Giant cystic schwannoma of the middle mediastinum with cervical extension

Giant middle mediastinal lesions: when tumor size correlates with mesenchymal origin-a retrospective single-center analysis

Background

The International Thymic Malignancy Interest Group (ITMIG) proposed an internationally accepted division of the mediastinum into three compartments based on computed tomography (CT): anterior (prevascular), middle (visceral) and posterior (paravertebral) compartment. There is no generally accepted definition for the term "giant" when applied to middle mediastinal lesions. We defined the term "giant" and described our surgical experience in treating patients with giant lesions of the middle mediastinum.

Methods

CT imaging of patients operated in our center from January 2016 to August 2021 for mediastinal lesions was reviewed. Lesions were categorized to one of the ITMIG-defined compartments. Lesion size at diagnosis was measured at its largest diameter on axial CT imaging. Giant middle mediastinal lesions were defined as lesions having a size ≥90th percentile of our middle mediastinal lesion cohort. Patients with giant middle mediastinal lesions were further analyzed.

Results

Thirty-six patients (23%) had lesions located in the middle mediastinal compartment. Most common diagnoses were mediastinal cysts (n=10, 28%), metastatic lesions (n=6, 17%), lymphomas (n=5, 14%), and sarcomas (n=3, 8%). Ninetieth percentile lesion size was 73 mm. As per definition, four patients had giant middle mediastinal lesions. All these four lesions were of mesenchymal origin including oesophageal leiomyoma, synovial sarcoma, leiomyosarcoma and undifferentiated round cell sarcoma. Resection was performed through posterolateral thoracotomy or sternotomy, with or without cardiopulmonary bypass.

Conclusions

The term "giant" could be defined as a mass larger or equal to 73 mm. This definition selected specifically lesions with mesenchymal origin and may therefore guide diagnostic algorithm and patient management.

A case of a giant thoracic schwannoma

Background:

Giant solitary schwannomas are rare, benign, and typically slow-growing tumors reaching up to 20 cm in size.

Case Description:

A 43-year-old male presented with shortness of breath and chest pain. The thoracic MRI showed a giant mass 15 cm in diameter filling the left chest cavity. The lesion was resected utilizing intrathoracic approach and required a multilevel approach. Vertebrectomy with instrumented fusion was performed. The pathological diagnosis was benign schwannoma without nuclear atypia. Postoperatively, the patient fully recovered without sequelae.

Conclusion:

A 43-year-old male presented with a 15 cm diameter chest mass that proved to be a schwannoma that was resected without long-term sequelae.

Surgical treatment of giant mediastinal tumors

Background

This study aims to evaluate the surgical treatment outcomes of giant mediastinal tumors.

Methods

Between July 2013 and July 2018, medical data of a total of 31 patients (26 males, 5 females; mean age 27.7±8.2 years; range, 18 to 56 years) who underwent radical surgery for a giant mediastinal tumor in our center and 47 cases (26 males, 21 females; mean age 45.4±16.7 years; range, 19 to 62 years) of giant mediastinal tumors retrieved from the National Center for Biotechnology Information database were retrospectively reviewed. Two-year overall survival and disease-free survival rates of the patients were evaluated.

Results

All patients underwent radical surgery (R0 resection). Symptoms caused by giant mediastinal tumors were relieved after radical surgery during follow-up. The two-year overall survival and disease-free survival rates were 100% and 86.7%, respectively, indicating a good prognosis. The surgical procedures for malignancies were more difficult than those for benign pathologies.

Conclusion

Radical surgery is the mainstay for treatment of giant mediastinal tumors to relieve symptoms in a short period of time and to achieve a good prognosis for up to two years, regardless of adjuvant therapy. The surgical route should be cautiously planned before radical surgery to reduce complications.