Massive Hemoptysis: A Rare Presentation of Posterior Mediastinal, Giant, Benign Vagal Schwannoma

Schwannomas are rare neurogenic tumor originating from Schwann cells of the nerve sheath, most frequently encountered type of posterior mediastinal tumors. In most cases, schwannomas are benign, malignant and multiple schwannomas are rare. Histopathologically, the tumor is composed of fascicles of spindle cells, which are strongly positive for S-100 proteins. Surgical resection is a treatment of choice, and prognosis is excellent. Here, we report a case of posterior mediastinal schwannoma in a 20- years old male patient who complained of right-sided back pain and two episodes of massive hemoptysis of recent onset. Contrast enhanced computed tomography (CECT) and magnetic resonance imaging of the chest showed a well circumscribed, heterogeneous mass in the posterior mediastinum, compressing the right lower lobe with widening of intervertebral foramens. CT-guided trucut biopsy revealed spindle cell neoplasm. On immunohisto-chemistry, tumor cells expressed strong positivity for S-100 protein. Final diagnosis was schwannoma, probably originating from the right vagus nerve. Surgical resection of the encapsulated tumor resulted in the successful recovery, without any recurrence over next one year follow up.