Matsuoka Hiroyasu, Matsubara Hirochika, Sugimura Aya, Uchida Tsuyoshi, Ichihara Tomofumi, Nakajima Hiroyuki
Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi, Japan.
Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo City, Yamanashi, Japan.
Int J Surg Case Rep. 2018;53:299-302. doi: 10.1016/j.ijscr.2018.10.076. Epub 2018 Nov 2.
A perforating mediastinal mature teratoma can cause severe inflammation and adhesion; therefore, open surgery is usually performed. Asymptomatic perforation involving a teratoma is very rare. Complete thoracoscopic surgery is often difficult because of inflammation associated with perforation and the frequently large size of a mediastinal mature teratoma. We report a rare case of an asymptomatic perforating mediastinal mature teratoma successfully treated with complete thoracoscopic surgery.
The patient was a 15-year-old girl with an abnormal shadow at the mediastinum seen on chest radiography at a health examination performed at her junior high school; an asymptomatic mediastinal tumour was suspected. Enhanced computed tomography revealed a 6.5 × 3.5-cm tumour associated with the right upper lobe. Thoracoscopic surgery was performed using 4 access ports. Although there were inflammatory changes, hemi-thymectomy and right upper lobectomy were achieved with complete thoracoscopic surgery. The tumour included the skin, sebaceous glands, hair, and pancreatic tissue and was diagnosed as a mature teratoma perforating the right upper lobe.
There might be limited inflammatory changes if the patient has few or no symptoms, as in our case. In such cases, the tumour may be excised even if it is large.
We report a rare case of an asymptomatic perforating mediastinal mature teratoma that was successfully treated with complete thoracoscopic surgery. Although infection, inflammatory adhesion, large tumour size, and the need for radical cure are concerns, complete thoracoscopic surgery might be helpful. In cases of few or no symptoms, thoracoscopic surgery is worth challenging.
纵隔成熟性畸胎瘤穿孔可导致严重炎症和粘连，因此通常采用开放手术。无症状性畸胎瘤穿孔非常罕见。由于穿孔相关炎症以及纵隔成熟性畸胎瘤通常体积较大，完全胸腔镜手术往往具有难度。我们报告一例罕见的无症状性纵隔成熟性畸胎瘤穿孔病例，成功接受了完全胸腔镜手术治疗。
患者为一名15岁女孩，在初中健康检查时胸部X线片显示纵隔有异常阴影，怀疑为无症状性纵隔肿瘤。增强计算机断层扫描显示一个6.5×3.5厘米的肿瘤，与右上叶相关。使用4个切口进行胸腔镜手术。尽管存在炎症改变，但通过完全胸腔镜手术实现了半胸腺切除术和右上叶切除术。肿瘤包含皮肤、皮脂腺、毛发和胰腺组织，被诊断为右上叶穿孔的成熟性畸胎瘤。
如果患者症状很少或没有症状，如我们的病例，炎症改变可能有限。在这种情况下，即使肿瘤很大也可以切除。
我们报告一例罕见的无症状性纵隔成熟性畸胎瘤穿孔病例，成功接受了完全胸腔镜手术治疗。尽管感染、炎症粘连、肿瘤体积大以及需要根治是需要考虑的问题，但完全胸腔镜手术可能会有所帮助。在症状很少或没有症状的情况下，胸腔镜手术值得尝试。
