Cardiothoracic Surgery |

Schwannoma Arising From the Left Phrenic Nerve: A Rare Location FREE TO VIEW

Francina Bolanos, AAS; Luis Marcelo Argote Greene, AAS; Guillermo Ponce de León Ballesteros, AAS; Maria de la Luz Jimenez Camacho, AAS; Anahí Torres Fierro, AAS; Rita Dorantes, AAS; Rafael Garza Castillón, AAS; Jaime Omar Herrera Caceres, AAS; Patricio Santillán Doherty, AAS
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Chest. 2013;144(4_MeetingAbstracts):92A. doi:10.1378/chest.1658307
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SESSION TITLE: Surgery Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Mediastinal tumors are unusual, and only 20% arise in the posterior mediastinum. Schwannomas are the most frequent posterior mediastinal tumor. Schwannomas in the middle mediastinum are rare. They originate from the phrenic or recurrent laryngeal nerve, and cause paralysis. Diagnosis is made by surgical resection and histopathological review.

CASE PRESENTATION: We present the case of a 54 y/o asymptomatic woman, from Sonora, Mexico. She was diagnosed with left diaphragmatic paralysis in a routine chest X-ray. Chest CT showed an oval left parahilar mass (3.9X3.1X6.7cm) abutting the main left pulmonary artery. An MRI showed the same heterogeneous extracardiac mass with calcified inclusions, vascular and fatty tissue, without pericardial invasion. We performed an en-bloc mid transsternal full resection middle mediastinum tumor with pericardium and later placed a mediastinal left Blake. Pathology: Benign schwannoma phrenic nerve with senescent changes. The more detail Shwann cells have ovoid nuclei that are pointed, with variation in nuclear size and eosinophilic cytoplasm.

DISCUSSION: The middle mediastinum tumors are rare occurring in fewer than 5%. There are three cases of schwannomas in middle mediastinum from the phrenic nerve, two on the right and one on the left side. We report this case was found incidentally and treatment of choice is surgical approach is preferred and safer for the patient.

CONCLUSIONS: Conclusion: We report the fourth case of tumor of neural origin in the middle mediastinum and the second reported in the left phrenic nerve in English literature. Was treated with surgical resection Transsternal. An evaluation of the phrenic nerve reconstruction in the future only if the patient is symptomatic.

Reference #1: Surgical Treatment of Neurogenic Tumors of the Chest. Masafumi Yamaguchi, Ichiro Yoshino,Seiichi Fukuyama, Atsushi Osoegawa, Toshifumi Kameyama, Tetsuzo Tagawa, and Yosihiko Maehara. Ann Thorac Cardiovasc Surg 2004; 10: 148-51.

Reference #2: Nicola Fierro, MD, Guiseppe D’ermo, MD, Giuseppe Di Cola, MD, Luca Salvatore Gallinaro, MD, Giorgio Galassi, MD, Giovanni Galassi, MD. Posterior Mediastinal Schwannoma Asian Cardiovasc Thorac Ann 2003;11:72-3.

Reference #3: Reardon MJ, Conklin LD, Fabre J, Reardon PR, Letsou GV. Thoracoscopic approach A Schwannoma in the Middle Mediastinum Originated from the Phrenic Nerve . Alpay Orki & Attila Ozdemir & Ayse A. Indian J Surg (March-April 2012) 74(2):199-200.

DISCLOSURE: The following authors have nothing to disclose: Francina Bolanos, Luis Marcelo Argote Greene, Guillermo Ponce de León Ballesteros, Maria de la Luz Jimenez Camacho, Anahí Torres Fierro, Rita Dorantes, Rafael Garza Castillón, Jaime Omar Herrera Caceres, Patricio Santillán Doherty

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