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Journal of Surgical Case Reports May 2021An angiolipoma is a benign tumor, and a primary mediastinal angiolipoma is extremely rare. Herein, we describe the presentation and management of a posterior mediastinal...
An angiolipoma is a benign tumor, and a primary mediastinal angiolipoma is extremely rare. Herein, we describe the presentation and management of a posterior mediastinal angiolipoma in a woman with loss of consciousness. Chest computed tomography (CT) revealed a contrast-enhancing mass in the right posterior mediastinum, with intercostal arterial blood supply identified on three-dimensional reconstruction CT (3D-CT). Magnetic resonance imaging revealed a fatty component. Pre-operative embolization of the supplying intercostal artery was performed to reduce intraoperative bleeding. Mass resection was performed using video-assisted thoracic surgery. Histopathology confirmed angiolipoma diagnosis. Although rare, a posterior mediastinum angiolipoma should be considered a possibility; 3D-CT and pre-operative embolization may be useful in the surgical treatment of hypervascular mediastinal tumors, such as angiolipomas.
PubMed: 33981406
DOI: 10.1093/jscr/rjab168 -
Insights Into Imaging Feb 2013Multiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic or asymptomatic patients. The location and composition of these...
BACKGROUND
Multiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic or asymptomatic patients. The location and composition of these lesions are critical to narrowing the differential diagnosis.
METHODS
Radiological compartmentalisation of the mediastinum helps in focusing the diagnosis of masses on the basis of their site. Some diseases, however, do not occur exclusively in any specific compartment and can spread from one compartment to another.
RESULTS
Tissular components of the mass, the degree of vascularisation and the relationships with mediastinal structures assessed by computed tomography (CT) or magnetic resonance imaging (MRI) are a leading edge of the radiological diagnosis. Special applications at MRI have been developed over the recent years in order to identify accurately tissular components of the mediastinal masses. The likelihood of malignancy of the mediastinal masses is influenced by the symptomatology and the age of the patient. This article reviews the most commonly encountered mediastinal masses considering clinical history and manifestations, anatomical position and certain details seen on different imaging modalities that allow correct diagnosis in many cases.
CONCLUSION
Familiarity with the radiological features of mediastinal masses facilitates accurate diagnosis, differentiation from other mediastinic processes and, thus, optimal patient treatment.
TEACHING POINTS
• CT and MRI are important for the diagnosis of mediastinal masses. • The location and tissue characteristics on imaging studies are critical to narrow down the differential diagnosis of mediastinal masses. • Symptomatology and patient age affect the likelihood of malignancy.
PubMed: 23225215
DOI: 10.1007/s13244-012-0201-0 -
Surgery Journal (New York, N.Y.) Apr 2016The aim of the study was to evaluate the results of surgery to remove huge mediastinal masses and their pathology. Surgical resection was chosen for accurate...
The aim of the study was to evaluate the results of surgery to remove huge mediastinal masses and their pathology. Surgical resection was chosen for accurate diagnosis and treatment of the huge mediastinal masses extending into the pleural cavity. Records were reviewed for eight patients who had the diagnosis of huge benign mediastinal masses and who underwent operation; details of the patients and operations were recorded. Mean age was 34.5 (range 22 to 44) years, and male-to-female ratio was 2:6. Computed tomography and magnetic resonance imaging (MRI) were used to evaluate the location and extent of the abnormality and to characterize the tissue components of the mass. Most of the tumors were located in the posterior mediastinum. The most frequent presenting symptom was exertional dyspnea. The majority of cases underwent posterolateral thoracotomy, and complete resection was possible in seven patients. Partial resection could only be performed in one. The mean diameter of the resected masses was 15 × 10 cm. Histopathologic examination revealed 3 neurogenic tumors, 2 teratomas, 1 thymolipoma, and 1 ectopic thyroid, and 1 hemangioma. Minor complication was seen in two cases. The presurgical thoracic MRI provided correct diagnosis along with radiologic characterization and topography. Surgery must be the preferred treatment in huge benign mediastinal masses.
PubMed: 28824990
DOI: 10.1055/s-0036-1584519 -
Jornal Brasileiro de Pneumologia :... 2007Tumors of the anterior mediastinum include several entities with different radiological and clinical manifestations, constituting a heterogeneous group of congenital,...
Tumors of the anterior mediastinum include several entities with different radiological and clinical manifestations, constituting a heterogeneous group of congenital, inflammatory, and neoplastic conditions. Among these lesions, the most common primary tumor of the mediastinum is thymoma, nearly followed by germ cell tumors and lymphomas. Tuberculosis of the thymus, an extremely rare condition, typically involves the mediastinal lymph nodes. We present, in this study, pathological, radiological, and clinical findings of one case of tuberculosis of the thymus in an 18-year-old patient who presented thoracic pain, dyspnea upon minimal effort, and progressive worsening of the symptoms in one week. The chest X-ray showed a large mass in the mediastinum, and computed tomography scans indicated that it was located anteriorly. The patient was submitted to surgery in order to excise the mass. Microscopy revealed a massive inflammatory response and granulomas in the thymic tissue. Ziehl-Neelsen staining for acid-fast bacilli yielded positive results, and a diagnosis of tuberculosis was made. Surgeons and pathologists should remain alert for this condition and should include it in the differential diagnosis of mediastinal masses.
Topics: Adolescent; Diagnosis, Differential; Humans; Lymphatic Diseases; Male; Mediastinitis; Radiography; Thymus Gland; Tuberculosis
PubMed: 17906800
DOI: 10.1590/s1806-37132007000300020 -
BMC Surgery Apr 2018The mediastinal ectopic thyroid is very rare, accounting for less than 1% of all cases of ectopic thyroid tissue. The differential diagnoses with other diseases such as... (Review)
Review
BACKGROUND
The mediastinal ectopic thyroid is very rare, accounting for less than 1% of all cases of ectopic thyroid tissue. The differential diagnoses with other diseases such as lymphomas, thymic tumors and dermoid cysts is mandatory, in fact each one, needs different management and treatment.
CASE PRESENTATION
Here, we discuss a rare case of mediastinal ectopic thyroid presenting with a paratracheal mass laying on the right bronchus without symptoms. A 63-year-old male presented with an abnormal well-defined mass along the right paratracheal side, detected by chest x-ray. The CT scan confirmed the presence of a 6 × 8 cm heterogeneously enhanced mass, located behind the superior vena cava and left brachiocephalic artery, reaching azygos vein and right bronchus, without a mass effect. Taking into account the clinical importance of a mediastinal mass, we removed it surgically, through a double surgical approach consisting in a classical transverse cervicotomy for the left thyroid lobe, followed then by a longitudinal sternal splitting to remove the mediastinal mass and complete the thyroidectomy.
CONCLUSIONS
In case of mediastinal masses, the surgical excision is recommended, presenting the double advantage to clarify the diagnosis and to treat the pathology. As demonstrated in this case, a mediastinal ectopic thyroid should be taken into account in the differential diagnosis, considering its clinical importance.
Topics: Bronchi; Diagnosis, Differential; Humans; Male; Mediastinum; Middle Aged; Radiography; Thyroid Dysgenesis; Thyroidectomy; Tomography, X-Ray Computed
PubMed: 29618346
DOI: 10.1186/s12893-018-0354-y -
International Journal of Surgery Case... Jan 2021Ectopic thyroid tissue is a rare entity, and accounts for approximately 1% of all mediastinal tumours. It is a differential diagnosis of the mediastinum tumors or...
INTRODUCTION
Ectopic thyroid tissue is a rare entity, and accounts for approximately 1% of all mediastinal tumours. It is a differential diagnosis of the mediastinum tumors or metastatic deposits from an orthotopic gland, as well as other benign or malignant masses. Although most cases are asymptomatic and discovered incidently by imaging, symptoms related to tumor size and its compression of adjacent structures may also appear which necessites explorations and lead to diagnosis.
CASE PRESENTATION
This is a 59-year-old women, followed for glaucoma and operated for bilateral congenital cataract reffered to our structure by the service of pnemology for a right laterotracheal mediastinal mass. The patient presented respiratory symptoms over four months, and the physical examination found patient in good condition with PS 0 and normal vital signs, a poor oral health was noticed. The CT scann showed a left basal opacity and a right laterotracheal mediastinal mass at the upper right mediastinum, pushing forward the superior vena cava and compressing the trachea on the contralateral side, with well-defined borders and without signs of infiltration of adjacent structure. The brochoscopy was perfomed which showed the yellowish granulous aspect and the pathophysiology revealed a pulmonary actinomycosis. The patient was treated with antibiotic based on parenteral infusion of penicillin G at 20 million / day for 6 weeks relayed by oral administration of 3 g / day for 3 months with a good response and the left basal opacity disappeared on the CT control but the mediastinal mass persisted. After multidisciplinary concertation, the mediastinoscopy was perfomed and has revealed an ectopic thyroid which was removed by Uniportal Videoassisted Thoracoscopic Surgery (U-VATS) approach.
DISCUSSION
The first case of ectopic thyroid gland was described by Hickman in 1869, since a few cases have been reported by the literature. Its prevalence is about 1 per 100 000-300 000 people, rising to 1 per 4000-8000 patients with thyroid disease. The main techniques indicated in the management of undetermined lesions of the anterior mediastinum, are midline exploratory sternotomy, anterior lateral thoracotomy and VATS. U-VATS has demonstrated its feasibility and safety compared to conventional techniques by several advantages.
CONCLUSION
Ectopic mediastinal thyroid is an unusual presentation of thyroid pathology. Complete surgical resection remains a therapeutic and a key diagnosis. The aim of this study is to prouve the feasibility, efficiency and efficacity of U-VATS approach as minimally invasive thoracic surgery for mediastinal mass resection.
PubMed: 33373924
DOI: 10.1016/j.ijscr.2020.12.032 -
African Health Sciences Sep 2022Mediastinal teratomas are rare in children. Nevertheless, they represent the most frequent mediastinal germ cell tumor. Most often, they are discovered incidentally in...
INTRODUCTION
Mediastinal teratomas are rare in children. Nevertheless, they represent the most frequent mediastinal germ cell tumor. Most often, they are discovered incidentally in older children or adolescents on chest X-ray. There are other signs of discovery but less frequent: chest pain, hemoptysis and signs of mediastinal compression. Rupture into pleural space, pericardium or tracheobronchial tree are exceptional.
CASE PRESENTATION
We report the case of 7-years old girl admitted for chest pain. The chest x-ray showed a mediastinal mass with calcifications and pleural effusion. Chest CT scan revealed a well limited heterogeneous anterior mediastinal mass with calcifications and a left pleural effusion. She underwent a median sternotomy and the tumor was completely excised. Histopathology confirmed the diagnosis of mature teratoma.
CONCLUSION
Intrapleural rupture is a rare complication of mature teratoma. Calcifications on chest imaging in afebrile children with pleural effusion should be suspected of mediastinal teratoma.
Topics: Female; Adolescent; Humans; Child; Mediastinal Neoplasms; Rupture, Spontaneous; Pleural Effusion; Teratoma; Chest Pain
PubMed: 36910395
DOI: 10.4314/ahs.v22i3.33 -
International Journal of Surgery Case... 2016A mediastinal thyroid mass discovered years after a total thyroidectomy represents an unusual and uncommon clinical situation. Few cases have been reported and...
INTRODUCTION
A mediastinal thyroid mass discovered years after a total thyroidectomy represents an unusual and uncommon clinical situation. Few cases have been reported and controversy exists regarding the etiology of this ectopic thyroid tissue as well as the optimal surgical approach for resection. We herein describe a case of a mediastinal thyroid goiter discovered five years after a total thyroidectomy.
PRESENTATION OF CASE
A 54-year-old Hispanic female was diagnosed with a diffuse cervical goiter secondary to Hashimoto's Thyroiditis and subsequently underwent a total thyroidectomy. Five years later the patient had a chest X-ray as part of a preoperative evaluation for an unrelated and elective surgical procedure. Significant tracheal deviation was identified. A computed tomography scan was obtained and demonstrated a well encapsulated mass in the superior mediastinum resulting in tracheal deviation and compression. This "forgotten" goiter was successfully resected utilizing a standard cervical approach and the patient recovered uneventfully.
DISCUSSION
A thyroid mass within the mediastinum following a total thyroidectomy is a condition often referred to as "forgotten goiter". Prior reported cases are few, and data is limited, with some uncertainty remaining as to the exact origin of this ectopic thyroid tissue. Possible etiologies include an incomplete removal of the thyroid gland during initial cervical thyroidectomy, or perhaps an autonomous intrathoracic goiter (AIG) - a thyroid gland located in the mediastinum, independent and with no parenchymatous or vascular connection with the cervical thyroid gland.
CONCLUSION
A trans-thoracic or sternal splitting approach is generally not required for resection of a mediastinal goiter and our experience confirms that the case of the "forgotten goiter" can be safely approached through a cervical incision as well.
PubMed: 27639205
DOI: 10.1016/j.ijscr.2016.08.036 -
Boletin Medico Del Hospital Infantil de... 2023Rhabdoid tumors are malignant neoplasms of low prevalence, aggressive behavior, and high mortality. They were initially described as renal tumors, although tumors with...
BACKGROUND
Rhabdoid tumors are malignant neoplasms of low prevalence, aggressive behavior, and high mortality. They were initially described as renal tumors, although tumors with the same histopathological and immunohistochemical characteristics have been discovered in other locations, mainly in the central nervous system. Few cases of mediastinal location have been reported internationally. This work aimed to describe the case of a mediastinal rhabdoid tumor.
CASE REPORT
We describe the case of an 8-month-old male patient admitted to the pediatric department with dysphonia and laryngeal stridor progressing to severe respiratory distress. Contrast-enhanced computed tomography of the thorax showed a large mass with homogeneous soft tissue density, and smooth and well-defined borders, with suspicion of malignant neoplasm. Due to the oncological emergency compressing the airway, empirical chemotherapy was initiated. Subsequently, the patient underwent incomplete tumor resection due to its invasive nature. The pathology report showed morphology compatible with a rhabdoid tumor, which immunohistochemical and genetic studies corroborated. Chemotherapy and radiotherapy to the mediastinum were administered. However, the patient died three months after the initial treatment due to the aggressive behavior of the tumor.
CONCLUSIONS
Rhabdoid tumors are aggressive and malignant entities difficult to control and have poor survival. Early diagnosis and aggressive treatment are required, although the 5-year survival does not exceed 40%. It is necessary to analyze and report more similar cases to establish specific treatment guidelines.
Topics: Child; Male; Humans; Infant; Mediastinum; Rhabdoid Tumor; Hospitalization
PubMed: 36867566
DOI: 10.24875/BMHIM.22000035 -
Diagnostic Pathology Jan 2019Mediastinal follicular dendritic cell sarcoma (FDCS) is extremely rare. Due to potential under-recognization of this disease, it happens to be misdiagnosed, especially... (Review)
Review
BACKGROUND
Mediastinal follicular dendritic cell sarcoma (FDCS) is extremely rare. Due to potential under-recognization of this disease, it happens to be misdiagnosed, especially on core needle biopsy. We report 3 cases of mediastinal FDCS and provide a literature review to improve better understanding of the tumor and to reduce misdiagnosis.
METHODS
Three cases of mediastinal FDCS in our clinic practice were studied, including their core needle biopsy and resected specimens, and those cases reported previously in English literature were retrieved and analyzed.
RESULTS
The core needle biopsy of case 1 showed a tumor reminiscent of classical Hodgkin's lymphoma (CHL), while the resected mass was finally diagnosed with FDCS combined with hyaline-vascular Castleman's disease. Both the biopsy and resected tissue of case 2 were constitutive of the clear epithelioid cells with marked atypia. In both cases, definitive diagnoses were not made on core needle biopsy. In case 3, there were some areas morphologically similar to CHL, and some areas contained ovoid to spindle-shaped tumor cells with fascicular pattern. The analysis of 43 cases of mediastinal FDCS showed the age of patients were from 16 to 76 years old, the male to female ratio was 1.5:1, the maximal tumor diameters were 3-17 cm. 18 cases were underwent preoperative biopsy, whereas 15 (83.3%) of which were misdiagnosed initially, often as lymphoma. 32 patients had available follow-up data, the rates of recurrence, metastasis, and mortality were 12.5, 18.8 and 28.1%, respectively. Current limited data suggested no statistical differences between adverse prognosis and gender, age, tumor size, necrosis, or different therapeutics, respectively.
CONCLUSIONS
Mediastinal FDCS is a rare malignancy that has yet not been fully understood and been often misdiagnosed, particularly when making a diagnosis on core needle biopsy. Increased awareness of this enigmatic tumor is crucial to avoid diagnostic pitfalls.
Topics: Adolescent; Adult; Aged; Biopsy, Large-Core Needle; Dendritic Cell Sarcoma, Follicular; Drug Therapy; Female; Humans; Male; Mediastinum; Middle Aged; Prognosis; Radiotherapy; Tomography, X-Ray Computed; Young Adult
PubMed: 30646936
DOI: 10.1186/s13000-019-0779-3