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1</a>A&#41; extending to the carina&#44; causing substantial dilation and right shift of the esophagus&#44; but with no evidence of stenosis&#46; The mediastinal mass showed pathological uptake on positron emission tomography &#40;SUV 7&#46;57&#41;&#46; Endoscopic ultrasound revealed a well-defined hypoechogenic lesion&#44; containing heterogeneous areas&#44; 30<span class="elsevierStyleHsp" style=""></span>cm from the dental arch&#44; protruding into the submucosa&#46; Fine needle aspiration was performed&#44; but the specimen was insufficient for diagnosis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Fiberoptic bronchoscopy&#47;endobronchial ultrasound showed extrinsic posterior compression of the trachea and carina&#44; with no infiltration&#46; Results from ultrasound-assisted biopsy confirmed fusocellular tumor&#44; with low-grade malignant cytology&#44; immunohistochemical study positive for S100&#44; and negative CD34 and CD117&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A right posterolateral thoracotomy was performed&#44; and a 10-cm tumor was found in the posterior mediastinum&#44; adhering closely to the supracarinal esophagus&#44; which was severely dilated &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; During resection of the tumor&#44; the tracheal membrane was torn and repaired by suturing&#46; In view of the close adhesion of the tumor to the esophagus&#44; the mucosa was left exposed&#44; so a 9<span class="elsevierStyleHsp" style=""></span>cm&#215;4<span class="elsevierStyleHsp" style=""></span>cm portion of the esophagus had to be resected <span class="elsevierStyleItalic">en bloque</span> with the tumor&#46; The esophageal defect was repaired with separate sutures in the mucous membrane and the muscle layer&#46; The vagus nerve could be preserved&#44; although this was not a significant consideration in our surgical strategy&#46; An esophageal transit study did not reveal any extravasation of contrast medium or difficulty in passage&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Diagnosis from the pathology laboratory was schwannoma extending to the tunica adventitia of the esophagus with no infiltration of the muscle layer&#46; Surgical borders were completely free of disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Schwannoma is a tumor originating in the Schwann cells<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> that surround the peripheral nerve fibers of the nerve roots or peripheral nerves&#46; It accounts for 20&#37; of mediastinal cancers in adults&#44; but 85&#37;&#8211;90&#37; of all tumors of the posterior mediastinum are schwannomas&#46; Up to 80&#37; of cases are asymptomatic&#44; and diagnosis in young and middle-aged adults is generally fortuitous&#46; Symptoms&#44; when they occur&#44; are due to local compression of the affected nerve or adjacent structures&#46; Schwannomas are benign&#44; encapsulated and well-delimited 98&#37; of the time&#44; but cases of very aggressive&#44; locally invasive&#44; malignant schwannomas that tend to relapse and metastasize have been described&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> CT is useful for planning the surgical approach and a definitive diagnosis can be reached using immunohistochemical techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Surgical resection via thoracotomy or video-assisted thoracoscopy is the treatment of choice in these neurogenic tumors&#44; and can be considered curative&#44; in view of the low relapse rate&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46; All the authors have read and approved the final manuscript&#46;</p></span></span>"
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Letter to the Editor
Intrathoracic Schwannoma of the Vagus Nerve
Schwannoma intratorácico del nervio vago
Carmen María Rodríguez
Corresponding author
mia_2612@hotmail.com

Corresponding author.
, Sara Naranjo, Miguel Carbajo
Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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1</a>A&#41; extending to the carina&#44; causing substantial dilation and right shift of the esophagus&#44; but with no evidence of stenosis&#46; The mediastinal mass showed pathological uptake on positron emission tomography &#40;SUV 7&#46;57&#41;&#46; Endoscopic ultrasound revealed a well-defined hypoechogenic lesion&#44; containing heterogeneous areas&#44; 30<span class="elsevierStyleHsp" style=""></span>cm from the dental arch&#44; protruding into the submucosa&#46; Fine needle aspiration was performed&#44; but the specimen was insufficient for diagnosis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Fiberoptic bronchoscopy&#47;endobronchial ultrasound showed extrinsic posterior compression of the trachea and carina&#44; with no infiltration&#46; Results from ultrasound-assisted biopsy confirmed fusocellular tumor&#44; with low-grade malignant cytology&#44; immunohistochemical study positive for S100&#44; and negative CD34 and CD117&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A right posterolateral thoracotomy was performed&#44; and a 10-cm tumor was found in the posterior mediastinum&#44; adhering closely to the supracarinal esophagus&#44; which was severely dilated &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; During resection of the tumor&#44; the tracheal membrane was torn and repaired by suturing&#46; In view of the close adhesion of the tumor to the esophagus&#44; the mucosa was left exposed&#44; so a 9<span class="elsevierStyleHsp" style=""></span>cm&#215;4<span class="elsevierStyleHsp" style=""></span>cm portion of the esophagus had to be resected <span class="elsevierStyleItalic">en bloque</span> with the tumor&#46; The esophageal defect was repaired with separate sutures in the mucous membrane and the muscle layer&#46; The vagus nerve could be preserved&#44; although this was not a significant consideration in our surgical strategy&#46; An esophageal transit study did not reveal any extravasation of contrast medium or difficulty in passage&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Diagnosis from the pathology laboratory was schwannoma extending to the tunica adventitia of the esophagus with no infiltration of the muscle layer&#46; Surgical borders were completely free of disease&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Schwannoma is a tumor originating in the Schwann cells<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> that surround the peripheral nerve fibers of the nerve roots or peripheral nerves&#46; It accounts for 20&#37; of mediastinal cancers in adults&#44; but 85&#37;&#8211;90&#37; of all tumors of the posterior mediastinum are schwannomas&#46; Up to 80&#37; of cases are asymptomatic&#44; and diagnosis in young and middle-aged adults is generally fortuitous&#46; Symptoms&#44; when they occur&#44; are due to local compression of the affected nerve or adjacent structures&#46; Schwannomas are benign&#44; encapsulated and well-delimited 98&#37; of the time&#44; but cases of very aggressive&#44; locally invasive&#44; malignant schwannomas that tend to relapse and metastasize have been described&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> CT is useful for planning the surgical approach and a definitive diagnosis can be reached using immunohistochemical techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Surgical resection via thoracotomy or video-assisted thoracoscopy is the treatment of choice in these neurogenic tumors&#44; and can be considered curative&#44; in view of the low relapse rate&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46; All the authors have read and approved the final manuscript&#46;</p></span></span>"
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Article information
ISSN: 15792129
Original language: English
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