Intrathoracic tumors of the vagus nerve

Robotic resection of mediastinal left vagus neurofibroma

A Correction has been published | View Neurogenic tumors represent 10 to 34% of all mediastinal tumors and among them, neurofibroma originating from the vagus nerve are rare entities. We present a case of a neurofibroma with cystic degeneration originating from the left branch of the vagus nerve in a 27-year-old man without von Recklinghausen disease. A complete robotic resection of the mediastinal mass has been performed, with amputation of the vagus nerve enclosed in the mass. The postoperative course was uneventful and the patient was discharged in two days.

A rare case of bilateral cervical vagal neurofibromas: role of high-resolution ultrasound

Background

Neurofibromas originating from vagus nerves are rarely reported in the literature. In particular, plexiform neurofibromas of the bilateral cervical vagus nerve are extremely rare.

Case presentation

A 21-year-old female presented with a 2-year history of swelling on the right side of her neck. Physical examination revealed a soft-tissue mass on the right side of her neck. Ultrasonography (US) and magnetic resonance (MR) imaging showed a tumor centered in the right carotid sheath between the internal jugular vein and the common carotid artery. In addition, a similar nodular mass in the left carotid sheath was detected on US. The right mass was surgically resected; histopathological examination revealed a neurofibroma.

Conclusions

US can be a valuable method for preoperative evaluation of cervical mass, as it is capable of displaying the vagus nerve and provides sufficient diagnostic information. The cervical vagal neurofibroma can manifest as solitary or multifocal lesion. Bilateral neurofibromas are usually associated with neurofibromatosis type 1 (NF1). Early diagnosis and prompt surgical treatment should be considered.

Large Cervical Vagus Nerve Tumor in a Patient with Neurofibromatosis Type 1 Treated with Gross Total Resection: Case Report and Review of the Literature

Neurofibromas are benign peripheral nerve sheath tumors that occur commonly in individuals with neurocutaneous disorders such as neurofibromatosis type 1. Vagal nerve neurofibromas, however, are a relatively rare occurrence. We present the case of a 22-year-old man with neurofibromatosis type 1 with a neurofibroma of the left cervical vagal nerve. The mass was resected through an anterior approach without major event. In the postoperative course, the patient developed left vocal cord paralysis treated with medialization with injectable gel. We then present a comprehensive review of the literature for surgical resection of vagal nerve neurofibromas.

Chest wall schwannoma presenting as a solitary malignant lesion: a case report

Background

Chest wall schwannomas are rare tumors arising from the intercostals nerves. Schwannomas are lobulated, encapsulated spherical masses, different from neurofibromas in that matter. Men and women are equally affected in their third and fourth decades.

Case presentation

A 42 year old female presented with a 6 month history of progressively worsening pain over the right shoulder and chest wall, aggravated by movement and with associated right arm oedema and paraesthesia. She believed mild symptoms began 2 years prior to presentation. The histopathological examination revealed a benign lesion; a schwannoma with degenerative changes. The section revealed a benign nerve sheath tumor characterized by a proliferation of band spindle cells arranged in fascicles and variable cellularity and associated with dilated and think walled blood vessels.

Conclusion

Chest wall schwannomas are rare; they mimic chest wall malignant lesions.

Mechanical Ptosis in Neurofibromatosis Type 1 Heralding the Diagnosis of Right Sided Cervical Vagus Nerve Neurofibroma: A Rare Case Report

Neurofibromatosis type 1 (NF1) is an autosomal dominant, multisystem disorder. In NF1, involvement of vagus nerve can occur in the form of neurofibroma. A few cases of neurofibroma of thoracic vagus nerve have been reported while neurofibroma of cervical vagus nerve with NF1 is quite rare. A 19-year-old male came with complaints of decreased vision of both eyes and right sided drooping of eyelid since childhood. He was diagnosed as having NF1 with neurofibroma of right cervical vagus nerve.

Giant cystic schwannoma of the middle mediastinum with cervical extension

Schwannomas (neurilemmomas) are benign tumors arising from the Schwann cells of the neural sheath. They are typically, well-encapsulated lesions which rarely adhere to the adjacent structures. In the chest, schwannomas are often seen within the posterior mediastinum and commonly originating along intercostal nerves. Several operative approaches have previously been described for the resection of these tumors, including thoracoscopic techniques and posterolateral thoracotomy. We report in this case a giant cystic mediastinal schwannoma of the left recurrent laryngeal nerve with cervical extension, unresectable by the usual described approaches, which was completely removed through a cervical approach.

Mediastinal Neurofibroma Originating from the Pulmonary Branch of the Right Vagus Nerve in a Patient without von Recklinghausen Disease

Intrathoracic neurofibromas originating from the vagus nerve in patients without von Recklinghausen disease is rare and poses a problem in etiological diagnosis. Surgical resection is usually necessary for precise diagnosis of such tumors. We report the first case of a neurofibroma originating from the right pulmonary branch of the vagus nerve in a 34-year-old male without von Recklinghausen disease. The diagnosis was suggested by the radiological features and was confirmed histologically after resection.

A recurrent vagal schwannoma in the middle mediastinum after surgical enucleation

A 50-year-old man underwent repeat surgery for a benign vagal schwannoma in the middle mediastinum. He had undergone tumor enucleation at another hospital 4 months before presentation. The tumor (99 × 88 × 76 mm) was located in the aortopulmonary window and arose from the left vagus nerve. It had been enucleated, leaving its sheath behind to preserve the nerve. Imaging studies showed tumor regrowth without distant metastasis, and the tumor was extirpated along with the involved nerve during cardiopulmonary bypass. There was no nerve dysfunction, recurrence, or metastasis 6 months after the operation. A benign vagal schwannoma can be excised with nerve transection or enucleated without nerve transection. The present case suggests that a vagal mediastinal schwannoma should be extirpated along with the nerve because insufficient enucleation might lead to tumor regrowth.

Bilateral mediastinal neurofibroma of the vagus nerves in a patient with neurofibromatosis type 1

Bilateral mediastinal vagus neurogenic tumors are very rare. We herein report the case of Neurofibromatosis type 1 (NF-1) patient with bilateral neurofibromas originating from the mediastinal vagus just distal site of the recurrent nerve, who underwent two-staged extirpations that successfully preserved both recurrent nerves. A 31-year-old female with a history of NF-1 was admitted to our hospital under a diagnosis of multiple tumors in the upper mediastinum. First, the tumor at the right paratracheal to precarinal site was completely resected through a median sternotomy, preserving the right recurrent nerve. After confirming no right recurrent nerve paralysis, thoracoscopic resection of the tumor at the aorto-pulmonary window was then performed preserving the left recurrent nerve. The histopathological diagnosis was neurofibroma originating from the bilateral mediastinal vagus nerves. A two-staged operation can be an option in cases with bilateral mediastinal vagus nerve tumors to avoid the risk of bilateral recurrent nerve paralysis.

Schwannoma of the vagus nerve, a rare middle mediastinal neurogenic tumor: case report

Schwannoma originating from the vagus nerve within the mediastinum is a rare, usually benign tumor. A 44-year old male was presented with chest pain. Chest radiography, CT scan and MRI showed a well circumscribed mass, 5 × 4 cm located in the aortopulmonary window. The mass was found at surgery to be in close proximity with the aortic arch and the left pulmonary hilum, alongside the left vagus nerve. The encapsulated tumor was completely resected through a left thoracotomy incision and it was found to be a benign schwannoma in pathology. The patient is free of recurrence 6 years after surgery.

Malignant peripheral nerve sheath tumors of intrathoracic vagus nerve

The authors report two cases of malignant peripheral nerve sheath tumors arising from the vagus nerve in the mediastinum in patients who had no stigmata of neurofibromatosis (von Recklinghausen's disease). Computed tomography showed homogeneous soft tissue masses, with minimal calcification seen in one patient. T2-weighted magnetic resonance images showed regions of low signal intensity caused by a dense cellular population.

Middle mediastinal lesions: imaging findings and pathologic correlation

Lesions primarily involving the middle mediastinum are uncommon and include lymph node diseases, cystic lesions, neurogenic tumors, mesenchymal tumors, tumors of mediastinal organ, amd other benign processes. In this article, we illustrate imaging findings of a variety of middle mediastinal lesions with pathologic correlation.

[Schwannoma of the intrathoracic vagus nerve]

Schwannomas, or neurilemomas, are tumors that originate in the sheaths covering peripheral nerve fibers. They are usually encapsulated, slow growing, and asymptomatic. Such tumors may appear in any nerve, although most are found in the extremities. Intrathoracic vagus schwannomas are very rare and only 72 cases have been reported. We present a new case in a 39-year-old man in whom chest film showed a well-defined, homogeneous mass measuring 3 cm in diameter located in the left para-aortic region. The presence of a smooth tumor on the vagus nerve and recurrent loop was confirmed by left lateral thoracotomy. After removal, the tumor was shown to be a vagal nerve schwannoma.

Thoracoscopic excision of a malignant schwannoma of the intrathoracic vagus nerve

Malignant schwannomas of the intrathoracic vagus nerve are rare tumors. A patient underwent resection of a mediastinal malignant schwannoma of the vagus nerve using video-assisted thoracoscopy, with no recurrence at 18 months.

Neurogenic tumors of the mediastinum originated from the vagus nerve

Thirty-nine patients with neurogenic tumors observed between 1974 to 1992 were reviewed. There were 32 patients with neurilemoma, one with neurofibroma, five with ganglioneuroma, and one with malignant neurilemoma. Two cases of neurilemoma originated from the vagus nerve, which is very rare. Surgical resection is recommended, not only to confirm the nature of the lesion, but also to prevent further growth and compression on adjacent structures. For benign encapsulated neurogenic tumors, resection is curative.

Malignant schwannoma of the intrathoracic vagus nerve: report of a case

We report herein the case of a 48-year-old man with malignant schwannoma of the intrathoracic vagus nerve associated with von Recklinghausen's disease. Malignant intrathoracic vagal tumors are extremely rare and to our knowledge, only four other cases have been documented in the literature, none of which were associated with von Recklinghausen's disease.

An intrathoracic vagus nerve schwannoma invading the trachea

A patient with a schwannoma of the intrathoracic vagus nerve is presented. The tumor invaded the trachea and caused dyspnea. It was successfully excised by a segmental resection of the trachea with end-to-end anastomosis. This instance of an intrathoracic vagus tumor invading the trachea is, as far as we know, the first reported in the world.

Primary mediastinal neoplasms (other than thymoma)

Primary mediastinal neoplasms encompass a long list of histologically diverse lesions that can arise from a wide variety of mediastinal structures. Recent advances in diagnostic techniques have considerably enhanced the evaluation of the mediastinum with use of noninvasive or minimally invasive procedures. In adults, most primary mediastinal neoplasms can be classified in one of four categories: thymus-derived neoplasms, neurogenic tumors, lymphomas, or germ cell neoplasms. In children, neurogenic tumors (especially neuroblastomas) and lymphomas are most frequently encountered. Because of the presence of many vital structures in the confined thoracic cavity, even benign mediastinal neoplasms can cause severe symptoms from the mass effect and therefore warrant a carefully planned management strategy. With modern therapeutic and surgical interventions, associated morbidity and mortality can often be substantially decreased.

Intrathoracic vagus nerve neurofibroma and sudden death in a patient with neurofibromatosis

A 21 year old man with type 1 neurofibromatosis was found dead in the middle of the night. Postmortem examination revealed a large neurofibroma arising from the right intrathoracic vagus nerve, which might have contributed to his sudden death.

Vagal schwannoma involving esophagus

A rare case of vagal schwannoma (neurilemoma) with involvement of the distal esophagus is presented. Chronic progressive dysphagia was the only complaint related to the schwannoma. Barium swallow showed narrowing of the distal esophagus. The tumor was embedded in the wall of the esophagus. After biopsy and diagnosis of benign schwannoma, it was dissected from the esophageal muscle and mucosa. Diagnosis of benign schwannoma should be made before excision of the lesion to avoid an unnecessary esophagectomy.