Combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization: a case report
Abstract Background Aortopulmonary mediastinal paragangliomas are rare. Complete resection of the tumor is desirable regardless of tumor size in view of the risk of sudden death induced by adjacent organ compression and poor prognosis after partial resection or untreated observation. Due to the hype...
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Japan Surgical Society
2022-09-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01534-2 |
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| author | Kota Itagaki Hirotsugu Notsuda Tomoyuki Suzuki Ryota Tanaka Hiroki Kamada Kei Omata Yuta Tezuka Hideki Ota Yoshinori Okada Yoshikatsu Saiki |
| author_facet | Kota Itagaki Hirotsugu Notsuda Tomoyuki Suzuki Ryota Tanaka Hiroki Kamada Kei Omata Yuta Tezuka Hideki Ota Yoshinori Okada Yoshikatsu Saiki |
| author_sort | Kota Itagaki |
| collection | DOAJ |
| description | Abstract Background Aortopulmonary mediastinal paragangliomas are rare. Complete resection of the tumor is desirable regardless of tumor size in view of the risk of sudden death induced by adjacent organ compression and poor prognosis after partial resection or untreated observation. Due to the hypervascularity of the tumor, the risk of intraoperative bleeding is significant, and cardiopulmonary bypass is often required for complete resection. Case presentation The patient was diagnosed as having bilateral carotid body tumors and supposedly an aortic body tumor at the age of 43 and eventually underwent resections of bilateral carotid body tumors at the age of 52. The pathology of the carotid body tumors was compatible with paraganglioma on both sides. A familial succinate dehydrogenase subunit D mutation was subsequently identified. Five years later, a contrast-enhanced computed tomography scan showed an enlarged tumor of 45 mm in size in the aortopulmonary mediastinum. Based on the previously known genetic mutation, the tumor was thought to be a paraganglioma. After confirming with an endocrinologist that the aortic body tumor was non-functional, radiologists performed preoperative embolization of the feeding vessels. Subsequently, a surgical team consisting of thoracic and cardiovascular surgeons resected the aortic body tumor using a video-assisted small left thoracotomy approach combined with a median sternotomy approach. The procedure was completed without cardiopulmonary bypass or blood transfusion. The patient was discharged home on postoperative day 9 uneventfully. Conclusions After conduction of preceding interventional embolization of multiple feeding vessels, we employed a video-assisted thoracoscopic surgical approach to dissect the aspects of the tumor adjacent to the esophagus, descending thoracic aorta, and left pulmonary artery, followed by a median sternotomy approach to dissect the other aspects of the tumor adjacent to the ascending aorta, aortic arch, right pulmonary artery, and trachea. There have been no reports on scheduled preoperative embolization of feeding vessels to an aortopulmonary mediastinal paraganglioma. Multidisciplinary approach was effective for complete resection of this challenging rare mediastinal tumor. |
| format | Article |
| id | doaj-art-e4ab7ba92c4e48b8bff6b5560e98b7b6 |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2022-09-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-e4ab7ba92c4e48b8bff6b5560e98b7b62025-08-20T03:19:07ZengJapan Surgical SocietySurgical Case Reports2198-77932022-09-01811810.1186/s40792-022-01534-2Combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization: a case reportKota Itagaki0Hirotsugu Notsuda1Tomoyuki Suzuki2Ryota Tanaka3Hiroki Kamada4Kei Omata5Yuta Tezuka6Hideki Ota7Yoshinori Okada8Yoshikatsu Saiki9Division of Cardiovascular Surgery, Tohoku University HospitalDepartment of Thoracic Surgery, Tohoku University HospitalDivision of Cardiovascular Surgery, Tohoku University HospitalDepartment of Thoracic Surgery, Tohoku University HospitalDepartment of Diagnostic Radiology, Tohoku University HospitalDivision of Nephrology, Endocrinology and Vascular Medicine, Tohoku University HospitalDivision of Nephrology, Endocrinology and Vascular Medicine, Tohoku University HospitalDepartment of Diagnostic Radiology, Tohoku University HospitalDepartment of Thoracic Surgery, Tohoku University HospitalDivision of Cardiovascular Surgery, Tohoku University HospitalAbstract Background Aortopulmonary mediastinal paragangliomas are rare. Complete resection of the tumor is desirable regardless of tumor size in view of the risk of sudden death induced by adjacent organ compression and poor prognosis after partial resection or untreated observation. Due to the hypervascularity of the tumor, the risk of intraoperative bleeding is significant, and cardiopulmonary bypass is often required for complete resection. Case presentation The patient was diagnosed as having bilateral carotid body tumors and supposedly an aortic body tumor at the age of 43 and eventually underwent resections of bilateral carotid body tumors at the age of 52. The pathology of the carotid body tumors was compatible with paraganglioma on both sides. A familial succinate dehydrogenase subunit D mutation was subsequently identified. Five years later, a contrast-enhanced computed tomography scan showed an enlarged tumor of 45 mm in size in the aortopulmonary mediastinum. Based on the previously known genetic mutation, the tumor was thought to be a paraganglioma. After confirming with an endocrinologist that the aortic body tumor was non-functional, radiologists performed preoperative embolization of the feeding vessels. Subsequently, a surgical team consisting of thoracic and cardiovascular surgeons resected the aortic body tumor using a video-assisted small left thoracotomy approach combined with a median sternotomy approach. The procedure was completed without cardiopulmonary bypass or blood transfusion. The patient was discharged home on postoperative day 9 uneventfully. Conclusions After conduction of preceding interventional embolization of multiple feeding vessels, we employed a video-assisted thoracoscopic surgical approach to dissect the aspects of the tumor adjacent to the esophagus, descending thoracic aorta, and left pulmonary artery, followed by a median sternotomy approach to dissect the other aspects of the tumor adjacent to the ascending aorta, aortic arch, right pulmonary artery, and trachea. There have been no reports on scheduled preoperative embolization of feeding vessels to an aortopulmonary mediastinal paraganglioma. Multidisciplinary approach was effective for complete resection of this challenging rare mediastinal tumor.https://doi.org/10.1186/s40792-022-01534-2ParagangliomaAortopulmonary mediastinal paragangliomaIntrathoracic paragangliomaAortic body tumorSDHDPheochromocytoma |
| spellingShingle | Kota Itagaki Hirotsugu Notsuda Tomoyuki Suzuki Ryota Tanaka Hiroki Kamada Kei Omata Yuta Tezuka Hideki Ota Yoshinori Okada Yoshikatsu Saiki Combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization: a case report Surgical Case Reports Paraganglioma Aortopulmonary mediastinal paraganglioma Intrathoracic paraganglioma Aortic body tumor SDHD Pheochromocytoma |
| title | Combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization: a case report |
| title_full | Combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization: a case report |
| title_fullStr | Combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization: a case report |
| title_full_unstemmed | Combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization: a case report |
| title_short | Combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization: a case report |
| title_sort | combined left thoracoscopic and median sternotomy approach to resect aortopulmonary mediastinal paraganglioma following feeding artery embolization a case report |
| topic | Paraganglioma Aortopulmonary mediastinal paraganglioma Intrathoracic paraganglioma Aortic body tumor SDHD Pheochromocytoma |
| url | https://doi.org/10.1186/s40792-022-01534-2 |
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