Rare Condition of Intrathoracic Phrenic Nerve Schwannoma Successfully Treated with Uniportal Video-Assisted Thoracoscopic Surgery

Abstract

Introduction. Neurogenic tumors in the mediastinum account for approximately 20-30% of all types of mediastinal tumors in adults. This pathology is usually benign and has no or very few symptoms. Schwannoma rarely involves the phrenic nerve. We report a unique case of schwannoma involvement of phrenic nerve. Case Presentation. The 43-year-old female patient has an annual check-up of computerized tomography to detect the mass in the right middle mediastinum, so the patient was admitted to the hospital. Chest computerized tomography image found a mass of the middle mediastinum with the size of 23 × 22.3 mm located between the right pulmonary artery and the pericardium with uniform margins and clear boundaries, not invading the surrounding organization. Very little contrast is absorbed after injection. She underwent a uniportal video-assisted thoracoscopic surgery, and this mass was found to be originating from the right phrenic nerve. Resection of the portion of phrenic nerve with mass was performed. Postoperatively, the patient was discharged from the hospital after 4 days of treatment in a clinical condition with no difficulty breathing and no chest pain; postoperative X-ray showed no abnormality, and the right diaphragm was unchanged. Conclusion. Although they are very rare, schwannomas of the phrenic nerve should be considered in the differential diagnosis of mediastinal tumors. Uniportal video-assisted thoracoscopic surgery is a preeminent option with properly sized tumors that deliver good results and have no postoperative complications associated with surgery.

Schwannoma of the phrenic nerve. A case report

“…The posterior mediastinum is rich in nerve fibres, which is why these tumors most frequently occur here, where they arise from peripheral and especially intercostal nerves, from ganglia and paraganglia of the sympathetic or vagus nerve, and rarely, more ventrally, from the phrenic nerve. In the available literature, schwannoma of nervus phrenicus is only described in a few cases, and it is, like other neurogenic mediastinal tumors, mostly asymptomatic 6 . Certain nonspecific symptoms such as chest or back pain are rarely mentioned in the literature.…”

“…The most common site of occurrence is along the costovertebral sulcus [3][4][5] . In recent literature, there are only a few reported cases of a schwannoma of the phrenic nerve 6 . Here we present a patient case with an incidental finding of a schwannoma of the phrenic nerve in the area of the middle mediastinum.…”

Neck schwannoma with phrenic nerve involvement: A rare case report

“…Approximately 25–45 % of extracranial schwannomas occur in the head and neck, primarily in the parapharyngeal space (PPS), with over two-thirds located outside the skull. Schwannomas originating from the phrenic nerve are quite rare [ [2] , [3] , [4] , [5] , [6] ].…”

“…Scarce neurogenic tumors such as schwannomas, which originate from the axonal components of nerves, represent a significant cause of mediastinal masses, accounting for approximately 20–30 % of these tumors [ 1 , 2 ]. This tumor, encapsulated and deriving from Schwann cells, is also known as neurilemmoma [ 3 ].…”

“…Schwannomas are associated with spinal ganglia, intercostal nerves, and both parasympathetic and sympathetic nerves [ 4 ]. Involvement of the phrenic nerve is uncommon, with sporadic reports in the literature [ [2] , [3] , [4] , [5] , [6] ]. Due to the lack of established guidelines, we present this case to broaden the global understanding of its management.…”