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The Tokai Journal of Experimental and... Apr 2024Angiosarcoma is a rare malignant tumor of endothelial origin. It is an aggressive neoplasm with early metastasis and poor prognosis and accounts for approximately 2% of...
Angiosarcoma is a rare malignant tumor of endothelial origin. It is an aggressive neoplasm with early metastasis and poor prognosis and accounts for approximately 2% of all soft tissue sarcomas. Primary tumors arising in the oral cavity account for only 1% of all angiosarcomas. Here, we report a rare case of metastatic angiosarcoma of the gingiva originating from a primary mediastinal lesion. The patient was an 83-year-old man who presented with a maxillary interincisor tumor; it was a painless mass with rounded superficial necrosis measuring 23 mm× 17 mm on the labial side and 20 mm× 17 mm on the palatal side. The histopathological diagnosis was of an epithelioid angiosarcoma. Imaging revealed lesions in the mediastinum, lungs, liver, and skin. The primary lesion was considered a mediastinal lesion. As the tumor had spread throughout the body, palliative therapy was administered. However, the patient's general condition deteriorated rapidly, and he died 3 weeks after the first visit. Identifying oral metastatic malignancies may result in detection of malignant tumors at other sites; thus, oral and maxillofacial surgeons must maintain a heightened awareness of angiosarcoma.
Topics: Male; Humans; Aged, 80 and over; Hemangiosarcoma; Gingiva
PubMed: 38509009
DOI: No ID Found -
The Tokai Journal of Experimental and... Apr 2024A 75-year-old male visited our hospital with bilateral hilar lymph node swelling detected on chest radiography during an annual medical checkup. Chest computed...
A 75-year-old male visited our hospital with bilateral hilar lymph node swelling detected on chest radiography during an annual medical checkup. Chest computed tomography revealed swelling of multiple hilar mediastinal lymph nodes. Histopathological and immunohistochemical examinations of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimens from the hilar lymph nodes revealed amyloid deposition. Bilateral hilar and mediastinal lymphadenopathies can be the first manifestations of amyloidosis diagnosed using EBUS-TBNA.
Topics: Male; Humans; Aged; Lung Neoplasms; Lymphadenopathy; Mediastinum; Lymph Nodes; Amyloidosis; Bronchoscopy
PubMed: 38509007
DOI: No ID Found -
Journal of Cardiothoracic Surgery Mar 2024A right-sided aortic arch is a rare congenital vascular structure variation. Right lobectomy is not commonly performed on patients with such a condition. Further, there...
Right upper lobectomy with mediastinal dissection under uniportal video-assisted thoracoscopic surgery for lung cancer in a patient with a right-sided aortic arch: a case report.
BACKGROUND
A right-sided aortic arch is a rare congenital vascular structure variation. Right lobectomy is not commonly performed on patients with such a condition. Further, there are no reports on lobectomy under uniportal video-assisted thoracoscopic surgery (VATS) in this patient group.
CASE PRESENTATION
A 67-year-old man with a right-sided aortic arch and Kommerell diverticulum underwent right upper lobectomy with mediastinal lymph node dissection under uniportal VATS for primary lung cancer. Due to the right descending aorta, which narrows the space of the dorsal hilum, handling of the stapler for stapling the right upper lobe bronchus from the uniport in the 6th intercostal space at the medial axillary line can be challenging. This issue was resolved by manipulating the staple over the azygos vein toward the inferior margin of the aortic arch. Via mediastinal lymphadenectomy, we found that the right recurrent laryngeal nerve branched from the right vagus nerve and hooked around the right-sided aortic arch.
CONCLUSIONS
Right lobectomy with mediastinal lymph node dissection under uniportal VATS can be performed for lung cancer in patients with a right-sided aortic arch.
Topics: Male; Humans; Aged; Lung Neoplasms; Thoracic Surgery, Video-Assisted; Aorta, Thoracic; Pneumonectomy; Mediastinum
PubMed: 38504342
DOI: 10.1186/s13019-024-02627-9 -
Translational Lung Cancer Research Feb 2024SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a class of high-grade malignant tumors that has only been described in recent years, with an undifferentiated or...
BACKGROUND
SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a class of high-grade malignant tumors that has only been described in recent years, with an undifferentiated or rhabdoid morphology and genetic deletion of (), a subunit of the -associated factors (BAFs) chromatin remodeling complex. It is a rare tumor type that occurs in young to middle-aged men and usually presents as a compressive thoracic mass with rapid progression and poor prognosis. However, much remains unknown about the clinical and imaging manifestations of the disease.
CASE DESCRIPTION
Herein, we report a 51-year-old man who came to our hospital with multiple enlarged lymph nodes in the chest after a computed tomography (CT) examination at another hospital. The patient underwent conventional ultrasound (US), contrast-enhanced ultrasound (CEUS), magnetic resonance imaging (MRI), F-fluorodeoxyglucose positron emission tomography/CT (PET/CT), and finally confirmed the diagnosis of SMARCA4-UT by US-guided puncture biopsy. After symptomatic management, the patient was transferred to another hospital and we performed a short-term follow-up.
CONCLUSIONS
During this procedure, we obtained a series of relevant clinical and imaging data, especially US and CEUS images, which were described for the first time, offering valuable imaging information that will contribute to the clinical diagnosis of this disease to a certain extent. Moreover, this case highlights the efficacy of CEUS in identifying internal necrosis within tumors and lymph nodes, thereby improving the success rate of obtaining tumor tissue for pathological diagnosis. These findings substantiate the practical utility of US and CEUS in the context of mediastinal SMARCA4-UT, emphasizing their potential for widespread clinical adoption.
PubMed: 38496696
DOI: 10.21037/tlcr-23-822 -
Journal of Cardiothoracic Surgery Mar 2024Benign mediastinal tumor is usually asymptomatic and exhibits uncomplicated clinical course. Posterior mediastinal schwannoma is common, but a huge benign tumor causing...
Benign mediastinal tumor is usually asymptomatic and exhibits uncomplicated clinical course. Posterior mediastinal schwannoma is common, but a huge benign tumor causing acute respiratory failure due to mass effect is unusual. We present a patient who suffered from acute respiratory failure due to huge mediastinal mass effect and improved after en bloc surgical resection. A 56-year-old woman had no history of systemic disease, but experienced general discomfort and malaise for several months. She was referred to our emergency department after developing sudden respiratory failure. Intubation was performed with ventilator support and she was admitted to the intensive care unit. Chest radiograph and computed tomography showed a huge mass over the left pleural cavity causing left lung, heart, and mediastinal compression. After en bloc resection, she was weaned off the ventilator successfully and was discharged at 24 days after the operation. Postoperative outpatient follow-up showed no symptoms. Mediastinal ancient schwannoma is a rare posterior mediastinal benign tumor. However, mass effect might lead to lethal complications. En bloc resection is necessary for curative treatment.
Topics: Female; Humans; Middle Aged; Mediastinal Neoplasms; Neurilemmoma; Mediastinum; Respiratory Insufficiency
PubMed: 38491470
DOI: 10.1186/s13019-024-02605-1 -
Clinics (Sao Paulo, Brazil) 2024Lung lymphatic drainage occurs mainly through a peribronchial path, but it is hypothesized that visceral pleural invasion could alter this path. This study aims to...
BACKGROUND
Lung lymphatic drainage occurs mainly through a peribronchial path, but it is hypothesized that visceral pleural invasion could alter this path. This study aims to investigate the association between visceral pleural invasion, node upstaging, and N2 skip metastasis and the impact on survival in a population of patients with non-small cell lung cancer of 3 cm or smaller.
METHODS
We retrospectively queried our institutional database of lung cancer resection for all patients with clinical stage IA NSCLC between June 2009 and June 2022. We collected baseline characteristics and clinical and pathological staging data. Patients were classified into two groups: The non-VPI group with negative visceral pleural invasion and the VPI group with positive. The primary results analyzed were the occurrence of nodal upstaging, skip N2 metastasis and recurrence.
RESULTS
There were 320 patients analyzed. 61.3 % were women; the median age was 65.4 years. The pleural invasion occurred in 44 patients (13.7 %). VPI group had larger nodules (2.3 vs. 1.7 cm; p < 0.0001), higher 18F-FDG uptake (7.4 vs. 3.4; p < 0.0001), and lymph-vascular invasion (35.7 % vs. 13.5 %, p = 0.001). Also, the VPI group had more nodal disease (25.6 % vs. 8.7 %; p = 0.001) and skip N2 metastasis (9.3 % vs. 1.8 %; p = 0.006). VPI was a statistically independent factor for skip N2 metastasis. Recurrence occurred in 17.2 % of the population. 5-year disease-free and overall survival were worse in the VPI group.
CONCLUSIONS
The visceral pleural invasion was an independent factor associated with N2 skip metastasis and had worse disease-free and overall survival.
Topics: Humans; Female; Aged; Male; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Retrospective Studies; Neoplasm Staging; Pleura; Neoplasm Invasiveness; Prognosis
PubMed: 38484584
DOI: 10.1016/j.clinsp.2024.100334 -
BMC Anesthesiology Mar 2024Mediastinal tumors pose a challenging respiratory and circulatory management during anesthesia procedures, there is a risk of circulatory collapse or complete airway...
BACKGROUND
Mediastinal tumors pose a challenging respiratory and circulatory management during anesthesia procedures, there is a risk of circulatory collapse or complete airway obstruction, which in severe cases can lead to cardiac arrest. We reported a case of anesthetic management using a bronchial blocker placed outside the tracheal tube. In this case report, the patient's trachea was so severely compressed that the airway was extremely narrow, only 4 mm at its narrowest point. By reporting the anesthetic management of this patient, we intend to provide an unusual approach for airway management.
CASE PRESENTATION
A 52-year-old male patient was admitted to the hospital due to cough and expectoration for one year. Additionally, the patient experienced chest tightness and asthma after physical activity. The enhanced computed tomography revealed there existed an irregular soft tissue mass in the right upper mediastinum, which significantly compressed the trachea and esophagus. The results of the mediastinal puncture pathology showed the presence of mesenchymal tumors. According to the results above, the patient was diagnosed with a mediastinal tumor and scheduled to undergo tumor resection under general anesthesia. We used a bronchial occluder outside the tracheal tube for general anesthesia. After surgery, the patient received thorough treatment and was subsequently discharged from the hospital.
CONCLUSION
In patients with severe airway compression from a mediastinal tumor airway compression, positioning a bronchial occluder externally to the tracheal tube is an effective method of airway management. However, we still need more clinical practice to help the process become more standardized.
Topics: Male; Humans; Middle Aged; Mediastinal Neoplasms; Bronchi; Trachea; Anesthesia, General; Anesthetics
PubMed: 38475719
DOI: 10.1186/s12871-024-02480-2 -
Cancer Medicine Feb 2024To explore whether the upper and/or middle mediastinal nodes (UMMN) should be dissected in Siewert type II adenocarcinoma (AC) according to the incidence of lymph node...
OBJECTIVE
To explore whether the upper and/or middle mediastinal nodes (UMMN) should be dissected in Siewert type II adenocarcinoma (AC) according to the incidence of lymph node metastasis. Additionally, to investigate the association between the length of esophageal involvement (LEI) and the UMMN metastases.
METHODS
A cohort with Siewert type II AC who were operated on by a surgical team that routinely treated esophagogastric junction (EGJ) tumors with esophagectomy and extended lymphadenectomy were assessed retrospectively. The primary endpoint of the research was the metastasis rate of UMMN.
RESULTS
A total of 94 patients with EGJ tumor from July 2018 to September 2022 were enrolled. Station 106recR (6.4%, 6/94) was the only station among upper mediastinal nodes (UMN) that presented positive nodes. Middle mediastinal nodes (MMN) metastases of station 107, 109 and station 108 were 2.1% (2/94) and 5.0% (4/80), respectively. Among the 11 patients with MMN or UMN metastases, 63.6% (7/11) had lesser than seven metastatic nodes, and 54.5% (6/11) had a pathological N stage ≤2. LEI >3 cm (p = 0.042) showed a higher risk for MMN metastases in univariable logistic analysis. However, no independent risk factor for mediastinal node metastases was detected.
CONCLUSION
This study demonstrated that the incidence of positive MMN and UMN is relatively low in resectable Siewert type II AC, which indicated that it is not necessary to perform a routine dissection upon these stations. LEI >3 cm might be associated with higher risk for mediastinal node metastasis. Certain patients could benefit from extended lymphadenectomy since most of the patients with positive MMN or UMN have a limited number of metastatic nodes.
Topics: Humans; Mediastinum; Lymphatic Metastasis; Retrospective Studies; Adenocarcinoma; Mediastinal Neoplasms
PubMed: 38466235
DOI: 10.1002/cam4.6919 -
Radiation Oncology (London, England) Mar 2024Centrally located lung tumours present a challenge because of their tendency to exhibit symptoms such as airway obstruction, atelectasis, and bleeding. Surgical...
Protocol of a phase II study to evaluate the efficacy and safety of deep-inspiration breath-hold daily online adaptive radiotherapy for centrally located lung tumours (PUDDING study).
BACKGROUND
Centrally located lung tumours present a challenge because of their tendency to exhibit symptoms such as airway obstruction, atelectasis, and bleeding. Surgical resection of these tumours often requires sacrificing the lungs, making definitive radiotherapy the preferred alternative to avoid pneumonectomy. However, the proximity of these tumours to mediastinal organs at risk increases the potential for severe adverse events. To mitigate this risk, we propose a dual-method approach: deep inspiration breath-hold (DIBH) radiotherapy combined with adaptive radiotherapy. The aim of this single-centre, single-arm phase II study is to investigate the efficacy and safety of DIBH daily online adaptive radiotherapy.
METHODS
Patients diagnosed with centrally located lung tumours according to the International Association for the Study of Lung Cancer recommendations, are enrolled and subjected to DIBH daily online adaptive radiotherapy. The primary endpoint is the one-year cumulative incidence of grade 3 or more severe adverse events, as classified by the Common Terminology Criteria for Adverse Events (CTCAE v5.0).
DISCUSSION
Delivering definitive radiotherapy for centrally located lung tumours presents a dilemma between ensuring optimal dose coverage for the planning target volume and the associated increased risk of adverse events. DIBH provides measurable dosimetric benefits by increasing the normal lung volume and distancing the tumour from critical mediastinal organs at risk, leading to reduced toxicity. DIBH adaptive radiotherapy has been proposed as an adjunct treatment option for abdominal and pelvic cancers. If the application of DIBH adaptive radiotherapy to centrally located lung tumours proves successful, this approach could shape future phase III trials and offer novel perspectives in lung tumour radiotherapy.
TRIAL REGISTRATION
Registered at the Japan Registry of Clinical Trials (jRCT; https://jrct.niph.go.jp/ ); registration number: jRCT1052230085 ( https://jrct.niph.go.jp/en-latest-detail/jRCT1052230085 ).
Topics: Humans; Heart; Breath Holding; Organs at Risk; Lung Neoplasms; Lung; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Clinical Trials, Phase II as Topic
PubMed: 38459580
DOI: 10.1186/s13014-024-02427-4 -
Leukemia May 2024Axicabtagene ciloleucel showed efficacy for relapsed/refractory large B-cell lymphomas (LBCL), including primary mediastinal B-cell lymphomas (PMBCL); however, only few... (Observational Study)
Observational Study
Axicabtagene ciloleucel showed efficacy for relapsed/refractory large B-cell lymphomas (LBCL), including primary mediastinal B-cell lymphomas (PMBCL); however, only few PMBCLs were reported. Aim was to evaluate efficacy and safety of axicabtagene ciloleucel in patients with PMBCL compared to those with other LBCL, enrolled in the Italian prospective observational CART-SIE study. PMBCLs (n = 70) were younger, with higher percentage of bulky and refractory disease, compared to other LBCLs (n = 190). Median follow-up time for infused patients was 12.17 months (IQR 5.53,22.73). The overall (complete + partial) response rate (ORR,CR + PR) after bridging was 41% for PMBCL and 28% for other LBCL, p = 0.0102. Thirty days ORR was 78% (53/68) with 50% (34) CR in PMBCL, and 75% (141/187) with 53% (100) CR in other LBCL, p = 0.5457. Ninety days ORR was 69% (45/65) with 65% (42) CR in PMBCL, and 54% (87/162) with 47% (76) CR in other LBCL; progressive disease was 21% in PMBCL and 45% in other LBCL, p = 0.0336. Twelve months progression-free survival was 62% (95% CI: 51-75) in PMBCL versus 48% (95% CI: 41-57) in other LBCL, p = 0.0386. Twelve months overall survival was 86% (95% CI: 78-95) in PMBCL versus 71% (95% CI: 64-79) in other LBCL, p = 0.0034. All grade cytokine release syndrome was 88% (228/260); all grade neurotoxicity was 34% (88/260), with 6% of fatal events in PMBCL. Non-relapse mortality was 3%. In conclusion, PMBCLs achieved significantly better response and survival rates than other LBCLs.
Topics: Humans; Lymphoma, Large B-Cell, Diffuse; Female; Male; Middle Aged; Biological Products; Mediastinal Neoplasms; Adult; Prospective Studies; Italy; Aged; Immunotherapy, Adoptive; Follow-Up Studies; Survival Rate; Antigens, CD19; Treatment Outcome
PubMed: 38459167
DOI: 10.1038/s41375-024-02213-x