Resection of a mediastinal schwannoma using video-assisted thoracoscopy

Surgical treatment of a cystic neoplasm of the posterior mediastinum: Case report and literature review

INTRODUCTION AND IMPORTANCE

The study presents a clinical case of removal of a paravertebral tumour by thoracoscopic method and a review of the literature on the diagnosis and treatment of posterior mediastinal tumours.

CASE PRESENTATION

A 26-year-old female patient presented with an extradural, paravertebral posterior mediastinal tumour and complaints of low back pain. The mass was diagnosed by computer tomography (CT) and magnetic resonance imaging (MRI). The mass was mobilised from the adjacent vital structures without rupturing the capsule by thoracoscopic approach. The histological examination of the extracted mass was diagnosed as a bronchogenic cyst.

CLINICAL DISCUSSION

Thoracoscopic surgery provides sufficient volume in the mediastinum to perform instrument manipulations with minimal damage to adjacent structures and meets oncological criteria.

CONCLUSION

Thoracoscopic surgery of posterior mediastinal tumours demonstrates clinically significant benefits and treatment efficacy compared to open surgery, and is characterised by a low incidence of postoperative complications, short surgery duration, rapid postoperative recovery and better cosmetic effect.

Giant solitary ancient schwannoma of the pleura masquerading as bronchopneumonia

We report a 53-year-old female who presented with complaints of sudden onset breathlessness, cough with expectoration for 6 months, and a right lung base lesion in the chest X-ray, which was diagnosed and treated as bronchopneumonia by the family physician. High-resolution computed tomography of the chest was done which revealed a large heterogeneously enhancing mass in the right thoracic cavity. She underwent thoracotomy and was found to have a giant encapsulated and well-circumscribed mass arising from the pleura. Excision biopsy of the mass revealed it to be an ancient schwannoma. Ancient schwannoma of the pleura is a very rare entity. Complete surgical resection is curative.

Videothoracoscopy in the treatment of benign neurogenic tumours of the posterior mediastinum

Introduction

The indications for videothoracoscopy are very broad and include the treatment of mediastinal tumours.

Aim

To present our experience of using the minimally invasive technique in treating benign neurogenic tumours.

Material and methods

Twenty-two patients were treated due to tumours of the posterior mediastinum from 2003 to 2012. The size of the tumours ranged from 2 cm to 25 cm. Tumours up to the size of 6 cm were treated using videothoracoscopy (VT), bigger ones through thoracotomy.

Results

The videothoracoscopy technique was used in 17 patients, thoracotomy in 5. In 2 cases conversion was required due to adhesions in the pleural cavity preventing VT treatment. Complications related to the procedure were not observed. The average time of hospital stay after VT treatment was 4 days, while after thoracotomy it was 6 days. Histologically, tumours of benign nature were found in all cases. Schwannoma was diagnosed in 15 patients, ganglioneuroma in 3 patients, neurofibroma in 3 patients, and chemodectoma in 1 patient. None of the 3 cases of neurofibroma was associated with Recklinghausen's disease. At a mean follow-up of 60 months no recurrence of the tumour was found.

Conclusions

In the case of tumours up to 6 cm the best surgical technique is videothoracoscopy. In the case of large tumours the best access is the open technique. The minimally invasive technique allows one to shorten the patient's treatment time, reduce postoperative pain and obtain a good cosmetic effect of the treatment.