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1.
Biomed Res Int ; 2022: 2012457, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36051485

RESUMO

Objective: To explore the feasibility and advantages of thoracoscopic resection of anterior mediastinal tumors through subxiphoid and lateral thoracic approaches. Method: 74 patients with anterior mediastinal tumors hospitalized in our hospital from January 2019 to January 2022 were retrospectively analyzed. They were divided into the lateral chest group (31 cases) and the infraxiphoid group (43 cases) according to different operation methods. The tumor size, operation time, intraoperative bleeding, postoperative pain score, postoperative complications, postoperative drainage tube removal time, and hospital stay were compared between the two groups. Result: The intraoperative bleeding and postoperative pain scores in the subxiphoid group were better than those in the lateral chest group. There was no significant difference in operation time and postoperative complications between the two groups. Conclusion: Compared with the lateral thoracic approach, the thoracoscopic subxiphoid approach can be more safe and effective in resectioning anterior mediastinal tumors.


Assuntos
Neoplasias do Mediastino , Processo Xifoide , Humanos , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/métodos , Processo Xifoide/patologia
2.
Kyobu Geka ; 75(10): 883-888, 2022 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-36155587

RESUMO

Mediastinal tumors rarely lead to acute symptomatic manifestations due to spontaneous rupture and perforation, intra-tumoral hemorrhage, and bacterial contamination. Moreover, giant mediastinal tumors can compress and infiltrate surrounding mediastinal structures, such as the trachea, bronchus, cardiac sac, and superior vena cava, at the first visit. In addition, mediastinal mature teratomas include various ectopic tissues such as digestive glands and sebaceous glands that can cause specific pathological conditions. To address and properly manage patients with these rare conditions, prior learning must be emphasized to facilitate in clinical decision-making. In this article, we classified four pathological conditions of emergency due to mediastinal tumors. These include the clinical conditions resulting from the compression of anatomical structures by the tumor, those resulting from infiltration and extension into the surrounding mediastinal structures by the tumor, the specific conditions attributable to mature teratomas, and the occurrence of hemothorax due to spontaneous rupturing of the tumor. Based on the review of our cases and other recently reported cases, we summarize and discuss practical pitfalls and pearls in the emergency surgical management of these rare but life-threatening clinical situations.


Assuntos
Neoplasias do Mediastino , Teratoma , Humanos , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Mediastino , Ruptura Espontânea , Teratoma/cirurgia , Veia Cava Superior
3.
Medicine (Baltimore) ; 101(35): e30377, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107546

RESUMO

RATIONALE: Paragangliomas are extremely rare neuroendocrine tumors arising from ganglia. These tumors are barely found in the middle mediastinum. PATIENT CONCERNS: A 31-year-old male patient was admitted to our hospital for treatment of an middle mediastinal tumor which was found incidentally on echocardiography during a medical checkup. Contrast-enhanced chest computed tomography (CT) demonstrated a well-defined hypervascularized heterogeneous mass located in the middle mediastinum. The tumor showed strong 18F-fluorodeoxyglucose (FDG) activity on positron emission tomography-computed tomography (PET-CT). DIAGNOSIS: Before the surgery, we presumed the mass was an angiogenic or neurogenic tumor. As a result, the histological features favored a diagnosis of paraganglioma. INTERVENTIONS: The tumor was completely removed by anterior thoracotomy, along with the proximal segment of the left anterior descending artery (LAD), and coronary artery bypass grafting (CABG) was performed immediately after the tumor excision. OUTCOMES: The patient had an uneventful recovery. The patient did well in the postoperative follow-up without any complications and signs of recurrence at 3 months, 1 year, 2 year and 4 year. LESSONS: This report can increase the confidence in surgeries of mediastinal paragangliomas adhering tightly the adjacent structures.


Assuntos
Neoplasias do Mediastino , Paraganglioma Extrassuprarrenal , Paraganglioma , Adulto , Artérias/patologia , Fluordesoxiglucose F18 , Humanos , Masculino , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Mediastino/diagnóstico por imagem , Mediastino/patologia , Mediastino/cirurgia , Paraganglioma/complicações , Paraganglioma/diagnóstico por imagem , Paraganglioma/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
4.
Chest ; 162(2): e81-e84, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35940667

RESUMO

CASE PRESENTATION: A 60-year-old woman, a care worker with no known comorbidities, presented to the pulmonary clinic for assessment of a left hilar tumor detected on chest radiography. She had a history of oophorocystectomy and was a 0.5-pack/day smoker. She was asymptomatic but desired a confirmative diagnosis.


Assuntos
Neoplasias do Mediastino , Feminino , Humanos , Pulmão , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/cirurgia , Mediastino , Pessoa de Meia-Idade , Radiografia
5.
Pediatr Surg Int ; 38(9): 1297-1302, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35794495

RESUMO

BACKGROUND: Pediatric mediastinal masses may be resected using an open or video-assisted thoracoscopic surgery (VATS) approach. We sought to define the preoperative imaging findings predicting amenability to VATS. METHODS: This multicenter retrospective study of pediatric patients undergoing either VATS or open surgical mediastinal mass resection between 2008 and 2018 evaluated the preoperative imaging descriptors associated with VATS. Postoperative endpoints included length of stay (LOS), 30-day readmission, 90-day mortality and complication rates. RESULTS: Mediastinal mass resection was performed in 33 patients. Median tumor size was 6 cm, and 51.5% had anterior mediastinal tumors. The 23 (69.7%) patients who underwent VATS were significantly older (144 months vs 32, P = 0.01) and larger (33.6 kg vs 13.8 P = 0.03). Preoperative imaging characteristics in VATS included "well circumscribed", "smooth margins" and "cystic", while the open surgery group were "heterogeneous" and "coarse calcification". The open group had more germ cell tumors (60.0% vs 13.0%, P = 0.16) but no difference in malignancy. VATS patients had shorter LOS (2 days vs 6.5, P = 0.24). Readmission, complication and mortality rates were similar. CONCLUSIONS: Pediatric patients with apparent malignancy frequently underwent open resection compared with the thoracoscopic group, although final malignant pathology was similar. Equivalent outcomes and shorter LOS should favor a minimally invasive approach. LEVEL OF EVIDENCE: Level III.


Assuntos
Neoplasias do Mediastino , Toracotomia , Criança , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
6.
World J Surg Oncol ; 20(1): 222, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35778770

RESUMO

BACKGROUND: To investigate the prognostic significance of station 4R lymph node (LN) dissection in patients who underwent operations for right primary non-small cell lung cancer (NSCLC). METHODS: We performed a retrospective study involving patients with right primary NSCLC who received lobotomy or pneumonectomy with mediastinal LN dissection between January 2011 and December 2017. Propensity score matching was performed. Disease-free survival (DFS) and overall survival (OS) were compared between patients with and without station 4R dissection. RESULTS: Our study included 2070 patients, with 207 patients having no station 4R dissection (S4RD- group) and 1863 patients having station 4R dissection (S4RD+ group). The 4R LN metastasis rate was 13.4% (142/1748), higher than that for other mediastinal LN metastases. Compared with the S4RD- group, the S4RD+ group had higher 5-year DFS (48.1% vs. 39.1%, P = 0.009) and OS (54.4% vs. 42.8%, P = 0.025). Station 4R dissection was an independent risk factor for DFS (odds ratio, OR, 1.28, 95% confidence interval, CI, 1.08-1.64, P = 0.007) and OS (OR 1.31, 95% CI 1.04-1.63, P = 0.018). Patients with adjuvant chemotherapy had a better prognosis after station 4R dissection than those without adjuvant chemotherapy (57.4% vs. 52.3%, P = 0.006). The 5-year OS in the station 4R metastasis group was lower than that in the station 4R non-metastasis group (26.9% vs. 44.3%, P = 0.006) among N2 patients. The 5-year OS of the single-station 4R metastasis group was lower than that of the single-station 7 metastasis group (15.7% vs. 51.6%, P = 0.002). CONCLUSIONS: Station 4R metastasis was the highest among all the mediastinal station metastases in right primary NSCLC patients. Station 4R dissection can improve the prognosis and should be recommended as a routine procedure for these patients.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Neoplasias do Mediastino , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologia , Excisão de Linfonodo/métodos , Metástase Linfática , Neoplasias do Mediastino/cirurgia , Prognóstico , Estudos Retrospectivos
10.
J Cardiothorac Surg ; 17(1): 143, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35668526

RESUMO

Posterior mediastinal paraganglioma (PM-PGL) is a rare disease that is difficult to diagnose. If PM-PGL is misdiagnosed preoperatively, surgeons may encounter severe tachycardia and hypertension and easy bleeding from the tumor during the operation. Therefore, it is essential to include PGL as a differential diagnosis for mediastinal tumors. We herein describe a 73-year-old Japanese man with a PM-PGL that was diagnosed preoperatively and resected safely by video-assisted thoracic surgery. Preoperative management of hypertension with doxazosin mesylate, soft coagulation of the peritumor area, and careful clipping of feeding arteries were effective for hemostasis. The patient's vital signs were stable during and after the operation.


Assuntos
Hipertensão , Neoplasias do Mediastino , Paraganglioma , Idoso , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Mediastino/patologia , Mediastino/cirurgia , Paraganglioma/diagnóstico , Paraganglioma/cirurgia , Cirurgia Torácica Vídeoassistida
11.
BMJ Case Rep ; 15(6)2022 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-35672059

RESUMO

Functional mediastinal paragangliomas (PGs) are rare, catecholamine-secreting tumours. Surgical resection is the preferred treatment, but it can be complicated by catecholamine-related symptoms, involvement of cardiac structures and/or tumour supply from major blood vessels. We report a case of a man in his 30s with a subcarinal functional PG complicated by all three factors. The PG had arterial supplies from the right coronary and bronchial arteries, with mass effect on the left atrium. Given the high risk of intraoperative bleeding, catecholamine surges and injury to right coronary artery, we attempted a minimally invasive strategy that incorporates best practices from the few published cases on functional PGs. We show that a multidisciplinary approach involving alpha/beta blockade, preoperative embolisation of tumour blood supply, robotic-assisted tumour mobilisation and, if needed, open resection with cardiopulmonary bypass can be a safe strategy in the treatment of functional mediastinal paragangliomas adherent to cardiac structures.


Assuntos
Neoplasias do Mediastino , Paraganglioma Extrassuprarrenal , Paraganglioma , Catecolaminas , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Mediastino , Paraganglioma/complicações , Paraganglioma/diagnóstico por imagem , Paraganglioma/cirurgia
12.
BMC Surg ; 22(1): 226, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690804

RESUMO

BACKGROUND: Ectopic Cushing syndrome (ECS) is a sporadic condition. Even uncommon is an ECS that derives from a carcinoid tumor of the thymus. These tumors may pose several diagnostic and therapeutic conundrums. This report discusses the differential diagnosis, clinicopathological findings, and effective treatment of a rare case of ECS using a minimally invasive approach. CASE PRESENTATION: A 29-year-old woman with Cushing syndrome presented with facial flushing. Physical examination revealed hypertension (blood pressure: 141/100 mmHg). A mediastinal tumor was discovered to be the cause of the patient's chronic hypokalemia and hypercortisolemia. Cortisol levels increased in the morning, reaching 47.7 ug/dL. The levels of the hormones ACTH, aldosterone, and renin were determined to be 281 pg/mL, 3.0 ng/dL, and 2.1 pg/mL, respectively. The presence of hypertension, hypokalemia, and alkalinity suggested Cushing's syndrome, which was proven to be ACTH-dependent ECS by a dexamethasone suppression test. A chest CT scan revealed inflammation in the posterior basal region of the right lower lobe. The superior anterior mediastinum was characterized by round-shaped isodensity lesions with distinct borders. She underwent thoracoscopic anterior mediastinal tumor excision via the subxiphoid technique (R0 resection); following surgery, her blood pressure returned to normal, and the hypernatremia/hypopotassemia resolved. The tumor was determined to be a thymic carcinoid. Most notably, cortisol levels fell to half of their presurgical levels after one hour of surgery, and other abnormalities corrected substantially postoperatively. CONCLUSION: Thoracoscopic excision of thymic tumors by subxiphoid incision may be a useful treatment option for ECS caused by neuroendocrine tumors of the thymus.


Assuntos
Síndrome de ACTH Ectópico , Tumor Carcinoide , Síndrome de Cushing , Hipertensão , Hipopotassemia , Neoplasias do Mediastino , Tumores Neuroendócrinos , Neoplasias do Timo , Síndrome de ACTH Ectópico/complicações , Síndrome de ACTH Ectópico/diagnóstico , Hormônio Adrenocorticotrópico , Adulto , Tumor Carcinoide/complicações , Tumor Carcinoide/cirurgia , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/etiologia , Síndrome de Cushing/cirurgia , Feminino , Humanos , Hidrocortisona , Hipertensão/complicações , Hipopotassemia/complicações , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/cirurgia , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia
13.
Chirurgia (Bucur) ; 117(2): 222-229, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35535785

RESUMO

Malignant extramucosal esophageal tumors are rare. We publish a case of an extramucosal esophageal tumor which turned out to be a yolk sac tumor. This type of tumor is extremely rare. We present the initial and also late management of this case (from the diagnostic to the management of the late complications). The patient was admitted for dysphagia. Contrast thoraco-abdominal CT scan revealed an important retrocardiac mass; echoendoscopy with biopsy confirmed one malignant extra-mucosal esophageal tumor. We performed an esophagectomy through triple approaches (McKeown) â?" right thoracotomy, laparotomy, and left cervicotomy for anastomosis. The pathological report raised the suspicion of a mediastinal tumor with germ cells or a poorly differentiated carcinoma. The immunohistochemistry tests confirmed a yolk sac tumor. The patient was referred to the oncologist and was treated with etoposide and cisplatin chemotherapy. Subsequently, the patient developed respiratory failure secondary to giant hiatal hernia which was surgically treated via laparoscopy.


Assuntos
Tumor do Seio Endodérmico , Neoplasias Esofágicas , Neoplasias do Mediastino , Cisplatino , Tumor do Seio Endodérmico/diagnóstico , Tumor do Seio Endodérmico/patologia , Tumor do Seio Endodérmico/cirurgia , Neoplasias Esofágicas/cirurgia , Humanos , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Resultado do Tratamento
14.
Khirurgiia (Mosk) ; (5): 43-51, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35593627

RESUMO

OBJECTIVE: To optimize therapeutic and tactical algorithm in patients with mediastinal tumors. MATERIAL AND METHODS: The study included 300 patients with mediastinal tumors examined and treated in the Thoracic Surgery Department of the Hertzen Moscow Cancer Research Center between 2008 and 2019. Patients were stratified into 2 groups. The diagnostic group consisted of 160 patients including 80 ones after 89 ultrasound-assisted transthoracic biopsies and 80 patients after open biopsy through parasternal mediastinotomy. The treatment group consisted of 140 patients who underwent 145 resections of mediastinal tumors. We analyzed the results of diagnosis and treatment in both groups, mistakes, risk factors of non-informative biopsies and complicated course of the postoperative period. Subsequently, a clinical algorithm was developed. Its effectiveness in 50 patients was compared with 90 patients who constituted the historical control group. RESULTS: The final histological diagnosis after transthoracic ultrasound-assisted biopsy of the mediastinum was established in 71 out of 89 cases (80%). Informative value of ultrasound-assisted biopsy for thymic tumors was 100%, for metastatic mediastinal lesions - 92%. Repeated ultrasound-assisted biopsies were performed in 7 (9%) patients that made it possible to establish the final diagnosis in 5 (71%) cases. In the parasternal mediastinotomy group, the final correct histological diagnosis was made in 79 out of 80 (99%) patients. Analyzing thoracoscopic approach and traditional sternotomy or thoracotomy, we found surgery time decrease from 187 (150-215) to 140 (122-165) min (p<0.01), blood loss from 300 (200-350) to 50 (35-150) ml (p<0.01), postoperative hospital-day from 12 (9-14.5) to 7 (6-8) days (p<0.01). Mean dimension of tumor was 5 (4-6) cm in the thoracoscopy group and 7.5 (6-10) cm in the open surgery group (p<0.01). Postoperative complications occurred in 19 (13%) patients, mortality rate was 2.8%. Multivariate analysis revealed superior vena cava syndrome (OR=5.1, 95% CI=1.246-21.343; p=0.024) and invasion of the right pleural cavity (OR 4.2, 95% CI 1.12-7.69; p=0.006) as the most significant predictors of postoperative complications. The proposed algorithms made it possible to reduce the incidence of non-informative biopsy from 12% to 0% (p<0.05), misdiagnosis from 9% to 1% (p<0.05), exploratory surgeries from 23% to 0% (p<0.05). CONCLUSION: The developed algorithm is valuable to avoid the errors and improve the results of diagnosis and treatment of patients with mediastinal tumors.


Assuntos
Neoplasias do Mediastino , Síndrome da Veia Cava Superior , Algoritmos , Humanos , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/cirurgia , Mediastino/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Síndrome da Veia Cava Superior/patologia
15.
J Clin Ultrasound ; 50(7): 1004-1012, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35394661

RESUMO

Fetal mediastinal teratomas represent only 10% of congenital teratomas in children and 2.6% of all mediastinal masses in children. Teratomas have multifactorial etiology, such as chromosomal abnormalities. Fetal mediastinal teratomas are rare. Mediastinal teratomas can cause hydrops fetalis, fetal demise, and neonatal respiratory distress; therefore, accurate perinatal management and interventions are very important. We describe a case of fetal mediastinal teratoma wherein the cystic fluid in the fetal tumor was aspirated and confirmed by surgical pathology after birth at the authors' center. The teratoma in this case was characterized by a large single cystic mass with clear borders in the anterosuperior mediastinum, which grew rapidly and was closely related to the thymus. The infant was healthy at birth, and the tumor was surgically removed the age of 1 year. The postoperative course was uneventful, and the patient was in good health 6 years postoperatively. This case and literature review suggests that ultrasound examination can accurately diagnose fetal mediastinal teratomas, which is beneficial to provide an accurate basis for fetal prenatal intervention and treatment. Additionally, an important ultrasound feature of a fetal unicystic mediastinal teratoma is a saddle-shaped mass with clear boundaries, which provided an accurate reference for the diagnosis of a fetal cystic mediastinal teratoma by prenatal ultrasonography.


Assuntos
Neoplasias do Mediastino , Teratoma , Criança , Feminino , Humanos , Hidropisia Fetal/etiologia , Lactente , Recém-Nascido , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Mediastino , Gravidez , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Ultrassom , Ultrassonografia Pré-Natal
16.
J Cardiothorac Surg ; 17(1): 67, 2022 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-35382841

RESUMO

BACKGROUND: Mediastinal teratomas are rare tumors that frequently occur in the anterior mediastinum. The majority of these tumors are benign and slow growing. Due to their low malignant potential, the treatment for these tumors is surgical resection. More recently, the surgical management has shifted from invasive approaches such as a sternotomy to minimally invasive ones such as robotic-assisted thoracoscopic resections utilizing lung isolation ventilation. We present a rare case of a locally advanced mediastinal teratoma requiring resection, which was initially attempted thoracoscopically using double lung ventilation. CASE PRESENTATION: A 43 year-old female was found to have an anterior mediastinal mass during work-up for an intermittent cough in 2009. Chest imaging and biopsy at the time showed evidence of a cystic teratoma without concerning features. She underwent imaging surveillance until 2018, when repeat chest imaging showed increasing growth and worrisome radiologic features concerning for malignant degeneration. She underwent an elective robotic-assisted thoracoscopic resection utilizing double lung ventilation, but due to extensive involvement of the right lung, pericardium, superior vena cava, and right phrenic nerve the patient had to be repositioned and started on single lung ventilation mid-procedure to facilitate a safe and complete resection. CONCLUSIONS: Anterior mediastinal teratomas can be successfully removed by robotic-assisted thoracoscopic resections utilizing single lung ventilation. Though robotic-assisted thoracoscopic resection utilizing double lung ventilation can be effective in performing certain procedures such as lung wedge resections, thymectomy, pleural biopsies and minimally invasive cardiac procedures, it is limited in removing locally advanced mediastinal tumors.


Assuntos
Neoplasias do Mediastino , Procedimentos Cirúrgicos Robóticos , Teratoma , Neoplasias do Timo , Adulto , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Teratoma/patologia , Teratoma/cirurgia , Veia Cava Superior/patologia
17.
Asian Cardiovasc Thorac Ann ; 30(7): 819-821, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35234544

RESUMO

Intracardiac extension of Ewing sarcoma is extremely rare. Herein, we report the case of a pediatric patient with mediastinal Ewing sarcoma which extended to right atrium via the azygos vein. Surgical resection was performed through longitudinal incision on anterior surface of the superior vena cava under cardiopulmonary bypass. Resection was feasible because the tumor was sufficiently elastic and non-adherent to the inner surface of the heart. The patient was received chemotherapy and proton beam radiation postoperatively and is doing well with no tumor recurrence for 5 years after surgery.


Assuntos
Neoplasias do Mediastino , Sarcoma de Ewing , Sarcoma , Criança , Átrios do Coração/cirurgia , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Recidiva Local de Neoplasia/patologia , Sarcoma/patologia , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/patologia , Sarcoma de Ewing/cirurgia , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/cirurgia
19.
Zentralbl Chir ; 147(1): 99-120, 2022 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-35235970

RESUMO

If mediastinal tumours cause symptoms these are related to their anatomical localization or a paraneoplastic syndrome. The differential diagnosis is based on the clinical situation with finding the lesion, and, furthermore, taking into account the age and sex of the patient, and the mediastinal compartment where the lesion is located. Cross-sectional radiographic diagnostic is essential for defining the therapeutic strategy. The anterior mediastinum is dominated by thymic tumours, mediastinal lymphomas, germ cell tumours and ectopic mediastinal poiters. The middle mediastinal compartment is the most frequent place of mediastinal cystic tumours, whereas the posterior mediastinum is the domain of neurogenic tumours. For selected cases a tissue biopsy is required. Surgery is the mainstay for most mediastinal tumours. Median sternotomy is the most frequent conventional surgical technique while minimally invasive surgery with thoracoscopic and above all robot assisted operation techniques are increasingly frequent. Combined chemotherapy and modern radiotherapy are essential components of the comprehensive treatment for mediastinal tumours.


Assuntos
Neoplasias do Mediastino , Timoma , Neoplasias do Timo , Estudos Transversais , Diagnóstico Diferencial , Humanos , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Timoma/diagnóstico , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia
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