[Surgical excision of a giant schwannoma located in the posterior mediastinum and partially in the retroperitoneum].

A characteristics of mediastinal disorders is that the high anatomical density of vital structures in this region represents a challenge for diagnosis and surgical treatment. Space-occupying lesions can grow without causing overt manifestations - or can progress symptom-free - hence they can reach an extreme size by the time of surgery. A 58-year-old male patient was hospitalized for pleural effusion and an extensive, space-occupying mediastinal lesion, which had been causing respiratory symptoms for 15 years. Cytology of the pleural effusion did not confirm malignancy. The CT scan depicted progression manifested as an increase in the size of the lesion with a likely site of origin in the left adrenal gland. According to the MRI, by contrast, the lesion might have originated in the region of vertebrae Th, as suggested by the lack of dural continuity. However, its adrenal origin could not be excluded either; endocrine activity was not detected. An operation was performed with a neurosurgeon included in the surgical team. A spinal tumor of the size of 20.2 by 11.1 by 10.8 cm was removed through thoraco-laparotomy, and reconstruction of the diaphragm was performed. Histology confirmed a schwannoma. Postoperatively, the expansion of the lung was only partial, because the patient discontinued respiratory rehabilitation. The follow-up CT scan depicted local recurrence. In the lack of alternative therapeutic modalities, surgical resection is usually the sole option for the management of large, mediastinal space-occupying lesions diagnosed at an advanced stage. Such operations should only be performed in specialist surgical centers and with multidisciplinary collaboration. Orv Hetil. 2019; 160(37): 1476-1479.