Epidemiology

• Most common of all neural tumors
• The most common causes of posterior mediastinal masses in adults are neurogenic tumors, accounting for more than 80%
• Neurogenic tumors of the mediastinum comprise 20% of adult and more than 35% of pediatric mediastinal tumors
• Age: most commonly develop in patients in their 30s or 40s
• Sex: equal sex predilection

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Physiology

• Benign lung neoplasm
• Arise from nerve root (and contain only Schwann cells)
• Typically arise from sympathetic and parasympathetic ganglia or from peripheral nerves of the spinal ganglia
  • They are most commonly located posteriorly
• Rarely arise from vagus or phrenic nerves

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Pathology

• Composed of Schwann cells with surrounding reticular tissue

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Diagnosis

• CXR/Chest CT Pattern:
  • Solitary Lung Nodule (usually well-defined):
    • Location: no lobar predilection
    • Calcification: rare
    • Cavitation: none
  • Posterior Mediastinal Mass:
    • Well rounded circumscribed mass, usually located contiguous to the vertebral body in the intercostal or paravertebral spaces
    • Sometimes an hourglass shaped lesion can develop
• MRI: T1-weighted magnetic resonance imaging is helpful in determining vertebral column and spinal cord involvement

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Clinical Presentations:

• Lung Nodule (see [[Lung Nodule or Mass]])
  • Usually asymptomatic
• Posterior Mediastinal Mass (see [[Mediastinal Mass]])
  • Almost always benign (but may be malignant in some cases)
  • Asymptomatic: often
  • Chest Wall Pain:
  • Cough:
  • Horner’s Syndrome: in rare instances
  • Neurologic Symptoms: parasthesias in UE consistent with a radiculopathy

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Treatment

• Surgical resection via thoracoscopy or thoracotomy: treatment of choice

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References

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