Skip to main content Skip to main navigation menu Skip to site footer

Resection of a mature giant teratoma with clamshell incision thoracotomy approach: Case report and literature review



Abstract

Introduction: Resection of giant teratomas can be challenging. An advanced surgical technique should be designed to ensure surgical safety and complete removal of giant teratomas. We describe a case of a mature giant teratoma successfully resected with a clamshell incision thoracotomy approach.

Case Description: A female, 11 years complained of shortness of breath for the last two weeks before being admitted to the hospital.  Physical examination revealed a retraction of the patient's chest wall, decreased breath sounds in the left lung field, and dull percussion in the left lung field. Chest CT scan with contrast was carried out with a minimal right pleural effusion with mediastinal mass size 14 x 17 x 16 cm. The patient underwent surgery to extract the mediastinal mass; an anterior thoracotomy was performed using the Clamshell incision method on the patient's chest. Complete resection of the mass was performed. Histopathology examination was performed on the mass with the results in accordance with the description of Mature Cystic Teratoma. The patient returned home in good condition and then controlled through the outpatient polyclinic.

Discussion: Clamshell incisions provide enough exposure for tumors in the mediastinum that extend into the thoracic cavity. For complete removal of a gigantic teratoma, extensive surgical and visual fields are required, as in this case.

Conclusion: Clamshell incisions in anterior thoracotomy give a good surgical field and can be safely performed in patients with large mediastinal teratomas.

Keywords: giant teratoma clamshell incision thoracotomy

References

  1. Verma S, Kalra K, Rastogi S, Sidhu HS. Clinical approach to childhood mediastinal tumors and management. Mediastinum. 2020;4.
  2. Kuniej T, Całka K, Jaźwiec P, Plucińska I, Magott-Derkacz A, Kedzierski B, et al. Radiological findings of large teratoma in anterior mediastinum. Polish J Radiol. 2006;71(4).
  3. Lakhoo K. Neonatal teratomas. Early Hum Dev. 2010;86(10).
  4. Shameem M, Qaseem SMD, Siddiqui MA, Shah NN, Ahmad A. Mature mediastinal teratoma in adult. Respir Med CME. 2010;3(2).
  5. Kim D, Kim SW, Hong JM. Rapid growing huge teratoma: Complete surgical resection. J Thorac Dis. 2014;6(10).
  6. Bains MS, Ginsberg RJ, Jones WG, McCormack PM, Rusch VW, Burt ME, et al. The clamshell incision: An improved approach to bilateral pulmonary and mediastinal tumor. Ann Thorac Surg. 1994;58(1).
  7. Hayati F, Ali NM, Kesu Belani L, Azizan N, Zakaria AD, Rahman MRA. Giant Mediastinal Germ Cell Tumour: An Enigma of Surgical Consideration. Case Rep Surg. 2016;2016.
  8. Li WWL, Van Boven WJP, Annema JT, Eberl S, Klomp HM, de Mol BAJM. Management of large mediastinal masses: Surgical and anesthesiological considerations. Vol. 8, Journal of Thoracic Disease. 2016.
  9. Minocha P, Hodzic E, Sharma M, Bhatla P, Nielsen J, Ramirez M, et al. Surgical Management of Giant Intrapericardial Teratoma Encasing the Coronary Artery. World J Pediatr Congenit Hear Surg. 2022;13(1).
  10. Chen CK, Chang YL, Jou ST, Tseng YT, Lee YC. Treatment of Mediastinal Immature Teratoma in a Child With Precocious Puberty and Klinefelter’s Syndrome. Ann Thorac Surg. 2006;82(5).
  11. Wolak P, Skiba R, Niedziela W. Giant teratoma of anterior mediastinum in a 14-year-old girl as an example of potential diagnostic problems and errors. Med Stud. 2013;3.
  12. Toda M, Izumi N, Tsukioka T, Komatsu H, Okada S, Hara K, et al. Huge mediastinal liposarcoma resected by clamshell thoracotomy: a case report. Surg Case Reports. 2017;3(1).
  13. Cooper JD, Patterson GA, Pohl MS. Current status of lung transplantation--report of the St. Louis International Lung Transplant Registry. Clin Transpl. 1992;
  14. Macchiarini P, Le Roy Ladurie F, Cerrina J, Fadel E, Chapelier A, Dartevelle P. Clamshell or sternotomy for double lung or heart-lung transplantation? Eur J Cardio-thoracic Surg. 1999;15(3).
  15. Shimizu J, Oda M, Morita K, Watanabe S, Ohta Y, Hayashi Y, et al. Evaluation of the clamshell incision for bilateral pulmonary metastases. Int Surg. 1997;82(3).
  16. Doss M, Woehleke T, Wood JP, Martens S, Greinecker GW, Moritz A. The clamshell approach for the treatment of extensive thoracic aortic disease. J Thorac Cardiovasc Surg. 2003;126(3).
  17. Detterbeck FC, Hennington MH. Single-stage replacement of the entire thoracic aorta via transverse thoracosternotomy. South Med J. 1996;89(3).
  18. Ergin MA, O’Connor J, Guinto R, Griepp RB. Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute arch dissections. J Thorac Cardiovasc Surg. 1982;84(5).
  19. Kouchoukos NT, Masetti P, Rokkas CK, Murphy SF. Single-stage reoperative repair of chronic type A aortic dissection by means of the arch-first technique. J Thorac Cardiovasc Surg. 2001;122(3).

How to Cite

Adhyasta Nata Prawira Subianto, & Maz Isa Ansyori Arsatt. (2022). Resection of a mature giant teratoma with clamshell incision thoracotomy approach: Case report and literature review. Intisari Sains Medis, 13(2), 530–533. https://doi.org/10.15562/ism.v13i2.1426
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
0

Total
0

Share

Search Panel

Adhyasta Nata Prawira Subianto
Google Scholar
Pubmed
ISM Journal

Maz Isa Ansyori Arsatt
Google Scholar
Pubmed
ISM Journal