Schwannoma mediastínico gigante / Giant mediastinal schwannoma

El schwannoma es un tumor neurogénico que se presenta más frecuentemente en el ángulo costovertebral del mediastino posterior, pero también en otras localizaciones dentro del tórax. Habitualmente suele ser una masa única, encapsulada, bien definida, con un tamaño aproximado 2 a 10 cm. Presentamos el caso de un paciente de 66 años, derivado a nuestro hospital por una masa de 13 cm localizada en el hemitórax inferior izquierdo. Se realizó una biopsia, y la resonancia magnética corroboró el diagnóstico de un tumor mediastínico gigante de la vaina neural. Se procedió a su resección completa sin complicaciones.

Schwannomas are neurogenic tumors, commonly located in the costovertebral angle of the posterior mediastinum, but with many intrathoracic locations. They usually present as a solitary, well-circumscribed and encapsulated mass with a size between 2 and 10 cm. We report a case of a 66-year-old male, referred to our hospital for a mass located at the left lower hemithorax with 13 cm in size. A percutaneous biopsy was performed, and magnetic resonance imaging confirmed the diagnosis of a resectable giant mediastinal nerve sheath tumor. Surgery was performed without complications.

What About Having a Hydropneumothorax Every Month?

INTRODUCTION: Endometriosis is a pathological, benign, inflammatory condition characterized by the presence of endometrial glands and stroma outside the uterine cavity, typically in the pelvis. In rare conditions, this estrogen-dependent disease may be extrapelvic, presenting with a variety of symptoms, including Thoracic Endometriosis. METHODS: A 37 year-old woman presented with her third right hydropneumothorax in three months. Her medical history included infertility, an ovarian mass (in study), biliary diskinesia and protein C deficiency. The CT showed a bleb in the right inferior lobe and a pleural effusion. A detailed clinical history revealed a temporal relationship of the hydropneumothoraxes and her menses. RESULTS: She underwent a videothoracoscopy: there were macroscopic tissue alterations all over the parietal and visceral pleura. We performed a biopsy of one of those spots (of the parietal pleura) and an atypical resection of the apex of the apical segment of the right inferior lobe, where the bleb was. A talc pleurodesis was also performed. The patient was discharged at day 1 and is currently under regular follow-up in ambulatory, with no recurrent pneumothoraxes for two months. The histopathology was compatible with a pleural Endometriosis. CONCLUSION: Thoracic endometriosis is a clinical diagnosis, although the histopathologic confirmation is preferred (but not necessary): it should be suspected in reproductive age women who present with hemothorax, pneumothorax, hemoptysis, chest or scapular pain, lung nodules or diaphragmatic rupture perimenstrually, especially right-sided. Most commonly it presents as catamenial pneumothorax and/or hemothorax. Those with high clinical suspicion and/ or imaging supportive of the diagnosis, should undergo an interventional procedure (thoracoscopy), both for diagnose and management. Primary treatment is chest tube drainage. Prevention of recurrence can be medical (hormonal suppression) or surgical (lung resection, pleurectomy, pleurodesis).

A challenging case of an ectopic cushing syndrome.

Bronchopulmonary carcinoids are rare pulmonary neoplasms although they account for most cases of ectopic ACTH syndromes. When feasible, the mainstay treatment is surgical resection of the tumor. We report the case of a 52-year-old woman with signs and symptoms suggestive of hypercortisolism for 12 months, admitted to our department because of community acquired pneumonia. Blood hormone analysis showed increased levels of ACTH and urinary free cortisol and nonsuppressibility to high- and low-dose dexamethasone tests. Pituitary MRI showed no lesion and no central-to-peripheral ACTH gradient was present in bilateral inferior petrosal sinus sampling. CRH stimulation test suggested an ectopic ACTH source. Thoracic CT scan revealed a nodular region measuring 12 mm located in the inferior lingular lobule of the left superior lung with negative uptake by (18)-FDG-PET scan and negative SRS. The patient was successfully treated with an atypical lung resection and histology revealed an atypical bronchial carcinoid tumor with positive ACTH immunoreactivity. This was an interesting case because the patient was admitted due to pneumonia that may have been associated with her untreated and chronic hypercortisolism and a challenging case of ectopic ACTH syndrome due to conflicting results on the diagnostic exams.