Posterolateral thoracotomy Approach for an Ectopic Mediastinum Thymoma: A Case Report

Document Type: Case Report

Authors

1 Thoracic Surgeon, Department of Surgery & Division of Thoracic Surgery, Teaching Hospital of Joseph Ravoahangy Andrianavalona. Faculty of Medecine, University of Antananarivo. Madagascar

2 Anesthesiologist, Department of Anesthesiology, Resuscitation and Intensive Medicine, Teaching Hospital of Joseph Ravoahangy Andrianavalona, Faculty of Medecine, University of Antananarivo. MadagascarDepartment of Anesthesiology, Resuscitation and Intensive Medicine

10.22038/jctm.2020.48733.1274

Abstract

Thymic epithelial neoplasms are commonly aetiology of the anterior mediastinum masses in adults. It represents 20–30% of all mediastinal tumours in adults. Ectopic thymomas usually affect the neck, mediastinal compartments, lung, and pleura, arising from aberrant thymic tissue. For giant thymoma, there is still no consensus on the surgical approach.  We herein report a patient with a giant thymoma that was successfully resected through a large right posterolateral thoracotomy. We report a rare case of a giant thymoma in the posterior mediastinal. Our patient underwent a conventional posterolateral thoracotomy to remove the mass. This latter was histologically diagnosed as a WHO classification type AB thymoma and Masaoka stage I.
The choice of surgical approach of mediastinal tumor is based on the tumour topography, the assessment of tumour extension and extirpation, the surgeon's experience and clinical symptomatology. A multidisciplinary approach is mandatory to achieve good results.

Keywords


  1. Azuma Y, Otsuka H, Makino T, Koezuka S, Anami Y, Sadamoto S, Wakayama M, Tochigi N, Shibuya K, Iyoda A. Giant thymoma successfully resected via median sternotomy and anterolateral thoracotomy: a case report. Journal of Cardiothoracic Surgery. 2018 Dec 1;13(1):26.
  2. Gulati N, Schmidt F, Patolia S, Narendra D, Perwaiz M, Enriquez D. Ectopic thymoma-presenting as a large pleural mass. Journal of Pulmonary & Respiratory Medicine. 2012; 2(06):1-4.
  3. Zhao W, & Fang W. Giant thymoma successfully resected via hemiclamshell thoracotomy: a case report. J Thorac Dis 2016;8(8):E677.
  4. Yamazaki K, Yoshino I, Oba T, Yohena T, Kameyama T, Tagawa T, Kawano D, Koso H, Maehara Y. Ectopic pleural thymoma presenting as a giant mass in the thoracic cavity. The Annals of thoracic surgery. 2007 Jan 1;83(1):315-7.
  5. Filosso PL, Delsedime L, Cristofori RC, Sandri A. Ectopic pleural thymoma mimicking a giant solitary fibrous tumour of the pleura. Interactive cardiovascular and thoracic surgery. 2012 Nov 1;15(5):930-2.
  6. Limmer S, Merz H, Kujath P. Giant thymoma in the anterior-inferior mediastinum. Interactive Cardio Vascular and Thoracic Surgery. 2010 Mar 1;10(3):451-3.
  7. Hasan R, Khan OS, Nahian SA, Aftabuddin M, Adhikary AB. Thymoma Presenting as a Giant Intrathoracic Mass. Journal of Bangladesh College of Physicians and Surgeons. 2016 Aug 8;34(1):37-41.
  8. Bozoğlan O, Meşe B, Eroğlu E, Sökmen A. Resection of a giant thymoma and coronary artery bypass graft surgery: a case report. Turkish Journal of Thoracic and Cardiovascular Surgery. 2013;21(4).
  9. Takenaka T, Ishida T, Handa Y, Tsutsui S, Matsuda H. Ectopic thymoma presenting as a giant intrathoracic mass: a case report. Journal of cardiothoracic surgery. 2012 Dec 1; 7(1):68.
  10. Santoprete S, Ragusa M, Urbani M etal.Shock induced by spontaneous rupture of a giant thymoma. Ann ThoracSurg 2007; 83(4): 1526-8.
  11. Ahsan I, Alfay W, Jarriel J, Marhefka G. Giant Thymoma and Cardiac Tamponade. Chest. 2016 Oct 1; 150(4):56A.
  12. Keen SJ, Libshitz HI. Thymic lesions: experience with computed tomography in 24 patients. Cancer 1987; 59:1520-1.
  13. Bazarbashi N, Siddique S, Elsayed A, Mohammed T, Alshammari A. Thymoma Inducing Superior Vena Caval Syndrome. J Vasc Med Surg. 2018;6(362):2.
  14. Terzi A, Bertolaccini L, Rizzardi G etal.Usefulness of 18-F FDG PET/CT in the pre-treatment evaluationofthymic epithelial neoplasms. Lung Cancer 2011; 74:239–43.
  15. Incarbone M, Voulaz E, &Alloisio M. Surgical approach to giant thymoma: Is the hemi-clamshell incision the best option. Thorac Cardiovasc Surg 2008; 56(04):241.
  16. Shintani Y, Kanzaki R, Kusumoto H, Nakagiri T, Inoue M, Okumura M. Pleuropneumonectomy for a large thymoma with multiple pleural dissemination using median sternotomy followed by posterolateral thoracotomy. Surgical case reports. 2015 Dec; 1(1):1-5.
  17. Deslauriers J, Mehran RJ. Posterolateral thoracotomy. Operative Techniques in Thoracic and Cardiovascular Surgery. 2003 May 1; 8(2):51-7.