A rare cause of mediastinal mass: Primary liposarcoma.

Liposarcoma is the most commonly diagnosed soft tissue sarcoma in adults and occurs predominantly in the lower limbs and retroperitoneum. Primary mediastinal liposarcomas are rare. Herein we report a case of a 68-year-old man with primary mediastinal liposarcoma involving the diaphragm and pericardium, which was successfully managed by complete surgical excision. The patient's postoperative course was uneventful with no evidence of recurrence 9 months after the operation. Surgical removal is the optimal treatment for a mediastinal liposarcoma, as it is in other sites. If the entire tumor can not be resected, surgical debulking often results in symptomatic relief. International literature suggests that recurrent disease occurs and therefore a long-term careful follow up is required.

Metastatic parathyroid carcinoma (mPCa): natural history and treatment of a case.

We report the case of a 46-year-old male patient who, after disease-free intervals of five, four and one and a half years following resection of an 'atypical' parathyroid adenoma in 1982, relapsed with clinical and laboratory recurrence of primary hyperparathyroidism (PHP). Noninvasive, traditional and modern imaging methods localized small distinct metastatic foci in both lungs without evidence of primary thyroid, neck or mediastinal tumor. Three successive bilateral lung nodule excisions resulted in a long PHP remission, while a three month treatment with normal saline infusions, diuretics, calcitonine and pamidronate infusions, following the last recurrence, resulted in moderate improvement of hypercalcemia and hypercalciuria with no effect on both PTH secretion or on the size of new metastatic lung foci. Recurrent mPCa with or without secretion of biologically active PTH is optimally treatable with successive surgical resections of the metastases and intermittent medical treatment to achieve PTH secreting tumor mass reduction and a beneficial metabolic effect.

Operative evaluation of cardiac tamponade in a patient with multiple myeloma.

Multiple myeloma presents with various clinical manifestations depending on the mode and the extent of organ involvement. Pericardial involvement by myeloma and subsequent cardiac tamponade is extremely rare. We report on the case of a patient with multiple myeloma who presented with cardiac tamponade and was evaluated surgically with thoracotomy and minimal debulking pericardiectomy (fenestration).