Electron microscopy:
Even a cursory scan of the grid rapidly established the diagnosis
of a schwannoma. The myriad of narrow, curvaceous, closely associated
cellular processes was characteristic (Fig. 3 and 4). An S100-protein
immunostain, not included in the original work up, was strongly
positive (Fig. 5).
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| Figure 3: Between the tumor cells are innumerable narrow, sinuous cellular processes. | Figure 4: The somewhat regular alignment of the narrow elongated cellular processes are pathognomonic for schwannoma. |
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| Figure 5: Immunostaining for S-100 protein is strongly positive in sections from the cell block. |
Follow Up:
This case illustrates how medical mangment can be influenced by
a definite diagnosis using a biopsy obtained with minimal inconvenience
to the patient.
When the patient was advised that
he had a benign tumor, he chose not to have surgery. Three years
later, his physician disclosed that the patient had only occasional,
mild chest wall discomfort and that x-ray revealed little change
in the size of the schwannoma.
