Thoracoscopic Surgery for Castleman’s Disease in the Posterior Mediastinum

Iwao Mikami, Shuji Haraguchi, Kiyoshi Koizumi, Kazuo Shimizu


A 15-year-old male athletic student was referred to our hospital with an abnormal shadow found on a routine chest X-ray.  A preoperative clinical diagnosis of neurogenic tumor was suspected.  The patient underwent total resection of the tumor through thoracoscopic surgery using four 12-mm instrument ports in order to spare the muscle and chest wall.  Bleeding increased just after dissection of the parietal pleura surrounding the tumor.  Hence, the intercostal arteries and veins, which are potential blood supply and drainage vessels of the tumor, were ligated with part of intercostal nerves before removing the tumor, and then the tumor was completely excised with the surrounding soft tissues.  The microscopic features were characteristic of the hyaline vascular type lesions seen in Castleman’s disease.  Profuse bleeding is often reported during resection of the tumor originated from posterior mediastinum.  The present case provides the first report that thoracoscopic surgery is technically feasible and can be performed safely and successfully for the treatment of Castleman’s disease in the posterior mediastinum.


Castleman’s disease, Bleeding, Thoracoscopic surgery, Posterior Mediastinum

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