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Complete resection of a giant mediastinal teratoma occupying the entire right hemithorax in a 14-year-old boy
© Zhao et al.; licensee BioMed Central Ltd. 2014
Received: 7 April 2014
Accepted: 19 August 2014
Published: 24 August 2014
Mature teratomas are the most common histological type of germ cell tumors.
A 14-year-old boy was referred to our hospital with a giant mature teratoma occupying the entire right hemithorax compressed the superior vena cava (SVC) and total atelectasis of the right lung. He was misdiagnosed as malignant teratoma by a fine-needle biopsy in a hospital. After 4-cycle of chemotherapy without effect, he underwent an unsuccessful exploratory thoracotomy. Venous conduit bypass between the right jugular vein and right femoral vein was established in the operating room for superior vena cava (SVC) replacement if needed. En bloc resection of the huge tumor, wedge resection of the dense adhesions of the right lung and partial pericardectomy were successfully performed, and lung function was recovered.
To the best of our knowledge, this is the first report of complete resection of the teratoma occupying the whole right hemithorax combined with wedge resection of the right upper, middle and lower lobes and partial resection of the pericardium.
Mature teratomas are the most common histological type of germ cell tumors. Germ cell tumors are predominantly found in gonads, while the anterior mediastinum is the most common extragonadal site. In the article, we have found a giant mediastinal teratoma occupying the entire right hemithorax in a 14-year-old boy by complete resection.
Mature teratomas are the most common histological type of germ cell tumors. Germ cell tumors are predominantly found in gonads, while the anterior mediastinum is the most common extragonadal site [1, 2]. Because of the early asymptomatic, teratomas were always got longer course, larger tumors and compression of surrounding organs. Some teratomas contain malignant components, but the effect of chemotherapy is poor. Surgical resection is the only effective way to treat teratoma, especially for mature teratoma.
The choice of incision for removing the giant mediastinal tumor depend on the tumor size, location, the relationships between the tumor and the associated vital structures, and the surgeon’s experience. In our case, right posterolateral access was chosen, as the tumor was almost entirely located into the right hemithorax, reaching and adherent to the left hemi-diaphragm. And contrast CT scan showed no signs of invasion of left brachial vein. As several literature reported, we agree that reducing the tumor volume by fluid aspiration via a small incision of the tumor wall facilitate the dissection for removing the huge mediastinal tumors [3–6]. During dissection of the giant mediastinal tumors, continued traction the tumor via the sutures placed on the tumor can prevent from compressing of the heart to avoid circulatory collapse. There are usually widespread and severe adhesions between huge mediastinal tumors and the adjacent structures. Great care must be taken during dissection as the damage of vital structures can induce fatal cardiopulmonary complications. As reported in our previous report, partially resection of the infiltrate pericardium or diaphragm is safe and helpful for dissection . We routinely set up the venous conduit bypass between the right/left jugular vein and right/left femoral vein before SVC replacement to preventing from high venous pressure when SVC clamped . As contrast CT scan showed the tumor severely adhered to SVC, we established the venous conduit bypass between the right jugular vein and right femoral vein before operation in case of SVC replacement. Although the division between the tumor and SVC was successful in this case, the venous bypass provided a safe support for surgery.
In conclusion, we report an unusual case of the teratoma occupying the whole right hemithorax in a 14-year-old boy, and the tumor was completely removed and combined with wedge resection of the right upper, middle and lower lobe and partial resection of the pericardium.
Written informed consent was obtained from the patient for publication of this case report including associated images and video.
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