What does this research mean for the field?

Rigorous preoperative evaluation and multidisciplinary collaboration are essential in determining the optimal diagnostic strategy for giant mediastinal tumors to avoid potentially unnecessary surgical resection when malignant lymphoma is suspected. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To highlight the complexities in diagnosing and treating giant anterior mediastinal malignant lymphoma through surgical intervention.

May 17, 2026The Journal of the Japanese Association for Chest Surgery0 citationsOpen Access

Giant anterior mediastinal malignant lymphoma resected through a semi-clamshell approach: Insights into diagnostic strategy

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ADAsahi Doki ATAkihiro Takahagi MIMahiro Ishizumi

Key Points

To highlight the complexities in diagnosing and treating giant anterior mediastinal malignant lymphoma through surgical intervention.
Patient presented with a 12 cm tumor compressing the heart, subjected to CT and PET-CT scans for assessment.
Underwent surgical resection using a semi-clamshell approach after initial difficulties during thoracoscopic surgery.
Histopathological evaluation confirmed diffuse large B-cell lymphoma, initiating R-CHOP therapy.
Surgical resection effectively removed the tumor, which was confirmed as malignant lymphoma post-operation.
The patient had elevated levels of LDH and soluble IL-2 receptor, commonly associated with lymphomas.
The case emphasizes the importance of preoperative evaluation and interdisciplinary collaboration.

Abstract

80歳代男性．嘔気，嘔吐で救急受診した際，心臓を前面から圧排する横径12 cmの腫瘍を指摘された．腫瘍は腹部CTで辺縁整・均一に造影され，PET-CTではSUVmax 16.9の均一なFDG集積を示した．血液検査ではLDHと可溶性IL-2受容体が軽度高値であった．以上は悪性リンパ腫を示唆する所見であったが，針生検による播種や心臓圧排増悪に伴う循環破綻を懸念し，診断と治療を兼ねて外科切除を選択した．右胸腔鏡で腫瘍を剥離後，左開胸を行ったが視野不良であり，胸骨横切開を加えsemi-clamshell切開としたことで安全に摘出し得た．術後病理でdiffuse large B-cell lymphomaと診断されR-CHOP療法が開始された．本症例は，悪性リンパ腫が示唆されながら外科切除を選択した点に診断戦略上の反省があり，巨大縦隔腫瘍における術前評価と他科連携の重要性を示すものである．

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Cite This Study

Doki et al. (2026) studied this question.

synapsesocial.com/papers/6a095ac47880e6d24efe0a0c https://doi.org/10.2995/jacsurg.40.414

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May 17, 2026The Journal of the Japanese Association for Chest Surgery0 citationsOpen Access

Giant anterior mediastinal malignant lymphoma resected through a semi-clamshell approach: Insights into diagnostic strategy

View Full Paper

ADAsahi Doki ATAkihiro Takahagi MIMahiro Ishizumi

Key Points

To highlight the complexities in diagnosing and treating giant anterior mediastinal malignant lymphoma through surgical intervention.
Patient presented with a 12 cm tumor compressing the heart, subjected to CT and PET-CT scans for assessment.
Underwent surgical resection using a semi-clamshell approach after initial difficulties during thoracoscopic surgery.
Histopathological evaluation confirmed diffuse large B-cell lymphoma, initiating R-CHOP therapy.
Surgical resection effectively removed the tumor, which was confirmed as malignant lymphoma post-operation.
The patient had elevated levels of LDH and soluble IL-2 receptor, commonly associated with lymphomas.
The case emphasizes the importance of preoperative evaluation and interdisciplinary collaboration.

Abstract

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View Full Paper

Cite This Study

Doki et al. (2026) studied this question.

synapsesocial.com/papers/6a095ac47880e6d24efe0a0c https://doi.org/10.2995/jacsurg.40.414

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