Neurogenic Tumors at the Pulmonary Apex

¹ From the Department of Radiology, University of Wisconsin Medical School and The State of Wisconsin General Hospital, Madison, Wis.

Neurogenic tumors form a distinct group of intrathoracic neoplasms and are found chiefly along the mediastinal borders. The benign tumors of this class are second only in frequency to the teratoid tumors. A favorite site of development appears to be at the pulmonary apex with the tumor arising from one of the upper intercostal nerves close to the vertebrae.

Clinically these neoplasms cause little in the way of physical signs or symptoms until they become large enough to produce pressure on adjacent structures. The possibility of malignant degeneration is always present and therefore surgical removal is recommended once the diagnosis has been reasonably well established.

Roentgenologically the tumor shadow is sharply circumscribed, rounded or ovoid in shape and located along the medial aspect of the pulmonary apex or at the apical summit. Pressure erosion of ribs or vertebrae may exist but invasive destruction is not seen.

Two cases are reported in which operative removal of the tumor was done. One was a neurofibroma and the other a neurofibrosarcoma of a low grade of malignancy. In addition two other cases are described with similar roentgen, findings which were observed over periods of six and seven years respectively but without histological proof of the diagnosis.

Differentiation from the malignant tumors of the pulmonary apex causing Pancoast's syndrome (usually carcinomas of the lung) is important and is possible when all of the clinical and roentgenologic factors are carefully considered.