[A case of mediastinal neurilemmoma diagnosed by X-ray guided needle biopsy]

A 70-year-old female was admitted to our hospital complaining of general lassitude. She had been treated for duodenal ulcer. A routine chest X-ray film at admission showed a large tumorous shadow in the right apical field. A computed tomographic scan revealed that it was a posterior mediastinal tumor containing multiple cystic lesions. After medical treatment for duodenal ulcer, a needle biopsy was performed for histological diagnosis. Under local anesthesia a small skin incision was made in the supraclavicular region to avoid parietal pleura and great vessels and a specimen was obtained by a needle guided by X-ray fluoroscopy. The tumor was diagnosed as neurilemmoma histologically. She was discharged because the complaint subsided. Five months later, however, she was again admitted complaining of righ nuchal pain. Thoracotomy was performed under general anesthesia and the tumor growing from the second intercostal nerve was resected. It was 5 x 4 x 5.5 cm in size, encapsulated and consisted of multiple cystic lesions macroscopically. It was confirmed as Antoni B type neurilemmoma histologically. The nuchal pain subsided and she has been doing well for more than three years after discharge. Recently computed tomography (CT) and ultrasonography (US) have been widely used as a guiding device for needle biopsy. In this case, however, CT guided needle biopsy was not applied for fear of possible complications such as pneumothorax. It was also impossible to perform US guided needle biopsy because the tumor was behind the costal and sternal bones and could not be visualized.(ABSTRACT TRUNCATED AT 250 WORDS)