[A case of mediastinal cystic lymphangioma in childhood]

We report a case of lymphangioma, which was widely extended from anterior to posterior mediastinum. The patient was an asymptomatic six-year-old male with a right upper mediastinal mass on chest roentgenograms. Computed tomogram showed a large anterior mediastinal mass, which extended to upper and posterior mediastinum, involving thymus, superior vena cava and innominate vein. Through midline sternotomy, the tumor was visualized and was invading the thymus, bilateral phrenic nerves, SVC and innominate veins. The tumor was also found to extend to the right side of the trachea and vertebra along the azygos vein. The tumor was resected successfully with the preservation of bilateral phrenic nerves. Macro-and microscopic examination revealed polycystic tumor with endothelialized inner spaces. Some cysts contained smooth muscle in their walls. Supportive structures contained variable amounts of fat and connective tissue. The patient weaned from mechanical respiratory support on the first post-operative day, although his diaphragms elevated slightly with poor movement. Phrenic nerve palsy was suspected, but the position and the movement of diaphragms improved four months after the operation. The patient has been well and free from tumor recurrence for four years since the operation.