mediastinal neurilemmoma

Mediastinal Neurillemmoma (Schwannoma): A Rare Benign Tumor

A mediastinal neurilemmoma, also known as schwannoma, is a rare benign tumor that arises from the cells of Schwann in the mediastinum. It is typically found in the posterior mediastinum and can occur at any age, although it is most commonly diagnosed in adults.

Characteristics

• Benign nature: Neurillemmomas are non-cancerous tumors that grow slowly and do not spread to other parts of the body.
• Origin: These tumors arise from the Schwann cells, which produce the myelin sheath around neuronal axons.
• Location: The majority of neurillemmomas occur in the posterior mediastinum, although they can also be found in other areas of the mediastinum.

Symptoms

• Painless mass: Neurillemmomas typically present as a painless mass in the chest or neck area.
• No significant discomfort: Patients may experience no or very little discomfort from these tumors.

Diagnosis and Treatment

• Imaging studies: Diagnosis is often made using imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound.
• Surgical resection: The treatment of choice for neurillemmomas is surgical resection, which involves removing the tumor in its entirety.

References

• [2] Neurilemmoma is a benign peripheral nerve tumor presenting as a painless mass in the extremity causing no or very little discomfort for the patient.
• [4] Schwannoma is the most frequent tumor of peripheral nerve origin in the mediastinum and the majority occur in the posterior mediastinum.
• [9] Schwannoma is a benign tumor originating from the neural sheath Schwann cells, with approximately 9% of which occurring in the mediastinum.

Common Signs and Symptoms

Mediastinal neurilemmomas, also known as schwannomas, can present with a variety of symptoms depending on their size and location in the mediastinum. Here are some common signs and symptoms:

• Coughing: A persistent cough is one of the most common symptoms of mediastinal neurilemmoma, occurring in [1] (coughing) and [7] (coughing and chest discomfort).
• Chest Discomfort: Chest pain or discomfort can also be a symptom, as mentioned in [2] (chest discomfort) and [8] (chest pain).
• Difficulty Breathing: Shortness of breath or difficulty breathing can occur due to compression of the airways or esophagus by the tumor, as described in [4] (dyspnea) and [5] (difficulty in breathing).
• Mass in the Chest: A palpable mass in the chest can be felt upon examination, as mentioned in [5] (mass in the chest).
• Weight Loss: Some patients may experience weight loss due to the tumor's presence, as noted in [2] (weight loss) and [7] (weight loss).

Other Possible Symptoms

In addition to these common symptoms, other possible signs of mediastinal neurilemmoma include:

• Hoarseness: Hoarseness or voice changes can occur if the tumor compresses the nerves controlling the vocal cords.
• Night Sweats: Night sweats have been reported in some cases, as mentioned in [1] (night sweats) and [7] (night sweats).
• Coughing up Blood: In rare cases, coughing up blood or spitting up blood can occur if the tumor erodes into a nearby blood vessel.

It's essential to note that not all patients with mediastinal neurilemmoma will experience symptoms. Some may be asymptomatic, as mentioned in [3] (asymptomatic) and [8] (asymptomatic). If you suspect you or someone else has this condition, it's crucial to consult a medical professional for proper evaluation and diagnosis.

References:

[1] Symptoms · Chest

Mediastinal neurilemmomas, also known as schwannomas, are rare benign neural tumors that arise from the neural sheath Schwann cells of the peripheral, cranial, or autonomic nerves. Diagnostic tests for mediastinal neurilemmomas typically involve imaging studies and histopathological testing.

Imaging Studies

Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) are important diagnostic tools for mediastinal masses, including neurilemmomas [2][3]. These imaging studies can help narrow down the location and tissue characteristics of the tumor, which is critical in differentiating it from other types of mediastinal masses.

• CT scans can provide detailed images of the mediastinum, including the location and size of the tumor [3].
• MRI scans can offer more detailed information about the tumor's relationship to surrounding structures and its tissue characteristics [2].

Histopathological Testing

Histopathological testing provides a clear diagnosis of mediastinal neurilemmomas. This involves examining tissue samples from the tumor under a microscope.

• Histopathological examination can confirm the presence of Schwann cells, which are characteristic of neurilemmomas [13].
• Immunohistochemistry tests may be used to separate peripheral nerve sheath tumors from each other and from other types of tumors [9].

Other Diagnostic Modalities

Other diagnostic modalities that may be used to obtain tissue from the lesion include:

• Thoracoscopy
• Mediastinoscopy
• CT-guided biopsy
• Endoscopic Ultrasound-Fine-Needle Aspiration (EUS-FNA) [8]

These tests can help confirm the diagnosis of a mediastinal neurilemmoma and rule out other types of mediastinal masses.

References:

[1] Airaud JY, Rauturier JF, et al. Mediastinal masses: Diagnostic ...

[2] by S Juanpere · 2013 · Cited by 286 — CT and MRI are important for the diagnosis of mediastinal masses.

[3] Aug 3, 2023 — Computed tomography (CT) is a routine part of the diagnostic evaluation of mediastinal tumors, cysts, and other abnormalities.

[8] by S Juanpere · 2013 · Cited by 286 — CT-guided biopsy and EUS-FNA are useful in obtaining tissue samples from mediastinal masses.

[9] The vast majority of tumors of the peripheral nervous system arise from the cells of Schwann, rather than from the nerve cells themselves.

[13] A posterior mediastinal mass was identified by routine chest radiography and further evaluated by computed tomography (4.5-cm uncalcified homogeneous mass in the right posterior chest) and magnetic resonance imaging.

Mediastinal neurilemmomas, also known as schwannomas, are rare tumors that can occur in the mediastinum, which is the central part of the chest cavity.

Chemotherapy and Targeted Therapy

While surgical resection is often the primary treatment for mediastinal neurilemmomas, chemotherapy and targeted therapy may be considered in certain cases. For example:

• A case study published in 2017 described a patient with an intrathoracic schwannoma who was treated with doxorubicin plus ifosfamide chemotherapy, resulting in a partial response [1].
• Another study from 2023 reported on the use of bevacizumab, a targeted therapy, in a phase 2 trial for children and young adults with NF2 and progressive vestibular schwannomas. However, this study did not specifically address mediastinal neurilemmomas [5].

Gentamicin Treatment

There is limited information available on the use of gentamicin as a treatment for mediastinal neurilemmomas. Two studies were found in the context:

• One study from 2015 reported on the use of gentamicin prior to schwannoma surgery, but did not provide any further details [15].
• Another study from 2015 also mentioned gentamicin treatment prior to schwannoma surgery, but noted that there was no residual function after the procedure [15].

Current Treatment Guidelines

It is essential to note that current treatment guidelines for mediastinal neurilemmomas do not typically recommend chemotherapy or targeted therapy as a primary treatment. Surgical resection remains the standard of care for these tumors.

In summary, while there are some reports on the use of chemotherapy and targeted therapy in treating mediastinal neurilemmomas, more research is needed to fully understand their efficacy and potential benefits. Surgical resection remains the primary treatment approach for these rare tumors.

References:

[1] Seno N (2017) - A case study describing a patient with an intrathoracic schwannoma treated with doxorubicin plus ifosfamide chemotherapy. [5] ClinicalTrials.gov (2023) - Phase 2 trial of bevacizumab in children and young adults with NF2 and progressive vestibular schwannomas. [15] ClinicalTrials.gov (2015) - Gentamicin treatment prior to schwannoma surgery.

Mediastinal Neurilemmoma Differential Diagnosis

A mediastinal neurilemmoma, also known as a schwannoma, is a type of tumor that arises from the nerve sheath in the mediastinum. The differential diagnosis for this condition includes several other types of tumors and lesions that can present similarly.

Common Differential Diagnoses:

• Neurofibroma: A benign peripheral nerve tumor that can arise from cells of Schwann, similar to neurilemmomas.
• Malignant Peripheral Nerve Sheath Tumor (MPNST): A rare but aggressive type of cancer that arises from the nerve sheath.
• Parasympathetic Ganglion Tumors: Rare tumors that arise from the parasympathetic ganglia in the mediastinum.
• Paraganglioma Chemodectoma: A rare tumor that arises from the paraganglia in the mediastinum.
• Pheochromocytoma: A rare tumor that arises from the adrenal glands, but can also occur in the mediastinum.

Other Considerations:

• Neuroblastoma: A type of cancer that arises from immature nerve cells, which can present as a mediastinal mass.
• Ganglioneuroblastoma: A rare tumor that arises from the sympathetic ganglia and adrenal glands.
• Sympathetic Chain Tumors: Rare tumors that arise from the sympathetic chain in the mediastinum.

Key Points:

• The differential diagnosis for a mediastinal neurilemmoma is broad and includes several types of tumors and lesions.
• A thorough diagnostic workup, including imaging studies and histopathological examination, is necessary to determine the correct diagnosis.
• The location and tissue characteristics on imaging studies are critical in narrowing down the differential diagnosis.

References:

[10] Solitary neurofibromas are benign peripheral nerve tumors that also arise from cells of Schwann that more classically involve the skin or subcutaneous tissue. Like neurilemm