RESUMEN
El schwannoma (neurilemoma) es un tumor benigno de lento crecimiento originado en la vaina de Schwann, cuya localización en la cavidad torácica es excepcional. En general es asintomático y se descubre en forma incidental, aunque puede ocasionar síntomas cuando la lesión crece o invade estructuras subyacentes. Su importancia radica en la posibilidad de confusión con tumores malignos. Presentamos una paciente con dolor torácico de evolución prolongada causado por un schwannoma. La imagen tomográfica es sugestiva de tumor extrapulmonar, por ello el schwannoma en esta localización debe ser considerado en el diagnóstico diferencial de tumores pleurales metastásicos o primarios como el lipoma, el tumor fibroso solitario y el mesotelioma.(AU)
The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.(AU)
RESUMEN
Antecedentes: La estadificación del cáncer de pulmón de células no pequeñas (CPCNP) es esencial para definir el tratamiento, siendo primordial la afección ganglionar mediastinica (N2). Objetivo: Determinar incidencia de afección insospechada N2 (estadio clínico IA, subdivisión vigente en T1a y T1b, localización lobar y supervivencia) Lugar de Aplicación: Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires Diseño: Cohorte, retrospectivo Población: Pacientes operados entre 2000 y 2010 con intención curativa (estadio clínico IA y diagnóstico final de CPNCP). Método: Evaluación de N2 insospechado (informe anátomo-patológico), correlación con tamaño tumoral (hasta 2 cm, entre 2 y 3 cm), localización, sexo, edad, histología y tabaquismo. Medidas de evaluación: test t de Student, Chi cuadrado y Fisher. Resultados: Intervenidos 115 pacientes. Tamaño del nódulo: 17.4 mm (6-30), 57.3% hasta 20 mm (T1a) y 42.7% mayores a 20 mm (T1b). Hombres: 54.7%. Edad promedio 61 años (44-85). Histología predominante: adenocarcinoma (82.6%). Se realizó lobectomia en 101 pacientes (87.8%). Compromiso insospechado N2 en 9 pacientes (7.8%). Subdivididos, 3 fueron T1a (4.5% de este subgrupo) y 6 T1b (12.2%) (p=0.14). Todas las afecciones N2 se observaron en tumores de lóbulos superiores o medio (9/80, 11.2%) (p= 0.03). Ningún nódulo menor a 10 mm (18) mostró enfermedad N2. No se halló otra correlación con afectación inesperada de N2 (P=NS). Supervivencia a 5 años (T1a): 91% Conclusión: En pacientes con estadio clínico IA (T1a) el N2 insospechado es muy bajo (4.5%) y en este grupo la tasa de supervivencia a 5 años fue satisfactoria (91%). Nódulos subcentimétricos y/o localizados en lóbulos inferiores no presentaron compromiso N2.(AU)
Background: Accurate staging in non small cell lung cancer (NSCLC) is essential to define the appropriate treatment, primary being the affection of mediastinal lymph node groups (N2). Objective: To determine the incidence of unexpected N2 compromise, according to the new subdivision of T1 tumors in T1a and T1b, and lobe tumor location, in patients with clinical stage IA. Setting: Thoracic Surgery Department, Hospital Británico de Buenos Aires Design: Restrospective, cohort Population: Patients operated on with curative intent, clinical Stage IA, with final histological diagnosis of NSCLC between 2000 and 2010. Methods: Incidence of unsuspected N2 disease was analyzed according to the tumor size (up to 20 mm, more than 20 to 30 mm), side, lobe location (upper and middle, lower lobes), sex, age, tumor type and smoking history. Outcome measures: Students t test, Chi square and Fisher. Results: 115 patients were included (men, 54.7%; mean age, 61 years, range 44-85). Average nodule size was 17.4 mm (6-30); 57.3% patients had nodules up to 20 mm (T1a) and 42.7% between 20 mm and 30 mm (T1b). Histology showed 82.6% adenocarcinoma. Lobectomy was performed in 101 patients (87.8%). Unsuspected N2 compromise was present in 9 (7.8%) patients. When divided into subgroups, 3 (4.5%) were T1a and 6 (12.2%) were T1b (p=0.14). All of the N2 were observed in tumors located in the upper or the middle lobes (9/80, 11.2%, p= 0.03). No nodules smaller than 10 mm showed N2 disease. The side, age, sex, tumor type and histology did not correlate with unsuspected N2 (p=NS). Conclusions: In patients with clinical stage IA with nodules up to 20 mm (T1a) the incidence of unsuspected N2 disease is very low (4.5%). The surgical resection, without invasive staging, achieves a satisfactory 5-year survival rate (91%) in this group of patients. Subcentimeter and lower lobe nodules showed no unsuspected N2 nodal metastastases.(AU)
RESUMEN
The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.