One-Stage Combined Thoracic Ancient Schwannomas Total Removal and Coronary Artery Bypass

Abstract

Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

Intrathoracic Neurogenic Tumors

“…Ancient schwannomas are encapsulated tumors showing regressive changes such as fatty degeneration, hemorrhage, and cystic formation. 11 Cellular schwannomas can be very cellular, somewhat pleomorphic, and mitotically active, and thus be confused with sarcoma. Malignant transformation of solitary schwannomas is extremely rare, and when it does occur, the prognosis seems good.…”

“…If CT was inconclusive, magnetic resonance imaging was performed to accurately define the presence and extent of the intraspinal component of the tumor. 11 Magnetic resonance imaging or conventional angiography can be used to show Adamkiewicz artery in dumbbell tumors localized in the lower posterior mediastinum (T8-L1). Metaiodobenzylguanidine scintigraphy (now replaced by positron emission tomography) helps to show tumor biological activity in neuroblastoma and functional paraganglioma.…”

Giant ancient schwannoma of the pleura: Commentary

“…Video-thoracoscopy is useful for determining the best approach together with information on its position and extent shown by CT scanning. However, in cases with a huge tumor, complete removal will require an open thoracotomy,[ 1 8 9 ] with the aspiration of fluid from the cystic part during the operation possibly useful to reduce its mass. [ 10 ]…”