Letters to the Editor
Case Report: Chest-Wall Lump Yields a Surprising Diagnosis
Am Fam Physician. 2021 Apr 1;103(7):393-394.
To the Editor: A 17-year-old patient presented with a solitary lump over the right chest wall of three years' duration. The patient reported that the lump was causing discomfort during contact sports and had an unattractive appearance. Clinical examination revealed a nontender, firm, and side-to-side mobile subcutaneous lump obliquely overlying the right anterolateral chest wall (Figure 1). Ultrasonography revealed a nonspecific solid heterogeneous mass measuring 76 mm × 26 mm × 18 mm. A punch biopsy result was inconclusive. Chest radiography and computed tomography were not considered practical imaging tools for this patient, and magnetic resonance imaging was not readily accessible. The patient was scheduled for an incisional biopsy under local anesthesia, with the option of excising the whole lump to avoid multiple procedures.
During the procedure, the mass was found to be protruding through the intercostal muscles and partially attached to the fascia. However, the distal part of the mass could be lifted, allowing the mass to be removed entirely following ligation of its proximal attachment to prevent arterial bleeding from the neurovascular bundle. The tumor was boat- or banana-shaped with a smooth, light-yellow surface (Figure 2). Closure of the surgical incision was uncomplicated (Figure 3). A histopathology analysis revealed a schwannoma. The patient had no postsurgical sequelae or recurrences during one year of follow-up.
Schwannomas (i.e., neuromas) are sporadically encountered benign tumors that originate from the sheath of peripheral nerves. They can manifest as lumps in the skin and body cavity.1 Schwannomas commonly occur between 40 and 60 years of age.2,3 This patient, who first noticed the tumor at 14 years of age, might be the youngest reported case.
Ultrasonography is a useful tool for evaluating the size, attachment, and vascularity of soft tissue lumps and confirming the more common diagnoses of lipoma or cyst. However, a punch biopsy is not a practical approach for the diagnosis of subcutaneous lumps. If magnetic resonance imaging is unavailable, core, incisional, or full excisional biopsies may be performed for tissue diagnosis. Surgical excision is a definitive treatment if a patient wants a large schwannoma removed.
Author disclosure: No relevant financial affiliations.
1. Inzirillo F, Giorgetta C, Ravalli E. Nerve-sparing schwannoma removal from two infrequent origins. Asian Cardiovasc Thorac Ann. 2015;23(4):493–495.
2. Sheikh MM, De Jesus O. Schwannoma. StatPearls. Accessed November 14, 2020. https://www.ncbi.nlm.nih.gov/books/NBK562312/?report=reader
3. Galukande M, Khingi A. Chest wall schwannoma presenting as a solitary malignant lesion: a case report. Springerplus. 2016;5(1):1549.
Send letters to email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.
Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions