# Synchronous Intercostal Nerve Schwannomas: A Rare Cause of Chest Wall Pain

## TL;DR

This paper reports a rare case of synchronous intercostal nerve schwannomas causing chest wall pain in a woman with a history of breast cancer.

## Contribution

The novelty lies in the detailed clinical and pathological confirmation of a rare case of synchronous intercostal nerve schwannomas.

## Key findings

- Surgical resection of the tumors led to significant pain relief without neurological defects.
- Neuropathology confirmed the presence of synchronous intercostal nerve schwannomas.
- Microsurgical intervention showed good outcomes for managing intercostal nerve neuropathy.

## Abstract

Schwannomas are nerve sheath tumors arising from Schwann cells. Schwannomas of the intercostal nerve are extremely rare, with limited published literature. These tumors are generally regarded as benign asymptomatic. When symptomatic, they manifest with radiculopathy or chest pain. Surgery is considered when the pain does not respond to medication. Complete resection has a low risk of recurrence or malignant transformation. Herein, we report a pathologically confirmed case of synchronous intercostal nerve schwannoma diagnosed with chest wall pain.

A 38-year-old woman with a breast cancer history treated with neoadjuvant chemotherapy, followed by radical mastectomy and radiotherapy, presented with a three-year history of dorsal pain radiating to the right costal grid (D6 radiculopathy). MRI showed an encapsulated tumor close to the right D6-D7 intervertebral foramen with bone remodeling and a smaller encapsulated tumor close to the costotransverse joint of the right sixth rib. After three years of unsuccessful treatment with pain medication, the patient underwent tumor resection. The right sixth costotransverse joint was exposed with the identification of the smallest tumor. Then, we exposed the right sixth costovertebral joint, and a solid tumor was identified next to the intervertebral foramen. Tumor debulking was carried out with an ultrasonic aspirator.

Postoperatively, the patient experienced significant pain relief, and there were no neurological defects. The neuropathology analysis revealed synchronous intercostal nerve schwannomas. Microsurgical intervention for the management of intercostal nerve neuropathy resulting from dorsal schwannomas has demonstrated a good outcome for the patient.