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Yoshida KI, Yoshida A. Sarcoma of the Lung and Mediastinum. Surg Pathol Clin 2024; 17:243-255. [PMID: 38692808 DOI: 10.1016/j.path.2023.11.008] [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] [Indexed: 05/03/2024]
Abstract
Primary sarcoma of the lung and mediastinum is rare. The diagnosis requires careful exclusion of sarcomatoid carcinoma, sarcomatoid mesothelioma, and metastases from extra-thoracic sites. This review summarizes the key morphologic, immunohistochemical, and molecular characteristics of sarcomas that are encountered in the lung and mediastinum. The tumor types discussed are synovial sarcoma, well-differentiated/dedifferentiated liposarcoma, myxoid pleomorphic liposarcoma, intimal sarcoma of the pulmonary artery, inflammatory myofibroblastic tumor, epithelioid hemangioendothelioma, primary pulmonary myxoid sarcoma, malignant peripheral nerve sheath tumor, Ewing sarcoma, and CIC-rearranged sarcoma. Relevant differential diagnoses are also addressed.
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Affiliation(s)
- Ken-Ichi Yoshida
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Rare Cancer Center, National Cancer Center, Tokyo, Japan.
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Mathai TS, Liu B, Summers RM. Segmentation of mediastinal lymph nodes in CT with anatomical priors. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03165-4. [PMID: 38740719 DOI: 10.1007/s11548-024-03165-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Lymph nodes (LNs) in the chest have a tendency to enlarge due to various pathologies, such as lung cancer or pneumonia. Clinicians routinely measure nodal size to monitor disease progression, confirm metastatic cancer, and assess treatment response. However, variations in their shapes and appearances make it cumbersome to identify LNs, which reside outside of most organs. METHODS We propose to segment LNs in the mediastinum by leveraging the anatomical priors of 28 different structures (e.g., lung, trachea etc.) generated by the public TotalSegmentator tool. The CT volumes from 89 patients available in the public NIH CT Lymph Node dataset were used to train three 3D off-the-shelf nnUNet models to segment LNs. The public St. Olavs dataset containing 15 patients (out-of-training-distribution) was used to evaluate the segmentation performance. RESULTS For LNs with short axis diameter ≥ 8 mm, the 3D cascade nnUNet model obtained the highest Dice score of 67.9 ± 23.4 and lowest Hausdorff distance error of 22.8 ± 20.2. For LNs of all sizes, the Dice score was 58.7 ± 21.3 and this represented a ≥ 10% improvement over a recently published approach evaluated on the same test dataset. CONCLUSION To our knowledge, we are the first to harness 28 distinct anatomical priors to segment mediastinal LNs, and our work can be extended to other nodal zones in the body. The proposed method has the potential for improved patient outcomes through the identification of enlarged nodes in initial staging CT scans.
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Affiliation(s)
| | - Bohan Liu
- Department of Radiology, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Ronald M Summers
- Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA
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Comacchio GM, Schiavon M, Zirafa CC, De Palma A, Scaramuzzi R, Meacci E, Bongiolatti S, Monaci N, Lyberis P, Novellis P, Brandolini J, Parini S, Ricciardi S, D'Andrilli A, Bottoni E, Gallina FT, Marino MC, Lorenzoni G, Francavilla A, Rendina EA, Cardillo G, Rena O, Solli P, Alloisio M, Luzzi L, Facciolo F, Voltolini L, Margaritora S, Curcio C, Marulli G, Ruffini E, Veronesi G, Melfi F, Rea F. Robotic thymectomy in thymic tumours: a multicentre, nation-wide study. Eur J Cardiothorac Surg 2024; 65:ezae178. [PMID: 38663851 DOI: 10.1093/ejcts/ezae178] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/11/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Robotic thymectomy has been suggested and considered technically feasible for thymic tumours. However, because of small-sample series and the lack of data on long-term results, controversies still exist on surgical and oncological results with this approach. We performed a large national multicentre study sought to evaluate the early and long-term outcomes after robot-assisted thoracoscopic thymectomy in thymic epithelial tumours. METHODS All patients with thymic epithelial tumours operated through a robotic thoracoscopic approach between 2002 and 2022 from 15 Italian centres were enrolled. Demographic characteristics, clinical, intraoperative, postoperative, pathological and follow-up data were retrospectively collected and reviewed. RESULTS There were 669 patients (307 men and 362 women), 312 (46.6%) of whom had associated myasthenia gravis. Complete thymectomy was performed in 657 (98%) cases and in 57 (8.5%) patients resection of other structures was necessary, with a R0 resection in all but 9 patients (98.6%). Twenty-three patients (3.4%) needed open conversion, but no perioperative mortality occurred. Fifty-one patients (7.7%) had postoperative complications. The median diameter of tumour resected was 4 cm (interquartile range 3-5.5 cm), and Masaoka stage was stage I in 39.8% of patients, stage II in 56.1%, stage III in 3.5% and stage IV in 0.6%. Thymoma was observed in 90.2% of patients while thymic carcinoma occurred in 2.8% of cases. At the end of the follow-up, only 2 patients died for tumour-related causes. Five- and ten-year recurrence rates were 7.4% and 8.3%, respectively. CONCLUSIONS Through the largest collection of robotic thymectomy for thymic epithelial tumours we demonstrated that robot-enhanced thoracoscopic thymectomy is a technically sound and safe procedure with a low complication rate and optimal oncological outcomes.
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Affiliation(s)
- Giovanni Maria Comacchio
- Unit of Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Schiavon
- Unit of Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carmelina Cristina Zirafa
- Robotic Multispecialty Centre for Surgery, Minimally Invasive and Robotic Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Angela De Palma
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
| | | | - Elisa Meacci
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Stefano Bongiolatti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Nicola Monaci
- Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy
| | - Paraskevas Lyberis
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Jury Brandolini
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sara Parini
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini Hospital, Rome, Italy
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Edoardo Bottoni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Maria Carlotta Marino
- Unit of Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini Hospital, Rome, Italy
- Unicamillus, International University of Health Sciences, Rome, Italy
| | - Ottavio Rena
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Luzzi
- Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Voltolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Curcio
- Thoracic Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Giuseppe Marulli
- Unit of Thoracic Surgery, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy
- Department of Biomedical Sciences, Thoracic Surgery, Humanitas University, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Giulia Veronesi
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Franca Melfi
- Robotic Multispecialty Centre for Surgery, Minimally Invasive and Robotic Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Federico Rea
- Unit of Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Silva NCCD, Almeida GL, Pimenta HODS, Guimarães ARF, Cordeiro ALL. Safety and feasibility of early mobilization in patients submitted to cardiac surgery using subxiphoid drain. J Bodyw Mov Ther 2024; 38:158-161. [PMID: 38763556 DOI: 10.1016/j.jbmt.2024.01.007] [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: 05/08/2023] [Revised: 11/18/2023] [Accepted: 01/13/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Patients submitted to heart surgery are restricted to the bed of the Intensive Care Units (ICUs), due to this period of immobility the individual is likely to present clinical and functional alterations. These complications can be avoided by early mobilization; however, in some hospitals, this is not feasible due to the use of subxiphoid drain in the immediate postoperative period. OBJECTIVE To verify the safety and feasibility of mobilizing patients after cardiac surgery using subxiphoid drain. METHODS This was a prospective cohort study. On the first day the patient was positioned in sedestration in bed, then transferred from sitting to orthostasis, gait training and sedestration in an armchair. On the second postoperative day the same activities were performed, but with walking through the ICU with a progressive increase in distance. At all these moments, the patient was using the subxiphoid and intercostal drain. The patients were seen three times a day, but physical rehabilitation was performed twice. The adverse events considered were drain obstruction, accidental removal or displacement, total atrioventricular block, postoperative low output syndrome, cardiorespiratory arrest, pneumomediastinum, infection, and pericardial or myocardial damage. RESULTS 176 patients were evaluated. Only 2 (0.4 %) of the patients had complications during or after mobilization, 1 (0.2 %) due to drain obstruction and 1 (0.2 %) due to accidental removal or displacement. CONCLUSION Based on the data observed in the results, we found that the application of early mobilization in patients using subxiphoid drain after cardiac surgery is a safe and feasible conduct.
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Huang J, Lorca MC, Chen IY, Chaturvedi A. Malignant Histiocytic Neoplasm of the Mediastinum with Pericardial Involvement in a Child. Radiol Imaging Cancer 2024; 6:e230133. [PMID: 38305715 PMCID: PMC10988343 DOI: 10.1148/rycan.230133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/10/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Jessie Huang
- From the Departments of Imaging Sciences (J.H., M.C.L., A.C.) and
Pathology and Laboratory Medicine (I.Y.C.), University of Rochester Medical
Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Maria Clara Lorca
- From the Departments of Imaging Sciences (J.H., M.C.L., A.C.) and
Pathology and Laboratory Medicine (I.Y.C.), University of Rochester Medical
Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Irene Y. Chen
- From the Departments of Imaging Sciences (J.H., M.C.L., A.C.) and
Pathology and Laboratory Medicine (I.Y.C.), University of Rochester Medical
Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Apeksha Chaturvedi
- From the Departments of Imaging Sciences (J.H., M.C.L., A.C.) and
Pathology and Laboratory Medicine (I.Y.C.), University of Rochester Medical
Center, 601 Elmwood Ave, Rochester, NY 14642
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Ding W, Gu Y, Wang H, Wu H, Zhang X, Zhang R, Wang H, Huang L, Lv J, Xia B, Zhong W, He Q, Hou L. Prenatal MRI assessment of mediastinal shift angle as a feasible and effective risk stratification tool in isolated right-sided congenital diaphragmatic hernia. Eur Radiol 2024; 34:1524-1533. [PMID: 37644150 DOI: 10.1007/s00330-023-10178-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/21/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To develop a mediastinal shift angle (MSA) measurement method applicable to right-sided congenital diaphragmatic hernia (RCDH) in fetal MRI and to validate the predictive value of MSA in RCDH. METHODS Twenty-seven fetuses with isolated RCDH and 53 controls were included in our study. MSA was measured on MRI axial image at the level of four-chamber view of the fetal heart. The angle between the sagittal midline landmark line and the left boundary landmark line touching tangentially the lateral wall of the left ventricle was used to quantify MSA for RCDH. Appropriate statistical analyses were performed to determine whether MSA can be regarded as a valid predictive tool for postnatal outcomes. Furthermore, predictive performance of MSA was compared with that of lung area to head circumference ratio (LHR), observed/expected LHR (O/E LHR), total fetal lung volume (TFLV), and observed/expected TFLV (O/E TFLV). RESULTS MSA was significantly higher in the RCDH group than in the control group. MSA, LHR, O/E LHR, TFLV, and O/E TFLV were all correlated with postnatal survival, pulmonary hypertension (PH), and extracorporeal membrane oxygenation (ECMO) therapy (p < 0.05). Value of the AUC demonstrated good predictive performance of MSA for postnatal survival (0.901, 95%CI: (0.781-1.000)), PH (0.828, 95%CI: (0.661-0.994)), and ECMO therapy (0.813, 95%CI: (0.645-0.980)), which was similar to O/E TFLV but slightly better than TFLV, O/E LHR, and LHR. CONCLUSIONS We developed a measurement method of MSA for RCDH for the first time and demonstrated that MSA could be used to predict postnatal survival, PH, and ECMO therapy in RCDH. CLINICAL RELEVANCE STATEMENT Newly developed MRI assessment method of fetal MSA in RCDH offers a simple and effective risk stratification tool for patients with RCDH. KEY POINTS • We developed a measurement method of mediastinal shift angle for right-sided congenital diaphragmatic hernia for the first time and demonstrated its feasibility and reproducibility. • Mediastinal shift angle can predict more prognostic information other than survival in right-sided congenital diaphragmatic hernia with good performance. • Mediastinal shift angle can be used as a simple and effective risk stratification tool in right-sided congenital diaphragmatic hernia to improve planning of postnatal management.
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Affiliation(s)
- Wen Ding
- Department of Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuanyuan Gu
- Department of Fetal Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Haiyu Wang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Huiying Wu
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xiaochun Zhang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Rui Zhang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Hongying Wang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Li Huang
- Department of Medical Imaging, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Junjian Lv
- Surgical Neonatal Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Bo Xia
- Surgical Neonatal Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wei Zhong
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Qiuming He
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Longlong Hou
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
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Enofe N, Garcia Russo M, Kadakia ER, Axelrod PI, Friedberg J, Su S, Kumar R. Mediastinal Mass, Cancer, or Infection, Atypical Paraesophageal Actinomycosis Infection, Clinical and Surgical Approach. Am Surg 2024; 90:468-470. [PMID: 38009532 DOI: 10.1177/00031348231211039] [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] [Indexed: 11/29/2023]
Abstract
Actinomyces israelii (AI) is a Gram-positive, rod-shaped bacterium that lives commensally on and within humans as a typical colonizer within the gastrointestinal tract, including the mouth. As an opportunistic pathogen, infection often results from tissue injury or breach of the mucosal barrier (ie, during various dental or GI procedures, aspiration, or specific pathologies such as diverticulitis). Symptoms generally present slowly as a non-tender, indurated mass that evolves into multiple abscesses, fistulae, or draining sinus tracts without regard for anatomical barriers, including fascial planes or lymphatic drainage. However, it may also present as an acute suppurative infection with pain and rapid progression to abscess formation.
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Affiliation(s)
- Nosayaba Enofe
- Division of Thoracic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
- Division of Thoracic Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Manuel Garcia Russo
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Esha R Kadakia
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Peter I Axelrod
- Division of Infectious Diseases, Department of Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Joseph Friedberg
- Division of Thoracic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
- Division of Thoracic Surgery, Temple University Hospital, Philadelphia, PA, USA
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Stacey Su
- Division of Thoracic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Rohit Kumar
- Division of Thoracic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
- Division of Pulmonology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Yamada D, Matsusako M, Kurihara Y. Review of clinical and diagnostic imaging of the thymus: from age-related changes to thymic tumors and everything in between. Jpn J Radiol 2024; 42:217-234. [PMID: 37801191 PMCID: PMC10899275 DOI: 10.1007/s11604-023-01497-w] [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: 04/07/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
The thymus, a primary lymphoid organ of the immune system, undergoes several changes due to a variety of reasons, ranging from aging to pathological conditions. These changes can make distinguishing between benign and neoplastic changes in the thymus challenging, thereby complicating the histopathological diagnoses of thymic tumors. Moreover, most patients with thymic tumors are asymptomatic at the time of diagnosis. Therefore, imaging plays an extremely important role in the evaluation of thymic lesions. In this review, we introduced the imaging characteristics of the thymus, ranging from benign findings, such as normal maturation and benign lesions, to neoplasms.
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Affiliation(s)
- Daisuke Yamada
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan.
| | - Masaki Matsusako
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Yasuyuki Kurihara
- Department of Radiology, St. Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan
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Kolwalkar J, Samant D, Borkar S, Vidyasagar MSC, Vaggar JN. Ectopic colloid goiter in mediastinum with normal thyroid gland. J Cardiothorac Surg 2024; 19:103. [PMID: 38378661 PMCID: PMC10880330 DOI: 10.1186/s13019-024-02574-5] [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: 04/02/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
Ectopic thyroid tissue is a rare developmental abnormality involving aberrant embryogenesis of the thyroid gland during passage from the primitive foregut to the pretracheal position. The most frequent position is the base of the tongue (lingual thyroid); however, it has been described in other sites, such as the submandibular region, trachea, mediastinum, and subdiaphragmatic regions.Here, we report a case of an adenomatous goiter that developed in mediastinal thyroid tissue without any connection to the pretracheal thyroid gland.
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Affiliation(s)
- Jagannath Kolwalkar
- Department of General and Cardiothoracic Surgery, Goa Medical College, Goa, India
| | - Dattaprasad Samant
- Department of General and Cardiothoracic Surgery, Goa Medical College, Goa, India.
| | - Shirish Borkar
- Department of General and Cardiothoracic Surgery, Goa Medical College, Goa, India
| | | | - Jagadeesh N Vaggar
- Department of General and Cardiothoracic Surgery, Goa Medical College, Goa, India
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Cheng TL, Huang ZS, Zhang J, Wang J, Zhao J, Kontogianni K, Fu WL, Wu N, Kuebler WM, Herth FJ, Fan Y. Comparison of cryobiopsy and forceps biopsy for the diagnosis of mediastinal lesions: A randomised clinical trial. Pulmonology 2024:S2531-0437(23)00240-4. [PMID: 38182469 DOI: 10.1016/j.pulmoe.2023.12.002] [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: 11/16/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard approach for lung cancer staging. However, its diagnostic utility for other mediastinal diseases might be hampered by the limited tissue retrieved. Recent evidence suggests the novel sampling strategies of forceps biopsy and cryobiopsy as auxiliary techniques to EBUS-TBNA, considering their capacity for larger diagnostic samples. METHODS This study determined the added value of forceps biopsy and cryobiopsy for the diagnosis of mediastinal diseases. Consecutive patients with mediastinal lesions of 1 cm or more in the short axis were enrolled. Following completion of needle aspiration, three forceps biopsies and one cryobiopsy were performed in a randomised pattern. Primary endpoints included diagnostic yield defined as the percentage of patients for whom mediastinal biopsy led to a definite diagnosis, and procedure-related complications. RESULTS In total, 155 patients were recruited and randomly assigned. Supplementing EBUS-TBNA with either forceps biopsy or cryobiopsy increased diagnostic yield, with no significant difference between EBUS-TBNA plus forceps biopsy and EBUS-TBNA plus cryobiopsy (85.7 % versus 91.6 %, P = 0.106). Yet, samples obtained by additional cryobiopsies were more qualified for lung cancer molecular testing than those from forceps biopsies (100.0 % versus 89.5 %, P = 0.036). When compared directly, the overall diagnostic yield of cryobiopsy was superior to forceps biopsy (85.7 % versus 70.8 %, P = 0.001). Cryobiopsies produced greater samples in shorter procedural time than forceps biopsies. Two (1.3 %) cases of postprocedural pneumothorax were detected. CONCLUSIONS Transbronchial mediastinal cryobiopsy might be a promising complementary tool to supplement traditional needle biopsy for increased diagnostic yield and tissue harvesting. TRIAL REGISTRATION ChiCTR2000030373.
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Affiliation(s)
- T-L Cheng
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Z-S Huang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - J Zhang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - J Wang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - J Zhao
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - K Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - W-L Fu
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - N Wu
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - W M Kuebler
- Department of Pathology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - F J Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Y Fan
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
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Song H, Lee MS, Jeong SY. CT and MRI Findings of Low-Flow Mediastinal Vascular Malformation: A Case Report. J Korean Soc Radiol 2024; 85:204-209. [PMID: 38362394 PMCID: PMC10864141 DOI: 10.3348/jksr.2023.0039] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 02/17/2024]
Abstract
Mediastinal vascular malformations are rare and their diagnosis can be challenging. Imaging is vital for diagnosing mediastinal vascular malformations and can help avoid unnecessary invasive procedures. Herein, we report the detailed CT and MRI findings of a rare low-flow mediastinal vascular malformation in an asymptomatic 63-year-old male.
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Soysal Ö, Çakır FB. Pediatric mediastinal tumors. Turk Gogus Kalp Damar Cerrahisi Derg 2024; 32:S98-S107. [PMID: 38584788 PMCID: PMC10995688 DOI: 10.5606/tgkdc.dergisi.2024.25799] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 04/09/2024]
Abstract
Mediastinal tumors are the most common thoracic tumor in the pediatric population. They include a spectrum of tumors, and most are malignant. These lesions can be anatomically and radiologically classified by means of compartments; anterior, middle, and posterior. Symptoms, signs, localization of the tumor, age of the child, and tumor markers are key points of diagnosis. Surgical approaches are typically needed for diagnosis, but sometimes tru-cut needle biopsies may be sufficient. Mediastinoscopy, mediastinotomy, and video-assisted thoracoscopic surgery may be used in the diagnostic workup of mediastinal tumors in children as they are used in adults. Frequently, diagnosis and treatment are both established by means of surgery. Surgery remains the mainstay of treatment of most benign and malignant nonlymphoid tumors. Combined modality of treatment incorporating chemotherapy and radiotherapy is often required in malignant tumors and is associated with high survival rates in these patients.
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Affiliation(s)
- Ömer Soysal
- Department of Thoracic Surgery, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Türkiye
| | - Fatma Betül Çakır
- Department of Pediatrics, Pediatric Hematology Oncology, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Türkiye
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13
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Choe J, Han A, Shin SH, Lee K, Um SW, Kim H, Kim TY, Huh HJ, Choi YL, Han J, Jeong BH. Clinical Course of Patients With Mediastinal Lymph Node Tuberculosis and Risk Factors for Paradoxical Responses. J Korean Med Sci 2023; 38:e348. [PMID: 38050909 PMCID: PMC10695755 DOI: 10.3346/jkms.2023.38.e348] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Paradoxical responses (PR) occur more frequently in lymph node tuberculosis (LNTB) than in pulmonary tuberculosis and present difficulties in differential diagnosis of drug resistance, new infection, poor patient compliance, and adverse drug reactions. Although diagnosis of mediastinal LNTB has become much easier with the development of endosonography, limited information is available. The aim of this study was to investigate the clinical course of mediastinal LNTB and the risk factors associated with PR. METHODS Patients diagnosed with mediastinal LNTB via endosonography were evaluated retrospectively between October 2009 and December 2019. Multivariable logistic regression was applied to evaluate the risk factors associated with PR. RESULTS Of 9,052 patients who underwent endosonography during the study period, 158 were diagnosed with mediastinal LNTB. Of these, 55 (35%) and 41 (26%) concurrently had pulmonary tuberculosis and extrapulmonary tuberculosis other than mediastinal LNTB, respectively. Of 125 patients who completed anti-tuberculosis treatment, 21 (17%) developed PR at a median of 4.4 months after initiation of anti-tuberculosis treatment. The median duration of anti-tuberculosis treatment was 6.3 and 10.4 months in patients without and with PR, respectively. Development of PR was independently associated with age < 55 years (adjusted odds ratio [aOR], 5.72; 95% confidence interval [CI], 1.81-18.14; P = 0.003), lymphocyte count < 800/μL (aOR, 8.59; 95% CI, 1.60-46.20; P = 0.012), and short axis diameter of the largest lymph node (LN) ≥ 16 mm (aOR, 5.22; 95% CI, 1.70-16.00; P = 0.004) at the time of diagnosis of mediastinal LNTB. CONCLUSION As PR occurred in one of six patients with mediastinal LNTB during anti-tuberculosis treatment, physicians should pay attention to patients with risk factors (younger age, lymphocytopenia, and larger LN) at the time of diagnosis.
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Affiliation(s)
- Junsu Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Areum Han
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Yeul Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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14
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Mahmoudi S, Gruenewald LD, Eichler K, Althoff FC, Martin SS, Bernatz S, Booz C, Yel I, Kinzler MN, Ziegengeist NS, Torgashov K, Mohammed H, Geyer T, Scholtz JE, Hammerstingl RM, Weber C, Hardt SE, Sommer CM, Gruber-Rouh T, Leistner DM, Vogl TJ, Koch V. Multiparametric Evaluation of Radiomics Features and Dual-Energy CT Iodine Maps for Discrimination and Outcome Prediction of Thymic Masses. Acad Radiol 2023; 30:3010-3021. [PMID: 37105804 DOI: 10.1016/j.acra.2023.03.034] [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: 02/15/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the diagnostic value of radiomics features and dual-source dual-energy CT (DECT) based material decomposition in differentiating low-risk thymomas, high-risk thymomas, and thymic carcinomas. MATERIALS AND METHODS This retrospective study included 32 patients (16 males, mean age 66 ± 14 years) with pathologically confirmed thymic masses who underwent contrast-enhanced DECT between 10/2014 and 01/2023. Two experienced readers evaluated all patients regarding conventional radiomics features, as well as DECT-based features, including attenuation (HU), iodine density (mg/mL), and fat fraction (%). Data comparisons were performed using analysis of variance and chi-square statistic tests. Receiver operating characteristic curve analysis and Cox-regression tests were used to discriminate between low-risk/high-risk thymomas and thymic carcinomas. RESULTS Of the 32 thymic tumors, 12 (38%) were low-risk thymomas, 11 (34%) were high-risk thymomas, and 9 (28%) were thymic carcinomas. Values differed significantly between low-risk thymoma, high-risk thymoma, and thymic carcinoma regarding DECT-based features (p ≤ 0.023) and 30 radiomics features (p ≤ 0.037). The area under the curve to differentiate between low-risk/high-risk thymomas and thymic cancer was 0.998 (95% CI, 0.915-1.000; p < 0.001) for the combination of DECT imaging parameters and radiomics features, yielding a sensitivity of 100% and specificity of 96%. During a follow-up of 60 months (IQR, 35-60 months), the multiparametric approach including radiomics features, DECT parameters, and clinical parameters showed an excellent prognostic power to predict all-cause mortality (c-index = 0.978 [95% CI, 0.958-0.998], p = 0.003). CONCLUSION A multiparametric approach including conventional radiomics features and DECT-based features facilitates accurate, non-invasive discrimination between low-risk/high-risk thymomas and thymic carcinomas.
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Affiliation(s)
- Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.).
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Friederike C Althoff
- Department of Internal Medicine II, University Hospital Frankfurt, Frankfurt am Main, Germany (F.C.A.)
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Maximilian N Kinzler
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany (M.N.K.)
| | - Nicole Suarez Ziegengeist
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Katerina Torgashov
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Hanin Mohammed
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Tobias Geyer
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Renate M Hammerstingl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Christophe Weber
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany (C.W., S.E.H.)
| | - Stefan E Hardt
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany (C.W., S.E.H.)
| | - Christof M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (C.M.S.)
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - David M Leistner
- Department of Internal Medicine III, University Hospital Frankfurt, Frankfurt am Main, Germany (D.M.L.)
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (S.M., L.D.G., K.E., S.S.M., S.B., C.B., I.Y., N.S.Z., K.T., H.M., T.G., J.-E.S., R.M.H., T.G.-R., T.J.V., V.K.)
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15
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Kummari M, Narahari NK, Kapoor A, Avala RC, Paramjyothi GK. A rare case of giant mediastino-pleural lipoma. Asian Cardiovasc Thorac Ann 2023; 31:739-742. [PMID: 37644798 DOI: 10.1177/02184923231197694] [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] [Indexed: 08/31/2023]
Abstract
Lipomas are common benign neoplastic mesenchymal tumours arising from adipose tissue anywhere in the body. Giant intra-thoracic lipoma extending across the anterior mediastinum into bilateral pleural spaces causing compression of the underlying lung resulting in respiratory embarrassment is rarely seen and reported. Giant lipomas of thorax require surgical excision as they continue to grow and cause compressive symptoms.
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Affiliation(s)
- Madhusudhan Kummari
- Department of Cardiothoracic Surgery, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Telangana, India
| | - Narendra Kumar Narahari
- Department of Pulmonary Medicine, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Telangana, India
| | - Anu Kapoor
- Department of Radiology and Imaging, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Telangana, India
| | | | - G K Paramjyothi
- Department of Pulmonary Medicine, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Telangana, India
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16
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Priya A, Philip SE, Jain A, Sikka A. Variations of azygos vein: a cadaveric study with clinical relevance. Anat Cell Biol 2023:acb.23.074. [PMID: 37710917 DOI: 10.5115/acb.23.074] [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: 03/18/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 09/16/2023] Open
Abstract
The azygos vein can be formed as a single root, two roots, and three roots, namely lateral, intermediate and the medial roots respectively. The hemiazygos vein and the accessory hemiazygos vein are the tributaries of azygos vein rather than its left side equivalents. Its variations, especially in young persons without any relevant risk factors, may result in thromboembolic illness. This study aimed to describe the morphological and morphometric variations of azygos system of veins. The present study was conducted on thirty formalin fixed adult human cadavers by dissecting azygos vein from formation to termination and variations were noted. The azygos vein was formed by a single root in 56.7%, by two roots: the lateral root and intermediate root in 36.7% cases and by the lateral root and medial root in 6.6%. The vertebral level of termination of azygos vein was seen at the level of T4 vertebrae in 70% cases, at the level of T3 vertebrae in 20% of cases and at the level of T5 vertebrae in 10% cases. The course of azygos vein was varying in 13.3%. These morphological variations can be useful while performing mediastinal surgery, mediastinoscopy, surgery of the deformations of the vertebral column, neurovascular surgeries of the retroperitoneal organs, disc herniation and fracture of thoracic vertebrae.
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Affiliation(s)
- Ananya Priya
- Department of Anatomy, Rajendra Institute of Medical Sciences, Ranchi, India
| | | | - Anjali Jain
- Department of Anatomy, Christian Medical College, Ludhiana, India
| | - Aparajita Sikka
- Department of Anatomy, Christian Medical College, Ludhiana, India
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17
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Ma TT, Chen G, Wang D, Xu H, Zhang JG. Clinical and imaging characteristics of patients with bronchogenic cysts: a single-center retrospective analysis. BMC Med Imaging 2023; 23:128. [PMID: 37710169 PMCID: PMC10503098 DOI: 10.1186/s12880-023-01042-1] [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: 10/20/2022] [Accepted: 06/05/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Bronchogenic cysts (BCs) are rare and usually asymptomatic malformations detected during imaging examinations. We aimed to investigate the clinical and imaging characteristics of patients with BCs. METHODS We retrospectively evaluated patients who received surgery to remove their BCs from January 2015 to January 2019. Their baseline characteristics, clinical information, and imaging results were reviewed. RESULTS Our study included 129 patients, with 57 males and 72 females and a mean age of 42.7 years old. The most common location for BCs was the mediastinum (67 patients, 51.9%). Fewer than half of the patients (53 patients, 41.1%) reported clinical symptoms, with chest pain being the most common (16 patients, 30.2%). Neck BCs were more frequently observed in young patients (P = 0.002) and were more often associated with thyroid cancer (P = 0.007). A computed tomography scan was the most commonly used method to diagnose BCs in the lung and mediastinum, whereas ultrasound was the most commonly used diagnostic method for neck BCs. The characteristic images were well-defined, thin-wall cystic lesions in varying densities. A few lesions showed small, calcified spots along the rim or cavities. CONCLUSIONS Although most BCs were found in the mediastinum, their locations could vary in different sex and age groups. Particular attention should be paid to young patients with BCs in the neck to rule out thyroid cancer.
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Affiliation(s)
- Tan-Tan Ma
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China
| | - Geng Chen
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China
| | - Dan Wang
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China
| | - Hong Xu
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China.
| | - Jian-Guang Zhang
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China.
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Navarro Sanchez JM, Oommen T, Lum C, Halford Z, Vierkoetter K. Mediastinal Epithelioid Angiosarcoma, New Insights into an Uncommon Diagnosis: A Case Report and Literature Review. Hawaii J Health Soc Welf 2023; 82:208-212. [PMID: 37694219 PMCID: PMC10485769] [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] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Angiosarcoma is an uncommon malignant mesenchymal neoplasm, accounting for 1-2% of all sarcomas. More than half are cutaneous, with the remainder arising in the deep soft tissue, breast, bone or viscera, particularly the liver, spleen and heart. Mediastinal angiosarcomas are exceedingly uncommon. While epithelioid morphology is sometimes a minor component in conventional angiosarcoma, tumors with a predominance of epithelioid morphologic features are designated as epithelioid angiosarcoma (EAS). This is a report of a 58-year-old woman presenting with severe chest pain, accompanied by worsening dyspnea and dysphagia. Chest computed tomography (CT) revealed a large pericardial effusion and a bulky mediastinal mass. Biopsy revealed a malignant neoplasm with vascular differentiation consistent with high-grade EAS. By immunohistochemistry, epithelioid angiosarcomas express endothelial cell markers, such as CD31, CD34, ERG and FLI-1. A variable proportion express low molecular weight cytokeratin (CK), epithelial membrane antigen (EMA) and CD30. The use of molecular techniques has proven useful in the diagnosis of this rare neoplasm. Targeted next generation sequencing showed aberrations in multiple genes including NRAS, KRAS, MYC and TP53.
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Affiliation(s)
- Janira M. Navarro Sanchez
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JMNS, CL, KV)
| | - Tiffany Oommen
- Department of Internal Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (TO)
| | - Christopher Lum
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JMNS, CL, KV)
| | - Zan Halford
- Diagnostic Laboratory Services, Aiea, HI (ZH)
| | - Koah Vierkoetter
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JMNS, CL, KV)
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19
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Wang ZL, Yan Y, Li XT, Li YL, Li ZW, Sun YS. Usefulness of attenuation value on computed tomography plain scan for diagnosing enlarged mediastinal lymph nodes metastases. Quant Imaging Med Surg 2023; 13:5759-5769. [PMID: 37711834 PMCID: PMC10498224 DOI: 10.21037/qims-22-1305] [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: 11/24/2022] [Accepted: 06/19/2023] [Indexed: 09/16/2023]
Abstract
Background To evaluate the diagnostic value of computed tomography (CT) attenuation in mediastinal lymph node metastases of malignant tumors. Methods A retrospective review was conducted of a Chinese institutional database of consecutive patients with a history of malignant tumors. Those who had enlarged, necrotic, or hypermetabolic lymph nodes detected in the mediastinum during routine CT examination or positron emission tomography (PET)/CT imaging from January 2019 to December 2021 were collected for investigation. All patients underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and were followed up for at least 6 months to diagnose lymph node metastases. One-to-one correlation was attempted between the CT images of the lymph nodes and EBUS-TBNA area of the same lymph node groups and similar size. Radiologists measured size, as well as plain CT and contrast-enhanced CT (CECT) attenuation values of mediastinal lymph nodes, and evaluated the effectiveness of these variables in diagnosing lymph node metastasis. Results A total of 135 lymph nodes of 114 patients were included in the study. In the univariate analysis, the long-axis diameter, short-axis diameter, short-axis/long-axis ratio, and plain CT attenuation values of lymph nodes were found to be statistically significantly different between the metastatic and non-metastatic lymph nodes. The areas under receiver operator characteristic (ROC) curves (AUCs) of long-axis diameter, short-axis diameter, short-axis/long-axis ratio, and plain CT attenuation value for diagnosing metastases were 0.711, 0.788, 0.671, and 0.827, respectively. The best value of the AUC for diagnosing lymph node metastases was 0.827 [95% confidence interval (CI): 0.749-0.890] using plain CT attenuation value ≤45 Hounsfield units (HU). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 92.8%, 69.2%, 86.5%, and 81.8%, respectively. Similar results were obtained from the 68 cases of lung cancer. Plain CT attenuation values reached the best AUC (0.860) for diagnosing lymph node metastases. Conclusions Plain CT attenuation of lymph nodes is an effective method for diagnosing enlarged mediastinal lymph nodes with a history of multiple malignancies or lung cancer. Plain CT could be used as an additional test where there is no PET/CT available in cases of diagnostic dilemma.
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Affiliation(s)
- Zhi-Long Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan-Ling Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhong-Wu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing, China
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Yao L, Zhang C, Xu B, Yi S, Li J, Ding X, Yu H. A deep learning-based system for mediastinum station localization in linear EUS (with video). Endosc Ultrasound 2023; 12:417-423. [PMID: 37969169 PMCID: PMC10631614 DOI: 10.1097/eus.0000000000000011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/12/2023] [Indexed: 11/17/2023] Open
Abstract
Background and Objectives EUS is a crucial diagnostic and therapeutic method for many anatomical regions, especially in the evaluation of mediastinal diseases and related pathologies. Rapidly finding the standard stations is the key to achieving efficient and complete mediastinal EUS imaging. However, it requires substantial technical skills and extensive knowledge of mediastinal anatomy. We constructed a system, named EUS-MPS (EUS-mediastinal position system), for real-time mediastinal EUS station recognition. Methods The standard scanning of mediastinum EUS was divided into 7 stations. There were 33 010 images in mediastinum EUS examination collected to construct a station classification model. Then, we used 151 videos clips for video validation and used 1212 EUS images from 2 other hospitals for external validation. An independent data set containing 230 EUS images was applied for the man-machine contest. We conducted a crossover study to evaluate the effectiveness of this system in reducing the difficulty of mediastinal ultrasound image interpretation. Results For station classification, the model achieved an accuracy of 90.49% in image validation and 83.80% in video validation. At external validation, the models achieved 89.85% accuracy. In the man-machine contest, the model achieved an accuracy of 84.78%, which was comparable to that of expert (83.91%). The accuracy of the trainees' station recognition was significantly improved in the crossover study, with an increase of 13.26% (95% confidence interval, 11.04%-15.48%; P < 0.05). Conclusions This deep learning-based system shows great performance in mediastinum station localization, having the potential to play an important role in shortening the learning curve and establishing standard mediastinal scanning in the future.
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Affiliation(s)
- Liwen Yao
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Chenxia Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Bo Xu
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Shanshan Yi
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Juan Li
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Xiangwu Ding
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Linsky PL. Redefining dogma and repealing of false rules-finding the true limits of medicine and surgery. Mediastinum 2023; 7:22. [PMID: 37701641 PMCID: PMC10493614 DOI: 10.21037/med-23-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023]
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Weissferdt A, Moran CA. Chromophobe-like carcinoma of the thymus: A clinicopathological and immunohistochemical correlation of 5 cases. Pathol Res Pract 2023; 248:154629. [PMID: 37348289 DOI: 10.1016/j.prp.2023.154629] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023]
Abstract
Five cases of primary thymic carcinoma with distinct histopathological features resembling chromophobe carcinomas are presented. The patients were four men and one woman ranging in age between 43 and 72 years. Clinically, the patients presented with non-specific symptoms of dyspnea and chest pain. Diagnostic imaging revealed the presence of anterior mediastinal masses. All patients underwent complete surgical resection of their tumors via thoracotomy. Grossly, the tumors measured between 4.0 and 5.5 cm in greatest diameter and were ill-defined neoplasms with infiltrative borders; they were light brown in color and had a lobulated surface. Areas of hemorrhage and necrosis were not identified. Histologically, all tumors shared similar histopathological features, mainly the presence of infiltrative tumor islands separated by a fibrocollagenous stroma. At higher magnification, the neoplastic cellular proliferation was composed of medium-sized, round to polygonal cells with eosinophilic or granular cytoplasm and a clear perinuclear cytoplasmic halo, which imparted a chromophobe-like appearance. Nuclear atypia and mitotic activity were identified. Histochemical stains for colloidal iron were negative while immunohistochemical stains for pancytokeratin, cytokeratin 5/6, and p40 were positive in all cases, supporting squamous differentiation in these tumors. Clinical follow-up information was obtained in three patients all of whom died between 3 and 5 years after initial diagnosis, while two patients were lost to follow-up. The cellular characteristics of these tumors represent an unusual variant of thymic carcinoma that may pose a diagnostic challenge in small biopsies and that could be easily confused with other primary or metastatic tumors.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Cesar A Moran
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Saito T, Muro S, Fujiwara H, Umebayashi Y, Sato Y, Tokunaga M, Akita K, Kinugasa Y. Histological study of the structural layers around the esophagus in the lower mediastinum. World J Gastrointest Surg 2023; 15:1331-1339. [PMID: 37555123 PMCID: PMC10405116 DOI: 10.4240/wjgs.v15.i7.1331] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND In Japan, the transhiatal approach, including lower mediastinal lymph node dissection, is widely performed for Siewert type II esophagogastric junction adenocarcinoma. This procedure is generally performed in a magnified view using laparoscopy or a robotic system, therefore, the microanatomy of the lower mediastinum is important. However, mediastinal microanatomy is still unclear and classification of lower mediastinal lymph nodes is not currently based on fascia or other microanatomical structures. AIM To clarify the fascia and layer structures of the lower mediastinum and classify the lower mediastinal tissue. METHODS We dissected the esophagus and surrounding organs en-bloc from seven cadavers fixed in 10% formalin. Organs and tissues were then cut at the level of the lower thoracic esophagus, embedded in paraffin, and serially sectioned. Tissue sections were stained with Hematoxylin-Eosin (all cadavers) and immunostained for the lymphatic endothelial marker D2-40 (three cadavers). We observed the periesophageal fasciae and layers, and defined lymph node boundaries based on the fasciae. Lymphatic vessels around the esophagus were observed on immunostained tissue sections. RESULTS We identified two fasciae, A and B. We then classified lower mediastinal tissue into three areas, paraesophageal, paraaortic, and intermediate, using these fasciae as boundaries. Lymph nodes were found to be present and were counted in each area. The dorsal part of the intermediate area was thicker on the caudal side than on the cranial side in all cadavers. On the dorsal side, no blood vessels penetrated the fasciae in six of the seven cadavers, whereas the proper esophageal artery penetrated fascia B in one cadaver. D2-40 immunostaining showed lymphatic vessel connections between the paraesophageal and intermediate areas on the lateral and ventral sides of the esophagus, but no lymphatic connection between areas on the dorsal side of the esophagus. CONCLUSION Histological studies identified two fasciae surrounding the esophagus in the lower mediastinum and the layers separated by these fasciae were used to classify the lower mediastinal tissues.
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Affiliation(s)
- Toshifumi Saito
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Hisashi Fujiwara
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Yuya Umebayashi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Yuya Sato
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-ku 113-8519, Tokyo, Japan
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Endara SA, Pinto JR, Torres GA, Arias PA, Ponton MP, Molina GA. Severe dysphagia due to an esophageal duplication cyst in sixth decade, unusual presentation of a rare pathology. J Cardiothorac Surg 2023; 18:238. [PMID: 37496023 PMCID: PMC10373318 DOI: 10.1186/s13019-023-02308-z] [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: 07/30/2022] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Esophageal duplication cysts are rare congenital tumors usually diagnosed and treated during childhood. Most of them are located in the mediastinum and appear as a mass besides the esophagus. Unfortunately, symptoms are non-specific and depend on the size and location of the mass; therefore, they can easily be missed. If symptoms appear, surgical resection is necessary to prevent troublesome complications. CASE PRESENTATION We present the case of a 60-year-old woman who presented with severe progressive dysphagia and epigastric pain. After further evaluation, a paraesophageal cystic mass was found, and surgery was required. Non-communicating esophageal duplication cyst was the final diagnosis. CONCLUSION Esophageal duplication cysts are a rare pathology in adults; their symptoms will vary depending on their size and location. Preoperative diagnosis is difficult as symptoms are non-specific and can be missed. If severe dysphagia, pain, or any other complication appears, surgery should not be delayed.
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Affiliation(s)
- Santiago A Endara
- Department of Surgery Division of Cardiothoracic Surgery, Hospital Metropolitano, Av. Mariana de Jesus Oe 7/47 y Conclina, Edificio Diagnostico 2000 tercer piso 3/3, Quito, Ecuador.
| | - Jaime R Pinto
- Department of Surgery, Division of Cardiothoracic Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Gustavo A Torres
- Department of Internal Medicine, Division of Gastroenterology, Hospital de los Valles, Quito, Ecuador
| | - Pablo A Arias
- PGY1, General Surgery, Universidad Internacional del Ecuador (UIDE), Quito, Ecuador
| | - M Patricia Ponton
- Department of Internal Medicine, Division of Pathology, Hospital Metropolitano, Quito, Ecuador
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de Carvalho VB, Dias JL, Nunes A. Paediatric Mediastinal Lipoblastoma. J Belg Soc Radiol 2023; 107:53. [PMID: 37483991 PMCID: PMC10360969 DOI: 10.5334/jbsr.3166] [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: 04/03/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023] Open
Abstract
Teaching Point: Lipoblastoma should be considered in the differential diagnosis of painful rapidly growing fatty mass within the mediastinum in infants or young children under three years old.
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Affiliation(s)
| | | | - Ana Nunes
- Centro Hospitalar Universitário Lisboa Central, PT
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26
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Safdar MN, Faiz Z, Khalid A, Iqbal S, Fatimi SH. Mediastinal paraganglioma of the aortopulmonary subtype - A surgical challenge. Int J Surg Case Rep 2023; 108:108448. [PMID: 37406536 PMCID: PMC10382815 DOI: 10.1016/j.ijscr.2023.108448] [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: 05/13/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE This case report describes the successful surgical management of a 30-year-old male with a non-functional carotid body tumor and a mediastinal paraganglioma occupying the aortopulmonary space. The report highlights the rarity of mediastinal paragangliomas and the challenges in their surgical management. CASE PRESENTATION The patient underwent pre-op angioembolisation of the carotid body tumor, followed by excision and left cervical lymph node dissection. A large mediastinal mass was identified and resected during surgery without needing a cardiopulmonary bypass. The patient recovered well from surgery. Histopathology confirmed the diagnosis of clinically recurrent paraganglioma. CLINICAL DISCUSSION Mediastinal paragangliomas are rare and challenging to manage due to their proximity to major vascular structures. Surgical intervention is the preferred treatment, but the risk of complications is high. In this case, the surgical approach involved resection of the mediastinal mass without cardiopulmonary bypass. This approach reduced the risk of complications associated with bypass procedures. The procedure's success underscores the importance of early diagnosis and prompt surgical intervention. CONCLUSION This case report highlights the successful surgical management of a rare and clinically challenging mediastinal paraganglioma without cardiopulmonary bypass. The report underscores the importance of prompt diagnosis and surgical intervention in mediastinal paragangliomas.
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Affiliation(s)
| | - Zohaa Faiz
- Medical Student, Aga Khan University, Karachi, Pakistan.
| | | | - Sara Iqbal
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Saulat H Fatimi
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Bao Y, Kang G, Wu X, Li J, Huang Y, Wang Y. Mediastinal parathyroid carcinoma: a case report and review of the literature. BMC Endocr Disord 2023; 23:130. [PMID: 37280629 DOI: 10.1186/s12902-023-01363-w] [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: 05/21/2021] [Accepted: 05/04/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Parathyroid carcinoma (PC) is an uncommon cause of primary hyperparathyroidism (PHPT) and particularly rare in the mediastinum. Herein, we present a case of mediastinal PC and conduct a related literature review. CASE PRESENTATION We described a case of a 50-year-old female patient with PHPT due to mediastinal PC. She was initially admitted to a local hospital in her hometown with hypercalcemia and high blood concentrations of PTH (parathyroid hormone). The patient underwent neck parathyroidectomy and pathological examination suggested parathyroid adenoma. Although the overproduction of serum calcium and PTH declined after the surgery, calcium and PTH increased again one month later, so the patient was transferred to our hospital. A 99mTc-sestamibi scan revealed an ectopic finding in the mediastinum, which was also indicated on the CT image. After removing the mediastinal mass, the metabolism of calcium and PTH quickly reverted to normal and the pathologic features of the mass were consistent with PC. By reviewing the related literature, we noticed that only scattered reports were published before 1982, and those were not included in the present review due to their differences with current radiological examination and treatment methods. After excluding outdated studies, we summarized and analyzed 20 reports of isolated mediastinal PC and concluded that. Parathyroidectomy remains the only curative treatment for the disease. Furthermore, the success of treatment directly depends on accurate preoperative localization. CONCLUSION With this study, we emphasize the importance of accurate preoperative diagnosis of mediastinal PC and improve clinicians' understanding of the disease.
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Affiliation(s)
- Yan Bao
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
- Present address: Department of Endocrinology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, Hubei, 430060, China.
| | - Ganjun Kang
- Departments of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoyan Wu
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jing Li
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yan Huang
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ye Wang
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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28
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Chakravarty S, Nagarkar NM, Ghosh A, Mehta R. Retrosternal Thyroid with Mediastinal Extension: Surgical Approach and Management. Indian J Otolaryngol Head Neck Surg 2023; 75:332-337. [PMID: 37275118 PMCID: PMC10235387 DOI: 10.1007/s12070-022-03231-w] [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: 06/25/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022] Open
Abstract
To assess the clinical presentation and the need for sternotomy as an additional approach for surgical excision of goitre with retrosternal extension. It was a retrospective review of 22 patients (13 female, 9 male; mean age: 50.36 years) who underwent total thyroidectomy for retrosternal extension. Between-group differences were assessed using Chi-square or Fisher exact test, appropriate P values < 0.05 were considered indicative of statistical significance. All cases were assessed by CT scan of neck and thorax to confirm mediastinal extension. The symptoms most commonly reported were dyspnoea 6 (27%), hoarseness (13%) and dysphagia 2 (9%). The retrosternal extent was grade 1(thoracic inlet to aortic arch) in 11 cases and grade 2(aortic arch to pericardium) in 11 cases. Overall, 13 (59%) patients showed CT evidence of tracheal deviation. Patients were divided into two groups based on the surgical approach: trans-cervical (n = 13) and trans-cervical plus trans-sternal (n = 9). The radiological extent of retrosternal descent of goitre in the mediastinum showed no significant correlation with the requirement of sternotomy in our cohort (odds ratio for sternotomy in grade 2 extension: 1.45). The need for sternotomy in cases of retrosternal thyroid does not depend on the radiological extent of tumour alone. It depends on multitude of factors like presence of dysphagia, dyspnoea or hoarseness. Preservation of recurrent laryngeal nerve and parathyroid glands is difficult in the restricted thoracic inlet space. Sternotomy is required for complete excision and preservation of major mediastinal vessels.
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Affiliation(s)
- Sharmistha Chakravarty
- Department of ENT & Head Neck Surgery, All India Institute of Medical Sciences, G.E Road, Tatibandh, Raipur, C.G 492099 India
| | - Nitin M. Nagarkar
- Department of ENT & Head Neck Surgery, All India Institute of Medical Sciences, G.E Road, Tatibandh, Raipur, C.G 492099 India
| | - Amritava Ghosh
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, G.E Road, Tatibandh, Raipur, C.G 492099 India
| | - Rupa Mehta
- Department of ENT & Head Neck Surgery, All India Institute of Medical Sciences, G.E Road, Tatibandh, Raipur, C.G 492099 India
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Kanj AN, Young WF, Ryu JH. Mediastinal Paraganglioma: A retrospective analysis of 51 cases. Respir Med 2023:107296. [PMID: 37257785 DOI: 10.1016/j.rmed.2023.107296] [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: 03/12/2023] [Revised: 05/05/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Paragangliomas are rarely found in the mediastinum, where they account for a small proportion of mediastinal masses. This study aimed to better characterize the presenting features and relevant aspects in optimizing the diagnosis and treatment of mediastinal paragangliomas. METHODS A computer-assisted search of electronic health records was performed to identify adult patients (≥18 years) who underwent evaluation for a primary mediastinal paraganglioma at Mayo Clinic between January 2000 and April 2022. Medical charts, laboratory tests and radiology images were reviewed to collect data. RESULTS The study included 51 patients, each with a single mediastinal paraganglioma. The median age was 47 years (IQR: 39-67), 67% females. Symptoms of catecholamine excess were manifest in 39% of patients, and 14% presented with mass effect, while the remaining 47% had no paraganglioma-related symptoms. Genetic testing was performed in 35 patients; 66% harbored a pathogenic variant in the succinate dehydrogenase enzyme complex. Most paragangliomas (71%) were in the middle mediastinum and showed uptake of intravenous contrast on chest imaging. Biopsies were performed in 30 (59%) patients; 27% were inconclusive and 10% resulted in major complications. Surgical resection occurred in 75%, primarily for relief of symptoms (50%) followed by proximity to critical structures (45%). Perioperative complications were common (66%), but there were no cases of local tumor recurrence during the follow-up period (median 8 years; IQR: 4-13). CONCLUSION Mediastinal paragangliomas are most located in the middle mediastinum and can often be diagnosed noninvasively using a combination of clinical, biochemical, and radiological features.
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Affiliation(s)
- Amjad N Kanj
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | - William F Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA.
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
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Uczkowski D, Ashraf H, Cherry M, Dimov N. Gray zone lymphoma: A case report and comprehensive review of literature. Leuk Res Rep 2023; 19:100372. [PMID: 37287497 PMCID: PMC10242558 DOI: 10.1016/j.lrr.2023.100372] [Citation(s) in RCA: 1] [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: 04/16/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
Gray zone lymphoma is a very rare liquid malignancy that possesses intersecting features between primary mediastinal B-cell lymphoma and classic Hodgkin Lymphoma. In the case presented and accompanying literature review, we will discuss a patient with a chief complaint of shortness of breath and was found to have a mediastinal mass with biopsy consistent with mediastinal gray zone lymphoma. Herein, we explore the historical and recently updated diagnostic criteria of gray zone lymphoma from 2022 as well as the pathophysiology as it pertains to gene expression, while also reviewing the histological findings, epidemiology and treatment modalities.
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Affiliation(s)
- Dariusz Uczkowski
- Overlook Medical Center, 99 Beauvoir Ave, Summit, 07901, New Jersey, United States of America
| | - Hamza Ashraf
- Overlook Medical Center, 99 Beauvoir Ave, Summit, 07901, New Jersey, United States of America
| | - Mohamad Cherry
- Morristown Medical Center, 435 South St, Morristown, 07960, New Jersey, United States of America
| | - Nikolay Dimov
- Morristown Medical Center, 435 South St, Morristown, 07960, New Jersey, United States of America
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31
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Velders BJJ, Schneider A, Braun J. Transpericardial resection of a mediastinal paraganglioma. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37212249 DOI: 10.1510/mmcts.2023.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Paragangliomas are tumours originating from the autonomic nervous system and rarely occur in the chest. They may manifest through symptoms of excess catecholamine release or due to local compression, can be an incidental finding on a computed tomography/magnetic resonance imaging examination or can be found when screening patients with specific gene mutations. Surgical removal is indicated in case of symptoms, (imminent) compression of vital structures or to prevent progression to malignancy. Resection of a paraganglioma in the middle mediastinum can be challenging. The relationship of the tumour to vital structures and its blood supply determine the surgical access route. In this case report, a large paraganglioma situated in the middle mediastinum is resected. Because of the close relationship to vital structures and the presence of feeding arteries from the aortic arch, a transsternal transpericardial approach is chosen. After a median sternotomy, stepwise dissection between the aorta, superior caval vein and right pulmonary artery and the opening of the posterior pericardium gives access to the middle mediastinum and the area between the tracheal bifurcation and the left atrial roof. These steps can be done without cardiopulmonary bypass. After identification and division of the feeding aortic arch arteries, the highly vascularized tumour can be further dissected and removed.
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Affiliation(s)
- Bart J J Velders
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriaan Schneider
- Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Maccarrone V, Liou C, D'souza B, Salvatore MM, Leb J, Belletti A, Palumbo D, Landoni G, Capaccione KM. The Macklin effect closely correlates with pneumo mediastinum in acutely ill intubated patients with COVID-19 infection. Clin Imaging 2023; 97:50-54. [PMID: 36889115 PMCID: PMC9984303 DOI: 10.1016/j.clinimag.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/01/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Patients with COVID-19 infection are frequently found to have pulmonary barotrauma. Recent work has identified the Macklin effect as a radiographic sign that often occurs in patients with COVID-19 and may correlate with barotrauma. METHODS We evaluated chest CT scans in COVID-19 positive mechanically ventilated patients for the Macklin effect and any type of pulmonary barotrauma. Patient charts were reviewed to identify demographic and clinical characteristics. RESULTS The Macklin effect on chest CT scan was identified in a total of 10/75 (13.3%) COVID-19 positive mechanically ventilated patients; 9 developed barotrauma. Patients with the Macklin effect on chest CT scan had a 90% rate of pneumomediastinum (p < 0.001) and a trend toward a higher rate of pneumothorax (60%, p = 0.09). Pneumothorax was most frequently omolateral to the site of the Macklin effect (83.3%). CONCLUSION The Macklin effect may be a strong radiographic biomarker for pulmonary barotrauma, most strongly correlating with pneumomediastinum. Studies in ARDS patients without COVID-19 are needed to validate this sign in a broader population. If validated in a broad population, future critical care treatment algorithms may include the Macklin sign for clinical decision making and prognostication.
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Affiliation(s)
- Valerie Maccarrone
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Connie Liou
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Belinda D'souza
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Kathleen M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, United States of America.
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Çinar HG, Gulmez AO, Üner Ç, Aydin S. Mediastinal lesions in children. World J Clin Cases 2023; 11:2637-2656. [PMID: 37214576 PMCID: PMC10198114 DOI: 10.12998/wjcc.v11.i12.2637] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/17/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
The mediastinum is where thoracic lesions most frequently occur in young patients. The histological spectrum of diseases caused by the presence of several organs in the mediastinum is broad. Congenital lesions, infections, benign and malignant lesions, and vascular diseases are examples of lesions. Care should be taken to make the proper diagnosis at the time of diagnosis in order to initiate therapy promptly. Our task is currently made simpler by radiological imaging techniques.
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Affiliation(s)
- Hasibe Gökçe Çinar
- Department of Pediatric Radiology, Ankara Etlik City Hospital, Ankara 06000, Turkey
| | - Ali Osman Gulmez
- Department of Radiology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan 24100, Turkey
| | - Çiğdem Üner
- Department of Pediatric Radiology, Ankara Etlik City Hospital, Ankara 06000, Turkey
| | - Sonay Aydin
- Department of Radiology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan 24100, Turkey
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Bouassida I, Hadj Dahmane M, Zribi H, Bessrour H, Hachicha S, Marghli A. A poor prognosis of a mediastinal bronchogenic cyst with malignant transformation: A case report. Int J Surg Case Rep 2023; 106:108246. [PMID: 37146554 DOI: 10.1016/j.ijscr.2023.108246] [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: 11/08/2022] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION Bronchogenic cysts (BC) are congenital lesions, it results from an abnormal budding of the tracheobronchial tree. Malignant transformation is very rare. We report a case of adenocarcinoma arising in a BC of the posterior mediastinum detected after surgery. PRESENTATION OF CASE We report the case of a 32-year-old man, without a particular medical history. The patient presented a cough associated with dyspnea, and a weight loss 4-month before the diagnosis. The imaging tools, showed a voluminous latero-tracheal mass of the posterior mediastinum. The diagnoses of a neurogenic tumor or a BC were suspected. The patient was treated by video-assisted thoracoscopy. Complete excision was done complicated by lesion's small rupture. The microscopic exam revealed unfortunately an adenocarcinoma arising in a BC. The patient had started the cure of chemotherapy. Six months later, the patient died due to tumor recurrence with cerebral metastasis. DISCUSSION Mediastinum BC, is usually located within the middle and posterior mediastinum. This condition is a benign congenital lesion. His curative therapy was a complete surgical resection with a good prognosis. However, malignant transformation may seldom occur and is most often accidentally diagnosed during the histological examination of specimens. In this case, the surgical treatment may be insufficient, and the prognosis may be poor. CONCLUSION Malignant degeneration of mediastinal BC, despite being rare, should be kept in mind, carefully avoided and managed.
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Affiliation(s)
- Imen Bouassida
- Department of Thoracic Surgery, Abderrahmen Mami Hospital of Ariana, Tunisia
| | - Mariem Hadj Dahmane
- Department of Thoracic Surgery, Abderrahmen Mami Hospital of Ariana, Tunisia.
| | - Hazem Zribi
- Department of Thoracic Surgery, Abderrahmen Mami Hospital of Ariana, Tunisia
| | - Habib Bessrour
- Department of Cardiothoracic Surgery, The Principal Military Hospital of Instruction of Tunis, Tunisia
| | - Saber Hachicha
- Department of Cardiothoracic Surgery, The Principal Military Hospital of Instruction of Tunis, Tunisia
| | - Adel Marghli
- Department of Thoracic Surgery, Abderrahmen Mami Hospital of Ariana, Tunisia
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Weissferdt A. Spindle cell thymoma and its histological mimickers. Mediastinum 2023; 7:25. [PMID: 37701646 PMCID: PMC10493621 DOI: 10.21037/med-22-50] [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: 10/18/2022] [Accepted: 03/31/2023] [Indexed: 09/14/2023]
Abstract
Spindle cell thymomas are the most common spindle cell neoplasms of the anterior mediastinum. These tumors belong to the group of thymic epithelial neoplasms and are known for their wide histomorphologic spectrum. This histological heterogeneity is the reason why unequivocal diagnosis can be challenging, especially when dealing with small biopsy material. Conversely, less conventional patterns of the tumor may also pose significant diagnostic problems in resected material and the differential diagnosis often includes other spindle cell neoplasms that are known to arise in the mediastinal cavity. These can be of variable origin and may share overlapping pathological features with spindle cell thymoma. Since spindle cell thymomas are tumors that primarily affect the adult population and predominantly arise from the thymic gland in the anterior mediastinum, this review will focus on the differential diagnosis with other spindle cell neoplasms that share similar demographic characteristics and, for the most part, originate from the anterior mediastinal compartment. These include other epithelial spindle cell tumors of thymic origin (sarcomatoid thymic carcinoma and spindle cell carcinoid tumor), mesenchymal neoplasms [solitary fibrous tumor (SFT), synovial sarcoma, and dedifferentiated liposarcoma] and various other tumors with spindle cell morphology, that may occasionally involve the anterior mediastinum. The clinical, pathological, immunohistochemical and molecular hallmarks of these lesions will be discussed and useful tips for the differential diagnosis with spindle cell thymoma will be provided.
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Affiliation(s)
- Annikka Weissferdt
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Weissferdt A, Moran CA. Atypical thymoma (epithelial-rich thymoma, well-differentiated thymic carcinoma, WHO type B3 thymoma): A conundrum. Pathol Res Pract 2023; 245:154459. [PMID: 37043966 DOI: 10.1016/j.prp.2023.154459] [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: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023]
Abstract
Thymomas composed predominantly of epithelioid tumor cells with scattered lymphocytes have been well recognized in the literature. This subtype of thymoma has been variously termed epithelial-rich thymoma, well-differentiated thymic carcinoma, atypical thymoma, or World Health Organization (WHO) type B3 thymoma. Regardless of the designation however, these tumors are known to show a spectrum of histopathological growth patterns that may pose challenges in interpretation and diagnosis, particularly when dealing with small mediastinoscopic biopsies. Just like any other type of thymoma, those composed predominantly of epithelioid cells may present as encapsulated or invasive tumors. Nevertheless, compared to other subtypes of thymoma, they are uncommon neoplasms. Therefore, it becomes very important to sufficiently sample thymomas before making a diagnosis of a particular subtype, especially when the tumor is rich in epithelioid cells and only has a scant lymphocytic component. Because of the unusual occurrence of these tumors, there are only few large series of cases that attempt to highlight not only the more salient histopathological features but also the most important immunohistochemical and molecular characteristics.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Cesar A Moran
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Pasricha S, Jajodia A, Sharma A, Bansal D, Batra U, Gupta G, Durga G, Kamboj M, Nathany S, Mehta A. Primary pulmonary NUT midline carcinoma: An elusive and a rare diagnostic entity. J Cancer Res Ther 2023; 19:816-818. [PMID: 37470617 DOI: 10.4103/jcrt.jcrt_1887_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Nuclear protein in testis (NUT) midline carcinoma is a poorly differentiated tumor, is more common in midline anatomic sites, and involves young adults and children mainly. Primary pulmonary NUT midline carcinoma (NMC) is a rare and poorly defined entity in the prevailing literature. Being a highly aggressive and fatal neoplasm, it gets incumbent for the oncologists and the pathologists to be aware of this entity as it holds distinct management protocol and prognosis. Currently, BET inhibitors (BETi) and histone deactylase inhibitors have shown promising results as targeted therapies in clinical trials in head and neck NMC. We present a case report of NMC of primary pulmonary location in a young male with widespread bony metastasis.
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Affiliation(s)
- Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ankush Jajodia
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anila Sharma
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Divya Bansal
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Gurudutt Gupta
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Garima Durga
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Meenakshi Kamboj
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Shrinidhi Nathany
- Department of Molecular Diagnostics Radiology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anurag Mehta
- Department of Laboratory, Molecular and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Karamustafaoğlu YA, Yanık F, Yörük Y. Wedge resection and pleurodesis through single-incision videothoracoscopic transmediastinal approach for bilateral spontaneous pneumothorax. Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31:295-299. [PMID: 37484633 PMCID: PMC10357863 DOI: 10.5606/tgkdc.dergisi.2023.20843] [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] [Received: 09/28/2020] [Accepted: 01/17/2021] [Indexed: 07/25/2023]
Abstract
In general, in cases of bilateral primary pneumothorax, videoassisted thoracoscopic surgery procedures are performed sequentially on both sides. However, there are only a few reported cases of bullectomy through video-assisted thoracoscopic surgery using a transmediastinal approach for bilateral primary spontaneous pneumothorax. A 20-year-old male patient was admitted to our clinic with a right pneumothorax and developed a left pneumothorax four days later while he was under treatment. He underwent bilateral bullectomy and pleurodesis via a singleincision video-assisted thoracoscopic surgery in the supine position. The patient was discharged uneventfully within 72 h after the procedure. In conclusion, bilateral bullectomy and pleurodesis using single-incision transmediastinal access video-assisted thoracoscopic surgery may be good choices that are technically reliable and provide favorable surgical outcomes.
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Affiliation(s)
| | - Fazlı Yanık
- Department of Thoracic Surgery, Medicine Faculty of Trakya University, Edirne, Türkiye
| | - Yener Yörük
- Department of Thoracic Surgery, Medicine Faculty of Trakya University, Edirne, Türkiye
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Fujii H, Yamada Y, Yamamura K, Ishida Y, Tsujimura M, Matsumoto K, Tanaka S, Date H, Nishikawa T, Yoshida Y, Kashima J, Yatabe Y, Ogawa S, Marx A, Ulbright TM, Haga H. A case of vasculogenic mesenchymal tumor in the mediastinum: whole-exome sequencing reveals origin from pre-existing germ cell tumor. Virchows Arch 2023; 482:923-927. [PMID: 36943470 DOI: 10.1007/s00428-023-03529-2] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
Vasculogenic mesenchymal tumor (VMT), a primitive mesenchymal neoplasm enriched by various-sized atypical vessels, is a new entity that develops in mediastinal germ cell tumors (GCTs) with yolk sac tumor (YST) components after chemotherapy. Notably, patients with VMT in the residual GCT have increased risk of developing sarcomas or hematopoietic malignancies. Here, we report a late-teenage male patient with residual teratoma and high-grade VMT after chemotherapy for a mediastinal mixed GCT, including YST. Whole-exome sequencing revealed biallelic inactivation of TP53 and extensive copy number alterations that suggested whole-genome doubling. The biopsy tissue of the mixed GCT before chemotherapy exhibited overlapping genetic alterations to those in the VMT. Immunohistochemical analyses of the VMT showed that the abnormal vessels were positive for cytokeratin, glypican 3, EZH2, and IMP3. The findings that VMT inherits the genetic alterations of pre-existing mixed GCT and exhibits a partly YST-like immunophenotype might contribute to its clinical aggressiveness.
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Affiliation(s)
- Hirotake Fujii
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Kentaro Yamamura
- Department of Dermatology, Kyoto University Hospital, Kyoto, Japan
| | - Yoshihiro Ishida
- Department of Dermatology, Kyoto University Hospital, Kyoto, Japan
| | - Marina Tsujimura
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | | | - Satona Tanaka
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tadaaki Nishikawa
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Jumpei Kashima
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Alexander Marx
- Institute of Pathology, Mannheim and Medical Faculty Mannheim, University Medical Centre, Heidelberg University, Mannheim, Germany
| | - Thomas M Ulbright
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Villamizar N. A quest for evidence supporting operative intervention for cystic lesions in the mediastinum. Mediastinum 2023; 7:12. [PMID: 37261093 PMCID: PMC10226886 DOI: 10.21037/med-23-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/17/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Nestor Villamizar
- DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
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41
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Tokairin Y, Kawamura Y, Muro S, Nagai K, Kawada K, Okada T, Tharnmanularp S, Jiamjunyasiri A, Akita K, Kinugasa Y. Histological study of the thin membranous dense connective tissues around the curving portion of the bilateral recurrent laryngeal nerves. Esophagus 2023. [PMID: 36867250 DOI: 10.1007/s10388-023-00991-4] [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] [Indexed: 03/04/2023]
Abstract
OBJECTIVE/AIM We aimed to demonstrate the anatomical relationship between the recurrent laryngeal nerves (RLNs), thin membranous dense connective tissue (TMDCT [e.g., the visceral or vascular sheaths around the esophagus]), and the lymph nodes around the esophagus at the curving portion of the RLNs for rational and efficient lymph node dissection. METHODS Transverse sections of the mediastinum at 5 mm or 1 mm intervals were obtained from four cadavers. Hematoxylin and eosin staining and Elastica van Gieson staining were performed. RESULTS The visceral sheaths could not be clearly observed the curving portions of the bilateral RLNs, which were observed on the cranial and medial side of the great vessels (aortic arch and right subclavian artery [SCA]). The vascular sheaths could be clearly observed. The bilateral RLNs diverged from the bilateral vagus nerves, which ran along with the vascular sheaths, went up around the caudal side of the great vessels and the vascular sheath, and ran cranially on the medial side of the visceral sheath. Visceral sheaths were not observed around the region containing the left tracheobronchial lymph nodes (No. 106tbL) or the right recurrent nerve lymph nodes (No. 106recR). The regions containing the left recurrent nerve lymph nodes (No. 106recL) and the right cervical paraesophageal lymph nodes (No. 101R) were observed on the medial side of the visceral sheath, with the RLN. CONCLUSION The recurrent nerve, which branched off from the vagus nerve descending along the vascular sheath, ascended the medial side of the visceral sheath after inversion. However, no clear visceral sheath could be identified in the inverted area. Therefore, during radical esophagectomy, the visceral sheath along No. 101R or 106recL may be recognized and available.
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Affiliation(s)
- Yutaka Tokairin
- Department of Surgery, Tokyo Metropolitan Toshima Hospital, 33-1 Sakaecho, Itabashi-Ku, Tokyo, 173-0015, Japan.
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Yudai Kawamura
- Department of Surgery, Tokyo Metropolitan Toshima Hospital, 33-1 Sakaecho, Itabashi-Ku, Tokyo, 173-0015, Japan
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Kagami Nagai
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Kenro Kawada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Takuya Okada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Suthasinee Tharnmanularp
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Areeya Jiamjunyasiri
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Markowiak T, Hofmann HS, Ried M. [Mediastinal tumors : Diagnosis and treatment of the most common tumor entities]. Chirurgie (Heidelb) 2023; 94:277-88. [PMID: 35876853 DOI: 10.1007/s00104-022-01685-w] [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] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 10/16/2022]
Abstract
The mediastinum is defined as the space formed ventrally by the sternum, dorsally by the spine, and laterally by the mediastinal pleura. A mediastinal mass is frequently an incidental finding. The wide spectrum of underlying diseases and the anatomic proximity to central structures makes diagnosis and treatment challenging. In many cases, the combination of anamnesis, physical examination, imaging and laboratory tests already provides valuable information about the tumor entity. In addition to diagnostic procedures for histological examination of an unclear mediastinal tumor, radical resection is very important for the prognosis of the patients, especially in the case of tumors of the thymus. Multimodal treatment of advanced tumors that involve adjacent structures is best performed in designated centers.
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Yamamoto R, Yoshida K, Ando M, Toyoda Y, Tanaka A, Kato K, Yamaguchi R. Retroperitoneal and Mediastinal Emphysema after Sigmoid Colon Resection. Case Rep Gastroenterol 2023; 17:137-142. [PMID: 36843657 PMCID: PMC9950965 DOI: 10.1159/000529282] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
Retroperitoneal and mediastinal emphysema after colon resection is extremely rare, especially in the absence of anastomotic leakage. The feasibility and safety of conservative treatment for this complication are unknown. We report a patient who underwent open sigmoid colon resection for colon cancer and developed retroperitoneal and mediastinal emphysema that was not caused by anastomotic leakage. Retroperitoneal and mediastinal emphysema occurred as a result of diverticular perforation. We were able to treat this patient successfully with conservative management.
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Affiliation(s)
- Ryusei Yamamoto
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
| | | | - Masataka Ando
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
| | | | - Aya Tanaka
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
| | - Kenji Kato
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
| | - Ryuzo Yamaguchi
- Division of Surgery, Inazawa Municipal Hospital, Inazawa, Japan
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Ajouz H, Villamizar N. Postoperative complications of mediastinal cyst resection and their management. Mediastinum 2023; 7:20. [PMID: 37261098 PMCID: PMC10226888 DOI: 10.21037/med-22-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/30/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Hana Ajouz
- Section of Thoracic Surgery, Department of Surgery, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
| | - Nestor Villamizar
- Section of Thoracic Surgery, Department of Surgery, Leonard M. Miller School of Medicine University of Miami, Miami, FL, USA
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45
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Lugo-Fagundo E, Lugo-Fagundo C, Weisberg EM, Fishman EK. CT of Castleman disease in the mediastinum. Radiol Case Rep 2023; 18:1161-1163. [PMID: 36660582 PMCID: PMC9842962 DOI: 10.1016/j.radcr.2022.12.054] [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: 11/24/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Castleman disease is a rare lymphoproliferative disease commonly occurring as a benign localized mass of lymph nodes in the mediastinum. Given that Castleman disease presents as asymptomatic or through non-specific thoracic symptoms, detection is considered complex. Ultimately, surgical resection is the preferred course of action with a greater than 90% relapse-free survival and no malignant transformation reported. In this article, we describe the case of a 34-year-old male with an unclear smoking history who was diagnosed with hyaline-vascular Castleman disease. We focus on optimizing diagnosis and management through the application of radiological imaging modalities, including computed tomography scans.
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Liu L, Zhang F, Wu Z, Tu S, Li Y. Diagnostic challenge and management of thymic cavernous hemangioma: a case report and review of the literature. Curr Med Imaging 2023:CMIR-EPUB-128654. [PMID: 36624647 DOI: 10.2174/1573405619666230109121128] [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: 06/03/2022] [Revised: 10/28/2022] [Accepted: 11/22/2022] [Indexed: 01/11/2023]
Abstract
Objective Thymic cavernous hemangioma (CH) as a benign lesion is extremely rare, and it is very difficult to distinguish it from other anterior mediastinal tumors on imaging. Case Presentation We treated a 63-year-old woman with thymic CH that was incidentally found by chest computed tomography (CT). Contrast-enhanced chest CT described an anterior superior mediastinal mass, approximately 2.5cm in diameter, with centripetal enhancement and an increased range of enhancement in the delayed period. The tumor and thymus were completely resected by video-assisted thoracic surgery (VATS) to provide a definitive diagnosis and precise treatment. Postoperative pathology suggested that the tumor was a thymus cavernous hemangioma. Conclusion We reported an extremely uncommon case of CH in the thymus and reviewed the previously published literature. CH can occur at any age and body tissue, and there is no significant difference between males and females. Most patients are asymptomatic, often found by chest CT. Enhanced chest CT suggested that an increased area of venous enhancement at a prolonged duration may be a feature of CH. Complete surgical resection is a safe and effective method for CH in the thymus.
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Affiliation(s)
- Li Liu
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, P.R. China
| | - Fangbiao Zhang
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, P.R. China
| | - Zhijun Wu
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, P.R. China
| | - Shaosong Tu
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, P.R. China
| | - Yan Li
- Department of Cardiothoracic Surgery, Zhejiang University, Lishui Hospital, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, P.R. China
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Dang Van S, Girault A, Bouthors C, Fadel E, Court C, Mercier O. En bloc video-assisted thoracoscopic vertebrectomy for a spinal tumour. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 36606669 DOI: 10.1510/mmcts.2022.095] [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: 01/07/2023]
Abstract
Complex thoracic vertebral tumours remain a surgical challenge in terms of the surgical approach to ensure a complete en bloc vertebrectomy with healthy margins, along with optimal control of the thoracic structures next to the spine. A combined three-port left thoracoscopic posterior approach, with the patient placed in a prone position with selective double-lumen intubation, can be performed in patients with spinal tumours involving soft tissues, for direct access to the thoracic structures, even with T10-T11 vertebral tumours next to the diaphragm. The video thoracoscopic technique with an enhanced view of the posterior mediastinum permits progressive dissection of the descending aorta, oesophagus, azygos vein, thoracic ductus and diaphragmatic pillars from the vertebral body that is involved by the spinal tumour. The complete dissection of those structures from the spine provides a good surgical view of the contralateral pleural cavity to enable complete control of the tumoral mass. A complete en bloc vertebrectomy with spinal cord ligation is then completely and safely performed with Gigli saws above and under the tumour, respecting healthy tissue margins, under video thoracoscopic monitoring of the anterior structures. Finally, a spinal prosthesis is positioned through the posterior access and stabilized with thoracic and lumbar spinal arthrodesis.
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Affiliation(s)
- Simon Dang Van
- Department of Thoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Antoine Girault
- Department of Thoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Charlie Bouthors
- Department of Orthopedic and Trauma Surgery, University Hospital of Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - Elie Fadel
- Department of Thoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Charles Court
- Department of Orthopedic and Trauma Surgery, University Hospital of Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - Olaf Mercier
- Department of Thoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France
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Mardani P, Kamran H, Geramizadeh B, Darabi MH, Najafi M, Amirian A, Shahriarirad R. Cavernous mediastinal hemangioma presenting with persistent cough: a rare case report and review of literature. J Cardiothorac Surg 2023; 18:3. [PMID: 36604701 PMCID: PMC9817268 DOI: 10.1186/s13019-023-02130-7] [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: 05/28/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cavernous hemangioma is a rare benign tumor which can sometimes mimic the clinical presentation and radiological findings of malignant tumors. Here we present a rare presentation of cavernous hemangioma in the mediastinum (CHM), along with a literature review among the main databases. CASE PRESENTATION We present a 48-year-old male who had suffered from persistent cough as the sole symptom of an anterior CHM. Computed tomography scan demonstrated a 12.5 × 10.8 cm mass in the anterior mediastinum. The mass was surgically resected, and histopathological evaluation established the diagnosis of CHM. The patient was discharged in good condition, in which during his four-month follow-up period, no recurrence of the tumor has been observed. CONCLUSION Although cavernous hemangioma rarely present in the mediastinum, it should be considered in the differential diagnosis of mediastinal tumors. However, our review of literature demonstrated a female dominance and average age of 40 years, with a 52% mortality rate based on previous reports.
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Affiliation(s)
- Parviz Mardani
- grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Hooman Kamran
- grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- grid.412571.40000 0000 8819 4698Shiraz Transplant Research Center (STRC), Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Darabi
- grid.412571.40000 0000 8819 4698Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Najafi
- grid.412571.40000 0000 8819 4698School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Amirian
- grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Reza Shahriarirad
- grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran ,grid.412571.40000 0000 8819 4698School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Soder SA, Pollock C, Ferraro P, Lafontaine E, Martin J, Nasir B, Liberman M. Post-Operative Outcomes Associated With Open Versus Robotic Thymectomy: A Propensity Matched Analysis. Semin Thorac Cardiovasc Surg 2023; 35:189-199. [PMID: 34838953 DOI: 10.1053/j.semtcvs.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 12/23/2022]
Abstract
To compare post-operative outcomes associated with thymectomy performed using either open or robotic approaches. Retrospective cohort study from a single-center prospective registry consisting of patients undergoing thymectomy between 2000 and 2020. Patients were grouped according to surgical approach (open vs robotic). A propensity-score matching analysis was performed in a 2:1 open to robotic ratio, and surgical outcomes were evaluated. We analyzed 234 thymectomies (155 open; 79 robotic). Myasthenia gravis was present in 23.2% and 32.9% (P = 0.249) in the open and in the robotic group, respectively. All covariates were balanced in the matched groups (open n = 114; robotic n =5 9), except lesion size. The robotic approach was significantly associated with shorter surgical time (median 95 vs 65 minutes, P < 0.001), lesser clinical (21.1% vs 6.8%, P = 0.016) and surgical (11.4% vs 1.7%, P = 0.036) complications during the same hospitalization, less Clavien-Dindo grade 2 or higher complication rates (28.1 vs 15.3%, P = 0.048), chest tube duration (median: 3 vs 0 days, P < 0.001) and in-hospital length of stay (median: 5 vs 0 days, P < 0.001). Bleeding (P = 0.214), ICU length of stay (P = 0.167), reoperation rate (open, 1.8% vs robotic 0%), 90-day mortality (P = 0.341) and readmission rate post discharge (P = 0.277) were similar between the groups. In the matched population with primary thymic epithelial tumors, the completeness of resection rate was similar (open, 92.1% vs robotic 96.8%, P = 0.66.). Robotic thymectomy is associated with improved post-operative outcomes when compared to open thymectomy, without compromising the goals of oncologic surgery. Longer follow-up is needed to ensure oncologic equivalence.
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Affiliation(s)
- Stephan A Soder
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Clare Pollock
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Pasquale Ferraro
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Edwin Lafontaine
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Jocelyne Martin
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Basil Nasir
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada
| | - Moishe Liberman
- Department of Surgery, Division of Thoracic Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), University of Montreal, Montreal, Quebec, Canada..
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Shah A, Rojas CA. Imaging modalities (MRI, CT, PET/CT), indications, differential diagnosis and imaging characteristics of cystic mediastinal masses: a review. Mediastinum 2023; 7:3. [PMID: 36926286 PMCID: PMC10011868 DOI: 10.21037/med-22-31] [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: 08/03/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022]
Abstract
Cystic mediastinal masses have traditionally represented a diagnostic dilemma with differentiation of malignant masses a particular area of concern. Each imaging modality has strengths and weaknesses in mediastinal imaging-computed tomography (CT) offers increased spatial resolution at the cost of poorer soft tissue differentiation and requiring ionizing radiation, while magnetic resonance imaging (MRI) offers superior soft tissue contrast/characterization at significantly greater cost. Ultrasound offers real-time visualization but is operator and tissue dependent. [18F]fluoro-D-glucose (F-18 FDG) positron emission tomography (F-18 FDG PET) CT provides functional information, but poorer spatial resolution. Recent advances have focused upon the use of magnetic resonance imaging to aid in characterization of cystic mediastinal lesions, particularly in the context of indeterminate CT findings. The mediastinum may be divided into three anatomic compartments: prevascular, visceral, and paravertebral. All three compartments extend superiorly from the thoracic inlet and inferiorly to the diaphragm. These compartments provide a useful framework for categorizing normal and pathologic mediastinal processes. In this article, we will review the imaging characteristics of mediastinal cystic lesions via a case-based review divided by anatomical mediastinal compartments. Characteristic imaging features and troubleshooting are particular areas of focus. Normal variants that may mimic cystic pathology are discussed. The roles of CT and MRI will be emphasized. Cases from our institution are presented as illustrative examples.
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Affiliation(s)
- Amar Shah
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ, USA
| | - Carlos A Rojas
- Department of Radiology, Mayo Clinic in Arizona, Phoenix, AZ, USA
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