studies with attention to lymphadenopathy, splenomegaly or hepato- megaly, as it is stated in the manuscript, were negative). 2. It is true that the markers ...
ARTICLE IN PRESS N. Barbetakis et al. / Interactive CardioVascular and Thoracic Surgery 12 (2011) 845–847
ESCVS Article Proposal for Bailout Procedure
w1x Barbetakis N, Asteriou C, Stefanidis A, Kynigou M. Mediastinal hibernoma presenting with hoarseness. Interact CardioVasc Thorac Surg 2011;12:845–847. w2x Hertoghs M, Van Schil P, Rutsaert R, Van Marck E, Vallaeys J. Intrathoracic hibernoma: report of two cases. Lung cancer 2009;64:367–370. w3x Santambrogio L, Cioffi U, De Simone M, Nosotti M, Pavoni G, Caputo V, Bonavina L. Cervicomediastinal hibernoma. Ann Thorac Surg 1997; 64:1160–1162.
Institutional Report
References
Protocol
w1x Cafarotti S, Porziella V, Margaritora S, Granone P. eComment: Diagnostic pathway in anterior mediastinal mass. Interact CardioVasc Thorac Surg 2011;12:846–847. w2x Barbetakis N, Asteriou C, Stefanidis A, Kynigou M. Mediastinal hibernoma presenting with hoarseness. Interact CardioVasc Thorac Surg 2011;12:845–847. w3x Kentos A, Rocmans P, Remmelink M, Feremans W. Long-term remission with surgery for recurrent localized Hodgkin lymphoma. J Thorac Cardiovasc Surg 2005;129:1172.
Work in Progress Report
References
Authors: Ugo Cioffi, Department of Surgery, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy; Matilde De Simone, Luigi Santambrogio doi:10.1510/icvts.2010.256750B We read with great interest the recent paper on mediastinal hibernoma by Barbetakis et al. w1x. They reported a case of a 52-year-old female presenting with slowly worsening hoarseness due to a mass measuring 4=4 cm located next to the aortic arch without invasion of the pulmonary hilum. Hibernoma is a benign soft-tissue tumor, derived from brown fat, that often presents as a painless, slow-growing mass. About 20 cases of intrathoracic hibernoma have been described in the world literature w2x, of which only a few cases were located in the mediastinal region w2, 3x. For an accurate interpretation of the case, it would be important to know if the surgical procedure was performed using a conventional or thoracoscopic approach. We reported a case of cervicomediastinal hibernoma measuring 14=16 cm, easily dissected through a left supraclavicular incision extended to the sternal notch without the necessity for sternotomy w3x. In our opinion, in selected patients, and for surgeons with video-assisted thoracic skills, this approach is a valid therapeutic option for the treatment of benign mediastinal masses, reserving more invasive surgical procedures for patients with large lesions or in whom malignancy is suspected.
New Ideas
The purpose of our case report was to highlight a rare cause of mediastinal mass (hibernoma) causing hoarseness as the first manifestation.
eComment: Minimally-invasive technique for benign mediastinal masses
Editorial
studies with attention to lymphadenopathy, splenomegaly or hepatomegaly, as it is stated in the manuscript, were negative). 2. It is true that the markers a-fetoprotein and b human chorionic gonadotropin (hCG) are often high in patients with mediastinal germ cell tumors, constituting an important differential diagnosis in males. The fact is that with the completely negative staging of the tumor and the imaging studies, surgery was the only option in this case. 3. Preoperative fine needle aspiration (FNA) or fine needle biopsy (FNB) of the tumor was risky because of the close proximity of the aorta and was not recommended by interventional radiologists. Due to the imaging studies an excisional biopsy of the tumor was preferred. 4. There is no doubt that chemoradiotherapy is the gold standard for mediastinal lymphoma. In the case reported here, there was no mediastinal or peripheral lymphadenopathy, or elevated LDH indicating the presence of a lymphoma. We would like to remind Cafarotti et al. that in selected cases, surgery has a role in localized mediastinal lymphomas and this is not considered as an over-treatment w3x.
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