• Tuberculosis and Respiratory Diseases
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• v.43 no.6
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• pp.1008-1018
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• 1996

Primary mediastinal nonseminomatous germ cell tumor is extremely rare. Apart from rarity and large size, mediastinal germ cell tumors show striking similarity to testicular tumors in age, incidence, and tumor type. The symptoms associated with these tumors are related mainly to size, invasion of neighboring structures, and distant metastases. Tissue diagnosis is obtained by biopsy of the primary lesion or by biopsy of metastatic sites. Tumors often present with advanced bulky disease, which are unresectable. So these tumors require an aggressive multidisciplinary approach to management. Optimal management includes aggressive surgical debulking and early use of cisplatin-bleomycin-based combination chemotherapy. Serial biomarker measurements permit early recognition of recwrence and improved timing of surgical intervention. The prognosis for mediastinal germ cell tumors is poor, not only because they are far advanced at the time of diagnosis but also because some of the tumors-such as embryonal carcinomas, choriocarcinomas, and endodermal sinus tumors-are very aggressive. In these cases, we present three young male patients with large mass on anterior mediastinum. Tissue diagnosis was obtained by primary lesion biopsy. All patients received surgical debulking and combination chemotherapy and experienced a brief response and eventually had relapses. We report these cases with a review of literatures.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.277-280
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• 2010

Purpose: The resection of locally advanced or recurred breast cancers frequently result in large chest wall defects and it leads to a great challenges to cover. Generally simple skin grafts are not a practical option for patients because of their poor cosmetic appearance and prognosis. The latissimus dorsi and rectus abdominis musculocutaneous flap have traditionally been recommended for closure of these large defects. Though the cosmetic result of reconstruction using these flaps is often excellent, but has significant drawbacks. Therefore, we thought that chest wall reconstruction using the external oblique musculocutaneous flap can be an alternative method for extensive chest wall defect related to large, locally advanced breast carcinoma. Methods & Results: We present a case of a 50-year-old Korean female, refered to our department with a left breast tumor for 10 months. CT demonstrate a large tumor on the left anterior chest wall and multiple nodules of varying size in the cervical areas and liver. FDG-PET showed areas of hot uptake throughout the left chest wall, mediastinum and liver. Biopsy was consistent with invasive ductal carcinoma (Grade III). The initial tumor was considered inoperable, so a series of chemotherapy was initiated. Though the size of the breast mass was slightly decreased, the patient continued to suffer from purulent discharge, unpleasant odor and contact bleeding of the mass, the salvage mastectomy was performed. Conclusion: We could reconstruct $23{\times}16\;cm$ sized large chest wall defect, resulting from the resection of a locally advanced breast carcinoma, using an external oblique musculocutaneous flap successfully. Immediate postoperatively checked flap was healthy. Overall result was good without any significant complications and discharged 3 weeks after operation.

• Journal of Chest Surgery
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• v.32 no.7
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• pp.686-689
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• 1999

Descending necrotizing mediastinitis(DNM) is a rare complication of the oropharyngeal and cervical infection. Descending necrotizing mediastinitis requires an early and aggressive surgical approach to reduce the high morbidity and mortality associated with this disease. A 39-year-old man complained of odynophagia, neck swelling, and disturbance of swallowing with dyspnea. CT scans of the neck suggested a peritonsillar abscess and retropharyngeal and peripharyngeal abscess. He underwent cervical drainage. He remained febrile and complained of severe both pain in both shoulders. On postoperative day 5, a follow-up CT scan confirmed a mediastinal abscess. Reexploration of the neck and right thoracotomy for debridement and drainage of the mediastinal abscess were performed.. A large amount of pus was drained from the anterior and posterior mediastinum and its necrotic tissue was debrided. The patient's condition and radiologic findings gradually improved. Cultures of the drain fluid revealed Klebsiella pneumoniae. He was discharged on the 85th hospital day. In our experience, both transcervical drainage and aggressive mediastinal exploration via thoracotomy can lead to an improvement in the survival of the patient with descending necrotizing mediastinitis. CT scanning is useful for early diagnosis of mediastinitis and for follow up.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.771-774
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• 2016

Thymic tumors are the most common tumors in the anterior mediastinum. Total resection is the main treatment and predictor of longer survival. Adjuvant radiotherapy alone or in combination with chemotherapy is recommended with incomplete excision or advanced disease. Thirty seven patients with thymic tumors were included in this retrospective study from January 2001 till December 2012. They were studied regarding age, sex, performance status, tumor size and invasion, stage, pathology, treatment given, overall and progression free survival. Myasthenia gravis was present in 18.1% of the patients. Masaoka stage III was diagnosed in 40.5% of the cases followed by stage II in 24.3% and the other stages with lower percentages. Pathology type B3 was the most frequent followed by B2 and B1 with percentages of 27, 24.3 and 21.7 respectively. Complete resection was conducted in 11 cases (29.75%). Partial resection or debulking was done in 15 (40.5%) and a biopsy was taken in 11 cases (29.8%) Adjuvant chemotherapy was given to 14 patients (37.8%) and neoadjuvant to 13 (35.2%). Adjuvant radiotherapy was given to 17 patients (46%) and neoadjuvant to 14 (37.8%). The 5-year overall survival by was 83% for stage I, 71% for stage II, 60% for stage III, and 44% for stage IV (p=0.0426). Five year progression free survival was 71% for stage I, 62% stage II, 42% stage III, and 37% for stage IV (p=0.0532). In conclusion with the rare thymic tumors early stage and complete resection have the highest impact on overall and progression free survival.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.718-722
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• 1999

Thymoma is the most common tumor in the compartment of anterior mediastinum. The malignant thymoma is classified into invasive thymoma(category I) and thymic carcinoma(category II). Recently, well-differentiated thymic carcinoma is a proposed category 1.5 used to describe a subset of thymic epithelial tumors, allowing for the existence of intermediate form based on the clinical features and the histological characteristics. Thymic cyst is a congenital or a acquired disorder. Congenital thymic cyst may develop due to failure of the thymopharyngeal duct to obliterate and acquired thymic cyst develops from inflammation(multilocular thymic cyst), or neoplasm(cystic thymoma). Cystic degeneration in thymoma is a relatively frequent but focal event. In rare cases, the process proceeds to the extent that most or all of the lesion becomes cystic. Until now, well-differentiated thymic carcinoma with extensive cystic degeneration has not been reported in our country. We experienced a case of 14 year-old female patient showing extensive cystic degeneration in well-differentiated thymic carcinoma. And so we report it with review of the articles related.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.482-485
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• 2006

Video-assisted thoracoscopic surgery has gained a broad acceptance for various thoracic lesions because it is the minimally invasive surgery with little tissue trauma, less pain, improved cosmetic results and short recovery time. However, there are some limitations for this method, such as restricted visual sensory information to a two-dimensional image and limited maneuverability of the tips of the instruments. To overcome these limitations, advanced technology has been introduced and the da $Vinci^{TM}$ Surgical System (Intuitive Surgical Inc, Mountain View, CA, USA) became available in 2001. In Korea, the da $Vinci^{TM}$ Surgical System was introduced in Severance hospital (Yonsei University College of Medicine) in May 2005, and approved by KFDA in July 2005. Herein, we report the first experience of robot-assisted thoracic surgery with the da $Vinci^{TM}$ Surgical System in extirpation of a large teratoma in anterior mediastinum.

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.244-247
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• 2010

Spontaneous pneumomediastinum in the absence of predisposing risk factors has been rarely observed in full-term neonates. A 3-day-old neonate, delivered vaginally at term without any perinatal complications or signs of respiratory difficulty, was referred to the Seoul National University Children's Hospital because of reduced heart sound detected during routine neonatal examination. Chest computed tomography (CT) showed air collection in the anterior mediastinum. The baby developed respiratory distress on the fourth day and required supplemental oxygen. On the seventh day, there was no sign of respiratory difficulty, and x-ray examination showed no demonstrable pneumomediastinum. Hence, careful neonatal physical examination is essential during the postnatal assessment of newborns, and spontaneous pneumomediastinum should be considered when a healthy newborn presents with reduced heart sound.

• The Korean Journal of Nuclear Medicine
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• v.35 no.4
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• pp.268-273
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• 2001

Thymoma is the most common primary tumor of anterior mediastinum, accounting for 20% to 30% of all mediastinal tumors. The recurrence rate after total resection of the thymoma ranges 8% to 18%. We reported one patient of recurrent malignant thymoma imaged with Tc-99m MIBI, Tc-99m Tetrofosmin and Tc-99m (V) DMSA. Early and delayed Tc-99m MIBI and Tc-99m Tetrofosmin scintigraphies showed an increased uptake in the mediastinal area. Also, Tc-99m (V) DMSA scintigraphy revealed an increased uptake tn the corresponding area. Coronal SPECT images of Tc-99m MIBI, Tc-99m Tetrofosmin and Tc-99m (V) DMSA revealed increased uptake of each radiopharmaceutical in the tumor lesion corresponding to the mediastinal lesion on the chest CT. However, the normal blood pool activities of the heart and great vessels of Tc-99m (V) DMSA obscured the recurrent malignant thymoma. Although Tc-99m (V) DMSA is a useful tumor seeking agent, we recommend Tc-99m MIBI and Tc-99m Tetrofosmin SPECT rather than Tc-99m (V) DMSA to detect primary and recurrent malignant thymoma.

• Korean Journal of Head & Neck Oncology
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• v.25 no.2
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• pp.174-177
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• 2009

Parathyroid cyst are rare lesion of the neck and superior mediastinum. They are classified as either functional or nonfunctional based on the presence or absence of hyperparathyroidism. They typically present as a palpable neck mass, or as an incidental finding during neck surgery. So, it must be included within the differential diagnosis of a neck lump. A 48-year old woman was admitted to our hospital for evaluation of left anterior neck mass. Physical finding showed soft, movable, non-tender mass on the lower left third of the neck. Laboratory findings revealed normal thyroid function and normal serum calcium level. On previous history, patient underwent two times sono-guided fine needle aspiration at local clinic, and about 10cc clear watery aspirate was noted. Computerized tomography findings showed non-enhancing hypodense cystic lesion on left thyroid area with tracheal deviation to right side. Preoperative diagnosis was thyroid cyst, and thyroidectomy was planed. Intra-operative finding showed huge cystic mass occupying the left thyroid area and smooth, shiny, semitransparent thin cyst wall was noted, which was loosely attached to the thyroid. The cyst was easily dissected free from the thyroid and surrounding tissues. After cyst removal, pathological study confirmed as a parathyroid cyst.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.240-243
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• 2007

Mediastinal lipoblastoma is a rare benign tumor originating from embryonic lipid cells and it almost always occurs during infanthood or early childhood. It is a tumor with a good prognosis despite its potential for local invasion and rapid growth. We report here on a three years old girl who was treated for a benign lipoblastoma in the anterior mediastinum. CT scanning showed a fat containing mass without internal calcification or fluid component, and the mass showed a compressive effect on the adjacent structures. The mass was located between the pericardium and right mediastinal pleura and it was removed completely without complication. Pathologic examination revealed a benign lipoblastoma. The patient showed no evidence of recurrence at the time of the report.