bims-netuvo Biomed News
on Nerves in tumours of visceral organs
Issue of 2024‒03‒24
fifteen papers selected by
Maksym V. Kopanitsa, The Francis Crick Institute
  1. Nociceptive neurons interact directly with gastric cancer cells via a CGRP/Ramp1 axis to promote tumor progression.
  2. Perineural invasion score system and clinical outcomes in resected pancreatic cancer patients.
  3. Genetic alterations in the neuronal development genes are associated with changes of the tumor immune microenvironment in pancreatic cancer.
  4. Trial watch: local anesthetics in cancer therapy.
  5. Mapping functional to morphological variation reveals the basis of regional extracellular matrix subversion and nerve invasion in pancreatic cancer.
  6. Intrapulmonary Ancient Schwannoma: a Rare Tumour.
  7. Differential diagnosis of rare adrenal cellular schwannomas: A case report.
  8. STING activation reprograms the microenvironment to sensitize NF1-related malignant peripheral nerve sheath tumors for immunotherapy.
  9. Gastric Schwannoma-Two Unusual Cases with Usual Presentation and Review of Literature.
  10. Case report and literature review: plexiform schwannoma in the penile and inguinal region in a child.
  11. Preoperative differentiation of gastric schwannomas and gastrointestinal stromal tumors based on computed tomography: a retrospective multicenter observational study.
  12. [Interdisciplinary Treatment Of Tumorous And Tumour-Like Lesions Of Peripheral Nerves].
  13. A Rare Sigmoid-Colon Schwannoma in a Premenopausal Woman: A Case Report.
  14. Effect of hormonal therapies for prostate cancer on cognition: The ongoing search for clarity.
  15. Huge mediastinal ancient schwannoma causing acute respiratory failure: a case report.
  1. bioRxiv. 2024 Mar 08. pii: 2024.03.04.583209. [Epub ahead of print]
    Nociceptive neurons interact directly with gastric cancer cells via a CGRP/Ramp1 axis to promote tumor progression.
    Xiaofei Zhi, Feijing Wu, Jin Qian, Yosuke Ochiai, Guodong Lian, Ermanno Malagola, Duan Chen, Sandra W Ryeom, Timothy C Wang.
      Cancer cells have been shown to exploit neurons to modulate their survival and growth, including through establishment of neural circuits within the central nervous system (CNS) 1-3 . Here, we report a distinct pattern of cancer-nerve interactions between the peripheral nervous system (PNS) and gastric cancer (GC). In multiple GC mouse models, nociceptive nerves demonstrated the greatest degree of nerve expansion in an NGF-dependent manner. Neural tracing identified CGRP+ peptidergic neurons as the primary gastric sensory neurons. Three-dimensional co-culture models showed that sensory neurons directly connect with gastric cancer spheroids through synapse-like structures. Chemogenetic activation of sensory neurons induced the release of calcium into the cytoplasm of cancer cells, promoting tumor growth and metastasis. Pharmacological ablation of sensory neurons or treatment with CGRP inhibitors suppressed tumor growth and extended survival. Depolarization of gastric tumor membranes through in vivo optogenetic activation led to enhanced calcium flux in nodose ganglia and CGRP release, defining a cancer cell-peptidergic neuronal circuit. Together, these findings establish the functional connectivity between cancer and sensory neurons, identifying this pathway as a potential therapeutic target.
    DOI:  https://doi.org/10.1101/2024.03.04.583209
  2. Pancreatology. 2024 Mar 15. pii: S1424-3903(24)00065-6. [Epub ahead of print]
    Perineural invasion score system and clinical outcomes in resected pancreatic cancer patients.
    Filippo Nozzoli, Martina Catalano, Luca Messerini, Fabio Cianchi, Romina Nassini, Francesco De Logu, Luigi Francesco Iannone, Filippo Ugolini, Sara Simi, Daniela Massi, Pierangelo Geppetti, Giandomenico Roviello.
      BACKGROUND/OBJECTIVES: Perineural invasion (PNI), classified according to its presence or absence in tumor specimens, is recognized as a poor prognostic factor in pancreatic ductal adenocarcinoma (PDAC) patients. Herein, we identified five histological features of PNI and investigated their impact on survival outcomes of PDAC resected patients.METHODS: Five histopathological features of PNI (diameter, number, site, sheath involvement, and mitotic figures within perineural invasion) were combined in an additional final score (ranging from 0 to 8), and clinical data of PDAC patients were retrospectively analyzed. PNI + patients were stratified in two categories according to the median score value (<6 and ≥ 6, respectively). Impact of PNI on disease-free survival (DFS) and overall survival (OS) were analyzed.
    RESULTS: Forty-five patients were enrolled, of whom 34 with PNI (PNI+) and 11 without PNI (PNI-). The DFS was 11 months vs. not reached (NR) (p = 0.258), while the OS was 19 months vs. NR (p = 0.040) in PNI+ and PNI- patients, respectively. A ≥6 PNI was identified as an independent predictor of worse OS vs. <6 PNI + patients (29 vs. 11 months, p < 0.001) and <6 PNI+ and PNI- patients (43 vs. 11 months, p < 0.001). PNI ≥6 was an independent negative prognostic factor of DFS vs. <6 PNI+ and PNI- patients (13 vs. 6 months, p = 0.022).
    CONCLUSIONS: We report a PNI scoring system that stratifies surgically-treated PDAC patients in a graded manner that correlates with patient prognosis better than the current dichotomous (presence/absence) definition. However, further and larger studies are needed to support this PNI scoring system.
    Keywords:  Disease free survival; Overall survival; PNI histopathological score system; Pancreatic adenocarcinoma; Perineural invasion
    DOI:  https://doi.org/10.1016/j.pan.2024.03.004
  3. Ann Pancreat Cancer. 2023 Nov;6(10):
    Genetic alterations in the neuronal development genes are associated with changes of the tumor immune microenvironment in pancreatic cancer.
    Kaiyi Mu, Juan Fu, Jessica Gai, Harshitha Ravichandran, Lei Zheng, Wei-Chih Sun.
      Background: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis and is highly metastatic. Our prior studies have demonstrated the critical role of axon guidance pathway genes in PDAC and the connection between neuronal development and the tumor microenvironment. A recent study newly identified 20 neuronal development genes [disks large homolog 2 (DLG2), neuron-glial-related cell adhesion molecule (NRCAM), neurexin3 (NRXN3), mitogen-activated protein kinase 10 (MAPK10), platelet-derived growth factor D (PDGFD), protein kinase C epsilon (PRKCE), potassium calcium-activated channel subfamily M alpha 1 (KCNMA1), polycystic kidney and hepatic disease 1 (PKHD1), neural cell adhesion molecule 1 (NCAM1), neuregulin-1 (NRG1), zinc finger protein 667 (ZNF667), cystic fibrosis transmembrane conductance regulator (CFTR), acyl-CoA medium-chain synthetase-3 (ACSM3), complement 6 (C6), protein tyrosine phosphatase receptor type M (PTPRM), hypoxia-inducible factor 1 alpha (HIF1A), adenylyl cyclase 5 (ADCY5), adherens junctions-associated protein 1 (AJAP1), neurobeachin (NBEA), sodium voltage-gated channel alpha subunit 9 (SCN9A)] that are associated with perineural invasion and poor prognosis of PDAC. The relationship between genetic alterations in these 20 genes and tumor immune microenvironment (TME) has not previously been investigated.Methods: We hence applied the sequential multiplex immunohistochemistry results of biopsy specimens from 63 PDAC patients to investigate this relationship.
    Results: We found that, except for PTPRM and NBEA, genetic alterations involving these 20 genes are associated with significant changes in the densities of major immune cell subtypes. Except for AJAP1, the copy number loss involving this panel of neuronal development genes is significantly associated with changes in immune cell infiltrates. In contrast, the copy number gain in fewer genes, including NRXN3, ZNF667, ACSM3, C6, ADCY5, SCN9A, and PRKCE, is significantly associated with changes in immune cell infiltrates.
    Conclusions: Our study suggested that neuronal development genes play a role in modulating TME in a pancreatic cancer setting.
    Keywords:  Pancreatic ductal adenocarcinoma (PDAC); neuronal development genes; tumor immune microenvironment (TME)
    DOI:  https://doi.org/10.21037/apc-23-13
  4. Oncoimmunology. 2024 ;13(1): 2308940
    Trial watch: local anesthetics in cancer therapy.
    Killian Carnet Le Provost, Oliver Kepp, Guido Kroemer, Lucillia Bezu.
      Preclinical evidence indicates potent antitumor properties of local anesthetics. Numerous underlying mechanisms explaining such anticancer effects have been identified, suggesting direct cytotoxic as well as indirect immunemediated effects that together reduce the proliferative, invasive and migratory potential of malignant cells. Although some retrospective and correlative studies support these findings, prospective randomized controlled trials have not yet fully confirmed the antineoplastic activity of local anesthetics, likely due to the intricate methodology required for mitigating confounding factors. This trial watch aims at compiling all published preclinical and clinical research, along with completed and ongoing trials, that explore the potential antitumor effects of local anesthetics.
    Keywords:  Cancer; immunity; local anesthetics; stress
    DOI:  https://doi.org/10.1080/2162402X.2024.2308940
  5. Cancer Cell. 2024 Mar 18. pii: S1535-6108(24)00079-5. [Epub ahead of print]
    Mapping functional to morphological variation reveals the basis of regional extracellular matrix subversion and nerve invasion in pancreatic cancer.
    Pierluigi Di Chiaro, Lucia Nacci, Fabiana Arco, Stefania Brandini, Sara Polletti, Andrea Palamidessi, Benedetta Donati, Chiara Soriani, Francesco Gualdrini, Gianmaria Frigè, Luca Mazzarella, Alessia Ciarrocchi, Alessandro Zerbi, Paola Spaggiari, Giorgio Scita, Simona Rodighiero, Iros Barozzi, Giuseppe R Diaferia, Gioacchino Natoli.
      Intratumor morphological heterogeneity of pancreatic ductal adenocarcinoma (PDAC) predicts clinical outcomes but is only partially understood at the molecular level. To elucidate the gene expression programs underpinning intratumor morphological variation in PDAC, we investigated and deconvoluted at single cell level the molecular profiles of histologically distinct clusters of PDAC cells. We identified three major morphological and functional variants that co-exist in varying proportions in all PDACs, display limited genetic diversity, and are associated with a distinct organization of the extracellular matrix: a glandular variant with classical ductal features; a transitional variant displaying abortive ductal structures and mixed endodermal and myofibroblast-like gene expression; and a poorly differentiated variant lacking ductal features and basement membrane, and showing neuronal lineage priming. Ex vivo and in vitro evidence supports the occurrence of dynamic transitions among these variants in part influenced by extracellular matrix composition and stiffness and associated with local, specifically neural, invasion.
    Keywords:  PDAC; extracellular matrix; histology; laser microdissection; pancreatic cancer; perineural invasion; spatial transcriptomics; tumor heterogeneity; tumor microenvironment
    DOI:  https://doi.org/10.1016/j.ccell.2024.02.017
  6. Indian J Surg Oncol. 2024 Mar;15(1): 193-196
    Intrapulmonary Ancient Schwannoma: a Rare Tumour.
    Sana Ahuja, Adil Aziz Khan, Sufian Zaheer.
      Schwannomas are benign encapsulated neoplasms which arise from Schwann cells of the neural sheath. Ancient schwannoma is a rare variant of schwannoma which is often misdiagnosed as a malignant neoplasm owing to degenerative changes. They are known to show degenerative nuclear atypia, cystic degeneration, hyalinization, myxoid change and haemorrhage. We present a rare case of an intrapulmonary ancient schwannoma in a 34-year-old female patient.
    Keywords:  Ancient; Degenerative; Intrapulmonary; Lung; Schwannoma
    DOI:  https://doi.org/10.1007/s13193-023-01867-w
  7. Medicine (Baltimore). 2024 Mar 22. 103(12): e37452
    Differential diagnosis of rare adrenal cellular schwannomas: A case report.
    Jiali Chen, Yan Huang, Jingjing Chen, Xianzhong Qi, Yue Ma, Miaoyan Wang, Fufeng Liu.
      BACKGROUND: Adrenal cellular schwannomas are exceptionally rare stromal tumors that are often misdiagnosed due to the lack of specific radiological, serological, or clinical features. In this report, we describe the differential diagnosis of a rare adrenal cellular schwannoma.METHODS: A 69-year-old man with a history of persistent hypertension, chronic kidney disease, hypertensive heart disease, and cardiac insufficiency was hospitalized due to bilateral lower extremity edema lasting for 3 months. Plain computed tomography at that time revealed a space-occupying lesion in the right adrenal gland. As serum levels of catecholamines, cortisol, and adrenocorticotropic hormone were within normal ranges, the edema was attributed to the chronic kidney disease and cardiac insufficiency, and the patient was referred to our hospital for surgical treatment. Contrast-enhanced computed tomography revealed heterogeneous enhancement in the adrenal mass indicating pheochromocytoma. An irregularly shaped 5 cm mass with a complete capsule in the right adrenal gland was laparoscopically resected. The postoperative histopathological diagnosis was adrenal cellular schwannoma.
    RESULTS: The postoperative course was unremarkable and the tumor did not recur during 5 years of follow-up.
    CONCLUSION: Adrenal cellular schwannoma is a very rare tumor that is extremely difficult to preoperatively diagnose. Histological and immunohistochemical analyses are required for differential diagnosis and confirmation. Cellular schwannomas can transform into malignant peripheral nerve sheath tumors, but not often. Consequently, regular postoperative follow-up is required for such patients, especially imaging.
    DOI:  https://doi.org/10.1097/MD.0000000000037452
  8. J Clin Invest. 2024 Mar 19. pii: e176748. [Epub ahead of print]
    STING activation reprograms the microenvironment to sensitize NF1-related malignant peripheral nerve sheath tumors for immunotherapy.
    Bandarigoda N Somatilaka, Laasya Madana, Ali Sadek, Zhiguo Chen, Sanjay Chandrasekaran, Renee M McKay, Lu Q Le.
      Neurofibromatosis Type 1 (NF1) is caused by mutations in the NF1 gene that encodes neurofibromin, a RAS GTPase-Activating Protein. Inactivating NF1 mutations cause hyperactivation of RAS-mediated signaling, resulting in development of multiple neoplasms, including Malignant Peripheral Nerve Sheath Tumors (MPNSTs). MPNSTs are an aggressive tumor and the main cause of mortality in NF1 patients. MPNSTs are difficult to resect and refractory to chemo- and radiotherapy, and no molecular therapies currently exist. Immune Checkpoint Blockade (ICB) is an approach to treat inoperable, undruggable cancers like MPNST, but successful outcomes require an immune cell-rich tumor microenvironment (TME). While MPNSTs are non-inflamed "cold" tumors, here, we turned MPNSTs into T cell-inflamed "hot" tumors by activating "stimulator of interferon genes" (STING) signaling. Mouse genetic and human xenograft MPNST models treated with STING agonist plus ICB exhibited growth delay via increased apoptotic cell death. This strategy offers a potential treatment regimen for MPNST.
    Keywords:  Cancer immunotherapy; Immunotherapy; Oncology; Therapeutics
    DOI:  https://doi.org/10.1172/JCI176748
  9. Indian J Surg Oncol. 2024 Mar;15(1): 117-120
    Gastric Schwannoma-Two Unusual Cases with Usual Presentation and Review of Literature.
    Monika Pohekar, Jakiyuddin Rampurwala, Sabireen, Rajesh S Shinde.
      Schwannomas, also known as neurilemmomas, are characteristically benign, slow growing neoplasms originating from Schwann cell sheath. Gastrointestinal schwannomas are very rare with stomach being the most affected organ representing approximately 0.2% of all gastric tumours. Malignant transformation is rarely reported in these tumors and complete surgical resection with negative margins is the recommended treatment. Herein, we report our experience of 2 cases of gastric submucosal spindle cell tumour (SMT), which were preoperatively assumed to be as gastrointestinal stromal tumor (GIST), however postoperatively confirmed as schwannoma on immunohistochemical examination.
    Keywords:  Gastric schwannoma; Gastric submucosal tumor; Neurilemmoma; Sarcoma
    DOI:  https://doi.org/10.1007/s13193-023-01847-0
  10. Front Oncol. 2024 ;14 1356000
    Case report and literature review: plexiform schwannoma in the penile and inguinal region in a child.
    Xiaoying Qi, Yifei Tan, Yanru Feng, Dan Ma, Ling Wang, Houqing Pang.
      Penile schwannoma is an uncommonly seen peripheral nerve tumor, of which penile plexiform schwannomas (PS) is extremely rare that has only been reported in several adults. We present a case of penile PS with a similar lesion in inguinal region in a 9-year-old child, which appeared as painless masses and rapidly growing within one year. Penile ultrasonography suggested well-defined lesions with limited vascularity. Both masses presented with low-to-intermediated signal intensity and no definite enhancement in computed tomography. The lesions were completely resected with minimal intraoperative bleeding, and a diagnose of benign PS was confirmed based on H&E staining and positive S-100 expression in immunohistochemistry. There was no evidence of tumor recurrence or metastasis after 6 months of follow-up. Only 6 cases of penile schwannoma in children were recorded, of which 5 were malignant, and none was PS. The malignancy rate of penile schwannoma in children may be overestimated due to delayed diagnose of benign ones. A rapidly growing penile mass with a suspected metastatic lesion in inguinal region could be easily misdiagnosed as malignant. This case report and literature review is expected to assist clinicians in getting a comprehensive understanding of children penile schwannomas and choosing the best management strategy when faced with this rare condition.
    Keywords:  children; inguinal region; penis; plexiform; schwannoma
    DOI:  https://doi.org/10.3389/fonc.2024.1356000
  11. Front Oncol. 2024 ;14 1344150
    Preoperative differentiation of gastric schwannomas and gastrointestinal stromal tumors based on computed tomography: a retrospective multicenter observational study.
    Luping Zhao, Guanjie Cao, Zhitao Shi, Jingjing Xu, Hao Yu, Zecan Weng, Sen Mao, Yueqin Chen.
      Introduction: Gastric schwannoma is a rare benign tumor accounting for only 1-2% of alimentary tract mesenchymal tumors. Owing to their low incidence rate, most cases are misdiagnosed as gastrointestinal stromal tumors (GISTs), especially tumors with a diameter of less than 5 cm. Therefore, this study aimed to develop and validate a diagnostic nomogram based on computed tomography (CT) imaging features for the preoperative prediction of gastric schwannomas and GISTs (diameters = 2-5 cm).Methods: Gastric schwannomas in 47 patients and GISTs in 230 patients were confirmed by surgical pathology. Thirty-four patients with gastric schwannomas and 167 with GISTs admitted between June 2009 and August 2022 at Hospital 1 were retrospectively analyzed as the test and training sets, respectively. Seventy-six patients (13 with gastric schwannomas and 63 with GISTs) were included in the external validation set (June 2017 to September 2022 at Hospital 2). The independent factors for differentiating gastric schwannomas from GISTs were obtained by multivariate logistic regression analysis, and a corresponding nomogram model was established. The accuracy of the nomogram was evaluated using receiver operating characteristic and calibration curves.
    Results: Logistic regression analysis showed that the growth pattern (odds ratio [OR] 3.626; 95% confidence interval [CI] 1.105-11.900), absence of necrosis (OR 4.752; 95% CI 1.464-15.424), presence of tumor-associated lymph nodes (OR 23.978; 95% CI 6.499-88.466), the difference between CT values during the portal and arterial phases (OR 1.117; 95% CI 1.042-1.198), and the difference between CT values during the delayed and portal phases (OR 1.159; 95% CI 1.080-1.245) were independent factors in differentiating gastric schwannoma from GIST. The resulting individualized prediction nomogram showed good discrimination in the training (area under the curve [AUC], 0.937; 95% CI, 0.900-0.973) and validation (AUC, 0.921; 95% CI, 0.830-1.000) datasets. The calibration curve showed that the probability of gastric schwannomas predicted using the nomogram agreed well with the actual value.
    Conclusion: The proposed nomogram model based on CT imaging features can be used to differentiate gastric schwannoma from GIST before surgery.
    Keywords:  computed tomography; diagnosis; gastric schwannoma; gastrointestinal stromal tumor; nomogram
    DOI:  https://doi.org/10.3389/fonc.2024.1344150
  12. Handchir Mikrochir Plast Chir. 2024 Feb;56(1): 11-20
    [Interdisciplinary Treatment Of Tumorous And Tumour-Like Lesions Of Peripheral Nerves].
    Nora Franziska Dengler, Maria Teresa Pedro, Jonas Kolbenschlag.
      Tumorous or tumour-like lesions of peripheral nerves are generally rare, heterogeneous and challenging to diagnose and treat. They may become apparent by a palpable swelling (lump) near nerves, sensory and/or motor deficits, pain to touch or neuropathic pain. In 91% of cases, tumours are benign. The differentiation of entities and their characteristics as well as a function-preserving resection strategy are highly relevant. Misdiagnosis and inadequate treatment can lead to severe deficits and pain syndromes. Benign tumours include schwannomas and neurofibromas, which can occur sporadically but can also be associated with neurogenetic tumour disposition syndromes if they occur more frequently. Rarer benign nerve tumours include perineuriomas, lipomas, aggressive fibrosis (desmoid tumours), paragangliomas and haemangiomas. Ganglion cysts are described as tumour-like lesions. The association of nerve tumours with neurogenetic syndromes and the correct classification of potentially malignant lesions such as MPNST (malignant peripheral nerve sheath tumour) or intermediate stages such as ANNUBPs (atypical neurofibromatous neoplasms with unknown biological potential) pose particular challenges. Interdisciplinarity is highly relevant for clinical treatment and a correct diagnosis. The aim of our work is to provide an overview of the relevant entities, diagnostic evaluation and contemporary treatment strategies based on the current data situation and taking into account the recently published interdisciplinary AWMF S2k guideline "Diagnosis and Treatment of Peripheral Nerve Tumours".
    DOI:  https://doi.org/10.1055/a-2250-7772
  13. Acta Med Litu. 2023 ;30(2): 188-193
    A Rare Sigmoid-Colon Schwannoma in a Premenopausal Woman: A Case Report.
    Aikaterini Selntigia, Benedetto Neri, Consuelo Russo, Francesco Giuseppe Martire, Giorgia Soreca, Dario Biasutto, Francesco Maria Di Matteo, Caterina Exacoustos.
      Background: Schwannomas of the gastrointestinal tract are a rare type of spindle cell tumor of peripheral nerve. Commonly, schwannomas are discovered incidentally, as they are usually asymptomatic.Case: 46-year-old female patient, suffering from secondary amenorrhea and nonspecific intermittent pelvic pain associated with constipation. During gynecological visit an ultrasonographic systematic transvaginal examination was performed. At the sigmoid-rectal level an intraluminal solid mass was described and an urgent colonoscopy was prescribed. Endoscopic submucosal dissection was performed with en-bloc resection. On immunohistochemical analysis, S100 was strongly positive in tumor cells. Finally, a benign schwannoma of the sigmoid colon was diagnosed.
    Conclusion: Our case highlights the importance of an adequate transvaginal pelvic examination with the evaluation of all pelvic organs. It could be challenging to make diagnosis in an early stage on asymptomatic patients.
    Keywords:  premenopause; rectal mass; sigmoid mass; surgical procedures; transvaginal ultrasound
    DOI:  https://doi.org/10.15388/Amed.2023.30.2.11
  14. Cancer. 2024 Mar 16.
    Effect of hormonal therapies for prostate cancer on cognition: The ongoing search for clarity.
    Guillaume Lim Fat, Shabbir Alibhai.
      
    Keywords:  androgen deprivation therapy; androgen-receptor axis-targeted therapies; cognitive decline; cognitive impairment; hormonal therapy; prostate cancer; subjective cognitive decline
    DOI:  https://doi.org/10.1002/cncr.35283
  15. J Cardiothorac Surg. 2024 Mar 15. 19(1): 131
    Huge mediastinal ancient schwannoma causing acute respiratory failure: a case report.
    Hsuan-Ying Huang, Chien-Ming Lo, Hung-I Lu, Jen-Ping Chang.
      Benign mediastinal tumor is usually asymptomatic and exhibits uncomplicated clinical course. Posterior mediastinal schwannoma is common, but a huge benign tumor causing acute respiratory failure due to mass effect is unusual. We present a patient who suffered from acute respiratory failure due to huge mediastinal mass effect and improved after en bloc surgical resection. A 56-year-old woman had no history of systemic disease, but experienced general discomfort and malaise for several months. She was referred to our emergency department after developing sudden respiratory failure. Intubation was performed with ventilator support and she was admitted to the intensive care unit. Chest radiograph and computed tomography showed a huge mass over the left pleural cavity causing left lung, heart, and mediastinal compression. After en bloc resection, she was weaned off the ventilator successfully and was discharged at 24 days after the operation. Postoperative outpatient follow-up showed no symptoms. Mediastinal ancient schwannoma is a rare posterior mediastinal benign tumor. However, mass effect might lead to lethal complications. En bloc resection is necessary for curative treatment.
    Keywords:  Mediastinal schwannoma; Respiratory failure
    DOI:  https://doi.org/10.1186/s13019-024-02605-1
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