Study on the Effect of MRI in the Diagnosis of Benign and Malignant Thoracic Tumors.

In order to investigate the effectiveness and accuracy of magnetic resonance imaging (MRI) in the diagnosis of benign and malignant thoracic tumors, the research retrospectively selected 80 patients with thoracic tumors admitted from May 2019 to May 2020 as the study subject and all patients were underwent MRI detection. Using pathological diagnostic results as the gold standard, the research analyzed the detection of benign and malignant thoracic tumors by MRI, as well as the diagnostic sensitivity and specificity. After pathological diagnosis, there were 35 malignant tumors and 45 benign tumors. 41 cases of malignant tumors and 39 cases of benign tumors were diagnosed by MRI, with a diagnostic sensitivity of 80.00%, a diagnostic specificity of 71.11%, and a diagnostic compliance rate of 75.00%. In the MRI diagnosis of tumors in different parts of the chest, the diagnostic sensitivity for lung tumors, mediastinal tumors, chest wall tumors, and esophageal tumors was 83.33%, 71.43%, 83.33%, 75.00%, and 87.50%, respectively, and the specificity was 66.67%, 77.78%, 57.14%, 50.00%, and 91.67% according to and breast tumors, respectively. And the accuracy was 73.33%, 75.00%, 69.23, 62.50%, and 90.00%, respectively, with the highest diagnostic sensitivity, specificity, and accuracy for breast tumors. MRI has a good effect on the diagnosis of benign and malignant thoracic tumors and has a high diagnostic value, which is helpful to identify the location, nature, source, and lesion scope of the tumor. It is safe and worthy of promotion.

A convolutional neural network-based system to classify patients using FDG PET/CT examinations.

BACKGROUND: As the number of PET/CT scanners increases and FDG PET/CT becomes a common imaging modality for oncology, the demands for automated detection systems on artificial intelligence (AI) to prevent human oversight and misdiagnosis are rapidly growing. We aimed to develop a convolutional neural network (CNN)-based system that can classify whole-body FDG PET as 1) benign, 2) malignant or 3) equivocal. METHODS: This retrospective study investigated 3485 sequential patients with malignant or suspected malignant disease, who underwent whole-body FDG PET/CT at our institute. All the cases were classified into the 3 categories by a nuclear medicine physician. A residual network (ResNet)-based CNN architecture was built for classifying patients into the 3 categories. In addition, we performed a region-based analysis of CNN (head-and-neck, chest, abdomen, and pelvic region). RESULTS: There were 1280 (37%), 1450 (42%), and 755 (22%) patients classified as benign, malignant and equivocal, respectively. In the patient-based analysis, CNN predicted benign, malignant and equivocal images with 99.4, 99.4, and 87.5% accuracy, respectively. In region-based analysis, the prediction was correct with the probability of 97.3% (head-and-neck), 96.6% (chest), 92.8% (abdomen) and 99.6% (pelvic region), respectively. CONCLUSION: The CNN-based system reliably classified FDG PET images into 3 categories, indicating that it could be helpful for physicians as a double-checking system to prevent oversight and misdiagnosis.

[Optimal lymphadenectomy for thoracic esophageal cancer: three-field or modified two-field lymphadenectomy].

Differences in operative procedure and knowledge of esophageal cancer exist among surgeons from different countries and regions. There is controversy in the surgical treatment of esophageal cancer, especially in the extent of lymphadenectomy. Until now, results of the three-field lymphadenectomy and two-field lymphadenectomy are mostly reported by retrospective studies from Japan and China. Three-field lymphadenectomy has been initiated in Fujian Provincial Cancer Hospital since 1990s. After evaluating our database, we found that three-field was superior to two-field lymphadenectomy in terms of long-term survival for patients with upper thoracic esophageal cancer, whereas for those with middle or lower thoracic esophageal cancer, the survival benefit of three-field lymphadenectomy was reduced. Therefore, we propose to perform three-field lymphadenectomy for upper thoracic esophageal cancer. In middle or lower thoracic esophageal cancer, we suggest to perform modified two-field lymphadenectomy in most cases, and three-field lymphadenectomy in selective cases. Video-assisted two-field lymphadenectomy is feasible. Based on the national condition of China, we advise to perform thoracic duct removal only in patients with posterior mediastinal or peri-ductus node metastasis to achieve curative effect.

[POSSIBILITIES FOR THE SURGICAL TREATMENT OF PATIENTS WITH EXTENSIVE MALIGNANT CHEST WALL NEOPLASMS].

The authors consider possibilities for the surgical treatment of patients with extensive malignant chest wall neoplasms. It is argued that combinedsugical interventions and resection of the affected parts of the chest wall together with the tumour and the use of plastic procedures allow to arrest further development of severe complications in the majority of patients and create conditions for the continuation of the anti-tumour treatment. Plastic and reconstructive surgery permits to extend operability limits and thereby improve the quality of the treatment and increase life expectancy of the patients with extensive tumorigenic process.

Cytokeratin 19 expression in primary thoracic tumors and lymph node metastases.

BACKGROUND: The use of one-step nucleic acid amplification (OSNA), which allows for the rapid intraoperative detection of lymph node (LN) metastasis, is becoming more widely accepted in breast cancer. To provide basic data for the development of this method for lung tumors, we conducted a large-scale investigation of cytokeratin (CK) 19 expression in thoracic tumors. PATIENTS AND METHODS: We examined CK19 expression in specimens from a total of 801 surgically resected samples of primary lung adenocarcinoma (ADC), squamous cell carcinoma (SQC), large-cell carcinoma (LCC), pleomorphic carcinoma (PC), large cell neuroendocrine carcinoma (LCNEC), small cell carcinoma (SCC), and carcinoid tumor (CT) as well as pleural malignant mesothelioma and lung metastatic deposits from breast cancer using tissue microarrays (TMAs) and whole sections. We also compared the CK19 expression status between primary sites and LN metastatic deposits. RESULTS: The overall rate of CK19 expression as observed on TMAs and whole sections in the 801 analyzed cases was 88.0%. CK19 expression was detected in 94.6% of ADCs, 93.6% of SQCs, 54.5% of LCCs, 54.8% of PCs, 77.4% of LCNECs, 31.8% of SCCs, 34.0% of CTs, and 92.9% of malignant mesotheliomas. Expression of CK19 was also detected in 90.9% of lung metastatic deposits from breast carcinomas. CK19 expression was maintained between CK19-positive primary sites and the corresponding LN metastatic deposits. Of note, a portion of CK19-negative primary tumors showed upregulation of CK19 protein expression in LN metastases. CONCLUSIONS: Most thoracic tumors, except for PCs, CTs, and SCCs, were positive for CK19. We also found that CK19 expression was maintained between CK19-positive primary tumors and the corresponding LN metastatic deposits. These results may be useful in the development of the OSNA method for the intraoperative detection of LN metastasis in non-small cell lung cancer (NSCLC).

Tumores primarios de la pared torácica / Primary tumors of the thorax wall

Se revisan aspectos teóricos en los tumores primarios de la pared torácica, sobre todo en la clasificación y en aspectos clínicos, diagnósticos y terapéuticos, con el propósito de conocer los resultados del tratamiento en el centro. Se realizó un estudio retrospectivo descriptivo para analizar los resultados del tratamiento quirúrgico en 22 pacientes (muestra) con tumores primarios de la pared torácica, en un período de 15 años (enero de 1993 a diciembre de 2008), en los servicios de cirugía general y ortopedia del Hospital Amalia Simoni de Camagüey. Hubo ligero predominio del sexo femenino y del grupo de edad entre 17 a 44 años (media 39,4), la comorbilidad que predominó fue la hipertensión arterial, el hemitórax derecho fue el más afectado, y las costillas de la 1 a la 4 las más lesionadas, y predominaron las afecciones benignas, entre ellas, el osteocondroma. El tratamiento más utilizado fue la resección quirúrgica, y la complicación posoperatoria que predominó fue la bronconeumonía. El índice de recidiva tumoral fue alto, no siempre por cáncer. Hubo 4 fallecidos por enfermedad maligna avanzada, y no se presentaron muertes perioperatorias. Conclusiones: fueron comparados los resultados con los de otros reportes y se hallaron puntos de coincidencia en diversos aspectos, pero también discrepantes, se trata de unificar criterios para mejorar el diagnóstico y los resultados del tratamiento en estos enfermos. La mayoría de los pacientes no presentaron complicaciones, y la recidiva tumoral estuvo por encima de lo esperado. La resección tumoral siempre debe ser amplia. El resultado global fue satisfactorio(AU)

the theoretical features in the primary tumors of the thorax wall, especially in the classification and clinical, diagnostic y therapeutical features were reviewed to know the results of treatment in our institution. A descriptive and retrospective study was conducted to analyze the results of surgical treatment in 22 patients (sample) with primary tumors of the thorax wall during 15 years (from January,1993 to December, 2008) in the services of general surgery and orthopedics of the Amalia Simoni Hospital of the Camagüey province. There was a slight predominance of female sex and the age group from 17 to 44 years (mean, 39.4), the predominant comorbid disease was the high blood pressure, the right hemithorax was the more involved and the ribs from 1 to 4 were the more injured with predominance of benign affections including the osteochondroma. The treatment more applied was the surgical resection and the postoperative complication predominant was the bronchopneumonia. The tumor relapse rate was high but not always due to cancer. The were 4 deceased due to advanced malignant disease without perioperative deaths. Conclusions: results were compared to other reports with coincidence points in different features but also differing and try to unify criteria to improve diagnosis y the results of treatment of these patients. Most of patients were without complications and the tumor relapse was over the expected. The tumor resection always must to be wide. Global result was satisfactory(AU)

Principles of chest wall resection and reconstruction.

Despite significant improvements in surgical technique and perioperative care, the management of patients requiring chest wall resection and reconstruction is an ongoing challenge for thoracic surgeons. A successful approach includes a thorough assessment of the patient and the lesion, an adequate biopsy to confirm tissue diagnosis, and a well-established treatment plan. In the case of a primary tumor of the chest wall, the extent of the resection should not be limited by the size of the resulting defect. Following resection, chest wall reconstruction mandates an appreciation for restoration of functional and structural components. An algorithmic approach to chest wall reconstruction begins with the assessment of the nature of the defect, taking into consideration factors such as infection, tumor location, previous radiation therapy, and surgical intervention. The latter factors bear influence on the type of tissue required as well as whether reconstruction can be performed in a single stage or whether it is better delayed. Finally, patient factors including lifestyle and work, as well as prognosis, are considered to determine the best reconstructive option.

[S100 protein positive sustentacular cells in pulmonary carcinoids and thoracic paragangliomas: differential diagnostic and prognostic evaluation]. / S100-Protein-positive Sustentakularzellen in pulmonalen Karzinoiden und thorakalen Paragangliomen : Differenzialdiagnostische und prognostische Bedeutung.

Paragangliomas have a classical histomorphology comprising a so-called "Zellballen" or nesting pattern with surrounding S100 protein positive sustentacular cells (SC) which form a meshwork with a wire-fence appearance. In adrenal and extra-adrenal paragangliomas the prevalence of SC is inversely associated with the patients' outcome. In order to get more insight into the prevalence as well as the prognostic and differential diagnostic value of this cell population in pulmonary carcinoids, we investigated a panel of 26 tumorlets, 147 typical and atypical pulmonary carcinoids and ten thoracic paragangliomas immunohistochemically. We were able to demonstrate that S100 protein positive cells are similarly distributed in both thoracic paragangliomas and pulmonary carcinoids. Hence, the presence and distribution of these cells does not appear to represent a reliable criterion in differential diagnosis. Moreover, all pulmonary carcinoid patients with a worse outcome had low numbers of or no S100 protein positive cells in their tissue specimens. Thus, the prevalence of these cells may potentially aid in prognostic assessment of pulmonary carcinoids, especially in biopsies.

[Solitary fibrous tumor and haemangiopericytoma: what is new?]. / Solitärer fibröser Tumor und Hämangioperizytom : Was ist neu?

Soft-tissue tumors with haemangiopericytoma (HPC)-like growth patterns can now be divided into three categories: (1) The solitary fibrous tumour (SFT) group with its variants; (2) lesions showing clear evidence of myoid/pericytic differentiation and corresponding to "true" HPCs (myopericytoma/glomangiopericytoma and a subset of sinonasal HPCs); (3) neoplasms that occasionally display HPC-like features (e.g. synovial sarcoma). In this study 268 intrathoracic and extrathoracic SFTs from the German consultation and reference center of soft tissue tumors in Jena were evaluated and analyzed immunohistochemically with antibodies CD34, Bcl-2, CD99, SMA, S100, PanCK and Ki-67. Furthermore, SFTs were categorized into the newly proposed SFT designation: Fibrous variant, cellular variant (more than 90% hypercellularity), fat-forming variant, giant cell-rich variant and malignant SFTs. This article should provide insights into the diagnosis of this entity with emphasis on the new international standard.

Neuroendocrine carcinomas (carcinoid, atypical carcinoid, small cell carcinoma, and large cell neuroendocrine carcinoma): current concepts.

Neuroendocrine carcinomas are ubiquitous neoplasms that may occur anywhere in the human body. A unifying concept regarding the classification of these tumors has been controversial. Although most neuroendocrine neoplasms occur in the gastrointestinal tract, current concepts regarding classification and nomenclature are being driven by studies of thoracic tumors. One issue that has been put forward to keep separate nomenclatures for these tumors in different organ systems is the different clinical behavior of these neoplasms in different systems. The most important aspect regarding this group of tumors is the fact that they should be considered neoplasms capable of local recurrence and distant metastasis. Close clinical correlation and appropriate treatment are important to improve the survival rate in this group of patients.

Quantitative CT analysis for assessing response in lymphoma (Cheson's criteria).

Standardized CT-based criteria used for lymphoma staging and follow-up and the current role of FDG-PET are reviewed. The current CT-based International Workshop Criteria (IWC) still have the main advantage of representing standardized criteria allowing comparability of clinical trials in patients with lymphoma. However, functional imaging with integrated IWC and FDG-PET provide more accurate response assessment, and challenge the current paradigm. Although integration of FDG-PET in IWC requires validation in a prospective trial with a large number of patients, new long-term clinical and therapeutic trials probably need to be designed using these new and hopefully standardized functional criteria. This potentially could allow a more risk-adapted approach to the treatment of aggressive lymphoma: intensive (reinforced) therapies for non-responders vs. less intensive therapies for good responders with the main goal of improved clinical outcome.

[Myofibroblastic sarcoma of the thoracic wall. Change in appearance in tumour recurrence]. / Myofibroblastisches Sarkom der Thoraxwand. Wandel des Erscheinungsbildes im Tumorrezidiv.

The existence of malignant mesenchymal tumours with myofibroblastic differentiation (myofibroblastic sarcoma, myofibrosarcoma) is controversially discussed. In the present case report a low-grade myofibroblastic sarcoma of the thoracic wall with varying morphological appearance in numerous recurrences over a number of years is described. The varying immunophenotypes of tumour cells with myofibroblastic differentiation suggests that changing of morphological and immunohistochemical phenotypes may occur in tumour cells with myofibroblastic characteristics corresponding to the "plasticity" of the myofibroblast. The classification of soft tissue tumours is based on a discernible line of differentiation. If cells of a malignant mesenchymal tumour show characteristic features of myofibroblasts by light microscopy and immunohistochemistry, this neoplasm should be classified as a myofibroblastic sarcoma, even if the ultrastructural detection of "fibronexus" is not possible.

Cytologic analyses of spindle-cell lesions of the thorax and retroperitoneum.

Thoracic and retroperitoneal spindle-cell lesions represent a diagnostic challenge in the evaluation of fine-needle aspiration (FNA) specimens. The challenge is due to the morphologic similarities and wide variety of different entities with spindle-cell morphology in these two sites. The purpose of this study was to identify criteria helpful in the classification and differential diagnosis of spindle-cell lesions in these two locations. A set of cytologic features was analyzed in 57 thoracic or retroperitoneal spindle-cell lesions. Our results show that pleomorphism and abundant single cells were parameters associated with high-grade tumors in univariate and multivariate analysis, while coarse chromatin pattern was significant only in a univariate analysis. The combination of absence of pleomorphism, rare single cells, tight cluster arrangement, fine chromatin pattern, and absence of macronucleoli was seen only in benign cases. Assessment of background material was helpful in the differential diagnosis and classification. Necrosis was only found in high-grade cases.

Lipoblastoma: better termed infantile lipoma?

Lipoblastoma is a rare adipose tumor occurring exclusively in childhood. There have been no reports of metastases, making the designation "blastoma" confusing, since this term is usually reserved for malignant tumors. Two recent cases treated at our institution confirm its benign nature. In addition, a review of the literature supports the idea that the tumor may more accurately be described as an "infantile lipoma". Infantile lipoma better reflects many of the tumor's characteristics such as, its early occurrence, it's ability to mature into a simple lipoma, it's cellular composition of mainly mature adipocytes, and its benign course. Although lipoblastoma is an uncommonly encountered tumor, making an effort to change its name to infantile lipoma will result in a more a accurate term that will facilitate treatment.

Staging computed tomography of the thorax for nasopharyngeal carcinoma.

BACKGROUND: To assess the role of staging CT of the thorax in advanced nodal stage nasopharyngeal carcinoma and to examine the hypothesis that contiguous spread of nodal metastases from the supraclavicular region to the upper mediastinal region occurs in this cancer. METHODS: Forty-four patients with newly diagnosed nasopharyngeal carcinoma with neck node metastases to the supraclavicular region (ie, AJCC N3b stage) underwent contrast-enhanced CT (CECT) thorax for staging. CT findings and clinical outcome were analyzed. RESULTS: No patient was found to have intrathoracic metastasis, although 1 had hepatic metastases on CECT of the thorax, resulting in upstaging in 1 of 44 (2%) of patients. With a median follow-up time of 21 months, 3 patients had lung metastases and 2 had axillary nodal metastases develop without evidence of upper mediastinal nodal metastases. CONCLUSION: Staging CECT of the thorax has a very low yield in nasopharyngeal carcinoma, even in advanced nodal disease. The hypothesis that contiguous spread of nodal metastases from the supraclavicular region to the upper mediastinum is not substantiated, and no evidence suggests that radiation therapy for N3b-stage disease needs to encompass the upper mediastinum.

Tumores neurogénicos del tórax / Neurogenic tumors of the thorax

En el período comprendido entre Enero de 1975 y Diciembre de 1994, se trataron un total de 36 pacientes con tumores neurogénicos del mediastino.La edad osciló entre los 15 y 62 años, y la distribución por sexo fue de 22 mujeres y 14 varones.Todos los casos fueron abordados quirurgicamente y dos de ellos fueron operados conjuntamente con el Servicio de Neurocirugía.De los 36 pacientes, 13 fueron sintomáticos (dolor torácico,tos seca y disnea de esfuerzoy los 23 cursaron en forma asintomática.el par radiológico y la tomografía computada lineal hasta 1980 y luego la Tomografía Axial Computada son los requisitos diagnósticos indispensables.Se hallaron 20 neurilemomas (55,5 por ciento) 7 neuroblastomas (19,4 por ciento), 4 neurofibromas (11,1 por ciento),3 Schwanomas malignos (8,3 por ciento) y 2 Tumores de Askin (5,5 por ciento).Creemos que la cirugía y terapéutica absoluta en los tumores neurogénicos del tórax

Tumores neurogénicos del tórax / Neurogenic tumors of the thorax

En el período comprendido entre Enero de 1975 y Diciembre de 1994, se trataron un total de 36 pacientes con tumores neurogénicos del mediastino.La edad osciló entre los 15 y 62 años, y la distribución por sexo fue de 22 mujeres y 14 varones.Todos los casos fueron abordados quirurgicamente y dos de ellos fueron operados conjuntamente con el Servicio de Neurocirugía.De los 36 pacientes, 13 fueron sintomáticos (dolor torácico,tos seca y disnea de esfuerzoy los 23 cursaron en forma asintomática.el par radiológico y la tomografía computada lineal hasta 1980 y luego la Tomografía Axial Computada son los requisitos diagnósticos indispensables.Se hallaron 20 neurilemomas (55,5 por ciento) 7 neuroblastomas (19,4 por ciento), 4 neurofibromas (11,1 por ciento),3 Schwanomas malignos (8,3 por ciento) y 2 Tumores de Askin (5,5 por ciento).Creemos que la cirugía y terapéutica absoluta en los tumores neurogénicos del tórax

Chest wall neoplasms and their management.

Although uncommon, primary and metastatic neoplasms can occur in the chest wall. For malignant neoplasms, the potential for cure depends on the completeness of resection, histologic type, and tumor stage. Each patient warrants individual evaluation for chest wall resection. Operative selection is based on the potential benefits, operative feasibility, patient health, and anticipated tumor biology. The choice of reconstruction techniques is based on the tumor's location, the size of the remaining defect, and the availability of autogenous graft materials. Skeletal and soft tissue reconstruction can be performed safely in a single stage.