Thoracoscopic resection of mediastinal bronchogenic cysts in adults

A poor prognosis of a mediastinal bronchogenic cyst with malignant transformation: A case report

INTRODUCTION

Bronchogenic cysts (BC) are congenital lesions, it results from an abnormal budding of the tracheobronchial tree. Malignant transformation is very rare. We report a case of adenocarcinoma arising in a BC of the posterior mediastinum detected after surgery.

PRESENTATION OF CASE

We report the case of a 32-year-old man, without a particular medical history. The patient presented a cough associated with dyspnea, and a weight loss 4-month before the diagnosis. The imaging tools, showed a voluminous latero-tracheal mass of the posterior mediastinum. The diagnoses of a neurogenic tumor or a BC were suspected. The patient was treated by video-assisted thoracoscopy. Complete excision was done complicated by lesion's small rupture. The microscopic exam revealed unfortunately an adenocarcinoma arising in a BC. The patient had started the cure of chemotherapy. Six months later, the patient died due to tumor recurrence with cerebral metastasis.

DISCUSSION

Mediastinum BC, is usually located within the middle and posterior mediastinum. This condition is a benign congenital lesion. His curative therapy was a complete surgical resection with a good prognosis. However, malignant transformation may seldom occur and is most often accidentally diagnosed during the histological examination of specimens. In this case, the surgical treatment may be insufficient, and the prognosis may be poor.

CONCLUSION

Malignant degeneration of mediastinal BC, despite being rare, should be kept in mind, carefully avoided and managed.

Prognostic Factors and Long-Term Results in Patients Who Underwent Videothoracoscopic Bronchogenic Cyst Excision

Background: Our aim in this study was to compare the results of video-assisted thoracoscopic surgery with those of open surgery regarding efficacy, morbidity, and long-term recurrence of bronchogenic cysts in light of the literature.

Methods: This study comprises the data of 51 patients whose pathological diagnosis revealed bronchogenic cyst after surgical excision between January 2010 and December 2016. There were two groups according to the type of resection: video-assisted thoracoscopic surgery (VATS) and thoracotomy.

Results: Of the patients included in the study, 25 (49%) were male and 26 (51%) were female. Their average age was 41.7 ± 14.1 years. While 14 patients (27.5%) were asymptomatic in the preoperative period, 37 patients (72.5%) had symptoms. The Charlson Comorbidity Index was 0 in 35 patients (68.6%) and 1 and above in 16 patients (31.4%). While 22 (43.1%) patients underwent cyst excision via VATS, 29 (56.9%) patients underwent thoracotomy. The average length of hospital stay was 1.77 ± 0.68 days for patients who had VATS, whereas it was 3.82 ± 3.3 days for patients who had thoracotomy (p <0.001).

Conclusion: VATS procedure is a safe method in the surgical treatment of bronchogenic cysts, with less hospitalization and similar recurrence rates.

Prone position surgery for a subcarinal bronchogenic cyst

Background

Prone position surgery has become widespread for esophageal cancer instead of the traditional lateral decubitus approach. Carbon dioxide insufflation and the gravity effect provide a better operative field without parenchymal retraction. We herein report a case of a subcarinal bronchogenic cyst, which was successfully removed by the prone position surgery.

Case presentation

A 65-year-old man presented with a subcarinal mass and was planned to undergo a surgical resection in the prone position. Although he required bilateral ventilation due to hypoxemia, the excellent operative field was maintained and we completed the thoracoscopic surgery without any additional parenchymal retractions.

Conclusions

Thoracoscopic surgery in the prone position is a feasible option for subcarinal tumors with an excellent operative view and would facilitate a solo surgery without the need for a skilled assistant.

Case Report: Severe back pain, epigastric distress and refractory nausea; an unusual presentation of mediastinal bronchogenic cyst

Background: Bronchogenic cysts are congenital malformations from abnormal budding of embryonic foregut and tracheobronchial tree. We present a case of bronchogenic cyst with severe back pain, epigastric distress and refractory nausea and vomiting.   Case Presentation: A 44-year-old Hispanic female presented with a 3-week history of recurrent sharp interscapular pain radiating to epigastrium with refractory nausea and vomiting. She underwent cholecystectomy 2-years ago. Computed tomography (CT) abdomen at that time showed a subcarinal mass measuring 5.4 X 5.0 cm. Subsequent endoscopic ultrasound diagnosed it as a bronchogenic cyst. Endobronchial ultrasound (EBUS) guided aspiration resulted in incomplete drainage and she was discharged after partial improvement. Current physical examination showed tachycardia and tachypnea with labs showing leukocytosis, elevated inflammatory markers, and hypokalemic metabolic alkalosis. CT chest showed an increased size of the bronchogenic cyst (9.64 X 7.7 cm) suggestive of possible partial cyst rupture or infected cyst. X-ray esophagram ruled out esophageal compression or contrast extravasation. Patient's symptoms were refractory to conservative management. The patient ultimately underwent right thoracotomy with cyst excision that resulted in complete resolution of symptoms. Conclusion: Bronchogenic cysts are the most common primary cysts of mediastinum with the prevalence of 6%. The most common symptoms are chest pain, dyspnea, cough, and stridor. Diagnosis is made by chest X-Ray and CT chest. Magnetic resonance imaging chest and EBUS are more sensitive and specific. Symptomatic cysts should be resected unless surgical risks are high. Asymptomatic cysts in younger patients should be removed due to low surgical risk and potential late complications. Watchful waiting has been recommended for asymptomatic adults or high-risk patients. This case presents mediastinal bronchogenic cyst as a cause of back, nausea and refractory vomiting. Immediate surgical excision in such cases should be attempted, which will lead to resolution of symptoms and avoidance of complications.

Thoracoscopic resection of a bronchogenic cyst in a 17-year-old girl

Bronchogenic cysts comprise approximately 6% of mediastinal tumors in children. The treatment consists in surgical resection of the cyst. The authors present the case of a 17-year-old girl who was accidentally diagnosed with a mediastinal cyst. The patient was successfully treated with thoracoscopic surgery with good early and late clinical outcomes.

Video-assisted thoracic surgery compared with posterolateral thoracotomy for mediastinal bronchogenic cysts in adult patients

BACKGROUND

Mediastinal bronchogenic cyst (MBC) is the most common primary cystic lesion of the mediastinum. This study aimed to investigate the efficacy and safety of video-assisted thoracic surgery (VATS) compared with posterolateral thoracotomy (PLT) for the treatment of MBCs in a large series.

METHODS

Patients with MBCs who underwent surgical resection between August 2005 and December 2015 were identified from the electronic database of the Department of Thoracic Surgery, West China Hospital. The patient demographic characteristics, intraoperative findings, postoperative outcomes and follow-up information were reviewed and analyzed.

RESULTS

A total of 99 patients underwent cystectomy were enrolled for the present study. Of those patients, 65 underwent VATS cystectomy (VATS group) and 34 underwent PLT cystectomy (PLT group) during the same period. The VATS group had shorter operative time than the PLT group (108.77±47.81 vs. 144.62±55.16, P=0.001), less intraoperative blood loss (median 20 vs. 100 mL, P<0.001), and less pleural drainage of the first three days after surgery (median 240 vs. 400 mL, P=0.002). In addition, the length of postoperative hospital stay and duration of chest drainage for the VATS group was also shorter than those of the PLT group (4.94±2.01 vs. 8.64±5.52 days, P=0.001; 2.52±1.29 vs. 3.71±1.55 days, P<0.001, respectively). No statistical significance was revealed among the two groups with regard to the maximum diameter of the cysts, pleural atresia, incomplete resection, surgery-related complications, duration of intensive care unit stay, and postoperative complications.

CONCLUSIONS

Both VATS and PLT are reliable approaches for the surgical resection of MBCs. The VATS approach is superior to PLT with shorter operative time, shorter duration of chest drainage, shorter postoperative hospital stay, less intraoperative blood loss, and less pleural drainage of the first three days after surgery. We conclude that VATS should be the preferred approach for the treatment of MBCs.