Middle mediastinal schwannoma concealed by asthma and GORD

Abstract

Neurogenic tumours of the mediastinum in adults occur most often at the posterior mediastinum, majority of which are benign of nerve sheath in origin. A 72-year-old woman, known asthmatic, presented with chronic symptoms of hoarseness, dysphagia, chest heaviness, easy fatigability, cough, epigastric pain, feeling of abdominal fullness and choking with food intake and at a supine position. Treated for other disorders, routine chest X-ray incidentally found a homogenous convex radiodensity at the right paratracheal area; mass which was also observed with CT and 18F-fludeoxyglucose-positron emission tomography/CT scan studies. Mediastinoscopy with biopsy showed spindle to plump cells with strong S100 positivity. Thoracoscopic surgery done to completely excise the mass found it to be benign schwannoma.

Large mediastinal schwannoma with great vessel encroachment requiring vascular reconstruction: a case report

“…However, given the propensity for the mediastinal tumor to continue to grow and potentially invade surrounding structures, the treatment of choice is surgical resection of the mass, either by video assisted thoracoscopy or thoracotomy, for definitive diagnosis and treatment ( 3 , 6 , 10 ). Ultimately, prognosis is excellent as benign schwannomas rarely recur ( 2 ).…”

“…Surgical approach must take into consideration the location of the tumor, structures involved and surgeon experience and minimally invasive and open techniques ( 2 ). Mediastinal tumors, including schwannomas, can often be approached with minimally invasive and robotic techniques.…”

“…Schwannomas are usually asymptomatic, solitary masses and are benign and approximately two thirds of cases. However, when symptoms do occur, they are often due to involvement and compression of neighboring structures and carry a greater risk of being malignant ( 2 ). Due to the indolent nature of the tumor, schwannomas have the potential to grow large and encase and invade important anatomical surrounding structures, such as the aorta, pulmonary vessels, and left subclavian and innominate arteries, which could lead to catastrophic consequences ( 4 ).…”

Angiographic embolization followed by piecemeal resection of giant posterior mediastinal schwannoma: Case report and concise review

“…Because imaging characteristics of mediastinal masses often do not allow for definitive diagnosis and may not differentiate benign from malignant conditions, histopathologic assessment is prudent. Depending on the location of the tumor, this may be accomplished with fine-needle aspiration, ultrasound or CT-guided percutaneous biopsy, mediastinotomy, or video-assisted thoracoscopic surgery [ 10 ]. However, less invasive approaches are preferred to reduce associated morbidity [ 11 ].…”

Mediastinal tumors of peripheral nerve origin (so-called neurogenic tumors)

“…Schwannoma is the most frequent tumor of peripheral nerve origin in the mediastinum ( 14 - 24 ) and the majority occur in the posterior mediastinum ( 25 , 26 ). Schwannomas develop as sporadic tumors in children or adults but are more frequent in adult patients in their 3rd–6th decades of life.…”