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犬颅纵隔肿物胸腔镜切除术后的切口部位转移

Portal site metastasis after thoracoscopic resection of a cranial mediastinal mass in a dog.

作者信息

Alwen Sarah G J, Culp William T N, Szivek Anna, Mayhew Philipp D, Eckstrand Christina D

出版信息

J Am Vet Med Assoc. 2015 Oct 1;247(7):793-800. doi: 10.2460/javma.247.7.793.

Abstract

CASE DESCRIPTION

An 11-year-old castrated male Vizsla was evaluated for excision of a cranial mediastinal mass.

CLINICAL FINDINGS

The dog had a 1-month history of a cough that had recently increased in frequency. On physical examination, the dog had a grade 2/6 left systolic heart murmur and multiple subcutaneous masses. A soft tissue mass was observed in the cranioventral aspect of the thorax on radiographs. Results of a CT scan revealed a well-defined, 2.8 × 3.2 × 3.9-cm soft tissue mass in the cranial mediastinum.

TREATMENT AND OUTCOME

The dog underwent video-assisted thoracoscopic removal of the mediastinal mass and recovered routinely. Histologic examination of excised tissues revealed malignant thymoma. Approximately 6.5 months after surgery, the dog was evaluated because of polyuria, polydipsia, decreased appetite, and vomiting. On physical examination, masses were found in both axillary regions. Results of serum biochemical analysis indicated hypercalcemia. Thoracic ultrasonography revealed pulmonary metastases and a large mass in the right caudoventral region of the thorax. The dog received supportive care and medical treatment for hypercalcemia, but clinical signs recurred. Euthanasia was elected; necropsy and histologic examination revealed thymic carcinoma.

CONCLUSIONS AND CLINICAL RELEVANCE

Descriptions of the development of portal site metastasis in canine patients are rare. In this patient, portal site metastasis developed rapidly after thoracoscopic resection of a malignant thymic mass and was associated with hypercalcemia. As use of thoracoscopic procedures increases in veterinary medicine, it will be important to monitor the development of major complications such as those in the patient of this report.

摘要

病例描述

一只11岁去势雄性维兹拉犬因切除纵隔前部肿块而接受评估。

临床发现

这只狗有1个月的咳嗽病史,近期咳嗽频率增加。体格检查时,该犬有2/6级左侧收缩期心脏杂音和多个皮下肿块。胸部X光片显示在胸廓前腹侧有一个软组织肿块。CT扫描结果显示在纵隔前部有一个边界清晰、大小为2.8×3.2×3.9厘米的软组织肿块。

治疗与结果

这只狗接受了电视辅助胸腔镜纵隔肿块切除术,并常规恢复。切除组织的组织学检查显示为恶性胸腺瘤。手术后约6.5个月,这只狗因多尿、多饮、食欲减退和呕吐接受评估。体格检查时,在双侧腋窝区域发现肿块。血清生化分析结果显示高钙血症。胸部超声检查显示有肺转移以及在胸廓右后腹侧区域有一个大肿块。这只狗接受了高钙血症的支持治疗和药物治疗,但临床症状复发。选择实施安乐死;尸检和组织学检查显示为胸腺癌。

结论与临床意义

犬类患者门静脉部位转移发展情况的描述很少见。在该患者中,胸腔镜切除恶性胸腺肿块后门静脉部位转移迅速发生,并与高钙血症相关。随着胸腔镜手术在兽医医学中的应用增加,监测如本报告患者中出现的这类主要并发症的发展情况将很重要。

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