Benign Esophageal Schwannoma Compressing the Trachea in Pregnancy

Mizuguchi, Shinjiro; Inoue, Kiyotoshi; Imagawa, Atsuo; Kitano, Yoshinori; Kameyama, Masao; Ueda, Haruhiko; Inoue, Yasuo

doi:10.1016/j.athoracsur.2007.07.088

Cited by 34 publications

(28 citation statements)

References 8 publications

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“…Extended lymph node dissection was not performed in the three cases, because all of the preoperative diagnoses were esophagus leiomyoma, and there were not any increscent lymph nodes around the thorax cavity. Thoracoscopic resection is advantageous because it is less invasive, therefore shortening the hospital stay, and reducing pain at the surgical wound site (8,10). A retrospective study showed that minimally invasive resection of benign esophageal tumors is technically safe and associated with a shorter length of stay compared with open approaches.…”

Section: Discussionmentioning

confidence: 99%

A report of three cases of surgical removal of esophageal schwannomas

et al. 2016

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Esophageal schwannomas are rarely observed, and the most frequent presenting symptom is dysphagia. In such cases, esophageal endoscopy shows a mucosal protrusion with normal esophageal mucosa. Esophagography shows a protruding smooth mass in the middle thoracic esophagus. Both fluorodeoxyglucose (FDG) positron emission tomography (PET) and endoscopic ultrasonography-fine needle aspiration (EUS-FNA) are limited for diagnosing the case. Diagnosis of this condition before surgery is difficult. The most common and effective treatment is enucleation through surgery or endoscopy.Thoracoscopic surgery is gradually becoming used more often, and the prognosis is particularly good. In comparison, thoracoscopy surgery is less invasive, with a shorter length of hospital stay, and reduced pain at the surgical wound site. Extended lymph node dissection was not performed. The positive expression of S-100 on immunohistochemistry examination indicates the nature of the schwannoma. In the present cases, the postoperative course was uneventful, and no evidence of recurrence has been noted. a 30-degree left lateral recumbent position, used a single lumen endotracheal intubation and two-lung ventilation, and then provided the thoracic cavity with carbon dioxide positive pressure using an enclosed trocar to make the lungs collapse. For the incision, we chose the mid-axillary line the 4th and 7th intercostal space, and the lower edge of the subscapula and the 9th intercostal space scapula line, which can be adjusted according to the specific circumstances of the patient. Two small tumors were found adjacent to the mid-thoracic esophagus without lymph glands. The muscle of the esophagus was detached and the tumor was excised. Intraoperative endoscopy was used for careful examination of the mucosa. We closed the muscular layer after enucleation by hand-sewing. KeywordsThe two tumors were well-demarcated and had a globular appearance, measuring 30 mm × 20 mm × 17 mm and 30 mm × 18 mm × 15 mm. Histopathological findings revealed spindle-shaped cells in long fascicles ( Figure 1E). Immunohistochemical staining revealed the tumor was positive for S-100 protein ( Figure 1F), but negative for smooth muscle actin (SMA), Dog-1, CD117, musclespecific actin (MSA), cytokeratin (CK), anaplastic lymphoma kinase (ALK), c-Kit, and CD34, and had a low proliferation rate (Ki-67 index of less than 10%). The patient started oral feeding at post-operative day (pod) 1 and was discharged on pod 5. The patient remains free of recurrence 1 year after the operation, and esophagography findings are normal. Case 2A 42-year-old woman had been suffering from dysphagia for 2 months. Her medical and family histories were unremarkable. Esophageal endoscopy demonstrated a submucosal tumor without ulceration, extending 17-19 cm from the incisors (Figure 2A). Immunohistochemical staining revealed the tumor was positive for S-100 protein ( Figure 2B), vimentin, nestin, and CD68, but was negative for Dog-1, CD117, CK, desmin, ALK, c-Kit, and SMA. The blood vesse...

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Section: Discussionmentioning

confidence: 99%

A report of three cases of surgical removal of esophageal schwannomas

et al. 2016

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“…Esophageal schwannomas are exceedingly rare with only a handful of cases reported in the literature [3]. A literature review performed for the past decade, 2005 -2015, revealed a total of 21 cases of which two cases were of concurrent esophageal schwannomas [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The surgical approaches to these include four thoracoscopic, six thoracotomy, five cervical approaches, and five esophagectomies or partial esophagectomies.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Enucleation of Schwannoma Masquerading as a Leiomyoma

2017

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We present a case, literature review, and video of a transabdominal laparoscopic enucleation of an esophageal schwannoma. A 53-yearold female with dysphagia was found to have a 23 × 27 mm mass in the lower esophagus, which was initially diagnosed as a leiomyoma on endoscopic ultrasound without biopsy. At the time of her laparoscopic enucleation 12 months later, the lesion had grown to 60 × 55 × 30 mm and was excised with a full-thickness segment of the esophageal wall, with closure of the resulting defect over a bougie. Postoperatively, the patient's recovery was complicated by an esophageal leak which was successfully managed with endoscopic drainage. Esophageal schwannomas are rare esophageal lesions that have historically been treated with esophagectomy. Thoracoscopic or laparoscopic enucleations of smaller lesions have been more recently reported but larger lesions have usually required open surgery. Internally placed endoscopic drains have previously been shown to be a valid alternative to external drainage in patients with contained collections after resection surgery. They have the advantage of allowing patients to continue oral fluids during the recovery phase rather than relying on enteral or parenteral feeding. We propose that laparoscopic transabdominal enucleation of esophageal schwannoma with closure of the resulting full-thickness defect be considered as an organ and function sparing alternative for the management of large lower esophageal schwannomas. We further propose that contained leaks resulting from esophageal operations can successfully be managed with internal endoscopic drainage.

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“…7) Most submucosal tumors of the esophagus are leiomyoma, 4) and schwannomas are less common. Esophageal schwannomas are commonly benign, with only a few reports of malignant cases, 8,9) After complete resection, patients make good progress.…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal schwannomas typically present in middle aged woman and the most frequent symptom is dysphagia. 4) While an esophageal schwannoma occasionally causes obstructive dyspnea, the immediate surgical treatment is rarely required. If the tracheal lumen narrows to 75% of that under the vocal cord, the patient generally presents with obstructive respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Benign Esophageal Schwannoma Causing Life-threatening Tracheal Obstruction

Tomono

Otowa

Imanishi

et al. 2015

ATCS

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IntroductionSchwannoma of the esophagus is rare and most frequently located in the upper thoracic esophagus. 1) Dyspnea frequently occurs and reports about it are recently increasing. [2][3][4][5][6] However, esophageal obstruction has not been previously reported, nor has acute surgical intervention been needed. We describe a case of a major schwannoma of the esophagus, which required emergency esophagectomy, and review 5 publications about tracheal compression. Case ReportA 59-year-old woman presented with a history of diabetes mellitus. She had been aware of dysphagia in the past 1 year. However, since this symptom seemed mild, she rejected further evaluation. She was transported to emergency room of another hospital after an emergency medical services (EMS) call, resulting from dyspnea and disturbed consciousness. Her condition required emergency intubation, which did not significantly improve her state. Laboratory data from arterial blood showed respiratory acidosis with hypoxemia and hypercapnia (pH 7.165, PaO2 79.8 mmHg and PaCO2 99.5 mmHg at bilateral positive airway pressure [BIPAP], FiO2 0.8, positive endexpiratory pressure [PEEP] 8 cmH2O, f 15). Hyperglycemia was also found. A computed tomography (CT) scan revealed a posterior mediastinal mass, about 10 cm in diameter. The tumor showed a heterogeneous pattern and strongly compressed the esophagus and trachea (Fig. 1a, b). The tracheal lumen narrowed to 9 × 4 mm at the minimum point. The CT scan also showed the pneumonia in the left lower lung lobe. The patient was then taken and A Case of Benign Esophageal Schwannoma Causing Life-threatening Tracheal ObstructionAyako Tomono, MD, 1 Tetsu Nakamura, MD, PhD, 1 Yasunori Otowa, MD, 1 Tatsuya Imanishi, MD, PhD, 1 Yugo Tanaka, MD, PhD, 2 Yoshimasa Maniwa, MD, PhD, 2 and Yoshihiro Kakeji, MD, PhD 1A 59-year-old woman presented with a 1-year history of dysphagia. She suffered from a large mediastinal mass obstructing trachea and bilateral main bronchus, which led to dyspnea and disturbed consciousness. Immediate intubation and surgery was required. A solid tumor that included esophagus and right vagal nerve, and adhered to the membranous part of the bronchus was found. However, the tumor could be resected en bloc and the patient has been free from recurrence. Pathologically, the tumor exhibited proliferative spindle cells and was diffusely positive for S-100 protein. It was therefore diagnosed as a benign esophageal schwannoma. To our knowledge, this is the first report of tracheal obstruction from a benign esophageal schwannoma, which we successfully treated with emergency subtotal esophagectomy.

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Benign Esophageal Schwannoma Compressing the Trachea in Pregnancy

Cited by 34 publications

References 8 publications

A report of three cases of surgical removal of esophageal schwannomas

A report of three cases of surgical removal of esophageal schwannomas

Laparoscopic Enucleation of Schwannoma Masquerading as a Leiomyoma

A Case of Benign Esophageal Schwannoma Causing Life-threatening Tracheal Obstruction

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