Cases reported "Mediastinal Neoplasms"

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1/27. Robot-assisted thoracoscopic resection of a benign mediastinal neurogenic tumor: technical note.

    OBJECTIVE: Robotic surgery systems were introduced recently with the objective of enhancing the dexterity and view during procedures that use a videoscope. The first case report of robot-assisted thoracoscopic removal of a benign neurogenic tumor in the thorax is presented. methods: A 46-year-old woman presented with a history of paravertebral pain. A chest x-ray revealed a left paravertebral mass. A magnetic resonance imaging scan revealed a well-encapsulated mass that was suspected to be a neuroma at the level of T8-T9, separate from vascular structures, without extension in the foramina, and without a spinal canal component. RESULTS: A left robot-assisted thoracoscopic resection of the tumor was performed. After placement of six trocars, the tumor was carefully dissected and removed through one of the trocar openings. The histopathological findings revealed an ancient schwannoma. CONCLUSION: This case report demonstrates the feasibility of robot-assisted thoracoscopic extirpation of a thoracic neurogenic tumor. Robot-assisted surgery may prove to be of additional value in challenging thoracoscopic surgery, such as the delicate surgical removal of benign neurogenic tumors, because of the support in manipulation and visualization during videoscopic interventions.
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2/27. Schwannoma of the left brachial plexus mimicking a cervicomediastinal goiter in a young Nigerian lady.

    The schwannoma is thought to arise from the schwann cells of the nerve sheath. This tumor is usually solitary and may arise from any cranial or peripheral nerve. It is encapsulated and appears to arise focally on a nerve trunk so that the nerve itself is stretched over the tumor rather than running through it as in neurofibroma. This report is unusual as the tumor started as a cervical swelling which subsequently grew into the mediastinum simulating a retrosternal goiter. The patient, a 25 year-old female was referred to the University College Hospital, Ibadan, 24 hours after an attempted thyroidectomy at a private hospital. The history was of a painless anterior neck swelling of 4 years duration devoid of symptoms of hyperthyroidism with associated dysphagia and weakness of the left hand. Examination showed an asthenic young woman. Her voice was hoarse but there were no eye signs suggestive of thyrotoxicosis. On the anterior neck was a sutured skin-crease scar over a diffuse anterior neck swelling which one could not get below. The left hand showed wasting of the thenar and hypothenar eminences. Thyroid function test results were within normal limits, indirect laryngoscopy showed a left vocal cord paralysis, packed cell volume was 38%. Her chest x-ray showed a huge left retrosternal and apical soft tissue mass displacing the trachea to the right (figure 1). A fine needle aspiration cytology was reported as a chronic lymphocytic thyroiditis. A presumptive diagnosis of thyroid carcinoma with retrosternal extension was made. At surgery, manipulation of the mass was difficult as the tissue was soft, slimy and ruptured easily. Severe hemorrhage was encountered necessitating a median sternotomy to control the bleeding vessels. Her post-operative period was stormy, however she thereafter made gradual progress to warrant her discharge six weeks post surgery.
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3/27. Thrombosed giant left atrium mimicking a mediastinal tumor.

    A patient with rheumatic heart disease, mitral stenosis, and mitral insufficiency is described. The thrombosed giant left atrium paralyzed the left vocal cord and completely obstructed the bronchi to the middle and lower lobes of the right lung. The giant left atrium mimicked a mediastinal tumor on the chest x-ray film.
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4/27. Cystic adenomatoid tumor of the mediastinum.

    A case of adenomatoid tumor presenting as a mass in the anterior mediastinum is described. The patient was a 56-year-old woman with left side chest wall pain who showed a mediastinal mass on chest x-ray and CT scans. Thorough clinical and radiographic examination did not reveal any evidence of tumor elsewhere. At surgery, the tumor was found adjacent to the anterior pericardial reflection. Grossly, the tumor measured 5.5 x 5.5 x 3 cm and showed a homogeneous cut surface with numerous cystic structures that varied from 0.5 to 1.5 cm in greatest diameter. Histologic examination showed numerous cystic spaces lined by flattened or cuboidal epithelial cells. The walls of the cysts showed a proliferation of small canalicular structures lined by round to polygonal epithelioid cells with vacuolated eosinophilic cytoplasm. Immunohistochemical studies showed strong positivity of the epithelioid cells for AE1/AE3 cytokeratin, CK5/CK6, and calretinin. Stains for CK7, CK20, alpha-fetoprotein, CD31, carcinoembryonic antigen, MOC 31, and chromogranin were negative. Electron microscopic examination showed numerous long microvilli on the cell surface and abundant tonofilaments/desmosomal plaques in the tumor cells, characteristic of mesothelial cells. The patient is alive and well and free of recurrence 1 year following surgery. adenomatoid tumor is a rare neoplasm that should be added in the differential diagnosis of anterior mediastinal masses. Immunohistochemical and ultrastructural studies may be of aid in identifying the characteristic features of mesothelial cells and to avoid mistaking this lesion for more ominous conditions.
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5/27. Congenital giant aneurysm of the left innominate vein: is surgical treatment required?

    Congenital aneurysms of the thoracic venous system are rare. In particular, innominate venous aneurysms are extremely rare. We describe a 16-year-old girl whose chest x-ray suggested a mediastinal tumor. Three-dimensional contrast-enhancement magnetic resonance venography showed a giant sacciform aneurysm of the left innominate vein and dilatation of the right innominate vein. The patient was asymptomatic, and there were no significant physical findings. Therefore, the patient is being followed without surgical treatment.
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6/27. BCG osteomyelitis as a rare cause of mediastinal tumor in a one-year-old child.

    A one-year-old child with BCG osteomyelitis of the upper spine is reported. The child was admitted because of viral infections of the upper respiratory tract. A lateral x-ray examination of the lung showed what was thought to be a mediastinal tumor. The preoperative diagnostic problems are discussed, because the etiology in our case was unknown until the histological report arrived. The knowledge of the complication, of osteomyelitis after vaccination, is small although the first case was published more than 40 years ago. Since then about 300 cases have been reported in the literature. The disease is seen in the first five years of life in otherwise healthy children. Most cases are localized near the epiphysis of the long bones. A localization in the spine, as described in our case, has been published only three times before. The highest frequency of BCG osteomyelitis is reported in finland and sweden with about 40 cases per 1 million vaccinations.
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7/27. A thoracoscopically resected case of mediastinal parathyroid cyst.

    A 67-year-old male visited his physician because of a 2-month history of cough and sputum. An abnormal shadow at the left upper mediastinum on chest x-ray film was detected, and the patient was referred to our department for further examination. Chest x-ray film revealed a round shadow at the left upper posterior mediastinum. Computed tomography(CT)revealed a uniform iso density mass about 4 cm in diameter, with a well-defined border. After the intravenous contrast administration, a slight peripheral enhancement was seen around the mass. On magnetic resonance imaging, the mass was hypointense in T1-weighting and hyperintense in T2-weighting. The contrast pattern was the same as that observed in the CT scan. On sagittal and coronal sections, the mass was adjacent to the aortic arch. Although a benign tumor was mostly suspected based on imaging findings, a malignant tumor was also possible. Accordingly, we resected this mass with video-assisted thoracoscopy. Findings at operation were a cystic mass. The pathological findings were compatible with benign parathyroid cyst, which was suspected to be the cystic degeneration of a parathyroid adenoma.
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8/27. diagnosis of a Morgagni hernia complicated by a previous normal chest x-ray.

    A normal chest x-ray in a child does not mean that a Morgagni hernia cannot develop in that patient. The case of a patient whose treatment was complicated by confusion of the herniation of fatty omentum with a primary mediastinal mass is presented here. The difficulty in diagnosing this case is illustrated by this patient report.
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9/27. Anterior mediastinal endodermal sinus (yolk sac) tumor in a female infant.

    The first known case of primary anterior mediastinal endodermal sinus (yolk sac) tumor in a female patient, occurring in a 20-month-old infant, is reported. The child presented with cough, fever, and listlessness. Chest x-ray revealed a right anterior mediastinal mass. At thoracotomy a large anterior mediastinal tumor extending from the neck to the diaphragm was found, and was almost totally resected. Microscopically, the tumor displayed many of the histologic patterns observed in EST. Other neoplastic germ cell elements were not identified. The ultrastructural and immunohistochemical findings further confirmed the diagnosis. serum alpha-fetoprotein (AFP) level, determined during surgery, was elevated to 65,200 ng/ml, whereas serum beta-human chorionic gonadotropin level was normal. Postoperatively, combination chemotherapy consisting of vinblastine, bleomycin, cisplatin, dactinomycin, cyclophosphamide, and doxorubicin was administered with a maintenance program. After 18 weeks on this regimen all the findings were normal, including serum AFP level. The child is well and disease-free 25 months after diagnosis.
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10/27. Lymphoepithelial cystic lesion related to adenocarcinoma in the mediastinum.

    The authors report here a case of lymphoepithelial cystic lesion (LECL) of unknown origin in the mediastinum, which is closely related to a signet-ring cell adenocarcinoma. A 73-year-old man presented with a mass as revealed on a chest x-ray. During surgical operation, a solid, well-circumscribed and encapsulated 9 X 9 X 8 cm tumor was isolated from the right anterior mediastinum. This tumor had neither undergone metastasis nor invaded into the surrounding tissue and lymph nodes. light microscopy revealed the tumor to be a signet-ring cell adenocarcinoma. Clinically, the neoplasm was coupled with an elevation in serum CEA level, which promptly returned to normal values following surgical removal. immunohistochemistry pointed out that the majority of neoplastic cells stained positive for CEA. In addition, LECL of unknown origin was distinguished at the periphery of the tumor. LECL was characterized by microcysts which were lined by columnar epithelial and surrounded by lymphoid tissue with germinal centers. Transition between the neoplastic cells and benign epithelial cells of LECL was evident, showing that the previously mentioned mediastinal adenocarcinoma may be derived from the epithelial elements of LECL. This paper discusses the histogenesis of LECL.
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