An unsual symptomatic case of mediastinal myelolipoma treated by VATS approach Published online (EP) 25 October 2013 - Ann. Ital. Chir 1 Pervenuto in Redazione Luglio 2013. Accettato per la pubblicazione Settembre 2013. Correspondence to: Marcello Migliore, MD, PhD, Department of Surgery, Sect. Thoracic Surgery, University of Catania, Ospedale Policlinico, Via Passo Gravina 63, 95123 Catania, Italy (e-mail: mmiglior@hotmail.com) Marcello Migliore*, Damiano Calvo*, Alessandra Criscione*, Rosario Caltabiano**, Nunzio Platania***, Giuseppe Barbagallo**, Vincenzo Albanese*** University of Catania, Catania Italy *Thoracic Surgery, Department of Surgery **Department of Pathology ***Neurosurgery An unusual symptomatic case of mediastinal myelolipoma treated by VATS approach. Symptomatic mediastinal location of an extra-adrenal myelolipoma is extremely rare. We describe a 56-year-old female with unusual pain in the right lower posterior chest radiated to the neck and to the upper abdomen. Chest CT showed a lesion of 3.5 x 2.2 cm in the posterior mediastinum. Video-assisted resection was performed and the final pathologic examination revealed the presence of a myelolipoma. Herein we discuss the clinical presentation, the differential diagno- sis and treatment of mediastinal myelolipoma. KEY WORDS:Mediastinum, Minimally invasive surgery, Myelolipoma, Thoracoscopy, Tumor, VATS ANNALI 953 - Lav. 2204 - EP A 56-year old obese female (BMI 44Kg/mt 2 ) was admit- ted to the hospital for severe pain in the right lower posterior chest radiated to the neck and anteriorly to the upper abdomen. Past medical history included surgery for thymoma and myasthenia gravis and cerebral menin- gioma. Thoracic physical examination and blood labo- ratory tests were normal. A chest-computed-tomography (CT) revealed a smooth, well-defined, right-sided par- avertebral lesion, and the magnetic resonance (MR) of the dorsal and lombosacral spine confirmed the lesion measuring 3.5x2.2 cm. in the Th8-Th9 intersomatic space well demarcated from the aorta. The lesion was adherent to the vertebral soma and to the origin of the 8th rib (Fig. 1). Chest tomography of the brain and abdomen was normal. A fine needle aspiration biopsy (FNAB) was not attempted, and surgical resection of the tumor was planned because the presence of symptoms. The operation was performed using a three ports VATS technique. The lesion was found to be tightly adherent to the vertebral soma. During the dissection some bleed- ing was detected, and following numerous attempts the definitive source of bleeding was not found, we decid- ed to enlarge the posterior port from 2 to 6 cm. The blood was found coming from the vertebral soma and was treated with 5 min. manual compression and haemo- static sponges. The roundish and soft lesion was then removed. Histopathologic examination showed erythro- poietic bone marrow mixed with mature adipose tissue, fibrovascular and connective tissue as shown in Fig. 2. The final diagnosis of mediastinal myelolipoma was made. The follow-up included a physical examination, laboratory investigations and spinal-dorsal MR. No signs of recurrence or chest pain were found at the 11 month follow-up. Ann. Ital. Chir. Published online (EP) 25 October 2013 pii: S2239253X13022044 www.annitalchir .com