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1.
J Cardiothorac Surg ; 14(1): 182, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665049

RESUMO

BACKGROUND: The authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments. CASE PRESENTATION: Two lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected. CONCLUSION: This case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.


Assuntos
Cisto Broncogênico/cirurgia , Neoplasias do Mediastino/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neurilemoma/cirurgia , Neoplasias do Timo/cirurgia , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/patologia , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Vértebras Torácicas , Toracoscopia/métodos , Timectomia/métodos , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 98(39): e17145, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574816

RESUMO

RATIONALE: Paragangliomas are rare neuroendocrine tumors that originate in specialized cells derived from the neural crest with metastasis to the thoracic spine being among the rarest forms. Here, we are presenting a detailed analysis of a case of malignant paraganglioma in the thoracic spinal region in a 14-year-old boy. Our focus is to emphasize the importance of considering malignant paraganglioma as a diagnosis and guiding the perioperative management upon surgical treatment. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS: A 14-year-old boy presented with a 5-month history of continuous and progressive elevated blood pressure and back pain. The patient, who had been diagnosed of malignant paraganglioma in the left posterior mediastinum for 3 months, received surgical resection of paraganglioma in the left posterior mediastinum, which had involved the left intervertebral foramen of T4. However, the tumor was not completely resected during the first operation. DIAGNOSES: Magnetic resonance imaging of spine and positron emission tomography-computed tomography showed spinal cord compression secondary to the epidural component of the T4 mass, with increased marrow infiltration of the left T4 intervertebral foramen, which was difficult to be removed. Postoperative pathology confirmed the diagnosis of spinal involvement of malignant paraganglioma. INTERVENTIONS: The patient underwent biopsy and percutaneous vertebroplasty of T4 and paravertebral lesions, and needle-track cement augmentation via a posterior approach. OUTCOMES: The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 10-month follow-up visit. There were no other complications associated with the operation during the follow-up period. LESSONS: Combined efforts of specialists from orthopedics, neurosurgery, thoracic surgery, and medical oncology led to the successful diagnosis and management of this patient. Malignant paraganglioma of thoracic spine, although rare, should be part of the differential diagnosis when the patient has a history of paraganglioma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the malignant paraganglioma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment. However, we need to take the potential risk of complications in bone cement applications into full consideration.


Assuntos
Neoplasias do Mediastino/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Ortopédicos/métodos , Paraganglioma/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Descompressão Cirúrgica , Humanos , Masculino , Neoplasias do Mediastino/patologia , Paraganglioma/patologia , Neoplasias da Coluna Vertebral/patologia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Vertebroplastia/métodos
4.
Orv Hetil ; 160(37): 1476-1479, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31495185

RESUMO

A characteristics of mediastinal disorders is that the high anatomical density of vital structures in this region represents a challenge for diagnosis and surgical treatment. Space-occupying lesions can grow without causing overt manifestations - or can progress symptom-free - hence they can reach an extreme size by the time of surgery. A 58-year-old male patient was hospitalized for pleural effusion and an extensive, space-occupying mediastinal lesion, which had been causing respiratory symptoms for 15 years. Cytology of the pleural effusion did not confirm malignancy. The CT scan depicted progression manifested as an increase in the size of the lesion with a likely site of origin in the left adrenal gland. According to the MRI, by contrast, the lesion might have originated in the region of vertebrae Th9-10, as suggested by the lack of dural continuity. However, its adrenal origin could not be excluded either; endocrine activity was not detected. An operation was performed with a neurosurgeon included in the surgical team. A spinal tumor of the size of 20.2 by 11.1 by 10.8 cm was removed through thoraco-laparotomy, and reconstruction of the diaphragm was performed. Histology confirmed a schwannoma. Postoperatively, the expansion of the lung was only partial, because the patient discontinued respiratory rehabilitation. The follow-up CT scan depicted local recurrence. In the lack of alternative therapeutic modalities, surgical resection is usually the sole option for the management of large, mediastinal space-occupying lesions diagnosed at an advanced stage. Such operations should only be performed in specialist surgical centers and with multidisciplinary collaboration. Orv Hetil. 2019; 160(37): 1476-1479.


Assuntos
Neoplasias do Mediastino/cirurgia , Mediastino , Neurilemoma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Humanos , Laparotomia , Masculino , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neurilemoma/patologia , Neoplasias Retroperitoneais/patologia , Tomografia Computadorizada por Raios X
5.
J Cardiothorac Surg ; 14(1): 161, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500651

RESUMO

BACKGROUND: Pulmonary sarcomatoid carcinoma (PSC) is a rare malignancy with both epithelial and sarcoma components, and high tumor metastasis potential. CASE PRESENTATION: A 63-year-old male patient had a tumor in the right posterior mediastinum, and was eventually diagnosed with PSC and gingival metastasis. The patient underwent thoracoscopic right upper pneumonectomy with lymph node dissections, and the subsequent gingival biopsy revealed a metastatic PSC. The immunohistochemistry revealed that both PSC site tissues were positive for vimentin, CKAE1/AE3 and Ki-67. The patient received radiotherapy and chemotherapy after surgery, and deceased two months later due to systemic tumor metastases. CONCLUSION: PSC metastasis is variable, and leads to diagnostic dilemma or erroneous diagnosis. A differential diagnosis can help to distinguish it from gingival cancer.


Assuntos
Neoplasias Gengivais/secundário , Neoplasias do Mediastino/patologia , Sarcoma/secundário , Biópsia , Terapia Combinada , Diagnóstico Diferencial , Neoplasias Gengivais/diagnóstico , Neoplasias Gengivais/terapia , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Neoplasias do Mediastino/cirurgia , Mediastino , Pessoa de Meia-Idade , Pneumonectomia , Sarcoma/diagnóstico , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
7.
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
8.
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
9.
Nucl Med Commun ; 40(9): 947-957, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31343606

RESUMO

BACKGROUND: Primary neuroendocrine tumours (NETs) of mediastinum are unusual tumours with aggressive biological behaviour with limited treatment options and guarded prognosis. METHODS: Twenty-seven patients with histopathologically and radiologically proven metastatic or advanced mediastinal NET, who had undergone 177Lu-DOTATATE PRRT, were included in this retrospective analysis. Descriptive statistics was employed to calculate the cumulative overall survival (OS) and progression-free survival (PFS), determining correlation and strength of correlation between different variables with OS and PFS and finally, predictors of outcome (OS and PFS). RESULTS: In all 27 patients enrolled and analyzed, complete symptomatic response was observed in 10 patients (37%), partial response in seven patients (25.9%), symptomatically stable disease in four patients (14.8%), and symptoms progressed or worsened in six patients (22.2%). Metabolic response evaluation demonstrated complete metabolic response in one patient (3.7%), partial metabolic response was seen in nine patients (33.3%), metabolically stable disease was seen in five patients (18.5%), and 12 patients (44.4%) showed metabolic disease progression. None of the patients achieved complete anatomical/morphological response, six (22.2%) showed partial response, seven (25.9%) showed stable disease, and in 14 patients (51.9%), there was morphological disease progression. At the time of analysis, 10 patients (37%) succumbed to the disease. The median PFS was 36 months and the median OS was 66 months. Bivariate analysis showed significant level of association of PFS with surgical intervention, higher cumulative PRRT dose, metabolic response, smaller sized primary lesion, and low lesional FDG uptake. With regard to OS, higher cumulative PRRT dose, low FDG uptake and longer PFS showed significant association. CONCLUSION: Previous surgical intervention (including debulking surgery with R1 resection), higher cumulative dose of PRRT, and low FDG uptake of the tumour are associated with prolonged OS and PFS in patients with metastatic or advanced mediastinal NETs and were independent favourable prognostic markers.


Assuntos
Complexos de Coordenação/uso terapêutico , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/radioterapia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/radioterapia , Octreotida/análogos & derivados , Receptores de Peptídeos/metabolismo , Adolescente , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/metabolismo , Pessoa de Meia-Idade , Metástase Neoplásica , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/metabolismo , Octreotida/uso terapêutico , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Medicine (Baltimore) ; 98(28): e16383, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305440

RESUMO

RATIONALE: Paraganglioma refers to a set of neuroendocrine tumors derived from the chromaffin cells of the adrenal diplomatic ganglion. Paragangliomas can be classified as functional or nonfunctional based on the ability to synthesize and release catecholamines. PATIENT CONCERNS: We report a 47-year-old man with a functional paraganglioma in the left posterior mediastinum and highlight the key elements of management of mediastinal paragangliomas. DIAGNOSES: A left posterior mediastinal mass was found by computed tomography (CT) scan and Chest-enhanced CT. Preoperative ultrasound-guided biopsy suggested the possibility of a paraganglioma. A diagnosis of paraganglioma was established by immunohistochemistry. INTERVENTIONS: The patient underwent single-stage resection of the lesion via left thoracotomy after preoperative oral α-adrenoceptor (phenoxybenzamine) therapy and intravenous fluid resuscitation for two weeks. OUTCOMES: The postoperative period was uneventful. The patient exhibited no abnormal blood pressure or recurrence during the 12-month follow-up period. LESSONS SUBSECTIONS AS PER STYLE: Pathological examination alone cannot determine whether it was a benign or malignant paraganglioma, which can be determined by pathological examination combined with distant metastasis. Long-term follow-up is required to assess the treatment effect.


Assuntos
Neoplasias do Mediastino/diagnóstico , Paraganglioma/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/terapia , Pessoa de Meia-Idade , Paraganglioma/patologia , Paraganglioma/terapia
11.
Medicine (Baltimore) ; 98(28): e16411, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305456

RESUMO

RATIONALE: Choriocarcinoma is a rare and highly invasive gestational trophoblastic tumor that secretes high levels of human chorionic gonadotropin (hCG). As one of the uncommon non-gestational choriocarcinoma, primary mediastinal choriocarcinoma is an exceeding rare, and aggressive malignancy with poor prognosis. PATIENT CONCERNS: A 26-year-old man was admitted to the hospital with cough, shortness of breath, and occasional hemoptysis. DIAGNOSES AND INTERVENTION: Imaging examinations revealed a large mediastinal mass, diffuse nodular opacities with blurred edges in both lungs, and multiple brain lesions. Laboratory tests showed an astonishing increase of serum ß-hCG. A diagnosis of primary mediastinal choriocarcinoma with advanced lung and brain metastases was finally made after 3 biopsies and immunohistochemical analyses. Surgery and radiotherapy were not applicable at the time of diagnosis, and both targeted therapy and immunotherapy were unavailable. During the first 4 cycles of trophoblastic tumor-based chemotherapy, the patient improved clinically with fewer symptoms, decreased ß-hCG and reduced lesions. However, drug resistance quickly emerged, forcing an alternative chemotherapy regimen that also failed. OUTCOMES: The patient finally endured symptoms including headache, dizziness and vomiting, and subsequently succumbed after an overall survival time of six and half months. LESSONS: Male primary choriocarcinoma is an extremely rare type of malignancy. Greater awareness, earlier diagnosis and novel treatments are urgently needed to benefit patients.


Assuntos
Coriocarcinoma/diagnóstico , Coriocarcinoma/secundário , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/terapia , Adulto , Coriocarcinoma/patologia , Coriocarcinoma/terapia , Diagnóstico Diferencial , Evolução Fatal , Humanos , Masculino , Neoplasias do Mediastino/patologia , Metástase Neoplásica
12.
J Craniofac Surg ; 30(5): e402-e404, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299792

RESUMO

Subglottic and mediastinal hemangioma are rare benign vascular tumors of childhood. They cause potentially life threatening condition which requires intervention. Several therapeutic options have been described in the literature with varying degrees of success and complications. We report a case of a stridulous 2-month old female infant with mediastinal and subglottic hemangioma. The child was treated with propranolol without the need for tracheostomy or any other surgical intervention, and with no reported side effects. Propranolol is an effective, non-invasive treatment for life threatening infantile hemangiomas compressing the airway, should be used as a firstline treatment for subglottic hemangiomas when intervention is required.


Assuntos
Hemangioma Capilar/cirurgia , Hemangioma/cirurgia , Neoplasias Laríngeas/cirurgia , Neoplasias do Mediastino/cirurgia , Feminino , Hemangioma/tratamento farmacológico , Hemangioma Capilar/tratamento farmacológico , Humanos , Lactente , Neoplasias Laríngeas/tratamento farmacológico , Neoplasias Laríngeas/patologia , Neoplasias do Mediastino/tratamento farmacológico , Neoplasias do Mediastino/patologia , Propranolol/uso terapêutico , Traqueostomia , Resultado do Tratamento
13.
Blood ; 134(10): 802-813, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31292115

RESUMO

Primary mediastinal large B-cell lymphoma (PMBL) represents a clinically and pathologically distinct subtype of large B-cell lymphomas. Furthermore, molecular studies, including global gene expression profiling, have provided evidence that PMBL is more closely related to classical Hodgkin lymphoma (cHL). Although targeted sequencing studies have revealed a number of mutations involved in PMBL pathogenesis, a comprehensive description of disease-associated genetic alterations and perturbed pathways is still lacking. Here, we performed whole-exome sequencing of 95 PMBL tumors to inform on oncogenic driver genes and recurrent copy number alterations. The integration of somatic gene mutations with gene expression signatures provides further insights into genotype-phenotype interrelation in PMBL. We identified highly recurrent oncogenic mutations in the Janus kinase-signal transducer and activator of transcription and nuclear factor κB pathways, and provide additional evidence of the importance of immune evasion in PMBL (CIITA, CD58, B2M, CD274, and PDCD1LG2). Our analyses highlight the interferon response factor (IRF) pathway as a putative novel hallmark with frequent alterations in multiple pathway members (IRF2BP2, IRF4, and IRF8). In addition, our integrative analysis illustrates the importance of JAK1, RELB, and EP300 mutations driving oncogenic signaling. The identified driver genes were significantly more frequently mutated in PMBL compared with diffuse large B-cell lymphoma, whereas only a limited number of genes were significantly different between PMBL and cHL, emphasizing the close relation between these entities. Our study, performed on a large cohort of PMBL, highlights the importance of distinctive genetic alterations for disease taxonomy with relevance for diagnostic evaluation and therapeutic decision-making.


Assuntos
Genômica/métodos , Linfoma Difuso de Grandes Células B/genética , Neoplasias do Mediastino/genética , Adolescente , Adulto , Idoso , Estudos de Coortes , Análise Mutacional de DNA , Feminino , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Linfoma Difuso de Grandes Células B/patologia , Masculino , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Mutação , Integração de Sistemas , Adulto Jovem
14.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289155

RESUMO

A 22-year-old female patient was admitted to hospital after being referred from the oral medicine clinic where she had been seen for persistent gingivitis and mouth ulcers. She described an insidious history of persistent fevers, dry cough and unexplained weight loss over 4-6 weeks. Imaging showed extensive bilateral pulmonary nodules with mediastinal lymphadenopathy and two lesions in the pancreas. MRI revealed these lesions to be well-defined fluid-filled cysts in the tail of the pancreas, without features of malignancy. Core biopsies taken from her lung nodules demonstrated features of vasculitis with granulomata. This was consistent with her positive immunology for c-antinuclear cytoplasmic antibodies and proteinase-3, which were sent after her fever failed to settle with antibiotic treatment. In keeping with a diagnosis of vasculitis, the patient showed a significant clinical and biochemical response to intravenous methylprednisolone and high-dose daily prednisolone thereafter.


Assuntos
Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Linfadenopatia/patologia , Administração Intravenosa , Anticorpos Anticitoplasma de Neutrófilos/sangue , Diagnóstico Diferencial , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/diagnóstico por imagem , Granulomatose com Poliangiite/metabolismo , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Mieloblastina/sangue , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Resultado do Tratamento , Adulto Jovem
15.
Clin Nucl Med ; 44(9): e540-e543, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31283613

RESUMO

Epithelioid hemangioendothelioma is a rare low- to intermediate-grade malignant vascular neoplasm with a variable clinical course and currently no standardized treatment. We present a case of a 65-year-old woman diagnosed as having mediastinal epithelioid hemangioendothelioma, a location which is very exceptional. FDG PET/CT was more sensitive than CT for staging, revealing intense FDG uptake in the primary tumor and in the metastatic disease. Despite high FDG uptake, the disease was stable with no further specific treatment. Only few reports utilizing FDG PET/CT are available; review of the literature on this subject is included.


Assuntos
Fluordesoxiglucose F18 , Hemangioendotelioma Epitelioide/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Transporte Biológico , Feminino , Fluordesoxiglucose F18/metabolismo , Hemangioendotelioma Epitelioide/metabolismo , Hemangioendotelioma Epitelioide/patologia , Humanos , Neoplasias do Mediastino/metabolismo , Neoplasias do Mediastino/patologia , Estadiamento de Neoplasias
17.
Rev Med Chil ; 147(4): 518-521, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344216

RESUMO

Klinefelter syndrome (47, XXY in most cases) is a frequently underdiagnosed chromosomal anomaly associated with multiple comorbidities in adult life. Patients with Klinefelter syndrome have a higher risk of cancer. Specifically, these patients have a higher risk for mediastinal germ cell tumors. It is estimated that 8% of male patients with mediastinal tumors have Klinefelter. We report a 42-years-old male who suffered recurrent respiratory infections. During the study, a mediastinal mass was found, whose pathological study disclosed a type B thymoma. The patient had a history of infertility, high stature, gynecomastia, obesity with gynecoid distribution of body fat and testicular atrophy. A karyotype was requested (47, XXY), confirming the diagnosis of Klinefelter syndrome.


Assuntos
Síndrome de Klinefelter/patologia , Timoma/patologia , Neoplasias do Timo/patologia , Adulto , Humanos , Síndrome de Klinefelter/diagnóstico , Síndrome de Klinefelter/genética , Masculino , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Radiografia Torácica , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico , Tomografia Computadorizada por Raios X
18.
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
20.
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
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