Primary intrathoracic neural tumours

Hair whorl as an indicator of a mediastinal plexiform neurofibroma

We report a boy with neurofibromatosis type 1 (NF-1) who had nonspecific respiratory symptoms and a mediastinal mass. In addition to multiple caté au lait macules and subcutaneous neurofibromas, he had a hair whorl over the spine at the level of a deep mediastinal mass demonstrated by CT scan and MR examination. Thoracoscopy and biopsy of the mass revealed a plexiform neurofibroma. The clinical sign of a hair whorl may assist the clinician in early recognition of a paraspinal plexiform neurofibroma.

Mediastinal tumours and cysts. A review of 91 cases

The experience with 91 primary tumours of the mediastinum during a period of 20 years is presented. A total of 24 separate cell types were identified. The most frequent lesions were thyroid tumours, neurogenic tumours, cysts and tumours of lymphatic origin. About 50% of the tumours were discovered by chance in asymptomatic patients undergoing routine chest examination. Twenty per cent of the patients with malignant lesions were free of symptoms. The pre-operative diagnosis was uncertain in most instances, and early surgical exploration is therefore recommended. Seventy-four patients underwent surgery and the operative mortality rate was 2.7%. The long-term survival was closely related to the histological nature of the neoplasm.

Intrathoracic neural tumours

The experience of one regional thoracic surgical unit in managing intrathoracic neural tumours over a 25-year period is presented. Neural tumour was diagnosed in 55 patients, of whom 41 were asymptomatic. In 11 patients complete resection was not achieved--the reasons for this and its effect on the outcome of the patient are discussed. There were 52 posterior mediastinal and three lateral chest wall tumours. The pathological distribution was as follows--benign nerve sheath tumours (neurofibroma, neurilemoma) 39, ganglioneuroma 13, and neuroblastoma 3. One neurofibroma recurred as a neurosarcoma six years after its apparently complete resection and was removed by an extensive resection at reoperation. One neuroblastoma recurred within the spinal canal four years after incomplete excision at thoracotomy--this patient died subsequently of widespread metastatic neuroblastoma. No other tumour is known to have recurred.

Diagnostic features of tumors of the lower thoracic sympathetic chain

Four cases of sympathetic neural tumors of the most inferior portion of the thoracic sympathetic chain are presented. The location of each tumor was such that a primary adrenal tumor might have been considered. However, each tumor was associated with erosion of the ipsilateral lower ribs or vertebral pedicles. Such radiologic findings indicate a primary posterior mediastinal tumor and primary exploration should be transthoracic.

A large mediastinal neurilemmoma associated with peptic ulcer and melena

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