Bony schwannoma is a rare benign tumor derived from schwann cells of nerve fibers in the bone. It accounts for less than 1% of bony benign tumor, and prone to occur in the sacrum and mandible, occurrence in scapula is very rare. Here we report a 42-year-old woman with the chief complaint of pain in the left scapula. Imaging examination showed a giant, irregular, swelling lesion with distinct border involving the left scapula, extending into the left shoulder glenoid and pressing the surrounding soft tissues. Needle biopsy showed that the tumor was composed of spindle cells with S-100 protein positive, mimicking a benign neurogenic tumor. Then a complete excision was performed by removing the tumor and the surrounding tissues including partial left shoulder glenoid. Histologically, Antoni type A areas were the predominant microscopic pattern with occasional alternation by Antoni type B areas. Immunohistochemistry found that the neoplastic cells were scatteredly positive for S-100 protein. All these features suggest a diagnosis of an intraosseous schwannoma of the left scapula. Follow-up of the patient for ten months found no recurrence or sign of other tumors following complete tumor resection without any adjuvant therapy. In conclusion, this case of giant intraosseous schwannoma of the scapula is a rare benign bony tumor, and its diagnosis combined with clinical, imaging and pre-operative needle biopsy is important to guide further therapy, and avoid overtreatment.
Virtual slides: The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1399352761104042.