Department of Thoracic Surgery
University of Ancona
We read with interest the article by Strollo and
colleagues1 on primary mediastinal tumors; we fully
support the descriptions of schwannoma symptoms, locations, diagnosis,
and treatment. These neoplasms are the most common mediastinal
neurogenic tumors; they are usually benign and slow growing and
frequently arise from a spinal nerve root, but may involve any thoracic
Recently, a 48-year-old woman was admitted to our hospital
because of dyspnea at rest, productive cough, and a referred vague
right chest pain of 10 years’ duration. Physical examination showed
dullness on percussion and decrease of breath sounds in the right
hemithorax. A chest radiograph showed extensive radiopacity involving
most of the right hemithorax. A chest CT scan showed a huge,
well-circumscribed, heterogeneous tumor with punctate calcifications in
the posterior mediastinum (Fig 1).
Complete resection of the mass and bilobectomy, because of the middle
and lower lobe destruction, due to extensive compression by the tumor,
was performed via thoracotomy. Histologic findings revealed a
well-circumscribed schwannoma arising from an intercostal nerve root.
In spite of the large volume of the mass, our patient did not
experience any frank paresthesia or nerve pain to confirm the
statements of Swanson2and Gale and
colleagues,3 even for larger schwannomas.
Our case showed that the indolent and slow growing nature of these
tumors can lead to a dangerous underestimation of the case.
Correspondence to: Majed Al Refai, MD, Clinica Chirurgia
Toracica, Ospedale Torrette, Via Conca 1, Torrette, Ancona, Italy
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