Surgery for posterior mediastinal dumbbell tumors: A case report

•A woman was diagnosis recurrent mediastinal dumbbell-shaped nerve sheath tumor.•However, pathological examination showed mixed hemangioma.•During the procedures, the intrathoracic component can be resected by biportal thoracoscopy in a prone position; however, removal of the intraspinal tumor was incomplete because of copious bleeding.•If the diagnosis of dumbbell tumor is not conclusive, an endoscopic biopsy should be performed before removing the tumor.

IntroductionMediastinal dumbbell tumors are rare, and special cases provide valuable knowledge to the existing literature.Presentation of caseA 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.DiscussionThe 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.ConclusionThe 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.