images in clinical medicine Wien Klin Wochenschr DOI 10.1007/s00508-014-0654-x
Supraclavicular approach for removal of apical thoracic schwannoma Borki Vucetic · Narcis Hudorovic · Visnja Vicic-Hudorovic
Received: 9 February 2014 / Accepted: 19 October 2014 © Springer-Verlag Wien 2014
Neurogenic tumours arising from the brachial plexus and presenting as apical mass are rare [1–4]. The incidence of schwannoma has been reported to vary from 16 to 26 % in primary brachial plexus tumours [1, 5]. Occasionally, there have been reports of their thoracic presentation as superior or apical posteromedial mediastinal tumour or as apical lung mass [6]. Although these are benign and encapsulated tumours, there have been reports of local recurrence and malignant transformation [5, 7]. Herein, we present a 32-year-old man with a palpable mass in the left supraclavicular region, paraesthesia and loss of strength in the left hand, with an ulnar distribution. An axial computed tomographic scan revealed a rounded firm mass occupying the apical region of the left chest (Fig. 1a). According to recently published articles [8] that recommended against thoracoscopic surgery for tumours > 6 cm in size located at the thoracic apex, a supraclavicular approach has been utilized. This approach provides a good exposure for schwannoma at the thoracic inlet and apex of the chest. Intraoperative electrophysiological monitoring helped to spare nerve function after tumour resection. The tumour was N. Hudorovic, MD, PhD () Department of Vascular Surgery, University Hospital Centre “Sestre milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia e-mail: [email protected] B. Vucetic, MD, PhD Department of Thoracic Surgery, University Clinical Center “Sestre milosrdnice”, Zagreb, Croatia V. Vicic-Hudorovic Croatian Nurses Association [CNA], Sortina 3, 10000 Zagreb, Croatia
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removed completely without causing any damage to the neurovascular bundle in the area (Fig. 1b). Histology of the tumour established the diagnosis of schwannoma (Fig. 1c). Patient’s preoperative symptoms were gone 12 months after the surgery. Postoperative magnetic resonance scan revealed no residual masses in the chest (Fig. 1d). Conflict of interest The authors declare that there are no actual or potential conflicts of interest in relation to this article.
References 1. Takeda S, Miyoshi S, Minami M, Matsuda H. Intrathoracic neurogenic tumors—50 years’ experience in a Japanese institution. Eur J Cardiothorac Surg. 2004;26(4):807–12. 2. Binder DK, Smith JS, Barbaro NM. Primary brachial plexus tumours: imaging surgical and pathological findings in 25 patients. Neurosurg Focus. 2004;16:E11. 3. Horowitz J, Kline DG, Keller SM. Schwannoma of the brachial plexus mimicking an apical lung tumour. Ann Thorac Surg. 1991;52:555–6. 4. Cardillo G, Carleo F, Khalil MW, Carbone L, Treggiari S, Salvadori L, Petrella L, Martelli M. Surgical treatment of benign neurogenic tumours of the mediastinum: a single institution report. Eur J Cardiothorac Surg. 2008;34(6):1210–4. 5. Horowitz J, Kline DG, Keller SM. Schwannoma of the brachial plexus mimicking an apical lung tumour. Ann Thorac Surg. 1991;52:555–6. 6. Li JM, Zhou XM, Hu JG. Surgical treatment of 219 cases of primary tumors and cysts of the mediastinum. Hunan Yi Ke Da Xue Xue Bao. 2001;26:149–51. 7. Nayler SJ, Leiman G, Omar T, Cooper K. Malignant transformation in a schwannoma. Histopathology. 1996;29:189–92. 8. Yamaguchi M, Yoshino I, Kameyama T, Osoegawa A, Tagawa T, Maehara Y. Thorascoscopic surgery combined with a supraclavicular approach for removing a cervicomediastinal neurogenictumor. A case report. Ann Thorac Cardiovasc Surg. 2006;12:194–96.
Supraclavicular approach for removal of apical thoracic schwannoma
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images in clinical medicine Fig. 1 An axial computed tomographic scan revealed a smooth, round, capsulated mass measuring 9.77 × 5.98 cm lying from thoracic inlet to just above the tracheal bifurcation (a). A left supraclavicular approach was made. A rounded firm mass of a size of 9.77 × 5.98 cm was seen occupying the apical region of the left chest. The mass appeared connected to the lower trunk of the brachial plexus close to the upper border of the first rib. Pleural cover and the remnant of the capsule at the root of neck were cleared (b). Histological examination of tumour tissue revealed the diagnosis of schwannoma (c). Magnetic resonance imaging performed 12 months after surgery showed no tumor recurrence (d)
2 Supraclavicular approach for removal of apical thoracic schwannoma
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Supraclavicular approach for removal of apical thoracic schwannoma Borki Vucetic · Narcis Hudorovic · Visnja Vicic-Hudorovic
Received: 9 February 2014 / Accepted: 19 October 2014 © Springer-Verlag Wien 2014
Neurogenic tumours arising from the brachial plexus and presenting as apical mass are rare [1–4]. The incidence of schwannoma has been reported to vary from 16 to 26 % in primary brachial plexus tumours [1, 5]. Occasionally, there have been reports of their thoracic presentation as superior or apical posteromedial mediastinal tumour or as apical lung mass [6]. Although these are benign and encapsulated tumours, there have been reports of local recurrence and malignant transformation [5, 7]. Herein, we present a 32-year-old man with a palpable mass in the left supraclavicular region, paraesthesia and loss of strength in the left hand, with an ulnar distribution. An axial computed tomographic scan revealed a rounded firm mass occupying the apical region of the left chest (Fig. 1a). According to recently published articles [8] that recommended against thoracoscopic surgery for tumours > 6 cm in size located at the thoracic apex, a supraclavicular approach has been utilized. This approach provides a good exposure for schwannoma at the thoracic inlet and apex of the chest. Intraoperative electrophysiological monitoring helped to spare nerve function after tumour resection. The tumour was N. Hudorovic, MD, PhD () Department of Vascular Surgery, University Hospital Centre “Sestre milosrdnice”, Vinogradska 29, 10000 Zagreb, Croatia e-mail: [email protected] B. Vucetic, MD, PhD Department of Thoracic Surgery, University Clinical Center “Sestre milosrdnice”, Zagreb, Croatia V. Vicic-Hudorovic Croatian Nurses Association [CNA], Sortina 3, 10000 Zagreb, Croatia
13
removed completely without causing any damage to the neurovascular bundle in the area (Fig. 1b). Histology of the tumour established the diagnosis of schwannoma (Fig. 1c). Patient’s preoperative symptoms were gone 12 months after the surgery. Postoperative magnetic resonance scan revealed no residual masses in the chest (Fig. 1d). Conflict of interest The authors declare that there are no actual or potential conflicts of interest in relation to this article.
References 1. Takeda S, Miyoshi S, Minami M, Matsuda H. Intrathoracic neurogenic tumors—50 years’ experience in a Japanese institution. Eur J Cardiothorac Surg. 2004;26(4):807–12. 2. Binder DK, Smith JS, Barbaro NM. Primary brachial plexus tumours: imaging surgical and pathological findings in 25 patients. Neurosurg Focus. 2004;16:E11. 3. Horowitz J, Kline DG, Keller SM. Schwannoma of the brachial plexus mimicking an apical lung tumour. Ann Thorac Surg. 1991;52:555–6. 4. Cardillo G, Carleo F, Khalil MW, Carbone L, Treggiari S, Salvadori L, Petrella L, Martelli M. Surgical treatment of benign neurogenic tumours of the mediastinum: a single institution report. Eur J Cardiothorac Surg. 2008;34(6):1210–4. 5. Horowitz J, Kline DG, Keller SM. Schwannoma of the brachial plexus mimicking an apical lung tumour. Ann Thorac Surg. 1991;52:555–6. 6. Li JM, Zhou XM, Hu JG. Surgical treatment of 219 cases of primary tumors and cysts of the mediastinum. Hunan Yi Ke Da Xue Xue Bao. 2001;26:149–51. 7. Nayler SJ, Leiman G, Omar T, Cooper K. Malignant transformation in a schwannoma. Histopathology. 1996;29:189–92. 8. Yamaguchi M, Yoshino I, Kameyama T, Osoegawa A, Tagawa T, Maehara Y. Thorascoscopic surgery combined with a supraclavicular approach for removing a cervicomediastinal neurogenictumor. A case report. Ann Thorac Cardiovasc Surg. 2006;12:194–96.
Supraclavicular approach for removal of apical thoracic schwannoma
1
images in clinical medicine Fig. 1 An axial computed tomographic scan revealed a smooth, round, capsulated mass measuring 9.77 × 5.98 cm lying from thoracic inlet to just above the tracheal bifurcation (a). A left supraclavicular approach was made. A rounded firm mass of a size of 9.77 × 5.98 cm was seen occupying the apical region of the left chest. The mass appeared connected to the lower trunk of the brachial plexus close to the upper border of the first rib. Pleural cover and the remnant of the capsule at the root of neck were cleared (b). Histological examination of tumour tissue revealed the diagnosis of schwannoma (c). Magnetic resonance imaging performed 12 months after surgery showed no tumor recurrence (d)
2 Supraclavicular approach for removal of apical thoracic schwannoma
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