A Mediastinal Liposarcoma Resected Using a Double Approach with a Thoracoscope

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Abstract

We report a case of a 45-year-old woman who underwent a complete resection of a liposarcoma using thoracoscopic and cervical approaches. General checkup and computed tomography revealed a large mediastinal tumor occupying the thoracic outlet, which had reached the posterior thyroid region, and another small tumor at a subcarina. A cervical method for evaluating a neck lesion and a thoracoscopic (video-assisted thoracic surgery) approach for assessing a mediastinal lesion were performed. This double approach provided excellent visualization and enabled us to perform fine manipulation even within the narrow thoracic outlet region. The patient was disease free at 11 months after surgery.

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Primary sarcomas of the mediastinum: results of therapy.

J K Ihde, M Bains, Bruce R Downey … (1998)

Primary sarcomas of the mediastinum are rare, and data concerning treatment and results of therapy are sparse. To assess presentation, management, prognostic factors, and survival in mediastinal sarcomas. We reviewed our experience with 47 patients with the diagnosis of primary sarcoma of the mediastinum. Data were collected from a computerized institutional database and medical records. Survival was analyzed by Kaplan-Meier method and comparisons of survival by log rank test. The median age of 47 patients with mediastinal sarcoma was 39 years (range 2.5 to 69 years), with a male/female ratio of 1.6. The most common complaints were chest/shoulder pain (38%) and dyspnea (23%). The most common tumor types were malignant peripheral nerve tumor (26%), spindle cell sarcoma (15%), leiomyosarcoma (9%), and liposarcoma (9%). Operation was the primary treatment modality in 72% of cases (n = 34); 22 sarcomas (47%) were completely resected. The overall 5-year survival was 32%. High-grade lesions had a significantly decreased survival (5-year survival = 27%) compared with low-grade tumors (5-year survival = 66%) (p = 0.05). The overwhelming factor determining survival was the ability to completely resect the tumors (5-year survival 49% for complete resection; 3-year survival 18% for incomplete or no resection) (p = 0.0016). Despite complete resection, local recurrence occurred in 64% of cases. Because the overall survival for patients with mediastinal sarcomas is 32% and the local recurrence is 64% for tumors completely resected, aggressive adjuvant therapy should continue to be systematically explored.

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Liposarcomas of the mediastinum and thorax: a clinicopathologic and molecular cytogenetic study of 24 cases, emphasizing unusual and diverse histologic features.

Jennifer Boland, Thomas Colby, Andrew L. Folpe (2012)

Liposarcoma rarely occurs in the mediastinum, and most reports predate the current genetically based classification system. We report the clinicopathologic and molecular genetic features of a series of thoracic liposarcomas identified over a 60-year period. Twenty-four confirmed cases were reclassified using the most recent World Health Organization classification. Fluorescent in situ hybridization for CPM amplification and/or DDIT3 rearrangement was performed on selected cases. The 24 cases occurred in 13 men and 11 women (mean age, 53 y; range, 15 to 73 y) and arose in all mediastinal compartments. All subtypes were encountered with 8 well-differentiated liposarcomas, 6 dedifferentiated liposarcomas (3 of 6 confirmed CPM+), 7 pleomorphic liposarcomas (2 of 7 confirmed CPM-, 1 of 7 confirmed DDIT3-), 2 myxoid liposarcomas, and 1 unclassifiable liposarcoma (CPM- and DDIT3-). Unusual histologic features included myxoid well-differentiated liposarcoma mimicking myxoid liposarcoma (2 cases), lipoleiomyosarcoma (1 case), dedifferentiated liposarcoma with "meningothelial"-like dedifferentiation, differentiated myxoid liposarcoma mimicking well-differentiated liposarcoma (CPM-), and pleomorphic liposarcoma with epithelioid and myxoid change. Follow-up information was available for 19 patients (mean, 55 mo; range, 8 to 252 mo). Outcome was strongly associated with histologic subtype, with death from disease occurring in 1 of 6 well-differentiated, 1 of 4 dedifferentiated, 5 of 7 pleomorphic, and 2 of 2 myxoid liposarcomas. The mediastinum shows a preponderance of uncommon subtypes and unusual morphologic variants. Correct classification has important implications, with most patients with well-differentiated/dedifferentiated liposarcoma having a protracted clinical course, in contrast to the more rapid disease progression seen in patients with myxoid and pleomorphic liposarcoma.

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Surgical resection of recurrent bilateral mediastinal liposarcoma through the clamshell approach.

Kazuyoshi Katayanagi, Tomomi Murata, Yasuhiko Ohta … (2004)

Primary mediastinal liposarcoma is an unusual variant of mediastinal neoplasms. We describe a long-term survivor who underwent repeated operations. After resections through a posterolateral thoracotomy and median sternotomy, a third operation was performed for recurrent bilateral huge tumors through a clamshell incision, and both tumors were removed en bloc. Results of pathologic examination showed that both tumors were well-differentiated liposarcoma. The patient is currently well 16 years after the first operation. Aggressive surgical intervention whenever possible appears to improve the quality of life and prolong the survival of patients with mediastinal liposarcoma.

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Author and article information

Journal

Journal ID (nlm-ta): Thorac Cardiovasc Surg Rep

Journal ID (iso-abbrev): Thorac Cardiovasc Surg Rep

Journal ID (doi): 10.1055/s-00024355

Title: The Thoracic and Cardiovascular Surgeon Reports

Publisher: Georg Thieme Verlag KG (Stuttgart · New York )

ISSN (Print): 2194-7635

ISSN (Electronic): 2194-7643

Publication date (Electronic): 25 October 2013

Publication date (Print): December 2013

Volume: 2

Issue: 1

Pages: 46-49

Affiliations

[1 ]Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan

[2 ]Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan

[3 ]Department of Breast and Endocrine Surgery, Shinshu University School of Medicine, Matsumoto, Japan

Author notes

Address for correspondence Kazuo Yoshida, MD, PhD Department of Thoracic Surgery, Shinshu University School of Medicine 3-1-1 Asahi Matsumoto 3908621Japan kxy13@ 123456shinshu-u.ac.jp

Article

Publisher ID: 130036cr

DOI: 10.1055/s-0033-1358605

PMC ID: 4176071

PubMed ID: 25360414

SO-VID: 66a8d3cf-5fa2-4963-bf7f-db9b1cb0b21c

History

Date received : 02 July 2013

Date accepted : 19 August 2013

A Mediastinal Liposarcoma Resected Using a Double Approach with a Thoracoscope

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Abstract

Most cited references 4

Primary sarcomas of the mediastinum: results of therapy.

Liposarcomas of the mediastinum and thorax: a clinicopathologic and molecular cytogenetic study of 24 cases, emphasizing unusual and diverse histologic features.

Surgical resection of recurrent bilateral mediastinal liposarcoma through the clamshell approach.

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