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Giant Pediatric Lymphangioma Resected by Robotic Surgery in the Mediastinum – Case Report

Received: 19 January 2023     Accepted: 10 February 2023     Published: 21 February 2023
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Abstract

Lymphangiomas are slow-developing benign malformations of the lymphatic system. They are characterized by lymphatic proliferation in mucous membranes. The diagnosis is based on clinical history and, mainly, imaging findings, such as CT and NMR. Standard treatment demands total surgical excision for curative purposes A 1 year and 4 months old boy went to the hospital’s ER presenting with cough and fever. Chest X-rays showed enlarged mediastinum, and computed tomography (CT) revealed a large cystic lesion in the anterior mediastinum measuring 91x40x68 mm. Propaedeutic was extended with nuclear magnetic resonance (NMR) and transthoracic echocardiogram. A multidisciplinary team formed by pediatricians, pediatric oncologists and thoracic surgeons decided for surgical resection of the mass with the thoracic robotic surgery. Although sternotomy and thoracotomy are classic surgical choices, resection by robotic surgery was preferred in this case. Port placement: the optical portal was positioned at the level of the ninth intercostal space in the posterior axillary line, and the others were positioned under vision, respecting a minimum distance of 7 cm between them. In this case, the trochanters positioning outside of the “remote center” was important, because of the small pleural cavity with less room for tweezers mobility. The dissection and release of tumor adhesions to the brachiocephalic vein, superior vena cava and internal thoracic veins were carried out and the tumor was removed. The patient’s condition improved in the postoperative period, being discharged from the ICU in the first postoperative day and hospital discharge was on the third postoperative day, without any complications. The anatomopathological confirmed mediastinal cavernous lymphangioma.

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 9, Issue 1)
DOI 10.11648/j.ijcts.20230901.11
Page(s) 1-4
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Mediastinal Neoplasms, Pediatric, Robotics, Case Report

References
[1] Verma S, Kalra K, Rastogi S, Sidhu HS. Clinical approach to childhood mediastinal tumors and management. Mediastinum. 2020 Sep 30; 4:21. doi: 10.21037/med-19-82. PMID: 35118289; PMCID: PMC8794350.
[2] Ranganath SH, Lee EY, Restrepo R, et al. Mediastinal Masses in Children. AJR Am J Roentgenol 2012; 198: W197-216. 10.2214/AJR.11.7027.
[3] O’Keeffe FN, Swischuk LE, Stansberry SD. Mediastinal pseudomass caused by compression of the thymus in neonates with anterior pneumothorax. AJR Am J Roentgenol 1991; 156: 145-8. 10.2214/ajr.156.1.1898549.
[4] Kaplan G, Sarino EF, Principato DJ. Pseudotumor of the Mediastinum. Chest 1973; 63: 620-1. 10.1378/chest.63.4.620
[5] Miceli A, Stewart K. Lymphangioma [Internet]. Ncbi.nlm.nih.gov. 2020 [cited 4 November2020]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470333/
[6] Stewart CJ, Chan T, Platten M. Acquired lymphangiectasia ('lymphangioma circumscriptum') of the vulva: a report of eight cases. Pathology. 2009; 41 (5): 448-53.
[7] Khalilzadeh S, Hassanzad M, Cheraghvandi A, Abdollah MP, Khodayari AA, Javaherzadeh M. Mediastinal lymphangioma in a child. Tanaffos. 2012; 11 (2): 58-60. PMID: 25191417; PMCID: PMC4153197.
[8] Ferguson R, Hodges J, Harness-Brumley C, Girod C, Bartolome S, DiMaio J. Thoracic Cavernous Lymphangioma Provoking Massive Chyloptysis. Journal of Investigative Medicine High Impact Case Reports. 2013; 1 (3).
[9] Straughan DM, Fontaine JP, Toloza EM. Robotic-Assisted Videothoracoscopic Mediastinal Surgery. Cancer Control. 2015 Jul; 22 (3): 326-30. doi: 10.1177/107327481502200310. PMID: 26351888.
[10] Savitt MA, Gao G, Furnary AP, et al. Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum. Ann Thorac Surg. 2005; 79 (2): 450-455.
[11] Ismail M, Swierzy M, Rückert JC. State of the art of robotic thymectomy. World J Surg. 2013; 37 (12): 2740-2746.
[12] Park J, Aubry M, Godfrey J, Midthun D. Mediastinal Lymphangioma: Mayo Clinic Experience of 25 Cases. Mayo Clinic Proceedings. 2006; 81 (9): 1197-1203.
[13] Ng E, Shah V, Armstrong D, Clarke H. Cavernous lymphangioma. The Journal of Pediatrics. 2001; 138 (1): 146.
[14] Mattioli, G; Petraglia, P.; Pediatric Robotic Surgery. Springer; 1st ed. 2017 edition (October 20, 2017) DOI10.1007/978-3-319-41863-6_20
[15] Denning NL, Kallis MP, Prince JM. Pediatric Robotic Surgery. Surg Clin North Am. 2020 Apr; 100 (2): 431-443. doi: 10.1016/j.suc.2019.12.004. Epub 2020 Feb 7. PMID: 32169188.
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    Erlon de Avila Carvalho, Marina Varela Braga de Oliveira, Philippe Chaves Winter, Ana Clara de Paula Caldas, Astunaldo Júnior de Macedo e Pinho, et al. (2023). Giant Pediatric Lymphangioma Resected by Robotic Surgery in the Mediastinum – Case Report. International Journal of Cardiovascular and Thoracic Surgery, 9(1), 1-4. https://doi.org/10.11648/j.ijcts.20230901.11

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    ACS Style

    Erlon de Avila Carvalho; Marina Varela Braga de Oliveira; Philippe Chaves Winter; Ana Clara de Paula Caldas; Astunaldo Júnior de Macedo e Pinho, et al. Giant Pediatric Lymphangioma Resected by Robotic Surgery in the Mediastinum – Case Report. Int. J. Cardiovasc. Thorac. Surg. 2023, 9(1), 1-4. doi: 10.11648/j.ijcts.20230901.11

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    AMA Style

    Erlon de Avila Carvalho, Marina Varela Braga de Oliveira, Philippe Chaves Winter, Ana Clara de Paula Caldas, Astunaldo Júnior de Macedo e Pinho, et al. Giant Pediatric Lymphangioma Resected by Robotic Surgery in the Mediastinum – Case Report. Int J Cardiovasc Thorac Surg. 2023;9(1):1-4. doi: 10.11648/j.ijcts.20230901.11

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  • @article{10.11648/j.ijcts.20230901.11,
      author = {Erlon de Avila Carvalho and Marina Varela Braga de Oliveira and Philippe Chaves Winter and Ana Clara de Paula Caldas and Astunaldo Júnior de Macedo e Pinho and Daniel Oliveira Bonomi},
      title = {Giant Pediatric Lymphangioma Resected by Robotic Surgery in the Mediastinum – Case Report},
      journal = {International Journal of Cardiovascular and Thoracic Surgery},
      volume = {9},
      number = {1},
      pages = {1-4},
      doi = {10.11648/j.ijcts.20230901.11},
      url = {https://doi.org/10.11648/j.ijcts.20230901.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20230901.11},
      abstract = {Lymphangiomas are slow-developing benign malformations of the lymphatic system. They are characterized by lymphatic proliferation in mucous membranes. The diagnosis is based on clinical history and, mainly, imaging findings, such as CT and NMR. Standard treatment demands total surgical excision for curative purposes A 1 year and 4 months old boy went to the hospital’s ER presenting with cough and fever. Chest X-rays showed enlarged mediastinum, and computed tomography (CT) revealed a large cystic lesion in the anterior mediastinum measuring 91x40x68 mm. Propaedeutic was extended with nuclear magnetic resonance (NMR) and transthoracic echocardiogram. A multidisciplinary team formed by pediatricians, pediatric oncologists and thoracic surgeons decided for surgical resection of the mass with the thoracic robotic surgery. Although sternotomy and thoracotomy are classic surgical choices, resection by robotic surgery was preferred in this case. Port placement: the optical portal was positioned at the level of the ninth intercostal space in the posterior axillary line, and the others were positioned under vision, respecting a minimum distance of 7 cm between them. In this case, the trochanters positioning outside of the “remote center” was important, because of the small pleural cavity with less room for tweezers mobility. The dissection and release of tumor adhesions to the brachiocephalic vein, superior vena cava and internal thoracic veins were carried out and the tumor was removed. The patient’s condition improved in the postoperative period, being discharged from the ICU in the first postoperative day and hospital discharge was on the third postoperative day, without any complications. The anatomopathological confirmed mediastinal cavernous lymphangioma.},
     year = {2023}
    }
    

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    AU  - Erlon de Avila Carvalho
    AU  - Marina Varela Braga de Oliveira
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    JO  - International Journal of Cardiovascular and Thoracic Surgery
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    AB  - Lymphangiomas are slow-developing benign malformations of the lymphatic system. They are characterized by lymphatic proliferation in mucous membranes. The diagnosis is based on clinical history and, mainly, imaging findings, such as CT and NMR. Standard treatment demands total surgical excision for curative purposes A 1 year and 4 months old boy went to the hospital’s ER presenting with cough and fever. Chest X-rays showed enlarged mediastinum, and computed tomography (CT) revealed a large cystic lesion in the anterior mediastinum measuring 91x40x68 mm. Propaedeutic was extended with nuclear magnetic resonance (NMR) and transthoracic echocardiogram. A multidisciplinary team formed by pediatricians, pediatric oncologists and thoracic surgeons decided for surgical resection of the mass with the thoracic robotic surgery. Although sternotomy and thoracotomy are classic surgical choices, resection by robotic surgery was preferred in this case. Port placement: the optical portal was positioned at the level of the ninth intercostal space in the posterior axillary line, and the others were positioned under vision, respecting a minimum distance of 7 cm between them. In this case, the trochanters positioning outside of the “remote center” was important, because of the small pleural cavity with less room for tweezers mobility. The dissection and release of tumor adhesions to the brachiocephalic vein, superior vena cava and internal thoracic veins were carried out and the tumor was removed. The patient’s condition improved in the postoperative period, being discharged from the ICU in the first postoperative day and hospital discharge was on the third postoperative day, without any complications. The anatomopathological confirmed mediastinal cavernous lymphangioma.
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Author Information
  • Thoracic Surgery Service, Clinical Hospital of Federal University of Minas Gerais and Mater Dei Health Hospital, Belo Horizonte, Brazil

  • Thoracic Surgery Service, Mater Dei Health Hospital, Belo Horizonte, Brazil

  • Thoracic Surgery Service, Mater Dei Health Hospital, Belo Horizonte, Brazil

  • Departament of Thoracic Surgery and Pneumology, Federal University of Minas Gerais, Belo Horizonte, Brazil

  • Thoracic Surgery Service, Clinical Hospital of Federal University of Minas Gerais and Mater Dei Health Hospital, Belo Horizonte, Brazil

  • Thoracic Surgery Service, Clinical Hospital of Federal University of Minas Gerais and Mater Dei Health Hospital, Belo Horizonte, Brazil

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