Halil YANARDAĞ, Ömer Nuri PAMUK, Sabriye DEMİRCİ, Tuncer KARAYEL, Yesari KARTER, Kamil KAYNAK

Posterior mediastende Schwannoma

Posterior mediastendeki kitlelerin ayırıcı ta¬nısında nörojenik neoplazmlar, kistler, özofa-geal tümörler, torasik vertebra hastalıkları ve abse oluşumu gibi infeksiyöz lezyonlar akla gelmelidir. Nörojenik tümörler %90 oranında posterior mediastene yerleşirler ve bu bölgede¬ki, bütün tümörlerin yaklaşık %75'ini oluştu- rurlar. Schwannoma (neurilemmoma) posteior mediasten yerleşimli, genellikle interkostal si¬nirlerden kaynaklanan ve çoğunlukla selim ka¬rakterli nörojenik bir tümördür. Nadiren habis dönüşüm gösterebildiği de bilinmektedir. Ço¬ğunlukla asemptomatik olup radyografide rast¬lantısal olarak soliter kitle şeklinde ortaya çık¬makta ve bazı durumlarda tanısı ve tedavisinde sorunlar oluşabilmektedir. Biz burada farklı endikasyonla istenen to-raks bilgisayarlı tomografisinde (BT) rastlantı¬sal olarak sağ posterior mediastende paraver-tebral yerleşimli 2 cm. çapında kitle saptanan 54 yaşında bir kadın hastayı sunmak istedik. Bu hastadaki kitlenin histopatolojik tanısını koymak amacı ile BT altında transkutanöz ince iğne aspirasyon biyopsisi yapıldı. Ancak yeter¬li materyel alınamadığı için kesin tanıya gidi¬lemedi. Tanı amacı ile hastaya sağ torakotomi yapıldı ve nodüler kitle rezeke edildi. Histolo-patolojik incelemede rezeke edilen kitlenin se¬lim schwannoma olduğu görüldü. Sonuç olarak; posterior mediasten kitleleri asemptomatik olsalar bile kesin tanı konulabil¬mesi, ileride olabilecek bası semptomlarının ve az da olsa görülebilen habis dönüşümlerin ön¬lenebilmesi ve hem de bizim olgumuzdaki gibi aynı zamanda tedavisininde sağlanabilmesi amacı ile rezeke edilmelidir.

Schwannoma in the posterior mediastinum

Background.- In the differential diagnosis of masses of the posterior mediastinum, neurogenic neoplasms, cysts, esophageal tumors, thoracic vertebral diseases, and infectious diseases like abscess formation should be considered. Neurogenic tumors are located in the posterior mediastinum in 90% of the cases and form approximately 75% of all of the tumors in that area. Schwannoma (neurilemmoma) is a neurogenic tumor which is located in the posterior mediastinum, generally originating from the intercostal nerves and mostly benign in character. It is known that it might undergo a malignant transformation rarely. It is asymptomatic most of the time, being diagnosed incidentally in radiography as a solitary mass; and occasionally problems might occur during its diagnosis and treatment. Observation.- In this report, we wanted to present a 54-year-old female in whom a mass 2 cm in diameter was detected incidentally in a paravertebral localization in the right posterior mediastinum in a computed tomography (CT) of the thorax which was performed for a different indication. In order to reach a histopathologic diagnosis of the mass in this patient, a transcutaneous fine-needle aspiration biopsy was performed under CT-guidance. However, a definite diagnosis could not be reached since adequate material could not be obtained. For diagnosis, the patient underwent right thoracotomy and the nodular mass was resected. The histopathologic examination revealed that the resected mass was a benign schwannoma. Conclusion.- As a result, even if posterior mediastinal masses are asymptomatic they must be resected in order to reach a definite diagnosis, to prevent symptoms of compression and the small risk of malignant transformation, and as was the situation in our case for curative purposes.

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