Mediastinal granular cell tumor arising from the left recurrent nerve; report of a case

Granular cell tumor is found in various organs but is rare in the mediastinum. We report a case of 36-year-old woman with a granular cell tumor in the left upper mediastinum. She was admitted to our hospital because of hoarseness. Laryngoscopic examination revealed left vocal cord paralysis. Chest computed tomography (CT) showed a 3.0 x 2.0 cm well circumscribed tumor at the left side of the trachea in the left upper mediastinum. As hoarseness was suspected to be attributable to the mediastinal tumor, tumor resection was performed. It was found that the tumor involved the left recurrent nerve. The tumor was completely excised with combined resection of the left recurrent nerve. Histopathologically, the tumor consisted of cells with eosinophilic granules and S-100 protein positive materials in the cytoplasm, and diagnosed a granular cell tumor.     

Intrathoracic tumors arising from the vagus nerve. Review of resected tumors in Japan

Nineteen surgically treated intrathoracic vagus nerve tumors (16 neurilemmomas, 3 neurofibromas), including three treated by the authors, were reviewed. Tumor resection with vagus nerve amputation was performed in 14 and intracapsular excision without nerve amputation in 3 of the 17 adequately recorded cases. The location of vagus nerve tumor was the left upper mediastinum in 11 patients, almost all of whom were hoarse postoperatively due to sacrifice of the recurrent laryngeal nerve.     

A case of schwannoma of intrathoracic right phrenic nerve

A 22-year old man was admitted because of an abnormal shadow on his chest X-ray film. Radiographic findings revealed that the tumor was located in the right middle mediastinum. At operation a smooth round tumor was found arising from the right phrenic nerve. The tumor was removed with phrenic nerve. Pathohistological examination revealed this tumor was benign schwannoma. Intrathoracic schwannoma usually arise from intercostal and sympathetic nerve and that arising from phrenic nerve is very rare. We removed the tumor by means of cutting his right phrenic nerve because of complete resection. Postoperatively he did well without any respiratory distress. And his respiratory function studies recovered normal 9 months after the operation. We think that schwannoma arising from phrenic nerve should be removed completely and in such a case cutting of the one side phrenic nerve is at ease if the patient have normal respiratory function.     

The superior mediastinum

The mediastinum is the area of the thorax that lies between the two pleural sacs. It is further divided by an imaginary line passing from the manubriosternal junction (angle of Louis) in front and the T4/T5 vertebral junction behind into a superior and inferior compartment. The inferior mediastinum contains the heart, within its pericardial sac, together with the descending aorta and lower oesophagus. The contents of the superior mediastinum comprise the retrosternal structures, the remnant of thymus and the great veins. These are made up as follows: the right and left brachiocephalic veins form from the internal jugular/subclavian junction behind each sternoclavicular joint. The right passes directly downwards; the left passes obliquely to join the right at the level of the first right costomanubrial junction to form the superior vena cava. This is joined by the vena azygos and drains into the right atrium. Posteriorly, the superior mediastinum contains the trachea (the right vagus descends on its right border). The trachea itself lies immediately in front of the oesophagus, which lies on the bodies of T1–T4. The left recurrent laryngeal nerve lies in the tracheo-oesophageal groove on its left side, while the thoracic duct lies on the left of the oesophagus. The aortic arch commences from the ascending aorta and arches posterolaterally to the left over the pulmonary trunk and left pulmonary artery. It is crossed by the left phrenic nerve and the left vagus nerve. The latter gives off the left recurrent laryngeal nerve. The aortic arch gives off from its upper margin the brachiocephalic, left common carotid and left subclavian arteries. These do not give off branches until they have left the thorax.     

Schwannoma of the vagus nerve, a rare middle mediastinal neurogenic tumor: case report

Schwannoma originating from the vagus nerve within the mediastinum is a rare, usually benign tumor. A 44-year old male was presented with chest pain. Chest radiography, CT scan and MRI showed a well circumscribed mass, 5 × 4 cm located in the aortopulmonary window. The mass was found at surgery to be in close proximity with the aortic arch and the left pulmonary hilum, alongside the left vagus nerve. The encapsulated tumor was completely resected through a left thoracotomy incision and it was found to be a benign schwannoma in pathology. The patient is free of recurrence 6 years after surgery.     

A case of invasive thymoma with retroperitoneal recurrence]

A case of invasive thymoma with retroperitoneal recurrence is reported. A 55-year-old man with invasive thymoma (Masaokas classification, Stage IVa) underwent thymo-thymectomy, partial resection of left upper lobe, resection of phrenic nerve and partial resection of parietal pleura on March 14, 1989. Histological findings revealed thymoma with predominantly lymphocytic type. Two years after the operation, the tumor of retroperitoneal recurrence was discovered in abdominal CT. This retroperitoneal tumor was huge in size (16 x 12 cm) and extended into posterior mediastinum via aortic hiatus. The patient underwent resection of tumor through thoracotomy and laparotomy on April 23, 1991, after two cycles of chemotherapy. Histological findings revealed thymoma with predominantly lymphocytic type. This case was rare among patients with recurrence of thymoma as far as the site of recurrence is concerned.     

Successful resection of mediastinal and abdominal recurrent tumors of esophageal leiomyosarcoma 12 years after surgery

A 57-year-old woman admitted to our hospital in October, 1988 because of the tumor of the abdominal wall and abnormal shadows of right chest wall and right upper mediastinum. Her esophagus had been resected and reconstructed by the stomach roll because of the esophageal leiomyosarcoma in May, 1976. Clinical examinations revealed that the abdominal mass and chest shadows were the recurrence of the leiomyosarcoma. The abdominal tumor was resected on 17th October, 1988. On 14th December, 1988 right thoracotomy was performed. Chest wall tumor (40 x 30 x 20 mm) and mediastinal tumor (45 x 40 x 35 mm) were resected completely. The mediastinal tumor was adhered to the remnant esophageal muscle layer. Microscopic section of the tumor showed spindle cell sarcoma with fine calcification, and it was diagnosed as the metastatic leiomyosarcoma.     

Long-term survival after removal of a malignant peripheral nerve sheath tumor originating in the anterior mediastinum

Malignant peripheral nerve sheath tumors (MPNSTs; malignant schwannomas) rarely occur in the anterior mediastinum, and their prognosis is poor. A 75-year-old man was referred to our hospital for examination of an anterior mediastinal tumor. A computed tomography-guided percutaneous needle biopsy revealed only fibrosis. The tumor was completely excised via a median sternotomy with partial resection of the pericardium and right upper lobe of the lung. Thereafter, the tumor was diagnosed as a storiform-pleomorphic type of malignant fibrous histiocytoma. At 1 year after the surgery, a distant metastasis was found in the interlobular space between the right middle and lower lobes. The tumor was completely excised via a right posterolateral thoracotomy. Reexamination of the primary and secondary tumors revealed an MPNST. No recurrence was found up to 5 years after the second surgery without adjuvant chemotherapy or radiation therapy. However, he died from multiple lung metastases after 6 years.     

Use of uniportal video-assisted thoracic surgery combined with a posterior approach to resect a dumbbell-shaped mediastinal granular cell tumor: A case report

IntroductionA dumbbell-shaped mediastinal granular cell tumor has never been reported, and there have been no reports of dumbbell-shaped tumors resected with a combination of uniportal video-assisted thoracic surgery and the posterior approach.Presentation of caseAn 18-year-old woman was diagnosed with a mediastinal dumbbell-shaped granular cell tumor by computed tomography. Complete resection was achieved via a posterior approach combined with the uniportal video-assisted thoracic surgery. First, a T3 left hemilaminectomy was performed in the prone position and the tumor located inside the intervertebral foramen was removed as far as possible. Next, the patient was repositioned to the right lateral decubitus position, a 2.5-cm skin incision was made on the 4th intercostal posterior axillary line, and resection of the residual tumor was performed. Pathological diagnosis of the resected tumor revealed a benign granular cell tumor. The patient recovered post-surgery and no tumor was reported in the 4-month follow-up magnetic resonance imaging.DiscussionThis is the first reported case of a mediastinal dumbbell-shaped granular cell tumor and its successful resection using a combined posterior and uniportal video-assisted thoracic surgery approach.ConclusionThis is a potentially safe and effective procedure for mediastinal granular cell tumors, with outstanding cosmetic advantages.     

Multiple schwannomas of the bilateral mediastinal vagus nerves

Multiple schwannomas arising from the mediastinal vagus nerve are very rare, but herein we report a case with such lesions involving the bilateral intrathoracic vagus nerves. A 43-year-old man presented with multiple mediastinal tumors during a check-up. A chest computed tomographic scan revealed multiple lesions that appeared strung together like beads along the right vagus nerve. Three small tumors were also evident on the left side of the esophagus. We performed a complete resection of the bilateral mediastinal tumors through right thoracoscopic surgery. The pathologic diagnosis for each of these tumors was a schwannoma without malignant components.     

Posterior mediastinal paraganglioma with a 60-year history; report of a case

We report a case of a 68-year-old man with a posterior mediastinal tumor. He remembered having difficulty in food passage through his esophagus in childhood. The preoperative thoracic computed tomography (CT) revealed a 5 x 3 cm mass with strong enhancement in the posterior mediastinum. A right thoracotomy was performed to resect this indeterminate mass. Complete resection was achieved. The pathologic diagnosis was paraganglioma. Postoperatively, he experienced more comfortable food passage through his esophagus than ever before. There has been no sign of recurrence 3 years after the operation. The tumor was clinically diagnosed as benign paraganglioma because of its long silent course.     

Benign mesenchymoma of the mediastinum.

We report our recent experience of a rare case of a benign mesenchymoma in the mediastinum. A 24-year-old man was admitted to our hospital with an abnormal shadow on chest X-ray. A chest computerized tomography scan and magnetic resonance imaging showed an anterior mediastinal mass along the right border of the pericardium. The tumor was surgically resected. It was yellow on the surface, 12.5 x 10.0 x 3.8 cm in size, and 230 g in weight. The histopathological diagnosis was a benign mesenchymoma. The postoperative course was uneventful. A search of the literature revealed that a benign mesenchymoma in the mediastinum is extremely rare. It seems to be difficult to reach a definitive diagnosis preoperatively. Surgical resection can confirm the diagnosis, and is curative.     

A case of schwannoma of the intrathoracic vagus nerve]

A 42-year-old female was noted to have a mediastinal mass on routine chest roentgenogram. She was asymptomatic and physical examination was unremarkable. Computed tomography of the chest confirmed the presence of a 3.5 cm well circumscribed mass in the middle mediastinum adjacent to the aortic arch. Operation was performed. A solitary middle mediastinal tumor was readily apparent at the aortic arch to the left subclavian artery, originating from the vagus nerve superior to the take-off of the recurrent laryngeal nerve. Excision was possible by enucleation of the mass. The postoperative period was uneventful, although there was paralysis of the left vocal cord as evidenced by hoarseness. Histologically the diagnosis of a schwannoma of the vagus nerve was made.     

An intrathoracic vagus nerve schwannoma invading the trachea

A patient with a schwannoma of the intrathoracic vagus nerve is presented. The tumor invaded the trachea and caused dyspnea. It was successfully excised by a segmental resection of the trachea with end-to-end anastomosis. This instance of an intrathoracic vagus tumor invading the trachea is, as far as we know, the first reported in the world.     

Neurogenic tumors of the cervical vagus nerve: report of four cases and review of the literature

OBJECTIVE AND IMPORTANCE: Nerve sheath tumors arising from the cervical vagus nerve are extremely rare. These tumors most often present as asymptomatic, slowly enlarging, lateral neck masses and therefore often come initially to the attention of otolaryngologists and general surgeons. Because they are nerve tumors, however, neurosurgeons must be able to recognize and treat these rare entities. We report three cases of schwannoma and one case of neurofibroma of the cervical vagus nerve that were encountered at our center (Louisiana State University Medical Center) during a 31-year period. CLINICAL PRESENTATION: The patients ranged from 31 to 61 years of age at the time of presentation to Louisiana State University Medical Center. Presenting complaints included hoarseness, Horner's syndrome, and palpation of an enlarging, asymptomatic, cervical mass. Reviews of systems revealed episodes of aspiration for one patient and frequent respiratory illnesses for two patients. These episodes were possibly related to their tumors. Imaging studies demonstrated well-circumscribed masses in the region of the carotid sheath. INTERVENTION: Using microsurgical techniques, gross total resection of all four tumors was accomplished. For one patient, the vagus nerve needed to be divided and an end-to-end anastomosis was performed. For the other three patients, resection of the tumor was achieved with the vagus nerve in continuity. CONCLUSION: Vagal nerve schwannomas and neurofibromas in the neck are rare neoplasms. We present four cases of these benign tumors. The pathological features, epidemiological characteristics, presentation, differential diagnosis, and management are discussed. Gross total resection with preservation of the vagus nerve remains the treatment of choice.     

A resected case of thymolipoma]

We reported a resected case of thymolipoma, which has been hardly experienced. The patient was 21-year-old female and consulted a doctor for general fatigue. Chest roentgenogram revealed a mass-like shadow at the right lower mediastinum, which was suspected mediastinal tumor. The mass of right anteroinferior mediastinum, which was clearly shown by chest CT scan and MRI, was continued to the right lobe of the thymus. Under a diagnosis of anterior mediastinal tumor, operation was carried out. The tumor, which was 10 x 8 x 7 cm in diameter and 160 g in weight, was removed together with right lobe of the thymus. Histological diagnosis of thymolipoma was obtained from the resected specimen.     

Giant primary liposarcoma of the chest

Liposarcomas are the most common soft tissue sarcomas in adults, although liposarcomas of the chest are uncommon. We report two cases of giant liposarcoma in the mediastinum and chest wall, respectively. An 82-year-old man presented with a mass in the right upper mediastinum, as seen by computed tomography (CT). He had a past history of subcutaneous lipoma resection on his back (19 years previously). The patient underwent tumor resection with a right thoracotomy. A 58-year-old woman presented with an enlarging mass of the right lateral chest, involving the diaphragm and ribs, as seen by CT. She had a past history of subcutaneous lipoma resection of the right chest (18 years previously). The patient underwent an en bloc resection that included the tumor and a part of the right diaphragm and ribs. Histological examination of both patients’ tumors revealed a well-differentiated liposarcoma, with no pathological relation to the previous lipoma resected in either case.     

Mucinous adenocarcinoma of the anterior mediastinum

The authors report are a rare case of primary mucinous adenocarcinoma of the anterior mediastinum in a 34-year-old Japanese woman. Routine chest radiography revealed an abnormal mass lesion in the left upper mediastinum. Her serum CA 19-9 level was elevated at 299 (normal < 37) U/ml. The large tumor in the anterior mediastinum, 8 cm in diameter, were made of multicystic part with thick wall and thick spetrum and solid part in chest computed tomography (CT). Teratoma was suggested by percutaneous needle biopsy under CT scanning. When the chest was opened through a median sternotomy, adding a left collar incision, we found a hard tumor occupying the superior anterior mediastinum and then resected the tumor together with the left brachiocephalic vein, the left pleura, the pericardium and the left phrenic nerve because of invaded them. Grossly, the tumor was 13 x 10 x 8 cm and weighted 400 g. Pathologic diagnosis was mucinous adenocarcinoma of the anterior mediastinum. No primary cancer lesions were found in pancreas, ovarium, gastrointestinal tract and mammary gland. Microscopic examination showed minimal atypia site in mucinous adenocarcinoma and normal thymic tissues surrounding this tumor. These findings have led this case to conclude the primary tumor of thymus.     

Lymph node metastasis and the recurrence of esophageal carcinoma with emphasis on lymphadenectomy in the neck and superior mediastinum

A series of 335 patients with squamous cell carcinoma of the thoracic esophagus undergoing resection and reconstruction via a right thoracotomy and laparotomy with cervical anastomosis between 1973 and 1990, were reviewed. Prior to 1982, the removal of lymph nodes was limited to the nodes in the mediastinum below the tracheal bifurcation and upper abdomen (142 patients). Nodal metastases were found in 89 of these patients at operation. The upper abdominal nodes were the most frequent sites of metastasis (47.2%). None of the 38 patients with positive nodes sampled from the neck and superior mediastinum survived for more than 45 months. In the 50 patients with recurrences, 30 were in the neck and/or superior mediastinum. During or after 1983, the superior mediastinal nodes, particularly the bilateral recurrent nerve nodal chains, were routinely removed (193 patients). Nodal metastasis was proven in 131 of the 193 patients, in whom 87 (45.1%) had metastasis in the neck and superior mediastinum. Eleven of these 87 patients survived for 45 months or more. In the 61 patients with recurrences, 20 were in the neck and/or superior mediastinum. These data suggest that recurrent nerve nodal chains should be removed to improve survival in patients with esophageal carcinoma.     

肾透明细胞癌骨化一例报告并文献复习

目的 探讨肾癌钙化骨化的发病机理、病理特点、鉴别诊断及预后. 方法 患者,男,48岁.因体检发现右肾钙化性占位2周人院.CT示右肾外形不规则,肾上极町见一类圆形占位性病变,伴明显骨化.PET-CT检查示右肾上极类圆形肿块,明显钙化,不伴有高功能性,考虑良性病变.术前拟诊断为肾癌,取右侧腹直肌旁切口行右肾探查术. 结果 术中见右肾中上极7.5 cmX5.0cm肿块,质硬如石,肾门周围未见肿大淋巴结,行右肾部分切除,术中冰冻病理提示肾透明细胞癌伴明显骨化,即行根治性肾切除加肾门周围淋巴组织清扫.术后病理报告:肾透明细胞癌伴广泛骨化纤维化,输尿管残端、血管残端及肾周组织未见癌组织浸润,未见转移淋巴结.术后随访8个月未见复发转移. 结论 肾癌骨化较少见,肾实质性占位伴明显钙化骨化术前应按恶性肿瘤对待,肾癌骨化预后相对较好.