Mediastinal malignant triton tumor: A rare case series and review of literature.

INTRODUCTION: In 1938, the Malignant Triton Tumor (MTT) was first explained by Mason. CASE PRESENTATION: Case 1: A man aged 28 years presented with chest pain and difficulty in breathing since last five months, there was no history of cough fever or night sweats. Clinical examination was unremarkable. His routine hematological tests including tumor markers were within normal range, testicular ultrasound was normal. CT scan of thorax revealed a mass in the anterior mediastinum. CT guided biopsy revealed a malignant triton tumor. Case 2: A 30 years old man, nonsmoker presented with history of chest tightness and feeling pressure while kneeling down since last 3 months, otherwise fit and healthy. His routine hematological investigations including tumor markers were within normal range. A CT scan of thorax revealed a large mass in the right posterior mediastinum. CT guided biopsy showed malignant triton tumor. Case 3: A man aged 28 years presented with chest pain and difficulty in breathing since last five months, there was no history of cough fever or night sweats. Clinical examination was unremarkable. His routine hematological tests including tumor markers were within normal range, testicular ultrasound was normal. CT scan of thorax revealed a mass in the anterior mediastinum. CT guided biopsy revealed a malignant triton tumor. DISCUSSION: Malignant peripheral nerve sheath tumors (MPNST) are uncommon sarcomatous tumors that are believed to be derived from Schwann cell or neighboring cells with perineurial differentiation. MTT is rarely reported in mediastinum, lung and heart (<10%) To the best of our knowledge, only few cases of MTT in the mediastinum have been reported in English literature, including, four were reported in the anterior mediastinum, three in the posterior mediastinum, one in the middle mediastinum and one between the ascending aorta and the main pulmonary artery. Most of the patients were young adults. We report three cases of rare mediastinal malignant triton tumors. They have been treated with palliative surgery/radical surgery +/- adjuvant therapy. The prognosis varied from a 3 month overall survival time to being alive at a 53 month follow-up period. CONCLUSION: In conclusion we report three rare cases of mediastinal malignant triton tumor treated with radical surgical resection and post-operative radiotherapy, one patient developed lung metastasis, and two had late local recurrence. The malignant triton tumor is a lethal neoplasm which carries very poor prognosis particularly when they occur in the mediastinum because it's very difficult to obtain wider tumor free margin due to the nature of location site.

Radical chest wall resection and modified reconstruction technique for solitary internal mammary lymph node recurrence in breast cancer.

INTRODUCTION: Although the incidence of internal mammary lymph node recurrence rate in breast cancer is low but still it is the second most common drainage site after axilla. Patients with solitary internal mammary lymph node (IMLN) recurrence have overall better prognosis. The role of chemo and radiotherapy in internal mammary lymph node involvement with breast cancer is still controversial. Radical surgical resection and reconstruction remains mainstay for good prognosis. PRESENTATION OF CASE: Here in we present a case of a 32 year old female with breast cancer who had left mastectomy followed by adjuvant chemo radiotherapy treatment for adenocarcinoma of breast in 2008. She presented with upper left parasternal pain in 2009. Computed tomographic scan (CT) of her thorax showed internal mammary lymph node enlargement, likely metastasis. We performed modified surgical reconstruction after enbloc radical resection of part of manubrium; hemi sternum, chest wall and left parasternal IMLN. Patient remained disease free to date. DISCUSSION: There is no standard treatment after IMLN metastasis. Previous surgical studies reported no survival benefit with ERM, but is there any role of adjuvant locoregional radiotherapy or systemic therapy to prevent relapses in IMLN is a matter of debate. CONCLUSION: To the best of our knowledge this is first case ever managed with radical enbloc surgical resection and modified reconstruction of chest wall using such technique. Our reconstruction technique provides better chest wall stability with minimal risk of plate dislodgement or excursion and at the same time provides good cosmoses and better survival.

Hoarseness of voice, respiratory distress and dysphagia due to giant primary posterior mediastinal ectopic goitre: a rare clinical entity.

Primary posterior mediastinal ectopic goitre is an extremely rare entity; we report a case of a 28-year-old man who presented with dysphagia, respiratory distress and hoarseness of voice, gradually worsening over a period of 3 months. CT scan of the thorax revealed a giant posterior mediastinal ectopic goitre. The mass was removed through a right posterolateral thoracotomy. The patient's symptoms, respiratory distress and dysphagia disappeared immediately after surgery while his voice gradually returned to normal after 6 weeks.

Late Intrathoracic Tracheal Stricture After Blunt Chest Trauma: A Rare Life-Threatening Condition.

Tracheal injury after blunt chest trauma is a rare but life-threatening condition. If diagnosed and treated early, the outcome is excellent. We report a case of an 18-year-old man who sustained a fracture of the right femur in a traffic accident. He underwent operation under spinal anesthesia and was discharged home after 2 weeks. Six weeks later, he was readmitted with acute respiratory distress, stridor, and drowsiness. Arterial blood gas analysis showed hypercarbia (PCO2 of 80 mm Hg; PO2 of 60 mm Hg). He was intubated with difficulty and ventilated. A computed tomographic (CT) scan of the chest showed a very tight supracarinal tracheal stricture. Emergency surgical resection of the tracheal stricture was performed, and an end-to-end anastomosis was fashioned. The patient had an excellent recovery.

Manubrioclavicular and Manubriosternal Reconstruction After Radical Resection for Chondrosarcoma of Manubriosternum: A Modified Surgical Technique.

Primary chondrosarcoma of the manubriosternum is a rare tumor. We describe the case of a 42 year-old man who presented with a swelling of the anterior chest wall. The computed tomography scan of the thorax showed a manubriosternal mass involving both clavicles. True-cut biopsy revealed a low-grade chondrosarcoma. The manubrium, the medial part of the clavicles, the sternum, and all costal cartilages were excised en bloc with wide, clear margins and reconstructed successfully without any residual deficit regarding the stability of the chest wall and upper arm movements. We present this rare case with a modified reconstruction technique using a methyl methacrylate Marlex mesh sandwich plate with excellent results. After 2 years' follow-up, there was no radiologic or clinical signs of recurrence.

Radical surgical resection for giant primary mediastinal endodermal sinus tumour with pulmonary metastasis after chemotherapy: can be curative.

Primary non-seminomatous germ cell tumours of anterior mediastinum are uncommon. Endodermal sinus tumour of the anterior mediastinum (yolk sac) is a rare but lethal neoplasm. We present a case of an 18-year-old man who presented with chest pain, cough and haemosputum with markedly raised serum α-fetoprotein (AFP) levels above 112,000 ng/mL. Chest roentgenogram and CT showed a giant anterior mediastinal mass. CT guided biopsy revealed a diagnosis of endodermal sinus tumour. After the completion of chemotherapy, extensive surgical resection was carried out along with the right lung metastastectomy. Five years postresection follow-up the patient is disease free with normal serum tumour markers. This is the longest survival ever reported of such tumours with highest AFP level (>112,000 ng/mL) and lung metastasis.

A rare cause of asymptomatic solitary pulmonary nodule: adult Schistosoma worm.

Solitary pulmonary nodule due to various pathologies has been reported in the medical literature. We report a case of solitary pulmonary nodule in an asymptomatic 60-year-old male smoker, who had a positive family history of pulmonary tuberculosis. His routine screening chest X-ray revealed a 2 × 1.5 cm nodule in the right lung upper zone. A CT scan of the thorax confirmed the finding. Bronchoscopy, lavage, biopsy and screening for tuberculosis were negative. Owing to its technical difficulty, a CT-guided biopsy was deferred by the radiologist, hence we decided to perform segmentectomy that showed granuloma harbouring an adult Schistosoma worm. This is the first case of asymptomatic solitary pulmonary nodule due to adult Schistosoma worm 26 years after the exposure.

Tracheal diverticulum: a rare cause of hoarseness of the voice.

Tracheal diverticulum is a rare benign disease also known as paratracheal air cyst. Mostly these are asymptomatic and are discovered incidentally on radiologic examination of the chest. Common symptoms are cough, recurrent respiratory tract infections, and sometimes dysphagia. Herein we report a rare case of hoarseness of voice caused by tracheal diverticulum. Computed tomography scan of neck revealed a large tracheal diverticulum, probably compressing the recurrent laryngeal nerve as bronchoscopy showed impaired right vocal cord movement. Two weeks after diverticulectomy, the patient's voice returned to normal.

Giant leiomyoma of the oesophagus with eosinophilic infiltration.

The most common benign tumour of the oesophagus is leiomyoma. Haemopoietic elements rarely infiltrate oesophageal leiomyoma. We report the case of a 24-year-old man with a long history of intermittent dysphagia. Endoscopy revealed external compression with normal oesophageal mucosa. A barium swallow study showed a defect in the oesophageal wall and a narrow oesophageal lumen. A CT scan of the chest confirmed a mass in the mid-oesophagus. A tumour was excised and the histology report revealed leiomyoma infiltrated with eosinophils, which is a rare variant.

Thoracoscopic enucleation of esophageal leiomyoma in patient with MEN I syndrome.

Minimal invasive thoracic surgery is growing rapidly and may become the standard of care for certain diseases. Its benefits over traditional surgery, including reduced morbidities and hospital stay, have been well established in several reports. We herein report a case of midesophageal leiomyoma in a patient with MEN I syndrome successfully enucleated by thoracoscopy highlighting the technical details of the procedure.