scholarly journals Hemorrhagic spinal melanotic schwannoma presenting as acute chest pain: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 164
Author(s):  
Dallas J. Soyland ◽  
Dylan R. Goehner ◽  
Kayla M. Hoerschgen ◽  
Troy D. Gust ◽  
Shawn M. Vuong
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
Carney Complex ◽  
Spinal Nerve ◽  
Nerve Sheath Tumor ◽  
Melanotic Schwannoma ◽  
Nerve Sheath ◽  
Ct Angiogram ◽  
Intradural Extramedullary

Background: Melanotic schwannoma (MS) is a rare variant of peripheral nerve sheath tumor. MS commonly arises along the spinal nerve sheath. Patients most often experience pain along the dermatome of the affected nerve root. Symptoms development is usually insidious. About half of MS cases are associated with Carney complex, a multi-neoplastic disorder. The remaining cases arise spontaneously. About 10–44% of these tumors undergo malignant transformation. Case Description: We describe a case of hemorrhagic MS presenting as acute chest pain mimicking myocardial infarction, a presentation which has not yet been described in the literature. Neurologic examination did not reveal any abnormalities. Myocardial infarction was ruled out in the ER, and a chest CT angiogram was ordered for evaluation of PE or aortic dissection which revealed an intradural extramedullary dumbbell-shaped mass extending through the left vertebral foramen at the level of T8. MRI revealed a heterogenous mass that was hyperintense with T2 and hypointense with T1-weighted imaging. The patient underwent an open laminectomy of the left T8 and T9 vertebrae and gross total resection (GTR) of a hemorrhagic black tumor. Microscopic examination showed fascicles and nests of plump spindle cells with variable intracellular melanin. Immunohistochemistry showed the cells to be positive for S100, SOX10, HMB-45, and MART-1, confirming diagnosis of MS. Two months after the operation, the patient was doing well and is free of recurrence. Conclusion: GTR is considered the optimal treatment for MS; radiotherapy and chemotherapy may be considered but have not been shown to improve patient outcomes.

scholarly journals Melanotic Schwannoma of the Vagina: A Report of a Very Rare Tumor and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Kofi Effah ◽  
Stefan Seidl ◽  
Edith Gorges ◽  
Patrick Kafui Akakpo
Keyword(s):  
Carney Complex ◽  
Spinal Nerve ◽  
Nerve Sheath Tumor ◽  
Nerve Roots ◽  
Melanotic Schwannoma ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Long Term Follow Up

Melanotic schwannoma (MS) is a rare nerve sheath tumor with fewer than 200 cases reported. MS has uncertain malignant potential and comprises 1% of all nerve sheath tumors with a predilection for the spinal nerve roots. An even rarer location for this tumor is the vagina. Up to 55% of MSs that contain psammoma bodies are associated with the Carney complex, an autosomal dominant syndrome. Criteria for malignancy in MS are still not well established and long term follow-up of patients is recommended. A 26-year-old woman presented with a bleeding vaginal tumor which was diagnosed as MS following excision. The clinical, histopathological, and immunohistochemical features of this tumor are discussed.

scholarly journals Pathology of Melanotic Schwannoma

2018 ◽  
Vol 142 (12) ◽  
pp. 1517-1523 ◽  
Author(s):  
Borislav A. Alexiev ◽  
Pauline M. Chou ◽  
Lawrence J. Jennings
Keyword(s):  
Correct Diagnosis ◽  
Molecular Genetic ◽  
Metastatic Potential ◽  
Carney Complex ◽  
Spinal Nerve ◽  
Current Status ◽  
Nerve Sheath Tumor ◽  
High Tendency ◽  
Melanotic Schwannoma ◽  
Nerve Sheath

Context.— Melanotic schwannoma (MS) is a nerve sheath tumor with a uniform composition of variably melanin-producing Schwann cells and metastatic potential. The MS is an uncommon neoplasm, accounting for less than 1% of all nerve sheath tumors, with a predilection for spinal nerve involvement. Microscopically, the tumors are characterized by spindle and epithelioid cells arranged in interlacing fascicles, with marked accumulation of melanin in neoplastic cells and associated melanophages. The MSs are frequently associated with Carney complex, showing features of psammoma bodies and adipose-like cells. Strict criteria of malignancy in MS are not well developed, although a combination of worrisome histologic features (large, vesicular nuclei, with macronucleoli, brisk mitotic activity, and necrosis) raises concern for aggressive behavior. Objective.— To review the current status of the MS literature, discussing putative etiology, histopathology, current genetics, and differential diagnoses, including overlap with other pigmented tumors. Data Sources.— Search of PubMed (National Center for Biotechnology Information, Bethesda, Maryland) and the authors' own experiences. Conclusions.— The occurrence of MS at several unusual anatomic sites and its spectrum of morphologic patterns can result in significant diagnostic difficulty, and correct diagnosis is particularly important because of its high tendency to recur locally and to metastasize, which highlights the importance of diagnostic recognition, ancillary molecular genetic testing, and close clinical follow-up of patients with MS.

Plasma Fibrinopeptide A and Beta-Thromboglobulin in Patients with Chest Pain

1983 ◽  
Vol 50 (02) ◽  
pp. 541-542 ◽  
Author(s):  
J T Douglas ◽  
G D O Lowe ◽  
C D Forbes ◽  
C R M Prentice
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Unstable Angina ◽  
Plasma Levels ◽  
Thrombin Generation ◽  
Acute Chest Pain ◽  
Fibrinopeptide A ◽  
Control Hospital ◽  
Hospital Patients ◽  
Platelet Release

SummaryPlasma levels of β-thromboglobulin (BTG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in 48 patients within 3 days of admission to hospital for acute chest pain. Twenty-one patients had a confirmed myocardial infarction (MI); 15 had unstable angina without infarction; and 12 had chest pain due to noncardiac causes. FPA and BTG were also measured in 23 control hospital patients of similar age. Mean plasma BTG levels were not significantly different in the 4 groups. Mean plasma FPA levels were significantly higher in all 3 groups with acute chest pain when compared to the control subjects (p < 0.01), but there were no significant differences between the 3 groups. Increased FPA levels in patients with acute chest pain are not specific for myocardial infarction, nor for ischaemic chest pain.

Heparin Neutralizing Activity in the Diagnosis of Acute Myocardial Infarction

1975 ◽  
Author(s):  
J. R. O’Brien ◽  
M. D. Etherington ◽  
S. Jamieson ◽  
J. Sussex
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
Platelet Factor 4 ◽  
Clotting Time ◽  
Platelet Factor ◽  
Neutralizing Activity ◽  
Platelet Poor Plasma ◽  
Activated Platelets

We have previously demonstrated that, relative to controls, patients long after myocardial infarction and patients with atherosclerosis have highly significantly shorter heparin thrombin clotting times (HTCT) using platelet poor plasma; but there was considerable overlap between the two groups.We have now studied 89 patients admitted with acute chest pain. In 54 of these a firm diagnosis of acute myocardial infarction (ac-MI) was made and the HTCT was very short (mean 12.8 sees) and in 48 it was less than 16 sees. In 34 patients, ac-MI was excluded and the diagnosis was usually “angina”; the HTCT was much longer (mean 25.1 sees) and in 32 it was over 16 sees. Thus there was almost no overlap between these two groups. It is suggested that this test should be adopted as a quick and reliable further test to establish a diagnosis of ac-MI (providing other reasons for very short HTCTs can be excluded, e.g. D. I. C., and provinding the patient’s thrombin clotting time is normal).This HTCT measures non-specific heparin neutralizing activity; nevertheless the evidence suggests that it is measuring platelet factor 4 liberated from damaged or “activated” platelets into the plasma. These findings underline the probable important contribution of platelets in ac-MI.

scholarly journals Gender-Related Differences of Cardiac Troponin-I Levels in Patients with Acute Myocardial Infarction at Time of Acute Chest Pain

2021 ◽  
pp. 199-205
Author(s):  
Mahir Abdulkadhum Khudhair Alzughaibi ◽  
Ammar Waheeb Obeiad ◽  
Nassar Abdalaema Abdalhadi Mera ◽  
Mohammed Sadeq Hamzah Al-Ruwaiee
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Troponin I ◽  
Statistical Significance ◽  
Acute Chest Pain ◽  
Blood Analysis ◽  
P Value ◽  
Cross Sectional ◽  
Time Of Admission

Background: Cardiac Troponins-I (CTNI) are myoregulatory polypeptides that control the actin-myosin interface, considered specific to cardiomyocytes. Age and sex variances in the extent of CTNI levels have arisen a recent debatable emphasis. Existing revisions do not display a reliable clinical power of sex-specific CTNI 99th centiles, which actually might mirror procedural aspects. Nevertheless, from a biochemical viewpoint, the trends of sex-specific CTNI 99th centiles seem sensible for the ruling-in of acute myocardial infarction AMI. Vulnerable females may be missed when applying the male sex-specific threshold. This study aimed to determine whether gender differences in CTNI exist in patients with AMI presented with chest pain. Methodology: The study was a cross-sectional, single-center, included 236-patients with AMI diagnosis by cardiologists at Merjan teaching hospital during the period from April to July 2020 from patients attending the hospital for cardiac consultation complaining of acute chest pain suggestive of AMI. Blood analysis had initiated at the time of admission included serum creatinine, blood urea, R/FBS, WBCs, PCV, and serum CTNI. A p-value below 0.05 specifies statistical significance. All statistical bioanalyses had performed by IBM-SPSS, version-25 for Windows. Results: The mean age of participants was 67.5 years, the men were dominant 76.2%. The incidence of DM and hypertension were significantly high and 24.5% of the patients were current smokers. Biochemical serum analysis revealed mean creatinine, urea, sugar, and STI values were 79.8±4.2 mmol/l, 15.9±1.7 mmol/l, 10.9±0.9 mmol/l, and 7.9±0.6 ng/ml separately. Both hypertension and smoking were significantly (p-0.001) more among males compared to the females, which is not the case for the prevalence of DM. The males were heavier significantly than females (p-0.001). Almost, there was no impact of gender on most of the other study variables other than serum TNI levels, which were significantly higher among the males (p-0.001). Conclusion: In patients with AMI presented with acute chest pain, the routine of CTNI in the diagnosis of AMI is based on the patient's gender. The application of gender-dependent cutoff levels for CTNI analyses appears to be highly suggested.

Abstract 16639: Low Yield of Additional Non-invasive Testing in Moderate Worst Stenosis by cCTA in Acute Chest Pain Patients - Results From a Clinical ED cCTA Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sumbal A Janjua ◽  
Harshna V Vadvala ◽  
Pedro V Staziaki ◽  
Richard A Takx ◽  
Anand M Prabhakar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Unstable Angina ◽  
Acute Chest Pain ◽  
Left Ventricular ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Lipid Rich Plaque ◽  
Pain Patients

Introduction: Coronary computed tomography angiography (cCTA) allows efficient triage of low-intermediate risk patients with suspected acute coronary syndrome (ACS); appropriate management of patients with moderate stenosis by cCTA is unknown. We evaluated the yield of downstream testing in moderate stenosis patients in a clinical ED cCTA registry. Methods: All consecutive ED patients with acute chest pain undergoing cCTA as part of routine care between October 2012 and July 2014 were screened. Patients with moderate as their worst stenosis (50-69% stenosis) on cCTA were included. Plaque characteristics, resting left ventricular function (by cCTA), results of any functional downstream non-invasive testing, invasive coronary angiography (ICA) and interventions, and discharge diagnosis were reported. ACS was defined as acute myocardial infarction (MI) or unstable angina pectoris (UAP) and adjudicated by an independent committee. Ischemia was defined as clear, territorial abnormality by myocardial perfusion scintigraphy imaging (MPI) or rest or stress echocardiogram, significant dynamic ST-T shift by exercise treadmill test (ETT) and stenosis >70% on ICA or fractional flow reserve (FFR) <0.75. Results: 586 patients underwent cCTA, with 7.2% (n=42) deemed moderate stenosis. Rate of ACS was 14.2% (n=6) with all adjudicated as UAP. Of these, 83% had stenosis caused by lipid-rich plaque; 33% had wall motion abnormalities on cCTA. The majority (n=28; 66%) underwent downstream non-invasive testing. Overall, n=2 (6%) of the non-invasive tests were positive for ischemia while n=3 (42%) of the invasive tests were diagnosed as positive for ischemia (all revascularized) (Figure 1). Conclusions: Unstable angina but not myocardial infarction is frequent among acute chest pain patients with moderate stenosis by cCTA. cCTA findings of lipid-rich plaque and resting functional abnormalities had a relatively higher yield vs. other non-invasive tests to detect ischemia.

ECG of the month

2021 ◽  
Vol 16 (1) ◽  
pp. 1-1
Author(s):  
Charles Bloe
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
St Elevation Myocardial Infarction ◽  
St Elevation ◽  
Lost To Follow Up

In this issue's ECG of the month, Charles Bloe highlights a case of a 36-year-old woman presenting with severe acute chest pain after previously being lost to follow up post ST-elevation myocardial infarction.

Diverse Characteristics of Spinal Nerve Sheath Tumor on Magnetic Resonance Images

2009 ◽  
Vol 16 (1) ◽  
pp. 38 ◽  
Author(s):  
Jae-Yoon Chung ◽  
Hyun-Jong Kim ◽  
Hyung-Yeon Seo ◽  
Jae-Joon Lee
Keyword(s):  
Magnetic Resonance ◽  
Spinal Nerve ◽  
Magnetic Resonance Images ◽  
Nerve Sheath Tumor ◽  
Nerve Sheath

Dumbbell Nerve Sheath Tumors

2018 ◽  
Author(s):  
Hussam Abou-Al-Shaar ◽  
Mark A. Mahan
Keyword(s):  
Imaging Modality ◽  
Spinal Nerve ◽  
Surgical Approaches ◽  
Nerve Sheath Tumor ◽  
Imaging Features ◽  
Neural Foramen ◽  
Dumbbell Tumor ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
The Individual

A dumbbell tumor is a nerve sheath tumor that arises from a spinal nerve in the neural foramen and grows as a dumbbell-shaped mass. The differential diagnosis for a dumbbell tumor includes schwannoma, neurofibroma, malignant peripheral nerve sheath tumor, and metastases, among others. MR imaging is considered the gold-standard imaging modality for diagnosis of dumbbell tumors. Surgical approaches that are tailored to the individual patient’s case can be utilized. The chapter reviews dumbbell tumors, including a case example and covers the incidence, clinical presentation, imaging features, decision-making strategy, surgical approaches, outcomes, and potential complications associated with their management.

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