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• W4387248160 abstract "SESSION TITLE: Lung Cancer: Rare Malignancies Presenting in the Lung SESSION TYPE: Case Reports PRESENTED ON: 10/09/2023 01:00 pm - 02:00 pm INTRODUCTION: Both benign and malignant peripheral nerve tumors can arise in the posterior mediastinum. Benign schwannomas are the most common tumor type (1). Schwannomas generally occur as growths that are closely associated with but distinct from the nerve and pathologically distinct by S-100 protein staining. Here we describe a patient with acute respiratory failure secondary to a giant intrathoracic schwannoma that led to respiratory and hemodynamic compromise. CASE PRESENTATION: A 31-year-old female with hypertension presented with acute respiratory distress and hypoxemia requiring prompt nasal intubation. Initial workup was noteworthy for positive Influenza A PCR; oseltamivir was started. CT chest imaging demonstrated a large heterogenous mass encompassing the right hemithorax with severe compression of the distal trachea and right sided airways (Figure 1). Additional history revealed that imaging from a year prior had identified similar findings but she had been lost to follow up. She was transferred to our tertiary center for further management. Upon arrival, bronchoscopy was performed and demonstrated erythema throughout the right bronchial tree and collapse of the right upper lobe. On hospital day 3, CT-guided biopsy was performed with preliminary pathology concerning for a spindle cell tumor and possible spindle cell melanoma. Surgical resection was delayed pending final pathology. In the interim she underwent a PET scan that demonstrated a hypermetabolic mass with multiple areas of internal necrosis (Figure 2). Pathology finalized as consistent with a schwannoma based on S-100 and SOX-10 immunostains (Figure 3). Angiography with embolization of feeding vessels was performed pre-operatively. Operative resection was completed while on ECMO support given the critical airway stenosis. She ultimately underwent hemiclamshell thoracotomy, excision of large mediastinal mass and right upper lobe wedge resection. She was weaned from VV ECMO intra-operatively and extubated on post operative day 1. The final pathology confirmed a diagnosis of giant Schwannoma. The patient was discharged home on room air with improved aeration on plain film. DISCUSSION: Schwannomas represent a large subset of intrathoracic nerve sheath tumors. Frequently these are identified as posterior mediastinal masses, however can arise at various locations including: the intercostal space, sympathetic ganglion, vagal nerve, and rarely along the bronchi or within the pulmonary parenchyma. (2). Symptoms usually occur when the benign mass expands leading to parenchymal compression and airway compromise or even cardiac tamponade. In this case the large size of the tumor resulted in dyspnea and respiratory failure when coupled with an influenza A infection. The differential for this tumor includes other spindle cell featuring malignancies including melanomas. The symptoms and CT findings are non-diagnostic and as in our case required S-100 staining confirmed the diagnosis (3). Treatment for schwannomas is generally surgical resection including dissection from the neural stalk. Due to the critical airway stenosis from the tumor this operation required both thoracic surgery and cardiac surgery for resection of the mass on ECMO support. CONCLUSIONS: Intrathoracic schwannomas are rare tumors that can lead to significant mass effect and in some cases respiratory failure. Optimal treatment involves resection and consideration of the need for VV ECMO. REFERENCE #1: Marchevsky AM, Balzer B. Mediastinal tumors of peripheral nerve origin (so-called neurogenic tumors). Mediastinum. 2020 Dec 30;4:32. REFERENCE #2: Wang J, Yan J, Ren S, Guo Y, Gao Y, Zhou L. Giant neurogenic tumors of mediastinum: report of two cases and literature review. Chin J Cancer Res. 2013;25(2):259-262. REFERENCE #3: Shao J, Zhu XH, Shi JY, Ma J, Ge XJ, You ZQ. Primary pulmonary schwannoma: clinical analysis of 7 cases and review of the literature. Zhonghua Jie He He Hu Xi Za Zhi. 2003 Jan;26(1):3-6. Chinese. DISCLOSURES: No relevant relationships by Kashika Goyal No relevant relationships by Jennica Johns No relevant relationships by Patrick Sylvester" @default.
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• W4387248160 date "2023-10-01" @default.
• W4387248160 modified "2023-10-03" @default.
• W4387248160 title "RARE GIANT INTRATHORACIC SCHWANNOMA" @default.
• W4387248160 doi "https://doi.org/10.1016/j.chest.2023.07.2766" @default.
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