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Kyobu Geka. the Japanese Journal of... May 2024A 73-year-old woman presented with left anterior chest pain and back pain. Computed tomography (CT) scan showed an anterior mediastinal tumor. It also showed partial...
A 73-year-old woman presented with left anterior chest pain and back pain. Computed tomography (CT) scan showed an anterior mediastinal tumor. It also showed partial anomalous pulmonary venous drainage (left superior pulmonary vein draining into the left brachiocephalic vein), and the tumor was located near the left brachiocephalic vein. The operation was performed through a median sternotomy to resect the thymus and tumor with partial resection of the left upper lobe due to the tumor's adhesion to the left upper lobe. One of the vascular anomalies encountered in adult thoracic surgery is partial anomalous pulmonary venous drainage. It is important to recognize the presence of such an anomaly on imaging and to anticipate the surgical procedure with a preoperative surgical technique.
Topics: Humans; Female; Aged; Pulmonary Veins; Thymoma; Tomography, X-Ray Computed; Thymus Neoplasms
PubMed: 38720610
DOI: No ID Found -
Kyobu Geka. the Japanese Journal of... May 2024A man in his 50s who presented an abnormal shadow on chest X-ray was diagnosed with posterior mediastinal tumor that had grown compared to the previous chest X-ray....
A man in his 50s who presented an abnormal shadow on chest X-ray was diagnosed with posterior mediastinal tumor that had grown compared to the previous chest X-ray. Computed tomography showed a 5.7×3.9 cm solid mass with a smooth surface in the posterior mediastinum. A neurogenic tumor was suspected, and the mediastinal tumor was resected through thoracotomy because it was strongly adherent. The postoperative course was good, and he was discharged from the hospital on postoperative day 3. Contrary to preoperative expectations, the tumor was pathologically diagnosed as a desmoid tumor. After 6 months postoperatively without any complications, no recurrence was observed.
Topics: Humans; Male; Mediastinal Neoplasms; Fibromatosis, Aggressive; Middle Aged; Thoracotomy; Tomography, X-Ray Computed
PubMed: 38720608
DOI: No ID Found -
Kyobu Geka. the Japanese Journal of... May 2024Sarcomatous transformation of fibrous dysplasia is extremely rare. We present the case of a 54-yearold man with multiple rib masses, multiple enlarged lymph nodes...
Sarcomatous transformation of fibrous dysplasia is extremely rare. We present the case of a 54-yearold man with multiple rib masses, multiple enlarged lymph nodes throughout the body, and multiple osteolytic lesions on computed tomography( CT). A positron emission tomography( PET) scan showed abnormal enhancement in each. A needle biopsy of the right supraclavicular fossa lymph node revealed sarcoidosis. Considering the possibility of malignancy associated with sarcoidosis, a rib tumor resection and mediastinal lymph node biopsy were performed to confirm the diagnosis of the rib lesion. The pathology results showed that the rib mass was a low-grade central osteosarcoma and the mediastinal lymph node was sarcoidosis. The distribution of the lesions was consistent with osteosarcoma secondary to multiple fibrous bone dysplasia. As the osteosarcoma was low grade, the patient was followed up. Three years after surgery, there was no increase in residual disease.
Topics: Humans; Male; Ribs; Osteosarcoma; Middle Aged; Bone Neoplasms; Tomography, X-Ray Computed; Fibrous Dysplasia of Bone; Fibrous Dysplasia, Polyostotic
PubMed: 38720603
DOI: No ID Found -
Zhonghua Xue Ye Xue Za Zhi = Zhonghua... Mar 2024Primary mediastinal large B-cell lymphoma (PMBL) is an aggressive B-cell lymphoma that is thought to arise from thymic (medullary) B cells and has unique...
Primary mediastinal large B-cell lymphoma (PMBL) is an aggressive B-cell lymphoma that is thought to arise from thymic (medullary) B cells and has unique clinicopathologic and molecular features. In recent years, the understanding of the pathogenesis and treatment of PMBL has been updated to varying degrees, particularly in the area of new drug therapy. In order to improve the diagnosis and treatment of PMBL in China, the Lymphocyte Disease Group of the Chinese Medical Association (CMA) and the Anti-Lymphoma Alliance of the Chinese Society of Clinical Oncology (CSCO) commissioned a group of experts to formulate this consensus.
Topics: Humans; Mediastinal Neoplasms; China; Lymphoma, Large B-Cell, Diffuse; Consensus
PubMed: 38716591
DOI: 10.3760/cma.j.cn121090-20231107-00252 -
World Journal of Surgical Oncology May 2024It was typically necessary to place a closed thoracic drainage tube for drainage following esophageal cancer surgery. Recently, the extra use of thoracic mediastinal...
BACKGROUND
It was typically necessary to place a closed thoracic drainage tube for drainage following esophageal cancer surgery. Recently, the extra use of thoracic mediastinal drainage after esophageal cancer surgery had also become more common. However, it had not yet been determined whether mediastinal drains could be used alone following esophageal cancer surgery.
METHODS
A total of 134 patients who underwent esophageal cancer surgery in our department between June 2020 and June 2023 were retrospectively analyzed. Among them, 34 patients received closed thoracic drainage (CTD), 58 patients received closed thoracic drainage combined with mediastinal drainage (CTD-MD), while 42 patients received postoperative mediastinal drainage (MD). The general condition, incidence of postoperative pulmonary complications, postoperative NRS score, and postoperative anastomotic leakage were compared. The Mann-Whitney U tests, Welch's t tests, one-way ANOVA, chi-square tests and Fisher's exact tests were applied.
RESULTS
There was no significant difference in the incidence of postoperative hyperthermia, peak leukocytes, total drainage, hospitalization days and postoperative pulmonary complications between MD group and the other two groups. Interestingly, patients in the MD group experienced significantly lower postoperative pain compared to the other two groups. Additionally, abnormal postoperative drainage fluid could be detected early in this group. Furthermore, there was no significant change in the incidence of postoperative anastomotic leakage and the mortality rate of patients after the occurrence of anastomotic leakage in the MD group compared with the other two groups.
CONCLUSIONS
Using mediastinal drain alone following esophageal cancer surgery was equally safe. Furthermore, it could substantially decrease postoperative pain, potentially replacing the closed thoracic drain in clinical practice.
Topics: Humans; Esophageal Neoplasms; Retrospective Studies; Male; Female; Middle Aged; Drainage; Esophagectomy; Postoperative Complications; Feasibility Studies; Aged; Mediastinum; Follow-Up Studies; Prognosis; Anastomotic Leak; Chest Tubes
PubMed: 38702817
DOI: 10.1186/s12957-024-03400-x -
Journal of Cardiothoracic Surgery May 2024Further explore the safety and feasibility of Uni-portal video assisted thoracoscopic (UVATS) left upper lobectomy by optimizing the treatment of incisions and blood...
BACKGROUND
Further explore the safety and feasibility of Uni-portal video assisted thoracoscopic (UVATS) left upper lobectomy by optimizing the treatment of incisions and blood vessels.
METHODS
We conducted a retrospective analysis of data from 32 patients who underwent UVATS left upper lobectomy and systematic mediastinal lymph node dissection utilizing the Export priority technique between January 2021 and December 2022. We documented perioperative indicators, including surgical time, intraoperative blood loss, the number of lymph nodes dissected, and postoperative pathological staging.
RESULTS
All surgeries were conducted utilizing the Export priority technique in UVATS. The mean surgical duration was (98.93 ± 14.98) minutes, with an average intraoperative blood loss of (79.53 ± 37.96) ml. The mean count of dissected lymph nodes was (13.96 ± 2.69). The length of hospital Stay averaged (5.62 ± 1.81) days. On the first postoperative day, the thoracic drainage volume was (101.87 ± 49.46) ml. The mean duration of postoperative thoracic tube insertion was (3.1 ± 1.84) days. No occurrences of postoperative hoarseness, pulmonary infection, or complications such as bronchopleural fistula were observed.
CONCLUSION
The application of the Export priority technique improves the safety and feasibility of UVATS left upper lobectomy.
Topics: Humans; Male; Pneumonectomy; Retrospective Studies; Thoracic Surgery, Video-Assisted; Female; Middle Aged; Lung Neoplasms; Aged; Lymph Node Excision; Operative Time; Adult; Length of Stay; Feasibility Studies
PubMed: 38702716
DOI: 10.1186/s13019-024-02738-3 -
Rozhledy V Chirurgii : Mesicnik... 2024Lung cancer is a serious health problem with a high mortality rate. In the context of surgical management, minimally invasive approaches, including uniportal... (Comparative Study)
Comparative Study
INTRODUCTION
Lung cancer is a serious health problem with a high mortality rate. In the context of surgical management, minimally invasive approaches, including uniportal thoracoscopic techniques, offer potential benefits such as faster recovery and increased patient cooperation. The aim of this study was to compare the accessibility of the mediastinal lymph nodes between uniportal and multiportal thoracoscopic approaches and to verify whether the use of the uniportal approach affects the radicality of the lymphadenectomy.
METHODS
A comparative study conducted from January 2015 to July 2022 at the University Hospital Ostrava focused on evaluating the radicality of mediastinal lymphadenectomy between subgroups of patients undergoing surgery using the uniportal thoracoscopic approach and the multiportal thoracoscopic approach.
RESULTS
A total of 278 patients were included in the study. There were no significant differences in the number of available lymphatic stations between the subgroups. The mean number of lymph node stations removed was 6.46 in the left hemithorax and 6.50 in the right hemithorax. Thirty-day postoperative morbidity for the entire patient population was 24.5%, with 18.3% having minor complications and 3.6% having major complications. The overall mortality rate in the study population was 2.5%, with a statistically significant difference in mortality between uniportal and multiportal approaches (1.0% vs 6.4%, p=0.020).
CONCLUSIONS
The uniportal approach demonstrated comparable accessibility and lymph node yield to the multiportal approach. There was also no difference in postoperative morbidity between the two approaches. The study suggests the possibility of lower mortality after uniportal lung resection compared with multiportal lung resection, but this conclusion should be interpreted with caution.
Topics: Humans; Lymph Node Excision; Lung Neoplasms; Mediastinum; Pneumonectomy; Male; Female; Thoracic Surgery, Video-Assisted; Middle Aged; Aged; Thoracoscopy; Postoperative Complications
PubMed: 38697813
DOI: 10.33699/PIS.2024.103.2.48-56 -
Human Pathology Jun 2024Extragonadal germ cell tumors (EGCTs) are rare, representing <5% of all germ cell tumors (GCTs). Whilst EGCTs share morphological and immunohistochemical features with...
Extragonadal germ cell tumors (EGCTs) are rare, representing <5% of all germ cell tumors (GCTs). Whilst EGCTs share morphological and immunohistochemical features with their gonadal counterparts, they tend to be more aggressive and are frequently associated with secondary somatic malignancies. The aim of our study was to evaluate the clinical, morphological and immunohistochemical features, and to analyze tumors for chromosomal abnormalities of 12p, in addition to any novel genetic alterations, in a series of EGCTs. Seventy-seven EGCTs were included. Anterior mediastinum was the most common anatomic site, followed by central nervous system, retroperitoneum, sacroccygeal area, and neck. Whole genome SNP array identified isochromosome 12p in 26% of tumors. Additional cytogenetic abnormalities included the presence of gain of chr 21 in 37% of tumors. Somatic-type malignancies were identified in 8% of patients. Disease progression (metastasis and/or recurrence) was documented in 8 patients, most of whom died from their relapse. Three patients who died of disease had somatic-type malignancies. Mediastinal seminomas had a significantly better overall survival when compared to mediastinal non-seminomatous GCTs. Our study demonstrates that EGCTs share similar histologic features, but diverse clinical outcomes compared to their gonadal counterparts. Outcomes vary according to anatomic location and histologic subtypes. Our data corroborate that somatic-type malignancies are frequently encountered in mediastinal EGCTs and that their presence portends a poorer prognosis.
Topics: Humans; Neoplasms, Germ Cell and Embryonal; Male; Adult; Female; Young Adult; Adolescent; Middle Aged; Biomarkers, Tumor; Child; Neoplasms, Second Primary; Mediastinal Neoplasms; Immunohistochemistry; Chromosomes, Human, Pair 12; Aged; Neoplasm Recurrence, Local; Disease Progression; Polymorphism, Single Nucleotide; Chromosome Aberrations; Genetic Predisposition to Disease; Testicular Neoplasms
PubMed: 38697270
DOI: 10.1016/j.humpath.2024.04.015 -
Journal of Robotic Surgery May 2024Current study aims to assess the safety and efficacy of robot-assisted thoracoscopic surgery (RATS) for sizable mediastinal masses with a minimum diameter ≥6 cm,... (Comparative Study)
Comparative Study
Current study aims to assess the safety and efficacy of robot-assisted thoracoscopic surgery (RATS) for sizable mediastinal masses with a minimum diameter ≥6 cm, compared with video-assisted thoracoscopic surgery (VATS) and open surgery. This study enrolled 130 patients with mediastinal tumors with no less than 6 cm diameter in Zhongnan Hospital, Wuhan University, including 33 patients who underwent RATS, 52 patients who underwent VATS and 45 patients who underwent open surgery. After classifying based on mass size and whether it has invaded or not, we compared their clinical characteristics and perioperative outcomes. There was no significant difference in age, gender, mass size, myasthenia gravis, mass location, pathological types (p > 0.05) in three groups. Patients undergoing open surgery typically presenting at a more advanced stage (p < 0.05). No obvious difference was discovered in the average postoperative length of stay, operation duration, chest tube duration and average postoperative day 1 drainage output between RATS group and VATS group (p > 0.05), while intraoperative blood loss in RATS group was significantly lower than VATS group (p = 0.046). Moreover, the postoperative length of stay, operation duration, chest tube duration and intraoperative blood loss in RATS group were significantly lower than open surgery group (p < 0.001). RATS is a secure and efficient approach for removing large mediastinal masses at early postoperative period. In comparison with VATS, RATS is associated with lower intraoperative blood loss. Compared with open surgery, RATS is also associated with shorter postoperative length of stay, operation duration, chest tube duration and intraoperative blood loss.
Topics: Humans; Robotic Surgical Procedures; Mediastinal Neoplasms; Male; Thoracic Surgery, Video-Assisted; Female; Middle Aged; Length of Stay; Adult; Operative Time; Treatment Outcome; Blood Loss, Surgical; Aged
PubMed: 38693421
DOI: 10.1007/s11701-024-01958-y -
Surgical Pathology Clinics Jun 2024Primary sarcoma of the lung and mediastinum is rare. The diagnosis requires careful exclusion of sarcomatoid carcinoma, sarcomatoid mesothelioma, and metastases from... (Review)
Review
Primary sarcoma of the lung and mediastinum is rare. The diagnosis requires careful exclusion of sarcomatoid carcinoma, sarcomatoid mesothelioma, and metastases from extra-thoracic sites. This review summarizes the key morphologic, immunohistochemical, and molecular characteristics of sarcomas that are encountered in the lung and mediastinum. The tumor types discussed are synovial sarcoma, well-differentiated/dedifferentiated liposarcoma, myxoid pleomorphic liposarcoma, intimal sarcoma of the pulmonary artery, inflammatory myofibroblastic tumor, epithelioid hemangioendothelioma, primary pulmonary myxoid sarcoma, malignant peripheral nerve sheath tumor, Ewing sarcoma, and CIC-rearranged sarcoma. Relevant differential diagnoses are also addressed.
Topics: Humans; Mediastinal Neoplasms; Lung Neoplasms; Sarcoma; Diagnosis, Differential; Biomarkers, Tumor
PubMed: 38692808
DOI: 10.1016/j.path.2023.11.008