Endobronchial ultrasound-guided transbronchial needle aspiration as a diagnostic modality for schwannoma: A case report

Abstract

Introduction: Schwannomas are the most common nerve sheath tumors in the paravertebral mediastinum. Although radiological imaging is helpful in diagnosing schwannomas, a definitive diagnosis is dependent on pathological features of a surgical specimen. For patients who require preoperative diagnosis, an incisional biopsy using minimally invasive surgery is preferred. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used for suspected schwannomas. Patient concerns: A 48-year-old woman presented to the clinic with complaints of productive cough for >1 month, expectorating yellow and mucoid sputum approximately 4 to 5 times per day. Chest computed tomography revealed a well-circumscribed, homogeneous, soft tissue mass lesion in right upper posterior mediastinum, measuring 55 mm × 44 mm. Vocal fremitus in the right upper lung was diminished, the percussion note was slightly dull, and breath sounds were slightly reduced on auscultation. The patient was a nondrinker and nonsmoker, with no other relevant medical history. There was no significant relevant family medical history. Diagnosis: Complete blood count and blood biochemistry were within normal limits, except for an elevated erythrocyte sedimentation rate (32 mm/h). EBUS-TBNA was performed and histopathological findings were consistent with schwannoma. Interventions: The patient underwent schwannoma excision by thoracoscopy. Pathological findings from the surgical specimen were consistent with the EBUS-TBNA results. Based on EBUS-TBNA and postsurgical pathology, the patient was diagnosed with a right upper mediastinal schwannoma (Antoni B). Outcomes: The patient experienced an uneventful postoperative recovery with no adjuvant therapy and was discharged on April 18, 2017. The patient has been followed up for 4 years and has not experienced any symptoms. Conclusions: Cell blocks obtained from EBUS-TBNA afford the possibility of cytological examination and immunocytochemical staining, which can confirm diagnosis of schwannoma.

Analysis of the prenatal ultrasound diagnostic value and prognostic factors of fetal mediastinal cysts

“…Mediastinal cysts are congenital, benign conditions that account for approximately 12–30% of all mediastinal lesions ( 6 ). If the volume of a cyst expands, it can exert pressure on adjacent organs, thereby affecting the cardiac and pulmonary function of the fetus.…”

Schwannoma diagnosed by endobronchial ultrasound‐guided intranodal forceps biopsy using standard‐sized biopsy forceps: A case report

“…Here we present a case of schwannoma diagnosed with EBUS‐IFB using SBFs. Diagnosis of neurogenic tumors requires histopathological and imaging examinations, which can be challenging, with the exception of cases where surgical biopsy is conducted 4,5 . Although several case reports have previously reported the diagnosis of schwannoma using EBUS‐TBNA alone, 11–15 a retrospective study of 86 neurogenic tumors of the mediastinum reported that the diagnosis was made in 84 cases using surgical specimens; two and three cases in which EBUS‐TBNA and TTB, respectively, were performed did not yield an accurate diagnosis of schwannoma 3 .…”

“…Diagnosis of neurogenic tumors requires histopathological and imaging examinations, which can be challenging, with the exception of cases where surgical biopsy is conducted. 4 , 5 Although several case reports have previously reported the diagnosis of schwannoma using EBUS‐TBNA alone, 11 , 12 , 13 , 14 , 15 a retrospective study of 86 neurogenic tumors of the mediastinum reported that the diagnosis was made in 84 cases using surgical specimens; two and three cases in which EBUS‐TBNA and TTB, respectively, were performed did not yield an accurate diagnosis of schwannoma. 3 Herein, EBUS‐TBNA with four punctures yielded insufficient specimens for diagnosis, and the addition of EBUS‐IFB using SBFs was diagnostically efficacious.…”

“…Patients with small tumors are usually asymptomatic, but subjective symptoms occur as the tumor grows and compresses adjacent vital organs 2,3 . Computed tomography (CT), magnetic resonance imaging, and positron emission tomography (PET)‐CT are used to diagnose schwannomas; however, biopsies such as endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA), endoscopic ultrasound‐guided fine needle aspiration, and transthoracic biopsy (TTB) are necessary for a definitive diagnosis 4,5 . However, the small specimens obtained via EBUS‐TBNA and nonsurgical methods often lack sufficient tumor components, leading to false‐negative results.…”

Deep learning models of ultrasonography significantly improved the differential diagnosis performance for superficial soft-tissue masses: a retrospective multicenter study

“…4 b); (3) for hemangioma , both of them paid much attention to the obvious internal honeycomb structure and the enhanced echo behind the lesion (Fig. 4 c); (4) for neurinoma [ 31 , 32 ], both of them focused on the “bright cap sign” of the lesions (Fig. 4 d); (5) for epidermal cyst [ 33 , 34 ], both of them were very concerned about the enhancement of the echo behind the lesion (Fig.…”