Identificación de las características de los ganglios evaluados en el procedimiento EBUS y su relación con el diagnóstico de malignidad en instituto de alta complejidad en cáncer / Identification of the Characteristics of the Lymph Nodes Evaluated in the EBUS Procedure and their Relationship with the Diagnosis of Malignancy in a Highly Complex Cancer Institute

Introducción: La EBUS ha sido el foco de numerosos estudios destinados a evaluar su utilidad y rendimiento diagnóstico en diversas patologías. Objetivo principal: Identificación de las características ganglionares evaluadas en el procedimiento de Ultrasonido Endobronquial (EBUS) y su relación con el diagnóstico de malignidad en pacientes del Instituto Nacional del Cáncer de Colombia del 1 de enero de 2017 al 31 de marzo de 2021.Métodos: Estudio analítico observacional transversal. La recopilación de datos implicó un muestreo de casos consecutivos no probabilísticos entre individuos que cumplían los criterios de inclusión.Resultados: Un total de 75 pacientes fueron sometidos a EBUS. Se identificaron 6 características ecográficas de los ganglios de la biopsia asociadas a malignidad destacándose los ganglios mayores de 1 cm, márgenes mal definidos, ecogenicidad heterogénea, ausencia de una estructura hiliar central, presencia de signos de necrosis o coagulación y presencia de conglomerado ganglionar. Conclusión: Este estudio caracterizó la frecuencia de los hallazgos en la ultrasonografía endobronquial destacando algunas características ecográficas de los ganglios mediastínicos que podrían predecir patología maligna.

Introduction: The EBUS has been the focus of numerous studies aiming to evaluate its utility and diagnostic performance across various pathologies. Objective: Identification of the node characteristics evaluated in the Endobronchial Ultrasound (EBUS) procedure and their relationship with malignancy diagnosis in patients at the National Cancer Institute of Colombia from January 1st, 2017, to March 31st, 2021. Methods: Observational cross-sectional analytical study. Data collection involved non-probabilistic consecutive case sampling among individuals meeting the inclusion criteria.Results: A total of 75 patients underwent the EBUS procedure. Our findings revealed six predictors of malignancy based on sonographic features of biopsy nodes, including nodes larger than 1 cm, poorly defined margins, heterogeneous echogenicity, absence of a central hilar structure, presence of signs indicating necrosis or coagulation, and the presence of a ganglion conglomerate. Conclusions: This study showed that endobronchial ultrasonography has several sonographic characteristics at the time of evaluating mediastinal nodes that could predict malignant and benign pathology.

Clinical efficacy of da Vinci robotic and thoracoscopic transxiphoid approach in the treatment of anterior mediastinal tumors: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective To compare the safety and efficacy of the da Vinci robot and thoracoscopic subxiphoid approach for the treatment of anterior mediastinal tumors. Methods The clinical data of patients who underwent anterior mediastinal tumor resection through the subxiphoid approach admitted to the same medical group in the Department of Thoracic Surgery of the First Hospital of Lanzhou University between June 2020 and April 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a robot-assisted thoracoscopic surgery (RATS) group and a video-assisted thoracoscopic surgery (VATS) group. The perioperative data and the incidence of postoperative complications were compared between the two groups. Results A total of 79 patients were enrolled. There were 41 patients in the RATS group, including 13 males and 28 females, with an average age of 45.61±14.99 years. There were 38 patients in the VATS group, including 14 males and 24 females, with an average age of 47.84±15.05 years. All patients completed the surgery successfully. Hospitalization cost and operative time were higher or longer in the RATS group than those in the VATS group, and the difference was statistically significant (P<0.05). Intraoperative bleeding, postoperative hospital stay, postoperative water and food intake time, postoperative off-bed activity time, white blood cell count, neutrophil percentage and visual analogue scale (VAS) score on the first postoperative day, white blood cell count and neutrophil percentage on the third postoperative day, duration of analgesic pump use, the number of voluntary compressions of the analgesic pump, and mediastinal drainage volume were all superior to those in the VATS group (P<0.05). The differences in VAS scores on the third postoperative day, duration of drainage tube retention and postoperative complication rates were not statistically different between the two groups (P>0.05). Conclusion RATS subxiphoid anterior mediastinum tumor resection is a safe and feasible surgical method with less injury and higher safety, which is conducive to rapid postoperative recovery and has wide clinical application prospects.

Tumor gigante de células germinales: un abordaje quirúrgico / Giant Mediastinal Germ Cell Tumor: a Surgical Approach

Los tumores de células germinales (TCGs) se forman a partir de células embrionarias y generalmente se presentan en pacientes de entre 11 y 30 años de edad. Los TCG pue-den presentarse como tumores extragonadales, siendo el mediastino anterior el sitio más común en el 50 a 70% de los casos. Presentamos a un paciente masculino de 21 años con un tumor sólido mediastinal de 17 x 15 cm que, de acuerdo a la tomografía de tórax (TC), ocupaba toda la cavidad torácica izquierda desplazando el corazón ha-cia la cavidad torácica derecha. El estudio patológico fue reportado por el patólogo co-mo un TCG.

Germ cell tumors (GCTs) are formed from embryonic cells and usually occur in patients between age 11 and 30 years. GCT can present as extra-gonadal tumors, with the an-terior mediastinum being the most common site in 50 to 70% of cases. We present a 21-year-old male patient with a solid mediastinal tumor of 17 x 15 cm that, according to the chest tomography (CT), it was occupying the entire left thoracic cavity moving the heart towards the right thoracic cavity. The pathological study was reported by the pathologist as a GCT tumor.

Síndrome de Hamman. Reporte de un caso

El síndrome de Hamman se caracteriza por la presencia de aire libre en el espacio intersticial del mediastino, asociado a enfisema subcutáneo. Se presenta el caso de un paciente masculino de 19 años de edad, remitido al Servicio de Cirugía General del Hospital General Docente Leopoldito Martínez, por presentar disnea de moderada intensidad, acompañada de aumento súbito de volumen del cuello y región anterior del tórax, posterior a un acceso de tos durante una crisis aguda de asma bronquial. Al examen físico se identificó enfisema subcutáneo en cuello, tórax, pared anterior del abdomen y miembros superiores. Se observó signo de Hamman positivo. Se indicó radiografía y tomografía axial computadorizada simple de tórax, que evidenció el enfisema subcutáneo y el neumomediastino. Se concluyó como un síndrome de Hamman. El tratamiento fue conservador y la evolución satisfactoria. Este síndrome es una entidad poco frecuente y autolimitada, que se presenta generalmente en pacientes jóvenes masculinos, aparentemente sanos. El diagnóstico se define por los estudios de imaginología y el tratamiento conservador es el recomendado. Se presenta este caso con el objetivo de exponer la presentación, diagnóstico y tratamiento de este síndrome.

Hamman's syndrome is characterized by the presence of free air in the interstitial space of the mediastinum, associated with subcutaneous emphysema. The case of a 19-years-old male patient, referred to the General Surgery Service of the Leopoldito Martínez General Teaching Hospital, presenting with moderate intensity dyspnea, accompanied by a sudden increase in volume of the neck and anterior region of the thorax, after a coughing fit during an acute attack of bronchial asthma is presented. The physical examination identified subcutaneous emphysema in the neck, thorax, anterior wall of the abdomen and upper limbs. A positive Hamman sign was observed. Chest X-ray and simple computed tomography were indicated, showing subcutaneous emphysema and pneumomediastinum. It was concluded as a Hamman syndrome. The treatment was conservative and the evolution was satisfactory. Hamman's syndrome is a rare and self-limiting entity that generally occurs in young, apparently healthy male patients. The diagnosis is defined by imaging studies and conservative treatment is recommended. This case is presented with the aim of exposing the presentation, diagnosis and treatment of this syndrome.

Mielolipoma primario mediastinal / Primary mediastinal myelolipoma

Resumen El mielolipoma es un tumor benigno no funcional, la mayoría de ellos son asintomáticos y descubiertos de forma incidental a través de estudios de imagen o en es tudios de autopsia. Aun cuando la mayoría de los casos se presenta en la glándula suprarrenal, también se han informado en sitios extra-adrenales. Presentamos el caso de una mujer de 65 años de edad con un mielolipoma primario mediastinal. La tomografía computarizada de tórax mostró un tumor ovoide de bordes bien definidos de 6.5 × 4.2 cm, localizado en el mediastino posterior. Se realizó biopsia transtorácica de la lesión y el estudio microscópico reveló elementos hematopoyéticos y tejido adiposo maduro. Aun cuando los estudios de imagen como la tomografía computarizada y la resonancia mag nética son efectivos en el diagnóstico del mielolipoma primario mediastinal, la evaluación histopatológica es esencial para el diagnóstico definitivo.

Abstract Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomo graphy and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.

Linfadenectomía mediastinal por muestreo vs. linfadenectomía completa en el cáncer pulmonar / Sampling Mediastinal Lymphadenectomy versus Complete Lymphadenectomy in Lung Cancer

Introducción: El muestreo y la linfadenectomía completa son técnicas de acceso al mediastino. Su evaluación permite definir la conducta en el enfermo con cáncer del pulmón. Objetivo: Determinar los resultados de supervivencia en los enfermos con lesiones resecables por cáncer de pulmón con linfadenectomía completa o linfadenectomía por muestreo. Métodos: Se realizó un estudio longitudinal tipo serie de casos en 118 pacientes con lesiones resecables de cáncer de pulmón de células no pequeñas. El total de pacientes se subdividieron en dos grupos. A los 73 enfermos pertenecientes al grupo A se les realizó linfadenectomía por muestreo (1996-2010), mientras que a los 45 del grupo B se les realizó linfadenectomía completa (2011-2019). Se analizaron las complicaciones y la supervivencia a los cinco años. Resultados: Se resecaron mayor cantidad de ganglios por paciente y por regiones en la linfadenectomía completa, con una supervivencia de 50,6 por ciento, superior al 39,7por ciento obtenido en el grupo donde se realizó un muestreo. No se recogieron complicaciones inherentes a las técnicas quirúrgicas. Conclusiones: Los pacientes operados con resección y linfadenectomía completa tuvieron mayor sobrevida que los intervenidos mediante resección y linfadenectomía por muestreo(AU)

Introduction: Sampling or complete lymphadenectomy are techniques for accessing the mediastinum. Their assessment allows to define the approach in patients with lung cancer. Objective: To determine survival outcomes in ill patients with resectable lesions due to lung cancer after complete or sampling lymphadenectomies. Methods: A longitudinal case series study was performed in 118 patients with resectable lesions of nonsmall-cell lung cancer. All the patients were divided into two groups. The 73 ill patients from group A underwent sampling lymphadenectomy (1996-2010), while the 45 patients from group B underwent complete lymphadenectomy (2011-2019). Complications and five-year survival were analyzed. Results: A higher amount of nodes were resected per patient and per region in complete lymphadenectomy, with a survival of 50.6 por ciento, higher than the 39.7 por ciento corresponding to the sampling group. No complications inherent to the surgical techniques were collected. Conclusions: Patients operated on by resection and complete lymphadenectomy had higher survival figures than those operated on by resection and sampling lymphadenectomy(AU)

Resección completa en dos tiempos de teratoma quístico gigante del mediastino que debuta con compromiso vital

Objetivo: Describir resolución quirúrgica de teratoma de mediastino en dos tiempos que debuta en paciente con urgencia vital. Materiales y Métodos: Revisión de caso clínico y descripción retrospectiva del manejo quirúrgico realizado. Resultados: Estudio imagenológico evidenció tumor con contenido quístico que comprometía ambos hemitórax. Dado compromiso vital del paciente, se realiza quistocentesis descompresiva en pabellón, seguido de videotoracoscopía que demuestra origen mediastínico y quistectomía parcial por toracotomía. En un segundo tiempo quirúrgico, se reseca remanente vía esternotomía media. Discusión: Los teratomas mediastínicos son extremadamente infrecuentes, reportándose 44 casos en literatura mundial, sin registros a nivel nacional. Afecta a jóvenes sanos, la mayoría asintomáticos, siendo su hallazgo tardío e incidental. El compromiso de estructuras mediastínicas y de vía aérea pueden ocasionar riesgo vital. Conclusión: La descompresión perioperatoria del contenido quístico del teratoma fue fundamental para mantener fuera de riesgo vital al paciente durante el acto quirúrgico.

Objective: To describe the successful surgical resolution of a giant teratoma of the mediastinum that presents with a vital emergency. Clinical Case: Male patient, 30 years old, with no known history, consulted for a 1-year history of dyspnea on minimal exertion, associated with weight loss without dietary restriction. Imaging study showed tumor with cystic content that compromised both hemithorax. Given the patient's vital commitment, decompressive cystocentesis was performed, followed by video-assisted thoracoscopy that showed mediastinal origin and partial cystectomy by thoracotomy. In a second surgical time, resection of the remnant was performed via median sternotomy. Discussion: Mediastinal teratomas are extremely rare, reporting 44 cases in the world literature, with no national registry. They usually affect healthy young people, most of them asymptomatic and therefore, their discovery is late and incidental. In this case, due to the compression of noble structures, perioperative cystic decompression was essential. Conclusion: Perioperative decompression of the cystic content of the teratoma was essential to maintain stable hemodynamics and subsequent surgical resection.

Evaluation of 18FDG PET-CT-positive mediastinal-hilar lymph nodes in extrathoracic malignancies by EBUS-TBNA; correlation of SUVmax, and short-axis diameter with the final diagnosis

Introduction: Intrathoracic lymph node metastasis from extrathoracic neoplasms are rare. Primary malignancies that metastasize to mediastinal-hilar lymph nodes are head and neck , carcinoma breast ,and genitourinary. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)/endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the preferred modality for mediastinal lymph node sampling. Methods: Fifty seven patients with extrathoracic malignancies with maximum standardized uptake value (SUVmax) of mediastinal-hilar lymph nodes greater than or equal to 2.5 were taken up for EBUS-TBNA. The histo-cytopathological results obtained from EBUS-TBNA were compared with SUVmax value and short-axis diameter of a lymph node as noted on EBUS. Results: Out of 74 sampled nodes, 49 (66.2%) were benign and 25 (33.8%) were malignant. The SUVmax range of benign nodes was 2.8� as compared to 3� of malignant nodes. The size range of malignant and benign nodes were 8� mm and 8� mm, respectively. The mean size of abnormal nodes (metastatic + granulomatous) was 17.5 (8� mm) and the mean SUVmax was 9.1 (3.4�), and it was a statistically significant difference when compared to reactive (normal) nodes. At SUVmax cut-off 7.5, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 78.5%, 81.2%, 84.6%, and 74.2%, respectively for detecting abnormal nodes. At 13 mm size cut-off, sensitivity, specificity, PPV, NPV were 75.5%, 65%, 75%, and 72%, respectively, for detecting abnormal nodes. Conclusion: The majority of mediastinal-hilar nodes with increased metabolic activity are benign in nature. Size and SUVmax are poor predictors of metastasis in tuberculosis endemic region. There should be a restrictive attitude toward invasive diagnostic testing for mediastinal-hilar nodes in extrathoracic malignancies.

Difficult Ventilation in a Patient with a Giant Aortic Aneurysm: A Challenge for the Anesthesiologist

Patients with Marfan syndrome present anatomic variations that may increase the risk of a difficult airway. Moreover, they can present large aortic aneurysms, which may cause extrinsic airway compression. Therefore, difficult ventilation during general anesthesia poses a challenge in that the anesthesiologist has to promptly make a crucial differential diagnosis. Multidisciplinary preoperative assessment and planning of the airway and ventilation management are of utmost importance in such uncommon and highly complex clinical cases. Fiberoptic bronchoscopy is probably a really useful tool in order to assess the severity and extent of the airway compression, both preoperatively and intraoperatively. We present a clinical case where difficult ventilation occurred immediately after the induction of general anesthesia.

Consideraciones anestésicas en pacientes sometidos a cirugía para resección de tumores intratorácicos: reporte de caso / Anesthetic considerations in patients undergoing surgery for intrathoracic tumor resection: case report

Resumen: Las grandes masas mediastínicas aumentan los riesgos asociados con la anestesia general. Las complicaciones más temidas en este tipo de pacientes son el colapso de la vía aérea, seguido del colapso cardiovascular. Presentamos el caso de una paciente de 30 años con diagnóstico de sarcoma sinovial con metástasis pulmonar y con la presencia de dos tumores intratorácicos. El objetivo del caso clínico es revisar las implicaciones anestésicas y su manejo en este grupo de pacientes.

Abstract: Large mediastinal masses increase the risks associated with general anesthesia. The most feared complications in this type of patients are the collapse of the airway, leading to cardiovascular collapse. We present the case of a 30-year-old patient diagnosed with synovial sarcoma with pulmonary metastasis, with the presence of two intrathoracic tumors. The objective of the clinical case is to review the anesthetic implications and their management in this group of patients.

Synchronous Primary Parosteal Osteosarcoma and Primary Mediastinal Germ Cell Tumour with Atypical Mycobacterial Infection – A Rare Phenomenon: A Case Report

@#Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a welldifferentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

Da Vinci robotic versus thoracoscopic surgery via subxiphoid approach for treatment of anterior mediastinal tumor: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To compare the effects of anterior mediastinal tumor resection by the Da Vinci robot and video-assisted thoracoscopy via subxiphoid approach. Methods     A retrospective cohort study was conducted to continuously enroll patients who underwent anterior mediastinal tumor resection between 2020 and 2021 in our department. They were divided into a robotic group and a subxiphoid thoracoscopic group. The differences of general indexes (intraoperative blood loss, postoperative drainage volume, postoperative catheterization time, postoperative hospital stay), postoperative pain visual analogue scale (VAS), perioperative declining levels of hemoglobin, hematocrit, serum prealbumin and serum albumin were compared and analyzed. Results     A total of 113 patients were enrolled. There were 76 patients in the robotic group (46 males and 30 females, median age of 50 years) and 37 patients in the subxiphoid thoracoscopic group (21 males and 16 females, median age of 51 years). Intraoperative blood loss, postoperative drainage volume, postoperative catheterization time and postoperative hospital stay of the robotic group were better than those in the subxiphoid thoracoscopic group (P<0.05). The postoperative VAS scores in the robotic group were lower than those in the subxiphoid thoracoscopic group, but there was no statistical difference (P>0.05). Perioperative declining levels of hemoglobin, and hematocrit were not statistically different between the two groups (P>0.05). Declining levels of serum prealbumin, and serum albumin in the robotic group were lower than those in the subxiphoid thoracoscopic group (P<0.05). Conclusion     Da Vinci robotic and subxiphoid video-assisted thoracoscopic surgeries for the treatment of anterior mediastinal tumors are both safe and reliable, with short postoperative hospital stay, mild postoperative pain and quick recovery. Da Vinci robot surgery has a slight advantage in the treatment outcome.

Expressions of mRNA and encoded proteins of mitochondrial uncoupling protein genes (UCP1, UCP2, and UCP3) in epicardial and mediastinal adipose tissue and associations with coronary artery disease

ABSTRACT Objective: To evaluate the expression of UCP1, UCP2, and UCP3 mRNA and encoded proteins in epicardial and mediastinal adipose tissues in patients with coronary artery disease (CAD). Subjects and methods: We studied 60 patients with CAD and 106 patients undergoing valve replacement surgery (controls). Expression levels of UCP1, UCP2, and UCP3 mRNA and encoded proteins were measured by quantitative real-time PCR and Western blot analysis, respectively. Results: We found increased UCP1, UCP2, and UCP3 mRNA levels in the epicardial adipose tissue in the CAD versus the control group, and higher UCP1 and UCP3 mRNA expression in the epicardial compared with the mediastinal tissue in the CAD group. There was also increased expression of UCP1 protein in the epicardial tissue and UCP2 protein in the mediastinum tissue in patients with CAD. Finally, UCP1 expression was associated with levels of fasting plasma glucose, and UCP3 expression was associated with levels of high-density lipoprotein cholesterol and low-density cholesterol in the epicardial tissue. Conclusions: Our study supports the hypothesis that higher mRNA expression by UCP genes in the epicardial adipose tissue could be a protective mechanism against the production of reactive oxygen species and may guard the myocardium against damage. Thus, UCP levels are essential to maintain the adaptive phase of cardiac injury in the presence of metabolic disorders.

Analysis of influencing factors for prolonged postoperative hospital stay after Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation and the process optimization / 中国胸心血管外科临床杂志

@# Objective     To analyze the risk factors for postoperative length of stay (PLOS) after mediastinal tumor resection by robot-assisted non-endotracheal intubation and to optimize the perioperative process. Methods    The clinical data of patients who underwent Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from 2016 to 2019 were retrospectively analyzed. According to the median PLOS, the patients were divided into two groups. The univariate analysis and multivariate logistic regression were used to analyze risk factors for prolonged PLOS (longer than median PLOS). Results    A total of 190 patients were enrolled, including 92 males and 98 females with a median age of 51.5 (41.0, 59.0) years. The median PLOS of all patients was 3.0 (2.0, 4.0) d. There were 71 patients in the PLOS>3 d group and 119 patients in the PLOS≤3 d group. Multivariate logistic regression showed that indwelled thoracic catheter [OR=11.852, 95%CI (2.384, 58.912), P=0.003], preoperative symptoms of muscle weakness [OR=4.814, 95%CI (1.337, 17.337), P=0.016] and postoperative visual analogue scale>5 points [OR=6.696, 95%CI (3.033, 14.783), P<0.001] were independent factors for prolonged PLOS. Totally no tube (TNT) allowed patients to be discharged on the first day after surgery. Conclusion    Robot-assisted mediastinal tumor resection with non-endotracheal intubation can promote rapid recovery. The methods of optimizing perioperative process are TNT, controlling muscle weakness symptoms and postoperative pain relief.

Diagnosis, treatment and prognosis of primary mediastinal yolk sac tumor in 18 patients / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical characteristics and treatment of primary mediastinal yolk sac tumor (PMYST). Methods    We collected the clinical data of PMYST patients who were admitted to the Department of Thoracic Surgery of Peking Union Medical College Hospital from September 2000 to September 2020. The clinical and pathological characteristics, treatment and prognosis of PMYST patients were retrospectively analyzed. Results     Finally 18 patients were enrolled, including 17 males and 1 female with a median age of 22.0 (16.6, 26.2) years. Patients had increased level of alpha fetoprotein (AFP). The pathological type can be single yolk sac tumor or combined with other mediastinal germ cell tumors. Chemotherapy and radical surgery were the main treatment methods. Extensive resection was feasible for patients with tumor invasion of other organs. Seven patients developed lung or pleural metastasis after operation, and 3 of them had extrapleural metastasis. One patient recurred within 1 year after surgery. All patients were followed up by telephone or outpatient department. At the last follow-up, 5 patients survived, 9 died, and 4 were lost to follow up, with a median survival of 16.8 months. The median disease-free survival was 14.9 months. The survival rates at 1, 3 and 5 years were 73.3%, 28.6% and 11.8%, respectively. Conclusion    PMYST often occurs in young-middle aged male patients. Preoperative puncture can provide an effective diagnostic basis. R0 resection, AFP returning to normal after treatment and no metastasis may be potential indicators of good prognosis. The overall prognosis of PMYST is poor, and some patients can achieve long-term survival after treatment.

Preliminary study on the value of fetal MRI lung volume and mediastinal shift angle for predicting prognosis of left congenital diaphragmatic hernia / 中华放射学杂志

Objective:To explore the value of fetal lung volume and mediastinal shift angle (MSA) based on fetal MRI in predicting the prognosis of congenital diaphragmatic hernia (CDH).Methods:Fetuses with left CDH that did fetal MRI in Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine from September 2016 to January 2022 were retrospectively collected. There were 65 patients, and their gestational age was 29 (26, 35) weeks when they were diagnosed with left CDH by MRI. Observed fetal lung volume and MSA were measured based on fetal MRI, and observed/expected lung volume (o/eFLV) based on gestational age was calculated. The clinical data were collected from birth to discharge, and patients were divided into survival group and death group in case of prognosis at discharge, with 54 cases in the survival group and 11 cases in the death group. The student′s t test was used to compare the difference of o/eFLV and MSA between the survival group and the death group, and the receiver operating characteristic (ROC) curve was used to evaluate the value of o/eFLV and MSA in predicting the prognosis of left CDH. Results:The o/eFLV of the survival group was 51.5%±18.3%, higher than that of the death group (27.8%±4.4%), and the difference was significant ( t=8.29, P<0.001). The MSA of the survival group was 33.1°±1.2°, lower than that of the death group (41.8°±2.7°), and the difference was significant ( t=-11.15, P<0.001). The area under the ROC curve (AUC) of o/eFLV to predict the fetal survival or death was 0.939 (95%CI 0.851-0.983), the cutoff value was 33.8%, the sensitivity was 100%, the specificity was 88.9%. The AUC of MSA was 0.998 (95%CI 0.941-1.000), the cutoff value was 37.2°, the sensitivity was 100%, the specificity was 98.2%. Conclusions:The o/eFLV and MSA that were measured based on fetal MRI can effectively predict the fetus′s prognosis with left CDH.

Clinical Efficacy of Da Vinci Robot-assisted Subxiphoid Versus Lateral Thoracic Approach for Treatment of Anterior Mediastinal Tumors / 肿瘤防治研究

Objective To compare the perioperative efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) for treatment of anterior mediastinal tumors through subxiphoid versus lateral thoracic approaches under the laryngeal mask anesthesia. Methods We retrospectively analyzed the clinical data of 102 patients with anterior-mediastinal tumors treated by RATS under laryngeal mask anesthesia completed by the same operator. Forty-five patients underwent the subxiphoid approach (subxiphoid group), and 57 patients were treated with the lateral thoracic approach (lateral thoracic group). The operating time, intraoperative bleeding, and total postoperative drainage volume in the two groups were compared and analyzed. Results All patients successfully completed resection of the anterior mediastinal tumor without the occurrence of perioperative death. In terms of total postoperative drainage volume, postoperative drainage time, postoperative hospital stay, and VAS pain on postoperative days 2 and 3, the subxiphoid group was more advantages (P < 0.05). No statistically significant difference was found between the two groups in terms of operative time, docking time, total operative time, intraoperative bleeding volume, postoperative day 1 VAS pain score, or postoperative complications (P > 0.05). Conclusion The subxiphoid approach of RATS is safe and feasible for resection of anterior mediastinal tumors. Compared with the lateral thoracic approach, the subxiphoid approach has advantages in terms of rapid postoperative recovery and postoperative pain.

Clinicopathological analysis of superior mediastinal lymph node metastases in medullary thyroid carcinoma / 中华肿瘤杂志

Objective: To investigate the clinicopathological characteristics of superior mediastinal lymph node metastases (sMLNM) in medullary thyroid carcinoma (MTC). Methods: This retrospective analysis enrolled the patients who were treated for sMLNM of MTC in our hospital from May 2012 to January 2021. All patients were suspected of sMLNM due to preoperative imaging. According to the pathological results, the patients were divided into two groups named sMLNM group and the negative superior-mediastinal-lymph-node group. We collected and analyzed the clinical features, pathological features, pre- and post-operative calcitonin (Ctn), and carcinoembryonic antigen (CEA) levels of the two groups. Logistic regression analysis was used to analyze risk factors, and receiver operation characteristic (ROC) curves were drawn to determine the optimal cut-off values of preoperative Ctn and preoperative CEA for predicting sMLNM. Results: Among the 94 patients, 69 cases were in the sMLNM group and 25 cases were in the non-SMLNM group. Preoperative Ctn level (P=0.003), preoperative CEA level (P=0.010), distant metastasis (P=0.022), extracapsular lymph node invasion (P=0.013), the number of central lymph node metastases (P=0.002) were related to sMLNM, but the multivariate analysis did not find any independent risk factors. The optimal threshold for predicting sMLNM by pre-operative Ctn is 1500 pg/ml and AUC is 0.759 (95% CI: 0.646, 0.872). The sensitivity, specificity, positive predictive value, and negative predictive value of diagnosis are 61.2%, 77.3%, 89.1%, 39.5%, respectively. In patients who underwent mediastinal lymph node dissection through transsternal approach, the metastatic possibility of different levels from high to low were level 2R (82.3%, 28/34), level 2L (58.8%, 20/34), level 4R (58.8%, 20/34), level 3 (23.5%, 8/34), level 4L (11.8%, 4/34). Postoperative complications occurred in 41 cases (43.6%), and there was no perioperative death in all cases. 14.8% (12/81) of the patients achieved biochemical complete response (Ctn≤12 pg/ml) one month after surgery, 5 of these patients were in sMLNM group. Conclusions: For patients who have highly suspicious sMLNM through imaging, combining with preoperative Ctn diagnosis can improve the accuracy of diagnosis, especially for patients with preoperative Ctn over 1 500 pg/ml. The superior mediastinal lymph node dissection for the primary sternotomy should include at least the superior mediastinal levels 2-4 to avoid residual lesions. The strategy of surgery needs to be cautiously performed. Although the probability of biochemical cure in sMLNM cases is low, nearly 40% of patients can still benefit from the operation at the biochemical level.

Intrathoracic masses in children and adolescents: a single tertiary pediatric institution experience

OBJECTIVES@#The Cancer and Hematology Division of the PCMC receives an average of 24 cases of pediatric intrathoracic masses annually. Comprehensive data on the demographic status, clinical profile, management, and outcome are still not available. This study aims to determine the clinical features, diagnosis, management and outcome of children and adolescents with intrathoracic masses from 2017 to 2019.@*MATERIALS AND METHODS@#Descriptive study design was utilized. Data were collected by doing a chart review. Possible associations between the clinical features and outcome were described.@*RESULTS@#Sixty-eight (68) cases were referred from January 2017 to December 2019. Mean age at diagnosis is 8.8 years with a 2.4:1 male to female ratio. Severe wasting was seen in 21%. All subjects were symptomatic at presentation, 50% with respiratory compromise. Anterior mediastinal lesions are observed at 82% of cases. Elevated LDH was seen in 50% of the patients. Malignant hematologic lesions are the most common etiology. Steroid pretreatment was given in 40% of patients. Only a small percentage (<20%) underwent definitive treatment. Patients were symptomatic for 18 days on average before consult. It took an average of 18 days for a case to be diagnosed definitively, and 10 days from the diagnosis to start of directed treatment. Mortality rate was high at 57.4%@*CONCLUSION@#Patients with intrathoracic mass and malnutrition are 1.4x more likely to die. Diagnosis is the most significant factor associated with death. Observed data can be used as basis to formulate protocols which can streamline the diagnostic and therapeutic approach in these patients.

2022 Chinese expert consensus on perioperative and whole-course diagnosis and treatment of mediastinal and chest wall tumors / 中国胸心血管外科临床杂志

@#Mediastinal and chest wall tumors contain various benign and malignant tumors. In order to further standardize the whole-course diagnosis and treatment of mediastinal and chest wall tumors, the consensus was formulated through discussion by the expert group. Based on the clinical diagnosis and treatment experience and various prospective and retrospective studies, the consensus was formed.