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.

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.

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.

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.

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.

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.

Recurrent primary mediastinal liposarcoma: A case report.

Primary mediastinal liposarcomas are extremely rare. The current study reports the case of a 63-year-old man presenting with a primary liposarcoma arising from the posterior mediastinum. The patient reported a 6-month history of chest pain with increasing dyspnea for 2 months. Enhanced computed tomography revealed a 10×16-cm mass in the posterior mediastinum. Other physical examinations were normal. Radical resection was performed under the agreement of patient. Subsequent pathological analysis indicated a liposarcoma. The patient recovered and was successfully discharged. However, at a follow-up examination 12 months after surgery, recurrence was identified in the anterior mediastinum. Therefore, the patient underwent surgery. The postoperative course was uneventful, however, there was evidence of disease recurrence 2 years after the second surgery. The patient refused any treatment and succumbed after 3 months.

Diagnosis and surgical treatment of esophageal gastrointestinal stromal tumors.

AIM: To retrospectively evaluate our experience with the diagnosis and surgical resection of esophageal gastrointestinal stromal tumors (GISTs). METHODS: Between January 2003 and August 2014, five esophageal GIST cases were admitted to our hospital. In this study, the hospital records, surgery outcomes, tumor recurrence and survival of these patients were retrospectively reviewed. RESULTS: The median age of the patients was 45.6 years (range: 12-62 years). Three patients presented with dysphagia, and one patient presented with chest discomfort. The remaining patient was asymptomatic. Four patients were diagnosed with esophageal GISTs by a preoperative endoscopic biopsy. Three patients underwent esophagectomy, and two patients underwent video-assisted thoracoscopic surgery. The mean operating time was 116 min (range: 95-148 min), and the mean blood loss was 176 mL (range: 30-300 mL). All tumors were completely resected. The mean length of postoperative hospital stay was 8.4 d (range: 6-12 d). All patients recovered and were discharged successfully. The median postoperative follow-up duration was 48 mo (range: 29-72 mo). One patient was diagnosed with recurrence, one patient was lost to follow-up, and three patients were asymptomatic and are currently being managed with close radiologic and clinical follow-up. CONCLUSION: Surgery is the standard, effective and successful treatment for esophageal GISTs. Long-term follow-up is required to monitor recurrence and metastasis.