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Radiation Oncology (London, England) Nov 2016Clinical target volumes (CTV) for radiotherapy (RT) in esophageal cancer (EC) are based on standard expansions of primary tumor volume. Data is needed to define regions...
PURPOSE
Clinical target volumes (CTV) for radiotherapy (RT) in esophageal cancer (EC) are based on standard expansions of primary tumor volume. Data is needed to define regions at highest risk for occult disease, based on histology and location of the primary tumor. We therefore reviewed PET scans in EC patients to characterize the location of FDG-avid lymph node metastases (LNM).
MATERIALS AND METHODS
We identified 473 EC patients with reviewable pre-treatment PET-CT scans. Tumors were classified by histology and location; 85% were distal or GE junction tumors and 71% were adenocarcinoma. FDG-avid LNM were classified using standard radiographic nodal atlases, and distances from primary tumor to paraesophageal LNM were also measured.
RESULTS
The most common LNM in upper EC were supraclavicular, retrotracheal and paratracheal. The most common LNM in lower EC were paraesophageal and in the gastrohepatic space. Overall, 55% of paraesophageal LNM were adjacent to primary tumor. Of upper esophageal tumors with paraesophageal LNM, 87% were adjacent to the tumor and none were >6 cm from tumor. However, 57% of lower esophageal tumors with paraesophageal LNM had non-adjacent paraesophageal nodes, 24% of which were >8 cm from the tumor.
CONCLUSION
A more data-driven and individualized approach to CTV delineation could improve the therapeutic ratio of RT in esophageal cancer. These results can guide CTV delineation by indicating the potential distribution of nodal involvement in esophageal cancer.
Topics: Adult; Aged; Aged, 80 and over; Esophageal Neoplasms; Esophagogastric Junction; Female; Fluorodeoxyglucose F18; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Positron Emission Tomography Computed Tomography
PubMed: 27887643
DOI: 10.1186/s13014-016-0731-6 -
Folia Medica Cracoviensia 2017The main goal of this study was to investigate possible residua of thymic tissue in 100 adult cadavers with no thoracic pathology known before, by dissection of standard...
The main goal of this study was to investigate possible residua of thymic tissue in 100 adult cadavers with no thoracic pathology known before, by dissection of standard locations of thymic tissue in perithyroid, periaortic, peritracheal and retrotracheal spaces, as well as areas located next to the course of phrenic, vagus and left recurrent laryngeal nerves. Thus obtained tissue samples were studied by two pathologists independently. The remnants of the thymic tissue were found in 61 out of 100 specimens studied. It means that residua of ectopic thymic tissue is common, which may have a huge impact on the results of treatment of many diseases i.e. myasthenia gravis in course of thymoma.
Topics: Adult; Cadaver; Choristoma; Female; Humans; Male; Mediastinal Diseases; Myasthenia Gravis; Thymus Neoplasms
PubMed: 28608859
DOI: No ID Found -
Journal of Clinical and Diagnostic... Nov 2015An aberrant right subclavian artery arising as the last vessel of the arch of aorta is an uncommon anatomic anomaly with prevalence reported between 0.2% and 2.0%. In...
An aberrant right subclavian artery arising as the last vessel of the arch of aorta is an uncommon anatomic anomaly with prevalence reported between 0.2% and 2.0%. In 80% of the cases the aberrant right subclavian artery takes a retro-oesophageal course to the right upper limb. During routine dissection of cadavers for teaching undergraduate medical students an anomalous retrotracheal right subclavian artery which is a very rare vascular anomaly was encountered in a 35-year-old male cadaver. The artery arose as the last branch of the arch of aorta and coursed to the right between the trachea and oesophagus. The presence of this vascular anomaly could be an unusual cause of dysphagia and breathing difficulty. The clinical significance and embryological aspects of this vascular variant is discussed in this paper.
PubMed: 26673689
DOI: 10.7860/JCDR/2015/14931.6722 -
Endocrinology, Diabetes & Metabolism... Oct 2023We report a 61-year-old male patient without personal history of thyroid carcinoma or radiation exposure. In 2011, he presented with a cervical mass whose biopsy...
SUMMARY
We report a 61-year-old male patient without personal history of thyroid carcinoma or radiation exposure. In 2011, he presented with a cervical mass whose biopsy diagnosed a papillary thyroid carcinoma (PTC) in a lymph node metastasis (LNM). Total thyroidectomy with lymphadenectomy of central and ipsilateral compartment was performed. Histopathology identified a 2 mm follicular variant of PTC and LNM in 25/25 lymph nodes. The patient was treated with 150 mCi of radioactive iodine (RAI), followed by levothyroxine suppressive therapy. In 2016, a retrotracheal mass was diagnosed, suggesting local recurrence; patient was submitted to surgical excision and RAI therapy (120 mCi). Due to seizures, in 2019, a brain CT was performed that diagnosed brain metastases. The patient underwent debulking of the main lesion. Histopathology analysis confirmed a metastatic lesion with variated morphology: classical PTC and follicular pattern and hobnail and tall cell features. Molecular analysis revealed BRAFV600E in LNM at presentation and BRAFV600E and TERT promoter (TERTp) mutations in the recurrent LNM and brain metastasis. Based upon this experience we review the reported cases of subcentimetric PTC with brain metastases and discuss the molecular progression of the present case.
LEARNING POINTS
Papillary microcarcinoma (PMCs) usually have very good prognosis with low impact on patient survival. PMCs presenting in elderly patients with LNM at diagnosis may carry a guarded outcome. Brain metastasis although rare indicate aggressive phenotypic features. Patient risk stratification of PMCs based on histopathological analysis and genetic testing may have a significant impact on prognosis providing therapeutic markers, that may predict disease progression and overall outcome.
PubMed: 38108305
DOI: 10.1530/EDM-23-0025 -
World Journal of Gastroenterology May 2005A 42-year-old man presented with a two-year history of progressive dysphagia and hoarseness. Esophagogram and endoscopy revealed submucosal mass effect on the upper...
A 42-year-old man presented with a two-year history of progressive dysphagia and hoarseness. Esophagogram and endoscopy revealed submucosal mass effect on the upper esophagus. Computed tomography and magnetic resonance imaging revealed an elongated mass in the retrotracheal region of the lower neck with extension to the posterior mediastinum. Partial tumor resection and histopathological evaluation revealed a WHO type B2 thymoma. Adjuvant radiation and chemotherapy were subsequently administered resulting in complete tumor regression. To our knowledge, this is the first report of ectopic retrotracheal thymoma with clinical and imaging manifestations mimicking those for esophageal submucosal tumor.
Topics: Adult; Deglutition Disorders; Diagnosis, Differential; Esophageal Neoplasms; Hoarseness; Humans; Male; Thymoma; Thymus Neoplasms
PubMed: 15918212
DOI: 10.3748/wjg.v11.i20.3165 -
Folia Morphologica 2018Diving goitres can descend the cervical region expanding directly into the thoracic cavity. In most cases, diving goitres extend into the anterosuperior compartment, but...
Diving goitres can descend the cervical region expanding directly into the thoracic cavity. In most cases, diving goitres extend into the anterosuperior compartment, but they may also extend behind the trachea. We herein present a case of a male patient with retrotracheal goitre and history of left thyroid lobectomy and median sternotomy for thoracic aortic aneurysm repair with graft placement. After detailed preoperative evaluation, the patient underwent surgical resection of the mass through a combined approach; the existing cervical incision and a right posterolateral mini-thoracotomy. The postoperative course of the patient was uncomplicated. One year after surgery, the patient is asymptomatic and disease-free. (Folia Morphol 2018; 77, 1: 166-169).
Topics: Aged; Aortic Aneurysm, Thoracic; Goiter; Humans; Male; Thoracic Cavity; Thyroid Gland; Thyroidectomy; Tomography, X-Ray Computed; Trachea
PubMed: 28832090
DOI: 10.5603/FM.a2017.0072 -
International Journal of Clinical and... 2015Cervical and mediastinal hemorrhaging caused by a spontaneous rupture of a parathyroid adenoma has been rarely reported. Herein, we report a case of a 52-year-old woman...
Cervical and mediastinal hemorrhaging caused by a spontaneous rupture of a parathyroid adenoma has been rarely reported. Herein, we report a case of a 52-year-old woman who experienced a sudden onset of cervical and mediastinal bleeding related to a parathyroid adenoma. The patient had a history of trauma to the left thorax with a fracture of two ribs. Ultrasonography and computer tomography revealed a nodule in the retrotracheal space and hematoma of the bilateral trachea and thorax. Laboratory examinations revealed significant hypercalcemia, hypophosphatemia, and a high level of intact parathyroid hormone. Surgery was performed and a dark-red, soft tumor was found behind the trachea, which adhered to the surrounding tissues. The pathological diagnosis was a parathyroid adenoma with hemosiderin deposition and fibrosis.
PubMed: 26885150
DOI: No ID Found -
BMJ Case Reports May 2016
Topics: Aged; Airway Obstruction; Aorta; Constriction, Pathologic; Hematoma; Humans; Intubation, Intratracheal; Male; Trachea; Wounds, Nonpenetrating
PubMed: 27226128
DOI: 10.1136/bcr-2016-215828 -
Annals of Palliative Medicine Apr 2022An esophageal stricture is an abnormal esophageal narrowing, usually caused by esophageal diseases and rarely by lung cancer. They cause malnutrition, performance status...
An esophageal stricture is an abnormal esophageal narrowing, usually caused by esophageal diseases and rarely by lung cancer. They cause malnutrition, performance status (PS) deterioration, and difficulty in the oral administration of antitumor drug tablets. A 78-year-old female patient with lung adenocarcinoma, harboring an epidermal growth factor receptor (EGFR)-sensitizing mutation, experienced dysphagia due to an esophageal stricture caused by retrotracheal lymph node metastases. Osimertinib is a third-generation EGFR-tyrosine kinase inhibitor that is efficacious against EGFR-sensitizing mutations. The esophageal stricture hampered food intake and oral administration of osimertinib, causing severe malnutrition and deterioration to PS 3. Esophagogastroduodenoscopy (EGD) revealed severe and entire circumferential stenosis (7 cm in length) of the upper esophagus without mucosal abnormality. A nasogastric tube was inserted under EGD guidance, and an osimertinib suspension was administered accordingly: a tablet containing 80 mg of osimertinib was suspended in 50 mL of sterile hot water (55 ℃) for ten minutes, and the suspension was administered through a nasogastric tube once daily. Dysphagia improved 15 days after the introduction of osimertinib. After 21 days, the patient could take foods and drugs orally, and her PS improved to 1. Administering an osimertinib suspension via a nasogastric tube was a viable option in managing esophageal strictures in patients with EGFR-sensitizing mutations.
Topics: Acrylamides; Aged; Aniline Compounds; Carcinoma, Non-Small-Cell Lung; Deglutition Disorders; ErbB Receptors; Esophageal Stenosis; Female; Humans; Lung Neoplasms; Malnutrition; Mutation
PubMed: 34263613
DOI: 10.21037/apm-21-940 -
Tuberkuloz Ve Toraks 2011The aim of this study was to determine whether or not radial probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is superior to... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim of this study was to determine whether or not radial probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is superior to conventional TBNA in the diagnosis of mediastinal lymphadenopathies in routine clinical practice. Consecutive patients, who were referred for TBNA, were randomized to conventional TBNA and EBUS-guided TBNA groups. Patients were also grouped according to the anatomic location of the pathologic lymph nodes to evaluate if there was a difference in the diagnostic yield with respect to lymph node station. Patients with subcarinal lymph nodes were designated as group A and patients with lymph nodes at station 2 (upper paratracheal), 3 (prevascular and retrotracheal), and 4 (lower paratracheal) were designated as group B. A 21-G aspiration needle was used during the procedure. Sixty patients with a mean age of 56.15 ± 15.32 years were included in the study. Thirty patients each underwent EBUS-TBNA and conventional TBNA. The overall diagnostic yield of conventional TBNA was 33.3% (10/30), while EBUS-TBNA had a yield of 66.7% (20/30; p= 0.010). In patients with subcarinal lymph nodes, the yield of conventional TBNA was 33.3% (4/12) compared to 62.5% (5/8) in the EBUS-guided group (p= 0.362). In patients with mediastinal lymph nodes other than subcarinal lymph nodes, EBUS-TBNA had a significantly higher yield compared to conventional TBNA [33.3% (6/18) vs. 68.2% (15/22) for conventional and EBUS-TBNA groups, respectively; p= 0.028]. In conclusion, the diagnostic yield of EBUS-TBNA was superior to the yield of conventional TBNA at stations other than subcarinal region. We suggest that EBUS is a useful tool to guide TBNA in the evaluation of mediastinal lymph nodes.
Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Bronchoscopy; Female; Humans; Lymph Nodes; Lymphatic Diseases; Lymphatic Metastasis; Male; Mediastinal Diseases; Mediastinum; Middle Aged; Ultrasonography, Interventional; Young Adult
PubMed: 21740390
DOI: 10.5578/tt.2403