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1.
J Cardiothorac Surg ; 18(1): 3, 2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36604701

RESUMO

BACKGROUND: Cavernous hemangioma is a rare benign tumor which can sometimes mimic the clinical presentation and radiological findings of malignant tumors. Here we present a rare presentation of cavernous hemangioma in the mediastinum (CHM), along with a literature review among the main databases. CASE PRESENTATION: We present a 48-year-old male who had suffered from persistent cough as the sole symptom of an anterior CHM. Computed tomography scan demonstrated a 12.5 × 10.8 cm mass in the anterior mediastinum. The mass was surgically resected, and histopathological evaluation established the diagnosis of CHM. The patient was discharged in good condition, in which during his four-month follow-up period, no recurrence of the tumor has been observed. CONCLUSION: Although cavernous hemangioma rarely present in the mediastinum, it should be considered in the differential diagnosis of mediastinal tumors. However, our review of literature demonstrated a female dominance and average age of 40 years, with a 52% mortality rate based on previous reports.


Assuntos
Hemangioma Cavernoso , Hemangioma , Neoplasias do Mediastino , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Mediastino/diagnóstico por imagem , Mediastino/patologia , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/cirurgia , Tosse/etiologia , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/diagnóstico por imagem
2.
J Cardiothorac Surg ; 18(1): 35, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36653856

RESUMO

Poland's syndrome, a rare genetic disorder that accompanies malignancies, musculoskeletal disorders, cardiac and genitourinary syndromes. There is no study that represents the association between cardiac angiosarcoma and Poland's syndrome. A 24-year-old female patient previously diagnosed with Poland's syndrome was admitted to our hospital complaining of dyspnea. Diagnostic imaging showed an irregular mass in the right atrial cavity. After successful surgery, she was discharged uneventfully and the 3rd month oncologic follow-up reveals none of residual mass. The coexistence has not been diagnosed and treated in a cardiac surgery department before. With this presentation, we aimed to contribute to the literature with this presentation, for the right and early diagnosis and management of possible new cases in the future can be diagnosed and treated correctly and early.


Assuntos
Neoplasias Cardíacas , Hemangiossarcoma , Neoplasias do Mediastino , Síndrome de Poland , Neoplasias do Timo , Feminino , Humanos , Adulto Jovem , Adulto , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/cirurgia , Neoplasias do Mediastino/complicações , Neoplasias do Timo/complicações , Síndrome de Poland/complicações , Síndrome de Poland/diagnóstico , Síndrome de Poland/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia
3.
Korean J Radiol ; 24(1): 62-78, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36606621

RESUMO

As the majority of incidentally detected lesions in the anterior mediastinum is small nodules with soft tissue appearance, the differential diagnosis has typically included thymic neoplasm and prevascular lymph node, with benign cyst. Overestimation or misinterpretation of these lesions can lead to unnecessary surgery for ultimately benign conditions. nonsurgical anterior mediastinal lesions. The pitfalls of MRI evaluation for anterior mediastinal cystic lesions are as follows: first, we acknowledge the limitation of T2-weighted images for evaluating benign cystic lesions. Due to variable contents within benign cystic lesions, such as hemorrhage, T2 signal intensity may be variable. Second, owing to extensive necrosis and cystic changes, the T2 shine-through effect may be seen on diffusion-weighted images (DWI), and small solid portions might be missed on enhanced images. Therefore, both enhancement and DWI with apparent diffusion coefficient values should be considered. An algorithm will be suggested for the diagnostic evaluation of anterior mediastinal cystic lesions, and finally, a management strategy based on MRI features will be suggested.


Assuntos
Neoplasias do Mediastino , Neoplasias do Timo , Humanos , Mediastino/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Neoplasias do Timo/diagnóstico , Imagem de Difusão por Ressonância Magnética/métodos , Diagnóstico Diferencial , Neoplasias do Mediastino/diagnóstico
4.
Acta Biomed ; 94(S1): e2023043, 2023 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-36718781

RESUMO

Thoracic duct (TD) is the largest lymphatic vessel in the body and drains the lymph at the junction between the left subclavian and jugular veins. Chylothorax (CTX) represents an accumulation of lymphatic fluid in the pleural space. We present a case of a 65 years-old man with an histologically diagnosed mediastinal type B non-Hodgkin Lymphoma, treated with chemo-immunotherapy. CT scan during follow up showed significant left side pleural effusion, amounting to 2.8 litres after drainage. Conservative treatment with low fat parenteral nutrition was started without reduction of drainage output, then lymphangiography (LP) with Lipiodol was performed demonstrating a leak in the distal TD. CTX increased in the following days, and a further LP was performed. Using transvenous retrograde access we catheterized TD at the left subclavian jugular veins using a microcatheter. The leak was treated with multiple conventional and controlled delivery microcroils and cyanoacrylate, obtaining complete embolization without residual leak.


Assuntos
Quilotórax , Linfoma não Hodgkin , Neoplasias do Mediastino , Derrame Pleural , Masculino , Humanos , Idoso , Ducto Torácico , Linfografia/efeitos adversos , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/terapia , Linfoma não Hodgkin/complicações
5.
Ann Diagn Pathol ; 62: 152071, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36495734

RESUMO

Three cases of primary neuroblastomas presenting as anterior mediastinal tumors are presented. The patients are two women and one man between the ages of 57 and 63 year. Clinically, the patients presented with symptoms of chest pain, cough, and shortness of breath. Diagnostic imaging revealed the presence of an anterior mediastina mass. Initial biopsy was non-diagnostic in two patients, while in one patient no biopsy was obtained. Surgical resection via thoracotomy was performed in all three patients. Grossly, the tumors vary in size from 3 to 4.5 cm in greatest dimension, and they were described as well circumscribed but not encapsulated, light brown in color. Areas of hemorrhage and/or necrosis were not described. Histologically, at low power the tumors were surrounded by a rim of adipose tissue containing remnants of thymic tissue with Hassall's corpuscles. At higher magnification, the tumors show the characteristic small round cell proliferation with varying amounts of neurophil. Mitotic activity was present but not in large number. Areas of necrosis and/or hemorrhage were not identified. Immunohistochemically, the tumors show positive staining for NSE, while synaptophysin highlighted neurophil. Other markers epithelial and neuroendocrine were negative. Clinical follow-up information shows that two patients have remained alive 8 and 12 months after initial surgical resection. One patient was lost to follow-up.


Assuntos
Neoplasias do Mediastino , Neuroblastoma , Neoplasias do Timo , Masculino , Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Neoplasias do Timo/patologia , Neoplasias do Mediastino/patologia , Necrose , Hemorragia
6.
J Cancer Res Ther ; 18(Supplement): S481-S485, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36511010

RESUMO

The objective is to report a rare case of extragonadal seminoma over the manubrium sterni on the chest wall. A 42-year-old male patient, a chronic alcoholic for 10 years presented with a firm mass of approximate size 10 cm × 12 cm overlying the manubrium part of the sternum. A clinical diagnosis of soft-tissue tumor was made. All relevant preoperative workup was done. Fine-needle aspiration cytology of the mass was suggestive of serous cystic lesion with chronic inflammation. Wide local excision of the mass and primary closure of the wound was done, followed by histopathological examination. Unanticipatedly, on histology, the mass turned out to be extragonadal seminoma. Postoperative wound healing was satisfactory. Subsequently, the patient underwent adjuvant chemotherapy. Primary extragonadal seminoma itself is a rare tumor that affects mainly young people with mediastinum as the most commonly involved site and has higher chances of metastasis. This case of extragonadal seminoma (extragonadal germ cell tumour) over manubrium sterni without any mediastinal involvement in a patient in early forties presenting as soft-tissue tumor, itself is a rarer entity and perhaps one of the kinds. Hence, the case needs to be reported and further progression and prevention have to be discussed.


Assuntos
Neoplasias do Mediastino , Neoplasias Embrionárias de Células Germinativas , Seminoma , Neoplasias de Tecidos Moles , Neoplasias Testiculares , Masculino , Humanos , Adolescente , Adulto , Seminoma/diagnóstico , Seminoma/cirurgia , Seminoma/patologia , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/cirurgia , Quimioterapia Adjuvante , Neoplasias Testiculares/diagnóstico , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/cirurgia , Neoplasias do Mediastino/patologia
7.
J Cardiothorac Surg ; 17(1): 307, 2022 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-36514095

RESUMO

BACKGROUND: Mediastinal cavernous hemangiomas are extremely rare vascular tumors. To the best of our knowledge less than 20 cases of posterior mediastinal hemangioma have been reported in literature, and this is the first case of mediastinal cavernous hemangioma presenting with massive pleural effusion. CASE PRESENTATION: We report a case of a 56-year-old female who presented with cough and chest tightness and was found with a massive pleural effusion in chest CT. It was mistaken for a malignant pleural effusion. A posterior mediastinal lesion was observed after thoracic drainage and misdiagnosed again as neurofibroma. The lesion was resected and post-operative histopathology suggested that it was a cavernous hemangioma. Post-operative recovery was uneventful, and a follow-up examination nearly 14 months later showed the patient had no recurrence. CONCLUSIONS: Due to the lack of diagnostic specificity and variety of clinical manifestations, CHM is often misdiagnosed prior to resection. This is the first description of mediastinal hemangioma presenting with massive pleural effusion. It is very important to consider mediastinal hemangioma before operation to reduce surgical complications, and it should be in the differential diagnosis of posterior mediastinal masses.


Assuntos
Hemangioma Cavernoso , Hemangioma , Neoplasias do Mediastino , Derrame Pleural , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/cirurgia , Neoplasias do Mediastino/patologia , Hemangioma Cavernoso/diagnóstico , Hemangioma/complicações , Erros de Diagnóstico/efeitos adversos
8.
Artigo em Inglês | MEDLINE | ID: mdl-36562742

RESUMO

Posterior mediastinal dumb-bell tumours are neurogenic tumours that extend from the mediastinum to the intraspinal canal. They represent a surgical challenge because they may be resected using a staged or a single-stage approach. Until recently, a classic posterolateral thoracotomy was the gold standard for surgical resection for the intrathoracic segment. In the meantime, video-assisted thoracoscopic surgery has gained great acceptance among most thoracic surgeons because of the decreased surgical trauma, less operative blood loss and fewer postoperative complications and the shorter hospital stays. Proper selection of cases for thoracoscopic excision is crucial for ensuring good surgical outcomes. Factors such as tumour size, location and presence or absence of features suggesting malignancy should be considered. This procedure can offer great help in different case scenarios involving posterior mediastinal dumb-bell tumours. For giant tumours that will eventually need a thoracotomy, video-assisted thoracoscopic surgery helps the surgical team to choose an optimal site for a tailored thoracotomy incision and rule out any metastatic pleura seedings. In cases of small intrathoracic segments of dumb-bell tumours (≤ 6-8 cm) that require combined spinal and thoracic procedures in a single-stage approach, a combined posterior and video-assisted thoracoscopic surgical approach can be implemented for total resection of the tumour.


Assuntos
Neoplasias do Mediastino , Mediastino , Humanos , Mediastino/patologia , Cirurgia Torácica Vídeoassistida/métodos , Neoplasias do Mediastino/cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias/cirurgia
9.
J Cardiothorac Surg ; 17(1): 333, 2022 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-36550490

RESUMO

BACKGROUND: Mature teratomas are benign germ cell tumors. On rare occasions, they have been associated with somatic malignancies and are termed rare germ cell tumors with a somatic-type malignancy (GCTSM). Mature teratomas commonly comprise adenocarcinomas; only seven previous cases of mature teratomas with neuroendocrine tumors have been reported to date. Here, we report a patient with a neuroendocrine tumor whithin a mature teratoma. CASE PRESENTATION: A 26-year-old man visited our department complaining of chest tightness. Contrast-enhanced computed tomography (CT) scans showed a strongly enhanced lesion within a 10-cm encapsulated cystic lesion in the anterior mediastinum. Positron emission tomography (PET) scans showed no areas of significant 18F-fluorodeoxyglucose (18F-FDG) accumulation. He underwent complete tumor resection via the transsternal approach. Histopathological examination of the specimen indicated a neuroendocrine tumor contained within a mature teratoma. CONCLUSIONS: In this case, a neuroendocrine tumor was contained within a mature teratoma. Our patient had no specific symptoms and his serum markers were within the normal range. Although PET is beneficial for diagnosing other GCTSM, it is not useful in detecting a neuroendocrine tumor. Therefore, the preoperative diagnosis of neuroendocrine tumors contained within mature teratomas remains challenging. However, GCTSM should be suspected in patients exhibiting CT findings of a mediastinal tumor, measuring ≥ 6 cm, in addition to characteristic GCTSM findings. Moreover, surgery should be performed carefully in such cases.


Assuntos
Neoplasias do Mediastino , Neoplasias Embrionárias de Células Germinativas , Tumores Neuroendócrinos , Teratoma , Masculino , Humanos , Adulto , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Teratoma/diagnóstico , Teratoma/cirurgia , Teratoma/complicações , Mediastino/patologia , Fluordesoxiglucose F18
12.
Medicine (Baltimore) ; 101(46): e31732, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401401

RESUMO

BACKGROUND: Lipofibroadenoma is an extremely rare thymic tumor, and the anterior mediastinum is the most common site. CASE SUMMARY: A 21-year-old male was admitted with fever without obvious cause for 2 months. After admission, the patient's highest temperature was 38.3°C, accompanied by diarrhea. Physical examination showed coarse breath sounds in both lungs. Chest enhanced computed tomography (CT) showed a mass of mixed density shadow on the left side of the anterior mediastinum with a size of approximately 9.2 cm × 5 cm × 2.1 cm and a clear boundary mixed with a low fat density shadow. Mediastinal tumors were removed under general anesthesia by video-assisted thoracoscopic surgery. Macroscopically, a clear boundary was shown between the tumor and the remaining thymus. Microscopically, the tumor contained a large amount of mature adipose and fibrous tissue with scattered cord-like epithelial tissue and a small number of lymphocytes scattered in the stroma. The tumor lacked thymic bodies. The neoplastic epithelial cells were oval or polygonal and arranged in fissures, the nuclei were uniform in size and mild in shape, and mitosis was rare. Epithelial cells were positive for AE1/AE3 and CK19, lymphocytes were positive for CD3 and CD20, and fat and fibrous tissue were positive for S-100 and vimentin, respectively. The Ki67 labeling index was less than 5%. Based on histological features and immunophenotype, thymic lipofibroadenoma was diagnosed. The patient was followed up 1 year after the operation, and no recurrence or residual lesions were found on the X-ray re-examination. CONCLUSION: Lipofibroadenoma is a benign thymic tumor, and thymectomy is regarded as the best treatment. The biological behavior of thymic lipofibroadenoma is good, and the recurrence rate is low.


Assuntos
Neoplasias do Mediastino , Timoma , Neoplasias do Timo , Humanos , Masculino , Adulto Jovem , Adulto , Mediastino/patologia , Timoma/patologia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia , Neoplasias do Timo/patologia , Timectomia , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/cirurgia , Neoplasias do Mediastino/patologia
13.
Am J Clin Oncol ; 45(12): 493-500, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36394133

RESUMO

OBJECTIVES: Extragonadal germ cell tumors (EGCT) are a rare entity, most of them being located in the mediastinum and retroperitoneum. Information on these tumors is scarce, requiring carrying out large population-based studies to better understand these diseases. We aimed to determine the clinical features and prognosis of patients with EGCT of the mediastinum and retroperitoneum. MATERIALS AND METHODS: Demographic and clinicopathological features of patients diagnosed with EGCT of the mediastinum and retroperitoneum from 1975 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS: A total of 1674 patients were included, 1297 (77.5%) of mediastinal origin and 377 (22.5%) of retroperitoneum. Nonseminomatous tumors (56.3%) were slightly more frequent than seminomas (43.7%) with similar distribution between mediastinum and retroperitoneum. After a median follow-up of 137 months, the median overall survival was 263 months (95% CI, 220-296) whereas the median cause-specific survival (CSS) has still not been reached. The 10-year overall survival and CSS were 57.4% (95% CI, 55-59.7) and 63% (95% CI, 60.6-65.2) respectively. Multivariate analysis showed that older age, mediastinal location, nonseminomatous histology, and distant disease at diagnosis were independent prognostic factors correlated with a worse prognosis. Patients with mediastinal choriocarcinoma and embryonal carcinoma have the worst prognosis, both with a median CSS of only 12 months. CONCLUSIONS: Despite a decreasing incidence observed in recent decades, EGCT continues to represent a challenge for oncologists. The prognosis of choriocarcinoma and embryonal carcinoma of the mediastinum remains poor and treatment strategies need to be improved urgently.


Assuntos
Carcinoma Embrionário , Coriocarcinoma , Neoplasias do Mediastino , Neoplasias Embrionárias de Células Germinativas , Neoplasias Testiculares , Masculino , Feminino , Humanos , Neoplasias do Mediastino/epidemiologia , Neoplasias do Mediastino/terapia , Mediastino/patologia , Neoplasias Embrionárias de Células Germinativas/epidemiologia , Neoplasias Embrionárias de Células Germinativas/terapia
14.
PLoS One ; 17(11): e0277200, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36395264

RESUMO

OBJECTIVES: This study presents the experiences of percutaneous CT-guided needle biopsy at a university hospital in Norway. METHODS: A retrospective examination of all mediastinal biopsy procedures between April 2015 and August 2019 was performed at Akershus University Hospital in Norway. We registered patient and procedure characteristics, along with lesion pathology and characteristics including localization according to anatomical and Felson mediastinal compartments. RESULTS: The study included 48 procedures, conducted in 45 patients (29 men and 16 women) with a mean age of 60,5 years. Pneumothorax occurred in 12 procedures (60% of the transpulmonary procedures) and pneumomediastinum in 18 procedures (38%). Pneumothorax was only seen in procedures with transpulmonal access. Four of the pneumothorax cases required pleural drainage. Diagnostic yield was 96%. We found significant (p = 0,006), moderate to high association between anatomical compartment localization and histopathological diagnosis (Cramér's V = 0,49) for tumours selected for CT-guided percutaneous biopsy. Felson's compartment division on the other hand, did not show any significant associations. CONCLUSION: We found CT-guided percutaneous needle biopsy of mediastinal tumours to be an effective and safe procedure with a diagnostic yield of 96%. The main complications were pneumothorax and pnumomediastinum, with a relatively low chest drainage rate. Anatomical mediastinum compartment showed a significant, moderate to high association with the histopathological diagnosis for tumours selected for percutaneous CT-guided biopsies, where most malignancies were seen in the anterior compartment.


Assuntos
Neoplasias do Mediastino , Pneumotórax , Masculino , Humanos , Feminino , Pneumotórax/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos
17.
J Med Case Rep ; 16(1): 397, 2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-36316785

RESUMO

BACKGROUND: Lymphangiomas are rare benign malformations of the lymphatics that occur due to blockage of the lymphatic system during fetal development. They commonly occur in the neck and axilla, while involvement of the pericardium is rare. We report herein the case of a 16-month-old Sri Lankan child with a large pericardial cystic lymphangioma presenting with sudden-onset shortness of breath. CASE PRESENTATION: A 16-month-old Sri Lankan boy presented with sudden-onset dyspnea for 1-day duration following a febrile illness that lasted 2 days. On examination, he was afebrile and had subcostal, intercostal, and suprasternal recessions, with a respiratory rate of 50 breaths per minute. He had a loud expiratory grunt. The chest expansion was reduced on the right side, which was dull to percussion. Auscultation revealed a marked reduction of air entry over the right lower and mid zones. Chest X-ray showed a well-demarcated opacity involving the lower and mid zones of the right hemithorax associated with a tracheal shift to the opposite side. Ultrasound scan of the chest revealed fluid-filled right hemithorax suggesting a septate pleural effusion. A contrast-enhanced computed tomography scan of the thorax showed a large multiloculated extrapulmonary cystic lesion involving the right hemithorax with a mediastinal shift towards the left side associated with displacement of the right-side mediastinal structures. He underwent mini-thoracotomy and surgical excision of the cyst. A large cyst originating from the pericardium was observed and excised during surgery. Histological examination revealed a lesion composed of cysts devoid of a lining epithelium but separated by connective tissue, mature adipose tissue, and lymphoid aggregates. The child showed complete recovery postoperatively with full expansion of the ipsilateral lung. CONCLUSION: We report the case of a patient with cystic lymphangioma who was perfectly well and asymptomatic until 16 months of age. This case report presents the very rare occurrence of a large cystic lymphangioma originating from the pericardium. It highlights the importance of considering rare possibilities and performing prompt imaging in situations of diagnostic uncertainty to arrive at an accurate diagnosis that can be lifesaving.


Assuntos
Cistos , Linfangioma Cístico , Linfangioma , Neoplasias do Mediastino , Síndrome do Desconforto Respiratório , Masculino , Criança , Humanos , Lactente , Linfangioma Cístico/diagnóstico , Linfangioma Cístico/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico , Linfangioma/complicações , Linfangioma/cirurgia , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Dispneia , Cistos/complicações
18.
Pathol Res Pract ; 239: 154161, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36274379

RESUMO

Lipoblastoma is a rare benign, but highly proliferative tumor most commonly seen in early childhood. Recurrence rates are high when complete resection is unfeasible and systemic therapy is necessary. We report the case of a large, aggressive thoracic and mediastinal lipoblastoma in a 20-year-old woman, which was surgically not resectable. The tumor has been characterized extensively including molecular pathology, molecular karyotyping, conventional chromosomal analysis and in vitro-chemosensitivity testing in search for alternative therapies. Nevertheless, this did not reveal treatable targets and systemic therapies, which were based on chemosensitivity testing proved ineffective. Despite all treatment attempts, the disease showed a progressive fatal course.


Assuntos
Lipoblastoma , Lipoma , Neoplasias do Mediastino , Feminino , Humanos , Pré-Escolar , Lactente , Adulto Jovem , Adulto , Neoplasias do Mediastino/patologia
19.
Khirurgiia (Mosk) ; (10): 35-43, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36223148

RESUMO

OBJECTIVE: To study the possibilities and results of reconstruction of caval veins. MATERIAL AND METHODS: We analyzed the results of reconstruction of caval veins in 31 patients (19 men and 12 women) including superior vena cava (SVC) in 5 cases and inferior vena cava (IVC) in 26 cases. Penetrating wounds with vascular damage were found in 8 patients. Iatrogenic damage to IVC was observed in 19 patients (nephrectomy for kidney cancer - 2, nephrectomy for secondary kidney wrinkling - 1, echinococcectomy from retroperitoneal space - 1, adrenalectomy for adrenal tumors - 5, right-sided lumbar sympathectomy - 1, resection of abdominal aortic aneurysm - 1, resection of a large retroperitoneal tumor - 6). Iatrogenic damage to SVC occurred in 2 patients during resection of mediastinal tumor. In other 4 cases, elective surgery for mediastinal tumor (1), pancreatic head cancer (2) and liver alveococcosis (1) was accompanied by resection and replacement of caval veins. RESULTS: All interventions for caval vein injury were performed under adequate infusion therapy. Seven (22.6%) patients died. One patient with blunt chest trauma and damage to SVC died during thoracotomy. In another patient, infrarenal IVC was intersected during mobilization of retroperitoneal hydatid cyst that required ligation for vital indications. High venous hypertension below the ligature led to eruption of sutures on the venous stump. The patient died from hypovolemia after additional IVC ligation. Other 5 patients died in early postoperative period without leaving the state of shock. These patients had damage to retrohepatic segment of IVC (1), vascular-organ (1) and iatrogenic (3) injuries. One patient died from pulmonary embolism, two patients - from venous bleeding between the 2nd and the 5th postoperative days. Patients died before reoperations. Two patients with postoperative bleeding underwent redo surgery with favorable outcomes. One patient underwent redo surgery for peritonitis with a favorable result. Thus, 7 (22.6%) patients with caval vein injury died in intraoperative and early postoperative period. Non-specific complications occurred in 4 (12.9%) patients. These events were corrected by conservative measures. Other 24 (77.4%) patients with traumatic and iatrogenic injuries of caval veins were discharged. CONCLUSION: Caval vein injury is less common event compared to other vascular damages. Nevertheless, this complication is accompanied by severe blood loss, shock and hypovolemia. We can only assume damage to a great vessel in patients with penetrating wounds before surgery and appropriate symptoms of internal bleeding. However, final diagnosis is made during surgery. Hemostasis is a responsible and difficult surgical stage in these patients. There is usually no alternative to reconstructive surgery in these cases. However, ligation is permissible in extremely ill patients and only in infrarenal segment of IVC. Vascular suture is a more acceptable and effective option for reconstruction. However, patch repair is advisable for large defects. In our opinion, this approach is better regarding long-term patency compared to total replacement with synthetic prostheses.


Assuntos
Neoplasias do Mediastino , Traumatismos Torácicos , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Ferimentos Penetrantes , Feminino , Humanos , Hipovolemia/patologia , Doença Iatrogênica , Masculino , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Veia Cava Superior/lesões
20.
Cancer ; 128(23): 4139-4149, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36223226

RESUMO

BACKGROUND: Primary malignant mediastinal germ cell tumors (GCTs) are rare pediatric tumors that have a poorer prognosis compared to GCTs occurring elsewhere in the body. The current study aimed to assess the prognostic factors and treatment outcomes of children with primary malignant mediastinal GCT in Taiwan. METHODS: The authors retrospectively reviewed children 0-18 years old who were newly diagnosed with primary malignant mediastinal GCT between January 1, 2005 and December 31, 2019 and were registered in the Taiwan Pediatric Oncology Group patient registry. The impact of presenting characteristics, including sex, age, tumor stage, histology subtype, surgical treatment, and chemotherapy regimens of the patients were analyzed. RESULTS: This study enrolled 52 children with malignant mediastinal GCT who had a median age of 16.0 (range, 6.0-17.9) years at diagnosis. The most common histological subtypes were mixed GCTs (n = 20) and yolk sac tumors (n = 15). Advanced disease stage and choriocarcinoma histology subtype were associated inferior outcomes. Children who received surgical treatment exhibited better outcomes compared to those who did not (5-year overall survival, 78% vs. 7%, p < .001). After comparing patients who received first-line cisplatin- and carboplatin-based chemotherapy, no difference in treatment outcomes was observed. Multivariate analysis showed that surgical management was the only independent predictor for superior OS. CONCLUSIONS: Surgical treatment is recommended for mediastinal GCT. Cisplatin-based chemotherapy was not superior to carboplatin-based chemotherapy as first-line treatment and may be avoided due to toxicity concerns.


Assuntos
Neoplasias do Mediastino , Neoplasias Embrionárias de Células Germinativas , Criança , Humanos , Adolescente , Recém-Nascido , Lactente , Pré-Escolar , Prognóstico , Cisplatino , Carboplatina/uso terapêutico , Estudos Retrospectivos , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/cirurgia , Neoplasias do Mediastino/terapia
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