Video assisted thoracoscopic resection of a posterior mediastinal Castleman's tumor

Abstract

Castleman's disease (CD) or angiofollicular lymph node hyperplasia is a rare spectrum of lymphoproliferative disorders. CD tumors are commonly localized in the mediastinum and are usually asymptomatic. The mainstay of treatment is surgical resection and has typically been performed using open thoracotomy. Few reports in the literature describe video assisted thoracoscopic resection of these tumors. The differential diagnosis for mediastinal masses is extensive, and CD tumors, although uncommon, should be considered. We describe a case report of a posterior mediastinal Castleman's tumor adherent to the esophagus, which was resected thoracoscopically and review the literature.

Successful Treatment of Mediastinal Unicentric Castleman’s Disease Using Video-Assisted Thoracoscopic Surgery with Preoperative Embolization

“…However, surgical resection of UCD may be complicated by serious intraoperative bleeding because of the inherent tumor hypervascularity [19], especially for posterior mediastinal tumors because of their dense adhesion to surrounding tissues [20]. Although VATS has growing popularity for the treatment of UCD cases [21–23], conversion from VATS to a thoracotomy was required because of uncontrollable intraoperative bleeding in a recent case report [20], and some studies have stated that VATS should not be recommended as a surgical approach for the resection of mediastinal Castleman's disease [24]. In our case, the patient was young woman who desired a minimally invasive procedure, such as VATS.…”

Intrathoracic Castleman disease

“…Due to the invasive nature of lymphadenopathy in multicentric diseases, complete surgical excision is rarely possible (17). While surgical approaches typically involve posterolateral thoracotomy, the literature contains a limited body of research on video-assisted thoracoscopic resection (8). The mode of surgical approach in our study mostly involved standard thoracotomy (78%) and videoassisted thoracoscopy (15%).…”

“…However, long-term follow-up is recommended for patients with multicentric CD due to their increased risk for developing multiple myeloma, B cell lymphoma, Hodgkin lymphoma, or Kaposi sarcoma. Median survival rate of patients with multicentric CD is 29 months; mortality was reported as 26% within 1 year of diagnosis (4,6,8,10). Two patients with multicentric-type CD in the present study were followed during the first year and the sixth month, respectively, without any problems.…”

“…An accepted approach for both diagnostic and therapeutic reasons is surgical excision of these lesions (15). The patients who underwent surgical excision showed that surgery is almost always curative for either the hyaline vascular type or plasma cell localized CD (8,10,16). Due to the invasive nature of lymphadenopathy in multicentric diseases, complete surgical excision is rarely possible (17).…”

Experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumours: a retrospective analysis of 58 patients

“…Thus, traditional thoracotomy procedure was promptly replaced by this mini‐invasive procedure . The anatomy was relatively simple in posterior mediastinal region; thus, the tumour origin from this region was one of the best indications for VAT procedure . However, the incidence of mediastinal tumour was relatively low, and those tumours from posterior mediastinal region account for less than 20% of all mediastinal tumours, so there was a lack of bulk of treatment reported.…”