A case of a large thoracic epidural hourglass neurinoma, incidentally detected on routine chest roentgenogram--with respect to the surgical approach

In case of the advanced extension into the thoracic cavity, it has been difficult to remove a large thoracic spinal hourglass tumor by conventional laminectomy, even adding costotransversectomy, due to high risk of injuring diverse important vessels and other organs by blind manipulation. A case of a large thoracic spinal hourglass neurinoma with advanced extension into the mediastinum is presented. A 49-year-old female was admitted for the further examination of the left mediastinal tumor, incidentally detected on routine chest roentgenogram, which was suspected as the part of spinal hourglass tumor. Her neurological examination was normal except hyperreflexia of bilateral lower extremities. Plain chest roentgenogram showed a left mediastinal mass behind the aortic arch and the descending aorta, which slightly enlarged in size, compared with its previous size in the chest film taken 3 years ago. Thoracic spine tomogram showed the destruction of the left pedicle of T4, the absorption of posterior aspect of the T4 vertebral body and the dilatation of the left intervertebral foramen between T4-T5. Myelogram showed the complete block of dye column at T4. Metrizamide CT scan revealed the large extradural hourglass tumor, which compressed the dural theca anterolaterally and extended through the dilated left T4-T5 intervertebral foramen into the left mediastinum and attached to the descending aorta. Two stage operation, the first for the removal of the left mediastinal tumor by transthoracic approach and the second for intraspinal canal tumor by posterior approach, was performed with success for this large thoracic spinal hourglass tumor.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case report of mediastinal cystic lymphangioma

Mediastinal lymphangioma is very rare in the literature. A resected case of mediastinal cystic lymphangioma was reported. A 41-year-old man admitted to our hospital complaining of sore throat. A chest X-ray examination showed a large mediastinal mass on the right. At the right thoracotomy, a large cystic mass filled the anterior mediastinum and extended from the thoracic inlet to the posterior costophrenic angle. The cyst contained about 600 ml yellowish brown fluid and was adherent to the surrounding tissue, especially to the aorta and the left main bronchus. The resected tumor was 20 x 12 x 10 cm in size and 620 g in weight. Histological diagnosis was cystic lymphangioma. The patient is alive and well 26 months later, and there is no sign of recurrence of the tumor.     

A case of dumb-bell-like neurilemmoma of the posterior mediastinum

A 56 year-old female was pointed out an abnormal shadow on chest X-ray film for the lung cancer screening study. Chest X-ray film showed a round mass shadow at the right superior mediastinum. Chest CT scan revealed the mass was in the paravertebral area abutting on the 2nd thoracic vertebral body and had extended into the intervertebral foramen. Preoperative diagnosis was a dumb-bell-like neurogenic tumor. Operation was carried out by posterior approach in the prone position. At first thoracotomy was done by removing the paravertebral portion of the 2nd and 3rd ribs, and then hemilaminectomy was added. Both the intrathoracic and intraforminal portions of the tumor were completely exposed, and excised. Pathological examination demonstrated the tumor was a typical neurilemmoma originating from the 2nd intercostal nerve. When a neurogenic tumor of the posterior mediastinum has an intraspinal extension, a posterior approach by a simultaneous thoracotomy and laminectomy will be useful to remove the tumor at one sitting.     

A case of intrathoracic perineurial cyst

A 67-year-old man was referred to our surgical clinic for evaluation of an abnormal shadow on the chest X-ray examination. CT scan and MRI revealed a tumor in the posterior mediastinum and destruction of the pedicle and intraspinal invagination by the tumor. The tumor in a paravertebral area are linked with a vertebral canal through a destructed intervertebral foramen. MRI showed that the tumor was a cyst which contained fluid. On thoracotomy a hen's egg sized cyst was found in the posterior mediastinum, the cyst was excised. Pathological diagnosis was a perineurial cyst. This case was clearly differentiated from an intrathoracic meningocele and a neurilemmoma microscopically. This case is the first intrathoracic perineurial cyst in Japan.     

Enucleation for a giant esophageal leiomyoma; report of a case

A 32-year-old man was referred to our hospital because of a mediastinal tumor with mild dysphagia. Computed tomography (CT) showed that the tumor was located in the neck and the posterior mediastinum. An esophagogram demonstrated severe distortion of the esophageal lumen and an endoscopic examination disclosed a submucosal bulge covered by normal mucosa with no erosion and no ulceration. A CT-guided needle biopsy for neck lesion of the tumor was performed and the histopathological diagnosis was an esophageal leiomyoma. Complete enucleation via a left anteroaxillary thoracotomy for the tumor was performed without perforation of esophageal mucosa. The resected tumor was 12 cm in size. The final diagnosis of the resected tumor located in the cervical, upper, middle and intramural esophagus was a rare giant esophageal leiomyoma. Postoperative course was uneventful. We suggested that enucleation with an operative procedure selected carefully for a giant esophageal leiomyoma was attempted for preservation of esophageal function.     

A case of chondromyxoid fibroma of the frontal bone

A case of chondromyxoid fibroma of the skull is reported. A 20-year-old boy visited our clinic on December, 1982 because of a recurrent forehead tumor. He had a 4 X 4 X 1.5 cm tumor on the right side of forehead and a 3 X 3 X 0.5 cm tumor on the left. Neurological examination showed no abnormalities. Skull X-ray film showed a large round radiolucent area with clear sclerotic margin in the frontal bone and right orbit. Right carotid angiogram showed marked posterior displacement of the anterior cerebral artery, but no tumor stain. Plain CT scan showed a mass with iso to low density area in the frontal region. It was markedly and irregularly enhanced with contrast media. Surgery was performed entirely in the epidural space, and the tumor was completely removed. The post-operative clinical course was uneventful. Histologically, the three components of chondroid, myxomatous and fibrous tissues in this tumor led to the diagnosis of "chondromyxoid fibroma."     

Experience of the malignant complete intrathoracic goiter: discussion on 13 cases of Japan

A 56-year-old woman was found to have a mediastinal mass on routine examination. Chest X-ray, CT scan, MRI and superior vena cavography showed a right upper mediastinal tumor invading the SVC. And it was diagnosed malignant intrathoracic goiter by histological examination by percutaneous needle biopsy. On thoracotomy and mediastinotomy, the tumor located only in the right upper mediastinum and had no relation to the cervical thyroid gland. Histological examination revealed papillary adenocarcinoma. We reported a malignant complete intrathoracic goiter and added discussion on another 12 cases seen in Japanese literature.     

Mediastinal cystic lymphangioma; report of a case

A cystic lymphangioma is a rare mediastinal benign tumor. A 38-year-old male was referred to our hospital because of an mediastinal mass incidentally detected on chest X-ray. The mass had enlarged rapidly during the course of 1 year. Computed tomography (CT) of the chest showed a 7 cm well defined cystic tumor in the left anterior mediastinum. Magnetic resonance imaging (MRI) demonstrated a mass with heterogeneous high signal intensity on enhanced T2-weighted images. The cystic tumor, localized in the mediastinal adipose tissue, was completely resected by a thoracoscopic procedure. A pathological examination confirmed the diagnosis of a cystic lymphangioma.     

Contrast magnetic resonance imaging diagnosis of periaortic bronchogenic cyst

A 39-year-old woman who had suffered from intermittent left back pain for 7 months was diagnosed as having a tumor in the posterior mediastinum to the left of the seventh thoracic vertebra. It was attached to the descending aorta and to a rib. Preoperative contrast magnetic resonance imaging strongly suggested that the tumor was a cystic lesion. We resected the tumor, and it was revealed to be a bronchogenic cyst. After 7 months' follow-up, the patient is asymptomatic and without complications. Bronchogenic cysts are rare developmental abnormalities of the primitive foregut and seldom arise in the posterior mediastinum, especially in a periaortic position. The preoperative diagnosis is difficult because of the diverse nature of a cyst's contents. We were able to predict preoperatively the nature of the tumor and its relation to other structures. Contrast magnetic resonance imaging is helpful in elucidating these cysts.     

Intrathoracic retroesophageal goiter causing tracheal stenosis

A 65-year-old woman presented with stridor revealed a mass on a chest X-ray on physical examination. A huge goiter arising in the left lobe of the thyroid had extended retroesophageally and across the midline to the right side of the posterior mediastinum far caudally down to the level of the carina. The trachea was remarkably compressed. Surgery was perfomed via a combined thoracic and cervical approach, and the tumor was completely removed with resultant relief from stridor. The patient is presently doing well at 1 year after the operation.     

Large malignant mesenchymoma of the left posterior mediastinum; report of a case

Malignant mesenchymoma is a soft tissue tumor arising preferentially in the extremities and retroperitoneum. We report a case of primary malignant mesenchymoma of the left posterior mediastinum. A 24-year-old woman was admitted to our hospital for complaining of cough. Chest X-ray showed a giant mass occupying the 2/3 of the left hemithorax. Chest computed tomography (CT) revealed a lobulated large mass with fat density area and calcified spot in the mediastinum and left pleural space. Chest magnetic resonance imaging (MRI) demonstrated a large solid mass consisting mainly of areas with the same intensity as fatty tissue and partly of areas with heterogenous moderate intensity. The tumor was resected completely under left posterolateral thoracotomy. The pathologic diagnosis was malignant mesenchymoma; well differentiated liposarcoma with osteocartilagenous differentiation. The patient has been well for 3 years and 3 months after surgery.     

达芬奇机器人纵隔肿物切除术23例临床分析

目的探讨应用达芬奇机器人行纵隔肿物切除术的可行性。方法回顾性分析2009年1月～2012年12月通过达芬奇机器人行纵隔肿物切除手术23例的临床资料。年龄33～72岁,平均48.8岁。前纵隔肿物19例,中纵隔肿物1例,后纵隔肿物3例。三孔法,左侧机械臂为抓钳,右侧机械臂为超声刀,中间为观察孔。前纵隔胸腺来源肿物行全胸腺切除术,后纵隔及中纵隔来源肿物沿肿物包膜完整切除。结果 23例手术均获成功,全胸腺切除术19例,中纵隔气管囊肿剥除术1例,后纵隔肿物切除术3例。手术时间（93.9±38.6）min,术中出血（55.2±18.6）ml,术后24小时胸管引流量（115.2±69.9）ml,术后住院时间（5.4±1.4）d。全组无围手术期死亡,无中转开胸。术后病理示胸腺瘤16例,神经鞘瘤3例,胸腺囊肿2例,胸腺增生及支气管囊肿各1例。23例随访1～48个月,平均20个月,无复发。结论应用达芬奇机器人行纵隔肿物切除术安全可行。     

Intrathoracic retroesophageal goiter causing tracheal stenosis.

A 65-year-old woman presented with stridor revealed a mass on a chest X-ray on physical examination. A huge goiter arising in the left lobe of the thyroid had extended retroesophageally and across the midline to the right side of the posterior mediastinum far caudally down to the level of the carina. The trachea was remarkably compressed. Surgery was performed via a combined thoracic and cervical approach, and the tumor was completely removed with resultant relief from stridor. The patient is presently doing well at 1 year after the operation.     

A case of intraosseous meningioma

A case of intraosseous meningioma at the posterior fossa was reported. Intraosseous meningioma is very rate and only six cases have been reported in Japanese literature. A 64 year-old woman complained of progressive headache and was admitted to Ichinomiya Neurosurgical Hospital. On admission, neurological examination did not reveal any abnormalities. However, plain skull X-p showed a hyperostotic lesion in the right posterior fossa. CT scan demonstrated homogeneously enhanced mass by contrast medium. MRI showed a mass lesion of the posterior fossa on T1 and T2 weighted images. The right vertebral angiogram showed an avascular area in the right posterior fossa and no tumor stain. The tumor, which was partially attached to the underlying dura, was successfully removed surgically. The operative finding confirmed an intraosseous meningioma which had arisen from the right asterion. The post operative course was uneventful. Histological examination revealed fibroblastic meningioma.     

Traumatic hemothorax resulting from rupture of mediastinal teratoma: a case report

Ruptured cystic mature teratoma of anterior mediastinum is rare. This 45-year-old woman complained of sudden onset of chest pain and dyspnea after a traffic accident. Physical examination revealed decrease of breath sounds over the left chest. Chest X-ray showed pleural fluid accumulation of the left pleural cavity. Computed tomography scan of the chest revealed a heterogenous cystic mass lesion approximately 11.5 x 10 x 7 cm in size in the left anterior mediastinum and left pleural effusion. Under the impression of mediastinal tumor and traumatic hemothorax, she received excision of the mediastinal mass and evacuation of left pleural fluid through a left lateral thoracotomy. She recovered uneventfully after operation and was discharged on postoperative day 11.     

Nonfunctioning paraganglioma of the posterior mediastinum]

A 23-year-old man, complaining of a discomfort in the chest, saw a physician nearby and was pointed out chest abnormal shadow in chest X-ray. He was admitted to our hospital for surgery. As a result of a close check-up at this department, a giant tumor extending from above the right diaphragm to the posterior mediastinum was found. Physical findings in the preoperative examination and general examinations showed no abnormality. The operation was performed and was diagnosed as paraganglioma. This tumor is abundant in blood vessels. Thus, preoperative angiography and securing of the field of operation in treating the blood vessels were considered indispensable for the safety of operation.     

Case report of calcifying fibrous pseudotumor of the adrenal grand

Calcifying fibrous (pseudo) tumour (CFP) is an uncommon and distinct pathological entity, which is usually occurring in the soft tissue of the extremities, trunk, axilla, pleura, mediastinum and peritoneum. We report a case of CFP of the adrenal gland. A 29-years-old previously healthy woman complained the left lumbago. A solid mass was found on computed tomography on the left adrenal gland. There were no abnormalities in physical examination and laboratory studies. Only urinary noradrenalines and dopamines levels were slightly high. Laparoscopic left adrenalectomy was performed. Pathological findings of the left adrenal tumor showed dense hyalinized fibrous tissue containing bland spindle-shaped cells, calcifications, and lymphoplasmacytic infiltrate. Our case seems to be the first case of CFP to be published in the Japanese literature.     

A case of lung cancer with mediastinal tumor

A 72-year-old female underwent surgical resection of lung cancer and mediastinal tumor. Abnormal shadows on the chest roentgenogram were incidentally detected by the regular health screening. The lung cancer existed in the left upper lobe, and the mediastinal tumor existed in the posterior mediastinum along left side of the spines. Serum CEA level was 299 ng/ml by enzyme immunoassay method. We judged the lung cancer as being in Stage I (T2 N0 M0), and the mediastinal tumor as benign neurogenic tumor unrelated to the lung cancer through detailed examination. Surgical resection of both tumors was performed through left thoracotomy, and the surgical procedure was curative operation. Pathological examination revealed the lung cancer was moderately differentiated adenocarcinoma and the mediastinal tumor was Schwannoma. Eight months after surgery, serum CEA level is 1.1 ng/ml without evidence of recurrence. This experience suggested us that a mediastinal tumor accompanied by lung cancer is not necessarily metastatic tumor, and that curative operation may be possible in these cases.     

Schwannoma of the recurrent laryngeal nerve; report of a case

A 57-year-old woman was admitted to our hospital because of an abnormal shadow on her chest X-ray film and a palpable left neck mass. She had a mild cough. Computed tomography (CT) scans and magnetic resonance imaging (MRI) of the chest demonstrated a well-circumscribed, huge mass (approximately 14 cm in diameter) in the left anterior mediastinum. On June 12th, 2000, the mass was resected. During surgery, the tumor seemed to arise from the left recurrent laryngeal nerve. The pathological examination revealed the tumor as a schwannoma. Recurrent laryngeal nerve schwannoma is extremely rare.     

Malignant fibrous histiocytoma of the mediastinum associated with bilateral adrenal gland metastases--a case report]

A 55-year-old female underwent complete resection of left posterior mediastinal tumor and both adrenal gland tumors. Histological examination revealed malignant fibrous histiocytoma (MFH) showing a storiform pattern. Her postoperative course was uneventful and well one year after the operation. We concluded the tumor arose from the mediastinum and metastasized to the bilateral adrenal glands. No other case was reported that primary MFH of the mediastinum with distant metastases was completely resected including metastatic lesions.