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1.
Medicine (Baltimore) ; 99(12): e19577, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195970

RESUMO

RATIONALE: The diagnosis of anaplastic lymphoma kinase (ALK)-negative inflammatory myofibroblastic tumors (IMT) remains challenging because of their morphological resemblance with spindle cell sarcoma with myofibroblastic characteristics. PATIENT CONCERNS: A 69-year-old female patient presented with loco-regional recurrent IMT several times within 8 years after primary treatment and neck lymph node metastasis 3.5 years after last recurrence. DIAGNOSIS: The primary, recurrence, and lymph node metastasis lesions were diagnosed as ALK-negative IMTs based on the histopathological features. INTERVENTIONS: Biopsy samples were obtained during repeated surgeries and evaluated for genomic alterations during first and recurrent presentations. The evaluation was done using pathway-driven massive parallel sequencing, and genomic alterations between primary and recurrent tumors were compared. OUTCOMES: Copy number gains and overexpression of mouse double minute 2 homolog (MDM2) and cyclin dependent kinase 4 (CDK4) were observed in the primary lesion, and additional gene amplification of Discoidin Domain Receptor Tyrosine Kinase 2 (DDR2), Succinate Dehydrogenase Complex II subunit C (SDHC), and thyroid stimulating hormone receptor (TSHR) Q720H were found in the recurrent tumors. Metastases to the neck lymph node were observed 3.5 years after recurrence. LESSONS: Our results indicated genetic evolution in a microscopically benign condition and highlighted the importance of molecular characterization of fibro-inflammatory lesions of uncertain malignant potential.


Assuntos
Granuloma de Células Plasmáticas/metabolismo , Neoplasias de Cabeça e Pescoço/secundário , Recidiva Local de Neoplasia/patologia , Neoplasias de Tecido Muscular/metabolismo , Quinase do Linfoma Anaplásico/metabolismo , Quinase 4 Dependente de Ciclina/metabolismo , Diagnóstico Diferencial , Feminino , Amplificação de Genes , Granuloma de Células Plasmáticas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Metástase Linfática , Mediastino/patologia , Pessoa de Meia-Idade , Miofibroblastos/patologia , Neoplasias de Tecido Muscular/patologia , Neoplasias de Tecido Muscular/radioterapia , Proteínas Proto-Oncogênicas c-mdm2/metabolismo
2.
Eur Radiol ; 30(1): 588-599, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31418086

RESUMO

OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the diagnostic outcomes and complication rates and to identify potential covariates that could influence these results for computed tomography (CT)-guided core needle biopsy (CNB) of mediastinal masses. METHODS: A computerized search of the PubMed and EMBASE databases was performed to identify original articles on the use of CT-guided CNB for mediastinal mass. The pooled proportions of the diagnostic yield and accuracy were assessed using random effects modeling. We assessed the pooled proportion of complication rates using random effects or fixed effects modeling. Multivariate meta-regression analyses were performed to evaluate the potential sources of heterogeneity. RESULTS: Eighteen eligible studies (1310 patients with 1345 CT-guided CNBs) were included. The pooled proportions of the diagnostic yield and accuracy of CT-guided CNB for mediastinal masses were 92% (18 studies, 1345 procedures) and 94% (15 studies, 803 procedures), respectively. In the subgroup analysis, the pooled proportions of the total complication rate and major complication rate were 13% and 2%, respectively. In the meta-regression analyses, the number of tissue samplings (odds ratio [OR], 3.3; p = 0.03), real-time fluoroscopy-guided (OR, 2.1; p = 0.02), and percentage of lymphoma (OR, 2.2; p < 0.001) for diagnostic yield, number of tissue samplings (OR = 2.0, p = 0.02) for diagnostic accuracy, and biopsy needle diameter (OR, 2.5; p = 0.002) for total complication rate were all sources of heterogeneity. CONCLUSIONS: CT-guided CNB for mediastinal mass demonstrates high diagnostic outcomes and low complication rates. The use of 20-gauge biopsy needles and obtaining ≥ 3 samples may be recommended to improve diagnostic outcomes and decrease complication rates. KEY POINTS: • The pooled estimates of diagnostic yield and accuracy of computed tomography (CT)-guided core needle biopsy (CNB) for mediastinal masses are 92% and 94%, respectively. • The pooled estimates of the total complication rate and major complication rate were 13% and 2%, respectively. • The use of a 20-gauge needle and ≥ 3 tissue samplings are recommended for CT-guided mediastinal CNB to achieve high diagnostic outcomes and lower complication rates.


Assuntos
Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Mediastino/diagnóstico por imagem , Mediastino/patologia , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos
3.
Isr Med Assoc J ; 21(11): 738-742, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713362

RESUMO

BACKGROUND: Transesophageal endoscopic ultrasound-guided fine-needle aspiration using a bronchoscope (EUS-B-FNA) allows clinicians to determine mediastinal staging and lung mass evaluation of lesions not accessible by endobronchial ultrasound (EBUS) or where endobronchial ultrasound-guided transbronchial needle aspiration might not be safe. OBJECTIVES: To evaluate the safety, diagnostic accuracy, and feasibility of EUS-B-FNA. METHODS: The study comprised patients who underwent a pulmonologist-performed EUS-B-FNA of mediastinal lymph nodes and parenchymal lung lesions between June 2015 and September 2017 at the Carmel Medical Center, Haifa, Israel. RESULTS: EUS-B-FNA was performed in 81 patients. The transesophageal procedure was performed for easier accessibility (49.4%) and in high-risk patients (43.3%). The most frequently sampled mediastinal stations were left paratracheal and sub-carinal lymph nodes or masses (38.3% and 56.7%, respectively). There were no complications (e.g., acute respiratory distress, esophageal perforation, or bleeding). An accurate diagnosis was determined in 91.3% of cases. CONCLUSIONS: Pulmonologist-performed EUS-B-FNA is safe and accurate for evaluating mediastinal and parenchymal lung lesions and lymphadenopathy. Diagnostic accuracy is high. EUS-B-FNA may allow access to sites not amenable to other forms of bronchoscopic sampling, or may increase diagnostic accuracy in patients where anatomic position predicts a low diagnostic yield.


Assuntos
Broncoscópios , Carcinoma Pulmonar de Células não Pequenas/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Mediastino/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Esôfago , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 98(41): e17549, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593136

RESUMO

BACKGROUND: The study aimed to evaluate and compare the dosimetric parameters of incidental irradiation to internal mammary node (IMN) from inverse intensity-modulated radiotherapy (I-IMRT) and field-in-field IMRT (F-IMRT), and 3-dimensional conformal radiotherapy (3D-CRT) in patients after breast-conservation surgery (BCS). METHODS: Eighty-four patients with BCS were selected. The breast, tumor bed, and IMN, including intercostal spaces (ICS) 1 to 3, were contoured. Three plans were generated. The prescription doses for the breast and tumor bed were 50.4 Gy/28 F and 60.2 Gy/28 F, respectively. If there was no tumor bed boost, patient was treated with 50 Gy/25 F for the whole breast only. The IMN was not included in planning target volume. RESULTS: The median mean dose (Dmean) of the IMNtotal (ICS 1-3) was 2740.2 cGy, 2973.9 cGy, and 2951.4 cGy for I-IMRT, F-IMRT, and 3D-CRT, respectively. Differences were not detected between any of the plans. After separating ICS 1 to 3 for further analysis, neither of the Dmean of ICS 1 to 2 was significantly different between the plans. However, for ICS 3, the median Dmean was highest for I-IMRT, and those for 3D-CRT and F-IMRT were not significantly different. After separating the 3 techniques for further analysis, the median Dmean was highest in ICS 3 and lowest in ICS 1 for all the 3 techniques. CONCLUSION: All 3 techniques failed to attain an adequate dose to cure subclinical disease, and there were no significant differences among the 3 techniques. It is risky to avoid IMN irradiation (IMNI) using any of the 3 techniques during whole-breast radiotherapy in women with indications for elective IMNI. However, in era of systematic therapy, whether the incidental dose could meet clinical acquirements needs further follow-up.


Assuntos
Mama/cirurgia , Radiometria/métodos , Radioterapia Conformacional/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos , Adulto , Idoso , Mama/patologia , Mama/efeitos da radiação , Feminino , Humanos , Linfonodos/patologia , Linfonodos/efeitos da radiação , Mastectomia Segmentar/métodos , Mediastino/patologia , Mediastino/efeitos da radiação , Pessoa de Meia-Idade , Radioterapia Conformacional/métodos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Parede Torácica/efeitos da radiação
6.
BMC Surg ; 19(1): 152, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651313

RESUMO

BACKGROUND: The number of patients with esophagogastric junction (EGJ) cancers has tended to increase. However, no clear consensus on the optimum treatment policy has yet been reached. METHODS: This study included patients diagnosed with adenocarcinoma of Sievert type II in whom resection was performed in our hospital. We performed a clinicopathological examination, and patients were divided into two groups by the tumor size: L group, tumor size ≥4 cm; and S group, tumor size < 4 cm. The clinical factors, such as nodal dissection and recurrence pattern, were then analyzed. RESULTS: A total of 48 patients were diagnosed with ECJ cancers. The average tumor size was 55.1 mm, and 32 cases (66.7%) had tumors ≥4 cm. Metastasis to the mediastinum was noted in 4 cases (12.5%) in the L group but none in the S group. Recurrence in the upper or middle mediastinum lymph nodes was noted in 3 cases (9.4%) in the L group. The 5-year overall survival rates were 49.7 and 83.9% in the L and S groups, respectively. CONCLUSIONS: As the tumor grows large, it is difficult to accurately judge EGJ on the image, and as a result it is difficult to understand the exact esophageal invasion distance of the tumor. Therefore, lymph node dissection including the upper mediastinum is considered vital, regardless of the degree of esophageal invasion.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/patologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Taxa de Sobrevida
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 932-936, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630489

RESUMO

In recent years, the incidence of adenocarcinoma of esophagogastric junction (AEG) keeps increasing. Siewert type II and type III AEG invades at 2-4 cm in the lower esophagus, and it has a higher rate of lower mediastinal lymph node metastasis. Lower mediastinal lymph node clearing through the abdomino-transhiatal (TH) approach is preferred, which can be accomplished by entering the lower mediastinum through the hiatus and mobilize the esophagus upward and the surrounding lymph and connective tissue for approximately 6.5 cm. Using the infracardiac bursa (IBC) as an anatomical landmark improves the safety and operability of the thorough dissection of the lower mediastinum. Total resection of the mesenterium at the esophagogastric junction can entirely dissect the lower mediastinal lymph nodes, which conforms to the safety principles in oncology.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Excisão de Linfonodo/métodos , Mesentério/cirurgia , Adenocarcinoma/patologia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Humanos , Mediastino/patologia , Mediastino/cirurgia , Mesentério/patologia
8.
Georgian Med News ; (292-293): 65-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31560665

RESUMO

Infection of the mediastinum is typically polymicrobial in nature resulting from a disruption of normal mucosal and tissue barriers. Infection may result from a rupture of the esophagus or trachea or from surgical intervention. Medaistinal abscess is the most lethal form of mediastinitis. A case report is presented: sepsis - induced polyorganic insufficiency with underlying severe somatic pathological condition and violation of hemodynamics. Clinically the insufficiency of all the organic systems developed at the background of cardio-respiratory-cerebral insufficiency, with functional insufficiency of all the organ systems and violation of buffer system. With reasonable pathognomic and symptomatic treatment eradication of vicious circle was possible. The patient was discharged from the clinic with positive clinical-laboratory recovery. The condition was stable. Neurological status -contacted, adequate, with high capacity to work. The fistula on the anterior wall of the trachea as well as stoma were removed.


Assuntos
Abscesso , Mediastinite/diagnóstico , Mediastino/patologia , Sepse/diagnóstico , Choque Séptico/diagnóstico , Abscesso/patologia , Abscesso/cirurgia , Humanos
10.
J Med Case Rep ; 13(1): 205, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31272492

RESUMO

BACKGROUND: We describe a combinatorial intensive care approach and discuss the critical factors that allowed us to successfully manage a life-threatening case of acute anaerobic septic shock triggered by descending necrotizing mediastinitis. CASE PRESENTATION: We admitted a 38-year-old critically ill Kosovar Albanian man to our intensive care unit because of clinical manifestations of severe sepsis. His condition had worsened in the previous 2 weeks following unsuccessful antibiotic therapy for tonsillitis complicated by retropharyngeal abscesses. Computed tomography and intraoperative observations identified abscesses in the anterior and middle mediastinum regions and the distal part of the neck, directly on the border with the left lobe of the thyroid gland. Cultures indicated infections with α-hemolytic Streptococcus and Clostridium species: High procalcitonin and lactate levels, blood gas analysis, poor peripheral capillary oxygen saturation, and severe hemodynamic instability pointed to a case of acute septic shock. The entire treatment consisted of an aggressive antibiotic regimen, transthoracic and mediastinal surgical evacuation of the abscess, vacuum sealing drainage with a pleural chest tube, continuous venovenous hemodiafiltration using cytokine-adsorbing hemofilters, and extracorporeal blood hyperoxygenation. CONCLUSIONS: Efficient treatment of severe anaerobic sepsis resulting from descending necrotizing mediastinitis should build on a multidisciplinary approach. In support of first-line therapies with targeted antibiotics and surgical debridement, clinicians should consider alternative therapies such as continuous venovenous hemodiafiltration with cytokine-adsorbing hemofilters and hyperoxygenation.


Assuntos
/métodos , Mediastinite/terapia , Sepse/terapia , Adulto , Terapia Combinada , Drenagem/efeitos adversos , Humanos , Masculino , Mediastinite/complicações , Mediastinite/diagnóstico por imagem , Mediastino/patologia , Necrose/complicações , Necrose/terapia , Sepse/complicações , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Georgian Med News ; (289): 55-61, 2019 Apr.
Artigo em Russo | MEDLINE | ID: mdl-31215880

RESUMO

There were more than 730 patients aged 3 months to 18 years with formations of the mediastinum, treated in Pediatric Clinic of Thoracic Surgery NMAPE P. L. Shupyk during the period from 1995 to 2018. The main group with benign tumors consisted of 294 patients. Complaints, life history of the disease, and clinical symptoms were studied, systematized and analyzed. Two varieties of the clinical course of mediastinal structures: asymptomatic and typical were identified. Asymptomatic was recorded in 39 (13.3%) patients. Typical course of mediastinal structures was clinically manifested by mediastinal compression syndrome of varying severity. Analysis of clinical data in a typical course of the disease allowed us to distinguish two periods: indistinct (limited) and organ-specific manifestal symptoms. In conditions of preferential organs or structures of the corresponding system compression, the top five organ specific symptoms were defined: respiratory, hemodynamic, dysphagy, neurogenic, osteogenic. Entities, transformed into malignant forms or complicated by suppuration, except compression, are characterized by: total intoxication and pain symptom. In case of primary airways (trachea, bronchus) compression, in limited organ specific symptoms pathogenesis period, the "local immobilization" link is indicated respectively to localization of pathologic entity, as the first level of airways compression and as a trigger mechanism of aerogenic (respiratory) symptom in this group of patients. Possible signs and risk group of children to have mediastinum entity was identified. Early WGC radiography survey in two projections is the main objectifying method, and computer, magnetic-resonance imaging and ultrasound scanning are the main diagnostic methods. Infrared thermography is highly informative and easy-going method for diagnosis of mediastinal structures. Surgical removal of mediastinal structures is the only radical method of treatment.


Assuntos
Doenças do Mediastino , Mediastino , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Imagem por Ressonância Magnética , Doenças do Mediastino/diagnóstico por imagem , Mediastino/patologia , Radiografia , Síndrome
13.
Respir Med Res ; 75: 1-4, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31235451

RESUMO

INTRODUCTION: Mediastinal lymphadenopathy in patients with extrathoracic malignancy is common. To obtain tissue proof of metastatic spread, EBUS-TBNA is an alternative to mediastinoscopy or thoracoscopy, but there are limited data about its diagnostic performance. The aim of this study was to determine the diagnostic accuracy of EBUS-TBNA for the evaluation of mediastinal lymphadenopathy in patients with extrathoracic cancers. METHODS: We performed a multicenter retrospective study based on an online questionnaire to collect data from January 2011 to December 2012 in all patients with proven extrathoracic malignancy (current or past) and suspected mediastinal lymph node metastases who underwent EBUS-TBNA for diagnosis. RESULTS: Hundred and eighty-five patients were included. Extrathoracic malignancies observed were urological (43), breast (35), gastrointestinal (33), head and neck (30), melanoma (11), lymphoma (6), and others (27). EBUS-TBNA confirmed malignancy in 93 patients (50.3%): concordant metastases in 67 (36.2%); new lung cancer in 25 (13.5%); and 1 unidentified cancer. The diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value were respectively 54.6%, 68.4%, 100%, 53.3%, and 100%. CONCLUSION: Mediastinoscopy remain the reference, but EBUS-TBNA may be considered as first line investigation in patients with suspected mediastinal lymph node metastases and extrathoracic malignancy. It prevented a surgical procedure in 50.3% of patients.


Assuntos
Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/secundário , Mediastino/patologia , Neoplasias/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Linfonodos/diagnóstico por imagem , Linfadenopatia/diagnóstico , Linfadenopatia/etiologia , Metástase Linfática , Masculino , Mediastinoscopia/métodos , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
14.
Cancer Imaging ; 19(1): 25, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31113494

RESUMO

BACKGROUND AND OBJECTIVE: Mediastinal lymph node (LN) staging in individuals with non-small-cell lung cancer plays an important role in staging and treatment planning. This study aimed to assess the accuracy of computed tomography (CT) texture analysis (CTTA) in differentiating benign and malignant mediastinal LNs. METHODS: Pathologically confirmed malignant and benign mediastinal LN samples, obtained using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), were retrospectively reviewed, in addition to chest CT and 18-fluorodeoxyglucose (FDG) uptake positron emission tomography (PET) data. For each LN, CTTA was performed using "AVIEW" software (Coreline Soft, Republic of Korea) by drawing a region of interest. RESULTS: A total of 132 LNs from 80 patients were included and classified into two groups according to pathology results: malignant (n = 61) and benign (n = 71). In EBUS, size > 1 cm, round shape, heterogeneous echogenicity, and presence of coagulation necrosis sign were more prevalent in malignant than in benign LNs; length was the only feature that distinguished the two groups. Among CTTA features, compactness and normalized standard deviation (SD) showed differences between the two groups. The ability to distinguish malignant LNs was higher using high standard uptake value (SUV) on FDG PET/CT (SUVmax ≥ 5) and normalized SD on CTTA (area under the receiver operating characteristic curve 0.739 versus 0.742, respectively); however, normalized SD demonstrated very low sensitivity despite high specificity. CONCLUSIONS: CTTA may be helpful in distinguishing between benign and malignant LNs; however, the diagnostic value was not high. Therefore, integrated evaluation with other imaging modalities is needed.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Neoplasias Pulmonares/patologia , Metástase Linfática/patologia , Masculino , Mediastino/diagnóstico por imagem , Mediastino/patologia , Pessoa de Meia-Idade
15.
Ann Thorac Surg ; 108(3): 845-851, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31102632

RESUMO

BACKGROUND: Adenocarcinoma of the gastroesophageal junction (AEG) poses a management challenge, as preoperative prediction of occult mediastinal nodal metastasis is difficult. We sought to identify factors predictive of mediastinal involvement among patients undergoing trimodality therapy. METHODS: Patients undergoing trimodality therapy for Siewert II and III AEG at a single institution between 2000 and 2015 were identified. Mediastinal involvement was defined as pathologic nodal involvement after neoadjuvant chemoradiation (ypN+) in mediastinal stations or mediastinal recurrence 2 years or less after resection. Maximal χ2 analysis and Youden's J index were used to identify the pretreatment proximal tumor extent that best discriminated mediastinal involvement. RESULTS: In all, 204 patients (151 [74%] AEG II, 53 [26%] AEG III) were included, of whom 47 (23%) had clinical evidence of thoracic nodal disease. Thirty-one of the 204 patients (15%) met criteria for mediastinal involvement (24 of 31 ypN+, 10 of 31 mediastinal recurrence). Patients with mediastinal involvement had greater proximal tumor extent (median 2 cm [interquartile range, 1.0 to 3.0 cm] vs 1.4 cm [interquartile range, 0.7 to 3.0 cm], P = .030), were more frequently Siewert II lesions (27 of 31 [87.1%] vs 124 of 173 [71.7%], P = .071), and were more often observed to have clinical thoracic nodal metastasis (cN) evidence (13 of 31 [42%] vs 34 of 173 [20%], P = .007) than patients who did not. On multivariable analysis of patients with intrathoracic cN0, esophageal extent of 1.5 cm or greater was independently predictive of mediastinal involvement (odds ratio 5.46, P = .011), whereas Siewert classification was not (Siewert II odds ratio 3.48, P = .116). CONCLUSIONS: Pretreatment proximal tumor extent, rather than Siewert classification, is an independent predictor of mediastinal involvement among AEG II/III patients without clinical evidence of mediastinal metastasis and should be considered during treatment planning.


Assuntos
Adenocarcinoma/patologia , Adenocarcinoma/terapia , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Linfonodos/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/mortalidade , Idoso , Quimiorradioterapia Adjuvante , Estudos de Coortes , Terapia Combinada , Intervalo Livre de Doença , Neoplasias Esofágicas/classificação , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Esofagectomia/métodos , Junção Esofagogástrica/cirurgia , Feminino , Gastrectomia , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Linfonodos/cirurgia , Metástase Linfática/patologia , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/classificação , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/terapia , Análise de Sobrevida
16.
Semin Oncol ; 46(2): 107-111, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31076171

RESUMO

BACKGROUD: Germ cell tumors (GCTs) are a group of neoplasms usually arising in the gonads, and very rarely in sites outside the gonads, mainly in the retroperitoneum, the anterior mediastinum, and pineal gland or the coccyx (mainly in childhood). The prognosis of nonseminoma primary mediastinal GCTs (PMGCTs), is considered to be poorer compared to its retroperitoneal or gonadal counterparts and, according to the International Germ Cell Cancer Collaborative Group, it is considered by definition as a "poor risk" disease. MATERIAL AND METHODS: Our review highlights the clinical features, prognostic factors, and therapeutic strategies in PMGCTs, as described in medical literature. So far available data were obtained through a Medline search of English-language papers. RESULTS: Due to the rarity of the disease, there are no prospective studies comparing different treatment strategies. For this reason, oncology societies recommend treating PMGCTs like other GCTs, according to general risk categories. CONCLUSION: Because of the rarity of the disease, poor categorization, and the lack of novel therapeutic strategies, an International database is required to obtain more information on these tumors. Additional efforts should be done, with the aims to find effective novel therapeutic agents.


Assuntos
Neoplasias do Mediastino/terapia , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias Testiculares/terapia , Gônadas/patologia , Humanos , Neoplasias do Mediastino/patologia , Mediastino/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Prognóstico , Fatores de Risco , Neoplasias Testiculares/patologia
17.
Pediatr Dermatol ; 36(4): e99-e101, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31132165

RESUMO

Lymphadenopathy is a common sign for drug reaction and eosinophilia with systemic symptoms (DRESS) syndrome, but hilar and mediastinal lymphadenopathy may be underreported. We describe a 7-year-old boy who started taking ethosuximide for absence seizures and presented with diffuse rash, fever, elevated transaminases, facial swelling, and hilar and mediastinal lymphadenopathy. His mediastinal lymphadenopathy was concerning for lymphoma, which led to more invasive testing to rule out malignancy. This report highlights an unusual and likely underreported presenting sign of DRESS syndrome in children.


Assuntos
Corticosteroides/uso terapêutico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Epilepsia Tipo Ausência/tratamento farmacológico , Etossuximida/efeitos adversos , Linfadenopatia/induzido quimicamente , Biópsia por Agulha , Criança , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/patologia , Eosinofilia/induzido quimicamente , Eosinofilia/fisiopatologia , Epilepsia Tipo Ausência/diagnóstico , Etossuximida/uso terapêutico , Seguimentos , Humanos , Imuno-Histoquímica , Linfadenopatia/patologia , Linfadenopatia/fisiopatologia , Masculino , Mediastino/patologia , Recidiva , Medição de Risco
18.
Ter Arkh ; 91(4): 107-113, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31094484

RESUMO

Mediastinal gray-zone lymphoma (MGZL, lymphoma with features intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma) was declared as a separate entity in WHO classification of Tumors of Haematopoetic and Lymphoid Tissues in 2008 and 2017 years. Despite of similar pathomorphological characteristics between primary mediastinal B-cell lymphoma and Hodgkin lymphoma, clinical features and optimal therapeutic approach to MGZL are not clearly defined. Usually MGZL manifests with mediastinal lymphadenopathy, although extranodal lesions often occur (grey-zone lymphoma, GZL). Patients with MGZL have unfavorable prognosis, taking into account high rate of relapse. This article describes two cases of MGZL. First case manifested by arrhythmias due to primary heart involvement. In spite of cardiac failure antracycline-containing chemotherapy (6 courses of R-DA-EPOCH) it allowed to achieve a complete remission and resolving of arrhythmias. Second case was represented by metachronous tumors: primary mediastinal B-cell lymphoma at the time of disease onset and classical Hodgkin lymphoma, NS II, diagnosed after disease progression. Thus, we demonstrated two examples of MGZL that differ by clinical manifestation, response to chemotherapy, which emphasizes an importance of pathogenesis studying, and using of new therapeutic approaches.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Neoplasias do Mediastino/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Esquema de Medicação , Doença de Hodgkin/diagnóstico , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Neoplasias do Mediastino/diagnóstico , Mediastino/patologia , Recidiva Local de Neoplasia , Indução de Remissão , Resultado do Tratamento
19.
J Int Med Res ; 47(6): 2702-2708, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31006299

RESUMO

Central vein perforation associated with a mediastinal lesion is a rare complication of catheterization. A 50-year-old woman was diagnosed with chronic kidney disease and required hemodialysis treatment. The patient developed central vein injury during attempted placement of a double-channel catheter. A computed tomographic scan and venography showed that the catheter had punctured the mediastinum from the central vein. After comprehensive assessment and multidisciplinary consultation, percutaneous catheter thrombin injection with follow-up balloon dilatation under fluoroscopy guidance successfully fixed the perforation. We summarize the therapeutic strategy of this complication and other treatment options, and discuss the related literature of central vein injury.


Assuntos
Cateterismo/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Mediastino/patologia , Insuficiência Renal Crônica/terapia , Lesões do Sistema Vascular/terapia , Feminino , Humanos , Mediastino/irrigação sanguínea , Pessoa de Meia-Idade , Prognóstico , Diálise Renal , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologia
20.
Monaldi Arch Chest Dis ; 89(1)2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-30996353

RESUMO

The conventional-trans bronchial needle aspiration (c-TBNA) has been the first procedure for sampling hilar/mediastinal lymph node for the diagnosis/staging of lung cancer. In the last decade the endobronchial ultrasound trans bronchial needle aspiration (EBUS-TBNA) was introduced in clinical practice and became the first-choice exam in diagnosis and staging of lung cancer. The aim of this study was to compare the diagnostic accuracy (DA), sensitivity and adequacy of c-TBNA and EBUS-TBNA. It was a retrospective and observational multicenter study. The first endpoint was diagnostic accuracy of EBUS-TBNA versus c-TBNA. The secondary end-points were sensitivity and adequacy. Two hundred and nine consecutive patients underwent the procedure, 99 EBUS-TBNA and 110 c-TBNA. When lymph nodes with short axis <2 cm the diagnostic accuracy for correct diagnosis was 94.2% in EBUS-TBNA group and 89.7% in c-TBNA group (p=0.01); the sample adequacy was 70.3% and 42%, respectively (p=0.01); the sensitivity was 93% (95% CI, 82-98%) and 86.4% (95% CI, 67.6-95.6%), respectively (p=0.002). In lymph nodes with short axis ≥2 cm the diagnostic accuracy was 95.7% in EBUS-TBNA group and 93% in c-TBNA group (p=0.939); the sample adequacy was 68.7% and 68.3%, respectively (p=0.889); the sensitivity was 95.1% (95% CI, 83-99%) and 92.1%, respectively (95% CI, 78.7-97.7%) (p=0.898). The EBUS-TBNA in patients with lymph nodes size <2 cm presented a statistically significant difference in the DA, adequacy and sensitivity compared to c-TBNA procedure, while there were no significant differences in the DA, adequacy and sensitivity between EBUS-TBNA and c-TBNA in patients with lymph node size ≥2 cm. The results of our study indicated that the EBUS-TBNA should be the first-choice procedure for the diagnosis/staging in lung cancer patients with lymph node size <2 cm. In patients with lymph node size ≥2 cm, instead, both procedures can be used for the diagnosis/staging of lung cancer.


Assuntos
Biópsia por Agulha Fina/normas , Broncoscopia/instrumentação , Linfonodos/patologia , Ultrassonografia/métodos , Idoso , Biópsia por Agulha Fina/tendências , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Metástase Linfática , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Padrões de Prática Médica/normas , Estudos Retrospectivos , Sensibilidade e Especificidade
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