Primary pleuro-pulmonary Ewing's sarcoma: multimodal approach with uniportal thoracoscopic resection.

Primitive neuroectodermal tumors (PNETs) and Ewing's sarcoma (ES) belong to the same family of malignant, small, round cell neoplasms of soft tissue or bone origin. With just around 30 cases reported so far, primary pleuro-pulmonary PNETs/ES are extremely rare in adults. We herein describe a case of a hexagenerian male diagnosed with primary pleuro-pulmonary PNETs/ES after tissue biopsy. He underwent neoadjuvant chemotherapy, and after significant downstaging of the tumor, he underwent complete resection of the lesion through uniportal video-assisted thoracoscopic surgery (u-VATS) followed by adjuvant chemo-radiotherapy. He was disease-free while under close follow-up for the past 1 year.

Reverse Macklin effect.

The Macklin effect is associated with alveolar rupture causing a centripetal spread of air along the peribronchovascular interstitial sheath leading to pneumomediastinum, usually seen in ventilator-related barotrauma or blunt chest trauma. We are presenting a peculiar case of iatrogenic (post-intubational) tracheal injury with massive subcutaneous emphysema and pneumomediastinum, in whom, we suspect that the primary tracheal injury and pneumomediastinum led to dissection of air along the peribronchovascular interstitium, culminating in atelectasis of lung due to compression of the distal-most airways, with no primary parenchymal abnormality. This supposed "reversal" of pathophysiological sequence of the Macklin effect makes it a unique finding.

Placental Site Trophoblastic Tumor in a Pulmonary Vascular Malformation With Spontaneous Pneumothorax.

Placental site trophoblastic tumor, a rare variety of gestational trophoblastic disease, is traditionally limited to the uterus, found within the placental implantation site where it can lead to arteriovenous malformations. Gestational trophoblastic diseases are known to metastasize to the lungs, of which choriocarcinomas are the most common. However arteriovenous malformations related to such metastatic lesions are extremely rare. The occurrence of spontaneous pneumothorax in pulmonary arteriovenous malformations, under any circumstances, is rarely reported. Herein we report a rare case of metastatic placental site trophoblastic tumor found within pulmonary arteriovenous malformations uniquely presenting with spontaneous pneumothorax.

Mediastinal Castleman disease with supraclavicular extension-a diagnostic dilemma and surgical challenge.

Castleman's disease, also known as angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder, with unicentric or multicentric variety. Herein, we present an unusual case of unicentric Castleman disease in a 19-year-old boy presenting as a left posterior mediastinal mass with supraclavicular extension, a rare form of presentation, with very few cases reported in the past. It can be misdiagnosed as other malignant pathology and mismanaged as in our case; hence, a high index of suspicion is necessary.

A rare case of a giant anterior mediastinal liposarcoma.

We report a case of a 53-year-old lady who was incidentally diagnosed to have giant anterior mediastinal mass while undergoing preoperative evaluation for another surgery. She came for surgery after 2 years when she became symptomatic. A large 6.7-lb (2800 g) tumor occupying both hemithoraces and engulfing heart was excised in its entirety through a clamshell thoracotomy under cardiopulmonary bypass standby. Histopathology revealed the final diagnosis as well as differentiated liposarcoma. She is now able to walk 2 km without any symptoms at the end of a 24-month follow-up.