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Giant cystic schwannoma of the middle mediastinum with cervical extension.

Gueldich M, Hentati A, Chakroun A, Abid H, Kammoun S, M'saad S, Frikha I - Libyan J Med (2015)

Bottom Line: They are typically, well-encapsulated lesions which rarely adhere to the adjacent structures.In the chest, schwannomas are often seen within the posterior mediastinum and commonly originating along intercostal nerves.We report in this case a giant cystic mediastinal schwannoma of the left recurrent laryngeal nerve with cervical extension, unresectable by the usual described approaches, which was completely removed through a cervical approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Surgery, Habib Bourguiba Hospital, Sfax, Tunisia.

ABSTRACT
Schwannomas (neurilemmomas) are benign tumors arising from the Schwann cells of the neural sheath. They are typically, well-encapsulated lesions which rarely adhere to the adjacent structures. In the chest, schwannomas are often seen within the posterior mediastinum and commonly originating along intercostal nerves. Several operative approaches have previously been described for the resection of these tumors, including thoracoscopic techniques and posterolateral thoracotomy. We report in this case a giant cystic mediastinal schwannoma of the left recurrent laryngeal nerve with cervical extension, unresectable by the usual described approaches, which was completely removed through a cervical approach.

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Chest radiography: enlargement of the superior mediastinum with right tracheal deviation.
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Figure 0001: Chest radiography: enlargement of the superior mediastinum with right tracheal deviation.

Mentions: A 44-year-old patient followed 2 years ago for wheezing nocturnal dyspnea associated with a dry cough treated as allergic asthma without symptomatic improvement. Evolution was marked by worsening of dyspnea with paroxysmal breath blockages. Clinical exam revealed only lung bases wheezing. The chest radiography showed an enlargement of the superior mediastinum associated to a right tracheal deviation (Fig. 1). The computed tomography chest scan revealed a cervico-mediastinal multilocular mass extended from the left thyroid lobe to the tracheal bifurcation measuring 12 cm in height (Fig. 2). These structures were not invaded by tumor and edging security was well identified. The cystic nature of the mass was confirmed by MRI. In addition, MRI has shown an intracystic liquid–liquid level with low intensity T2 confirming the hemorrhagic nature of the fluid content. At the cervical and mediastinal regions, diameter of the mass was 4 and 8 cm, respectively. Esophagus and trachea were partially compressed by the tumor which represses the supra aortic trunks without invasion signs. Bronchoscopy showed an extrinsic compression of the trachea and paralysis of the left vocal cord. The patient had urgently been operated on because of the occurrence of an acute respiratory failure. Cystic mass was completely resected by a transversal cervicotomy after aspiration of the hemorrhagic content (Fig. 3a). The left recurrent laryngeal nerve seems to be carried away with the tumor (Fig. 3b). Histological findings confirm diagnosis of giant schwannoma developed at the expense of the left recurrent laryngeal nerve with necrosis areas. The postoperative course was marked by persistence of left vocal cord paralysis which has been well evolved after speech therapy rehabilitation. One year follow-up did not show any signs suggestive of a tumor recurrence.


Giant cystic schwannoma of the middle mediastinum with cervical extension.

Gueldich M, Hentati A, Chakroun A, Abid H, Kammoun S, M'saad S, Frikha I - Libyan J Med (2015)

Chest radiography: enlargement of the superior mediastinum with right tracheal deviation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390562&req=5

Figure 0001: Chest radiography: enlargement of the superior mediastinum with right tracheal deviation.
Mentions: A 44-year-old patient followed 2 years ago for wheezing nocturnal dyspnea associated with a dry cough treated as allergic asthma without symptomatic improvement. Evolution was marked by worsening of dyspnea with paroxysmal breath blockages. Clinical exam revealed only lung bases wheezing. The chest radiography showed an enlargement of the superior mediastinum associated to a right tracheal deviation (Fig. 1). The computed tomography chest scan revealed a cervico-mediastinal multilocular mass extended from the left thyroid lobe to the tracheal bifurcation measuring 12 cm in height (Fig. 2). These structures were not invaded by tumor and edging security was well identified. The cystic nature of the mass was confirmed by MRI. In addition, MRI has shown an intracystic liquid–liquid level with low intensity T2 confirming the hemorrhagic nature of the fluid content. At the cervical and mediastinal regions, diameter of the mass was 4 and 8 cm, respectively. Esophagus and trachea were partially compressed by the tumor which represses the supra aortic trunks without invasion signs. Bronchoscopy showed an extrinsic compression of the trachea and paralysis of the left vocal cord. The patient had urgently been operated on because of the occurrence of an acute respiratory failure. Cystic mass was completely resected by a transversal cervicotomy after aspiration of the hemorrhagic content (Fig. 3a). The left recurrent laryngeal nerve seems to be carried away with the tumor (Fig. 3b). Histological findings confirm diagnosis of giant schwannoma developed at the expense of the left recurrent laryngeal nerve with necrosis areas. The postoperative course was marked by persistence of left vocal cord paralysis which has been well evolved after speech therapy rehabilitation. One year follow-up did not show any signs suggestive of a tumor recurrence.

Bottom Line: They are typically, well-encapsulated lesions which rarely adhere to the adjacent structures.In the chest, schwannomas are often seen within the posterior mediastinum and commonly originating along intercostal nerves.We report in this case a giant cystic mediastinal schwannoma of the left recurrent laryngeal nerve with cervical extension, unresectable by the usual described approaches, which was completely removed through a cervical approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Surgery, Habib Bourguiba Hospital, Sfax, Tunisia.

ABSTRACT
Schwannomas (neurilemmomas) are benign tumors arising from the Schwann cells of the neural sheath. They are typically, well-encapsulated lesions which rarely adhere to the adjacent structures. In the chest, schwannomas are often seen within the posterior mediastinum and commonly originating along intercostal nerves. Several operative approaches have previously been described for the resection of these tumors, including thoracoscopic techniques and posterolateral thoracotomy. We report in this case a giant cystic mediastinal schwannoma of the left recurrent laryngeal nerve with cervical extension, unresectable by the usual described approaches, which was completely removed through a cervical approach.

Show MeSH
Related in: MedlinePlus