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Asaf BB, Bishnoi S, Vardhanpuri H, Pulle MV, Kumar A. Robotic excision of posterior mediastinal neurogenic tumours: Technique and surgical outcomes. J Minim Access Surg 2024; 20:136-141. [PMID: 37282429 PMCID: PMC11095809 DOI: 10.4103/jmas.jmas_151_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/13/2022] [Accepted: 03/21/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Neurogenic tumours are the most common tumours of the posterior mediastinum and account for 75% of the tumours in this region. Till recently, open transthoracic approach has been the standard of care for their excision. Thoracoscopic excision of these tumours is being commonly employed because of lesser morbidity and shorter hospital stay. The robotic surgical system offers a potential advantage over conventional thoracoscopy. We herein report our technique and surgical outcomes of excision of posterior mediastinal tumours using the Da Vinci Robotic Surgical System. MATERIALS AND METHODS We retrospectively reviewed 20 patients who underwent Robotic Portal-Posterior Mediastinal Tumour (RP-PMT) Excision at our centre. The demographic data, clinical presentation, characteristics of the tumour, operative and post-operative variables including, total operative time, blood loss, conversion rate, duration of the chest tube, hospital stay and complications were noted. RESULTS Twenty patients underwent RP-PMT Excision and were included in the study. The median age was 41.2 years. The most frequent presentation was chest pain. Schwannoma was the most common histopathological diagnosis. There were two conversions. The total operative time was 110 min with an average blood loss of 30 mL. Two patients developed complications. The postoperative hospital stay was 2.4 days. With a median follow-up of 36 months (6-48 months), all except patients are recurrence-free, except the patient with malignant nerve sheath tumour who developed local recurrence. CONCLUSION Our study demonstrates the feasibility and safety of robotic surgery for posterior mediastinal neurogenic tumours with good surgical outcomes.
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Affiliation(s)
- Belal Bin Asaf
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Harsh Vardhanpuri
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Mohan Venkatesh Pulle
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
| | - Arvind Kumar
- Department of Thoracic Surgery, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation, Medanta-The Medicity, Gurugram, Haryana, India
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Zhang Q, Zhou T, Hou P, Mu W, Wang D, Fang J, Li A. A single-center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors. Thorac Cancer 2022; 14:44-51. [PMID: 36351570 PMCID: PMC9807445 DOI: 10.1111/1759-7714.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To study the feasibility, safety, and efficacy of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors, and summarize the treatment experiences and surgical skills. METHODS A single-center retrospective analysis of 37 patients with pediatric mediastinal neurogenic tumors was conducted. Clinical charactersistics and postoperative complications were all analyzed. RESULTS All the operations were successfully completed. There was no statistically significant difference in tumor diameter between the two groups (p > 0.05). The open surgery group had an average operation time of 96.5 ± 32.38 min, while the thoracoscopic surgery group had an average operation time of 78.3 ± 24.51 min (p < 0.05). The thoracoscopic surgery group had significantly lower intraoperative blood loss than the open surgery group (p < 0.05). In addition, the duration of the postoperative thoracic drainage tube was 5.43 ± 0.76 days in the open surgery group, which was longer than the 2.38 ± 0.87 days in the thoracoscopic surgery group (p < 0.05). Furthermore, the postoperative length of hospital stay was an average of 10.23 ± 1.43 days for the open surgery group, longer than for the thoracoscopic surgery group (4.36 ± 0.87 days) (p < 0.05). CONCLUSIONS Thoracoscopic surgery has several advantages in the treatment of pediatric mediastinal neurogenic tumors and is worthy of clinical popularization and application. For giant mediastinal malignant neurogenic tumors, puncture biopsy and adjuvant chemotherapy can be performed before surgery to lessen the tumor volume and enlarge the operation space, which would reduce bleeding and complications.
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Affiliation(s)
- Qiangye Zhang
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Tingting Zhou
- Thoracic Surgery DepartmentChildren's Hospital Capital Institute of PediatricsBeijingChina
| | - Peimin Hou
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Weijing Mu
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Dongming Wang
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Jun Fang
- Pediatric OrthopaedicsYidu Central Hospital of WeifangWeifangChina
| | - Aiwu Li
- Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
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Smith JL, Christopher AN, Evans NR. Novel Two-Stage Open Spine and Robotic Thoracic Approach to Resection of a Mediastinal Tumor. Ann Thorac Surg 2021; 111:e27-e29. [DOI: 10.1016/j.athoracsur.2020.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/01/2020] [Indexed: 12/12/2022]
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Razumovskiy AY, Rachkov VE, Alkhasov AB, Zadvernyuk AS, Sukhov MN, Talypov SR, Andreev ES, Uskova NG. [Thoracoscopic operations for neurogenic tumors in children]. Khirurgiia (Mosk) 2015:68-73. [PMID: 26762081 DOI: 10.17116/hirurgia2015968-73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To present an overall experience of endoscopic operations in children with neurogenic tumors in two medical institutions. MATERIAL AND METHODS Thoracoscopic excision of tumors was performed in 19 children aged 1 month-7.5 years (mean 1.5 years) in two clinics for the period 2010-2014. In 9 children (47.3%) age did not exceed 1 year. In our study ganglioneuroma was diagnosed in 9 cases, ganglioneuroblastoma--in 2 patients, neuroblastoma stage I--in 8 cases. All patients were under observation and treated according to NB2004 protocol. Tumor's diameter ranged from 1 to 6 cm (mean 4.9±1.9 cm). Mean duration of surgery was 62±22 minutes. There were no any intraoperative complications. Early postoperative period in all patients after endoscopic surgery was more favorable than in those after open operations. Any local recurrences were not observed for the follow-up period. RESULTS Thoracoscopic operations can become more preferable method in treatment of children with neurogenic tumors if great vessels are not involved into neoplastic process and limited volume of tumor is absent.
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Affiliation(s)
- A Yu Razumovskiy
- N.F. Filatov Children's City Clinical Hospital #13; Chair of Pediatric Surgery of N.I. Pirogov Russian Research Medical University
| | - V E Rachkov
- Chair of Pediatric Surgery of N.I. Pirogov Russian Research Medical University; Dmitry Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology; ZAO European Medical Center
| | - A B Alkhasov
- N.F. Filatov Children's City Clinical Hospital #13; Chair of Pediatric Surgery of N.I. Pirogov Russian Research Medical University
| | - A S Zadvernyuk
- N.F. Filatov Children's City Clinical Hospital #13; Chair of Pediatric Surgery of N.I. Pirogov Russian Research Medical University
| | - M N Sukhov
- Dmitry Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology
| | - S R Talypov
- Dmitry Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology
| | - E S Andreev
- Dmitry Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology
| | - N G Uskova
- Dmitry Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology
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Li Y, Wang J. Experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumours: a retrospective analysis of 58 patients. ANZ J Surg 2012; 83:664-8. [PMID: 22900594 DOI: 10.1111/j.1445-2197.2012.06174.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2012] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The objective of this study was to review the experience of video-assisted thoracoscopic resection of posterior mediastinal neurogenic tumours and to investigate the technical features and difficulties of this thoracoscopic approach. METHODS From May 2001 to June 2011, 58 consecutive patients underwent thoracoscopic resection of posterior mediastinal tumours sequentially in our institution, including 36 males and 22 females. The median age of the patients was 38.7 years. The median tumour size was 4.9 cm. Twenty-four lesions were located at the left side, 33 lesions at the right side and 1 lesion at the bilateral side. All procedures generally required three ports, and intracapsular enucleation was preferred. For bulky tumours, dense adhesion and massive bleeding, conversion to thoracotomy was performed by extending the anterior incision to 6-10 cm. RESULTS All procedures were successfully performed without death or serious complications occurring. The average operating duration was 127.2 min. The average intraoperative blood loss was 206.4 mL. The average chest tube drainage duration was 2.72 days. The average post-operative stay was 5.19 days. Fifty-three procedures were performed entirely under thoracoscopy to achieve gross total resection. There were five cases (8.6%) of conversion to thoracotomy procedure. Seven patients suffered from post-operative complications, including four Horner syndromes. No local recurrence occurred after an average follow-up of 44.9 months. CONCLUSION Video-assisted thoracoscopic resections of the posterior mediastinal tumours were safe and reliable for selected patients with mastered thoracoscopic skills. Intracapsular enucleation was demonstrated to be a safe procedure. For tumours larger than 6 cm and located in the apex, the risk of the operation increased significantly.
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Affiliation(s)
- Yun Li
- Department of Thoracic Surgery, People's Hospital of Peking University, Beijing, China
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Abstract
Schwannoma is a rare tumor of neural crest cell origin. Most schwannomas occur in the head, neck, stomach or limbs, with a few cases occurring in the retroperitoneal space. A 30-year-old Taiwanese woman presented with a 1-week history of left anterior chest discomfort and left flank pain. The laboratory findings and endocrine studies were all within normal limits. Chest X-ray revealed masses in the posterior mediastinum. Chest computed tomography and magnetic resonance imaging showed several masses in the left paraspinal region and in the left adrenal region. The patient underwent total excision of the left paraspinal tumors and laparoscopic left adrenalectomy. Pathologic studies showed a picture of benign schwannoma. In conclusion, preoperative differentiation of benign schwannoma from malignant peripheral nerve sheath tumor or other tumors is important for good prognosis. Total excision of benign schwannoma is associated with favourable outcome in patients.
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Affiliation(s)
- Chwen-Yi Yang
- Division of Endocrinology and Metabolism, Department of Medicine, Chi-Mei Hospital, Tainan, Taiwan, ROC.
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Kan P, Schmidt MH. Minimally Invasive Thoracoscopic Resection of Paraspinal Neurogenic Tumors: Technical Case Report. Oper Neurosurg (Hagerstown) 2008. [DOI: 10.1227/01.neu.0000313118.73941.d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
The posterior mediastinum is a common location for benign neurogenic tumors. They are frequently asymptomatic but can present with local compressive or neurological symptoms.
Methods:
Thoracoscopy is used increasingly over posterolateral thoracotomy for the removal of these lesions.
Results:
Complete resection of these tumors through a thoracoscopic approach is possible in most cases, but dumbbell tumors present as special challenges, which require a combined thoracoscopic and open posterior approach.
Conclusion:
In this article, we outline the technique of thoracoscopic resection of paraspinal neurogenic tumors through an operative video and a review of the literature to summarize the surgical outcomes of patients with these lesions.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Meic H. Schmidt
- Spinal Oncology Service, Huntsman Cancer Institute, and Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
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Lacreuse I, Valla JS, de Lagausie P, Varlet F, Héloury Y, Temporal G, Bastier R, Becmeur F. Thoracoscopic resection of neurogenic tumors in children. J Pediatr Surg 2007; 42:1725-8. [PMID: 17923203 DOI: 10.1016/j.jpedsurg.2007.05.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of thoracoscopy in neurogenic tumors in infants and children. MATERIALS AND METHODS From January 2000 to October 2005, 21 patients aged 7 months to 14 years (mean, 6 years) underwent thoracoscopy for tumor resection in 5 French institutions. One 10-mm optical port and 2 operative 5-mm ports were needed. Selective intubation was required for 3 patients aged about 12 years. Tumor was removed with an endoscopic bag in all cases. RESULTS All procedures were completed successfully without any incomplete resection or recurrence. One conversion was necessary because of a huge mass. A chest tube was left for a mean of 2 days for 17 children. Two children had not had any drainage. Two postoperative chylothorax required chest drainage for 12 days. Only 5 of the 6 older patients (mean age, 12 years) needed a patient-controlled analgesia. The mean operative time was about 100 minutes. Hospital stay ranged from 4 to 12 days. Tumors were neuroblastoma or ganglioneuroblastoma in 16 cases and ganglioneuroma in the 5 other cases. CONCLUSION Thoracoscopy for resection of thoracic neurogenic tumors in children is a feasible, safe, and efficient procedure. The surgeon has a better visualization of the tumor and its anatomic connections. Resection can be as complete as an open procedure without having to complicate the operative technique in the same operating time. It avoids cosmetic and functional disorders because of thoracotomy. It allows a good cosmetic resection without spillage.
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Barrenechea IJ, Fukumoto R, Lesser JB, Ewing DR, Connery CP, Perin NI. Endoscopic resection of thoracic paravertebral and dumbbell tumors. Neurosurgery 2007; 59:1195-201; discussion 1201-2. [PMID: 17277682 DOI: 10.1227/01.neu.0000245617.39850.c9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Neurogenic paravertebral tumors are uncommon neoplasms arising from neurogenic elements within the thorax. These tumors may be dumbbell shaped, extending into the spinal canal or exclusively paraspinal. Generally encapsulated, they are located in the posterior mediastinum. In this report, we present our experience in the thoracoscopic resection of these tumors, including surgical technique and potential pitfalls. METHODS A retrospective review of patients undergoing endoscopic surgery for paravertebral tumors was undertaken. Patient demographics, charts, operative reports, and pre- and postoperative images were reviewed. RESULTS Between 1997 and 2004, 13 patients were treated thoracoscopically for paravertebral tumors in our departments. Our population consisted of four men and nine women. The median age was 44.9 years (range, 29-66 yr). Eight patients presented with pain, dyspnea, cough, and weakness. Five patients had tumors found incidentally. Sizes of the tumors varied from 3 to 9 cm. Final pathology included four neurofibromas, eight schwannomas, and one unclassified granular cell tumor. Gross total resection was achieved endoscopically in all cases. Three patients required a hemilaminectomy for resection of the intraspinal dumbbell component of the tumor during the same operation. The mean operative time was 229.5 minutes. The mean estimated blood loss was 371.1 ml. Postoperative morbidities included one each of tongue swelling, ulnar neuropathy, and intercostal hyperesthesia. The mean hospital stay was 2.8 days. CONCLUSION Paravertebral tumors in the posterior mediastinum are amenable to endoscopic removal, even in hard to reach locations. Tumors with intraspinal extension can be removed concurrently by performing a hemilaminectomy, followed by thoracoscopy, without the need for a thoracotomy.
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Affiliation(s)
- Ignacio J Barrenechea
- Minimally Invasive Spine Surgery Center, Department of Neurosurgery, St. Luke's/Roosevelt, and Beth Israel Medical Centers, New York, New York 10019, USA
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Petty JK, Bensard DD, Partrick DA, Hendrickson RJ, Albano EA, Karrer FM. Resection of Neurogenic Tumors in Children: Is Thoracoscopy Superior to Thoracotomy? J Am Coll Surg 2006; 203:699-703. [PMID: 17084332 DOI: 10.1016/j.jamcollsurg.2006.07.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Revised: 07/20/2006] [Accepted: 07/21/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Minimally invasive resection of solid tumors is controversial because of concerns of inadequate resection and local recurrence. Thoracoscopy has been used in the diagnosis of mediastinal tumors in children, but its role in resection is unproved. The purpose of this study was to compare thoracoscopic and open approaches to the resection of thoracic neurogenic tumors in children. STUDY DESIGN The tumor registry of a regional children's hospital was queried to identify patients who underwent resection of neurogenic tumors over a 6-year period. Thoracoscopic and open groups were compared for demographic, operative, oncologic, and outcomes characteristics. RESULTS Seventeen children underwent resection of mediastinal neurogenic tumors (10 thoracoscopic resections, 7 open resections). Mean age was 4.7 years (range 6 months to 12 years). The thoracoscopic and open groups showed no difference in operative time or blood loss. Tumors in the two groups were comparable in size (5.2+/-2.2 cm versus 5.7+/-2.6 cm), histology, surgical margin, and stage. Hospital stay was shorter after thoracoscopic resection (1.9+/-0.7 days versus 4.1+/-2.5 days, p<0.05). There were no regional recurrences. Distant metastases developed in one patient in each group. Eight of 10 children with malignant tumors remain disease-free at an average of 25 months of followup (range 3 to 80 months). CONCLUSIONS Thoracoscopic resection of neurogenic tumors achieved similar local control and disease-free survival when compared with open resection in this preliminary series. These results were accompanied by a shorter hospital stay. These findings suggest that thoracoscopic resection of neurogenic tumors in children may offer advantages to open resection and should be studied in the context of a large, cooperative trial.
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Affiliation(s)
- John K Petty
- Department of Pediatric Surgery, The Children's Hospital/University of Colorado, Denver, CO 80218, USA
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Tiel R, Kline D. Peripheral nerve tumors: surgical principles, approaches, and techniques. Neurosurg Clin N Am 2004; 15:167-75, vi. [PMID: 15177316 DOI: 10.1016/j.nec.2004.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The surgical treatment of peripheral nerve sheath tumors is dependent on the tumor's neoplastic nature and its anatomic location. Surgical principles for nerve sheath tumors focus on surgical decision making common to all peripheral nerve sheath tumor operations and then on that particular to a given tumor type. Surgical approaches for nerve sheath tumors vary according to the local anatomy. Exposure on an extremity is relatively straightforward, but as the location becomes more proximal, anatomy conspires to protect nerves, plexuses, and the spinal cord, making surgical exposure more difficult. As a consequence, selected surgical approaches to nerve sheath tumors in these more protected areas are specifically described.
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Affiliation(s)
- Robert Tiel
- Louisiana State Medical Center, 1542 Tulane Avenue, New Orleans, LA 70112-2822, USA.
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Ko SF, Ng SH, Hsieh MJ, Lin JW, Huang CC, Lee TY, Chen WJ. Castleman disease of the pleura: experience with eight surgically proven cases. Ann Thorac Surg 2003; 76:219-24. [PMID: 12842545 DOI: 10.1016/s0003-4975(03)00133-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Castleman disease of the pleura is unusual, and we present our experience with eight surgically proven cases. METHODS Between 1980 and 2002, 8 patients (7 women and 1 man; age range, 20 to 53 years; mean, 26.5 years) with surgically proven, pleural Castleman disease (six hyaline vascular type, one plasma cell type, and one mixed type) were encountered. Their clinical, imaging, and surgical findings were reviewed. RESULTS Five patients were asymptomatic, 1 had dyspnea, 1 had cough, and 1 experienced chest discomfort. Chest radiography showed a well-circumscribed interlobar, cardiophrenic, or paraaortic mass in 6 patients, a massive effusion in 1, and a focal diaphragmatic bulge in 1. Six tumors showed varying degrees of contrast enhancement (10 to 95 HU; mean, 46 HU) on computed tomography. Three cases appeared as well-defined, heterogeneously hyperintense pleural masses on magnetic resonance imaging. The masses varied in size from 3 to 10 cm (mean, 5.2 cm). Five masses greater than 5 cm had prominent pleural arterial blood supply and severe adhesions requiring thoracotomy and resection of nearby structures for radical tumor excision. Blood loss from patients varied between 100 and 850 mL (mean, 620 mL). No tumor recurrence was noted during follow-up (range, 1 to 16 years; mean, 6.5 years). CONCLUSIONS Pleural Castleman disease predominately affects young women and manifests as a well-circumscribed mass with a varying degree of contrast enhancement on computed tomography and heterogeneity on magnetic resonance imaging. Tumors greater than 5 cm have profuse pleural blood supplies and severe adhesion necessitating open thoracotomy and resection of neighboring structures. Radical resection can produce a satisfactory outcome.
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Affiliation(s)
- Sheung-Fat Ko
- Departments of Radiology, Keelung Hsien and Taoyuen Hsien, Taiwan.
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Fierro N, D'ermo G, Di Cola G, Gallinaro LS, Galassi G, Galassi G. Posterior mediastinal schwannoma. Asian Cardiovasc Thorac Ann 2003; 11:72-3. [PMID: 12692029 DOI: 10.1177/021849230301100118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An exceptional case of neurilemmoma in a 33-year-old asymptomatic man is described. Complete excision of an encapsulated 7.2-cm mass was achieved successfully. Pathological findings were consistent with a diagnosis of schwannoma with areas of sclerosis.
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Affiliation(s)
- Nicola Fierro
- Department of Surgical Sciences and Applied Medical Technologies, University of Rome, La Sapienza, Rome, Italy.
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Partrick DA, Rothenberg SS. Thoracoscopic resection of mediastinal masses in infants and children: an evaluation of technique and results. J Pediatr Surg 2001; 36:1165-7. [PMID: 11479848 DOI: 10.1053/jpsu.2001.25740] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Thoracoscopy has been accepted as a technique in pediatric surgery for diagnosis of thoracic pathology, but there has been little experience using it as a therapeutic modality as well. The purpose of this report is to describe and critically evaluate a 7-year experience with thoracoscopic diagnosis and resection of mediastinal masses in infants and children. METHODS From February 1993 to June 2000, 39 patients presented with mediastinal masses and no tissue diagnosis. Age ranged from 5 months to 18 years old and weight from 3.6 to 110 kg. Twelve children had anterior mediastinal masses, 27 posterior. The patients were positioned in a modified prone or supine position, and single lung ventilation was performed on the contralateral side. Three or 4 valved trocars were utilized with 3 and 5 mm instrumentation. RESULTS A total of 38 of 39 procedures were completed successfully endoscopically. The procedure in 1 patient with a sarcoma was converted to thoracotomy because of extensive disease. Operating times ranged from 20 to 185 minutes. Diagnosis was obtained in all cases, and complete excision was performed in 33. All children were extubated in the operating room; 8 chest tubes were placed but removed within 24 hours. Hospital stay ranged from 12 hours to 4 days. Pathology included 12 foregut duplications, 7 ganglioneuromas, 6 neuroblastomas, 6 lymphomas, 3 teratomas, 2 sarcomas, and 3 other lesions. CONCLUSION Thoracoscopy is a safe and effective method to evaluate, biopsy, and in most cases resect lesions of the anterior and posterior mediastinum in infants and children.
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Affiliation(s)
- D A Partrick
- Department of Pediatric Surgery, Hospital for Infants and Children, Presbyterian/St Luke's Medical Center and The Children's Hospital, University of Colorado, Denver, CO, USA
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