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Kim, Park, Park, Jung, Jang, Kim, Lee, Kim, Kim, Hwang, Jin, and Uh: A Case of Double Primary Neurilemmoma on Both Chest Wall, One of Them is Bulging to Skin from Intercostal Nerve
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2008; 65(4): 318-322.

Published online: 31 October 2008

DOI: https://doi.org/10.4046/trd.2008.65.4.318

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

Chul Kim, M.D.1, Sang Mo Park, M.D.4, Eui Ju Park, M.D.1, Eun Jung Jung, M.D.1, Won Ho Jang, M.D.2, Yang Ki Kim, M.D.1, Young Mok Lee, M.D.1, Ki-Up Kim, M.D.1, Hyun Zo Kim, M.D.2, Jung Hwa Hwang, M.D.3, So Young Jin, M.D.4, Soo-taek Uh, M.D.1

1Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.

2Department of Chest Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.

3Department of Radiology, Soonchunhyang University College of Medicine, Seoul, Korea.

4Department of Pathology, Soonchunhyang University College of Medicine, Seoul, Korea.

Address for correspondence: Ki-Up Kim, M.D. Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Soonchunhyang University Hospital, 657 Hannam-dong, Yongsan-gu, Seoul 140-743, Korea. Phone: 82-2-709-9027, Fax: 82-2-709-9554, kukim@hosp.sch.ac.kr

Received 23 July 2008       Accepted 11 August 2008

Copyright © 2008 The Korean Academy of Tuberculosis and Respiratory Diseases

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.

Keywords: Bilateral neurilemmomas, Chest wall

Figures and Tables

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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