Szewczyk Joanne B, Hachey Krista, Rey Jorge, Nguyen Dao M, Villamizar Nestor R
Thoracic Surgery Section, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA.
Division of Vascular Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA.
Mediastinum. 2021 Dec 25;5:37. doi: 10.21037/med-20-71. eCollection 2021.
The most common posterior mediastinal masses are neurogenic tumors such as peripheral nerve sheath tumors (PNST). Schwannomas, a subtype of PNST, are most often benign, well encapsulated tumors of neural crest cell origin, and are frequently incidentally found, ranging in size from small asymptomatic mediastinal tumors to large masses. Rarely, large schwannomas are discovered when symptoms develop due to compression or involvement of nearby structures leading to an array of possible sequela which can include, but not limited to, persistent cough, hemoptysis, and dysphagia. Management decisions are based off of tumor size, location, concern for underlying malignant pathology, and potential for complications related to tumor invasion of vital anatomical structures. A majority of the schwannomas undergo surgical resection, though a subset of small, asymptomatic, benign tumors on imaging or pathology may be managed with surveillance. This case report describes a large posterior mediastinal schwannoma adherent to the posterior aortic arch and encasing the left subclavian and vertebral arteries. Surgical resection required vascular resection of a segment of the left subclavian artery and graft reconstruction using polytetrafluoroethylene (PTFE). This report further highlights the importance of preoperative planning with consideration of a multidisciplinary approach in preparation for resection of large, complex posterior mediastinal masses.
后纵隔最常见的肿块是神经源性肿瘤，如周围神经鞘瘤（PNST）。施万细胞瘤是PNST的一种亚型，通常是起源于神经嵴细胞的良性、包膜完整的肿瘤，常为偶然发现，大小从小的无症状纵隔肿瘤到巨大肿块不等。很少有大的施万细胞瘤在因压迫或累及附近结构而出现症状时被发现，这会导致一系列可能的后遗症，包括但不限于持续性咳嗽、咯血和吞咽困难。治疗决策基于肿瘤大小、位置、对潜在恶性病理的担忧以及与肿瘤侵犯重要解剖结构相关的并发症可能性。大多数施万细胞瘤需接受手术切除，不过影像学或病理学检查显示的一部分小的、无症状的良性肿瘤可通过观察来处理。本病例报告描述了一例附着于主动脉弓后方并包绕左锁骨下动脉和椎动脉的巨大后纵隔施万细胞瘤。手术切除需要切除一段左锁骨下动脉并使用聚四氟乙烯（PTFE）进行血管移植重建。本报告进一步强调了术前规划的重要性，即在准备切除巨大、复杂的后纵隔肿块时应考虑采用多学科方法。
