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A 23-year-old nonsmoking, female was sent to respiratory medicine department with suspicion of malignant intrathoracic lesion. The diagnosis was confirmed by performing Computed tomography of thorax. Suspicion for Benign posterior mediastinal schwannoma was raised as it is one of the most common posterior mediastinal mass. Complete resection of the mass was done & findings were confirmed by histopathological examination. We present here a case of posterior mediastinal schwannoma who presented with complaints of left-sided anhidrosis, headache, frequent tingling sensation & weakened hand grip for 4 years. To study the clinical presentation, course of progression, diagnosis & management of posterior mediastinal schwannoma. A case of posterior mediastinal schwannoma was studied with regular investigations, surgical management & follow-up. The patient recovered with complete resolution & uneventful postoperative period. In the list of common differential diagnoses for posterior mediastinal masses neurogenic tumors acquire the top position. Currently, video-assisted thoracoscopic surgery is the technique of choice for the diagnosis and treatment of benign posterior mediastinal masses as it is less invasive& has fewer complications. Survival rates for patients with benign neurogenic tumors are excellent. The benign posterior mediastinal schwannoma is completely resectable with less recurrence.

Abstract Schwannomas are classified as neurogenic tumors and are the most frequent nerve sheath tumors in the paravertebral mediastinum. Recently, the addition of endobronchial ultrasound‐guided intranodal forceps biopsy (EBUS‐IFB) using standard‐sized biopsy forceps (SBFs) to endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) for metastatic lymph nodes in lung cancer patients reportedly improved the quality and quantity of the obtained specimens without significant complications. However, reports on the usefulness of this technique for benign diseases remain scarce. Here we report a case of schwannoma in the middle mediastinum, which was diagnosed by EBUS‐IFB using SBFs, despite inadequate specimens obtained via EBUS‐TBNA. An 80‐year‐old woman presented with dyspnea and a 5‐cm sized middle mediastinal tumor. EBUS‐TBNA and EBUS‐IFB using SBFs were performed for histological diagnosis. No complications were associated with the bronchoscopy procedure, and schwannoma was solely diagnosed using the EBUS‐IFB specimens. EBUS‐IFB using SBFs is potentially useful for diagnosing benign diseases, including schwannomas, which are often difficult to diagnose with EBUS‐TBNA.

Extraskeletal Ewing sarcoma is a rare and aggressive tumor, often presenting diagnostic challenges because of its nonspecific radiologic and clinical features. This case report highlights a unique instance of a primary extraskeletal spinal Ewing sarcoma (PESES), initially misdiagnosed as a neurogenic tumor. The report discusses the imaging characteristics that led to the initial misdiagnosis and reviews the distinguishing features of PESES on advanced imaging modalities. This case emphasizes the necessity of a comprehensive diagnostic approach for an accurate diagnosis of PESES, including a high degree of suspicion, advanced imaging techniques, and histopathological correlation. [ABSTRACT FROM AUTHOR]

Schwannomas are classified as neurogenic tumors and are the most frequent nerve sheath tumors in the paravertebral mediastinum. Recently, the addition of endobronchial ultrasound‐guided intranodal forceps biopsy (EBUS‐IFB) using standard‐sized biopsy forceps (SBFs) to endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) for metastatic lymph nodes in lung cancer patients reportedly improved the quality and quantity of the obtained specimens without significant complications. However, reports on the usefulness of this technique for benign diseases remain scarce. Here we report a case of schwannoma in the middle mediastinum, which was diagnosed by EBUS‐IFB using SBFs, despite inadequate specimens obtained via EBUS‐TBNA. An 80‐year‐old woman presented with dyspnea and a 5‐cm sized middle mediastinal tumor. EBUS‐TBNA and EBUS‐IFB using SBFs were performed for histological diagnosis. No complications were associated with the bronchoscopy procedure, and schwannoma was solely diagnosed using the EBUS‐IFB specimens. EBUS‐IFB using SBFs is potentially useful for diagnosing benign diseases, including schwannomas, which are often difficult to diagnose with EBUS‐TBNA. [ABSTRACT FROM AUTHOR]

Schwannoma in primary neurogenic tumors of the trachea is an extremely rare disease. A 21-year-old male patient with stridor was followed up with a diagnosis of asthma for two years. While no lesion was observed in the chest X-ray, tracheal schwannoma was diagnosed in the case who underwent tracheotomy due to the lesion obstructing the trachea almost completely on chest CT. The clinical findings of the patient improved ultimately in the postoperative period. We aimed to discuss the approach and follow-up of the disease with our case, although it is rare that schwannoma might be in the differential diagnosis of masses with upper airway obstruction. [ABSTRACT FROM AUTHOR]

Schwannomas are benign tumors derived from the sheath of Schwann cells. Though it is common to see schwannomas in the head and neck region, auricular schwannomas are rare and only few cases have been reported. There are no distinguishing clinical findings or images; therefore, the histopathological diagnosis is mandatory. We describe a case of auricular schwannoma with clinical pictures and discuss the differential diagnoses according to histopathologic findings. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical presentation, diagnostic strategy, treatment approach, and postoperative morbidity of neurogenic tumors in the neck region, which are rarely observed and cannot be easily distinguished from other masses of this region. Material and Methods: A retrospective analysis of the medical data of patients with histopathologically confirmed neurogenic tumors who underwent surgery at the otorhinolaryngology department over the 20 years from 2000 to 2019. Results: Twenty-one patients were evaluated. Fifteen (71%) of them were women and 6 (29%) were men, with ages of 0-75 years. Out of 21 cases, 19 (90%) were benign, while 2 (10%) cases had malignant histology. Of the patients, 14 (67%) were diagnosed with peripheral nerve sheath tumors, 5 (24%) with ganglion cell tumors, and 2 (9%) with paraganglion cell tumors. The most common presentation symptom was neck swelling. Other symptoms included pain and numbness in the arm, dyspnea, dysphagia, and snoring. Postoperative morbidities included Horner’s syndrome, vocal cord palsy, and motor weakness of the upper limp. While fine-needle aspiration cytology was not diagnostic in any of the patients. Conclusion: Neurogenic tumors located in the neck are extremely rare. Differential diagnoses of these tumors are critical to provide patients with information about possible postoperative neurological deficits and other morbidities. Neither imaging methods nor preoperative biopsies can provide clear information about the definitive diagnosis. [ABSTRACT FROM AUTHOR]

Ganglioneuroma is a rare benign tumor originating in the sympathetic ganglia, composed of differentiated ganglion cells, nerve sheath cells, and nerve fibers, which tend to occur in the posterior mediastinum, adrenal gland, retroperitoneal, and other locations, occurring in the head and neck is relatively rare, and parapharyngeal space involvement is extremely rare. In our report, we present 2 adult male patients whose preoperative imaging and fine needle cytology did not confirm the diagnosis of a parapharyngeal space mass and who completely resected the tumor through a combined cervical and oral approach. Finally, pathology confirmed ganglioneuroma; we also reviewed the English articles on parapharyngeal ganglioneuroma over the past 40 years, and summarized the diagnostic and treatment characteristics of parapharyngeal ganglioneuroma in combination with our cases to improve understanding of the disease. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the safety and feasibility of ultrasound-guided nerve block prior to biopsy of potentially neurogenic tumors. Materials and methods: A retrospective review of the medical record from June 2017 to June 2022 identified ultrasound-guided biopsies of potentially neurogenic tumors that were performed with a pre-procedural nerve block. Patient demographics, biopsy site, number of passes, needle gauge, use of sedation, pathology results, and procedural complications were recorded and summarized. Results: The structured search found 16 patients that underwent biopsies of 18 potentially neurogenic tumors with the use of a pre-procedural nerve block at a variety of upper and lower extremity locations. Average patient age was 52 (range 18–78) and 9 patients (56%) were female. Of the 16 patients, 10 were performed without intravenous sedation. Three patients were unable to tolerate biopsy until a nerve block was used. All biopsies yielded a diagnostic sample with 13 of the tumors neurogenic in origin. One patient reported mild postprocedural pain which resolved with conservative treatment; no other complications were reported. Conclusion: Nerve block prior to ultrasound-guided biopsy of potentially neurogenic tumors is a safe and feasible technique. Further study is needed to determine the extent to which nerve block can decrease intra-procedural pain and reduce or eliminate the need for sedation during biopsy. [ABSTRACT FROM AUTHOR]

Brachial plexus tumors are rare and pose challenges for neurosurgeons due to their anatomical complexity. Retrosternal extension of a tumor makes it more difficult for the surgeons as well as for the anesthesiologists to secure a definitive airway. A cardiopulmonary bypass would be lifesaving in the event of acute cardiorespiratory decompensation. Multidisciplinary collaboration and cooperation between the neurosurgeon, oncosurgeon, cardiothoracic surgeon, and anesthesiologist are imperative to ensure good patient outcomes. Meticulous preoperative evaluation and operative planning are essentially the key factors in anesthetic management. Here we report a successful management of a 49-year-old male patient presented with a large painless mass arising from his right supraclavicular region and compressing the roots of the brachial plexus, trachea, and esophagus and extending up to the apex of the lungs, posted for mini sternotomy and excision of the mass. [ABSTRACT FROM AUTHOR]

Brachial plexus tumors are rare and pose challenges for neurosurgeons due to their anatomical complexity. Retrosternal extension of a tumor makes it more difficult for the surgeons as well as for the anesthesiologists to secure a definitive airway. A cardiopulmonary bypass would be lifesaving in the event of acute cardiorespiratory decompensation. Multidisciplinary collaboration and cooperation between the neurosurgeon, oncosurgeon, cardiothoracic surgeon, and anesthesiologist are imperative to ensure good patient outcomes. Meticulous preoperative evaluation and operative planning are essentially the key factors in anesthetic management. Here we report a successful management of a 49-year-old male patient presented with a large painless mass arising from his right supraclavicular region and compressing the roots of the brachial plexus, trachea, and esophagus and extending up to the apex of the lungs, posted for mini sternotomy and excision of the mass.

Schwannomas are benign tumors originating from Schwann cells in the peripheral nervous system. They mostly occur in the head and neck region but are rare in the larynx, and present with various symptoms. Surgical removal is the recommended treatment. This study presents a 12-year-old female with sudden onset hemoptysis, snoring, difficulty breathing, dysphagia, and voice changes. On examination, she was conscious and had muffled voice while speaking, without signs of respiratory distress. Endoscopic laryngoscopy revealed a large laryngeal mass obstructing the vocal cords. Endoscopic excision and biopsy confirmed the presence of the laryngeal schwannoma. Postoperative recovery was uneventful, with normal vocal cord function and no recurrence at follow-up. [ABSTRACT FROM AUTHOR]

Abstract Background Neuroblastic tumors arise from primitive sympathetic ganglion cells and are the most common extracranial solid tumor of childhood. Ganglioneuroma is the most well-differentiated, benign subtype and comprises less than 1% of all soft tissue tumors. One to 5% of these occur in the head and neck, including the parapharyngeal space. It is uncommon to find a physically detectable, neoplastic parapharyngeal space mass in a child. Case report A 7-year-old boy presented with a painless left neck mass. Imaging revealed a 2.6 × 2.7 × 6.1 cm left parapharyngeal space mass. Fine-needle aspiration suggested a ganglioneuroma. The patient developed compressive symptoms, notably pain, thus the decision was made to surgically resect. The tumor was excised transcervically, preserving the great vessels, phrenic and cranial nerves. Postoperatively, the patient developed a mild ipsilateral Horner’s syndrome, suggesting the mass to be a ganglioneuroma of the sympathetic chain. Conclusions Cervical ganglioneuromas typically present as slow-growing masses that cause compressive symptoms or are found incidentally. Resection is reserved for those with significant symptoms and is often complicated by Horner’s syndrome. In the review of literature, there are 23 reported cases of ganglioneuroma in the head/neck with a median age of 17 years. Eight of these occurred in the para/retropharyngeal spaces. Of these, five presented as an asymptomatic neck mass, two presented with compressive symptoms, and one was discovered incidentally. It is important to consider ganglioneuroma in the workup of pediatric neck masses, even in young children. Asymptomatic masses should be monitored for symptomatic transformation, and excision should be considered.

Ganglioneuroma is a rare, differentiated, and benign neurogenic tumor that could grow into a huge size with minimal or no symptoms at all. Ganglioneuroma is typically found in older children or adults and is commonly detected within the posterior mediastinum (other than retroperitoneal). Here, we present a case of a 3-year-old patient with shortness of breath, and radiological examination showed a giant mediastinal tumor which proved to be a ganglioneuroma after histopathological examination. This study highlights the possibility of ganglioneuroma occurring in younger children and the role of imaging in assessing ganglioneuroma as a posterior mediastinal tumor.

Phrenic nerve schwannomas of the head and neck are exceedingly rare pathologies that can present as an asymptomatic neck mass. Surgery is the definitive treatment, and a conservative surgical approach is preferred if a benign pathology is suspected. We present a rare case of a phrenic nerve schwannoma successfully treated with enucleation and preservation of the phrenic nerve. [ABSTRACT FROM AUTHOR]

Abstract Phrenic nerve schwannomas of the head and neck are exceedingly rare pathologies that can present as an asymptomatic neck mass. Surgery is the definitive treatment, and a conservative surgical approach is preferred if a benign pathology is suspected.

Malignant peripheral nerve sheath tumors are rare sarcomas of the heart. Herein, we report the case of a 24-year-old man who complained of dyspnea, cough, and upper left back pain. He was found to have multiple primary heart tumors obstructing the right superior pulmonary vein in the left atrium, which were diagnosed as malignant peripheral nerve sheath tumors. The patient underwent successful resection of the tumors and immunohistochemistry was utilized for diagnosis.

Abstract Background Mucosal Schwann cell hamartomas are rare neurogenic tumors which present most commonly in the distal colon. They are usually discovered as small, single polyps in asymptomatic patients. Case presentation An asymptomatic 64-year-old man was referred to us after a 12 mm subepithelial lesion was discovered incidentally on screening colonoscopy. Follow-up colonoscopy conducted 2 months later revealed that the tumor had disappeared, leaving multiple edematous, submucosal tumor-like elevations presenting as skip lesions throughout the sigmoid colon. Lesions had elongated pits on magnifying endoscopy and were limited to the first layer on endoscopic ultrasound. Biopsies revealed unclearly delineated foci of spindle-shaped cells limited to the lamina propria. On immunohistochemistry, all lesions were positive for S-100 protein and negative for CD34, CD56, and neurofilament protein. The patient was diagnosed with multiple mucosal Schwann cell hamartomas of the sigmoid colon. He remains asymptomatic after 18 months of follow-up, but the lesions have also remained unchanged. Conclusion We report a case of multiple non-polypoid mucosal Schwann cell hamartomas. Endoscopic findings may assist in the differential diagnosis, particularly when presenting as non-polypoid, submucosal tumor-like lesions.

Ependymomas arise from ependymal cells and can grow at any site in the central nervous system (CNS), as well as in some locations outside of the CNS. The latter is rare, contributing to the frequent misdiagnoses of such cases. Herein, we present the case of a 54-year-old man with a history of lower limb weakness and numbness. Magnetic resonance imaging revealed an extradural, heterogeneously enhanced solid lesion with a regular and well-defined border in the posterior mediastinum. A post-resection histopathological examination revealed tumor-forming perivascular pseudo-rosettes that showed immunoreactivity against glial fibrillary acidic protein, epithelial membrane antigen, and vimentin, as well as a high Ki-67 labeling index. Based on pathological features, a diagnosis of anaplastic ependymoma was established.

Retroperitoneal neurogenic tumors are extremely rare pathological entities; therefore, few clinical features and natural courses, especially originating from the pancreatic/peripancreatic regions, have been reported. This study aimed to investigate the clinicopathological features of pancreatic and peripancreatic neurogenic tumors and assess the diagnostic value of computed tomography (CT) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). Between 2006 and 2018, patients who were diagnosed with neurogenic tumors were included. In total, 90 histologically confirmed cases of neurogenic tumors located in the pancreatic/peripancreatic regions were selected for analysis. The mean age was 49.2 ± 13.1 years. There were no differences in sex distribution of the tumors. Schwannomas (44.4%) and paragangliomas (41.1%) were the most common neurogenic tumors. The sensitivity of CT was 62.2% in 90 cases. EUS-FNB was performed in 30 cases and the sensitivity of it was 83.3%. The diagnosis of neurogenic tumors with EUS-FNB or CT was not significantly associated with tumor location and size. Surgical resection was performed in 78 cases. Of the 12 patients who did not undergo surgery, 10 cases were followed-up without any increase in tumor size. Through the present study, we verified radiological, pathological, and clinical aspects of the pancreatic/peripancreatic neurogenic tumors which little known before, therefore, this study can serve as the basis for research to present an optimal diagnosis and treatment of neurogenic tumors. In addition, EUS-FNB is useful in the diagnosis of pancreatic/peripancreatic neurogenic tumors with relatively high sensitivity and can help establish therapeutic plans before the surgery. [ABSTRACT FROM AUTHOR]

Background: Thoracoscopic surgery has been increasingly used for a variety of indications. Posterior mediastinal tumors form an important component of a thoracic surgeon’s workload. This report represents a summary of our initial experience in thoracoscopic management of such tumors. Methods: We retrospectively reviewed the clinical and operative data from records over the study period. We also describe our usual perioperative management and surgical techniques. Results: A total of 11 patients, 8 being females, were operated during the period of 30 months. Seven were incidental findings, and chest pain was the commonest presentation in symptomatic patients. The mean age of the patients was 38.7 years; mean tumor diameter was 4.4 cm; eight had benign schwannoma, and no patient had a malignant tumor. Mean operative duration was 175.5 min; there were no conversions and no transfusion was required. Mean length of stay in the hospital was 5.6 days. There were no perioperative deaths or major complications. Three minor complications were recorded. Follow-up (4 to 18 months) was uneventful. Conclusions: Thoracoscopic management of posterior mediastinal tumors is feasible and safe.

Castleman disease is a relatively rare disease, characterized by well-circumscribed benign lymph-node hyperplasia. The disease may develop anywhere in the lymphatic system, but is most commonly reported as unicentric Castleman disease in the mediastinum along the tracheobronchial tree. It is usually asymptomatic and detected on plain chest radiography as an incidental finding. We report an incidentally detected case of Castleman disease in the paravertebral space that was preoperatively diagnosed as a neurogenic tumor and treated by complete surgical resection.

Schwannomas are uncommon benign nerve sheath tumors and often arise in the posterior mediastinum and costovertebral angle. However, endobronchial schwannomas are rare. In fact, there are only a few reported cases in the literature. Here, we describe a case of an endobronchial schwannoma causing obstruction of the right upper lobe bronchus.

Background: Mucosal Schwann cell hamartomas are rare neurogenic tumors which present most commonly in the distal colon. They are usually discovered as small, single polyps in asymptomatic patients.Case Presentation: An asymptomatic 64-year-old man was referred to us after a 12 mm subepithelial lesion was discovered incidentally on screening colonoscopy. Follow-up colonoscopy conducted 2 months later revealed that the tumor had disappeared, leaving multiple edematous, submucosal tumor-like elevations presenting as skip lesions throughout the sigmoid colon. Lesions had elongated pits on magnifying endoscopy and were limited to the first layer on endoscopic ultrasound. Biopsies revealed unclearly delineated foci of spindle-shaped cells limited to the lamina propria. On immunohistochemistry, all lesions were positive for S-100 protein and negative for CD34, CD56, and neurofilament protein. The patient was diagnosed with multiple mucosal Schwann cell hamartomas of the sigmoid colon. He remains asymptomatic after 18 months of follow-up, but the lesions have also remained unchanged.Conclusion: We report a case of multiple non-polypoid mucosal Schwann cell hamartomas. Endoscopic findings may assist in the differential diagnosis, particularly when presenting as non-polypoid, submucosal tumor-like lesions. [ABSTRACT FROM AUTHOR]

Background:MYC associated factor X (MAX) is a tumor suppressor gene and has been identified as one of the pathogenic genes of hereditary pheochromocytoma (PCC). To date, there have been no reports of ganglioneuroma (GN) with MAX variants.Case Presentation: The proband was a 45-years-old Chinese female with paroxysmal hypertension and palpitations who had undergone adrenalectomy for PCC 14 years ago. Her plasma free normetanephrine and 24-h urinary norepinephrine excretion were significantly increased, and abdominal computed tomography (CT) revealed an irregular mass in the left adrenal region, suggesting a recurrence of PCC. The mass was surgically removed and pathologically diagnosed as PCC with lymph node metastasis. The proband's son suffered from paroxysmal hypertension and palpitations. His plasma free metanephrine levels were normal. CT revealed a mass in the right adrenal. The tumor was surgically removed, and the pathological diagnosis was GN. Genetic testing of peripheral blood DNA revealed that the proband and her son had germline pathogenic MAX variant c.C97T, p.Arg33Ter, while proband's parents did not have MAX variants. Tumor DNA sequencing showed the same MAX variant (c.C97T, p.Arg33Ter) in PCC of the proband and GN of her son, both with retention of heterozygosity. Immunohistochemistry demonstrated loss of MAX protein expression in most tumor cells in PCC of the proband and some Schwannian cells in GN of the proband's son.Conclusion: We report a family with a new clinical phenotype of germline pathogenic variants in MAX who developed both PCC and GN. Germline pathogenic variants in MAX may contribute to the development of GN. Our findings suggest that it is not just paternally inherited MAX variants that can cause tumors.

Background: MYC associated factor X (MAX) is a tumor suppressor gene and has been identified as one of the pathogenic genes of hereditary pheochromocytoma (PCC). To date, there have been no reports of ganglioneuroma (GN) with MAX variants. Case Presentation: The proband was a 45-years-old Chinese female with paroxysmal hypertension and palpitations who had undergone adrenalectomy for PCC 14 years ago. Her plasma free normetanephrine and 24-h urinary norepinephrine excretion were significantly increased, and abdominal computed tomography (CT) revealed an irregular mass in the left adrenal region, suggesting a recurrence of PCC. The mass was surgically removed and pathologically diagnosed as PCC with lymph node metastasis. The proband's son suffered from paroxysmal hypertension and palpitations. His plasma free metanephrine levels were normal. CT revealed a mass in the right adrenal. The tumor was surgically removed, and the pathological diagnosis was GN. Genetic testing of peripheral blood DNA revealed that the proband and her son had germline pathogenic MAX variant c.C97T, p.Arg33Ter, while proband's parents did not have MAX variants. Tumor DNA sequencing showed the same MAX variant (c.C97T, p.Arg33Ter) in PCC of the proband and GN of her son, both with retention of heterozygosity. Immunohistochemistry demonstrated loss of MAX protein expression in most tumor cells in PCC of the proband and some Schwannian cells in GN of the proband's son. Conclusion: We report a family with a new clinical phenotype of germline pathogenic variants in MAX who developed both PCC and GN. Germline pathogenic variants in MAX may contribute to the development of GN. Our findings suggest that it is not just paternally inherited MAX variants that can cause tumors. [ABSTRACT FROM AUTHOR]

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Schwannoma is a benign encapsulated tumor of the nerve sheath. Amongst other sites, it develops in the posterior mediastinum in the costovertebral sulcus. We herein present a case of a 68-year-old woman with an incidental finding of a subcarinal mass. Radiological and histopathological studies were suggestive of schwannoma. Therefore, the mass was completely resected through a right thoracotomy, and a definite histopathological diagnosis was established. Although the subcarinal area is a rare site for this tumor to appear, the schwannoma should be considered as part of the differential diagnosis of lesions in the subcarinal region. Treatment of choice is the nerve-sparing surgical excision of the mass with excellent prognosis. A review of the literature on this topic was performed.

Head and neck schwannomas represent a considerable percentage of extracranial schwannomas. However, intraoral locations are very rare. Schwannomas of the tongue base have been sporadically reported. The exceedingly paucity of literature reports in this location made them usually skipped out when evaluating a tongue base mass. In this work, we aimed to review the literature about this tumor and to report a new case. A comprehensive review in English literature of tongue base schwannomas was done with extraction of the related articles and descriptive analysis of the collected data. Also, we presented a new case of 20-year old girl that presented with a slowly enlarging mass of the tongue over 11 years duration. CT and MRI revealed a large well-defined tongue base mass. Biopsy revealed schwannoma. Transoral complete resection with safety margins was done. Forty-three cases have been reported in literature with slight female predominance. Transoral approach was the commonest approach (76.7%) with the maximal diameter of schwannoma removed transoral was 7.9 cm. In conclusion; despite their rarity, tongue base schwannomas should be included when ever a benign swelling is suspected. Transoral approach is still the standard approach with the least morbidities and best functional outcomes. [ABSTRACT FROM AUTHOR]

Background: Malignant tumors arising from peripheral nerves or displaying differentiation along the lines of the various elements of the nerve sheath are referred to Malignant peripheral nerve sheath tumors (MPNST) and also called malignant schwannomas or neurofibrosarcomas. The common sites of involvement are head, neck, extremities and thorax. This case was discussed due to its rare incidence, namely less than 5% of soft tissue malignant tumor. The overall five year survival rate is approximately 50% in patients with resectable tumor. Case: We report a case of MPNST arising from mediastinum, the patient was a male, 41-years-old, with chief complaint are chest pain and mass in the back. Contrast enhanced chest CT Scan showed a solid mass (10.02 × 6.97 × 10.53 cm) in the right side of the posterior mediastinum. On microscopic examination with hematoxylin eosin imunostaining, of the mass on mediastinum showed typical features of MPNST, which were positive for S-100 imunostaining. Based on convensional histopathologic and imunostaining, this case was concluded as Malignant peripheral nerve sheath tumors (MPNST). Conclusion: The treatment of chest wall MPNSTs is multimodality, including wide local excision, adjuvant radiotherapy, and chemotherapy. In our case, we performed direct excision due to the infiltrating mass to the surrounding tissue, so the prognosis for this case was good. This case indicates the role of chemotherapy in treatment of advanced MPNST. Studies shows the superiority of the doxorubicin–ifosfamide regimen. As in this case the patient showed complete respons after surgery and adjuvant chemotherapy.

Antik schwannomlar nadiren görülen tümörlerdir. Genellikle retroperiton yerleşimlidirler. Asemptomatik olarak büyük boyutlara ulaşabilmektedir. Radyolojik tetkikler tümörün yerleşimi ve karakteri hakkında yardımcı olmaktadır. Tedavisi cerrahi olarak rezeksiyondur. Tanısı patolojik olarak konur.