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Anesthetic and surgical considerations of giant pericardial cyst: Case report and literature review.Annals of Medicine and Surgery (2012) Jul 2020Pericardial cysts are considered as a rare congenital abnormality, mostly found incidentally. The estimated incidence of pericardial cyst is 1:100,000 and represent...
INTRODUCTION
Pericardial cysts are considered as a rare congenital abnormality, mostly found incidentally. The estimated incidence of pericardial cyst is 1:100,000 and represent approximately 6% of all mediastinal masses. Patients can present with symptoms similar to acute chest pain or right-sided heart failure or can be asymptomatic.
PRESENTATION
A 46-year-old female who is known to have hypertension and hypothyroidism presented to the breast clinic with left breast mass that was proved by core needle biopsy as proliferative breast lesion. During the preoperative assessment, the patient reported progressive shortness of breath and cough over the last two years and bilateral lower limb edema. Her preoperative chest X-ray showed a well-defined oval like opacification at the right cardiophrenic angle that was proved by chest computed tomography imaging as a cystic mass od most likely a pericardial origin. A huge pericardial cyst originating from the right diaphragmatic surface was excised through a mini-sternotomy incision with smooth postoperative recovery. The patient-reported significant improvement in her symptoms and her lifestyle during her follow up.
DISCUSSION
Pericardial cysts represent 6%-7% of all mediastinal masses with an estimated incidence of 1:100,000. About 70% of pericardial cysts originate at the right cardiophrenic angle and less frequently at the left cardiophrenic angle, they are usually suspected when the chest x-ray shows an enlarged contour of the right heart border. Mediastinal cysts have many differential diagnoses and the preoperative decision might be challenging in many cases. Pericardial cysts appear as oval, thin-walled homogeneous masses on cardiac computed tomography. The choice between surgical intervention and conservative follow up is related mainly to the size and symptoms that are induced by the cyst.
CONCLUSION
As pericardial cysts are rarely diagnosed pathology, a high index of suspicion is essential for diagnosis. Surgical resection is indicated when they are huge, enlarging in size or symptomatic. Morbidity and mortality risks following pericardial cyst excision are very low.
PubMed: 32547739
DOI: 10.1016/j.amsu.2020.05.038 -
Surgical Case Reports Jan 2022Teratoma is the second most common mediastinal neoplasm, but malignant transformation in mature teratomas is uncommon, and cases of carcinoid tumor with teratoma are...
BACKGROUND
Teratoma is the second most common mediastinal neoplasm, but malignant transformation in mature teratomas is uncommon, and cases of carcinoid tumor with teratoma are described in only a few studies. In addition, multilocular thymic cyst associated with mature mediastinal teratoma is also a rare entity. There have been no reports of case with the coexistence of these three pathological lesions.
CASE PRESENTATION
The patient was a 24-year-old man who was referred to our hospital due to a 2-day history of left shoulder pain, a feeling of severe chest tightness and high fever. Pre-operative computed tomography (CT) showed a large, fluid-filled and well-demarcated multilocular cyst in the anterior to superior mediastinum measuring up to 12 cm in size. Contrast-enhanced CT also revealed that the tumor contained a solid component with slight contrast enhancement and spotty wall-thickening septation. Therefore, cystic thymoma, thymic cyst, cystic teratoma, or germ cell tumor with an inflammatory reaction were considered as differential diagnoses. The patient underwent tumor extirpation under median sternotomy. The pathological diagnosis was multilocular thymic cyst with mature teratoma including carcinoid tumor (Grade 2) in the mediastinum.
CONCLUSIONS
The relationship between thymic cyst, teratoma and carcinoid tumor is unclear at present; therefore, further research is needed to clarify the relationship between these entities. In this report, we present a case of multilocular thymic cyst with mature teratoma including a carcinoid component in the mediastinum that was detected by complete surgical resection.
PubMed: 35092531
DOI: 10.1186/s40792-022-01373-1 -
Revista Chilena de Infectologia :... Apr 2007Hydatid disease is caused by the larval stages of a cestodes belonging to the genus Echinococcus. In humans, hydatid larva and cysts are located >90% in the liver and/or... (Review)
Review
Hydatid disease is caused by the larval stages of a cestodes belonging to the genus Echinococcus. In humans, hydatid larva and cysts are located >90% in the liver and/or lungs. Primary mediastinal location, with absence of documented lung infection, is extremely rare and has not been previously reported in Chile. We report the first case of a primary mediastinal hydatid cyst in Chile and review the literature. A 38 year old woman was admitted because of a painful right supraclavicular mass, dyspnea on exertion and logical dysphagia. Presurgical evaluation evidenced a mediastinal tumor extending to the cervical region that was successfully removed. The diagnosis of mediastinal hydatid cyst was confirmed macroscopically and by biopsy.
Topics: Adult; Echinococcosis; Female; Follow-Up Studies; Humans; Mediastinal Cyst; Treatment Outcome
PubMed: 17453074
DOI: 10.4067/s0716-10182007000200010 -
BMC Endocrine Disorders Dec 2022The hallmark of hyperparathyroidism is hypersecretion of parathyroid hormone (PTH) which results in hypercalcemia and hypophosphatemia. While hypercalcemia due to...
BACKGROUND
The hallmark of hyperparathyroidism is hypersecretion of parathyroid hormone (PTH) which results in hypercalcemia and hypophosphatemia. While hypercalcemia due to malignancy is often brought about by PTH-related protein in adults, PTH-producing tumors are quite rare in clinical practice. Additionally, from the point of embryology, it is very difficult to examine ectopic PTH-producing tissue such as ectopic parathyroid glands. Furthermore, clear histopathological criteria are not present.
CASE PRESENTATION
A 57-year-old woman was referred to our hospital for hypercalcemia. Her parathyroid hormone (PTH) level was elevated, but there were no enlarged parathyroid glands. Although 99mTc-MIBI confirmed a localized and slightly hyperfunctioning parathyroid tissue in the anterior mediastinum, it was not typical as hyperfunctioning parathyroid. We finally diagnosed her as ectopic PTH-producing cyst-like tumor with venous sampling of PTH. She underwent anterosuperior mediastinal ectopic PTH-producing cyst-like tumor resection. It is noted that intact-PTH concentration of the fluid in the cyst was very high (19,960,000 pg/mL). Based on histopathological findings, we finally diagnosed her as ectopic PTH-producing parathyroid cyst inside the thymus. After resection of anterosuperior mediastinal thymus including ectopic PTH-producing parathyroid cyst, calcium and intact-PTH levels were decreased, and this patient was discharged without any sequelae.
CONCLUSIONS
We should know the possibility of superior mediastinal ectopic PTH-producing parathyroid cyst inside the thymus among subjects with ectopic PTH-producing parathyroid glands. Particularly when the cyst is present in the superior mediastinum, it is necessary to do careful diagnosis based on not only positive but also negative findings in 99mTc-MIBI. It is noted that the patient's bloody fluid in the cyst contained 19,960,000 pg/mL of intact-PTH, and its overflow into blood stream resulted in hyperparathyroidism and hypercalcemia. Moreover, in such cases, the diagnosis is usually confirmed after through histological examination of ectopic PTH-producing parathyroid glands. We think that it is very meaningful to let clinicians know this case.
Topics: Humans; Adult; Female; Middle Aged; Parathyroid Glands; Parathyroid Hormone; Hypercalcemia; Hormones, Ectopic; Parathyroid Neoplasms; Hyperparathyroidism, Primary; Cysts
PubMed: 36544116
DOI: 10.1186/s12902-022-01256-4 -
International Journal of Infectious... Aug 2023
Topics: Animals; Humans; Paragonimus westermani; Mediastinal Cyst; Paragonimiasis
PubMed: 37150353
DOI: 10.1016/j.ijid.2023.05.001 -
Journal of Thoracic Disease Dec 2017Thymic cysts are rare benign developmental anomalies and there is no consensus management for thymic cysts. The aim of this study was to disclose the efficacy of...
BACKGROUND
Thymic cysts are rare benign developmental anomalies and there is no consensus management for thymic cysts. The aim of this study was to disclose the efficacy of perioperative diagnosis for thymic cysts by chest computerized tomography (CT) and to elucidate the surgical procedure by video-assisted thoracic surgery (VATS) in the management of thymic cysts.
METHODS
We retrospectively reviewed 108 consecutive thymic cyst patients who underwent VATS at our institution between April 2001 and August 2015. All patients received chest CT preoperatively and underwent VATS treatment. Clinical characteristics, imaging features and surgical exploration were taken into consideration to determine the surgical extent.
RESULTS
Multivariate logistic regression analysis showed that a diameter ≤3 cm [risk ratio (RR) =4.525; 95% confidence interval (CI), 1.027-20.000; P=0.046] and an unenhanced CT value >20 Hounsfield unit (Hu) (RR =7.043; 95% CI, 1.750-28.345; P=0.006) were independent factors of incorrect diagnosis of chest CT. Three different surgical procedures were performed, which included thymectomy (n=49), cyst resection and partial thymectomy (n=46), and extended thymectomy (n=13). No serious postoperative complications were observed. The median follow-up-time was 60.6 months (range, 12.0-168.0 months) with no late complications or recurrences.
CONCLUSIONS
A diameter ≤3 cm and an unenhanced CT value >20 Hu were independent factors of incorrect diagnosis of chest CT. VATS is a reliable approach for the surgical resection of thymic cysts. We think that local resection is adequate for simple thymic cysts. However, thymectomy is necessary when there is suspicion of a thymoma or multilocular thymic cyst, and radical thymectomy is advisable for patients with autoimmune diseases.
PubMed: 29312727
DOI: 10.21037/jtd.2017.10.148 -
Journal of Medical Case Reports Oct 2013Mediastinal localization of hydatidosis is very rare even in endemic areas. The diagnosis is based on typical clinical and radiological criteria.
INTRODUCTION
Mediastinal localization of hydatidosis is very rare even in endemic areas. The diagnosis is based on typical clinical and radiological criteria.
CASE PRESENTATION
We report a case of a mediastinal location of hydatidosis in a 60-year-old Arab man admitted for chest pain. The chest radiograph showed a rounded and homogeneous opacity. Computed tomography showed a right mediastinal cyst, without other thoracic or abdominal sites. Through a posterolateral thoracotomy, we found a cystic mass in the posterior mediastinum. The patient received a cystectomy with medical treatment based on albendazole. He improved a few weeks later.
CONCLUSION
Mediastinal cysts remain rare, even in endemic countries, which makes initial diagnosis difficult. Our observation shows the importance of keeping this diagnosis in mind when a patient presents with signs of mediastinal compression.
PubMed: 24099329
DOI: 10.1186/1752-1947-7-236 -
Diagnostic Pathology Oct 2013Ectopic pancreas in the mediastinum is extremely rare. We are reporting on a case of a twenty two year old woman who presented to our clinic with a large cervical mass.... (Review)
Review
UNLABELLED
Ectopic pancreas in the mediastinum is extremely rare. We are reporting on a case of a twenty two year old woman who presented to our clinic with a large cervical mass. The CT scan revealed a cystic lesion in the anterior mediastinum. The patient underwent surgical resection by cervical approach. A Cystic mass with pseudocysts, cysts and complete pancreatic tissue were found in pathology. There were no signs of pancreatitis or malignancy. No recurrence was observed after a follow up of four years. We reviewed the case reports describing this rare condition in the medical literature.We conclude that the possibility of ectopic pancreatic tissue should be included in the differential diagnosis of anterior mediastinal cystic mass, though as a remote possibility. Surgery is probably needed for the diagnosis and treatment. Posterior mediastinal pseudocyst is a different entity associated with acute pancreatitis. In those cases surgery is not recommended. Our third conclusion is that pancreatic tissue should be actively sought, if a structure resembling a pseudocyst is found in an unexpected location.
VIRTUAL SLIDES
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1849369005957671.
Topics: Adult; Choristoma; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Mediastinal Neoplasms; Pancreatic Cyst; Pancreatic Pseudocyst; Tomography, X-Ray Computed; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 24152726
DOI: 10.1186/1746-1596-8-176 -
Lung India : Official Organ of Indian... 2015To study unusual lesions in the mediastinum, which do not originate from the thymus, lymph nodes, neural tissues or germ cells, and tissues that normally engender...
OBJECTIVES
To study unusual lesions in the mediastinum, which do not originate from the thymus, lymph nodes, neural tissues or germ cells, and tissues that normally engender pathologic lesions in the mediastinum.
MATERIALS AND METHODS
Of the 65 cases seen, 12 unusual lesion were encountered in a 5½ year period from 2006 to 2011.
RESULTS
Two cases of nodular colloid goiter and one each of the mediastinal cyst, undifferentiated carcinoma, and Langerhans cell histiocytosis (LCH) affected the anterosuperior mediastinum. In the middle mediastinum, one case each of the mesothelioma, malignant gastrointestinal stromal tumor (GIST), squamous cell carcinoma (SCC), solitary fibrous tumor (SFT), and pleomorphic sarcoma (PS) was seen. One case of meningeal melanocytoma (Mme) and primary pleural liposarcoma (PL) involved the posterior mediastinum. Persistent disease was seen in LCH after 2 years. Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.
CONCLUSION
The cases of primary and SCC, LCH, melanocytoma, liposarcoma and PS, and GIST are unexpected and very rarely have paradigms in the mediastinum. Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location. A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.
PubMed: 26664161
DOI: 10.4103/0970-2113.168104 -
Texas Heart Institute Journal 2011The purpose of this retrospective study was to analyze our experience with mediastinal cysts, emphasizing the clinical presentations and results of surgery.Thirty-two...
The purpose of this retrospective study was to analyze our experience with mediastinal cysts, emphasizing the clinical presentations and results of surgery.Thirty-two patients with mediastinal cysts underwent surgery from January 2000 through June 2005. The records of these patients were reviewed for age at presentation, sex, signs and symptoms at presentation, results of the imaging techniques, types of mediastinal cysts, location and size of cysts, types of surgical procedure, length of hospital stay, early postoperative complications, death, and other follow-up information.The 32 mediastinal cysts comprised 12 bronchogenic, 9 pericardial, 7 thymic, and 2 enteric cysts, together with 2 cystic teratomas. Overall, 14 of the 32 patients with mediastinal cysts were asymptomatic. The surgical approach was thoracotomy in 30 patients and median sternotomy in 2 patients. The mean length of hospital stay was 7.7 ± 2.6 days. All patients were free from recurrence during the mean follow-up period of 4.4 ± 3.3 years.Surgery for mediastinal cysts is associated with low morbidity and mortality rates and a very low recurrence rate. It offers a definitive diagnosis and cure, avoiding the higher morbidity and mortality risks associated with conservative observation.
Topics: Adolescent; Adult; Asymptomatic Diseases; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Length of Stay; Male; Mediastinal Cyst; Middle Aged; Retrospective Studies; Sternotomy; Thoracotomy; Time Factors; Treatment Outcome; Turkey; Young Adult
PubMed: 21841863
DOI: No ID Found