Case 301 -- Neck and Back Pain

Contributed by Pascale Hummel-Levine MD (1), Vallo Benjamin MD (2), David Zagzag MD, PhD (1,2,3)
Department of Pathology, Division of Neuropathology (1), Department of Neurosurgery (2), and the Kaplan Cancer Center (3) of New York University Medical Center
Published on line in March 2002


In the aftermath of a car accident the patient, a 28-year-old female, complained of a sharp pain of the anterior and posterior base of the neck on expiration and with exertion. Subsequently, she noticed a feeling of discomfort in her back when lifting her arm above her head. Her medical history was significant for a questionable rheumatic fever without cardiac sequela at the age of 6 and pernicious anemia at age 13. On physical examination, she was alert and oriented with no distress. There was no evidence of gross motor or sensory deficits, and no polyneuropathy.


CT and MRI scans of the thoracic spine (figures 1 and 2 respectively) revealed a 2 x 1.5 x 1.5cm smooth wall, benign appearing, tumor mass. It involved the third intercostal nerve on the right side of T2, respecting the intraspinal compartment and showed increased T2 signal. The differential diagnosis included neurofibroma and neurilemmoma. Thereafter, the mass was followed radiographically every year.

Five years later, an increase in size (2.5 x 2.1 x 1.8 cm) warranted a transthoracic, transpleural removal en bloc of this lesion.


At surgery, a 3 cm soft tissue tumor engulfed the third intercostal nerve and extended into the third intervertebral foramen where the proximal part of the nerve root was enlarged. The lesion was covered by non-adherent parietal pleura. The right third intercostal nerve was dissected and sectioned along with the tumor, after negative nerve stimulation..

Two pieces of pink, red and tan soft tissue, together 1.7 x 1.0 x 0.6 cm, were received for frozen section, labeled "neurofibroma". For light microscopy, two additional specimens labeled "proximal root neurofibroma" and "neurofibroma" consisting of pink, tan rubbery soft tissue, measuring together 3 x 2.3 x 1.2 cm, were fixed in 10% formalin and embedded in paraffin.



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