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Pneumologie (Stuttgart, Germany) Jun 2024Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the gold standard in the diagnosis of mediastinal and hilar lesions. For certain... (Review)
Review
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the gold standard in the diagnosis of mediastinal and hilar lesions. For certain purposes, such as the diagnosis and subtyping of lymphoproliferative disorders or molecular pathology, a larger amount of intact sample material is required. EBUS cryobiopsy is a new and efficient tool for this purpose. As it is a new approach, there is still no standardised workflow. In this review, we present the procedure step by step as it is performed at the Ruhrlandklinik in Essen.
Topics: Humans; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Mediastinal Neoplasms; Mediastinal Diseases; Bronchoscopy; Mediastinum; Cryosurgery
PubMed: 38866027
DOI: 10.1055/a-2295-5921 -
Puerto Rico Health Sciences Journal Jun 2024Currently, there is limited data available comparing Primary Mediastinal Large B-cell Lymphoma (PMBL) and mediastinal Hodgkin disease, nodular sclerosis type (HDNS).... (Comparative Study)
Comparative Study
Currently, there is limited data available comparing Primary Mediastinal Large B-cell Lymphoma (PMBL) and mediastinal Hodgkin disease, nodular sclerosis type (HDNS). This is a retrospective cohort study that compares the clinical features, histology through immunohistochemistry (IHC) and treatment outcomes of 19 cases of PMBL and 39 cases of HDNS diagnosed over 13 years at a single institution in San Juan, PR. Superior Vena Cava syndrome (SVCS) and elevated Lactate Dehydrogenase (LDH) levels were more frequently seen in the PMBL cohort. At the median follow-up visit, of 74 months, no significant difference was seen in overall survival or progression free survival between PMBL and HDNS. Almost all of the relapses in the PMBL group occurred within 12 months of diagnosis. Our data suggests that PMBL and HDNS differ in their clinical presentation and have a favorable prognosis.
Topics: Humans; Mediastinal Neoplasms; Retrospective Studies; Hodgkin Disease; Male; Female; Adult; Middle Aged; Lymphoma, Large B-Cell, Diffuse; Young Adult; Aged; Cohort Studies; Treatment Outcome; Follow-Up Studies; Prognosis; Adolescent; Superior Vena Cava Syndrome; Progression-Free Survival; Survival Rate
PubMed: 38860961
DOI: No ID Found -
Zhonghua Jie He He Hu Xi Za Zhi =... Jun 2024We reported a case of a 36-year-old woman who presented with cough, dyspnea, hypereosinophilia, multiple pulmonary nodules and mediastinal lymphadenopathy. The...
We reported a case of a 36-year-old woman who presented with cough, dyspnea, hypereosinophilia, multiple pulmonary nodules and mediastinal lymphadenopathy. The percentage of eosinophils in bronchoalveolar lavage fluid (BALF) was as high as 65%. Pathogenic tests and cytologic examination of BALF were negative. Transbronchial lung biopsy and endobronchial ultrasound-guided transbronchial needle aspiration revealed only eosinophil infiltration. As the patient responded poorly to high-dose corticosteroids, a surgical lung biopsy was performed. The pathological diagnosis was angioimmunoblastic T-cell lymphoma. The patient received chemotherapy and achieved a partial response. Her eosinophil count returned to the normal range, and the pulmonary nodules on chest CT partially resolved.
Topics: Humans; Female; Adult; Multiple Pulmonary Nodules; Bronchoalveolar Lavage Fluid; Eosinophils; Tomography, X-Ray Computed; Hypereosinophilic Syndrome; Lung; Lung Neoplasms
PubMed: 38858204
DOI: 10.3760/cma.j.cn112147-20231205-00357 -
Journal of Magnetic Resonance Imaging :... Jun 2024Preoperative differentiation of the types of mediastinal tumors is essential. Magnetic resonance (MR) elastography potentially provides a noninvasive method to assess...
BACKGROUND
Preoperative differentiation of the types of mediastinal tumors is essential. Magnetic resonance (MR) elastography potentially provides a noninvasive method to assess the classification of mediastinal tumor subtypes.
PURPOSE
To evaluate the use of MR elastography in anterior mediastinal masses and to characterize the mechanical properties of tumors of different subtypes.
STUDY TYPE
Prospective.
SUBJECTS
189 patients with anterior mediastinal tumors (AMTs) confirmed by histopathology (62 thymomas, 53 thymic carcinomas, 57 lymphomas, and 17 germ cell tumors).
FIELD STRENGTH/SEQUENCE
A gradient echo-based 2D MR elastography sequence and a diffusion-weighted imaging (DWI) sequence at 3.0 T.
ASSESSMENT
Stiffness and apparent diffusion coefficients (ADC) were measured in AMTs using MR elastography-derived elastograms and DWI-derived ADC maps, respectively. The aim of this study is to identify whether MR elastography can differentiate between the histological subtypes of ATMs.
STATISTICAL TESTS
One-way analysis of variance (ANOVA), two-way ANOVA, Pearson's linear correlation coefficient (r), receiver operating characteristic (ROC) curve analysis; P < 0.05 was considered significant.
RESULTS
Lymphomas had significantly lower stiffness than other AMTs (4.0 ± 0.63 kPa vs. 4.8 ± 1.39 kPa). The mean stiffness of thymic carcinomas was significantly higher than that of other AMTs (5.6 ± 1.41 kPa vs. 4.2 ± 0.94 kPa). Using a cutoff value of 5.0 kPa, ROC analysis showed that lymphomas could be differentiated from other AMTs with an accuracy of 59%, sensitivity of 97%, and specificity of 38%. Using a cutoff value of 5.1 kPa, thymic carcinomas could be differentiated from other AMTs with an accuracy of 84%, sensitivity of 67%, and specificity of 90%. However, there was an overlap in the stiffness values of individual thymomas (4.2 ± 0.71; 3.9-4.5), thymic carcinomas (5.6 ± 1.41; 5.0-6.1), lymphomas (4.0 ± 0.63; 3.8-4.2), and germ cell tumors (4.5 ± 1.79; 3.3-5.6).
DATA CONCLUSION
MR elastography-derived stiffness may be used to evaluate AMTs of various histologies.
TECHNICAL EFFICACY
Stage 2.
PubMed: 38855820
DOI: 10.1002/jmri.29481 -
BMJ Case Reports Jun 2024Multiple myeloma associated with extramedullary plasmacytoma at initial presentation is rare. We describe a case of a man in his 30s who initially presented with...
Multiple myeloma associated with extramedullary plasmacytoma at initial presentation is rare. We describe a case of a man in his 30s who initially presented with symptoms of spinal cord compression. Further imaging revealed a mediastinal tumour, with a biopsy confirming plasmacytoma. Immunofixation revealed IgA lambda paraprotein. Bone marrow biopsy demonstrated atypical T-cell cytotoxic proliferation and trilineage hypoplasia. The patient was diagnosed with extramedullary plasmacytoma with active IgA multiple myeloma. The patient received mediastinal radiation to the tumour, followed by anti-myeloma therapy. This diagnosis is critical as managing a solitary plasmacytoma drastically differs from an extramedullary plasmacytoma with active multiple myeloma.
Topics: Humans; Male; Multiple Myeloma; Spinal Cord Compression; Plasmacytoma; Mediastinal Neoplasms; Immunoglobulin A; Adult; Magnetic Resonance Imaging; Diagnosis, Differential
PubMed: 38844357
DOI: 10.1136/bcr-2023-257026 -
Annals of Thoracic and Cardiovascular... 2024Esophagogastric junction cancer (EGJC) is a rare malignant disease that occurs in the gastroesophageal transition zone. In recent years, its incidence has been rapidly... (Review)
Review
Esophagogastric junction cancer (EGJC) is a rare malignant disease that occurs in the gastroesophageal transition zone. In recent years, its incidence has been rapidly increasing not only in Western countries but also in East Asia, and it has been attracting the attention of both clinicians and researchers. EGJC has a worse prognosis than gastric cancer (GC) and is characterized by complex lymphatic drainage pathways in the mediastinal and abdominal regions. EGJC was previously treated in the same way as GC or esophageal cancer, but, in recent years, it has been treated as an independent malignant disease, and treatment focusing only on EGJC has been developed. A recent multicenter prospective study revealed the frequency of lymph node metastasis by station and established the optimal extent of lymph node dissection. In perioperative treatment, the combination of multi-drug chemotherapy, radiation therapy, molecular targeted therapy, and immunotherapy is expected to improve the prognosis. In this review, we summarize previous clinical trials and their important evidence on surgical and perioperative treatments for EGJC.
Topics: Humans; Esophagogastric Junction; Esophageal Neoplasms; Treatment Outcome; Esophagectomy; Gastrectomy; Stomach Neoplasms; Lymph Node Excision; Chemotherapy, Adjuvant; Lymphatic Metastasis; Risk Factors; Neoadjuvant Therapy
PubMed: 38839368
DOI: 10.5761/atcs.ra.24-00056 -
International Immunopharmacology Jul 2024Although immune checkpoint inhibitors (ICIs) combined with angiogenesis inhibitors (AGIs) has become increasingly used for cancers, the impact of combination therapy on...
Immune-related adverse events of immune checkpoint inhibitors combined with angiogenesis inhibitors: A real-world pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) database (2014-2022).
INTRODUCTION
Although immune checkpoint inhibitors (ICIs) combined with angiogenesis inhibitors (AGIs) has become increasingly used for cancers, the impact of combination therapy on immune-related adverse events (irAEs) in real-world settings has not been well elucidated to date.
METHODS
The FDA Adverse Event Reporting System (FAERS) database from 2014 to 2022 was retrospectively queried to extract reports of irAEs referred as standardized MedDRA queries (SMQs), preferred terms (PTs) and system organ classes (SOCs). To perform disproportionality analysis, information component (IC) and reporting odds ratio (ROR) were calculated and lower limit of 95 % confidence interval (CI) for IC (IC) > 0 or ROR (ROR) > 1 with at least 3 reports was considered statistically significant.
RESULTS
Compared to ICIs alone, ICIs + AGIs demonstrated a lower IC/ROR for irAEs-SMQ (2.343/5.082 vs. 1.826/3.563). Regarding irAEs-PTs, there were fewer irAEs-PTs of significant value in ICIs + AGIs than ICIs alone (57 vs. 150 PTs) and lower signal value for most PTs (88 %) in ICIs + AGIs. Moreover, lower IC for most of irAEs-SOCs in ICIs + AGIs (11/13) compared with ICIs alone was observed. As for outcomes of irAEs, ICIs + AGIs showed a lower frequency of "fatal" for irAEs-SMQ than ICIs alone (4.88 % vs. 7.83 %), so as in cardiac disorder (SOC) (15.45 % vs. 26.37 %), and respiratory, thoracic and mediastinal disorders (SOC) (13.74 % vs. 20.06 %). Similarly, there were lower occurrence and fewer fatality of irAEs in ICIs + AGIs + chemotherapy (CT) than ICIs + CT.
CONCLUSION
ICIs combined with AGIs may reduce incidence and mortality for most of irAEs compared to ICIs alone whether or not with CT.
Topics: Humans; Immune Checkpoint Inhibitors; Pharmacovigilance; United States; Adverse Drug Reaction Reporting Systems; Male; United States Food and Drug Administration; Female; Angiogenesis Inhibitors; Retrospective Studies; Middle Aged; Databases, Factual; Aged; Neoplasms; Adult; Young Adult; Adolescent; Aged, 80 and over
PubMed: 38838553
DOI: 10.1016/j.intimp.2024.112301 -
Clinical Nuclear Medicine Jul 2024Fibroblast activation protein (FAP) is a new promising molecular target for theragnostic approach. FAP inhibitors (FAPIs) labeled with 177Lu could be potentially a...
Fibroblast activation protein (FAP) is a new promising molecular target for theragnostic approach. FAP inhibitors (FAPIs) labeled with 177Lu could be potentially a therapeutic radiopharmaceutical. Here, we presented the experience of 4 cycles of 177Lu-FAPI in a 67-year-old man with an unresectable mediastinal sarcoma.
Topics: Humans; Male; Mediastinal Neoplasms; Aged; Sarcoma; Neoplasm Metastasis; Lutetium
PubMed: 38831513
DOI: 10.1097/RLU.0000000000005255 -
Zhonghua Bing Li Xue Za Zhi = Chinese... Jun 2024
Topics: Humans; Endodermal Sinus Tumor; Male; Mediastinal Neoplasms; Adult; Retrospective Studies; Pleural Effusion, Malignant; Young Adult; alpha-Fetoproteins; Keratins; Diagnosis, Differential; Transcription Factors; Glypicans; Alkaline Phosphatase; Proto-Oncogene Proteins c-kit; Diagnostic Errors; Immunophenotyping; Isoenzymes; GPI-Linked Proteins
PubMed: 38825911
DOI: 10.3760/cma.j.cn112151-20231010-00245 -
Journal of Cardiothoracic Surgery May 2024Lung cancer is the second most diagnosed cancer and the leading cause of cancer deaths worldwide. Surgical lung resection is the best treatment modality in the early...
BACKGROUND
Lung cancer is the second most diagnosed cancer and the leading cause of cancer deaths worldwide. Surgical lung resection is the best treatment modality in the early stages of lung cancer as well as in some locally advanced cases. Postoperative air leak is one of the most common complications after pulmonary resection with incidence ranging between 20 and 33%. The majority of air leaks seal, within 5 days after surgery, on their own by conservative management. However, at least 5% of patients still have prolonged air coming out from the residual lung at discharge. This report describes the management of a thin lady with right lung cancer who underwent a right lower lobectomy and then suffered from a delayed air leak 7 weeks after surgery and required extensive thoracic and general surgery collaboration.
CASE PRESENTATION
A 72-year-old heavy smoker female patient diagnosed with stage I lung cancer underwent right robotic-assisted thoracoscopic surgery converted to thoracotomy because of a fused fissure, right lower lobectomy, and mediastinal lymphadenectomy presented with delayed air leak 49 days after surgery. VATS decortication and mechanical pleurodesis were done 2 weeks after unsuccessful conservative treatment. Still, the lung failed to expand four weeks later so the patient was sent to surgery; she is underweight (BMI of 18) with not many options for a big flap to fill the chest cavity empty space. Accordingly; the decision was to use multiple pedicle flaps; omentum, intercostal muscle, and serratus anterior muscle to cover the bronchopleural fistulas and fill the pleural space in addition to mechanical and chemical pleurodesis. Full expansion of the lung was obtained. The patient was discharged on Post-Operative day 5 without remnant pneumothorax.
CONCLUSIONS
Air leaks After lobectomy usually presents directly postoperatively; various management options are available ranging from conservative and minimally invasive to major operative treatment. We presented what we believe was unusual delayed bronchopleural fistula post-lobectomy in a thin lady which demonstrates clearly how a delayed air leak was detected and how collaborative efforts were crucial for delivering high-quality, safe, and patient-centered care till treated and complete recovery.
Topics: Humans; Female; Aged; Pneumonectomy; Lung Neoplasms; Bronchial Fistula; Pleural Diseases; Postoperative Complications; Thoracic Surgery, Video-Assisted
PubMed: 38822353
DOI: 10.1186/s13019-024-02795-8