最常见的后纵隔肿块是神经源性肿瘤,例如周围神经鞘瘤(PNST)。Schwannmas,PNST的一个亚型,通常是良性的,包裹良好的神经c细胞来源的肿瘤,并且经常偶然发现,大小从无症状的纵隔小肿瘤到大肿块。很少,当由于附近结构的压迫或受累导致一系列可能的后遗症而出现症状时,就会发现大型神经鞘瘤,但不限于,持续性咳嗽,咯血,和吞咽困难.管理决策是基于肿瘤大小,location,关注潜在的恶性病理学,以及与肿瘤侵入重要解剖结构相关的潜在并发症。大多数神经鞘瘤都经过手术切除,虽然是一小部分,无症状,影像学或病理学上的良性肿瘤可接受监测.该病例报告描述了一个大的后纵隔神经鞘瘤粘附在后主动脉弓上,并包裹了左锁骨下动脉和椎动脉。手术切除需要对左锁骨下动脉的一部分进行血管切除,并使用聚四氟乙烯(PTFE)进行移植物重建。本报告进一步强调了术前计划的重要性,并考虑了多学科方法在准备大切除,复杂的后纵隔肿块。
The most common posterior mediastinal masses are neurogenic tumors such as peripheral nerve sheath tumors (PNST). Schwannomas, a subtype of PNST, are most often benign, well encapsulated tumors of neural crest cell origin, and are frequently incidentally found, ranging in size from small asymptomatic mediastinal tumors to large masses. Rarely, large schwannomas are discovered when symptoms develop due to compression or involvement of nearby structures leading to an array of possible sequela which can include, but not limited to, persistent cough, hemoptysis, and dysphagia. Management decisions are based off of tumor size, location, concern for underlying malignant pathology, and potential for complications related to tumor invasion of vital anatomical structures. A majority of the schwannomas undergo surgical resection, though a subset of small, asymptomatic, benign tumors on imaging or pathology may be managed with surveillance. This
case report describes a large posterior mediastinal schwannoma adherent to the posterior aortic arch and encasing the left subclavian and vertebral arteries. Surgical resection required vascular resection of a segment of the left subclavian artery and graft reconstruction using polytetrafluoroethylene (PTFE). This report further highlights the importance of preoperative planning with consideration of a multidisciplinary approach in preparation for resection of large, complex posterior mediastinal masses.