Ganglioneuroma is an extremely rare tumor that is derived from neural crest. Many ganglioneuroma cases are detected incidentally unless they are large enough to cause compressive symptoms. We report an 18-year-old pat...Ganglioneuroma is an extremely rare tumor that is derived from neural crest. Many ganglioneuroma cases are detected incidentally unless they are large enough to cause compressive symptoms. We report an 18-year-old patient with posterior mediastinal ganglioneuroma which was abutting the descending aorta. The patient underwent successful resection by thoracoscopic approach and was followed up for one year with no complications. In summary, a detailed review with experts in both radiology and pathology is mandated to diagnose these tumors. Informed consent was obtained from the patient.展开更多
BACKGROUND Mediastinal bronchogenic cysts and pericardial defects are both rare.It is extremely rare that both occur simultaneously.To the best of our knowledge,this is the first case of a coexistent bronchogenic cyst...BACKGROUND Mediastinal bronchogenic cysts and pericardial defects are both rare.It is extremely rare that both occur simultaneously.To the best of our knowledge,this is the first case of a coexistent bronchogenic cyst and pericardial defect reported in China.We performed a literature review and found a relationship between bronchogenic cysts and pericardial defects,which further revealed the correlation between the bronchus and pericardium during embryonic development.CASE SUMMARY A 14-year-old boy attended a local hospital for ankylosing spondylitis.Chest radiography showed an enhanced circular-density shadow near the left mediastinum.The patient had no chest symptoms and the physical examination was normal.Because of the mediastinal occupation,the patient visited our department of chest surgery for further treatment.During surgery,a left pericardial defect was observed.The bronchogenic cyst was removed by thoracoscopic surgery,but the pericardial defect remained untreated,and a satisfactory outcome was achieved after the operation.The patient was diagnosed with a mediastinal tumor.The pathological diagnosis of the tumor was a bronchogenic cyst.CONCLUSION This case further reveals the correlation between the bronchus and pericardium during embryonic development.展开更多
BACKGROUND Pulmonary sequestration-both intralobar and extralobar-is a rare congenital developmental malformation.Extralobar pulmonary sequestrations(EPS)have their own pleura but are separated from the bronchus and u...BACKGROUND Pulmonary sequestration-both intralobar and extralobar-is a rare congenital developmental malformation.Extralobar pulmonary sequestrations(EPS)have their own pleura but are separated from the bronchus and usually occur in the left lung.They are mainly found mainly between the lower lobe and the mediastinum.EPS is rarely found within the mediastinum itself,even rarer so in the posterior mediastinum.CASE SUMMARY We report the case of a 27-year-old man who was misdiagnosed with a neurogenic tumor based on preoperative contrast-enhanced computed tomography(CT)and magnetic resonance imaging findings.Contrast-enhanced chest CT revealed a posterior mediastinal mass measuring 1.2 cm×1.4 cm×3.3 cm,which consisted of some cystic areas and showed slight enhancement.The mass was in the 11th paravertebral region and attached to the 11th thoracic vertebra behind the descending aorta in the posterior mediastinum.An arteriole originating from the intercostal artery and a vein originating directly from the hemiazygos vein were found in the pedicle of the mass.The mass was resected in a uniport videoassisted thoracoscopic surgery.During the operation,the pyramid-shaped mass appeared well-encapsulated.Postoperative histopathology established a diagnosis of EPS.One month later,a follow-up CT of the thorax showed good recovery.CONCLUSION Although EPS rarely occurs in the posterior mediastinum,its diagnosis should be considered when posterior mediastinal tumors are suspected.展开更多
BACKGROUND Thymolipoma is a rare benign tumor arising from the anterior mediastinal thymus and is composed of mature fatty tissue and interspersed nonneoplastic thymic tissue. This tumor accounts for only a small perc...BACKGROUND Thymolipoma is a rare benign tumor arising from the anterior mediastinal thymus and is composed of mature fatty tissue and interspersed nonneoplastic thymic tissue. This tumor accounts for only a small percentage of mediastinal masses, and the majority of them are asymptomatic and found incidentally. To date, fewer than 200 cases have been published in the world literature, of which most excised tumors weighed less than 0.5 kg and the largest weighed 6 kg.CASE SUMMARY A 23-year-old man presented with a complaint of progressive breathlessness for 6mo. His forced vital capacity was only 23.6% of the predicted capacity, and his arterial partial pressure of oxygen and carbon dioxide were 51 and 60 mmHg,respectively, without oxygen inhalation. Chest computed tomography revealed a large fat-containing mass in the anterior mediastinum that measured 26 cm × 20cm × 30 cm in size and occupied most of the thoracic cavity. Percutaneous mass biopsy revealed only thymic tissue without signs of malignancy. A right posterolateral thoracotomy was successfully performed to remove the tumor along with the capsule, and the excised tumor weighed 7.5 kg, which to our knowledge, was the largest surgically removed tumor of thymic origin. Postoperatively, the patient’s shortness of breath was resolved, and the histopathological diagnosis was thymolipoma. No signs of recurrence were observed at the 6-mo follow-up.CONCLUSION Giant thymolipoma causing respiratory failure is rare and dangerous. Despite the high risks, surgical resection is feasible and effective.展开更多
Background: The mediastinum is a complex anatomical region which contains many vital structures. Many aspects of mediastinal surgery, like that for other anatomic regions, have evolved from a maximally invasive approa...Background: The mediastinum is a complex anatomical region which contains many vital structures. Many aspects of mediastinal surgery, like that for other anatomic regions, have evolved from a maximally invasive approach involving a median sternotomy, anterior mediastinotomy, mediastinoscopy or thoracotomy, to a minimally invasive video-assisted approach. Robotic surgery is presently the most advanced form of minimally invasive surgery. Methods: We reviewed our experience with a robotic approach to mediastinal pathology. In addition, an extensive search was conducted using PubMed, in order to extract references for the application of robotics to surgical conditions of the mediastinum. Results: The first robotic procedure by our group was a mediastinal procedure in 2003. In the past eighteen years, 203 patients have undergone robotic surgery for mediastinal pathology. There were 119 procedures for the Anterior Mediastinum, 33 procedures for the Middle Mediastinum, and 51 procedures for the Posterior Mediastinum. 78 patients underwent robotic thymectomy using a left-sided approach. 43/78 (55%) patients underwent radical thymectomy for Myasthenia Gravis. Thymoma was histologically identified in 32% of patients with Myasthenia Gravis. In patients with thymoma, there was no tumor recurrence. In patients with Myasthenia Gravis, the overall improvement rate after robotic radical complete thymectomy was 91% (39/43). Following robotic surgery for the mediastinal disease, the median hospitalization was 3 days, major complications occurred in 0.9% of patients and there was no mortality. Conclusion: With the advent of robotic surgery, many of the current surgical approaches to diseases of the mediastinum will likely be replaced over time by robotic surgery. When applied to the mediastinum, robotics has a number of benefits when compared to conventional Video-Assisted Thoracic Surgery (VATS) including three-dimensional visualization, magnification of the operative field, precise instrument movement, and improved dexterity. Much of the mediastinal disease encountered in an adult is benign, making it especially suited to a minimally invasive approach. With the use of the robot, a complete anatomical and oncological procedure can be performed through a number of small incisions or ports, while at the same time providing the patient with minimally invasive benefits including shorter hospitalizations, quicker returns to preoperative activity, less pain, less inflammatory response and better cosmesis. The excellent range of motion of the robotic instruments makes them particularly suitable to maneuver around the vital structures and the rigid axial skeleton encountered in various compartments of the mediastinum, and for reaching those “distant” areas of the mediastinum that are difficult to explore and dissect with conventional Video-Assisted Thoracic Surgery (VATS).展开更多
文摘Ganglioneuroma is an extremely rare tumor that is derived from neural crest. Many ganglioneuroma cases are detected incidentally unless they are large enough to cause compressive symptoms. We report an 18-year-old patient with posterior mediastinal ganglioneuroma which was abutting the descending aorta. The patient underwent successful resection by thoracoscopic approach and was followed up for one year with no complications. In summary, a detailed review with experts in both radiology and pathology is mandated to diagnose these tumors. Informed consent was obtained from the patient.
文摘BACKGROUND Mediastinal bronchogenic cysts and pericardial defects are both rare.It is extremely rare that both occur simultaneously.To the best of our knowledge,this is the first case of a coexistent bronchogenic cyst and pericardial defect reported in China.We performed a literature review and found a relationship between bronchogenic cysts and pericardial defects,which further revealed the correlation between the bronchus and pericardium during embryonic development.CASE SUMMARY A 14-year-old boy attended a local hospital for ankylosing spondylitis.Chest radiography showed an enhanced circular-density shadow near the left mediastinum.The patient had no chest symptoms and the physical examination was normal.Because of the mediastinal occupation,the patient visited our department of chest surgery for further treatment.During surgery,a left pericardial defect was observed.The bronchogenic cyst was removed by thoracoscopic surgery,but the pericardial defect remained untreated,and a satisfactory outcome was achieved after the operation.The patient was diagnosed with a mediastinal tumor.The pathological diagnosis of the tumor was a bronchogenic cyst.CONCLUSION This case further reveals the correlation between the bronchus and pericardium during embryonic development.
文摘BACKGROUND Pulmonary sequestration-both intralobar and extralobar-is a rare congenital developmental malformation.Extralobar pulmonary sequestrations(EPS)have their own pleura but are separated from the bronchus and usually occur in the left lung.They are mainly found mainly between the lower lobe and the mediastinum.EPS is rarely found within the mediastinum itself,even rarer so in the posterior mediastinum.CASE SUMMARY We report the case of a 27-year-old man who was misdiagnosed with a neurogenic tumor based on preoperative contrast-enhanced computed tomography(CT)and magnetic resonance imaging findings.Contrast-enhanced chest CT revealed a posterior mediastinal mass measuring 1.2 cm×1.4 cm×3.3 cm,which consisted of some cystic areas and showed slight enhancement.The mass was in the 11th paravertebral region and attached to the 11th thoracic vertebra behind the descending aorta in the posterior mediastinum.An arteriole originating from the intercostal artery and a vein originating directly from the hemiazygos vein were found in the pedicle of the mass.The mass was resected in a uniport videoassisted thoracoscopic surgery.During the operation,the pyramid-shaped mass appeared well-encapsulated.Postoperative histopathology established a diagnosis of EPS.One month later,a follow-up CT of the thorax showed good recovery.CONCLUSION Although EPS rarely occurs in the posterior mediastinum,its diagnosis should be considered when posterior mediastinal tumors are suspected.
基金Supported by Hunan Provincial Natural Science Foundation of China,No. 2022JJ40246Hunan Cancer Hospital Climb Plan,No. 2021NSFC-B005。
文摘BACKGROUND Thymolipoma is a rare benign tumor arising from the anterior mediastinal thymus and is composed of mature fatty tissue and interspersed nonneoplastic thymic tissue. This tumor accounts for only a small percentage of mediastinal masses, and the majority of them are asymptomatic and found incidentally. To date, fewer than 200 cases have been published in the world literature, of which most excised tumors weighed less than 0.5 kg and the largest weighed 6 kg.CASE SUMMARY A 23-year-old man presented with a complaint of progressive breathlessness for 6mo. His forced vital capacity was only 23.6% of the predicted capacity, and his arterial partial pressure of oxygen and carbon dioxide were 51 and 60 mmHg,respectively, without oxygen inhalation. Chest computed tomography revealed a large fat-containing mass in the anterior mediastinum that measured 26 cm × 20cm × 30 cm in size and occupied most of the thoracic cavity. Percutaneous mass biopsy revealed only thymic tissue without signs of malignancy. A right posterolateral thoracotomy was successfully performed to remove the tumor along with the capsule, and the excised tumor weighed 7.5 kg, which to our knowledge, was the largest surgically removed tumor of thymic origin. Postoperatively, the patient’s shortness of breath was resolved, and the histopathological diagnosis was thymolipoma. No signs of recurrence were observed at the 6-mo follow-up.CONCLUSION Giant thymolipoma causing respiratory failure is rare and dangerous. Despite the high risks, surgical resection is feasible and effective.
文摘Background: The mediastinum is a complex anatomical region which contains many vital structures. Many aspects of mediastinal surgery, like that for other anatomic regions, have evolved from a maximally invasive approach involving a median sternotomy, anterior mediastinotomy, mediastinoscopy or thoracotomy, to a minimally invasive video-assisted approach. Robotic surgery is presently the most advanced form of minimally invasive surgery. Methods: We reviewed our experience with a robotic approach to mediastinal pathology. In addition, an extensive search was conducted using PubMed, in order to extract references for the application of robotics to surgical conditions of the mediastinum. Results: The first robotic procedure by our group was a mediastinal procedure in 2003. In the past eighteen years, 203 patients have undergone robotic surgery for mediastinal pathology. There were 119 procedures for the Anterior Mediastinum, 33 procedures for the Middle Mediastinum, and 51 procedures for the Posterior Mediastinum. 78 patients underwent robotic thymectomy using a left-sided approach. 43/78 (55%) patients underwent radical thymectomy for Myasthenia Gravis. Thymoma was histologically identified in 32% of patients with Myasthenia Gravis. In patients with thymoma, there was no tumor recurrence. In patients with Myasthenia Gravis, the overall improvement rate after robotic radical complete thymectomy was 91% (39/43). Following robotic surgery for the mediastinal disease, the median hospitalization was 3 days, major complications occurred in 0.9% of patients and there was no mortality. Conclusion: With the advent of robotic surgery, many of the current surgical approaches to diseases of the mediastinum will likely be replaced over time by robotic surgery. When applied to the mediastinum, robotics has a number of benefits when compared to conventional Video-Assisted Thoracic Surgery (VATS) including three-dimensional visualization, magnification of the operative field, precise instrument movement, and improved dexterity. Much of the mediastinal disease encountered in an adult is benign, making it especially suited to a minimally invasive approach. With the use of the robot, a complete anatomical and oncological procedure can be performed through a number of small incisions or ports, while at the same time providing the patient with minimally invasive benefits including shorter hospitalizations, quicker returns to preoperative activity, less pain, less inflammatory response and better cosmesis. The excellent range of motion of the robotic instruments makes them particularly suitable to maneuver around the vital structures and the rigid axial skeleton encountered in various compartments of the mediastinum, and for reaching those “distant” areas of the mediastinum that are difficult to explore and dissect with conventional Video-Assisted Thoracic Surgery (VATS).
