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Takeuchi T, Takizawa H, Bando Y, Hosokawa A, Sumitomo H, Miyamoto N, Sakamoto S, Morishita A, Kawakita N, Toba H. Robot-assisted thoracoscopic resection of a posterior mediastinal tumor with immunoglobulin G4-related disease: a case report. J Cardiothorac Surg 2024; 19:291. [PMID: 38755707 PMCID: PMC11097461 DOI: 10.1186/s13019-024-02655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 03/19/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Immunoglobulin (Ig)G4-related disease affects nearly every organ, and its clinical course varies depending on the involved organ; however, its occurrence in the mediastinum is rarely reported. CASE PRESENTATION A 58-year-old woman presented with a posterior mediastinal tumor along the thoracic spine on imaging. Based on her elevated serum IgG4 level of 349.7 mg/dL, IgG4-related disease was suspected. Since the tumor was growing and malignancy could not be excluded, surgical resection was performed for definitive diagnosis. Robot-assisted thoracoscopic surgery was performed via the left semipronation and right thoracic approaches. The irregularly-shaped tumor was located on the level of the seventh to ninth thoracic vertebra, along the sympathetic nerve. A malignancy was not excluded based on the appearance of the tumor. The tumor had poor mobility. The sympathetic nerves, intercostal arteries, and veins were also excised. In this case, the articulated forceps, used during the robotic surgery, were useful in achieving complete tumor resection along the vertebral body. The pathological examination revealed IgG4-positive plasma infiltration, which fulfilled the criteria for IgG4-related diseases. The postoperative course was uneventful, and the patient underwent follow-up on an outpatient basis without additional medications. CONCLUSION The clinical presentation of IgG4-related disease varies, based on the involved organs. This case was rare because the mediastinum was involved, and it emphasized the effectiveness of surgical resection.
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Affiliation(s)
- Taihei Takeuchi
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8503, Japan.
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8503, Japan
| | - Yoshimi Bando
- Division of Pathology, Tokushima University Hospital, Tokushima City, Tokushima, 770-8503, Japan
| | - Akio Hosokawa
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8503, Japan
| | - Hiroyuki Sumitomo
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8503, Japan
| | - Naoki Miyamoto
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8503, Japan
| | - Shinichi Sakamoto
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8503, Japan
| | - Atsushi Morishita
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8503, Japan
| | - Naoya Kawakita
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8503, Japan
| | - Hiroaki Toba
- Department of Thoracic, Endocrine Surgery, and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8503, Japan
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Zhang Z, Guan W, Lin Q, Yu W. Thoracic paravertebral involvement in patients with IgG4-related disease: CT and MR imaging findings. Rheumatology (Oxford) 2021; 59:3878-3885. [PMID: 32556185 DOI: 10.1093/rheumatology/keaa254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/19/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To retrospectively evaluate CT and magnetic resonance (MR) imaging thoracic paravertebral findings at baseline and follow-up in patients with IgG4-related disease. METHODS The study consisted of 36 patients with IgG4-related disease involving thoracic paravertebral regions (32 men and four women; mean age, 58 years; range, 25-78 years). A total of 36 patients underwent CT or MR imaging at baseline; 20 patients underwent follow-up. CT and MR images were reviewed and analysed in consensus by two radiologists for the various features of thoracic paravertebral lesions. RESULTS All lesions were located around two or more thoracic vertebrae, particularly the lower thoracic vertebrae (n = 36). The right side of vertebrae was predominantly affected in all cases (n = 36). Radiologically, IgG4-related thoracic paravertebral lesions were categorized into three types: solitary or multiple saddle-like masses type (32 patients); multiple nodules type (three patients); and invasively irregular mass type (three patients). All the types showed soft-tissue density on CT images, isointense on T1- and T2-weighted images, and homogeneous enhancement with penetration of small arteries in the lesions on contrast-enhanced CT and MR images. Steroid therapy administered to 20 patients dramatically diminished the mean maximum thickness in 18 patients. One patient with T7-12 vertebrae involved improved after steroid therapy. CONCLUSION IgG4-related paravertebral lesions occur mainly around the right side of the lower thoracic vertebrae and manifest as three major patterns of CT and MR imaging findings. Recognition of these diagnostic features will assist in the diagnosis and treatment of IgG4-related disease.
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Affiliation(s)
- Zaizhu Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wenmin Guan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qiang Lin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Zhai B, Zhang Y, Chen Z, Yang F, Dong X, Chen Z, Cui Y, Wang P, Shi L, Yu W. Effect of video-assisted thoracoscopic surgery on pain stress indicators NO, IL-1β and IL-6 in the treatment of mediastinal tumor in children. Oncol Lett 2020; 19:3931-3936. [PMID: 32391101 PMCID: PMC7204486 DOI: 10.3892/ol.2020.11515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/12/2020] [Indexed: 12/17/2022] Open
Abstract
This study aimed to investigate the effect of video-assisted thoracoscopic surgery (VATS) on pain stress indicators nitric oxide (NO), interleukin-1β (IL-1β) and IL-6 in the treatment of mediastinal tumor in children, so as to explore the clinical application value of this surgery. A retrospective analysis was performed on 82 children with mediastinal tumor undergoing operation in Children's Hospital Affiliated to Zhengzhou University from January 2012 to January 2016. Among them, 48 children undergoing VATS were enrolled as an observation group, and 34 children undergoing conventional thoracotomy were enrolled as a control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the preoperative and postoperative expression levels of NO, IL-1β and IL-6. The intraoperative clinical data, postoperative pain degree and infection rate were observed and recorded in real time, and then compared between the two groups. Before operation (T0), there were no statistically significant differences between the two groups in serum NO, IL-1β and IL-6 expression levels, which were lower in the observation group than those in the control group at 12 h (T1) and 24 h (T2) after operation (P<0.05). The visual analog scale (VAS) score in the observation group was lower than that in the control group at T1 (P<0.05). Compared with the control group, the largest blade opening, intraoperative blood loss, drainage duration and postoperative pain degree were significantly improved in the observation group. The postoperative infection rate was 4.17% in the observation group, significantly lower than 17.64% in the control group. VATS is effective for postoperative pain stress indicators and infection control in children with mediastinal tumor, which is therefore more suitable for children with the disease and has a higher clinical value.
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Affiliation(s)
- Bo Zhai
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
| | - Yonghong Zhang
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
| | - Zhenliang Chen
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
| | - Fang Yang
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
| | - Xiangyang Dong
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
| | - Zhongjian Chen
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
| | - Yazhou Cui
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
| | - Penggao Wang
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
| | - Lei Shi
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
| | - Wenbo Yu
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, P.R. China
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