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International Journal of Clinical and... 2017Sclerosing thymoma is a rare variant of thymomas, recently recognized in pathology. Since its first description in 1994, only 15 cases have been reported. Furthermore,...
Sclerosing thymoma is a rare variant of thymomas, recently recognized in pathology. Since its first description in 1994, only 15 cases have been reported. Furthermore, osseous metaplasia in sclerosing thymoma is an even unusual characteristic. To date, only 7 such cases have been described, while half of them show the symptom of myasthenia gravis. Herein we present a 57-year-old female with ossifying sclerosing thymoma and myasthenia gravis, which is the first case in literature of type B3 sclerosing thymoma with extensive ossification and myasthenia gravis. In consideration of its rarity, awareness of the possible occurrence of extensive ossification and sclerosis in thymomas helps to avoid a diagnostic pitfall, especially in mediastinoscopic biopsy specimens.
PubMed: 31966408
DOI: No ID Found -
Journal of Thoracic Disease Jun 2014The purpose of this study was to explore the indications of radical vedio-assisted mediastinoscopic resection for esophageal cancer.
OBJECTIVE
The purpose of this study was to explore the indications of radical vedio-assisted mediastinoscopic resection for esophageal cancer.
METHODS
The data of 109 patients with T1 esophageal cancer who underwent video-assisted mediastinoscopic resection (VAMS group) in Third Affiliated Hospital of Soochow University Hospital from December 2005 to December 2011 were collected in the study for comparison with the 58 patients with T1 esophageal cancer who underwent video-assisted thoracoscopic surgery (VATS group) in Zhongshan Hospital, Fudan University. The perioperative safety and survival were compared between the two groups.
RESULTS
All operations were successful in both groups. One perioperative death was noted in the VATS group. The incidences of post-operative complications were not significantly different between these two groups, whereas the VAMS group was favorable in terms of operative time (P<0.001) and blood loss (P<0.001), and a significantly larger number of chest lymph nodes were dissected in the VATS group compared with the VAMS group (P<0.001). Long-term follow-up showed that the overall survival was not significantly different between these two groups (P=0.876).
CONCLUSIONS
T1N0M0 esophageal cancer can be as the indication of VAMS radical resection. VAMS radical resection can be considered as the preferred option for patients with poor pulmonary and cardiac function or a history of pleural disease.
PubMed: 24976988
DOI: 10.3978/j.issn.2072-1439.2014.06.29 -
Turk Patoloji Dergisi May 2011Sarcoidosis is a systemic granulomatous inflammation that occurs as a result of disturbed immune regulation in individuals exposed to certain environmental agents....
OBJECTIVE
Sarcoidosis is a systemic granulomatous inflammation that occurs as a result of disturbed immune regulation in individuals exposed to certain environmental agents. Although tissue sampling is considered the "gold standard" for the diagnosis of sarcoidosis, a medically treated disease, minimally invasive diagnostic methods are preferred instead of surgical tissue sampling. Transbronchial needle aspiration has been reported as an effective diagnostic method.
MATERIAL AND METHOD
In this study, transbronchial needle aspiration cytology samples were assessed from 38 patients where sarcoidosis was suspected clinically and radiologically. The existence of epithelioid histiocytes and/or giant cells that formed granulomas was used as a cytological diagnostic criterion for chronic granulomatous inflammation. The presence of lymphocytes and/or germinal center cells, and of histiocytes in lymph nodes was regarded as adequate sampling criteria.
RESULTS
A total of 31 out of the 38 patients were diagnosed as sarcoidosis with clinical, radiological and microbiological findings, after chronic granulomatous inflammation was considered by cytologic assessment. Cytologic diagnosis was achieved in: 4 of 7 patients with sampling from a single lymph node region, 25 of 28 patients with sampling from two different lymph node regions and 2 of 3 patients with sampling from three different lymph node regions. Two of the 7 patients who could not be diagnosed cytologically underwent a transbronchial parenchyma biopsy and the rest were diagnosed histologically from mediastinoscopic lymph node sampling.
CONCLUSION
We would like to emphasize that transbronchial needle aspiration is a successful diagnostic method. We highlighted the adequacy criteria of cytological sampling and the encountered cytological findings of chronic granulomatous inflammation.
Topics: Adult; Aged; Biopsy, Fine-Needle; Bronchi; Female; Humans; Male; Middle Aged; Sarcoidosis, Pulmonary
PubMed: 21630202
DOI: 10.5146/tjpath.2011.01064 -
Tuberculosis and Respiratory Diseases Dec 2012A 55-year-old woman was admitted for an elevated serum carbohydrate antigen-125 (CA-125) level, and a left pleural effusion, which were detected at a routine health...
A 55-year-old woman was admitted for an elevated serum carbohydrate antigen-125 (CA-125) level, and a left pleural effusion, which were detected at a routine health examination. Computed tomography of the chest was performed upon admission, revealing extensive bilateral paratracheal and mediastinal lymph node enlargement with a massive left-sided pleural effusion. Subsequent analysis of the pleural fluid demonstrated consistency with an exudate, no evidence of malignant cells, and a normal adenosine deaminase. However, the pleural fluid and serum CA-125 levels were 2,846.8 U/mL and 229.5 U/mL, respectively. A positron emission tomography did not reveal any primary focus of malignancy. Finally, a surgical mediastinoscopic biopsy of several mediastinal lymph nodes was performed, revealing non-necrotizing granulomas, consistent with sarcoidosis. After a month of treatment of prednisolone, the left pleural effusion had resolved, and after 2 months the serum CA-125 level was normalized.
PubMed: 23319994
DOI: 10.4046/trd.2012.73.6.320 -
The Journal of Thoracic and... Mar 1995From October 1989 to February 1992, 74 patients with mediastinoscopically staged IIIA (N2) non-small-cell lung cancer from 30 CALGB-affiliated hospitals received two... (Clinical Trial)
Clinical Trial
Results of cancer and leukemia group B protocol 8935. A multiinstitutional phase II trimodality trial for stage IIIA (N2) non-small-cell lung cancer. Cancer and Leukemia Group B Thoracic Surgery Group.
From October 1989 to February 1992, 74 patients with mediastinoscopically staged IIIA (N2) non-small-cell lung cancer from 30 CALGB-affiliated hospitals received two cycles of preresectional cisplatin and vinblastine chemotherapy. Patients with responsive or stable disease underwent standardized surgical resection and radical lymphadenectomy. Patients who underwent resection received sequential adjuvant therapy with two cycles of cisplatin and vinblastine, followed by thoracic irradiation (54 Gy after complete resection and 59.4 Gy after incomplete resection or no resection at 1.8 Gy per fraction). There were no radiographic complete responses to the neoadjuvant chemotherapy, although 65 (88%) patients had either a response or no disease progression. During induction chemotherapy, disease progressed in seven patients (9%). Sixty-three patients (86%) had exploratory thoracotomy, and 46 of those (75%) had resectable lesions. A complete surgical resection was accomplished in 23 patients, and 23 patients had an incomplete resection with either a diseased margin or diseased highest node resected. Operative mortality was 3.2% (2/63). In 10 patients (22% of the 46 having resection) the disease was pathologically downstaged. There was no correlation between radiographic response to the induction chemotherapy and downstaging at surgical resection. The full protocol was completed by 33 patients (45% of original cohort). Overall survival at 3 years was 23%. Patients undergoing resection had significantly improved survival at 3 years compared with patients not having resection: 46% for complete resection (median 20.9 months), 25% for incomplete resection (median 17.8 months), and 0% for no resection (median 8.5 months). Five deaths occurred during the treatment period. A total of 18 of the 46 (39%) patients who underwent resection are either alive and disease-free or have died without recurrence.
Topics: Aged; Carcinoma, Non-Small-Cell Lung; Chemotherapy, Adjuvant; Cisplatin; Disease-Free Survival; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Radiotherapy, Adjuvant; Remission Induction; Survival Analysis; Vinblastine
PubMed: 7877308
DOI: 10.1016/s0022-5223(95)70278-4 -
Journal of Thoracic Disease Jun 2014Takayasu's arteritis (TA) is a rare chronic large-vessel vasculitis. The early diagnosis is difficult, because of lack of characteristic clinical manifestations. In this...
Takayasu's arteritis (TA) is a rare chronic large-vessel vasculitis. The early diagnosis is difficult, because of lack of characteristic clinical manifestations. In this paper, we reported a TA case of young female was misdiagnosed as mediastinal malignant lymphoma and mediastinoscope biopsy was performed. The biopsy result demonstrated that thickened tissue adjacent to the aortic arch pathological presentations were in accord with TA. Glucocorticoid was administrated and the condition was greatly improved after treatment. Therefore, we reported this case and review of the pertinent literature in order to help clinicians improve the understanding of TA and PET/CT manifestations of TA at early phase to realize the early diagnosis and treatment of TA, finally reducing the hazards.
PubMed: 24977018
DOI: 10.3978/j.issn.2072-1439.2014.04.13 -
Journal of Cardiothoracic Surgery Jun 2012The tumorous infiltration or carcinosis of the pericardium could cause pericardial effusion in up to one-third of cases of malignancy, thus potentially interfere with...
BACKGROUND
The tumorous infiltration or carcinosis of the pericardium could cause pericardial effusion in up to one-third of cases of malignancy, thus potentially interfere with the otherwise desirable oncological treatment. The existing surgical methods for the management of pericardial fluid are well-established but are not without limitations in the symptomatic relief of malignant pericardial effusion (MPE). The recurrence rate ranges between 43 and 69% after pericardiocentesis and 9 to 16% after pericardial drainage. The desire to overcome relative limitations of the existing methods led us to explore an alternative approach.
METHODS
The standard armamentarium of the Carlens collar mediastinoscopy procedure was utilized in a Chamberlain parasternal approach of the pericardial sac. The laterality of approach was decided based upon the pleural involvement, as tumor-free pericardiopleural reflection is required. A pericardio-pleural window at least 3 cm in diameter was created. From January 2000 to December 2009, 22 cases were operated on with mediastinoscope-controlled parasternal fenestration (MCPF). Considering the type of the primary tumor, there were 11 lung cancer, 6 breast cancers, 2 haematologic malignancies and in 3 patients the origin of malignancy could not be verified.
RESULTS
There were no operative deaths. We lost one patient (4.5%) in the postoperative hospital period. All of the surviving patients had a minimum of 2 months of symptom-free survival. We detected transient recurrence of MPE in one patient (4.5%) 14 days after the MCPF, which disappeared spontaneously after 24 hours.
CONCLUSION
The MCPF offers a real alternative in certain cases of pericardial effusion. We recommend this method especially for the definitive surgical palliation of MPE.
Topics: Adult; Aged; Female; Heart Neoplasms; Humans; Kaplan-Meier Estimate; Male; Mediastinoscopy; Middle Aged; Neoplasms; Pericardial Effusion; Pericardial Window Techniques
PubMed: 22713743
DOI: 10.1186/1749-8090-7-56 -
Korean Journal of Anesthesiology Jul 2012Biopsy, using mediastinoscopy is commonly employed for accurate histologic diagnosis of a mediastinal mass. However, since the mass is not removed during the procedure,...
Biopsy, using mediastinoscopy is commonly employed for accurate histologic diagnosis of a mediastinal mass. However, since the mass is not removed during the procedure, it may cause compression of vital structures such as major airways, the heart, the pulmonary artery, and the superior vena cava after surgery. We observed a case of a 66-year-old man with a mediastinal mass that caused severe airway obstruction during recovery from anesthesia following mediastinoscopic biopsy, probably caused by upper airway edema which seemed to originate from compression of the superior vena cava. Therefore, we suggest that unexpected airway obstruction in a patient with a mediastinal mass can be due to superior vena cava compression.
PubMed: 22870368
DOI: 10.4097/kjae.2012.63.1.65 -
Korean Journal of Anesthesiology Jul 2010There are many causes of prolonged postoperative muscle weakness, including drugs, residual anesthetics, cerebrovascular events, electrolyte imbalance, hypothermia, and...
There are many causes of prolonged postoperative muscle weakness, including drugs, residual anesthetics, cerebrovascular events, electrolyte imbalance, hypothermia, and neuromuscular disease. Neuromuscular diseases are relatively rare, with the most common being myasthenia gravis and Lambert-Eaton myasthenic syndrome (LEMS). We report an unusual case in which a patient who was given a muscle relaxant during mediastinoscopy developed postoperative muscle weakness that was ultimately diagnosed as secondary to LEMS.
PubMed: 20651998
DOI: 10.4097/kjae.2010.59.1.45 -
A fluorodeoxyglucose avid mediastinal parathyroid adenoma masquerading as metastatic bladder cancer.Interactive Cardiovascular and Thoracic... Sep 2012A 64-year old male with a prior medical history of bladder transitional cell carcinoma treated with a cystoprostatectomy and adjuvant platinum-based chemotherapy 10...
A 64-year old male with a prior medical history of bladder transitional cell carcinoma treated with a cystoprostatectomy and adjuvant platinum-based chemotherapy 10 years earlier underwent a surveillance positron emission tomography (PET) scan that revealed a metabolically active 2-cm nodule in the superior mediastinum, anterior to the origin of the innominate artery. The lesion was removed due to concerns of metastatic disease using a cervical mediastinoscope. Final pathology revealed an ectopic mediastinal parathyroid adenoma. The combination of the rare presentation, uncommon surgical approach and pathology makes this case unique.
Topics: Carcinoma, Transitional Cell; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Male; Mediastinal Neoplasms; Middle Aged; Parathyroid Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Urinary Bladder Neoplasms
PubMed: 22645294
DOI: 10.1093/icvts/ivs232