Cornel Savu1,2, Vasile Grigorie3, Alexandru Melinte3, Camelia Diaconu2,4, Laura Iliescu2,5, Mihai Dimitriu2,6, Irina Balescu7, Nicolae Bacalbasa2,8,9. 1. Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophtisiology, Bucharest, Romania drsavu25@yahoo.com. 2. "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. 3. Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophtisiology, Bucharest, Romania. 4. Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania. 5. Department of Internal Medicine, "Fundeni" Clinical Institute, Bucharest, Romania. 6. Department of Obstetrics and Gynecology, "Sf. Pantelimon" Emergency Clinical Hospital, Bucharest, Romania. 7. Department of Visceral Surgery, "Ponderas Academic Hospital", Bucharest, Romania. 8. Department of Visceral Surgery, Center of Excellence in Translational Medicine, "Fundeni" Clinical Institute, Bucharest, Romania. 9. Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania.
Abstract
BACKGROUND/AIM: Thoracic neurogenic tumors are most frequently located in the posterior part of the mediastinum or on the chest wall, along the intercostal nerves. Schwannomas are very well tolerated for a long period, until the tumor reaches a large size and compression of the neighbouring mediastinal organs, chest wall or spine appears. The purpose of this article was to present a case of a giant right forth intercostal nerve Schwannoma, completely resected by a right antero-lateral thoracotomy. In addition, intrathoracic giant neurogenic tumors are a rarity. CASE REPORT: The patient presented with only diminished tolerance to physical activity with no other obvious symptoms. Standard chest radiography revealed a well-defined opacity of subcostal intensity, occupying two thirds of the right hemithorax, forming a common body with the mediastinal shadow. Thoracic computed tomography (CT) identified a 21/11 cm solid mass that compresses the right lung and the right main bronchus with both a solid component and a central liquid area. Open surgery was performed in order to remove the tumor, which was 20.5/12.5/9 cm in size and weighed 1,830 g, well defined, with no invasion of the adjacent organs, having a solid-fibromatous aspect as well as a central necrotic area. The origin of the tumor was confirmed from the posterolateral part of the forth intercostal nerve. Pathology examination and immunohistochemistry confirmed the diagnosis of a benign Schwannoma. CONCLUSION: Benign intrathoracic Schwannomas are asymptomatic for long periods and the main therapeutic option is complete surgical resection. The surgical approach, either open or video-assisted is dictated by the localisation of the tumor, local extension and most importantly the size of the neurogenic mass. Copyright
BACKGROUND/AIM: Thoracic neurogenic tumors are most frequently located in the posterior part of the mediastinum or on the chest wall, along the intercostal nerves. Schwannomas are very well tolerated for a long period, until the tumor reaches a large size and compression of the neighbouring mediastinal organs, chest wall or spine appears. The purpose of this article was to present a case of a giant right forth intercostal nerve Schwannoma, completely resected by a right antero-lateral thoracotomy. In addition, intrathoracic giant neurogenic tumors are a rarity. CASE REPORT: The patient presented with only diminished tolerance to physical activity with no other obvious symptoms. Standard chest radiography revealed a well-defined opacity of subcostal intensity, occupying two thirds of the right hemithorax, forming a common body with the mediastinal shadow. Thoracic computed tomography (CT) identified a 21/11 cm solid mass that compresses the right lung and the right main bronchus with both a solid component and a central liquid area. Open surgery was performed in order to remove the tumor, which was 20.5/12.5/9 cm in size and weighed 1,830 g, well defined, with no invasion of the adjacent organs, having a solid-fibromatous aspect as well as a central necrotic area. The origin of the tumor was confirmed from the posterolateral part of the forth intercostal nerve. Pathology examination and immunohistochemistry confirmed the diagnosis of a benign Schwannoma. CONCLUSION: Benign intrathoracic Schwannomas are asymptomatic for long periods and the main therapeutic option is complete surgical resection. The surgical approach, either open or video-assisted is dictated by the localisation of the tumor, local extension and most importantly the size of the neurogenic mass. Copyright