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Collaud S, Stork T, Kaman H, Bauer S, Pöttgen C, Schildhaus HU, Schmack B, Aigner C. Giant middle mediastinal lesions: when tumor size correlates with mesenchymal origin-a retrospective single-center analysis. Mediastinum 2023; 7:24. [PMID: 37701639 PMCID: PMC10493615 DOI: 10.21037/med-22-49] [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] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 08/02/2023] [Indexed: 09/14/2023]
Abstract
Background The International Thymic Malignancy Interest Group (ITMIG) proposed an internationally accepted division of the mediastinum into three compartments based on computed tomography (CT): anterior (prevascular), middle (visceral) and posterior (paravertebral) compartment. There is no generally accepted definition for the term "giant" when applied to middle mediastinal lesions. We defined the term "giant" and described our surgical experience in treating patients with giant lesions of the middle mediastinum. Methods CT imaging of patients operated in our center from January 2016 to August 2021 for mediastinal lesions was reviewed. Lesions were categorized to one of the ITMIG-defined compartments. Lesion size at diagnosis was measured at its largest diameter on axial CT imaging. Giant middle mediastinal lesions were defined as lesions having a size ≥90th percentile of our middle mediastinal lesion cohort. Patients with giant middle mediastinal lesions were further analyzed. Results Thirty-six patients (23%) had lesions located in the middle mediastinal compartment. Most common diagnoses were mediastinal cysts (n=10, 28%), metastatic lesions (n=6, 17%), lymphomas (n=5, 14%), and sarcomas (n=3, 8%). Ninetieth percentile lesion size was 73 mm. As per definition, four patients had giant middle mediastinal lesions. All these four lesions were of mesenchymal origin including oesophageal leiomyoma, synovial sarcoma, leiomyosarcoma and undifferentiated round cell sarcoma. Resection was performed through posterolateral thoracotomy or sternotomy, with or without cardiopulmonary bypass. Conclusions The term "giant" could be defined as a mass larger or equal to 73 mm. This definition selected specifically lesions with mesenchymal origin and may therefore guide diagnostic algorithm and patient management.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- Lung Clinic, Department of Thoracic Surgery, Hospital Cologne-Merheim, University Witten Herdecke, Cologne, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- Lung Clinic, Department of Thoracic Surgery, Hospital Cologne-Merheim, University Witten Herdecke, Cologne, Germany
| | - Hafsa Kaman
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- Lung Clinic, Department of Thoracic Surgery, Hospital Cologne-Merheim, University Witten Herdecke, Cologne, Germany
| | - Sebastian Bauer
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
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Collaud S, Aigner C. A case report of a giant middle mediastinal leiomyosarcoma. Mediastinum 2022; 6:38. [PMID: 36582976 PMCID: PMC9792857 DOI: 10.21037/med-21-44] [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] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/18/2022] [Indexed: 01/01/2023]
Abstract
Primary mediastinal leiomyosarcomas are extremely rare soft tissue tumors, accounting for less than 15% of all primary mediastinal sarcomas. Middle mediastinal tumors are very rare, with a prevalence of 0.1% in healthy individuals. Usually, mediastinal leiomyosarcoma originates and involves mediastinal structures such as oesophagus, heart or great vessels. Here we report the rare case of a giant middle mediastinal leiomyosarcoma without involvement of any surrounding structures in a 70 years old female. Main related symptoms were cough and increasing dyspnea. Imaging work-up showed an 11-cm giant middle mediastinal tumor located in the subcarinal space and compressing the oesophagus. Cytopathologic examination of endobronchial ultrasound-guided transbronchial needle aspiration diagnosed leiomyosarcoma. The tumor was completely removed through a right posterolateral thoracotomy in the fifth intercostal space. None of the surrounding structures were involved by the tumor intraoperatively. The patient underwent adjuvant chemoradiation as advised by the sarcoma tumor board (5 cycles of dacarbazine and doxorubicin followed by 60 Gy). At last follow-up, no evidence of recurrence was seen on imaging ten months after surgery. This rare case confirms that giant middle mediastinal leiomyosarcoma may not involve surrounding mediastinal structure and that resection can be completely and safely done without the need for resection of neighboring structures. The relevant literature on the subject is reviewed here.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
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Drevet G, Chalabreysse L, Gamondes D, Tronc F, Maury JM. Epicardial carvernous hemangioma: The diagnostic challenge of a middle mediastinal mass. Thorac Cancer 2021; 12:2404-2406. [PMID: 34288503 PMCID: PMC8410526 DOI: 10.1111/1759-7714.14074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/01/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022] Open
Abstract
Primary tumors in the middle mediastinum are rare and pose diagnostic challenges. Lymphomas, mediastinal cysts and thymomas most frequently affect this anatomic area. Primary cardiac tumors are rare and constitute a differential diagnosis for the inferior middle mediastinum. Surgical exploration and resection is often mandatory in order to make a definitive diagnosis. Here, we report the case of a 69 year-old women who presented with persistent dyspnea. A complete preoperative workup revealed a large tissular mass adjacent to the right atrium. A diagnosis of a typical epicardial cavernous hemangioma was made following surgical resection.
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Affiliation(s)
- Gabrielle Drevet
- Department of Thoracic Surgery and Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Delphine Gamondes
- Department of Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - François Tronc
- Department of Thoracic Surgery and Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery and Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
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Abstract
ABSTRACT Thymomas are typically located in the anterior mediastinum and are rarely identified in other locations. A 48-year-old male patient was admitted to the hospital due to myasthenia gravis (MG). A mass in the middle mediastinum, obstructing the superior vena cava, was revealed by computed tomography and magnetic resonance imaging examination. The postoperative diagnosis was thymoma type AB, stage III. After surgery, he was treated with radiation therapy neoadjuvant. At the 5-year follow-up, recurrence was not observed. Ectopic thymoma in the middle mediastinum has been reported in 26 other cases in the literature. Most were classified as thymoma type A or AB, and all were stage I or II. Most of them were located in the upper right mediastinum, adjacent to the right trachea, and in the retro innominate vein area. Thymoma should be considered a differential diagnosis when a mass is observed in the middle mediastinum.
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Affiliation(s)
- Phung Anh Tuan
- Department of Radiology, Vietnam Millitary Medical University, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Children's Hospital 02, Ho Chi Minh City, Vietnam.,Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Exposito J, Mammino JR, O'Toole TJ, Haq F, Awad S. Sarcoidosis Presenting as a Right Paraesophageal Mass Abutting the Left Atrium. Cureus 2019; 11:e5403. [PMID: 31620326 PMCID: PMC6793595 DOI: 10.7759/cureus.5403] [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] [Indexed: 11/06/2022] Open
Abstract
We herein report a unique case of sarcoidosis in a 44-year-old Caucasian female. The patient was initially evaluated for hematochezia and diagnosed with diverticulitis after computed tomography (CT) scan of the abdomen and pelvis. This imaging also incidentally showed a large mass abutting the esophagus. Further imaging of the mass revealed widespread lymphadenopathy in the thorax without any respiratory or classic B symptoms present. The remaining workup caused concern for possible lung or hematologic malignancy. Following biopsy of a thoracic lymph node, the patient was diagnosed with sarcoidosis. This patient met only one of the usual demographic criteria associated with sarcoidosis and none of the lab criteria. While sarcoidosis is typically a benign disease, this case exemplifies how it may appear as a more sinister entity and warrants extensive workup to rule out malignancy.
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Affiliation(s)
| | | | - Timothy J O'Toole
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Furqan Haq
- Internal Medicine, Oak Hill Hospital, Tampa, USA
| | - Said Awad
- Internal Medicine, Largo Medical Center, Largo, USA
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Wang W, Cui M, Ma HX, Zhang H, Zhang ZH, Cui YB. A large schwannoma of the middle mediastinum: A case report and review of the literature. Oncol Lett 2016; 11:1719-1721. [PMID: 26998067 PMCID: PMC4774518 DOI: 10.3892/ol.2016.4148] [Citation(s) in RCA: 8] [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: 08/11/2014] [Accepted: 10/19/2015] [Indexed: 11/29/2022] Open
Abstract
Schwannoma of the mediastinum is a rare and typically benign type of tumor. The present study describes the case of a 61-year-old woman who presented with a continuous cough and facial edema. Pre-operative chest radiography, enhanced computed tomography (CT) and three-dimensional CT scans identified a well-circumscribed mass. The large cyst, measuring 6.5×6.1×5.0 cm, was located anterior to the trachea and posterior to the superior vena cava. The mass was observed to be in close proximity to the right pulmonary hilum and the superior vena cava was flattened due to the pressure on the right vagus nerve. Therefore, the encapsulated tumor was completely resected under thoracoscopy and was subsequently diagnosed as a benign schwannoma upon pathological examination. The respiratory tract symptoms and facial edema resolved immediately after the surgery, and no recurrence was observed during the 6-month follow-up period. At the time of writing, the patient remained alive. The present study records the rarely successful resection of a middle mediastinal tumor by video-assisted thoracoscopy.
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Affiliation(s)
- Wei Wang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ming Cui
- Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, P.R. China
| | - Hong Xi Ma
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hong Zhang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhen-Hua Zhang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - You-Bin Cui
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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