Neuroganglioma in the posterior mediastinum: an incidental discovery.

Ganglioneuroma, a rare benign neuroblastic tumor, typically arises in the posterior mediastinum, but it can be found in the anterior mediastinum and thymus. Predominantly affecting the young, these asymptomatic tumors are often discovered incidentally through imaging. In our reported case, a 44-year-old woman post-hysterectomy with persistent jaundice was diagnosed with a neuroganglioma in the right posterior mediastinum via a computed tomography (CT) scan. Thoracotomy and resection revealed a 10-cm neuroganglioma untangled from mediastinal planes. Post-surgery, chylothorax emerged, which was managed through a 5-day fasting approach. Thoracic neurogangliomas, rare and often asymptomatic, demand meticulous diagnosis, emphasizing imaging and histopathology, with postoperative vigilance for complications.

Radical aggressive treatment among non-small cell lung cancer patients with malignant pleural effusion without extra-thoracic disease.

Malignant pleural effusion (MPE) is an indicator of advanced disease (stage M1a) in patients with non-small cell lung cancer (NSCLC). Typically, these patients are candidates for palliative treatment. There is a lack of evidence about the radical surgical treatment in carcinomatous pleuritis with massive effusion. Here, we present data from a specific subset of patients with MPE treated with systemic therapy and aggressive surgical therapy. M1a NSCLC adenocarcinoma patients with MPE and without extra-thoracic disease were included. After receiving systemic therapy, all patients underwent surgical treatment, which included pneumonectomy or lobectomy, plus mediastinal dissection. Following surgery, patients received radiotherapy to thoracic wall and mediastinum. A total of six patients were analyzed. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status ≤1, two patients harbored EGFR mutation and were treated with tyrosine kinase inhibitors (TKIs), the other four patients were treated with pemetrexed and platin as first-line treatment. Following systemic therapy, two patients had a pneumonectomy, four patients had a lobectomy plus pleurectomy performed. All patients continued with maintenance systemic therapy, and achieved complete responses, according to RECIST 1.1 criteria. The media progression-free survival (PFS) time was 15.9 months (95% CI: 15.6-55.5 months). At the last follow-up, all patients were still alive, with 4 of them without signs of macroscopic tumoral activity. The median overall survival (OS) was not reached. NSCLC patients with MPE without extra-thoracic disease could benefit from an aggressive surgical approach following standard of care systemic therapy. However, considering the low sample size of this study and the relatively low incidence of MPE without extra-thoracic disease, further prospective multi-center studies are necessary to evaluate aggressive surgery as a therapeutic option.

Extended resections of large thymomas: importance of en bloc thymectomy.

BACKGROUND: Primary tumors of the thymus are rare; the most common histologic type is thymoma. Most important prognostic factors are anatomical extent of tumor and completeness of surgical resection. Large size has not been directly associated with survival, but is strongly associated with advanced disease and high rates of incomplete resections. METHODS: A retrospective cohort of patients who underwent thymectomy for thymomas of 5 cm or larger at the National Cancer Institute (INCan) of México from January 2005 to December 2016 was analyzed. Primary end-points were rate of complete resection, morbidity and mortality of thymectomy. Secondary end-points were overall survival (OS) and disease-free survival (DFS). RESULTS: A total of 25 patients were identified and included in the final analysis. Mean age was 56.6 years (27-82 years). Median size of thymoma was 8.3 cm (5-14 cm). Transesternal approach was used in 72% of cases, most of cases (68%) required an extended resection to achieve negative margins. Complete resection was achieved on 23 cases (92%). A 90-day morbidity of 24% and mortality of 8% was found, with a median follow-up of 34.5 months (1-113 months). The only factor associated with OS was completeness of surgical resection (P<0.0001). CONCLUSIONS: Size of thymomas should not be considered as a contraindication for surgical treatment. Our data suggest that extended surgery is feasible even in advanced cases and provides the best chance for cure. Complete resection remains as one of the most important prognostic factor in thymomas and is associated with prolonged DFS and OS.

Manejo del derrame pericárdico en el paciente con cáncer / Management of pericardial effusion in cancer patients

Introducción. El derrame pericárdico es la complicación cardiaca más frecuente en el paciente con cáncer. El cáncer de pulmón y el cáncer de mama son las neoplasias sólidas más frecuentemente asociadas con derrame pericárdico. El manejo oncológico multimodal ha permitido un aumento de la supervivencia global y ha expuesto complicaciones oncológicas que exigen manejo individualizado para estos pacientes. Objetivo. Se describe la experiencia en el manejo del derrame pericárdico, desde su fisiopatología, la adecuada clasificación en derrame pericárdico asociado a neoplasia maligna, derrame pericárdico maligno o carcinomatosis pericárdica, hasta su abordaje diagnóstico y terapéutico. Resultados. La incidencia del derrame pericárdico en nuestra institución es de 12 %. En casi 100 procedimientos en 11 años de ventana pericárdica, pericardiectomía e instalación de catéter subcutáneo (tunnelized) pericárdico o pleuropericárdico temporal, la mortalidad posoperatoria fue de 1,2 %, y la recurrencia del derrame pericárdico fue de 2,1 % comparada con una de 33 % en los pacientes sometidos a pericardicentesis. Conclusión. El derrame pericárdico maligno es una urgencia oncológica. Requiere manejo costo-efectivo en términos de ser resolutivo, expedito y duradero, sin agregar morbilidad en un paciente ya con deterioro de su estado general. La ventana pericárdica por toracoscopia (Video-Assisted Thoracoscopic Surgery, VATS) en pacientes seleccionados y la minitoracotomía antero-lateral son la vía ideal de abordaje del paciente con derrame pericárdico maligno

Introduction: Pericardial effusion is the most frequent cardiac complication in the cancer patient. Lung cancer and breast cancer are the most common solid neoplasms associated with pericardial effusion. Multimodal oncology management has allowed an increase in overall survival and has exposed oncological complications, which require individualized management for these patients Objective: We present our experience in the management of pericardial effusion, from its physiopathology, adequate classification in: pericardial effusion associated with malignancy, pericardial effusion and pericardial carcinomatosis. Diagnostic and therapeutic approach. Results: the incidence of pericardial effusion in our institution is 12%. In almost 100 pericardial window procedures, pericardiectomy and installation of a pericardial or pleuropericardial tunnelled catheter, in 11 years postoperative mortality was 1.2% and pericardial effusion recurrence was 2.1% compared to 33% recurrence in patients Led to pericardicentesis. Conclusion: Malignant pericardial effusion is an oncologic emergency. It requires cost-effective management in terms of being resolute, expeditious and lasting, with no additional morbidity to a patient, who already appears deteriorated in his general condition. The pericardial window by thoracoscopy, VATS in selected patients and the mini anterolateral thoracotomy are the ideal approach for the patient with malignant pericardial effusion

Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description.

BACKGROUND: Descending necrotizing mediastinitis is a serious infection involving the neck and the chest, in which an odontogenic, pharyngeal, or cervical infection spreads rapidly to the thoracic cavity, with a high death rate by sepsis and organic failure if not treated quickly and properly. METHODS: A systematic search in the electronic database PubMed was conducted using the keywords "mediastinitis" and "descending necrotizing mediastinitis" resulting in 2560 items, filters were activated (systematic review, meta-analysis, and clinical trial) resulting in 60 articles, from which we selected relevant articles on the topic. RESULTS: The best available evidence we could obtain was from 26 case series with evidence level III. The overall mortality in this period was 17.5%. CONCLUSION: For mediastinitis limited to the upper part of the mediastinum, transcervical drainage may be sufficient; cases that extended below the tracheal carina may require cervical and transthoracic drainage. A multidisciplinary therapeutic approach has allowed a reduction in its mortality. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2275-E2283, 2016.

Lung metastasectomy: long-term outcomes in an 18-year cohort from a single center.

Lung metastasectomy is an area of interest and controversy in surgical oncology. Most of the available evidence derives from small cohorts with short follow-up. The aim of this study was to evaluate the oncologic outcomes in an 18-year cohort from a single center. We retrospectively reviewed 398 patients with several malignancies who underwent lung metastasectomy between January 1990 and December 2008. Demographic, clinical, and surgical variables were evaluated. Uni- and multivariate analyses were performed to identify factors associated with overall survival (OS). Mean follow-up was 20 months. Wedge resection was performed in 297 cases and 101 required anatomic resections. In 303 patients the disease-free interval (DFI) was >6 months meanwhile 95 patients had a DFI ≤6 months. Complete resection was achieved in 351 patients (88.2%). Median OS for all patients was 81.9 months (95% CI, 36.9-126.9). On multivariate analysis, factors associated with a poor overall survival were DFI <6 months (HR, 1.74; 95% CI, 1.24-2.4; p=0.001) and incomplete resection (HR, 1.58 95% CI, 1.01-2.5; p=0.0047). Independent prognostic factors associated with better survival were DFI >6 months and complete resection. Size and number of metastases as well as re-do metastasectomy were not associated with worse survival.

Schwannomas medaastinales: comunicación de casos y revisión de la literatura

Introducción: Los tumores del mediastino comprenden un grupo heterogéneo de neoplasias raras con comportamiento biológico muy variable. En México, las estadísticas reportan que corresponde al 0.88% de todas las neoplasias. En general, del 30 al 76% de todos estos tumores son malignos. De éstos el 53% corresponden a tumores neurógenos. Objetivo del estudio: Conocer la frecuencia del Schwannoma mediastinal, en el Instituto Nacional de Cancerología (INCan), así como el manejo de esta patología. Material y métodos: Se revisaron expedientes del archivo clínico de 1980 a 2003 con diagnóstico de tumor mediastinal. Se registraron edad, sexo, presentación clínica, presentación radiológica, métodos diagnósticos, tratamientos previos, histología, tratamiento y resultados. Resultados: 109 pacientes con diagnóstico de tumor mediastinal fueron tratados en el INCan entre 1980 al 2003; 9 casos correspondían a tumores de origen neuroepitelial; 4 pacientes fueron llevados a cirugía. Se realizaron 3 resecciones y una tumorectomía. La histología y el tamaño son factores que influyen en el resultado. La resección completa es curativa y la adyuvancia con radioterapia posoperatoria puede ser útil.

Introduction: Mediastinal tumors include an heterogenous group of neoplasms with variable biological behavior. In Mexico they represent 0.88% of all neoplasms. Thirty to 76% of these tumors are malignant; of these, 53% are neurogenic. Objectives: To study the frequency of mediastinal Schwannomas at our institute. Material and methods: A chart review of mediastinal tumors from 1980 to 2003 was done. Age, sex, clinical presentation, radiological features, previous diagnoses and treatments, histology, treatment and results were recorded. Results: 109 patients with mediastinal tumors were treated in the National Institute of Cancer from 1980 to 2003; 9 cases were tumors of neuroepithelial origin, 4 patients were taken to surgery. Histology and size were factors that influenced the result. Complete resection is the standard of care; adjuvant radiotherapy is useful.