CASE PRESENTATION: A 73-year-old woman presented with
shortness of breath, and computed tomography scan exhibited a giant mediastinal
tumor causing severe
tracheal stenosis. An upper gastrointestinal endoscopy revealed a giant submucosal lesion without mucosal changes located 18-23 cm from the incisor teeth. 18F-fluorodeoxyglucose (FDG)-positron emission tomography image revealed an upper mediastinal homogeneous mass and left supraclavicular lymph node with increased FDG accumulation. We performed endoscopic ultrasound-guided fine-needle aspiration biopsy; however, a definitive diagnosis could not be determined. During further investigation, her
shortness of breath suddenly worsened and she suffered from
wheezing. Because of risk of smothering, we decided to perform quasi-urgent lifesaving surgery. Under the preparation of
extracorporeal membrane oxygenation (ECMO) when tracheal intubation fails, bronchial blocker was inserted over the
tracheal stenosis and the left-lung ventilation was performed via intubation alone. Under
general anesthesia, the patient was placed in the left lateral position and we performed right
thoracotomy. The
tumor strongly adhered to the trachea; however, the trachea or recurrent laryngeal nerves were not damaged in the surgery. Following
esophagectomy, we performed gastric conduit reconstruction through the posterior mediastinum, and hand-sewn anastomosis was performed in the left neck. Immunohistochemical staining was positive for S-100 but negative for c-KIT, CD34, α-SMA, and
desmin; these morphological and immunohistochemical characteristics were consistent with the diagnosis of
neurofibroma.
CONCLUSIONS: