PMC8371657_01
Preoperative, intraoperative, and postoperative images: (a) preoperative chest X-ray (arrow); (b) the middle mediastinal tumor (arrow); (c) intraoperative tumor and the right phrenic nerve (arrow); (d) removed tumor image (arrow); (e) postoperative chest X-ray; (f) the chest CT scanner 1 month after surgery.
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The manifestation on thoracic X-ray: right pulmonary hilum has an even, well-defined border (Figure 1(a)). A modest amount of contrast was absorbed after injection (Figure 1(b)). The intraoperative examination found that the tumor of the right diaphragmatic nerve was about 2 x 3 cm in size (Figure 1(c)) with clear tumor boundary to surrounding organs (including pericardium, pulmonary artery, and lung parenchyma), proving the noninvasiveness. We conducted a segmentation of the right phrenic nerve to remove the tumor and release the length of the phrenic nerve associated with reconnecting the right phrenic nerve with a prolene 8/0 through endoscopy (Figure 1(d)). Postoperatively, the patient was discharged after 4 days of treatment with a clinical condition of no difficulty breathing and no chest pain, and postoperative X-ray showed no abnormality; the right diaphragm was unchanged (Figure 1(e)). CT scanner result 1 month after discharge showed no abnormal images compared to the preoperative results (Figure 1(f)).
Images of postoperative pathologies: (a) gross picture; (b) HE x 50 and HE x 400, tumors with a dense cellularity and a small cystic degeneration areas; tumor cells were spindle-shaped and quite uniform and have fine chromatine, unknown nucleoli, no abnormalities, and poor mitoses. (c) The tumor cells have an unknown cytoplasmic boundary, arranged in parallel bands, suggesting a palisading.
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The removed specimen was pale yellow with superficial hemorrhage (Figure 2).