PMC3461777_01
(a) Preoperative photo of the patient. (b) Photo showing tumor arising from the lateral thoracic nerve. (c) Photo showing lateral thoracic meningoceles. (d) Postoperative photo of the patient
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F1
There was winging of the scapula indicating the involvement of the lateral thoracic nerve [Figure 1a]. The nerve along with the mass was excised [Figures 1b and 4a & b]. The meningoceles were dissected till their openings into the defects and then the defects were repaired with a G-patch (artificial dural graft; Figures 1c and 4c).
X-Ray of the chest showing meningoceles as a mass lesion
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F2
(a) CT scan of the tumor. (b) MRI showing both the tumor and the meningoceles. (c) CT scan showing lateral meningocele with a spinal defect and the tumor. (d) MRI lateral view showing the meningoceles
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F3
A cystic lesion of about 8x5 cm size was also seen in the right intrathoracic paraspinal region [Figure 3a and c]. T2 hyperintense space-occupying lesions in the right paravertebral region from D1-2 to D7-8 levels which appeared lobulated and septated with well-defined walls, contiguous with each other, and extending into the spinal canal via large neural foramina. There was no internal enhancement on the postcontrast study suggestive of thoracic meningoceles/duralectasia [Figure 3b and d].
(a) Intraoperative photo while raising skin flaps. (b) Tumor with the lateral thoracic nerve excised in TOTO. (c) Repair of meningocele defects being done with a G-patch (artificial dural patch)
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F4
The nerve along with the mass was excised [Figures 1b and 4a & b]. The meningoceles were dissected till their openings into the defects and then the defects were repaired with a G-patch (artificial dural graft; Figures 1c and 4c).
(a) Histopathology scanner view (x4) showing tumor with areas of necrosis. (b) Histopathology photographic view (x10) showing tumor cells arranged in fascicles with nuclear pleomorphism
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F5
IHC positive for vimentin
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F6
Diagnosis of the MPNST was confirmed [Figure 6].