Neurofibroma
Presentation
A 25-year-old man is referred to you after an employment-screening chest x-ray reveals an abnormal finding. He is a recent college graduate previously employed as a waiter. He has no past medical or surgical history, has not traveled outside the United States, and denies any history of smoking. He does not have symptoms of weight loss, fever, chills, or night sweats. His vital signs are normal, and his physical examination is unremarkable.
▪ Chest X-rays
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Chest X-ray Report
There is a posterior, paravertebral, round mass. The anterior mediastinum is not enlarged, and there are no other masses or pleural effusions. ▪
Discussion
The patient has a recently discovered, asymptomatic, isolated, posterior mediastinal mass. Tumors most commonly found in the posterior mediastinum are those of neurogenic origin. Benign neurogenic tumors include schwannoma (neurilemmoma), neurofibroma, ganglioneuroma, chemodectoma, and pheochromocytoma. Neurofibrosarcoma, ganglioneuroblastoma, neuroblastoma, malignant chemodectoma, and malignant pheochromocytoma are the most common malignant neurogenic tumors. The neuroblastomas are very aggressive malignant tumors that usually present in early childhood and infancy; adult cases are rare. Most extraadrenal pheochromocytomas arise from the aortic body and are found in the retroperitoneum. Both chemodectomas and pheochromocytomas arise from paraganglionic tissue; however, chemodectomas are hormonally inactive. Hypertension associated with increased catecholamine metabolites in the urine is helpful in establishing the diagnosis of pheochromocytomas. Posterior mediastinal tumors may extend intraspinally or invade adjacent structures. Computed tomography (CT) is crucial in anatomic localization of the tumor and also in planning a diagnostic and therapeutic approach.
▪ CT Scans
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