© 2014 Wiley Periodicals, Inc.
IMAGES
IN
639
CARDIAC SURGERY _____________________________________________________
Thymoma Following Coronary Bypass Graft Surgery Yihua Liu, M.D.,*,y Pablo Maureira, M.D., Ph.D.,*,y Erick Portocarrero, M.D.,* and Jean-pierre Villemot, M.D., Ph.D.*,y *Department of Cardiovascular Surgery and Heart Transplantation, University Hospital of de Lorraine, Nancy, France Brabois, Nancy, France; and yUniversite doi: 10.1111/jocs.12304 (J Card Surg 2014;29:639–640)
A 67-year-old male presented with an asymptomatic enlarging anterior mediastinal mass 18 months following coronary artery bypass graft (CABG) surgery. Computed tomography (CT) angiography showed a 4.5 cm 6.3 cm anterior mediastinal mass (Fig. 1A) with patent bypass grafts (Fig. 1B). Following a reoperative median sternotomy, the tumor was located between the right internal
mammary artery graft, a saphenous vein graft, and the ascending aorta (Fig. 2A). The tumor was resected en bloc without injury to any of the grafts (Fig. 2B). The histology showed this to be a mixed cell thymoma (AB) with both an epithelial and a lymphoid cell component (Fig. 2C). The patient tolerated the procedure well and had an uncomplicated postoperative course.
Figure 1. Preoperative imaging. (A) CT with intravenous contrast showed a tumor with heterogeneous enhancement and a distinguishable capsule. (B) Coronary CT angiography demonstrated patent coronary grafts and their anatomical relation with the thymoma.
Conflict of interest: The authors acknowledge no conflict of interest in the submission. e du Address for correspondence: Pablo Maureira, M.D., Ph.D., 1, Alle s-Nancy, Nancy, France. Fax: þ33Morvan, F-54500, Vandoeuvre-le 383154954; e-mail: [email protected]
640
LIU, ET AL. THYMOMA FOLLOWING CORONARY BYPASS GRAFT SURGERY
J CARD SURG 2014;29:639–640
Figure 2. Perioperative view and pathological examinations. (A) The thymoma (indicated by the hollow arrow) was located between the right internal mammary artery (identified by the blue elastic cord) and saphenous vein graft (under the pericardial suspending suture). (B) The gross cross-section revealed a lobulated homogeneous grayish tumor with some cystic changes. (C) A representative histological view (hematoxylin and eosin, original magnification 20, bar ¼ 100 mm) demonstrated a nodule of numerous polygonal epithelial cells surrounded by lymphoid stroma of small-size lymphocytes.
IMAGES
IN
639
CARDIAC SURGERY _____________________________________________________
Thymoma Following Coronary Bypass Graft Surgery Yihua Liu, M.D.,*,y Pablo Maureira, M.D., Ph.D.,*,y Erick Portocarrero, M.D.,* and Jean-pierre Villemot, M.D., Ph.D.*,y *Department of Cardiovascular Surgery and Heart Transplantation, University Hospital of de Lorraine, Nancy, France Brabois, Nancy, France; and yUniversite doi: 10.1111/jocs.12304 (J Card Surg 2014;29:639–640)
A 67-year-old male presented with an asymptomatic enlarging anterior mediastinal mass 18 months following coronary artery bypass graft (CABG) surgery. Computed tomography (CT) angiography showed a 4.5 cm 6.3 cm anterior mediastinal mass (Fig. 1A) with patent bypass grafts (Fig. 1B). Following a reoperative median sternotomy, the tumor was located between the right internal
mammary artery graft, a saphenous vein graft, and the ascending aorta (Fig. 2A). The tumor was resected en bloc without injury to any of the grafts (Fig. 2B). The histology showed this to be a mixed cell thymoma (AB) with both an epithelial and a lymphoid cell component (Fig. 2C). The patient tolerated the procedure well and had an uncomplicated postoperative course.
Figure 1. Preoperative imaging. (A) CT with intravenous contrast showed a tumor with heterogeneous enhancement and a distinguishable capsule. (B) Coronary CT angiography demonstrated patent coronary grafts and their anatomical relation with the thymoma.
Conflict of interest: The authors acknowledge no conflict of interest in the submission. e du Address for correspondence: Pablo Maureira, M.D., Ph.D., 1, Alle s-Nancy, Nancy, France. Fax: þ33Morvan, F-54500, Vandoeuvre-le 383154954; e-mail: [email protected]
640
LIU, ET AL. THYMOMA FOLLOWING CORONARY BYPASS GRAFT SURGERY
J CARD SURG 2014;29:639–640
Figure 2. Perioperative view and pathological examinations. (A) The thymoma (indicated by the hollow arrow) was located between the right internal mammary artery (identified by the blue elastic cord) and saphenous vein graft (under the pericardial suspending suture). (B) The gross cross-section revealed a lobulated homogeneous grayish tumor with some cystic changes. (C) A representative histological view (hematoxylin and eosin, original magnification 20, bar ¼ 100 mm) demonstrated a nodule of numerous polygonal epithelial cells surrounded by lymphoid stroma of small-size lymphocytes.
