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1.
Khirurgiia (Mosk) ; (1): 89-93, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994506

RESUMO

A well-known feature of primary hyperparathyroidism (PHPT) is possible ectopic localization of parathyroid adenoma that can significantly complicate diagnostic process. Ectopia in the aortic window is extremely rare and accounts only 1% of ectopic parathyroid adenomas in the mediastinum and 0.24% among all parathyroid adenomas. Combination of multinodular toxic goiter and primary hyperparathyroidism with a rare variant of ectopia makes this observation very valuable from scientific and practical point of view.


Assuntos
Adenoma/complicações , Bócio Nodular/complicações , Hiperparatireoidismo Primário/etiologia , Neoplasias do Mediastino/complicações , Neoplasias das Paratireoides/complicações , Humanos
2.
BMJ Case Rep ; 12(12)2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31806632

RESUMO

Superior vena cava (SVC) syndrome refers to the clinical manifestation due to an obstruction in the SVC; resulting in decreased venous return from the head, neck and upper extremities. The obstruction can occur either due to tumour invasion of the vessel wall with associated thrombus or due to vessel wall compression by the tumour mass. The patient being reported is a young male who presented with recurrent episodes of syncope and was found to have mediastinal Gardner fibroma causing SVC syndrome. Gardner fibroma is a benign soft tissue lesion; and its occurrence in the mediastinum resulting in SVC syndrome has not been reported yet.


Assuntos
Síndrome de Gardner/complicações , Neoplasias do Mediastino/complicações , Síndrome da Veia Cava Superior/etiologia , Síncope/etiologia , Adulto , Síndrome de Gardner/diagnóstico por imagem , Síndrome de Gardner/patologia , Síndrome de Gardner/cirurgia , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Radiografia Torácica , Tomografia Computadorizada por Raios X
3.
World J Surg Oncol ; 17(1): 151, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462247

RESUMO

BACKGROUND: While calcification of thymoma is common, "eggshell" calcification is rare. We report a case of an eggshell calcified thymoma that "hatched" after 4 years of follow-up. Pathologically, it revealed that sarcoidosis accompanied this case of thymoma, which might cause in calcification. CASE PRESENTATION: The patient was a 68-year-old female. A 20-mm anterior mediastinal nodule completely covered with calcification was noted in an annual health check-up. However, as the nodule did not change during 6 months of follow-up, she discontinued regular examinations. Four years later, an abnormality in her chest X-ray was noted again. The tumor grew outside the calcification to reach 63 mm. She underwent resection of this anterior mediastinal tumor. Pathologically, the tumor was diagnosed as thymoma of type B1 in the WHO classification. The histology of the tumor inside and outside of the calcification was not different, suggesting that the tumor grew from the inside of the calcification. The calcification was located within the fibrotic capsule of thymoma. Sarcoidosis also presented in her lung and mediastinal lymph nodes. CONCLUSIONS: Although the mechanism of calcification of the capsule was not clear, sarcoidosis might be related to this case because macrophage accumulation and altered lipid metabolism in sarcoidosis present with similar dystrophic calcification.


Assuntos
Calcinose/patologia , Neoplasias do Mediastino/patologia , Sarcoidose/patologia , Timoma/patologia , Neoplasias do Timo/patologia , Idoso , Calcinose/complicações , Calcinose/cirurgia , Feminino , Humanos , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/cirurgia , Prognóstico , Sarcoidose/complicações , Sarcoidose/cirurgia , Timoma/complicações , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/cirurgia
4.
Medicine (Baltimore) ; 98(32): e16732, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393382

RESUMO

Medical decisions should be well-planned to improve prognosis and reduce complications of mediastinal tumors. In this study, we analyzed the clinical presentations of pediatric mediastinal tumors and their correlation with long-term clinical outcome.Forty patients under 18 years of age diagnosed with mediastinal tumors at China Medical University Children's Hospital between 2001 and 2016 were enrolled. The patients' sex, age of onset, initial clinical symptoms, and treatment outcomes were analyzed.75% of the patients with mediastinal tumors in this study were men, and the median age of onset was 13 years old (age range: 0-17 years). The overall mortality rate was 40%. The most common tumors were lymphoma (47.5%), followed by germ cell tumors (12.5%), neuroblastoma (12.5%), and thymoma (7.5%). Neuroblastoma was more prevalent in girls younger than 5 years old. The initial presentations of these patients included breathing difficulty (65%), productive cough (47.5%), pleural effusion (54.5%), superior vena cava (SVC) syndrome (35%), neck mass (35%), airway compression (32.5%), fever (30%), chest pain (27.5%), and pericardial effusion (25%). Lymphomas were more likely to be accompanied by neck mass (52.6% vs19.0%, P = .04) and SVC syndrome (52.6% vs 19.0%, P = .026), yet also had a better 1-year-survival rate (68.4% vs 52.4%, P = .02).Overall, lymphoma should be suspected when children present with neck mass and SVC syndrome. Neuroblastoma with a posterior mediastinal origin should be suspected among children younger than 5 years old. Tumor-related airway obstruction, pleural effusion, and pericardial effusion were leading cause of cardiopulmonary instability during sedation for invasive procedures, which should be managed cautiously.


Assuntos
Neoplasias do Mediastino/epidemiologia , Neoplasias do Mediastino/patologia , Adolescente , Idade de Início , Criança , Pré-Escolar , Dispneia/etiologia , Feminino , Humanos , Lactente , Masculino , Neoplasias do Mediastino/complicações , Derrame Pleural/etiologia , Fatores Sexuais , Síndrome da Veia Cava Superior/etiologia
5.
J Cardiothorac Surg ; 14(1): 148, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387607

RESUMO

BACKGROUND: Mediastinal lipoma/liposarcoma is a rare tumor of the mediastinum. CASE PRESENTATION: This article reported one case of giant anterior superior mediastinum well-differentiated liposarcoma involving the left thoracic cavity with symptom of dysphagia. The mediastinum liposarcoma was completely resected through a left thoracotomy. Histologic examination and molecular pathological test clarified the diagnosis as well-differentiated mediastinal liposarcoma. There has been no evidence of recurrence during the 8 months follow-up. CONCLUSION: Molecular pathological examination of the MDM2, CDK4 and p16 gene in tumors provides the diagnostic gold standard in distinguishing well-differentiated liposarcoma from lipoma. Complete surgical resection is the first-line treatment choice for mediastinal lipoma/ liposarcoma.


Assuntos
Lipossarcoma/cirurgia , Neoplasias do Mediastino/cirurgia , Adulto , Transtornos de Deglutição/etiologia , Humanos , Lipoma/patologia , Lipossarcoma/complicações , Lipossarcoma/patologia , Masculino , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/patologia , Cavidade Torácica , Toracotomia
6.
Medicine (Baltimore) ; 98(30): e16582, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348294

RESUMO

RATIONALE: The presence of a mediastinal neurilemmoma accompanied by intrapulmonary sequestration is a rare occurrence. The clinical symptoms of a neurilemmoma depend on the site of the tumor. Diagnosis of pulmonary sequestration mainly depends on the presence of aberrant feeding arteries. PATIENT CONCERNS: A 78-year-old woman was admitted to our hospital with a mediastinal space-occupying lesion of 50 years. Computed tomography and magnetic resonance imaging showed 2 roundish low-density shadows in the left posterior mediastinum. DIAGNOSIS: The pathological findings of the upper cystic mass support the diagnosis of neurilemmoma. A branch of aorta was found supplying blood to the lower mass; it was considered a pulmonary sequestration. INTERVENTIONS: Left-sided thoracotomy was planned to remove the chest space-occupying lesions. Two masses were completely removed. Severe adhesion between the left lower lobe and the diaphragm was successfully separated, the aberrant feeding vessel was properly managed, and the lower lobe was resected completely. OUTCOMES: The patient experienced remission of symptoms, had no significant postoperative complications, and was discharged from the hospital. LESSONS: Special attention should be paid to neurological involvement of the neurilemmoma and the fragile feeding arteries of the intrapulmonary sequestration. Early diagnosis and treatment are important in such cases.


Assuntos
Sequestro Broncopulmonar/complicações , Neoplasias do Mediastino/complicações , Neurilemoma/complicações , Idoso , Sequestro Broncopulmonar/diagnóstico , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Neurilemoma/diagnóstico , Neurilemoma/patologia
8.
J Cardiothorac Surg ; 14(1): 100, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164140

RESUMO

BACKGROUND: Chylothorax is a life-threatening pathological condition associated with significant morbidity and mortality. If chyle leakage does not close spontaneously with medical therapy, surgical treatment is inevitable. Herein, we reported a case of spontaneous persistent chylothorax from mediastinal seminoma that was successfully closed between the descending thoracic aorta, and the vertebral column through a left mini-thoracotomy. CASE PRESENTATION: A 24-year old man with mediastinal seminoma was referred to our attention for management of high output persistent chylothorax (> 800 ml/24 h for 30 days) that did not close with conservative treatment. As the leak was isolated within left upper chest cavity, we planned to close the thoracic duct via Poirier's triangle by uniportal thoracoscopy. However, the long conservative treatment favoured the formation of multiple, tenacious, and bleeding adhesions that made unfeasible thoracoscopy. A conversion to mini-thoracotomy was performed; by the incision of the posterior parietal pleura, the thoracic duct was isolated and ligated behind the thoracic aorta, in an anatomical space delimited by the 4th and the 5th posterior intercostal arteries and the vertebral column. CONCLUSIONS: Complete resolution of chylothorax was obtained the day after. Patient was discharged on post-operative day 5, and no recurrence was observed during the follow-up.


Assuntos
Quilotórax/cirurgia , Neoplasias do Mediastino/complicações , Seminoma/complicações , Ducto Torácico/cirurgia , Toracotomia/métodos , Aorta Torácica , Quilotórax/etiologia , Humanos , Ligadura , Masculino , Adulto Jovem
9.
J Pak Med Assoc ; 69(6): 902-904, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31201402

RESUMO

We report a case of a 28 year old female who presented to us in November 2016 with a swelling in front of neck for three years and worsening shortness of breath for last one year, causing right sided tracheal deviation and mildSuperior Vena Caval obstruction. X-ray showed a soft tissue density mass in antero-superior mediastinum with cephalad extension. Contrast enhanced CT neck and chest revealed a multi cystic lesion extending from the root of neck to anterior mediastinum causing compression and deviation of trachea, and nearby structures especially Superior Vena Cava (SVC) along with collateral formation. Mass was surgically excised from the neck and mediastinum with uneventful post-operative recovery. Histopathology was consistent with benign mature cystic teratoma.


Assuntos
Neoplasias do Mediastino/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Adulto , Dispneia/etiologia , Feminino , Humanos , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Pescoço , Invasividade Neoplásica , Síndrome da Veia Cava Superior/etiologia , Teratoma/complicações , Teratoma/patologia , Teratoma/cirurgia , Tomografia Computadorizada por Raios X
10.
J Cardiothorac Surg ; 14(1): 113, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221172

RESUMO

BACKGROUND: Extralobar sequestration is a rare congenital malformation of lung tissue, which can be combined with other foregut and cardiac abnormalities. Our case is the first to report extralobar sequestration, absence of pericardium and atrial septal defect in the same patient. CASE PRESENTATION: A 22-year-old female with atrial septal defect came for her recent atypical symptom of intermittent palpitation and shortness of breath. Her computed tomography showed a cystic mass located in left superior anterior mediastinum near the pulmonary trunk. With specious of cystic teratoma prior to video-assisted thoracoscopic surgery, she finally was diagnosed as extralobar sequestration, while incidentally found with congenital absence of pericardium during surgery. CONCLUSIONS: Extralobar sequestration, absence of pericardium and atrial septal defect can occur in the same patient. The preoperative diagnostic rate of extralobar sequestration and asymptomatic absence of pericardium remains low attributed to atypical imaging features. A cardiac magnetic resonance imaging is highly recommended if necessary. Regular follow-up is essential to asymptomatic absence of pericardium and atrial septal defect patients. To patients with extralobar sequestration, an operation could be performed.


Assuntos
Sequestro Broncopulmonar/diagnóstico , Comunicação Interatrial/diagnóstico , Neoplasias do Mediastino/diagnóstico , Pericárdio/anormalidades , Teratoma/diagnóstico , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Sequestro Broncopulmonar/complicações , Sequestro Broncopulmonar/diagnóstico por imagem , Sequestro Broncopulmonar/cirurgia , Diagnóstico Diferencial , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos , Imagem por Ressonância Magnética , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Teratoma/complicações , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
J Cardiothorac Surg ; 14(1): 96, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118058

RESUMO

BACKGROUND: This case highlights the challenges of preoperative differential diagnosis and management in a patient with an uncommon clinical presentation of giant intrathoracic teratoma. The age of the patient, location and size of the tumor, and clinical presentation makes this case unique. Typically, intrathoracic teratomas are found between the ages of 20-30, they are located in the anterior mediastinum, and tumors larger than 25 cm clinically present with cough or dysphagia. CASE PRESENTATION: A giant intrathoracic teratoma presents in a 51-year-old female as a mid to posterior mediastinal mass compressing the whole left lung with symptoms of depression, anorexia, unintentional weight loss, and cachexia. Due to her severe deconditioning she was optimized for 1 month in a skilled nursing facility with aggressive physical therapy and enteral nutrition. She underwent left thoracotomy with complete resection of the tumor. In follow up her BMI had improved, and she was regaining strength. CONCLUSIONS: Complete resection was achieved via left thoracotomy after aggressive rehabilitation.


Assuntos
Neoplasias do Mediastino/diagnóstico , Teratoma/diagnóstico , Caquexia/etiologia , Diagnóstico Diferencial , Dispneia/etiologia , Feminino , Humanos , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Pessoa de Meia-Idade , Teratoma/complicações , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Toracotomia
12.
Monaldi Arch Chest Dis ; 89(2)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31107038

RESUMO

Anterior mediastinal masses are relatively uncommon and include a wide variety of lesions. Lymphomas account for 25% of anterior mediastinal masses. Lymphomas and other haematological malignancies are associated with pericardial effusion. There are also cases where a cardiac tamponade occurred. The aim of the case reported herein is to discuss the surgical approach and particularly the mediastinal debulking as an adjunct to systematic treatment for haematological diseases presenting as an anterior mediastinal mass responsible for a cardiac tamponade.


Assuntos
Tamponamento Cardíaco/etiologia , Procedimentos Cirúrgicos de Citorredução , Leucemia-Linfoma de Células T do Adulto/cirurgia , Neoplasias do Mediastino/cirurgia , Humanos , Leucemia-Linfoma de Células T do Adulto/complicações , Masculino , Neoplasias do Mediastino/complicações , Adulto Jovem
14.
Rinsho Shinkeigaku ; 59(6): 349-355, 2019 Jun 22.
Artigo em Japonês | MEDLINE | ID: mdl-31142709

RESUMO

The case of a 17-year-old man with Hodgkin's lymphoma who presented with paraneoplastic sensory neuropathy is presented. The patient visited our hospital because of acute progression of dysesthesiae in the bilateral face and extremities. He also developed an ataxic gait due to decreased deep sensation. Post-contrast T1-weighted MRI showed enhancement of both trigeminal nerves and the cauda equina. Cerebrospinal fluid examination was unremarkable. Intravenous immunoglobulin therapy and subsequent steroid pulse therapy did not improve his symptoms. Laboratory data showed an elevated serum soluble interleukin-2 receptor level. His chest X-ray and CT showed enlarged lymph nodes in the mediastinum, and the histopathologic examination of a lymph node biopsy specimen showed classical Hodgkin's lymphoma. He was treated with chemotherapy. His symptoms of neuropathy improved promptly while the lymphoma was being successfully treated, and he was able to walk with a cane. The present case was characterized by paraneoplastic sensory neuropathy as the initial clinical feature in association with Hodgkin's lymphoma. It is necessary to consider a paraneoplastic neurological syndrome even in a young patient with acute/subacute sensory neuropathy. Paraneoplastic sensory neuropathy associated with Hodgkin's lymphoma could be expected to improve with oncotherapy, and examination of the malignancy and early treatment are important.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/complicações , Doença de Hodgkin/tratamento farmacológico , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/tratamento farmacológico , Polineuropatia Paraneoplásica/tratamento farmacológico , Polineuropatia Paraneoplásica/etiologia , Parestesia/tratamento farmacológico , Parestesia/etiologia , Doença Aguda , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Ataxia/tratamento farmacológico , Ataxia/etiologia , Bleomicina/administração & dosagem , Dacarbazina/administração & dosagem , Doxorrubicina/administração & dosagem , Doença de Hodgkin/diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias do Mediastino/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vimblastina/administração & dosagem
17.
J Pediatr Surg ; 54(2): 251-254, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30503023

RESUMO

OBJECTIVE: The objective of this study was to report our multidisciplinary diagnostic approach for patients with anterior mediastinal masses (AMM). METHODS: A retrospective review of patients with AMM at a tertiary pediatric surgical oncology centre (January 2011-December 2016) was performed. We analyzed data on clinical presentation, mode of tissue diagnosis, anesthetic techniques, and complications. RESULTS: Of the 44 patients admitted with AMM (median age 11 years, 27 males and 17 females), 22 had respiratory symptoms. Imaging revealed tracheobronchial compression in 26 children. Twenty patients had a lymph node biopsy. Ten patients had image-guided core biopsy of the mediastinal mass, and 2 had mediastinoscopic biopsy of a paratracheal lymph node. One patient with likely recurrence of a relapsed metastatic ethmoid carcinoma did not have a biopsy. The diagnosis was made from alternative tissues, such as pleural fluid in 4 and peripheral blood in 7 patients. Twenty-five anesthetics were assessed, as 14 patients required no or only local anesthesia, and 5 had unavailable anesthetic notes. Eighteen of 25 patients were anesthetized maintaining spontaneous breathing, mostly by means of ketamine sedation. There were no major anesthetic complications. CONCLUSION: Safe tissue diagnosis of anterior mediastinal masses can be obtained by a personalized multidisciplinary approach. Use of alternative tissues, local anesthesia, and ketamine sedation help minimize the need for general anesthesia, muscle paralysis, and controlled ventilation. LEVEL OF EVIDENCE: IV (Case Series with no Comparison Group).


Assuntos
Linfonodos/patologia , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Adolescente , Anestesia Geral , Anestesia Local , Anestésicos Dissociativos , Criança , Pré-Escolar , Feminino , Humanos , Biópsia Guiada por Imagem , Ketamina , Masculino , Neoplasias do Mediastino/complicações , Mediastinoscopia , Equipe de Assistência ao Paciente , Derrame Pleural/etiologia , Doenças Respiratórias/etiologia , Estudos Retrospectivos
18.
Thorac Cancer ; 10(1): 111-115, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30407736

RESUMO

Herein, we report a case of an angiosarcoma in a mediastinal non-seminomatous germ cell tumor that exhibited growing teratoma syndrome during chemotherapy. A 26-year-old man presented with a giant anterior mediastinal mass, which was diagnosed as a non-seminomatous germ cell tumor. The patient was administered three cycles of chemotherapy (bleomycin, etoposide, and cisplatin), but the mass grew despite normalization of tumor markers. Massive bleeding during thoracic surgery resulted in incomplete resection, and the mass was clinically and pathologically diagnosed as growing teratoma syndrome (only mature teratoma). The residual mass continued to grow, and complete resection was subsequently achieved after a detailed analysis of its vascular anatomy using angiography. The final pathological findings revealed angiosarcoma, which indicated a rare somatic type of mediastinal non-seminomatous germ cell tumor.


Assuntos
Hemangiossarcoma/diagnóstico , Neoplasias do Mediastino/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Teratoma/diagnóstico , Neoplasias Testiculares/tratamento farmacológico , Adulto , Biomarcadores Tumorais , Bleomicina/administração & dosagem , Bleomicina/efeitos adversos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/cirurgia , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Hemangiossarcoma/induzido quimicamente , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Hemorragia/etiologia , Hemorragia/patologia , Humanos , Masculino , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Neoplasias Embrionárias de Células Germinativas/complicações , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Teratoma/induzido quimicamente , Teratoma/patologia , Teratoma/cirurgia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Tomografia Computadorizada por Raios X
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