-
Archives of Pathology & Laboratory... Aug 2022Mediastinal tumors/lesions are frequently encountered in daily cytopathology practice. These lesions are accessible through endoscopic/endobronchial ultrasound-guided or... (Review)
Review
CONTEXT.—
Mediastinal tumors/lesions are frequently encountered in daily cytopathology practice. These lesions are accessible through endoscopic/endobronchial ultrasound-guided or computed tomography-guided fine-needle aspiration cytology and represent a wide range of primary and metastatic tumors. This often poses diagnostic challenges because of the complexity of the mediastinal anatomic structures. Tumors metastatic to mediastinal lymph nodes represent the most common mediastinal lesions and must be differentiated from primary lesions.
OBJECTIVE.—
To provide an updated review on the fine-needle aspiration cytology of mediastinal tumors/lesions, with an emphasis on diagnostic challenges. This review encompasses thymic epithelial neoplasms, mediastinal lymphoproliferative disorders, germ cell tumors, neuroendocrine tumors, soft tissue tumors, and metastatic tumors. Differential diagnoses; useful ancillary studies, including targeted immunohistochemical panels; and diagnostic pitfalls are discussed.
DATA SOURCES.—
Data were gathered from a PubMed search of peer-reviewed literature on mediastinal tumors. Data were also collected from the authors' own practices.
CONCLUSIONS.—
Fine-needle aspiration cytology plays a vital role in evaluation of mediastinal lesions. Being familiar with the clinical and cytomorphologic features of these lesions, appropriately triaging the diagnostic material for ancillary testing, and correlating with radiologic findings are important in arriving at correct diagnoses and guiding management.
Topics: Biopsy, Fine-Needle; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Mediastinal Neoplasms; Mediastinum
PubMed: 34402861
DOI: 10.5858/arpa.2021-0108-RA -
The Lancet. Oncology Apr 2020
Topics: Acanthosis Nigricans; Adolescent; Female; Hand Dermatoses; Humans; Lymphoma, B-Cell; Mediastinal Neoplasms; Pruritus
PubMed: 32240613
DOI: 10.1016/S1470-2045(20)30075-9 -
Seminars in Diagnostic Pathology Jul 2020Lymphoma is the most common malignancy involving the mediastinum but can be challenging to diagnose on small biopsy specimens. This review provides a pattern-based... (Review)
Review
Lymphoma is the most common malignancy involving the mediastinum but can be challenging to diagnose on small biopsy specimens. This review provides a pattern-based approach to help triage small tissue samples for the diagnosis of mediastinal lymphoid proliferations, with focus on the main primary mediastinal lymphomas. The use of ancillary studies is highlighted, along with considerations to avoid misdiagnosis and scenarios to request additional tissue.
Topics: Diagnosis, Differential; Humans; Lymphoma; Mediastinal Neoplasms
PubMed: 32451144
DOI: 10.1053/j.semdp.2020.04.005 -
Lung Cancer (Amsterdam, Netherlands) May 2024Mediastinal neoplasms are typical but uncommon thoracic diseases with increasing incidence and unfavorable prognoses. A comprehensive understanding of their... (Observational Study)
Observational Study
OBJECTIVES
Mediastinal neoplasms are typical but uncommon thoracic diseases with increasing incidence and unfavorable prognoses. A comprehensive understanding of their spatiotemporal distribution is essential for accurate diagnosis and timely treatment. However, previous studies are limited in scale and data coverage. Therefore, this study aims to elucidate the distribution of mediastinal lesions, offering valuable insights into this disease.
MATERIALS AND METHODS
This multi-center, hospital-based observational study included 20 nationwide institutions. A retrospective search of electronic medical records from January 1st, 2009, to December 31st, 2020, was conducted, collecting sociodemographic data, computed tomography images, and pathologic diagnoses. Analysis focused on age, sex, time, location, and geographical region. Comparative assessments were made with global data from a multi-center database.
RESULTS
Among 7,765 cases, thymomas (30.7%), benign mediastinal cysts (23.4%), and neurogenic tumors (10.0%) were predominant. Distribution varied across mediastinal compartments, with thymomas (39.6%), benign cysts (28.1%), and neurogenic tumors (51.9%) most prevalent in the prevascular, visceral, and paravertebral mediastinum, respectively. Age-specific variations were notable, with germ cell tumors prominent in patients under 18 and aged 18-29, while thymomas were more common in patients over 30. The composition of mediastinal lesions across different regions of China remained relatively consistent, but it differs from that of the global population.
CONCLUSION
This study revealed significant heterogeneity in the spatiotemporal distribution of mediastinal neoplasms. These findings provide useful demographic data when considering the differential diagnosis of mediastinal lesions, and would be beneficial for tailoring disease prevention and control strategies.
Topics: Humans; Male; Female; Mediastinal Neoplasms; Adult; Middle Aged; Retrospective Studies; Adolescent; Young Adult; Aged; Child; Spatio-Temporal Analysis; Child, Preschool; Tomography, X-Ray Computed; Incidence
PubMed: 38569278
DOI: 10.1016/j.lungcan.2024.107558 -
American Journal of Surgery Aug 2021
Topics: Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Humans; Mediastinal Neoplasms; Polytetrafluoroethylene; Vena Cava, Superior
PubMed: 33461731
DOI: 10.1016/j.amjsurg.2021.01.005 -
Kyobu Geka. the Japanese Journal of... Sep 2021The mediastinum contains large blood vessels, airways, and spinal cord, which are anatomically important parts of the human body because they survive by injury,...
The mediastinum contains large blood vessels, airways, and spinal cord, which are anatomically important parts of the human body because they survive by injury, obstruction, and compression, and are involved in activities of daily living( ADL). Therefore, even benign tumors have been indicated for aggressive surgical intervention. Dissection procedures from these anatomically important structures is extremely risky and difficult in reoperation for recurrence of mediastinal tumors, so careful consideration and attention must be paid to the surgical indications and methods. In this paper, we have described the points to be noted and points regarding the reoperation of mediastinal tumors with some review of the literature, including our own cases.
Topics: Activities of Daily Living; Humans; Mediastinal Neoplasms; Mediastinum; Neoplasm Recurrence, Local; Reoperation
PubMed: 34548456
DOI: No ID Found -
European Journal of Cardio-thoracic... May 2022Mediastinal arterio-venous haemangiomas are rare benign vascular tumours. To the best of our knowledge, very few cases of mediastinal arterio-venous haemangiomas have...
Mediastinal arterio-venous haemangiomas are rare benign vascular tumours. To the best of our knowledge, very few cases of mediastinal arterio-venous haemangiomas have ever been reported. Herein, we report about a 55-year-old woman who presented to our hospital with a mass in the right posterior mediastinum. The tumour was successfully resected via video-assisted thoracoscopic surgery, and further pathological analysis confirmed the mass to be an arterio-venous haemangioma. The patient made a full recovery without any postoperative complications.
Topics: Arteriovenous Malformations; Female; Hemangioma; Humans; Mediastinal Neoplasms; Mediastinum; Middle Aged; Thoracic Surgery, Video-Assisted
PubMed: 34986218
DOI: 10.1093/ejcts/ezab566 -
Hematology (Amsterdam, Netherlands) Dec 2023Primary mediastinal large B-cel l lymphoma (PMBCL) is a rare subtype of B-cell lymphoma that is not yet fully understood. This population-based study aimed to assess the...
OBJECTIVES
Primary mediastinal large B-cel l lymphoma (PMBCL) is a rare subtype of B-cell lymphoma that is not yet fully understood. This population-based study aimed to assess the latest survival and treatment strategies for patients with PMBCL.
METHODS
The study used the dataset from the Surveillance, Epidemiology, and End Results Program registry to retrospectively analyze adult patients diagnosed with PMBCL between 2001 and 2018. The primary outcome measures included overall survival (OS) and disease-specific survival (DSS).
RESULTS
Among the 814 identified cases, the study revealed a 5-year OS rate of 86.7% and a 5-year DSS rate of 88.2% after a median follow-up of 54 months. Cox regression analysis indicated that age over 60 years, pre-2010 diagnosis, non-White ethnicity, advanced stage, and absence of chemotherapy significantly reduced both OS and DSS. It also found that chemotherapy has remained the primary therapeutic protocol for PMBCL over the last 20 years, whereas the utilization of surgery and radiation declined significantly. Patients diagnosed with PMBCL between 2010 and 2018 had a significantly reduced mortality risk (∼50%) compared to those diagnosed between 2001 and 2009. Notably, in the era of rituximab's widespread usage, recipients of radiotherapy exhibited a poorer OS rate than non-recipients.
CONCLUSION
Survival outcomes for patients with PMBCL have significantly improved in the current era, possibly due to the evolving treatment paradigm. The value of radiotherapy in PMBCL is still debated and requires further prospective evaluation.
Topics: Adult; Humans; Middle Aged; Retrospective Studies; Antineoplastic Combined Chemotherapy Protocols; Mediastinal Neoplasms; Lymphoma, B-Cell; Registries; Lymphoma, Large B-Cell, Diffuse
PubMed: 37260259
DOI: 10.1080/16078454.2023.2217396 -
Bulletin Du Cancer Jan 2020A growing number of studies suggest a tumor suppressor role for the SWI/SNF complex involved in the remodeling of chromatin. Alterations of this complex have been found... (Review)
Review
A growing number of studies suggest a tumor suppressor role for the SWI/SNF complex involved in the remodeling of chromatin. Alterations of this complex have been found in many tumors of different origins, with topographic, morphologic and phenotypic diversity. Notably, they define 2 types of thoracic tumors: SMARCA4-deficient non-small cell lung carcinoma and SMARCA4-deficient sarcoma. Some clinical features appear to be common to both, such as intrathoracic localization, smoking exposure, male predominance and poor prognosis. However, the histological distinction between these two entities is sometimes difficult and it is not excluded that these entities belong to the same tumor spectrum with different degrees of differentiation. The therapy of these tumors is not yet codified. These tumors do not seem associated with oncogenic driver mutations allowing the prescription of targeted therapy, but immunotherapy has been shown to be effective in rare reported cases. More specific treatments using EZH2 inhibitors also seem promising in SMARCA4 deficient sarcomas.
Topics: Carcinoma, Non-Small-Cell Lung; Chemoradiotherapy; Chromatin Assembly and Disassembly; Combined Modality Therapy; Cytoreduction Surgical Procedures; DNA Helicases; Enhancer of Zeste Homolog 2 Protein; Gene Expression Regulation, Neoplastic; Humans; Lung Neoplasms; Mediastinal Neoplasms; Molecular Targeted Therapy; Multiprotein Complexes; Neoplasm Invasiveness; Neoplasm Proteins; Nuclear Proteins; SMARCB1 Protein; Sarcoma; Thoracic Neoplasms; Transcription Factors
PubMed: 31916995
DOI: 10.1016/j.bulcan.2019.12.001 -
Histopathology Jan 2022Primary mediastinal germ cell tumours (PMGCTs) are rare mediastinal neoplasms, and their diagnosis can be challenging, owing to small biopsy samples. The aim of this...
AIMS
Primary mediastinal germ cell tumours (PMGCTs) are rare mediastinal neoplasms, and their diagnosis can be challenging, owing to small biopsy samples. The aim of this study was to develop a diagnostic algorithm using immunohistochemical staining, with a focus on novel markers, and molecular analysis of isochromosome 12p [i(12p)].
METHODS AND RESULTS
Paraffin-embedded tissues of 32 mediastinal tumours were analysed with immunohistochemical staining for sal-like transcription factor 4 (SALL4), Lin-28 homologue A (LIN28), octamer-binding transcription factor 3/4 (OCT3/4), D2-40, cluster of differentiation 117 (CD117), sex-determining region Y-box 17, sex-determining region Y-box 2 (SOX2), cluster of differentiation 30, the β-subunit of human chorionic gonadotropin (β-hCG), GATA-binding protein 3 (GATA3), forkhead box protein A2 (FOXA2), glypican-3 (GPC3), α-fetoprotein (AFP), terminal deoxynucleotidyl transferase (TdT), nuclear protein of the testis (NUT), and pan-cytokeratin. Quantitative real-time polymerase chain reaction was performed to investigate the i(12p) status. Fifteen seminomas, seven teratomas, one yolk sac tumour, one choriocarcinoma and seven mixed PMGCTs were diagnosed. Each entity had different immunohistochemical staining patterns, which helped to distinguish them: OCT3/4, D2-40, CD117 and TdT for seminoma; OCT3/4 and SOX2 for embryonal carcinoma; FOXA2, GPC3 and AFP for yolk sac tumour; and β-hCG and GATA3 for choriocarcinoma. Mature teratomas stained positively for pan-cytokeratin in epithelial components and focally for SALL4, SOX2, GATA3, D2-40, and FOXA2. Furthermore, a NUT carcinoma mimicking a PMGCT was diagnosed, showing strong nuclear SOX2 staining and speckled nuclear NUT staining. i(12p) was detected in 24 of 27 PMGCTs (89%).
CONCLUSION
A diagnostic algorithm is of great importance for a reliable diagnosis of PMGCT in, usually small, tissue biopsy samples. Therefore, a combination of three to four antibodies to identify the correct histological subtype is usually necessary, in addition to morphological features. The i(12p) status serves as an additional option to indicate a germ cell origin in selected cases.
Topics: Adolescent; Adult; Aged; Algorithms; Biomarkers, Tumor; Child; Female; Humans; Immunohistochemistry; Male; Mediastinal Neoplasms; Middle Aged; Neoplasms, Germ Cell and Embryonal; Pathology, Molecular; Young Adult
PubMed: 34506648
DOI: 10.1111/his.14560