-
Diagnostic Pathology Jun 2024Pulmonary hamartomas are benign lung lesions. Histopathologically, pulmonary hamartoma is composed of varying amounts of mesenchymal elements, including chondroid...
BACKGROUND
Pulmonary hamartomas are benign lung lesions. Histopathologically, pulmonary hamartoma is composed of varying amounts of mesenchymal elements, including chondroid tissue, mature adipose tissue, fibrous stroma, smooth muscle, and entrapped respiratory epithelium. Most pulmonary hamartoma cases are asymptomatic and found incidentally during imaging. They usually appear as well-circumscribed lesions with the largest dimension of less than 4 cm. Asymptomatic giant pulmonary hamartomas that more than 8 cm are rare.
CASE PRESENTATION
In the current case report, a 12.0 × 9.5 × 7.5 cm lung mass was incidentally noticed in a 59-year-old female during a heart disease workup. Grossly, the lesion was lobulated with pearly white to tan-white solid cut surface and small cystic areas. Microscopically, representative tumor sections demonstrate a chondromyxoid appearance with relatively hypocellular stroma and entrapped respiratory epithelium at the periphery. No significant atypia is noted. No mitosis is noted, and the proliferative index is very low (< 1%) per Ki-67 immunohistochemistry. Mature adipose tissue is easily identifiable in many areas. Histomorphology is consistent with pulmonary hamartoma. A sarcoma-targeted gene fusion panel was further applied to this case. Combined evaluation of microscopic examination and sarcoma-targeted gene fusion panel results excluded malignant sarcomatous transformation in this case. The mediastinal and hilar lymph nodes are histologically benign. After surgery, the patient had an uneventful postoperative period.
CONCLUSIONS
Giant pulmonary hamartoma is rare; our case is an example of a huge hamartoma in an asymptomatic patient. The size of this tumor is concerning. Thus, careful and comprehensive examination of the lesion is required for the correct diagnosis and to rule out co-existent malignancy.
Topics: Humans; Hamartoma; Female; Middle Aged; Lung Diseases; Incidental Findings; Lung Neoplasms
PubMed: 38909245
DOI: 10.1186/s13000-024-01506-0 -
Indian Journal of Pathology &... Jun 2024Myeloid sarcoma (MS) is a tumor mass comprising myeloid blasts with or without maturation occurring in any site other than bone marrow. It is a rare and distinct...
BACKGROUND
Myeloid sarcoma (MS) is a tumor mass comprising myeloid blasts with or without maturation occurring in any site other than bone marrow. It is a rare and distinct clinical presentation of myeloid neoplasm.
MATERIALS AND METHODS
This is a retrospective study over 7 years (2015-2022) comprising a series of eight cases, which includes clinical details, morphology, immunohistochemistry (IHC) markers, cytogenetics, and molecular details.
RESULTS
These cases showed up as an isolated MS (3/8), as an initial clinical presentation in acute myeloid leukemia (1/8), as acute myeloid leukemia (1/8), as a disease progression in primary myelofibrosis (1/8), as chronic myeloid leukemia (1/8), and as BCR-ABL-negative myelodysplastic syndrome/myeloproliferative neoplasm (1/8). One of the three isolated MS was incorrectly identified as having Ewing's sarcoma. One case each presented at the cervical lymph node, mediastinum, skin, sacral soft tissue, maxillary sinus, and perinephric fat, and two cases presented at the hard palate.
CONCLUSION
Four of the cases in our study were clinically thought of as lymphoma/sarcoma, which was a major diagnostic challenge. All but one case succumbed to their disease. Without adequate clinical history and appropriate use of ancillary techniques such as IHC in tissue biopsies, flow cytometry, cytogenetics, and molecular studies, these cases have a high chance of being misdiagnosed as non-Hodgkin lymphoma, small round blue cell tumor, or undifferentiated carcinomas, which can complicate patient management and prognosis.
PubMed: 38904435
DOI: 10.4103/ijpm.ijpm_474_23 -
World Journal of Surgical Oncology Jun 2024Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren's syndrome (SjS). SjS is rarely accompanied by serositis....
BACKGROUND
Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren's syndrome (SjS). SjS is rarely accompanied by serositis. Here, we describe the first case of postoperative cardiac tamponade and acute pleuritis in a patient with thymic MALT lymphoma associated with SjS.
CASE PRESENTATION
A 33-year-old woman with SjS presented with an anterior mediastinal mass on chest computed tomography, which was performed for further examination of the condition. Suspecting a thymic MALT lymphoma or thymic epithelial tumor, total thymectomy was performed. The mediastinal mass was histopathologically diagnosed as a thymic MALT lymphoma. The patient was discharged with a good postoperative course but visited the hospital 30 days after surgery for dyspnea. Cardiac tamponade was observed and drainage was performed. Four days after pericardial drainage, chest radiography revealed massive left pleural effusion, and thoracic drainage was performed. The patient was diagnosed with serositis associated with SjS and treated with methylprednisolone, which relieved cardiac tamponade and pleuritis.
CONCLUSIONS
Surgical invasion of thymic MALT lymphomas associated with SjS may cause serositis. Postoperative follow-up should be conducted, considering the possibility of cardiac tamponade or acute pleuritis due to serositis as postoperative complications.
Topics: Humans; Lymphoma, B-Cell, Marginal Zone; Female; Adult; Cardiac Tamponade; Sjogren's Syndrome; Pleurisy; Thymus Neoplasms; Postoperative Complications; Thymectomy; Prognosis; Tomography, X-Ray Computed; Acute Disease
PubMed: 38902721
DOI: 10.1186/s12957-024-03442-1 -
International Journal of Surgery Case... Jul 2024Giant cell tumors of bone (GCTB) are infrequent tumors that usually impact the epiphyses of long bones and uncommonly manifest in the ribs. Herein, we report a case of...
INTRODUCTION AND IMPORTANCE
Giant cell tumors of bone (GCTB) are infrequent tumors that usually impact the epiphyses of long bones and uncommonly manifest in the ribs. Herein, we report a case of asymptomatic GCTB directly invading the lung tissue.
CASE PRESENTATION
A 36-year-old man was referred to our emergency department with only left chest pain. Computed tomography revealed a large heterogeneous solid cystic mass in the left lung apex and amorphous calcification and distraction in the posterior part of the left fourth rib. Histological examination also exhibited that the GCTB originated from the rib. The patient underwent an en-bloc resection with no recurrence in his one-year follow-up.
CLINICAL DISCUSSION
GCTB is characterized by osteoclast-like multinucleated giant cells and can exhibit aggressive local behavior. GCTB in the rib is rare, mainly found in the posterior arc. Radiographic features include lytic lesions with bone remodeling, often seen eccentrically in long bone epiphyses. Aggressive tumors may show cortical destruction and soft tissue extension. Surgery is often recommended for GCTB management, aiming for complete resection with sufficient surgical margins.
CONCLUSION
The absence of well-defined diagnostic criteria hinders the accurate diagnosis of GCTB, making a comprehensive assessment through radiological and histological examinations crucial. Upon physical examination, GCTB should be considered in the differential diagnosis for mediastinal lesions, regardless of their size. Furthermore, surgical removal can be taken into account as the primary treatment strategy for tumors that originate from the posterior arc of the ribs, such as GCTB.
PubMed: 38896991
DOI: 10.1016/j.ijscr.2024.109896 -
Journal of Thoracic Disease May 2024Diagnosis of mediastinal lesions on computed tomography (CT) images is challenging for radiologists, as numerous conditions can present as mass-like lesions at this...
BACKGROUND
Diagnosis of mediastinal lesions on computed tomography (CT) images is challenging for radiologists, as numerous conditions can present as mass-like lesions at this site. This study aimed to develop a self-attention network-based algorithm to detect mediastinal lesions on CT images and to evaluate its efficacy in lesion detection.
METHODS
In this study, two separate large-scale open datasets [National Institutes of Health (NIH) DeepLesion and Medical Image Computing and Computer Assisted Intervention (MICCAI) 2022 Mediastinal Lesion Analysis (MELA) Challenge] were collected to develop a self-attention network-based algorithm for mediastinal lesion detection. We enrolled 921 abnormal CT images from the NIH DeepLesion dataset into the pretraining stage and 880 abnormal CT images from the MELA Challenge dataset into the model training and validation stages in a ratio of 8:2 at the patient level. The average precision (AP) and confidence score on lesion detection were evaluated in the validation set. Sensitivity to lesion detection was compared between the faster region-based convolutional neural network (R-CNN) model and the proposed model.
RESULTS
The proposed model achieved an 89.3% AP score in mediastinal lesion detection and could identify comparably large lesions with a high confidence score >0.8. Moreover, the proposed model achieved a performance boost of almost 2% in the competition performance metric (CPM) compared to the faster R-CNN model. In addition, the proposed model can ensure an outstanding sensitivity with a relatively low false-positive rate by setting appropriate threshold values.
CONCLUSIONS
The proposed model showed excellent performance in detecting mediastinal lesions on CT. Thus, it can drastically reduce radiologists' workload, improve their performance, and speed up the reporting time in everyday clinical practice.
PubMed: 38883643
DOI: 10.21037/jtd-24-679 -
Mediastinum (Hong Kong, China) 2024Giant anterior mediastinal tumors sometimes may cause circulatory collapse and respiratory failure, known as mediastinal mass syndrome (MMS). The prediction and... (Review)
Review
BACKGROUND AND OBJECTIVE
Giant anterior mediastinal tumors sometimes may cause circulatory collapse and respiratory failure, known as mediastinal mass syndrome (MMS). The prediction and prevention of MMS is challenging. The aim of this study is to summarize the evaluation methods for MMS and formulate treatment strategies for giant anterior mediastinal tumors.
METHODS
We performed a thorough analysis of recent international literature on giant anterior mediastinal tumors (>10 cm in diameter) and MMS published in the PubMed database. The search spanned the duration of the preceding 10 years from August 19, 2023, and only studies published in English were included.
KEY CONTENT AND FINDINGS
Mature teratomas and liposarcomas are the most common giant anterior mediastinal tumors and MMS develops most frequently in case of malignant lymphomas. Here, we propose a new treatment strategy for giant anterior mediastinal tumors. Based on imaging findings, giant anterior mediastinal tumors can be classified as cystic or solid and further blood investigation data are useful for a definitive diagnosis. When malignant lymphoma or malignant germ cell tumor is highly suspected, the first choice of treatment is not surgery but chemotherapy and radiotherapy. Moreover, image-guided drainage may be effective if giant cystic anterior tumors develop into MMS. The risk classification of MMS is important for treating giant anterior mediastinal tumors. If the MMS risk classification is 'unsafe' or 'uncertain', the intraoperative management deserves special attention. The surgical approach should however be based on tumor localization and invasion of surrounding tissues. Multidisciplinary team coordination is indispensable in the treatment of giant anterior mediastinal tumors.
CONCLUSIONS
When giant anterior mediastinal tumors are encountered, it is important to follow the appropriate treatment strategy, focusing on the development of MMS based on imaging findings and symptoms.
PubMed: 38881815
DOI: 10.21037/med-23-40 -
Radiology Case Reports Aug 2024A 51-year-old male presented to our tertiary referral hospital with progressive shortness of breath and orthopnea. A computed tomography (CT) of the chest was performed...
A 51-year-old male presented to our tertiary referral hospital with progressive shortness of breath and orthopnea. A computed tomography (CT) of the chest was performed that showed a large cystic middle mediastinal mass. Magnetic resonance imaging (MRI) of the chest demonstrated a large, well-circumscribed, T2-hyperintense cystic middle mediastinal mass resulting in significant compression of the trachea, brachiocephalic artery, superior vena cava, and azygos vein. The patient subsequently developed a right hemispheric stroke due to compression of the brachiocephalic artery and was too clinically unstable to undergo or definitive operative management of the mediastinal cyst. Percutaneous CT-guided aspiration of the cystic middle mediastinal mass was performed, with successful decompression resulting transient improvement in mass-effect on the surrounding mediastinal structures. Six days after successful aspiration of the mass, the patient underwent attempted bronchoscopy for management of tracheobronchial secretions which was complicated by massive pulmonary hemorrhage leading to cardiopulmonary arrest and death. An autospy was conducted, revealing pathological finding consistent with a mature cystic teratoma.
PubMed: 38872748
DOI: 10.1016/j.radcr.2024.05.004 -
Frontiers in Surgery 2024Although the robotic surgical system has accumulated rich experience in the development of thoracic surgery, its application in Tibet area is relatively late. We report...
OBJECTIVE
Although the robotic surgical system has accumulated rich experience in the development of thoracic surgery, its application in Tibet area is relatively late. We report our experience concerning da Vinci Xi system in thoracic surgery and observe its practicability and surgical effect.
METHODS
We retrospectively analyzed 26 patients who underwent robotic thoracic surgery including: twelve lung resection, two esophagectomies, ten mediastinal surgeries and two rib mass resection. The data of patient characteristics, operative time, perioperative complications were collected.
RESULTS
Of the 26 patients, 22 cases were completed with da Vinci system successfully, including 7 segmentectomies, 4 lobectomies, 1 subsegmentectomy, 2 esophagectomies, 10 mediastinal surgeries (6 thymic resections, 3 posterior mediastinal tumor resection, 1 mediastinal cyst resection) and 2 rib mass resection. In which, 3 cases of lung resection begun with robotic technique were converted to thoracoscopic surgery (due to calcification of hilar lymph node), 1 case of bilobectomy was converted to thoracotomy due to thoracic adhesion. All the operations went well and no patients need blood transfusion. All patients had satisfactory postoperative recovery.
CONCLUSION
It is safe, reliable and effective to carry out robotic thoracic surgery on the plateau. On the premise of carefully and seriously discussing the indications of surgery, we should actively carry out the application of da Vinci robotic surgery system in Tibet Plateau.
PubMed: 38872721
DOI: 10.3389/fsurg.2024.1415704 -
Tuberkuloz Ve Toraks Jun 2024Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (MTB). Although it typically affects the lungs (pulmonary TB), one-fifth of TB...
Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (MTB). Although it typically affects the lungs (pulmonary TB), one-fifth of TB cases present as extrapulmonary TB. The diagnosis of extrapulmonary TB is often overlooked due to its atypical clinical and radiological manifestations. Differentiating TB from neoplastic conditions poses significant challenges. A 33-year-old female patient was admitted to the emergency clinic with shortness of breath, cough, and abdominal pain. Postero-anterior chest X-ray revealed massive pleural effusion leading to mediastinal shift. With a preliminary diagnosis of malignant pleural effusion, a pleural catheter was inserted, and the patient was referred for a positron emission tomography (PET/CT) to assess the primary site and the optimal location for a biopsy. The PET/CT revealed asymmetric soft tissue thickening on the left side of the nasopharynx, and increased fluorodeoxyglucose (FDG) uptake in the left cervical lymph nodes raised suspicion regarding primary nasopharyngeal cancer. Additionally, there was an increased FDG uptake observed in the mass lesion located in the right upper lobe, mediastinal lymph nodes, pleural surfaces in the left hemithorax, perihepatic areas, and peritoneum, indicating diffuse metastatic disease. Tuberculosis diagnosis was confirmed through biopsies demonstrating granulomatous inflammation in the lung and nasopharynx, along with culturing MTB from pleural effusion. Positron emission tomography played a crucial role in identifying sites of TB involvement. Despite its rarity, healthcare professionals should consider nasopharyngeal TB as a potential diagnosis when evaluating nasopharyngeal masses.
Topics: Humans; Female; Adult; Diagnosis, Differential; Positron Emission Tomography Computed Tomography; Tuberculosis; Fluorodeoxyglucose F18; Neoplasm Metastasis
PubMed: 38869209
DOI: 10.5578/tt.202402915 -
Radiology Case Reports Aug 2024Actinomycosis is a rare chronic suppurative granulomatous disease. Surgical biopsy is often performed in patients with chest actinomycosis because malignancy is...
Actinomycosis is a rare chronic suppurative granulomatous disease. Surgical biopsy is often performed in patients with chest actinomycosis because malignancy is suspected in most cases. A 62-year-old man presented to our hospital with fever and exertional dyspnea that had persisted for several months. Contrast-enhanced computed tomography showed an irregularly shaped mass with contrast enhancement in the anterior mediastinum and consolidation in the left upper lung lobe contiguous with this mass, as well as multiple nodules in both lungs. The pulmonary artery trunk was stenotic and surrounded by the mass, and the right heart system was enlarged. Thoracoscopic biopsy was performed but failed to yield a diagnosis. Contrast-enhanced computed tomography after one month revealed an increased mass and worsening right heart strain. F-FDG (fluorodeoxyglucose) positron emission tomography/computed tomography and contrast-enhanced magnetic resonance imaging also suggested a malignant tumor, and an open chest biopsy was performed. No malignant cells were identified and actinomycetes were detected by histopathology and bacterial culture. The patient was treated with antibiotics, following which his contrast-enhanced computed tomography findings and general condition improved.
PubMed: 38860267
DOI: 10.1016/j.radcr.2024.05.001