Synchronous Intrapulmonary Schwannoma and Primary Lung Cancer

A 67-year-old male underwent radiological examination as a consequence of a persistent cough. Chest X-ray first and computer tomography (CT) scan later showed an area of pulmonary consolidation at the level of lower right lobe (Fig. 1a, yellow arrow) and a round-shape pulmonary nodule in the lower left lobe (Fig. 1a, b, red arrow). The patient underwent bronchoscopy with trans-bronchial biopsy, and the histo/cytological examination showed a primary mucinous adenocarcinoma of the right lower lobe, while fine-needle biopsy of the left lesion was inadequate to achieve a certain diagnosis. Positron emission tomography (PET)/CT scan for staging purpose revealed a moderate uptake at the level of both right (SUVmax = 3.1, Fig. 1c, d, yellow arrow) and left (SUVmax = 3.2, Fig. 1c, d, red arrow) lung lesions, while no uptake was observed in other sites. Institutional Tumor Board interpreted the radiological scenario as a primary adenocarcinoma with single contralateral lung metastases scheduling sequential surgical lung resections. Thus, the patient underwent right lower lobectomy with mediastinal lymph-nodal dissection (confirming a pT2N0 adenocarcinoma) and, subsequently, a wedge resection of the right upper lobe. Macroscopically, the nodule appeared well defined by thin fibrous capsule (Fig. 2a), while microscopically fascicles of elongated cells with spindle-shaped nuclei (Fig. 2b), walled and ectatic vessels, and hemorrhagic area with perivascular hemosiderin deposition were observed (Fig. 2c). Immunohistochemical staining showed tumor cells positive for S-100 protein (Fig. 2d) and negative for cytokeratin AE1/AE3, smooth muscle actin, desmin, and CD34. A final diagnosis of intrapulmonary schwannoma was done, and no adjuvant chemotherapy was performed. Pulmonary schwannomas are extremely rare neoplasm accounting for \0.2 % of all pulmonary neoplasms [1].