Ectopic uterus? A rare presentation of a giant leiomyoma in the posterior mediastinum
In March 2021, a 17-year-old female from Kilimanjaro region presented with a 3-month history of gradually progressive left-sided chest pain associated with cough, difficulty in breathing and chest tightness. The pain was worse on lying on the affected side. No history of hemoptysis, fever, night sweats or weight loss, neither exertional dyspnea nor orthopnea reported. No contact with tuberculosis reported. No significant past medical history. She does not use tobacco or alcohol. Upon examination, she was comfortable at rest and saturating at 99% in room air. Her axillary temperature, pulse rate and blood pressure were 36.4°C, 100 beats per minute and 116/79 mmHg, respectively. On chest examination, trachea was deviated to the right and there was reduced air entry on the left side. Apex beat was at fifth intercostal space mid-clavicular line and s1 and s2 sounds were heard with no added sounds. Other systems were unremarkable. Her hemoglobin level was 12.9 g/dl; serum creatinine of 72 μmol/l; prothrombin time and international normalization ratio were 11.3 and 0.89 seconds, respectively. Serum electrolytes were within normal range.\nAn initial chest radiograph of the patient confirmed tracheal deviation and revealed a mass in the left hemithorax. Chest CT scan () showed a large mass occupying the entire left posterior hemithorax measuring 12.3 cm (AP) × 14.4 cm (T) × 22.8 cm (CC) with associated partial collapse of the left lung and mediastinal shift to the contralateral side suggestive of pleuropulmonary blastoma vs. neurogenic tumor (ganglioneuroma). This was followed by a CT-guided core needle biopsy which revealed benign spindle cells on a myxoid background. Abdominopelvic ultrasound was normal.\nWe performed a left-sided sixth-interspace thoracotomy. Intra-operatively, we found a huge, firm mass in the posterior mediastinum arising from the parietal pleura adjacent to thoracic vertebrae and fixed to the posterior ribs and intercostal muscles. The mass was in close proximity to the descending aorta from which it had one main feeder vessel. The left lung was collapsed yet normal. The tumor was excised and weighed 2.4 kg. The specimen () was submitted for histopathology examination ( and ). The left lung was inflated and expanded normally.\nPost-operatively, the patient was monitored in ICU and kept on parenteral ceftriaxone 1 g and gentamicin 80 mg 12-hourly, paracetamol 1 g 8-hourly and pethidine 25 mg 6-hourly. She was extubated on post-operative Day 1 and transferred to general ward on the second day. The patient was discharged on 9th post-operative day. She was followed up at the surgical outpatient clinic at 2, 4 and 6 weeks post-operation where she reported full recovery and had normal findings on physical examination and chest X-ray ().