A case of giant mediastinal leiomyoma with long-term survival.

Abstract

A 67-year-old female was emergently admitted to our hospital because of severe dyspnea with cyanosis. One month before admission, she consulted a doctor and chest x-ray disclosed a huge tumor shadow occupying most of the left hemithorax. At that time, she did not complain of any particular symptoms except slight cough. Twelve days after admission, the patient lost consciousness and an emergency operation was performed. The tumor showed severe adhesion to the aorta and the lower lobe of the left lung, but not to the esophagus. After the operation, mechanical ventilation was necessary for 13 days to recover pulmonary function. Histological diagnosis was made as leiomyoma, which is rarely seen in the mediastinal region. At present, the patient survived 10 years without any symptom of recurrence. In this paper, the authors report a case of mediastinal leiomyoma which received an emergency operation and attained long term survival. Twelve similar cases reported in the past were also reviewed. mediastinal leiomyoma ; emergency operation ; long-term survivalMediastinal masses have interesting diagnostic and therapeutic problems for the clinician.Recent advances in radiographic, surgical and anesthesia tech niques have improved clinical understanding and therapeutic results for medias tinal tumors. However, there are still considerable cases that definite diagnosis is difficult before surgery. Leiomyoma of mediastinum origin is quite rare in incidence (Morrison 1958 ;Petrikova 1982). Clinical features, including initial symptoms, radiographic appearance, and therapeutic results are still unclear. In this paper, the authors report a case with giant mediastinal leiomyoma which received an emergency operation and attained long-term disease-free survival.There were 12 cases of mediastinal leiomyoma reported in the literature, 7 from other countries and 5 from Japan (Nishimoto et al. 1957;Rasaretnam and Panabokke 1975;Suzuki et al. 1982).

Mesenchymal tumours of the mediastinum—part II

“…To qualify as a primary mediastinal leiomyoma, tumours should arise from the somatic soft tissue of the mediastinum, whilst esophageal and large vessel primaries should be excluded. If these criteria are applied, primary mediastinal leiomyoma is very rare with approximately 20 reported cases in the literature [ 14 , 19 , 136 , 139 , 149 , 162 , 180 , 205 , 227 ]. Mediastinal leiomyoma is twice as common in females as in males and is mainly seen in the posterior mediastinum of older adults (age range 23–75 years; median age 50 years).…”

Case Report : Primary Mediastinal Leiomyoma

“…In the only less than 20 cases of primary mediastinal leiomyomas have been described. In the different cases described, primary mediastinal leiomyomas are frequent in adult women [1,2,3]. However, Li and al.…”

Surgical treatment of giant mediastinal tumors

“…The malignant tumors consisted of nine liposarcomas,[ 4 - 13 ] five thymomas (Masaoka Stage II-III),[ 14 - 18 ] three schwannomas,[ 19 , 20 ] one gangliocytoma,[ 21 ] one angiolipoma,[ 22 ] one endodermal sinus tumor,[ 23 ] one epithelioid angiosarcoma,[ 24 ] one stromal tumor,[ 25 ] and one solitary fibrous tumor. [ 26 ] The benign tumors included five mature teratomas,[ 27 - 31 ] five schwannomas,[ 2 , 32 - 35 ] five t hymolipomas,[ 36 - 40 ] two leiomyomas,[ 41 , 42 ] two thymomas (Masaoka Stage I),[ 43 , 44 ] one pericardial cyst,[ 45 ] one germ cell tumor,[ 46 ] one cavernous hemangioma,[ 47 ] one lymphangioma,[ 48 ] and one pericardial paraganglioma. [ 49 ]…”