Daoud Daoud, Darwish Bassam, Zahra Sarmad, Qaddoura Monir
Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
Department of Thoracic Surgery, Al-moassat Hospital, Damascus, Syrian Arab Republic.
Ann Med Surg (Lond). 2021 Sep 13;70:102859. doi: 10.1016/j.amsu.2021.102859. eCollection 2021 Oct.
Thymoma is an epithelial tumor that commonly lies in the anterior mediastinum. It rarely extends to the pleural cavities. There is no standard approach for resecting similar giant thymomas.
An eighteen-year-old woman presented with a six-month history of progressive exertional dyspnea, weight loss, and loss of appetite. Radiological imaging demonstrated a giant mediastinal mass extending to both pleural cavities, a transthoracic needle biopsy was then performed, which indicated thymic hyperplasia.
The tumor was completely resected using a two-step approach, starting with a median sternotomy then extending it to a hemiclamshell incision, which provided better exposure of the tumor and caused less morbidity.The left part of the thymoma was resected using a median sternotomy, which took a relatively long time and caused significant blood loss. Then the incision was extended to a hemiclamshell incision through the pleural cavity to remove the right part of the tumor. This approach helped us to visualize the tumor better and did not cause any significant blood loss.The removed mass measured 36 × 29 × 10 cm and weighed 4500 g. Pathologic diagnosis indicated a type B1 tumor with no capsular invasion according to the World Health Organization classification.
The hemiclamshell approach is superior to the median sternotomy incision in resecting giant thymomas extending to the pleural cavity, as it saves time and causes less morbidity.
胸腺瘤是一种上皮性肿瘤，通常位于前纵隔。它很少延伸至胸腔。对于切除类似的巨大胸腺瘤，目前尚无标准方法。
一名18岁女性，有进行性劳力性呼吸困难、体重减轻和食欲减退6个月的病史。影像学检查显示一个巨大的纵隔肿块延伸至双侧胸腔，随后进行了经胸针吸活检，结果提示胸腺增生。
采用两步法完全切除肿瘤，先做正中胸骨切开术，然后将其延长至半蛤壳状切口，这样能更好地暴露肿瘤且并发症更少。胸腺肿瘤的左侧部分通过正中胸骨切开术切除，耗时较长且失血量大。然后通过胸腔将切口延长至半蛤壳状切口以切除肿瘤的右侧部分。这种方法有助于我们更好地观察肿瘤，且未导致任何明显失血。切除的肿块大小为36×29×10 cm，重4500 g。根据世界卫生组织分类，病理诊断为B1型肿瘤，无包膜侵犯。
在切除延伸至胸腔的巨大胸腺瘤时，半蛤壳状入路优于正中胸骨切开术切口，因为它节省时间且并发症更少。
