Eur J Cardiothorac Surg 2007;32:174-175. doi:10.1016/j.ejcts.2007.04.005
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Two cases of intra-pericardial tumors arising from the ascending aorta in adults
Olivier Chataigner*,
Sacha Mussot,
Elie Fadel,
Philippe G. Dartevelle
Marie-Lannelongue Hospital, Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, 133, avenue de la resistance, 92350, Le Plessis Robinson, France
Received 31 January 2007;
received in revised form 23 March 2007;
accepted 2 April 2007.
* Corresponding author. Tel.: +33 140948572; fax: +33 140945583. (Email: o.chataigner{at}ccml.fr).
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Abstract
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Two female patients aged 64 and 50 years, who had intra-pericardial tumors arising from the ascending aorta, are reported. Both patients were admitted with mediastinal mass. Surgery was performed by median sternotomy with complete excision. Histology revealed teratoma and ectopic thyroid. Tumors arising from the ascending aorta are very rare and should be considered in the differential diagnosis of the mediastinal masses.
Key Words: Mediastinal tumor • Aorta • Surgery • Teratoma • Thyroid
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1. Introduction
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We present two cases of intra-pericardial tumor. Both were developed from the adventitia of the ascending aorta inside the pericardium. One was an ectopic thyroid gland and the other one was a teratoma. They underwent an excision through a median sternotomy. There are only three reported cases of tumor developed from the ascending aorta in the literature, and none of them – moreover, none of intra-pericardial tumor – was an ectopic thyroid gland.
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2. Case reports
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2.1 Patient 1
A 64-year-old female was admitted with a mediastinal mass found incidentally on chest radiography. She had a history of right breast tumor (T1 N0 M0) treated with tumorectomy and radiation therapy (50Gy). Transthoracic and transesophageal echocardiography revealed a 30 mm x 30 mm extra-cardiac and extra-pulmonary mass, adjacent to the ascending aorta. It could not be determined whether the mass was in the pericardium or not. Subsequent computerized tomography (CT) of the thorax revealed a 55 mm x 40 mm intra-pericardial tissular mass in the middle mediastinum between the right auricular cavity and the ascending aorta. She underwent a mediastinal exploration through a median sternotomy. As the pericardial sac was opened, a circular pedunculated tumor located on the ascending aorta was seen. It appeared to be attached to the adventitia of the mid-part of the anterolateral wall of the ascending aorta. The lesion was excised with the adventitia of the aorta (Fig. 1
). Pathologic examination showed an ectopic thyroid gland. The patient is asymptomatic for 2 years.
2.2 Patient 2
A 50-year-old female patient with accidental chest X-ray finding of a mass in the middle mediastinum. Chest CT scan showed a 65 mm x 45 mm hypodense mass with heterogeneous enhancement and calcifications (Fig. 2
). This mass was in the pericardium, between the right auricular cavity, the pulmonary artery, and the ascending aorta. The lesion was accessed through a median sternotomy. The opening of the pericardial sac showed a large tumor located on the ascending aorta. It was excised, after liberation of its attachments to the pulmonary artery and with the adventitia of the ascending aorta. Pathologic examination revealed a teratoma. Follow-up at 3 years revealed no recurrence.
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3. Comment
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After a mediastinal mass was found incidentally on chest radiography, transthoracic and transesophageal echocardiography define more precisely its intra- or extra-cardiac localization, but it could not be determined weather the mass was in the pericardium or not. Although CT scan seems to be the best radiological examination to determine the anatomic characteristics of the lesion, it is still difficult to be sure of its intra-pericardial localization.
There are only three reported cases in the literature of a tumor arising from the ascending aorta. One is a spindle-cell sarcoma [1], one a malignant fibrous histiocytoma [2], and the other one a lipoma [3].
Our two cases differed because of pathologic examination. One was a teratoma and the other one an ectopic thyroid tissue.
Abnormalities in the embryologic development during migration of the thyroid gland can result in ectopic thyroid tissue. The development of thyroid tissue can occur anywhere during the migration of the thyroid along the thyroglossal duct. Ectopic thyroid has been observed in lingual (at tongue base), sublingual (below the tongue), prelaryngeal (in front of the larynx), and substernal (in the mediastinum) ectopy. Thyroglossal duct cyst is the most common type of clinical abnormality related to thyroid ectopy [4,5]. Review of the literature has identified no other such location of ectopic thyroid. This intra-pericardial location cannot be justified with embryologic migration of the thyroid cells. Moreover, this lesion arose from the adventitia of the intra-pericardial ascending aorta.
In conclusion, tumors arising from the ascending aorta are very rare, and outcome of the complete resection is excellent.
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References
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- Kreisel D, Engels FH, Krupnick AS, Szeto WY, Krasinskas AM, Popma SH, Tomaszewski JE, Arcasoy SM, Kotloff RM, Blumenthal NP, Buell JF, Rosengard BR. Emergent lung retransplantation after discovery of two primary malignancies in the donor. Transplantation 2001;71:1859-1862.[CrossRef][Medline]
- Guvendik L, Ross JK, Marshall RJ. Primary aortic malignant fibrous histiocytoma: a successfully treated case by surgical excision. Ann Thorac Surg 1986;42:578-580.[Abstract]
- Davierwala PM, David TE, Butany J. A large lipoma of the ascending aorta. Ann Thorac Surg 2004;77:1079-1080.[Abstract/Free Full Text]
- Walling AD. Ectopic thyroid tissue. Am Fam Physician 1987;36:147-150.[Medline]
- Galizia G, Lieto E, Ferrara A, Castellano P, Pelosio L, Imperatore V, Palladino E. Ectopic thyroid: report of a case. G Chir 2001;22:85-88.[Medline]
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Abstract
1. Introduction
