Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.218
Filtrar
1.
J Bras Pneumol ; 46(6): e20190221, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33111752

RESUMO

OBJECTIVE: Lung cancer (LC) is one of the leading causes of death worldwide. Accurate mediastinal staging is mandatory in order to assess prognosis and to select patients for surgical treatment. EBUS-TBNA is a minimally invasive procedure that allows sampling of mediastinal lymph nodes (LNs). Some studies have suggested that EBUS-TBNA is preferable to surgical mediastinoscopy for mediastinal staging of LC. The objective of this systematic review and meta-analysis was to compare EBUS-TBNA and mediastinoscopy in terms of their effectiveness for mediastinal LN staging in potentially operable non-small cell lung cancer (NSCLC). METHODS: This was a systematic review and meta-analysis, in which we searched various databases. We included studies comparing the accuracy of EBUS-TBNA with that of mediastinoscopy for mediastinal LN staging in patients with NSCLC. In the meta-analysis, we calculated sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. We also analyzed the risk difference for the reported complications associated with each procedure. RESULTS: The search identified 4,201 articles, 5 of which (with a combined total of 532 patients) were selected for inclusion in the meta-analysis. There were no statistically significant differences between EBUS-TBNA and mediastinoscopy in terms of the sensitivity (81% vs. 75%), specificity (100% for both), positive likelihood ratio (101.03 vs. 95.70), or negative likelihood ratio (0.21 vs. 0.23). The area under the summary ROC curve was 0.9881 and 0.9895 for EBUS-TBNA and mediastinoscopy, respectively. Although the number of complications was higher for mediastinoscopy, the difference was not significant (risk difference: -0.03; 95% CI: -0.07 to 0.01; I2 = 76%). CONCLUSIONS: EBUS-TBNA and mediastinoscopy produced similar results for mediastinal staging of NSCLC. EBUS-TBNA can be the procedure of first choice for LN staging in patients with NSCLC.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Linfonodos/cirurgia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Mediastinoscopia/métodos , Mediastino/diagnóstico por imagem , Broncoscopia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Endoscopia , Humanos , Neoplasias Pulmonares/cirurgia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Neoplasias do Mediastino/cirurgia , Mediastino/cirurgia , Estadiamento de Neoplasias , Sensibilidade e Especificidade
2.
Rev Port Cir Cardiotorac Vasc ; 27(3): 217-219, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33068513

RESUMO

A 19 years-old woman, on her 17th week of pregnancy presented to the emergency department with thoracic pain and vomiting. An empyema was diagnosed and she was transferred to a tertiary hospital for treatment. After drainage of the empyema a mediastinal mass was detected and a thoracic MRI revealed a multicystic lesion of the anterior mediastinum, causing cardiac and left lung compression, suggestive of a complicated teratoma. After a multidisciplinary discussion involving pulmonology, radiology, obstetrics and thoracic surgery, she was operated successfully by clamshell incision. A mature complicated teratoma was resected and a left pleurectomy/decortication performed. She was discharged on day 17 with no obstetrical or respiratory symptoms..


Assuntos
Neoplasias do Mediastino , Complicações Neoplásicas na Gravidez , Teratoma , Cirurgia Torácica , Dor no Peito , Feminino , Humanos , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Gravidez , Radiografia , Teratoma/complicações , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Adulto Jovem
4.
Medicine (Baltimore) ; 99(38): e21765, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957306

RESUMO

INTRODUCTION: Neurogenic tumors are the most frequent neoplasms of the lower posterior mediastinum. Traditionally, lower posterior mediastinal tumors are excised by video-assisted thoracic surgery. However, the available robotic treatment for the lower posterior mediastinum tumors to date are rare. Herein, we report a case of a right lower posterior mediastinal tumors successfully treated with retroperitoneal robot-assisted surgery using a transdiaphragmatic approach. PATIENT CONCERNS: A 54-year-old male patient without any symptoms was admitted into our department with a right lower posterior mediastinal paravertebral tumor that was detected during a medical check-up. DIAGNOSIS: A right lower posterior mediastinal paravertebral tumor. INTERVENTIONS: Retroperitoneal robot-assisted resection using a transdiaphragmatic approach was performed. OUTCOMES: The patient was treated with retroperitoneal robot-assisted surgery using a transdiaphragmatic approach and remained disease-free throughout a 6-month follow-up. His postoperative course was uneventful. Histopathological examination revealed a benign schwannoma. CONCLUSION: Our initial experience showed that retroperitoneal robot-assisted resection of a lower posterior mediastinal tumor using a transdiaphragmatic approach is technically feasible and can be considered a potential alternative for either video-assisted thoracic surgery or a thoracotomy.


Assuntos
Neoplasias do Mediastino/cirurgia , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Masculino , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neurilemoma/patologia
5.
J Card Surg ; 35(8): 2047-2049, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652625

RESUMO

Mediastinal paragangliomas are very uncommon neuroendocrine neoplasms. Due to their tissue of origin (sympathetic ganglia of the great vessels), they tend to arise deep within pericardial space and, more importantly, intimately attached to great vessels, which makes surgical resection, even with cardiopulmonary bypass, very challenging. This commentary accompanies the case report describing complex surgical management of a paraganglioma located in the anterior mediastinum that was initially thought to be a thymoma.


Assuntos
Neoplasias do Mediastino/cirurgia , Paraganglioma/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Ponte Cardiopulmonar , Diagnóstico Diferencial , Diagnóstico por Imagem , Galactosamina/análogos & derivados , Humanos , Imino Piranoses , Neoplasias do Mediastino/diagnóstico , Mediastino/cirurgia , Paraganglioma/diagnóstico , Timoma , Neoplasias do Timo
6.
Khirurgiia (Mosk) ; (6): 114-117, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573542

RESUMO

Patients with anterior mediastinum tumors fall into a difficult category due to high risk of invasion of vital structures and complexity of surgical correction. We report resection of recurrent hemangioma of anterior mediastinum with aortic arch replacement and simultaneous resection of left atrial myxoma in a 35-year-old woman. Successful treatment of these patients correlates with aggressive surgical approach followed by total resection of tumor and all affected vessels and other tissues.


Assuntos
Neoplasias Cardíacas/cirurgia , Hemangioma/cirurgia , Neoplasias do Mediastino/cirurgia , Mixoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Adulto , Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Cirúrgicos Cardiovasculares/métodos , Feminino , Átrios do Coração/cirurgia , Humanos , Mediastino/cirurgia
7.
Am J Med ; 133(11): e676-e677, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32473873
8.
Artigo em Inglês | MEDLINE | ID: mdl-32520448

RESUMO

The clamshell incision (also known as a transverse or crossbow transsternal incision) was the common approach to the heart in the early days of cardiac surgery and was occasionally also used to access mediastinal tumors or both lungs. However, with the introduction of the median sternotomy, the clamshell incision was virtually forgotten, except for cardiothoracic trauma and double lung transplant. However, in rare situations, such as in large space-occupying lesions in the mediastinum, surgeons will resort to the clamshell approach to achieve exposure and complete resection.  In this video tutorial, we demonstrate the operative steps for using the clamshell approach in one of those rare clinical scenarios. The resected mass was a giant mediastinal teratoma measuring 21 x 27 x 6 cm.


Assuntos
Neoplasias do Mediastino/cirurgia , Teratoma/cirurgia , Toracotomia/métodos , Feminino , Humanos , Adulto Jovem
9.
J Cardiothorac Surg ; 15(1): 77, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393292

RESUMO

BACKGROUND: Primary fallopian tube carcinoma (PFTC) is a malignant tumor of the female genital tract that mostly presents intraperitoneal dissemination in clinical practice. The incidence of upper anterior mediastinal metastasis in PFTCs is extremely rare. We herein report a rare case of PFTC mediastinal metastasis after radical resection. When anterior mediastinal metastasis of an unknown origin is encountered, the possibility of PFTC should be considered. CASE PRESENTATION: A 68-year-old female who was previously diagnosed with PFTC after radical resection of a primary tumor in the fallopian tube was admitted to our department with a right anterior mediastinum mass. Radical resection of the mediastinal mass was performed, and poorly differentiated metastatic adenocarcinoma of the fallopian tube was confirmed. There was no recurrence in the 24 months after the curative operation. CONCLUSION: To our knowledge, no mediastinal metastasis of PFTC has been reported yet. Thus, we presented this rare case indicating the heterogeneity of this malignant disease and to draw attention to the occasional distant metastasis of PFTC in clinical practice.


Assuntos
Adenocarcinoma/patologia , Neoplasias das Tubas Uterinas/patologia , Neoplasias do Mediastino/secundário , Mediastino/patologia , Recidiva Local de Neoplasia/cirurgia , Adenocarcinoma/cirurgia , Idoso , Neoplasias das Tubas Uterinas/cirurgia , Tubas Uterinas , Feminino , Humanos , Incidência , Neoplasias do Mediastino/cirurgia
10.
J Ayub Med Coll Abbottabad ; 32(1): 132-135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468772

RESUMO

Paediatric thoracic tumours resection is one of the most difficult procedure for any anaesthetist. Paediatric population is different from adults in many aspects, as they have small thoracic volume and more compressible mass effect on their airway and vascular structures. we are reporting a case of a huge paediatric thoracic tumour resection occupying the left thoracic cavity. The possible mechanism, consequences, prevention and management discussed in this report.


Assuntos
Neoplasias do Mediastino , Teratoma , Criança , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Teratoma/diagnóstico , Teratoma/patologia , Teratoma/cirurgia , Tórax/diagnóstico por imagem , Tórax/patologia
12.
Ann R Coll Surg Engl ; 102(6): e133-e135, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32233849

RESUMO

Ganglioneuroma is a rare benign neoplasm. Patients with ganglioneuroma show no symptoms. We describe a rare case of giant ganglioneuroma with scoliosis in a 35-year-old woman, who presented to our hospital for haemoptysis. We combined with neurosurgeons to remove the tumour successfully. After 16 months of follow-up, there is no evidence of tumour recurrence.


Assuntos
Ganglioneuroma/cirurgia , Hemoptise/etiologia , Neoplasias do Mediastino/cirurgia , Escoliose/diagnóstico , Vértebras Torácicas/cirurgia , Adulto , Feminino , Ganglioneuroma/complicações , Ganglioneuroma/diagnóstico , Ganglioneuroma/patologia , Humanos , Imagem por Ressonância Magnética , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Invasividade Neoplásica/diagnóstico por imagem , Escoliose/complicações , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral
13.
BMC Surg ; 20(1): 45, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138719

RESUMO

BACKGROUND: Robot-assisted thoracoscopic surgery (RATS) is useful for surgery in the apical region of the chest cavity, as it narrows towards the head. Here, we describe a nonfunctional, rib-invasive paraganglioma arising in the posterior mediastinum that was successfully removed using RATS combined with chest wall resection. CASE PRESENTATION: A 31-year-old woman presented with a posterior mediastinal mass on chest computed tomography (CT) scan during a medical check-up 2 years prior. Positron emission tomography/computed tomography scan with F-18 fluorodeoxyglucose revealed a mass associated with standardized uptake maximum value of 2.69. With a preoperative diagnosis of neurogenic tumor by CT-guided percutaneous fine-needle aspiration biopsy, we performed robot-assisted tumor resection combined with chest wall resection. The wristed instruments of the robotic surgical system have increased range of motion and enabled the tumor resection without organ injury in the thoracic cavity. Histopathology examination revealed a non-functional paraganglioma with rib invasion. CONCLUSIONS: RATS is a useful technique, enabling safer and easier resection of a mediastinal tumor adjacent to surrounding organs.


Assuntos
Neoplasias do Mediastino/cirurgia , Paraganglioma/cirurgia , Toracoscopia/métodos , Adulto , Feminino , Humanos , Mediastino/patologia , Robótica , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios X
14.
J Cardiothorac Surg ; 15(1): 35, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32051013

RESUMO

BACKGROUND: Mediastinal mature teratomas are rare tumors with diverse surgical approaches. The aim of this study is to review our experience of thoracoscopic surgery management in patients with teratomas. METHODS: We retrospectively reviewed 28 consecutive patients with mediastinal mature teratomas who underwent thoracoscopic surgery at Viet Duc University Hospital from January 2008 to August2018. Patients were divided into 2 groups with 2 types of thoracoscopic surgery, closed thoracoscopic surgery (CTS) group and video-assisted thoracoscopic surgery (VATS) group. The selection of sugical approach was based on sizes, locations and characteristics of tumors. Post-operative outcomes were assessed and compared between these 2 groups. RESULTS: There were 14 female and 14 male patients with a median age of 41.2 ± 13.8 years. A total of 22 teratomas were located on the right side of the chest cavity and 6 on the left side. We performed CTS in 21 patients (75%) and VATS in 7 patients (25%) for tumor resection. There were 3 cases (10.7%) required conversion to minithoracotomy (5 cm in incision length). Skin appendages accounted for the highest rate (96.4%) in pathology. There was no record of mortality or tumor recurrence detected by computerized tomography. CONCLUSION: A thoracoscopic surgery for a mediastinal mature teratoma was a feasible choice. Challenging factors such as large tumors, intraoperative bleeding and strong tumor cell adhesion were considered handling by conversion to mini-thoracotomy that could ensure safety procedures and complete removal of tumors. Extraction of tumor contents might be performed for patients with large mature cystic teratomas to facilitate thoracoscopic surgery.


Assuntos
Neoplasias do Mediastino/cirurgia , Teratoma/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adolescente , Adulto , Criança , Conversão para Cirurgia Aberta , Feminino , Humanos , Masculino , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Teratoma/patologia , Toracotomia , Resultado do Tratamento , Carga Tumoral , Adulto Jovem
16.
J Cardiothorac Surg ; 15(1): 36, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066478

RESUMO

BACKGROUND: Mediastinal teratoma is a rare disease, many cases were reported before, but few articles focus on large case analyses. The objective of this article is to summarize the clinical characteristics of benign mediastinal teratoma and the experience of surgical treatment, especially thoracoscopic surgery for benign mediastinal teratoma. METHODS: The clinical data of 108 patients with benign mediastinal teratoma confirmed by operation and pathology from January 1992 to January 2018 were analyzed retrospectively. The clinical symptoms, imaging examination, surgical methods and prognosis of all patients were analyzed. We compared the difference of thoracoscopic surgery and thoracotomy surgery using 102 patients underwent only chest surgery. Normally distributed continuous variables were compared by independent sample t test. Categorical variables were analyzed by chi-square test. RESULTS: Imaging examination showed that all 108 cases of mediastinal teratoma were located in the anterior region of mediastinum. All cases underwent surgical resection, postoperative pathology confirmed that all cases were benign. 1 case was taken simple neck collar incision, 5 case was taken median thoracotomy combined with neck incision, other 102 cases were taken thoracoscopic surgery (22) or thoracotomy surgery (80). 4 cases were treated with partial pericardial resection due to adhesions, 12 cases underwent partial pericardial resection, 5 cases underwent lobectomy, 9 cases underwent wedge resection of lobe, and 2 patients underwent anonymous vein angioplasty. 1 case underwent second operation because of postoperative bleeding, 1 case of chylothorax, 1 case of recurrent laryngeal nerve injury, 2 cases of wound infection, 1 case of secondary pulmonary infection. 106 cases were followed up, period from 12 months to 10 years, no recurrence of tumor was found. Comparing to take thoracotomy surgery, patients underwent thoracoscopic surgery has strong advantage on intraoperative blood loss and hospital stay days after surgery (P < 0.05). tumor maximum diameter is larger for thoracotomy surgery group, as well as more patients suffer estimated adhesions from preoperative imaging. so we compared above parameters in patients with tumor diameter less than 10 cm with or without estimated adhesions from preoperative imaging, a strong advantage still can be found in thoracoscopic surgery group, inpatients with estimated adhesions from preoperative imaging, intraoperative blood loss (38.75 ± 15.53 vs 169.17 ± 208.82., P = 0.04) and hospital stay days after surgery (5.50 ± 0.93 vs 9.43 ± 6.54., P = 0.04) were better. In patients without estimated adhesions from preoperative imaging, intraoperative blood loss (46.67 ± 10.00 vs 110.53 ± 123.13., P = 0.06) and hospital stay days after surgery (4.70 ± 1.16 vs 7.53 ± 2.32., P = 0.01) were better. Especially, in thoracoscopic surgery group, hospital stay days after surgery was significantly shorter. CONCLUSION: The clinical manifestations and imaging performance of benign mediastinal teratoma were complicated, and the surgical treatment was effective. Compared with traditional thoracotomy surgery, thoracoscopic surgery can improve patients' quality of life, less intraoperative blood loss, and less hospital stay days after surgery, so if condition is permitted, thoracoscopic surgery should be a better choice.


Assuntos
Neoplasias do Mediastino/cirurgia , Teratoma/cirurgia , Toracoscopia , Toracotomia , Adulto , Perda Sanguínea Cirúrgica , Feminino , Humanos , Tempo de Internação , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Teratoma/diagnóstico por imagem , Teratoma/patologia , Toracoscopia/efeitos adversos , Toracotomia/efeitos adversos , Aderências Teciduais/complicações , Aderências Teciduais/cirurgia , Carga Tumoral
17.
J Med Case Rep ; 14(1): 14, 2020 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-31954403

RESUMO

BACKGROUND: The condition of mediastinal chondrosarcoma causing severe airway compression has never been reported before, and its complexity makes its surgical management challenging. We implemented two new techniques to overcome this problem. Creative mockup analogy of a distorted trachea and tumor lesion using a 3-D printing module, with reprogramming by computed tomography, streamlined the panorama with intricate correlation. CASE PRESENTATION: Our patient was a previously healthy 52-year-old slender yellow man who had no obvious medical history. In the last 3 years, upper respiratory tract infection and productive cough were noted frequently, and the patient's symptoms were aggravated with shortness of breath when his head was positioned below 90 degrees during squatting and hunching of the body. The patient manifested prone sleep with ashen complexion, and he had lost 3-4 kg of body weight over the 3 weeks before admission to our hospital. Virtual bronchoscopy with computed tomography revealed an 8.3 × 7.5 × 4-cm lobulated right upper mediastinal mass with amorphous calcification and severe, intricate airway compression. A creative mockup analogy module of the distorted trachea and tumor was generated by 3-D printing and reprogrammed by computed tomography to streamline the sophisticated correlation. The patient underwent a two-stage operation comprising stabilization of the airway for innovative T-tube insertion preceded by thoracoscopy-assisted radical removal of the tumor. Postoperative adjuvant radiotherapy was administered. The patient recovered uneventfully and stayed healthy for 2 solid years in follow-up. CONCLUSIONS: An advanced 3-D printing model provides affirmative information related to treatment strategy and is also a prospective tool for better doctor-patient communication regarding the disease.


Assuntos
Condrossarcoma/diagnóstico por imagem , Condrossarcoma/cirurgia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Impressão Tridimensional , Estenose Traqueal/diagnóstico por imagem , Estenose Traqueal/cirurgia , Broncoscopia , Constrição Patológica , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Relações Médico-Paciente , Toracoscopia , Tomografia Computadorizada por Raios X
18.
Interact Cardiovasc Thorac Surg ; 30(5): 788-789, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31985793

RESUMO

Mediastinal teratomas are uncommon, fast-growing thoracic tumours, which are usually diagnosed in childhood or adolescence. Neonatal forms are the rarest and often present with life-threatening respiratory distress syndrome. In our case, respiratory failure in a neonate was aggravated by severe cardiogenic shock due to aortic and systemic venous compression, extreme heart displacement and rotation, necessitating an emergency operation on the first day of life.


Assuntos
Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/cirurgia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Choque Cardiogênico/etiologia , Teratoma/complicações , Teratoma/cirurgia , Fatores Etários , Aorta/patologia , Feminino , Humanos , Recém-Nascido , Neoplasias do Mediastino/diagnóstico , Teratoma/diagnóstico , Veias/patologia
19.
Pract Radiat Oncol ; 10(2): 104-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31783172

RESUMO

PURPOSE: (1) Demonstrate feasibility of electrocardiogram-gated computed tomography with coronary angiography (E-CTA) in treatment planning for mediastinal lymphoma and (2) assess whether inclusion of cardiac substructures in the radiation plan optimization (CSS optimization) results in increased cardiac substructure sparing. METHODS AND MATERIALS: Patients with mediastinal lymphomas requiring radiation therapy were prospectively enrolled in an observational study. Patients completed a treatment planning computed tomography scan and E-CTA in the deep inspiration breath hold position. Avoidance structures (eg, coronary arteries and cardiac valves) were created in systole and diastole and then merged into a single planning organ-at-risk volume based on a cardiac substructure contouring atlas. In the photon cohort, 2 volumetric modulated arc therapy plans were created per patient with and without CSS optimization. Dosimetric endpoints were compared. RESULTS: In the photon cohort, 7 patients were enrolled. For all 7 patients, the treating physician elected to use the CSS optimization plan. At the individual level, 2 patients had reductions of 10.8% and 16.2% of the right coronary artery receiving at least 15 Gy, and 1 had a reduction of 9.6% of the left anterior descending artery receiving 30 Gy. No other differences for coronary arteries were detected between 15 and 30 Gy. Conversely, 5 of 7 patients had >10% reductions in dose between 15 to 30 Gy to at least 1 cardiac valve. The greatest reduction was 22.8% of the aortic valve receiving at least 30 Gy for 1 patient. At the cohort level, the maximum, mean, and 5-Gy increment analyses were nominally similar between planning techniques for all cardiac substructures and the lungs. CONCLUSIONS: Cardiac substructure delineation using E-CTA was feasible, and inclusion in optimization led to modest improvements in sparing of radiosensitive cardiac substructures for some patients.


Assuntos
Angiografia Coronária/métodos , Eletrocardiografia/métodos , Coração/fisiopatologia , Linfoma/diagnóstico por imagem , Linfoma/cirurgia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Adolescente , Adulto , Feminino , Humanos , Linfoma/radioterapia , Masculino , Neoplasias do Mediastino/radioterapia , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
20.
Ann Thorac Cardiovasc Surg ; 26(2): 95-99, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-29607872

RESUMO

INTRODUCTION: Primary leiomyosarcomas (LMS) of the mediastinum are extremely rare malignant mesenchymal tumors developing from soft tissues or great vessels. We present a case of a primary leiomyosarcoma of the middle mediastinum in which long-term survival was achieved. CASE REPORT: A 77-year-old man presented to us for examination with an extrapleural sign in his upper mediastinum on chest X-ray. Computed tomography (CT) revealed a well-circumscribed mass in the middle mediastinum. Thoracoscopic resection of the mediastinal tumor and immunohistological findings, which were positive for smooth muscle actin (SMA), HHF-35, vimentin, and desmin confirmed primary leiomyosarcoma. It recurred twice with solid right pulmonary metastases, which were resected. He was followed-up for a total of 9 years and 6 months from the first surgery with no signs of recurrence after his last surgery. CONCLUSION: Surgical resection of both the primary tumor and pulmonary metastases remains the mainstay of treatment of primary leiomyosarcomas.


Assuntos
Leiomiossarcoma/cirurgia , Neoplasias Pulmonares/cirurgia , Neoplasias do Mediastino/cirurgia , Metastasectomia , Pneumonectomia , Toracoscopia , Idoso , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/secundário , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA