-
Journal of Computer Assisted Tomography 2019We set out to evaluate a set of demographic and computed tomography imaging features for diagnosing anterior mediastinal masses.
OBJECTIVE
We set out to evaluate a set of demographic and computed tomography imaging features for diagnosing anterior mediastinal masses.
METHODS
We identified 223 patients with anterior mediastinal masses, which we divided into training and validation sets. One radiologist evaluated computed tomography imaging features on the training set. Then, predictive features were identified, and 3 radiologists evaluated these on the validation set. A naive Bayesian classifier based on the features was compared with the radiologists' first-choice diagnosis.
RESULTS
Internal mammary lymphadenopathy and mediastinal encasement were strongly associated with lymphomas. Low attenuation and midline location were strongly associated with benign lesions, and older age was associated with thymic epithelial neoplasms. The average accuracy of the 3 radiologists' diagnoses was 78%, compared with 71% for the classifier.
CONCLUSIONS
Nine demographic and imaging features were found to be helpful in diagnosing anterior mediastinal masses. By using these features, radiologists can suggest the diagnosis with fair accuracy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Mediastinal Neoplasms; Mediastinum; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 30052619
DOI: 10.1097/RCT.0000000000000782 -
Radiologic Clinics of North America Mar 2021The high soft tissue contrast and tissue characterization properties of magnetic resonance imaging allow further characterization of indeterminate mediastinal lesions on... (Review)
Review
The high soft tissue contrast and tissue characterization properties of magnetic resonance imaging allow further characterization of indeterminate mediastinal lesions on chest radiography and computed tomography, increasing diagnostic specificity, preventing unnecessary intervention, and guiding intervention or surgery when needed. The combination of its higher soft tissue contrast and ability to image dynamically during free breathing, without ionizing radiation exposure, allows more thorough and readily appreciable assessment of a lesion's invasiveness and assessment of phrenic nerve involvement, with significant implications for prognostic clinical staging and surgical management.
Topics: Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Mediastinum; Reproducibility of Results
PubMed: 33551086
DOI: 10.1016/j.rcl.2020.11.001 -
Lymphoblastic Lymphoma: Guidelines From the International Lymphoma Radiation Oncology Group (ILROG).International Journal of Radiation... Nov 2018Presentation with a large mediastinal mass is a hallmark of acute lymphoblastic lymphoma, a disease that is treated in the same way as acute lymphoblastic leukemia even... (Review)
Review
Presentation with a large mediastinal mass is a hallmark of acute lymphoblastic lymphoma, a disease that is treated in the same way as acute lymphoblastic leukemia even in the absence of marrow involvement. The role of mediastinal radiation for patients who achieve complete remission after chemotherapy has been overlooked and controversial. This document presents current knowledge on the role of radiation for lymphoblastic lymphoma and best practices for addressing how to deliver mediastinal radiation with modern technology.
Topics: Combined Modality Therapy; Computer Simulation; Humans; International Cooperation; Mediastinum; Motion; Practice Guidelines as Topic; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Radiation Oncology; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Remission Induction; Societies, Medical; Tomography, X-Ray Computed
PubMed: 30238900
DOI: 10.1016/j.ijrobp.2018.05.078 -
International Journal of... 2021Mycobacterium tuberculosis infection (TB) masquerading as lung tumor is well reported, but its mimicry as metastatic thoracic cancer is rare. We report the case of a...
Mycobacterium tuberculosis infection (TB) masquerading as lung tumor is well reported, but its mimicry as metastatic thoracic cancer is rare. We report the case of a young male who presented with clinical and radiological picture of lung cancer but investigations confirmed it as TB. A 35-year-old male, with 18-pack year of smoking history, presented with dry cough, anorexia, weight loss, and lower back and left hip pain. Chest imaging showed right upper lobe speculated mass with mediastinal and hilar lymphadenopathy and a lytic lesion in the left sacral area. Magnetic resonance imaging of the spine and pelvis revealed lytic lesion in the left sacrum. Fluorodeoxyglucose positron emission tomography computed tomography scan of the whole body showed hypermetabolic lung lesion with ipsilateral mediastinal, supraclavicular, splenic, and bone metastasis in the left aspect of the sacrum. Computed tomography (CT)-guided biopsy of the lung lesion showed necrotizing granuloma and tissue culture was positive for pan-susceptible M. tuberculosis. Follow-up CT scan showed complete resolution of the lung lesion and lymph nodes after anti-TB treatment with significant reduction in the sacral lesion. Mycobacterial infection may mimic metastatic lung cancer and should always be considered a differential diagnosis.
Topics: Adult; Humans; Lung Neoplasms; Male; Mediastinum; Mycobacterium tuberculosis; Tomography, X-Ray Computed; Tuberculosis
PubMed: 34494575
DOI: 10.4103/ijmy.ijmy_89_21 -
The Journal of Thoracic and... Oct 2016
Topics: Humans; Mediastinal Neoplasms; Mediastinum
PubMed: 27474176
DOI: 10.1016/j.jtcvs.2016.06.001 -
Journal of Thoracic Oncology : Official... Apr 2020Mediastinal lesions are uncommon; studies on their distribution are, in general, small and from a single institution. Furthermore, these studies are usually based on...
INTRODUCTION
Mediastinal lesions are uncommon; studies on their distribution are, in general, small and from a single institution. Furthermore, these studies are usually based on pathology or surgical databases and, therefore, miss many lesions that did not undergo biopsy or resection. Our aim was to identify the distribution of lesions in the mediastinum in a large international, multi-institutional cohort.
METHODS
At each participating institution, a standardized retrospective radiology database search was performed for interpretations of computed tomography, positron emission tomography-computed tomography, and magnetic resonance imaging scans including any of the following terms: "mediastinal nodule," "mediastinal lesion," "mediastinal mass," or "mediastinal abnormality" (2011-2014). Standardized data were collected. Statistical analysis was performed.
RESULTS
Among 3308 cases, thymomas (27.8%), benign mediastinal cysts (20.0%), and lymphomas (16.1%) were most common. The distribution of lesions varied among mediastinal compartments; thymomas (38.3%), benign cysts (16.8%), and neurogenic tumors (53.9%) were the most common lesions in the prevascular, visceral, and paravertebral mediastinum, respectively (p < 0.001). Mediastinal compartment was associated with age; patients with paravertebral lesions were the youngest (p < 0.0001). Mediastinal lesions differed by continent or country, with benign cysts being the most common mediastinal lesions in the People's Republic of China, thymomas in Europe, and lymphomas in North America and Israel (p < 0.001). Benign cysts, thymic carcinomas, and metastases were more often seen in larger hospitals, whereas lymphomas and thymic hyperplasia occurred more often in smaller hospitals (p < 0.01).
CONCLUSIONS
Our study confirmed that the spectrum and frequency of mediastinal lesions depend on mediastinal compartment and age. This information provides helpful demographic data and is important when considering the differential diagnosis of a mediastinal lesion.
Topics: China; Europe; Humans; Lung Neoplasms; Mediastinal Neoplasms; Mediastinum; Radiology; Retrospective Studies; Thymus Neoplasms
PubMed: 31870881
DOI: 10.1016/j.jtho.2019.12.108 -
BMJ Case Reports Jun 2022Functional mediastinal paragangliomas (PGs) are rare, catecholamine-secreting tumours. Surgical resection is the preferred treatment, but it can be complicated by...
Functional mediastinal paragangliomas (PGs) are rare, catecholamine-secreting tumours. Surgical resection is the preferred treatment, but it can be complicated by catecholamine-related symptoms, involvement of cardiac structures and/or tumour supply from major blood vessels. We report a case of a man in his 30s with a subcarinal functional PG complicated by all three factors. The PG had arterial supplies from the right coronary and bronchial arteries, with mass effect on the left atrium. Given the high risk of intraoperative bleeding, catecholamine surges and injury to right coronary artery, we attempted a minimally invasive strategy that incorporates best practices from the few published cases on functional PGs. We show that a multidisciplinary approach involving alpha/beta blockade, preoperative embolisation of tumour blood supply, robotic-assisted tumour mobilisation and, if needed, open resection with cardiopulmonary bypass can be a safe strategy in the treatment of functional mediastinal paragangliomas adherent to cardiac structures.
Topics: Catecholamines; Humans; Male; Mediastinal Neoplasms; Mediastinum; Paraganglioma; Paraganglioma, Extra-Adrenal
PubMed: 35672059
DOI: 10.1136/bcr-2022-250500 -
BMC Endocrine Disorders Jun 2023Parathyroid carcinoma (PC) is an uncommon cause of primary hyperparathyroidism (PHPT) and particularly rare in the mediastinum. Herein, we present a case of mediastinal... (Review)
Review
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 99Tc-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.
Topics: Humans; Female; Middle Aged; Parathyroid Neoplasms; Mediastinum; Calcium; Parathyroid Hormone; Parathyroidectomy; Hyperparathyroidism, Primary
PubMed: 37280629
DOI: 10.1186/s12902-023-01363-w -
World Journal of Nuclear Medicine Sep 2022Mediastinal mass lesions span a wide histopathological and radiological spectrum. Partition of the mediastinum into specific compartments aids in differential...
Mediastinal mass lesions span a wide histopathological and radiological spectrum. Partition of the mediastinum into specific compartments aids in differential diagnosis of mass lesions, assistance in biopsies, and other surgical procedures. Multidetector row computed tomography (MDCT) is a promising three-dimensional imaging tool allowing substantial anatomical volumes to be routinely covered with isotropic submillimeter spatial resolution to precisely localize lesions and biopsy needles for both benign and malignant disease lesions of the mediastinum. The aim of this study was to categorize mass lesions according to the mediastinal compartments to study their MDCT characteristics and to provide a comparative role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the diagnostic evaluation of mediastinal mass lesions. Patients with clinical or radiological suspicion of mediastinal lesions on the basis of an abnormal chest radiograph were referred to the department of radiodiagnosis at a tertiary care center between April 2015 and December 2019 for MDCT evaluation. A total of 80 cases were correlated with the histopathological diagnosis excluding aneurysms. Size, CT density (Hounsfield unit [HU] mean), and maximum standardized uptake value (SUV ) of mediastinal and chest wall lesions were determined on FDG-PET/CT. This study included a total of 102 cases, 72 males and 29 females. Mediastinal mass lesions were most common in the age group 46 to 60 years. Anterior mediastinum ( = 43, 42.2%) is the most commonly involved compartment followed by posterior mediastinum ( = 37, 35.9%) and middle mediastinum ( = 22, 21.8%). Transcompartmental involvement is more commonly seen involving the anterior and middle mediastinum. The SUV , HU mean, and size were higher in malignant cases ( = 0.001, = 0.003, and = 0.004, respectively). The current study found a cutoff value of 4.61 for SUV to discriminate benign lesions from malignant ones with a sensitivity and specificity of 73.7 and 75.9%, respectively (area under the curve: 0.841, 95% confidence interval: 0.793-0.965, = 0.0001). The values of SUV and HU mean were higher in solid benign lesions than those of cystic benign lesions ( = 0.007 and = 0.003, respectively). In the current study, MDCT has high diagnostic accuracy of ∼94% overall as compared with histopathology, and 97 and 92% for benign and malignant lesions, respectively, in the evaluation of mediastinal mass lesions. FDG-PET/CT may be complementary to conventional imaging methods for the evaluation of mediastinal and chest wall mass lesions. However, confirmatory tissue sampling is required to confirm PET positive findings for the definite diagnosis.
PubMed: 36060087
DOI: 10.1055/s-0042-1751032 -
South Dakota Medicine : the Journal of... Aug 2023Testicular embryonal carcinoma is a type of nonseminomatous germ cell tumor (NSGCT) that commonly presents with scrotal swelling due to testicular mass. About half of...
Testicular embryonal carcinoma is a type of nonseminomatous germ cell tumor (NSGCT) that commonly presents with scrotal swelling due to testicular mass. About half of patients with NSGCTs will present with metastases at initial diagnosis. Rarely, testicular embryonal carcinoma can present primarily in the mediastinum. Treatment is well-studied and effective: chemotherapy with bleomycin, etoposide, and cisplatin. Post-chemotherapy retroperitoneal lymph node dissection (RPLND) is common adjuvant therapy. In this report we present a case of testicular embryonal carcinoma in a 32-year-old Caucasian man. The rarity of the case resides in its presentation: supraclavicular lymphadenopathy and no testicular mass on palpation or scrotal ultrasound.
Topics: Male; Humans; Adult; Mediastinum; Carcinoma, Embryonal; Testicular Neoplasms; Neoplasms, Germ Cell and Embryonal; Etoposide
PubMed: 37734076
DOI: No ID Found