Yasukawa Motoaki, Uchiyama Tomoko, Kawaguchi Takeshi, Sawabata Noriyoshi, Ohbayashi Chiho, Taniguchi Shigeki
Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Department of Diagnostic Pathology, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Int J Surg Case Rep. 2020;66:408-411. doi: 10.1016/j.ijscr.2019.11.016. Epub 2020 Jan 14.
Thymic atypical carcinoid has high recurrence and metastasis rates due to frequent lymph node metastases. The aim of the study is to report a case of atypical thymic carcinoid mimicking a paraganglioma and to further explain the benefits of using median sternotomy (MS) approach even in thymic epithelial tumours (TETs) sized less than 5 cm.
The patient was a 59-year-old asymptomatic man. During a medical check-up, positron emission tomography/computed tomography (PET/CT) showed a 4.5 cm-diameter thymus with remarkable uptake. Thoracic surgery was performed to completely remove the tumour with lymph node dissection using MS because of possible malignancy. Although MS is accepted as the standard approach for TETs, minimally invasive thoracotomy (MIT) has emerged over recent decades. Maintaining surgical safety is priority; MIT is generally selected in <5-cm-diameter tumours. Here, we considered that the tumour could be resected using MIT. However, because PET/CT showed marked uptake, we selected the MS approach. Thus, MS can be applied even for small-sized TETs.
Thymic atypical carcinoid should be considered when PET/CT shows high-uptake tumours in the anterior mediastinum. Clinicians should consider using the MS approach, even if the tumour is <5 cm.
胸腺非典型类癌由于频繁发生淋巴结转移，具有较高的复发和转移率。本研究的目的是报告一例酷似副神经节瘤的非典型胸腺类癌病例，并进一步解释即使对于直径小于5厘米的胸腺上皮肿瘤（TETs），采用正中胸骨切开术（MS）的益处。
患者为一名59岁无症状男性。在体检期间，正电子发射断层扫描/计算机断层扫描（PET/CT）显示直径4.5厘米的胸腺有明显摄取。由于可能为恶性肿瘤，遂行胸外科手术，采用MS完全切除肿瘤并进行淋巴结清扫。尽管MS被公认为TETs的标准手术方法，但近几十年来微创开胸术（MIT）已出现。维持手术安全是首要任务；一般在直径<5厘米的肿瘤中选择MIT。在此，我们认为该肿瘤可以用MIT切除。然而，由于PET/CT显示明显摄取，我们选择了MS方法。因此，MS甚至可应用于小尺寸的TETs。
当PET/CT显示前纵隔有高摄取肿瘤时，应考虑胸腺非典型类癌。即使肿瘤<5厘米，临床医生也应考虑采用MS方法。
