Benign Pericardial Schwannoma: Case Report and Summary of Previously Reported Cases

Abstract

BACKGROUND Primary pericardial tumors have a prevalence of between 6.7% and 12.8% of all tumors arising in the cardiac region. Pericardial schwannoma is a rare entity. It arises from the cardiac plexus and vagus nerve innervating the heart. Most of the reported cases, have presented with benign behavior, however, in rare situations, they can undergo transformation to malignant behavior When comparing the prevalence of cardiac tumors to that of pericardial tumors, the latter is much lower in occurrence. A review of English literature identified six pericardial schwannoma cases. CASE REPORT We present a case of a 30-year-old male patient who presented to our center with the chief complaint of six months of gradually progressive left chest pain. His past medical history (PMH) was positive for panic attacks (for which he was taking beta-blockers), paroxysmal tachycardia, sweating, and irritability. A computed tomography chest scan was done; a differential diagnosis of paraganglioma was suggested. However, histopathological examination confirmed the pericardial mass was a schwannoma. The patient was surgically treated by thoracotomy to resect the lesion. CONCLUSIONS This case adds to the existing limited literature on pericardial schwannoma as the seventh reported case. Neurogenic cardiac tumors; our case marks the second case reported to occur in the subcarinal area near the left atrium.

Figure 1.

Computed tomography chest scan revealed a 3×2 cm enhancing, subcarinal mass that was documented as an intrapericardial mass lesion adjacent to the left atrium.

Figure 2.

Positron emission tomography shows mild flurodeoxyglucose (FDG-avid) uptake.

Figure 3.

Monomorphic Schwann cells with focal nuclear palisading (A, B). Schwann cells with inconspicuous cytoplasm and nuclei suspended in myxoid matrix (C). Immunohistochemical stain is positive for S-100 protein (D).