Mediastinal paraganglioma successfully resected by robot-assisted thoracoscopic surgery with en bloc chest wall resection: a case report

Abstract

Background: Robot-assisted thoracoscopic surgery (RATS) is useful for surgery in the apical region of the chest cavity, as it narrows towards the head. Here, we describe a nonfunctional, rib-invasive paraganglioma arising in the posterior mediastinum that was successfully removed using RATS combined with chest wall resection.

Case presentation: A 31-year-old woman presented with a posterior mediastinal mass on chest computed tomography (CT) scan during a medical check-up 2 years prior. Positron emission tomography/computed tomography scan with F-18 fluorodeoxyglucose revealed a mass associated with standardized uptake maximum value of 2.69. With a preoperative diagnosis of neurogenic tumor by CT-guided percutaneous fine-needle aspiration biopsy, we performed robot-assisted tumor resection combined with chest wall resection. The wristed instruments of the robotic surgical system have increased range of motion and enabled the tumor resection without organ injury in the thoracic cavity. Histopathology examination revealed a non-functional paraganglioma with rib invasion.

Conclusions: RATS is a useful technique, enabling safer and easier resection of a mediastinal tumor adjacent to surrounding organs.

Keywords: Mediastinal tumor; Paraganglioma; Robot-assisted thoracoscopic surgery.

Fig. 1

a Contrast-enhanced computed tomography revealing a solitary nonhomogeneous 4-cm mass in the posterior mediastinum. b, c The mass invaded the left 2nd rib (black arrow). d, e Magnetic resonance imaging (MRI) showing that the signal inside the mass was representative of muscle tissues equivalent to that on the T1-weighted image and hyperintense on the T2-weighted image. f Contrast-enhanced MRI showing similar signal changes and contrast effects on the dorsal side of the second rib in contact with the tumor. Bone infiltration is noted (white arrow). g Positron emission tomography/computed tomography scan with F-18 fluorodeoxyglucose showing standardized uptake values of 2.69

Fig. 2

a Port placement (red circle) and posterior skin incision (red line). (ICS, Intercostal; C, Camera). b Intraoperative findings after the da Vinci surgical system was docked with the patient, and the left chest was explored

Fig. 3

a Macroscopic findings of the resected specimen. The tumor consists of a tan red irregular ovoid mass measuring 4.5 × 3.3 × 2.2 cm. b The specimen is stained with hematoxylin-eosin; original magnification: × 20. The specimen is a nodular lesion continuous with the peripheral nerve, characterized by epithelial-like cells with abundant proliferating eosinophilic endoplasmic reticulum forming small clusters. There are a few atypical spindle cells in the background. c Rib bone tissue stained with HE revealing invasion; original magnification: × 4. The specimen is also stained with d S-100, e chromogranin and f synaptophysin; original magnification: × 20