Vascular tumor in the mediastinum

Mediastinal venous hemangioma is a very rare neoplasm. Here, we describe our experience in treating a patient demonstrating such a tumor. The patient, a 23-year-old man, was admitted to our hospital because of a mediastinal cyst. A biopsy of the cystic wall was performed by Video-Assisted-Thoracic-Surgery, in April 1999. Clear serous fluid was found in the cyst, and it was thus incorrectly diagnosed to be a thymic cyst. The cyst continued to increase in size, and the patient began to show an increased temperature after being discharged. A resection of the tumor was performed in June 1999. The cyst was filled with bloody fluid and, according to the pathological analysis, was diagnosed to be a mediastinal venous hemangioma.     

Transcervical superior mediastinal lymphadenectomy in the management of papillary thyroid carcinoma

AIM: Surgery is the treatment of choice for lymph node metastases in papillary thyroid carcinoma. When adequately treated by surgical extirpation, the presence of lymph node involvement does not seem to have a negative impact on cure rates or survival. Surgical lymphadenectomy for metastatic papillary thyroid carcinoma has been well described for both the central and the lateral compartments of the neck. Superior mediastinal lymphadenectomy, however, has only sporadically been mentioned. We describe our experience with transcervical superior mediastinal lymphadenectomy (TSML) that avoids the morbidity of the traditional sternal split. MATERIALS AND METHODS: This retrospective analysis included 30 patients (24 women and 6 men; age range, 17-72 years) who underwent TSML by the senior author (JLF) for papillary carcinoma metastatic to the superior mediastinum between 1985 and 1999. Histopathologic examination confirmed positive nodes in all the mediastinal dissections. All patients received postoperative I(131). RESULTS: All the patients are alive after a median follow-up of 5 years (range, 1-14 years). Twenty-nine of 30 patients remain free of disease, whereas one patient is alive with lung and bone metastases. No patient has had local or regional relapse. The only significant complication was a high incidence of temporary (70%) and later permanent (50%) hypoparathyroidism. CONCLUSIONS: TSML is a safe and effective treatment for superior mediastinal metastases in papillary thyroid carcinoma.     

Surgical management of mediastinal paraganglioma: All hands on deck!

Mediastinal paragangliomas are very uncommon neuroendocrine neoplasms. Due to their tissue of origin (sympathetic ganglia of the great vessels), they tend to arise deep within pericardial space and, more importantly, intimately attached to great vessels, which makes surgical resection, even with cardiopulmonary bypass, very challenging. This commentary accompanies the case report describing complex surgical management of a paraganglioma located in the anterior mediastinum that was initially thought to be a thymoma.     

Primary Osteogenic Sarcoma of the Posterior Mediastinum

Extraosseous osteogenic sarcoma of the mediastinum is an extremely rare tumour, usually arising in the anterosuperior compartment. Clinical findings in the first reported case of high-grade osteogenic sarcoma arising in the posterior mediastinum are described.     

Familial neurilemmomatosis: Report of a case

We report herein a case of familial neurilemmomatosis seen in a 16-year-old girl and her 38-year-old mother. The girl presented to us with an intrathoracic vagal neurilemmoma, as well as neurilemmomas on the right fifth intercostal nerve and in the serratus anterior muscle. Two years after these tumors were resected, bilateral acoustic neuromas and multiple brain stem tumors appeared. Her mother was being treated simultaneously at another hospital for multiple neurilemmomas, including bilateral acoustic neurilemmomas, suggesting the possibility that neurilemmomatosis is an autosomal dominantly inherited disorder.     

纵隔疑难疾病的纵隔镜诊断和鉴别诊断

目的　探讨纵隔镜手术在纵隔疑难疾病诊断中的应用价值。　方法　自 1999年 11月至2 0 0 2年 2月为 35例纵隔疑难疾病患者进行了纵隔镜手术 ,对胸部CT等检查发现的纵隔病变进行活检 ,获取气管周围、胸骨后、隆突下以及双侧肺门等部位的肿物组织送病检。　结果　本组除 1例外全部获得明确病理诊断 ,确诊率 97% (34/ 35 )。其中恶性病变 18例 (5 2 9% ) ,良性病变 16例 (47 1% )。术前术后诊断符合率 4 7 1% (16 / 34) ,术前误诊率 5 2 9%。术前误诊的病例中以良性病变多见 ,本组 16例良性病变中 ,有 6 2 5 % (10 / 16 )的病人术前误诊为恶性肿瘤。纵隔镜手术后发生声音嘶哑 1例 ,并发症发生率为 2 9% (1/ 35 )。无围手术期死亡。　结论　纵隔镜手术 ,可使一般方法难以确诊的纵隔疾病获得明确病理诊断 ,且具有创伤小、安全、取材可靠等优点 ,因此应作为纵隔疑难疾病诊断的常规手段。     

Giant mediastinal lymphangioma in a neonate: Report of a case

We report herein the case of a male neonate with a giant cystic lymphangioma confined to the bilateral anterior mediastinum. He developed very severe respiratory distress on the 8th day of life due to the mediastinal mass, and almost total excision of the bilateral mass was performed on the 12th day of life through a right axillar thoracotomy. The pathological diagnosis was cystic lymphangioma. Postoperatively, right phrenic nerve dysfunction was evident, for which diaphragmatic plication could only be performed 5 weeks after the initial surgery due to the prolonged respiratory support. In the 4 years since undergoing surgery the child has shown no sign of recurrence and has not experienced any further respiratory problems.     

Anesthesia for children with anterior mediastinal masses

Children with an anterior mediastinal mass may have cardiopulmonary compromise that can be exacerbated under general anesthesia. Signs and symptoms such as cough, shortness of breath, stridor, orthopnea, accessory muscle use, a history of respiratory arrest, and the presence of a pleural effusion and upper body edema are predictive of perioperative complications. A larger mediastinal mass on imaging is predictive of perioperative complications. Risk stratification of patients, together with an individualized plan, will best guide operative management for patients with an anterior mediastinal mass. General anesthesia (GA) should be avoided if possible, but a spontaneous breathing technique is recommended if GA is required.     

Oesophageal Hiatus Hernia:Follow-up Studies after Surgical Correction

The purpose of these studies was to examine the experience of the surgical correction of oesophageal hiatus hernia at the University Hospital (Landspitalinn), Reykjavik. It contains a detailed review of 45 patients operated on during a 15-year period with variable techniques and two main approaches, the transthoracic and the transabdominal. The operative techniques are analysed and operated co-existing diseases are listed. The primary mortality was 2.2%. There is a detailed follow-up of 38 patients. They were all interviewed for clinical results and all underwent barium-meal radiological examinations. The clinical successes of the operations numbered 36 out of 38 patients, or 94.8%. The radiological recurrence as estimated by recurrence of the hernia, reflux, or both, was 28.9%. The recurrence hernias were on the average smaller than the original hernias. Better results are shown by transthoracic as compared with transabdominal approach. Comparisons are made with other reported series.     

Posterior mediastinal teratomas

Eight benign posterior mediastinal teratomas have been found in the world's literature. Including our case, four teratomas were intimately involved with, and often required, partial resection of the major surrounding structures--aorta, chest wall, and esophagus. Preoperative evaluation of posterior mediastinal teratomas should include consideration of a barium swallow and/or aortography to rule out significant local involvement.     

Carcinoma positive for Epstein-Barr virus staining

A 44-year-old man undergoing radical excision of metastatic carcinoma of the mediastinal lymph node with unknown primary sites remains alive and disease-free 14 years after surgery. His cancer cells were positive for the Epstein-Barr virus, which may have been related to the oncogenesis of this tumor. This case is unique in the patient's long, disease-free survival and its positive presence of the Epstein-Barr virus.     

Mediastinal mass obscured by a large pericardial effusion in a child: a potential cause of serious anaesthetic morbidity

Anaesthesia in the presence of a mediastinal mass is known to be hazardous. We report a case of a 5-year-old boy with a presumed postviral pericardial effusion presenting for pericardiocentesis under general anaesthesia. Cardiorespiratory collapse following induction of anaesthesia occurred due to an undiagnosed mediastinal tumour. The reasons for misdiagnosis, mechanisms for perioperative complications and optimal management are discussed. Mediastinal masses and underlying malignancy should always be considered in patients with large pericardial effusions.     

Mediastinal cyst with rim calcification

A 58-year-old man who had been undergoing treatment for chronic pericarditis for 15 months was found to have a calcified mediastinal mass shadow on a chest X-ray and was referred to us for further study and treatment. Chest computed tomography and magnetic resonance imaging showed an anterior mediastinal multilocular tumor with rim calcification. Tumor markers were within normal limits. The patient was preoperatively diagnosed as having a calcified mediastinal cyst, and median sternotomy was performed to remove the cystic tumor and the surrounding thymic tissues. Histological examination revealed that the cyst wall consisted of dense fibrous tissue and calcification without epithelial cell lining on the inner surface. Thymic tissue was present around the cyst wall. Although we suspected a thymic cyst from the intraoperative findings, the final diagnosis was made as mediastinal cyst with rim calcification. We herein present a rare case of mediastinal cyst with rim calcification.     

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。     

血管重建在原发性纵隔肿瘤中的临床应用

目的总结血管重建在原发性纵隔肿瘤中的应用经验和疗效。方法经外科手术治疗并血管重建的原发性纵隔肿瘤76例,22例（28.9%）单纯侵及上腔静脉;16例（21.1%）侵及单纯左或右无名静脉;34例（44.7%）侵及上腔静脉和左或右无名静脉;有4例（5.3%）单纯侵及主动脉外膜。行完整切除70例,部分切除6例;行血管置换46例,血管成形30例。结果全组病人无一例围术期死亡。上腔静脉阻断时间为（10-30）min,平均（18.0±5.3）min。左或右无名静脉单侧阻断时间为（11-25）min,平均（16.5±4.2）min。全组病人均获随访,时间为12-26个月,术后生活质量满意。结论纵隔肿瘤侵及上腔静脉及其属支大血管的病人,如全身无系统功能严重受损应积极手术治疗,可选用血管置换或血管成形术。     

Anaesthetic management of an infant with anterior mediastinal mass

A substantial mediastinal mass in a small infant can create a dilemma regarding the safest mode of airway management. To ensure safety at all times, we adopted one lung ventilation for fear of compression of the carina and/or both main bronchi. Anaesthesia was maintained at a very light plane by the use of local nerve blocks to secure the airway and epidural analgesia for surgery until the tumour was mobilized.     

Hemangioma in the anterior mediastinum

Anterior mediastinal hemangiomas are very rare neoplasms in mediastinal tumors. A 58-year-old woman was revealed to have a mass measuring 4×3 cm in size in the anterior mediastinum with calcification on computed tomography. It was initially suspected to be a thymoma. We performed tumor extirpation in November 1998. The tumor was close to the thymus and slightly adhered to the superior vena cava, ascending aorta and right phrenic nerve, however, it did not invade any surrounding organs. Histopathologically, it was diagnosed to be a venous type hemangioma composed of vessels covered by smooth muscle and a cavernous type hemangioma composed of dilated vessels covered by one layer of endothelial cells.     

Postoperative chylothorax following partial resection of mediastinal lymphangioma: Report of a case

We report herein the rare case of a 20-year-old man in whom a mediastinal lymphangioma was incidentally detected by a chest roentgenogram taken during a routine health examination. Both computed tomography and magnetic resonance imaging confirmed a mass measuring 3×7 cm in diameter in the left anterior mediastinum. A thoracoscopic exploration was done, which confirmed a diagnosis of mediastinal lymphangioma, and 3 days later a sternotomy was performed. However, the tumor could not be completely extirpated due to partial invasion. Following the thoracoscopic procedure, a chylous discharge developed which was difficult to treat conservatively and he continued to drain 700–1,000 ml of chyle daily 2 weeks following the tumor extirpation. Therefore, a right thoracotomy with ligation of the thoracic duct was performed which resolved the chylothorax. The patient remains well without any regrowth of the regional tumor 9 months after his operation.     

Malignant germ cell tumor of the mediastinum: A multimodality therapeutic approach

Twenty-five patients with a malignant germ cell tumor of the mediastinum were treated at the National Cancer Center Hospital, Tokyo. Three patients had pure seminomas while 22 had a nonseminomatous histology. The treatment modalities consisted of surgery alone in 7 patients, surgery with chemotherapy and/or radiation in 14, and chemotherapy and/or radiation without surgery in 4. Cisplatin-based chemotherapy was administered in nine patients, one of whom successfully underwent high-dose chemotherapy with autologous bone marrow transplantation after resection of the tumor. A complete response was achieved in only five patients. The overall survival rate at 5 years was 33.5% and the median survival time was 51 weeks. Eight patients (32%), all of whom underwent surgery either with or without chemotherapy and/or radiation, were free of disease with a mean follow-up period of 439 weeks (72–1,120 weeks). The median survival times for 14 patients undergoing combined modality treatment, 7 patients undergoing surgery alone, and 4 patients undergoing chemotherapy and/or radiation were 83, 16, and 18 weeks, respectively.