Totally thoracoscopic resection of schwannoma located in retroperitoneum and posterior mediastinum:case report

症例は40歳代,男性.頚部痛のため近医を受診し,CTで後腹膜に腫瘤性病変を認め,精査加療目的で当科紹介となった.CTでは,腹部大動脈の左側で左腎臓を圧排する51×47mmの境界明瞭で内部がやや不均一に造影される腫瘤を認めた.腫瘤の大部分は後腹膜に存在していたが,頭側の一部は後縦隔に存在していた.MRIでは,T1WIで低信号,T2WIで低信号と高信号の混在する腫瘤を認めた.神経原性腫瘍を疑い手術を施行した.胸腔と腹腔からアプローチすることとし,先行して胸腔鏡下に摘出を行った.4ポートによる胸腔鏡下で摘出を開始したところ,腫瘍の後腹膜部分も胸腔鏡下に剥離可能であり,胸腔鏡下アプローチのみで腫瘍を損傷することなく切除を完遂した.病理組織検査の結果,腫瘍は良性の神経鞘腫であった.術後経過は良好で術後7日目に退院となった.今回,胸腔鏡を用いて摘出し得た胸腹移行部の後腹膜神経鞘腫を経験したため報告する.

We here report a case of retroperitoneal and posterior mediastinal schwannoma resected via a thoracoscopic approach.A man in his 40s was referred to our hospital because a well-circumscribed 51×47 mm diameter mass had been identified in the retroperitoneal area between the abdominal aorta and left kidney by computed tomography(CT).The mass also extended into the posterior mediastinum. The suspected diagnosis being neurogenic tumor, surgery was performed for diagnostic and therapeutic purposes. Surgery was initiated via a thoracoscopic approach because the tumor head was located in the posterior mediastinum. The tumor appeared to have originated in the sympathetic trunk and was removed completely via the thoracoscopic approach. The pathological diagnosis was retroperitoneal benign schwannoma. The postoperative course was uneventful and the patient was discharged 7 days post-surgery. Thus, schwannoma located in retroperitoneum and posterior mediastinum could be successfully resected via a thoracoscopic approach.

後腹膜腫瘍

神経鞘腫

胸腔鏡下手術