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Rahouma M, Baudo M, Khairallah S, Dabsha A, Tafuni A, El-Sayed Ahmed MM, Lau C, Iannacone E, Naka Y, Girardi L, Gaudino M, Lorusso R, Mick SL. Primary Cardiac Schwannoma: A Meta-Analysis of Individual Case Reports. J Clin Med 2023; 12:jcm12103356. [PMID: 37240461 DOI: 10.3390/jcm12103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Primary cardiac schwannoma (PCS) is a neurogenic tumor that arises from Schwann cells. Malignant schwannoma (MSh) is an aggressive cancer comprising 2% of all sarcomas. Information on the proper management of these tumors is limited. Four databases were searched for case reports/series of PCS. The primary outcome was overall survival (OS). Secondary outcomes included therapeutic strategies and the corresponding outcomes. Among 439 potentially eligible studies, 53 met the inclusion criteria. The patients included had 43.72 ± 17.76 years and 28.3% were males. Over 50% of patients had MSh, with 9.4% also demonstrating metastases. Schwannoma commonly occurs in the atria (66.0%). Left-sided PCS were more common than right-sided ones. Surgery was performed in almost 90% of the cases; chemotherapy and radiotherapy were used in 16.9% and 15.1% of cases, respectively. Compared to benign cases, MSh occurs at a younger age and is commonly located on the left side. OS of the entire cohort at 1 and 3 years were 60.7%, and 54.0%, respectively. Females and males OS were similar up to 2 years follow-up. Surgery was associated with higher OS (p < 0.01). Surgery is the primary treatment option for both benign and malignant cases and was the only factor associated with a relative improvement in survival.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Massimo Baudo
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
- Cardiac Surgery Department, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy
| | - Sherif Khairallah
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Anas Dabsha
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Alessandro Tafuni
- Unit of Pathology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Magdy M El-Sayed Ahmed
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Surgery, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Christopher Lau
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Erin Iannacone
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Yoshifumi Naka
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Leonard Girardi
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Mario Gaudino
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht University, 6202 AZ Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, 6229 ER Maastricht, The Netherlands
| | - Stephanie L Mick
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY 10065, USA
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Wang F, Li L, Ma H, Chi XX. A primary cardiac schwannoma of the right ventricle: a case report and literature review. BMC Cardiovasc Disord 2022; 22:498. [PMID: 36418938 PMCID: PMC9682788 DOI: 10.1186/s12872-022-02941-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary cardiac schwannoma remains extremely rare and difficult to distinguish from other myocardial tumours. We report a case of cardiac schwannoma that occurred in the lateral wall of the right ventricle and grew in the myocardial walls. It is the third case of schwannoma that occurred in the free wall of the right ventricle. Moreover, we reviewed and summarised the literature for cases involving benign cardiac schwannomas. CASE PRESENTATION We present a case of a 64-year-old woman who presented to our centre with syncope for 1-2 min. Echocardiogram and contrast-enhanced computed tomography subsequently revealed a 2.9 × 1.9 cm homogeneous mass originating from the anterior wall of the right ventricle. The patient underwent thoracotomy to resect the mass, which was pathologically verified as Schwann cell tumour. CONCLUSIONS This is a rare case added to the limited existing literature on cardiac schwannoma. Comprehensive analysis of various imaging examinations is helpful to determine the extent of the tumour. Complete surgical resection is recommended for similar cases involving cardiac schwannomas, especially when the patient has related symptoms. Patients generally have a good prognosis. The pathogenesis of cardiac schwannoma needs further research in order to prevent and manage this rare lesion.
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Affiliation(s)
- Fang Wang
- grid.440323.20000 0004 1757 3171Department of Radiology, Shangdong Province, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20, Yuhuangding East Road, Zhifu District, Yantai, 264000 People’s Republic of China
| | - Lin Li
- Department of Pathology, Yucheng People’s Hospital, Yucheng, Dezhou, China
| | - Heng Ma
- grid.440323.20000 0004 1757 3171Department of Radiology, Shangdong Province, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20, Yuhuangding East Road, Zhifu District, Yantai, 264000 People’s Republic of China
| | - Xiao-Xiao Chi
- grid.440323.20000 0004 1757 3171Department of Radiology, Shangdong Province, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20, Yuhuangding East Road, Zhifu District, Yantai, 264000 People’s Republic of China
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Keita IK, Nazario Dolz AM, Falcón Vilariño GC, Castillo Toledo L, Rodríguez Fernández Z, Romero García LI. Consideraciones en torno a los tumores del mediastino. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El desarrollo de las imágenes diagnósticas hizo posible el diagnóstico topográfico de los tumores de mediastino; sin embargo, aún con los avances actuales de la cirugía, la anestesiología y la reanimación, el acceso quirúrgico a ese espacio medio de la caja torácica continúa siendo el gran reto que enfrentan los cirujanos torácicos.
Objetivo. Profundizar en los diferentes aspectos cognoscitivos actualizados sobre los tumores mediastinales.
Métodos. Búsqueda documental digital en bases de datos: Scielo, Lilacs, Web of Science, PubMed, realizada en enero de 2019, de publicaciones sobre el tema en la presente centuria.
Resultados. Las neoplasias mediastinales son poco frecuentes, pueden aparecer a cualquier edad, aunque son más frecuentes entre la tercera y quinta décadas, y la mayoría se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Los tumores malignos del mediastino son poco frecuentes, pero los benignos constituyen un desafío diagnóstico para radiólogos y patólogos. En las neoplasias malignas se identifica una amplia gama de variedades histológicas, atribuibles a las características del órgano afectado.
Conclusiones. El diagnóstico definitivo generalmente se establece mediante el estudio histopatológico posquirúrgico, si bien la tomografía computarizada, asociada o no a la biopsia percutánea, es el estándar de oro para el diagnóstico preoperatorio. La selección de la vía de entrada al tórax, así como el procedimiento quirúrgico, están condicionados por la localización y el tamaño del tumor en el mediastino.
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Huang Z. Successful resection of a huge schwannoma of the aortic root with 5-years follow-up. J Card Surg 2020; 35:2084-2086. [PMID: 32652658 DOI: 10.1111/jocs.14797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/01/2022]
Abstract
Primary benign schwannomas of the heart are very rare. We report the case of a patient with a huge schwannoma of unique aortic origin. The complete resection of the rare tumor has been successfully performed. There is no recurrent tumor in the 5 years follow-up. We focus our attention on the surgical technique.
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Affiliation(s)
- Zhixiong Huang
- Department of Cardiovascular Surgery, Cardiovascular Institute, Fu Wai Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
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Kang LH, Shin DH, Yoon S. Schwannoma arising in mediastinal lymph node diagnosed by endobronchial ultrasound. Respirol Case Rep 2019; 7:e00481. [PMID: 31452898 PMCID: PMC6702317 DOI: 10.1002/rcr2.481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/03/2019] [Accepted: 08/05/2019] [Indexed: 12/02/2022] Open
Abstract
Schwannoma is a peripheral nerve sheath tumour that largely originates from the posterior mediastinum. Schwannoma arising in mediastinal lymph node is extremely rare. A 53-year-old female was referred to our hospital for the evaluation of enlarged mediastinal lymph node. Computed tomography scan revealed a non-enhancing soft tissue mass at Rt. paratracheal area. Endobronchial ultrasound showed a well-defined round-shaped lymph node and transbronchial needle aspiration was performed from this lymph node. Pathologic findings revealed spindle cells with strong S100 positivity. Complete surgical excision was done. We report a rare case of schwannoma arising in mediastinal lymph node diagnosed by endobronchial ultrasound.
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Affiliation(s)
- Lae Hyung Kang
- Department of Internal Medicine, School of MedicinePusan National UniversityYangsanRepublic of Korea
| | - Dong Hoon Shin
- Department of Pathology, School of MedicinePusan National UniversityYangsanRepublic of Korea
| | - Seong‐Hoon Yoon
- Department of Internal Medicine, School of MedicinePusan National UniversityYangsanRepublic of Korea
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Abstract
Schwannomas of the large blood vessels are extremely rare, and tumors adjacent to
major vessels may not be considered to originate from the vessels. There have
been no previous reports of schwannomas of the common iliac artery. We report on
a 57-year-old woman who presented with a mass in the left retroperitoneum.
Computed tomography showed a mass abutting and adhering to the left common iliac
artery. A portion of the artery was resected together with the mass and vascular
reconstruction was carried out. The histological diagnosis was a schwannoma
arising in the left common iliac artery. Despite its rarity, a schwannoma of a
large artery should be considered as a differential diagnosis in patients with a
retroperitoneal mass adjacent to a major vessel. Awareness of this entity might
avoid profuse bleeding and enable surgeons to prepare for vascular
interposition.
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Affiliation(s)
- Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea
| | - Chang Gok Woo
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea
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Loftus TJ, Pipkin M, Machuca T, Oduntan O. Angiographic embolization followed by piecemeal resection of giant posterior mediastinal schwannoma: Case report and concise review. Int J Surg Case Rep 2018; 53:250-253. [PMID: 30439671 PMCID: PMC6234618 DOI: 10.1016/j.ijscr.2018.10.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/14/2018] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
Radiographic assessment of spinal cord involvement is essential. Histology is necessary to establish etiology, prognosis, and treatment plan. Large tumors may require posterolateral thoracotomy and piecemeal resection. Preoperative angiography may identify arteries shared by the tumor and spinal cord. Preoperative angioembolization may reduce tumor vascularity and operative blood loss.
Introduction: Posterior mediastinal masses present unique diagnostic and therapeutic challenges, particularly when large highly vascularized tumors extend toward or emanate from the spinal cord. The rare nature of these tumors precludes the development of standardized management algorithms, underscoring the importance of case reports. Presentation of case: A 57 year old female presented with exertional dyspnea and right chest pressure. Chest radiography followed by computed tomography (CT) scan demonstrated a 13 cm posterior mediastinal mass involving the T7 vertebral body. CT-guided percutaneous biopsy confirmed benign schwannoma. During open exploration, the tumor bled easily with contact. Angiography with intercostal arterial embolization decreased tumor vascularity while preserving spinal cord perfusion. Subsequent piecemeal resection facilitated exposure of the tumor base and complete resection. Postoperative recovery was uneventful. Discussion: Neurogenic tumors are most commonly located in the posterior mediastinum. When untreated, schwannomas continue to grow, and will inevitably cause compressive symptoms if given sufficient time. Therefore, resection is recommended. This may be performed thoracoscopically in select patients with small tumors, avoiding the morbidity of a thoracotomy incision. Conclusion: Large posterior mediastinal schwannomas require posterolateral thoracotomy and resection. Preoperative angiography helps identify arteries shared by the tumor and the spinal cord, and embolization may reduce tumor vascularity and operative blood loss thereby permitting safer resection.
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Affiliation(s)
- Tyler J Loftus
- Department of Surgery, University of Florida, Gainesville, FL, United States
| | - Mauricio Pipkin
- Department of Surgery, University of Florida, Gainesville, FL, United States
| | - Tiago Machuca
- Department of Surgery, University of Florida, Gainesville, FL, United States
| | - Olusola Oduntan
- Department of Surgery, University of Florida, Gainesville, FL, United States.
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Dy P, Lajom C, Sanchez J. Middle mediastinal schwannoma concealed by asthma and GORD. BMJ Case Rep 2018. [PMID: 29535096 DOI: 10.1136/bcr-2017-223795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurogenic tumours of the mediastinum in adults occur most often at the posterior mediastinum, majority of which are benign of nerve sheath in origin. A 72-year-old woman, known asthmatic, presented with chronic symptoms of hoarseness, dysphagia, chest heaviness, easy fatigability, cough, epigastric pain, feeling of abdominal fullness and choking with food intake and at a supine position. Treated for other disorders, routine chest X-ray incidentally found a homogenous convex radiodensity at the right paratracheal area; mass which was also observed with CT and 18F-fludeoxyglucose-positron emission tomography/CT scan studies. Mediastinoscopy with biopsy showed spindle to plump cells with strong S100 positivity. Thoracoscopic surgery done to completely excise the mass found it to be benign schwannoma.
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Affiliation(s)
- Prudence Dy
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Cristina Lajom
- Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Josephino Sanchez
- Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
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9
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Primary pulmonary valve sarcoma involving pulmonary artery and right ventricular outflow tract. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Thomason JD, Rapoport G, Fallaw T, Calvert CA, Sakamoto K. Pulmonary edema secondary to a cardiac schwannoma in a dog. J Vet Cardiol 2015; 17:149-53. [DOI: 10.1016/j.jvc.2015.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/24/2015] [Accepted: 01/27/2015] [Indexed: 11/16/2022]
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Intrathoracic peripheral nerve sheath tumors-a clinicopathological study of 75 cases. Hum Pathol 2014; 46:419-25. [PMID: 25595633 DOI: 10.1016/j.humpath.2014.11.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/20/2014] [Accepted: 11/26/2014] [Indexed: 11/24/2022]
Abstract
Although peripheral nerve sheath tumors (PNSTs) are common in the posterior mediastinum, they are rare in other mediastinal compartments and in the pleuropulmonary parenchyma. We sought to characterize the clinicopathological features of PNSTs occurring in the lung, pleura, and mediastinum. Diagnoses were confirmed by slide review. Study cases include 21 benign pleuropulmonary PNSTs, 49 benign mediastinal PNSTs, and 5 malignant PNSTs. Benign pleuropulmonary tumors comprised 13 schwannomas, 6 neurofibromas, 1 perineurioma, and 1 ganglioneuroma. Six lesions were endobronchial (3 neurofibromas, 1 schwannoma, 1 perineurioma, 1 ganglioneuroma), whereas the remaining schwannomas and neurofibromas formed parenchymal masses (usually pleural based). Benign mediastinal PNSTs (46 posterior, 2 middle, and 1 anterior) were all schwannomas and showed a female predominance. None of the patients with benign PNSTs experienced recurrence. Of the 5 malignant PNSTs, 4 were pleuropulmonary (3 pleural based) and 1 occurred in the anterior mediastinum. Two of the 5 patients had a history of neurofibromatosis type 1 (aged 27 and 45 years). At last follow-up, 3 of the 5 patients had died of disease, 1 was alive with disease, and 1 was alive with no evidence of disease (41 months). Although rare, a wide histologic range of PNSTs occur in the lung. Although neurofibroma, perineurioma, and ganglioneuroma were observed as endobronchial lesions, most pulmonary schwannomas were pleural-based masses. Mediastinal PNSTs are dominated by posterior mediastinal schwannomas, although schwannomas rarely occur in the other mediastinal compartments as well. Malignant PNSTs are very rare in the thorax, where they show aggressive behavior.
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