CASE REPORTS   

Minerva Pneumologica 2016 June;55(2):23-6

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

A novel surgical approach for giant thymoma in the anterior-inferior mediastinum

Mariano DI MARTINO, Ashok KAR, Stephen J. EDMONDSON

Department of Cardiothoracic Surgery, St Bartholomew’s Hospital, West Smithfield, London, UK

Thymomas found beyond the superior mediastinum are rare and the surgical approach and management is controversial. We describe a case of giant thymoma in the anterior-inferior mediastinum, nearly filling the entire left hemithorax. Intraoperative inspection demonstrated the tumor was infiltrating: the left upper lobe and most part of the lower lobe; a large portion of pericardium without involvement of myocardium; the parietal pleura laterally; the phrenic nerve, mammary artery and mammary veins superiorly. This was successfully resected via median sternotomy and concomitant splitting of the sternum along the 2nd intercostal space via left anterior thoracotomy. Postoperative histology revealed type B (B3/B2) thymic carcinoma with infiltration through capsule into lung, pleura and pericardium. The patient 5 months post-resection is having ongoing chemotherapy but has no signs of local recurrence. Complete resection, size and type of tumor are the major determinants of prognosis for giant thymoma. Due to this tumor invading the lateral pericardium and left lung, our novel surgical approach was the only method possible to enable adequate exposure and achieve complete resection (including intra-pericardial pneumonectomy). To our knowledge this is the first reported case of anterior-inferior mediastinal giant thymoma resected using this type of versatile incision.