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.

O-BN07 Transesophageal Endoscopic Resection of Mediastinal Cysts

Background Primary mediastinal cysts are infrequent lesions derived from a variety of mediastinal organs or structures. Complete surgical resection is the treatment of choice even in asymptomatic patients to prevent severe adverse events (AEs) and establish the diagnosis. Transesophageal endoscopic resection of benign mediastinal tumors has been proven feasible. The aim of this study is to evaluate the feasibility, safety and efficacy of transesophageal endoscopic surgery for mediastinal cysts. Methods From January 2016 to May 2021, patients with mediastinal cysts who underwent transesophageal endoscopic resection were retrospectively included. Clinicopathological characteristics, procedure-related parameters, AEs, and follow-up outcomes were analyzed. Results A total of 10 patients with mediastinal cysts were included in this study. The mean cyst size was 3.3±1.3 cm. Histopathology revealed 3 bronchogenic cysts (30.0%), 4 esophageal duplication cysts (40.0%), 2 gastroenteric cysts (20.0%), and 1 lymphatic cyst (10.0%). All procedures were performed uneventfully. En bloc resection was achieved in 6 patients (60.0%). Aggressive resection was avoided to prevent damage to the surrounding vital organs. Mean procedure time was 63.4±36.5 min. No major pneumothorax, bleeding, mucosal injury or fistula occurred. One patient had a transient febrile episode (>38.5 °C). Mean postoperative hospital stay was 2.7±0.9 days. No residual or recurrent lesions were observed in any patient during a mean follow-up period of 29.8±19.5 months. Conclusions Transesophageal endoscopic surgery appears to be a feasible, safe, effective and much less invasive approach for mediastinal cyst resection. Larger prospective studies are required to fully assess the efficacy and safety of this novel technique.

Factors Associated With Suggestive of Pulmonary Hypertension Measured by Echocardiography in Patients With A Mediastinal Tumor: A Single-Center Study

Ultrasound techniques are generally not used as a primary tool in the evaluation of mediastinal tumors and cysts. This study aimed to identify factors associated with pulmonary hypertension (PH) measured by transthoracic echocardiography (TTE) in patients with a mediastinal tumor. This retrospective, observational study was performed from January 2015 to December 2020. Fifty-five patients (mean age, 62 ± 13 years; 31 [56%] women) who had a mediastinal tumor and underwent TTE were included. Patients were classified as with PH or without PH. We analyzed clinical factors and echocardiographic parameters. PH was found in 21 (38%) patients. Twenty-two patients were asymptomatic, and none had symptoms associated with PH. Forty-seven (86%) patients underwent surgery, and 23 (42%) patients were diagnosed with malignant tumors. The presence of PH was not related with malignancy. Patients with PH were older than those without PH (67 ± 10 versus [vs.] 59 ± 14 years, p = 0.017). Small left ventricular (LV) systolic dimension (29.4 ± 3.6 vs. 31.6 ± 3.6 mm, p = 0.040) and dimension (4.2 ± 0.3 vs. 4.5 ± 0.3 mm, p = 0.004) and hyperdynamic LV ejection fraction (EF, 69 ± 6 vs. 65 ± 5%, p = 0.019) were associated with PH. Among them, older age, small LV dimension, and high EF were independently associated with PH.The presence of PH had no significant effect on patients’ clinical manifestation or malignancy.

Clinical report of a patient with primary mediastinal B-large cell lymphoma

Primary mediastinal B-cell lymphoma is a variant of non-Hodgkin's lymphoma with the predominant involvement of mediastinal lymph nodes, which affects young women. Diagnosis of this nosology is difficult due to the rare involvement of peripheral lymph nodes, as well as the rapid increase of clinical manifestations, such as the syndrome of compression of the vena cava superior and the development of the respiratory failure. The article presents a clinical case of a patient who was operated and complications that occurred due to inadequate diagnostic and therapeutic tactics. There aren`t any descriptions of the clinical manifestations of the disease which could led to a diagnostic error in literature. We present our own observation of a patient with PMBCL and discuss a practical diagnostic algorithms for mediastinal tumors. The diagnosis of PMBCL can be established only as a result of morphological examination, it is important that surgeons and pathologists remember about it. This case is important not only because it provides information about such a lymphoproliferative disease as PMBCL, but also reminds about such a diagnostic error in oncology-treatment without verification. We tried to emphasize the nesessary of strict implementation of the algorithm for differential diagnosis of the anterior mediastinal neoplasms, especially for young people. I hope that this case will contribute to the expansion of knowledge and the prevention of errors in order to achieve better results.

Sarcomatoid Carcinoma Of The Mediastinal : A Rare Case of Giant Mass Thymic Carcinoma Subtype

Introduction: Sarcomatoid carcinoma is a type of thymus carcinoma that contains partial or complete spindle cells. Incidence of Sarcomatoid Carcinoma 5-10% of all patients with thymic carcinoma. Carcinoma Sarcomatoid is a highly progressive tumor, most patients will die after 3 years of diagnosis despite aggressive multimodality therapy. Case Description: A 47-year-old woman with chest pain, shortness of breath, coughing, weight loss, enlarging lump in the neck and chest was felt for 1 month. Physical and supporting examination showed anterior superior mediastinal tumors and soft mass tissue in the right region of the Colli. Based on the Transthoracal FNAB Guiding ultrasound and FNAB the anterior colli region concluded that Thymoma, thyroid oncocytic adenoma and Nodular colloid goiter with azkanasy cell proliferation. The patient had Partial Sternotomy (Hemiclamshell), thymectomy with the final diagnosis of Sarcomatoid Carcinoma. Discussion: Sarcomatoid carcinoma is a type of thymic carcinoma that has both malignant epithelium (carcinomatous) and spindle cells (sarcomatous/sarcomatoid), generally with a transition between the two. This case was interesting because of the rare occurrence of Sarcomatoid Carcinoma plus the large size of tumor mass in this patient.

Diagnostic Challenges in Fine-Needle Aspiration Cytology of Mediastinal Tumors and Lesions

Context.— Mediastinal tumors/lesions are frequently encountered in daily cytopathology practice. These lesions are accessible through endoscopic/endobronchial ultrasound-guided or computed tomography–guided fine-needle aspiration cytology and represent a wide range of primary and metastatic tumors. This often poses diagnostic challenges because of the complexity of the mediastinal anatomic structures. Tumors metastatic to mediastinal lymph nodes represent the most common mediastinal lesions and must be differentiated from primary lesions. Objective.— To provide an updated review on the fine-needle aspiration cytology of mediastinal tumors/lesions, with an emphasis on diagnostic challenges. This review encompasses thymic epithelial neoplasms, mediastinal lymphoproliferative disorders, germ cell tumors, neuroendocrine tumors, soft tissue tumors, and metastatic tumors. Differential diagnoses; useful ancillary studies, including targeted immunohistochemical panels; and diagnostic pitfalls are discussed. Data Sources.— Data were gathered from a PubMed search of peer-reviewed literature on mediastinal tumors. Data were also collected from the authors' own practices. Conclusions.— Fine-needle aspiration cytology plays a vital role in evaluation of mediastinal lesions. Being familiar with the clinical and cytomorphologic features of these lesions, appropriately triaging the diagnostic material for ancillary testing, and correlating with radiologic findings are important in arriving at correct diagnoses and guiding management.

Rare Condition of Intrathoracic Phrenic Nerve Schwannoma Successfully Treated with Uniportal Video-Assisted Thoracoscopic Surgery

Introduction. Neurogenic tumors in the mediastinum account for approximately 20-30% of all types of mediastinal tumors in adults. This pathology is usually benign and has no or very few symptoms. Schwannoma rarely involves the phrenic nerve. We report a unique case of schwannoma involvement of phrenic nerve. Case Presentation. The 43-year-old female patient has an annual check-up of computerized tomography to detect the mass in the right middle mediastinum, so the patient was admitted to the hospital. Chest computerized tomography image found a mass of the middle mediastinum with the size of 23 × 22.3 mm located between the right pulmonary artery and the pericardium with uniform margins and clear boundaries, not invading the surrounding organization. Very little contrast is absorbed after injection. She underwent a uniportal video-assisted thoracoscopic surgery, and this mass was found to be originating from the right phrenic nerve. Resection of the portion of phrenic nerve with mass was performed. Postoperatively, the patient was discharged from the hospital after 4 days of treatment in a clinical condition with no difficulty breathing and no chest pain; postoperative X-ray showed no abnormality, and the right diaphragm was unchanged. Conclusion. Although they are very rare, schwannomas of the phrenic nerve should be considered in the differential diagnosis of mediastinal tumors. Uniportal video-assisted thoracoscopic surgery is a preeminent option with properly sized tumors that deliver good results and have no postoperative complications associated with surgery.

Robotic-assisted Thoracoscopic Resection of Anterior Mediastinal Cystic Teratoma: A Case Report and Literature Review

BackgroundMediastinal teratomas are rare tumors that most frequently occur in the anterior mediastinum. The majority of these tumors are benign and slow growing. Due to their low malignant potential, the treatment for these tumors is surgical resection. The surgical management has shifted from invasive approaches such as a sternotomy to minimally invasive ones such as robotic-assisted thoracoscopic resections. Though many cases of mediastinal teratomas have been reported, we present a rare case of a locally advanced mediastinal teratoma requiring patient repositioning and change in ventilatory management mid-procedure to facilitate complete resection.Case PresentationA 43 year-old female was found to have an anterior mediastinal mass during work-up for an intermittent cough in 2009. Chest imaging and biopsy at the time showed evidence of a cystic teratoma without concerning features. She underwent imaging surveillance until 2018, when chest imaging showed increasing growth and worrisome radiologic features concerning for malignant degeneration. She underwent an elective robotic-assisted thoracoscopic resection utilizing double lung ventilation, but due to extensive involvement of the right lung, pericardium, superior vena cava, and right phrenic nerve the patient had to be repositioned and started on single lung ventilation mid-procedure to facilitate a safe and complete resection.ConclusionsAnterior mediastinal teratomas can be successfully removed by robotic-assisted thoracoscopic resections utilizing single lung ventilation. Though robotic-assisted thoracoscopic resection utilizing double lung ventilation can be effective in performing lung wedge resections and pleural biopsies, it is limited in removing locally advanced mediastinal tumors.