PDF (5 MB) - Jurnalul de Chirurgie

CASE REPORT 173Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 2THYMOMA WITH LATERAL AND PARACARDIACEVOLVEMENTOana-Raluca Lucaciu 1 , P.V-H. Boţianu 1 , T. Hogea 1 ,Claudia Dorobăţ 2 , A-M. Boţianu 11) Department of Surgery, University of Medicine and Pharmacy Tg. Mureş, Romania2) Department of Radiology, Emergency Clinic County Hospital Tg. Mureş, RomaniaTHYMOMAS WITH LATERAL AND PARACARDIAC EVOLVEMENT (Abstract): Thymomais the most common tumor of the anterior mediastinum originating from epithelial thymic cells.The tumors are often asymptomatic or with non specific symptoms. We present herein three casesadmitted in our surgical for mediastinal tumor. The imagery exams revealed thymomas withlateral and paracardiac evolvement. Intraoperatively, we found tumors in closed contact with thepericardium, developed posterior to the phrenic nerve. In all cases, we performed completeexcision of the tumors using a posterolateral thoracotomy. Frozen section was inconclusive in allcases; the final pathological exam diagnosed stage I thymoma. The postoperative course wasuneventful for all three patients. The long term follow-up (14 years) revealed no recurrence.KEY WORDS: THYMOMA; MEDIASTINAL TUMORS; THORACOTOMY.SHORT TITLE: Lateral & paracardiac thymomaHOW TO CITE: Lucaciu OR, Boţianu PVH, Hogea T, Dorobăţ C, Boţianu AM. Thymoma with lateral and paracardiac,evolvement. Jurnalul de chirurgie (Iaşi). 2013; 9(2): 173-178. DOI: 10.7438/1584-9341-9-2-9.INTRODUCTIONThymoma is a tumor originating fromepithelial thymus cells, the thymocytes [1].Most often it is located in anteriormediastinum (95%); other sites as cervicalregion, pulmonary hilar regions, lungparenchyma, visceral mediastinum,cardiophrenic angle, paravertebral sulcus,tracheal wall (like a tracheal polypappearance) are also noted [2].Thymoma is often asymptomatic anddiagnosed incidentally during a routinethoracic X-ray exam or associated with signsof mediastinal compression (superior venacava syndrome, dysphagia, dyspnea, chestpain); in 30 to 45% it is associated withmyasthenia gravis [2].During the last 15 years we had 3cases referred to our unit with the diagnosisof mediastinal / pulmonary tumor, where thepreoperative imagery showed a mediastinaltumor, with lateral-paracardiac evolvement.Case 1A 47 years old woman was admitted inour service for chest pain, medium dyspneaand irritating cough. The symptoms startedthree months before. On admission, physicalexam found no other pathological aspects.The thoracic X-ray exam showed a roundopacity in the ½ upper chest, over theheart near the intersection with large vessels(Fig. 1). Computed tomography (CT)showed a solid mass in the superiormediastinum, well defined, encapsulated;ultrasound exam revealed no pericardial andpleural fluid.After conducting interdisciplinarypreoperative pulmonology and cardiologycheckups and achieving a properpreoperative preparation, the surgicalintervention was performed under generalanaesthesia with orotracheal intubation.Intraoperatively, we performed aposterolateral thoracotomy that gave us anReceived date: 12.03.2013Accepted date: 23.03.2013Correspondence to: Oana-Raluca Lucaciu, MDStr. George Coşbuc, no. 11/9, 540119, Tg. Mureş, Mureş County, RomaniaPhone: 0040 (0) 745 54 37 76E-mail : lucaciuoanaraluca@yahoo.com