Paraspinal Intramuscular Schwannoma: Case Presentation and Literature Review of a Rare Pathology

Background: A pure intramuscular paraspinal schwannoma is extremely rare, with only few case reports in the literature. Due to low frequency, lack of specific clinical signs and symptoms and difficult radiological assessment, the pre-surgical workup leads to a broad differential diagnosis. The aim of the work carried out was therefore to search for evidence of common clinical and radiological signs of the intramuscular paraspinal schwannoma, useful in the diagnostic work-up, and to highlight possible standards of treatment. Methods: Starting from the analysis of our case, we have extended a search to similar cases on the databases PubMed and Google Scholar. The outcome of the analysis gathered, up to August 2021, six relevant papers. Result: We treated a 69-year-old female with a thoracic intramuscular paraspinal mass. The pre-operative MRI had identified two typical signs of schwannoma (“split-fat” sign and the “entry-exit” sign). Intraoperative nerve isolation was performed and complete surgical excision was achieved. At the pathological analysis, we could confirm a rare OMS grade I “ancient schwannoma”. The analysis of the literature data showed a homogeneous picture of radiological presentation of the pathology. Moreover, surgical treatment was always the treatment of choice. Conclusions: The proposed assessment and treatment were consistent with the standard collected in the literature. Typical radiological signs were also found in the other cases collected. Radical surgery is the preferred treatment.

Chemotherapy-induced immunological breast cancer dormancy: a new function for old drugs?

Breast cancer remains the main cause of cancer-related mortality for women world-wide. Main cause of death is the development of therapy-resistant metastases. Relapses occur with a bimodal temporal distribution, with a first peak at 1-2 years after initial therapy and a second peak 2-3 years later. This discontinuous growth kinetics is consistent with the notion that disseminated cancer cells can remain dormant over a prolonged period of time before resuming growth. How cancer cells enter, sustain and exit dormancy, are unanswered questions with relevance to cancer biology, monitoring and therapy. Investigating mechanisms of breast cancer dormancy remains challenging, as in patients the condition is elusive and experimentally there are only a few models that recapitulate the clinical condition. Thus, developing new models to identify clinically relevant mechanisms and candidate therapeutic targets may open new avenues for novel therapies to induce and prolong dormancy. We have observed that cells surviving chemotherapy can enter a state of immunological dormancy. Using this model, we identified IRF-7/Interferon type I/IFNRA as signaling axis essential for this effect. Here we will review concepts and recent developments in cancer metastasis and dormancy with emphasis on breast cancer, and elaborate strategies to exploit them therapeutically.