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Communications to the Editor |

Giant Schwannoma of the Posterior Mediastinum FREE TO VIEW

Majed Al Refai, MD; Alessandro Brunelli, MD; Aroldo Fianchini, MD
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Department of Thoracic Surgery University of Ancona Ancona, Italy



Chest. 1999;115(3):907-908. doi:10.1378/chest.115.3.907
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To the Editor:

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 nerve.1

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

Figure Jump LinkFigure 1.  CT scan of the chest showing a heterogeneous tumor arising from the paraspinal sulcus, compressing the lung and displacing the mediastinum with the subocclusion of the main right bronchus.Grahic Jump Location
Strollo, DC, Rosado-de-Christenson, ML, Jett, JR (1997) Primary mediastinal tumors. Part II: tumors of the middle and posterior mediastinum.Chest112,1344-1357. [PubMed] [CrossRef]
 
Swanson, PE Soft tissue neoplasms of the mediastinum.Semin Diagn Pathol1991;8,14-34. [PubMed]
 
Gale, AW, Jelihovsky, T, Grant, AF, et al Neurogenic tumors of the mediastinum.Ann Thorac Surg1974;17,434-443. [PubMed]
 

Figures

Figure Jump LinkFigure 1.  CT scan of the chest showing a heterogeneous tumor arising from the paraspinal sulcus, compressing the lung and displacing the mediastinum with the subocclusion of the main right bronchus.Grahic Jump Location

Tables

References

Strollo, DC, Rosado-de-Christenson, ML, Jett, JR (1997) Primary mediastinal tumors. Part II: tumors of the middle and posterior mediastinum.Chest112,1344-1357. [PubMed] [CrossRef]
 
Swanson, PE Soft tissue neoplasms of the mediastinum.Semin Diagn Pathol1991;8,14-34. [PubMed]
 
Gale, AW, Jelihovsky, T, Grant, AF, et al Neurogenic tumors of the mediastinum.Ann Thorac Surg1974;17,434-443. [PubMed]
 
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