Surgery for posterior mediastinal dumbbell tumors: A case report

INTRODUCTION: Mediastinal dumbbell tumors are rare, and special cases provide valuable knowledge to the existing literature. PRESENTATION OF CASE: A 57-year-old woman was diagnosed with a recurrent dumbbell-shaped nerve sheath tumor with intrathoracic and intraspinal components. We attempted to resect the tumor via combined biport thoracoscopy and laminectomy with the patient in a prone position. However, copious bleeding prevented complete removal of the intraspinal component of the tumor. Pathological examination of the operative specimens showed a mixed hemangioma. DISCUSSION: The first report on the use of triportal thoracoscopy for treatment of a posterior mediastinal dumbbell tumor with the patient in the prone position was published in 1995. However, this technique is not widely used. The technique used in our case is unique only in that biportal rather than triportal thoracoscopy was used to resect the intrathoracic component of the tumor. The differential diagnoses of posterior mediastinal dumbbell-shaped tumors include neurogenic tumors, meningiomas, and hemangiomas. Very rarely, cavernous and capillary hemangiomas also present as dumbbell-shaped lesions. To our knowledge, a mixed hemangioma presenting as a dumbbell-shaped lesion has not been previously reported. CONCLUSION: The intrathoracic component of a posterior mediastinal dumbbell tumor can be resected by biportal thoracoscopy with the patient in a prone position, reducing the operative time. If the diagnosis of a dumbbell tumor is inconclusive, an endoscopic biopsy should be performed before removing the tumor.