Abstract
We report the case of a 64-year-old woman with recurrent mediastinal dedifferentiated liposarcoma. She had undergone surgical resection twice. Subsequently, on regular follow-up visits, chest computed tomography demonstrated a third local recurrence of the tumor with invasion into adjacent intrathoracic organs. Adhesion of the heart to the anterior chest wall through a pericardial defect that had been inadvertently created at the second operation was suspected. We decided to use a thoracoabdominal approach with four-dimensional computed tomography (4DCT) for preoperative guidance. The patient had also undergone MRI; however, the result was equivocal regarding adhesion of intrathoracic organs. The use of 4DCT enabled successful en bloc resection of the tumor. Results of the pathology examination showed complete resection of a dedifferentiated liposarcoma. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 19.
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Acknowledgments
We thank Dr. Mitsugu Omasa, Department of Thoracic Surgery, and Dr. Takeshi Kubo, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, for arranging and analyzing 4DCT. We thank Prof. Dr. Kohei Yokoi, Nagoya University, for providing us with former operation records and Prof. Dr. Kouichi Kaneko, Saitama Medical University, for presentation of the patient’s latest clinical course.
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All the authors have declared no competing interest.
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Video 1: Four-dimensional computed tomography (4DCT) suggests that the tumor is infiltrating adjacent organs. 4DCT shows the synchronized movement of the tumor with the surrounding structures, including the diaphragm, anterior chest wall, pericardium (left, mediastinal condition), and lung (right, lung condition), suggesting adhesion and probable invasion of the tumor into these structures. The left panel also shows synchronized movement of the lung and the chest wall, suggesting that pleural adhesion is likely caused by previous operations. (WMV 971 kb)
Video 2: 4DCT suggests separation of the heart from the chest wall. It demonstrates non-synchronized movement of the heart and the anterior chest wall, suggesting separation of these structures. (WMV 867 kb)
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Fujimoto, R., Sato, M., Miyata, R. et al. Successful resection of recurrent mediastinal liposarcoma using preoperative evaluation of organ invasion by four-dimensional computed tomography. Gen Thorac Cardiovasc Surg 64, 488–491 (2016). https://doi.org/10.1007/s11748-014-0510-y
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DOI: https://doi.org/10.1007/s11748-014-0510-y