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Hormones (Athens, Greece) Mar 2022In this article, we present a case of neuroendocrine neoplasm of unknown primary origin (UPO NEN), which is a rare cause of ectopic Cushing's syndrome (ECS) presenting... (Review)
Review
BACKGROUND
In this article, we present a case of neuroendocrine neoplasm of unknown primary origin (UPO NEN), which is a rare cause of ectopic Cushing's syndrome (ECS) presenting numerous challenges, together with a literature review.
CASE REPORT
A 43-year-old male patient presented with clinical features consistent with Cushing's syndrome (CS) and adrenocorticotropic hormone (ACTH)-dependent hypercortisolemia. Despite a suspicious lesion on pituitary MRI, the high-dose dexamethasone suppression test and bilateral inferior petrosal sinus sampling results were not compatible with Cushing's disease. Bilateral non-homogeneous opacities were observed in the thorax CT of the patient, who also had a history of COVID-19 infection, but no tumoral lesion was detected. When Ga-SSTR PET/CT and FDG-PET/CT were performed, multiple metastatic foci were detected in mediastinal and hilar lymph nodes and the axial skeleton. Paratracheal-subcarinal lymph nodes were excised mediastinoscopically, and the diagnosis of NEN was made. Histopathological findings indicated that the possible origin was an atypical pulmonary carcinoid with a low Ki-67 labeling index. After controlling hypercortisolemia, a regimen of somatostatin analogs and capecitabine plus temozolomide was decided upon as treatment by a multidisciplinary council.
CONCLUSION
This is a challenging case of UPO NEN presenting with ECS and confounding factors, such as previous infection and incidental lesions, during the diagnosis process. The case in question highlighted the fact that atypical pulmonary carcinoid with a low proliferation index may cause visible metastases even when radiologically undetectable.
Topics: ACTH Syndrome, Ectopic; Adrenocorticotropic Hormone; Adult; COVID-19; Carcinoid Tumor; Cushing Syndrome; Humans; Lung Neoplasms; Male; Neoplasms, Unknown Primary; Neuroendocrine Tumors; Positron Emission Tomography Computed Tomography
PubMed: 34478059
DOI: 10.1007/s42000-021-00316-z -
Journal of Thoracic Oncology : Official... Apr 2007The development of a two-bladed spreadable videomediastinoscope in 1992 allowed increased exposure and bimanual dissection of mediastinal structures. Concurrent with...
BACKGROUND
The development of a two-bladed spreadable videomediastinoscope in 1992 allowed increased exposure and bimanual dissection of mediastinal structures. Concurrent with technical progress in mediastinoscopy, neoadjuvant treatment of stage III lung cancer was introduced, and accuracy of pretreatment mediastinal staging became a topic at issue. In this setting, development of a videomediastinoscopic technique for complete mediastinal lymphadenectomy was the obvious thing to do.
METHODS
Video-assisted mediastinoscopic lymphadenectomy (VAMLA) dissection is guided by anatomical landmarks, very similar to open lymphadenectomy. It includes en bloc resection of the right and central compartments and dissection and lymphadenectomy of the left-sided compartments. In a preliminary case-control study of 40 patients, VAMLA technique was standardized and evaluated against open lymphadenectomy. A second study investigated 130 patients with resectable lung cancer and radiographically normal mediastinum who underwent VAMLA and consecutive lung resection with mediastinal reexploration.
RESULTS
VAMLA harvested significantly more nodes than open lymphadenectomy. With a mean duration of 54 minutes and a complication rate of 4.6%, VAMLA appeared applicable to clinical routine. We noted a sensitivity of 93.8%, a specificity of 100%, and a false-negative rate of 0.9%.
CONCLUSIONS
In our experience, VAMLA is a feasible method of mediastinal staging. Its accuracy and radicality can equal open lymphadenectomy. However, VAMLA is minimally invasive and therefore pretherapeutically available. Its advantages might be of interest with neoadjuvant strategies, trials, involved field radiation, video-assisted thoroscopic lobectomy, and left-sided tumors.
Topics: Carcinoma, Non-Small-Cell Lung; Cohort Studies; Female; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Male; Mediastinoscopy; Neoplasm Staging; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Thoracic Surgery, Video-Assisted
PubMed: 17409814
DOI: 10.1097/01.JTO.0000263725.89512.d7 -
Surgical Case Reports Sep 2022Mediastinal foreign bodies might cause mediastinal organ injury or mediastinal abscess. The prompt removal surgery of mediastinal foreign bodies is needed to prevent...
BACKGROUND
Mediastinal foreign bodies might cause mediastinal organ injury or mediastinal abscess. The prompt removal surgery of mediastinal foreign bodies is needed to prevent those complications. We report a case in which a mediastinal foreign body was removed by video-mediastinoscopy.
CASE PRESENTATION
The patient, a 74-year-old man with a chief complaint of hoarseness, was referred to our department for surgical management of a wooden foreign body that had traumatically migrated into the superior mediastinum. During the surgery, the video-mediastinoscopy was introduced under the pneumomediastinal pressure. We could dissect the scar tissue and remove the azalea tree branch safely and carefully, without damaging the other mediastinal organs. He was discharged on postoperative day 5, with no complications.
CONCLUSIONS
Video-mediastinoscopic approach under pneumomediastinal pressure is minimally invasive and could provide wide surgical view. Therefore, we consider it useful and effective for removal of foreign bodies in the mediastinum.
PubMed: 36138272
DOI: 10.1186/s40792-022-01525-3 -
Mediastinum (Hong Kong, China) 2019The aim of this study was to retrospectively evaluate long-term survival of stage IIIA-N2 non-small cell lung cancer patients operated after induction chemotherapy or...
BACKGROUND
The aim of this study was to retrospectively evaluate long-term survival of stage IIIA-N2 non-small cell lung cancer patients operated after induction chemotherapy or chemoradiotherapy and negative mediastinal restaging with transcervical extended mediastinal lymphadenectomy (TEMLA).
METHODS
From January 2007 to December 2013, 48 stage IIIA-N2 non-small cell lung cancer (NSCLC) patients (36 men, 12 women) underwent anatomic pulmonary resection after induction therapy and negative result of mediastinal restaging with TEMLA. Mean age was 58.3 years (range, 46-75 years). There were 28 squamous cell carcinomas, 13 adenocarcinomas, 1 mixed carcinoma and 6 non-small cell lung cancers. Neoadjuvant chemotherapy was given in 24 patients, chemoradiotherapy in 23 and chemotherapy with bradytherapy in 1 patient. All patients were followed-up until death or 60 months since pulmonary resection.
RESULTS
There were 29 pneumonectomies, 2 lower bilobectomies and 17 lobectomies. 2 patients had R1 resection. After negative TEMLA, persistent metastatic N2 nodes were discovered in 5 patients (10.4%). The only complication after TEMLA was bilateral vocal cord paralysis observed in 1 patient (2.1%); 2 patients died in early postoperative period due to bronchial fistula (4.2%). Overall 5-year survival of patients operated after negative TEMLA was 39.5%. 5-year survival was not statistically different in patients who underwent lobectomy/bilobectomy and in patients who underwent pneumonectomy (47.4% . 34.5%). Five-year survival was lower in patients after chemoradiotherapy than in patients after chemotherapy alone (21.7% . 56.0%, P=0.022). 5-year survival was not statistically different in patients with true mediastinal downstaging and in patients with false negative TEMLA (41.9% . 20%, P=0.19).
CONCLUSIONS
Stage IIIA-N2 non-small cell lung cancer patients who underwent pulmonary resection after induction treatment and negative mediastinal restaging with TEMLA showed good long-term survival. In these patients aggressive surgery, including pneumonectomy, lead to satisfactory outcomes. However, prognosis of patients after induction chemoradiotherapy was worse.
PubMed: 35118266
DOI: 10.21037/med.2019.09.01 -
Journal of Korean Medical Science Feb 2010Mycobacteruim kansasii occasionally causes disseminated infection with poor outcome in immunocompromised patients. We report the first case of disseminated M. kansasii... (Review)
Review
Mycobacteruim kansasii occasionally causes disseminated infection with poor outcome in immunocompromised patients. We report the first case of disseminated M. kansasii infection associated with multiple skin lesions in a 48-yr-old male with myelodysplastic syndrome. The patient continuously had taken glucocorticoid during 21 months and had multiple skin lesions developed before 9 months without complete resolution until admission. Skin and mediastinoscopic paratracheal lymph node (LN) biopsies showed necrotizing granuloma with many acid-fast bacilli. M. kansasii was cultured from skin, sputum, and paratracheal LNs. The patient had been treated successfully with isoniazid, rifampin, ethmabutol, and clarithromycin, but died due to small bowel obstruction. Our case emphasizes that chronic skin lesions can lead to severe, disseminated M. kansasii infection in an immunocompromised patient. All available cases of disseminated M. kansasii infection in non HIV-infected patients reported since 1953 are comprehensively reviewed.
Topics: Antitubercular Agents; Clarithromycin; Glucocorticoids; Humans; Immunocompromised Host; Isoniazid; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Myelodysplastic Syndromes; Rifampin; Skin Diseases, Bacterial; Sputum; Sweet Syndrome
PubMed: 20119588
DOI: 10.3346/jkms.2010.25.2.304 -
Journal of Korean Medical Science Apr 2006This is to examine whether aggressive multimodality therapy improves the treatment outcomes in stage IIIA non-small cell lung cancer (NSCLC). Fifty-three consecutive...
This is to examine whether aggressive multimodality therapy improves the treatment outcomes in stage IIIA non-small cell lung cancer (NSCLC). Fifty-three consecutive NSCLC patients with N2 disease, confirmed by mediastinoscopic biopsy, received preoperative thoracic radiation therapy (45 Gy/5 weeks) concurrent with two cycles of oral etoposide and intravenous cisplatin and surgery. Postoperative radiation therapy (PORT, 18 Gy/2 weeks) was optionally recommended for those with the risk factors of loco-regional recurrence based on the surgical and pathological findings. Surgical resection was performed in 38 patients (71.7%), and down-staging was achieved in 19 patients (50%). The median survival period was 27 months in 38 patients who underwent resection, and the rates at 3-yr of overall survival, loco-regional control, distant metastasis-free survival, and disease-free survival were 44.3%, 87.9%, 32.9%, and 29.3%. Significantly favorable factor regarding overall survival was achieving p0/I stage by the multivariate analysis. PORT was successful in reducing locoregional recurrences in patients with the risk factors. Current preoperative concurrent radiochemotherapy and surgery by the authors resulted in comparable survival with other reports, however, further refinement of multimodality approach may be warranted for more effective reduction of distant metastasis.
Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Non-Small-Cell Lung; Combined Modality Therapy; Disease-Free Survival; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Prognosis; Survival Rate; Time Factors; Treatment Failure
PubMed: 16614506
DOI: 10.3346/jkms.2006.21.2.229 -
Surgery Today 2008Video-assisted surgery for esophageal cancer is an advanced surgical technique. It has been developed on the basis of the concept of minimally invasive surgery. Given...
Video-assisted surgery for esophageal cancer is an advanced surgical technique. It has been developed on the basis of the concept of minimally invasive surgery. Given that there are several options regarding the operative procedures for thoracic esophageal cancer, several laparoscopic approaches have been proposed. The first video-assisted thoracoscopic esophagectomy through a right thoracoscopic approach and the first transhiatal esophagectomy were reported in the early 1990s. A mediastinoscope-assisted esophagectomy has also been reported as a substitute for a blunt dissection of the esophagus. Moreover, a video-assisted Ivor-Lewis esophagectomy by right thoracotomy with intrathoracic anastomosis has also been performed. Furthermore, laparoscopic gastric mobilization and gastroplasty are also widely accepted substitutions for open laparotomy. This article reviews the literature on the laparoscopic approaches for esophageal cancer.
Topics: Adenocarcinoma; Esophageal Neoplasms; Esophagectomy; Humans; Lymph Node Excision; Robotics; Thoracic Surgery, Video-Assisted; Thoracoscopy; Video-Assisted Surgery
PubMed: 18306993
DOI: 10.1007/s00595-007-3606-5 -
Journal of Thoracic Disease Jul 2015The purpose of this study was to detect the feasibility, safety, and effectiveness of mediastinoscopic esophagectomy for early esophageal cancer.
OBJECTIVE
The purpose of this study was to detect the feasibility, safety, and effectiveness of mediastinoscopic esophagectomy for early esophageal cancer.
METHODS
The clinical data of 194 patients who underwent mediastinoscopic esophagectomy for early esophageal cancer in our center from December 2005 to October 2014 were retrospectively analyzed.
RESULTS
All the surgery was performed successfully. The average duration of thoracic surgery was 48.2±7.8 min and the average intra-operative blood loss was 128.1±34.5 mL. An average of 3.1±1.6 lymph node stations were dissected, with an average number of dissected lymph nodes being 9.38±6.2, among which 4.2±5.4 were mediastinal lymph nodes. No peri-operative mortality was noted, and the rate of peri-operative morbidity was 13.4%. The median duration of follow-up was 39 [3-108] months, and the overall survival was 72.73%. The overall survival rates significantly differed among different T stages; more specifically, the 5-year survival was 95.23% in patients with stage T1a esophageal cancer, 70.15% for T1b, and 55.56% for T2 (P<0.001). The overall survival was significantly better in patients with negative lymph nodes than those with lymph nodes metastasis (P=0.003); more specifically, the 5-year survival rate was 84.9% for N0, 62.5% for N1, and 50.0% for N2 + N3.
CONCLUSIONS
The mediastinoscopic esophagectomy can achieve a similar effectiveness as the conventional thoracoscopic surgery for patients with early stage esophageal cancer.
PubMed: 26380740
DOI: 10.3978/j.issn.2072-1439.2015.07.20 -
Journal of Surgical Oncology Apr 2022Transcervical inflatable mediastinoscopic esophagectomy (TIME) is a novel method of minimally invasive esophagectomy (MIE) for esophageal cancer. However, whether TIME...
Transcervical inflatable mediastinoscopic esophagectomy versus thoracoscopic esophagectomy for local early- and intermediate-stage esophageal squamous cell carcinoma: A propensity score-matched analysis.
BACKGROUND AND OBJECTIVE
Transcervical inflatable mediastinoscopic esophagectomy (TIME) is a novel method of minimally invasive esophagectomy (MIE) for esophageal cancer. However, whether TIME is effective and feasible as conventional MIE remains unclear. This study aimed to evaluate the efficacy of TIME by comparing it with thoracoscopic esophagectomy (TE).
METHODS
Surgical outcomes and relapse-free survival (RFS) rates of patients with local early- or intermediate-stage thoracic esophageal squamous cell carcinoma that underwent TIME or TE from January 2017 to December 2019 were analyzed in this retrospective study. Propensity score matching was used to control the confounding factors.
RESULTS
The mean operation time in TIME was shorter than that in TE (p < 0.05). Patients in the TIME group achieved postoperative ambulation earlier than those in the TE group (p < 0.05). The rate of pulmonary complications was lower in TIME than in TE (p < 0.05). The number of lymph nodes harvested during surgery and the RFS rates of two groups did not have significant differences.
CONCLUSION
TIME may be a feasible and safe method to treat local early- and intermediate-stage thoracic esophageal squamous cell carcinoma effectively and it could be a supplementary surgical method of TE for patients with poor pulmonary function or cannot undergo TE.
Topics: Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Esophagectomy; Humans; Postoperative Complications; Propensity Score; Retrospective Studies; Thoracoscopy; Treatment Outcome
PubMed: 35066884
DOI: 10.1002/jso.26798 -
Mediastinum (Hong Kong, China) 2019Studies in larger populations and long-term outcomes of Mediastinoscopic esophagectomy (ME) were needed. The aim of this study was to report the long-term survival and...
BACKGROUND
Studies in larger populations and long-term outcomes of Mediastinoscopic esophagectomy (ME) were needed. The aim of this study was to report the long-term survival and surgical process for reducing the postoperative complications after ME.
METHODS
From December 2005 to March 2018, 269 patients diagnosed with esophageal squamous cell carcinoma were participated for ME in our center, while we improved the surgical process in November 1st 2014, clinical data was collected and analyzed.
RESULTS
The overall survival rate after ME was 60.3% at 10-year and 69.2% at 5-year, and the survival curve was markedly associated with T and N stages. N stage resulted in lower survival time, while the median survival was 36 months. After Nov. 2014, the positive rate of lymph nodes around left recurrent laryngeal nerve (LRLN) was increased from 6.7% to 14.5% (P<0.05), and the morbidity of vocal cord paralysis decreased from 9.8% to 3.9% (P<0.05), while the incidence of anastomotic fistula decreased from 15% to 5.3% in ME (P<0.05), compared with the data before Nov. 2014.
CONCLUSIONS
ME was an effective surgical method for esophageal cancer. The processes of isolating and marking the LRLN and reinforcing the posterior wall of anastomosis were proved valuable for improvement of postoperative complications.
PubMed: 35118262
DOI: 10.21037/med.2019.08.01