array:24 [ "pii" => "S2387020620300048" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.02.042" "estado" => "S300" "fechaPublicacion" => "2020-03-13" "aid" => "4792" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;154:194" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775319301423" "issn" => "00257753" "doi" => "10.1016/j.medcli.2019.02.010" "estado" => "S300" "fechaPublicacion" => "2020-03-13" "aid" => "4792" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;154:194" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Schwannoma del plexo cervical en una mujer de 76 años" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "194" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Schwannoma of the cervical plexus in a 76-year-old woman" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Irene Vacas Muñoz, Inmaculada Ruiz Molina, Antonio Gallardo Ávila" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Irene" "apellidos" => "Vacas Muñoz" ] 1 => array:2 [ "nombre" => "Inmaculada" "apellidos" => "Ruiz Molina" ] 2 => array:2 [ "nombre" => "Antonio" "apellidos" => "Gallardo Ávila" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020620300048" "doi" => "10.1016/j.medcle.2019.02.042" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620300048?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775319301423?idApp=UINPBA00004N" "url" => "/00257753/0000015400000005/v2_202004200610/S0025775319301423/v2_202004200610/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020620300036" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.02.041" "estado" => "S300" "fechaPublicacion" => "2020-03-13" "aid" => "4790" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;154:195-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Vertebral artery dissection secondary to hangman's fracture" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "195" "paginaFinal" => "196" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Disección de arteria vertebral secundaria a fractura tipo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1237 "Ancho" => 1074 "Tamanyo" => 103695 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial magnetic resonance imaging of the cervical spine in T2-weighted TSE sequence. There is an increase in the signal of the right vertebral artery (red arrow) with respect to the contralateral one (yellow arrow), which points to a possible dissection of the first.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Jesús Láinez Ramos-Bossini, Regina Gálvez López, Jorge Pastor Rull" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Antonio Jesús" "apellidos" => "Láinez Ramos-Bossini" ] 1 => array:2 [ "nombre" => "Regina" "apellidos" => "Gálvez López" ] 2 => array:2 [ "nombre" => "Jorge" "apellidos" => "Pastor Rull" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S002577531930140X" "doi" => "10.1016/j.medcli.2019.02.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S002577531930140X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620300036?idApp=UINPBA00004N" "url" => "/23870206/0000015400000005/v2_202004200617/S2387020620300036/v2_202004200617/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020620300024" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.10.040" "estado" => "S300" "fechaPublicacion" => "2020-03-13" "aid" => "4712" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2020;154:192-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Serous papillary peritoneal carcinoma diagnosed by pleural biopsy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "192" "paginaFinal" => "193" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma papilar seroso primario de peritoneo diagnosticado por biopsia pleural" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 575 "Ancho" => 1800 "Tamanyo" => 155986 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest x-ray with right pleural effusion and blunting of the left costophrenic angle. (B) PET/CT image showing pleural effusion and hypermetabolic foci in the pleura (SUVmax 5.36) suggestive of malignancy. (C) Anatomical pathology image of the pleural biopsy in which a nest of neoplastic cells with papillary projection showing immunostaining for CK7 is observed.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eva Cabrera César, M. Carmen Fernández Aguirre, Lidia Pérez Villa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Eva Cabrera" "apellidos" => "César" ] 1 => array:2 [ "nombre" => "M. Carmen Fernández" "apellidos" => "Aguirre" ] 2 => array:2 [ "nombre" => "Lidia Pérez" "apellidos" => "Villa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775318307395" "doi" => "10.1016/j.medcli.2018.10.036" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318307395?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620300024?idApp=UINPBA00004N" "url" => "/23870206/0000015400000005/v2_202004200617/S2387020620300024/v2_202004200617/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Schwannoma of the cervical plexus in a 76-year-old woman" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "194" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Irene Vacas Muñoz, Inmaculada Ruiz Molina, Antonio Gallardo Ávila" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Irene" "apellidos" => "Vacas Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Inmaculada" "apellidos" => "Ruiz Molina" "email" => array:1 [ 0 => "macuap@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Antonio" "apellidos" => "Gallardo Ávila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Otorrinolaringología del Hospital Infanta Margarita, Cabra, Córdoba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica del Hospital Infanta Margarita, Cabra, Córdoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Schwannoma del plexo cervical en una mujer de 76 años" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Schwannoma is an encapsulated, slow-growth, round or fusiform benign tumour of the nerve sheath closely associated with the peripheral nerve from which it originates. It was first described by Verocay in 1908. In most cases it is solitary or sporadic, although it can be occasionally multiple and associated with von Recklinghausen's disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> A brachial plexus involvement is rare, and due to the anatomical complexity of this region it represents a surgical challenge.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 76-year-old woman, diabetic, who presented with a 1-month history of paroxysmal pain in the right arm and a supraclavicular tumour sensitive to palpation. On examination, a right lateral cervical level IV palpable increase of soft tissue with painful sensation radiated to her right arm was observed. Cervical ultrasound confirms this tumour, cervical CT with iv contrast shows a fusiform lesion of 41<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>26<span class="elsevierStyleHsp" style=""></span>mm after SCM in continuity with the C6/C7 nerve roots, and the MRI confirms the well-defined margin tumour and its neurogenic cell line (schwannoma or neurofibroma). A right cervicotomy is performed under general anaesthesia, with tumour removal, cutting C6 and repairing by microsurgery. Histopathological examination of the specimen shows a lesion of neural habituation, alternating Antoni A and B pattern areas with large, hyperchromatic, multilobed and atypical nuclei, without mitosis, intermingled with hemosiderin-laden histiocytes and immunoexpression for S100. Compatible with "ancient" schwannoma. The patient had a postoperative period without hemorrhagic incidents and with rehabilitation treatment. Six months after surgery, the patient shows a slight limitation in the last degrees of flexion and abduction of the right arm with C6 analgesia and C7 hypoesthesia.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Schwannoma can appear at any age, but it is more common between the ages of 20 and 50, affecting both sexes proportionally. It prefers the head and neck (as a palpable lateral-cervical mass) and the lower and upper limb flexor surfaces. It usually presents with pain and paraesthesia, with neurological defects being uncommon. It is motile when it affects small nerves, except at its original nerve anchor point. In the major nerves the tumour is fixed along the major nerve axis, limiting motility. It can arise from the cranial nerves, the sympathetic cervical chain, the cervical sensory plexus and the brachial plexus. Hourglass-shaped tumours that extend to the spinal canal have been described when they are located in the posterior mediastinum, posing therapeutic challenge due to the risk of developing serious neurological abnormalities.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Macroscopically it is white, yellow or pink, normally less than 5<span class="elsevierStyleHsp" style=""></span>cm in size. If larger, it shows frequent secondary degenerative changes. Histologically, it has Antoni A and B area patterns, whose representations are variable, mixing or alternating. The Antoni A areas are formed by compact fusiform cells arranged in short or interlocking bundles. If they are very differentiated, the nuclei have a palisade arrangement, with 2 well-aligned compact nuclei rows. The Antoni B areas are less cellular and orderly, characterized by fusiform or oval cells arranged randomly in a lax matrix. This tumour shows immunohistochemical staining for S100. Another important component is the large vessels (more evident in the poorly cellular Antoni B areas) with large lumens, thrombi and thick walls. Glands, benign epithelial structures and cystic spaces can also be observed.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Imaging studies help make the diagnosis. When they arise from the vagus nerve or the cervical sympathetic chain, there is usually an anterior displacement of the internal carotid artery. Most schwannomas have a significant enhancement in contrast MRI, which can lead to confusing them with paragangliomas.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Surgical treatment of neurogenic tumours involves the separation of the mass from the nerve trunk avoiding permanent function loss. This may be impossible in neurofibromas and cranial nerve lesions. Most authors prefer an external approach, since it allows for better exposure and haemostasis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, despite nuclear atypia and degenerative findings, it is a very rare benign tumour with very few cases described in the literature.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vacas Muñoz I, Ruiz Molina I, Gallardo Ávila A. Schwannoma del plexo cervical en una mujer de 76 años. Med Clin (Barc). 2020;154:194.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Schwannoma in the supraclavicular region: case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Keleş" 1 => "O. Eroğlu" 2 => "İH. Özercan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Turk Arch Otorhinolaryngol." "fecha" => "2018" "volumen" => "56" "numero" => "1" "paginaInicial" => "54" "paginaFinal" => "57" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Benign tumors of peripheral nerves" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.M. Enzinger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "F.M.Enzinger, S.W.Weiss" "titulo" => "Soft tissue tumors" "paginaInicial" => "853" "paginaFinal" => "862" "serieFecha" => "2008" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Head and neck schwannomas: a surgical challenge-a series of 5 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I. Ansari" 1 => "A. Ansari" 2 => "A.A. Graison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2018/4074905" "Revista" => array:6 [ "tituloSerie" => "Case Rep Otolaryngol." "fecha" => "2018" "volumen" => "2018" "numero" => "4" "paginaInicial" => "1" "paginaFinal" => "10" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sudden-onset C8 radiculopathy due to a plexiform schwannoma of the cervical nerve root: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Komatsu" 1 => "H. Toda" 2 => "S. Matsumoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2169/internalmedicine.0114-17" "Revista" => array:7 [ "tituloSerie" => "Intern Med." "fecha" => "2018" "volumen" => "57" "numero" => "22" "paginaInicial" => "3317" "paginaFinal" => "3320" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29984772" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015400000005/v2_202004200617/S2387020620300048/v2_202004200617/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015400000005/v2_202004200617/S2387020620300048/v2_202004200617/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620300048?idApp=UINPBA00004N" ]
Journal Information
Vol. 154. Issue 5.
Pages 194 (March 2020)
Share
Download PDF
More article options
Vol. 154. Issue 5.
Pages 194 (March 2020)
Letter to the Editor
Schwannoma of the cervical plexus in a 76-year-old woman
Schwannoma del plexo cervical en una mujer de 76 años
Visits
7
This item has received
Article information
These are the options to access the full texts of the publication Medicina Clínica (English Edition)
Subscriber
Subscribe
Purchase
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail