RESUMO
Malignant peripheral nerve sheath tumors (MPNSTs) are rare and can be associated with type 1 neurofibromatosis. They are rarely located at the mediastinum, most often at the posterior mediastinal compartment or the paravertebral gutters. MPNSTs of the anterior mediastinum arising from the phrenic nerve are exceptional. Their prognosis is poor due to the high potential of local tumor recurrence and metastasis. Complete surgical resection remains the only radical treatment. However, the outcomes after this treatment alone cannot be considered satisfactory. Preoperative chemotherapy could be an interesting therapeutic option for unresectable tumors. We report here the case of a 77-year-old woman with an MPNST located at the anterior mediastinum arising from the phrenic nerve. This tumor was successfully managed with multimodal therapy combining preoperative chemotherapy, complete surgery and adjuvant radiation.
RESUMO
OBJECTIVE: Scarf pin inhalation is becoming a frequent accident among young Moroccan woman who wears islamic veil. The aim of the study is to highlight indications, principles and challenges of surgical removal of that particular foreign body. METHODS: Twenty-eight patients were hospitalized in Thoracic Surgery department of Ibn Sina Hospital at Rabat between January 2008 and June 2013 for surgical removal of a pin scarf after unsuccessful endoscopy. RESULTS: Mean age was 20 years. Inhalation was accidental in all cases. Average interval between inhalation and surgery was 10 days. Penetration syndrome was found in 82% of patients. Pin was located at the left tracheo-bronchial tree in 53.5% of cases and at the right one in 46.4%. All were operated by thoracotomy. Surgery was conservative in all cases, and postoperative course was uneventful. CONCLUSION: In case of failure endoscopic treatment, surgery remains the only alternative. It must be as conservative as possible. Short interval between inhalation accident and surgery prevents parenchymal resection.