A prospective observational study of postoperative adjuvant chemotherapy for non-small cell lung cancer in elderly patients (≥ 75 years).

BACKGROUND: To examine the effects of postoperative adjuvant chemotherapy for elderly (≥ 75 years of age) patients with completely resected non-small cell lung cancer (NSCLC), we conducted a multi-institutional and prospective observational study. METHODS: Patients were recruited between January 2014 and December 2017, and assigned to two cohort groups based on the patients' choice either to receive postoperative adjuvant chemotherapy (Cohort B) or not (Cohort A). All the patients were observed for 2 years after enrollment. The primary endpoint was the postoperative change of Karnofsky Performance Status (KPS) at 2 years. The secondary endpoints were postoperative recurrence-free survival (RFS) and overall survival (OS) at 2 years, and the completion rate of the adjuvant chemotherapy. RESULTS: Two hundred and seventy-two patients were enrolled (Cohort A, n = 225; Cohort B, n = 47). At any time point after surgery, no marked difference of KPS was observed between Cohort B and Cohort A. The RFS at 2 years was 70.8% (95% confidence interval [CI], 64.3-76.4) in Cohort A and 76.0% (95% CI 60.8-85.9) in Cohort B. The OS at 2 years was 85.9% (95% CI 80.4-89.9) in Cohort A and 89.1% (95% CI 75.8-95.3) in Cohort B. The completion rate of planned chemotherapy was 49.9% (95% CI 34.1-63.9%). CONCLUSIONS: The elderly patients were not likely to choose to receive postoperative adjuvant chemotherapy; however, no significant adverse effect on postoperative KPS was identified. TRIAL REGISTRATION: Clinical Trial Registration ID: UMIN000020736.

[Chest surgery in patients with pulmonary metastasis from head and neck cancer].

There have been only a few reports about a surgical resection of pulmonary metastasis from malignant head and neck tumors. Here we reviewed the literatures concerning the surgical results of pulmonary metastasectomy from malignant head and neck tumors, and discussed the indication for surgery. The 5-year overall survival after a metastasectomy was approximately 50.0% including all the histological types of head and neck cancer. Limiting to the squamous cell carcinoma (SCC), the 5-year overall survival was approximately 30.0%. Of the head and neck SCCs, the oral cavity SCC such as SCC of the tongue showed an extremely poor survival after metastasectomy. A pulmonary metastasectomy of squamous cell carcinoma is thus justified with the exception of oral cavity origin. Both adenoid cystic carcinoma of salivary glands and thyroid cancer are of low malignant nature, and the progression after occurrence of distant metastases is also very slow. Therefore, the survival benefit by those pulmonary metastasectomy is not evident.

Prognosis and therapeutic response according to the World Health Organization histological classification in advanced thymoma.

PURPOSE: The clinical efficacy of the World Health Organization (WHO) classification of thymoma has been reported to be a prognostic factor for patients with thymomas. This study focuses on the relationship between the therapeutic response and the WHO histological classification in patients with advanced thymoma. METHODS: A retrospective review was performed on 22 patients with Masaoka stage III and IV thymoma treated from 1975 to 2007. There were 1, 1, 7, 3, and 10 patients with WHO histological subtypes A, AB, B1, B2, and B3, respectively. RESULTS: Surgery was performed on 10 patients. There were 2 complete resections, 2 incomplete resections, and 6 exploratory thoracotomies. Of 18 patients with unresectable tumors, 8, 5, and 5 were treated with radiotherapy, chemotherapy, and chemoradiotherapy as the initial therapy, respectively. The response rate in 9 patients with type A-B2 was significantly better than that in 9 patients with type B3 regardless of treatment modality (100% vs 11.1%, P = 0.0001). Only the WHO classification was significantly associated with survival, with type B3 having a worse prognosis than A-B2 (P = 0.01). CONCLUSIONS: Type B3 thymoma showed a lower response rate to treatments and thus shorter survival. The WHO classification is a good predictive factor for therapeutic response in advanced thymoma.

Non-small cell lung carcinoma of the superior sulcus: The evolution of treatment outcomes with multimodality treatment at a single institution.

OBJECTIVES: We evaluated the efficacy of the multimodality approach in treating superior sulcus non-small cell lung carcinoma (SS NSCLC). METHODS: We retrospectively analyzed the records of 57 patients with SS NSCLC who were treated at our institution between 1982 and 2007. RESULTS: During the study period, 3- and 5-year survival increased significantly from 42.6% and 42.6% in the first half of the study period (1982-1994) to 72.7% and 65.4% in the second half (1995-2007), respectively. Methods of clinical staging were unchanged between the two time periods, although the ratio of adenocarcinoma was increased, and multimodality treatment, particularly concurrent chemoradiotherapy followed by surgical resection, was used more frequently in the second half of the study period. The 5-year survival of patients who received preoperative chemoradiotherapy followed by surgery (n = 27) was better than that of those who received other treatment regimen with surgery (n = 22, 64.6% vs. 49.6%; P = 0.044). Five-year survival in patients with complete resection after chemoradiotherapy was 70.4%. Thirteen patients (48%) achieved a pathologic complete response or minimal microscopic disease. CONCLUSIONS: Multimodality treatment with concurrent chemoradiotherapy followed by surgery appears to contribute to improved outcomes over time in patients with SS NSCLC.

Successful curative surgery for postoperative oesophageal recurrence of oesophagogastric junction cancer.

A man in his 70s had undergone total gastrectomy for oesophagogastric junction cancer. Three years and 11 months later, he began to vomit after meals and was diagnosed with mediastinal recurrence of oesophagogastric junction cancer. A CT scan showed that the tumour was suspected of infiltrating the aorta and lung. He received two cycles of chemotherapy with S-1 plus cisplatin, resulting in tumour reduction. The patient underwent resection of the lower oesophagus, including the tumour, the left lower lobe of the lung and the pericardium through a left thoracoabdominal incision. This is the first report of a patient surgically resected for postoperative oesophageal recurrence of oesophagogastric junction cancer. Although most postoperative recurrences of oesophagogastric junction cancer are far advanced at the time of diagnosis and prognosis is poor, chemotherapy followed by surgery may improve the prognosis of patients with locoregional recurrence.

Resection of mediastinal granulocytic sarcoma triggered the rapid progression of acute myeloid leukemia.

Mediastinal granulocytic sarcoma (GS) is a relatively rare disease. We experienced a case of acute myeloid leukemia (AML) that took a rapid turn for the worse after the resection of a mediastinal GS. A healthy 60-year-old man had been in good general health all his life, but was diagnosed with a mediastinal tumor by his family physician and was referred to our department. The patient underwent resection of the mediastinal tumor because thymoma was highly suspected. On postoperative day (POD) 3, the patient suffered a fever as well as an elevated white blood cell (WBC) count and a high C-reactive protein level. His WBC count was 77,240 at its peak on POD 9, at which point the patient was diagnosed with AML by bone marrow aspiration. The immunohistological findings showed the features of leukemia, and GS was diagnosed. Despite chemotherapy, the patient died on POD 28 as a result of rapid disease progression.

The influence of comorbidity on the postoperative survival in elderly (≥ 75 years old) with lung cancer.

OBJECTIVES: We conducted a multi-institutional prospective observational study of elderly patients (≥ 75 years-old) with resected non-small cell lung cancer. In this report, we have followed the cohorts for 2 years after surgery and examined both the influence of preoperative comorbidity [Adult Comorbidity Evaluation-27 (ACE-27) index] on the postoperative survival and the change in the Karnofsky Performance Status (KPS). METHODS: From March 2014 to April 2015, 264 patients were prospectively registered from 22 hospitals affiliated with the National Hospital Organization. The mean age at the time of surgery was 79.3 years (range 75-90 years), and 41% of the patients were ≥ 80 years of age. A total of 26% underwent sublobar resection. The study endpoints were the postoperative overall survival (OS), its prognostic factors, and the changes in the postoperative KPS. RESULTS: The 2-year OS was 85.3% (95% confidence interval 80.4-89.1%). Male gender, age ≥ 80, a smoking history, grade 2 of ACE-27, and an advanced disease stage were significantly poor prognostic factors for the OS in the univariate risk analysis. The multivariate analysis showed that male gender, age ≥ 80, an advanced disease stage and sublobar resection were significantly poor prognostic factors for the OS. In comparison with the preoperative KPS, no marked decline was observed in the postoperative chorological change of KPS. CONCLUSIONS: In the surgical treatment of elderly patients, the comorbidity as assessed by the ACE-27 index might affect the postoperative survival, and therefore should be taken into accounts in the preoperative evaluation of the surgical indications.

Late-period-onset chylothorax after a pulmonary resection for lung cancer: a case report.

A 65-year-old female had been diagnosed with right lung cancer by her family physician, and she was introduced to our Department of Thoracic Surgery at Matsuyama Red Cross Hospital in May 2004. She underwent a right upper lobectomy and wedge resection of S6 with the systematic dissection of her mediastinal lymph nodes. The patient made an uneventful recovery and was discharged on postoperative day 19. However, chylothorax was detected on a chest roentgenogram when she consulted our outpatient clinic again for dyspnea on exertion and chest pain. Chylothorax occurred in postoperative day 34. The patient initially received conservative therapy, but subsequently underwent surgical treatment and fibrin glue intubation when conservative therapy proved to be unsuccessful.

Comparison of the prognostic values of preoperative inflammation-based parameters in patients with breast cancer.

Peripheral blood-derived inflammation-based markers, including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are indicators of prognosis in various malignant tumors. The present study aimed to identify the inflammation-based parameters that are most suitable for predicting outcomes in patients with breast cancer. Two hundred ninety-six patients who underwent surgery for localized breast cancer were reviewed retrospectively. The association between clinicopathological factors and inflammation-based parameters were investigated. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic indicators associated with disease-free survival (DFS). The NLR level correlated significantly with tumor size (P<0.05). The PLR level correlated with the expression of estrogen receptor and lymph node involvement (P<0.05). Univariate analysis revealed that lower CRP and PLR values as well as tumor size, lymph node involvement, and nuclear grade were significantly associated with superior DFS (CRP: P<0.01; PLR, tumor size, lymph node involvement, and nuclear grade: P<0.05). On multivariate analysis, CRP (hazard ratio [HR]: 2.85, 95% confidence interval [CI]: 1.03-7.88, P<0.05), PLR (HR: 2.61, 95% CI: 1.07-6.36, P<0.05) and nuclear grade (HR: 3.066, 95% CI: 1.26-7.49, P<0.05) were significant prognostic indicators of DFS in patients with breast cancer. Neither LMR nor NLR significantly predicted DFS. Both preoperative CRP and PLR values were independently associated with poor prognosis in patients with breast carcinoma; these were superior to other inflammation-based scores in terms of prognostic ability.

A Prospective Observational Study of Pulmonary Resection for Non-small Cell Lung Cancer in Patients Older Than 75 Years.

The operative morbidity rate in elderly patients with lung cancer is high in comparison to nonelderly patients, probably because of the increase in comorbidities that occurs with aging. However, previous reports were retrospective and were performed at single institutions; thus, the preoperative comorbidities and operative morbidity could not be fully assessed. We conducted a multi-institutional prospective observational study of elderly patients (>75 years of age) with a completely resected non-small cell lung cancer. From March 2014 to April 2015, 264 patients from 22 hospitals affiliated with the National Hospital Organization in Japan were prospectively registered in the present study. The primary end point was operative morbidity (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0). The secondary end points were operative mortality and the risk factors for operative morbidity. Preoperative comorbidities were assessed according to the Adult Comorbidity Evaluation-27 index. The mean age at the time of surgery was 79.3 years (range 75-90 years). Forty-one percent of the patients were >80 years of age. Twenty-six percent underwent sublobar resection. The incidence of morbidities of any grade was 43.2% (90% confidence interval: 38.2%-48.2%). Respiratory system-related morbidity (19.3%), followed by cardiovascular system-related morbidity (10.2%), was the most common morbidity. The in-hospital mortality rate was 1.1% (3 of 264 patients). A multivariate analysis of the risk factors for operative morbidity showed that both Adult Comorbidity Evaluation-27 grade and the blood loss volume were significant factors. The results of the present prospective multi-institutional study should be used as a reference in the surgical treatment of elderly patients with lung cancer.

A randomized phase II study to assess the effect of adjuvant immunotherapy using α-GalCer-pulsed dendritic cells in the patients with completely resected stage II-IIIA non-small cell lung cancer: study protocol for a randomized controlled trial.

BACKGROUND: As the toxicity associated with the α-GalCer-pulsed dendritic cell (DC) therapy could be considered to be negligible, its addition to postoperative adjuvant chemotherapy would be expected to greatly improve the therapeutic effect, and could result in prolonged survival. The aim of the present study is to compare the therapeutic efficacy of alpha-galactosylceramide-pulsed DC therapy in patients who have undergone a complete resection of stage II-IIIA non-small-cell lung cancer (NSCLC) followed by postoperative adjuvant therapy with cisplatin plus vinorelbine, to that in patients who did not receive additional treatment (surgical resection plus postoperative adjuvant chemotherapy only). METHODS: Subsequent to the complete resection of NSCLC, followed by the administration of cisplatin plus vinorelbine dual-agent combination adjuvant chemotherapy, patients who satisfy the inclusion criteria will be randomly allocated to either the α-GalCer-pulsed DC immune therapy group, or the standard treatment group. In total, 56 patients will be included in the study. The primary endpoint is recurrence-free survival, and the secondary endpoints are natural killer T-cell-specific immune response, the frequency of toxic effects and safety, and overall survival. DISCUSSION: In order to determine the efficacy of α-GalCer-pulsed DC therapy, the present study compares patients with stage II-III NSCLC who underwent complete surgical resection followed by postoperative adjuvant therapy with cisplatin plus vinorelbine, to those who did not receive additional treatment (surgical resection plus postoperative adjuvant chemotherapy only). TRIAL REGISTRATION: UMIN000010386 ( R000012145 ). Registered on 1 April 2013. UMIN-CTR is officially recognized as a registration site which satisfies ICMJE criteria.

Completely wide resection of malignant fibrous histiocytoma of the chest wall; expect for long survival.

Malignant fibrous histiocytoma (MFH) rarely occurs in the chest wall. A case of MFH originating from the chest wall is herein reported. We performed radical en-block resection of the whole chest wall together with the tumor and reconstructed it with Marlex mesh. There was no recurrence 4 years after operation. We consider radical en-block resection for MFH and reconstruction with Marlex mesh a safe operation and may provide a long-term survival.

Prognostic Factors for Survival after Resection of Pulmonary Metastases from Colorectal Carcinoma.

PURPOSE: As chemotherapy has improved, the survival of patients with metastatic colorectal carcinoma has reached up to 2.5 years. Many of these patients experience pulmonary metastases; however, the prognosis after pulmonary metastasectomy is not satisfying. In this study, we analyzed the prognostic factors for survival in patients who underwent pulmonary metastasectomy. METHODS: Eighty-seven patients with colorectal carcinoma received pulmonary metastasectomy. The pathological status of the primary tumor, outcome of the pulmonary metastasectomy, disease-free interval, perioperative carcinoembryonic antigen (CEA) level and history of liver metastases were assessed. RESULTS: The five-year survival was 42.5% after pulmonary metastasectomy. A univariate analyses revealed that the CEA level (p = 0.043) and the number of pulmonary metastases (p = 0.047) were prognostic factors for survival. The CEA level was an independent prognostic factor in a multivariate analysis (relative risk = 2.01, p = 0.037). Among cases with elevated preoperative CEA levels, those whose CEA level normalized after metastasectomy had a better prognosis compared with those whose CEA level decreased but was still high, or whose level increased after metastasectomy (median survival time of 41.8 months compared with 28.1 or 15.7 months, respectively p = 0.021). CONCLUSION: The CEA level can be a predictive marker for the prognosis in patients with pulmonary metastases from colorectal carcinoma.

Carcinoma of the ampulla of Vater diagnosed after surgical treatment for Lemmel's syndrome.

Lemmel's syndrome encompasses a range of conditions in which a juxtapapillary duodenal diverticulum exerts mechanical and functional effects on the common bile and pancreatic ducts, leading to jaundice and pancreatitis. In this report, we describe a very rare case of carcinoma of the ampulla of Vater that was detected during postoperative follow-up in a patient who had undergone choledochojejunostomy following a diagnosis of Lemmel's syndrome. We present our clinical and pathological experiences with the diagnosis and treatment of this case as well as a review of the present literature concerning Lemmel's syndrome.

Higher expression of RhoC is related to invasiveness in non-small cell lung carcinoma.

PURPOSE: The activation of Rho proteins has been shown to lead to loss of polarity in cancer cells, as well as reorganization of the cytoskeleton and facilitation of cell motility, possibly resulting in their malignant potential. The clinicopathological significance of RhoC, however, is not yet well known in the case of non-small cell lung cancer (NSCLC). EXPERIMENTAL DESIGN: The intratumor expression level of RhoC mRNA was determined and compared with that in adjacent nontumorous lung tissue using quantitative reverse transcription-PCR in 49 patients with NSCLC. The relationship between the level of RhoC transcript and clinicopathological factors was examined. RhoC protein expression was confirmed by immunohistochemistry and Western blot analysis in several cases. RESULTS: Tumor tissue of NSCLC patients demonstrated a copy number of RhoC mRNA that was well correlated with its protein level in each case and was significantly higher than that found in the corresponding nontumorous lung tissue (2.73 x 10(5) versus 1.13 x 10(4) copies/0.08 micro g mRNA; P < 0.05). Histopathologically positive cases of lymphatic permeation showed a significantly higher copy number of RhoC than negative cases (4.31 x 10(5) versus 1.93 x 10(5) copies/0.08 micro g mRNA; P < 0.05). With regard to venous permeation, the RhoC copy number in positive cases tended to be higher than that seen in negative cases (3.72 x 10(5) versus 2.14 x 10(5) copies/0.08 micro g mRNA; P = 0.06). CONCLUSIONS: This is the first demonstration that the expression level of RhoC is correlated to vascular permeation in NSCLC.

Video-assisted thoracoscopic resection of a giant anterior mediastinal tumor (lipoma) using an original sternum-lifting technique.

We report here the complete thoracoscopic resection of a giant lipoma (18x15x5 cm, 560 g) in a 33-year-old man using an original sternum-lifting technique. The patient had an uncomplicated postoperative course and was discharged on the seventh postoperative day. This is the largest reported anterior mediastinal tumor that was completely resected by video-assisted thoracic surgery without median sternotomy or thoracotomy. This original method may be useful from the standpoint of minimal access, rapid recovery, less pain, and good cosmetic results for an anterior mediastinal giant tumor.

Detection of loss of heterozygosity by high-resolution fluorescent system in non-small cell lung cancer: association of loss of heterozygosity with smoking and tumor progression.

BACKGROUND: We recently developed a novel system for detecting microsatellite alteration, which is an important process in carcinogenesis. In patients with non-small cell lung cancer (NSCLC), loss of heterozygosity (LOH) is frequently observed and causes functional disorders of tumor suppressor genes. PATIENTS AND METHODS: In a consecutive series of 51 patients with NSCLC who had undergone a surgical resection, microsatellite instability (MSI) and LOH in tumors were analyzed by polymerase chain reaction using five fluorescence-labeled dinucleotide markers (D2S123, D5S107, D10S197, D11SS904, and D13S175) and an autosequencer. RESULTS: MSI was detected in only one patient (2.0%) with only one marker. LOH was detected in at least one chromosomal region that was tested in 39 patients (76%). The mean (+/- SD) number of LOHs detected by each marker was 1.74 +/- 1.40, with 1 LOH detected in 10 patients, 2 LOHs detected in 15 patients, 10 LOHs detected in 3 patients, 1 LOH detected in 4 patients, and 3 LOHs detected in 5 patients. The number of LOHs detected in each patient was significantly associated with the pack-year index (rho = 0.501; p = 0.0004), although there was no relationship with having a history of multiple cancers and familial cancer. Patients with stage IA disease showed a significantly lower number of LOHs than did patients with other stages of disease (1.15 vs 2.38, respectively; p = 0.0013). CONCLUSION: LOH is very common in patients with NSCLC, and the number of LOHs increases with increases in smoking, suggesting the presence of an important event in lung carcinogenesis.

Operative results of clinical stage I non-small cell lung cancer.

BACKGROUND: Clinical stage (c-stage) I non-small cell lung cancer (NSCLC) is generally indicated for surgery, however, surgical exploration sometimes reveals advanced disease, thus resulting in incomplete resection. PATIENTS AND METHODS: A total of 645 consecutive patients were investigated in which 347 were diagnosed to have c-stage IA in 347 and 298 were diagnosed to have IB disease. All cases underwent operation and were investigated for resectability and the cause of an incomplete resection. RESULTS: The c-Stage IA patients included 16.6% of T3/4 and 10.4% of N2 whereas clinical stage IB patients included 14.4% of T3/4 and 18.8% of N2/3. A complete resection was performed in 594 patients (91%). In 347 c-stage IA patients, the complete resection rates were 93% in adenocarcinomas (235/252), 100% in squamous cell carcinomas (76/76), and 89% in others (17/19). In 298 c-stage IB patients, the complete resection rates were 86% in adenocarcinomas (141/164), 90% in squamous cell carcinomas (90/100), and 94% in others (31/33). The 5-year survival rates of the c-stage IA and IB patients who underwent a complete resection were 66.4 and 48.3%, respectively. However, the same rates were 18.4 and 14.7% for c-stage IA and IB patients who underwent an incomplete resection. The reasons for an incomplete resection in 54 patients were malignant pleurisy in 38 (70.4%), extranodal invasion of mediastinal nodal metastasis in ten (19%), an incomplete bronchial margin in three (5.6%), and ipsilateral pulmonary metastases in two (3.7%), and ipsilateral adrenal metastasis in one (1.3%). In 13% of the c-stage IB adenocarcinomas, pleural metastasis was discovered during thoracotomy. CONCLUSIONS: Pleural dissemination was the most frequent cause of an incomplete resection, and its prevalence was high in c-stage IB adenocarcinomas.

A time trend of profile and surgical results in 1123 patients with non-small cell lung cancer.

BACKGROUND: A time trend for characteristics and prognoses of patients with non-small cell lung cancer (NSCLC) who underwent surgical resection was investigated. METHODS: A series of 1123 consecutive patients with NSCLC who underwent surgical resection from 1975 to 1998 was reviewed with respect to changes in patient profile and surgical outcome among subgroups classified by clinicopathologic factors. RESULTS: With time, the proportion of female, elderly (> or =70 years), pathologic stage IA, nonsmoking, and adenocarcinoma patients increased significantly whereas pneumonectomy, incomplete resection, and pathologic stage IIIA patients decreased significantly. Overall survival showed an upward trend with 5-year survival rates of 30.0% in the 1970s, 41.6% in the 1980s, and 50.1% in the 1990s (P <.0001). This tendency was similar in every pathologic stage that was observed. The proportion of female patients with adenocarcinoma that exhibited the most favorable prognosis among subpopulations classified by gender and cell types was significantly higher in the 1990s (28.0%) than in the 1970s (14.0%). Multivariate analysis revealed that female gender, adenocarcinoma, complete resection, and early pathologic stage were independently favorable factors whereas advanced age was an unfavorable factor. CONCLUSIONS: The improved survival following surgical resection for NSCLC during the study period was associated with an increasing population of female patients with adenocarcinoma, more detection of early disease, and effective elimination of unresectable cases.

Surgical treatment of neurogenic tumors of the chest.

BACKGROUND: Neurogenic tumors are commonly found in the mediastinum, especially in the posterior mediastinum or in the chest wall, and have a variety of clinical and histological features. We reviewed our experience with these types of tumors and assessed diagnostic and therapeutic approaches. PATIENTS AND METHODS: A series of 60 consecutive patients with a neurogenic tumor of the chest, all seen at a single institute, was retrospectively reviewed. RESULTS: The mean age of the 60 patients was 40 years, including 32 males and 28 females. Preoperative symptoms were present in seven patients (11.7%). Median tumor size was 5.3 cm, ranging from 1.4 to 20 cm. The major location of the tumor was the posterior mediastinum in 38 cases (63.3%) and the chest wall in 16 cases (26.7%). The operative procedure performed was tumor extirpation in 58 cases (96.7%), in which video-thoracoscopic procedure was performed in nine patients and chest wall resection in two cases. The major histological type was neurilemmoma in 51 patients (85%), and malignant tumor was only diagnosed in one patient with malignant schwannoma. Tumor related death occurred in only one case with malignant schwannoma. Ten patients with neurilemmoma were precisely diagnosed by magnetic resonance imaging. CONCLUSION: Almost all cases of intrathoracic neurogenic tumors were benign in nature. Therefore, surgical indications may be carefully determined in cases with no symptom and with imaging that indicate benign neurilemmoma.