Matsui Yusuke, Shiono Satoshi, Mizumoto Masahiro, Nakamura Megumi, Suzuki Jun, Watanabe Hikaru, Uchida Tetsuro
Department of Surgery II, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, Japan.
Department of Thoracic Surgery, Saitama Cardiovascular and Respiratory Center, Saitama, Japan.
Gen Thorac Cardiovasc Surg Cases. 2024 Dec 20;3(1):54. doi: 10.1186/s44215-024-00181-3.
Mature teratomas are benign cystic tumors that are most commonly asymptomatic. However, in some cases, mediastinal teratomas rupture the lungs and mediastinum with potentially fatal outcomes. Herein, we report a case of a large mediastinal mature teratoma that expanded to the entire left hemithorax in a child with common cold-like symptoms.
A 2-year-7-month old girl visited a family doctor because of cough and rhinorrhea. Chest radiography revealed a large tumor occupying the left hemithorax, necessitating transfer to our institution. Chest computed tomography (CT) revealed a large tumor with calcifications and an encapsulated surface. The lesion was 10.5 cm in size and covered the entire left hemithorax, deviating significantly from the heart. CT suggested a mature mediastinal teratoma. Considering the risk of tumor dissemination, we did not perform a diagnostic biopsy; however, surgery was performed as an oncological emergency. As ventilation and circulation were difficult to maintain during the surgery, extracorporeal membrane oxygenation was performed. During surgery, although the large tumor tightly adhered to the sternum and innominate vein, it could be safely removed from these structures, and the tumor was completely removed through median sternotomy. The pathological diagnosis revealed a benign mature mediastinal teratoma. The patient's postoperative course was uneventful.
As the clinical course of child-specific problems in mature teratomas tends to be severe, a surgical strategy should be meticulously planned to ensure safety.
成熟畸胎瘤是良性囊性肿瘤，通常无症状。然而，在某些情况下，纵隔畸胎瘤会破裂进入肺部和纵隔，可能导致致命后果。在此，我们报告一例大型纵隔成熟畸胎瘤病例，该肿瘤在一名出现类似普通感冒症状的儿童中扩展至整个左半胸。
一名2岁7个月大的女孩因咳嗽和流鼻涕就诊于家庭医生。胸部X线检查显示一个大型肿瘤占据左半胸，因此需要转至我院。胸部计算机断层扫描（CT）显示一个带有钙化和包膜表面的大型肿瘤。病变大小为10.5厘米，覆盖整个左半胸，心脏明显移位。CT提示为成熟纵隔畸胎瘤。考虑到肿瘤播散的风险，我们未进行诊断性活检；然而，作为肿瘤急症进行了手术。由于手术过程中难以维持通气和循环，因此进行了体外膜肺氧合。手术中，尽管大型肿瘤与胸骨和无名静脉紧密粘连，但仍可安全地从这些结构上分离，通过正中胸骨切开术将肿瘤完全切除。病理诊断显示为良性成熟纵隔畸胎瘤。患者术后恢复顺利。
由于成熟畸胎瘤中儿童特定问题的临床过程往往较为严重，应精心规划手术策略以确保安全。
