A 51-Year-Old Man With a Large Posterior Mediastinal Mass.

CASE PRESENTATION: A 51-year-old White male never-smoker presented with intermittent cough and progressive dyspnea. His symptoms started after an exposure to bat guano while cleaning his attic approximately 9 months earlier. He has received several courses of antibiotic and corticosteroid for these symptoms, with short-term relief.

A Case of Lymphangiomatosis With Infected Lymphangiomas Effectively Treated by Thoracoscopic Debridement and Drainage.

A 40-year-old woman with lymphangiomatosis also had an intrathoracic lymphangioma infection. Since the age of 8 years, the patient had undergone repeated abdominal and mediastinal cyst surgeries and had received a diagnosis of lymphangiomatosis. At this time, she showed a high fever of 38.5°C. Cultures of both blood and fluid aspirated from the cyst were positive for Staphylococcus aureus. Chest CT imaging revealed an enlarged right-sided mediastinal cystic lymphangioma with new septa in it. A chest tube was inserted into the cyst to remove effusion. The patient was then started with the antibacterial drug cefazolin at 3 g/d. But effective drainage was difficult because of the high viscosity of the effusion and septa working as barriers. We removed these components with endoscopic surgical instruments and via a pulsed-lavage system under general anesthesia. Postoperative CT images showed reexpanded lung structure and reduced cyst size. The patient has taken a favorable course for 2 years.

Mediastinal desmoplastic small round cell tumor.

RATIONALE: Desmoplastic small round cell tumor (DSRCT) is a rare distinct tumor with a high-grade malignancy. PATIENT CONCERNS: A 51-year-old male visited a local hospital in April 2016 complaining of shortness of breath, chest tightness and pain, and exhibited significant swelling in both sides of the chest. DIAGNOSES: CT demonstrated thoracic symmetry and no abnormalities were observed in the soft tissues of the ribs and the chest wall. A general observation of CT-guided puncture biopsy revealed 2 stripes of gray and grayish-white puncture tissues of 0.5 and 1 cm in length, respectively, and 0.1 cm in diameter. These results preliminarily suggested a (mediastinum) malignant small round cell tumor. INTERVENTION: Given the progression of the disease, the chemotherapy regimen, consisting of ifosfamide and etoposide, was altered during the course and radiotherapy (total of 70 Gy of mediastinal Y field radiation) was conducted. OUTCOMES: The patient and his family declined further treatment. Through follow-up, the total survival period was determined as 17 months. LESSONS: DSRCT is a rare interstitial malignant tumor. Effective cytoreduction combined with comprehensive therapies could achieve partial remission or prolong the survival of patients.

Mediastinal Neuroendocrine Carcinoma Slowly Growing for 8 Years after Surgical Resection of Esophageal Squamous Cell Carcinoma.

A 70-year-old woman was referred to our department due to a solitary mediastinal tumor which gradually grew near the site of anastomosis for 8 years after radical surgery of esophageal squamous cell carcinoma. It was difficult to distinguish the lymph node recurrence of esophageal cancer from another tumor of unknown primary origin. Endoscopic ultrasound-guided fine-needle aspiration was performed, and the tumor was diagnosed to be neuroendocrine carcinoma. She received concurrent chemoradiotherapy with etoposide plus cisplatin. After the completion of chemoradiotherapy, the tumor disappeared. A solitary growing tumor which develops after radical resection of cancer would be better to be examined histologically in order to make an accurate diagnosis and select the most appropriate treatment.

A case of an unexpected posterior mediastinal functional paraganglioma: case report and literature review.

BACKGROUND: Paraganglioma can be found in a wide range of locations. However, paraganglioma in the posterior mediastinum is rare. An unexpected paraganglioma located in the posterior mediastinum was found during surgery. The anesthesia management of this patient was challenging. CASE PRESENTATION: A 65-year-old male with a posterior mediastinal tumor was scheduled for thoracoscopic mediastinal tumor resection. Severe hemodynamic changes during the operation and postoperative pathological diagnosis showed that the patient had a rare case of posterior mediastinal functional paraganglioma, which was not found before the operation. Although the patient did not experience side effects after surgery, he did experience a dangerous surgical process. CONCLUSIONS: The correct diagnosis of paraganglioma, intensive preoperative screening, adequate preoperative preparation, and accurate intraoperative anesthesia management could provide better anesthesia for paraganglioma patients.

Six-year-old boy with mediastinal mass.

Lymphoblastic lymphomas account for 20-30% of all non-Hodgkin lymphomas (NHL) in children, and most cases of childhood lymphoblastic lymphoma are T-cell type (T-LL). T-LL occurs most frequently in late childhood and adolescence; with male predominance of 2:1.We present a paediatric case with a right sided mediastinal mass causing mediastinal shift diagnosed as T-LL.

Anterior mediastinal leiomyosarcoma mimicking thymoma: A case report.

RATIONALE: Mediastinal leiomyosarcoma is very rare. In this paper, we report one case of anterior mediastinal leiomyosarcoma and retrospectively review the imaging findings of previously reported cases. PATIENT CONCERNS: A 61-year-old male patient was admitted to our hospital due to the presence of a mediastinal space-occupying lesion for two years. Two years previously, chest computed tomography (CT) showed a small nodule in the anterior mediastinum. Twenty days previously, the CT examination was repeated at the local hospital due to respiratory symptoms, which showed a mass in the anterior mediastinum and interstitial inflammation of both lungs. After admission to our hospital, chest contrast-enhanced CT scanning showed a mass in the right anterior mediastinum that was approximately 3.3 × 5.2 cm2 in size that had a clear boundary, slightly heterogeneous internal density and heterogeneous enhancement. INTERVENTIONS: The patient underwent a mediastinal lump resection. DIAGNOSES: Finally, the pathological diagnosis was anterior mediastinal leiomyosarcoma. OUTCOMES: The patient recovered well after the operation. LESSONS: Accidental discovery of anterior mediastinal nodules should be followed up. Mediastinal leiomyosarcoma is common in the posterior mediastinum. Imaging shows a heterogeneous mass with a space-occupying effect that may easily involve adjacent mediastinal vessels or infiltrate surrounding organs.

Small cell lung cancer mimicking lymphoma in CT and 68Ga-DOTA-NOC PET/CT: A case report.

RATIONALE: Small cell lung cancer accounts for 15-20% of all lung cancers and is the most common pulmonary neuroendocrine neoplasm. Most small cell lung cancers arise from lobar or main bronchi, the most common manifestations of small cell lung cancer is a large mass centrally located within the lung parenchyma or a mediastinal mass involving the hilus. Small cell lung cancer is easily ignored by clinicians without lung parenchyma and hilus involvement. Here, we report a case of small cell lung cancer, which was misdiagnosed as the lymphoma in contrast enhanced CT and Ga-DOTA-NOC PET/CT imagings. PATIENT CONCERNS: A 49-year-old male with chief complaint of discontinuous cough for 1 month. DIAGNOSES: Small cell lung cancer. INTERVENTIONS: Radiotherapy and chemotherapy were given thereafter. OUTCOMES: The case had multiple enlarged lymph nodes due to tumor progression. LESSONS: Small cell lung cancer is a malignant and progressive disease, and easy to be ignored in clinical. The case of small cell lung cancer without parenchyma and hilus involvement has never been reported before. Here, we report it and hope it provides a differential diagnosis for clinicians in the following similar cases.

Anterior mediastinal Hodgkin lymphoma presenting as an extremely hypervascular tumor on computed tomography: A case report.

RATIONALE: In the thorax, Hodgkin lymphoma (HL) most frequently involves the anterior mediastinal and paratracheal regions and tends to spread to contiguous nodal groups. Enlarged lymph nodes typically have homogeneous soft tissue attenuation similar to that of muscle tissue on computed tomography (CT). PATIENT CONCERNS: A contrast-enhanced CT examination of a 19-year-old man with right-sided chest pain showed an intense, heterogeneously enhancing mass with organization of serpentine and dilated blood vessels in the right anterior mediastinum that had invaded the upper lobe of the right lung. DIAGNOSES: Following a wedge resection, histopathological examination showed Reed-Sternberg cells that were positive for CD-15 and CD-30, which is typical of HL. INTERVENTIONS: The patient was started treatment with 6 cycles of doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD) regimen. OUTCOMES: After chemotherapy, the patient had shown a partial response to the treatment. LESSONS: This presentation of HL as an extremely hypervascular anterior mediastinal mass on CT imaging has not been previously reported in the literature. This case suggests that HL should be included in the differential diagnosis of a hypervascular anterior mediastinal mass, especially if the patient is a young adult.

[Resection of a Posterior Mediastinal Tumor Using Intraoperative Motor Evoked Potential Monitoring;Report of a Case].

A 20-year-old man with a posterior mediastinal tumor incidentally found on a chest X-ray was referred to our hospital. Chest computed tomography showed a 3 cm nodule located on the left side of the 10-11th thoracic vertebra, where the artery of Adamkiewicz is presumed to arise. He underwent left thoracotomy to remove the lesion. The tumor was safely resected with the assistance of intraoperative motor evoked potential(MEP) monitoring. The postoperative diagnosis was a benign schwannoma. In thoracic surgery for posterior mediastinal tumors, intraoperative MEP monitoring is useful for preventing paraplegia.

Nuclear protein in testis carcinoma of the mediastinum: a case report.

BACKGROUND: Nuclear protein in testis carcinoma is a rare and very aggressive undifferentiated cancer which characteristically arises in the midline of the head, neck, and mediastinum. CASE PRESENTATION: We describe the case of a 46-year-old white woman admitted for superior vena cava syndrome revealing a mediastinal tumor. Pathological examination of specimens obtained by mediastinoscopy revealed an undifferentiated tumor with solid growth and positive immunoreactivity for p40 and negative immunoreactivity for cytokeratin markers. Immunohistochemical staining was positive for nuclear protein in testis, allowing the diagnosis of nuclear protein in testis midline carcinoma of the mediastinum. CONCLUSIONS: We present a rare case of mediastinal nuclear protein in testis carcinoma with diagnosis based on nuclear protein in testis protein positivity and atypical immunohistochemical features including p40 positivity and anti-cytokeratin negativity. Physicians must remain aware of the possibility of nuclear protein in testis carcinoma especially in young patients with thoracic symptoms and suspicion of neoplasm.

A case study evaluating deep inspiration breath-hold and intensity-modulated radiotherapy to minimise long-term toxicity in a young patient with bulky mediastinal Hodgkin lymphoma.

Radiotherapy plays an important role in the treatment of early-stage Hodgkin lymphoma, but late toxicities such as cardiovascular disease and second malignancy are a major concern. Our aim was to evaluate the potential of deep inspiration breath-hold (DIBH) and intensity-modulated radiotherapy (IMRT) to reduce cardiac dose from mediastinal radiotherapy. A 24 year-old male with early-stage bulky mediastinal Hodgkin lymphoma received involved-site radiotherapy as part of a combined modality programme. Simulation was performed in free breathing (FB) and DIBH. The target and organs at risk were contoured on both datasets. Free breathing-3D conformal (FB-3DCRT), DIBH-3DCRT, FB-IMRT and DIBH-IMRT were compared with respect to target coverage and doses to organs at risk. A 'butterfly' IMRT technique was used to minimise the low-dose bath. In our patient, both DIBH (regardless of mode of delivery) and IMRT (in both FB and DIBH) achieved reductions in mean heart dose. DIBH improved all lung parameters. IMRT reduced high dose (V20), but increased low dose (V5) to lung. DIBH-IMRT was chosen for treatment delivery. Advanced radiotherapy techniques have the potential to further optimise the therapeutic ratio in patients with mediastinal lymphoma. Benefits should be assessed on an individualised basis.

Female fertility following dose-adjusted EPOCH-R chemotherapy in primary mediastinal B-cell lymphomas.

We assessed fertility/gonadal function in premenopausal women treated with dose-adjusted EPOCH-Rituximab for untreated primary mediastinal B-cell lymphoma (PMBL). Eligible patents were ≤ 50 years and premenopausal. Serial reproductive histories were obtained and hormonal assays were performed on serum samples before, at the end of treatment and 4-18 months later. Twenty-eight eligible women had a median age (range) of 31 (21-50) years and were followed a median of 7.3 years. Of 23 patients who completed a questionnaire, 19 (83%) were and four were not menstruating prior to chemotherapy. Amenorrhea developed in 12 patients during chemotherapy. At > 1-year follow-up, 14/19 (74%) patients were menstruating, all < 35 years old, and six (43%) of these patients delivered healthy children. Hormonal assays showed ovarian dysfunction during chemotherapy in all patients with varying recovery at 4-18 months after treatment. Fertility was preserved in most women with ovarian failure confined to patients > 40 years old.