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Tellez-Zarate M, Meza-Hernandez J, Jimenez-Fuentes E. Neuroganglioma in the posterior mediastinum: an incidental discovery. J Surg Case Rep 2024; 2024:rjae156. [PMID: 38495045 PMCID: PMC10942810 DOI: 10.1093/jscr/rjae156] [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: 01/31/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Ganglioneuroma, a rare benign neuroblastic tumor, typically arises in the posterior mediastinum, but it can be found in the anterior mediastinum and thymus. Predominantly affecting the young, these asymptomatic tumors are often discovered incidentally through imaging. In our reported case, a 44-year-old woman post-hysterectomy with persistent jaundice was diagnosed with a neuroganglioma in the right posterior mediastinum via a computed tomography (CT) scan. Thoracotomy and resection revealed a 10-cm neuroganglioma untangled from mediastinal planes. Post-surgery, chylothorax emerged, which was managed through a 5-day fasting approach. Thoracic neurogangliomas, rare and often asymptomatic, demand meticulous diagnosis, emphasizing imaging and histopathology, with postoperative vigilance for complications.
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Affiliation(s)
- Maximiliano Tellez-Zarate
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, Mexico City 14090, Mexico
- Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City 04510, Mexico
| | - Javier Meza-Hernandez
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, Mexico City 14090, Mexico
- Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City 04510, Mexico
| | - Edgardo Jimenez-Fuentes
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, Mexico City 14090, Mexico
- Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City 04510, Mexico
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Helmink AJ, Alshomrani A, Lauer SR, Yuil-Valdes A. Thoracic SMARCA4-Deficient Undifferentiated Tumors With Unusual Presentations: A Case Series. Int J Surg Pathol 2023:10668969231206350. [PMID: 37903457 DOI: 10.1177/10668969231206350] [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] [Indexed: 11/01/2023]
Abstract
CONTEXT Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a recently described aggressive neoplasm of young smokers defined by SMARCA4 inactivating mutations and characterized by cells with rhabdoid morphology, high mitotic activity, and abundant necrosis. OBJECTIVE Describe and compare 3 unusual presentations of SMARCA4-UT in older adults, including one presenting as a metastatic lesion mimicking a primary bone sarcoma. Discuss the molecular characteristics of SMARCA4-UT and their relationship to nonsmall-cell lung carcinomas with SMARCA4. DESIGN Three patients with SMARCA4-UTs were identified utilizing a natural language search in CoPath. hematoxylin and eosin sections from all patients as well as Papanicolaou-stained slides and Diff-Quik-stained slides for the first patient were examined. A broad range of immunostains, including BRG1/SMARCA4, were evaluated. Molecular testing was performed via next-generation sequencing. RESULTS The 3 patients were aged 58, 70, and 70 years. All had a significant smoking history. The first patient presented with an iliac bone mass and mediastinal lymphadenopathy, the second with mediastinal adenopathy, and the third with a paratracheal mass. All 3 tumors showed a diffuse proliferation of pleomorphic, rhabdoid cells with high mitotic activity and tumor necrosis. SMARCA4 was lost in all 3 tumors by immunohistochemistry. Molecular testing revealed SMARCA4 alterations in the first 2. CONCLUSIONS Thoracic SMARCA4-UT should be considered in the differential diagnosis of pleomorphic rhabdoid tumors in older adults with a smoking history. Although most present as lung and/or mediastinal masses, they may occasionally present as a metastasis and mimic an undifferentiated sarcoma, representing a potential diagnostic pitfall.
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Affiliation(s)
- Austin J Helmink
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ahmad Alshomrani
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Scott R Lauer
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ana Yuil-Valdes
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
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3
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King KA, Tsao T, Abdulrahim A, Hildenbrand A. A Case of Thoracic Epidural Angiolipoma Causing Severe Spinal Cord Compression With Neurologic Manifestations. Cureus 2023; 15:e45305. [PMID: 37720116 PMCID: PMC10503948 DOI: 10.7759/cureus.45305] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 09/19/2023] Open
Abstract
A spinal epidural angiolipoma is a rare, benign tumor of adipocytes and blood vessels that accounts only for a small percentage of all spinal axis tumors. We report a case of a 44-year-old male who presented with three months of progressive decreased sensation and strength from about six cm above the umbilicus down to his feet bilaterally. He presented to the emergency room when he could no longer walk. He also had neurogenic urinary retention and likely neurogenic constipation. Physical exam was notable for decreased sensation, decreased strength, and increased patellar reflexes bilaterally. MRI of the thoracic spine showed a posterior epidural mass that spanned from T2 to T3, measuring 1.2 x 1.7 x 4.3 cm, and severely compressed the spinal cord posteriorly. The patient underwent an urgent laminectomy for decompression and mass resection. Pathology was consistent with an angiolipoma. Postoperatively, he experienced a drastic improvement in strength and gross motor skills. The sensation had a partial return following surgery and continued to improve over the hospital stay. In general, the literature reports significant symptomatic improvement in patients with spinal epidural angiolipomas after surgical resection.
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Affiliation(s)
- Kali A King
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Tiffany Tsao
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Ahmed Abdulrahim
- Pathology and Laboratory Medicine, Creighton University School of Medicine, Omaha, USA
| | - Alec Hildenbrand
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
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4
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Xiang Y, Tang W, Wang J, Wang Z, Bi N. Pseudoprogression of thoracic tumor after radiotherapy in the era of immunotherapy: a case series. Front Oncol 2023; 13:1021253. [PMID: 37576884 PMCID: PMC10419187 DOI: 10.3389/fonc.2023.1021253] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Pseudoprogression is rarely mentioned after radiotherapy except for central nervous system tumors. With the widespread of immunotherapy, the incidence of pseudoprogression of thoracic tumor after radiotherapy is increasing. This study summarized the clinical features of pseudoprogression in 4 patients who had underwent thoracic radiotherapy after and/or followed by immunotherapy. All of them had received chemotherapy and immunotherapy before thoracic radiotherapy. After radiotherapy, pseudoprogression occurred within 3 months after initiation of immune consolidation/rechallenge therapy. At least a 20% increase in the sum of the longest diameter of target lesions were measured on their chest image. During this period, patients' ECOG PS scores remained stable, specific serum tumor markers did not increase significantly. Treatment strategies did not change after pseudoprogression. The causes of radiographic pseudoprogression in this case series may be attributed to disturbances such as pneumonitis, atelectasis, mucus blockages and infection. In the era of immunotherapy, pseudoprogression of thoracic tumors after chest radiotherapy might become a common phenomenon. It is important for us to identify pseudoprogression based on patient's general status, radiological changes, and laboratory tests.
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Affiliation(s)
- Yongbo Xiang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Tang
- Center for National Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianyang Wang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhijie Wang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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5
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Ikeda T, Sumiya R, Sugimura A, Hirai H, Nagasaka S. Liver herniation mimicking a thoracic tumor with restoration of the liver surface structure on closure of the hernia orifice under thoracoscopic surgery. Asian J Endosc Surg 2022; 15:805-808. [PMID: 35445564 DOI: 10.1111/ases.13067] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
Non-congenital, non-traumatic spontaneous diaphragmatic liver hernia in adults is extremely rare and sometimes misdiagnosed as a thoracic tumor. Almost all previous reports with a definitive diagnosis reported preservation; thus, differential diagnosis is extremely important for planning optimal management of such clinical conditions. An abnormal shadow in the right lower lung field was detected on chest radiography in a 61-year-old woman. Further imaging study revealed a 33-mm diameter mass adjacent to the right diaphragm. Thoracoscopic surgery was performed as diagnostic treatment. We found a pale hemispherical herniated liver on the central tendon of the diaphragm. After repositioning the herniated liver, the orifice was closed with a non-absorbable suture, and the surface of the liver returned to being a perfectly smooth surface. With this result, we believe that repair of diaphragmatic liver hernia through a minimally invasive procedure has great benefits for patients.
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Affiliation(s)
- Takeshi Ikeda
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryusuke Sumiya
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aya Sugimura
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hoshie Hirai
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Nagasaka
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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6
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Chan YC, Kan ANC, Yuen LYP, Wan IYP, Fung KKF, Cheung YF, Leung KKY, Ku DTL, Liu APY. Case Report: Primary Thoracic Low-Grade Fibromyxoid Sarcoma in a Young Girl Presenting With Mediastinal Mass Syndrome. Front Pediatr 2022; 10:885068. [PMID: 35783305 PMCID: PMC9247646 DOI: 10.3389/fped.2022.885068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Low-grade fibromyxoid sarcomas (LGFMSs) are typically adult-onset tumors that arise from the extremities. Here, we report an exceptional case of primary thoracic LGFMS in an 8-year-old girl that resulted in mediastinal syndrome. In reporting this case, we discuss the clinical challenges, role of molecular profiling and review reported cases of pediatric thoracic LGFMSs.
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Affiliation(s)
- Yat Chi Chan
- LKS Faculty of Medicine, The University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Amanda N C Kan
- Department of Pathology, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR, China
| | - Liz Y P Yuen
- Division of Genetic and Genomic Pathology, Department of Pathology, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR, China
| | - Innes Y P Wan
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kevin K F Fung
- Department of Radiology, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR, China
| | - Yiu-Fai Cheung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR, China.,Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Karen K Y Leung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR, China
| | - Dennis T L Ku
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR, China
| | - Anthony P Y Liu
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Kowloon, Hong Kong SAR, China.,Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Kowloon, Hong Kong SAR, China
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7
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Terry W, Carlisle EM, Mallinger P, Nelson A, Gordon D, Messinger YH, Field A, Dehner LP, Hill DA, Schultz KAP. Thoracic Sertoli-Leydig cell tumor: An alternative type of pleuropulmonary blastoma associated with DICER1 variation. Pediatr Blood Cancer 2021; 68:e29284. [PMID: 34398502 PMCID: PMC8463509 DOI: 10.1002/pbc.29284] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022]
Abstract
A 2-year-old boy presented with a large cystic and solid chest mass arising from the lung, radiographically consistent with pleuropulmonary blastoma (PPB). He underwent right lower lobectomy with resection of a well-circumscribed, mixed solid and cystic mass. The solid areas were composed of cords and nests of tumor cells in the myxoid stroma and retiform foci whose pathologic and immunophenotypic findings were consistent with a sex cord-stromal tumor with features of a Sertoli-Leydig cell tumor. Tumor testing showed a pathogenic variant in the DICER1 RNase IIIb hotspot domain. Family history was suggestive of DICER1 germline pathogenic DICER1 variation in absence of a detectable germline variant. He received 12 cycles of chemotherapy with ifosfamide, vincristine, dactinomycin and doxorubicin (IVADo) and surgery with complete response. One year after completion of chemotherapy, imaging studies showed concern for recurrence confirmed by thorascopic biopsy of a pleural-based mass. He is currently receiving cisplatin-based chemotherapy with reduction in tumor size. Review of the literature showed no similar cases; however, review of our pathology files revealed a single similar case of anterior mediastinal Sertoli cell tumor in a 3-year-old girl.
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Affiliation(s)
- William Terry
- Division of Pediatric Hematology/Oncology, Stead Family Children’s Hospital, Iowa City, IA
| | - Erica M. Carlisle
- Division of Pediatric Surgery, Stead Family Children’s Hospital, Iowa City, IA
| | - Paige Mallinger
- International PPB/DICER1 Registry, Children’s Minnesota, Minneapolis, MN,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Alexander Nelson
- International PPB/DICER1 Registry, Children’s Minnesota, Minneapolis, MN,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - David Gordon
- Division of Pediatric Hematology/Oncology, Stead Family Children’s Hospital, Iowa City, IA
| | - Yoav H. Messinger
- International PPB/DICER1 Registry, Children’s Minnesota, Minneapolis, MN,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | | | - Louis P. Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University Medical Center, St. Louis, MO
| | - D. Ashley Hill
- Department of Pathology and Laboratory Medicine, Children’s National Medical Center, Washington, DC
| | - Kris Ann P. Schultz
- International PPB/DICER1 Registry, Children’s Minnesota, Minneapolis, MN,International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN,Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
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8
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Ji Z, Sun H, Jiang Y, Chen Y, Guo F, Fan J, Wang J. Analysis on the accuracy of CT-guided radioactive I-125 seed implantation with 3D printing template assistance in the treatment of thoracic malignant tumors. J Radiat Res 2021; 62:910-917. [PMID: 34350955 PMCID: PMC8438469 DOI: 10.1093/jrr/rrab068] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/10/2021] [Indexed: 06/13/2023]
Abstract
This article analyzes the accuracy of needle track and dose of a 3-dimensional printing template (3DPT) in the treatment of thoracic tumor with radioactive I-125 seed implantation (RISI). A total of 28 patients were included. The technical process included: (i) preoperative CT positioning, (ii) preoperative planning design, (iii) 3DPT design and printing, (iv) 3DPT alignment, (v) puncture and seed implantation. The errors of needle position and dosimetric parameters were analyzed. A total of 318 needles were used. The mean errors in needle depth, needle insertion point, needle tip and needle angle were 0.52 ± 0.48 cm, 3.4 ± 1.7 mm, 4.4 ± 2.9 mm and 2.8 ± 1.7°, respectively. The differences between actual needle insertion angle and needle depth and those designed in the preoperative were statistically significant (p < 0.05). The mean values of all the errors of the chest wall cases were smaller than those of the lungs, and the differences were statistically significant (p < 0.05). There was no significant difference between the D90 calculated in the postoperative plan and those designed in the preoperative and intraoperative plans (p > 0.05). Some dosimetric parameters of preoperative plans such as V100, V200, CI and HI were not consistent with that of preoperative plans, and the difference was statistically significant (p < 0.05). However, there were no statistical difference in the dosimetric parameters between the postoperative plans and intraoperative plans (p > 0.05). We conclude that for thoracic tumors, even under the guidance of 3DPT, there will be errors. The plan should be optimized in real time during the operation.
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Affiliation(s)
- Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yi Chen
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Fuxin Guo
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Jinghong Fan
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Junjie Wang
- Corresponding author. Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China.
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9
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Konakondla S, Nakhla J, Xia J, Barber SM, Fridley JS, Oyelese AA, Gokaslan ZL, Rainov NG, Haritonov DG, Wagner R, Telfeian AE. A Novel Endoscopic Technique for Biopsy and Tissue Diagnosis for a Paraspinal Thoracic Tumor in a Pediatric Patient: A Case Report. Int J Spine Surg 2020; 14:S66-S70. [PMID: 33900947 DOI: 10.14444/7167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/20/2022] Open
Abstract
BACKGROUND Conventional approaches to the thoracic spine can require extensive tissue dissection, bony disruption, and instability that may warrant the need for instrumentation and fusion. Furthermore, anterior approaches may require the involvement of various surgeons from multiple disciplines to ensure a successful operation and mitigate complications. Currently, available minimally invasive approaches still require bony removal and usually rely heavily on computed tomography (CT)-guided imaging without direct gross visualization. Endoscopic spinal procedures have provided an ultra-minimally invasive alternative to access many areas in and around the spinal column. METHODS We present a 12-year-old boy with a right-sided 2.0 × 3.2-cm paravertebral lesion at the level of T5. The patient successfully underwent an endoscopic approach to the lesion with minimal tissue and bony disruption for tissue diagnosis and tumor resection. RESULTS At initial and 6-month follow-up, the patient remained asymptomatic and without issues. CONCLUSIONS We demonstrate here the feasibility and suggest the safety of a posterior ultra-minimally invasive endoscopic spinal approach to obtain a tissue biopsy of an incidentally found ventrolateral paraspinal tumor in the thoracic region in a pediatric patient. This minimal approach can prove to achieve similar results as other approaches that may otherwise necessitate more extensive or transthoracic procedures.
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Affiliation(s)
- Sanjay Konakondla
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Jonathan Nakhla
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Jimmy Xia
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Sean M Barber
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Jared S Fridley
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Adetokunbo A Oyelese
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Ziya L Gokaslan
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | | | | | - Ralf Wagner
- Ligamenta Spine Centre, Frankfurt am Main, Germany
| | - Albert E Telfeian
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
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10
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Abstract
Mature thoracic intraspinal teratomas are rare tumors in adults. In this case study, we present a case of intradural, extramedullary teratoma, which was surgically resected. A 50 year old man presented with progressive bilateral leg pain, severe myelopathy and weakness. Magnetic Resonance Imaging (MRI) revealed a cystic mass lesion in the T11-12 region region. Microsurgical resection of the tumor using CO2 laser with neuromonitoring was performed. Postoperatively, the patient had a remarkable clinical improvement. Mature spinal teratomas are rare, slow growing spinal tumors. Surgical resection provides excellent recovery, and recurrence rates are low.
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Affiliation(s)
- Aaron P Danison
- Department of Neurosurgery, University of California, Davis, CA, USA
| | - Dinesh Ramanathan
- Department of Neurosurgery, University of California, Davis, CA, USA
| | - Mahan Matin
- Department of Neurosurgery, University of California, Davis, CA, USA
| | - Kee Kim
- Department of Neurosurgery, University of California, Davis, CA, USA
| | - Ripul R Panchal
- Department of Neurosurgery, University of California, Davis, CA, USA
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11
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Abstract
Immunohistochemistry is a widely available technique that is less challenging and can provide clinically meaningful results quickly and cost-efficiently in comparison with other techniques. In addition, immunohistochemistry allows for the evaluation of cellular localization of proteins in the context of tumor structure. In an era of precision medicine, pathologists are required to classify lung cancer into specific subtypes and assess biomarkers relevant to molecular-targeted therapies. This review summarizes the hot topics of immunohistochemistry in lung cancer, including (i) adenocarcinoma vs squamous cell carcinoma; (ii) neuroendocrine markers; (iii) ALK, ROS1, and EGFR; (iv) PD-L1 (CD274); (v) lung carcinoma vs malignant mesothelioma; and (vi) NUT carcinoma. Major pitfalls in evaluating immunohistochemical results are also described.
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Affiliation(s)
- Kentaro Inamura
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
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12
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Zhao J, Zhang M, Zhai F, Wang H, Li X. Setup errors in radiation therapy for thoracic tumor patients of different body mass index. J Appl Clin Med Phys 2018; 19:27-31. [PMID: 29493070 PMCID: PMC5978940 DOI: 10.1002/acm2.12270] [Citation(s) in RCA: 7] [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: 03/05/2017] [Revised: 10/19/2017] [Accepted: 11/14/2017] [Indexed: 11/27/2022] Open
Abstract
Purpose To assess the setup errors in radiation therapy for thoracic tumors patients of different somatotypes, and to seek an individualized mathematical basis for defining the planning target volume (PTV). Methods Sixty patients with thoracic tumors were divided into four somatotypes according to their body mass index (BMI), and their body positions were setup by two groups of technicians independently. CT simulations were performed and the reconstructed radiography was digitally generated as reference images for location verification and error measurement. By setting positioning error ranges, the within‐range positioning correction rate was compared among groups. Results Position setups for patients in the emaciated group, moderate group, and overweight group were relatively stable (with minor setup error differences between the two groups of technicians). In emaciated group, moderate group, overweight group, and obese group, setup errors in the right–left direction (R‐L) were 2.2 ± 1.3 mm, 2.2 ± 1.6 mm, 3.9 ± 3.1 mm, and 8.8 ± 3.5 mm, respectively; whereas the setup errors in the four groups in the superior–inferior(S‐I) direction were 2.4 ± 1.8 mm, 2.1 ± 1.9 mm, 3.2 ± 2.6 mm, and 5.4 ± 3.5 mm, and in the anterior–posterior (A‐P) direction were 2.2 ± 1.7 mm, 1.9 ± 1.9 mm, 3.2 ± 2.9 mm, and 6.2 ± 4.2 mm, respectively. Moreover, in the moderate group, the positioning correction rate in the three directions (R‐L, S‐I, and A‐P) was 20%, 9%, 8% within the error range of 5–10 mm, and 3%, 0%, 1% with a more than 10 mm error range. However, in overweight group and obese group, the positioning correction rate in these three directions (also with a more than 10 mm error range) was 23%, 27%, 19% and 21%, 16%, 23%, respectively. Conclusions In radiation therapy for patients with thoracic tumors, the definition of PTV should be individualized. Meanwhile, with the increase in BMI, positioning correction rate has a tendency to rise too.
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Affiliation(s)
- Jin Zhao
- Department of Oncology, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Mingyun Zhang
- Department of Radiation Oncology, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Fushan Zhai
- Department of Radiation Oncology, Third Hospital of Hebei Medical University, Cangzhou, Hebei, China
| | - Haiyan Wang
- Department of Radiation Oncology, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Xingde Li
- Department of Radiation Oncology, Cangzhou Central Hospital, Cangzhou, Hebei, China
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Chen H, Yao J, Tang Y, Zhang H. A giant gastrointestinal stromal tumor of the stomach presenting as a posterior mediastinal mass. Int J Clin Exp Pathol 2017; 10:8741-8745. [PMID: 31966734 PMCID: PMC6965399] [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] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/20/2017] [Indexed: 06/10/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) involving thoracic region are very rare, most of which are esophageal in origin. Herein, we report a gastric GIST presenting as a posterior mediastinal mass, which provided diagnostic pitfalls due to its unusual anatomic location. The patient was a 68-year-old Chinese female, presenting with dysphagia, nausea and weight loss of 5 kg within 4 months. The contrast-enhanced thoracic computed tomography scan revealed a huge heterogeneous soft tissue mass in the posterior mediastinum. The core biopsy revealed a spindle cell tumor. The pathological features, in conjunction with the strong immunostaining pattern for CD117 and DOG-1 and the identification of KIT exon 11 mutation, confirmed the diagnosis of GIST. The subsequent surgery revealed the tumor located entirely in the abdominal cavity, laying beneath the diaphragm, and pushing the diaphragm upward into the posterior mediastinum. To our best, there has been only one similar case reported in the English literature. As patients with GISTs either resectable or not may get potential benefits from imatinib currently, the identification of GIST is very important even before surgery. Clinicians and pathologists should keep in mind that GISTs involving thoracic region do exist. The morphological features, immunohistochemical panel including CD117 and DOG-1 and molecular genetic test, in combination with clinicopathological correlation are helpful in confirming the correct diagnosis.
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Affiliation(s)
- Huijiao Chen
- Department of Pathology, West China Hospital, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Jin Yao
- Department of Radiology, West China Hospital, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Yuan Tang
- Department of Pathology, West China Hospital, Sichuan UniversityChengdu 610041, Sichuan, China
| | - Hongying Zhang
- Department of Pathology, West China Hospital, Sichuan UniversityChengdu 610041, Sichuan, China
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Zhang Z, Pan X, Qiu H, Guo T, Ou D, Ding H. [Application of vascular repair and reconstruction in surgical treatment of superior vena cava syndrome caused by thoracic tumor]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017; 31:231-234. [PMID: 29786259 DOI: 10.7507/1002-1892.201610036] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the clinical experience of vascular repair and reconstruction for treating superior vena cava syndrome (SVCS) caused by thoracic tumor. Methods Between October 2008 and June 2016, 26 patients with thoracic tumor and SVCS were admitted. There were 18 males and 8 females, aged from 27 to 70 years (mean, 45.9 years). Tumor was typed as B1-B3 thymoma in 13 cases, thymic carcinoma in 6 cases, large B-cell lymphoma in 3 cases, T lymphocytic lymphoma in 1 case, malignant teratoma in 1 case, right lung squamous cell carcinoma in 1 case, and carcinoid in 1 case. The tumor diameter ranged from 8 to 15 cm with an average of 10 cm. The patients had different degrees of neck, face, and upper extremity edema, jugular vein distention, and chest wall collateral venous filling. The superior vena cava pressure was 2.45-5.39 kPa. After excision of tumor and invading superior vena cava, 7 patients underwent superior vena cava reconstruction and 19 patients underwent artificial vascular replacement. Results There was no perioperative death, and the symptoms of superior vena cava obstruction were eliminated. Postoperative pulmonary infection, respiratory muscle weakness, and right chylothorax occurred in 4 cases, 1 case, and 1 case respectively. Twenty-four patients were followed up 2-92 months (mean, 37 months), and 2 patients failed to be followed up. At 1, 3, and 5 years, the survival rate was 83.3% (20/24), 41.7% (10/24), and 25% (6/24), respectively. In 6 patients with 5-year survival, there were 1 case of type B1 thymoma, 3 cases of type B3 thymoma, and 2 cases of large B-cell lymphoma. Conclusion For preoperative evaluation of SVCS caused by resectable thoracic tumors, vascular repair and recons-truction technique can be used to quickly and effectively relieve the clinical symptoms and improve the quality of life.
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Affiliation(s)
- Zhenlong Zhang
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001, P.R.China
| | - Xiaojie Pan
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001,
| | - Hanfan Qiu
- Department of Cardiac Surgery, the Affiliated Union Hospital, Fujian Medical University, Fuzhou Fujian, 350001, P.R.China
| | - Tianxing Guo
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001, P.R.China
| | - Debin Ou
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001, P.R.China
| | - Hang Ding
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001, P.R.China
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Xiong W, Xu Q, Xu Y, Sun C, Li N, Zhou L, Liu Y, Zhou X, Wang Y, Wang J, Bai S, Lu Y, Gong Y. Stereotactic body radiation therapy for post-pulmonary lobectomy isolated lung metastasis of thoracic tumor: survival and side effects. BMC Cancer 2014; 14:719. [PMID: 25260301 PMCID: PMC4189164 DOI: 10.1186/1471-2407-14-719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/24/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) has emerged as an alternative treatment for patients with early stage non-small cell lung cancer (NSCLC) or metastatic pulmonary tumors. However, for isolated lung metastasis (ILM) of thoracic malignances after pulmonary lobectomy, reported outcomes of SBRT have been limited. This study evaluates the role of SBRT in the treatment of such patients. METHODS A retrospective search of the SBRT database was conducted in three hospitals. The parameters analyzed in the treated patients were local control, progression-free survival (PFS), overall survival (OS), and the treatment-related side-effects. RESULTS In total, 23 patients with single ILM after pulmonary lobectomy treated with SBRT were identified and the median follow-up time was 14 months (range: 6.0-47.0 months). Local recurrences were observed in two patients during follow-up and the 1-year local control rate was 91.3%. Median PFS and OS for the studied cohort were 10.0 months [95% confidence interval (CI) 5.1-14.9 months] and 21.0 months (95% CI 11.4-30.6 months), respectively. Acute radiation pneumonitis (RP) of grade 2 or worse was observed in five (21.7%) and three (13.0%) patients, respectively. Other treatment-related toxicities included chest wall pain in one patient (4.3%) and acute esophagitis in two patients (8.7%). By Pearson correlation analysis, the planning target volume (PTV) volume and the volume of the ipsilateral lung exposed to a minimum dose of 5 Gy (IpV5) were significantly related to the acute RP of grade 2 or worse in present study (p < 0.05). The optimal thresholds of the PTV and IpV5 to predict RP of acute grade 2 or worse RP were 59 cm3 and 51% respectively, according to the receiver-operating characteristics curve analysis, with sensitivity/specificity of 75.0%/80.0% and 62.5%/80.0%. CONCLUSIONS SBRT for post-lobectomy ILM was effective and well tolerated. The major reason for disease progression was distant failure but not local recurrence. The PTV and IpV5 are potential predictors of acute RP of grade 2 or higher and should be considered in treatment planning for such patients.
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Affiliation(s)
- Weijie Xiong
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
- />Chengdu Fifth People’s Hospital and Chengdu Third People’s Hospital, Chengdu, China
| | - Qingfeng Xu
- />Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Yong Xu
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Changjin Sun
- />Department of Radiation Oncology, The Second People’s Hospital of Sichuan Province, Chengdu, 610031 PR China
- />Chengdu Fifth People’s Hospital and Chengdu Third People’s Hospital, Chengdu, China
| | - Na Li
- />Department of Oncology, Second Affiliated Hospital of Anhui Medical University, Hefei, 230601 PR China
| | - Lin Zhou
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Yongmei Liu
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Xiaojuan Zhou
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Yongsheng Wang
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Jin Wang
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Sen Bai
- />Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - You Lu
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Youling Gong
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
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Abstract
A rare case of thoracic fetus in fetu is reported. Complete excision was curative.
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Affiliation(s)
- Ramesh K Reddy
- Department of Pediatric Surgery, Niloufer Hospital, Hyderabad, Andhra Pradesh, India
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