Resection of a posterior mediastinal mass: Lessons learned from a failed exploration for presumed schwannoma

Kim, Samuel Suk; Yoo, Brian; Baaj, Ali A.; Little, Alex G.

doi:10.1016/j.jtcvs.2016.04.030

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…But, as previously reported, a mediastinal mass is not always what it seems and can create some surprises during surgical resection. 9 This was the case in our patient when we discovered a cardiac tumor arising from the epicardium.…”

Section: Discussionmentioning

confidence: 59%

Epicardial carvernous hemangioma: The diagnostic challenge of a middle mediastinal mass

et al. 2021

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Primary tumors in the middle mediastinum are rare and pose diagnostic challenges. Lymphomas, mediastinal cysts and thymomas most frequently affect this anatomic area. Primary cardiac tumors are rare and constitute a differential diagnosis for the inferior middle mediastinum. Surgical exploration and resection is often mandatory in order to make a definitive diagnosis. Here, we report the case of a 69 year-old women who presented with persistent dyspnea. A complete preoperative workup revealed a large tissular mass adjacent to the right atrium. A diagnosis of a typical epicardial cavernous hemangioma was made following surgical resection.

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Section: Discussionmentioning

confidence: 59%

Epicardial carvernous hemangioma: The diagnostic challenge of a middle mediastinal mass

et al. 2021

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“…A biopsy was successfully completed and revealed that the tumour was actually a chordoma. On CT, the mass showed obliteration of the plane between the spine and tumour, more characteristic of a chordoma [ 8 ]. This case highlights the importance of chordomas in the differential diagnosis, despite their rarity.…”

Section: Discussionmentioning

confidence: 99%

A rare posterior mediastinal mass: chordoma

Willatt,

Wollheim,

Ehrsam

et al. 2024

Journal of Surgical Case Reports

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A 72-year-old female presented with 2 years of pro-gradient pain in the upper thoracic spine radiating to the left arm and leg. MRI revealed a 2.7 × 2.0 × 12 cm paravertebral mass at T2/T3, extending into the foraminal and epidural nerves with extensive dural sac contact in the left hemithorax. The removed tumour was surprisingly soft for a schwannoma or chordoma. However, after the surgery, histopathology revealed the presence of brachyury protein (T-box transcription factor T), which is characteristic of a chordoma. While chordomas are extremely rare, it is important that they are kept in mind for the differential diagnosis of a posterior mediastinal mass. Successful treatment can only be achieved through a complete en bloc resection. This can often be complex due to their location along the spine. This case report aims to highlight the features and treatment of this rare disease.

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“…It was mentioned that the most common presenting complaint was chest or back pain, followed by anterior mediastinal compression syndrome, hoarseness, dysphagia, and cough. 5 One-third of reported patients were asymptomatic and detected during routine chest examinations 20 Many preliminary reports described several presentations for thoracic chordoma 10 , 12 , 15 Among these reports, chordomas were initially misdiagnosed as different neoplasia, including hemangioma, benign neurinomas, 23 and adenocarcinomas. 13 Others reported chordomas metastasizing to lymph nodes, lungs, 18 bones, brain, and viscera.…”

Section: Discussionmentioning

confidence: 99%

Unusual Presentation of Thoracic Chordoma with Spinal Epidural Hematoma: A Rare Case Report and PRISMA-Driven Systematic Review

Abualkhair,

Sharif,

Eid

et al. 2024

Clin Med Insights Case Rep

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A chordoma is a slow growing, locally invasive, low-grade tumor belonging to the sarcoma family. It mainly affects the sacrum and skull base. We present a case of thoracic chordoma initially presented with epidural hematoma (EDH), which is a rare clinical entity. We reported this case, and also performed a PRISMA-driven systematic review to summary the similar cases in the literature. This review includes the clinical characteristics and outcome of thoracic chordoma. Our case involves a 60-year-old male who, despite no history of trauma, presented with acute paraparesis. An epidural hematoma was identified at T6 level, leading to a surgical intervention involving T4-6 laminectomy and fixation. Six months subsequent to surgery, the patient experienced progressive lower limb weakness and spasticity. Computed tomography (CT) exhibited erosion of T6 and an associated aggressive mass. Magnetic resonance imaging (MRI) revealed a large heterogenous soft tissue mass arising from the vertebral body and right pedicle of D6, protruding in the epidural space and compressing the spinal cord focally at this level. The mass measured approximately 5 × 4 × 3.5 cm. Magnetic resonance myelography indicated a filling defect at T5–6 level, confirming the intraspinal location of the soft tissue lesion. Complete excision of the mass confirmed the diagnosis of thoracic chordoma. Postoperative follow-up demonstrated notable improvement in the lower limb spasticity and paraparesis, and the patient started adjuvant radiotherapy. This case underscores the importance of maintaining a high index of suspicion when evaluating presentations resembling EDH.

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Resection of a posterior mediastinal mass: Lessons learned from a failed exploration for presumed schwannoma

Abstract: Side-by-side comparison of thoracic chordoma versus extradural schwannoma. Central MessageMisdiagnosis and pitfalls in the operation for posterior mediastinal mass can be avoided with a multidisciplinary team approach.

Cited by 8 publications

References 6 publications

Epicardial carvernous hemangioma: The diagnostic challenge of a middle mediastinal mass

Epicardial carvernous hemangioma: The diagnostic challenge of a middle mediastinal mass

A rare posterior mediastinal mass: chordoma

Unusual Presentation of Thoracic Chordoma with Spinal Epidural Hematoma: A Rare Case Report and PRISMA-Driven Systematic Review

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