplasm Metastasis* ; Neurilemmoma* ; Radiography, Thoracic ; Spine ; Thorax

OBJECTIVETo evaluate the diagnostic criteria and morphologic difference of primary schwannoma from that of soft tissue schwannoma.

METHODSAll neurogenic tumors of the bone in this hospital from 2002 to 2013 were reviewed, four cases of primary schwannoma arising from bone were selected. Their clinical features, radiologic appearance and pathologic findings were evaluated. Immunophenotyping was performed using EnVision method.

RESULTSAll four cases had classic morphologic features and immunophenotype of conventional schwannoma. Compared with schwannoma of the soft tissue, primary bone schwannoma had the following features: benign radiological appearance, absence of capsule under light microscope, local infiltration of bone or destruction of bone cortex, occasionally involving extra-osseous soft tissue. Most tumors were solid, with less cystic degeneration. Histologically, the tumors were mainly composed of compact areas of spindle cells (Antoni A), and areas of hypercellularity could often be observed.

CONCLUSIONSPrimary schwannoma of the bone is rare, usually arises within the long bones and flat bones. Compared to conventional soft tissue schwannoma, it shows different growth pattern, imaging and pathologic features; thus care should be exercised not to misdiagnose schwannoma of the bone as other primary low-grade malignant spindle cell sarcoma of the bone and to avoid unnecessary over-treatment.

Bone Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Humans ; Immunophenotyping ; Neurilemmoma ; diagnosis ; diagnostic imaging ; pathology ; Radiography ; Sarcoma ; diagnosis ; diagnostic imaging ; pathology

The present study was undertaken to analyze the radiologic findings of intratemporal and extratemporal schwannoma (ITS & ETS). We retrospectively reviewed the CT (9 cases), MR (3 cases) and medical records of 10 facial schwannoma patients. After classifying these into ITS and ETS, radiologic and clinical findings were analyzed. The most common clinical manifestations were facial nerve dysfunction (6/6 cases, 100%) and hearing impairment (5/6 cases, 83.3%) in ITS and parotid mass (4/4 cases, 100%) in ETS. Geniculate ganglion (GG) was the most commonly involved segment of ITS (5/6 cases, 83.5%). On CT, ITS arising in GG (4 cases) showed erosion of the petrous bone (4 cases), cochlea (3 cases), lateral semicircular canal (1 case) and ossicles (3 cases). ITS arising in the mastoid segment (1 case) showed the destruction of the jugular plate and external auditory canal wall. All three ITS in which MRI was performed showed iso- to hypointensity on T1WI, hyperintensity on T2WI and well-enhanced on post-enhanced T1WI. ETS showed various findings, but all four ETS were located in the posterolateral portion of the retromandibular vein and extended toward the stylomastoid foramen. In conclusion, ITS shows the schwannoma on MR. ETS shows various findings. However, if the tumor is located along the extratemporal facial nerve course, then facial schwannoma may be suspected.
Adult ; Cranial Nerve Neoplasms/diagnosis* ; Facial Nerve* ; Female ; Geniculate Ganglion/radiography ; Geniculate Ganglion/pathology ; Human ; Magnetic Resonance Imaging* ; Male ; Middle Age ; Neurilemmoma/diagnosis* ; Tomography, X-Ray Computed*

A 14-year-old Maltese dog presented with progressive exophthalmos and external deviation of the right eye. Ultrasonography revealed the presence of a retrobulbar mass and fine-needle aspiration cytology was performed, which detected a malignant mass. There was no evidence of metastasis on thoracic and abdominal radiography. Computed tomography showed no invasion into the bony orbit and no metastasis to the lung or lymph nodes. Exenteration was performed to remove the mass completely. Malignant peripheral nerve sheath tumor was confirmed by histopathological examination.
Adolescent ; Animals ; Biopsy, Fine-Needle ; Dogs ; Exophthalmos ; Humans ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Neurilemmoma* ; Orbit* ; Peripheral Nerves ; Radiography, Abdominal ; Recurrence* ; Ultrasonography

OBJECTIVE: To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors. MATERIALS AND METHODS: We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time. RESULTS: Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004). CONCLUSION: Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.
Adult ; Aged ; Aged, 80 and over ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Stromal Tumors/pathology/*radiography ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Logistic Models ; Male ; Middle Aged ; Neurilemmoma/pathology/*radiography ; Retrospective Studies ; Statistics, Nonparametric ; Stomach Neoplasms/pathology/*radiography ; Tomography, X-Ray Computed/*methods

We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach.
Adult ; Atrial Septum/pathology/surgery ; Cardiomegaly/*etiology/radiography ; *Cardiopulmonary Bypass ; Female ; Heart Atria/pathology ; Heart Neoplasms/pathology/*surgery ; Humans ; Magnetic Resonance Imaging, Cine ; Neurilemmoma/*pathology/surgery ; *Printing, Three-Dimensional ; Sternotomy ; Treatment Outcome ; Vena Cava, Superior/pathology

OBJECTIVETo evaluate the safety and efficiency of hemi-semi laminectomy approach for the microsurgical treatment of spinal schwannomas.

METHODSA total of 22 patients underwent hemi-semi laminectomy for the microsurgical removal of spinal schwannomas during a period of 2009 and 2011 in Affiliated Hospital of Nantong University. We retrospectively analyzed the clinical outcomes of these patients.

RESULTSOf them, 5 cases were diagnosed with cervical schwannomas, 9 with thoracic schwannomas, and 8 with lumbar schwannomas. All the tumors including two dumbbell schwannomas were totally removed without major complications. Postoperatively, all patients were followed up from 6 to 36 months. The symptoms and signs were obviously improved, and no tumor recurrence or spinal deformity occurred.

CONCLUSIONHemi-semi laminectomy is a safe and effective method for resection of spinal schwannomas.

Adolescent ; Adult ; Aged ; Female ; Humans ; Laminectomy ; methods ; Magnetic Resonance Imaging ; Male ; Microsurgery ; methods ; Middle Aged ; Models, Biological ; Neurilemmoma ; diagnostic imaging ; surgery ; Radiography ; Retrospective Studies ; Spinal Cord Neoplasms ; diagnostic imaging ; surgery ; Treatment Outcome ; Young Adult

BACKGROUND AND OBJECTIVEDuring the resection of jugular foramen tumors via the basic far lateral approach, the jugular foramen tumor area as well as its adjacent structures, especially the intracranial part, can be better exposed, which avoids stripping of the petrous part of temporal bone and displacement of facial nerve, and protects the patient's hearing from damage. However, when applied in tumors developed from ventral to the brain stem and middle fossa, with extracranial tumors, this surgical approach seems to be inadequate and limited. This study was to explore the microsurgical technique and clinical value for treating giant dumbbell-shaped tumors at jugular foramen (JF) via a modified far lateral approach.

METHODSA retrospective analysis was performed in 16 patients with huge dumbbell-shaped tumors at JF which were removed through the modified far lateral approach (suboccipital transjugular-jugular tubercle-jugular process) between January 2001 and December 2008. The process of operation, and pre-and postoperative clinical data were included in the analysis.

RESULTSGross total tumor removal was achieved in 14 cases, subtotal removal in 1 case, and partial removal in 1 case. Follow-up examinations in most patients demonstrated that the patient with an obvious preoperative deficit had a good recovery. During the follow-up from three months to seven years, 10 (76.9%) cases with lower cranial nerve involvement showed obvious improvement of symptom after operation, 8 (80.0%) cases with facial palsy obtained various degrees of alleviation, and 7 (77.8%) cases with hearing impairment at different levels restored hearing. Two patients developed new lower cranial nerve palsies after operation, and underwent functional rehabilitation in the three-month follow-up.

CONCLUSIONSModified far lateral approach is helpful for removing the huge tumors at JF, especially for tumors extending to the petroclival region ventral part of pontomedullary junction. It has a higher rate of total resection, preoperative cranial nerve function impairment is expected to restore, and also has the advantage of protecting the facial nerve, labyrinth and vertebral artery structure from unnecessary damage.

Adult ; Cranial Nerve Diseases ; etiology ; Female ; Follow-Up Studies ; Glomus Jugulare Tumor ; complications ; diagnosis ; diagnostic imaging ; surgery ; Hearing Loss ; etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Meningioma ; surgery ; Microsurgery ; methods ; Middle Aged ; Neurilemmoma ; surgery ; Radiography ; Recovery of Function ; Retrospective Studies