Primary extraskeletal intradural Ewing sarcoma with acute hemorrhage: a case report and review of the literature.

BACKGROUND: Spinal cord tumors present a challenge in diagnosis and treatment due to their varied histopathological characteristics. While Ewing sarcoma is a rare malignant tumor typically originating from skeletal bone, cases of primary intradural extraskeletal Ewing sarcoma are exceptionally rare. The similarity of its presentation to other spinal tumors further complicates its identification and management. CASE PRESENTATION: We report a case of a 58-year-old Palestinian male with intradural extraskeletal lumbar Ewing sarcoma. The patient initially presented with lower back pain and bilateral S1 radiculopathy, with more severe symptoms on the left side. Magnetic resonance imaging revealed a 7 cm oval-shaped mass with homogeneous contrast enhancement, obstructing the spinal canal from L3/L4 to L5/S1 levels. Initially, a myxopapillary ependymoma was suspected, but the patient's sensory and motor functions suddenly deteriorated during hospitalization. Repeat magnetic resonance imaging indicated heterogeneous contrast enhancement, indicating acute intratumoral hemorrhage. Consequently, the patient underwent emergent L3-L5 laminotomy, with successful gross total resection of the tumor. Histopathological and immunohistochemical analyses confirmed the diagnosis of intradural extraskeletal Ewing sarcoma. Adjuvant therapy was administered to minimize the risk of local recurrence or distant metastasis. A systematic review of relevant literature, along with retrospective analysis of medical records, operative reports, radiological studies, and histopathological findings of similar cases, was also conducted. CONCLUSIONS: Intradural extraskeletal Ewing sarcoma is an infrequently encountered condition in adult patients, emphasizing the importance of considering it in the differential diagnosis of spinal tumors. Surgeons must possess a comprehensive understanding of this rare entity to ensure accurate staging and optimal management, particularly in the early stages when prompt intervention may improve prognosis.

Uniportal video-assisted thoracoscopy in pediatrics-initial experience.

Background: It has become apparent that the endoscopic surgeries are rapidly developing, and they have become an essential part of every specialty of surgery. Single port thoracoscopic surgery is developing, enhancing the advantages of muti-portal video-assisted thoracoscopic surgery (VATS). Although becoming a well-recognised approach for adult patients, extremely limited literature exists concerning uniportal VATS among pediatric cases. This study aims to present our initial experience with this approach in a single tertiary hospital and extrapolate its feasibility and safety in this specific context. Methods: Perioperative parameters and surgical outcomes for all pediatric patients who underwent an intercostal or subxiphoid uniportal VATS surgery in our department in 2 years retrospectively reviewed. The median length of follow-up was 8 months. Results: Sixty-eight pediatric patients underwent different uniportal VATS operation for different types of pathology. The median age was (3.5 years). Median operating time was 116 minutes. Three cases converted to open. The mortality rate was zero. The median length of stay was 5 days. Three patients presented complications. Three patients lost from follow-up. Conclusions: Despite literature data heterogeneity, these results provide support to the feasibility and applicability of uniportal VATS in the pediatric population. Further studies are required to explore the benefit of uniportal over multi-portal VATS (including chest wall deformities, cosmesis and quality of life).

Case report and review of literature: Resection of a huge mediastinal low-grade fibromyxoid sarcoma with neck, axillary, and lung involvement.

Low-grade fibromyxoid sarcoma is an extremely rare malignant neoplasm, with an incidence of 0.18 per million, and comprises 0.6% of all soft tissue sarcomas. It has a high recurrence rate and late metastatic spread and is chemotherapy and radiotherapy insensitive. This paper reports a case of an unusually large mediastinal low-grade fibromyxoid sarcoma in a 55-year-old patient. The tumor was engulfing the main blood vessels of the mediastinum, involving the lung, and extending beyond the chest cavity to involve the cervical and axillary regions. The patient has a 21-year history of frequent surgical resections for lesions that were repeatedly misdiagnosed as neurofibroma. The tumor was successfully resected by a challenging operation that involved mediastinal mass resection, chest wall mass resection, and wedge resection of the left upper lobe of the lung. The deceivingly benign-looking histology of this tumor makes it a commonly misdiagnosed one, requiring careful assessment by pathologists to reach the right diagnosis. Surgical resection with clear margins remains the treatment of choice for these lesions. Due to the behavior of this tumor, once detected and managed, extensive long-term follow-up is always recommended.

Thoracic surgery in Palestine.

Thoracic surgery in Palestine ran across a significant shift in the past couple of years, moving from performing all surgeries by open thoracotomy incision to the current rate of more than two-thirds of surgeries being conducted using Uniportal video-assisted thoracic surgery (VATS). Thoracic surgeons most commonly deal with lung cancer, followed by chest trauma, inflammatory or infectious diseases, and congenital malformations of the chest. One of the most prominent strengths that Palestinian thoracic surgeons have is their extensive experience in managing trauma and hydatid cyst patients. While the limited number of thoracic surgeons, the complex referral process between governmental and private hospitals, and the late presentation of lung cancer patients are considered the specialty's weaknesses. Despite the challenges that thoracic surgeons face, they aim to overcome them by establishing lung cancer screening programs and enhancing the role of the primary healthcare system in order to achieve better outcomes in early diagnosed patients. Moreover, thoracic surgeons are relentlessly determined to take part in global research and publish their most notable contributions to share their experiences and prove that they can make a real change. Finally, the authors emphasize establishing a well-constructed thoracic surgery unit, which also includes a residency training program to ensure self-sufficiency in the future by having national graduates who will be the leading providers and researchers.

Case Report and Review of Literature: Familial Malignant Pleural Mesothelioma in a 39 Years Old Patient With an Inconclusive 18F-FDG PET/CT Result.

Malignant pleural mesothelioma (MPM) is a rare yet aggressive neoplasm that was linked only to asbestos exposure for decades, although familial clusters were diagnosed with MPM without a known history of asbestos exposure most likely due to genetic susceptibility. Here, we describe a case of familial malignant mesothelioma in a 39 years old patient with a confirmed BAP1 mutation in addition to a known family history with the same mutation. The patient presented with progressive shortness of breath and recurrent pleural effusions and diagnosis was made through biopsies taken during uniportal Video-Assisted Thoracoscopic Surgery. After the inconclusive result of 18F-FDG PET/CT scan, subxiphoid uniportal Video-Assisted Thoracoscopic Surgery left pleural and laparoscopic peritoneal biopsies were obtained for staging and evaluating contralateral lung and peritoneal cavity. Finally, two important educational values should be acquired from this case: genetic predisposition and BAP1 tumor suppressor gene mutation might affect the age of presentation and overall prognosis of the disease. Also, 18F-FDG PET/CT scan may not be the best modality for staging and confirming the diagnosis of malignant pleural mesothelioma.