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Journal of the American Veterinary... Feb 2020
Topics: Animals; Dog Diseases; Dogs; Male; Mediastinal Neoplasms
PubMed: 31999520
DOI: 10.2460/javma.256.4.423 -
Journal of Thoracic Oncology : Official... Jan 2009To determine the sensitivity and accuracy of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for clarification of the nature of...
INTRODUCTION
To determine the sensitivity and accuracy of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) for clarification of the nature of fluorodeoxyglucose-positron emission tomography (FDG) positive hilar and/or mediastinal lymph nodes in patients with (suspected) lung cancer.
METHODS
All consecutive patients who had undergone EBUS-TBNA alone for assessment of abnormal FDG-uptake in hilar and/or mediastinal lymph nodes between January 2005 and August 2007 were reviewed.
RESULTS
One-hundred-nine patients underwent EBUS-TBNA of 127 positron emission tomography positive lymph nodes. Hilar (station 10 or 11) nodes (N1 or N3) were aspirated in 26 patients and mediastinal (stations 2, 4, 7) nodes (N2 or N3) in 90 patients. In 7 patients both hilar and mediastinal nodes were sampled. There were no procedure-related complications. Malignancy was detected in 77 (71%) cases. Thirty-two patients were tumor negative by EBUS-TBNA; subsequent surgical biopsy in 19 showed malignancy in 7. In four cases the false negative result was due to sampling error and in three cases due to detection error. In 13 cases surgical staging was not performed although long term follow-up in 3 showed no evidence of malignancy. The sensitivity and accuracy of EBUS-TBNA for malignancy in patients with reference pathology was 91% and 92%, respectively. The negative predictive value was 60%. If the 10 cases for which confirmatory surgical staging was not performed are assumed to be false negative results, overall sensitivity and accuracy were 82% and 84%, respectively.
CONCLUSIONS
EBUS-TBNA offers an effective accurate, minimally invasive strategy for evaluating FDG avid hilar and mediastinal lymph nodes. However, negative findings should be confirmed by surgical staging.
Topics: Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Bronchoscopy; Endosonography; Female; Humans; International Agencies; Lung Neoplasms; Lymph Nodes; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Staging; Positron-Emission Tomography; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Thoracoscopy; Tomography, X-Ray Computed
PubMed: 19096305
DOI: 10.1097/JTO.0b013e3181914357 -
The New England Journal of Medicine Jul 2000Determining the stage of non-small-cell lung cancer often requires multiple preoperative tests and invasive procedures. Whole-body positron-emission tomography (PET) may... (Clinical Trial)
Clinical Trial
BACKGROUND
Determining the stage of non-small-cell lung cancer often requires multiple preoperative tests and invasive procedures. Whole-body positron-emission tomography (PET) may simplify and improve the evaluation of patients with this tumor.
METHODS
We prospectively compared the ability of a standard approach to staging (computed tomography [CT], ultrasonography, bone scanning, and, when indicated, needle biopsies) and one involving PET to detect metastases in mediastinal lymph nodes and at distant sites in 102 patients with resectable non-small-cell lung cancer. The presence of mediastinal metastatic disease was confirmed histopathologically. Distant metastases that were detected by PET were further evaluated by standard imaging tests and biopsies. Patients were followed postoperatively for six months by standard methods to detect occult metastases. Logistic-regression analysis was used to evaluate the ability of PET and CT to identify malignant mediastinal lymph nodes.
RESULTS
The sensitivity and specificity of PET for the detection of mediastinal metastases were 91 percent (95 percent confidence interval, 81 to 100 percent) and 86 percent (95 percent confidence interval, 78 to 94 percent), respectively. The corresponding values for CT were 75 percent (95 percent confidence interval, 60 to 90 percent) and 66 percent (95 percent confidence interval, 55 to 77 percent). When the results of PET and CT were adjusted for each other, only PET results were positively correlated with the histopathological findings in mediastinal lymph nodes (P<0.001). PET identified distant metastases that had not been found by standard methods in 11 of 102 patients. The sensitivity and specificity of PET for the detection of both mediastinal and distant metastatic disease were 95 percent (95 percent confidence interval, 88 to 100 percent) and 83 percent (95 percent confidence interval, 74 to 92 percent), respectively. The use of PET to identify the stage of the disease resulted in a different stage from the one determined by standard methods in 62 patients: the stage was lowered in 20 and raised in 42.
CONCLUSIONS
PET improves the rate of detection of local and distant metastases in patients with non-small-cell lung cancer.
Topics: Adult; Aged; Biopsy, Needle; Carcinoma, Non-Small-Cell Lung; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Staging; Prospective Studies; Sensitivity and Specificity; Tomography, Emission-Computed; Tomography, X-Ray Computed; Ultrasonography
PubMed: 10911007
DOI: 10.1056/NEJM200007273430404 -
The Journal of Veterinary Medical... Jun 2021Mediastinal masses in dogs were diagnosed as basaloid carcinoma associated with multiple thymic cysts (MTCs). The masses were composed of MTCs and proliferating...
Mediastinal masses in dogs were diagnosed as basaloid carcinoma associated with multiple thymic cysts (MTCs). The masses were composed of MTCs and proliferating intracystic neoplastic basaloid cells, which immunohistochemically diffusely expressed p63 and cytokeratin 19. A gradual transition from the basal cell layers lining the cysts walls to the neoplastic cells was seen, and it was indicated that the neoplastic cells had originated from the basal cell layers of the cysts. To the best of our knowledge, this is the first report of basaloid carcinoma occurring in the mediastinal cavity in dogs. Although these tumors were demonstrated to be rare origins, basaloid carcinoma should be included in the differential diagnoses for canine mediastinal tumors.
Topics: Animals; Carcinoma; Diagnosis, Differential; Dog Diseases; Dogs; Mediastinal Cyst; Mediastinal Neoplasms
PubMed: 33814518
DOI: 10.1292/jvms.20-0518 -
Medicine Jul 2019Choriocarcinoma is a rare and highly invasive gestational trophoblastic tumor that secretes high levels of human chorionic gonadotropin (hCG). As one of the uncommon...
RATIONALE
Choriocarcinoma is a rare and highly invasive gestational trophoblastic tumor that secretes high levels of human chorionic gonadotropin (hCG). As one of the uncommon non-gestational choriocarcinoma, primary mediastinal choriocarcinoma is an exceeding rare, and aggressive malignancy with poor prognosis.
PATIENT CONCERNS
A 26-year-old man was admitted to the hospital with cough, shortness of breath, and occasional hemoptysis.
DIAGNOSES AND INTERVENTION
Imaging examinations revealed a large mediastinal mass, diffuse nodular opacities with blurred edges in both lungs, and multiple brain lesions. Laboratory tests showed an astonishing increase of serum β-hCG. A diagnosis of primary mediastinal choriocarcinoma with advanced lung and brain metastases was finally made after 3 biopsies and immunohistochemical analyses. Surgery and radiotherapy were not applicable at the time of diagnosis, and both targeted therapy and immunotherapy were unavailable. During the first 4 cycles of trophoblastic tumor-based chemotherapy, the patient improved clinically with fewer symptoms, decreased β-hCG and reduced lesions. However, drug resistance quickly emerged, forcing an alternative chemotherapy regimen that also failed.
OUTCOMES
The patient finally endured symptoms including headache, dizziness and vomiting, and subsequently succumbed after an overall survival time of six and half months.
LESSONS
Male primary choriocarcinoma is an extremely rare type of malignancy. Greater awareness, earlier diagnosis and novel treatments are urgently needed to benefit patients.
Topics: Adult; Choriocarcinoma; Diagnosis, Differential; Fatal Outcome; Humans; Male; Mediastinal Neoplasms; Neoplasm Metastasis
PubMed: 31305456
DOI: 10.1097/MD.0000000000016411 -
Medicine Nov 2016Angiomyofibroblastoma (AMFB) is an extremely rare disease. It commonly occurs in middle-aged females and mainly involves the vulvovaginal region. Pathological... (Review)
Review
INTRODUCTION
Angiomyofibroblastoma (AMFB) is an extremely rare disease. It commonly occurs in middle-aged females and mainly involves the vulvovaginal region. Pathological examination plays an important role in differentiating from other tumors. But far less published literature focus on the imaging characteristics of AMFB.
CLINICAL FINDINGS/DIAGNOSES
We reported a case of AMFB in a 73-year-old male, involving the mediastinum with computed tomography (CT) imaging and pathologic findings. Preoperative unenhanced CT scan of chest revealed a 6.9 × 7.4 × 9.3 cm mass with equal density, located in the posterior mediastinum. On contrast-enhanced CT images, the tumor presented moderate, heterogeneous enhancement. Due to the unclear interface between the tumor and adjacent tissues, this patient underwent operative partial resection of the tumor. The pathologic diagnosis was AMFB.
CONCLUSIONS
This tumor represents a further example of unusual location different from conventional AMFB. This case adds to the experience with AMFB by summarizing its characteristics, and also reviewing the literature.
Topics: Aged; Angiomyoma; Contrast Media; Diagnosis, Differential; Humans; Male; Mediastinal Neoplasms; Tomography, X-Ray Computed
PubMed: 27902605
DOI: 10.1097/MD.0000000000005484 -
Chest Aug 2022A 60-year-old woman, a care worker with no known comorbidities, presented to the pulmonary clinic for assessment of a left hilar tumor detected on chest radiography. She...
A 60-year-old woman, a care worker with no known comorbidities, presented to the pulmonary clinic for assessment of a left hilar tumor detected on chest radiography. She had a history of oophorocystectomy and was a 0.5-pack/day smoker. She was asymptomatic but desired a confirmative diagnosis.
Topics: Female; Humans; Lung; Mediastinal Neoplasms; Mediastinum; Middle Aged; Radiography
PubMed: 35940667
DOI: 10.1016/j.chest.2022.03.026 -
Blood Jan 2013Mediastinal large B-cell lymphoma (MLBL) represents 2% of mature B-cell non-Hodgkin lymphoma in patients ≤ 18 years of age. We analyzed data from childhood and... (Randomized Controlled Trial)
Randomized Controlled Trial
Mediastinal large B-cell lymphoma (MLBL) represents 2% of mature B-cell non-Hodgkin lymphoma in patients ≤ 18 years of age. We analyzed data from childhood and adolescent patients with stage III MLBL (n = 42) and non-MLBL DLBCL (n = 69) treated with Group B therapy in the French-American-British/Lymphome Malins de Burkitt (FAB/LMB) 96 study. MLBL patients had a male/female 26/16; median age, 15.7 years (range, 12.5-19.7); and LDH < 2 versus ≥ 2 × the upper limit of normal, 23:19. Six MLBL patients (14%) had < a 20% response to initial COP (cyclophosphamide, vincristine, and prednisone) therapy. Central pathology revealed approximately 50% with classical features of primary MLBL. Five-year event-free survival for the stage III MLBL and non-MLBL DLBCL groups was 66% (95% confidence interval [CI], 49%-78%) and 85% (95% CI, 71%-92%), respectively (P < .001; 14%). The 5-year overall survival in the 42 MLBL patients was 73% (95% CI, 56%-84%). We conclude that MLBL in adolescent patients is associated with significantly inferior event-free survival compared with stage III non-MLBL DLBCL and can be of multiple histologies. Alternate treatment strategies should be investigated in the future taking into account both adult MLBL approaches and more recent biologic findings in adult MLBL.
Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Child; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Lymphoma, Large B-Cell, Diffuse; Male; Mediastinal Neoplasms; Neoplasm Staging; Treatment Outcome
PubMed: 23149845
DOI: 10.1182/blood-2012-04-422709 -
In Vivo (Athens, Greece) 2020To evaluate the efficacy of residual site radiation therapy (RSRT) on local control (LC), progression-free (PFS) and overall (OS) survival in patients with primary...
AIM
To evaluate the efficacy of residual site radiation therapy (RSRT) on local control (LC), progression-free (PFS) and overall (OS) survival in patients with primary mediastinal lymphoma (PMBCL), following rituximab and chemotherapy treatment (ICHT).
PATIENTS AND METHODS
The study included 34 patients with PMBCL treated between 2006 and 2014 with ICHT with/without autologous stem cell transplantation and RSRT. Between the end of ICHT/stem cell transplantation and RSRT, patients were evaluated with F-fluorodeoxyglucose positron-emission tomography. The gross tumor volume included morphological mediastinal residual disease after ICHT/SCT. The percentage of LC, PFS and OS were assessed.
RESULTS
All patients received RSRT with a median dose of 30 Gy. Median follow-up was 82 months. One patient out of 34 (3%) showed progressive disease 9 months from diagnosis. The 10-year PFS and OS were 97% and 97% respectively.
CONCLUSION
RSRT in patients with PMBCL treated with ICHT did not impact unfavorably on LC and patient survival.
Topics: Adolescent; Adult; Aged; Antineoplastic Agents, Immunological; Female; Fluorodeoxyglucose F18; Humans; Lymphoma, B-Cell; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Staging; Neoplasm, Residual; Positron-Emission Tomography; Retreatment; Retrospective Studies; Young Adult
PubMed: 32354938
DOI: 10.21873/invivo.11921 -
Clinics (Sao Paulo, Brazil) 2011To disseminate transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) as an alternative to investigate mediastinal tumoral lesions because it is an underused...
OBJECTIVES
To disseminate transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) as an alternative to investigate mediastinal tumoral lesions because it is an underused modality that has been available in Brazil for more than 15 years.
METHODS
Descriptive analysis of a single endoscopy service's experience since 1997 in the accomplishment of EUSFNA for mediastinal staging of previously known malignancies (Group 1) or diagnostic definition of suspect lymph nodes and masses (Group 2).
RESULTS
EUS-FNA was performed in 51 patients between 26 and 87 years of age. The diameter of the lesions ranged between 1.1 and 9.8 cm (mean 3.9 cm). Their location corresponded to the following stations: higher paratracheal (4 cases), lower paratracheal (7), aortic window (12), para-aortic (6), subcarinal (9), paraesophageal (8), and hilar (5). In Group 1, 17 patients had previously diagnosed primary lung (9), breast (4), kidney (2), colon (1), and bladder (1) cancer. Fifteen of these punctures were positive for malignity. Two others were later submitted to mediastinoscopy, which identified metastases not detected by EUS-FNA. Group 2 comprised 34 patients. Among these patients, EUS-FNA diagnosed 22 neoplasms, five cases of tuberculosis and two duplication cysts. Cytology was inconclusive or without a specific diagnosis in five other cases. Mediastinoscopy identified two undiagnosed cases of oat-cell carcinoma, one lymphoma and one cryptococcosis, and confirmed one reactive lymphadenitis. There were no complications related to the method.
CONCLUSIONS
EUS-FNA obviated the need for surgical procedures in 86.3% of cases. Therefore, oncologists, pulmonologists, and thoracic surgeons should always remember the technique's potential and availability.
Topics: Adult; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Brazil; Carcinoma, Small Cell; Cross-Sectional Studies; Endosonography; Female; Humans; Lymph Nodes; Lymphoma; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Staging; Retrospective Studies; Ultrasonography, Interventional
PubMed: 22179163
DOI: 10.1590/s1807-59322011000900013