Ganglioneuroma de mediastino posterior: a propósito de un caso

RESUMEN Los tumores de origen neuroectodérmico son la principal causa de tumores de mediastino. De ellos el ganglioneuroma es el de mayor benignidad y el menos frecuente, con una incidencia de 1 en 100,000 niños. Ocurre predominantemente en la infancia con una media de presentación a los siete años. La mayor parte de estos tumores cursan asintomáticos y son diagnosticados de manera incidental. El 43 % de ellos tienen manifestación intratorácica y están localizados en los ganglios simpáticos del mediastino posterior. Los medios de diagnóstico por imágenes aportan ventajas para mostrar la localización, tamaño y extensión del tumor. Estos exámenes resultan de gran beneficio para el cirujano. El pronóstico es generalmente favorable, lo que constituye signo de buen pronóstico, la aparición posterior a los cinco años de edad y las localizaciones en el mediastino posterior. Se presenta el caso de una paciente a la que se le realizó toracoscopia con resección total del tumor, con evolución favorable durante su seguimiento. A esta paciente se le diagnosticó un ganglioneuroma en mediastino posterior. Se realizó una revisión bibliográfica a propósito de este caso. Se presenta este reporte porque el ganglioneuroma es un tumor benigno poco frecuente en edad pediátrica.

ABSTRACT Neuroectodermal tumors are the main cause of mediastinal tumors. Of these, the ganglioneuroma is the most benign and the least frequent, with an incidence of 1 in 100,000 children. It occurs predominantly in childhood with a mean presentation at age seven. Most of these tumors are asymptomatic and diagnosed incidentally. The 43 % of them showing intrathoracic manifestation and located in the sympathetic ganglia of the posterior mediastinum. Imaging studies provide advantages for the location, size and extent of the tumor. These tests are of great benefit to the surgeon. The prognosis is generally favorable, which is a sign of good prognosis when it appears after five years of age and when it is located in the posterior mediastinum. The case of a patient who underwent thoracoscopy with total resection of the tumor, with a favorable evolution during her follow-up is presented. This patient was diagnosed with a ganglioneuroma in the posterior mediastinum. A literature review was carried out regarding this case. This report is presented because ganglioneuroma is a rare benign tumor in children.

Teratoma mediastinal con áreas de malignidad, reporte de un caso y discusión / Mediastinal Teratoma with Malignant Areas: Case Report and Discussion

Resumen Varios tipos de tumores pueden surgir en el mediastino anterior, de los cuales los tumores de células germinales constituyen el 10- 15%, y el más frecuente es el teratoma maduro. El hallazgo de un componente maligno en un teratoma maduro es raro, habiéndose descrito pocos casos de malignidad en forma de carcinoma escamoso, adenocarcinoma, sarcoma o tumores neuroendocrinos. Presentamos el caso de una mujer joven con diagnóstico de teratoma maduro y desarrollo de adenocarcinoma en la pared, lo que confiere un pronóstico desfavorable, con opciones de tratamiento mal definidas dada la excepcionalidad de la enfermedad. Este caso clínico destaca que se requiere un muestreo histopatológico cuidadoso de las áreas sólidas en un teratoma, incluso en pacientes jóvenes cuyas lesiones son más pequeñas. Aunque existen recomendaciones a favor de la quimioterapia, se basan en series de un número limitado de pacientes. La resección completa de la neoplasia y el seguimiento multidisciplinario serán de relevancia para el control de las recidivas locales y a distancia.

Abstract Several types of tumors may occur in the anterior mediastinum, of which germ cell tumors constitute 10-15%, the most frequent being the mature teratoma. The finding of a malignant component in mature teratoma is rare, and few cases of malignancies such as squamous carcinoma, adenocarcinoma, sarcoma, or neuroendocrine tumors have been described. We present the case of a young woman diagnosed with mature teratoma and development of adenocarcinoma within tumor wall, conferring an unfavorable prognosis, with poorly defined treatment options given the exceptional a mature of the disease. This clinical case highlights the fact that careful histopathological sampling of solid areas is required in a teratoma, even in young patients whose lesions are smaller. Although there are recommendations in favor of chemotherapy, they are based on series of a limited number of patients. Complete resection of the neoplasm and multidisciplinary follow-up would be of relevance for the control of local and distant recurrences.

Primary mediastinal giant malignant synovial sarcoma: two cases reports / 中国医师杂志

Objective:To understand the clinical features and computed tomography (CT) imaging performance of mediastinal giant malignant synovial sarcoma (SS) and to improve the clinicians′ diagnosis and treatment of this disease.Methods:We report the clinical data of 2 cases of primary mediastinal giant malignant SS, and reviews the literature for CT presentation and differential diagnosis.Results:Primary giant malignant SS of mediastinum is rare in clinic. CT showed irregular cystic and solid mass with mural nodules, adjacent osteolytic destruction, unclear boundary with adjacent tissues. The enhancement showed that the solid components of the tumor and mural nodules were enhanced, while the cystic necrosis area had no enhanced uneven enhancement. The two cases in this paper showed " borehole-like" growth above the clavicle and growth into the left thoracic cavity, with pulmonary metastasis and lymphatic metastasis respectively.Conclusions:Mediastinal malignant SS is a rare disease with high malignancy and easy to metastasize, which emphasizes " early detection, early diagnosis and early treatment" . It should be taken into account in the differential diagnosis of mediastinal tumors, but the confirmation of diagnosis needs to be combined with pathological and immunohistochemical findings. Clinicians need to take advantage of imaging examinations to provide auxiliary guidance on the diagnosis, metastasis assessment and surgical treatment options of SS.

Giant mediastinal capillary hemangioma in a fetus: a case report / 中华围产医学杂志

We describe a rare case of fetal mediastinal capillary hemangioma presenting as pleural effusion and a huge pleural occupying lesion during late pregnancy. The patient was admitted at 36 +3 weeks of gestation, with a fetal chest occupying lesion for 11 days. Routine prenatal ultrasound and MRI indicated right pleural effusion and a huge chest occupying lesion in the fetus. The woman was administered oxytocin and delivered a live baby boy at 36 +5 weeks of gestation. The baby was diagnosed as mediastinal hemangioma by postnatal CT, angiography and 3D reconstruction and was discharged after oral propranolol treatment. However, he was readmitted one month after birth due to "pneumonia and tachypnea". After multidisciplinary consultation, the baby underwent a right-side thoracic mediastinal mass resection, and a mediastinal capillary hemangioma was confirmed by pathology. The child continued taking propranolol orally and received regular follow-up and rehabilitation after the operation up to 7 months old, by which time no obvious abnormalities were found.

Progress of primary mediastinal large B-cell lymphoma / 白血病·淋巴瘤

Primary mediastinal large B-cell lymphoma (PMBCL) is an aggressive large B-cell lymphoma originating in the mediastinum. Because of its distinct clinical and histological features, PMBCL has been reclassified as a separate entity by the World Health Organization classification of lymphoid neoplasms. The diagnosis of PMBCL mainly depends on the pathological features, imaging examination and clinical features. Currently, there are many therapeutic schemes for PMBCL, the most commonly used schemes are R-CHOP and R-EPOCH regimens. Radiotherapy is beneficial in some patients, but it can also lead to long-term toxicity. Research and development of new drugs are ongoing, including chimeric antigen receptor T-cell therapy, anti-programmed death receptor 1 drugs, etc. PET-CT is mainly used to assess the curative effect after treatment and to guide the next treatment strategy.

Bloqueo plano erector de la espina en toracotomía pediátrica / Pediatric thoracotomy in erector spinae plane block

Erector spinae plane block (ESP) is a regional anesthesia technique consisting of blocking the interfascial plane, where local anesthetic (LA) is injected at the site where the dorsal branch of the spinal nerve emerges. There are various publications on the application of the block (EPS) in the adult population, however there are few reports of the use of this block in pediatric surgery. We present the first case report of an infant under 9 months of age with the presence of a tumor in the anterior mediastinum, who underwent a resection through the 6th intercostal space, previous blockage of the erector spinae under ultrasound vision. The patient did not present adverse effects and was discharged on the fourth postoperative day.

El bloqueo del plano erector de la espina (ESP) es una técnica de anestesia regional consistente en bloquear el plano interfascial, donde se inyecta anestésico local (LA) en el sitio donde emerge la rama dorsal del nervio espinal. Existen diversas publicaciones sobre la aplicación del bloqueo (EPS) en población adulta, sin embargo, hay pocos reportes del uso de este bloqueo en cirugía pediátrica. Presentamos el primer reporte de caso de una lactante menor de 9 meses de edad con presencia de tumor en mediastino anterior, al cual se le hizo una resección a través del 6° espacio intercostal, previo bloqueo del erector de la espina bajo visión ecográfica. La paciente no presentó efectos adversos y fue dada de alta al cuarto día posoperatorio.

Consideraciones en torno a los tumores del mediastino / Considerations about mediastinal tumours

Introducción. El desarrollo de las imágenes diagnósticas hizo posible el diagnóstico topográfico de los tumores de mediastino; sin embargo, aún con los avances actuales de la cirugía, la anestesiología y la reanimación, el acceso quirúrgico a ese espacio medio de la caja torácica continúa siendo el gran reto que enfrentan los cirujanos torácicos. Objetivo. Profundizar en los diferentes aspectos cognoscitivos actualizados sobre los tumores mediastinales.Métodos. Búsqueda documental digital en bases de datos: Scielo, Lilacs, Web of Science, PubMed, realizada en enero de 2019, de publicaciones sobre el tema en la presente centuria. Resultados. Las neoplasias mediastinales son poco frecuentes, pueden aparecer a cualquier edad, aunque son más frecuentes entre la tercera y quinta décadas, y la mayoría se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Los tumores malignos del mediastino son poco frecuentes, pero los benignos constituyen un desafío diagnóstico para radiólogos y patólogos. En las neoplasias malignas se identifica una amplia gama de variedades histológicas, atribuibles a las características del órgano afectado. Conclusiones. El diagnóstico definitivo generalmente se establece mediante el estudio histopatológico posquirúrgico, si bien la tomografía computarizada, asociada o no a la biopsia percutánea, es el estándar de oro para el diagnóstico preoperatorio. La selección de la vía de entrada al tórax, así como el procedimiento quirúrgico, están condicionados por la localización y el tamaño del tumor en el mediastino

Introduction. The development of diagnostic images made the topographic diagnosis of mediastinal tumors possible; however, even with current advances in surgery, anesthesiology, and resuscitation, surgical access to this mid-rib cage space continues to be the great challenge faced by chest surgeons.Objective. To deepen in the different updated cognitive aspects about mediastinal tumors.Methods. Digital documentary search in databases: Scielo, Lilacs, Web of Science, and PubMed, performed in January 2019, of publications on the subject in the present century.Results. Mediastinal neoplasms are rare, they can appear at any age, although they are most common between the third and fifth decades, and most are discovered incidentally on a routine chest radiograph in asymptomatic patients. Malignant tumors of the mediastinum are rare, but benign tumors pose a diagnostic challenge for radiologists and pathologists. In malignant neoplasms, a wide range of histological varieties is identified, attributable to the characteristics of the affected organ.Conclusions. The definitive diagnosis is generally established by postoperative histopathological study, although computed tomography, associated or not with percutaneous biopsy, is the gold standard for preoperative diagnosis. The selection of the entry route to the thorax, as well as the surgical procedure, are conditioned by the location and size of the tumor in the mediastinum

EBUS-TBNA versus surgical mediastinoscopy for mediastinal lymph node staging in potentially operable non-small cell lung cancer: a systematic review and meta-analysis / EBUS-TBNA versus mediastinoscopia cirúrgica no estadiamento linfonodal mediastinal do câncer de pulmão de células não pequenas potencialmente operável: revisão sistemática e meta-análise

ABSTRACT Objective: Lung cancer (LC) is one of the leading causes of death worldwide. Accurate mediastinal staging is mandatory in order to assess prognosis and to select patients for surgical treatment. EBUS-TBNA is a minimally invasive procedure that allows sampling of mediastinal lymph nodes (LNs). Some studies have suggested that EBUS-TBNA is preferable to surgical mediastinoscopy for mediastinal staging of LC. The objective of this systematic review and meta-analysis was to compare EBUS-TBNA and mediastinoscopy in terms of their effectiveness for mediastinal LN staging in potentially operable non-small cell lung cancer (NSCLC). Methods: This was a systematic review and meta-analysis, in which we searched various databases. We included studies comparing the accuracy of EBUS-TBNA with that of mediastinoscopy for mediastinal LN staging in patients with NSCLC. In the meta-analysis, we calculated sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. We also analyzed the risk difference for the reported complications associated with each procedure. Results: The search identified 4,201 articles, 5 of which (with a combined total of 532 patients) were selected for inclusion in the meta-analysis. There were no statistically significant differences between EBUS-TBNA and mediastinoscopy in terms of the sensitivity (81% vs. 75%), specificity (100% for both), positive likelihood ratio (101.03 vs. 95.70), or negative likelihood ratio (0.21 vs. 0.23). The area under the summary ROC curve was 0.9881 and 0.9895 for EBUS-TBNA and mediastinoscopy, respectively. Although the number of complications was higher for mediastinoscopy, the difference was not significant (risk difference: −0.03; 95% CI: −0.07 to 0.01; I2 = 76%). Conclusions: EBUS-TBNA and mediastinoscopy produced similar results for mediastinal staging of NSCLC. EBUS-TBNA can be the procedure of first choice for LN staging in patients with NSCLC.

RESUMO Objetivo: O câncer de pulmão (CP) é uma das principais causas de morte no mundo. Um estadiamento mediastinal preciso é obrigatório para avaliação do prognóstico e seleção de pacientes para tratamento cirúrgico. EBUS-TBNA é um procedimento minimamente invasivo que permite a amostragem de linfonodos mediastinais. Alguns estudos sugerem que a EBUS-TBNA é preferível que a mediastinoscopia cirúrgica no estadiamento mediastinal do CP. O objetivo desta revisão sistemática e meta-análise foi comparar a eficácia da EBUS-TBNA e da mediastinoscopia no estadiamento linfonodal mediastinal do câncer de pulmão de células não pequenas (CPCNP) potencialmente operável. Métodos: Foram pesquisados diversos bancos de dados. Estudos comparando a precisão da EBUS-TBNA e da mediastinoscopia no estadiamento linfonodal mediastinal em pacientes com CPCNP foram incluídos. Na meta-análise, foram calculadas sensibilidade e especificidade, bem como razões de verossimilhança positiva e negativa. A diferença de risco de complicações relatadas para cada procedimento também foi analisada. Resultados: A pesquisa identificou 4.201 artigos, dos quais 5 foram selecionados para a meta-análise (total combinado de 532 pacientes). Não houve diferenças estatisticamente significativas entre EBUS-TBNA e mediastinoscopia: sensibilidade (81% vs. 75%), especificidade (100% para ambas), razão de verossimilhança positiva (101,03 vs. 95,70) e razão de verossimilhança negativa (0,21 vs. 0,23). A área sob a curva summary ROC para EBUS-TBNA e para mediastinoscopia foi de 0,9881 e 0,9895, respectivamente. Embora o número de complicações tenha sido maior para mediastinoscopia, não foi encontrada diferença significativa (diferença de risco: −0,03; IC95%: −0,07 to 0,01; I2 = 76%). Conclusões: EBUS-TBNA e mediastinoscopia apresentaram resultados semelhantes no estadiamento mediastinal do CPCNP. EBUS-TBNA pode ser o procedimento de primeira escolha no estadiamento linfonodal em pacientes com CPCNP.

Tumor mediastinal de células germinales en un paciente con melanoptisis / Mediastinal germ cell tumor in a patient with melanoptysis / Tumor de células germinativas mediastinais em paciente com melanoptise

Figuras A Y B: Radiografía de Tórax Anteroposterior (AP) y Lateral. Presencia de gran lesión al parecer del mediastino medio (Flechas blancas), con diámetros de 11 x 15 x 12 cm, de densidad homogénea, con efecto de masa y desviación de todas las estructuras (Flechas negras) y compresión sobre el lóbulo superior derecho (*), sin calcificaciones en su interior. Figura C. Tomografía computarizada de tórax con contraste corte coronal. En la región central del mediastino anterior, se identifica una masa hipodensa, heterogénea, con densidad de predominio de tejido blando, con algunas imágenes de densidad cálcica en su interior, de 14.3 x 10.2 x 12.6 (Línea amarilla) cm, que se encuentra desplazando la aorta ascendente, con trayecto tortuoso (Flecha azul), la flecha roja señala el tronco braquiocefálico. Figura D. Tomografía computarizada de tórax corte axial en ventana mediastinal. Masa hipodensa, heterogénea, con densidad de predominio de tejido blando, con algunas imágenes de densidad cálcica en su interior, la cual se encuentra desplazando y ocupando gran parte de la porción anterior del hemitórax derecho. Así mismo se encuentra desplazando estructuras mediastinales como el tronco de la pulmonar (Flecha azul), esta masa se encuentra generando atelectasia pasiva del lóbulo medio derecho (Flecha roja). Cómo citar. López-Salazar JP, Delgado-Serrano J. Tumor mediastinal de células germinales en un paciente con melanoptisis. MedUNAB. 2020;23(2): 191-194. doi:10.29375/01237047.3748

Figures A and B: Anteroposterior (AP) and Lateral Chest X-ray. Presence of a large mass, apparently from the middle mediastinum (white arrows), diameters of 11 x 15 x 12 cm, homogeneous density, with the mass effect on other mediastinal structures (black arrows) and compression on the right upper lobe (*), without inner calcifications. Figure C. Chest Computed Tomography, coronal section. In the anterior mediastinum it shows a hypodense, heterogeneous mass, with predominance of soft tissue density, with some calcifications inside, diameters of 14.3 x 10.2 x 12.6 (yellow line) cm, displacing the ascending aorta (blue arrow), the red arrow indicates the brachiocephalic trunk. Figure D. Computed tomography of the chest, axial section. Hypodense, heterogeneous mass, with predominance of soft tissue density, with some calcifications inside, which occupying a large parto f the anterior right hemithorax. It is also displacing mediastinal structures such as the trunk of the pulmonary artery (blue arrow), this mass is generating passive atelectasis of the right middle lobe (red arrow). Cómo citar. López-Salazar JP, Delgado-Serrano J. Tumor mediastinal de células germinales en un paciente con melanoptisis. MedUNAB. 2020;23(2): 191-194. doi:10.29375/01237047.3748

Figuras A e B: Radiografia de tórax (anteroposterior (AP) e lateral). Presença de grande massa, aparentemente do mediastino médio (Setas brancas), diâmetros de 11 x 15 x 12 cm, densidade homogênea, com efeito de massa em outras estruturas mediastinais (setas pretas) e compressão no lobo superior direito (*), sem calcificações internas. Figura C. Tomografia computadorizada de tórax, corte coronal. No mediastino anterior, mostra uma massa hipodensa e heterogênea, com predominância da densidade de partes moles, com algumas calcificações internas, diâmetros de 14,3 x 10,2 x 12,6 (Linha amarela) cm, deslocando a aorta ascendente (seta azul), a seta vermelha indica o tronco braquiocefálico. Figura D. Tomografia computadorizada de tórax, corte axial. Massa hipodensa, heterogênea, com predominância da densidade de partes moles, com algunas calcificações internas, que ocupam grande parte do hemitórax anterior direito. Também está deslocando estruturas mediastinais, como o tronco da artéria pulmonar (Seta azul), essa massa está gerando atelectasia passiva do lobo médio direito (Sseta vermelha). Cómo citar. López-Salazar JP, Delgado-Serrano J. Tumor mediastinal de células germinales en un paciente con melanoptisis. MedUNAB. 2020;23(2): 191-194. doi:10.29375/01237047.3748

Sarcoma cardíaco metastático a miembros inferiores / Cardiac sarcoma with metastasis to the lower limbs / Sarcoma cardíaco metastático dos membros inferiores

Introducción. Las neoplasias de corazón son patologías infrecuentes con tasas de incidencias en reportes de autopsias menores al 0.02 %. El 75 % de esos tumores son de comportamiento benigno y solo el 25 % restante se considera cáncer. Aunque se presentan en ambos sexos, la relación hombres mujeres es de 2.5:1 respectivamente. Presentación del caso. Reportamos el caso de un paciente de 41 años a quien se diagnosticó con un sarcoma primario de corazón, en atrio izquierdo, con inmunohistoquímica compatible con sarcoma indiferenciado con metástasis a miembros inferiores, que debutó con deterioro de la clase funcional y pérdida de peso involuntaria, lo cual lo llevó a consultar al médico. Discusión. Los sarcomas indiferenciados constituyen una patología poco frecuente en la literatura médica, encontrando solo unos pocos reportes de casos que comparten datos relacionados con el sitio de localización de la lesión y los síntomas clínicos de los pacientes. Sin embargo, aquí se pone de manifiesto un extraño caso de metástasis a miembros inferiores, el cual fue considerado luego de descartar la presencia de un foramen oval permeable o lesiones pulmonares que hicieran pensar en una secuencia de migración tumoral diferente. Conclusiones. Se trata de una patología compleja con pobre pronóstico a largo plazo, la cual requiere mayor investigación y tratamiento multifactorial con equipos multidisciplinarios para mejorar la calidad de vida de los pacientes.

Introduction. Neoplasms of the heart are infrequent pathologies with incidence rates in autopsy reports less than 0.02%. 75 % of these tumors are benign and only the remaining 25 % are considered cancerous. Although they occur in both sexes, the male to female ratio is 2.5: 1 respectively. Case report. We report the case of a 41-year-old patient who was diagnosed with a primary heart sarcoma, in the left atrium, with immunohistochemistry compatible with undifferentiated sarcoma with metastases to the lower limbs, who debuted with impairment of functional class and loss of involuntary weight which led him to consult the doctor. Discussion. Undifferentiated sarcomas constitute a rare pathology in the medical literature, finding only a few cases reports that share data, such as the location of the lesion and the clinical symptoms of the patients. However, this case reveals a strange case of metastasis to lower limbs, which was considered, after ruling out the presence of a patent foramen ovale or lung lesions that suggested a different tumor migration sequence. Conclusions. This is a complex pathology with a poor long-term prognosis that requires more re- search and multifactorial treatment with multidisciplinary teams to improve the quality of life of patients

Introdução. As neoplasias do coração são patologias pouco frequentes, com taxas de incidência em relatórios de autópsia inferiores a 0,02%. 75% desses tumores são benignos e apenas 25% restantes são considerados câncer. Embora ocorram em ambos os sexos, a proporção entre homens e mulheres é de 2,5: 1 respectivamente. Apresentação do caso. Relatamos o caso de um paciente de 41 anos de idade com diagnóstico de sarcoma primário do coração, no átrio esquerdo, com imuno-histoquímica compatível com sarcoma indiferenciado com metástase nos membros inferiores, que começou com deterioração da classe funcional e perda involuntária de peso, o que o levou a consultar o médico. Discussão. Os sarcomas indiferenciados constituem uma patologia rara na literatura médica, encontrando apenas alguns relatos de casos que compartilham dados relacionados ao local da localização da lesão e aos sintomas clínicos dos pacientes. No entanto, aqui é revelado um caso estranho de metástase nos membros inferiores, que foi considerado após descartar a presença de forame oval permeável ou lesões pulmonares que sugerem uma sequência de migração tumoral diferente. Conclusões. É uma patologia complexa, com mau prognóstico a longo prazo, que requer mais investigação e tratamento multifatorial com equipes multidisciplinares para melhorar a qualidade de vida dos pacientes.

Teratocarcinoma gigante de mediastino anterosuperior / Giant teratocarcinoma of anterosuperior mediastinum

RESUMEN Los tumores de células germinales no son tan frecuentes, dentro de ellos se encuentra el teratoma como el más usual en ubicación mediastinal, es más habitual en hombres jóvenes cuando es maligno (teratocarcinoma), con una relación por género de 13,5:1, y una edad promedio de 26 años. Se describe la evolución de un hombre de 19 años de edad con un tumor mediastinal, con metástasis pulmonares e infiltración intracardíaca, resecado satisfactoriamente, cuyos síntomas más frecuentes fueron: disnea, dolor retroesternal, fiebre, tos, pérdida de peso y síndrome de vena cava superior. El diagnóstico se realizó por radiografía de tórax y tomografía axial computarizada. Se logró realizar la excéresis total del tumor y las metástasis, así como la tumoración intracardíaca, con reparación de la válvula tricúspide. El paciente ha tenido una evolución satisfactoria durante el primer año de seguimiento.

ABSTRACT Germ cell tumors are not so frequent; among them, teratomas are most common in the mediastinal location. Teratomas in young men are usually malignant (teratocarcinoma), with a gender ratio of 13.5:1, and an average age of 26 years. We describe the evolution of a 19-year-old man with a mediastinal tumor, with pulmonary metastases and intracardiac infiltration, successfully removed; whose most frequent symptoms were: dyspnea, retrosternal pain, fever, cough, weight loss and superior vena cava syndrome. The diagnosis was made by chest x-ray and computed tomography. Total removal of the tumor and metastases was achieved, as well as the intracardiac tumor, with tricuspid valve repair. The patient had a satisfactory outcome during the first follow-up year.

Tumor de células germinales primario de mediastino (seminoma de mediastino) / Cell Germ primary tumor of mediastinum (seminoma of mediastinum)

RESUMEN Fundamento: el tumor de células germinales de mediastino anterior, es una formación de células neoplásicas localizada en mediastino. Se forman por defectos congénitos en la etapa embrionaria por migración de la célula germinal primordial y derivan de células que están dentro de las gónadas (germinales), pueden migrar y localizarse fuera de estas (extra gonadal) como el caso que se presentó, y situarse en mediastino anterior (seminoma). La localización más reportada de los extra gonadales es en mediastino anterior. Objetivo: describir un enfermo con tumor primario de células germinales del mediastino anterior. Caso clínico: paciente de 23 años de edad, masculino, con antecedentes de asma bronquial, acudió al cuerpo de guardia con tos seca y frecuente, pérdida de peso de 7 kg en un mes y fiebre de 38˚C hace dos días. Al examen físico, ligera palidez cutáneo mucosa, murmullo vesicular abolido en hemitórax derecho sin estertores. Después de estudios analíticos, radiografía de tórax, tomografía axial computarizada de pulmón y estudio histológico, se concluyó como neoplasia de células germinales primitiva extra gonadal de mediastino anterior. Conclusiones: la localización más frecuente de los tumores de células germinales de mediastino, extragonadal, es mediastino anterior. Son los tumores sólidos de mediastino más frecuentes en varones y afecta entre los 20 y 40 años de edad, hecho infrecuente en la práctica clínica.

ABSTRACT Background: the anterior mediastinal germ cell tumor is a formation of neoplastic cells located in the mediastinum. They are formed by congenital defects in the embryonic stage by migration of the primordial germ cell and dermal cells that are within the gonads (germinal), being able to migrate and localize outside of these (extra gonadal) as the case presented, and to be located in the anterior mediastinum (Seminoma). The most reported location of the extra gonadal is in the anterior mediastinum. Objective: to describe a patient with primary tumor of germ cell of the anterior mediastinum. Clinical case: a 23-year-old male patient with a history of bronchial asthma attended the emergency room with a dry, frequent cough, weight loss of 7 kg in one month and fever of 38˚C for 2 days. At physical examination, slight mucous skin pallor, vesicular murmur abolished in right hemi-thorax without rales. After analytical studies, chest x-ray, computerized lung tomography and histological study, it was concluded as primitive extra-gonadal germ cell neoplastic of anterior mediastinum. Conclusions: the most frequent location of mediastinal germ cell tumors, extra-gonadal, is anterior mediastinum. They are the most frequent mediastinal solid tumors in men and affect between 20 and 40 years of age; being the case that occupies a male patient of 23 years, uncommon in clinical practice.

Subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumor: A retrospective clinical study / 第二军医大学学报

ObjectiveTo explore the feasibility and clinical effect of subxiphoid uniportal video-assisted thoracoscopic surgery in the treatment of the anterior mediastinal tumors. MethodsThe clinical data of 38 patients, who underwent subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumor in Shanghai Pulmonary Hospital of Tongji University from Oct. 2014 to Aug. 2018, were retrospectively analyzed. Among them, 20 were males and 18 were females, the average age was (57.8±14.8) years, and the average diameter of anterior mediastinal tumors was (2.8±1.7) cm. The surgery was performed under video-assisted thoracoscope through an about 4 cm subxiphoid longitudinal incision. ResultsAll the 38 cases of subxiphoid uniportal video-assisted thoracoscopic surgery were performed successfully without conversion to thoracotomy or perioperative death. Except for one patient who received mechanical ventilatory support for 1 week because of worsened myasthenia gravis symptoms, there were no other complications. The operative time, volume of bleeding, volume of drainage on the operation day and hospital stay after surgery were 1-4 (1.9±0.8) h, 10-400 (87.5±68.7) mL, 50-650 (237.4±176.4) mL and 1-19 (4.1±2.9) d, respectively. Postoperative pathology showed 1 case of type A thymoma, 1 case of type B2 thymoma, 1 case of type B3 thymoma, 5 cases of type AB thymoma, 1 case of thymic squamous carcinoma, 6 cases of thymic hyperplasia, 16 cases of thymic cyst, 6 cases of simple thymus and fat and 1 case of bronchial cyst. The visual analogue scale scores on 1, 3 and 6 months after surgery were 3.8±2.2, 1.5±1.4 and 0.8±0.6, respectively. ConclusionSubxiphoid uniportal video-assisted thoracoscopic surgery is a safe, efficient, satisfactory procedure for early stage thymoma, benign anterior mediastinal tumors and some early stage anterior mediastinal malignant tumors, and it can effectively avert the intractable incision pain caused by intercostal nerve injury.

CT features of primary mediastinal neuroendocrine carcinoma / 中华内分泌外科杂志

Objective@#To investigate the CT features of primary mediastinal neuroendocrine carcinoma and improve the diagnostic accuracy.@*Methods@#CT findings of 12 patients with primary mediastinal neuroendocrine carcinoma diagnosed by clinic and pathology were retrospectively analyzed. The location, size, growth pattern, density, degree of enhancement, invasion of surrounding tissues and metastasis of the tumor were observed, a control analysis was performed.@*Results@#Among the 12 cases, 4 cases were located in the anterior superior mediastinum, 4 cases in the middle superior mediastinum and 4 cases in the middle mediastinum. There were 5 cases on the left side, 4 cases on the right side and 3 cases in the middle. The maximum diameter of the tumor ranged from 1.5 cm to 12.0 cm, with an average of (6.74±3.65) cm. The tumors were round or quasi-round in 6 cases, irregular in 6 cases, clear boundary in 9 cases and unclear in 3 cases. Uniform density was found in 6 cases. The density was heterogeneous in 6 cases, including necrosis and cystic degeneration in 4 cases, and fine-grained calcification in 1 case. The average CT value of plain scan was (38±4.8) HU. There was 1 case of perivascular growth, 2 cases of adjacent vascular compression, 3 cases of adjacent pleural invasion, and 6 cases of infiltrating the surrounding fat space. After contrast enhancement, all cases showed mild and moderate enhancement, including 4 cases with homogeneous enhancement and 8 cases with heterogeneous enhancement. After contrast enhancement, the mean CT value was (55±7.7) HU. There were 9 cases with mild enhancement and 3 cases with moderate enhancement. There were 3 cases with small linear abnormally enhanced vascular shadow in the tumor, and 4 cases with no enhancement both in the central necrosis and the cystic areas. There were 7 cases of typical carcinoid, 2 cases of atypical carcinoid, 2 cases of small cell carcinoma and 1 case of large cell neuroendocrine carcinoma.@*Conclusion@#Primary mediastinal neuroendocrine carcinoma is mainly located in the anterior-mediastinum. When the tumor is large, necrosis, cystic degeneration and invasive growth are easy to occur. The enhanced scan shows mild and moderate enhancement. Combined with clinical history, it can improve the accuracy of diagnosis.

CT features of primary mediastinal neuroendocrine carcinoma / 中华内分泌外科杂志

Objective To investigate the CT features of primary mediastinal neuroendocrine carcinoma and improve the diagnostic accuracy. Methods CT findings of 12 patients with primary mediastinal neuroen-docrine carcinoma diagnosed by clinic and pathology were retrospectively analyzed. The location, size, growth pat-tern, density, degree of enhancement, invasion of surrounding tissues and metastasis of the tumor were observed, a control analysis was performed. Results Among the 12 cases, 4 cases were located in the anterior superior medi-astinum, 4 cases in the middle superior mediastinum and 4 cases in the middle mediastinum. There were 5 cases on the left side, 4 cases on the right side and 3 cases in the middle. The maximum diameter of the tumor ranged from 1.5 cm to 12.0 cm, with an average of(6.74±3.65) cm. The tumors were round or quasi-round in 6 cases, ir-regular in 6 cases, clear boundary in 9 cases and unclear in 3 cases. Uniform density was found in 6 cases. The density was heterogeneous in 6 cases, including necrosis and cystic degeneration in 4 cases, and fine-grained cal-cification in 1 case. The average CT value of plain scan was (38±4.8) HU. There was 1 case of perivascular growth, 2 cases of adjacent vascular compression, 3 cases of adjacent pleural invasion, and 6 cases of infiltrating the sur-rounding fat space. After contrast enhancement, all cases showed mild and moderate enhancement, including 4 cases with homogeneous enhancement and 8 cases with heterogeneous enhancement. After contrast enhancement, the mean CT value was (55±7.7) HU. There were 9 cases with mild enhancement and 3 cases with moderate enhance-ment. There were 3 cases with small linear abnormally enhanced vascular shadow in the tumor, and 4 cases with no enhancement both in the central necrosis and the cystic areas. There were 7 cases of typical carcinoid, 2 cases of atypical carcinoid, 2 cases of small cell carcinoma and 1 case of large cell neuroendocrine carcinoma. Conclu-sion Primary mediastinal neuroendocrine carcinoma is mainly located in the anterior-mediastinum. When the tumor is large, necrosis, cystic degeneration and invasive growth are easy to occur. The enhanced scan shows mild and moderate enhancement. Combined with clinical history, it can improve the accuracy of diagnosis.

Imaging findings of primary mediastinal yolk sac tumors / 中国医学影像技术

Objective: To explore CT and PET/CT features of primary mediastinal yolk sac tumor (PMYST). Methods: CT, PET/CT and clinical data of 14 patients with PMYST confirmed by percutaneous biopsy were retrospectively analyzed. All patients underwent plain scan and enhanced chest CT examination, while 7 patients underwent PET/CT examination. Results: CT showed round or lobulated masses in all 14 cases. The maximum diameter of masses was 4.10-13.50 cm, with an average of (10.65±2.27) cm. Lesions with the maximum diameter≥10.00 cm were in 13 cases (13/14, 92.86%).Plain CT showed non-uniform density or heterogeneous density, and the enhanced CT showed multiple strip, thin linear partition enhanced focus and flake non-enhanced area in 14 cases, among which moderate and mild enhancement were observed in 11 cases (11/14, 78.57%) and 3 cases (3/14, 21.43%), respectively. Cardiac envelope involvement was found in 5 cases (5/14, 35.71%), left cephalobrachial vein and/or superior vena cava involvement were detected in 3 cases (3/14, 21.43%), while the right upper and middle lobe involvement was noticed in 1 case (1/14, 7.14%).There were 3 patients (3/14, 21.43%) with right hilar and mediastinal lymph node metastasis, 1 (1/14, 7.14%) with right pleural metastasis and 1 (1/14, 7.14%) with right lower lung metastasis. Pericardial effusion (7/14, 50.00%) and pleural effusion (7/14, 50.00%) were found each in 7 cases, respectively. PET/CT showed markedly increased radioactivity uptake in all 7 cases. During following-up after treatment, stable or recovered well after operation were observed in 9 cases (9/14, 64.29%), whereas progressive or recurred after operation in 5 cases (5/14, 35.71%). Conclusion: The main imaging manifestations of PMYST include large round or lobulated non-uniform mass in the anterior mediastinum, often invading surrounding vessels, tissue and organs, mostly with lymph nodes and distant metastasis. The specific manifestations of PMYST are multiple strip-like, linear septate-like enhancement foci and patchy non-enhancement areas in enhanced CT. 18F-FDG uptake of the lesions are markedly hypermetabolic.

Thymic teratoma presenting as non-immune hydrops fetalis

Teratomas are one of the most frequent tumors in the pediatric population. They occur anywhere along the midline of the body, following the course of the embryonic germ cell ridge. In the mediastinal location, they exert space occupying effects, leading to a myriad of complications, including non-immune hydrops fetalis. We describe a fatal case of an immature thymic teratoma in a neonate presenting with hydrops fetalis. This case emphasizes the importance of early diagnosis and surgical intervention in such cases.

Lymphoma with mediastinal bulky masses: a clinical analysis of 17 cases / 白血病·淋巴瘤

Objective To analyze the clinical characteristics, pathological types, treatment modalities of lymphoma patients with mediastinal bulky masses. Methods The clinical data of 17 lymphoma patients with mediastinal bulky masses from January 2010 to January 2017 in Beijing Friendship Hospital were analyzed retrospectively. Results All the patients were pathologically diagnosed, including 6 cases of primary mediastinal large B-cell lymphoma , 5 cases of lymphoblastic lymphoma , 3 cases of Hodgkin lymphoma and 3 cases of other non-Hodgkin lymphoma. Four cases with bulky disease were treated with combined chemoradiotherapy regimen, 7 cases were treated with combined chemotherapy, 5 cases were treated with combined chemotherapy regimens followed by autologous bone marrow transplantation and 1 case was treated with high dose chemotherapy followed by allogeneic stem cell transplantation. The effects were evaluated after the final treatments. Twelve patients achieved complete remission, 1 case achieved partial remission, 1 case achieved stable disease, 1 case achieved progressive disease and 3 cases died. Conclusions The prognosis of lymphoma patients with mediastinal bulky masses is related with histopathology and treatment response. Combined treatment modalities including chemoradiotherapy regimen and chemotherapy regimen followed by autologous or allogeneic stem cell transplantation are helpful to improve treatment effects.

Early diagnostic value of multi-slice spiral CT for cystic mediastinal tumor / 中国基层医药

Objective To evaluate the value of multi-slice spiral CT in the early diagnosis of cystic mediastinal tumors.Methods 60 cases with cystic mediastinal tumor were collected.All patients were examined by multi-slice spiral CT,and the CT findings of all patients with various types of mediastinal tumors were statistically detected.Results (1) CT manifestations of thymic cyst showed clear boundary of the circular or oval or triangular mass,thin cyst wall,uniform density,internal watery density,no enhancement,the diagnostic accuracy rate was 90.48％.(2)CT manifestations of thymoma sac variable showed round or oval,cystic wall smooth,uniform density of the inner edge of the center for low density cystic variable.Enhanced scan showed uniform or mild enhancement of the inhomogeneous enhancement,the diagnostic accuracy rate was 93.75％.(3)CT manifestations of teratoma showed round and similar to the round or irregular in shape,the thickness of cystic wall,fuzzy edge,different density,enhancement,the diagnostic accuracy rate was 100.00％.(4)CT manifestations of bronchogenic cyst showed round or oval mass,clear boundary,thickness of cystic wall,uniform density,internal watery density,cyst wall strengthening,lesions no enhancement,the diagnostic accuracy rate was 90.00％.Conclusion Cystic mediastinal tumors can be diagnosed by CT,which has guiding significance for clinical.

Surgical management of mediastinal hemangioma: a report of 18 cases / 中华胸心血管外科杂志

Objective To summarize our experience in surgical intervention of patients with mediastinal hemangioma.Methods From January 1994 to August 2017,18 patients underwent surgical treatment were diagnosed with mediastinal hemangioma in our department.There were 9 females and 9 males,with the average age of(50.9 ± 14.0) years.Seven patients were seen with signs and symptoms related to the tumor,and the other 11 patients had no symptom.Three cases were located in the anterior mediastinum,1 case in the middle mediastinum and 14 cases in the posterior mediastinum.All of the cases experienced chest computed tomography(unenhanced or contrast-enhanced CT scan).Most mediastinal hemangiomas manifested as well-marginated masses at CT.Seven hemangiomas showed heterogeneous enhancement at contrast-enhanced CT.Calcifications were demonstrated in 2 patients.Preoperative diagnosis was not confirmed in all patients.Two cases were suspected to be hemangioma preoperatively,other cases were suspected to be thymoma,neurofibroma or malignancy.Eight cases were treated by video-assisted thoracic surgery approach,3 of those converted to thoracotomy due to high risk of hemorrhage.Ten cases experienced traditional thoracotomy.Results Seventeen patients had total excision,but one experienced biopsy because of hemorrhage.There were no operative death and major complications.The average operation time was(105.0 ± 49.6) minutes,and the average blood loss was(111.7 ± 138.9) ml.The postoperative hospital stay was (4.7 ± 3.5) days on average.Follow-up time ranged from 1 to 18 months(median,9.6 months).No recurrence was found in the patients with total excision at the time of follow-up.The patient undergoing biopsy showed no progression of the disease for 12 months.Conclusion Mediastinal hemangiomas were rare tumors,without relatively specific clinical manifestation.Calcification and phleboliths on CT scan were helpful in suggesting the vascular nature of the mass.Preoperative diagnosis of mediastinal hemangioma was usually very difficult.Mediastinal hemangiomas were mainly treated by surgical approach and had good prognosis.