Mediastinal lymphangioma in an adult

Lymphangiomas are rare benign neoplasms derived from portions of lymph sacs. They most often occur in children in the cervical region and 90% have manifested by the end of the second year of life. An isolated mediastinal lymphangioma in an adult is an uncommon disease entity. We report the case of a mediastinal lymphangioma in a 29-year-old man presenting as a suprasternal lump, which was resected through a partial sternotomy/hemiclamshell thoracotomy.     

Successful excision of an isolated mediastinal cystic lymphangioma with bilateral thoracoscopic surgery

Lymphangioma is a well-known benign tumor and its cystic abnormalities of the lymph vessels are predominantly congenital. Cystic lymphangioma usually occurs in the neck, axillary region, and rarely in the mediastinum, which frequently occurs in children and young adults. A 20-year-old woman had symptoms of palpitation, cough, and dyspnea during the recent 1 month. Both chest comuted tomography and magnetic resonance imaging of the chest revealed a well-defined, 13 × 10-cm cystic lesion in the anterior mediastinum. The patient underwent bilateral video-assisted thoracoscopic excision of the cyst and lymphangioma was confirmed based on histopathologic examination. Here, we report a rare case of isolated mediastinal cystic lymphangioma that was successfully excised using a minimally invasive technique.     

Surgical analysis of mediastinal lymphangioma--analysis of 7 cases]

Mediastinal lymphangioma is a very rare disease. In this study, we evaluated 7 surgically treated cases of mediastinal lymphangioma. Four males and 3 females with ages ranging from 5 months to 74 years (average 31.4 years) were examined. Four patients were asymptomatic but had abnormal shadows on their chest X-ray. Of the remaining patients, one had hoarseness and another had superior vena cava syndrome and both had dyspnea. The other patient was discovered because of cervical tumor. Multiple lymphangiomas were found in only 2 patients. One patient had 4 tumors and the other had 2 tumors in the mediastinum. Of all lymphangiomas, 2 were found in the superior mediastinum, 2 in the anterior mediastinum, 3 in the median mediastinum and 3 in the posterior mediastinum. All patients had cystic lymphangioma including 1 with capillary lymphangioma and 1 with cavernous lymphangioma. Median sternotomy was performed in 3 of the patients and posterolateral thoracotomy was performed in the remainder. The cervical tumor was removed by local incision. Complete resection of the lymphangiomas was performed and no recurrence was observed after surgery.     

Isolated cystic lymphangioma of the mediastinum

Cystic lymphangiomas are relatively uncommon benign tumours of the lymphatic system. These lesions frequently are apparent at birth and more than 90% are detected before the end of the second year of life. More commonly cystic lymphangioma presents as a soft tissue mass in the neck and only rarely does it extend into the mediastinum. Isolated mediastinal lymphangiomas are exceedingly rare and have been reported infrequently. Herein we have reported two cases of mediastinal cystic lymphangioma, one in a child and the other in an adult patient, who were treated successfully by complete surgical excision     

Five cases of the lymphangioma of the mediastinum in adult.

Mediastinal lymphangioma is rare disease. Above all cavernous type of mediastinal lymphangioma is very rare. We report 5 cases of mediastinal lymphangioma including cavernous type. CT was performed in all and revealed that they were smoothly marginated and cystic. All were surgically resected and specimens were classified pathologically into cystic type (3 cases), cavernous type (1 case) and mixed type of the two (1 case). MRI was performed in the cavernous type and suggested that the mass was lymphangioma because of pathognomonic lesion. Despite preoperative diagnosis of mediastinal lymphangioma is difficult, MRI is able to useful examination. In the follow-ups there has been no recurrence in our series.     

A case of mediastinal cystic lymphangioma--case reports and review of the literature in Japan

A 15-year-old woman was admitted to our hospital with complaints of left anterior chest pain and an abnormal shadow on her chest X-ray film. At the left thoracotomy, a large cyst (20.5 x 15 x 3 cm) was located in the left anterior mediastinum and contained translucent yellow fluid. Histological diagnosis was cystic lymphangioma. Mediastinal cystic lymphangioma is very rare among mediastinal tumors. Altogether 32 cases of mediastinal cystic lymphangioma including our case were collected from the Japanese literature and reviewed.     

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.     

Mediastinal lymphangioma treated under video-assisted thoracic surgery

Mediastinal lymphangioma is a rare benign tumor that is usually seen in anterior mediastimun of the adult. A 15-year-old girl with anterior mediastinal tumor, 10 cm in length, was suspected to have lymphangioma based on magnetic resonance imaging. She underwent tumor resection under video-assisted thoracic surgery. Pathological examination reveled that tumor was composed of lymphatic ducts and smooth muscles, and diagnosis of lymphangioma was established. Both the onset of young age and location of left side of the mediastinum are considered to be unusual.     

Neck and mediastinal node dissection in pharyngolaryngoesophageal tumors

BACKGROUND: Specific reports about neck node metastasis in cervical esophageal tumors and mediastinal node metastasis in patients with pharyngolaryngoesophageal tumors are lacking. This study was undertaken to evaluate the need for neck and mediastinal lymph node dissection when dealing with carcinomas of this region. METHODS: A retrospective review of the records of 34 patients who underwent total pharyngolaryngoesophagectomy and gastric transposition (TPLEGT) for squamous cell carcinoma of the pharyngoesophageal junction was done. Sixteen patients had esophageal carcinomas, 14 had hypopharyngeal carcinomas, and 4 had laryngeal carcinomas. The mediastinal dissection was designed to remove mainly the paratracheal and paraesophageal lymph nodes down to the aortic arch, without thoracotomy. Neck and mediastinal lymph node metastases were studied with specific reference to main primary site, and comparison with the literature was undertaken. RESULTS: Twenty-five neck dissections were performed in 19 patients and yielded positive nodes in 16 patients (47% of all patients). The neck nodes were positive in 75%, 64.2%, and 18.7% of the patients with laryngeal, hypopharyngeal, and esophageal carcinomas, respectively. Mediastinal dissection data were available on 27 patients, and 16 (59.2%) had mediastinal node metastasis. These mediastinal nodes were positive in 0%, 72.7%, and 61.5% of the patients with laryngeal, hypopharyngeal, and esophageal carcinomas, respectively. CONCLUSIONS: There is little controversy about neck dissections in tumors of the larynx and hypopharynx when a TPLEGT is contemplated. A similar situation applies to mediastinal dissections for cervical esophageal carcinomas. Although we observed a low incidence of positive neck nodes (18.7%) in patients with cervical esophageal carcinomas, there is a need for a larger prospective series. Our finding of 72.7% positive mediastinal nodes in hypopharyngeal carcinomas is high enough to deserve further study. Laryngeal carcinomas showed no positive mediastinal nodes in this series.     

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.     

Cystic abdomino-mediastinal lymphangioma. Apropos of a case. Review of the literature

A further case of cystic lymphangioma is reported, characteristic features being the multiple abdominal and thoracic localizations of the lesions. Apart form splenic sites, it is rare to detect lesions in the mesogastric and mediastinal regions, particularly as propagation of abdominal lymphangioma towards the mediastinum is an exceptional occurrence. A literature review provides data on the various regions in which cysts have been reported in the body, and the diagnostic problems they raise.     

Incidental pleural-based pulmonary lymphangioma

Adult benign thoracic lymphangiomas typically present as incidental mediastinal lesions, or, more rarely, as solitary pulmonary nodules. Symptomatic compression of vital structures may require lesion resection or sclerotherapy. In the present report, we describe the incidental finding of a solitary pleural-based pulmonary lymphangioma in a 38-year-old woman with chronic arm and shoulder pain. Positron emission tomography revealed that the lesion was highly fluorodeoxyglucose-avid. Biopsy exposed benign tissue consistent with lymphangioma. After continued radiographic tests, the lesion was determined to be an unlikely source of the patient's chronic pain. The present report is, to our knowledge, the first published case of solitary pleural-based pulmonary lymphangioma in the medical literature.     

Cystic lymphangioma confined to mediastinum in an adult

Mediastinal lymphangiomas are very rare tumors among the slow-growing mediastinal masses in the literature. We present the successful resection of a 52-year-old woman who was referred to our hospital. Past medical history consisted of surgical treatment for cervical mass and pathological diagnosis of lymphoma nine years earlier. She underwent postoperative radiotherapy. Preoperative chest roentgenogram and computed tomogram of the chest showed a cystic mass in the anterior mediastinum. The tumor was completely resected. The preoperative diagnosis was never questioned until the histopathological examination confirmed that the lesion was a cystic lymphangioma. Cystic lymphangiomas are benign tumors with the evidence of progression in tumor size and invasion into the vital structures. As our case shows, the tumor involvement with the vital structures causes difficulty in removal.     

Cystic lymphangioma of the heart mimicking a mediastinal tumor.

Primary cardiac tumors are rare and myxomas are the most frequent. Cystic lymphangiomas are most often of cervicomediastinal locations and are exceedingly rare in the mediastinum. Cystic lymphangioma involving the heart has never been reported. We report a case of cystic lymphangioma involving the posterior wall of left atrium mimicking a mediastinal tumor. Complete resection was performed via a median sternotomy under cardiopulmonary bypass and cardiac arrest after transection of the aorta and pulmonary trunk.     

A thyroglossal duct cyst of the anterior mediastinum

Thyroglossal duct cysts (TGDCs) are developmental anomalies arising from the embryonic thyroglossal duct. They are commonly midline cervical structures associated with the hyoid bone. We report a 3.5-cm diameter isolated TGDC of the anterior mediastinum in a 65-year-old European woman who was treated by transcervical excision. The mass was limited to the mediastinum with a normal neck on computed tomographic scan and clinical examination. This is the second case of mediastinal TGDC known to be reported, and the oldest known age at presentation. The TGDC should be considered as an uncommon differential diagnosis of an anterior mediastinal mass.     

Cardiac lymphangioma: case report and review of the literature

Cardiac lymphangioma is uncommon and constitutes one of the rare forms of cardiac diseases. A 6-year-old girl had an abnormal electrocardiogram in a screening test on admission to an elementary school. Echocardiogram, computed tomogram, and magnetic resonance imaging showed a mediastinal multicystic mass that was adjacent to the left ventricle of the heart. The tumor was found to be originated in myocardium by left thoracotomy and pericadiotomy. A partial resection of tumor and a pericardial window were done. This case, to the authors' knowledge, represents the sixth reported case of cardiac lymphangioma. J Pediatr Surg 37:E32.     

Spontaneous parathyroid adenoma hemorrhage

We report a case of spontaneous parathyroid adenoma hemorrhage. A 50-year-old man with a sore throat, and swelling and ecchymosis of the entire anterior neck was found in cervical and chest computed tomography revealed to have a low-density area extending from the parapharyngeal region to below the carina, Suspecting descending necrotizing mediastinitis secondary to a peritonsillar abscess, we conducted mediastinal and cervical drainage, but found no abscess. No evidence was found, either, in bacteriological culture of sputum and pleural effusion. After the hematoma disappeared, cervical ultrasonography indicated parathyroid adenoma. Serum calcium was marginally increased, indicating that serum calcium should be determined if cervical or mediastinal hematoma develops without an obvious cause.     

The treatment of lymphangioma in the buccal mucosa by radiofrequency ablation: a case report.

Lymphangioma is a benign, hamartomatous tumor of the lymphatic system. It is usually found in the head and neck region and is widely regarded as a developmental lesion rather than a true neoplasia. Most lymphangiomas are present at birth (60%), and by the age of 2 years 80% to 90% are present. In the head and neck area, the most common location is the submandibular region, followed by the parotid gland. When lymphangioma occurs in the mouth, the anterior two thirds of the tongue is the most commonly affected region. Various methods have been tried for treatment of lymphangioma including surgery, radiation, laser therapy, and sclerotherapy. Recently, a new and more conservative surgical approach to this lesion using radiofrequency ablation has been described. In this report, a case of lymphangioma in the right buccal mucosa of the mental foramen area that has been treated by radiofrequency ablation is presented.     

Descending necrotising mediastinitis: report of two cases

Descending necrotising mediastinitis is a severe infection spreading from the cervical region to the mediastinal connective tissue. It represents a virulent form of mediastinal infection, requiring prompt diagnosis and treatment to reduce the high mortality associated. An optimal debridement and drainage through an open thoracotomy access are the keys for a successful outcome. Two patients, males, 70 and 75-years-old with descending necrotising mediastinitis were treated in our Institution in April '05. One had an odontogenic abscess and the other had a retropharyngeal abscess. Operative procedures included thoracotomy with radical surgical debridement of the mediastinum and excision of necrotic tissue associated with transcervical surgical debridement and drainage. Postoperatively mediastinum-pleural and cervical irrigation with iodopovidone 2 per thousand was performed until a culture of pleural effusion become negative. Postoperatively both patients suffered from severe complication including septic shock and acute respiratory distress syndrome. The 70-years-old patient had an acute renal failure too. Postoperatively the length of the intensive care unit stay was 40 and 42 days, respectively. The outcome was favorable in both patients. Early detection and immediate open surgical treatment could be the best way to reduce morbidity and mortality rate. Descending Necrotising Mediastinitis cannot be adequately treated without mediastinal and cervical excision of necrotic tissue and drainage including an open thoracic and cervical approach.     

Resection of a thoracic duct lymphangioma using video-assisted thoracoscopic surgery

Thoracic duct lymphangioma is a rare mediastinal tumor. Most patients are asymptomatic. Symptoms may include dysphagia, dyspnea, cough, or chest pain. Workup may include chest computed tomography or lymphangiography, or both. Surgery should be considered the treatment of choice. We present a 60-year-old man with a 2.4-cm mass in the retro-cardiac space to the right of the esophagus. The patient underwent a thoracoscopic resection of the mass with ligation of the thoracic duct. We conclude that video-assisted thoracoscopic surgery allows for safe evaluation and resection of mediastinal pathology.