4K 3D内視鏡下に肉眼的完全切除を行った胸膜播種を有する浸潤型胸腺腫の1例

Invasive Thymoma with Unexpected Pleural Dissemination Completely Resected Under 4K Three-dimensional Endoscopy：Report of a Case

はじめに　胸腺腫瘍診療ガイドラインでは，肉眼的完全切除が可能な臨床病期Ⅳ期胸腺上皮性腫瘍に対して外科切除が推奨されている1）．われわれは術中に胸膜播種が判明した浸潤型胸腺腫に対して，4K 3D内視鏡下に肉眼的完全切除を行った1例を経験したので報告する．

According to the guidelines for thymic tumors, surgical resection is recommended for clinical stageⅣ thymic epithelial tumors if completely resectable. A 38-year-old woman presented with fever, chest pain, and back pain. Computed tomography （CT） revealed a mediastinal tumor, which was diagnosed as thymoma type B3 through CT-guided biopsy. Intraoperatively, using 4K three-dimensional （3D） endoscopy, tumor invasion into the left upper lobe and pleural dissemination on the parietal pleura and diaphragm were observed. To preserve the possibility of future re-resection, operation was thoracoscopically performed and the tumor was removed, including partial resection of the left upper lobe. All visible pleural dissemination lesions were also resected, including part of the left diaphragm. The diaphragmatic defect was reconstructed using a Gore-Tex Patch. There is no established treatment strategy for thymoma with incidental pleural dissemination, and the 4K 3D endoscopy may contribute to the successful completion of such a complex operation.