Subcostal schwannoma in pregnancy

Schwannoma subcostal na gravidez

LETTERS

Subcostal schwannoma in pregnancy

Schwannoma subcostal na gravidez

Júverson Alves Terra Júnior^I; Edmilson Rodrigo Daneze^II; Guilherme Azevedo Terra^III; Renata Margarida Etchebehere^IV; Aldo Benjamim Rodrigues Barbosa^V; Sílvia Azevedo Terra^{VI, *}

^IMD, Professor of Surgery, Department of Surgery, Federal University of Triângulo Mineiro (UFTM), Uberaba MG, Brazil

^IIVeterinarian, Faculdade Doutor Francisco Maeda (FAFRAM/FE), Ituverava SP, Brazil

^IIIMedical Student, Department of Surgery, Federal University of Triângulo Mineiro (UFTM), Uberaba MG, Brazil

^IVPhD, Professor of Pathology, Department of Pathology, Federal University of Triângulo Mineiro (UFTM), Uberaba MG, Brazil

^VMD, Radiologist, Department of Radiology. Santa Casa de Misericórdia de Ituverava, Ituverava SP, Brazil

^VIPhD, Professor of Pathology, Department of Pathology, Federal University of Triângulo Mineiro (UFTM), Uberaba MG, Brazil

^{Correspondence}

The schwannoma is a supporting cells tumor of peripheral nervous system, characterized by the formation of grayish, firm, circumscribed and usually solitary masses, which is located close to the roots of cranial and spinal nerves. Most of them have a benign character¹.

CASE REPORT

A 27-year-old Caucasian female, with pregnancy at term, who was subjected to routine ultrasound, which observed the presence of hyperechoic lesion at the left hypochondrium along the costal margin, in intimate contact with the abdominal wall. The surgical evaluation detected the presence of a hardened, fixed, painless lesion, which became more prominent after effort maneuver. Clinical follow-up was kept until delivery.

One month postpartum, the patient was submitted to computed tomography (CT) scan, which observed an hypodense lesion, closely related to the 20^th left rib, measuring 8x4 cm, in close contact with the diaphragm (Fig 1A). After preoperative evaluation, left lombotomy was performed, which found the neoplasm related to the left subcostal nerve. The lesion was completely excised and submitted to anatomopathological analysis (Fig 1B). The patient recovered satisfactorily after the surgery.

DISCUSSION

Schwannoma is a rare neoplasm involving the spinal cord and its roots, being responsible for 27% of the spinal tumours. It can affect children and adults², usually between the third and fifth decades of life with equal incidence on both sexes³.

The pregnancy has no significant effect on the incidence and behaviour of gliomas. However, pregnancy appears to increase its growth. About 70% of gliomas have progesterone receptors and 30% have estrogen receptors. Unfortunately, there is lack of documented reports on accelerated cancer growth during pregnancy.

The occurrence of schwannomas during pregnancy rests on the hypothesis of a possible hormonal influence on the growth of a subset of Schwann cells, due to the presence of progesterone receptors. Progesterone levels increase during pregnancy, which may explain their accelerated growth.

Physiological changes during pregnancy may mask the symptoms, as clinical manifestations depend on the size of the mass and on its anatomical location⁴. Our patient did not report pain even after effort maneuver, which made the lesion prominent.

In symptomatic cases located in the chest wall, the most frequently reported symptoms are nonproductive cough, dyspnea, backache, and dysphagia, depending on the anatomic site involved³.

Clinical follow-up until delivery was chosen as the lesion had no apparent risks for the mother and for the fetus. Once malignancy is extremely rare in these neoplasms, surgical excision is indicated. There was no indication of radiotherapy, due to the neoplasm slow growth rate and its nonresponse to this treatment, besides the possibility of miscarriage and birth defects.

The anatomopathological analysis related hardened consistency lesion, fixed, limited and well-defined, with cystic formation and content with mucous aspect (Fig 1B).

The histopathological analysis observed two characteristic growth patterns, with fusiform tumoral cells arranged in palisades, forming the Verocay bodies^1,3, with elongated cell shape and regular oval nuclei, both positive for S-100 protein on the immunohistochemical.

Received 04 May 2012

Received in final form 11 May 2012

Accepted 18 May 2012

Conflict of interest: There is no conflict of interest to declare.

* in memoriam.

• 1. Rodriguez CA, Munhoz AHN, Zampier JA, Silva APG, Fustes OH. Schwannoma benigno do nervo intercostal simulando neoplasia de pulmão. Arq Neuropsiquiatr 2004;62:1100-1103.
• 2. McClenathan JH, Bloom RJ. Peripheral tumors of the intercostal nerves. Ann ThoracSurg 2004;78:713-714.
• 3. Henn LA, Gonzaga RV, Crestani J, Cerski MR. Schwannoma intercostal simulando neoplasia pulmonar. Rev Ass Med Brasil 1998;44:146-148.
• 4. Sakuray H, Hada M, Mitsui T, Ashizawa I. Extratoracic neurilenoma of the lateral chest wall mimicking a subcutaneous tumor: report of a case. Ann Thoracic Cardiovasc Surg 2006;12:133-136.

Publication Dates

• Publication in this collection
  14 Nov 2012
• Date of issue
  Nov 2012