PLACE OF SURGERY IN THE DIAGNOSIS AND TREATMENT OF MEDIASTINAL NEUROFIBROMA

Abstract

TYPE: Abstract TOPIC: Disorders of the Mediastinum PURPOSE: Mediastinal neurofibroma is a benign nerve tumor caused by a disorderly proliferation of Schwann cells intertwined with nerve fibers.These tumors may pose diagnostic difficulties.The discovery is often fortuitous on imagery.Surgical treatment is required for any resectable lesion because of the risk of malignant transformation or the risk of spinal cord compression. METHODS: Retrospective study of 19files of patients operated on for mediastinal neurofibroma from 2000to 2020 in our thoracic surgery department RESULTS: They were 19patients.The average age was 43years.11 patients were symptomatic.Symptomatologie was made of dyscpnea with chest pain, cought, dysphagia, back pain, and coffee spots characteristic of Von Recklinghausen's disease.The discovery was fortuitous for the other patients.All the patients were explored by a thoracic scan specifying the site, the size, the nature of the lesion and its relationship with neighboring structures.The mean lesion size was 58mm.The localization was in the posterior mediastinum in16 cases, straddling the middle and posterior mediastinum in3 cases.Chest MRI was performed in 7patients to look for spinal endocanal extension.The surgical procedure consisted of a lumpectomy by posterolateral thoracotomy in 13 cases, VATS in 3 cases and exclusive video thoracoscopy in 3 cases.The diagnosis was made on the pathological examination of the surgical specimen.One patient presented with a recurrent tumor who was treated with chemotherapy. CONCLUSIONS: The diagnosis of mediastinal neurofibroma is suggested on imaging, and confirmed by pathological examination of the surgical specimen. CLINICAL IMPLICATIONS: Treatment is based on surgical resection of the tumor to prevent malignant transformation which can occur in about 4% of cases, mainly occurring in neurofibromatosis. DISCLOSURE: Nothing to declare. KEYWORD: neurofibroma, surgery