Surgical treatment of dermoid cysts of the mediastinum

Introduction. A dermoid cyst of the mediastinum is a rare benign tumor that develops from embryonic tissues as a result of dysembryogenesis.
Aim. To present the experience of surgical treatment of mediastinal dermoid cysts.
Materials and methods. A retrospective analysis of the treatment of 16 patients after removal of a mediastinal dermoid cyst was performed. Gender and age, clinical symptoms, tumor size and location, surgical approach and duration of surgery, volume of blood loss, pain syndrome, duration of drainage and hospitalization, postoperative complications according to the Clavien–Dindo classification were assessed.
Results. The study included 6 (37.5 %) men and 10 (62.5 %) women aged 11 months to 61 years (average age 33.2 years).
Among the patients, 62.5 % were asymptomatic, the rest complained of shortness of breath, cough, discomfort and retrosternal pain. The tumor size ranged from 4.5 to 18.2 cm. The tumor was detected in the anterior-superior zone of the mediastinum in 13 (81.25 %) cases, in the posteroinferior zone – in 3 (18.75 %). Open access was used in 7 (43.75 %) cases, thoracoscopic – in 8 (50 %). In 1 case, conversion to sternotomy was performed. The lung was resected in 3 patients, the thymus gland – in 6, the left brachiocephalic vein and pericardium in 1 case each, of which 5 were resected using the thoracoscopic approach. During thoracoscopy, the volume of blood loss (12.5 (5; 65) and 100 (60; 125) ml, respectively) and the duration of surgery (72.5 (45; 155) and 141.5 (105; 154) min, respectively) were significantly lower than with open access.Pleural drainage was removed on days 1–3 after surgery. Quantitative indicators are presented as a median (25th percentile; 75th percentile). After open approaches, pain was 4–6 points on the visual analogue scale, decreasing to 2–3 points by the end of hospitalization, after thoracoscopic ones – no more than 4 points and stopped after drainage removal. Postoperative complications of I–II degree were in 3 (18.75 %) patients after open operations. Hospitalization after thoracoscopy was significantly shorter and amounted to 5.5 (5; 6.5) bed-days, with open ones – 12 (7.5; 14). There were no fatal cases. No tumor recurrences were noted in the late period.
Conclusion. The absence of specific diagnostic criteria and the presence of contraindications for transthoracic puncture biopsy of the mediastinal dermoid cyst prevent preoperative verification. The surgical method is the only effective option with a favorable prognosis. and thoracoscopic intervention reduces blood loss and hospitalization time.

1. Travis W.D., Brambilla E., Burke A.P. et al. Introduction to the 2015 World Health Organization classification of tumors of the lung, pleura, thymus, and heart. J Thorac Oncol 2015;10(9):1240–2. DOI: 10.1097/JTO.0000000000000663

2. Bohm A., Campbell C., Peters C., Datoo N. Timely diagnostics and safe procedures in children with anterior mediastinal masses (AMMs): a qualitative review of the AMM protocol at BC Children’s Hospital in Vancouver BC. Pediatr Hematol Oncol 2023;40(1):51–64. DOI: 10.1080/08880018.2022.2072985

3. Pearson J.K., Tan G.M. Pediatric anterior mediastinal mass: a review article. Semin Cardiothorac Vasc Anesth 2015;19(3):248–54. DOI: 10.1177/1089253215578931

4. Dolzhansky O.V., Gurevich L.E., Bazarov D.V. Mature teratoma of the anterior mediastinum with a predominance of the pancreatic component and signs of focal nesidioblastosis. Arhiv patologii = Russian Journal of Archive of Pathology 2022;84(3):52–9. (In Russ.). DOI: 10.17116/patol20228403152

5. Pikin O.V., Ryabov A.B., Kolbanov K.I., Stepanov S.O. Opukholi sredosteniya: sbornik. Moscow: Molodaya gvardiya, 2019. (In Russ.).

6. Ahmed A., Lotfollahzadeh S. Cystic teratoma. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK564325/

7. Hu X.L., Zhang D., Zhu W.Y. Uniportal video-assisted thoracoscopic surgery for complex mediastinal mature teratoma: a case report. World J Clin Cases 2021;9(26):7870–5. DOI: 10.12998/wjcc.v9.i26.7870

8. Hwang S.K., Park S.I., Kim Y.H. et al. Clinical results of surgical resection of mediastinal teratoma: efficacy of video-assisted thoracic surgery. Surg Endosc 2016;30(9):4065–8. DOI: 10.1007/s00464-015-4721-9

9. Zheng R., Devin C.L., O’Malley T. et al. Surgical management of growing teratoma syndrome: robotic-assisted thoracoscopic resection of mediastinal teratoma. Surg Endosc 2020;34(2):1019–23. DOI: 10.1007/s00464-019-07177-z

10. Bazarov D.V., Grigorchuk A.Yu., Povolotskaya O.B. et al. Treatment of postoperative complications in cardiothoracic surgery: single- center 10-year experience. Khirurgiya. Zhurnal im. N.I. Pirogova = Pirogov Russian Journal of Surgery 2024;12-2:66–71. (In Russ.). DOI: 10.17116/hirurgia202412266

11. Topolnitskiy E.B., Borodina Yu.A. Videothoracoscopic interventions for tumors and cysts of the mediastinum. Endoskopicheskaya khirurgiya = Endoscopic Surgery 2020;26(6):17–21. (In Russ.). DOI: 10.17116/endoskop20202606117

12. Raza A., Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg 2016;5(1):33–7. DOI: 10.3978/j.issn.2225-319X.2015.10.01

13. Topolnitskiy E.B., Borodina Yu.A. Immediate results of surgical treatment of non-small cell lung cancer in elderly and senile patients. Khirurgiya. Zhurnal im. N.I. Pirogova = Pirogov Russian Journal of Surgery 2020;10:23–8. (In Russ.). DOI:10.17116/hirurgia202010123

14. Shefer N.A., Topolnitskiy E.B., Drozdov E.S., Dambayev G.C. Possibilities of short-term pulmonary rehabilitation in the preoperative preparation of lung cancer patients with COPD. Sibirskoye meditsinskoye obozreniye = Siberian Medical Review 2021;3:66–72. (In Russ.). DOI: 10.20333/25000136-2021-3-66-72

15. Topolnitskiy E.B., Gusakov V.V. Thoracoscopic thymectomy for myasthenia gravis and non-invasive thymoma after COVID-19 pneumonia. Khirurgiya. Zhurnal im. N.I. Pirogova = Pirogov Russian Journal of Surgery 2024;8:26–33. (In Russ.). DOI: 10.17116/hirurgia202408126

16. Barabrah A.M., Zaben B., Tuqan A.R. et al. Mature cystic teratoma of anterior mediastinum in a child: a case report and literature review. J Investig Med High Impact Case Rep 2024;12:23247096241274510. DOI: 10.1177/23247096241274510

17. Tian Z., Liu H., Li S. et al. Surgical treatment of benign mediastinal teratoma: summary of experience of 108 cases. J Cardiothorac Surg 2020;15(1):36. DOI: 10.1186/s13019-020-1075-8

18. Peiró J.L., Sbragia L., Scorletti F. et al. Management of fetal teratomas. Pediatr Surg Int 2016;32(7):635–47. DOI: 10.1007/s00383-016-3

19. Saikia J., Deo S.V.S., Bhoriwal S. et al. Video assisted thoracoscopic surgery in paediatric mediastinal tumors. Mediastinum 2020;4:2. DOI: 10.21037/med.2019.09.04

20. Shchadenko S.V., Topolnitskiy E.B. Case of successful application of method for 3D visualization and modeling in thoracic oncology. Byulleten’ sibirskoj mediciny = Bulletin of Siberian Medicine 2016;2:128–34. (In Russ.). DOI: 10.20538/1682-0363-2016-2-127-133

21. Topolnitskiy E., Chekalin T., Marchenko E., Volinsky A. Treatment of post-resuscitation cicatricial tracheal stenosis after suffering severe COVID-19 associated pneumonia: a report of 11 cases. Respir Med Case Rep 2022;40:101768. DOI: 10.1016/j.rmcr.2022.101768

22. Ramcharran H., Wallen J. Robotic-assisted thoracoscopic resection of anterior mediastinal cystic teratoma: a case report and literature review. J Cardiothorac Surg 2022;17(1):67. DOI: 10.1186/s13019-022-01806-w

23. Parshin V.D., Parshin A.V., Ursov M.A. et al. Surgery for mediastinal teratoma containing pancreatic tissue. Khirurgiya. Zhurnal im. N.I. Pirogova = Pirogov Russian Journal of Surgery 2024;(2): 75–83. (In Russ.). DOI: 10.17116/hirurgia202402175

24. Topolnitskiy E.B., Shefer N.A., Usoltseva S.V., Kapitanova D.V. Giant epidermoid cyst of the anterior neck with an unusual magnetic resonance pattern. Sarkomy kostei, miagkikh tkanei i opukholi kozhi = Bone and Soft Tissue Sarcomas, Tumors of the Skin 2024;16(3):81–4. (In Russ.). DOI: 10.17650/2219-4614-2024-16-3-81-84

25. Topolnitskiy E.B., Mikhed R.A., Shefer N.A., Marchenko E.S. Two-port video-assisted thoracoscopic plication of the relaxed diaphragm. Endoskopicheskaya khirurgiya = Endoscopic Surgery 2022;28(6):12–21. (In Russ.). DOI: 10.17116/endoskop20222806112