PMC6240726_01
Chest plain radiography shows a 4.0 x 3.5 cm tumour adjacent to the mediastinum.
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A 15-year-old female patient was admitted to our hospital because of an abnormal shadow at the mediastinum seen on chest radiography at a health examination performed at her junior high school (Fig. 1).
Enhanced computed tomography shows a 6.5 x 3.5-cm tumour with areas of fat density and a thick enhancing nodular wall on the mediastinal aspect. The B3 bronchus is obstructed by the tumour (white arrow) and there are ground glass opacities at the right upper lobe around the tumour (white corn). (A. Horizontal view).. The tumour is contiguous to the superior vena cava (black arrow), but there are no oppressed vessels. (B. Coronal view and C. sagittal view)
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B3 bronchus was obstructed by the tumour and ground glass opacities were observed at the right upper lobe around the tumour (Fig. 2). Blood examinations showed no inflammatory changes.
Left hemi-lateral position. Four-port thoracoscopic surgery. Three ports (5 mm) are set along with extension of the inframammary line (respectively 3rd, 4th, 5th intercostal space). Another port (2 cm) is set on the middle axillary line of the 6th intercostal space. (A. Port setting).. Intraoperative thoracic findings. The tumour appears to arise from the right upper lobe and attached to the thymus. (B. Schema). The right upper lobe appears to contain abscess or fat like tissue and does not collapse. (C. Thoracoscopic picture)
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In the left hemilateral position, thoracoscopic surgery was performed using 4 access ports (Fig. 3A) by 3 surgeons including 2 specialists at general thoracic surgery. Almost half of the collapsed right upper lobe had pleural discoloration (Fig. 3B, C).
Macroscopically, the tumour is a 5 x 3-cm cystic lesion with sebum, hair, and cartilage.
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Macroscopically, the tumour was a 5 x 3-cm cystic lesion containing sebum and hair (Fig. 4).
Microscopic findings (haematoxylin and eosin staining). The tumour contains pancreatic tissue.
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Microscopically, the tumour included skin, sebaceous glands, hair, and pancreatic tissue (Fig. 5) and was covered by a fibrous capsule without any immature or atypical cells.