Surgical approach for histopathological determination of anterior mediastinal malignant lymphoma

In a retrospective review of all patients who admitted our hospital between January 1992 and December 2006, we identified 9 with anterior mediastinal malignant lymphoma. They represented 6.8% of the 133 patients with mediastinal tumor. Histology revealed 3 cases of primary mediastinal large B-cell lymphoma, 2 of Hodgkin lymphoma, 2 of precursor T-lymphoblastic lymphoma and 2 of thymic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma. Careful attention should be paid to the relatively high incidence of malignant lymphoma in the anterior mediastinal tumors. It is highly important to differentiate of malignant lymphoma from other diseases that shape anterior mediastinal tumor to avoid unnecessary operation. Early and accurate diagnosis of these tumors is also important because some of these patients require immediate treatment by hematology specialists.     

Surgical resection of recurrent bilateral mediastinal liposarcoma through the clamshell approach

Primary mediastinal liposarcoma is an unusual variant of mediastinal neoplasms. We describe a long-term survivor who underwent repeated operations. After resections through a posterolateral thoracotomy and median sternotomy, a third operation was performed for recurrent bilateral huge tumors through a clamshell incision, and both tumors were removed en bloc. Results of pathologic examination showed that both tumors were well-differentiated liposarcoma. The patient is currently well 16 years after the first operation. Aggressive surgical intervention whenever possible appears to improve the quality of life and prolong the survival of patients with mediastinal liposarcoma.     

Cosmetic approach to anterior mediastinal masses

A new approach for the removal of thymic tissue or any anterior mediastinal pathology is described. It uses a novel low U-shaped skin incision combined with a J-shaped upper mini-sternotomy. This technique was designed to provide wide exposure of the mediastinum and to be cosmetically appealing. Our study included 12 patients, 4 with a preoperative diagnosis of myasthenia gravis. There were no operative mortality and three complications. This procedure allows for complete removal of all thymic tissue under direct vision, and is less invasive that full sternotomy.     

Rosai-Dorfman disease mimicking mediastinal lymphoma

Rosai-Dorfman disease is rare and typically presents with cervical lymphadenopathy. The disease is generally indolent and self-limited, but it carries a poor or fatal prognosis when it is advanced or when it involves and compresses vital structures. We herein report a rare case of Rosai-Dorfman disease affecting only the mediastinal-hilar region in a 66-year-old woman.     

Novel thoracoscopic approach to difficult posterior mediastinal tumors

Thoracoscopic resection is the preferred treatment of posterior mediastinal tumors. However, thoracotomy may be necessary if the tumors are large or adherent; if they are demonstrate invasion or intraspinal growth; or if they are located in the superoposterior mediastinum or posterior costodiaphragmatic angle. We describe a case of a large, adherent posterior costodiaphragmatic mediastinal mass that would have been otherwise difficult to resect thoracoscopically if it were not for the three-dimensional visualization, greater dexterity, and accurate dissection offered by the Da Vinci robot.     

巨大纵隔肿瘤的外科治疗

目的　探讨巨大纵隔肿瘤外科治疗的经验。方法　回顾性分析 1993年 5月～ 2 0 0 3年 5月收治的 13例病人临床资料。结果　 13例病人中良性肿瘤 8例 ( 62 % ) ,恶性肿瘤 5例( 3 8% ) ,肿瘤完整切除 11例 ,部分切除 1例 ,1例因术中大出血死亡。 10例随访 3个月～ 10年 ,良性肿瘤无复发 ,恶性肿瘤 2例复发。结论　巨大纵隔肿瘤以手术治疗为主。囊性肿瘤及其他肿瘤有液化者可在术前穿刺减压 ,术中暴露困难时可先部分切除 ,注意处理复张性肺水肿及术中大出血。