Voice and swallowing implications in patients with tumors in their mediastinum / Implicações na voz e na deglutição de pacientes com tumores no mediastino

ABSTRACT Purpose: to verify voice and swallowing implications in patients diagnosed with tumors in the mediastinum. Methods: the study was carried out with 21 individuals aged between 18 and 60 years, with a diagnosis of tumors in their mediastinum. Data collection was performed at Oncology, OncoHematology and Thoracic Oncology Surgery ambulatory, and in the wards of the aforementioned clinics at an oncology reference hospital. The data was obtained by applying a questionnaire, and by evaluating voice and swallowing, using CAPE-V and O'Neil protocols, respectively. Results: there was a higher prevalence of females with mean age at 40 years. A higher prevalence of tumors in the anterior region of the mediastinum and non-Hodgkin's lymphomas was found, however, Hodgkin's lymphomas presented worse results in all the parameters of the voice evaluation. Fourteen subjects presented some degree of dysphagia, ranging from mild to moderate. Conclusion: patients with tumors in the mediastinum have significant impairments in voice and swallowing functions, especially when they are located in the anterior mediastinal region and Hodgkin lymphomas.

RESUMO Objetivo: verificar as implicações na voz e na deglutição em pacientes com diagnóstico de tumores localizados no mediastino. Métodos: o estudo foi realizado em 21 indivíduos com idades entre 18 e 60 anos, com diagnóstico de tumores localizado no mediastino. A coleta de dados foi realizada nos ambulatórios de Oncologia Clínica, OncoHematologia e Cirurgia Torácica Oncológica, e nas enfermarias das clínicas acima mencionadas de um hospital de referência em Oncologia. Os dados foram obtidos por meio da aplicação de um questionário próprio para a pesquisa, e da avaliação da voz e da deglutição, por meio dos protocolos CAPE-V e O'Neil, respectivamente. Resultados: houve maior prevalência do sexo feminino com média de idade aos 40 anos. Observou maior prevalência de tumores na região anterior do mediastino e dos linfomas do tipo não Hodgkin, no entanto, os linfomas do tipo Hodgkin apresentaram piores resultados em todos os parâmetros da avaliação de voz. Quanto à disfagia, 14 sujeitos apresentaram algum grau de disfagia, compreendendo da disfagia discreta a moderada. Conclusão: pacientes com tumores no mediastino apresentam comprometimentos significantes nas funções de voz e deglutição, principalmente nos tumores localizadas na região anterior do mediastino e Linfomas do tipo Hodgkin.

Multiple Thymoma in a Patient with Myasthenia Gravis: Case Report

A thymoma often occurs in patients with myasthenia gravis, but the development of multiple thymoma is very rare. The authors report the radiologic and pathologic findings of multiple invasive thymoma in a 59-year-old male with myasthenia gravis.

Rapidly Growing Mature Teratoma in the Anterior Mediastinum: Case Report

Mature teratoma is a benign tumor composed of a number of different types of well-differentiated tissues. Mature teratomas of the mediastinum usually grow slowly and are commonly asymptomatic. We report a case of mediastinal mature teratoma with rapid growth resulting in rupture

Embryonal Rhabdomyosarcoma of the Posterior Mediastinum: A Case Report

A rhabdomysarcoma originating during childhood is an easily-detected soft tissue sarcoma which frequently occurs in the head, and neck, or genitourinary system. It has been reported that in the mediastinum its rate of occurrence is 1 percent, though the rate at which it occurs in the posterior mediastinumhas not been reported. We recently encountered a case of embryonal rhabdomyosarcoma of the posterior mediastinum in a 12-year-old girl with neurofibromatosis type 1. Initial chest X-rays revealed a well-marginated round mass, with destruction of the right posterior rib. CT scans indicated the presence of an iso-dense mass which after contrast infusion showed heterogeneous enhancement. T1-and T2-weighted MR images showed, respectively, slight and heterogenous hyperintensity, with invasion of the thoracic spine and compression of the spinal cord. After surgery, embryonal rhabdomyosarcoma of the posterior mediastinum was pathologically confirmed.

The Usefulness of Thin-Section Spiral CT in the Evaluation of Mediastinal Lymph Node Metastasis from Non-Small Cell Lung Cancer: AProspective Study and Comparison with Thick-Section Spiral CT

PURPOSE: To compare the accuracy of thick-and thin-section spiral CT and to determine whether, in diagnosing mediastinal lymph node metastasis from non-small cell lung cancer, the latter is superior to the former. MATERIALS AND METHODS: Between March 1997 and March 1998, 51 patients with pathologically proven non-s-mall cell lung cancer underwent thoracotomy with full nodal dissection. Thick- and thin-section spiral CT were performed in all patients, with a mean interval of 14 days. The former was performed with 10 mm thick-ness and 10 mm interval, and the latter with 3 mm thickness and 3 mm interval. Mediastinal lymph nodes were localized according to the lymph node mapping scheme of the American Thoracic Society and were considered positive for metastasis if they exceeded 10 mm in short-axis diameter. RESULTS: A total of 227 mediastinal nodal stations in 51 patients were obtained. Of these, 188 stations included in thin-section spiral CT were analyzed and the prevalence of ediastinal nodal metastasis was found to be 10%. On a station-by-station basis, and for thick-and thin-section spiral CT, respectively, the overall sensitivi-ties of mediastinal lymph node metastasis were 32% and 53% (p .05). Although there were no statistically significant differences in sensitivity and specificity according to nodal station, thin-section spiral CT tended to be superior to the thick-section type for stations 7 and 10R in terms of sensitivity, and for stations 4L and 5 in terms of specificity. CONCLUSION: Thin-section spiral CT was more sensitive than thick-section spiral CT is the evaluation of medi-astinal lymph node metastasis from non-small cell lung cancer. This may be due to the higher resolution of the former and its ability to discriminate between lymph node and vessel.

Angiolipoma of the Posterior Mediastinum with Extension into the Spinal Canal: A Case Report

Angiolipoma is a rare benign soft tissue tumor, an unusual variant of lipoma,consisting of fatty and vascular components and located in the subcutis, usually in the trunk and extremities. We report a case of posterior mediastinal angiolipo-ma extending into the spinal canal and showing both fat and angiomatous fea-tures on CT scan.

Teratoma with Malignant Transformation in the Anterior Mediastinum: A Case Report

Malignant transformation of teratoma in the anterior mediastinum is rare; the mass usually has a long history and is seen in older patients. We report a case of teratoma with malignant transformation in the anterior mediastinum, complicated by rupture. CT revealed a lobulated, inhomogeneous cystic mass with a fat com-ponent and wall calcifications. The lateral wall was disrupted and consolidation in the adjacent left upper lobe was noted, suggesting rupture. A heterogeneously enhanced solid portion, obliterating the fat plane between the mass and the great vessels was present in the medial aspect of the mass, and pathologic examina-tion demonstrated the presence of adenocarcinoma.

Accuracy of CT in Detection of Mediastinal Lymph Node Metastasis in Patients with Lung Cancer: A ProspectiveStudy

PURPOSE: To determine the accuracy of CT in the evaluation of mediastinal nodal metastases of non-small celllung cancer. MATERIALS AND METHODS: Between November 1994 and June 1997, 178 patients with non-small cell lung cancer underwent thoracotomy and full nodal sampling. The results of preoperative CT scanning and of pathologicexamination of regional lymph node metastases were compared. Each scan was prospectively interpreted by one chestradiologist. Mediastinal lymph nodes were localized according to the lymph node mapping scheme of the AmericanThoracic Society and were considered abnormal if they exceeded 10mm in short-axis diameter. All accessible nodeswere either removed or sampled during thoracotomy. RESULTS: Of the 178 non-small cell lung cancers, 90 weresquamous cell carcinoma, 60 were adenocarcinoma, 13 were brochioloalveolar carcinoma, ten were large cellcarcinoma, and five were others (basaloid, 1; sarcomatoid, 1; spindle cell, 1; adenosquamous cell, 2). A total of615 mediastinal nodal stations were obtained. The sensitivity of CT for the diagnosis of mediastinal nodemetastasis on a station-by-station basis was 21%, with a specificity of 93% (squamous cell carcinoma: 21% and 91%;adenocarcinoma: 20% and 95%, respectively). Sensitivities were higher for groups 7 and 5. In 13 bronchioloalveolarcarcinomas, no lymph node metastasis was found on either CT or pathologic examination. The sensitivity of CT forthe diagnosis of mediastinal node metastasis on a per-patient basis was 43%, with a specificity of 83%. CONCLUSION: Because of the relative insensitivity of CT for the detection of mediastinal lymph node metastasis, nodalsampling with mediastinoscopy or thoracotomy is essential in the staging work-up of non-small cell lung cancerother than bronchioloalveolar carcinoma.

CT Findings of Ganglioneuroma

PURPOSE: Ganglioneuroma is a relatively uncommon benign tumor and han no pathognomonic radiological findings;diagnosis is therefore difficult. In order to better diagnose this tumor we analysed its CT findings andpathologic correlation. MATERIALS AND METHODS: Seventeen tumors in 16 patients(M:F=9:7) diagnosed asganglioneuroma between 1992 and 1996 were retrospectively analysed with regard to location, size, contour, longaxis of the mass, enhancement pattern, calcification, necrosis and capsulation, all as seen on CT, and comparedwith histo- pathologic findings. RESULTS: Tumors were 1.5 to 10(mean, 5.6)cm in size, and their location wasmediastinal(n=12), cervical(n=2), retroperitoneal (n=2) or adrenal(n=1). Fifteen had an oval or round contour andtwo were dumb-bell-shaped. The long axis of the lesion was craniocaudal in 14 cases and non-specific in three.Thirteen lesions showed heterogeneous enhancement, and four homogeneous. Capsule-like enhancement was noted on CTscans in eight cases;there was no definite correlation between enhancement pattern and pathologic findings.Calcification was seen in six cases and an inner low-density lesion in two. CONCLUSION: Ganglioneuroma is abenign neurogenic tumor, occurring most frequently at the the posterior mediastinum. General CT findings of thistumor are a well-defined oval shape with a variable enhancement pattern, but several cases showed focalcalcification or inner low density. For accurate diagnosis of ganglioneuroma both common and uncommon findingsmust therefore be considered.

CT Differentiation of Invasive thymoma and Thymic carcinoma

PURPOSE: In order to determine the differential points between them, we analyzed the CT findings of invasivethymoma and thymic carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 14 patients withinvasive thymoma and 15 with thymic carcinoma, confirmed by surgery(n=19) or percutaneous needle aspiration (n=10)between 1988 and 1996. CT findings were evaluated in each group for intrathoracic spread (posterior, directposterior, and anterolateral), obliteration of the fat plane between the mass and vascular structures, vesselencasement, invasion of adjacent mediastinal structures, pleural implants, mediastinal nodes and distantmetastasis. RESULTS: Direct posterior spread was more common in thymic carcinoma than invasive thymoma ; it wasseen in one case (7%) of invasive thymoma and 12(80%) of thymic carcinoma(p=0.00). Posterior spread was seen insix cases (43%) of invasive thymoma and nine (60%) of thymic carcinoma. Anterolateral spread was seen only in twocases (13%) of thymic carcinoma. Obliteration of the fat plane was seen in nine cases (64%) of invasive thymomaand 14 (93%) of thymic carcinoma, while vessel encasement was seen in two cases (14%) of invasive thymoma and13(87%) of thymic carcinoma(p=0.00). Invasion of adjacent structures was seen in two cases (14%) of invasivethymoma and eight (53%) of thymic carcinoma. Pleural implants were more common in invasive thymoma than thymiccarcinoma, being seen in six cases (43%) of the former and one (7%) of the latter(p=0.04). Mediastinallymphadenopathy was seen in three cases (21%) of invasive thymoma and ten (67%) of thymic carcinoma. Distantmetastases were observed only in six cases (40%) of thymic carcinoma(p=0.02). CONCLUSION: Althoughdifferentiation between invasive thymoma and thymic carcinoma is difficult on the basis of CT findings, there arecertain differential points. Thymic carcinomas showed a higher rate of direct posterior intrathoracic spread,vessel encasement, mediastinal nodes and distant metastases than invasive thymomas. These, however, were morecommonly associated with pleural implants than were thymic carcinoma.

Evaluation of Mediastinal Lymph Node Metastasis in Lung Cancer: Factors influencing the Diagnostic Accuracy ofCT

PURPOSE: To evaluate factors influencing the CT assessment of mediastinal lymph node metastasis in patientswith non-small cell lung cancer. MATERIALS AND METHODS: CT scans of 198 patients who had undergone thoracotomyand mediastinal lymph node dissection for non-small cell lung cancer were retrospectively evaluated using a sizecriterion of > or = 10mm in the short axis. To evaluate the accuracy of CT in diagnosing lymph node metastasis on anodal station-by-station basis, CT and pathological results were correlated. Analysis included a comparison of thesensitivity and specificity of CT according to 1) cell type of tumor, squamous cell carcinoma versusadenocarcinoma (excluding bronchioloalveolar cell carcinoma) ; 2) histologic differentiation;3) tumor size;4)central and peripheral of the tumor;5) the presence or absence of obstructive pneumonitis and/or atelectasis;6)the presence or absence of prior granulomatous disease. RESULTS: The overall sensitivity, Specificity, positive predictive value, and negative predictive value of CT in diagnosing mediastinal lymph node metastasis were 65%,84%, 43%, and 93%, respectively. Sensitivity for squamous cell carcinoma (72%) was significantly higher than thatfor adenocarcinoma(44%)(p<0.01). Higher specificities were noted in patients without obstructive pneumonitisand/or atelectasis(91% versus 75%)(P<0.01), and with a peripherally located tumor (90% versus 82%)(P<0.01).sensitivity and specificity were not appreciably altered by other variables. CONCLUSION: In the CT assessment ofmediastinal lymph node metastasis the cell type of adenocarcinoma adversely affected sensitivity, with a highfrequency of normal-sized metastatic nodes. Obstructive pneumonitis caused by central tumor adversely affectedspecificity with the frequent occurrence of hyperplastc nodes.