The effect of bioactivity of airway epithelial cells using methacrylated gelatin scaffold loaded with exosomes derived from bone marrow mesenchymal stem cells.

The current evidence provides support for the involvement of bone marrow mesenchymal stem cells (BMSCs) in the regulation of airway epithelial cells. However, a comprehensive understanding of the underlying biological mechanisms remains elusive. This study aimed to isolate and characterize BMSC-derived exosomes (BMSC-Exos) and epithelial cells (ECs) through primary culture. Subsequently, the impact of BMSC-Exos on ECs was assessed in vitro, and sequencing analysis was conducted to identify potential molecular mechanisms involved in these interactions. Finally, the efficacy of BMSC-Exos was evaluated in animal models in vivo. In this study, primary BMSCs and ECs were efficiently isolated and cultured, and high-purity Exos were obtained. Upon uptake of BMSC-Exos, ECs exhibited enhanced proliferation (p < .05), while migration showed no difference (p > .05). Notably, invasion demonstrated significant difference (p < .05). Sequencing analysis suggested that miR-21-5p may be the key molecule responsible for the effects of BMSC-Exos, potentially mediated through the MAPK or PI3k-Akt signaling pathway. The in vivo experiments showed that the presence of methacrylated gelatin (GelMA) loaded with BMSC-Exos in composite scaffold significantly enhanced epithelial crawling in the patches in comparison to the pure decellularized group. In conclusion, this scheme provides a solid theoretical foundation and novel insights for the research and clinical application of tracheal replacement in the field of tissue engineering.

CT and PET/CT findings of primary pulmonary malignant melanoma: a case report and literature review.

Primary malignant melanoma of the lung (PMML) is an extremely rare and refractory tumor, and its diagnosis is a significant challenge. The current study presents the case of a 62-year-old man who presented to the Department of Cardiothoracic Surgery (Lishui Municipal Central Hospital, Lishui, China) with chest tightness and fatigue for 3 months. Chest computed tomography (CT) revealed a 1.5- × 1.9-cm mass with irregular borders and heterogenous density located in the right lower lung lobe. Contrast-enhanced CT revealed slight enhancement of the mass, but there was no clear evidence of malignancy. Positron emission tomography (PET)/CT revealed a defined-margin mass, with slightly high uptake (standardized uptake value [SUV]: 3.6). The patient underwent video-assisted thoracoscopic surgery (VATS), and the final diagnosis was PMML on the basis of the results of the pathological examination. The patient received four courses of immunotherapy after the operation, and eventually declined further immunotherapy owing to the high cost. The patient was followed-up for 1 year without metastasis or recurrence.

Diagnostic Challenge and Management of Thymic Cavernous Hemangioma: A Case Report and Review of the Literature.

OBJECTIVE: Thymic cavernous hemangioma (CH) as a benign lesion is extremely rare, and it is very difficult to distinguish it from other anterior mediastinal tumors on imaging. CASE PRESENTATION: We treated a 63-year-old woman with thymic CH that was incidentally found by chest computed tomography (CT). Contrast-enhanced chest CT described an anterior superior mediastinal mass, approximately 2.5cm in diameter, with centripetal enhancement and an increased range of enhancement in the delayed period. The tumor and thymus were completely resected by video-assisted thoracic surgery (VATS) to provide a definitive diagnosis and precise treatment. Postoperative pathology suggested that the tumor was a thymus cavernous hemangioma. CONCLUSION: We reported an extremely uncommon case of CH in the thymus and reviewed the previously published literature. CH can occur at any age and body tissue, and there is no significant difference between males and females. Most patients are asymptomatic, often found by chest CT. Enhanced chest CT suggested that an increased area of venous enhancement at a prolonged duration may be a feature of CH. Complete surgical resection is a safe and effective method for CH in the thymus.

Imaging characteristics and treatment strategies of traumatic diaphragmatic hernia with aortic dissection: a report of 3 cases.

BACKGROUND: Traumatic aortic dissection with traumatic diaphragmatic hernia is a rare traumatic disease. The purpose of this article is to investigate the imaging characteristics and treatment strategies for traumatic diaphragmatic hernia with aortic dissection. CASE PRESENTATION: The imaging and clinical data of 3 patients with traumatic diaphragmatic hernia combined with aortic dissection were analyzed retrospectively. Of the three cases, two were males, and one was female; their mean age was 52.7 years (range, 47-62 years). Plain chest CT scans revealed diaphragmatic hernia in 2 patients, but no traumatic aortic dissection was found. Diaphragmatic hernia repair was performed in all patients. Aortic dilatation was found during intraoperative exploration, and aortic dissection was confirmed by postoperative enhanced CT. One patient underwent stent implantation and recovered smoothly (Case 1). The other patient refused stent implantation and died of thoracic hemorrhage (Case 2). The third patient underwent preoperative enhanced CT to identify traumatic diaphragmatic hernia with aortic dissection (Case 3). Aortic covered stent implantation was performed immediately, and diaphragmatic hernia repair was performed at a selected time. The patient's postoperative recovery was good. CONCLUSION: A preoperative plain chest CT scan indicated diaphragmatic hernia in major blunt thoracic trauma patients with a history of trauma and blurred periaortic spaces accompanied by hematocele and other imaging manifestations. Chest-enhanced CT should be performed to improve the diagnostic accuracy of aortic dissection.

Car accident as a trigger for reverse takotsubo-like cardiomyopathy with paraganglioma: Case report and literature review.

Paraganglioma (PGL), which may cause acute Takotsubo-like cardiomyopathy (TLC), is a rare neuroendocrine neoplasm derived from various body sites. TLC has been associated with excessive catecholamine secretion and shares the same cardiac presentation with Takotsubo cardiomyopathy (TTC). We present the case of a 58-year-old male who arrived at the hospital after a car accident, reporting symptoms of chest tightness, shortness of breath, and abdominal pain after a car accident. The patient was found to have elevated troponin and severely depressed left ventricular function. Echocardiography depicted a normal contracting apex with the rest of the left ventricle being hypokinetic. Coronary computed tomography (CT) angiogram revealed mild coronary artery disease. Abdominal CT further revealed a mass on the left side of the epigastric aorta, confirmed by autopsy as a PGL.

Oesophageal rupture after right pneumonectomy: A case report.

Oesophageal rupture after pneumonectomy is very rare. Management remains a significant challenge. This current case report describes a patient that underwent right pneumonectomy for right central squamous cell carcinoma. On the third day after the operation, food residues were observed in the thoracic tube. Considering oesophageal rupture, surgery was performed. Intraoperative oesophageal rupture was observed and intermittent suture was performed. Unfortunately, an oesophageal pleural fistula developed. Anti-infection treatment, chest drainage, thoracic irrigation, nutrition support and stent implantation were used after the operation. The patient recovered smoothly and had no discomfort when eating. Oesophageal rupture after pneumonectomy is extremely rare and treatment is very difficult. In our opinion, surgical repair is the key to the treatment of oesophageal rupture. Once an oesophageal pleural fistula occurs, enhanced nutrition, adequate irrigation and drainage and stent implantation are critical factors.

Epithelial-Myoepithelial Carcinoma of the Esophagus: A Case Report.

Epithelial-myoepithelial carcinoma (EMC) of the esophagus is a rare biphasic tumor with low malignant potential, which has not previously been reported in the published literature. The present study describes the case of an asymptomatic, 53-year-old male who presented with EMC in the esophagus during a gastroscopic examination. Esophageal computed tomography (CT) showed thickening of the wall of the lower esophagus with a thickness of about 0.7 cm, and an enhanced scan showed uneven enhancement of the thickened esophageal wall. Thoracoscopic esophagectomy was performed because the tumor was malignant. Histopathology revealed that the tumor was characterized by a biphasic architecture consisting of cuboidal ductal cells and myoepithelial cells. The patient's postoperative recovery was eventful, an anastomotic fistula occurred, and the patient was discharged from the hospital after 84 days. One year postsurgery, the patient remained in good health, with no evidence of metastasis and recurrence.

Efficacy and analysis of modified "three-tube method" in the treatment of intrathoracic anastomotic leakage after esophagectomy.

BACKGROUND: This study aimed to retrospectively evaluate the clinical efficacy of the modified "three-tube method" for the treatment of intrathoracic anastomotic leakage (IAL) after esophagectomy, and to analyze the independent risk factors for prolonging the treatment time of the modified "three-tube method". METHODS: From January 2013 to December 2018, IAL was reported in 22 patients with esophageal cancer who underwent esophagectomy with intrathoracic anastomosis. By reviewing and analyzing the clinical data of the 22 patients, the efficacy of the modified "three-tube method" treatment and the independent risk factors associated with a longer treatment duration of the modified "three-tube method" were evaluated. RESULTS: Of the 22 patients, 19 were male (86.4%). The average age was 65.2 years old. A total of 4 patients (18.2%) underwent preoperative neoadjuvant chemotherapy; 6 patients (27.3%) had a Charlson comorbidity index (CCI) score of 1-3; the average diagnosis time of IAL was 9.5 days; the median intervention time was 4 days; and the average fistula length was 1.5 cm. The average albumin level after surgery was 30.5 g/L, and the average C-reactive protein (CRP) level was 139.4 mg/L. The modified "three-tube method" average treatment time was 19.5 days. One patient (4.5%) died of respiratory failure during treatment. Univariate analysis and multivariate analysis by establishing multiple linear regression model found that the date of intervention and the fistula size were significantly associated with a longer treatment duration of the modified "three-tube method". CONCLUSIONS: The modified "three-tube method" is a safe and effective means for non-surgical treatment of IAL after esophagectomy. The intervention time and the fistula size are independent risk factors for prolonging the treatment time of the modified "three-tube method".

Cerebral Air Embolism After Pigtail Catheter Drainage for Pneumothorax: A Case Report and Review of the Literature.

Objective: Cerebral air embolism (CAE) is an extremely rare but serious complication of pigtail catheter drainage. The aim of the case report is to review our experience in the diagnosis and treatment for CAE after pigtail catheter drainage. Case presentation: In our study, we report a case of CAE following pigtail catheter insertion for pneumothorax. A 50-year-old man was diagnosed with a pulmonary mass in the right lower lobe. He underwent a right lower lobectomy. Pneumothorax was present after the removal of the chest tube. Pigtail catheter drainage was used in order to treat the pneumothorax, which resulted in convulsions, limb stiffness, and unconsciousness. A brain CT scan was immediately performed and showed multiple low densities in the right occipital lobe, which was diagnosed as CAE. Assisted breathing, antibiotic treatment, and antiepileptic therapy were used and the patient gradually improved and was discharged at 27 days of treatment but the muscle strength of the left limb was weakened. Conclusion: We analyzed and summarized the possible causes of CAE in the literature, and the findings of the case could enhance the vigilance of clinicians.

Rapid metastasis of stage IA primary pulmonary high-grade mucoepidermoid carcinoma with a cystic airspace: a case report and reflection.

Primary pulmonary high-grade mucoepidermoid carcinoma (MEC) with a cystic airspace is uncommon, and early metastasis is extremely rare. In such cases, however, it is clinically important for clinicians to consider whether the tumor has spread to the lymph nodes through the cystic airspace. A 77-year-old man presented to our hospital with cough and hemoptysis. Chest computed tomography showed a 25-mm-diameter mass with a cystic airspace located in the upper lobe of the left lung. The possibility of malignancy was considered. Without a definitive preoperative diagnosis, left upper lobectomy and mediastinal lymphadenectomy were performed. Histopathological examination revealed the typical histological characteristics of high-grade MEC (stage IA) and no lymph node metastasis. However, lymph node metastasis was found 6 months after surgical resection, and radiochemotherapy was performed. The patient developed widespread metastatic disease 4 months following completion of radiochemotherapy and died 2 months later. Primary pulmonary MEC with a cystic airspace is a rare malignant disease with uncommon imaging findings. Complete surgical resection is the main treatment method for high-grade MEC. In this case, we hypothesize that early metastasis was caused by seeding of tumor cells through the cystic airspace.

Posterior Mediastinal Epithelioid Angiosarcoma Arising in Schwannoma: A Case Report and Review of the Literature.

Epithelioid angiosarcoma arising in schwannoma is an extremely rare mesenchymal tumor that accounts for only 1 to 2% of all sarcomas. This type of tumor occurs in all parts of the body, most often in the skin and soft tissues and rarely in the mediastinum. The present study describes the case of an asymptomatic, 58-year-old male who presented with epithelioid angiosarcoma in the posterior mediastinum during a physical examination. Enhanced computed tomography of the chest revealed a 3.5 × 3.1-cm mass in the posterior mediastinum. Thoracoscopic mediastinal mass resection was performed under general anesthesia due to the possibility that the tumor was malignant. Pathological examination revealed the presence of angiosarcoma and schwannoma components. Immunohistochemical staining for cluster of differentiation (CD) 31, CD34, early growth response (EGR), vimentin, Sry-related HMG box (SOX)-10 and S-100 was strongly positive. The patient recovered and was discharged on postoperative day 5. Two months postsurgery, the patient returned for evaluation, and no evidence of tumor recurrence was observed.

Biocompatibility and cellular compatibility of decellularized tracheal matrix derived from rabbits.

OBJECTIVE: To study the different concentrations of Triton X-100 and nuclease needed to remove cells from the tracheal matrix of rabbits and analyse their biocompatibility and cellular compatibility. METHODS: Fifty tracheas were harvested from donor New Zealand rabbits. Thirty tracheas were randomly divided into five groups (n = 6 each). The tracheas in group A were untreated and served as a control group, and those in groups B, C, D and E were treated with different concentrations of Triton X-100 (1%, 2%, 3% and 4%), respectively. The tracheas of the five groups were assessed by histological observation, scanning electron microscopy and mechanical evaluation. The remaining 20 donor tracheas, which were divided into a control group and an optimally decellularized group, were used for xenogeneic transplantation and cell seeding. RESULTS: Many epithelial cells and cartilage cells were observed in the tracheas of group A. There were fewer cartilage cells in the tracheas of groups C, D and E than in the tracheas of groups A and B under histological observation. In scanning electron microscopy, there were many ciliated epithelial cells in the tracheas of group A; in groups B and C, the ciliated epithelial cells disappeared, but the basement membrane was intact. The basement membranes were broken in the tracheas of groups D and E. Implanted decellularized tracheas showed good biocompatibility. Bone marrow mesenchymal stem cells grown in the decellularized tracheal matrix grew well. CONCLUSION: Decellularized tracheal matrix obtained from rabbits by 2% Triton X-100 may be suitable for the construction of tissue-engineered trachea because of its favourable morphological and biomechanical properties as well as its biocompatibility and cellular compatibly.

Inhibition of CXCR4 regulates epithelial mesenchymal transition of NSCLC via the Hippo-YAP signaling pathway.

CXCR4 has been shown to play a key role in the metastasis of non-small cell lung cancer (NSCLC). And CXCR may be associated with the Hippo-Yes kinase-associated protein (YAP) pathway, thus involving in the occurrence and progression of NSCLC. This study aims to investigate the effect of CXCR4 inhibition on epithelial-mesenchymal transition (EMT), invasion and migration of NSCLC cells via the Hippo-YAP pathway. QRT-PCR and Western blot were employed to detect CXCR4 expression in NSCLC cell lines. A549 and H1299 cells were treated with WZ811 (0, 10, 30, and 50 µM), and A549 cells were also divided into the Control, WZ811, YAP siRNA, and WZ811 + YAP groups. Wound-healing, Transwell assay, immunofluorescent staining, and a luciferase reporter gene assay were performed in this experiment. Compared with human bronchial epithelial (HBE) cells, CXCR4 expression was up-regulated in NSCLC cell lines. WZ811 increased E-cadherin; decreased expression of Twist, vimentin, Snail, p-YAP, CTGF, and BIRC5; blocked GTIIC reporter activity; and reduced migration and invasion of A549 cells, all in a dose-dependent manner. YAP siRNA had a similar effect to WZ811 by inhibiting EMT, invasion and migration of A549 cells. However, compared with A549 cells in the YAP siRNA and WZ811 groups, cells in the WZ811 + YAP group showed a dramatically enhanced EMT phenotype as well as invasion and migration abilities. Inhibition of CXCR4 may reduce EMT, invasion and migration of NSCLC cells, thereby providing a new therapeutic target for NSCLC.

Cavernous hemangioma of the thymus: A case report and review of the literature.

RATIONALE: Cavernous hemangioma is a congenital venous malformation with the potential to develop in all tissues of the body. However, cavernous hemangioma of the thymus is extremely rare. PATIENT CONCERNS: The present study describes the case of an asymptomatic, 30-year-old female who presented with a cavernous hemangioma in the thymus during a physical examination. Enhanced computed tomography of the chest revealed a 2.3 × 1.7 × 1.3 cm mass in the thymus. DIAGNOSES: Histopathological examination revealed that the tumor exhibited the typical histological findings of a cavernous hemangioma. INTERVENTIONS: The patient underwent surgical resection due to the uncertain diagnosis and the possibility that the mass was a thymoma or teratoma. OUTCOMES: One-year post surgery, the patient was alive with no evidence of tumor recurrence. LESSONS: Cavernous hemangioma of the thymus is a very rare disease. Complete surgical resection may be a critical therapeutic option.

Surgery combined with radio-chemotherapy for esophageal mucoepidermoid carcinoma: A case report.

RATIONALE: Primary mucoepidermoid carcinoma (MEC) of the esophagus is a rare type of malignant neoplasm. Its morphology resembles that of MEC of the salivary glands. It is characterized by a diffuse mixture of squamous and mucus-secreting glandular carcinoma cells. Due to the low incidence of esophageal MEC, the biological behavior and treatment of this tumor have not been well studied. PATIENT CONCERNS: In this case report, we describe a case of a 59-year-old man who presented with difficulty in swallowing. Iohexol swallowing revealed a malignant-appearing structure in the inferior-thoracic region. DIAGNOSES: Biopsy of the lesion under endoscopy demonstrated a mucoepidermoid carcinoma of the esophagus. INTERVENTIONS: We performed esophagectomy, esophagogastrostomy through the esophageal bed and 2-field lymphadenectomy. Histopathological analysis of the tumor revealed histological characteristics typical of an esophageal MEC. Radio-chemotherapy was administered to this patient. OUTCOMES: Seventeen months after surgery, an esophageal computed tomography (CT) scan revealed that the wall of esophagus was evenly thickened. However, endoscopic assessment revealed no evidence of recurrence. Further CT scans at 19 and 31 months after surgery also showed a thickened esophageal wall, although endoscopic assessment at 31 months still revealed no esophageal stricture and no evidence of recurrence. The patient is alive with no dysphagia and no evidence of recurrence for over 39 months. LESSONS: There is little evidence of effective treatment nor guidelines for treatment of esophageal MEC. Although the general prognosis of esophageal MEC is poor, comprehensive treatment of surgery and radio-chemotherapy appeared to be effective in this case. Radio-chemotherapy is a possible treatment option that was shown to have acceptable short-term effects.

Metastatic epithelioid trophoblastic tumor of the lung: A case report.

RATIONALE: Epithelioid trophoblastic tumor (ETT) is a very rare form of gestational trophoblastic disease (GTD) which arises from neoplastic proliferation of intermediate trophoblasts. Metastatic ETT of the lung is extremely rare in postmenopausal women. PATIENT CONCERNS: Here we describe a 50-year-old woman with a metastatic ETT of the lung showing increasing tracer uptake at PET/CT. DIAGNOSIS: Hematoxylin-eosin staining showed a tumor composed of nests of epithelioid cells with necrotic debris and peritumoral hyaline-like material. Immunohistochemical staining of the tumor cells was positive for human chorionic gonadotropin (HCG) and cytokeratin 18. INTERVENTIONS: The patient underwent thoracoscopic lower left lobectomy combined with mediastinal lymphadenectomy. At surgery, a solid mass (size 3.0 × 3.0 cm) was found in the left lower lung. OUTCOMES: The patient was discharged on the tenth day postsurgery, following an uneventful recovery. Three months postsurgery, the patient was asymptomatic and is currently being managed with close follow-up. LESSONS: Metastatic ETT of lung is a very rare disease. Complete surgical resection and chemotherapy may be the critical therapeutic option.

Primary intrapulmonary solitary fibrous tumours.

Due to the extreme rarity of primary intrapulmonary solitary fibrous tumours (SFTs), their clinical course, imaging characteristics, diagnosis, treatment and prognosis are poorly understood. The present study therefore assessed the diagnosis and management of primary intrapulmonary SFTs and systematically reviewed previously reported cases in the literature. A total of 5 patients who underwent resection for primary intrapulmonary SFTs were enrolled in the present study and their clinical course, tumour characteristics, management and survival were assessed in this retrospective study. Relevant studies regarding primary intrapulmonary SFTs were searched using PubMed and tumour characteristics, clinicopathologic features, therapeutic strategy and survival outcomes were reviewed. Of the 5 cases, all were males, with a mean age of 57.6 years (range, 37-68 years). All patients were asymptomatic and were identified incidentally on routine computed tomography examination. A total of 3 patients underwent thoracotomy and 2 patients underwent video-assisted thoracoscopic surgery. All tumours were completely resected. Postoperative haemorrhage occurred in 1 patient and he received surgical intervention for haemostasis. The average hospital stay was 15 (4-22) days, and no mortality occurred. The mean length of the postoperative follow-up was 37.6 (1-67) months. One patient was lost to follow-up, and 4 patients were asymptomatic. A total of 19 studies were identified from database searches. They included a total of 45 patients: Twenty-three males and 22 females (mean age, 59.4 years; range, 7-81 years). A total of 12 patients were asymptomatic, and pain and coughing were the major symptoms. Five, one, two, four, and 17 tumours occurred in the right upper lobe, right middle lobe, right lower lobe, left upper lobe and left lower lobe, respectively. A total of 39 patients underwent surgery, 1 patient underwent radiotherapy, and 1 patient underwent radiofrequency ablation. A total of 22 patients were followed up and the mean length of the postoperative follow-up was 48 (1-168) months. One patient was diagnosed with chest wall metastases, and 5 patients succumbed to mortality. To conclude, primary intrapulmonary SFTs are extremely rare and typically identified incidentally. The present findings indicated that the left lower lobe was the most common site location and complete surgical resection is a safe and effective treatment.

Ganglioneuroma in unusual sites: clinical, radiologic and pathological features.

BACKGROUND: The aim of this retrospective study is to review the clinical, radiologic and pathological features of GN and to bring awareness of GNs that may occur in unusual locations to clinicians. METHODS: Data from 11 patients from the Lishui Center Hospital, Zhejiang University, (Lishui, China) were analyzed between January 1999 and May 2016, and the clinical, radiologic and pathological features in these patients are discussed here. RESULTS: Our retrospective study involved 11 patients, 5 males and 6 females, with an average age of 34.1 (1-76) years, who underwent surgical intervention for GN. Tumors occurred in the following locations: one tumor in the cervical cord, one tumor in the subcutaneous layer, two tumors in the posterior mediastinum, two tumors in the nerve root, two tumors in the posterior peritoneum, and three tumors in the adrenal gland. Two patients presented with lumbocrural pain, one patient presented with neck and shoulder pain, and one patient presented with abdominal discomfort, with the remaining patients being asymptomatic. Homogenous density, oval mass and well-defined borders were characteristic radiologic features of GN. All patients underwent surgery, and their tumors were completely resected. Histopathological examinations showed that the tumors were characteristic of GN and consisted of nerve fibers and mature ganglion cells. The immunohistochemical reactions for S-100 were positive in all patients. The mean length of the hospital stays was 15.7 d (range: 8-28 d). The mean duration of follow-up was 96 mo (range: 5-180 mo). Two patients did not follow-up, and nine patients were asymptomatic. CONCLUSIONS: GNs are rare benign tumors, and their diagnosis is challenging. Complete surgical excision is an effective and successful treatment, and long-term follow-up is necessary.

Expression characteristics of AXL and YAP in non-small cell lung cancer and prognostic importance.

Lung cancer has some of the highest morbidity and mortality. It is an urgent task to illuminate the exact mechanism of tumorigenesis of lung cancer. Previous studies suggested that receptor tyrosine kinase family member AXL and Hippo signal pathway co-activator YAP may be important signal molecules in tumorigenesis. In this paper we detect AXL and YAP expression in 81 non-small cell lung cancer cases that received surgery, and we discuss the relationship between the expression of AXL and YAP and tissue type, pathological staging, and degree of differentiation. We found that in NSCLC tissues AXLLowYAPLow was 29.63%, AXLHighYAPLow was 13.58%, AXLLowYAPHigh was 25.93% and AXLHighYAPHigh was 30.86%. The expression pattern of AXL and YAP was related to the degree of differentiation, T stage and pathological stage. Based on clinical follow-up data, we assessed the prognostic significance of AXL and YAP combined, with respect to recurrence and long-term survival. NSCLC tended to show AXL and YAP high expression, and high expression of AXL and YAP in NSCLC tissues suggested worse prognosis. Combined detection of AXL and YAP may be a new index to predict NSCLC patients' prognosis.

Rapid metastasis of mediastinal solitary fibrous tumor: Report a case.

RATIONALE: Mediastinal solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms. Complete resection is considered as the effective treatment and the prognosis is quite good. Rapid metastasis after surgery is extremely rare. PATIENT CONCERNS: In this case report we describe a 42-year-old man who present with a mediastinal malignant SFTs. Enhanced computed tomography of chest revealed a 4.5 × 4.0-cm mass in the anterior mediastinum. DIAGNOSES: The tumor is composed of massive proliferation of atypical spindle cells. Immunohistochemical staining for cluster of differentiation (CD) 34, CD99, and vimentin were strongly positive. INTERVENTIONS: Due to the possibility that the tumor was malignant, a standard median sternotomy was performed under general anesthesia. The mediastinal tumor and the affected part of the pericardium and right upper lobe of the lung were completely resected. OUTCOMES: The patient underwent surgery and recovered uneventfully. After 2 months follow-up postoperation, there was recurrence in the chest wall and right middle lung. The patient refused any treatment and was dead after 2 months. LESSONS: The present cases indicate that mediastinal SFTs should always be kept in mind for rapid metastasis. Once found, surgical intervention should be performed promptly. Due to the rapid metastasis, radiotherapy, and chemotherapy may be needed after surgery and long-term follow-up is required to monitor the metastasis of this type of tumor.