Simultaneous Surgical Management of Anterior Mediastinal Mature Cystic Teratoma and Triple Vessel Coronary Artery Disease in a Patient with Inguinal Hernia: A Case Report

Document Type : Case Report

Authors

1 Senior Consultant, Institute of Chest Surgery, Medanta, Gurugram, India.

2 Associate Director, Cardiac Care, Medanta, Gurugram, India.

3 Associate Director, Institute of Chest Surgery, Medanta, Gurugram, India.

4 Consultant, Institute of Chest Surgery, Medanta, Gurugram, India.

5 Associate Consultant, Institute of Chest Surgery, Medanta, Gurugram, India.

6 Resident, Institute of Chest Surgery, Medanta, Gurugram, India.

7 Resident, Dayanand Medical College, Ludhiana, Punjab, India.

8 Chairman, Critical Care, Medanta, Gurugram, India.

9 Clinical Research Associate, Institute of Chest Surgery, Medanta, Gurugram, India .

10 Chairman, Institute of Chest Surgery, Medanta, Gurugram, India.

Abstract

We present a case of a 61-year-old diabetic male patient who was incidentally found to have a large anterior mediastinal mature cystic teratoma during a routine chest radiograph performed as part of pre-anaesthesia evaluation for inguinal hernia surgery. Although, the patient was largely asymptomatic, but reported mild exertional dyspnea. Further investigations revealed triple vessel coronary artery disease (TVCAD. A multidisciplinary approach involving thoracic, cardiac and anesthesia teams led to the decision of performing a single-stage surgery. The surgical procedure involved resecting the mediastinal mass and subsequently performing coronary artery bypass grafting (CABG) for the triple vessel disease. The patient’s postoperative recovery was smooth, with no significant complications, and he was discharged in stable condition. His histopathological examination confirmed the diagnosis of a mature cystic teratoma. This case shows the importance of a coordinated, multidisciplinary strategy in managing complex coexisting pathologies, showing the feasibility of simultaneous surgical intervention for both mediastinal and coronary conditions.

Keywords


  1. Fong CY, Gauthaman K, Bongso A. Teratomas from pluripotent stem cells: a clinical hurdle. Journal of cellular biochemistry. 2010 Nov 1;111(4):769-81.
  2. Revere DJ, Makaryus AN, Bonaros EP, Graver LM. Chylopericardium presenting as cardiac tamponade secondary to an anterior mediastinal cystic teratoma. Texas Heart Institute Journal. 2007;34(3):379.
  3. Mahajan N, Polavaram L, Vankayala H, Ference B, Wang Y, Ager J, et al. Diagnostic accuracy of myocardial perfusion imaging and stress echocardiography for the diagnosis of left main and triple vessel coronary artery disease: a comparative meta-analysis. Heart. 2010 Jun 1;96(12):956-66.
  4. Tian Z, Liu H, Li S, Chen Y, Ma D, Han Z, et al. Surgical treatment of benign mediastinal teratoma: summary of experience of 108 cases. Journal of Cardiothoracic Surgery. 2020 Dec;15:1-5.
  5. Zaki SA, Dadge D, Shanbag P, Choudhury R. Mature cystic teratoma: Unusual presentation as dysphagia. The Indian Journal of Pediatrics. 2009 Dec;76:1275-6.
  6. Wang R, Li H, Jiang J, Xu G. Incidence, treatment, and survival analysis in mediastinal malignant teratoma population. Translational Cancer Research. 2020 Apr;9(4):2492.
  7. Romagnani E, Gallerani E, Cavalli F. Mediastinal mature teratoma with an immature component—what about the treatment?. Annals of oncology. 2006 Oct 1;17(10):1602-4.
  8. Kaku R, Teramoto K, Ishida K, Igarashi T, Hashimoto M, Kitamura S, et al. Simultaneous resection of pulmonary tumor following cardiovascular surgery. Asian journal of surgery. 2017 Mar 1;40(2):123-8.
  9. Khan MS. Coronary Artery Bypass Grafting: Surgical Anastomosis: Tips and Tricks. The Current Perspectives on Coronary Artery Bypass Grafting, IntechOpen, Rijeka. 2020 Jul 29:79-108.