Posterior Mediastinum

The most common neurogenic tumor in the posterior mediastinum is a benign neurolemmoma; in children the most common neurogenic tumor is the malignant neuroblastoma. The histologic classification is predominantly that of nerve sheath tumors and ganglionic/paraganglionic tumors. The benign nerve sheath tumors is the neurolemmoma or neurofibroma; its malignant counterpart is the malignant schwannoma (Figs. 18.3, 18.4, 18.5). The autonomic tumors are the benign ganglioneuroma; its malignant counterpart is the ganglioneuroblastoma or the malignant neuroblastoma. Pheochromocytomas are also autonomic tumors and 90% of them are benign. CT scanning is an important part of the diagnostic armamentarium. Serum epinephrine and norepinephrine levels should be obtained as well as urinary VMA levels.

Suggested Reading

1. Bergh NP, Gatzinsky P, Larsson S et al. Tumors of the thymus and thymic region: I. Clinicopathologic Studies on thymomas. Ann Thorac Surg 1978; 25:91-98.

2. Wilkins EW Jr. Thymectomy. In: Cohn LH ed. Modern techniques in surgery (cardiac/thoracic surgery). Mount Kisco: Futura Publishing, 1981; 38:1-13.

3. Wychulis AR, Payne WS, Clagett OT, Woolner LB. Surgical treatment of mediastinal tumors. A 40 year experience. J Thorac Cardiovasc Surg 1971; 62:379-392.

4. Marchevsky AM, Kaneko M. Surgical pathology of the mediastinum. New York: Raven Press, 1984.

5. Hsu CP et al. Thymic carcinoma. Ten years' experience in twenty patients. J Thorac Cardiovasc Surg 1994; 107:615

6. Namba T, Brunner NG, Grob D. Myasthenia gravis in patients with thymoma, with particular reference to onset after thymectomy. Medicine 1978; 57:411

7. Allen MS, Trastek VF, Pairolero PC. Benign germ cell tumors of the mediastinum. In Shields TW (ed). General Thoracic Surgery, 5th ed. Lippincott Williams & Wilkins, Philadelphia, 2000; 2275-88.

Fig 18.3. Benign thymoma seen at the time of surgery. No evidence of gross invasion is seen.

Fig 18.4. Schwannoma (+) in posterior mediastinum invading the vertebral body. Resection of the tumor and vertebral body was performed followed by a spinal stabilization procedure.

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