PMC8799930_01
Radiological findings during the initial visit (A) and after intensive chemotherapy (B). The axial (left) and coronal (middle) views with computed tomography show that the large tumor is in contact with vital mediastinal structures. After chemotherapy, the tumor expanded and further compressed the neighboring organs. Positron emission tomography (right) revealed that the lesion exhibited decreased uptake after chemotherapy.
med-05-19-f1.jpg
PMC8799930_01_med-05-19-f1.jpg
f1
This tumor was a mixture of a yolk sac tumor and an immature teratoma (Figure 1A). In contrast, the teratoma component of the PMNSGCT grew to a size of 16x14 cm (Figure 1B).
Surgical findings. (A) The cephalad position for stable circulation dynamics during anesthesia induction. Vessel access routes in the right femoral artery and vein were secured. (B) Intraoperative findings. The tumor unexpectedly extended inside and outside of the pericardium and directly compressed the heart. (C) The bleeding point in the pulmonary trunk immediately adjacent to the right ventricular (RV) outflow tract (after reparation). (D) Resection completion.
med-05-19-f2.jpg
PMC8799930_01_med-05-19-f2.jpg
f2
Safety measures, including airway management in the cephalad position and securing the femoral blood roots for assisted circulation, were taken during anesthesia (Figure 2A). During surgery, we unexpectedly observed that the tumor extended inside and outside of the pericardium, and it appeared to have grown from the pericardium and caused cardiac compression (Figure 2B). Thus, we were able to proceed with the resection (Figure 2C). Finally, the tumor was resected using modified HCST with combined partial resection of the pericardium and left upper lung and pericardial patch plasty (Figure 2D).