Abstract
Introduction: Childhood endodermal sinus tumors arising from the lung parenchyma are quite rare. The aim of this case presentation is to discuss the a patient with a germ cell tumor originated from thorax invading the abdomen trans- diaphragmatically.
Case: Two years old girl admitted with opacity in the right lung like a giant mass and opacity like a rib in this infiltration and minimal effusion in X-Ray. In an emergency thoracotomy due to respiratory distress and mediastinal shift; a giant encapsuled mass was seen in the right intrathorasic cavity; it was completely covering the right middle and lower hemithorax. The mass was penetrated and fixed into the diaphragm approximately 10 cm in diameter.It had penetrated towards the abdomen. The mass was separated by blunt dissections from the surrounding pleural tissues and pericardium.
At the same time with the right upper subcostal incision, the mass was mobilized from the liver and gerato fascia by the blunt dissection. One cm away from the penetrating edge of diaphragm it has been incised and the mass (with thoracal part, and abdominal part, and penetrated diaphragm) totally removed via abdominal incision through the diaphragmatic defect. Remaining edges of the diaphragm closed primarily. The histopathological diagnosis was combined malignant germ cell tumor (yolc sac tumor and mature teratoma) and she has been followed up and treated by pediatric oncology clinic. Postoperative local recurrence or metastasis was not found three years later.
Conclusion: A giant thoracal mass spreading transdiaphragmatically towards abdomen was excised succesfully via thoracotomy and laparotomy. In huge thoracal mass, removing of the mass without perforation may not be possible with just a thoracotomy; if necessary, try to avoid abdominal incision.
Keywords
mediastinum abdomen teratoma endodermal sinus tumor extragonadal germ cell tumors neoplasia malignancy
References
- Dulmet EM, Macchiarini P, Suc B, et al. Germ cell tumors of the mediastinum: a 30 years experience. Cancer. 1993; 72: 1894-1901.
- Arai K, Ohta S, Suzuki M, et al. Primary immature mediastinal teratoma in adulthood. Eur J Surg Oncol. 1997; 23: 64-67.
- Moeller KH, Rosado-de-Christenson ML, Templeton PA. Mediastinal mature teratoma: imaging features. AJR Am J Roentgenol. 1997; 169: 985-990.
- Hiroshima K, Toyozaki T, Iyoda A, et al. Apoptosis and proliferative activity in mature and immature teratomas of the mediastinum. Cancer. 2001; 92: 1798-1806.
- Lakhoo K, Boyle M, Drake DP. Mediastinal teratomas: review of 15 pediatric cases. J Pediatr Surg. 1993; 28: 1161-1164.
- Mueller DK. Teratomas and Other Germ Cell Tumors of the Mediastinum Annals of Oncology. 2004, 15: 1377-1399.
- Smahi M, Achir A, Chafik A, et al. Mature teratoma of the mediastinum. Ann Chir. 2000; 125: 965-971.
- Iyoda A, Hiroshima K, Yusa T, et al. The primary mediastinal growing teratoma syndrome. Anticancer Res. 2000; 20: 3723-3726.
- McLeod NP, Vallely MP, Mathur MN. Massive immature mediastinal teratoma extending into the left pleural cavity. Heart Lung Circ. 2005; 14: 45-47.
Abstract
Giriş: Akciğer parenkiminden kaynaklanan çocukluk çağı endodermal sinus tümörleri oldukça nadirdir. Bu çalışmanın amacı, transdiyafragmatik penetrasyonu ile toraksdan batına yayılan bir germ hücre tümörlü hastanın tartışılmasıdır.
Olgu: 2 yaşında bir kız hasta ağır solunum distresi ile başvurduruldu. Akciğer grafilerinde sağ akciğerde opakt kitle görünümü, kitlenin içinde ayrıca kosta şeklinde başka bir opasite ve sola mediastinal kayma mevcuttu. Ağır solunum sıkıntısı ve mediastinal kayma nedeniyle yapılan acil torakotomide, sağ intratorasik kaviteyi tamamen kaplayan büyük kapsüllü dev bir kitle olduğu görüldü. Kitle, 10 cm çapında geniş bir tabanla diyafragmaya sıkıca yapışmış ve penetre etmişti.
Eş zamanlı yapılan subkostal insizyon ile batına girilerek kitle karaciğer ve Gerato kapsülünden mobilize edildi. Diyafragmada tümör penetrasyonu kenarından 1 cm uzaktan yapılan insizyon ile; torakal kısım, diyafragmatik infiltrasyon kısım, abdominal kısım olmak üzere kitle tümüyle diyafragmadaki defekten aşağıya çekilerek subkostal insizyondan batın dışına alındı. Diyafragmatik defekt kenarı primer onarım yapıldı. Histopatolojik tanı, Yolk Sac tümörü ve matür teratom olmak üzere “combine malign germ hücreli tümör” idi. Hasta takip ve tedavi için pediatrik onkoloji kliniğine refere edildi. 3 yıllık takipte postoperatif lokal rekürrens veya metaztaz gözlenmedi.
Sonuç: Transdiyafragmatik olarak batına doğru yayılan bir dev torakal kitle, torakotomi ve laparotomik yoldan iki insizyonla başarıyla çıkarıldı. Dev torakal kitlelerin sadece torakotomi insizyonu ile perfore edilmeden çıkarılması her zaman mümkün olamayabilir; gereken durumlarda abdominal insizyon yapmaktan kaçınılmamalıdır.
Keywords
mediasten abdomen teratom endodermal sinus tümorü extragonadal germ hücreli tümörler neoplazi malinite
References
- Dulmet EM, Macchiarini P, Suc B, et al. Germ cell tumors of the mediastinum: a 30 years experience. Cancer. 1993; 72: 1894-1901.
- Arai K, Ohta S, Suzuki M, et al. Primary immature mediastinal teratoma in adulthood. Eur J Surg Oncol. 1997; 23: 64-67.
- Moeller KH, Rosado-de-Christenson ML, Templeton PA. Mediastinal mature teratoma: imaging features. AJR Am J Roentgenol. 1997; 169: 985-990.
- Hiroshima K, Toyozaki T, Iyoda A, et al. Apoptosis and proliferative activity in mature and immature teratomas of the mediastinum. Cancer. 2001; 92: 1798-1806.
- Lakhoo K, Boyle M, Drake DP. Mediastinal teratomas: review of 15 pediatric cases. J Pediatr Surg. 1993; 28: 1161-1164.
- Mueller DK. Teratomas and Other Germ Cell Tumors of the Mediastinum Annals of Oncology. 2004, 15: 1377-1399.
- Smahi M, Achir A, Chafik A, et al. Mature teratoma of the mediastinum. Ann Chir. 2000; 125: 965-971.
- Iyoda A, Hiroshima K, Yusa T, et al. The primary mediastinal growing teratoma syndrome. Anticancer Res. 2000; 20: 3723-3726.
- McLeod NP, Vallely MP, Mathur MN. Massive immature mediastinal teratoma extending into the left pleural cavity. Heart Lung Circ. 2005; 14: 45-47.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | PEDIATRIC SURGERY |
| Authors | |
| Publication Date | June 18, 2015 |
| Published in Issue | Year 2015 Volume: 46 Issue: 2 |
