A rare case of unicentric plasma cell type Castleman's disease in the mediastinum.

Castleman's disease is a very rare (and thus little-known) lymphoproliferative disorder characterized by lymph node follicular hyperplasia with abnormal interfollicular vascular growth. It can be classified into unicentric and multicentric variants according to its localization, and into three histological types: hyaline-vascular, plasma cell and mixed. We describe the case of a 51 year-old woman who presented with precordial chest pain. Chest X-Ray and computed tomography (CT) raised the suspicion of an aortic aneurysm, and the patient was sent to the Interventional Cardiology Clinic at the Military Emergency Clinical Center for Cardiovascular Diseases (CCUBCVA), where the diagnosis of mediastinal tumor was made by ultrasonography, coronarography and CT. The patient was transferred to our clinic, where a diagnostic mediastinoscopy proved histolopathologically inconclusive. A lateral thoracotomy with ideal tumorectomy was decided upon and carried out, and the diagnosis of plasma cell type Castleman's disease was established. This paper discusses the pathogenic mechanisms, symptoms, diagnosis and treatment of Castleman's disease.

Left paraxiphoidian approach for drainage of pericardial effusions.

Pericardial effusion is one of the frequent complications of malignancies, up to 15-20% of the autopsy specimens showing pericardial or cardiac metastasis. Often the pericardial fluid accumulates in large quantities leading to cardiac tamponade, which can be fatal in the absence of appropriate treatment. The authors present another type of pericardial drainage: the approach is paraxiphoidian, not subxiphoidian or with xiphoid resection. Without xiphoid process resection, the surgery is better tolerated by patients (frequently the drainage is made under local anesthesia). In the case of xiphoid preservation, the surgical intervention is easier (no need for hard retraction of this bone). In all the five cases with this access, the postoperative results were very good, with complete evacuation of pericardial effusion. In all the cases, the pericardial biopsy performed under visual control was sufficient for a histological diagnosis and the immunohistochemical tests, if required.

[Cervico-mediastinal lymphangioma]. / Limfangiomul cervico-mediastinal.

The authors are describing three cases of lymphangioma, one at a seven years old child with cervico-mediastinal localization; another at a 39 years old person, situated only in mediastinum, the third is a cervical lymphangioma at a 55 years old subject. The respiratory symptoms are present in the two cases with mediastinal involvement. The patient with cervical localization had no symptoms. The radiological exams: thoracic radiography, CT or the ultrasound test are revealing a cystic tumor in mediastinum or in cervical region. We performed a complete surgical tumor resection through median sternotomy, left thoracotomy and cervicotomy. The evolution was very good in all cases. The diagnosis had histopathological confirmation.