HAIKOU — Surgeons at the Second Affiliated Hospital of Hainan Medical University (SHHMU) have successfully removed a giant thoracic tumor measuring 18 centimeters in maximum diameter and weighing 1.7 kilograms from an 18-year-old male patient. The senior high school graduate delayed medical treatment to complete the national college entrance examination (Gaokao) before undergoing surgery. Suffering severe compression of the heart and right lung caused by the massive tumor, the patient achieved a smooth postoperative recovery and was discharged on the 10th day after the multidisciplinary procedure.

    The patient, identified anonymously as Ma, is a recent Gaokao candidate. Starting in May this year, he developed persistent dry cough and aggravated chest tightness and shortness of breath after physical activity, particularly during prolonged studying with his head bowed or brisk walking. Determined to focus on his crucial final-year review and mock examinations amid the intense Gaokao preparation, Ma concealed his symptoms from his family and avoided medical consultation. He persisted with his study schedule and successfully completed all Gaokao subjects from June 7 to 9.

    Shortly after the examination, Ma’s chest compression and coughing deteriorated significantly. His family immediately arranged a chest CT scan at a local hospital, which revealed a massive space-occupying lesion occupying nearly the entire right thoracic cavity. The tumor caused obvious leftward displacement of the heart and mediastinum and severe compression of the right lung. The patient was subsequently transferred to the Department of Thoracic Surgery at SHHMU for further diagnosis and treatment.

After a thorough review of the patient’s imaging scans, Director Sun Wei from the Department of Thoracic Surgery confirmed that the 18-centimeter tumor was located in the right thoracic cavity, closely adhering to the middle and lower lobes of the right lung. It exerted compression on the superior vena cava, heart and inferior vena cava. Fortunately, the tumor featured a relatively clear boundary with no definitive invasion of surrounding major blood vessels or pericardium. Based on the patient’s age and clinical manifestations, Director Sun diagnosed the lesion as a primary intrathoracic tumor and confirmed surgical resection as the optimal treatment option.

    Given the tumor’s enormous size and anatomically complex location, the surgery carried potential high risks including massive hemorrhage, phrenic nerve injury and severe lung tissue damage. To ensure surgical safety, Director Sun’s team conducted comprehensive preoperative multidisciplinary discussions with the Department of Anesthesiology and the Intensive Care Unit (ICU). A detailed surgical contingency plan was formulated, and full communication was conducted with the patient and his family regarding surgical risks and expected treatment outcomes.

    The operation was performed on the third day after admission. Intraoperative observations showed the tumor occupied most of the right thoracic space, severely collapsing the middle and lower lobes of the right lung, with adhesions to the phrenic nerve, pericardium and vena cava wall. Meticulously operating along the tumor capsule, Director Sun’s team completely excised the mass while fully protecting the superior vena cava, inferior vena cava, right atrium and phrenic nerve, and maximally preserving normal lung tissue.

    The four-hour surgery achieved excellent clinical outcomes with only 200 milliliters of intraoperative blood loss and no blood transfusion required. No ribs were cut, and no metallic foreign materials were left in the patient’s body, with full preservation of phrenic nerve function. The resected tumor measured 18cm×15cm×10cm and weighed 1.7 kilograms. With precise anesthetic management delivered by anesthesiologist Zheng Yuxiu, the patient regained consciousness smoothly after surgery with stable vital signs, and was transferred directly to a general ward without ICU admission.

    The patient’s postoperative recovery progressed rapidly. On the first postoperative day, Ma started in-bed limb exercises. On the second day, he stood and walked slowly with nursing assistance. A chest X-ray reexamination on the fourth day showed satisfactory re-expansion of the right lung and basically restored mediastinal position. On the 10th day after surgery, the drainage tube was removed successfully. The patient’s dyspnea symptoms completely resolved, and his surgical wound healed well, meeting all discharge criteria.

    “Despite his young age, Ma showed exceptional cooperation throughout the perioperative period. His active early ambulation after surgery effectively reduced the risks of postoperative complications such as pulmonary infection and deep vein thrombosis, and his positive mindset greatly facilitated rapid recovery,” said attending physician Luo Defan.

    Ma shared that he endured physical discomfort during exam preparation to avoid disrupting his Gaokao plans. Now with successful surgery and steady physical recovery, he expressed full anticipation for his upcoming university life.

    According to Director Sun Wei, primary giant intrathoracic tumors are clinically rare but generally resectable. Such tumors present atypical early symptoms, mainly manifested as gradually worsening cough, chest tightness and shortness of breath during physical exertion. Due to insidious onset, most patients overlook mild discomfort, resulting in large tumor growth when obvious compressive symptoms appear.

Director Sun reminded the public, especially adolescent students, to seek timely chest imaging examinations including X-rays or CT scans at regular medical institutions once unexplained persistent dry cough, exertional shortness of breath or vague chest pain occurs. Delayed diagnosis and treatment due to academic or work demands should be avoided. Early detection and standardized treatment can ensure a favorable prognosis for the vast majority of intrathoracic tumors.

    While Ma’s perseverance in completing the Gaokao despite severe illness is commendable, timely and standardized surgical treatment was the key to eliminating his life-threatening health risks, marking a new lease of life for the 18-year-old youth.