Case Report

Ancient Beyond Its Years: Giant Intrathoracic Ancient Schwannoma in an Adolescent

Maha Batool
Department of Medicine, Gulab Devi Teaching Hospital, Lahore
Minahil Binte Irfan
Department of Medicine, Gulab Devi Teaching Hospital, Lahore
Imman Akram
Department of Medicine, Gulab Devi Teaching Hospital, Lahore
Farah Babar
Department of Medicine, Gulab Devi Teaching Hospital, Lahore
Muhammad Imran
Department of Medicine, Gulab Devi Teaching Hospital, Lahore

✉ Correspondence: Maha Batool Email: mahabatool16@gmail.com

DOI https://doi.org/10.70302/jpsim.v7i3.2649
Volume: 7, Issue 3 Pages: 262–266 Published: 21 Aug 2026
Received: 23 Jan 2026 Revised: 19 May 2026 Accepted: 12 Aug 2026 Published Online: 21 Aug 2026

Abstract

Posterior mediastinal masses in the paediatric population present a diagnostic challenge because the imaging appearances of diverse entities frequently overlap. Neurogenic tumours are among the most common primary neoplasms of the posterior mediastinum, constituting roughly 20% of cases in adults and up to 35% in children. Schwannomas, well-encapsulated tumours arising from the myelin-forming cells of peripheral nerves, represent the commonest benign subtype within this group. The ancient schwannoma is an uncommon variant characterised by protracted degenerative change — cystic transformation, intralesional haemorrhage, vessel wall hyalinisation, dystrophic calcification, and nuclear pleomorphism — that accumulates over years. Despite the alarming histological appearances, ancient schwannoma carries no malignant potential; however, its atypical radiological and microscopic features may prompt an erroneous presumptive diagnosis.
We report a 15-year-old girl who presented with a one-year history of progressive exertional dyspnoea and nocturnal dry cough. Contrast-enhanced CT of the chest revealed a large hypodense septated lesion in the right thoracic apex displacing the superior mediastinal vasculature, an appearance that suggested a bronchogenic cyst. She underwent right posterolateral thoracotomy, and a complete en bloc excision of a 7.3 cm encapsulated mass was performed. Histopathological examination confirmed an ancient schwannoma. The postoperative recovery was uncomplicated. This report illustrates the diagnostic pitfalls of an ancient schwannoma in a young patient and affirms the central role of tissue pathology in the evaluation of atypical mediastinal masses.

Keywords
Schwannoma mediastinal masses exertional dyspnea well-encapsulated tumours

How to Cite This Article

Batool M, Irfan MB, Akram I, Babar F, Imran M. Ancient Beyond Its Years: Giant Intrathoracic Ancient Schwannoma in an Adolescent. J Pak Soc Intern Med. 2026;7(3):262–266. doi:10.70302/jpsim.v7i3.2649

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Conflict of Interest

The authors declare no conflict of interest.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

This research received no specific grant from any funding agency.

Funder information follows the Crossref Funder Registry standard.

Ethics Statement

not_applicable

Conducted in accordance with the Declaration of Helsinki.

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Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2026 Journal of Pakistan Society of Internal Medicine.
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