-
Journal of Thoracic Oncology : Official... Sep 2014Division of the mediastinum into compartments is used to help narrow the differential diagnosis of newly detected mediastinal masses, to assist in planning biopsy and...
Division of the mediastinum into compartments is used to help narrow the differential diagnosis of newly detected mediastinal masses, to assist in planning biopsy and surgical procedures, and to facilitate communication among clinicians of multiple disciplines. Several traditional mediastinal division schemes exist based upon arbitrary landmarks on the lateral chest radiograph. We describe a modern, computed tomography-based mediastinal division scheme, which has been accepted by the International Thymic Malignancy Interest Group as a new standard. This clinical classification defines a prevascular (anterior), a visceral (middle), and a paravertebral (posterior) compartment, with anatomic boundaries defined clearly by computed tomography. It is our intention that this definition be used in the reporting of clinical cases and the design of prospective clinical trials.
Topics: Consensus; Diagnosis, Differential; Humans; Mediastinal Neoplasms; Mediastinum; Tomography, X-Ray Computed
PubMed: 25396318
DOI: 10.1097/JTO.0000000000000292 -
Scientific Reports Feb 2019First-order radiomic features, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), are associated with disease progression in early-stage classical...
First-order radiomic features, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), are associated with disease progression in early-stage classical Hodgkin lymphoma (HL). We hypothesized that a model incorporating first- and second-order radiomic features would more accurately predict outcome than MTV or TLG alone. We assessed whether radiomic features extracted from baseline PET scans predicted relapsed or refractory disease status in a cohort of 251 patients with stage I-II HL who were managed at a tertiary cancer center. Models were developed and tested using a machine-learning algorithm. Features extracted from mediastinal sites were highly predictive of primary refractory disease. A model incorporating 5 of the most predictive features had an area under the curve (AUC) of 95.2% and total error rate of 1.8%. By comparison, the AUC was 78% for both MTV and TLG and was 65% for maximum standardize uptake value (SUV). Furthermore, among the patients with refractory mediastinal disease, our model distinguished those who were successfully salvaged from those who ultimately died of HL. We conclude that our PET radiomic model may improve upfront stratification of early-stage HL patients with mediastinal disease and thus contribute to risk-adapted, individualized management.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Area Under Curve; Disease Progression; Female; Glycolysis; Hodgkin Disease; Humans; Male; Mediastinal Neoplasms; Mediastinum; Middle Aged; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Radiometry; Tumor Burden; Young Adult
PubMed: 30718585
DOI: 10.1038/s41598-018-37197-z -
Respiratory Medicine Feb 2005Endoscopic ultrasonography (EUS) is a novel method for staging of the mediastinum in lung cancer patients. The recent development of linear scanners enables safe and... (Review)
Review
BACKGROUND
Endoscopic ultrasonography (EUS) is a novel method for staging of the mediastinum in lung cancer patients. The recent development of linear scanners enables safe and accurate fine-needle aspiration (FNA) of mediastinal and upper abdominal structures under real-time ultrasound guidance. However, various methods and equipment for mediastinal EUS-FNA are being used throughout the world, and a detailed description of the procedures is lacking. A thorough description of linear EUS-FNA is needed.
METHODS
A step-by-step description of the linear EUS-FNA procedure as performed in our hospital will be provided. Ultrasonographic landmarks will be shown on images. The procedure will be related to published literature, with a systematic literature search.
RESULTS
EUS-FNA is an outpatient procedure under conscious sedation. The typical linear EUS-FNA procedure starts with examination of the retroperitoneal area. After this, systematic scanning of the mediastinum is performed at intervals of 1-2cm. Abnormalities are noted, and FNA of the abnormalities can be performed. Specimens are assessed for cellularity on-site. The entire procedure takes 45-60 min.
CONCLUSIONS
EUS-FNA is minimally invasive, accurate, and fast. Anatomical areas can be reached that are inaccessible for cervical mediastinoscopy. EUS-FNA is useful for the staging of lung cancer or the assessment and diagnosis of abnormalities in the posterior mediastinum.
Topics: Biopsy, Fine-Needle; Endosonography; Humans; Lung; Lung Neoplasms; Lymphatic Metastasis; Mediastinal Neoplasms; Neoplasm Staging; Ultrasonography, Interventional
PubMed: 15715184
DOI: 10.1016/j.rmed.2004.06.011 -
Journal of Thoracic Oncology : Official... Sep 2014Mediastinal masses are relatively uncommon, yet include a large variety of entities. Some tumors can be diagnosed with confidence based on imaging alone; others when a... (Review)
Review
Mediastinal masses are relatively uncommon, yet include a large variety of entities. Some tumors can be diagnosed with confidence based on imaging alone; others when a typical appearance is combined with the right clinical presentation. A structured approach for radiologists is presented to facilitate evaluation of patients with anterior mediastinal tumors. The approach focuses first on the more common tumors and on imaging features that strongly suggest a particular diagnosis. Discussion with the clinician can be very helpful in formulating a presumptive diagnosis. This article also discusses that confirmatory imaging or biopsy tests are most beneficial in particular situations.
Topics: Diagnostic Imaging; Humans; Mediastinal Neoplasms; Tomography, X-Ray Computed
PubMed: 25396307
DOI: 10.1097/JTO.0000000000000295 -
Diagnostic Pathology Aug 2021First described in 1955 Primary mediastinal seminomas are rare. Only 1-4% of mediastinal tumours are germ cell tumors; majority of which are teratomas. They typically... (Review)
Review
BACKGROUND
First described in 1955 Primary mediastinal seminomas are rare. Only 1-4% of mediastinal tumours are germ cell tumors; majority of which are teratomas. They typically present in men aged between 20 and 40 years. Very few cases are reported in the literature. Florid follicular lymphoid hyperplasia can obscure the malignant cells and is a rarer finding still. We present a rare case of a 48 year old man with a primary mediastinal seminoma with florid follicular lymphoid hyperplasia; found following excision of a clinically presumed thymoma.
CASE PRESENTATION
A 48 year old man was referred for excision of a thymic mass. The presumed diagnosis was a thymoma; following preoperative investigations. The mass was incidentally found on a radiological imaging. However, the patient did report mid-sternal discomfort on lying flat and breathlessness. The patient underwent a thymectomy via a partial median sternotomy with good recovery. Histological assessment was that the mass was in fact a primary mediastinal seminoma with florid follicular lymphoid hyperplasia. A primary testicular malignancy was excluded and the patient required no further oncological treatment.
CONCLUSIONS
Only 11 cases have previously been reported of primary mediastinal seminoma with florid follicular lymphoid hyperplasia. Although rare, a primary mediastinal seminoma should be considered as a differential diagnosis for presentations with a thymic mass. Tumour markers can be helpful, however are only positive in third of cases. Ultrasound imaging of the gonads is essential to exclude a primary gonadal lesion. Pure seminomas are radiotherapy and chemotherapy sensitive however the mainstay treatment of primary mediastinal seminomas remains surgical excision. Radiotherapy is reserved postoperatively for incomplete surgical margins.
Topics: Adult; Biomarkers, Tumor; Humans; Hyperplasia; Male; Mediastinal Neoplasms; Middle Aged; Seminoma; Treatment Outcome; Young Adult
PubMed: 34419077
DOI: 10.1186/s13000-021-01137-9 -
Blood Feb 2016Primary central nervous system lymphomas (PCNSLs) and primary testicular lymphomas (PTLs) are extranodal large B-cell lymphomas (LBCLs) with inferior responses to...
Primary central nervous system lymphomas (PCNSLs) and primary testicular lymphomas (PTLs) are extranodal large B-cell lymphomas (LBCLs) with inferior responses to current empiric treatment regimens. To identify targetable genetic features of PCNSL and PTL, we characterized their recurrent somatic mutations, chromosomal rearrangements, copy number alterations (CNAs), and associated driver genes, and compared these comprehensive genetic signatures to those of diffuse LBCL and primary mediastinal large B-cell lymphoma (PMBL). These studies identify unique combinations of genetic alterations in discrete LBCL subtypes and subtype-selective bases for targeted therapy. PCNSLs and PTLs frequently exhibit genomic instability, and near-uniform, often biallelic, CDKN2A loss with rare TP53 mutations. PCNSLs and PTLs also use multiple genetic mechanisms to target key genes and pathways and exhibit near-uniform oncogenic Toll-like receptor signaling as a result of MYD88 mutation and/or NFKBIZ amplification, frequent concurrent B-cell receptor pathway activation, and deregulation of BCL6. Of great interest, PCNSLs and PTLs also have frequent 9p24.1/PD-L1/PD-L2 CNAs and additional translocations of these loci, structural bases of immune evasion that are shared with PMBL.
Topics: Central Nervous System Neoplasms; Female; Genetic Loci; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Mediastinal Neoplasms; Neoplasm Proteins; Testicular Neoplasms; Translocation, Genetic
PubMed: 26702065
DOI: 10.1182/blood-2015-10-673236 -
Journal of Cardiothoracic Surgery Dec 2022Mediastinal cavernous hemangiomas are extremely rare vascular tumors. To the best of our knowledge less than 20 cases of posterior mediastinal hemangioma have been...
BACKGROUND
Mediastinal cavernous hemangiomas are extremely rare vascular tumors. To the best of our knowledge less than 20 cases of posterior mediastinal hemangioma have been reported in literature, and this is the first case of mediastinal cavernous hemangioma presenting with massive pleural effusion.
CASE PRESENTATION
We report a case of a 56-year-old female who presented with cough and chest tightness and was found with a massive pleural effusion in chest CT. It was mistaken for a malignant pleural effusion. A posterior mediastinal lesion was observed after thoracic drainage and misdiagnosed again as neurofibroma. The lesion was resected and post-operative histopathology suggested that it was a cavernous hemangioma. Post-operative recovery was uneventful, and a follow-up examination nearly 14 months later showed the patient had no recurrence.
CONCLUSIONS
Due to the lack of diagnostic specificity and variety of clinical manifestations, CHM is often misdiagnosed prior to resection. This is the first description of mediastinal hemangioma presenting with massive pleural effusion. It is very important to consider mediastinal hemangioma before operation to reduce surgical complications, and it should be in the differential diagnosis of posterior mediastinal masses.
Topics: Female; Humans; Middle Aged; Pleural Effusion; Mediastinal Neoplasms; Hemangioma, Cavernous; Hemangioma; Diagnostic Errors
PubMed: 36514095
DOI: 10.1186/s13019-022-02082-4 -
Cancer Reports (Hoboken, N.J.) Feb 2021Malignant mediastinal germ cell tumor (MGCT) is rare and has poor outcomes even after multimodality treatment. Data from resource-poor countries are scarce in the...
BACKGROUND
Malignant mediastinal germ cell tumor (MGCT) is rare and has poor outcomes even after multimodality treatment. Data from resource-poor countries are scarce in the literature.
AIMS
To evaluate the clinicopathologic features and treatment outcome of primary malignant MGCT at our center.
METHODS AND RESULTS
Single institutional data review of patients aged ≥18 years, treated with a diagnosis of malignant MGCT between Nov'2013 and Nov'2019. Risk stratification was done as per International Germ Cell Cancer Collaborative Group (IGCCCG) classification. Patients were treated with platinum based chemotherapy and surgical resection for the residual disease was performed in non-seminomatous histology.28 patients had MGCT with a median age of 25 years (range:18-36) and all were male. Seven patients had superior vena cava obstruction (SVCO) at diagnosis and pre-treatment histological diagnosis was available in 23 (82%) patients. Seven (25%) patients had seminoma histology, all were of good risk as per IGCCCG risk criteria, whereas others had non-seminoma histology with poor-risk group. Seven patients with seminoma histology achieved a complete response after initial treatment. Six patients with non-seminoma histology underwent complete resection of residual disease post-chemotherapy and five revealed residual viable tumors. After a median follow-up of 10.8 months (range:2.9-75), 3-year progression-free survival (PFS) and overall survival (OS) estimate was 61.2% and 94.7% in the whole cohort, respectively and 3-year PFS and OS estimate was 100% in patients with seminoma histology.
CONCLUSIONS
This is the largest data set of MGCT patients' outcomes reported from India with multi-modality treatment. All patients were male and one-fourth had SVCO at presentation. Seminoma histology patients had a 100% outcome after initial platinum based chemotherapy. But, those with non-seminoma histology had a poor outcome even with chemotherapy and surgery.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Female; Humans; Male; Mediastinal Neoplasms; Mediastinum; Neoplasm, Residual; Neoplasms, Germ Cell and Embryonal; Progression-Free Survival; Retrospective Studies; Risk Factors; Young Adult
PubMed: 33029924
DOI: 10.1002/cnr2.1306 -
Diagnostic Pathology Jan 2017Clear cell sarcoma (CCS) is a rare malignant soft-tissue neoplasm that displays melanocytic markers and exhibits striking histopathological features. The tumour has a... (Review)
Review
BACKGROUND
Clear cell sarcoma (CCS) is a rare malignant soft-tissue neoplasm that displays melanocytic markers and exhibits striking histopathological features. The tumour has a predilection for the lower extremities and rarely presents in the mediastinum.
CASE PRESENTATION
We present a case of primary mediastinal CCS in a 57-year-old man. Computer tomography (CT) revealed a 12 × 12 × 7.5 cm mass in the anterior mediastinum. Microscopically, the tumour mainly consisted of epithelioid cells with oval vesicular nuclei and eosinophilic cytoplasm. Immunohistochemically, the tumour was positive for human melanoma black 45 (HMB-45) and vimentin but negative for S-100 and Melan-A. Fluorescence in situ hybridisation (FISH) showed a translocation involving the EWSR1 gene region.
CONCLUSION
This report will illustrate that the mediastinum is a potential site for primary CCS and FISH plays an important role in making a conclusive diagnosis.
Topics: Biomarkers, Tumor; Humans; Immunohistochemistry; Male; Mediastinal Neoplasms; Middle Aged; Sarcoma, Clear Cell
PubMed: 28086809
DOI: 10.1186/s13000-016-0594-z -
The Netherlands Journal of Medicine Dec 2017Angiomatosis is a rare benign vascular lesion, usually seen in females in the first two decades of life. It commonly involves the lower extremities. Angiomatosis of... (Review)
Review
Angiomatosis is a rare benign vascular lesion, usually seen in females in the first two decades of life. It commonly involves the lower extremities. Angiomatosis of mediastinum is very rare and we report two such cases with a review of the literature on solitary mediastinal angiomatosis. Both of our patients were female, aged 34 and 57 years. One patient presented with left-sided subcutaneous supraclavicular swelling. Magnetic resonance imaging showed a mass extending from the left upper mediastinum to the left supraclavicular area. The other patient presented with pleural effusion. Computed tomography of the chest disclosed an infiltrative mass in the mediastinum. Both patients were treated by excision of the lesions, histologically confirmed to be angiomatosis. Despite the rarity of mediastinal angiomatosis, this clinicopathological entity must be taken into consideration when the treatment of mediastinal tumours is planned.
Topics: Adult; Angiomatosis; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Middle Aged; Tomography, X-Ray Computed
PubMed: 29256416
DOI: No ID Found