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. 2023 Jul;14(19):1824-1830.
doi: 10.1111/1759-7714.14927. Epub 2023 May 18.

Intrathoracic neurogenic tumors (ITNs): Management of solid and cystic lesions

Giovanni Natale  1 , Stefano Forte  2 , Gaetana Messina  1 , Beatrice Leonardi  1 , Rosa Mirra  1 , Francesco Leone  1 , Vincenzo Di Filippo  1 , Davide Gerardo Pica  1 , Francesca Capasso  1 , Mary Bove  1 , Antonio Noro  1 , Giorgia Opromolla  1 , Mario Martone  1 , Sabrina De Angelis  1 , Alfonso Fiorelli  1
Affiliations

Intrathoracic neurogenic tumors (ITNs): Management of solid and cystic lesions

Giovanni Natale et al. Thorac Cancer. 2023 Jul.

Abstract

Background: Intrathoracic neurogenic tumors (INTs) are derived from nerve tissue and grow within the chest. Preoperative diagnosis can be challenging and only complete surgical exeresis enables confirmation of the suspected diagnosis. Here, we analyzed our experience on management of paravertebral lesions with solid and cystic patterns.

Methods: A monocentric retrospective study was conducted, which included 25 consecutive cases of ITNs in the period from 2010 to 2022. These cases had been surgically treated by thoracoscopic resection alone, or in combination with neurosurgery in the case of dumbbell tumors. The demographic and operative data along with complications were recorded and analyzed.

Results: Twenty-five patients were diagnosed with a paravertebral lesion of which 19 (76%) had solid features and six (24%) had cystic features. The most common diagnosis was schwannoma (72%), followed by neurofibroma (20%) and malignant schwannoma (8%). In four cases (12%) the tumor showed an intraspinal extension. None of the patients had recurrence until 6 months of follow-up. Comparison between the VATS and thoracotomy procedures showed that outcome of discharge on the postoperative day, on average, was 2.61 ± 0.5 versus 3.51 ± 0.53, respectively (p-value <0.001).

Conclusion: The treatment of choice for INTs is complete resection which is tailored to tumor size, location, and extension. In our study, paravertebral tumors with cystic characteristics were not associated with an intraspinal extension and did not show a different behavior from solid tumors.

Keywords: ITNs; neurogenic tumors; paravertebral tumors; schwannoma.

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Conflict of interest statement

The authors confirm that there are no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
A 26‐year‐old woman with a symptomatic intrathoracic neurogenic tumor (ITN) on the right T2/3. Computed tomography (CT) scan and magnetic resonance imaging (MRI) did not show a spinal extension of the tumor (a, b) that was removed by right video‐assisted thoracoscopic surgery (VATS) (c, d).
FIGURE 2
FIGURE 2
Removal of a malignant schwannoma by video‐assisted thoracoscopic surgery (VATS). The pleura surrounding the tumor was dissected with an energy device (a), the tumor was mobilized exclusively with the use of the energy tool (b). The peripheral attachment of the tumor to the intercostal nerve was identified and then clipped and divided last (c, d).
FIGURE 3
FIGURE 3
A 44‐year‐old woman with a symptomatic dumbbell tumor located on the right T8/9. (a) The patient underwent combined surgery. The first phase consisted of posterior microneurosurgical removal of spinal component (b) and second phase consisted of thoracoscopic removal of the intrathoracic tumor (c, d).
See this image and copyright information in PMC

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