ABSTRACT
El sarcoma folicular de células dendríticas (SFCD) es una neoplasia maligna rara derivada de las células dendríticas foliculares. Ha sido clasificado, dadas sus características inmunohistoquímicas, como parte del grupo de los sarcomas, donde representa un porcentaje menor al 1%. Actualmente, existen menos de 1.000 reportes en la literatura a nivel mundial, lo cual plantea una dificultad no sólo diagnóstica, siendo confundido frecuentemente con neoplasias de tipo linfoide; sino también terapéutica al no existir un claro consenso sobre su manejo definitivo. Esta revisión de caso clínico describe el primer caso reportado de SFCD en Costa Rica.
Follicular dendritic cell sarcoma (SFCD) is a rare malignant neoplasm derived from follicular dendritic cells, which has been classified, given its immunohistochemical characteristics, as part of the group of sarcomas, where it represents less than 1%. Currently, there are less than 1000 reports in the literature worldwide, which generates a difficulty not only in diagnosis, being frequently confused with lymphoid type neoplasms; but also, as therapeutic as there is no clear consensus on its definitive management. This clinical case review describes the first reported case of SFCD in Costa Rica.
Subject(s)
Humans , Female , Adult , Asthma/diagnosis , Cough/diagnosis , Dendritic Cell Sarcoma, Follicular/diagnosis , Mediastinal Neoplasms/diagnosis , Obesity/diagnosis , Biopsy , Case Reports , Diagnostic Imaging , Immunohistochemistry , Thoracotomy , Costa RicaABSTRACT
Introducción: La EBUS ha sido el foco de numerosos estudios destinados a evaluar su utilidad y rendimiento diagnóstico en diversas patologías. Objetivo principal: Identificación de las características ganglionares evaluadas en el procedimiento de Ultrasonido Endobronquial (EBUS) y su relación con el diagnóstico de malignidad en pacientes del Instituto Nacional del Cáncer de Colombia del 1 de enero de 2017 al 31 de marzo de 2021.Métodos: Estudio analítico observacional transversal. La recopilación de datos implicó un muestreo de casos consecutivos no probabilísticos entre individuos que cumplían los criterios de inclusión.Resultados: Un total de 75 pacientes fueron sometidos a EBUS. Se identificaron 6 características ecográficas de los ganglios de la biopsia asociadas a malignidad destacándose los ganglios mayores de 1 cm, márgenes mal definidos, ecogenicidad heterogénea, ausencia de una estructura hiliar central, presencia de signos de necrosis o coagulación y presencia de conglomerado ganglionar. Conclusión: Este estudio caracterizó la frecuencia de los hallazgos en la ultrasonografía endobronquial destacando algunas características ecográficas de los ganglios mediastínicos que podrían predecir patología maligna.
Introduction: The EBUS has been the focus of numerous studies aiming to evaluate its utility and diagnostic performance across various pathologies. Objective: Identification of the node characteristics evaluated in the Endobronchial Ultrasound (EBUS) procedure and their relationship with malignancy diagnosis in patients at the National Cancer Institute of Colombia from January 1st, 2017, to March 31st, 2021. Methods: Observational cross-sectional analytical study. Data collection involved non-probabilistic consecutive case sampling among individuals meeting the inclusion criteria.Results: A total of 75 patients underwent the EBUS procedure. Our findings revealed six predictors of malignancy based on sonographic features of biopsy nodes, including nodes larger than 1 cm, poorly defined margins, heterogeneous echogenicity, absence of a central hilar structure, presence of signs indicating necrosis or coagulation, and the presence of a ganglion conglomerate. Conclusions: This study showed that endobronchial ultrasonography has several sonographic characteristics at the time of evaluating mediastinal nodes that could predict malignant and benign pathology.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Lymphadenopathy/pathology , Lung Neoplasms/diagnosis , Lymph Nodes/diagnostic imaging , Mediastinal Neoplasms/diagnosis , Biopsy/methods , Ultrasonography/methods , Colombia , Neoplasm Staging/methodsABSTRACT
Klinefelter syndrome (47, XXY in most cases) is a frequently underdiagnosed chromosomal anomaly associated with multiple comorbidities in adult life. Patients with Klinefelter syndrome have a higher risk of cancer. Specifically, these patients have a higher risk for mediastinal germ cell tumors. It is estimated that 8% of male patients with mediastinal tumors have Klinefelter. We report a 42-years-old male who suffered recurrent respiratory infections. During the study, a mediastinal mass was found, whose pathological study disclosed a type B thymoma. The patient had a history of infertility, high stature, gynecomastia, obesity with gynecoid distribution of body fat and testicular atrophy. A karyotype was requested (47, XXY), confirming the diagnosis of Klinefelter syndrome.
Subject(s)
Humans , Male , Adult , Thymoma/pathology , Thymus Neoplasms/pathology , Klinefelter Syndrome/pathology , Thymoma/diagnostic imaging , Thymus Neoplasms/diagnosis , Radiography, Thoracic , Tomography, X-Ray Computed , Klinefelter Syndrome/diagnosis , Klinefelter Syndrome/genetics , Mediastinal Neoplasms/diagnosis , Mediastinal Neoplasms/pathologyABSTRACT
Resumen: Las masas mediastinales son poco frecuentes, las mismas están constituidas por un grupo heterogéneo de tumores representan el 3 % de la cirugía torácica en niños (Benignos 75% y malignos 25%), a su vez pueden encontrarse en el mediastino anterior medio o posterior.1 Los síntomas, dependen de su ubicación más que del tamaño o la estirpe tumoral. Los tumores de mediastino anterior, son un desafío para el anestesiólogo por su relación con las estructuras anatómicas con riesgo de colapso del sistema cardiorespiratorio. El objetivo de esta publicación, es presentar un caso clínico de una niña con una masa mediastinal anterior y exponer el manejo anestesiológico del perioperatorio. Se enfatizarán, los conceptos más relevantes en lo referente a: presentación de cuadro clínico, exámenes de diagnósticos e implicancias anestésicas, así como el tratamiento preoperatorio, manejo anestésico del intraoperatorio y sus posibles complicaciones.
Abstract: Mediastinal masses are infrequent; they consist of a heterogeneous group of tumors that represent 3% of all thoracic surgeries performed in children (benign 75%, malignant 25%). They can be found in the mediastinum anterior middle or posterior, and the symptoms seem to depend on their location, rather than the size or tumor strain. Anterior mediastinal tumors are a challenge for anesthesiologists, because of their relationship with anatomical structures and the risk of collapse of the cardiorespiratory system. The objective of this article is to present a clinical case of a girl with an anterior mediastinal mass and to expose the anesthesiological management of the perioperative process. An emphasis is placed on the most relevant concepts regarding: clinical presentation, diagnostic tests, and anesthetic implications, and on preoperative treatment, intraoperative anesthetic management, and possible complications.
Resumo: As massas mediastinais são pouco frequentes, as mesmas consistem em um grupo heterogêneo de tumores que representam 3% da cirurgia torácica em crianças (75% benignos e 25% malignos), podem ser encontrados no mediastino anterior, médio ou posterior. 1 Os sintomas dependem mais da sua localização; que do tamanho ou estirpe tumoral. Os tumores mediastinais anteriores são um desafio para o anestesiologista, devido à sua relação com estruturas anatômicas com risco de colapso do sistema cardiorrespiratório. O objetivo desta publicação é apresentar um caso clínico de uma menina com massa mediastinal anterior e expor a manipulação anestésica do período pré-operatório. Será dada ênfase aos conceitos mais relevantes sobre: a apresentação do quadro clínico, testes diagnósticos e implicações anestésicas, assim como tratamento pré-operatório, manipulação anestésica intra-operatório e suas possíveis complicações.
Subject(s)
Humans , Perioperative Period , Anesthesia/methods , Mediastinal Neoplasms , Mediastinal Neoplasms/surgery , Mediastinal Neoplasms/diagnosisABSTRACT
Este material tem como objetivo orientar as equipes que atuam na AB, qualificando o processo de referenciamento de usuários para outros serviços especializados. É uma ferramenta, ao mesmo tempo, de gestão e de cuidado, pois tanto guiam as decisões dos profissionais solicitantes quanto se constitui como referência que modula as avaliações apresentadas pelos médicos reguladores.
Subject(s)
Humans , Adult , Primary Health Care/standards , Secondary Care/standards , Thoracic Surgery/standards , Lung Neoplasms/therapy , Pulmonary Medicine/standards , Clinical Protocols/standards , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/therapy , Thoracic Diseases/diagnosis , Thoracic Diseases , Mediastinum/pathology , Lung Neoplasms/diagnosis , Mediastinal Neoplasms/diagnosis , Thoracic Surgical Procedures/standards , Health Care Coordination and MonitoringABSTRACT
Se presenta el seguimiento y control de un caso clínico de diagnóstico prenatal, a las 26 semanas de gestación, de una masa multiquística mediastinal fetal. Luego del nacimiento y tras el tratamiento quirúrgico, el estudio anatomopatológico reveló una masa formada por tejido conectivo con proliferación de vasos linfáticos compatible con linfangioma.
Subject(s)
Humans , Female , Pregnancy , Lymphangioma, Cystic/diagnosis , Lymphangioma, Cystic , Mediastinal Neoplasms/diagnosis , Mediastinal Neoplasms , Ultrasonography, Prenatal/instrumentation , Ultrasonography, PrenatalABSTRACT
Omental hernia through the esophageal hiatus is extemely infrequent. Paraesophageal hiatal hernia with omentum in the herniary sac mimics a mediastinal lipomatous tumor and differential diagnosis should be made. This diagnosis requires experience and knowledge of the differences between these two pathologies. In the following study we describe the case of an omental hernia and the characteristics that make it different from other pathologies.
Subject(s)
Hernia, Hiatal/diagnosis , Mediastinal Neoplasms/diagnosis , Diagnosis, Differential , Female , Humans , Hernia, Hiatal/surgery , Omentum , Middle AgedABSTRACT
Magnetic resonance imaging (MRI) of the breast is used for various indications. Contrary to computed tomography as a staging tool, breast MRI focuses on the breast parenchyma and axilla. In spite of narrow field of view, many structures such as the anterior portion of the lungs, mediastinum, bony structures and the liver are included which should not be neglected because the abnormalities detected on the above structures may influence the staging and provide a clue to systemic metastasis, which results in the change of treatment strategy. The purpose of this pictorial essay was to review the unexpected extra-mammary findings seen on the preoperative breast MRI.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Axilla , Bone Neoplasms/diagnosis , Breast Neoplasms/diagnosis , Incidental Findings , Liver Neoplasms/diagnosis , Lung Neoplasms/diagnosis , Magnetic Resonance Imaging/methods , Mediastinal Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
Objetivo: revisar e informar la experiencia adquirida con el manejo de tumores de células germinales del mediastino, en el Hospital Calderón Guardia. Metodología: previa autorización acumulada en la base de datos del Servicio de Cirugía de Tórax y los expedientes clínicos de 29 pacientes con tumores de células germinales del mediastino, operados entre 1986 y 2012. Resultados: se encontró mayor frecuencia en hombres jóvenes con una relación por género de 13.5:1, y edad promedio de 26 años. La localización correspondió en 28 casos al mediastino antero superior y 1 al medio. La presentación en 27 casos fue una radiografía de tórax con ensanchamiento del mediastino, uno con derrame pleural y uno con derrame pleural y mediastino ensanchado. Los síntomas más frecuentes fueron: disnea, dolor retrosternal, fiebre, tos, pérdida de peso, síndrome de vena cava superior, hemoptisis y ginecomastía en un varón con coriocarcinoma. La muestra para diagnóstico se obtuvo por mediastinotomía en 14 casos, toracotomía en 8, videotoracoscopía en 4 esternotomía en 1, mediastinoscopía en 1 y broncoscopía en 1. Conclusión: los tumores germinales del mediastino son infrecuentes; la extirpación quirúrgica es el tratamiento de elección para los técnicamente resecables y se acompaña de curación de los benignos. En los malignos, la aparente resección completa no es garantía de curación, por lo que debe considerarse la quimioterapia adyuvante, que demostró ser de gran utilidad, por cuanto varios tumores parcialmente resecados se curaron con quimioterapia, y algunos con aparente resección completa recidivaron...
Subject(s)
Humans , Male , Adolescent , Adult , Female , Mediastinal Neoplasms/surgery , Mediastinal Neoplasms/diagnosis , Mediastinal Neoplasms/drug therapy , Mediastinal Neoplasms/therapyABSTRACT
Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells with malignant cytological features and multi-organ involvement that typically has a poor prognosis. We experienced 2 cases of LCS in children less than 2 years of age and report them based primarily on CT and MR findings. Both children had findings of hepatosplenomegaly with low-attenuation nodular lesions, had multiple lymphadenopathy, and had shown recurrent lesions invading the skull during follow-up after chemotherapy.
Subject(s)
Female , Humans , Infant , Hepatomegaly/diagnosis , Langerhans Cell Sarcoma/diagnosis , Magnetic Resonance Imaging , Mediastinal Neoplasms/diagnosis , Neoplasm Recurrence, Local , Skull Neoplasms/diagnosis , Splenomegaly/diagnosis , Tomography, X-Ray ComputedABSTRACT
We report an unusual case of 9.5-cm-sized embryonal rhabdomyosarcoma arose from a mediastinal mature teratoma in a 46-yr-old man. A man presented with chest trauma as a result of an accident at 10 September 2011. On chest X-ray, an anterior mediastinal mass was detected. To obtain further information, chest computed tomography (CT) with contrast enhancement was performed, revealing an anterior mediastinal mass. Complete surgical excision was performed and entire specimen was evaluated. Pathologic diagnosis was embryonal rhabdomyosarcoma arising in mature cystic teratoma. After surgical excision, two cycles of dactinomycin-based chemotherapy were performed. Lung metastasis was detected on follow up CT in September 2012, and wedge resection was performed. Pathological finding of the lung lesion showed same feature with that of primary rhabdomyosarcoma.
Subject(s)
Humans , Male , Middle Aged , Antibiotics, Antineoplastic/therapeutic use , Dactinomycin/therapeutic use , Desmin/metabolism , Immunohistochemistry , Lung Neoplasms/diagnostic imaging , Mediastinal Neoplasms/diagnosis , Neoplasms, Germ Cell and Embryonal/drug therapy , Rhabdomyosarcoma, Embryonal/drug therapy , Teratoma/diagnosis , Tomography, X-Ray ComputedSubject(s)
Humans , Male , Young Adult , Mediastinal Neoplasms/diagnosis , Rhabdomyosarcoma, Embryonal/diagnosis , Rhabdomyosarcoma, Embryonal , Biopsy, Fine-Needle/methods , Dyspnea/etiology , Rhabdomyosarcoma/diagnosis , Sarcoma/diagnosis , Histological Techniques , Tomography, X-Ray Computed/methods , Deglutition Disorders/etiologySubject(s)
Humans , Male , Cushing Syndrome , Carcinoid Tumor/diagnosis , Mediastinal Neoplasms/diagnosisABSTRACT
Mediastinal lymphadenopathy [ML] is a cause for concern, especially in patients with previous malignancy. We report our experience with the use of endoscopic ultrasound-guided fine needle aspiration [EUS-FNA] with immunocytochemical stains in patients being evaluated for ML. Retrospective analysis of patients with ML of unknown origin who underwent EUS-FNA. On-site evaluation was performed by experienced cytologist, and special immunocytochemical stains were requested as indicated. A total of 116 patients were included, and a total of 136 mediastinal LN were sampled. Prior malignancy was present in 45%. The most common site of examined lymph node [LN] were subcarinal [76%, 103 LN]. The median long and short axis diameters were 28 mm and 13 mm, respectively. FNA was read on-site as malignant, 21 [16%]; benign, 100 [76.9%]; suspicious, six [4%]; atypical, 3 [2%]; and inadequate sample, six [4%]. Sixty-four LN were deferred for additional studies; 22 for immunocytochemical and 26 for Gimesa [GMS] stain and 21 for flow cytometry. Final FNA read was malignant in 28 [21%], benign in 103 [76%], suspicious in three [2%], and atypical in two [1%]. Metastatic malignancies disclosed included Hodgkin's and Non-Hodgkin's lymphoma, melanoma, hepatoma, breast, lung, colon, renal, endometrial, Fallopian tube, and unknown carcinoma. The sensitivity, specificity, and accuracy of the final FNA read to predict malignancy were 100%. EUS-guided FNA with additional ancillary studies is useful in disclosing metastatic ML from a variety of neoplasms. Due to its safety and accuracy profile, it should be considered the test of choice in evaluating abnormal ML in appropriately selected patients
Subject(s)
Humans , Female , Male , Mediastinal Neoplasms/diagnosis , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Immunohistochemistry , Neoplasm Metastasis , Lymph Nodes/pathology , Mediastinal Diseases/pathologyABSTRACT
This was a case of a 35-year-old man with mediastinal mass requiring computed tomography [CT]-guided biopsy for tissue diagnosis. A posterior approach with an 18-gauge biopsy needle was used to obtain tissue sample. Post biopsy, patient condition deteriorated and multiphase CT study detected active bleeding in arterial phase at the biopsy site with massive hemothorax. Subsequent angiography showed arterial bleeder arising from the apical branch of the right pulmonary artery. Selective endovascular embolization with NBCA [n-Butyl cyanoacrylate] was successful. Patient survived the complication. The case highlighted a rare complication in a common radiology procedure and the value of the interventional radiology unit in avoiding a fatal outcome
Subject(s)
Humans , Male , Mediastinal Neoplasms , Radiology, Interventional , Mediastinal Neoplasms/diagnosis , Tomography, X-Ray Computed , Biopsy , Embolization, TherapeuticABSTRACT
Se estudió un paciente masculino, de 20 años de edad, que sólo refería como síntoma dolor en hombro izquierdo de 1 año de evolución. De forma fortuita se le realiza rayos X de tórax y se observa ensanchamiento mediastinal. Se diagnosticó, por citología, un seminoma extragonadal de localización mediastinal
A male patient aged 20 was studied presenting a painful symptom in his left shoulder of a year of course. In a causal way he undergoes thorax Ray-X observing mediastinum widening. According to cytology an extra-gonadal seminoma of mediastinum location was diagnosed
Subject(s)
Mediastinal Neoplasms/diagnosis , Seminoma/diagnosisABSTRACT
Mediastinal tumors have multiple presentation forms and various pathological origins. Sometimes they reach a large size and can involve the system of superior vena cava by compression or infiltration. We present a 48 year old man admited for dyspnea, headache and palpitations in decubitus, for the last two months. The X-ray and chest computed tomography showed an anterior mediastinal tumor and the tru-cut pathological study concluded leiomyosarcoma. He underwent surgical treatment; the tumor compromised the system of the superior vena cava and was resected with ligation and resection the left brachiocephalic trunk. Part of the superior vena cava was reconstructed with autologous pericardium. The right phrenic nerve was surrounded by the tumor mass and was resected in block. The patient recovered satisfactorily and was discharged on the eleventh day post surgery. The histopathologic study of the surgical specimen confirmed a leiomyosarcoma G2 (3,100 gr). Full adjuvant radiotherapy was done. At 15 months after surgery the patient is in good condition without evidence of recurrence or superior vena cava syndrome.
Los tumores del mediastino pueden tener múltiples formas de presentación y diversos orígenes anato-mopatológicos. A veces alcanzan gran tamaño y pueden comprometer por compresión o infiltración el sistema de la vena cava superior. Presentamos el caso de un hombre de 48 años que consultó por disnea, cefalea y palpitaciones en decúbito de dos meses de evolución. En la radiografía y en la tomografía computada de tórax se demostró un tumor de mediastino anterior, el estudio anatomopatológico mediante biopsia trucut concluyó leiomiosarcoma. Se realizó tratamiento quirúrgico, se resecó la masa tumoral que comprometía el sistema de la vena cava superior, se ligó y resecó el tronco venoso braquiocefálico izquierdo o innominado y se reconstruyó parte de la vena cava superior con parche de pericardio autólogo. El nervio frénico derecho se encontraba rodeado por la masa tumoral y se resecó junto con el tumor. El paciente evolucionó satisfactoriamente y fue dado de alta al décimo primer día post operado. El estudio de anatomía patológica de la pieza operatoria confirmó un leiomiosarcoma G2 de 3.100 gramos. Se completó tratamiento con radioterapia post operatoria. A 15 meses post operado el paciente se encuentra en buenas condiciones generales, sin evidencias de recidiva y sin síndrome de vena cava superior.