Cervical Lymph Node Schwannoma-An Unexpected Diagnosis.

INTRODUCTION: Schwannomas-Schwann cells-originating tumors-may develop in many locations. However, primary schwannomas arising within lymph nodes are extremely rare, with only a few cases described to this date in the English literature. For the intranodal location, most of the cases are described in the abdominal cavity. In these cases, clinicians may consider and check for familial disorders, such as neurofibromatosis type 2 (NF2) and schwannomatosis also called neurofibromatosis type 3. Schwannomas are benign neoplasms. Histologically, differential diagnosis for spindle-cell lesions in lymph nodes is important and must be done carefully, mainly because they may be attributable to metastatic disease. We report a case of a primary schwannoma arising in a cervical lymph node. BACKGROUND: Primary schwannomas arising within lymph nodes are extremely rare, with only a few cases reported. Since they are benign neoplasms, the differential diagnosis with other intranodal spindle cell lesions, mostly malignant, is important. METHODS: An asymptomatic 69-year-old woman, previously submitted to left hemithyroidectomy for a benign folicular nodule, underwent thyroidectomy totalization following the identification of a large thyroid nodule in routine evaluation. RESULTS: Gross and microscopic examination and ancillary studies were consistent with the diagnosis of intranodal schwannoma. The patient had acquired bilateral hypoacusia. Therefore, type 2 neurofibromatosis was considered and vestibular schwannomas ruled out. CONCLUSION: Herein, we present the second case of a primary schwannoma in a cervical lymph node reported so far. The relevance of the differential diagnosis is highlighted.

Serum vascular endothelial growth factor levels in patients with medullary thyroid carcinoma.

BACKGROUND: High levels of vascular endothelial growth factor (VEGF) have been reported in patients with cancers of different origins. There are no data comparing serum VEGF levels of medullary thyroid carcinoma (MTC) patients with that of the healthy subjects. OBJECTIVE: We tried to assess whether serum VEGF concentration in MTC patients is correlated with tumour extension and whether this marker might be used to further refine the selection of candidates for future therapies with receptor tyrosine kinase inhibitors. METHODS: Sera from 57 individuals divided into five groups: group I, healthy individuals (n=14); group II, MTC patients in remission (n=10); group III, MTC patients with residual disease (n=12); group IV, MTC patients with loco-regional disease (n=11) and group V, MTC patients with distant metastases (n=10) were analysed for serum VEGF and calcitonin (CT) levels. RESULTS: Analysis of serum VEGF did not disclose significant differences among the five groups. Mean serum VEGF level of patients with distant metastases was not significantly different from that observed in healthy individuals (319.4+/-49.78 vs 313.7+/-43.13 ng/l). Serum VEGF levels correlated positively with serum CT (r=0.4891; P=0.0394) for CT values below 2500 ng/l whereas there was no correlation for CT values above this threshold. CONCLUSIONS: Serum VEGF levels in MTC patients are not significantly different from those found in healthy individuals and did not correlate with the extension of disease.