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The Pan African Medical Journal 2017Thymic neuroendocrine tumors (TNET) are rare, with little-known prognosis. This study aims to report a case of TNET and to highlight the diagnostic and therapeutic... (Review)
Review
Thymic neuroendocrine tumors (TNET) are rare, with little-known prognosis. This study aims to report a case of TNET and to highlight the diagnostic and therapeutic difficulties in low-resource settings. A 60-year-old man presented with chest pain, greasy cough and recent weight loss. Chest CT scan showed anterior mediastinal tissue mass. Histologic evaluation of a 4 months-biopsy specimen obtained from anterior mediastinotomy showed a well differentiated TNET, labeled intensely positive for chromogranin and synaptophysin. The search for other neuroendocrine tumors and the extent of extension were negative. The tumor was immediately inextricable and radiation therapy was unavailable. The patient underwent two lines of first line chemotherapy. At 16 months follow-up, the patient was asymptomatic but showed tumor progression. The diagnosis of TNET may be delayed when immunohistochemistry is not routinely performed. Chemotherapy is associated with symptoms improvement in palliative care situation.
Topics: Animals; Antineoplastic Agents; Biopsy; Chest Pain; Cough; Disease Progression; Follow-Up Studies; Humans; Male; Middle Aged; Neuroendocrine Tumors; Thymus Neoplasms; Tomography, X-Ray Computed; Weight Loss
PubMed: 28451004
DOI: 10.11604/pamj.2017.26.25.11500 -
Journal of Laparoendoscopic & Advanced... May 2024Lung cancer remains the leading cause of cancer deaths in the United States despite declining incidence and improved outcomes because of advancements in early detection...
Lung cancer remains the leading cause of cancer deaths in the United States despite declining incidence and improved outcomes because of advancements in early detection and development of novel therapies. Accurate mediastinal lymph node staging is crucial for determining prognosis and guiding treatment decisions, particularly for non-small cell lung cancer (NSCLC). A systematic search of PubMed was conducted to identify English language articles published between January 2010 and January 2024 focusing on preoperative lymph node staging in adults with NSCLC. Case series, observational studies, randomized trials, guidelines, narrative reviews, systematic reviews, and meta-analyses were included. Various imaging modalities, surgical and nonsurgical procedures for mediastinal lymph node staging were reviewed, including positron emission tomography with computed tomography, cervical mediastinoscopy, video-assisted cervical mediastinoscopy, anterior mediastinotomy, video-assisted thoracoscopy, endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA), transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and computed tomography-guided percutaneous lymph node biopsy. EBUS-FNA emerged as the preferred initial staging procedure because of its high sensitivity and low complication rate. Combining it with other procedures or confirmatory testing may be helpful in determining appropriate treatment. Although cervical mediastinoscopy remains a valuable confirmatory procedure in select cases, its role as a first-line staging modality is diminishing with the widespread adoption of EBUS-FNA and EUS-FNA. The combination of EBUS-FNA and EUS-FNA allows access to nearly all mediastinal lymph node stations with high diagnostic accuracy. Future research may further refine the selection criteria for invasive mediastinal staging procedures, ultimately optimizing patient outcomes in the management of NSCLC.
PubMed: 38727568
DOI: 10.1089/lap.2024.0138 -
Khirurgiia 2020Pneumomediastinum and subcutaneous emphysema are the main manifestations of gas syndrome in patients with tracheal injury. Traditional mediastinal decompression in case...
Pneumomediastinum and subcutaneous emphysema are the main manifestations of gas syndrome in patients with tracheal injury. Traditional mediastinal decompression in case of tension emphysema is carried out through different types of cervical or transpleural mediastinotomy and subsequent passive drainage. Clinical observation of the use of VAC-therapy in the patient with injury of the membranous part of trachea followed by tension pneumomediastinum is presented. Cervicotomy with dissection of anterior mediastinum and installation of vacuum-assisted dressing were performed. Fast regression of subcutaneous emphysema and relief of pneumomediastinum were noted. There were no complications. The patient was discharged in 6 days after admission. Effectiveness of VAC-therapy in patients with tension subcutaneous emphysema and pneumomediastinum was confirmed.
Topics: Humans; Mediastinal Emphysema; Neck; Negative-Pressure Wound Therapy; Pneumothorax; Subcutaneous Emphysema; Trachea; Vacuum
PubMed: 32352674
DOI: 10.17116/hirurgia202004177 -
Evaluation of surgical procedures in primary mediastinal cysts and tumors: single-center experience.Kardiochirurgia I Torakochirurgia... Oct 2019In this study, we aimed to evaluate the results of our patients with a primary mediastinal mass and the surgical techniques applied in our clinic retrospectively.
AIM
In this study, we aimed to evaluate the results of our patients with a primary mediastinal mass and the surgical techniques applied in our clinic retrospectively.
MATERIAL AND METHODS
Between March 2015 and March 2019, the results and treatment protocols of 32 patients with a primary mediastinal mass or cysts who were followed up and treated in our clinic were evaluated retrospectively. Twenty-six patients who underwent surgery for biopsy or resection were included in the study.
RESULTS
Sixteen of our patients were male and 10 were female. The mean age was 39 years. 80.2% of our patients were symptomatic and 19.2% were asymptomatic and a mediastinal mass was incidentally detected in these asymptomatic patients. The most common symptom was dyspnea with frequency of 38.4%. In terms of localization, the mass was lateralized on the right side in 7 patients, on the left side in 5 patients. In 13 patients, the tumor was located in the posterior mediastinum. 8 patients underwent anterior mediastinotomy and 1 patient underwent biopsy with video-assisted thoracoscopic surgery (VATS). Most commonly a thymus-derived mass was seen. Fifteen patients underwent excision with VATS, 3 thoracotomy, 2 sternotomy and in 1 patient VATS assisted anterior minithoracotomy was performed.
CONCLUSIONS
Mediastinal tumors and cysts have different histopathological features. Robotic surgery and VATS-assisted surgery are increasingly used in surgical excision.
PubMed: 31708982
DOI: 10.5114/kitp.2019.88597 -
Journal of Bronchology & Interventional... Jan 2018Nonsmall cell lung cancer (NSCLC) treatment is based on an accurate staging. Mediastinal lymph nodes staging has a critical impact on treatment management.
BACKGROUND
Nonsmall cell lung cancer (NSCLC) treatment is based on an accurate staging. Mediastinal lymph nodes staging has a critical impact on treatment management.
METHODS
The objective was to assess the current accuracy of preoperative tools for predicting mediastinal and hilar lymph nodes staging with NSCLC. Retrospective analysis of 997 biopsy-proven NSCLC patients treated at a single academic medical center between January 2006 and April 2012. Mediastinal lymph nodes were evaluated with preoperatively with: computed tomography (CT), positron emission tomography (PET), endobronchial ultrasound-guided fine needle aspiration, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Results are compared with pathologic surgical biopsy.
RESULTS
A total of 217 cervical mediastinoscopies, 15 anterior mediastinotomies, and 952 surgical lymphadenectomies were performed. The sensitivity of CT scan for mediastinal lymph nodes detection was 18.9% and PET-CT scan was 33.8%. Specificities were 94.9% and 93.8%, respectively. For hilar lymph nodes detection, CT was less sensitive (17.0% vs. 39.7%); however, more specific (94.7% vs. 80.3%) than PET-CT. Endobronchial ultrasound-guided fine needle aspiration (72.7% sensitivity and 100% specificity) and endoscopic ultrasound-guided fine needle aspiration (51.9% sensitivity and 100% specificity) both demonstrated superior results.
CONCLUSIONS
The majority of biopsy-proven mediastinal lymph nodes metastases are not associated with positive results on preoperative CT or PET. CT and PET have low positive predictive value for mediastinal lymph node. This study supports the routine utilization of invasive mediastinal lymph nodes staging in NSCLC, especially for patients with tumors of >4 cm diameter, regardless of CT or PET-CT results.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Endoscopic Ultrasound-Guided Fine Needle Aspiration; False Negative Reactions; Female; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Mediastinum; Middle Aged; Neoplasm Staging; Positron-Emission Tomography; Predictive Value of Tests; Preoperative Period; Tomography, X-Ray Computed; Ultrasonography, Interventional; Young Adult
PubMed: 29261576
DOI: 10.1097/LBR.0000000000000425 -
Annals of Surgical Oncology Jan 2018The treatment of non-small cell lung cancer is largely dependent on accurate staging in order to determine appropriate therapy. Despite advances in imaging, such as...
The treatment of non-small cell lung cancer is largely dependent on accurate staging in order to determine appropriate therapy. Despite advances in imaging, such as computed tomography and positron emission tomography, invasive mediastinal staging is frequently needed to rule out mediastinal involvement prior to curative-intent stereotactic ablative radiotherapy or surgical resection. Surgical mediastinal staging with mediastinoscopy, or anterior mediastinotomy, were traditionally considered the gold standard for invasive mediastinal staging. Endobronchial and endoscopic ultrasound have emerged as modern techniques that are being used as first-line options instead of surgical staging. As experience is gained with these newer techniques, the need for confirmatory surgical staging continues to diminish. This article addresses the situations in which negative results should be confirmed by a more invasive procedure.
Topics: Bronchi; Carcinoma, Non-Small-Cell Lung; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; False Negative Reactions; Humans; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Mediastinoscopy; Mediastinum; Neoplasm Staging; Positron-Emission Tomography; Predictive Value of Tests; Tomography, X-Ray Computed
PubMed: 28074327
DOI: 10.1245/s10434-016-5674-5 -
The Annals of Thoracic Surgery Feb 2016The objective was to evaluate whether endobronchial ultrasonography (EBUS) or endoscopic ultrasonography (EUS) staging techniques of the mediastinum for lung cancer can...
BACKGROUND
The objective was to evaluate whether endobronchial ultrasonography (EBUS) or endoscopic ultrasonography (EUS) staging techniques of the mediastinum for lung cancer can change the treatment plan compared with the "gold standard" of surgical staging.
METHODS
Patients were retrospectively identified from a prospectively collected database. Endoscopic staging was compared with the "gold standard" cervical mediastinoscopy (CM). In cases where mediastinoscopy was not performed, EBUS/EUS was compared with "ideal" CM, a virtual procedure, which was assumed to have 100% rates of sensitivity and specificity.
RESULTS
EBUS was performed in 324 patients (99%), EUS in 295 patients (90%), and CM in 101 patients (31%); 226 patients (69%) were assumed to have undergone a virtual ideal CM and a virtual surgical mediastinal staging; 108 positive biopsies (33.0%) with endosonography had sampling of targets that were out of the scope of CM. Distant metastatic disease was diagnosed by EBUS/EUS in 7 patients (2.1%); 22 patients (6.7%) had positive targets outside the reach of the CM or virtual CM. If the 14 patients who had positive stations 5, 6, 10, and 11 are excluded (accessible with anterior mediastinotomy or extended cervical mediastinoscopy), there were 6 patients (1.8%) in whom endosonography upstaged the patient over ideal surgical mediastinal staging. In 20 patients (6.1%), ultrasound-guided biopsy made the diagnoses, which changed the treatment plan over CM and ideal CM.
CONCLUSIONS
Combined EBUS- and EUS-guided biopsies can access more targets, including lung and distant metastasis, and thus have the potential to upstage patients compared with mediastinoscopy and change the treatment plan.
Topics: Biopsy, Fine-Needle; Carcinoma, Non-Small-Cell Lung; Female; Humans; Image-Guided Biopsy; Lung Neoplasms; Male; Mediastinoscopy; Middle Aged; Neoplasm Staging; Reproducibility of Results; Retrospective Studies; Ultrasonography, Interventional
PubMed: 26545625
DOI: 10.1016/j.athoracsur.2015.08.070 -
European Journal of Cardio-thoracic... Oct 2015
Topics: Female; Hernia; Herniorrhaphy; Humans; Lung Diseases; Mediastinum; Middle Aged; Rare Diseases; Surgical Mesh; Thoracotomy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25681419
DOI: 10.1093/ejcts/ezv022 -
Pneumologie (Stuttgart, Germany) Mar 2015Proper staging of lung cancer represents the basis for any stage-adapted and optimized treatment. This is today implemented in specialized centers mainly through the use...
Proper staging of lung cancer represents the basis for any stage-adapted and optimized treatment. This is today implemented in specialized centers mainly through the use of modern imaging methods and minimally-invasive measures. However, general thoracic surgery has a role not only in the therapeutic management of lung cancer, but offers additional staging information whenever endoscopic or interventional methods fail to achieve representative tissue biopsies of mediastinal lymph nodes or suspect lesions for conclusive diagnosis. The thoracic surgical armentarium comprises of cervical or extended mediastinoscopy, video-assisted mediastinal lymphadenectomy (VAMLA), anterior mediastinotomy (Chamberlain procedure) and video-thoracoscopy (VATS). Indications for any invasive diagnostic methods always have to respect a therapeutic benefit for the patient.
Topics: Diagnostic Techniques, Surgical; Humans; Lung Neoplasms; Neoplasm Staging; Preoperative Care; Thoracic Surgery
PubMed: 25750096
DOI: 10.1055/s-0034-1391100 -
Asian Cardiovascular & Thoracic Annals Jan 2016There is sparse information concerning approaches to metachronous lung cancer in patients who had a previous pneumonectomy for lung carcinoma. We describe the case of a...
There is sparse information concerning approaches to metachronous lung cancer in patients who had a previous pneumonectomy for lung carcinoma. We describe the case of a 55-year-old woman who underwent a left pneumonectomy for lung carcinoma. Four years later, a radiological examination revealed a hypermetabolic nodule in the right upper lobe, which was located in the left hemithorax because of right lung hyperinflation and a mediastinal shift to the left. Wedge resection was carried out through a left anterior mediastinotomy. We believe that an anterior mediastinotomy represents a valuable option for the management of recurrent lung cancer after previous surgery.
Topics: Adenocarcinoma; Adenocarcinoma of Lung; Female; Humans; Lung Neoplasms; Mediastinum; Middle Aged; Multimodal Imaging; Neoplasms, Second Primary; Pneumonectomy; Positron-Emission Tomography; Reoperation; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26124429
DOI: 10.1177/0218492315593696