대한흉부영상의학회 Weekly Chest Cases

Case No : 402 Date 2005-07-11

Courtesy of Kyung-Min Shin M.D., Duk-Sik Kang M.D. / Kyung-Min Shin M.D., Duk-Sik Kang M.D.
Age/Sex 47 / M
Chief ComplaintIncidentally detected chest X-ray abnormality

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Diagnosis With Brief Discussion

Diagnosis: Neurilemmoma (Sympathetic nerve origin)
Radiologic Findings: Posteroanterior and lateral chest radiographs show right paratracheal mass with sharply demarcated margin. Contrast-enhanced CT scan shows a well-defined round mass with homogenous low attenuation and thick rim. Dense calcifications are also seen in the periphery of the mass. Specimen photograph of resected specimen shows well-demarcated cystic mass.
Brief Review: Neurilemmomas (Schwannomas) are solitary, encapsulated tumors and consist of a population of Schwann cell, with variable amount of reticulin fiber, but do not contain nerve tissue or collagen fiber. Tumors usually consist of two different components,: a highly ordered cellular component (Antoni type A tissue) and a loose myxoid component (Antoni type B tissue). They are usually found in the posterior mediastinum, usually originated from sympathetic nervous system or intercostal nerve.

At CT, a neurilemmoma appears as a well-demarcated round or oval mass that frequently demonstrates prominent cystic degeneration and calcification. At contrast-enhanced CT, neurilemmomas demonstrate variable homogenous or heterogenous enhancement. Attenuation of the tumors on enhanced CT depends on the extent of Antoni A or B tissue and the amount of myxoid or cystic degeneration or hemorrhage.
References: 1. Lee JY, Lee KS, Han JH, et al. Spectrum of neurogenic tumors in the thorax: CT and pathologic findings. JCAT 1999;23:399-406.

2. Cohen LM, Schwartz AM, Rockoff SD. Benign schwannomas: pathologic basis for CT inhomogeneities. AJR 1986;147:141-143.
Keywords: Mediastinum, Benign tumor,

No. of Applicants : 26

▶ Correct Answer : 19/26, 73.1%

- SSGH, Vadodara, Gujarat, India Sushil Mansingani
- Yonsei University Hospital, Korea Eun Hye Yoo
- Saint Luke's International Hospital, Tokyo, Japan Sokun Fuwa
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Ewha Womans University Hospital, Korea Shim Sung Shine
- Daejon Saint Mary's Hospital, Korea Chae Hun Lim
- Max Hospital, New Delhi, India Vickrant Malhotra
- Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
- --- Ram Prakash Galwa
- Ewha Womans University Mokdong Hospital, Korea Yookyung Kim
- Annemasse, Polyclinique de Savoie, France Gay-Depassier
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Incheon Sarang Hospital, Incheon, Korea Jung Hee Kim
- Annecy Hospital, France Gilles Genin
- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh

▶ Semi-Correct Answer : 2/26, 7.7%

- Monaldi Hospital, Naples, Italy Gaetano Rea
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 402 Date 2005-07-11

Discussion

No. of Applicants : 26