Leiomiosarcoma primario de mediastino que compromete el sistema de la vena cava superior: Resección quirúrgica asociada a reconstrucción venosa

Abstract

Primary leiomyosarcoma of the mediastinum involving the superior vena cava system. Surgical resection and venous reconstructionMediastinal tumors have multiple presentation forms and various pathological origins. Sometimes they reach a large size and can involve the system of superior vena cava by compression or infi ltration. We present a 48 year old man admited for dyspnea, headache and palpitations in decubitus, for the last two months. The X-ray and chest computed tomography showed an anterior mediastinal tumor and the tru-cut pathological study concluded leiomyosarcoma. He underwent surgical treatment; the tumor compromised the system of the superior vena cava and was resected with ligation and resection the left brachiocephalic trunk. Part of the superior vena cava was reconstructed with autologous pericardium. The right phrenic nerve was surrounded by the tumor mass and was resected in block. The patient recovered satisfactorily and was discharged on the eleventh day post surgery. The histopathologic study of the surgical specimen confi rmed a leiomyosarcoma G2 (3,100 gr). Full adjuvant radiotherapy was done. At 15 months after surgery the patient is in good condition without evidence of recurrence or superior vena cava syndrome.Key words: Leiomyosarcoma, mediastinum, vena cava superior, thoracic surgery, cardiovascular surgical procedures. ResumenLos tumores del mediastino pueden tener múltiples formas de presentación y diversos orígenes anatomopatológicos. A veces alcanzan gran tamaño y pueden comprometer por compresión o infi ltración el sistema de la vena cava superior. Presentamos el caso de un hombre de 48 años que consultó por disnea, cefalea y Rev. Chilena de Cirugía.