Schwannoma mediastínico gigante / Giant mediastinal schwannoma

El schwannoma es un tumor neurogénico que se presenta más frecuentemente en el ángulo costovertebral del mediastino posterior, pero también en otras localizaciones dentro del tórax. Habitualmente suele ser una masa única, encapsulada, bien definida, con un tamaño aproximado 2 a 10 cm. Presentamos el caso de un paciente de 66 años, derivado a nuestro hospital por una masa de 13 cm localizada en el hemitórax inferior izquierdo. Se realizó una biopsia, y la resonancia magnética corroboró el diagnóstico de un tumor mediastínico gigante de la vaina neural. Se procedió a su resección completa sin complicaciones.

Schwannomas are neurogenic tumors, commonly located in the costovertebral angle of the posterior mediastinum, but with many intrathoracic locations. They usually present as a solitary, well-circumscribed and encapsulated mass with a size between 2 and 10 cm. We report a case of a 66-year-old male, referred to our hospital for a mass located at the left lower hemithorax with 13 cm in size. A percutaneous biopsy was performed, and magnetic resonance imaging confirmed the diagnosis of a resectable giant mediastinal nerve sheath tumor. Surgery was performed without complications.

Development of Castleman Disease in the Paravertebral Space Mimicking a Neurogenic Tumor / 대한흉부외과학회지

Castleman disease is a relatively rare disease, characterized by well-circumscribed benign lymph-node hyperplasia. The disease may develop anywhere in the lymphatic system, but is most commonly reported as unicentric Castleman disease in the mediastinum along the tracheobronchial tree. It is usually asymptomatic and detected on plain chest radiography as an incidental finding. We report an incidentally detected case of Castleman disease in the paravertebral space that was preoperatively diagnosed as a neurogenic tumor and treated by complete surgical resection.

Prognostic Analysis of Postoperative Children with Gigantic Thoracic Tumors / 医学研究杂志

Objective To investigate the clinical features and prognostic factors of children with gigantic thoracic tumors.Methods Clinical data were collected from the database of Cardiothoracic Surgery,Shanghai Children's Hospital between January 2009 and June 2015.The analyses were mainly focused on the clinical data of 76 cases of thoracic giant tumor that underwent surgical treatment,Univariate survival analysis was performed with Kaplan Meier method.Results Pathological results showed that 35 cases were benign tumors and 41 cases were malignant tumors.For benign tumors,the main pathological classification were ganglioneuroma in 12 cases,vascular tumors in 9 cases,germ cell tumors in 8 cases.For malignant tumors,the main pathological classification were neuroblastoma in 13 cases,ganglioneuroblastoma in 7 cases and lymphoma in 7 cases,etc.After surgical resection 31 cases of benign tumors were long-term survival.The 5 year survival rates of 70 patients with gigantic thoracic tumors was more than 75％,39 patients with malignant tumors were more than 50％.Single factor in Kaplan Meier analysis showed that gender,location of primary tumor were not associated with neurogenic tumor prognosis(P ＞ 0.05).The age of patients,tumor stage,tumor pathological type,whether chemotherapy are associated with prognosis of neurogenic tumors the difference has statistical significance (P ＜ 0.05).Conclusion Surgical resection is a prognostic factor for patients with benign thoracic giant tumor.The recurrence and metastasis rates of malignant tumor is high.Its prognosis is poor.The survival time of patients with postoperative chemotherapy or radiotherapy can be prolonged.The most common children gigantic thoracic tumors are neurogenic tumors,There is no correlation between the prognosis of neurogenic tumors and sex or primary site.While age,tumor stage,pathology and whether with chemotherapy are associated with neurogenic tumor prognosis.

Extraforaminal Extrusion of Intervertebral Disc Misdiagnosed as Neurogenic Tumor: a Case Report

A 55-year-old male presented with dysesthesia of the right anteromedial thigh. A magnetic resonance image revealed a globular mass at the right extraforaminal area of the L3/4 level. Based on the diagnosis of neurogenic tumor, surgical excision was performed. The surgical impression and pathology confirmed extrusion of intervertebral disc. In a retrospective review of the magnetic resonance image, we noticed a fibrillary pattern directed from the intervertebral disc space to the lesion, and disrupted annulus fibrosus and indentation caused by the ring apophysis. We suggest aforementioned features, indicative of intervertebral disc lesions, to be checked when interpreting mass lesions around the intervertebral foramen.

Extraforaminal Extrusion of Intervertebral Disc Misdiagnosed as Neurogenic Tumor: a Case Report

A 55-year-old male presented with dysesthesia of the right anteromedial thigh. A magnetic resonance image revealed a globular mass at the right extraforaminal area of the L3/4 level. Based on the diagnosis of neurogenic tumor, surgical excision was performed. The surgical impression and pathology confirmed extrusion of intervertebral disc. In a retrospective review of the magnetic resonance image, we noticed a fibrillary pattern directed from the intervertebral disc space to the lesion, and disrupted annulus fibrosus and indentation caused by the ring apophysis. We suggest aforementioned features, indicative of intervertebral disc lesions, to be checked when interpreting mass lesions around the intervertebral foramen.

Single Stage Posterior Approach for Total Resection of Presacral Giant Schwannoma: A Technical Case Report

The neurogenic tumor of frequent occurrence in the presacral area is a schwannoma. Giant presacral schwannoma has a risk for anterior surgical approach because of its massive size and proximity to abundant vascularity of presacral region. We report a single stage posterior approach for total resection of a giant presacral schwannoma. A 40-year-old female patient experienced left buttock pain and tingling sensation at left S1 dermatome. Magnetic resonance imaging showed that the presacral huge mass at S1–3 level with osseous extension and structural remodeling in left sacral ala. The presacral mass was ranging in maximum diameter from 8.0 to 8.6 cm. S2 foramen laminectomy was performed to expose the mass. The tumor capsule and the root were carefully dissected away. The tumor was removed while preserving the capsule by dissecting the plane between the inner wall of the capsule and the tumor. The single stage posterior approach for presacral giant schwannoma is feasible, and it can be a good surgical alternative to prevent pelvic organ or vascular damage and anterior approach related dystocia and infertility.

Application of value analysis to high frequency ultrasound in displaying connection nerves of neurogenic tumor / 中国医学装备

Objective:To investigate the localization and identification value of high frequency ultrasound in displaying connection nerves of SNT, and to improve the accuracy of ultrasound diagnosis.Methods: Retrospective analysis the results of high frequency ultrasound to 49 cases proved by pathology annually patients (54 tumors, 54 connection nerves), and compared with the results of pathological diagnosis, evaluating the accuracy of high frequency ultrasound in displaying connection nerves. Results: The longitudinal section appearance of tumor connection nerve showed hypoechoic band and parallel fine belt-like structure surrounded by hyperechoic lines, it was enlarged gradually and became triangular close to the tumor. To the distribution of sex, age and course of the disease, the rates of high frequency ultrasound in displaying connection nerves were no significant difference (x2=0.083,x2=0.454,x2=1.277;P>0.05). The rate of high frequency ultrasound in displaying connection nerves of SNT was 94.4%, compared with the results of pathological diagnosis, the distribution ratio and the rate of high frequency ultrasound in displaying connection nerves showed no significant difference(x2=0.015,P>0.05).Conclusion: When using high frequency ultrasound observed connection nerves of SNT, there were obvious image characteristics, and the rate of high frequency ultrasound in displaying connection nerves of SNT was high, it would be a better value to diagnostic SNT.

Intracranial Cystic Metastasis Mimicking Neurocysticercosis in a Pregnant Woman

Brain metastasis can form large cystic lesions, and its differentiation on the basis of imaging findings alone is difficult. A 36-year-old woman with headache visited emergency room. Two years ago, she was diagnosed as neurocysticercosis and had taken anti-parasite medications. However, in the current visit, the sizes of intracranial cystic lesions increased. Brain biopsy reported metastatic neuroendocrine tumor, and chest CT showed the primary site of the tumor. Cystic brain metastasis should be considered in cases with cystic brain lesions.

Heterotopic Ossification Mimics Neurogenic Tumor: A Case Report / 대한골관절종양학회지

Heterotopic ossification is an abnormal bone formation after surgery or without any reason. Large joint, such as hip and knee joint, is a known most common site. Operation itself and postoperative early range of motion exercise are risk factors. We present a case of heterotopic ossification mimics neurogenic tumor after high tibial osteotomy.

A Case of Recurrent Cerebral Infarction due to Carotid Compression by a Neurogenic Tumor in the Neck / 대한뇌졸중학회지

A 62-year-old man with a neurogenic tumor in the neck was admitted to our hospital for recurrent ischemic stroke due to carotid occlusion. The magnetic resonance (MR) angiograms revealed the occlusion of the right internal carotid artery (ICA). Arterial compression by the tumor could be considered as the cause of ICA occlusion. Since neurogenic tumors of the neck have significant surgical risks, the patient underwent extracranial-intracranial arterial bypass (EC-IC bypass) surgery. We report a case with recurrent ischemic stroke due to carotid compression by a neurogenic tumor of the neck.

Completely Thoracoscopic Resection of Benign Neurogenic Tumors on Apical Chest / 华中科技大学学报(医学版)

Objective To discuss the feasibility,safety,technical points and clinical effects of completely thoracoscopic resection of benign neurogenic tumors on apical chest.Methods From January 2004 to June 2009,11 patients underwent surgical resection of benign neurogenic tumours on apical chest.A complete thoracoscopy was used in 5 cases,and the remaining 6 cases received traditional open thoracotomy.By analysis on the clinical symptoms,tumor types,complications,operative time,blood loss and drainage time after operation,the advantages and disadvantages of complete thoracoscopy were compared to traditional open thoracotomy for resection of benign neurogenic tumors on apical chest.Results There was one patient in each group that suffered from light transient Horner's syndrome,who recovered spontaneously.The group of complete thoracoscopy was superior to the group of traditional open thoracotomy in operative time,blood loss during the operation,drainage time and postoperative hospital stay.Conclusion For benign neurogenic tumors on apical chest,a resection with complete thoracoscopy is as safe and effective as the traditional open thoracotomy,and the former is characterized by less operative trauma and quicker recovery.

Schwannoma Mimicking Laryngocele

A schwannoma of the larynx is a rare benign tumor that usually presents as a submucosal mass in the pyriform sinus and the aryepiglottic space, and this type of schwannoma constitutes a diagnostic and therapeutic challenge for otolaryngologists. We present here two cases of supraglottic schwannomas that were misdiagnosed as laryngoceles. Both were excised through a lateral thyrotomy approach without a tracheostomy, and the laryngeal function was successfully maintained. We discuss the clinical and imaging findings and the management of this rare neoplasm with focusing on the differential diagnosis of laryngeal schwannoma and laryngocele. We also review the relevant medical literature.

A Case Report of Large Schwannoma Arising in Sciatic Nerve

PURPOSE: Schwannoma is one of common neoplasm in the central and peripheral nervous systems. However, schwannoma of sciatic nerve is rare, especially large schwannoma arising in sciatic nerve is extremely rare. This is a report of our experience with large schwannoma arising in sciatic nerve with minimal neurologic symptoms. METHODS: A 65-year-old man presented with palpable mass in middle portion of posterior thigh. No definitive neurologic deficits were detected on physical examinations. CT and sonography showed well-defined mass with large dimension. The mass was excised and confirmed histologically as a schwannoma. In postoperative period, NCS and EMG were followed. RESULTS: The patient complained of difficulty in dorsiflexion of ipsilateral ankle joint postoperatively. NCS and EMG obtained immediately and showed sciatic neuropathy. After 2 months postoperatively, NCS and EMG were followed and abnormal findings of previous NCS and EMG were not found. Dorsiflexion of ankle joint was improved to normal range of motion. CONCLUSION: We report a rare case of large schwannoma arising in sciatic nerve with no definitive neurologic symptoms.

The Ultrasonographic Findings of a Gallbladder Schwannoma: A Case Report

A schwannoma of the gallbladder is an extremely rare tumor. We report a case of a 45-year-old woman with a polypoid mass in her gallbladder. The mass was discovered incidentally as a heterogeneous enhancing mass in the infundibulum of the gallbladder on an abdominal CT scan performed during an evaluation of a reported nonspecific left lower abdominal pain. An ultrasonography revealed that the overlying mucosa of gallbladder was intact. Moreover, a laparoscopic cholecystectomy was performed and the mass was confirmed as a gallbladder schwannoma.

Spontaneous Massive Hemothorax Associated with Solitary Posterior Mediastinal Neurilemmoma / 결핵및호흡기질환

Neurogenic tumors are common in posterior mediastinal tumors and neurilemmoma represents approximately 40% of neurogenic tumors arising in the mediastinum. It is usually asymptomatic, and is generally diagnosed incidentally. In some cases, they presented with symptoms of nerve or airway compression. However, a solitary neurilemmoma, particularly not associated with von Recklinghausen disease, with spontaneous hemothorax is quite rare. We report a case of spontaneous massive hemothorax associated with a solitary neurilemmoma.

Diagnosis of primary neurogenic tumor on chest wall using CT imaging / 中国基层医药

Objective To discuss manifestations of neurogenic tumors on chest wall on CT imaging and pathology.Methods 7 patients with neurogenic tumors on chest wall confirmed surgically and pathologically were reviewed.To facilitate differential diagnosis,3 cases of malignant sarcoma were reviewed for their features on CT.Results 4 out of 5 cases of neurinoma were benign,with one case showing even density on plain CT scan,3 were poorly even,one case showed obvious evenness after enhancement,and 1 case was poorly evenly enhanced,2 benign cases had compression absorption of surrounding bone of scapula or ribs.One case of moderate malignancy was uneven in plain scan and slightly enhanced after enhancement procedure,and neighboring bone of scapula and rib were compressed and destroyed and absorbed,and neighboring muscular interspace and upper mediastinum were involved.One case showed single lesion of neurofibroma,displaying relatively even density on plain scan and moderate unevenness after enhancement procedure,as well as compression and absorption of neighboring ribs.One case of neurofibroma had multiple lesions,showing uneven density on plain scan.This case did not undergo enhanced scan.The remaining 3 cases were all sarcoma including 2 cases of fibrosarcoma and one case of synovial sarcoma.Conclusion Mass of soft tissues that are situated on chest wall or paravertebral area and with smooth edge are suggestive for benign neurogenic tumor.On the contrary,rough edge and coarse shape and infiltration into neighboring tissues are characteristic for malignant ones.

Video-Assisted Thoracoscopic Resection of Posterior Mediastinal Benign Neurogenic Tumors:An Analysis of 40 Cases / 中国微创外科杂志

Objective To evaluate the therapeutic value of video-assisted thoracoscopy in treating posterior mediastinal benign neurogenic tumors.Methods From May 1994 to May 2006,40 patients received thoracoscopic resection of posterior mediastinal benign neurogenic tumor.Double lumen endotrocheal intubation was applied and 3 trocars were placed according to the location of the tumor.A mini-incision was used if the tumor was too large to be safely resected.Results The complete resections were successfully finished in 34 cases while the remaining 6 cases needed a 6 cm mini-incision to complete the surgery.Pathological examination showed 20 cases of neurilemoma,14 cases of neurofibroma,and 6 cases of paraganglioma.The average diameter of these tumors was 4.7 cm(range:2-12 cm).The average thoracic drainage time was 2.2 days(1-7 days).And the average postoperative hospital stay was 4.8 days(3-13 days).Only 2 cases experienced minor complications.There was no death in this study.The time of follow-up was 9 months to 12 years,in which 16 cases were followed for less than 3 years,12 cases for 3-5 years and 7 cases for over 5 years,5 cases lost contact.Only one patient received re-resection due to local recurrence.Conclusions Video-assisted thoracoscopic resection of posterior mediastinal benign neurogenic tumor is safe,reliable and minimally invasive,and can thus be regarded as the therapy of first choice.

Relation of Multiple Neurogenic Tumors in the Spinal Canal to Neurofibromatosis

OBJECTIVE: The authors characterize a syndrome of multiple neurogenic tumors in the spinal canal, which is unclassifiable by the current National Institute of Health(NIH) criteria for neurofibromatosis. METHODS: We retrospectively examined cases in which two or more spinal neurogenic tumors were detected by magnetic resonance(MR) imaging and which had been pathologically confirmed. Eighteen patients were recruited between February 1986 and March 2002. According to NIH criteria, eight cases were neurofibromatosis type 1(NF1), four were type 2(NF2), and six were neither type 1 nor type 2 (Unclassifiable: UC). The locations of lesions, clinical presentations, radiological findings, and pathological results with immunohistochemistry were reviewed. RESULTS: In the case of NF2, three of four cases were intradural tumors. Pathological examinations revealed neurilemmomas in two of four NF2 and all of the UC cases. In the case of NF1, pathological examinations showed seven neurofibromas and one neurilemmoma. Concerning UC, the age at presentation was middle-aged to late (mean age 48.5, range 35 to 64), which contrasted with ordinary NF2, where patients tended to become symptomatic before 20years of age. The pathological examinations of UC cases revealed neurilemmoma similar to most of NF2 and the immunohistochemical study showed characteristic of NF1. CONCLUSION: Multiple neurogenic tumors in the spinal canal are an under-recognized disease entity. Further studies for genetic aberration in multiple spinal neurogenic tumors are needed.

Microsurgical Resection of Schwannoma of the Brachial Plexus: A case report / 대한흉부외과학회지

Neurogenic tumors of the brachial plexus region are relatively rare. We report a recent experience of schwannoma of the right brachial plexus in the inferior trunk, which was successfully treated by microsurgical resection. A 38-year- old man presented a dysesthetic pain in the supraclavicular area and the right forearm of C6, 7 dermatome. Rubbery hard mass was palpated in the right supraclavicular area and magnetic resonance imaging showed a well circumscribed, well enhanced ovoid mass with cystic degeneration on the right brachial plexus portion. The patient underwent complete removal of the mass through the anterior cervicothoracic (modified Dartevelle) approach. At the postoperative 3 months, there is no neurologic deficit.

Neurogenic Tumor of the Brachial Plexus: case report / 대한흉부외과학회지

Neurogenic tumors of brachial plexus are rare lesions. Recently I experienced a case of Schwannoma arising from the brachial plexus. Thirtyfour-year-old man presented with a slow-growing mass on the left supraclavicular area. Magnetic resonance imaging revealed a well demarcated solid mass on posterosuperior aspect of the left subclavian artery. During operation, a well-encapsulated mass was seen beneath the brachial plexus. I performed intracapsular enucleation of the tumor from the nerve in an effort to avoid damaging nerve fibers as much as possible. Post-operative neurological deficit was not found.