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2.
Medicine (Baltimore) ; 99(5): e18990, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000435

RESUMO

RATIONALE: Thymic neuroendocrine tumor (TNET) is very rare and characterized by a tendency to invade adjacent structures, frequent metastasis, resistance to therapy, and a poor prognosis. Viscum album extracts (VAE) have shown immunological, apoptogenic, and cytotoxic properties. PATIENT CONCERNS: A 54-year-old Peruvian man was suffering from constant fatigue, cough, dyspnea, and fever for a couple of months. DIAGNOSES: He was diagnosed with TNET (12.8 cm × 10 cm × 7 cm) stage IIIa, G1. Due to the size and extensive invasiveness (vena cava superior, also obstructing 85% of its lumen, pericardium, and pleura), the TNET was inoperable. INTERVENTIONS: We report the case of this patient who declined chemotherapy and was treated instead with sole subcutaneous VAE 3 times per week for 85 months. No other tumor-specific intervention was applied. OUTCOMES: Quality of life (QoL) improved substantially. The patient returned to work, and the tumor remained stable for 71 months. Thereafter, the tumor progressed, and the patient died 90 months after initial diagnosis. Besides self-limited local skin reactions around the application site, no side effects occurred. LESSONS: This is an exceptionally good course of disease of an inoperable, large, obstructing, and invasive TNET with a reduced baseline condition (Karnofsky index: 50-60) due to pronounced symptoms. Given the considerable reduction of symptoms and improved QoL following the onset of VAE therapy and other reports describing long disease stability and improvement of the QoL using VAE in different cancer types, we presume that the VAE treatment was supportive in this case. As TNETs are rare and few trials are available, future treatments of TNETs using VAE should be carefully documented and published to help determine whether further investigation of the use of VAE in TNET treatment is worthwhile.


Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Tumores Neuroendócrinos/tratamento farmacológico , Neoplasias do Timo/tratamento farmacológico , Viscum album , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tumores Neuroendócrinos/diagnóstico por imagem , Qualidade de Vida , Neoplasias do Timo/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
Vet Radiol Ultrasound ; 61(1): 25-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574584

RESUMO

In order to identify CT signs that could be used to distinguish cranial mediastinal lymphoma and thymic epithelial neoplasia, a retrospective case-control study was done. Associations between CT signs and diagnosis were tested using binary logistic regression and results expressed as odds ratio and 95% confidence interval. Sixty-two dogs that had thoracic CT and confirmed diagnosis of lymphoma (n = 33) or thymic neoplasia (n = 29) were sampled. Thymic neoplasms included 24 thymomas and five thymic carcinomas. Dogs with thymic epithelial neoplasia were significantly older than dogs with lymphoma (median age 8.6 years versus 6.0 years, P = .007), but there were no significant differences in prevalence of clinical signs. Diagnosis of thymic epithelial neoplasia was associated with heterogeneous attenuation in pre- (odds ratio 23.3, 95% confidence interval, 4.5-121.1) and post-contrast (odds ratio 30.7, 95% confidence interval, 3.6-265.0) images. Conversely, envelopment of the cranial vena cava by the mass was less likely with thymic epithelial neoplasia than lymphoma (odds ratio 0.07, 95% confidence interval, 0.007-0.66). Greater standard deviation of Hounsfield unit values in post-contrast images was associated with thymic epithelial neoplasia (P = .005). Based on ROC analysis, SD > 17HU of the mass in post-contrast images had a sensitivity of 72% and specificity of 79% for thymic epithelial neoplasia. There were no significant differences in morphology, prevalence of calcification, mediastinal lymphadenopathy, cranial vena cava invasion, collateral vessels, or pleural fluid associated with these tumors. Thymic epithelial neoplasms tended to occur in older dogs and were heterogeneous in CT images, whereas mediastinal lymphoma was more homogeneous and more likely to envelop the cranial vena cava.


Assuntos
Doenças do Cão/diagnóstico por imagem , Linfoma/veterinária , Neoplasias do Mediastino/veterinária , Neoplasias Epiteliais e Glandulares/veterinária , Neoplasias do Timo/veterinária , Tomografia Computadorizada por Raios X/veterinária , Veia Cava Superior/diagnóstico por imagem , Animais , Estudos de Casos e Controles , Cães , Feminino , Linfoma/diagnóstico por imagem , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Estudos Retrospectivos , Neoplasias do Timo/diagnóstico por imagem
4.
AJR Am J Roentgenol ; 214(2): 341-347, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31691609

RESUMO

OBJECTIVE. The purpose of this study is to differentiate between low- and high-risk types of thymoma using quantitative 3D shape analysis of CT images. MATERIALS AND METHODS. This retrospective study included 44 patients with a pathologic diagnosis of thymoma. Two radiologists semiautomatically contoured CT images of the tumors and evaluated 3D shape parameters-namely, quantitative indicators of surface smoothness, including sphericity, ellipsoidality, and discrete compactness. The visual CT findings that were analyzed included longest diameter, shape (round-oval, lobulated, or irregular), calcification, cystic or necrotic changes, and enhancement pattern (homogeneous or heterogeneous). The difference and discriminating performance between low-risk (types A, AB, and B1) and high-risk (types B2 and B3) thymomas were statistically assessed. Interobserver agreement was determined using the concordance correlation coefficient. RESULTS. Twenty-three low-risk and 21 high-risk thymomas were identified on the basis of pathologic findings. The median values of sphericity and ellipsoidality were significantly higher for low-risk thymomas than for high-risk thymomas (for sphericity, 0.566 vs 0.517; for ellipsoidality, 0.941 vs 0.875; p < 0.05 for both). The AUC values of sphericity and ellipsoidality were 0.704 and 0.712, respectively. The best cutoff values were 0.528 and 0.919 for sphericity and ellipsoidality, respectively. Risk assessment combining these cutoff values and the mode of tumor detection (incidental detection or detection based on the presence of symptoms) improved the AUC value to 0.856 (sensitivity, 81.0% [17 of 21 patients]; specificity, 82.6% [19 of 23 patients]). All 3D shape parameters showed almost perfect interobserver agreement (concordance correlation coefficient, > 0.90). The visual CT findings were not significantly different between low- and high-risk thymomas (p > 0.05 for all). CONCLUSION. Quantitative 3D shape analysis has excellent reproducibility, and combining this technique with information on the detection mode helps differentiate low- from high-risk thymomas.


Assuntos
Imageamento Tridimensional , Interpretação de Imagem Radiográfica Assistida por Computador , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Timoma/patologia , Neoplasias do Timo/patologia
5.
AJR Am J Roentgenol ; 214(2): 328-340, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31799873

RESUMO

OBJECTIVE. The purpose of this study was to explore the performance of MRI radiomics in predicting the pathologic classification and TNM staging of thymic epithelial tumors (TETs). MATERIALS AND METHODS. Clinical and MRI data for 189 patients with TETs were retrospectively collected. A total of 2088 radiomics features were extracted from T2-weighted images and T2-weighted fat-suppressed (FS) images. With the use of a support vector machine with recursive feature elimination, the optimal feature subsets were selected and used to construct two predictive models for pathologic classification and TNM staging. In multivariable logistic regression analysis, we incorporated the radiomics model, conventional MRI findings, and clinical variables to develop a radiomics nomogram for predicting risk stratification of advanced TETs. RESULTS. Of the extracted features, 125 features were selected to construct the radiomics model for predicting pathologic classification, and 69 features were selected to construct the radiomics model for predicting TNM staging. The models achieved AUC values of 0.880 and 0.948 in the training cohort and 0.771 and 0.908 in the test cohort, respectively, for distinguishing among low-risk thymomas, high-risk thymomas, and thymic carcinomas and differentiating between early-stage and advanced-stage TETs. The radiomics model, symptom, and pericardial effusion constituted a radiomics nomogram, with an AUC value of 0.967 (95% CI, 0.891-0.989) in the training cohort and 0.957 (95% CI, 0.842-0.974) in the test cohort. CONCLUSION. MRI radiomics analysis has the potential to differentiate the pathologic classification and TNM staging of TETs. A radiomics nomogram provides a useful tool for in dividualized prediction of the risk of advanced-stage TET before a patient undergoes treatment.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Epiteliais e Glandulares/patologia , Nomogramas , Projetos Piloto , Valor Preditivo dos Testes , Estudos Retrospectivos , Máquina de Vetores de Suporte , Neoplasias do Timo/patologia
6.
Clin Nucl Med ; 45(2): 148-150, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876825

RESUMO

A 43-year-old woman presented with progressive muscle weakness and myalgia for 1 month. Laboratory tests revealed the elevation of myogenic enzymes. MRI of the thighs demonstrated a pattern of edema for inflammatory myopathy. Electromyography showed diffuse myopathic disorder, and muscle biopsy indicated polymyositis. F-FDG PET/CT was performed to investigate the potential paraneoplastic syndrome and revealed a soft tissue lesion with F-FDG avidity in the right anterior mediastinum, as well as diffusely increased activity throughout the body muscles. The patient's symptoms and biochemical abnormalities were gradually relieved after the tumor resection, and the histopathology indicated a type AB thymoma.


Assuntos
Polimiosite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Adulto , Feminino , Fluordesoxiglucose F18 , Humanos , Polimiosite/complicações , Compostos Radiofarmacêuticos , Timoma/complicações , Neoplasias do Timo/complicações
7.
J Surg Oncol ; 121(3): 480-485, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31853990

RESUMO

BACKGROUND: Somatostatin analog functional imaging with gallium-68 (Ga-68) dotatate positron emission tomography/computed tomography (PET/CT) has demonstrated superiority in lesion detection in patients with neuroendocrine tumors (NETs). The clinical impact of this imaging modality on US surgical and medical oncology practices has not been established. METHODS: Consecutive patients with NET at our institution who received an initial Ga-68 dotatate PET/CT between July 2017 and September 2018 were included. Ga-68 dotatate PET/CT was compared with prior imaging. RESULTS: Among 101 eligible patients, 51 of 50 were female/male, site of origin was gastroenteropancreatic (75%), unknown primary (13%), lung (8%), thymus (2%), and other (2%). All NETs were histologically well/moderately differentiated. Ga-68 dotatate imaging findings altered management in 36 (35.6%) patients: documentation of progression led to the initiation of systemic therapy in 14 patients, obviated the need for biopsy in four patients, and altered surgical plans in 7 of 14 (50%) patients referred for surgery. In 11 patients, decisions regarding peptide receptor radionucleotide therapy and somatostatin analogs were altered. CONCLUSIONS: In this series, Ga-68 dotatate PET/CT altered diagnosis and management in one-third of patients and changed operative plans in half of the patients who were referred for surgical evaluation. These results support the routine use of this imaging in the care of patients with early-stage and advanced NETs.


Assuntos
Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/terapia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/terapia , Compostos Organometálicos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/terapia , Feminino , Radioisótopos de Gálio , Humanos , Neoplasias Intestinais/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Primárias Desconhecidas/terapia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Neoplasias do Timo/terapia
8.
J Clin Ultrasound ; 48(1): 19-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31609458

RESUMO

OBJECTIVES: To summarize the contrast-enhanced ultrasound (CEUS) features of mediastinal lymphomas and thymic epithelial tumors (including thymomas and thymic carcinomas) and to explore the value of CEUS in the differential diagnosis of lymphomas and thymic epithelial tumors. METHODS: Sixty-nine patients with 69 mediastinal lesions who underwent CEUS and had disease confirmed by histopathology were enrolled in the study. There were 33 cases of lymphoma, 19 cases of thymic carcinoma, and 17 cases of thymoma. CEUS features, including the enhancement pattern, enhancement distribution, enhancement time, inner necrosis status, wash out pattern, and vascular morphology, were evaluated in each group. RESULTS: Thymomas often presented with homogeneous (88.2%, 15/17) and late (88.2%, 15/17) enhancement and a low rate of inner necrosis (17.6%, 3/17). Late (73.7%, 14/19), heterogeneous (68.4%, 13/19), and centripetal (63.2%, 12/19) enhancement were more often observed in thymic carcinoma, as was a high rate of inner necrosis (78.9%, 15/19). Lymphomas showed a homogeneous enhancement rate of 57.6% (19/33) and a late enhancement rate of 54.5% (18/33). The rate of inner necrosis for lymphomas was 45.5% (15/33). The diagnostic accuracy of this finding for distinguishing thymic epithelial tumors from lymphomas was 63.8%, the sensitivity was 80.6%, and the specificity was 45.5%. Enlarged blood vessels were a feature specific to lymphomas, while small vessels arranged in a comb shape was a feature specific to thymic epithelial tumors. CONCLUSION: This study describes the CEUS features of common mediastinal tumors and may stimulate further studies in this field.


Assuntos
Linfoma/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Adulto , Idoso , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Ultrassonografia
9.
Cancer Imaging ; 19(1): 80, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791411

RESUMO

BACKGROUND: Thymoma is a rare tumor that originates from thymic epithelial cells and is usually associated with myasthenia gravis. Radiofrequency ablation (RFA) is a minimally invasive and curative treatment for other tumors, but RFA has not been used for the early treatment of thymoma. METHODS: The current study included 13 patients with stage I thymoma who were not candidates for surgical resection or video-assisted thoracoscopic surgery (VATS). All patients underwent first-line CT-guided percutaneous RFA. The feasibility and therapeutic effects of the intervention were thoroughly documented. RESULTS: All tumors were completely ablated (13 / 13, 100%). During follow-up (median 80.5 months, range, 64.6-116.9 months), only 1 of the 13 patients had recurrence of thymoma (1 / 13, 7.7%) at 35.5 months after the initial ablation. There were no surgery-related deaths after RFA treatment. The most common complications were fever (13 / 13, 100%) and pain (13 / 13, 100%). There was only one patient who occurred severe puncture-related bleeding during the procedure that needed blood transfusion and intravascular embolization of the punctured-injured vessel. CONCLUSION: CT-guided percutaneous RFA for treatment of stage I thymoma is associated with minor trauma, few complications and good treatment outcomes.


Assuntos
Ablação por Cateter/métodos , Cirurgia Assistida por Computador/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adolescente , Adulto , Ablação por Cateter/efeitos adversos , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Assistida por Computador/efeitos adversos , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
10.
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
12.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570341

RESUMO

A 57-year-old man with a known anterior mediastinal mass presented with abdominal distension, jaundice, and signs of urinary and bowel obstruction. Labs revealed leukocytosis, transaminitis, direct hyperbilirubinaemia and elevated levels of alkaline phosphatase, lactate dehydrogenase and uric acid. Subsequent imaging revealed the anterior mediastinal mass and diffuse liver lesions consistent with metastatic disease. MRI of the spine and brain were negative for metastases. Liver biopsy and immunohistochemistry revealed basaloid squamous cell carcinoma of thymic origin. Treatment with capecitabine was initiated but was complicated by worsening liver and kidney failure. Eventually, due to continued worsening of the patient's condition and minimal treatment response, capecitabine was stopped during cycle 1 and the patient was discharged to inpatient hospice with comfort care. In this case report, we highlight the presenting features, imaging findings and management of a patient with metastatic thymic carcinoma.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Hepáticas/secundário , Neoplasias do Mediastino/secundário , Neoplasias do Timo/patologia , Biópsia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/tratamento farmacológico , Progressão da Doença , Evolução Fatal , Humanos , Imuno-Histoquímica , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/tratamento farmacológico , Pessoa de Meia-Idade , Conforto do Paciente , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/tratamento farmacológico
14.
Vet Radiol Ultrasound ; 60(6): 659-667, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31397033

RESUMO

Canine thymomas have been evaluated based on clinical features, treatment options, surgical excision, and outcomes with limited information on specific CT features. The objective of this retrospective, descriptive, cross-sectional study was to describe the CT characteristics of confirmed thymomas and to compare these imaging features to outcome. A total of 22 dogs met the inclusion criteria of histologically confirmed thymomas with concurrent CT imaging. Tumor size varied widely ranging from small and well-circumscribed to large and invasive. Delayed-phase, contrast-enhanced CT studies were best for determining the degree of contrast enhancement in tumors. Of these, 19 of 22 masses had heterogeneous enhancement and three of 22 masses had homogeneous enhancement. Vascular invasion was present in seven of 22 cases. Larger tumors were associated with vascular invasion (height: P = .04; width and volume: P = .02). On precontrast CT, larger tumors (16/21) were heterogeneous and cystic, with smaller tumors (5/21) being more homogeneous (all values P < .05). A larger size was associated with recurrence in fully resected masses (height: P = .03), but not a shorter outcome (P > .3 for all size dimensions). Postoperative complications and incomplete tumor resection were associated with shorter outcome (both values P < .01). Metastasis was confirmed in four cases. There were six cases with lymphadenopathy noted on CT; five of the six cases did not have evidence of metastasis. Larger tumors were more likely to be cystic and associated with vascular invasion.


Assuntos
Doenças do Cão/diagnóstico por imagem , Recidiva Local de Neoplasia/veterinária , Timoma/veterinária , Neoplasias do Timo/veterinária , Animais , Estudos Transversais , Doenças do Cão/cirurgia , Cães , Feminino , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Estudos Retrospectivos , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária
15.
J Thorac Imaging ; 34(6): 345-350, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31464819

RESUMO

PURPOSE: The purpose of this article was to compare magnetic resonance imaging (MRI) depiction of thymic malignancy progression/recurrence with that of computed tomography (CT). METHODS: We retrospectively reviewed all surgically treated thymic epithelial malignancy (TEM) patients between 2011 and 2018 who were followed-up with chest CT and MRI. We compared the detection of recurrence and metastatic disease between the CT and MRI scans in each of these patients. RESULTS: Of 187 patients treated in our institution for TEM, 22 were followed-up with both CT and MRI. TNM stage at diagnosis was as follows: I (n=14), II (n=1), IIIa (n=4), IIIb (n=2), IVa (n=1), and IVb (n=0). Patients were followed-up for a mean of 6.2 years, range 0.7 to 17.7 years. The mean interval between CT and MRI was 5.4 (range, 1 to 15) months. Most patients had no recurrence (n=16), 4 had recurrence after R0 or R1 resection, 1 had stable disease, and 1 had progression of disease after R2 resection. CT and MRI performed equally in the identification of pleural spread (n=5), lymphadenopathy (n=4), and pulmonary metastases (n=1). Retrosternal recurrence (n=1) was identified by MRI despite sternotomy wire artifacts. MRI identified bone involvement and extension of disease into the thecal sac earlier and more readily. Three patients had an indeterminate mediastinal finding on CT that was correctly identified as a benign cyst or pericardial fluid collection by MRI. CONCLUSION: MRI is an alternative option to follow-up patients after treatment for TEM. However, for those with metallic sternotomy wires, we recommend alternating the follow-up with CT as well.


Assuntos
Imagem por Ressonância Magnética/métodos , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Neoplasias Epiteliais e Glandulares/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Artefatos , Meios de Contraste , Progressão da Doença , Feminino , Seguimentos , Corpos Estranhos/diagnóstico por imagem , Humanos , Iohexol , Masculino , Meglumina , Pessoa de Meia-Idade , Compostos Organometálicos , Estudos Retrospectivos , Esternotomia
16.
BMJ Case Rep ; 12(7)2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31320375

RESUMO

Thymic epithelial tumours (TETs) are rare lesions that represent less than 1% of all malignancies in adults. Presentation occurs in three ways: asymptomatic, with local thoracic symptoms or with paraneoplastic symptoms. Heterotopic ossifications are rare histological features in neoplasms and non-neoplastic lesions. Here, we present a 49-year-old male patient with a thymoma type B2 mimicking an aortic aneurysm. Alongside the thymoma, a cholesterol granuloma with unusual ossification features was found as well. This clinical presentation and pathological diagnosis are unusual findings.


Assuntos
Aneurisma Aórtico/diagnóstico , Calcinose/diagnóstico por imagem , Granuloma/diagnóstico por imagem , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Aorta/diagnóstico por imagem , Calcinose/cirurgia , Dor no Peito/etiologia , Colesterol , Diagnóstico Diferencial , Granuloma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Timoma/complicações , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X
17.
Medicine (Baltimore) ; 98(28): e16385, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305442

RESUMO

RATIONALE: Invasive thymoma with intraluminal tumor thrombus may cause pulmonary artery thrombus if the tumor thrombus shed off during operation. However, there is no clinical case report focused on such complication. PATIENT CONCERNS: A 40-year-old woman presented with repeated chest pain. DIAGNOSIS: Chest computer tomography showed huge mediastinal mass. Postoperative pathology revealed type B2 and B3 thymoma, with B3 as the main type. INTERVENTIONS: The patient underwent tumor resection through midline sternotomy in our hospital on September 17, 2018. She received emergent pulmonary artery exploration because the tumor thrombus in superior vena cava shed off unexpectedly during operation. Postoperative pulmonary computer tomography angiography showed right pulmonary artery embolism. Then emergent right pulmonary artery embolectomy was performed through lateral thoracic incision on September 29, 2018. OUTCOMES: The patient recovered well after surgery. D-dimer reduced rapidly and returned to normal 1 month after the second operation. LESSONS: Intraluminal tumor thrombus in invasive thymoma patients has a risk of shedding off during operation. Prevention strategy should be made beforehand. Pulmonary artery exploration is necessary once happened.


Assuntos
Complicações Intraoperatórias , Embolia Pulmonar/etiologia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Reoperação , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia
18.
Oncology ; 97(5): 264-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307031

RESUMO

INTRODUCTION: Pleural metastases are common among patients with thymic carcinoma. Accurate and consistent measurement of pleural lesions is often difficult because of their unique locations and growth patterns. To minimize intraobserver variability, the International Thymic Malignancies Interest Group (ITMIG) proposed modified criteria for measurement of tumor response for thymic epithelial tumors. METHODS: We conducted a retrospective review of the medical records of advanced or recurrent thymic carcinoma patients treated with chemotherapy between 1980 and 2016 in our institution. The best objective responses were assessed using the Response Evaluation Criteria in Solid Tumor version 1.1 (RECIST 1.1) and the ITMIG-modified criteria. RESULTS: A total of 26 patients were included in the present study. According to the RECIST criteria, 1 (3.8%) patient showed complete response (CR), and 13 (50.0%), 10 (38.5%), and 2 (7.7%) showed partial response (PR), stable disease (SD), and progressive disease (PD), respectively. All 26 patients had the same best overall response using the ITMIG criteria. The median time to progression (TTP) according to the RECIST criteria and the ITMIG-modified criteria was 5.5 months (95% confidence interval [CI] 3.8-8.6) and 7.0 months (95% CI 3.8-9.3), respectively (p = 0.993). CONCLUSION: The ITMIG-modified criteria showed a high concordance rate with RECIST 1.1 criteria in response assessment of thymic carcinoma.


Assuntos
Neoplasias do Timo/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Pleurais/secundário , Estudos Retrospectivos , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Adulto Jovem
19.
Surg Today ; 49(8): 656-660, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31134370

RESUMO

PURPOSE: We assessed the utility of the tumor doubling time (TDT) for predicting the histological type of thymic epithelial tumors. METHODS: We retrospectively reviewed 130 patients with thymic epithelial tumors who underwent computed tomography two or more times before surgery. The patients were divided into low-risk thymoma (types A, AB and B1), high-risk thymoma (types B2 and B3) and thymic carcinoma (thymic carcinoma and thymic neuroendocrine tumor) groups. In the 96 patients who showed tumor enlargement, the relationship between the histological type and the TDT of the tumor was investigated. RESULTS: The study population included 55 men and 41 women from 26 to 82 years of age. The TDT of the thymic carcinoma group (median 205 days) was significantly shorter in comparison to the low-risk thymoma (median 607 days) and high-risk thymoma (median 459 days) groups. No significant differences were observed between the low-risk thymoma and high-risk thymoma groups. When we set the cutoff time for differentiating thymic carcinoma group from thymoma at 313 days, the sensitivity and specificity were 83.8% and 82.1%, respectively. CONCLUSIONS: The TDT is a useful parameter for differentiating between thymoma and thymic carcinoma group.


Assuntos
Transformação Celular Neoplásica/patologia , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias do Timo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Estudos Retrospectivos , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X
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