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Year : 2022  |  Volume : 65  |  Issue : 4  |  Page : 942-943
Multi-locular anterior mediastinal cyst – Schwannomatous surprise


Department of Pathology (Cardiovascular and Thoracic Division), Seth G.S. Medical College and KEM Hospital, Mumbai, India

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Date of Submission11-Feb-2021
Date of Decision04-Apr-2021
Date of Acceptance04-Jun-2021
Date of Web Publication06-Jun-2022
 

How to cite this article:
Kumar A, Kolhe S, Vaideeswar P. Multi-locular anterior mediastinal cyst – Schwannomatous surprise. Indian J Pathol Microbiol 2022;65:942-3

How to cite this URL:
Kumar A, Kolhe S, Vaideeswar P. Multi-locular anterior mediastinal cyst – Schwannomatous surprise. Indian J Pathol Microbiol [serial online] 2022 [cited 2022 Dec 7];65:942-3. Available from: https://www.ijpmonline.org/text.asp?2022/65/4/942/346685





   Case History Top


A 45-year-old female presented with episodic dyspnea on exertion and vague chest pain. Imaging studies revealed a cystic anterior mediastinal mass, which was abutting the upper and left part of the pericardium. The mass [Figure 1]a and [Figure 1]b was excised by thoracotomy. The cyst was capsulated and measured 9 × 8 × 3 cm. It was multi-loculated and contained hazy amber colored fluid with small blood clots. The loculi had thin walls (at places even translucent) with irregular, rusty brown inner surfaces; there were no solid areas. On histology, the fibrous wall contained bundles of wavy spindle-shaped cells with focal characteristic nuclear palisading and Verocay bodies [Figure 1]c. The inner lining showed deposits of fibrin and blood clots at places. Collections of hemosiderophages [Figure 1]d were also present in the cyst walls. The final histopathological diagnosis was multi-loculated purely cystic schwannoma.
Figure 1: (a) Capsulated anterior mediastinal cyst; (b) The cut surface shows multiple loculations devoid of solid areas with a rusty brown to deep yellow inner lining; Sections of the wall revealed (c) presence of characteristic Verocay bodies and (d) clusters of hemosiderophages (H and E ×200)

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   Discussion Top


Despite the “apparent” limited area, the mediastinum is a veritable treasure trove of non-neoplastic and neoplastic cystic and solid lesions. The anatomic divisions into superior, anterior, middle and posterior compartments[1] has clinicopathologic relevance too, since majority of the lesions have an unerring localization to specific areas of the mediastinum. Cystic lesions account for 15 to 20% of all mediastinal masses and arise through developmental, infective, inflammatory or neoplastic processes.[2] The largest spectrum of solid and cystic lesions occur in the anterior mediastinum, and the most common cystic lesions occurring in this region are foregut developmental cysts, thymic cysts, cystic teratomas and lymphangiomas.[3] Although several nerves such the vagus, phrenic and right recurrent laryngeal nerves traverse the anterior compartment, neurogenic tumors, including schwannoma (as seen in the present case) are extremely uncommon[4]; however, a connection to the nerve was not noted during the excision. Moreover, a diagnosis of schwannoma was not entertained on imaging because of complete cystic degeneration,[5] which was the main characteristic finding in our case. Such cystic schwannomas occur due to degradation of the Antoni B areas in long standing tumors leading to unilocular or multilocular cysts and can be indistinguishable from the other cysts. Most of the mediastinal schwannomas remain asymptomatic as they are located commonly in the posterior compartment. Localization in the anterior mediastinum often leads to symptoms related to compression of the adjacent structures including the heart, as has been reported earlier[6] and also noted in the current case. The case reiterates that accurate diagnosis would require correlation of the clinical, imaging and pathological findings.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Carter BW, Tomiyama N, Bhora FY, Rosado de Christenson ML, Nakajima J, Boiselle PM, et al. A modern definition of mediastinal compartments. J Thorac Oncol 2014;9:S97-101.  Back to cited text no. 1
    
2.
Madan R, Ratanaprasatporn L, Ratanaprasatporn L, Carter BW, Ackman JB. Cystic mediastinal masses and the role of MRI. Clin Imaging 2018;50:68-77.  Back to cited text no. 2
    
3.
Nakazona T, Yamaguci K, Egashira R, Mizuguchi M, Irie H. Anterior mediastinal lesions: CT and MRI features and differential diagnosis. Jpn J Radiol 2021;39:101-17.  Back to cited text no. 3
    
4.
Marchevsky AM, Balzer B. Mediastinal tumors of peripheral nerve origin (so-called neurogenic tumors). Mediatinum 2020;4:32.  Back to cited text no. 4
    
5.
Mubashir M, Salam A, Sonawalla A, Fatima H, Fatimi SH. Rare presentation of a posterior mediastinal cystic schwannoma as a large pleural effusion. Cureus 2017;9:e1558.  Back to cited text no. 5
    
6.
Yamamoto T, Yamashita K, Hagiwara H, Nakayama T, Sakai A, Miyamae K, et al. Extrinsic compression of the left main coronary artery: A rare cause of cardiogenic shock. Radiol Case Rep 2021;16:714-7.  Back to cited text no. 6
    

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Correspondence Address:
Swati Kolhe
Department of Pathology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpm.ijpm_157_21

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