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Liu B, Zhang Y, Zhang L, Zhang F, Li H, Li S, Liu Y, Du J, Zhao L. A rare case of bilateral cervical vagal neurofibromas: role of high-resolution ultrasound. BMC Neurol 2017; 17:26. [PMID: 28166752 PMCID: PMC5294879 DOI: 10.1186/s12883-017-0806-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/23/2017] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Bin Liu
- Department of Hand Surgery, the First Bethune Hospital of Jilin University, Changchun, 130021, China
| | - Yuanding Zhang
- Department of Otolaryngology, the First Bethune Hospital of Jilin University, Changchun, 130021, China
| | - Lili Zhang
- Department of Electrical Diagnosis, the First Bethune Hospital of Jilin University, No. 3302, Jilin Road, Changchun, 130021, China
| | - Fan Zhang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Hongyu Li
- Department of Electrical Diagnosis, the First Bethune Hospital of Jilin University, No. 3302, Jilin Road, Changchun, 130021, China
| | - Shuang Li
- Department of Electrical Diagnosis, the First Bethune Hospital of Jilin University, No. 3302, Jilin Road, Changchun, 130021, China
| | - Yafang Liu
- Department of Pathology, the First Bethune Hospital of Jilin University, Changchun, 130021, China
| | - Jie Du
- Department of Electrical Diagnosis, the First Bethune Hospital of Jilin University, No. 3302, Jilin Road, Changchun, 130021, China
| | - Lirong Zhao
- Department of Electrical Diagnosis, the First Bethune Hospital of Jilin University, No. 3302, Jilin Road, Changchun, 130021, China.
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2
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Patel MA, Eytan DF, Bishop J, Califano JA. Favorable Swallowing Outcomes following Vagus Nerve Sacrifice for Vagal Schwannoma Resection. Otolaryngol Head Neck Surg 2016; 156:329-333. [PMID: 27899468 DOI: 10.1177/0194599816678210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine the impact of unilateral vagal sacrifice for vagal schwannoma on postoperative swallowing function. Study Design Case series, chart review. Setting Academic medical institution. Subjects and Methods Ten patients underwent vagus nerve sacrifice for vagal schwannoma resection. Archived pathology records dating from 1985 through 2012 at our institution were retrospectively queried for cases of vagal schwannoma with vagus nerve sacrifice. Medical records were abstracted for demographic and disease information as well as cranial nerve and swallowing function. Preoperative and postoperative cranial nerve function, subjective and objective measures of swallowing function, Functional Oral Intake Scale (FOIS) level, and need for vocal fold medialization were variables collected. Data were analyzed with summary statistics. Results The patients who underwent vagal sacrifice for vagal schwannoma at our institution had a mean age of 42.3 years (median, 44 years; range, 15-63 years) and follow-up of 35.6 months (median, 9 months; range, 1-115 months). Most presented with no preoperative cranial nerve deficit or difficulty swallowing. Immediately postoperatively, 90% had a vagus nerve deficit, but 50% had no subjective difficulty swallowing, and 70% had a FOIS level of 7 at postoperative hospital discharge. Within 1 month after surgery, 70% had normal swallowing function according to a modified barium swallow study. A full diet was tolerated by mouth within an average of 2.7 days (median, 2 days; range, 1-6 days) after surgery in this cohort. Seventy percent required vocal fold medialization postoperatively for incomplete glottic closure. Conclusion Vagal nerve sacrifice during resection of vagal schwannoma can be performed with normal postoperative swallowing function.
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Affiliation(s)
- Mira A Patel
- 1 Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Danielle F Eytan
- 2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Justin Bishop
- 3 Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph A Califano
- 2 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,4 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Moores Cancer Center, University of California, San Diego, San Diego, California, USA
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3
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Esophageal schwannoma: report of a case and review of the literature. Eur Surg 2014. [DOI: 10.1007/s10353-014-0252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kirschbaum A, Ritz R, Pehl A, Bartsch D. Giant intrathoracic left-sided vagal schwannoma. Thorac Cardiovasc Surg Rep 2013; 2:19-22. [PMID: 25360405 PMCID: PMC4176068 DOI: 10.1055/s-0033-1337368] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/18/2013] [Indexed: 10/29/2022] Open
Abstract
Extensive intrathoracic tumors are rarely diagnosed radiologically without pre-existing symptoms. If located in the posterior mediastinum, it is most probably a neurogenic tumor. Schwannoma is the most frequent neurogenic neoplasia in this location, and most schwannomas are benign. To specify the diagnosis, a thoracic computed tomography must be done; if the growth is close to the medullary canal, a magnetic resonance tomography of the spinal column is necessary to detect neuroforamen infiltration. Our surgical goal was complete excision of the tumor, although many authors favor a minimally invasive approach. In our patient we performed open, en bloc removal of the tumor; removal of parts of the intraforamen was also necessary, which necessitated revision of the affected neuroforamen. Histologically this was a very rare case of vagal schwannoma (which has an incidence of less than 6% of all neurogenic tumors). This patient has a very promising prognosis following complete tumor resection.
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Affiliation(s)
| | - Rainer Ritz
- Department of Neurosurgery, Marburg University Hospital, Marburg, Germany
| | - Anika Pehl
- Department of Pathology, Marburg University Hospital, Marburg, Germany
| | - Detlef Bartsch
- Department of Surgery, Marburg University Hospital, Marburg, Germany
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5
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Fujita K, Nakashima K, Kumakura H, Minami K. A recurrent vagal schwannoma in the middle mediastinum after surgical enucleation. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:832-5. [PMID: 23445793 DOI: 10.5761/atcs.cr.12.02125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Kishu Fujita
- Department of Cardiovascular Surgery, Kitakanto Jyunkanki Hospital, Gunma, Japan
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6
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Kanzaki R, Inoue M, Minami M, Sawabata N, Shintani Y, Nakagiri T, Okumura M. Bilateral mediastinal neurofibroma of the vagus nerves in a patient with neurofibromatosis type 1. Ann Thorac Cardiovasc Surg 2012; 19:293-6. [PMID: 23232267 DOI: 10.5761/atcs.cr.12.01937] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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7
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Bilancia R, Ampollini L, Cattelani L, Carbognani P, Rusca M. Schwannoma of the cervical vagus nerve. Ann Thorac Surg 2010; 91:e13. [PMID: 21172470 DOI: 10.1016/j.athoracsur.2010.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/03/2010] [Accepted: 09/07/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Rocco Bilancia
- Chirurgia Toracica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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8
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Szyfter W, Pabiszczak M, Wierzbicka M, Kaczmarek J, Zurawski J. [Rare case of the cervical vagal neurinoma]. Otolaryngol Pol 2008; 61:740-3. [PMID: 18552010 DOI: 10.1016/s0030-6657(07)70516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neurinoma is the most common tumor of the neurogenic origin. Primary location in the neck with the vagal nerve as a source is very rare clinical situation (less than 100 cases published in the literature). The authors would like to present a case of 35 old men with vagal neurinoma. Main symptoms included painless neck tumor found on palpation. Differential diagnosis included the pedicled cyst and metastatic neck mass. The ultrasound picture was unclear. The intraoperative findings suggested the tumor arising from the vagal nerve. In first day after the surgery hoarseness appeared with paresis of the right vocal cord in the examination. The final histological evaluation revealed neurinoma.
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Affiliation(s)
- W Szyfter
- Klinika Otolaryngologii i Onkologii Laryngologicznej Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu
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9
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Basoglu A, Celik B, Sengul TA, Yildiz L. Esophageal schwannoma. J Thorac Cardiovasc Surg 2006; 131:492-3. [PMID: 16434293 DOI: 10.1016/j.jtcvs.2005.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 09/09/2005] [Indexed: 11/21/2022]
Affiliation(s)
- A Basoglu
- Department of Thoracic Surgery, Ondokuz Mayis University, Medical School, Samsun, Turkey.
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10
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Essman SC, Hoover JP, Bahr RJ, Ritchey JW, Watson C. An intrathoracic malignant peripheral nerve sheath tumor in a dog. Vet Radiol Ultrasound 2002; 43:255-9. [PMID: 12088320 DOI: 10.1111/j.1740-8261.2002.tb00999.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 7-year-old, neutered male Labrador Retriever presented for a persistent, productive cough and regurgitation. Radiography, ultrasonography, and computed tomography confirmed a large, smoothly marginated intrathoracic mass causing tracheal compression. The mass was removed via a thoracotomy, and a malignant peripheral nerve sheath tumor, most likely originating from the ventral spinal nerve roots, was confirmed using immunohistochemistry.
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Affiliation(s)
- Stephanie C Essman
- Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater 74078-2042, USA
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11
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Ogino H, Hara M, Satake M, Miyagawa H, Itoh M, Ohba S, Goodman PC. Malignant peripheral nerve sheath tumors of intrathoracic vagus nerve. J Thorac Imaging 2001; 16:181-4. [PMID: 11428419 DOI: 10.1097/00005382-200107000-00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- H Ogino
- Department of Radiology, Nagoya City University Medical School, Nagoya, Japan
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12
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Heras F, Ramos G, Castanedo M, Cortejoso A, Duque JL, Yuste MG. [Schwannoma of the intrathoracic vagus nerve]. Arch Bronconeumol 1997; 33:360-2. [PMID: 9410439 DOI: 10.1016/s0300-2896(15)30586-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- F Heras
- Servicio de Cirugía Torácica, Hospital Universitario de Valladolid
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13
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Sugio K, Inoue T, Inoue K, Tateishi M, Ishida T, Sugimachi K. Neurogenic tumors of the mediastinum originated from the vagus nerve. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1995; 21:214-6. [PMID: 7720904 DOI: 10.1016/s0748-7983(95)90798-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- K Sugio
- Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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14
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Maebeya S, Miyoshi S, Fujiwara K, Sekii H, Suzuma T, Yosimasu T, Naito Y, Nishino E. Malignant schwannoma of the intrathoracic vagus nerve: report of a case. Surg Today 1993; 23:1078-80. [PMID: 8118122 DOI: 10.1007/bf00309097] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
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.
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Affiliation(s)
- S Maebeya
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical College, Japan
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Heitmiller RF. Reply. Ann Thorac Surg 1991. [DOI: 10.1016/0003-4975(91)90042-o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
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.
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Affiliation(s)
- R Vaghei
- Thoracic Vascular Section, VA Medical Center, Martinsburg, WV 25401
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