Giant Leiomyoma Arising from the Mediastinal Pleura: A Case Report

Pleural Neoplasms-What Could MRI Change?

The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies' detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.

Giant tumors of the posterior mediastinum: a narrative review of surgical treatment

Background and Objective

The posterior mediastinum is a potential space along the paravertebral sulci or between the posterior aspect of the pericardium and the vertebrae. This compartment is classically the most frequent location site of neurogenic tumors. Whereas neurofibroma and schwannoma are neurogenic tumors that commonly arise from peripheral nerves, sympathetic nerves are the origin of ganglioneuroma, neuroblastoma, ganglioneuroblastoma, and neuroectodermal cells closely associated with autonomic nerves are the origin of paragangliomas and pheochromocytomas. Additionally, tumors from the esophagus, tumors of mesenchymal origin, lymphoma, ectopic goiter, and diseases with lymph node hyperplasia may also settle on this compartment. The objectives are to identify term "giant posterior mediastinal tumor" and the etiology, clinical features, diagnostic methods, pathological types, surgical methods applied, and technical details of these methods for the treatment of these tumors.

Methods

In this review, the term "giant tumor" was used to define tumors larger than 10 cm settled in the posterior mediastinum. PubMed database was searched with keywords "posterior mediastinum, giant mass" or "posterior mediastinum, tumor, giant" limited to English language and full-text available studies published between years 1984-2021.

Key Content and Findings

As a result of the literature review with the relevant terms, 23 case reports were found in accordance with the inclusion criteria. We detected the most common giant posterior mediastinum tumors were neurogenic origin (schwannoma, ganglioneuroma, ganglioneuroblastoma, triton tumor) in that review. The most common surgical approach was posterolateral thoracotomy. Treatment response to surgical total excision was good in most of cases.

Conclusions

The definitive diagnosis and treatment of giant posterior mediastinal tumors is made by surgical excision. Diagnostic procedures and subsequent surgical planning may vary depending on the origin and localization. Adjuvant treatment and follow-up should be conducted on the histopathological features.

Primary Extra-Pleura Leiomyoma: A Case Report and Literature Review

Leiomyomas are a common type of benign soft tissue tumor arising from smooth muscle, most often occurring within females’ genitourinary and gastrointestinal tract. However, primary leiomyomas of the chest wall residing in the extra-pleural space are an extremely rare subset of leiomyomatous lesion presentation. We present a case of a fifty-two-year-old male who initially presented complaining of dyspnea worsening with exertion. Computed tomography imaging was performed showing an extra-pleural mass residing under the left sixth rib. Subsequent core needle biopsy and immunohistochemical staining were performed, and the definitive diagnosis of primary leiomyoma of the posterior mediastinal chest wall. Although extremely rare, this neoplastic condition should be included in your differential diagnosis when diagnostic imaging reveals a benign mass residing in the extra-pleural space, and subsequent biopsy specimens consist of smooth muscle fibers.

Trends, Symptoms, and Outcomes of Resectable Giant Mediastinal Tumors

Describing the changes in surgical procedures and factors affecting the surgical outcome of patients who have undergone complete resection of giant mediastinal tumors (GMTs, diameter ≥ 10 centimeters) could improve preoperative decision-making and prognostic evaluations. We accessed data from three sources, which are case reports on surgical treatment of GMTs from PubMed, Web of Science, and EMBASE until June 1, 2019; patients with resected GMT from the Surveillance, Epidemiology, and End Results (SEER) database; and retrospective review of medical records in our institution from 2000 to 2019. The worldwide distribution, clinicopathological characteristics, symptom profile, prognosis of patients with GMT resection, and nomogram for surgical outcome prediction are reported. A total of 242 rare GMT cases from four continents (Asia, North America, South America, and Europe) were included. The median age of the patients was 40 (IQR: 27, range: 13–83) years, and the male-to-female ratio was 1.57:1. Dyspnea, shortness of breath, cough, and chest pain or discomfort were the major symptoms at presentation. The prognosis of benign and low-grade malignant GMTs was superior to that of high-grade malignant GMTs. Tumor malignancy played the most critical role in predicting postoperative survival, followed by longest tumor diameter and a posterior mediastinum location. The findings of this study suggest that the number of successful GMT surgeries has increased over the last decade and describe clinical features of GMTs. Physicians should prioritize tumor malignancy as a leading factor in predicting outcome rather than tumor size.

Ectopic uterus? A rare presentation of a giant leiomyoma in the posterior mediastinum

Leiomyomas are benign mesenchymal tumors derived from smooth muscles. Uterus is the commonest site of origin for leiomyomas; however, unusual growth patterns and locations have been reported posing diagnostic challenges, clinically and radiologically. Histological diagnosis remains the gold standard of diagnosis. Here, we present a 17-year-old female with a 3-month history of chest pain, cough, difficulty in breathing and chest tightness. Chest CT scan showed a 12.3 cm × 14.4 cm × 22.8 cm mass occupying the entire left posterior hemithorax. The patient underwent thoracotomy and recovered well after surgery. Histopathology of the excised specimen confirmed it to be leiomyoma. Despite its rarity, primary mediastinal leiomyoma should be considered in the differential diagnosis of an unexplained mediastinal mass. Its accurate pre-operative diagnosis is difficult. Respiratory compromise and risk of transformation to sarcoma mandate complete surgical resection for a definitive diagnosis and good prognosis.

Primary Leiomyoma of the Visceral Pleura: An Unexpected Occurrence

BACKGROUND/AIM

Leiomyoma is a rare benign tumor originating from smooth muscle fibres. In the respiratory tract, these tumors are rare and in the pleura, cases are exceptional, with only a few reported so far. This is the main reason we decided to present this case of primary leiomyoma of the visceral pleura.

CASE REPORT

We present a case of a 51-year-old asymptomatic patient who, during a routine medical examination using standard chest radiography, presented with a 3 by 2 cm homogenous mass in the right superior pulmonary area, tangent to the chest wall (same level with the 3rd rib). Further investigation using computed tomography (CT) in the chest confirmed the presence of a 31/18 mm solid mass in the right upper lobe, in contact with the parietal pleura. Surgery was performed for two reasons: i) removal of the tumoral mass and ii) establishing a histopathological diagnosis. Intraoperatively, a well-defined, homogenous, ivory white non-infiltrating mass was discovered in the right upper lobe on the visceral pleura and in close proximity to the minor fissure. The mass was removed with negative surgical margins and was left with healthy tissue. Histopathological examination and immunohistochemistry came as a surprise, establishing our diagnosis of leiomyoma.

CONCLUSION

Primitive pleural leiomyoma must remain a possibility when considering the differential diagnosis of pleural tumors. The main course of treatment is complete surgical resection. In our case, long-term follow up did not present any local recurrence.

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.

Anterior and Posterior Mediastinum Leiomyomas Arising From the Parietal Pleura

A 72-year-old male patient was found with enlarged nodes in the anterior and posterior mediastinum on screening imaging studies of the chest. The anterior node appeared as a single cystic lesion without significant metabolic activity on scintigraphy images. The posterior node was a single solid lesion in the lower left periesophageal space above the diaphragmatic crura with moderate metabolic uptake. Endoscopic ultrasound allowed a transesophageal endosonography-guided fine needle aspiration of the posterior node. The anterior lesion was sampled via percutaneous transthoracic approach. Biopsy revealed aggregates of mesenchymal cells with spindle nuclei; immunohistochemistry confirmed two primary leiomyomas of the mediastinum.

Intercostal leiomyoma in a child: review of the literature

Leiomyomas of the chest wall are very rare. In a review of the current literature twelve cases were found, of which only one concerns of an intercostal leiomyoma of the chest wall. We report a case of 1 year old male child with intercostal leiomyoma who presented with a painless rigid swelling of the right chest wall. The radiological control revealed a solid mass in the right anterior sixth intercostal space. En-bloc excision of the mass by abrading of the sixth rib through right anterior thoracotomy was performed. Histopatological analysis showed a localized intercostal leiomyoma. The patient has a close follow-up for 6 months without evidence of recurrence. This is the first case of a primary intercostal leiomyoma in a child which was excised totally without reconstruction of the chest wall.