P2.04-035 Surgical Perplexities in a Rare Case of Symptomatic Mediastinal Lymphangioma: Topic: Esophageal Cancer and Other Malignancies

Abstract

Mediastinal lymphangiomas are very rare and are often found in close proximity to vital structures of the head and neck. Thus, the surgical approach can be challenging. It is debatable to employ open surgery techniques via a trap-door incision or median-sternotomy in attempt to achieve complete surgical resection for a benign lesion. We report a case of symptomatic mediastinal lymphangioma that was successfully managed with a Video Assisted Thoracoscopic Surgery (VATS) approach. A 28-year-old female with no significant past medical history was found to have a superior mediastinal mass on a chest radiograph whilst undergoing investigations for acute left-sided upper back pain. Computed tomography (CT) study of the thorax revealed a large lobulated soft tissue mass in the left superior mediastinum, extending to the supraclavicular region, measuring approximately 4.4 × 4.9 × 7.4 cm, encasing the left carotid, subclavian and vertebral arteries, and the left internal jugular and brachiocephalic veins. Ultrasound guided core biopsy was inconclusive. The patient underwent surgery via left VATS approach. Frozen section of the lesion revealed partial lymphoid infiltrates and scattered cystic-like spaces. No atypical cells or malignancy was seen. Maximal debulking of the lesion was performed with the aid of bipolar diathermy and harmonic ultrasonic energy devices instead of a complete resection. The patient made an uneventful recovery and was discharged home on the first post-operative day. Histological examination showed lymphoid aggregates and dilated lymphatic spaces with a rim of smooth muscle that are typical of lymphangiomas. She remained well and pain free at her 1yr follow-up clinic. In conclusion, due to the unique nature and characteristics of mediastinal lymphangiomas, pre-operative diagnosis and treatment are challenging. Minimally invasive techniques for maximum debulking are useful for symptomatic treatment as complete resection may not always be possible.