Fukino S, Fukata T, Hayashi E, Okada K, Metsugi H, Suda T, Morio S
Department of Surgery, Tottori Prefectural Kousei Hospital, Kurayoshi, Japan.
Kyobu Geka. 2002 Jun;55(6):519-22.
We report thoracoscopic resection of Castleman lymphoma originated from the posterior mediastinum. The patient was a 19-year-old woman, who was pointed out to show an abnormal shadow in the left upper lung in the chest X-ray photograph. It was diagnosed as a blood-rich posterior mediastinal tumor by dynamic MRI, and thoracoscopic surgery was performed. The tumor was adjacent to the vertebral body of the fourth thoracic vertebra. Although operation involved 2 hours and 40 minutes and 670 ml of bleeding due to a strong adhesion between the tumor and the intercostal muscle and considerable bleeding from the tumor itself, it was successfully removed under thoracoscopy. The tumor was elastic and hard, and 50 x 45 x 25 mm in size. The histopathological diagnosis was a Castleman lymphoma, hyaline vascular type. The postoperative course was satisfactory, and the patient was discharged from the hospital on the 7th postoperative day. Castleman lymphoma originated from the posterior mediastinum tends to bleed considerably during its resection. If a blood-rich posterior mediastinal tumor was found preoperatively, thoracoscopic operation must be advanced carefully keeping this disease in mind.
我们报告了1例起源于后纵隔的Castleman淋巴瘤的胸腔镜切除术。患者为19岁女性,胸部X线片显示左上肺有异常阴影。动态MRI诊断为血供丰富的后纵隔肿瘤,并进行了胸腔镜手术。肿瘤与第四胸椎椎体相邻。尽管手术耗时2小时40分钟,因肿瘤与肋间肌粘连紧密及肿瘤本身出血量大导致出血670毫升,但在胸腔镜下成功切除。肿瘤质地硬且有弹性,大小为50×45×25毫米。组织病理学诊断为透明血管型Castleman淋巴瘤。术后病程顺利,患者术后第7天出院。起源于后纵隔的Castleman淋巴瘤在切除过程中往往出血较多。如果术前发现血供丰富的后纵隔肿瘤,必须牢记这种疾病,谨慎推进胸腔镜手术。