Neurogenic tumors of the posterior mediastinum
Clinica de Chirurgie Toracica, Institutul Oncologic Prof. Dr. Alexandru Trestioreanu, U.M.E Carol Davila Bucureşti, România.Chirurgia (Bucharest, Romania: 1990) (Impact Factor: 0.78). 03/2011; 106(2):199-203.
The posterior mediastinum is the potential space along each side of the vertebral column and adjacent proximal portions of the ribs--the paravertebral sulci. From the posterior mediastinal tumors, the most commonly encountered are the neurogenic tumors (75%), the remaining 25% are represented by a heterogenous group of rare tumors including teratoma, lymphoma, sarcoma and other lesions arising outside the mediastinum and projecting into the posterior compartment. Surgical excision, by thoracotomy or miniinvasive techniques, is the first line of treatment in the posterior mediastinal tumors. Tumors with extension into the spinal canal (dumbbell tumors), accounting for nearly 10% of the posterior mediastinal tumors, require a multidisciplinary approach: thoracic surgeon and neurosurgeon. We present the experience of the "Carol Davila" University of Medicine and Pharmacy Thoracic Surgery Clinic in the surgery of neurogenic posterior mediastinal tumors throughout a 9 year period (2001 - 2010). 42 cases admitted and operated in this period are being analysed.
Article: Thoracic Neurogenic Tumours[Show abstract] [Hide abstract]
ABSTRACT: Summary Intrathoracic neurogenic tumours are neoplasms arising from any of the neurogenic elements of the mediastinum. Schwannomas and neurofibromas develop from nerve sheath, ganglioneuromas and neuroblastomas from autonomic ganglions. The aim of in this study we present the clinical and pathological details of these patients and to determine only extending the mediastinum. Materials and methods: We reached retrospective clinical data of 16 patients (10 males and 6 females) with neurogenic tumours of the mediastinum undergoing surgical treatment 2008 to 2012. Age of the patients ranged from 5 to 66 years (mean 46 years). When the patients admitted our clinic to surgery. All patients had detailed history and physical examination, routine chest radiography, electrocardiography and standard laboratory blood tests. For localizations and to define the nature of the tumour whole the patients were performed computed tomographic (CT). Especially when we suspected involvement of intervertebral space and vascular space magnetic resonance imaging. Results: Preoperative symptoms were observed in 13 cases (%81), as follows: back and thoracic pain in 10 (%63), short of breathness in 3 (%19) patient.The preoperative CT showed the tumour as a solid lesion in 16 cases. The tumour was located on the posterior mediastinum in 10 (%63) patients and cases.2 (%13) patients upper mediastinum and 4 (%25) patients from thoracic wall. The histological type of the tumours was in 3 (%19) cases, ganglioneuroma, in 3 (%19) cases benign neurofibroma, in 9 (%56) cases schwannomas. 1 (%6) case originated from malignant peripheral nerve sheet tumour (MPNST). Complete surgical excision was achieved in all patients, with no postoperative mortality. There was no significant intraoperative and postoperative blood loss and no major surgical complications occurred. Conclusions: After the surgical indications may be carefully determined in cases. There is a good result in these tumours. MRI would facilitate therapeutic determination by distinguishing nature, spread and invasion of the neurogenic tumour. Patient with benign neurogenic tumours have a good survival prospect following operations.
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ABSTRACT: A 54-year-old man was admitted to our hospital for left chest pain. Imaging studies (chest radiography, computed tomography, and magnetic nuclear resonance imaging) showed a well-defined left paraspinal mass with central necrosis (6 × 5 × 4 cm), located between T7 and T9. Urine levels of metanephrine and normetanephrine were within normal limits. The patient underwent a complete resection of the tumor through a posterolateral thoracotomy. Perioperative vital signs were normal. The diagnosis of paraganglioma was confirmed histologically. The patient was discharged on the 3rd postoperative day. Radiological imaging studies revealed no signs of recurrence during the 18-month postoperative follow-up.
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ABSTRACT: This work describes clinical development of a sarcoma in the left axilla of a 36-year-old woman. The macroscopic picture changed from the initial inflammatory reddening to globular resistance of 2.5 cm, suggestive of an enlarged lymph node. Mammography did not reveal any associated breast disease. Colliquation found on the ultrasound images led to a biopsy, the result of which indicated only an inflammation, without any malignancy. Rapid growth of the axillar tumor to 10 cm in size within 8 weeks prompted surgery allowing proper diagnosis of a small mature-to-immature sarcoma. Special examinations performed by a histopathologist (at the Institute for Histopathology) could not establish the precise histogenesis, i.e. the tissue origin. Therefore it was necessary to remove any clinically obscuring tumor for the final proper histological diagnosis and adequate treatment of the patient.
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