Schwannoma of the Recurrent Laryngeal Nerve, a Rare Neurogenic Tumor of the Middle Mediastinum: Diagnostic and Therapeutic Aspects

Neurogenic tumors of the mediastinum represent a heterogeneous group of neoplasms arising from nervous tissue and account for up to 34% of all mediastinal tumors, predominantly localized in the posterior mediastinum. This category includes tumors of the peripheral nerve sheaths, the sympathetic nervous system, and paraganglia, which are crucial in determining prognosis and in selecting the optimal surgical strategy.

The most common schwannomas typically arise from intercostal nerves and are characterized by an encapsulated, lobulated structure. A rare variant is schwannoma of the recurrent laryngeal nerve, which presents a particular clinically challenge due to the risk of vocal dysfunction resulting from potential impairment of laryngeal innervation.

Diagnosis is based on computed tomography and magnetic resonance imaging; however, definitive diagnosis can only be established through histological examination of tissue samples. Surgical intervention remains the mainstay of treatment, with the use of a videoassisted thoracoscopic approach contributing to reduced tissue trauma.

Complete preservation of nerve function is often not feasible, thereby necessitating subsequent multidisciplinary rehabilitation.

This clinical case demonstrates the successful performance of surgical intervention and the subsequent implementation of a complex rehabilitation program, highlighting the importance of the multidisciplinary approach involving specialists from various fields to achieve optimal treatment outcomes.

1. Sasaki K, Kohno T, Mun M, Yoshiya T. Thoracoscopic removal of middle mediastinal schwannoma originating from recurrent nerve. Thorac Cardiovasc Surg. 2008;56(6):375-377. PMID: 18704866. https://doi.org/10.1055/s-2008-1038471

2. Ito T, Komatsu D, Nakata T, Kumaki T, Aoki T, Kasuga Y. Neurilemoma originating from the left recurrent nerve in the superior mediastinum: report of a case. Surg Today. 2004;34(9):769-771. PMID: 15338351. https://doi.org/10.1007/s00595-004-2794-5

3. Gueldich M, Hentati A, Chakroun A, et al. Giant cystic schwannoma of the middle mediastinum with cervical extension. Libyan J Med. 2015;10(1):27409. PMID: 25854982. PMCID: PMC4390562. https://doi.org/10.3402/ljm.v10.27409

4. Kolbanov KI, Ryabov AB, Volchenko NN. Rare primary malignant non-epithelial lung tumor: sarcoma originating from peripheral nerve sheaths. P.A. Herzen Journal of Oncology. 2021;10(3):29-33. (In Russ.) https://doi.org/10.17116/onkolog20211003129

5. Konuk BM, Güneş SG, Kahya Y, Ceyhan K, Enon S. A middle mediastinal schwannoma: A rare case report. Turk Gogus Kalp Damar Cerrahisi Derg. 2021;29(2):283-284. PMID: 34104527. PMCID: PMC8167468. https://doi.org/10.5606/tgkdc.dergisi.2021.20195

6. Rammos KS, Rammos SK, Foroulis CN, Zaramboukas TK. Schwannoma of the vagus nerve, a rare middle mediastinal neurogenic tumor: case report. J Cardiothorac Surg. 2009;4:68. PMID: 19941638. PMCID: PMC2788545. https://doi.org/10.1186/17498090-4-68

7. Knulst R, Bosman WM, Ritchie ED, da Costa A. Cystic schwannoma of the recurrent laryngeal nerve: a rare finding posing diagnostic difficulties. BMJ Case Rep. 2014;2014:bcr2014203873. PMID: 24769666. PMCID: PMC4009921. https://doi.org/10.1136/bcr-2014-203873

8. Shchadenko S.V., Topolnitskiy E.B. Case of successful application of method for 3D visualization and modeling in thorasic oncology. Bulletin of Siberian Medicine. 2016;15(2):127-133. (In Russ.) https://doi.org/10.20538/1682-0363-2016-2-127-133

9. Xu XQ, Hong T, Zheng CJ. Schwannoma originating from the recurrent laryngeal nerve in a thyroid cancer patient: A case report and review of the literature. World J Clin Cases. 2018;6(16):1202-1205.PMID: 30613683. PMCID: PMC6306646. https://doi.org/10.12998/wjcc.v6.i16.1202

10. Miyauchi A, Inoue H, Tomoda C, et al. Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve. Surgery. 2009;146(6):1056-1062. PMID: 19958932. https://doi.org/10.1016/j.surg.2009.09.018

11. Eshonkhodjaev O.D., Rakhimiy Sh.U., Porhanov V.A. Comparative Study of Surgical Approaches for Mediastinal Masses. Innovative Medicine of Kuban. 2025;10(2):16-23. (In Russ.) https://doi.org/10.35401/2541-9897-2025-10-2-16-23

12. Topolnitskiy EB, Borodina YuA. Videothoracoscopic interventions for tumors and cysts of the mediastinum. Endoscopic Surgery. 2020;26(6):17-21. (In Russ.) https://doi.org/10.17116/endoskop20202606117

13. Bazarov D.V., Kazaryan G.A., Adamyan R.T., Grigorchuk A Yu., Kavochkin A.A., Kabakov D.G. Reconstruction of the phrenic nerve with tumor lesion. The first case in Russia. Issues of Reconstructive and Plastic Surgery. 2023;26(2):43-48. (In Russ.) https://doi.org/10.52581/1814-1471/85/05

14. Shefer NA, Topolnitskiy EB. Enhanced recovery after lung resection in high-risk patients. Pirogov Russian Journal of Surgery. 2023;(2):21-29. (In Russ.) https://doi.org/10.17116/hirurgia202302121

15. Topolnitskiy EB, Usoltseva SV, Garcheva AS. Endoscopic ultrasonography with transbronchial fine needle aspiration biopsy and thoracoscopic removal of ectopic middle mediastinal thymoma. P.A. Herzen Journal of Oncology. 2025;14(2):41-46. (In Russ.) https://doi.org/10.17116/onkolog20251402141

16. Romanov MD, Kireeva EM. Neurogenic tumors of the mediastum with distribution to the retroperitoneal space. Ulyanovsk Medical Biological Journal. 2018;1:64-70. (In Russ.).