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1.
BMC Surg ; 21(1): 38, 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33446156

RESUMO

BACKGROUND: Chemotherapy can cause thymic atrophy and reduce T-cell output in cancer patients. However, the thymus in young adult patients has regenerative potential after chemotherapy, manifesting as thymic hyperplasia which can be easily mistaken as residual disease or recurrence in patients suffering lymphoma. CASE PRESENTATION: This study reports a case of lymphoma in a young female adult who was initially diagnosed with an anterior mediastinal mass, and was found to have soft tissue occupying the anterior mediastinum repeatedly after chemotherapy, suggesting a lymphoma residue or disease progression. From discussions by a multi-disciplinary team (MDT), the anterior mediastinal mass of the patient was considered unknown and might be thymus tissue or tumor tissue, and it was eventually identified as thymus tissue via histopathology. CONCLUSIONS: The anterior mediastinal mass appearing after chemotherapy in patients with lymphoma can be considered as enlarged thymus, and such phenomenon is frequent in young adult patients who undergo chemotherapy or autologous hematopoietic stem cell transplantation. Additionally, detection of thymic output cells in peripheral blood might be a feasible approach to differentiate thymic hyperplasia from lymphoma.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Linfoma/tratamento farmacológico , Neoplasias do Mediastino/tratamento farmacológico , Hiperplasia do Timo/induzido quimicamente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Erros de Diagnóstico , Progressão da Doença , Feminino , Humanos , Linfoma/patologia , Neoplasias do Mediastino/patologia , Mediastino/diagnóstico por imagem , Mediastino/patologia , Recidiva Local de Neoplasia , Timo/patologia , Hiperplasia do Timo/diagnóstico , Hiperplasia do Timo/diagnóstico por imagem , Hiperplasia do Timo/patologia
2.
Medicine (Baltimore) ; 99(44): e22921, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126354

RESUMO

RATIONALE: Desmoplastic small round cell tumor (DSRCT) is a rare distinct tumor with a high-grade malignancy. PATIENT CONCERNS: A 51-year-old male visited a local hospital in April 2016 complaining of shortness of breath, chest tightness and pain, and exhibited significant swelling in both sides of the chest. DIAGNOSES: CT demonstrated thoracic symmetry and no abnormalities were observed in the soft tissues of the ribs and the chest wall. A general observation of CT-guided puncture biopsy revealed 2 stripes of gray and grayish-white puncture tissues of 0.5 and 1 cm in length, respectively, and 0.1 cm in diameter. These results preliminarily suggested a (mediastinum) malignant small round cell tumor. INTERVENTION: Given the progression of the disease, the chemotherapy regimen, consisting of ifosfamide and etoposide, was altered during the course and radiotherapy (total of 70 Gy of mediastinal Y field radiation) was conducted. OUTCOMES: The patient and his family declined further treatment. Through follow-up, the total survival period was determined as 17 months. LESSONS: DSRCT is a rare interstitial malignant tumor. Effective cytoreduction combined with comprehensive therapies could achieve partial remission or prolong the survival of patients.


Assuntos
Tumor Desmoplásico de Pequenas Células Redondas , Etoposídeo/administração & dosagem , Ifosfamida/administração & dosagem , Neoplasias do Mediastino , Mediastino , Radioterapia/métodos , Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica , Quimiorradioterapia/métodos , Tumor Desmoplásico de Pequenas Células Redondas/patologia , Tumor Desmoplásico de Pequenas Células Redondas/fisiopatologia , Tumor Desmoplásico de Pequenas Células Redondas/terapia , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/fisiopatologia , Neoplasias do Mediastino/terapia , Mediastino/diagnóstico por imagem , Mediastino/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
5.
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
6.
Ann Thorac Cardiovasc Surg ; 26(5): 294-297, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-32741884

RESUMO

The Montgomery T-tube is widely used to stent airway stenotic diseases. Conventional insertion methods can sometimes fail in the case of long-distance subglottic stenosis due to the flexibility of a T-tube made of silicon, which kinks when forced against resistance. Therefore, an alternative approach can assist in the insertion of an extra-long T-tube, especially when using a long proximal limb. We report herein the case of a patient with a large mediastinal tumor caused by neurofibromatosis type 1 in which airway obstruction was avoided through the use of a novel extra-long T-tube placement technique.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Neoplasias do Mediastino/complicações , Neurofibromatose 1/complicações , Estenose Traqueal/terapia , Adolescente , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/patologia , Estenose Traqueal/diagnóstico por imagem , Estenose Traqueal/etiologia , Resultado do Tratamento , Carga Tumoral
7.
Clin Nucl Med ; 45(9): e422-e424, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32657867

RESUMO

Primary neuroendocrine tumor of the mediastinum is a relatively rare entity. In metastatic/inoperable disease, therapeutic options are limited to cytotoxic chemotherapy in poorly differentiated tumors and peptide receptor radionuclide therapy in case of well-differentiated tumors. We present the case of a 52-year-old man with mediastinal atypical carcinoid (grade II) neuroendocrine tumor showing mild somatostatin receptor expression and intense FDG avidity with progressive disease on chemotherapy. Chemokine receptor targeted PET/CT with CXCR4 (Ga-CXCR4) showed tracer avidity in tumor sites higher than the physiological sites, which may pave the way for CXCR4-targeted radionuclide therapy in this subgroup of patients.


Assuntos
Tumor Carcinoide/tratamento farmacológico , Tumor Carcinoide/metabolismo , Regulação Neoplásica da Expressão Gênica , Neoplasias do Mediastino/tratamento farmacológico , Neoplasias do Mediastino/metabolismo , Receptores CXCR4/metabolismo , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/patologia , Fluordesoxiglucose F18 , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Receptores de Somatostatina/metabolismo
9.
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
10.
J Cancer Res Ther ; 16(1): 183-185, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32362635

RESUMO

Diffuse large B-cell lymphomas (DLBCL) with MYC translocations combined with translocations involving BCL-2 or BCL-6 are referred to as double-hit lymphomas. These lymphomas are generally refractory to currently available therapies and have a poor prognosis. Primary mediastinal B-cell lymphoma (PMBL) is a rare subtype of DLBCL, which shares clinical, pathologic, and genetic similarities with classical Hodgkin's lymphoma. Unlike DLBCL, rearrangements involving MYC, BCL-2, and BCL-6 are typically absent in PMBL. We present a patient with PMBL who had increased gene copy numbers of MYC and BCL-2 along with increased protein expression of BCL-2 (c-Myc expression was about 15%-20% by immunostain). The disease was refractory to standard and salvage chemotherapies. The lymphoma, however, responded to brentuximab vedotin, a CD30-directed chemoimmunoconjugate.


Assuntos
Brentuximab Vedotin/uso terapêutico , Antígeno Ki-1/metabolismo , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Neoplasias do Mediastino/tratamento farmacológico , Mutação , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Proteínas Proto-Oncogênicas c-myc/genética , Adulto , Antineoplásicos Imunológicos/uso terapêutico , Feminino , Humanos , Linfoma Difuso de Grandes Células B/genética , Linfoma Difuso de Grandes Células B/metabolismo , Linfoma Difuso de Grandes Células B/patologia , Neoplasias do Mediastino/genética , Neoplasias do Mediastino/metabolismo , Neoplasias do Mediastino/patologia , Prognóstico , Proteínas Proto-Oncogênicas c-bcl-2/genética
11.
Clin Nucl Med ; 45(6): 477-479, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32366789

RESUMO

Soft tissue giant cell tumor (GCT) is rare. It usually involves the extremities. We report the case of a 37-year-old woman who was suspected of having mediastinal tumor on radiograph. Thoracic CT revealed the tumor had extensive calcification and invaded the adjacent vertebrae and spinal canal. It intensively accumulated Tc-methylene diphosphonate on bone scan. The tumor showed hypointensity on T1-weighted and mixed intensity on T2-weighted fat-saturated sagittal images. Finally, a soft tissue GCT was confirmed by pathology. The case cautions us soft tissue GCT should be in the differential diagnosis spectrum in a calcified posterior mediastinal mass with Tc-methylene diphosphonate accumulation.


Assuntos
Tumores de Células Gigantes/metabolismo , Neoplasias do Mediastino/metabolismo , Neoplasias de Tecidos Moles/metabolismo , Medronato de Tecnécio Tc 99m , Adulto , Diagnóstico Diferencial , Feminino , Tumores de Células Gigantes/diagnóstico por imagem , Tumores de Células Gigantes/patologia , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Tomografia Computadorizada por Raios X
13.
PLoS One ; 15(4): e0231523, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298324

RESUMO

BACKGROUND: Ultrasound-guided transthoracic core needle biopsy (US-TCNB) is a promising method for establishing the correct diagnosis of mediastinal masses. However, the existing studies in this area are scant and with small samples. PURPOSE: To evaluate the diagnostic value and the complication rate of US-TCNB, particularly large bore cutting biopsy in patients with mediastinal lesions. MATERIAL AND METHODS: This retrospective study includes 566 patients with mediastinal lesions suspicious of malignancy evaluated between March 2004 and December 2018. Inclusion criteria: 1. Patients with mediastinal lesions detected on thoracic CT scan; 2. Lesions more than 15 mm; 3. Negative histological diagnosis after bronchoscopic biopsy; 4. Normal coagulation status; 5. Cooperative patient; 6. Written informed consent. US visualization of the mediastinal lesions was successful in 308 (54.4%). In all of them, US-TCNB was performed. All patients with mediastinal lesions unsuitable for US visualization were evaluated for a CT-guided transthoracic needle biopsy (CT-TTNB), which was done if the presence of a safe trajectory was available (n = 41, 7.2%). All patients inappropriate for image-guided TTNB were referred to primary surgical diagnostic procedures (n = 217, 38.3%). RESULTS: The US-TCNB is a highly effective (accuracy 96%, sensitivity 95%) and safe tool (2.6% complications) in the diagnosis of all subgroups mediastinal lesions. It is non-inferior to CT-TTNB (90%) and comes close to the effectiveness of surgical biopsy techniques (98.4%), but is less invasive and with a lower complication rate. CONCLUSION: US-TCNB of mediastinal lesions is highly effective and safe tool which is particularly helpful in critically ill patients.


Assuntos
Biópsia por Agulha/métodos , Neoplasias do Mediastino/diagnóstico , Mediastino/patologia , Ultrassonografia de Intervenção/métodos , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia de Intervenção/efeitos adversos
14.
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
15.
Anticancer Res ; 40(4): 1875-1882, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234875

RESUMO

BACKGROUND: The method of quickly identifying metastatic mediastinal lymph nodes has become an urgent problem for lung cancer surgery. Indocyanine green (ICG) has the characteristic of being retained in or around the lymph nodes; its pharmacokinetic characteristics and optimal imaging time have not yet been elucidated. MATERIALS AND METHODS: The IVIS Lumina Imaging System was used to detect near infrared (NIR) fluorescence signals at different ICG doses, times and excitation/emission wavelengths in vitro. An artificial lymphogenous metastatic model of squamous lung carcinoma was established in 32 SCID-CB17 mice using Ma44.3 cells. An intratracheal injection of 1.25 ml/kg ICG (1.25×10-2 mg/ml) was performed, then 780 nm Ex and 845 nm Em were used to visualize ICG at four different times. The metastatic mediastinal lymph nodes and the implanted local tumor site in the left lung were confirmed with bioluminescence and hematoxylin and eosin (H&E) staining of pathological specimens. RESULTS: ICG had the strongest NIR fluorescence signal when using 780 nm Ex and 845 nm Em at 2 to 4 h after administrating 1.25×10-2 mg/ml ICG in vitro. Combined with pathological H&E examination, fluorescence imaging of ICG reflected true-positive mediastinal metastasis of the mediastinum at 0.5 h and 2 h after the injection of ICG in vivo. While true-positive local tumor growth at the site of implantation in the left lung was reflected within 4 h after the injection of ICG. CONCLUSION: ICG was able to display the metastatic mediastinal lymph nodes within 2 h after endotracheal injection in an orthotopic squamous lung carcinoma implantation model.


Assuntos
Verde de Indocianina/farmacologia , Neoplasias Pulmonares/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Animais , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Amarelo de Eosina-(YS)/farmacologia , Feminino , Hematoxilina/farmacologia , Xenoenxertos , Humanos , Neoplasias Pulmonares/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/secundário , Mediastino/diagnóstico por imagem , Mediastino/patologia , Camundongos , Imagem Óptica
17.
Cancer Radiother ; 24(3): 206-214, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32171674

RESUMO

PURPOSE: The aim of this study was to extensively describe the epidemiological, clinical and therapeutic outcomes of adolescents and young adults (AYA) population with classical Hodgkin Lymphoma (cHL). Then, a comparison between AYAs and adults and between the subgroups of AYAs treated with the same adult protocol was accomplished to further inform on optimal therapy approach of choice for adolescent patients. MATERIAL AND METHODS: In this mono-centric, retrospective study, we reviewed the medical records. We analyzed 112 consecutive North Tunisian patients, including 66 AYAs (15 to 39 years) and 46 adults (≥40years) affected by cHL treated from 2000 to 2015 at Salah Azaiez Institute. Then, we performed a comparative analysis between AYA and 46 adult patients and a subgroup analysis between adolescents and young adults. All patients were treated according to the national protocol for HL, edited by the Tunisian Society of Hematology. The treatment included chemotherapy and involved-field radiotherapy (RT) at a dose of 20 or 30 Grays (Gy) for responders and 36Gy for non-responders. RESULTS: AYA patients presented with adverse features with nodular sclerosis subtype (p=3.88×10-02) and mediastinal mass involvement (p=9.40×10-04). At a median follow-up of 51 and 32 months for AYAs and adults, respectively, no statistical difference in terms of 3 and 5-years overall survival (OS) and event-free survival (EFS) was shown. Using the Kaplan-Meier method, in AYAs, the ABVD regimen has an impact on 3-years EFS (p=4.63×10-02). The 36Gy RT was associated with the best 3-years EFS (p=9.24×10-03). Besides, AYA patients with advanced-stage had the worst 3-years OS (76%) (p=2.41×10-02). Although the adolescents and young adults shared similar clinical presentation, we noted that the adolescent group had the worst 3-years EFS (48%), but the best 3-years OS (91%). We identified 15% of primary refractory patients and a rate of toxicity of 5.3% in AYA. CONCLUSION: The treatment approach used is well tolerated by adult patients. However, the AYA patients and particularly adolescent subgroup had more advanced disease at diagnosis and should be treated more intensively in dedicated units. RT dose<36Gy and ABVD chemotherapy were associated with lower EFS in this population.


Assuntos
Doença de Hodgkin/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Ciclofosfamida/administração & dosagem , Dacarbazina/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/mortalidade , Doença de Hodgkin/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Mecloretamina/administração & dosagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Prednisona/administração & dosagem , Procarbazina/administração & dosagem , Dosagem Radioterapêutica , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Tunísia/epidemiologia , Vimblastina/administração & dosagem , Vincristina/administração & dosagem , Adulto Jovem
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