Benign Intrathoracic Schwannoma with Bloody Pleural Effusion: A Case Report and Literature Review

神經性腫瘤佔所有縱膈腔腫瘤的20%及後縱膈腔腫瘤的80%。其中，神經鞘瘤是由神經鞘的許旺氏細胞所長出的良性腫瘤，它通常位於後縱膈腔且源自於某一條肋間神經。一40歲女性，因左側胸部鈍痛及氣促3日而求診，胸部攝片顯示左側肋膜積液與肺葉塌陷，電腦斷層顯示後縱膈腔有一顆肋膜外的卵圓形腫塊。胸腔穿刺發現為血狀肋膜積液，但積液細胞學檢查及肋膜切片皆無發現惡性細胞。接著，以左側開胸手術取出一顆11.5×9.5×9.0 cm之腫塊，發現其源自左側第5肋間神經。術後，患者症狀緩解，於1週後移除胸管。胸部攝片顯示左側肺葉已經完全展開。組織病理顯示Antoni A型態之神經鞘瘤，且無任何惡性成分。截至目前為止，僅有非常少數的神經鞘瘤有合併肋膜積液報告過。本個案為巨大神經鞘瘤合併血狀肋膜積液，實屬罕見，特提出報告。

關鍵字

神經鞘瘤；肋膜積液；肺塌陷；開胸手術

並列摘要

Neurogenic tumors account for 20% of all mediastinal tumors and 80% of all posterior mediastinal tumors. Among these, schwannomas (neurilemmomas), which are benign tumors arising from the Schwann cells of the nerve sheath, are most commonly found within the posterior mediastinum and usually originate along one of the intercostal nerves. A 40-year-old woman complained of dull pain at the left side of the chest and dyspnea for three days. Chest radiographs (CXR) showed massive pleural effusion and collapse of the left lung. Chest computed tomography revealed an extrapleural ovoid mass at the posterior mediastinum. Thoracocentesis revealed bloody pleural effusion; however, both cytology and pleural biopsy were negative for malignancy. Subsequently, exploratory thoracotomy of the left side was performed, and an 11.5 x 9.5 x 9 cm huge mass arising from the left fifth intercostal nerve was removed. Postoperatively, symptoms subsided and the chest tube was removed one week later. Follow-up CXR showed a wellexpanded left lung. Pathologic examination revealed an Antoni type A schwannoma without any malignant component. To date, only four cases of benign intrathoracic schwannomas have been reported to present with pleural effusion. Here we report this interesting rare case of a huge benign intrathoracic schwannoma with bloody pleural effusion.

並列關鍵字

Schwannoma ； Pleural effusion ； Atelectasis ； Thoracotomy

國際替代計量

Benign Intrathoracic Schwannoma with Bloody Pleural Effusion: A Case Report and Literature Review

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