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Journal of Medical Case Reports Jun 2017Neuroendocrine tumors are a large group of tumors with a wide spectrum of behavior, affecting mainly the digestive system and the lung. The thymus is very rarely...
BACKGROUND
Neuroendocrine tumors are a large group of tumors with a wide spectrum of behavior, affecting mainly the digestive system and the lung. The thymus is very rarely affected.
CASE PRESENTATION
A 28-year-old Arab woman presented with chronic chest pain and dyspnea. A computed tomography scan showed a huge anterior mediastinal mass invading neighboring structures. A mediastinotomy was performed with biopsies of the mass. Pathological findings were consistent with a thymic large cell neuroendocrine carcinoma.
CONCLUSIONS
The occurrence of a large cell neuroendocrine carcinoma in the thymus, especially in young people, is extremely rare. In this current report, we discuss the clinicopathological issues of this rare tumor according to recent literature data.
Topics: Adult; Antineoplastic Agents; Carcinoma, Neuroendocrine; Chest Pain; Disease Progression; Dyspnea; Female; Humans; Thoracic Surgical Procedures; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28602157
DOI: 10.1186/s13256-017-1331-2 -
The Pan African Medical Journal 2017Thymic neuroendocrine tumors (TNET) are rare, with little-known prognosis. This study aims to report a case of TNET and to highlight the diagnostic and therapeutic... (Review)
Review
Thymic neuroendocrine tumors (TNET) are rare, with little-known prognosis. This study aims to report a case of TNET and to highlight the diagnostic and therapeutic difficulties in low-resource settings. A 60-year-old man presented with chest pain, greasy cough and recent weight loss. Chest CT scan showed anterior mediastinal tissue mass. Histologic evaluation of a 4 months-biopsy specimen obtained from anterior mediastinotomy showed a well differentiated TNET, labeled intensely positive for chromogranin and synaptophysin. The search for other neuroendocrine tumors and the extent of extension were negative. The tumor was immediately inextricable and radiation therapy was unavailable. The patient underwent two lines of first line chemotherapy. At 16 months follow-up, the patient was asymptomatic but showed tumor progression. The diagnosis of TNET may be delayed when immunohistochemistry is not routinely performed. Chemotherapy is associated with symptoms improvement in palliative care situation.
Topics: Animals; Antineoplastic Agents; Biopsy; Chest Pain; Cough; Disease Progression; Follow-Up Studies; Humans; Male; Middle Aged; Neuroendocrine Tumors; Thymus Neoplasms; Tomography, X-Ray Computed; Weight Loss
PubMed: 28451004
DOI: 10.11604/pamj.2017.26.25.11500 -
Pneumonologia I Alergologia Polska 2015A 29-year old man was admitted to the intensive care unit after losing consciousness. On physical examination, a loud systolic murmur over the heart was found....
A 29-year old man was admitted to the intensive care unit after losing consciousness. On physical examination, a loud systolic murmur over the heart was found. Echocardiography revealed narrowing of pulmonary artery with high pressure gradient. Computed tomography of the chest revealed the presence of large tumour localised in the upper anterior mediastinum. Due to the risk of total closure of the pulmonary artery, interventional mediastinotomy was performed and diagnosis of carcinoma embryonale was established. Subsequent chemotherapy (BEP regimen) has brought regression of tumour and significant improvement in haemodynamic parameters (relief of pressure gradient in pulmonary artery). During the second surgery, the resection of all accessible tumour mass together with marginal resection of the right upper lobe was performed. No signs of cardiac or great vessels infiltration was found. Histopathologic examination revealed the necrotic masses and neoplastic foci diagnosed as teratoma immaturum. In a four-month follow-up the patient's condition remained good. The patient is still under the care of both oncological and cardiological specialists. Thus far he has not required further chemotherapy. Holter ECG monitoring revealed no arrhythmia, but the patient is still treated with mexiletine. The patient is planning to return to work.
Topics: Adult; Anti-Arrhythmia Agents; Carcinoma, Embryonal; Echocardiography; Heart Murmurs; Humans; Male; Mediastinal Neoplasms; Mediastinum; Mexiletine; Stenosis, Pulmonary Artery; Tomography, X-Ray Computed
PubMed: 25754058
DOI: 10.5603/PiAP.2015.0024 -
Pneumologie (Stuttgart, Germany) Mar 2015Proper staging of lung cancer represents the basis for any stage-adapted and optimized treatment. This is today implemented in specialized centers mainly through the use...
Proper staging of lung cancer represents the basis for any stage-adapted and optimized treatment. This is today implemented in specialized centers mainly through the use of modern imaging methods and minimally-invasive measures. However, general thoracic surgery has a role not only in the therapeutic management of lung cancer, but offers additional staging information whenever endoscopic or interventional methods fail to achieve representative tissue biopsies of mediastinal lymph nodes or suspect lesions for conclusive diagnosis. The thoracic surgical armentarium comprises of cervical or extended mediastinoscopy, video-assisted mediastinal lymphadenectomy (VAMLA), anterior mediastinotomy (Chamberlain procedure) and video-thoracoscopy (VATS). Indications for any invasive diagnostic methods always have to respect a therapeutic benefit for the patient.
Topics: Diagnostic Techniques, Surgical; Humans; Lung Neoplasms; Neoplasm Staging; Preoperative Care; Thoracic Surgery
PubMed: 25750096
DOI: 10.1055/s-0034-1391100 -
Annals of Thoracic Medicine Jul 2014Ligation and dissection of internal mammary vessels is the most under-estimated complication of anterior mediastinotomy. However, patients requiring anterior... (Review)
Review
Ligation and dissection of internal mammary vessels is the most under-estimated complication of anterior mediastinotomy. However, patients requiring anterior mediastinotomy may experience long survival that makes the development of ischemic heart disease throughout their life possible. Therefore, the un-judicial sacrifice of the internal mammary pedicle may deprive them from the benefit to have their internal mammary artery used as a graft in order to successfully bypass severe left anterior descending artery stenoses. We recommend the preservation of the internal mammary pedicle during anterior mediastinotomy, which should be a common message among our colleagues from the beginning of their training.
PubMed: 24987471
DOI: 10.4103/1817-1737.134067 -
F1000Research 2014Pericardial synovial sarcoma is an extremely rare tumor with poor prognosis. Timely diagnosis and aggressive multimodal management improves patient outcome. We present...
INTRODUCTION
Pericardial synovial sarcoma is an extremely rare tumor with poor prognosis. Timely diagnosis and aggressive multimodal management improves patient outcome. We present our experience of diagnosis and management of a young patient with monophasic synovial sarcoma arising from pericardium.
CASE
A 27-year-old man presented with dyspnea and cough of three weeks duration. Examination revealed sinus tachycardia, distant heart sounds and elevated jugular venous pressure. Chest X-ray showed widened mediastinum. Transthoracic echocardiogram (TTE) noted large pericardial effusion with tamponade physiology. Therapeutic pericardiocentesis yielded hemorrhagic fluid. Computed tomography (CT) of the chest showed persistent pericardial effusion and a left anterior mediastinal mass. Left anterior thoracotomy, pericardial window and left anterior mediastinotomy were done, revealing a well-encapsulated gelatinous tumor originating from the pericardium. Histology and immunohistochemical profile showed the tumor to be a monophasic synovial sarcoma. Fluorescent in-situ hybridization (FISH) was positive for SS18 (SYT) gene rearrangement on chromosome 18q11, substantiating the diagnosis. Work-up for metastases was negative. Neo-adjuvant chemotherapy with high dose ifosfamide led to substantial reduction in the size of the tumor. The patient underwent surgical resection and external beam radiation therapy (EBRT) post surgery. He had symptom-free survival for 8 months prior to local recurrence. This was managed with left lung upper lobectomy and follow-up chemotherapy with docetaxel. The patient is currently stable with an acceptable functional status.
CONCLUSION
In patients with pericardial effusions of unknown etiology, multiple modalities of cardiac imaging must be employed if there is suspicion of a pericardial mass. CT and magnetic resonance imaging (MRI) are useful to evaluate for pericardial thickening or masses in addition to TTE. Treatment of synovial sarcoma is not well established. Surgery is the cornerstone of treatment. In non-resectable tumors, aggressive neo-adjuvant chemotherapy with ifosfamide followed by surgical resection and EBRT may lead to improved outcome.
PubMed: 24715974
DOI: 10.12688/f1000research.3-15.v2 -
Multimedia Manual of Cardiothoracic... Jan 2012Surgical exploration of subaortic and para-aortic lymph nodes has traditionally required the combination of standard cervical mediastinoscopy and left anterior...
Surgical exploration of subaortic and para-aortic lymph nodes has traditionally required the combination of standard cervical mediastinoscopy and left anterior mediastinotomy. Video-assisted thoracoscopic surgery is another technique that allows the exploration of these nodal stations. Extended cervical mediastinoscopy is a useful and safe technique for the assessment of para-aortic and subaortic nodal stations through the same incision of the standard cervical mediastinoscopy.
PubMed: 24414721
DOI: 10.1093/mmcts/mms018 -
Journal of the West African College of... Jan 2011Background Cicatricial corrosive oesophageal strictures are usually multiple and occasionally single but the thoracic inlet segment of the oesophagus being a rapid...
UNLABELLED
Background Cicatricial corrosive oesophageal strictures are usually multiple and occasionally single but the thoracic inlet segment of the oesophagus being a rapid transit section is not a common site for isolated strictures. Thoracic inlet located strictures pose two major problems. First, in cases with total obstruction of the oesophagus radiological assessment even with luminal contrast fails to delineate the lower limits and real extent of the lesions. The purported single stricture in such cases becomes merely a sentinel to perhaps a coexisting rosary of strictures more distally. Secondly, the technical difficulty associated with their surgical approach is inherent in the location. The customary anterior low cervical approach is often inadequate thereby making necessary a complementary high left posterolateral thoracotomy, partial anterior mediastinotomy or hiatal approach particularly in situations where the excision of the damaged gullet is advisable.
MATERIALS AND METHODS
In a series of cases treated for cicatricial corrosive stricture those with apparently isolated strictures in the thoracic inlet formed the cohort for this study. Only oesophagoscopy and contrast barium studies were available for the definition of the lesions. Treatment varied from simple resection with end to end anastomosis in seven (7) to more extended resections with gastric or colonic conduits as replacement in four (4) who had extensive cicatricial obliteration of the lumen with tubularization and rigidity of the gullet distal to the apparently solitary stricture. In some of these cases transgastric retrograde bouginage was an option for a reasonable evaluation of the luminal state of the oesophagus distal to the proximal lesion at the thoracic inlet. The reconstructive oesophageal anastomoses were all placed in the neck; none was intrathoracic.
RESULTS
In a series of 316 cases treated for cicatricial corrosive oesophageal strictures, 11 had isolated strictures located in the region of the thoracic inlet. Free swallowing was restored in all cases and where anastomotic leakage occurred they healed spontaneously.
CONCLUSION
Isolated corrosive oesophageal strictures in the region of the thoracic inlet are uncommon and not necessarily single. There are finite diagnostic and operative challenges inherent in their location.
PubMed: 25452943
DOI: No ID Found -
Cases Journal Dec 2009Several lesions have been described as post-intubation complications. Most frequent are injuries of the pharynx/larynx or trachea. Cranial nerve injury following routine...
INTRODUCTION
Several lesions have been described as post-intubation complications. Most frequent are injuries of the pharynx/larynx or trachea. Cranial nerve injury following routine endo-tracheal intubation appears to be rare, and most reports describe Tapia's syndrome with hypoglossus/recurrent laryngeal nerve paralysis; cases that describe only bilateral hypoglossus palsy are infrequent. The cause is attributed to neuropathy of the nerve, provoked by compression following inflation of the cuff within the larynx or damage after neck hyperextension during a difficult intubation. However, similar cases after non-traumatic intubation have not been reported.
CASE PRESENTATION
We report here a case of bilateral hypoglossus palsy in a young man undergoing a diagnostic anterior mediastinotomy that was attributed to prolonged non-complicated oro-tracheal intubation. Progressive recovery of function by the patient supports neuropraxic damage as the cause.
CONCLUSION
To avoid such problems, special attention should be paid to the correct positioning of the head during surgery or during rapidly performed tracheostomy if prolonged intubation is anticipated.
PubMed: 20062625
DOI: 10.1186/1757-1626-2-9301 -
Annals of the Royal College of Surgeons... May 2007
Topics: Biopsy; Humans; Mediastinal Neoplasms; Thoracic Surgery, Video-Assisted
PubMed: 17539188
DOI: 10.1308/rcsann.2007.89.4.435