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Seminars in Thoracic and Cardiovascular... Oct 2000Lymphoproliferative disorders may present in any organ of the body. The mediastinum is an uncommon location for presentation of these heterogeneous disorders, but... (Review)
Review
Lymphoproliferative disorders may present in any organ of the body. The mediastinum is an uncommon location for presentation of these heterogeneous disorders, but involvement of the mediastinum may be the sole site of disease for several aggressive lymphomas. Both Hodgkin's disease and non-Hodgkin's lymphoma may present in the mediastinum. The most common types of non-Hodgkin's lymphoma involving the mediastinum include lymphoblastic lymphoma and mediastinal large cell lymphoma. These lymphomas most commonly develop in the anterior mediastinum but may be seen in the middle and posterior mediastinum. Symptoms associated with a mediastinal presentation of a lymphoproliferative disorder are often attributable to compression of mediastinal structures (eg, superior vena cava syndrome) or invasion of thoracic structures such as the pericardium or pleura. Although staging can be performed with routine imaging studies, surgical intervention is often required to ensure accurate histologic diagnosis of these lymphomas. Once a diagnosis has been established, therapeutic modalities usually include chemotherapy and/or radiotherapy.
Topics: Humans; Lymphoma; Mediastinal Neoplasms; Neoplasm Staging
PubMed: 11154724
DOI: 10.1053/stcs.2000.16736 -
Asian Cardiovascular & Thoracic Annals Sep 2015Mediastinal tumors can reach a huge size and give rise to serious surgical and oncological problems.
BACKGROUND
Mediastinal tumors can reach a huge size and give rise to serious surgical and oncological problems.
METHODS
A review of 18 patients with huge mediastinal tumors was performed. Ages ranged from 16 to 61 years, and 10 were male. In 4 cases, exploratory thoracotomies had been undertaken in other hospitals; in one patient, the tumor recurred after incomplete resection. We performed a median sternotomy in 17 patients and a lateral thoracotomy in one. Radiotherapy and platinum-based chemotherapy was administered in cases found to be malignant.
RESULTS
In 15 patients, the tumor was removed completely. In one patient, the operation was palliative because of vena caval and atrial invasion, and another had exploration only; biopsies revealed malignant transformation in these 2 patients. The blood loss was 425-2530 mL (average 690 mL); bleeding was fatal in one patient. Tissue diagnosis showed mature teratomas in 10 patients. Foci of malignant transformation were found in 5 cases. Chemodectoma was found in one patient, and thymoma in two. Patients with mature teratomas are free of disease. Two patients with malignant teratomas died from tumor recurrence despite irradiation and chemotherapy.
CONCLUSIONS
Clinical and oncological problems lie in the fact that malignant transformation of the tumor is diagnosed only after surgery. Extensive blood loss is a crucial surgical problem. Median sternotomy is the optimal operative approach. Surgical treatment of mature mediastinal tumors results in good outcomes unless malignancy is detected.
Topics: Adolescent; Adult; Chemoradiotherapy, Adjuvant; Female; Humans; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Retrospective Studies; Russia; Sternotomy; Survival Analysis; Teratoma; Thoracotomy; Tumor Burden
PubMed: 26071604
DOI: 10.1177/0218492315592072 -
Current Medical Imaging Reviews 2019Epithelioid Hemangioendothelioma (EHE) is a rare vascular neoplasm. Common locations of EHE are the bone, soft tissue, liver, and lung, but the mediastinal location is... (Review)
Review
INTRODUCTION
Epithelioid Hemangioendothelioma (EHE) is a rare vascular neoplasm. Common locations of EHE are the bone, soft tissue, liver, and lung, but the mediastinal location is extremely rare. Few cases of mediastinal EHE, invading the Superior Vena Cava (SVC) have been reported.
CASE PRESENTATION
We report a case of a 21-year-old man with EHE invading the SVC, which was incidentally detected on performing chest radiography. A contrast-enhanced chest Computed Tomography (CT) scan demonstrated a well-defined, oval mass located on the right side of the anterior mediastinum. The mass showed homogeneous enhancement with punctate calcifications, and it invaded the SVC at the confluence area of the right and left brachiocephalic veins.
CONCLUSION
Mediastinal EHE invading the SVC may present as a homogeneously enhancing mass with punctate calcifications. It should be added to the differential diagnosis of tumors of the mediastinum. Accurate preoperative diagnosis of EHE is critical for surgical planning; therefore, knowledge of the radiologic features of EHE is important.
Topics: Hemangioendothelioma, Epithelioid; Humans; Male; Mediastinal Neoplasms; Neoplasm Invasiveness; Neoplasm Staging; Prognosis; Risk Assessment; Tomography, X-Ray Computed; Treatment Outcome; Vascular Neoplasms; Vena Cava, Superior; Young Adult
PubMed: 31989887
DOI: 10.2174/1573405614666180124141817 -
Seminars in Thoracic and Cardiovascular... Oct 2000The goal of minimal-access surgery is to cause the least trauma necessary to gain exposure for an operative procedure. Application of this principle to mediastinal... (Review)
Review
The goal of minimal-access surgery is to cause the least trauma necessary to gain exposure for an operative procedure. Application of this principle to mediastinal neoplasms involves the use of small incisions with both mediastinoscopy and video-assisted thoracoscopic surgery (VATS). The mediastinum is divided into anterior, middle, and posterior compartments, and this anatomy provides a framework for discussion of diagnostic and therapeutic procedures. Neoplasms occur with a characteristic frequency that varies with age and location. Neurogenic tumors and thymic neoplasms account for one third of all masses. Knowledge of the potential cause of a neoplasm and the surrounding anatomy provides the context for determining the surgical approach. The operative indications and goals of a procedure should not be significantly affected by the operative approach. Conversion from a minimal-access approach to a more traditional incision should be an anticipated possibility that is often undertaken as the next logical step rather than an expression of exasperation.
Topics: Biopsy, Needle; Humans; Mediastinal Neoplasms; Minimally Invasive Surgical Procedures; Neoplasm Staging; Thoracic Surgery, Video-Assisted
PubMed: 11154725
DOI: 10.1053/stcs.2000.17919 -
American Journal of Respiratory and... Jul 2017
Topics: Humans; Laminectomy; Lymphangioma, Cystic; Magnetic Resonance Imaging; Male; Mediastinal Neoplasms; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Radiography, Thoracic; Spinal Canal; Spinal Cord Compression; Tomography, X-Ray Computed; Tumor Burden; Young Adult
PubMed: 28363031
DOI: 10.1164/rccm.201611-2388IM -
The Annals of Thoracic Surgery Aug 1990An elderly woman was seen with a left mediastinal mass in the region of the aortic arch on chest roentgenography. Further imaging with computed tomography, angiography,...
An elderly woman was seen with a left mediastinal mass in the region of the aortic arch on chest roentgenography. Further imaging with computed tomography, angiography, and magnetic resonance demonstrated a highly vascular neoplasm adjacent to the aortic arch. Pathological analysis of the resected specimen showed a leiomyoma. A brief review of the 10 previous reported cases of primary mediastinal leiomyoma is provided.
Topics: Aged; Diagnostic Imaging; Female; Hemangioma; Humans; Leiomyoma; Mediastinal Neoplasms
PubMed: 2383121
DOI: 10.1016/0003-4975(90)90757-w -
Revue de Pneumologie Clinique Feb 2010Mediastinal adenopathies without pulmonary disease may be benign, lymphomatous or the metastases from intra- or extrathoracic malignancy or more rarely metastases with... (Review)
Review
Mediastinal adenopathies without pulmonary disease may be benign, lymphomatous or the metastases from intra- or extrathoracic malignancy or more rarely metastases with unknown primary site. We observed 507 patients with isolated mediastinal adenopathies: benign, lymphomatous and metastatic disease represented 41.4% (210/507), 26.8% (136/507), 31.8% (161/507) of them, respectively. Management of the latter was the most challenging. Surgery was generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes in 84% of patients (135/161). However, radical surgery consisting in lymphadenectomy proved effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed long-term good results in such cases, which also was demonstrated by case reports in the literature. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients.
Topics: Combined Modality Therapy; Diagnosis, Differential; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Mediastinal Neoplasms; Neoplasm Recurrence, Local; Neoplasm Staging; Patient Care Team; Prognosis
PubMed: 20207295
DOI: 10.1016/j.pneumo.2009.12.002 -
Respirology (Carlton, Vic.) Nov 2007Thymoma is a common primary neoplasm of the anterior mediastinum. However, it can also arise in other locations, including the neck, the posterior mediastinum, the lung,...
Thymoma is a common primary neoplasm of the anterior mediastinum. However, it can also arise in other locations, including the neck, the posterior mediastinum, the lung, base of the skull and the pleural cavity. There are only three previous case reports of thymoma located in the middle mediastinum. This report describes a patient together with a review of the literature on middle mediastinal thymoma.
Topics: Aged; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed
PubMed: 17986129
DOI: 10.1111/j.1440-1843.2007.01165.x -
General Thoracic and Cardiovascular... Dec 2020Ependymomas are tumors located in the central nervous system, mostly in the brain and spinal cord. This tumor is rarely seen as a primary mediastinal location. The aim...
Ependymomas are tumors located in the central nervous system, mostly in the brain and spinal cord. This tumor is rarely seen as a primary mediastinal location. The aim of this study is to discuss this rare pathology in the clinical course of an unusual case. A 47-year-old female patient was referred to our clinic with the complaint of back and shoulder pain, via VATS posterior mediastinum located paravertebral mass excision was performed. The pathology reported as ependymoma. Two years later, CT scans of the routine control showed the well-defined mass in anterior mediastinum. The SUVmax of the lesion was measured as 9.3 at PET-CT. The lesion in the anterior mediastinum was excised by partial sternotomy. The pathology result was the same as the prior operation: Ependymoma. As our case, in these kinds of tumors meticulous follow-up of the patients is important for the detection and treatment of recurrent localization and distant metastases.
Topics: Ependymoma; Female; Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed
PubMed: 31983051
DOI: 10.1007/s11748-020-01293-7 -
Thoracic Cancer Dec 2018Liposarcoma has been subclassified histologically into well-differentiated, myxoid, pleomorphic, and dedifferentiated types. The dedifferentiated type generally shows... (Review)
Review
BACKGROUND
Liposarcoma has been subclassified histologically into well-differentiated, myxoid, pleomorphic, and dedifferentiated types. The dedifferentiated type generally shows poorer prognosis than the well-differentiated type. Because of its rarity, the clinicopathological features and clinical outcomes of primary mediastinal dedifferentiated liposarcoma remain unclear.
METHODS
Five patients with primary mediastinal dedifferentiated liposarcoma were treated at Shinshu University Hospital between January 2012 and August 2017. We investigated the clinical characteristics, including age, gender, radiographic findings, pathological status, and clinical and treatment outcomes.
RESULTS
Four of the five patients initially underwent radical surgical resection. One patient was disease-free after surgery, but the remaining three patients developed local recurrence in the mediastinum after surgical resection. Two of these patients underwent repeat surgical resection, resulting in long survival (60 and 40 months, respectively), while the other underwent proton beam therapy and showed no evidence of recurrence as of 17 months after treatment. The remaining patient was treated with chemotherapy using doxorubicin because of advanced inoperable disease, but failed to show a response and died within a month of the initiation of chemotherapy. Although the maximum standardized uptake values on fluorodeoxyglucose-computed tomography were relatively low, there was a slight positive relation between these values and the Ki-67-positive ratio in the tumor.
CONCLUSION
Aggressive treatment by surgical resection should be considered for mediastinal dedifferentiated liposarcoma, even in cases with local recurrence.
Topics: Aged; Aged, 80 and over; Biomarkers, Tumor; Biopsy; Female; Humans; Immunohistochemistry; Liposarcoma; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Grading; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed; Tumor Burden
PubMed: 30329218
DOI: 10.1111/1759-7714.12888