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Belayachi B, Fenane H, Msougar Y. Surgical management of mediastinal mature cystic teratoma of the elderly remaining asymptomatic. J Cardiothorac Surg 2024; 19:28. [PMID: 38281986 PMCID: PMC10822176 DOI: 10.1186/s13019-024-02503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/14/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Mediastinal teratoma is an uncommon disease, nevertheless they represent the most common mediastinal germ cell tumors. It may grow silently for several years and remain undiagnosed until the occurrence of a complication. AIM The main aim of this article is to illustrate the silent evolution of an anterior mediastinal teratoma for over 70 years without presenting any notable complications. CASE PRESENTATION We present the case of a 70-year-old female, treated for hypertension referred to our department for managing a voluminous mediastinal mass, discovered fortuitously by a general practitioner in a chest X-ray. The anamnesis didn't relate any chest pain, cough, dyspnea nor hemoptysis. The clinical examination, in particular pleuropulmonary, was unremarkable. The workup (Chest X-Ray and CT scan) demonstrated a voluminous pleural mass at the expense of the right mediastinal pleura, rounded in shape, with calcified wall and fluid content. Blood tests did not demonstrate eosinophilia, and hydatid IgG serology was negative. serum human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) levels were found to be normal. The patient subsequently underwent a right posterolateral thoracotomy with resection of the lesion. The mass was dissected very carefully and then resected in toto. The macroscopic and microscopic histological examination demonstrated a mature cystic teratoma. Surgical resection was an adequate treatment and the prognosis was excellent for the patient. CONCLUSION Cystic mature teratomas are rare thoracic tumors, often recognized by radiological examination. This article relates the silent evolution that a teratoma could have, and the late appearance of symptoms that it could have.
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Affiliation(s)
- Badreddine Belayachi
- Department of Thoracic surgery, Mohammed VI University Hospital, Marrakesh, Morocco.
| | - Hicham Fenane
- Department of Thoracic surgery, Mohammed VI University Hospital, Marrakesh, Morocco
| | - Yassine Msougar
- Department of Thoracic surgery, Mohammed VI University Hospital, Marrakesh, Morocco
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2
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Joalsen I, Caesario M, Sahniar N, Boenjamin AA. Uniportal vats approach to bronchogenic cyst, East Borneo experience: A case report. Int J Surg Case Rep 2023; 109:108527. [PMID: 37541013 PMCID: PMC10407889 DOI: 10.1016/j.ijscr.2023.108527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Abnormalities in the development of the ventral foregut may result in bronchogenic cysts. Depending on the extent of aberrant budding, the location of a bronchogenic cyst might vary. The location and, more crucially, the size of the mass determine the onset of symptoms in individuals with bronchogenic cysts. Mediastinal bronchogenic cysts are mostly asymptomatic mediastinal masses discovered incidentally in adults. With the recent advancements in thoracoscopy, the removal can now be performed without the need for thoracotomies. CASE PRESENTATION We reported the case of incidental findings of an asymptomatic mediastinal bronchogenic cyst and opted for single-incision video-assisted thoracic surgery. The patient required no postoperative intensive care and discharged on third day after surgery with no complications. DISCUSSION Single-incision video-assisted thoracic surgery, also known as uniportal VATS, has swept the field of thoracic surgery in recent years, allowing us to execute challenging surgeries with a small single incision, avoiding the inherent morbidity of the standard open thoracotomy. We were able to remove mediastinal bronchogenic cysts using uniportal VATS completely. This method eliminates the need for post-operative critical care, reducing scarring and shortening hospital stays. CONCLUSION Bronchogenic cysts are uncommon mediastinal masses necessary for surgical therapy when discovered. The advancement of minimally invasive techniques offers surgeons safe new alternatives.
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Affiliation(s)
- Ivan Joalsen
- Division of Thoracic, Cardiac, and Vascular Surgery, Universitas Mulawarman/Abdul Wahab Sjahranie Hospital, Samarinda, East Borneo, Indonesia.
| | - Michael Caesario
- Division of Thoracic, Cardiac, and Vascular Surgery, Universitas Mulawarman/Abdul Wahab Sjahranie Hospital, Samarinda, East Borneo, Indonesia
| | - Novita Sahniar
- Intern Doctor of Thoracic, Cardiac, and Vascular Surgery, Abdul Wahab Sjahranie Hospital, Samarinda, East Borneo, Indonesia
| | - Abdul Azis Boenjamin
- General Surgery Resident Universitas Mulawarman/Abdul Wahab Sjahranie Hospital, Samarinda, East Borneo, Indonesia
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Shirzadi R, Roshanzamir Z, Pak N, Rajabi R, Mohammadi F. An unusual site of a pericardial cyst in a child: A case report. Radiol Case Rep 2023; 18:1498-1501. [PMID: 36816338 PMCID: PMC9932291 DOI: 10.1016/j.radcr.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
Pericardial cysts are rare congenital anomalies, often clinically silent and incidentally found on imaging. However, patients with pericardial cysts may present with chest pain, tachypnea, and, rarely, symptoms secondary to cardiac tamponade. Echocardiography (transthoracic or transesophageal) and chest computed tomography (CT) scan with contrast are diagnostic modalities of choice in patients with pericardial cysts. Conservative management is justified in asymptomatic patients, while a surgical approach is recommended in symptomatic patients. Here, we describe the case of a 12-year-old boy who underwent imaging during the coronavirus disease 2019 (COVID-19) pandemic and was incidentally found to have a pericardial cyst.
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Affiliation(s)
- Rohola Shirzadi
- Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Roshanzamir
- Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran,Pediatric Respiratory Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Pak
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Mohammadi
- Tehran University of Medical Sciences, Tehran, Iran,Children's Medical Center, No 63, Gharib Ave, Keshavarz Blvd., Tehran, 14194, Iran,Corresponding author.
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Hsu DS, Banks KC, Velotta JB. Surgical approaches to mediastinal cysts: clinical practice review. Mediastinum 2022; 6:32. [PMID: 36582973 PMCID: PMC9792838 DOI: 10.21037/med-22-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques, there have been successful cases completed via video-assisted thoracoscopic (VATS) and robot-assisted thoracoscopic surgery (RATS). Although mediastinal cysts are uncommon, they are a significant and relevant topic in the practice of thoracic surgery. Thus, this clinical practice review aims to summarize and highlight some of the key case series and retrospective studies in order to provide insight on each of the approaches. In addition, there is a brief review of other approaches, such as subxiphoid, and the utility of endobronchial ultrasound in the management of mediastinal cysts. In this review, the identified benefits of VATS and RATS lie largely in quality improvement of the patient experience-decreased length of stay (LOS) and pain-without compromising patient outcomes. However, the open approach remains a viable option, particularly for the management of large cysts or as a bail-out option. When surgeons approach with VATS or RATS and encounter bleeding or difficult dissection planes, it is consistent in the literature that conversion to thoracotomy is the safe next step. Our clinical practice is to attempt VATS or RATS approach for mediastinal cysts when possible. The data used for this review relies heavily on case reports and case series, and thus is the main limitation of this clinical practice review.
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Affiliation(s)
- Diana S. Hsu
- UCSF East Bay Surgery, Highland Hospital, Oakland, CA, USA;,Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Kian C. Banks
- UCSF East Bay Surgery, Highland Hospital, Oakland, CA, USA;,Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Jeffrey B. Velotta
- Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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5
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Zhou S, Wei H, Zhai H. Streptococcus pyogenes infection of a mediastinal cyst after endoscopic ultrasound-guided fine-needle aspiration. Heliyon 2022; 8:e11900. [PMID: 36561704 DOI: 10.1016/j.heliyon.2022.e11900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/08/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022] Open
Abstract
Mediastinal masses are uncommon and difficult to diagnose. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a minimally invasive technique for diagnosis of mediastinal lesions with few complications. Our report described a mediastinal bronchogenic cyst with soft tissue density infected by Streptococcus pyogenes (S. pyogenes) after EUS-FNA, accompanied by respiratory cardiac arrest and superior vena cava syndrome. The patient underwent cardiopulmonary resuscitation to gain the chance for emergency surgery and recovered. Clinicians should be aware that mediastinal mass with soft tissue density shown on imaging may be mediastinal cyst containing high density mucin, FNA should be avoided if cystic masses cannot be ruled out.
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Choe J, Lee SM, Ahn Y, Kim CH, Seo JB, Lee HY. Characteristics and outcomes of anterior mediastinal cystic lesions diagnosed on chest MRI: implications for management of cystic lesions. Insights Imaging 2022; 13:136. [PMID: 35976511 PMCID: PMC9385942 DOI: 10.1186/s13244-022-01275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chest MRI is a useful diagnostic modality for the evaluation of anterior mediastinal lesions but the outcomes of anterior mediastinal cystic lesions diagnosed on chest MRI are unclear. METHODS In this multicenter retrospective study, patients who underwent contrast-enhanced chest MRI in two tertiary centers to assess anterior mediastinal cystic lesions were included after excluding overt solid tumors and thymic hyperplasia. Anterior mediastinal cystic lesions were classified into two categories: probable (simple) cyst or indeterminate lesion (complex cyst). Size and imaging features of lesions during follow-up were evaluated and clinical outcomes were assessed. RESULTS A total of 204 patients (mean age, 59 ± 11 years; M:F = 111:93) were studied; 186 (91.2%) were classified as probable cysts and 18 (8.8%) as indeterminate lesions on MRI. Among patients with probable cysts and more than 2 years of follow-up, lesion size was unchanged in 39.6% (36/91), decreased in 16.5% (15/91), and fluctuated in 8.8% (8/91). All patients who underwent surgery were confirmed cysts. None developed mural nodules or irregular wall thickening, suspicious for malignancy during follow-up. In patients with indeterminate lesions, 16.7% (3/18) had pathologically confirmed thymoma and 44.4% (8/18) had proven cysts. Follow-up numbers and intervals after MRI in patients with probable cysts were variable among physicians and institutions in clinical practice (p < 0.05) but more than half were followed for up to 2 years in two centers. CONCLUSION Diagnosing anterior mediastinal cysts using MRI is reliable. MRI-based management of anterior mediastinal lesions may reduce the number of unnecessary follow-ups and surgeries.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea.
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea
| | - Chu Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, Korea.
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7
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Ramdani H, Benelhosni K, Billah NM, Nassar I. An unusual cause of pulmonary hypertension: Mediastinal hydatid cyst. Radiol Case Rep 2021; 17:86-90. [PMID: 34765067 PMCID: PMC8571532 DOI: 10.1016/j.radcr.2021.09.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/28/2021] [Indexed: 10/26/2022] Open
Abstract
Hydatid disease is a parasitic zoonosis prevalent in sheep-rearing areas. The lung is the second most commonly involved organ following the liver. Intra-thoracic and extra-pulmonary hydatid disease is rare and can affect the mediastinum, heart, diaphragm, pleura, and chest wall. Uncommon locations represent a diagnostic challenge. We report clinical and imaging manifestations of a compressive mediastinal hydatid cyst revealed by pulmonary hypertension. Radiologists must be familiar with the imaging features of hydatid disease and contemplate the diagnosis when facing atypical chest cystic lesions, especially in patients from endemic regions or with evidence of hydatidosis in a different anatomical location.
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Affiliation(s)
- Hanae Ramdani
- Radiology department, Ibn Sina University Hospital Center, Lamfadel Cherkaoui Street, Rabat, MA 10170, Morocco
| | - Khadija Benelhosni
- Radiology department, Ibn Sina University Hospital Center, Lamfadel Cherkaoui Street, Rabat, MA 10170, Morocco
| | - Nabil Moatassim Billah
- Radiology department, Ibn Sina University Hospital Center, Lamfadel Cherkaoui Street, Rabat, MA 10170, Morocco
| | - Ittimade Nassar
- Radiology department, Ibn Sina University Hospital Center, Lamfadel Cherkaoui Street, Rabat, MA 10170, Morocco
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8
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Ackman JB, Chung JH, Walker CM, Bang TJ, Carter BW, Hobbs SB, Kandathil A, Lanuti M, Madan R, Moore WH, Shah SD, Verde F, Kanne JP. ACR Appropriateness Criteria® Imaging of Mediastinal Masses. J Am Coll Radiol 2021; 18:S37-S51. [PMID: 33958117 DOI: 10.1016/j.jacr.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
Mediastinal masses can present with symptoms, signs, and syndromes or incidentally. Selecting the appropriate diagnostic imaging study for mediastinal mass evaluation requires awareness of the strengths and weaknesses of the various imaging modalities with regard to tissue characterization, soft tissue contrast, and surveillance. This publication expounds on the differences between chest radiography, CT, PET/CT, ultrasound, and MRI in terms of their ability to decipher and surveil mediastinal masses. Making the optimal imaging choice can yield diagnostic specificity, avert unnecessary biopsy and surgery, guide the interventionist when necessary, and serve as a means of surveillance for probably benign, but indeterminate mediastinal masses. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | | | - Tami J Bang
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen B Hobbs
- University of Kentucky, Lexington, Kentucky, Councilor, ACR Kentucky Chapter, Vice Chair, Informatics and Integrated Clinical Operations, University of Kentucky
| | | | - Michael Lanuti
- Massachusetts General Hospital, Boston, Massachusetts, The Society of Thoracic Surgeons, Director, Thoracic Oncology, Division of Thoracic Surgery, Massachusetts General Hospital
| | - Rachna Madan
- Brigham & Women's Hospital, Boston, Massachusetts
| | - William H Moore
- New York University Langone Medical Center, New York, New York
| | - Sachin D Shah
- University of Chicago, Chicago, Illinois, Primary care physician. Associate Chief Medical Information Officer, University of Chicago Medicine
| | - Franco Verde
- Johns Hopkins University School of Medicine, Baltimore, Maryland, Director, Diagnostic Imaging, Johns Hopkins Bayview Medical Center
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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9
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SABZI F, FARAJI R. The Ruptured Pericardial Cyst to the Right Atrium: A Case Report. Iran J Parasitol 2020; 15:142-146. [PMID: 32489387 PMCID: PMC7244842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The pericardial cysts (PC) are rare congenital anomaly. They are usually asymptomatic or incidentally found during surgery or by an imaging modality. We report a 35-yr-old man referred to Imam Ali Hospital, Kermanshah, western Iran in 2017, with palpitation, chest pain and dyspnea and physical exam revealed sign and symptoms of right atrial compression and tamponade.
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Affiliation(s)
- Freidoun SABZI
- Preventive Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza FARAJI
- Department of Biomedical Engineering, Zagros Higher Education Institute, Kermanshah, Iran,Correspondence
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10
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Njem JM, Ugwu B, Collins J, Emmanuel I, Philip OA, Awodi J. Aberrant pancreatic tissue in a giant mediastinal cyst: an uncommon entity. J Cardiothorac Surg 2019; 14:134. [PMID: 31286963 PMCID: PMC6615225 DOI: 10.1186/s13019-019-0955-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/25/2019] [Indexed: 12/25/2022] Open
Abstract
Background Heterotopia of pancreatic tissue in the thorax and mediastinum is uncommon, although, a common developmental anomaly in the gastrointestinal tract where the aberrant tissue is a component of gastrointestinal duplication cysts, intralobular pulmonary sequestration or teratomas. Case presentation We report a case of an ectopic pancreas located in a giant mediastinal cyst in a 2-year old girl who presented with severe dyspnoea due to external compression of the intra-thoracic structures, mainly the right main bronchus. Surgical resection was carried out with complete relief of symptoms. The cyst was confirmed histopathologically to contain pancreatic tissue. Literature review showed that this is an uncommon presentation hence the need to report the case. Conclusion Heterotopia of the pancreas although, an uncommon occurrence in the thorax and mediastinum, should be considered when dealing with cystic lesions of the mediastinum and surgery plays an important role in its management. Trial registration JUTH/DCS/ADM/127/XXV/203. Registered 2nd September 2018.
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Affiliation(s)
- Josiah Miner Njem
- Cardiothoracic Surgery Unit, Department of Surgery Jos University Teaching Hospital, Jos, Nigeria.
| | - Benjamin Ugwu
- Cardiothoracic Surgery Unit, Department of Surgery Jos University Teaching Hospital, Jos, Nigeria
| | - John Collins
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Innocent Emmanuel
- Department of Pathology & Morbid Anatomy, Jos University Teaching Hospital, Jos, Nigeria
| | - Ojile Akpa Philip
- Department of Pathology & Morbid Anatomy, Jos University Teaching Hospital, Jos, Nigeria
| | - John Awodi
- Cardiothoracic Surgery Unit, Department of Surgery Jos University Teaching Hospital, Jos, Nigeria
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Abstract
CASE SERIES SUMMARY Mediastinal cysts were diagnosed as incidental findings in six cats evaluated for non-thoracic disease, including staging for historical bladder leiomyosarcoma, flea dermatitis and hairballs, and hyperthyroidism. Radiographically, the cysts appeared as soft tissue opacities cranial to the heart. Ultrasound revealed the masses to be thin-walled, single lumen, anechoic, fluid-filled structures. One cat also had thoracic and abdominal CT performed for cancer staging; the CT revealed a well-defined, fluid-attenuating mass without peripheral contrast enhancement in the cranial mediastinum. Fine-needle aspiration confirmed acellular fluid consistent with a cyst in five cases; in one case the cyst ruptured during aspiration and no fluid was obtained. Post-aspiration, all masses were no longer visible with ultrasound or radiographs. No treatment was recommended for the cysts. Long-term follow-up (2-9 years post-diagnosis) was available in all six cats. The cysts recurred in five cats but were never associated with clinical signs. RELEVANCE AND NOVEL INFORMATION Mediastinal cysts are an important benign differential for cranial mediastinal masses in cats. Treatment for the cysts does not appear to be indicated. This series also includes the first CT description of this clinical entity.
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Affiliation(s)
| | | | - Laura D Garrett
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, IL, USA
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12
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Sekimura A, Iwai S, Funasaki A, Motono N, Usuda K, Uramoto H. Müllerian cyst in posterior mediastinum: A report of a case. Int J Surg Case Rep 2018; 49:163-165. [PMID: 30015213 PMCID: PMC6068079 DOI: 10.1016/j.ijscr.2018.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/23/2018] [Accepted: 06/29/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A Müllerian cyst is a recently defined rare benign tumor of the posterior mediastinum. It is necessary to distinguish it from neurogenic tumor or bronchogenic cyst arising in the posterior mediastinum. Herein, we have reported and reviewed a case of Müllerian cyst in the light of the existing literature. PRESENTATION OF A CASE A 40-year-old woman was referred to our department for abnormal mediastinal tumor on computed tomography (CT). Chest CT revealed a 2-cm nodule in the left posterior mediastinum, while magnetic resonance imaging (MRI) T2-weighted scan revealed an elliptical, homogenous, and high-intensity neoplasm, and bronchogenic cyst or neurogenic tumor was suspected. She did not present with any symptoms. A thoracoscopic surgery was performed for the cyst removal. Histopathological examination revealed that the cyst wall was covered with a layer of columnar epithelium. Immunohistochemical staining revealed the presence of estrogen receptor (ER) and progesterone receptor (PgR). Therefore a diagnosis of mediastinal Müllerian cyst was made. DISCUSSION AND CONCLUSION It is important to differentiate Müllerian cyst in the posterior mediastinal from other mediastinal cystic tumor for optimal decision-making in treatment.
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Affiliation(s)
- Atsushi Sekimura
- Department of Thoracic Surgery, Kanazawa Medical University, Japan.
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, Japan
| | - Aika Funasaki
- Department of Thoracic Surgery, Kanazawa Medical University, Japan
| | - Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Japan
| | - Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Japan
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Kocaturk CI, Sezen CB, Aker C, Kalafat CE, Bilen S, Kutluk AC, Karapinar K, Erdogan S, Saydam O. Surgical approach to posterior mediastinal lesions and long-term outcomes. Asian Cardiovasc Thorac Ann 2017; 25:287-291. [PMID: 28376631 DOI: 10.1177/0218492317705040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Posterior mediastinal lesions are classified as solid lesions and cysts. The treatment for both types is surgery. We evaluated the surgical outcomes and recurrence rates after video-assisted thoracic surgery and thoracotomy for posterior mediastinal lesions. Methods Data of 66 resections for posterior mediastinal masses between 2000 and 2014 were reviewed retrospectively. Twenty-two patients were treated by video-assisted thoracic surgery (group V) and 44 underwent thoracotomy (group T); 29 (43.9%) were female and 37 (56.1%) were male, the mean age was 45.9 ± 14.7 years. Results Bronchogenic cyst was the most common cystic lesion (10/12, 83.3%), and benign schwannoma was the most common solid lesion (32/54, 59.2%). The mean diameter of solid lesions was 5.19 ± 2.4 cm (group V 3.98 ± 1.8 vs. group T 5.78 ± 2.5 cm, p = 0.006). The tumor diameter was 4.06 ± 1.9 cm in asymptomatic patients and 6.93 ± 2.2 cm ( p < 0.001) in symptomatic patients. In group V, hospital stay and duration of drainage were significantly shorter than in group T ( p = 0.02, p = 0.01). Local recurrence was detected in 4 (6.1%) patients. Cystic lesions had a higher recurrence rate than solid lesions ( p = 0.01). There was no significant difference in recurrence rates in groups V and T ( p = 0.59). Conclusion Video-assisted thoracic surgery is a safe method for surgical treatment of posterior mediastinal lesions, with a shorter drainage time and postoperative hospitalization and similar recurrence rates. More recurrences are seen in patients with cystic lesions.
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Affiliation(s)
- Celalettin I Kocaturk
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Celal B Sezen
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cemal Aker
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cem E Kalafat
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Salih Bilen
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali C Kutluk
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kemal Karapinar
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sertan Erdogan
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozkan Saydam
- Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Hino H, Nishimura T, Seki A, Nitadori JI, Arai T, Nakajima J. Microthymoma in elderly-onset myasthenia gravis detected preoperatively. Asian Cardiovasc Thorac Ann 2016; 24:818-821. [PMID: 27510987 DOI: 10.1177/0218492316665057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 77-year-old woman with a 3-month history of muscle weakness was diagnosed with elderly-onset generalized myasthenia gravis (Myasthenia Gravis Foundation of America classification IIa) based on a high serum acetylcholine receptor antibody level (25.4 nmol·L-1) and neurological findings. Computed tomography detected a small nodule (diameter 15 mm) in the anterior mediastinum, which was suspected to be a thymoma. An extended thymectomy was performed. The pathological examination revealed a 6-mm-diameter thymoma, termed a microthymoma, accompanied with a unilocular thymic cyst without capsule formation (type B2 according to the World Health Organization classification). Some fat tissue was also found within the tumor.
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Takashi Nishimura
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Atsuko Seki
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Jun-Ichi Nitadori
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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15
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Varona Porres D, Persiva Ó, Pallisa E, Sansano I. Diagnostic imaging in spontaneous rupture of a thoracic duct cyst in the mediastinum. Radiologia 2016; 58:491-495. [PMID: 27117300 DOI: 10.1016/j.rx.2016.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/10/2016] [Accepted: 03/13/2016] [Indexed: 11/26/2022]
Abstract
Thoracic duct cysts in the mediastinum are extremely rare; they can give rise to chylothorax when they spontaneously rupture or after they are operated on. We present the case of an adult woman with a thoracic duct cyst in the mediastinum and chylothorax from its spontaneous rupture; to our knowledge, this phenomenon has not been specifically reported before. We describe the clinical and radiological findings, the therapeutic management, and the pathology findings, reviewing the literature for this entity.
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Affiliation(s)
- D Varona Porres
- Departamento de Radiodiagnóstico, Hospital Vall d'Hebron, Barcelona, España.
| | - Ó Persiva
- Departamento de Radiodiagnóstico, Hospital Vall d'Hebron, Barcelona, España
| | - E Pallisa
- Departamento de Radiodiagnóstico, Hospital Vall d'Hebron, Barcelona, España
| | - I Sansano
- Departamento de Anatomía Patológica, Hospital Vall d'Hebron, Barcelona, España
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16
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Dahdah J, Validire P, Grigoroiu M, Lenoir S, Gossot D, Stern JB. [Cystic mediastinal schwannoma appended to the vagus nerve]. Rev Mal Respir 2015; 33:383-7. [PMID: 26303098 DOI: 10.1016/j.rmr.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/31/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Schwannomas are a form of rare tumor, arising from neural tissue and representing 2 % of mediastinal tumors. They are usually located in the posterior mediastinum, most often in the paravertebral gutters and typically appended to intercostal nerves. CASE REPORTS We report two cases of unusual mediastinal schwannomas, appended to the vagus nerve. The schwannoma was located in the subcarinal region in the first case and in the right para-tracheal region in the second case. The lesions were thought to be bronchogenic cysts preoperatively in both cases because of a cystic appearance on preoperative CT scan and endobronchial ultrasonography. A surgical approach was adopted to remove the tumors. Video-assisted thoracoscopy was used in one case and robotic-assisted surgery in the second case, without any complication, allowing for complete resection and to establish a certain pathological diagnosis. CONCLUSION Despite this location and cystic presentation being unusual, schwannoma should be considered as a possible cause of cystic lesions in the mediastinum. Minimally invasive surgery allows for complete resection and definitive pathological diagnosis.
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Affiliation(s)
- J Dahdah
- Département thoracique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - P Validire
- Département d'anatomie pathologique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - M Grigoroiu
- Département thoracique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - S Lenoir
- Département d'imagerie médicale, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - D Gossot
- Département thoracique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - J-B Stern
- Département thoracique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
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17
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Abstract
BACKGROUND Mediastinal tumors can reach a huge size and give rise to serious surgical and oncological problems. METHODS A review of 18 patients with huge mediastinal tumors was performed. Ages ranged from 16 to 61 years, and 10 were male. In 4 cases, exploratory thoracotomies had been undertaken in other hospitals; in one patient, the tumor recurred after incomplete resection. We performed a median sternotomy in 17 patients and a lateral thoracotomy in one. Radiotherapy and platinum-based chemotherapy was administered in cases found to be malignant. RESULTS In 15 patients, the tumor was removed completely. In one patient, the operation was palliative because of vena caval and atrial invasion, and another had exploration only; biopsies revealed malignant transformation in these 2 patients. The blood loss was 425-2530 mL (average 690 mL); bleeding was fatal in one patient. Tissue diagnosis showed mature teratomas in 10 patients. Foci of malignant transformation were found in 5 cases. Chemodectoma was found in one patient, and thymoma in two. Patients with mature teratomas are free of disease. Two patients with malignant teratomas died from tumor recurrence despite irradiation and chemotherapy. CONCLUSIONS Clinical and oncological problems lie in the fact that malignant transformation of the tumor is diagnosed only after surgery. Extensive blood loss is a crucial surgical problem. Median sternotomy is the optimal operative approach. Surgical treatment of mature mediastinal tumors results in good outcomes unless malignancy is detected.
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Affiliation(s)
- Igor Ya Motus
- Department of Thoracic Surgery, Urals Research Institute for Phthisiopulmonology, Ekaterinburg, Russia
| | - Alexander V Bazhenov
- Department of Thoracic Surgery, Urals Research Institute for Phthisiopulmonology, Ekaterinburg, Russia
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18
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Chon SH, Im UJ, Song DS. Paravertebral mediastinal Mullerian cyst resected by video assisted thoracoscopic surgery. J Thorac Dis 2015; 7:E47-9. [PMID: 25922749 DOI: 10.3978/j.issn.2072-1439.2014.12.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/26/2014] [Indexed: 11/14/2022]
Abstract
Ever since Hattori et al. had described the mediastinal Mullerian cyst in 2005 there has been several new cases described in the literature. We report a 51-year-old woman with an incidentally found 2 cm × 3 cm mass in her left paravertebral mediastinum. She underwent thoracoscopic removal with the impression of a neurogenic tumor and was unexpectedly found with a ciliated cyst of Mullerian origin.
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Affiliation(s)
- Soon-Ho Chon
- 1 Department of Thoracic and Cardiovascular Surgery, 2 Department of Anesthesiology, S-Jungang Hospital, Jeju, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Wonkwang University Sanbon Hospital, Gunpo, South Korea
| | - Ui Jae Im
- 1 Department of Thoracic and Cardiovascular Surgery, 2 Department of Anesthesiology, S-Jungang Hospital, Jeju, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Wonkwang University Sanbon Hospital, Gunpo, South Korea
| | - Dong Seop Song
- 1 Department of Thoracic and Cardiovascular Surgery, 2 Department of Anesthesiology, S-Jungang Hospital, Jeju, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Wonkwang University Sanbon Hospital, Gunpo, South Korea
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19
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Abstract
Benign esophageal and paraesophageal masses and cysts are a rare but important group of pathologies. Although often asymptomatic, these lesions can cause a variety of symptoms and, in some cases, demonstrate variable biological behavior. Contemporary categorization relies heavily on endoscopic ultrasound and other imaging modalities and immunohistochemical analysis when appropriate. Minimally invasive options including endoscopic, laparoscopic, and thoracoscopic methods are increasingly used for symptomatic or indeterminate lesions.
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Affiliation(s)
- Cindy Ha
- Department of Surgery, Division of General Surgery at SIU, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA
| | - James Regan
- Department of Surgery, Division of General Surgery at SIU, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA
| | - Ibrahim Bulent Cetindag
- Department of Surgery, Division of General Surgery at SIU, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA
| | - Aman Ali
- Department of Internal Medicine, Division of Gastroenterology, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA
| | - John D Mellinger
- Department of Surgery, Division of General Surgery at SIU, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA.
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20
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Abstract
Mediastinal cysts account for 20% of all mediastinal masses. Symptomatic cysts need treatment, and surgical excision is the treatment of choice. One approach to resect them is video-assisted mediastinoscopy. An 80-year-old man with cough and dyspnea at rest was referred for evaluation. Chest computed tomography revealed a mediastinal cyst. Because of his symptoms, he was a candidate for surgery, and the cyst was resected by video-assisted mediastinoscopy through a cervical incision. Video-assisted mediastinoscopy is a safe and effective approach for complete resection of mediastinal cysts.
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Affiliation(s)
- Ali Sadrizadeh
- Cardiothoracic Surgery and Transplant Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Bagheri
- Cardiothoracic Surgery and Transplant Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Afghani
- Cardiothoracic Surgery and Transplant Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Molaei
- General Surgery Department, Zahedan University of Medical Sciences, Zahedan, Iran
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21
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Abstract
Rhabdomyosarcoma is a common paediatric soft tissue tumour. However, the anterior mediastinum is an extremely rare site for its occurrence. This report describes the imaging and histological findings of such a tumour in a 4-month-old boy.
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Affiliation(s)
- W P Chu
- Department of Radiology, Princess Margaret Hospital, Laichikok, Hong Kong (currently at the Department of Radiology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong)
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22
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Aydin Y, Araz O, Ozgokce M, Ince I, Alper F, Eroglu A. Video-Assisted Thoracoscopic Surgery of Mediastinal Cysts: Report of 13 Cases. Indian J Surg 2012; 77:236-9. [PMID: 26730000 DOI: 10.1007/s12262-012-0782-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 11/21/2012] [Indexed: 11/25/2022] Open
Abstract
Mediastinal cysts are rare anomalies. The purposes of this study were to present our experience with mediastinal cysts, which were thoracoscopically treated in our clinic, and to discuss our findings along with those from the literature. We retrospectively investigated 13 patients who were diagnosed and thoracoscopically treated for mediastinal cysts in our clinic between January 2008 and December 2011. Seven patients were female and six were male. The average age of the patients was 41.3 ± 20.3 (7-82 years old). The mediastinal cysts comprised five pericardial cysts: four bronchogenic cysts, one hydatid cyst, one benign cystic teratoma, one thymic cyst, and one neurenteric cyst. In the case of a ruptured hydatid cyst, we passed it to thoracotomy intra-operatively due to the presence of advanced adhesion related to inflammation. Postoperative complications and mortality did not occur in any case. The average postoperative hospitalisation period was 3.8 days (2-7 days). Video-assisted thoracoscopic surgery in mediastinal cysts is a reliable and effective approach with low morbidity and a shorter hospital stay.
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Affiliation(s)
- Yener Aydin
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, 25240 Erzurum, Turkey
| | - Omer Araz
- Department of Chest Diseases, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Mesut Ozgokce
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Ilker Ince
- Department of Anesthesia and Reanimation, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Fatih Alper
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Atilla Eroglu
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, 25240 Erzurum, Turkey
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23
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Abdul-Ghafar J, Yong SJ, Kwon W, Park IH, Jung SH. Primary thymic mucinous adenocarcinoma: a case report. Korean J Pathol 2012; 46:377-81. [PMID: 23110032 PMCID: PMC3479823 DOI: 10.4132/koreanjpathol.2012.46.4.377] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 09/29/2011] [Accepted: 11/01/2011] [Indexed: 01/19/2023]
Abstract
Primary thymic mucinous adenocarcinoma is an extremely rare aggressive subtype of thymic carcinoma. With a review of literatures, only nine cases have been reported up to present. A 36-year-old woman was admitted for further evaluation and treatment of a mediastinal mass. The patient had no medical history of cancer. The clinicoradiological examination disclosed no tumor elsewhere. After the surgical excision of mediastinal mass, it was grossly a round semi-solid mass with mucin-filled cystic areas. Microscopically solid areas showed cords, small nests and dilated glands infiltrating the fibrotic parenchyma, while the cystic areas were lined by mucinous epithelium with tumor cells floating in extracellular-mucin pools. Some cystic walls underwent malignant transformation of the benign thymic epithelium. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7, CK20, CD5, and CDX-2, and negative for thyroid transcription factor-1. In conclusion, the mucinous thymic adenocarcinoma should be recognized as a separate histopathological entity and considered in the differential diagnosis of mediastinal carcinomas.
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Affiliation(s)
- Jamshid Abdul-Ghafar
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
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24
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Kim EK, Lee SC, Park SB, Park S, Bahng S, Choe YH, Sung K. A huge mediastinal organizing hematoma causing reversal of atrial septal defect shunt flow. Korean Circ J 2011; 41:97-100. [PMID: 21430995 PMCID: PMC3053567 DOI: 10.4070/kcj.2011.41.2.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 06/08/2010] [Accepted: 07/12/2010] [Indexed: 11/30/2022] Open
Abstract
We report a case of a 46-year-old woman who presented with subacute exertional dyspnea and severe hypoxia. A large cystic mass compressing the right side of the heart along with right-to-left atrial shunt flow through an alleged atrial septal defect (ASD) were detected on echocardiography. CT scan of the chest and MRI of the heart revealed a loculated cystic mediastinal mass with hemorrhage measuring 5.5×8 cm compressing the right atrium and ventricle. The patient underwent cyst resection and primary closure of the ASD. This report illustrates a case of an unusual symptomatic pericardial mass compressing the right atrium and ventricle in a patient with an secundum ASD.
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Affiliation(s)
- Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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