12-year-old girl Xiaoxiu (pseudonym) occasionally felt heart palpitations discomfort. During an examination at the hospital, it was found that there was a huge tumor hidden in the left chest cavity. The CT image showed teratoma , which was severely squeezing the heart and lungs. Recently, Guangdong Provincial People's Hospital Cardiac Surgery Department organized multidisciplinary efforts to successfully complete the resection of a huge teratoma in the left posterior mediastinum, with a tumor diameter of 20 cm. Xiaoxiu recovered and was discharged from the hospital 10 days after the operation, and her follow-up condition is in good condition.
A multidisciplinary team of experts worked together to remove the giant mediastinal teratoma.
It is understood that teratomas are embryogenic tumors that commonly occur in young adults under the age of 30. Most of them are mature and differentiated benign teratomas. The main treatment is surgical resection.
The mediastinal tumor is 20 centimeters in diameter
According to Xiaoxiu’s parents, about half a year ago, the child occasionally complained that his heartbeat was fast and his chest felt a little uncomfortable. The parents were worried after hearing the child talk too much, so they took her to the local hospital for treatment. Chest CT showed a huge space-occupying lesion in the left posterior mediastinum, measuring approximately 13.7 × 10.7 × 17.6 cm. According to the lipid content of the tumor , bone and other ossified components, clinical teratoma is initially considered.
’s parents immediately took Xiaoxiu to seek medical treatment in many places, and were told that surgery was needed. However, due to the deep location of the tumor and the complexity of the condition, it was recommended that Xiaoxiu seek treatment at a first-level hospital. The parents took Xiaoxiu to the outpatient clinic of Director Chen Jimei of the Institute of Cardiovascular Diseases of Guangdong Provincial People's Hospital.
After understanding the situation, Director Chen Jimei considered that the huge tumor on the left mediastinum of the child was closely adhered to the surrounding heart, great blood vessels and other important organs, so he transferred the child to cardiac and great vascular surgery, and organized pediatric cardiac surgery, thoracic surgery, etc. Multidisciplinary consultation including surgery, cardiac anesthesiology, cardiac intensive care, extracorporeal circulation, and blood transfusion departments will be conducted to discuss and formulate specific diagnosis and treatment plans.
After being admitted to the hospital, Xiaoxiu underwent further examinations such as MR, aortic CTA, and cardiac ultrasound, and found that the tumor was located deep in the left posterior inferior mediastinum, with a maximum diameter of nearly 20 cm, exceeding the midline of the abdominal cavity, and partially compressing the pericardium of the heart, the left lower lung, and the left side. The diaphragm and retroperitoneal organs cause heart displacement, left lower lung atelectasis, diaphragm left kidney obvious downward displacement, and the tumor is tightly adherent to the descending aorta with unclear boundaries, and is adjacent to the esophagus, thoracic duct and multiple nerves. , and several nutrient vessels originate from the descending aorta to supply blood supply to the tumor, which undoubtedly increases the difficulty and risk of the operation.
How to completely remove the tumor while avoiding damage to surrounding important organs is the biggest challenge faced by surgeons. Multidisciplinary experts analyzed the problems that may be encountered during the operation one by one and made a treatment plan. They finally decided to perform general anesthesia (left thoracoabdominal combined incision) resection of the huge mediastinal teratoma on Xiaoxiu. If necessary, Descending aorta repair or artificial blood vessel replacement is performed with the assistance of cardiopulmonary bypass .
Multidisciplinary collaboration to dismantle the giant tumor
On the day of the operation, at 9:50, directed by Director Chen Jimei, the surgical team of Director Sun Tucheng and Director Yu Changjiang of the Department of Cardiac and Vascular Surgery and Director Zhou Haiyu of the Thoracic Surgery Department began to operate around Xiaoxiu's tumor. Adjacent areas were carefully dissected and dissected, pericardial and pulmonary adhesions were released, diaphragmatic adhesions were released, the mediastinum at the base of the tumor was released layer by layer, the vasa vasorum at the tumor pedicle was freed and ligated root by root, and the descending aorta was blocked and repaired locally.
Director Sun Tucheng said that according to the preoperative prediction, the mediastinal tumor has a rich blood supply, with three blood vessels connected to the thoracoabdominal aorta. It cannot be ruled out that there are still some small and tortuous blood vessels, and it cannot be ruled out that the tumor has broken through the diaphragm and grown to More troublesome situations such as abdominal cavity. Fortunately, after thoracotomy through the intercostal incision, it was found that the child's diaphragm was intact, the tumor was clearly demarcated, several important blood supply vessels were relatively thick, free ligation was smooth, and intraoperative bleeding was controlled to a few hundred milliliters. Under the life monitoring of the team of the anesthesia department, double-lumen endotracheal intubation on one side of the lung ventilation also provided a lot of convenience for the surgical operation, and no need to use extracorporeal circulation during the operation.
With the close cooperation of all members of the surgical team, at about 12 noon that day, the child's mediastinal teratoma was completely removed from the chest cavity. According to on-site measurement by doctors, the size of the mediastinal teratoma was 20.5 × 15 × 10 cm, and fat and bone were visible to the naked eye during the anatomy. The postoperative pathological results confirmed that it was a benign mature differentiated teratoma.
Benign teratoma was cured by surgery
Xiao Xiu's various indicators were stable after the operation. The tracheal intubation was removed in the operating room and he resumed spontaneous breathing. He was transferred to the general ward after intensive care unit html for 22 days. He was successfully discharged from the hospital a week later and is currently following treatment. The diagnosis is good and he can move freely. Director Sun Tucheng of
introduced that teratoma is an embryonic tumor that mostly occurs in young adults under the age of 30. It is caused by some mutations during the generation, migration and development of germ cells during embryonic development. It usually occurs in gonads, such as ovaries and testicles, and can also occur in the midline of the body, such as the sacrococcygeal region, , mediastinum, , retroperitoneum and other parts. . Mediastinal teratomas account for approximately 15%-20% of primary mediastinal tumors.
Clinically, teratomas are mostly benign, but may also undergo poorly differentiated malignant transformation. Generally, it grows slowly. Symptoms often appear when it grows to a certain extent and compresses surrounding tissues and organs, such as chest pain and difficulty breathing due to compression of the lungs. It can also be complicated by infection, bleeding, or ulceration into the bronchus or pericardium, causing serious consequences. Some patients are discovered accidentally during physical examination. Such a large teratoma like Xiaoxiu's, which occurs in the posterior mediastinum, is clinically rare. For benign teratomas, surgical resection can be curative.
[Reporter] Jiang Ling
[Correspondent] Zhang Lanxi Jin Ting
