PMC7738784_01
Before initial operation: (a) horizontal view, (b) frontal view. Chest computed tomography (CT) radiograph showing a left superior mediastinal tumor (*) measuring 123 x 120 x 88 mm in size with massive pleural effusion. Before third operation: (c) horizontal view, (d) frontal view. Follow-up chest CT revealing local recurrence with rapid growth in the left superior mediastinum. The tumor had attached to the left common carotid artery (LCCA) and the left subclavian artery (LSA).
CRIPU2020-8882080.001.jpg
PMC7738784_01_CRIPU2020-8882080.001.jpg
fig1
For the first surgery, owing to the rapid growth of the tumor and presence of dyspnea, he underwent an emergent operation through trap door thoracotomy (Figures 1(a) and 1(b)). Chest computed tomography (CT) showed that the recurrent tumor attached the left clavicular head, the first rib, upper sternal bone, the LCCA, and LSA (Figures 1(c) and 1(d)).
Intraoperative view. (a) Resected wall of the left subclavian artery (LSA), one-third of the circumference, causing no bleeding (arrow). (b) The resected portion was covered with a pericardial patch (arrow).
CRIPU2020-8882080.002.jpg
PMC7738784_01_CRIPU2020-8882080.002.jpg
fig2
Subsequently, the thoracic wall was reconstructed with Gore-Tex  dual mesh (Figures 2(a) and 2(b)).
(a) The resected specimen (mediastinal view); (b) the cut surface on the red line of (a). (c) Microscopically, the fibrotic tissue surrounding the left subclavian artery (LSA) was free of malignancy (arrow). (d) Microscopically, the fibrosis surrounding the left common carotid artery (LCCA: arrow) was free from malignancy, but the tumor had infiltrated the left brachiocephalic vein (*).
CRIPU2020-8882080.003.jpg
PMC7738784_01_CRIPU2020-8882080.003.jpg
fig3
Pathologically, the tumor had not infiltrated into LCCA and LSA, and the surgical margin was negative (Figure 3).