Intrathoracic schwannoma originating from intrathoracic vagus nerve

Abstract

In differential diagnosis of posterior mediastinal mass should be included the intrathoracic vagus nerve tumor. Surgical excision of intrathoracic vagus nerve schwannoma is associated with a low recurrence rate and excellent long‐term results. Benign schwannoma from intrathoracic vagus nerve should be included in differential diagnosis of posterior mediastinal tumors. Surgical excision of intrathoracic vagus nerve schwannoma is associated with a low recurrence rate and excellent long‐term results

Full text

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Clin Case Rep. 2020;8:3582–3584.
wileyonlinelibrary.com/journal/ccr3
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INTRODUCTION
A 60-year-old woman was referred to our hospital with a me-
diastinal mass in magnetic resonance images. The mediasti-
num tumor was surrounded by left atrium, descending aorta,
esophagus, and left inferior pulmonary vein. The tumor was
resected through the left lateral thoracotomy, and diagnosis
was benign schwannoma of left vagus nerve.
A 60-year-old woman was referred to our hospital with
a mediastinal mass in magnetic resonance images (MRI).
The patient was asymptomatic. Chest MRI as well as chest
computed tomography (CT) scan was revealed a well-cir-
cumscribed mass with smooth and clear margins without
calcification. The tumor was located in the posterior medi-
astinal compartment (Figure1A, B). The patient underwent
a left standard posterolateral thoracotomy via the 5th inter-
costals space. The tumor was resected with the sparing of
left vagal trunk, and the maximal diameter of tumor was
3.5cm (Figure2A-D). Pathological diagnosis was benign
schwannoma (Figure3). The postoperative period was un-
eventful, and the patient was discharged at home on day 5
post-op and she was free from a recurrence at 1-year fol-
low-up. Neurogenic tumor frequency is 20% of all adult
mediastinal neoplasms.1 The neurogenic tumors are usu-
ally localized in the posterior mediastinum (costo-vertebral
angle) and as they grow, it spread on lateral surface of the
spine and the initial parts of the ribs. Unusual locations of
neurogenic tumors are a phrenic nerve or one of the vagus
nerves. MRI is helpful for determination of the tumor origi-
nating. Surgical excision of schwannoma is associated with
a low recurrence rate and excellent long-term results.2
Received: 16 May 2020
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Revised: 28 July 2020
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Accepted: 11 August 2020
DOI: 10.1002/ccr3.3287
CLINICAL IMAGE
Intrathoracic schwannoma originating from intrathoracic vagus
nerve
GeorgeSamanidis1,2
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MeletiosKanakis3
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LoukasKaklamanis4
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Despina N.Perrea2
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium,
provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd
1Department of Adult Cardiac Surgery,
Onassis Cardiac Surgery Center, Athens,
Greece
2Laboratory of Experimental Surgery and
Surgical Research “N.S Christeas”, Athens
Medical School, National and Kapodistrian
University of Athens, Athens, Greece
3Department of Pediatric and Congenital
Heart Surgery, Onassis Cardiac Surgery
Center, Athens, Greece
4Department of Pathology, Onassis Cardiac
Surgery Center, Athens, Greece
Correspondence
George Samanidis, Onassis Cardiac Surgery
Center, 356 Leoforos Syggrou, 17674,
Athens, Greece.
Email: gsamanidis@yahoo.gr
Abstract
In differential diagnosis of posterior mediastinal mass should be included the intratho-
racic vagus nerve tumor. Surgical excision of intrathoracic vagus nerve schwannoma
is associated with a low recurrence rate and excellent long-term results.
KEYWORDS
mediastinum, neurilemmoma, schwannoma, vagus nerve

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FIGURE 1 A well-circumscribed mass with smooth margin which located in the visceral mediastinal compartment (with black arrow) in the
chest computed tomography scan (A) and with white arrow in the chest magnetic resonance images (B)
FIGURE 2 Intra-operative views. A,
The tumor (black arrow) located between
the left atrium, the descending aorta, the
esophagus, and the left inferior pulmonary
vein. B, Sparing left vagal nerve (black
arrow) after tumor resection and esophagus
(white arrow). C and D, Resected tumor
(A) (C)
(B) (D)

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ACKNOWLEDGMENTS
All authors contributed equally in carrying out the medical
literature and writing the manuscript. Published with written
consent of the patient.
CONFLICT OF INTEREST
None declared.
AUTHOR CONTRIBUTIONS
GS: involved in medical literature search, wrote the origi-
nal draft and revised the draft, and reviewed and edited the
draft. MK: involved in medical literature search, wrote the
original draft and revised the draft, and reviewed the draft.
LK: performed pathological diagnosis. DP: supervised the
draft.
ETHICAL APPROVAL
Informed consent was obtained from the patient.
ORCID
George Samanidis https://orcid.
org/0000-0001-6355-1932
Meletios Kanakis https://orcid.
org/0000-0002-9708-0523
REFERENCES
1. Huang TW, Yang MH, Cheng YL, Tsai WC, Lee SC. Vagus nerve
schwannoma in the middle mediastinum. Thorac Cardiovasc Surg.
2010;58:312-314.
2. Eguchi T, Yoshida K, Kobayashi N, et al. Multiple schwanno-
mas of the bilateral mediastinal vagus nerves. Ann Thorac Surg.
2011;91:1280-1281.
How to cite this article: Samanidis G, Kanakis M,
Kaklamanis L, Perrea DN. Intrathoracic schwannoma
originating from intrathoracic vagus nerve. Clin Case
Rep. 2020;8:3582–3584. https://doi.org/10.1002/
ccr3.3287
FIGURE 3 Fascicle of spindle cell without features of cytological
atypia or necrosis