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Sample records for diagnosing mediastinal lymph

  1. Mediastinal lymph node size in lung cancer

    SciTech Connect

    Libshitz, H.I.; McKenna, R.J. Jr.

    1984-10-01

    Using a size criterion of 1 cm or greater as evidence for abnormality, the size of mediastinal lymph nodes identified by computed tomography (CT) was a poor predictor of mediastinal lymph node metastases in a series of 86 patients who had surgery for bronchogenic carcinoma. The surgery included full nodal sampling in all patients. Of the 86 patients, 36 had nodes greater than or equal to 1 cm identified by CT. Of the 21 patients with mediastinal metastases proven at surgery, 14 had nodes greater than or equal to 1 cm (sensitivity = 67%). Of the 65 patients without mediastinal metastases, 22 had nodes greater than or equal to 1 cm. Obstructive pneumonia and/or pulmonary collapse distal to the cancer was present in 39 patients (45%). Obstructive pneumonia and/or pulmonary collapse is a common occurrence in bronchogenic carcinoma, but mediastinal nodes greater than or equal to 1 cm in this circumstance cannot be presumed to represent metastatic disease. Metastatic mediastinal lymph node involvement was related to nodal size also in patients with evidence of prior granulomatous disease and in patients with no putative benign cause for nodes greater than or equal to 1 cm.

  2. Pathological assessment of mediastinal lymph nodes in lung cancer: implications for non-invasive mediastinal staging.

    PubMed Central

    Kerr, K M; Lamb, D; Wathen, C G; Walker, W S; Douglas, N J

    1992-01-01

    BACKGROUND: The use of computed tomography in mediastinal staging of lung cancer relies on the premiss that malignant lymph nodes are larger than benign ones. This hypothesis was tested by linking node size and presence or absence of malignancy and looking at factors possibly influencing the size of benign nodes. METHODS: All accessible mediastinal lymph nodes were taken from 56 consecutive patients with lung cancer who underwent thoracotomy. Nodes were measured and histologically examined. Resected cancer bearing lung from 44 of these patients was assessed for degree of acute and chronic inflammation. RESULTS: Lymph node size was not significantly related to the presence of metastatic disease, 58% of malignant and 43% of benign lymph nodes measuring over 15 mm. Similarly, there was no statistically significant relation between size of lymph nodes and the likelihood of malignancy, 20% of lymph nodes of 10 mm or more but also 15% of those less than 10 mm being malignant. Thresholds of 15 and 20 mm showed similar results. The maximum size of benign lymph nodes was significantly greater in those patients with histological evidence of acute pulmonary inflammation than in those without. CONCLUSIONS: The study shows that in patients with lung cancer (1) malignant mediastinal lymph nodes are not larger than benign nodes; (2) small mediastinal lymph nodes are not infrequently malignant; and (3) benign adenopathy is more common in patients with acute pulmonary inflammation. Images PMID:1609375

  3. The flow and composition of lymph from the caudal mediastinal lymph node of sheep.

    PubMed Central

    Spencer, J; Hall, J G

    1984-01-01

    By cannulating the efferent duct of the caudal mediastinal lymph node in sheep, lymph from the lower respiratory tract was collected under physiological conditions for several days. In 18 such preparations the flow rate varied from 4 to 12 ml/hr between individuals and the lymphocyte count between 4000 and 117,000/mm3. The protein content of the lymph plasma averaged nearly 60% of that of the blood, and this indication of the high permeability of the capillary bed of the lungs was confirmed by measuring the time taken for intravenous doses of 125I-albumin to equilibrate between the blood and mediastinal lymph plasma. The concentration of immunoglobulin A was higher in the mediastinal lymph than in blood serum, while the reverse was true of the concentrations of IgG1, IgG2, and IgM. This evidence for the local production of IgA by the intra thoracic lymphoid tissue was supported by the demonstration by immunoperoxidase techniques of IgA-containing plasma cells in sections cut from the caudal mediastinal nodes, and of IgA-containing immunoblasts in the lymph. Images Figure 3 PMID:6715022

  4. Lung Cancer Detected 5 Years after Resection of Cancer of Unknown Primary in a Mediastinal Lymph Node: A Case Report and Review of Relevant Cases from the Literature

    PubMed Central

    Arakaki, Kazunari; Taira, Naohiro; Furugen, Tomonori; Ichi, Takaharu; Yohena, Tomofumi; Kawabata, Tsutomu

    2015-01-01

    We report the rare and interesting case of a primary lung cancer detected 5 years after cancer of unknown primary (CUP) of a mediastinal lymph node (LN) was resected. A 40-year-old male was diagnosed with adenocarcinoma of unknown primary in a mediastinal lymph node after resection of the mediastinal tumor. Five years after resection of the CUP in mediastinal LN, a small, abnormal nodular shadow in left upper lobe was detected by chest CT. This pulmonary tumor was diagnosed as a lung adenocarcinoma. The pathological and immunohistological findings of the resected pulmonary tumor resembled those of the LN resected 5 years before. We speculated that the pulmonary lesion represented primary lung cancer that enlarged later than the metastatic mediastinal LN. This case illustrates the importance of careful observation and long-term follow-up in patients treated for CUP of a thoracic LN. PMID:26328596

  5. [Mediastinal lymph node carcinoma of unknown primary site; report of a case].

    PubMed

    Miura, K; Yoshizawa, K; Tamaki, M; Okumura, K; Furukita, Y

    2009-03-01

    A 44-year-old woman was admitted to our hospital because of mediastinal mass. Serum levels of carcinoembryonic antigen (CEA) were found to be elevated. No preoperative examination could detect the primary lesion. The tumor was resected through right thoracotomy. Histological examination revealed poorly differentiated adenocarcinoma. She was diagonosed as metastatic mediastinal lymph node carcinoma of unknown primary site. She received radiotherapy and chemotherapy and is desease free 29 months after operation. Good results may be obtained by multimodality therapies for cancer in mediastinal lymph node of unknown primary site. PMID:19280962

  6. Mediastinal lymph node metastasis of renal cell carcinoma: A case report

    PubMed Central

    MIYAZAKI, KUNIHIKO; SATO, SHINYA; KODAMA, TAKAHIDE; KURISHIMA, KOICHI; SATOH, HIROAKI; HIZAWA, NOBUYUKI

    2016-01-01

    Renal cell carcinoma (RCC) may metastasize to mediastinal lymph nodes without any abdominal lymph node involvement. The present study describes an autopsy-proven case of RCC presenting with a large mediastinal mass; the case had been previously misdiagnosed as small cell lung carcinoma due to imaging analysis results, an elevated serum level of neuron-specific enolase and the presence of small atypical cells with a high nuclear/cytoplasmic ratio. Despite RCC occurrence being rare, it should be considered in the differential diagnosis, particularly when a mass located in the kidneys presents with metastases to the mediastinal lymph nodes, even if there is no involvement of the abdominal lymph nodes and the primary lesion is of a small size. PMID:26893788

  7. Solitary mediastinal lymph node recurrence after curative resection of colon cancer.

    PubMed

    Matsuda, Yasuhiro; Yano, Masahiko; Miyoshi, Norikatsu; Noura, Shingo; Ohue, Masayuki; Sugimura, Keijiro; Motoori, Masaaki; Kishi, Kentaro; Fujiwara, Yoshiyuki; Gotoh, Kunihito; Marubashi, Shigeru; Akita, Hirofumi; Takahashi, Hidenori; Sakon, Masato

    2014-08-27

    We report two cases of solitary mediastinal lymph node recurrence after colon cancer resection. Both cases had para-aortic lymph node metastasis at the time of initial surgery and received adjuvant chemotherapy for 4 years in case 1 and 18 mo in case 2. The time to recurrence was more than 8 years in both cases. After resection of the recurrent tumor, the patient is doing well with no recurrence for 6 years in case 1 and 4 mo in case 2. Patients should be followed up after colon cancer surgery considering the possibility of solitary mediastinal lymph node recurrence if they had para-aortic node metastasis at the time of initial surgery. PMID:25161766

  8. Colon cancer metastasis to mediastinal lymph nodes without liver or lung involvement: A case report.

    PubMed

    El-Halabi, Mustapha M; Chaaban, Said A; Meouchy, Joseph; Page, Seth; Salyers, William J

    2014-11-01

    Colon cancer is the second most common type of cancer in females and the third in males, worldwide. The most common sites of colon cancer metastasis are the regional lymph nodes, liver, lung, bone and brain. In this study, an extremely rare case of colon adenocarcinoma with extensive metastasis to the mediastinal lymph nodes without any other organ involvement is presented. A 44-year-old Caucasian male presented with abdominal pain, a change in bowel habits, melena and weight loss. Colonoscopy revealed a large friable, ulcerated, circumferential mass in the ascending colon. Biopsies were consistent with the diagnosis of invasive moderately differentiated adenocarcinoma. Subsequently, right colon resection was performed, and pathological analysis revealed moderately differentiated adenocarcinoma of the right colon with extensive regional lymph node involvement. Computed tomography (CT) scans of the chest, abdomen and pelvis were performed preoperatively as part of routine staging for colon cancer. No liver or lung pathology was identified; however, multiple pathologically enlarged mediastinal lymph nodes were observed. Endoscopic ultrasound with fine needle aspiration of the largest mediastinal lymph node, which measured 5.2×3.5 cm on CT scans, was performed. The pathology was again consistent with the diagnosis of metastatic colorectal primary adenocarcinoma. At present, no optimum treatment has been identified for metastatic colon cancer to the mediastinal lymph nodes. The patient in the current case received chemotherapy with folinic acid, fluorouracil and oxaliplatin (FOLFOX), as well as with bevacizumab. Initial follow-up CT scans of the chest revealed a positive response to treatment. Physicians, in particular, radiologists, must consider the mediastinum during the first evaluation and further follow-up of patients with colorectal carcinoma even in the absence of metastasis. PMID:25289100

  9. Impact of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration on Diagnostic Yield of Bronchoscopy in Patients with Mediastinal Lymph Node Enlargement.

    PubMed

    Osinka, K; Zielińska-Krawczyk, M; Korczyński, P; Górnicka, B; Krenke, R

    2016-01-01

    Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) had an enormous impact on the current advancement in diagnostic bronchoscopy. The aims of the present study were: (1) to evaluate the added value of EBUS-TBNA to routine diagnostic bronchoscopy performed in patients with mediastinal lymph node enlargement and (2) to identify factors that affect the diagnostic yield of EBUS-TBNA. We retrospectively analyzed 712 EBUS-TBNA procedures out of the 4081 bronchoscopies performed in the years 2009-2014. The number of EBUS-TBNA procedures increased from 61 (8.8 % of all bronchoscopies) in 2009 to 160 (21.4 %) in 2014. In 625 (87.8 %) patients adequate cytological material was obtained. Based on cytological examination of EBUS-TBNA aspirates, specific diagnosis was made in 367 (51.5 %) patients. The forceps biopsy of endobronchial lesions provided specific diagnosis in only 204 (28.6 %) patients. The percentage of patients with EBUS-TBNA based diagnosis increased steadily from 34.4 % in 2009 to 65.0 % in 2014 (p < 0.0001). The median lymph node diameter in patients with positive EBUS-TBNA findings was 20 (IQR 15-30) mm and was significantly larger than that in patients with negative EBUS-TBNA results (15 (IQR 10-20) mm, p = 0.0001). The highest diagnostic yield (78.5 %) was found in patients with lymph node dimension between 31 mm and 40 mm. We conclude that EBUS-TBNA is a valuable diagnostic method in an unselected group of patients with mediastinal lymph node enlargement. The percentage of positive EBUS-TBNA diagnoses is related to lymph node dimensions. The overall efficacy of EBUS-TBNA improves with increasing years of experience. PMID:26987324

  10. Posterior mediastinal mass diagnosed as schwanomma with concomittant tuberculosis

    PubMed Central

    Tripathi, Surya Kant; Mishra, Ashwini Kumar; Verma, Ajay Kumar; Prakash, Ved

    2014-01-01

    A 21-year-old non-smoker, non-hypertensive male without diabetes was referred to our pulmonary medicine department with suspected malignant intrathoracic mass. The clinicoradiological evaluation revealed that it could be a posterior mediastinal mass. The same diagnosis was confirmed on performing CT and MRI. Benign posterior mediastinal schwanomma was suspected as it is the most common posterior mediastinal mass. It was completely resected. Histopathological examination confirmed the same. The mass was also sent for culture for mycobacterium which came out to be positive. The patient recovered from the surgery and postoperative X-ray showed complete clearance. He was treated with antitubercular treatment and responded very well. PMID:25246469

  11. [Multiple retroperitoneal and mediastinal lymph cysts in primary ectatic lymph vessels].

    PubMed

    Graf, D; Pfister, J; Streuli, H K

    1993-09-01

    A unique case of a large retroperitoneal and multiple mediastinal lymphcysts is presented. Cystic abdominal tumors of lymphatic origin are very rare. Usually single cases or small numbers have been reported in the international literature. The aetiology, clinical findings and therapy of these lesions are discussed.

  12. [Mediastinitis].

    PubMed

    Martínez Vallina, Primitivo; Espinosa Jiménez, Dionisio; Hernández Pérez, Lucía; Triviño Ramírez, Ana

    2011-01-01

    Mediastinitis is defined as acute or chronic inflammation of the mediastinal structures and generally has a low incidence. The most frequent acute cause is sternotomy following cardiac revascularization surgery with both internal mammary arteries, with an incidence of 0.4% to 5% and a mortality of 16.5% to 47%. The most frequent vector is Staphylococcus aureus. Esophageal perforation, usually iatrogenic, is the second most frequent cause of acute mediastinitis, produced by common oropharyngeal flora, with a mortality rate of 20% to 60%, depending on the time of diagnosis. The third most frequent cause is descending necrotizing mediastinitis, the origin being an odontogenous focus in 60% and beta-hemolytic streptococcus the causative agent in 71.5% of cases. The most accurate diagnostic imaging technique is computed tomography. Treatment is almost always surgical and survival depends on its early performance. The worst postsurgical prognostic factor is septic shock.

  13. Mediastinitis

    MedlinePlus

    ... heart valve surgery, or coronary artery bypass surgery. Did You Know... A child who swallows a button ... treatment for fibrosing mediastinitis. Resources In This Article Did You Know 1 Did You Know... Pleural and ...

  14. Mediastinitis

    MedlinePlus

    ... Trauma Other causes of mediastinitis include: Histoplasmosis Radiation Sarcoidosis Tuberculosis Breathing in anthrax Cancer Risk factors include: ... of breath If you have tuberculosis, histoplasmosis, or sarcoidosis and develop any of these symptoms, contact your ...

  15. Differential Motion Between Mediastinal Lymph Nodes and Primary Tumor in Radically Irradiated Lung Cancer Patients

    SciTech Connect

    Schaake, Eva E.; Rossi, Maddalena M.G.; Buikhuisen, Wieneke A.; Burgers, Jacobus A.; Smit, Adrianus A.J.; Belderbos, José S.A.; Sonke, Jan-Jakob

    2014-11-15

    Purpose/Objective: In patients with locally advanced lung cancer, planning target volume margins for mediastinal lymph nodes and tumor after a correction protocol based on bony anatomy registration typically range from 1 to 1.5 cm. Detailed information about lymph node motion variability and differential motion with the primary tumor, however, is lacking from large series. In this study, lymph node and tumor position variability were analyzed in detail and correlated to the main carina to evaluate possible margin reduction. Methods and Materials: Small gold fiducial markers (0.35 × 5 mm) were placed in the mediastinal lymph nodes of 51 patients with non-small cell lung cancer during routine diagnostic esophageal or bronchial endoscopic ultrasonography. Four-dimensional (4D) planning computed tomographic (CT) and daily 4D cone beam (CB) CT scans were acquired before and during radical radiation therapy (66 Gy in 24 fractions). Each CBCT was registered in 3-dimensions (bony anatomy) and 4D (tumor, marker, and carina) to the planning CT scan. Subsequently, systematic and random residual misalignments of the time-averaged lymph node and tumor position relative to the bony anatomy and carina were determined. Additionally, tumor and lymph node respiratory amplitude variability was quantified. Finally, required margins were quantified by use of a recipe for dual targets. Results: Relative to the bony anatomy, systematic and random errors ranged from 0.16 to 0.32 cm for the markers and from 0.15 to 0.33 cm for the tumor, but despite similar ranges there was limited correlation (0.17-0.71) owing to differential motion. A large variability in lymph node amplitude between patients was observed, with an average motion of 0.56 cm in the cranial-caudal direction. Margins could be reduced by 10% (left-right), 27% (cranial-caudal), and 10% (anteroposterior) for the lymph nodes and −2%, 15%, and 7% for the tumor if an online carina registration protocol replaced a

  16. Automatic localization of IASLC-defined mediastinal lymph node stations on CT images using fuzzy models

    NASA Astrophysics Data System (ADS)

    Matsumoto, Monica M. S.; Beig, Niha G.; Udupa, Jayaram K.; Archer, Steven; Torigian, Drew A.

    2014-03-01

    Lung cancer is associated with the highest cancer mortality rates among men and women in the United States. The accurate and precise identification of the lymph node stations on computed tomography (CT) images is important for staging disease and potentially for prognosticating outcome in patients with lung cancer, as well as for pretreatment planning and response assessment purposes. To facilitate a standard means of referring to lymph nodes, the International Association for the Study of Lung Cancer (IASLC) has recently proposed a definition of the different lymph node stations and zones in the thorax. However, nodal station identification is typically performed manually by visual assessment in clinical radiology. This approach leaves room for error due to the subjective and potentially ambiguous nature of visual interpretation, and is labor intensive. We present a method of automatically recognizing the mediastinal IASLC-defined lymph node stations by modifying a hierarchical fuzzy modeling approach previously developed for body-wide automatic anatomy recognition (AAR) in medical imagery. Our AAR-lymph node (AAR-LN) system follows the AAR methodology and consists of two steps. In the first step, the various lymph node stations are manually delineated on a set of CT images following the IASLC definitions. These delineations are then used to build a fuzzy hierarchical model of the nodal stations which are considered as 3D objects. In the second step, the stations are automatically located on any given CT image of the thorax by using the hierarchical fuzzy model and object recognition algorithms. Based on 23 data sets used for model building, 22 independent data sets for testing, and 10 lymph node stations, a mean localization accuracy of within 1-6 voxels has been achieved by the AAR-LN system.

  17. Motion Analysis of 100 Mediastinal Lymph Nodes: Potential Pitfalls in Treatment Planning and Adaptive Strategies

    SciTech Connect

    Pantarotto, Jason R.; Piet, Anna H.M.; Vincent, Andrew; Soernsen de Koste, John R. van; Senan, Suresh

    2009-07-15

    Purpose: The motion of mediastinal lymph nodes may undermine local control with involved-field radiotherapy. We studied patterns of nodal and tumor motion in 41 patients with lung cancer. Methods and Materials: Four-dimensional (4D) computed tomography planning scans were retrospectively evaluated to identify patients with clearly visible mediastinal lymph nodes. One hundred nodes from 14 patients with Stage I and 27 patients with Stage III were manually contoured in all 4D computed tomography respiratory phases. Motion was derived from changes in the nodal center-of-mass position. Primary tumors were also delineated in all phases for 16 patients with Stage III disease. Statistical analysis included a multivariate mixed-effects model of grouped data. Results: Average 3D nodal motion during quiet breathing was 0.68 cm (range, 0.17-1.64 cm); 77% moved greater than 0.5 cm, and 10% moved greater than 1.0 cm. Motion was greatest in the lower mediastinum (p = 0.002), and nodes measuring 2 cm or greater in diameter showed motion similar to that in smaller nodes. In 11 of 16 patients studied, at least one node moved more than the corresponding primary tumor. No association between 3D primary tumor motion and nodal motion was observed. For mobile primary tumors, phase offsets between the primary tumor and nodes of two or more and three or more phases were observed for 33% and 12% of nodes, respectively. Conclusions: Mediastinal nodal motion is common, with phase offsets seen between the primary tumor and different nodes in the same patient. Patient-specific information is needed to ensure geometric coverage, and adaptive strategies based solely on the primary tumor may be misleading.

  18. Automatic identification of IASLC-defined mediastinal lymph node stations on CT scans using multi-atlas organ segmentation

    NASA Astrophysics Data System (ADS)

    Hoffman, Joanne; Liu, Jiamin; Turkbey, Evrim; Kim, Lauren; Summers, Ronald M.

    2015-03-01

    Station-labeling of mediastinal lymph nodes is typically performed to identify the location of enlarged nodes for cancer staging. Stations are usually assigned in clinical radiology practice manually by qualitative visual assessment on CT scans, which is time consuming and highly variable. In this paper, we developed a method that automatically recognizes the lymph node stations in thoracic CT scans based on the anatomical organs in the mediastinum. First, the trachea, lungs, and spines are automatically segmented to locate the mediastinum region. Then, eight more anatomical organs are simultaneously identified by multi-atlas segmentation. Finally, with the segmentation of those anatomical organs, we convert the text definitions of the International Association for the Study of Lung Cancer (IASLC) lymph node map into patient-specific color-coded CT image maps. Thus, a lymph node station is automatically assigned to each lymph node. We applied this system to CT scans of 86 patients with 336 mediastinal lymph nodes measuring equal or greater than 10 mm. 84.8% of mediastinal lymph nodes were correctly mapped to their stations.

  19. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.

    PubMed

    Jenssen, Christian; Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin-Wu; Borst, Mathias Maximilian; Dietrich, Christoph Frank

    2015-10-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.

  20. A case of lymphangioleiomyomatosis affecting the supraclavicular lymph nodes.

    PubMed

    Kamitani, Takeshi; Yabuuchi, Hidetake; Soeda, Hiroyasu; Matsuo, Yoshio; Okafuji, Takashi; Sakai, Shuji; Hatakenaka, Masamitsu; Minami, Takahiro; Inoue, Hiromasa; Tanaka, Atsuo; Kohno, Hiroyuki; Tanaka, Michiko; Nakashima, Yutaka; Honda, Hiroshi

    2006-01-01

    The case of a 46-year-old woman with lymphangioleiomyomatosis (LAM) involving the supraclavicular, mediastinal, and pelvic lymph nodes in addition to the lungs is reported. Computed tomography incidentally revealed multiple thin-walled pulmonary cysts and low-attenuating masses in the supraclavicular, mediastinal, and retroperitoneal lymph nodes. A biopsy of the supraclavicular mass was performed and diagnosed as LAM histopathologically. The common sites of extrapulmonary LAM include retroperitoneal and mediastinal lymph nodes; however, supraclavicular lymph node involvement is extremely rare.

  1. Initial experience with real-time elastography using an ultrasound bronchoscope for the evaluation of mediastinal lymph nodes.

    PubMed

    Andreo García, Felipe; Centeno Clemente, Carmen Ángela; Sanz Santos, José; Barturen Barroso, Ángel; Hernández Gallego, Alba; Ruiz Manzano, Juan

    2015-02-01

    Real-time elastography performed during endoscopic ultrasonography is a relatively new method for characterizing tissue stiffness, and has been used successfully as a predictor of malignancy in mediastinal lymph nodes. This case report describes our practical experience with this technique using an ultrasound bronchoscope to examine mediastinal lymph nodes. We present a case of sectorial endobronchial ultrasound and the first published case of endoscopic ultrasound elastography using ultrasound bronchoscope in two patients with non-small cell lung carcinoma. Qualitative tissue color pattern was obtained in both cases and correlated with pathological evaluation. The initial feasibility results are promising and suggest that ultrasound bronchoscopy techniques, such as guided nodal staging, merit additional studies. It may be important to categorize the risk of malignancy to facilitate sampling decisions. PMID:25443586

  2. Initial experience with real-time elastography using an ultrasound bronchoscope for the evaluation of mediastinal lymph nodes.

    PubMed

    Andreo García, Felipe; Centeno Clemente, Carmen Ángela; Sanz Santos, José; Barturen Barroso, Ángel; Hernández Gallego, Alba; Ruiz Manzano, Juan

    2015-02-01

    Real-time elastography performed during endoscopic ultrasonography is a relatively new method for characterizing tissue stiffness, and has been used successfully as a predictor of malignancy in mediastinal lymph nodes. This case report describes our practical experience with this technique using an ultrasound bronchoscope to examine mediastinal lymph nodes. We present a case of sectorial endobronchial ultrasound and the first published case of endoscopic ultrasound elastography using ultrasound bronchoscope in two patients with non-small cell lung carcinoma. Qualitative tissue color pattern was obtained in both cases and correlated with pathological evaluation. The initial feasibility results are promising and suggest that ultrasound bronchoscopy techniques, such as guided nodal staging, merit additional studies. It may be important to categorize the risk of malignancy to facilitate sampling decisions.

  3. Mediastinal lymph node detection on thoracic CT scans using spatial prior from multi-atlas label fusion

    NASA Astrophysics Data System (ADS)

    Liu, Jiamin; Zhao, Jocelyn; Hoffman, Joanne; Yao, Jianhua; Zhang, Weidong; Turkbey, Evrim B.; Wang, Shijun; Kim, Christine; Summers, Ronald M.

    2014-03-01

    Lymph nodes play an important role in clinical practice but detection is challenging due to low contrast surrounding structures and variable size and shape. We propose a fully automatic method for mediastinal lymph node detection on thoracic CT scans. First, lungs are automatically segmented to locate the mediastinum region. Shape features by Hessian analysis, local scale, and circular transformation are computed at each voxel. Spatial prior distribution is determined based on the identification of multiple anatomical structures (esophagus, aortic arch, heart, etc.) by using multi-atlas label fusion. Shape features and spatial prior are then integrated for lymph node detection. The detected candidates are segmented by curve evolution. Characteristic features are calculated on the segmented lymph nodes and support vector machine is utilized for classification and false positive reduction. We applied our method to 20 patients with 62 enlarged mediastinal lymph nodes. The system achieved a significant improvement with 80% sensitivity at 8 false positives per patient with spatial prior compared to 45% sensitivity at 8 false positives per patient without a spatial prior.

  4. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases.

    PubMed Central

    Martini, N; Flehinger, B J; Zaman, M B; Beattie, E J

    1983-01-01

    From 1974 to 1981, 1598 patients with non-oat cell carcinoma of the lung were seen and treated. All were staged according to the AJC staging system. Of these, 706 patients had evidence of mediastinal lymph node metastases (N2). There were 151 patients (21%) who had complete, potentially curative resection of their primary tumor and all accessible mediastinal lymph nodes. The histologic type of tumor was adenocarcinoma in 94 patients, epidermoid carcinoma in 46 patients, and large-cell carcinoma in 11 patients. The extent of pulmonary resection consisted of a lobectomy in 119 patients, pneumonectomy in 26 patients, and wedge resection or segmentectomy in six patients. Almost all patients also received radiation therapy to the mediastinum. Clinical staging of the primary tumor and the mediastinum was based on the radiographic presentation of the chest and on bronchoscopy. Before treatment, 104 of 151 patients (69%) were believed to have had stage I (90 patients) or II (14 patients) disease, and 47 patients had stage III disease, of whom only 33 had evidence of mediastinal lymph node involvement. Excluding deaths from unrelated causes, the overall survival rate was 74% at 1 year, 43% at 3 years and 29% at 5 years. Survival in patients with clinical stage I or II disease treated by resection was favorable despite the presence of N2 nodes (50% at 3 years). Survival in obvious clinical N2 disease was poor (8% at 3 years). There was no difference in survival between patients with adenocarcinoma and those with epidermoid carcinoma. However, survival was poorer in patients with N2 nodes in the inferior mediastinum compared to those without lymph node involvement at that level. PMID:6615059

  5. Stereotactic radiation therapy for oligometastases or oligorecurrence within mediastinal lymph nodes

    PubMed Central

    Wang, Huan-Huan; Zaorsky, Nicholas G.; Meng, Mao-Bin; Zeng, Xian-Liang; Deng, Lei; Song, Yong-Chun; Zhuang, Hong-Qing; Li, Feng-Tong; Zhao, Lu-Jun; Yuan, Zhi-Yong; Wang, Ping; Hao, Xi-Shan

    2016-01-01

    Aims This study evaluated the safety and efficacy of stereotactic radiation therapy (SRT) for the treatment of patients with oligometastases or oligorecurrence within mediastinal lymph nodes (MLNs) originating from different tumors. Methods Between October 2006 and May 2015, patients with MLN oligometastases or oligorecurrence were enrolled and treated with SRT at our hospital. The primary endpoint was MLN local control (LC). Secondary endpoints were time to symptom alleviation, overall survival (OS) after SRT, and toxicity using the Common Terminology Criteria for Adverse Events (CTCAE v4.0). Results Eighty-five patients with 98 MLN oligometastases or oligorecurrences were treated with SRT. For the entire cohort, the 1-year and 5-year actuarial LC rates were 97% and 77%, respectively. Of 53 symptomatic patients, symptom alleviation was observed in 47 (89%) after a median of 5 days (range, 3-30 days). The median OS was 27.2 months for all patients. For patients with non-small cell lung cancer, univariate and multivariate analyses revealed that a shorter interval between diagnosis of primary tumors and SRT and larger MLN SRT volume were associated with worse OS. CTCAE v4.0 ≥ Grade 3 toxicities occurred in six patients (7%), with Grade 5 in three patients (all with RT history to MLN station 7). Conclusions SRT is a safe and efficacious treatment modality for patients with oligometastases or oligorecurrence to MLNs originating from different tumors, except for patients who received radiotherapy to MLN station 7. Further investigation is warranted to identify the patients who benefit most from this treatment modality. PMID:26919113

  6. Intensity targeted radial structure tensor analysis and its application for automated mediastinal lymph node detection from CT volumes

    NASA Astrophysics Data System (ADS)

    Oda, Hirohisa; Nimura, Yukitaka; Oda, Masahiro; Kitasaka, Takayuki; Iwano, Shingo; Honma, Hirotoshi; Takabatake, Hirotsugu; Mori, Masaki; Natori, Hiroshi; Mori, Kensaku

    2016-03-01

    This paper presents a new blob-like enhancement filter based on Intensity Targeted Radial Structure Tensor (ITRST) analysis to improve mediastinal lymph node detection from chest CT volumes. Blob-like structure enhancement filter based on Radial Structure Tensor (RST) analysis can be utilized for initial detection of lymph node candidate regions. However, some of lymph nodes cannot be detected because RST analysis is influenced by neighboring regions whose intensity is very high or low, such as contrast-enhanced blood vessels and air. To overcome the problem, we propose ITRST analysis that integrate the prior knowledge on detection target intensity into RST analysis. Our lymph node detection method consists of two steps. First, candidate regions are obtained by ITRST analysis. Second, false positives (FPs) are removed by the Support Vector Machine (SVM) classifier. We applied the proposed method to 47 cases. Among 19 lymph nodes whose short axis is no less than 10 mm, 100.0 % of them were detected with 247.7 FPs/case by ITRST analysis, while only 80.0 % were detected with 123.0 FPs/case by RST analysis. After the false positive (FP) reduction by SVM, ITRST analysis outperformed RST analysis in lymph node detection performance.

  7. Insight into the differences in classification of mediastinal and hilar lymph nodes between Wang's lymph node map and the International Association for the Study of Lung Cancer lymph node map.

    PubMed

    Li, Ya-Qing; Wang, Ko-Pen; Ben, Su-Qin

    2015-12-01

    Lung cancer is the leading cause of malignant-tumor-related morbidity and mortality worldwide. Transbronchial needle aspiration (TBNA) has for the past 30 years been an effective technique for the diagnosis and staging of lung cancer. Understanding the anatomy of mediastinal and hilar lymph nodes is essential to improve the yield of TBNA. Wang's lymph node map is based on the lymph node map of the American Thoracic Society (ATS), and on the TBNA technique; it was published in 1994, and has promoted the development of both conventional TBNA (cTBNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In 2009, the International Association for the Study of Lung Cancer (IASLC) developed a new chest lymph node map to reconcile the differences between the Naruke and The Mountain-Dresler (MD)-ATS lymph node maps. The IASLC lymph node map was incorporated into the seventh edition of the tumor, node, metastasis (TNM) staging system for lung cancer, which directly affected the treatment and prognosis of lung cancer. There are significant differences between Wang's lymph node map and the IASLC lymph node map in TNM staging, and it is imperative to understand these differences and correlate these maps for the prognosis and staging of lung cancer using cTBNA or EBUS-TBNA.

  8. F-18-fluorodeoxyglucose positron emission tomography-guided sampling of mediastinal lymph nodes in the diagnosis of cardiac sarcoidosis.

    PubMed

    Simonen, Piia; Lehtonen, Jukka; Kandolin, Riina; Schildt, Jukka; Marjasuo, Suvi; Miettinen, Heikki; Airaksinen, Juhani; Vihinen, Tapani; Tuohinen, Suvi; Haataja, Petri; Kupari, Markku

    2015-11-15

    Histologic proof of granulomatous inflammation is prerequisite for the diagnosis of cardiac sarcoidosis (CS). Because of the limited sensitivity of endomyocardial biopsy (EMB), confirmation of sarcoidosis often has to be acquired from extracardiac biopsies. We set out to review our experience of F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG PET) in guiding extracardiac tissue biopsies in suspected CS. We included in this work 68 consecutive patients with proved CS who had undergone cardiac F-18-FDG PET with (n = 57) or without whole-body imaging as part of initial diagnostic evaluation. Their hospital charts, imaging studies, and diagnostic biopsies were reviewed in retrospect. Whole-body PET images showed extracardiac foci of abnormally high F-18-FDG uptake in 39 of 57 patients, of whom 38 had involvement of mediastinal lymph nodes (MLN). Parallel F-18-FDG uptake was found in other lymph nodes (n = 10), lungs (n = 9), liver (n = 3), spleen (n = 2), and thyroid gland (n = 1). Adding the mediastinal findings at cardiac PET without whole-body imaging, abnormal F-18-FDG uptake in MLN was found in totally 43 of the 68 patients with CS (63%). Histology of systemic sarcoidosis was known at presentation of cardiac symptoms in 8 patients. Of the 60 patients with missing histology, 24 patients underwent mediastinoscopy for sampling of PET-positive MLN, most often (n = 20) after nondiagnostic EMB; microscopy revealed diagnostic noncaseating granulomatous inflammation in 24 of the 24 cases (sensitivity 100%). In the remaining 36 patients, sarcoidosis histology was confirmed by EMB (n = 30), by biopsy of lungs (n = 2) or peripheral lymph nodes (n = 2), or at autopsy (n = 1) or post-transplantation (n = 1). In conclusion, MLN accumulate F-18-FDG at PET in most patients with CS and provide a highly productive source for diagnostic biopsies either primarily or subsequent to nondiagnostic EMB. PMID:26411357

  9. Normal mediastinal lymph node size and number: CT and anatomic study

    SciTech Connect

    Genereux, G.P.; Howie, J.L.

    1984-06-01

    Normal lymph nodes were studied retrospectively by computed tomography (CT) in 39 patients and by dissection at autopsy in 12 cadavers. The mediastinum was divided arbitrarily into four zones relating to the left innominate vein (zone 1), pretracheal space (zone 2), precarinal/subcarinal compartment (zone 3), and aorticopulmonary window (zone 4). Of 225 lymph nodes from all zones in the CT study, 99% measured less than 16 mm in largest diameter. Using contiguous 10-mm CT scans, lymph nodes were detected in 65%-95% of patients, depending on the zone studies. The mean number of lymph nodes on a representative section was 1.1. There was a significant size difference between lymph nodes residing in the superior mediastinum compared with those in the middle mediastinum contiguous to the carina. Thus, only 7% of lymph nodes in zone 1 were larger than 5 mm, whereas 90% and 67% of lymph nodes in zones 3 and 4, respectively, were larger, in the 6-10 mm range.

  10. Persistent mediastinal and axillary lymph node tuberculosis in a renal transplant patient with successful outcome.

    PubMed

    Oguz, Y; Yilmaz, M I; Eyileten, T; Caglar, K; Yenicesu, M; Kaya, A; Tasar, M; Saglam, M; Doganci, L; Gulec, B; Oner, K; Oktenli, C; Vural, A

    2006-06-01

    Tuberculosis is an opportunistic infection that carries substantial morbidity and mortality in renal transplant recipients. We report here about a 21 year-old man with a living related renal transplant from his mother who developed persistent extra-pulmonary tuberculosis. The disease showed aggressive invasion to the axillary and mediastinal regions with abscess formations, despite standard antituberculosis treatment. During the course of the disease, immunosuppressive therapy was stopped, and the patient received extraordinary doses of multiple antituberculosis drugs. The patient then showed an uneventful course with good clinical and radiological responses.

  11. Volume or Position Changes of Primary Lung Tumor During (Chemo-)Radiotherapy Cannot Be Used as a Surrogate for Mediastinal Lymph Node Changes: The Case for Optimal Mediastinal Lymph Node Imaging During Radiotherapy

    SciTech Connect

    Elmpt, Wouter van; Ollers, Michel; Herwijnen, Henrieke van; Holder, Linda den; Vercoulen, Lindsay; Wouters, Monique; Lambin, Philippe; De Ruysscher, Dirk

    2011-01-01

    Purpose: Primary lung tumors can be visualized mostly with cone beam computed tomography (CT), whereas visualization is much more difficult for mediastinal lymph nodes (LN). If the volumetric and positional changes of the primary tumor could be used as a surrogate for the LN, this would facilitate image-guided radiotherapy. The purpose of this study was to investigate the relationship between the positional and volumetric changes in primary tumors and the involved LN during (chemo)radiotherapy treatment of non-small-cell lung cancer patients. Methods and Materials: [{sup 18}F]fluorodeoxyglucose positron emission tomography/computed tomography imaging was performed before radiotherapy and in the second week of treatment in 35 patients. Gross tumor volumes (GTV) of the primary tumor (GTVprim) and of the involved LN (GTVlymph) were delineated. Changes in position and volume of GTVprim with respect to GTVlymph and the bony anatomy were compared. Results: In individual cases, large displacements up to 1.6 cm and volume changes of 50% of the primary tumor may occur that are not correlated to the changes in involved LN. The volume of GTVprim reduced, on average, by 5.7% {+-} 19.0% and was not correlated with the small increase of 1.4% {+-} 18.2% in involved LN volume. Compared to bony anatomy, displacement of the primary tumor was statistically correlated to the involved LN displacement. Conclusions: Volume and position changes of the primary tumor are not always predictive for LN changes. This suggests that for characterization of involved LN, repeated state-of-the-art mediastinal imaging during radiotherapy may be necessary.

  12. Esophageal Microperforation due to Calcified Mediastinal Lymph Node Leading to Tracheoesophageal Fistula.

    PubMed

    Dwivedi, Sankalp; Schrickel, E Brooke; Siddiqui, Fayez; O'Brien, John; Kruer, James

    2016-01-01

    A 42-year-old male presented with worsening gastroesophageal reflux disease symptoms and cough. The clinical symptoms during the early course of illness were striking for aspiration pneumonia. He was given a prescription of proton pump inhibitors and antibiotics. Rapid decline in the clinical condition with worsening respiratory status was noted. Worsening symptoms of fever, cough, and chest pain prompted further diagnostic work-up suggesting esophageal microperforation. Esophagogram was found to be suggestive of tracheoesophageal fistula. The tracheoesophageal fistula was due to subcarinal lymph node of nontuberculous origin. PMID:27366334

  13. Multimodality systematic approach to mediastinal lymph node staging in non-small cell lung cancer.

    PubMed

    Saettele, Timothy M; Ost, David E

    2014-08-01

    Establishing an accurate diagnosis and stage for non-small cell lung cancer has important implications for treatment and prognosis. Ideally, the process should be performed in a way that maximizes the information from each procedure while minimizing the risk to the patient. The concepts of decision analysis and Bayes' theorem form a basis to develop the strategy. In this framework, the pre-test probability of malignancy is estimated in the lung nodule or mass, the regional lymph nodes and in distant sites. Invasive diagnostic tests are performed in sites with a pre-test probability greater than the testing threshold, beginning with those sites that would yield the highest stage, if positive. Modalities are chosen that are able to biopsy the suspicious sites and present the least amount of risk to the patient. Following each test, the post-test probability of malignancy is calculated to determine if it crosses the testing or test-treatment thresholds. The process continues with further tests until a diagnosis and stage are established.

  14. Differential Gene Expression Profiles and Selected Cytokine Protein Analysis of Mediastinal Lymph Nodes of Horses with Chronic Recurrent Airway Obstruction (RAO) Support an Interleukin-17 Immune Response

    PubMed Central

    2015-01-01

    Recurrent airway obstruction (RAO) is a pulmonary inflammatory condition that afflicts certain mature horses exposed to organic dust particulates in hay. Its clinical and pathological features, manifested by reversible bronchoconstriction, excessive mucus production and airway neutrophilia, resemble the pulmonary alterations that occur in agricultural workers with occupational asthma. The immunological basis of RAO remains uncertain although its chronicity, its localization to a mucosal surface and its domination by a neutrophilic, non-septic inflammatory response, suggest involvement of Interleukin-17 (IL-17). We examined global gene expression profiles in mediastinal (pulmonary-draining) lymph nodes isolated from RAO-affected and control horses. Differential expression of > 200 genes, coupled with network analysis, supports an IL-17 response centered about NF-κB. Immunohistochemical analysis of mediastinal lymph node sections demonstrated increased IL-17 staining intensity in diseased horses. This result, along with the finding of increased IL-17 concentrations in lymph node homogenates from RAO-affected horses (P = 0.1) and a down-regulation of IL-4 gene and protein expression, provides additional evidence of the involvement of IL-17 in the chronic stages of RAO. Additional investigations are needed to ascertain the cellular source of IL-17 in this equine model of occupational asthma. Understanding the immunopathogenesis of this disorder likely will enhance the development of therapeutic interventions beneficial to human and animal pulmonary health. PMID:26561853

  15. Unusual mediastinal lymph node uptake and peritoneopleural fistula demonstrated on Technetium-99m macro-aggregated human serum albumin (Tc-99m MAA) peritoneal scintigraphy in a patient with portal hypertension.

    PubMed

    Tan, C J; Thang, S P; Lam, W W

    2016-04-01

    Peritoneal radionuclide scan is an established imaging modality for evaluating peritoneopleural communications. In this case report, unusual mediastinal lymph node radiotracer uptake is seen in a patient with portal hypertension on peritoneal scintigraphy. This was suspected to be due to marked lymphatic enlargement from longstanding portal hypertension since childhood, permitting passage of the large Tc-99m MAA particle. The nodes were morphologically benign on CT. Mediastinal lymph node uptake on peritoneal scintigraphy is rare but should not raise undue clinical concern, particularly in a patient with chronic portal hypertension. Anatomic correlation with SPECT-CT can provide reassurance. PMID:27326945

  16. Mediastinal lymph node staging of non-small-cell lung cancer: a prospective comparison of computed tomography and positron emission tomography.

    PubMed

    Scott, W J; Gobar, L S; Terry, J D; Dewan, N A; Sunderland, J J

    1996-03-01

    We compared the abilities of positron emission tomography and computed tomography to detect N2 or N3 lymph node metastases (N2 or N3) in patients with lung cancer. Positron emission tomography detects increased rates of glucose uptake, characteristic of malignant cells. Patients with peripheral tumors smaller than 2 cm and a normal mediastinum were ineligible. All patients underwent computed tomography, positron emission tomography, and surgical staging. The American Thoracic Society lymph node map was used. Computed and positron emission tomographic scans were read by separate radiologists blinded to surgical staging results. Lymph nodes were "positive" by computed tomography if larger than 1.0 cm in short-axis diameter. Standardized uptake values were recorded from areas on positron emission tomography corresponding to those from which biopsy specimens were taken; if greater than 4.2, they were called "positive." Seventy-five lymph node stations (2.8 per patient) were analyzed in 27 patients. Computed tomography incorrectly staged the mediastinum as positive for metastases in three patients and as negative for metastases in three patients. Sensitivity and specificity of computed tomographic scans were 67% and 83%, respectively. Positron emission tomography correctly staged the mediastinum in all 27 patients. When analyzed by individual node station, there were four false positive and four false negative results by computed tomography (sensitivity = 60%, specificity = 93%, positive predictive value = 60%). Positron emission tomography mislabeled one node station as positive (100% sensitive, 98% specific, positive predictive value 91%). The differences were significant when the data were analyzed both for individual lymph node stations (p = 0.039) and for patients (p = 0.031) (McNemar test). Positron emission tomography and computed tomography are more accurate than computed tomography alone in detecting mediastinal lymph node metastases from non-small-cell lung

  17. Pitfalls in CT recognition of mediastinal lymphadenopathy

    SciTech Connect

    Glazer, H.S.; Aronberg, D.J.; Sagel, S.S.

    1985-02-01

    Computed tomography (CT) has become the most accurate radiologic technique for the evaluation of mediastinal lymph nodes. Since the introduction of thoracic CT, a variety of anatomic structures, both normal and aberrant, have been described that can be confused with enlarged mediastinal lymph nodes; these represent potential diagnostic pitfalls. This essay illustrates many of these structures and distinguish them from abnormal lymph nodes.

  18. Esophageal gel-shifting technique facilitating eradicative boost or reirradiation to upper mediastinal targets of recurrent nerve lymph node without damaging esophagus

    PubMed Central

    Kishi, Kazushi; Iida, Takeshi; Ojima, Toshiyasu; Sonomura, Tetsuo; Shirai, Shintaro; Nakai, Motoki; Sato, Morio; Yamaue, Hiroki

    2013-01-01

    We developed a new technique using hyaluronic gel injection as a spacer to safely move the esophagus away from the high-dose area during interstitial brachytherapy of a mediastinal target close to the esophagus. We percutaneously injected a high-molecular-weight hyaluronic gel mixed with contrast medium to create a space between the esophagus and the target during interstitial brachytherapy. We applied this technique to two cases of relapsed recurrent nerve lymph node metastasis from esophageal cancer: one refractory tumor after 50 Gy of radiotherapy, and one recurrence after mediastinal radiotherapy of total 64 Gy. We prescribed 20 Gy and 18 Gy in one fraction to each target, with calculated esophageal D2cc (the minimum dose to the most irradiated volume of 2 cc) of 4.0 Gy and 6.8 Gy, respectively. Calculated enhancement factor by gel shifting in equivalent dose was 2.69 and 2.34, respectively. In each patient, accumulated esophageal D1cc (minimum dose to the most irradiated volume of p cc. minimum dose to the most irradiated volume of 1 cc) was 74.4 Gy and 85.6 Gy without shifting, and 59.1 Gy and 37.6 Gy with shifting, respectively. There were no procedure-related complications. Four months after the brachytherapy, each tumor was remarkably diminished. No evidence of recurrences or late complications were observed 8 months and 9 months after the procedure, respectively. The esophageal gel-shifting technique may facilitate eradicative brachytherapy to upper mediastinal targets without damaging the esophagus, and can be used in conjunction with boost irradiation or reirradiation to overcome the problem of salvage failure. PMID:23436229

  19. Utility of microbiological testing of thoracic lymph nodes sampled by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with mediastinal lymphadenopathy.

    PubMed

    Harris, Rebecca M; Arnaout, Ramy; Koziel, Henry; Folch, Erik; Majid, Adnan; Kirby, James E

    2016-02-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) represents a minimally invasive technique to sample peribronchial and mediastinal lymph nodes for diagnosis of cancer, lymphoma, or sarcoidosis. However, the value of EBUS-TBNA in diagnosis of respiratory infections has not been well explored. Here, microbiologic testing data for EBUS-TBNA samples collected from 82 patients over a 30-month period were retrospectively reviewed. No organisms were identified on Gram, acid-fast, or fungal stains. Bacterial cultures were positive in 52% of samples; however, all but 1 culture were considered contaminants. Mycobacterial cultures yielded Mycobacterium avium-intracellulare not identified in a concurrent bronchoalveolar lavage sample in 1 patient. Fungal cultures were negative. Overall, routine microbiologic tests on EBUS-TBNA samples do not appear sufficiently sensitive to rule out infectious causes of adenopathy. High clinical suspicion for infection may require modification of sampling techniques or more sensitive detection methods.

  20. Mediastinal Imaging Pitfalls.

    PubMed

    Lieberman, Sivan; Truong, Mylene T; Marom, Edith M

    2016-06-01

    Potential pitfalls in the interpretation of diseases involving the mediastinum are seen when imaging with computed tomography and [18F]-fluoro-2-deoxy-d-glucose positron emission tomography. These pitfalls can involve any mediastinal structure, including the mediastinal vessels, heart, lymph nodes, thymus, trachea, esophagus, and fat. Misinterpretation of normal variants or benign conditions as pathology can affect staging and alter treatment. After reading this review, the reader should be able to identify common mediastinal imaging pitfalls and apply ancillary measures to confirm the correct diagnosis and thus reach an accurate diagnosis to facilitate correct patient treatment. PMID:27261349

  1. Integration of single-fiber reflectance spectroscopy into ultrasound-guided endoscopic lung cancer staging of mediastinal lymph nodes

    NASA Astrophysics Data System (ADS)

    Kanick, Stephen Chad; van der Leest, Cor; Aerts, Joachim G. J. V.; Hoogsteden, Henk C.; Kaščáková, Slávka; Sterenborg, Henricus J. C. M.; Amelink, Arjen

    2010-01-01

    We describe the incorporation of a single-fiber reflectance spectroscopy probe into the endoscopic ultrasound fine-needle aspiration (EUS-FNA) procedure utilized for lung cancer staging. A mathematical model is developed to extract information about the physiological and morphological properties of lymph tissue from single-fiber reflectance spectra, e.g., microvascular saturation, blood volume fraction, bilirubin concentration, average vessel diameter, and Mie slope. Model analysis of data from a clinical pilot study shows that the single-fiber reflectance measurement is capable of detecting differences in the physiology between normal and metastatic lymph nodes. Moreover, the clinical data show that probe manipulation within the lymph node can perturb the in vivo environment, a concern that must be carefully considered when developing a sampling strategy. The data show the feasibility of this novel technique; however, the potential clinical utility has yet to be determined.

  2. The Impact of Extent and Location of Mediastinal Lymph Node Involvement on Survival in Stage III Non-Small Cell Lung Cancer Patients Treated With Definitive Radiotherapy

    SciTech Connect

    Fernandes, Annemarie T.; Mitra, Nandita; Xanthopoulos, Eric; Evans, Tracey; Stevenson, James; Langer, Corey; Kucharczuk, John C.; Lin, Lilie; Rengan, Ramesh

    2012-05-01

    Purpose: Several surgical series have identified subcarinal, contralateral, and multilevel nodal involvement as predictors of poor overall survival in patients with Stage III non-small-cell lung cancer (NSCLC) treated with definitive resection. This retrospective study evaluates the impact of extent and location of mediastinal lymph node (LN) involvement on survival in patients with Stage III NSCLC treated with definitive radiotherapy. Methods and Materials: We analyzed 106 consecutive patients with T1-4 N2-3 Stage III NSCLC treated with definitive radiotherapy at University of Pennsylvania between January 2003 and February 2009. For this analysis, mediastinal LN stations were divided into four mutually exclusive groups: supraclavicular, ipsilateral mediastinum, contralateral mediastinum, and subcarinal. Patients' conditions were then analyzed according to the extent of involvement and location of mediastinal LN stations. Results: The majority (88%) of patients received sequential or concurrent chemotherapy. The median follow-up time for survivors was 32.6 months. By multivariable Cox modeling, chemotherapy use (hazard ratio [HR]: 0.21 [95% confidence interval (CI): 0.07-0.63]) was associated with improved overall survival. Increasing primary tumor [18F]-fluoro-2-deoxy-glucose avidity (HR: 1.11 [CI: 1.06-1.19]), and subcarinal involvement (HR: 2.29 [CI: 1.11-4.73]) were significant negative predictors of overall survival. On univariate analysis, contralateral nodal involvement (HR: 0.70 [CI: 0.33-1.47]), supraclavicular nodal involvement (HR: 0.78 [CI: 0.38-1.67]), multilevel nodal involvement (HR: 0.97 [CI: 0.58-1.61]), and tumor size (HR: 1.04 [CI: 0.94-1.14]) did not predict for overall survival. Patients with subcarinal involvement also had lower rates of 2-year nodal control (51.2% vs. 74.9%, p = 0.047) and 2-year distant control (28.4% vs. 61.2%, p = 0.043). Conclusions: These data suggest that the factors that determine oncologic outcome in Stage III NSCLC

  3. Fibrosing mediastinitis mimicking bronchogenic carcinoma

    PubMed Central

    Bayiz, Hulya; Mutluay, Neslihan; Koyuncu, Adem; Demirag, Funda; Dagli, Gulfidan; Berktas, Bahadir; Berkoglu, Mine

    2013-01-01

    Fibrosing mediastinitis is a rare but benign disorder characterized by an excessive fibrotic reaction in the mediastinum which can result in compromise of airways, great vessels, and other mediastinal structures. In this paper we presented a patient with fibrosing mediastinitis mimicking bronchogenic carcinoma. The patient was a 32-year-old diabetic male admitting with cough and hemoptysis. There was a right hilar mass and multiple mediastinal conglomerated lymph nodes on chest computed tomography. Positron emission tomography with computed tomography (PET/CT) scan demonstrated increased fluorodeoxyglucose (FDG) uptake at the right hilar mass lesion and mediastinal lymph nodes. Fiberoptic bronchoscopy showed mucosal distortion of right upper lobe. Pathologic examination of the mucosal biopsy revealed inflammation. Endobronchial ultrasound guided transbronchial needle and cervical mediastinoscopic lymph node biopsies were undiagnostic. Diagnostic thoracotomy confirmed the diagnosis fibrosing mediastinitis. Administration of six months of systemic corticosteroid and antituberculous therapy was not beneficial. In conclusion, despite being a rare clinical entity, fibrosing mediastinitis should be kept in mind in the differential diagnosis of mediastinal mass lesions of unknown etiology. The diagnosis is exceptionally difficult in the presence of atypical radiological findings. The treatment is particularly challenging without any proven effective therapy. PMID:23372962

  4. [Mediastinal lymphomas].

    PubMed

    Rauthe, S; Rosenwald, A

    2016-09-01

    Lymphomas infiltrating the mediastinum are a challenge for the treating physician as well as for the pathological diagnostics. The clinical scenario is often an emergency situation, while the pathologist is usually confronted only with small biopsy samples. Classical Hodgkin's lymphoma is by far the most frequently occurring lymphoma in the mediastinum and predominantly the nodular sclerosis subtype. In small and very sclerotic specimens it can be difficult to morphologically detect Hodgkin and Reed-Sternberg cells and to identify the characteristic phenotype by immunohistochemistry. Primary mediastinal large B‑cell lymphomas should be distinguished from classical Hodgkin's lymphomas as the treatment is different. This is characterized by the detection of sheets of blast cells, which immunohistochemically show a strong B‑cell phenotype (positivity for CD20 and CD79a), while CD30 can also often be expressed. The intimate biological relationship between classical Hodgkin's lymphomas and mediastinal large B‑cell lymphomas is illustrated by the existence of B‑cell lymphomas with intermediate features (so-called mediastinal grey zone lymphomas). It is important to recognize and diagnose these lymphomas as they are associated with a slightly inferior prognosis. Extranodal thymic marginal zone lymphomas of the mucosa-associated lymphoid tissue (MALT) type are a rare form of lymphoma encountered in the mediastinum, which can be associated with autoimmune diseases. T‑lymphoblastic lymphomas and leukemia, which occur predominantly in children and young adults, represent a rapidly growing precursor cell neoplasia and must be distinguished from thymomas in the differential diagnostics as well as from normal and hyperplastic thymus glands. PMID:27507160

  5. Primary Amyloidosis of Celiac/Para-Pancreatic Lymph Nodes Diagnosed by Endosonography-Guided Fine Needle Aspiration: A Case Report.

    PubMed

    Akbar, Nuralhuda; Kubbara, Aahd; Nawras, Ali

    2015-01-01

    Introduction. Primary amyloidosis is a disorder resulting from the deposition of fibrillary protein in extracellular tissue. Diagnosis of primary amyloidosis in the celiac/para-pancreatic lymph nodes via endoscopic ultrasound-guided fine needle aspiration has not been reported in the literature. In this article, we report our first observation. Our patient is a 64-year-old Caucasian man who was referred to our institution from an outlying hospital for recurrent abdominal pain. Radiological imaging revealed an enlarged abdominal lymph node that was already biopsied under computed tomography needle guidance but diagnosis was not achieved on pathological examination. At our institution, endoscopic ultrasound-guided fine needle aspiration showed enlarged para-celiac/pancreatic lymph nodes. Endosonography-guided fine needle aspiration revealed the diagnosis of primary amyloidosis. The patient tolerated the procedure well with follow-up as an outpatient. Conclusions. Lymph node involvement in amyloidosis is not uncommon. However, the involvement of the pancreatic/celiac lymph nodes by amyloidosis is obscure in this case. This case shows a rare presentation of amyloidosis diagnosed for the first time by the technique of endosonography-guided fine needle aspiration. In the future, this might serve as an establishment to standardize diagnosing abdominal lymph node amyloidosis, once suspected, by endosonography-guided fine needle aspiration. PMID:26904706

  6. Randomized Trial of Mediastinal Lymph Node Sampling Versus Complete Lymphadenectomy During Pulmonary Resection in the Patient with N0 or N1 (Less Than Hilar) Non-Small Cell Carcinoma: Results of the ACOSOG Z0030 Trial

    PubMed Central

    Darling, Gail E.; Allen, Mark S.; Decker, Paul A.; Ballman, Karla; Malthaner, Richard A.; Inculet, Richard.; Jones, David R.; McKenna, Robert J.; Landreneau, Rodney J.; Rusch, Valerie W.; Putnam, Joe B.

    2016-01-01

    Objective To determine if mediastinal lymph node dissection (MLND) improves survival compared to mediastinal lymph node sampling (MLNS) in patients undergoing resection for N0 or non-hilar N1, T1 or T2 non-small cell lung cancer (NSCLC). Methods Patients with NSCLC underwent sampling of 2R, 4R, 7 and 10R for right sided tumors, and 5, 6, 7 and 10L for left sided tumors. If all were negative for malignancy, patients were randomized to no further lymph node sampling (MLNS) or complete MLND. Results Of 1,111 patients randomized, 1,023 (498 MLNS, 525 MLND) were eligible/evaluable. There were no significant differences between the two groups in terms of demographics, ECOG status, histology, location of the cancer, type or extent of resection, or pathological stage. Occult N2 disease was found in 21 patients in the MLND group. At median follow-up of 6.5 years, 435 (43%) patients have died; (MLNS: 217 (44%);MLND:218 (42%)). The median survival for MLNS is8.1 years, and 8.5 years for MLND (p=0.25). The 5-year disease free survival rate was 69% (95% CI: 64%-74%) in the MLNS group versus 68%(95% CI: 64%-73%) years in the MLND group (p=0.92). There was no difference for local (p=0.52), regional (p=0.10), or distant (p=0.76) recurrence between the two groups. Conclusions If systematic, thorough presection sampling of the mediastinal and hilar lymph nodes is negative, MLND does not improve survival in patients with early stage NSCLC but these results are not generalizable to patients staged radiographically or those with higher stage tumors. PMID:21335122

  7. Analysis of Incidental Radiation Dose to Uninvolved Mediastinal/Supraclavicular Lymph Nodes in Patients with Limited-Stage Small Cell Lung Cancer Treated Without Elective Nodal Irradiation

    SciTech Connect

    Ahmed, Irfan; DeMarco, Marylou; Stevens, Craig W.; Fulp, William J.; Dilling, Thomas J.

    2011-01-01

    Classic teaching states that treatment of limited-stage small cell lung cancer (L-SCLC) requires large treatment fields covering the entire mediastinum. However, a trend in modern thoracic radiotherapy is toward more conformal fields, employing positron emission tomography/computed tomography (PET/CT) scans to determine the gross tumor volume (GTV). This analysis evaluates the dosimetric results when using selective nodal irradiation (SNI) to treat a patient with L-SCLC, quantitatively comparing the results to standard Intergroup treatment fields. Sixteen consecutive patients with L-SCLC and central mediastinal disease who also underwent pretherapy PET/CT scans were studied in this analysis. For each patient, we created SNI treatment volumes, based on the PET/CT-based criteria for malignancy. We also created 2 ENI plans, the first without heterogeneity corrections, as per the Intergroup 0096 study (ENI{sub off}) and the second with heterogeneity corrections while maintaining constant the number of MUs delivered between these latter 2 plans (ENI{sub on}). Nodal stations were contoured using published guidelines, then placed into 4 'bins' (treated nodes, 1 echelon away, >1 echelon away within the mediastinum, contralateral hilar/supraclavicular). These were aggregated across the patients in the study. Dose to these nodal bins and to tumor/normal structures were compared among these plans using pairwise t-tests. The ENI{sub on} plans demonstrated a statistically significant degradation in dose coverage compared with the ENI{sub off} plans. ENI and SNI both created a dose gradient to the lymph nodes across the mediastinum. Overall, the gradient was larger for the SNI plans, although the maximum dose to the '1 echelon away' nodes was not statistically different. Coverage of the GTV and planning target volume (PTV) were improved with SNI, while simultaneously reducing esophageal and spinal cord dose though at the expense of modestly reduced dose to anatomically distant

  8. Primary Mediastinal Classical Hodgkin Lymphoma.

    PubMed

    Piña-Oviedo, Sergio; Moran, Cesar A

    2016-09-01

    Primary mediastinal Classical Hodgkin lymphoma (CHL) is rare. Nodular sclerosis CHL (NS-CHL) is the most common subtype involving the anterior mediastinum and/or mediastinal lymph nodes. Primary thymic CHL is exceedingly rare. The disease typically affects young women and is asymptomatic in 30% to 50% of patients. Common symptoms include fatigue, chest pain, dyspnea and cough, but vary depending on the location and size of the tumor. B-symptoms develop in 30% of cases. By imaging, primary mediastinal CHL presents as mediastinal widening/mediastinal mass that does not invade adjacent organs but may compress vital structures as bulky disease. Histopathology is the gold standard for diagnosis. Primary mediastinal NS-CHL consists of nodules of polymorphous inflammatory cells surrounded by broad fibrous bands extending from a thickened lymph node capsule. The cellular nodules contain variable numbers of large Hodgkin/Reed-Sternberg cells, required for diagnosis. Primary thymic CHL may exhibit prominent cystic changes. The histopathologic recognition of NS-CHL can be challenging in cases with prominent fibrosis, scant cellularity, artifactual cell distortion, or an exuberant granulomatous reaction. The differential diagnosis includes primary mediastinal non-HLs, mediastinal germ cell tumors, thymoma, and metastatic carcinoma or melanoma to the mediastinum. Distinction from primary mediastinal non-HLs is crucial for adequate therapeutic decisions. Approximately 95% of patients with primary mediastinal CHL will be alive and free of disease at 10 years after treatment with short courses of combined chemoradiotherapy. In this review, we discuss the history, classification, epidemiology, clinicoradiologic features, histopathology, immunohistochemistry, differential diagnosis, and treatment of primary mediastinal CHL. PMID:27441757

  9. Enhanced sonographic imaging to diagnose lymph node metastasis: importance of blood vessel volume and density.

    PubMed

    Li, Li; Mori, Shiro; Kodama, Mizuho; Sakamoto, Maya; Takahashi, Shoki; Kodama, Tetsuya

    2013-04-01

    Lymph node size is an important variable in ultrasound diagnosis of lymph node metastasis. However, the size criterion often leads to oversight of tumor-positive lymph nodes within the range of "normal" size, such that more accurate diagnostic criteria for lymph node metastasis are required. In this study, we show how diagnosis of lymph node metastasis can be improved by evaluating changes in blood vessel volume and density using a novel contrast-enhanced high-frequency ultrasound (CE-HFUS) system with Sonazoid. An MRL/MpJ-lpr/lpr (MRL/lpr) mouse model of lymph node metastasis was used in which lymph nodes are similar in size to humans. Metastasis via lymphatic vessels to proper axillary lymph nodes (proper ALN) was induced by injection of tumor cells into the subiliac lymph nodes. Within 21 days of injection, significant increases in blood vessel volume and density, but no increases in the size of the proper ALNs, were observed. The increase in blood vessel density was confirmed with immunohistochemical analysis and was positively related to tumor cell proliferation as measured using bioluminescence imaging. Together, our results showed that alterations in blood vessel volume and density precede alterations in lymph node size in the early stages of lymph node metastasis. Detection of these changes by ultrasonography may offer new criteria for early diagnosis of lymph node metastasis.

  10. Sarcoidal granulomas in the mediastinal lymph nodes after treatment for marginal zone lymphoma of the esophagus: report of a case with review of the concept of the sarcoidosis-lymphoma syndrome

    PubMed Central

    Ishida, Mitsuaki; Hodohara, Keiko; Furuya, Aya; Okuno, Hiroko; Yoshii, Miyuki; Horinouchi, Akiko; Shirakawa, Ayaka; Iwai, Muneo; Kagotani, Akiko; Yoshida, Takashi

    2014-01-01

    Patients with sarcoidosis have a high risk of development of malignant lymphoma, and this association was coined the term “sarcoidosis-lymphoma syndrome”. Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is a distinct clinicopathological entity, and the stomach is the most common site. The occurrence of this type of lymphoma in the esophagus is extremely rare. In this report, we describe the first documented case of sarcoidal granulomas in the mediastinal lymph nodes after treatment for MALT lymphoma of the esophagus. A 60-year-old Japanese female was found to have a submucosal tumor in the esophagus. Histopathological study revealed proliferation of small- to medium-sized lymphoid cells with convoluted nuclei, and immunohistochemically, these lymphoid cells were diffusely positive for CD20, bcl-2, and MUM1. R-CHOP therapy was performed, which led to tumor remission. Two years later, swelling of the mediastinal lymph nodes was detected. Histopathological study of the lymph nodes revealed presence of variably-sized epithelioid granulomas without caseating necrosis but no malignant lymphoma was noted. Sarcoidal granulomas can be observed in patients with malignant tumors including malignant lymphoma and carcinoma without history of systemic sarcoidosis. It is important to recognize that systemic sarcoidosis and sarcoidal reaction without evidence of systemic disease can occur after development of malignant lymphoma, therefore, sarcoidal reaction must be included in the differential diagnostic consideration of recurrent malignant lymphoma. PMID:25120829

  11. Tension pneumothorax as a severe complication of endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph nodes

    PubMed Central

    Szlubowski, Artur; Gil, Tomasz; Kocoń, Piotr; Ziętkiewicz, Mirosław; Twardowska, Magdalena; Kużdżał, Jarosław

    2015-01-01

    This article presents a case report of a patient suffering from bullous emphysema and chronic obstructive pulmonary disease, who was diagnosed with tension pneumothorax after undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Tension pneumothorax is a severe but rare complication of EBUS-TBNA. It can result from lung injury caused by the biopsy needle or, in patients suffering from bullous emphysema, from spontaneous rupture of an emphysematous bulla resulting from increased pressure in the chest cavity during cough caused by bronchofiberoscope insertion. The authors emphasize that patients should be carefully monitored after the biopsy, and, in the case of complications, provided with treatment immediately in proper hospital conditions. Patients burdened with a high risk of complications should be identified before the procedure and monitored with extreme care after its completion. PMID:26855656

  12. An uncommon presentation of Kikuchi-Fujimoto disease as mediastinal lymphadenopathy.

    PubMed

    Hino, Haruaki; Nishimura, Takashi; Nitadori, Jun-Ichi; Miyakoshi, Shigesaburo; Seki, Atsuko; Arai, Tomio; Nakajima, Jun

    2016-05-01

    We experienced an uncommon presentation of Kikuchi-Fujimoto disease (KFD) with sole mediastinal lymphadenopathy in senior age, which was histologically diagnosed by thoracoscopic biopsy leading to appropriate therapy. A 69-year-old man was admitted due to intermittent high fever, general malaise, and appetite loss lasting over 3 months along with 10-kg weight loss in 6 months. Chest computed tomography (CT) showed isolated mediastinal lymphadenopathy, and malignant diseases including malignant lymphoma or metastatic carcinoma, tuberculous lymphadenitis, and sarcoidosis were considered. Therefore thoracoscopic biopsy should be performed for the correct diagnosis, even in uncommon portion of lymph node swelling and age for KFD. PMID:27162693

  13. [Analysis of mediastinal lymphadenopathy in sarcoidosis with transesophageal ultrasonic endoscopy; influences on cardiovascular system].

    PubMed

    Dambara, T; Ueki, J; Aiba, M; Tamaki, S; Saito, H; Matsuda, K; Nukiwa, T; Kira, S

    1989-01-01

    We studied influences of mediastinal lymphadenopathy on cardiovascular system in nine cases of sarcoidosis with transesophageal ultrasonic endoscopy. Chest x-ray films revealed bilateral hilar lymphadenopathy in all cases, whose diagnoses were made histologically with biopsies of peripheral lung through flexible fiber optic bronchoscope and/or of lymph nodes. These findings were typical in this disease. Many compartments of cardiovascular system in mediastinal and hilar regions were visible with this technique in all subjects. And enlarged lymph nodes changed dimensions in these compartments, especially in main pulmonary arteries, left atria, pulmonary veins and aorta. Furthermore, these phenomena were seen in azygos vein and superior caval vein in some cases. It is suggested that these lymph nodes may influence hemodynamics in above-mentioned compartments of cardiovascular system, if this phenomenon deteriorates more progressively. PMID:2657139

  14. Mediastinal tumor

    MedlinePlus

    ... contains the heart, large blood vessels, windpipe (trachea), thymus gland, esophagus, and connective tissues. The mediastinum is divided into three sections: Anterior (front) Middle Posterior (back) Mediastinal ... Cancer Browse the Encyclopedia A.D.A.M., ...

  15. CT of chronic infiltrative lung disease: Prevalence of mediastinal lymphadenopathy

    SciTech Connect

    Niimi, Hiroshi; Kang, Eun-Young; Kwong, S.

    1996-03-01

    Our goal was to determine the prevalence of mediastinal lymph node enlargement at CT in patients with diffuse infiltrative lung disease. The study was retrospective and included 175 consecutive patients with diffuse infiltrative lung diseases. Diagnoses included idiopathic pulmonary fibrosis (IPF) (n = 61), usual interstitial pneumonia associated with collagen vascular disease (CVD) (n = 20), idiopathic bronchiolitis obliterans organizing pneumonia (BOOP) (n = 22), extrinsic allergic alveolitis (EAA) (n = 17), and sarcoidosis (n = 55). Fifty-eight age-matched patients with CT of the chest performed for unrelated conditions served as controls. The presence, number, and sites of enlarged nodes (short axis {ge}10 mm in diameter) were recorded. Enlarged mediastinal nodes were present in 118 of 175 patients (67%) with infiltrative lung disease and 3 of 58 controls (5%) (p < 0.001). The prevalence of enlarged nodes was 84% (46 of 55) in sarcoidosis, 67% (41 of 61) in IPF, 70% (14 of 20) in CVD, 53% (9 of 17) in EAA, and 36% (8 of 22) in BOOP. The mean number of enlarged nodes was higher in sarcoidosis (mean 3.2) than in the other infiltrative diseases (mean 1.2) (p < 0.001). Enlarged nodes were most commonly present in station 10R, followed by 7, 4R, and 5. Patients with infiltrative lung disease frequently have enlarged mediastinal lymph nodes. However, in diseases other than sarcoid, usually only one or two nodes are enlarged and their maximal short axis diameter is <15 mm. 11 refs., 2 figs., 1 tab.

  16. Mediastinal Abscess Following Endobronchial Ultrasound Transbronchial Needle Aspiration in a Patient With Sarcoidosis.

    PubMed

    McGovern Murphy, Frederic; Grondin-Beaudoin, Brian; Poulin, Yannick; Boileau, Robert; Dumoulin, Elaine

    2015-10-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a low rate of complications. It is used in the diagnosis of malignant and benign disease such as sarcoidosis. We report a case a 42-year-old man who had undergone EBUS-TBNA for diagnosis of mediastinal and hilar lymph node enlargement. Sarcoidosis was diagnosed on cytologic examination. Three weeks after the procedure, he developed a mediastinal abscess secondary to EBUS-TBNA. Sarcoidosis may be a risk factor for mediastinal infection complication. A local immune defect related to sarcoidosis may explain this risk. Our case underlines the importance of considering and recognizing this complication, and its possibility should be taken into account when undertaking the procedure for benign disease.

  17. Positron emission tomography of lung tumors and mediastinal lymph nodes using [18F]fluorodeoxyglucose. The Members of the PET-Lung Tumor Study Group.

    PubMed

    Scott, W J; Schwabe, J L; Gupta, N C; Dewan, N A; Reeb, S D; Sugimoto, J T

    1994-09-01

    Positron emission tomography detects increased glucose uptake in malignant tissue using the glucose analogue [2-18F]fluoro-2-deoxy-D-glucose. We reviewed the scans obtained in 62 patients with lung tumors. All had undergone computed tomography and had tissue-based diagnoses: 22 had adenocarcinomas, 12 had squamous cell carcinomas, 13 had other malignancies, 1 had organizing pneumonia, 1 had a hamartoma, and 13 had granulomas. Positron emission tomography with [2-18F]fluoro-2-deoxy-D-glucose identified 44 of 47 malignancies. Two of three false-negative findings were tumors that were 1 cm2 or less and the other was a bronchioloalveolar carcinoma. All three false-positive findings were granulomas. The sensitivity and specificity of the technique were 93.6% and 80%, respectively, and the positive and negative predictive values were 93.6% and 80%, respectively. The differential uptake ratio was determined in all 62 patients. The mean differential uptake ratio (+/- the standard error of the mean) for malignant tumors was 6.4 +/- 0.56 and that for benign tumors was 1.14 +/- 0.26 (p < 0.0001, t test). Twenty-five of the patients had N2 lymph nodes evaluated pathologically. Positron emission tomography with [2-18F]fluoro-2-deoxy-D-glucose identified negative N2 nodes in 19 of 22 patients (86%) with negative nodes and positive N2 nodes in 2 of 3 patients (66%) with positive nodes, including one instance missed by computed tomography.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7944691

  18. [An unusual mediastinal opacity].

    PubMed

    Margery, J; Bâ-Fall, K; Rouquet, P; Rique, M; Lefebvre, N; Chevalier, B; Camara, P; Mbaye, P S; Debonne, J-M; Sané, M

    2006-12-01

    A 36-year old immunocompetent male from Senegal with an uneventful history was admitted for exploration of a bullous collection in the posterior mediastinum. Multifocal tuberculosis was diagnosed. Computed tomography-guided drainage removed 600 cc of caseum. The diagnosis as rupture of intrathoracic Pott's abscess complicated by a probably esophageal fistula. The clinical course was rapidly favorable with later development of mediastinal fibrosis. This uncommon case illustrates the contribution of interventional radiology recently developed in the Principal Hospital in Dakar, Senegal.

  19. Tuberculous constrictive pericarditis complicated with tuberculous mediastinitis - case report.

    PubMed

    Man, Milena Adina; NiŢu, Mimi Floarea; Strâmbu, Lelia; Florescu, Cristina; Streba, Costin Teodor; Trofor, Antigona Carmen

    2016-01-01

    Constrictive pericarditis is a rare and severe disease. A 37-year-old patient was admitted in the hospital for dyspnea, precordial pain, right-sided cardiac failure. Chest X-ray showed cardiac enlargement and an opacity suggestive for pleural effusion. Echocardiography revealed an adhesive-effusive-constrictive pericarditis, a very thickened pericardium and bilateral pleural effusion. After a pericardiectomy done to restore cardiac compensation and to identify etiological factors, a tuberculous pericarditis (TBP) was diagnosed. After surgery and starting anti-TB treatment, the patient presented altered clinical status, dyspnea, dry cough, fever and delayed callus formation at sternum level. Thoracic scan revealed mediastinal air collections, pericarditis and pleurisy. Thus, the TBP diagnosis was extended to mediastinal TB and anti-TB therapy was continued. After four months of treatment, another thoracic scan showed disappearance of the mediastinal air-leakage bubbles, multiple new micronodules in both lungs and lymph nodes of up to 15 mm; also increasing pericardial and pleural effusions. This case was interpreted as a TB treatment failure situation. A retreatment regimen was started, resulting in a slow favorable outcome. Pericardial TB is a rare condition, usually with delayed diagnosis and poor treatment benefits. Whenever possible, earlier diagnostic can contribute to better management of these cases.

  20. Tuberculous constrictive pericarditis complicated with tuberculous mediastinitis - case report.

    PubMed

    Man, Milena Adina; NiŢu, Mimi Floarea; Strâmbu, Lelia; Florescu, Cristina; Streba, Costin Teodor; Trofor, Antigona Carmen

    2016-01-01

    Constrictive pericarditis is a rare and severe disease. A 37-year-old patient was admitted in the hospital for dyspnea, precordial pain, right-sided cardiac failure. Chest X-ray showed cardiac enlargement and an opacity suggestive for pleural effusion. Echocardiography revealed an adhesive-effusive-constrictive pericarditis, a very thickened pericardium and bilateral pleural effusion. After a pericardiectomy done to restore cardiac compensation and to identify etiological factors, a tuberculous pericarditis (TBP) was diagnosed. After surgery and starting anti-TB treatment, the patient presented altered clinical status, dyspnea, dry cough, fever and delayed callus formation at sternum level. Thoracic scan revealed mediastinal air collections, pericarditis and pleurisy. Thus, the TBP diagnosis was extended to mediastinal TB and anti-TB therapy was continued. After four months of treatment, another thoracic scan showed disappearance of the mediastinal air-leakage bubbles, multiple new micronodules in both lungs and lymph nodes of up to 15 mm; also increasing pericardial and pleural effusions. This case was interpreted as a TB treatment failure situation. A retreatment regimen was started, resulting in a slow favorable outcome. Pericardial TB is a rare condition, usually with delayed diagnosis and poor treatment benefits. Whenever possible, earlier diagnostic can contribute to better management of these cases. PMID:27151714

  1. Parotid area lymph node metastases from preliminarily diagnosed patients with nasopharyngeal carcinoma: report on tumor characteristics and oncologic outcomes

    PubMed Central

    Xiao, Youping; Zong, Jingfeng; Qiu, Sufang; Bai, Penggang; Dai, Yitao; Zhou, Lin; Chen, Xiaolin; Zheng, Wei; Chen, Yunbin; Lin, Shaojun; Pan, Jianji

    2016-01-01

    The parotid area lymph node (PLN) is an uncommon site of metastasis originating from nasopharyngeal carcinoma (NPC). The study aimed to investigate clinical characteristics and outcomes of patients with preliminarily diagnosed NPC with PLN metastases. Here we retrospectively reviewed Magnetic resonance imaging (MRI) scans of 2221 patients with untreated nonmetastatic NPC who received intensity-modulated radiation therapy (IMRT). Finally, 64 (2.9%) patients were identified with PLN metastases, of which, 34 received PLN-sparing IMRT and 30 received PLN-radical IMRT. We also found that 42.2% had N3 disease and 95.3% had stages III-IVb. PLN metastases on MRI were characterized by ipsilateral retropharyngeal lymph node (RLN) or level II nodal extracapsular spread (ECS), ipsilateral giant cervical nodes, ipsilateral parapharyngeal extension, or solitary parotid metastasis. The 5-year overall survival, distant metastasis-free survival, regional relapse-free survival, and parotid relapse-free survival rates were 70.4%, 64.3%, 76.7%, and 87.9%, respectively. Distant metastases were the main cause of treatment failure and death. Using PLN-sparing IMRT, sparing PLN with minimal axial diameter of <10 mm, could increase the risk of parotid recurrence. However, it was not an independent prognostic factor. N classification and concurrent-based chemotherapy were almost statistically significant for distant failure and death. Overall, we demonstrated that the PLN metastases might be derived from RLN or level II nodal ECS, giant cervical nodes in a retrograde fashion, or parapharyngeal extension. Sparing PLN of <10 mm by IMRT should consider the risk of parotid recurrence. Distant metastases remained the dominant treatment failure. Further effective systemic chemotherapy should be explored. PMID:26934439

  2. IκB kinase β inhibitor, IMD-0354, prevents allergic asthma in a mouse model through inhibition of CD4(+) effector T cell responses in the lung-draining mediastinal lymph nodes.

    PubMed

    Maślanka, Tomasz; Otrocka-Domagała, Iwona; Zuśka-Prot, Monika; Mikiewicz, Mateusz; Przybysz, Jagoda; Jasiecka, Agnieszka; Jaroszewski, Jerzy J

    2016-03-15

    IκB kinase (IKK) is important for nuclear factor (NF)-κB activation under inflammatory conditions. It has been demonstrated that IMD-0354, i.e. a selective inhibitor of IKKβ, inhibited allergic inflammation in a mouse model of ovalbumin (OVA)-induced asthma. The present study attempts to shed light on the involvement of CD4(+) effector (Teff) and regulatory (Treg) T cells in the anti-asthmatic action of IMD-0354. The animals were divided into three groups: vehicle treated, PBS-sensitized/challenged mice (PBS group); vehicle treated, OVA-sensitized/challenged mice (OVA group); and IMD-0354-treated, OVA-sensitized/challenged mice. The analyzed parameters included the absolute counts of Treg cells (Foxp3(+)CD25(+)CD4(+)), activated Teff cells (Foxp3(-)CD25(+)CD4(+)) and resting T cells (CD25(-)CD4(+)) in the mediastinal lymph nodes (MLNs), lungs and peripheral blood. Moreover, lung histopathology was performed to evaluate lung inflammation. It was found that the absolute number of cells in all studied subsets was considerably increased in the MLNs and lungs of mice from OVA group as compared to PBS group. All of these effects were fully prevented by treatment with IMD-0354. Histopathological examination showed that treatment with IMD-0354 protected the lungs from OVA-induced allergic airway inflammation. Our results indicate that IMD-0354 exerts anti-asthmatic action, at least partially, by blocking the activation and clonal expansion of CD4(+) Teff cells in the MLNs, which, consequently, prevents infiltration of the lungs with activated CD4(+) Teff cells. The beneficial effects of IMD-0354 in a mouse model of asthma are not mediated through increased recruitment of Treg cells into the MLNs and lungs and/or local generation of inducible Treg cells. PMID:26868187

  3. An anterior mediastinal lesion in TAFRO syndrome showing complete remission after glucocorticoid and tocilizumab therapy.

    PubMed

    Sakashita, Kentaro; Murata, Kengo; Inagaki, Yuji; Oota, Souichi; Takamori, Mikio

    2016-09-01

    Thrombocytopenia (T), anasarca (A), myelofibrosis (F), renal dysfunction (R), and organomegaly (O) (TAFRO) syndrome is a variant of multicentric Castleman's disease. We describe here a 57-year-old man who presented with persistent fever, pleural effusion, and ascites. He was negative for human immunodeficiency virus and human herpes virus-8. A computed tomography scan showed an anterior mediastinal mass and small inguinal lymphadenopathy. Although a biopsy of the anterior mediastinum showed fatty tissue infiltrated with CD20 (+) and CD45RO (+) lymphocytes, a biopsy of the left inguinal lymph node revealed a hyaline vascular type of Castleman's disease. He subsequently developed severe thrombocytopenia and renal dysfunction. In addition, his bone marrow biopsy showed myelofibrosis. TAFRO syndrome was diagnosed based on the lymph node pathology and the characteristic manifestations of the syndrome. Tocilizumab and glucocorticoid therapy achieved complete remission and regression of the mediastinal mass. To our knowledge, this is the first report of TAFRO syndrome accompanied by an anterior mediastinal mass, which responded very well to therapy. PMID:27516889

  4. Pulmonary Hypertension Complicating Fibrosing Mediastinitis

    PubMed Central

    Seferian, Andrei; Steriade, Alexandru; Jaïs, Xavier; Planché, Olivier; Savale, Laurent; Parent, Florence; Amar, David; Jovan, Roland; Fadel, Elie; Sitbon, Olivier; Simonneau, Gérald; Humbert, Marc; Montani, David

    2015-01-01

    Abstract Fibrosing mediastinitis is caused by a proliferation of fibrous tissue in the mediastinum with encasement of mediastinal viscera and compression of mediastinal bronchovascular structures. Pulmonary hypertension (PH) is a severe complication of fibrosing mediastinitis caused by extrinsic compression of the pulmonary arteries and/or veins. We have conducted a retrospective observational study reviewing clinical, functional, hemodynamic, radiological characteristics, and outcome of 27 consecutive cases of PH associated with fibrosing mediastinitis diagnosed between 2003 and 2014 at the French Referral Centre for PH. Fourteen men and 13 women with a median age of 60 years (range 18–84) had PH confirmed on right heart catheterization. The causes of fibrosing mediastinitis were sarcoidosis (n = 13), tuberculosis-infection confirmed or suspected (n = 9), mediastinal irradiation (n = 2), and idiopathic (n = 3). Sixteen patients (59%) were in NYHA functional class III and IV. Right heart catheterization confirmed moderate to severe PH with a median mean pulmonary artery pressure of 42 mm Hg (range 27–90) and a median cardiac index of 2.8 L/min/m2 (range 1.6–4.3). Precapillary PH was found in 22 patients, postcapillary PH in 2, and combined postcapillary and precapillary PH in 3. Severe extrinsic compression of pulmonary arteries (>60% reduction in diameter) was evidenced in 2, 8, and 12 patients at the main, lobar, or segmental levels, respectively. Fourteen patients had at least one severe pulmonary venous compression with associated pleural effusion in 6 of them. PAH therapy was initiated in 7 patients and corticosteroid therapy (0.5–1 mg/kg/day) was initiated in 3 patients with sarcoidosis, with 9 other being already on low-dose corticosteroids. At 1-year follow-up, 3 patients had died and among the 21 patients evaluated, 3 deteriorated, 14 were stable, and only 4 patients with sarcoidosis improved (4 receiving corticosteroids and 1

  5. A cytopathological approach to diagnosing intrathoracic lymphadenopathy using aspirates obtained by the transbronchial needle aspiration method.

    PubMed

    Özyalvaçlı, Gülzade; Yaşar, Zehra; Çetinkaya, Erdoğan

    2016-03-01

    Transbronchial needle aspiration (TBNA) is an effective, safe and cost-effective technique that allows for sampling of the mediastinal lymph node and peribronchial lesions. It is used in bronchogenic carcinoma staging, peribronchial and submucosal lesions, diagnosis of sarcoidosis and tuberculosis, differentiating submucosal invasion, and in diagnosing mediastinal masses. From our experience at the University of Abant Izzet Baysal and from a review of the literature, we discuss the adequacy and the differential diagnosis of aspiration material obtained by TBNA and cytopathological-histopathological evaluation in intrathoracic lymphadenopathies to increase the success rate of the TBNA method. PMID:27266286

  6. Enlarging mediastinal/hilar lymphadenopathy with calcification.

    PubMed

    Adachi, Takashi; Nakahata, Masashi; Moritani, Suzuko; Iida, Hiroatsu; Ogawa, Kenji

    2016-02-01

    A 77-year-old man was referred to our hospital due to enlarging mediastinal/hilar lymphadenopathy with calcification. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and bone marrow aspiration were performed. Subsequently, monoclonal gammopathy of undetermined significance (MGUS) associated with mediastinal amyloidosis was diagnosed. We hereby report a case in which EBUS-TBNA led to a successful diagnosis of amyloidosis. PMID:26862422

  7. Fine-needle aspiration of a primary mediastinal large B-cell lymphoma: a case report with cytologic, histologic, and flow cytometric considerations.

    PubMed

    Hoda, Rana S; Picklesimer, Lee; Green, Kimberly M; Self, Sally

    2005-06-01

    Fine-needle aspiration (FNA) cytology and immunophenotyping by flow cytometry (FCM) are increasingly being used for diagnosing and subclassifying lymphoma in the REAL/WHO classification. Herein, we report a case of primary mediastinal large B-cell lymphoma (PMBL), a subtype of diffuse large B-cell lymphoma in the WHO classification, diagnosed by FNA cytology in conjunction with FCM. This, to our knowledge, has not previously been reported. A 57-yr-old woman presented with bilateral axillary lymphadenopathy and intermittent shortness of breath. CT scan revealed a 5-cm anterior mediastinal mass and mediastinal lymphadenopathy. Endoscopic ultrasound-guided FNA of a 4.5-cm subcarinal lymph node showed medium to large atypical lymphocytes with scant to moderate finely vacuolated cytoplasm. Nuclei were enlarged, cleaved, noncleaved, lobulated, and hyperchromatic. The background showed lymphoglandular bodies. Malignant large cell lymphoma was cytologically diagnosed. FCM, performed on a portion of the FNA specimen, demonstrated large B cells devoid of surface immunoglobulin expression, the characteristic immunophenotype of PMBL. The histologic diagnosis was PMBL. Touch-imprint cytology of the histologic specimen showed large cells with a narrow rim of clear cytoplasm and prominent outer cell border. Nuclear features were similar to the FNA specimen. In the presence of a mediastinal mass, FNA cytology in conjunction with FCM can effectively diagnose PMBL in the appropriate clinical setting. PMID:15880713

  8. The influence of the metastasis pattern of mediastinal lymph nodes on the postoperative radiotherapy’s efficacy for the IIIA-pN2 non-small-cell lung cancer: a retrospective analysis of 220 patients

    PubMed Central

    Zhang, Baozhong; Zhao, Lujun; Yuan, Zhiyong; Pang, Qingsong; Wang, Ping

    2016-01-01

    Objective The use of postoperative radiotherapy (PORT) remains controversial for Stage IIIA-N2 non-small-cell lung cancer (NSCLC) patients, a possible reason is that IIIA-pN2 NSCLC diseases are a heterogeneous group with different clinicopathologic features. The aim of this research was to prove whether the mediastinal lymph nodes’ (LNs) skipping status could indicate the necessity of the PORT for the pN2 NSCLC patients. Methods The skip metastasis was defined as pN0N2 (no N1 LN involved), and nonskip metastasis was pN1N2 (one or more N1 LNs involved). Patients were divided into two groups: LNs nonskip and LNs skip, and postoperative chemoradiotherapy (POCRT) and postoperative chemotherapy. Then, the LN nonskip and LN skip groups were further divided into subgroups: POCRT and point of care testing (POCT) for subgroup analysis. Results There were 220 cases included in the analysis, and 43 of them received PORT. On univariate analysis, the median 3-year progression-free survival (PFS) was, respectively, 16 months (27.7%) for the LN skip group and 11 months (15.3%) for the LN nonskip group (P=0.001). The median 3-year overall survival (OS) was, respectively, 35 months (47.0%) for the LN skip group and 27 months (38.7%) for the LN nonskip group (P=0.025). The median 3-year local recurrence-free survival (LRFS) was, respectively, 25 months (41.0%) for the LN skip group and19 months (29.9%) for the LN nonskip group (P=0.014). The median 3-year distant metastasis-free survival (DMFS) was, respectively, 22 months (32.5%) for the LN skip group and 15 months (20.4%) for the LN nonskip group (P=0.013). The median 3-year PFS was, respectively, 17 months (25.6%) for the POCRT group and 12 months (18.6%) for the POCT group (P=0.037). Although the POCRT group showed better OS, LRFS, and DMFS than the POCT group, the results showed no statistical significance. In subgroup analysis, there was no statistical significance in the Kaplan–Meier analysis between subgroups, but it

  9. Mediastinal syndrome: A report of three cases

    PubMed Central

    Zardi, Enrico Maria; Pipita, Maria Elena; Afeltra, Antonella

    2016-01-01

    Mediastinal syndromes are a group of disorders involving the anatomical structures of the mediastinum. An increase in the incidence of this syndrome has been observed following the widespread use of diagnostic imaging. In the present study, three different cases of mediastinal syndrome, one of which was complicated by superior vena cava syndrome, are discussed. The treatment in the three cases was dependent on the etiology. While a patient with goiter experienced resolution of the symptoms following thyroidectomy, and a patient with lymphoma experienced beneficial effects following medical treatment, the patient with lymph node metastasis caused by a gastric tumor succumbed to the disease. In conclusion, the present case reports demonstrated that mediastinal syndrome is a life threatening condition whose prognosis depends on the underlying cause. PMID:27698718

  10. Mediastinal syndrome: A report of three cases

    PubMed Central

    Zardi, Enrico Maria; Pipita, Maria Elena; Afeltra, Antonella

    2016-01-01

    Mediastinal syndromes are a group of disorders involving the anatomical structures of the mediastinum. An increase in the incidence of this syndrome has been observed following the widespread use of diagnostic imaging. In the present study, three different cases of mediastinal syndrome, one of which was complicated by superior vena cava syndrome, are discussed. The treatment in the three cases was dependent on the etiology. While a patient with goiter experienced resolution of the symptoms following thyroidectomy, and a patient with lymphoma experienced beneficial effects following medical treatment, the patient with lymph node metastasis caused by a gastric tumor succumbed to the disease. In conclusion, the present case reports demonstrated that mediastinal syndrome is a life threatening condition whose prognosis depends on the underlying cause.

  11. Evaluation of the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration for metastatic mediastinal tumors

    PubMed Central

    Dziedzic, Dariusz; Peryt, Adam; Szolkowska, Malgorzata; Langfort, Renata; Orlowski, Tadeusz

    2016-01-01

    Background and Objectives: The mediastinum is a relatively uncommon site of distant metastases, which typically appear as peripheral lung nodules. We chose to assess the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of distant metastases to the mediastinum. Materials and Methods: Over the period 2008–2013, a total of 446 patients with concurrent or previously diagnosed and treated extrathoracic malignancies were evaluated. Results: Surgical treatment was carried out in 414 patients (156 women and 237 men aged 26–68 years, mean age of 56.5 years) presenting with distant metastases to the lungs: Thoracoscopic wedge resection was completed in 393 patients and lobectomy and segmentectomy were performed in 7 and 14 patients, respectively. The median time from primary tumor resection was 6.5 years (range: 4.5 months to 17 years). Thirty-two of these patients underwent EBUS-TBNA for mediastinal manifestation of the underlying disease. EBUS-TBNA specimens were aspirated from the subcarinal or right paratracheal lymph node stations in 26 (81%) patients and from the hilar lymph nodes in 6 (18.8%) patients only. Metastases to lymph nodes were confirmed in 14 of these patients (43.8%). Primary lung cancer was diagnosed in seven patients. Mediastinoscopy was performed in two patients to reveal either lymph node metastasis or sarcoidosis. Thoracotomy for pulmonary metastases resection and mediastinal lymph node biopsy was performed in nine patients. Lymph node metastasis was confirmed in five patients (15.6%). The diagnostic efficacy, sensitivity, specificity, and negative predictive value (NPV) of EBUS-TBNA were 78.8%, 93.3%, 100%, and 87.5%, respectively. Conclusion: EBUS-TBNA is a valuable diagnostic tool in a selected group of patients with secondary tumors in the mediastinum and lungs. PMID:27386474

  12. Concurrent cranial mediastinal Blastomyces granuloma and carcinoma with cranial vena caval syndrome in a dog

    PubMed Central

    Evans, Natashia A.; Viviano, Katrina R.

    2015-01-01

    This report describes an unusual progression of blastomycosis in a dog with concurrent mediastinal carcinoma. The dog was evaluated for respiratory distress. Diagnostic results revealed chylothorax and a cranial vena caval thrombus. Histopathology of the cranial mediastinal mass diagnosed mediastinal carcinoma and fungal granuloma. Intercurrent disease may complicate the clinical presentation and clinical course of blastomycosis. PMID:26538674

  13. Advantages of Combined PET-CT in Mediastinal Staging in Patients with Non-small Cell Lung Carcinoma

    PubMed Central

    Beslic, Nermina; Sadija, Amera; Milardovic, Renata; Ceric, Timur; Ceric, Sejla; Beganovic, Adnan; Kristic, Spomenka; Cavaljuga, Semra

    2016-01-01

    Introduction: Precise mediastinal lymph node staging in patients with non-small cell lung carcinoma (NSCLC) provides important prognostic information and it is obligatory in treatment strategy planning. 18Fluoro-deoxy-glucose (18F-FDG) positron emission tomography - computerized tomography (PET-CT) based on detection of metabolic activity showed superiority in preoperative staging of lung carcinoma. Materials and Methods: Total number of 26 patients diagnosed with NSCLC were included in this retrospective, cross-sectional study. Status of mediastinal lymph nodes was assessed in all patients comparing contrast enhanced CT and 18F-FDG PET-CT findings. Discussion: We found in our study that 50% of patients had different N stage on contrast enhanced CT comparing to 18F-FDG PET-CT findings. Among the total number of patients which had different nodal status on PET-CT comparing to CT alone, we found in our study that 54% of patients had change in further therapy protocol after PET-CT change of nodal stage. Conclusion: Combined PET-CT which offers advantages of both modalities is excellent method for nodal (N) staging, so it is recommended in initial staging in patients with NSCLC. PET-CT used preopratively for mediastinal nodal staging has significant impact on further therapy planning and also has an consequential impact on health system savings. PMID:27147799

  14. Contemporary mediastinal tuberculosis.

    PubMed Central

    Bloomberg, T J; Dow, C J

    1980-01-01

    Mediastinal lymphadenopathy is a prominent feature of adult tuberculosis in immigrant groups in the United Kingdom. Chest radiography of 95 tuberculous immigrants showed mediastinal gland enlargement in 29 cases, whereas none of the 42 Europeans showed this feature. An analysis has been made of the distribution of the disease in all groups together with a more detailed evaluation of mediastinal involvement in the immigrants. Pericardial effusions were seen in eight patients together with the following three unusual complications: (1) broncho-oesophageal fistula; (2) bronchial erosion; (3) superior mediastinal obstruction. Images PMID:7434292

  15. Detection of lymph node metastases with ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging in oesophageal cancer: a feasibility study

    PubMed Central

    van der Jagt, E.J.; van Westreenen, H.L.; van Dullemen, H.M.; Kappert, P.; Groen, H.; Sietsma, J.; Oudkerk, M.; Plukker, J.Th.M.; van Dam, G.M.

    2009-01-01

    Abstract Aim: In this feasibility study we investigated whether magnetic resonance imaging (MRI) with ultrasmall superparamagnetic iron oxide (USPIO) can be used to identify regional and distant lymph nodes, including mediastinal and celiac lymph node metastases in patients with oesophageal cancer. Patients and methods: Ten patients with a potentially curative resectable cancer of the oesophagus were eligible for this study. All patients included in the study had positive lymph nodes on conventional staging (including endoscopic ultrasound, computed tomography and fluorodeoxyglucose-positron emission tomography). Nine patients underwent MRI + USPIO before surgery. Results were restricted to those patients who had both MRI + USPIO and histological examination. Results were compared with conventional staging and histopathologic findings. Results: One patient was excluded due to expired study time. Five out of 9 patients underwent an exploration; in 1 patient prior to surgery MRI + USPIO diagnosed liver metastases and in 3 patients an oesophageal resection was performed. USPIO uptake in mediastinal lymph nodes was seen in 6 out of 9 patients; in 3 patients non-malignant nodes were not visible. In total, 9 lymph node stations (of 6 patients) were separately analysed; 7 lymph node stations were assessed as positive (N1) on MRI+USPIO compared with 9 by conventional staging. According to histology findings, there was one false-positive and one false-negative result in MRI + USPIO. Also, conventional staging modalities had one false-positive and one false-negative result. MRI + USPIO had surplus value in one patient. Not all lymph node stations could be compared due to unforeseen explorations. No adverse effects occurred after USPIO infusion. Conclusion: MRI+USPIO identified the majority of mediastinal and celiac (suspect) lymph nodes in 9 patients with oesophageal cancer. MRI+USPIO could have an additional value in loco-regional staging; however, more

  16. Is an increase in CD4/CD8 T-cell ratio in lymph node fine needle aspiration helpful for diagnosing Hodgkin lymphoma? A study of 85 lymph node FNAs with increased CD4/CD8 ratio

    PubMed Central

    Hernandez, Osvaldo; Oweity, Thaira; Ibrahim, Sherif

    2005-01-01

    Background An elevated CD4/CD8 T-cell ratio on flow cytometry (FCM) analysis has been reported in the literature to be associated with Hodgkin lymphoma (HL). The purpose of our study was to determine the diagnostic significance of an elevated CD4/CD8 ratio in lymph node fine needle aspiration (FNA) specimens. Design Between 1996 and 2002, out of 837 lymph node FNAs submitted for flow cytometry analysis, 85 cases showed an elevated CD4/CD8 ratio, defined as greater than or equal to 4, without definitive evidence of a lymphoproliferative disorder. The cytologic diagnoses of these 85 cases were grouped into four categories: reactive, atypical, Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL). Histologic follow-up was available in 17/85 (20%) of the cases. Results 5 of the 64 cases in which FCM and cytology did not reveal evidence of a lymphoproliferative disease had tissue follow-up because of persistent lymphadenopathy and high clinical suspicion. 3/5 (60%) confirmed the diagnosis of reactive lymphadenopathy. The two remaining cases (40%) were positive for lymphoma (1HL, 1NHL). 8/15 cases called atypical on cytology had histologic follow-up. 7/8 (87.5%) cases were positive for lymphoma (3HL, 4NHL). 3/4 cases called HL on cytology had tissue follow-up and all 3 (100%) confirmed the diagnosis of HL. One case diagnosed as NHL on cytology was found to be a diffuse large B-cell lymphoma. In summary, out of 17 cases with histologic follow-up 4/17 (24%) were reactive with CD4/CD8 T-cell ratio of 4.1–29, 7/17 (41%) were HLs with CD4/CD8 T-cell ratio of 5.3 – 11, and 6/17 (35%) were NHLs with CD4/CD8 T-cell ratio of 4.2 – 14. Conclusion An elevated CD4/CD8 ratio on FCM is a nonspecific finding which may be seen in both reactive and lymphoproliferative disorders. The cytomorphologic features of the smear are more relevant than the sole flow cytometric finding of an elevated CD4/CD8 ratio. PMID:16153296

  17. Unusual metastases of thyroid cancer to mediastinal blood vessels.

    PubMed

    Ma, Hong Yun; Moadel, Renee; Freeman, Leonard M

    2015-01-01

    Poorly differentiated thyroid cancer is a rare thyroid cancer, accounts for approximately 5% of all thyroid cancer cases, and is associated with a poor prognosis. It commonly metastasizes to regional lymph nodes, lung, and bones. We present a patient with poorly differentiated thyroid cancer with unusual extensive spread to mediastinal blood vessels.

  18. [Plunging and mediastinal goiters].

    PubMed

    Barrault, S; Gandon, J; Le Guillou, C

    1986-01-01

    Of 185 cases of substernal goitre operated upon between 1976 and 1985, four were patients with autonomous mediastinal goitre. Diagnosis was established from results of clinical examination, a scan of mediastinum and radiologie imaging with a cervical and mediastinal CT scan as the investigation of choice. Treatment is exclusively surgical because of the risk of mediastinal compression. Most cases in this series were operated upon through a purely cervical approach, but 22 patients required partial upper sternotomy combined with cervicotomy, this minimal approach route allowing very good exposure of upper mediastinum.

  19. [One Case about Primary Mediastinal Primary Mediastinal Tumor 
with Mediastinal Sarcoma and Literature Review].

    PubMed

    Du, Jinchen; Li, Qingxin; Chao, Dong; Ban, Yulian; Li, Qunqun

    2016-09-20

    Primary mediastinal seminoma is a kind of germ cell malignancy outside the gonads, and it's rarer with sarcoma component. This disease which has no special clinical manifestations and imaging characteristics is difficult to identify with other mediastinal tumors and mediastinal type lung cancer. This paper reported a case of primary mediastinal seminoma with mediastinal sarcoma. Through the analysis of the diagnosis and treatment process in this patient, we will make a comprehensive review of the disease. PMID:27666557

  20. [Occult mediastinal node involvement in non-small cell lung cancer after negative uptake on PET/CT: ripples through staging and therapy. Case report and critical review].

    PubMed

    Trodella, L; Salvati, F; Martelli, M; Mattia, P; Graziano, P; Ippolito, E

    2011-01-01

    A 78-years old man, heavy smoker, with a persistent and hacking cough, was diagnosed with an adenocarcinoma of upper lobe of left lung. Clinical stage was defined as cT2N0M0 also on the basis of a negative (18)FDG-PET/TC. After lobectomy, pathological stage resulted, on the contrary, pT2N2M0. Because the considerable incidence of preoperative false negative uptakes of PET/TC for involvement of mediastinal lymph nodes, this case report is highlighted as emblematic, particularly in relation to post-operative treatment of early stage NSCLC. PMID:22262330

  1. Mediastinal thoracic duct cyst.

    PubMed Central

    Gowar, F J

    1978-01-01

    A case of mediastinal thoracic duct cyst is described; it is believed to be the first to be reported in Britain. Five surgically treated cases have been reported but in none was the diagnosis made before operation. Symptoms are caused by pressure of the cyst on the trachea and oesophagus and my be aggravted by eating a fatty meal. Differential diagnosis from other mediastinal tumours, especially bronchogenic cyst and neurofibroma, could perhaps be established before operation by lymphangiography. Images PMID:746509

  2. Mediastinal angiomatosis: a rare case report

    PubMed Central

    Pak, Min Gyoung; Choi, Phil Jo; Choi, Won Suk; Kang, Eun Ju

    2015-01-01

    Angiomatosis refers to a rare condition of large hamartomatous vascular lesions that extensively affect a region of the body or several different tissue types in a contiguous way. Several cases have been reported in the mediastinum. We experienced a histologically proven case of mediastinal angiomatosis in a 56-year-old woman that was incidentally detected as multiple conglomerated masses mimicking metastatic lymph nodes on chest radiography. Despite its rareness, our case emphasizes that pathologists and radiologists need to be aware of the rare diagnosis of angiomatosis in the mediastinum. PMID:26793386

  3. [Mediastinal germ cell tumors].

    PubMed

    Bremmer, F; Ströbel, P

    2016-09-01

    The mediastinum is among the most frequent anatomic region in which germ cell tumors (GCT) arise, second only to the gonads. Mediastinal GCT (mGCT) account for 16 % of all mediastinal neoplasms. Although the morphology and (according to all available data) the molecular genetics of mediastinal and gonadal GCT are identical, a number of unique aspects exist. There is a highly relevant bi-modal age distribution. In pre-pubertal children of both sexes, mGCT consist exclusively of teratomas and yolk sac tumors. The prognosis is generally favorable with modern treatment. In post-pubertal adults, virtually all patients with malignant mGCT are males; the prognosis is more guarded and depends (among other factors) on the histological GCT components and is similar to GCT in other organs. So-called somatic type malignancies (i. e. clonally related, non-germ cell neoplasias arising in a GCT) are much more frequent in mGCT than in other organs, and the association between mediastinal yolk sac tumors and hematological malignancies, such as myelodysplasias and leukemias, is unique to mediastinal tumors. The prognosis of GCT with somatic type malignancies is generally dismal. PMID:27491549

  4. Mediastinal Mass with Hyper-eosinophilia in a Young Boy -A Diagnostic Dilemma

    PubMed Central

    Prem, Shruti; Jacob, Priya Mary; Nair, Rekha Appukuttan

    2016-01-01

    Mediastinal masses in children comprises of a heterogeneous group of tumours. In such cases, biopsy and histological analysis are mandatory for planning of treatment. We have reported an unusual aetiology for a mediastinal mass in a young boy presenting with features of Superior Vena Caval Obstruction (SVCO) who also had marked blood and marrow eosinophilia mimicking Chronic Eosinophilic Leukaemia (CEL). We have also discussed the differential diagnoses of mediastinal tumours with hyper-eosinophilia and possible therapeutic implications.

  5. Mediastinal Mass with Hyper-eosinophilia in a Young Boy -A Diagnostic Dilemma.

    PubMed

    Parambil, Abdul Shahid Poovathum; Prem, Shruti; Jacob, Priya Mary; Nair, Rekha Appukuttan

    2016-07-01

    Mediastinal masses in children comprises of a heterogeneous group of tumours. In such cases, biopsy and histological analysis are mandatory for planning of treatment. We have reported an unusual aetiology for a mediastinal mass in a young boy presenting with features of Superior Vena Caval Obstruction (SVCO) who also had marked blood and marrow eosinophilia mimicking Chronic Eosinophilic Leukaemia (CEL). We have also discussed the differential diagnoses of mediastinal tumours with hyper-eosinophilia and possible therapeutic implications.

  6. Mediastinal Mass with Hyper-eosinophilia in a Young Boy -A Diagnostic Dilemma

    PubMed Central

    Prem, Shruti; Jacob, Priya Mary; Nair, Rekha Appukuttan

    2016-01-01

    Mediastinal masses in children comprises of a heterogeneous group of tumours. In such cases, biopsy and histological analysis are mandatory for planning of treatment. We have reported an unusual aetiology for a mediastinal mass in a young boy presenting with features of Superior Vena Caval Obstruction (SVCO) who also had marked blood and marrow eosinophilia mimicking Chronic Eosinophilic Leukaemia (CEL). We have also discussed the differential diagnoses of mediastinal tumours with hyper-eosinophilia and possible therapeutic implications. PMID:27630938

  7. Mediastinal Mass with Hyper-eosinophilia in a Young Boy -A Diagnostic Dilemma.

    PubMed

    Parambil, Abdul Shahid Poovathum; Prem, Shruti; Jacob, Priya Mary; Nair, Rekha Appukuttan

    2016-07-01

    Mediastinal masses in children comprises of a heterogeneous group of tumours. In such cases, biopsy and histological analysis are mandatory for planning of treatment. We have reported an unusual aetiology for a mediastinal mass in a young boy presenting with features of Superior Vena Caval Obstruction (SVCO) who also had marked blood and marrow eosinophilia mimicking Chronic Eosinophilic Leukaemia (CEL). We have also discussed the differential diagnoses of mediastinal tumours with hyper-eosinophilia and possible therapeutic implications. PMID:27630938

  8. Lymph nodes

    MedlinePlus Videos and Cool Tools

    ... and conveying lymph and by producing various blood cells. Lymph nodes play an important part in the ... the microorganisms being trapped inside collections of lymph cells or nodes. Eventually, these organisms are destroyed and ...

  9. [Prognosis of childhood mediastinal lymphoma].

    PubMed

    Okamura, J; Ikuno, Y; Sakata, N; Kai, T; Tasaka, H

    1990-11-01

    Between 1973 and 1989, 16 children with non-Hodgkins lymphoma (NHL) with a mediastinal mass (MM) were treated at our institution with multi-agent chemotherapy and radiotherapy. They also received central nervous system (CNS) prophylaxis including intrathecal methotrexate administration (14 cases) and cranial irradiation (7 cases). Twelve were boys and 4 girls. Median age was 11 +/- 3. One patient died of air way obstruction one day after admission. Fourteen of 15 patients entered into complete remission (CR) and one patient partial remission. Five remains in CR 7 to 175 months after diagnosis (median 76 months). Nine patients relapsed in the bone marrow (3 cases), CNS (3), testicles (1), neck lymph node (1) and bones plus kidneys (1). Of these, 7 patients died within 13 months after initial relapse. The disease free survival (DFS) and overall survival of all patients were 27% and 33%, respectively. Analysis of the prognostic factors among patients with MM+ -NHL revealed that the serum LDH level below 1,000IU/l was a good prognostic sign. Other factors such as age, stage, initial WBC count, size of MM and response of the MM to the initial treatment did not correlate with DFS. Because of its rarity and the poor treatment result, we need more aggressive treatment program by a multiinstitutional study for MM+ -NHL. PMID:2287064

  10. Mediastinal bronchogenic cyst mimicking congenital lobar emphysema.

    PubMed

    Arun, Sumitha; Kumar, Manish; Ross, Benjamin Jeyanth

    2016-01-01

    Bronchogenic cyst (BC) is a rare congenital malformation of the lung. Most patients remain asymptomatic until adulthood while some are symptomatic in the first few years of life. However, symptoms in newborn period are rare. We report a case of a 3-day-old preterm baby with respiratory distress diagnosed as congenital lobar emphysema on chest X-ray. A CT scan revealed a mediastinal cyst causing obstructive lobar emphysema. The cyst was excised and pathological examination was suggestive of BC. PMID:27609589

  11. Minimally invasive mediastinal surgery

    PubMed Central

    Melfi, Franca M. A.; Mussi, Alfredo

    2016-01-01

    In the past, mediastinal surgery was associated with the necessity of a maximum exposure, which was accomplished through various approaches. In the early 1990s, many surgical fields, including thoracic surgery, observed the development of minimally invasive techniques. These included video-assisted thoracic surgery (VATS), which confers clear advantages over an open approach, such as less trauma, short hospital stay, increased cosmetic results and preservation of lung function. However, VATS is associated with several disadvantages. For this reason, it is not routinely performed for resection of mediastinal mass lesions, especially those located in the anterior mediastinum, a tiny and remote space that contains vital structures at risk of injury. Robotic systems can overcome the limits of VATS, offering three-dimensional (3D) vision and wristed instrumentations, and are being increasingly used. With regards to thymectomy for myasthenia gravis (MG), unilateral and bilateral VATS approaches have demonstrated good long-term neurologic results with low complication rates. Nevertheless, some authors still advocate the necessity of maximum exposure, especially when considering the distribution of normal and ectopic thymic tissue. In recent studies, the robotic approach has shown to provide similar neurological outcomes when compared to transsternal and VATS approaches, and is associated with a low morbidity. Importantly, through a unilateral robotic technique, it is possible to dissect and remove at least the same amount of mediastinal fat tissue. Preliminary results on early-stage thymomatous disease indicated that minimally invasive approaches are safe and feasible, with a low rate of pleural recurrence, underlining the necessity of a “no-touch” technique. However, especially for thymomatous disease characterized by an indolent nature, further studies with long follow-up period are necessary in order to assess oncologic and neurologic results through minimally

  12. Glioblastoma arising within a mediastinal mature teratoma.

    PubMed

    Liu, Liping; Jentoft, Mark E; Boland, Jennifer M

    2016-10-01

    Herein we present the case of a 42-year-old man who presented with an anterior mediastinal mass, which was found to represent a mature teratoma. Within it, there was a secondary somatic malignant glial neoplasm with mitotic activity and necrosis, compatible with glioblastoma. He experienced early local recurrence and lymph node metastasis, but is alive and well 3 1/2 years after diagnosis. Neither the teratoma nor the glioblastoma components had abnormalities of chromosome 12, which may implicate that this teratoma was more closely related to those arising along the midline of infants and children (type I germ cell tumor) than to the typically malignant testicular examples, which often contain mixed germ cell elements (type II germ cell tumor). PMID:27327191

  13. Idiopathic azygos vein aneurysm: a rare cause of mediastinal mass

    PubMed Central

    Gallego, M.; Mirapeix, R.; Castaner, E.; Domingo, C.; Mata, J.; Marin, A.

    1999-01-01

    Venous aneurysm of the azygos arch is a very rare cause of mediastinal mass and is usually an incidental finding on chest radiography. Nowadays the diagnosis is made by non-invasive tests such as thoracic CT scanning and/or magnetic resonance imaging. The case is described of an asymptomatic woman in whom a mediastinal mass due to an azygos vein aneurysm was diagnosed by non-invasive procedures, the aetiology of which, in all probability, was idiopathic.

 PMID:10377213

  14. Computed tomography versus magnetic resonance imaging for diagnosing cervical lymph node metastasis of head and neck cancer: a systematic review and meta-analysis

    PubMed Central

    Sun, J; Li, B; Li, CJ; Li, Y; Su, F; Gao, QH; Wu, FL; Yu, T; Wu, L; Li, LJ

    2015-01-01

    Computed tomography (CT) and magnetic resonance imaging (MRI) are common imaging methods to detect cervical lymph node metastasis of head and neck cancer. We aimed to assess the diagnostic efficacy of CT and MRI in detecting cervical lymph node metastasis, and to establish unified diagnostic criteria via systematic review and meta-analysis. A systematic literature search in five databases until January 2014 was carried out. All retrieved studies were reviewed and eligible studies were qualitatively summarized. Besides pooling the sensitivity (SEN) and specificity (SPE) data of CT and MRI, summary receiver operating characteristic curves were generated. A total of 63 studies including 3,029 participants were involved. The pooled results of meta-analysis showed that CT had a higher SEN (0.77 [95% confidence interval {CI} 0.73–0.87]) than MRI (0.72 [95% CI 0.70–0.74]) when node was considered as unit of analysis (P<0.05); MRI had a higher SPE (0.81 [95% CI 0.80–0.82]) than CT (0.72 [95% CI 0.69–0.74]) when neck level was considered as unit of analysis (P<0.05) and MRI had a higher area under concentration-time curve than CT when the patient was considered as unit of analysis (P<0.05). With regards to diagnostic criteria, for MRI, the results showed that the minimal axial diameter of 10 mm could be considered as the best size criterion, compared to 12 mm for CT. Overall, MRI conferred significantly higher SPE while CT demonstrated higher SEN. The diagnostic criteria for MRI and CT on size of metastatic lymph nodes were suggested as 10 and 12 mm, respectively. PMID:26089682

  15. Computed tomography versus magnetic resonance imaging for diagnosing cervical lymph node metastasis of head and neck cancer: a systematic review and meta-analysis.

    PubMed

    Sun, J; Li, B; Li, C J; Li, Y; Su, F; Gao, Q H; Wu, F L; Yu, T; Wu, L; Li, L J

    2015-01-01

    Computed tomography (CT) and magnetic resonance imaging (MRI) are common imaging methods to detect cervical lymph node metastasis of head and neck cancer. We aimed to assess the diagnostic efficacy of CT and MRI in detecting cervical lymph node metastasis, and to establish unified diagnostic criteria via systematic review and meta-analysis. A systematic literature search in five databases until January 2014 was carried out. All retrieved studies were reviewed and eligible studies were qualitatively summarized. Besides pooling the sensitivity (SEN) and specificity (SPE) data of CT and MRI, summary receiver operating characteristic curves were generated. A total of 63 studies including 3,029 participants were involved. The pooled results of meta-analysis showed that CT had a higher SEN (0.77 [95% confidence interval {CI} 0.73-0.87]) than MRI (0.72 [95% CI 0.70-0.74]) when node was considered as unit of analysis (P<0.05); MRI had a higher SPE (0.81 [95% CI 0.80-0.82]) than CT (0.72 [95% CI 0.69-0.74]) when neck level was considered as unit of analysis (P<0.05) and MRI had a higher area under concentration-time curve than CT when the patient was considered as unit of analysis (P<0.05). With regards to diagnostic criteria, for MRI, the results showed that the minimal axial diameter of 10 mm could be considered as the best size criterion, compared to 12 mm for CT. Overall, MRI conferred significantly higher SPE while CT demonstrated higher SEN. The diagnostic criteria for MRI and CT on size of metastatic lymph nodes were suggested as 10 and 12 mm, respectively.

  16. [Malignant mediastinal lesions with invasion to the superior vena cava].

    PubMed

    Kitada, M; Kubo, Y; Hirata, S; Yatsuyanagi, E; Nosaka, T; Sugimoto, S; Moriyama, H; Koshigo, S; Muraki, S; Sasajima, T

    1995-11-01

    Four patients underwent resection of mediastinal malignant tumors with invasion to the superior vena cava. Two patients had invasive thymoma, one seminoma, and one metastatic mediastinal lymph nodes of unknown origin. Prior to resection of the tumor, an ePTFE graft was anastomosed between the innominate vein and the right atrium to maintain the venous drainage from the brain and the upper extremities. In two patients, the superior vena cava was reconstructed by patch angioplasty after the tumor with a part of the vena cava was safely resected. One patient died of acute respiratory failure, but the other three are alive and well without any evidence of graft obstruction. This safe and useful method in order to prevent cerebral congestion during and after resection of the tumor.

  17. A 70-Year-Old Man With Large Cervical and Mediastinal Lymphadenopathies

    PubMed Central

    Narechania, Shraddha; Valent, Jason; Farver, Carol

    2015-01-01

    We present a case of a 70-year-old man with enlarged mediastinal and cervical lymph nodes that provided interesting radiologic and pathologic observations. The 70-year-old black man was found to have enlarged mediastinal lymph nodes. He had symptoms of atypical chest pain and generalized weakness for 2 weeks prior to the diagnosis. He denied shortness of breath, fever, chills, or night sweats. He was treated for hypertension and onychomycosis. Basic laboratory findings were within normal limits. Pulmonary function tests at the time of presentation showed FEV1, FVC, and FEV1/FVC ratio of 123% predicted, 133% predicted, and 0.7, respectively. Meanwhile, total lung capacity and carbon monoxide diffusing capacity were 103% and 107% predicted, respectively. Two weeks before he presented to our institution, the patient underwent bronchoscopy with transbronchial biopsies of the right lower lobe and endobronchial ultrasound-guided transbronchial needle aspiration of the right hilar lymph nodes. PMID:26149568

  18. Detection of scalene lymph node metastases from lung cancer. Positron emission tomography.

    PubMed

    Scott, W J; Gobar, L S; Hauser, L G; Sunderland, J J; Dewan, N A; Sugimoto, J T

    1995-04-01

    Preliminary data indicate that positron emission tomography (PET) following injection of fluorodeoxyglucose F18 (FDG) is sensitive and specific for detecting malignant cells in chest tumors and mediastinal lymph nodes. We report a case of non-small cell lung cancer metastatic to clinically normal scalene lymph nodes that was correctly staged by FDG-PET. PMID:7705136

  19. [Mediastinitis and bilateral pleural effusion of pancreatic origin (author's transl)].

    PubMed

    Holzer, R; Pesendorfer, F X; Pridun, N

    1982-01-01

    A case report is presented of a patient admitted to a thoracic specialist unit on account of predominantly pulmonary symptomatology. There was a left-sided haemorrhagic pulmonary effusion, which rapidly returned after tapping. The patient then developed a high fever and shock. Mediastinal widening was noted on X-ray, as well as a right-sided pleural effusion. Repeated tapping of the pleural effusions and drainage of a mediastinal abscess, which was diagnosed on mediastinoscopy as well as the administration of antibiotics led to an improvement in the patient's previously poor general condition. Sonography and subsequent endoscopic retrograde pancreatography were instrumental in eventually diagnosing chronic recurrent pancreatitis with cyst formation and retroperitoneal perforation into the mediastinum and pleural space. Laparotomy with removal of the pancreatic cysts and abdominal drainage led to complete recovery. The pathogenetic processes involved in the formation of internal fistulae, diagnostic problems and therapeutic management are discussed.

  20. Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass

    PubMed Central

    Chaudhary, Kapil; Gupta, Anshu; Wadhawan, Sonia; Jain, Divya; Bhadoria, Poonam

    2012-01-01

    Anesthetic management of superior vena cava syndrome carries a possible risk of life-threatening complications such as cardiovascular collapse and complete airway obstruction during anesthesia. Superior vena cava syndrome results from the enlargement of a mediastinal mass and consequent compression of mediastinal structures resulting in impaired blood flow from superior vena cava to the right atrium and venous congestion of face and upper extremity. We report the successful anesthetic management of a 42-year-old man with superior vena cava syndrome posted for cervical lymph node biopsy. PMID:22557753

  1. Thoracoscopic radical esophagectomy and laparoscopic transhiatal lymph node dissection for superficial esophageal cancer associated with lymph node metastases in the dorsal area of the thoracic aorta.

    PubMed

    Ninomiya, Itasu; Okamoto, Koichi; Tsukada, Tomoya; Saito, Hiroto; Fushida, Sachio; Ikeda, Hiroko; Ohta, Tetsuo

    2015-12-01

    Esophageal cancer invading the muscularis mucosa sometimes involves regional lymph node metastases. However, lymph node metastases are rare in the dorsal area of the thoracic aorta. We describe a patient with an intramucosal esophageal cancer invading the muscularis mucosa, accompanied by lymph node metastases in the dorsal area of the thoracic aorta. These lesions were successfully resected by hand-assisted laparoscopic surgery using a transhiatal approach. A 60-year-old man was diagnosed with superficial esophageal cancer during a routine health examination. Endoscopic examination and ultrasonography revealed a superficial cancer, of diameter 6.0 cm, invading the submucosal layer and intramural metastases caudal to the primary tumor. Enhanced computed tomography and F-deoxyglucose positron emission tomography demonstrated the two metastatic lymph nodes, one in the dorsal area of the thoracic aorta and the other near the left gastric artery. Thoracoscopic radical esophagectomy with three-field lymph node dissection was performed. The metastatic lymph node in the dorsal area of the thoracic aorta was successfully removed by hand-assisted laparoscopic surgery using a transhiatal approach. Histopathological examination showed primary cancer invading the muscularis mucosa and intramural metastases in the lamina propria mucosa and submucosal layer. The pathological diagnosis according to the Japanese classification of esophageal cancer was MtLt, 47 mm, 0-IIa + IIb, pT1a-MM, ie(+), INF-b, ly3, v0, pN4(4a), pIM1, M0, and pstage IVa. The patient underwent two courses of adjuvant chemotherapy, consisting of CDDP and 5-fluorouracil. At present, 1 year and 8 months after surgery, the patient remains alive without tumor recurrence. Although the lymph node in the dorsal area of the thoracic aorta is not recognized as regional nodes of thoracic esophageal cancer, solitary mediastinal metastases from a mucosal cancer may indicate the existence of direct lymphatic flow

  2. Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging in lung cancer*

    PubMed Central

    Fernández-Bussy, Sebastián; Labarca, Gonzalo; Canals, Sofia; Caviedes, Iván; Folch, Erik; Majid, Adnan

    2015-01-01

    OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic test with a high diagnostic yield for suspicious central pulmonary lesions and for mediastinal lymph node staging. The main objective of this study was to describe the diagnostic yield of EBUS-TBNA for mediastinal lymph node staging in patients with suspected lung cancer. METHODS: Prospective study of patients undergoing EBUS-TBNA for diagnosis. Patients ≥ 18 years of age were recruited between July of 2010 and August of 2013. We recorded demographic variables, radiological characteristics provided by axial CT of the chest, location of the lesion in the mediastinum as per the International Association for the Study of Lung Cancer classification, and definitive diagnostic result (EBUS with a diagnostic biopsy or a definitive diagnostic method). RESULTS: Our analysis included 354 biopsies, from 145 patients. Of those 145 patients, 54.48% were male. The mean age was 63.75 years. The mean lymph node size was 15.03 mm, and 90 lymph nodes were smaller than 10.0 mm. The EBUS-TBNA method showed a sensitivity of 91.17%, a specificity of 100.0%, and a negative predictive value of 92.9%. The most common histological diagnosis was adenocarcinoma. CONCLUSIONS: EBUS-TBNA is a diagnostic tool that yields satisfactory results in the staging of neoplastic mediastinal lesions. PMID:26176519

  3. Epithelial and pancreatic choristoma in bovine lymph nodes.

    PubMed

    Quesada, O; Suárez-Bonnet, A; Andrada, M; Fernández, A; de los Monteros, A Espinosa

    2010-01-01

    Lymph nodes from 186 cows were evaluated as part of a bovine tuberculosis eradication programme. The mediastinal lymph nodes of 13 animals contained atypical structures. In 12 cases (6.45%) these consisted of multiple epithelial structures and, in one case, of pancreatic-like tissue. Immunohistochemistry (IHC) revealed that the epithelial structures were consistent with respiratory epithelium and with ectopic pancreatic tissue, respectively. To the best of our knowledge these are the first histological and immunohistochemical descriptions of epithelial and pancreatic choristomas in bovine lymph nodes.

  4. Tracheal varices caused by mediastinal compression of a large intrathoracic goiter: report of a case

    PubMed Central

    LUCCHINI, R.; SANTOPRETE, S.; TRIOLA, R.; POLISTENA, A.; MONACELLI, M.; AVENIA, S.; SANGUINETTI, A.; PUMA, F.; AVENIA, N.

    2015-01-01

    Introduction Tracheal varices are a rare condition but they can be an important source of massive or recurrent haemoptysis. Usually they are related to increased pressure in the pulmonary veins. Mediastinal goiter is often associated to compressive effects on the surrounding structures, including mediastinal vessels with potential superior vena cava syndrome. Case report We describe a case, not previously reported in literature, of mediastinal goiter with hemoptysis as first clinical manifestation. Bleeding was attributed to a superior vena cava syndrome associated to a tracheal fragile mucosa with an easily bleeding intramural nodule which was diagnosed as tracheal varices after total thyroidectomy. The nodule in fact disappeared together with the venous hypertensive signs after venous decompression of the mediastinum. Conclusions Compressive symptoms including tracheal varices, related to mediastinal goiter, can be treated surgically by total thyroidectomy via cervicotomy and when required with associated median sternotomy. PMID:25827666

  5. A rare presentation of a huge mature mediastinal teratoma with right lung cavitation

    PubMed Central

    Pattnaik, Manoj Kumar; Majhi, Paresh Chandra; Nayak, Anil Kumar; Senapati, Debadutta

    2014-01-01

    A school-going child presented with fever and productive cough for a short period, which after laboratory and radiological survey was diagnosed as mediastinal teratoma with lung cavitation. Preoperatively the exact cause of lung pathology could not be established, although more common causes prevalent in this zone such as, tuberculosis and lung abscess were excluded. Surgical treatment was planned and excision of the mediastinal mass with segmentectomy of the right-upper lobe carried out through median sternotomy. Mature teratoma is the most common primary germ cell tumour of the mediastinum accounting for 60–70% of all mediastinal germ cell tumours. On very rare occasions it involves the adjacent lung, usually the left lung, producing secondary changes inviting suspicion of a separate lung pathology. Here we present a rare case of a huge mature mediastinal teratoma with secondary right lung cavitation. PMID:24842359

  6. Combined mediastinal and retroperitoneal fibrosis

    PubMed Central

    Salmon, H. W.

    1968-01-01

    A case of combined idiopathic mediastinal fibrosis and retroperitoneal fibrosis is described. It is possibly the twelfth case to be reported during life. A review of the literature reveals the `ubiquity' of localized collagenosis and the trend of opinion as regards aetiology and treatment. Images PMID:5654073

  7. Thyroid Storm and Incidental Anterior Mediastinal Teratoma: Coincidence or Correlation?

    PubMed Central

    Wang, Cheng-An; Chen, Wei-Ta; Cheng, Ho-Shun; Chung, Cheng-Chih; Chen, Yu-Ju; Hsieh, Ming-Hsiung

    2013-01-01

    Teratoma is a rare cause of thyrotoxicosis. Among the different types of teratoma, struma ovarii is the main type which contains thyroid tissue. There is no evidence in the literature that would indicate mediasternal teratoma would also lead to thyrotoxicosis or thyroid storm. Herein we report a 37-year-old woman who suffered from palpitation. Her chest X-ray showed a mass lesion at the left hilum, and chest computed tomography scan yielded a suspicion of pericardial cyst. Thereafter, video-assisted thoracoscopic surgery was performed, and thymic cyst was diagnosed during the operation. However, subsequent pathological studies confirmed a diagnosis of mature cystic teratoma. A thyroid function test demonstrating hyperthyroidism was completed prior to the patient’s operation, and thyroid storm was diagnosed by clinical presentation. The patient’s symptoms did not improve after the operation until we added beta blocker and anti-thyroid agents. Therefore, was the presence of thyroid storm and anterior mediastinal teratoma coincident or correlative in this case? The special stain of teratoma tissues did not reveal any thyroid tissues. In conclusion, thyroid storm and anterior mediastinal teratoma in our case occurred coincidentally. However, a survey of possible hyperthyroidism in patients with anterior mediastinal tumor before operation is critical to avoid perioperative complications. PMID:27122746

  8. Primary mediastinal choriocarcinoma with brain metastasis in a female patient.

    PubMed

    Kuno, I; Matsumoto, Y; Kasai, M; Fukuda, T; Hashiguchi, Y; Ichimura, T; Yasui, T; Sumi, T

    2016-01-01

    Nongestational choriocarcinoma is very rare and carries a poor prognosis in female patients. In this report, the authors present a case of nongestational choriocarcinoma with brain metastasis in a female. A 58-year-old female with intermittent back pain was referred to a private hospital. On examination, a mediastinal tumor and a pancreatic tumor were detected. Endoscopic ultrasound-guided fine needle aspiration biopsy of the tumor was performed for histological evaluation. Pathological diagnosis was difficult because only a small amount of tissue was collected. Head MRI showed multiple metastatic tumors in the brain. The patient was diagnosed with primary mediastinal choriocarcinoma with brain metastasis. She was treated with one course of an etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine regimen, but her general condition gradually deteriorated, and she died on day 41. Nongestational choriocarcinoma is drug resistant, whereas gestational choriocarcinoma has better chemotherapeutic sensitivity. PMID:27172760

  9. Thoracoscopic resection of functional posterior mediastinal paraganglioma: a case report

    PubMed Central

    Ma, Lin; Mei, Jianong

    2014-01-01

    A 48-year-old man with posterior mediastinal mass was diagnosed as functional mediastinal paraganglioma during surgical exploration via open thoracotomy in another hospital. The operation was terminated because of severe hypertension when touching the tumor. He was transferred to our center later. After systemic evaluation, the patient was medicated with oral alpha- and beta-blockades, as well as intravenous fluid resuscitation for two weeks. His blood pressure became stable and a second operation was planned. The tumor was removed completely via the thoracoscopic approach, and was finally confirmed as functional paraganglioma by immunohistochemistry. The patient recovered uneventfully after surgery, with no recurrence during one year follow-up visit. PMID:25589992

  10. Lymph node biopsy

    MedlinePlus

    Biopsy - lymph nodes; Open lymph node biopsy; Fine needle aspiration biopsy; Sentinel lymph node biopsy ... then sent to the laboratory for examination. A needle biopsy involves inserting a needle into a lymph ...

  11. From cytology to histology: diagnosis of a relapsed mediastinal lymphoma by endobronchial ultrasound transbronchial histological needle.

    PubMed

    Ariza-Prota, Miguel Angel; Bango Álvarez, Antonio; Pérez, Liliana; Pando-Sandoval, Ana; Fuentes, Nelson; Casan, Pere

    2015-06-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is highly accurate in diagnosing mediastinal lymphadenopathies of lung cancer and benign disorders, with the advantage that it is a minimally invasive technique, unlike open surgery and mediastinoscopy. However, the diagnostic accuracy of EBUS-TBNA for the diagnosis of lymphoma in patients with mediastinal lymphadenopathy is not well defined. The lack of tissue architecture obtained by cytological needles decreases the diagnostic accuracy for diagnosis and subtyping of de novo and relapsed mediastinal lymphomas. We present the first described case in the literature of an anaplastic large cell lymphoma relapsed, diagnosed on tissue fragments obtained by EBUS-TBNA with the particularity of using a histological needle. PMID:26090115

  12. Mediastinal hemangioma: Masquerading as pleural effusion.

    PubMed

    Deepak, J; Babu, M Narendra; Gowrishankar, B C; Ramesh, S

    2013-10-01

    We present a rare case of mediastinal hemangioma in a 4-year-old child. The child presented with cough and fever and the chest radiograph revealed right pleural effusion. On further work-up with chest computed tomography mediastinal cystic mass occupying the right hemithorax was identified. The cystic mass was resected completely through a right thoracotomy. Histopathological examination established the final diagnosis of mediastinal capillary hemangioma. PMID:24347874

  13. Anatomy and nomenclature of murine lymph nodes: Descriptive study and nomenclatory standardization in BALB/cAnNCrl mice.

    PubMed

    Van den Broeck, Wim; Derore, Annie; Simoens, Paul

    2006-05-30

    Murine lymph nodes are intensively studied but often assigned incorrectly in scientific papers. In BALB/cAnNCrl mice, we characterized a total of 22 different lymph nodes. Peripheral nodes were situated in the head and neck region (mandibular, accessory mandibular, superficial parotid, cranial deep cervical nodes), and at the forelimb (proper axillary, accessory axillary nodes) and hindlimb (subiliac, sciatic, popliteal nodes). Intrathoracic lymph nodes included the cranial mediastinal, tracheobronchal and caudal mediastinal nodes. Abdominal lymph nodes were associated with the gastrointestinal tract (gastric, pancreaticoduodenal, jejunal, colic, caudal mesenteric nodes) or were located along the major intra-abdominal blood vessels (renal, lumbar aortic, lateral iliac, medial iliac and external iliac nodes). Comparative and nomenclative aspects of murine lymph nodes are discussed. The position of the lymph nodes of BALB/cAnNCrl mice is summarized and illustrated in an anatomical chart containing proposals for both an official nomenclature according to the Nomina Anatomica Veterinaria and English terms.

  14. A Case of a Methicillin-Resistant Staphylococcus Aureus Retropharyngeal Abscess With Mediastinal Extension in an 11-Month-Old Girl.

    PubMed

    Shanti, Rabie M; Hastings, Mary L; Patel, Stavan; Yeoh, Melvyn S

    2016-04-01

    We present the case of an 11-month-old girl with Mycoplasma pneumoniae-associated pneumonia who was subsequently diagnosed with a methicillin-resistant Staphylococcus aureus retropharyngeal abscess with mediastinal extension. PMID:26541226

  15. Benign Mature Mediastinal Dysembryoma with Pulmonary Extension Revealed by Recurrent Hemoptysis in a Young Woman

    SciTech Connect

    Filaire, M.; Michel-Letonturier, M.; Garcier, J. M.; Escande, G.; Boyer, L.

    2006-06-15

    We report one case of mature mediastinal teratoma with pulmonary extension surgically diagnosed in a 22-year-old woman complaining of recurrent hemoptyses for which no etiological explanation could be found. Thoracic surgery was only decided on after three embolizations proved ineffective.

  16. [Minimally Invasive Thoracoscopic Surgery for Mediastinal Lesions].

    PubMed

    Maeda, Sumiko

    2016-07-01

    This review article describes minimally invasive thoracoscopic surgery for anterior mediastinal lesions. The operative procedures for anterior mediastinal lesions have been changed in a couple of decades from open surgery under median sternotomy to complete thoracoscopic mediastinal surgery with sternal lifting or carbon dioxide insufflation. Carbon dioxide insufflation of the thoracic cavity or the mediastinum is now prevailing to improve the surgical field and facilitate the operative procedures. Surgical indications for complete thoracoscopic mediastinal surgery include benign cystic lesions generally regardless of their size and non-invasive anterior mediastinal tumors usually less than 50~60 mm in the greatest dimension. There are currently three surgical approaches in the complete thoracoscopic surgery for the anterior mediastinal lesions. One is the unilateral or bilateral transthoracic approach. The second is the combination of the subxiphoid and the transthoracic approach. The last is the subxiphoid approach. The selection of the surgical approach depends on the surgeon's preference and experiences. When carbon dioxide insufflation is applied during the operation, following complications may occur;hypercapnia, gas embolism, subcutaneous emphysema, endotracheal tube dislocation due to the mediastinal sift, and hypotention. Special safety considerations are necessary during the complete thoracoscopic mediastinal surgery with carbon dioxide insufflation. PMID:27440034

  17. Optimal treatment of descending necrotising mediastinitis

    PubMed Central

    Corsten, M. J.; Shamji, F. M.; Odell, P. F.; Frederico, J. A.; Laframboise, G. G.; Reid, K. R.; Vallieres, E.; Matzinger, F.

    1997-01-01

    BACKGROUND: Descending necrotising mediastinitis is caused by downward spread of neck infection and has a high fatality rate of 31%. The seriousness of this infection is caused by the absence of barriers in the contiguous fascial planes of neck and mediastinum. METHODS: The recent successful treatment of seven adult patients with descending necrotising mediastinitis emphasises the importance of optimal early drainage of both neck and mediastinum and prolonged antibiotic therapy. The case is also presented of a child with descending necrotising mediastinitis, demonstrating the rapidity with which the infection can develop and lead to death. Twenty four case reports and 12 series of adult patients with descending necrotising mediastinitis published since 1970 were reviewed with meta-analysis. In each case of confirmed descending necrotising mediastinitis the method of surgical drainage (cervical, mediastinal, or none) and the survival outcome (discharge home or death) were noted. The chi 2 test of statistical significance was used to detect a difference between cases treated with cervical drainage alone and cases where mediastinal drainage was added. RESULTS: Cervical drainage alone was often insufficient to control the infection with a fatality rate of 47% compared with 19% when mediastinal drainage was added (p < 0.05). CONCLUSIONS: Early combined drainage with neck and chest incisions, together with broad spectrum intravenous antibiotics, should be considered standard care for this disease. 


 PMID:9337829

  18. [Mediastinal tuberculous adenopathies in Djibouti. Report of 159 cases].

    PubMed

    Auregan, G; Ali, B; Chakib, S; Etienne, B; Migueres, J

    1990-01-01

    One hundred and fifty-nine cases of confirmed mediastinal tuberculous adenopathy were analysed retrospectively. This series, which is the first reported in French-speaking Africa, shows that the disease is not uncommon there, and not restricted to black Africans living in Europe. The clinical symptoms are not specific. Radiography is more interesting, and the extreme scarcity of bacillys-containing expectoration encourages endoscopy. The finding of a fistula at fibroscopy confirms the diagnosis. This easy examination is particularly useful since M. tuberculosis can be grown in cultures from ground bronchial fistula biopsies in 86% of the cases. Associated tuberculous lesions in other sites are very frequent (45%), as is extension of the disease from lymph nodes to lung tissue (79%). This clinical form of tuberculosis can be treated with modern short course chemotherapy which is remarkably effective. PMID:2075364

  19. Lymph node hyalinization in elderly Japanese.

    PubMed

    Taniguchi, I; Murakami, G; Sato, A; Fujiwara, D; Ichikawa, H; Yajima, T; Kohama, G

    2003-10-01

    Lymph node hyalinization has been comprehensively investigated using specimens obtained from elderly Japanese and white Americans. Onion-peel lesions and associated meshwork areas were often found in the medullary sinus of the thoracic node (mediastinal-type hyalinization), while eosinophilic, glassy and spotty lesions were consistently seen in B lymphocyte areas of the pelvic node (pelvic-type hyalinization). The mediastinal-type hyalinization was comprised of thin collagen fibrils (ca 50 nm in diameter), whereas the pelvic-type hyalinization had thick fibrils (ca 150 nm in diameter). This difference seemed to be consistent with a difference in composite collagen fibrils of vascular walls between the thoracic and pelvic regions. The pelvic-type hyalinization was often or sometimes seen in other nodes, such as cervical, axillary, abdominal and inguinal nodes, especially in white Americans. The mediastinal-type hyalinization, usually in combination with a sinus filled with anthracotic macrophages, tended to be observed in Japanese more frequently than in white Americans. Anthracosis seemed to be connected to the pathogenesis of the hyalinization. On the other hand, because the lesion was weakly positive for Factor VIII immunohistochemistry and because lesions were located along thin vessels, the pelvic-type hyalinization seemed to originate from vascular degeneration in the nodal cortex. Due to the high incidence and large proportion in total volume of the node, the hyalinization seems to be one of the major events that diminish the nodal filtration function and ruin the node with aging. PMID:12973685

  20. Giant Right Coronary Artery Aneurysm Mimicking a Mediastinal Cyst With Compression Effects: A Case Report

    PubMed Central

    Dadkhah Tirani, Heidar; Aghajanzadeh, Manouchehr; Pourbahador, Reza; Hassanzadeh, Rasool; Ebrahimi, Hannan

    2016-01-01

    Introduction Giant coronary artery aneurysm is an extremely rare form of coronary artery disease. The most common cause of coronary artery aneurysms is atherosclerosis. Although it is usually asymptomatic, it may have various clinical presentations, including angina, myocardial infarction or sudden death. Case Presentation A 32-year-old woman presented with edema of the upper and lower limbs, palpitation, and chest pain, and was diagnosed with a giant right coronary artery aneurysm that had initially mimicked a mediastinal cyst. Although computed tomography (CT) suggested a mediastinal cyst, trans-thoracic echocardiography revealed an extra pericardial cyst. The definitive diagnosis of right coronary artery aneurysm was made based on CT angiography and coronary angiography findings. As treatment, aneurysmectomy was performed, and she was discharged on the sixth postoperative day with good general health condition. Conclusions Coronary artery aneurysm should be a differential diagnosis in cases of mediastinal cyst and mass lesion. PMID:27800453

  1. Left upper lobectomy and systematic lymph nodes dissection in enlarged pulmonary hilar lymph nodes in primary lung cancer patient by uniportal video-assisted thoracic surgery.

    PubMed

    Fan, Jun-Qiang; Yao, Jie; Chang, Zhi-Bo; Wang, Qi

    2016-08-01

    Uniportal video-assisted thoracic surgery (VATS) anatomical pulmonary resection, with only one small incision for surgery instruments and camera insertion, requires higher operative skills, especially in the cases of the enlarged pulmonary hilar lymph nodes. With improved technology and increased experiences in VATS lobectomy, uniportal VATS lobectomy has been applied in major medical centers recently. A 67-year-old male patient with left upper peripheral lung cancer and enlarged hilar lymph nodes underwent unipotal VATS lobectomy and systemic mediastinal lymph node dissection. The patient recovered uneventfully. PMID:27621887

  2. Left upper lobectomy and systematic lymph nodes dissection in enlarged pulmonary hilar lymph nodes in primary lung cancer patient by uniportal video-assisted thoracic surgery

    PubMed Central

    Yao, Jie; Chang, Zhi-Bo; Wang, Qi

    2016-01-01

    Uniportal video-assisted thoracic surgery (VATS) anatomical pulmonary resection, with only one small incision for surgery instruments and camera insertion, requires higher operative skills, especially in the cases of the enlarged pulmonary hilar lymph nodes. With improved technology and increased experiences in VATS lobectomy, uniportal VATS lobectomy has been applied in major medical centers recently. A 67-year-old male patient with left upper peripheral lung cancer and enlarged hilar lymph nodes underwent unipotal VATS lobectomy and systemic mediastinal lymph node dissection. The patient recovered uneventfully. PMID:27621887

  3. Left upper lobectomy and systematic lymph nodes dissection in enlarged pulmonary hilar lymph nodes in primary lung cancer patient by uniportal video-assisted thoracic surgery

    PubMed Central

    Yao, Jie; Chang, Zhi-Bo; Wang, Qi

    2016-01-01

    Uniportal video-assisted thoracic surgery (VATS) anatomical pulmonary resection, with only one small incision for surgery instruments and camera insertion, requires higher operative skills, especially in the cases of the enlarged pulmonary hilar lymph nodes. With improved technology and increased experiences in VATS lobectomy, uniportal VATS lobectomy has been applied in major medical centers recently. A 67-year-old male patient with left upper peripheral lung cancer and enlarged hilar lymph nodes underwent unipotal VATS lobectomy and systemic mediastinal lymph node dissection. The patient recovered uneventfully.

  4. Left upper lobectomy and systematic lymph nodes dissection in enlarged pulmonary hilar lymph nodes in primary lung cancer patient by uniportal video-assisted thoracic surgery.

    PubMed

    Fan, Jun-Qiang; Yao, Jie; Chang, Zhi-Bo; Wang, Qi

    2016-08-01

    Uniportal video-assisted thoracic surgery (VATS) anatomical pulmonary resection, with only one small incision for surgery instruments and camera insertion, requires higher operative skills, especially in the cases of the enlarged pulmonary hilar lymph nodes. With improved technology and increased experiences in VATS lobectomy, uniportal VATS lobectomy has been applied in major medical centers recently. A 67-year-old male patient with left upper peripheral lung cancer and enlarged hilar lymph nodes underwent unipotal VATS lobectomy and systemic mediastinal lymph node dissection. The patient recovered uneventfully.

  5. Mediastinal impalement with a fibreglass sheet

    PubMed Central

    Wimalachandra, Welege Samantha Buddhika; Asmat, Atasha

    2014-01-01

    Mediastinal impalement injuries are uncommon and often fatal. There have been very few reported cases of survival following mediastinal impalement. Patients who present with these injuries always undergo operative intervention regardless of their underlying haemodynamic status or associated injuries. We herein present a case of mediastinal impalement injury, where a sheet of fibreglass had fractured the manubrium and entered thffige anterior mediastinum with no associated great vessel injury. The fibreglass sheet was removed via a partial sternotomy and the patient made an uneventful postoperative recovery. PMID:25273944

  6. Primary mediastinal seminoma. [X ray

    SciTech Connect

    Bush, S.E.; Martinez, A.; Bagshaw, M.A.

    1981-10-15

    Primary mediastinal seminoma is a rare germ cell neoplasm histologically identical to testicular seminoma. Thirteen patients have been treated with definitive megavoltage radiotherapy at the Stanford University Medical Center, Division of Radiation Therapy, between 1961 and 1976. Doses ranged from 2500 rads over five weeks to 6000 rads over seven weeks. Actuarial survival at ten years is 69% with relapse-free survival of 54%. No patient receiving greater than 4700 rads to the primary lesion had local or systemic relapse. Patterns of relapse and recommendations for diagnostic evaluation are discussed. Primary megavoltage irradiation to the mediastinum and neck with a dose of 4500 to 5000 rads over five to six weeks is appropriate treatment.

  7. Distinguishing benign mediastinal masses from malignancy in a histoplasmosis-endemic region

    PubMed Central

    Naeem, Fouzia; Metzger, Monika L.; Arnold, Sandra R.; Adderson, Elisabeth E.

    2015-01-01

    Objective To describe the characteristics of benign and malignant mediastinal masses, which may predict their etiology and facilitate the safe and timely management of patients, especially those residing in histoplasmosis-endemic regions. Study design We conducted a retrospective review of the health records of 131 patients aged <19 years who were referred to two tertiary care children's hospitals from 2005-2010 for the evaluation of mediastinal masses. Results Most patients (79%) had benign masses, including 98 with confirmed or suspected histoplasmosis. Overall, patients with benign etiologies were younger, more likely to be African American, more likely to complain of cough and to have pulmonary nodules by chest computed tomographs than patients with cancer. Patients with malignant disease were more likely to complain of malaise and to have neck swelling, abnormal extrathoracic lymphadenopathy, lymphopenia, anterior mediastinal involvement and/or pleural effusion. Positive histoplasmosis serologic tests were specific but insensitive for a benign etiology. No single clinical, laboratory or radiologic feature was sufficiently sensitive and specific to distinguish between benign and malignant masses. For cancer, however, the presence of lymphopenia, anterior mediastinal involvement or enlarged cervical lymph nodes on computerized tomography had a sensitivity of 93%, specificity of 95%, positive predictive value of 86%, and negative predictive value of 97% for cancer. Sixty-four patients (49%) underwent invasive testing, including 37 (36%) of patients with benign masses. Conclusions Patients in this series who had involvement of the anterior mediastinum, lymphopenia or enlarged cervical lymph nodes had a high likelihood of cancer. Expectant management of patients lacking these characteristics may be safe and reduce unnecessary invasive testing. PMID:26009018

  8. Descending necrotizing mediastinitis associated with Lactobacillus plantarum

    PubMed Central

    2013-01-01

    Background Descending necrotizing mediastinitis (DNM), a severe infection with a high fatality rate, develops in mediastinal spaces due mainly to deep cervical abscesses. The majority of causative microbes of DNM are Streptococci and oral anaerobes. DNM associated with Lactobacillus-infection is rather rare. Case presentation A 69-year-old male with an unremarkable past medical history was referred to our hospital for surgical resection of advanced laryngeal cancer. Full examination revealed a neck abscess and DNM with a background of untreated diabetes mellitus. Initially, he was treated with meropenem. However, Lactobacillus plantarum was isolated from surgical drainage of a mediastinal abscess. Despite using antibiotics capable of eradicating all isolates with susceptibilities not differing significantly from those of the neck and mediastinal abscesses, we attributed DNM to the L. plantarum detected only in the mediastinal abscess. After DNM treatment, he underwent total pharyngolaryngectomy with bilateral neck dissection followed by reconstruction using free jejunum. He was discharged fully recovered. Conclusion We concluded that L. plantarum as the sole cause of the mediastinal abscess in the present case cannot be ruled out. As the number of immunocompromised patients increases, we should be cautious regarding this “familiar” microbe. PMID:23987907

  9. Videothoracoscopy in the treatment of mediastinal cysts

    PubMed Central

    Brzeziński, Daniel; Kozak, Józef

    2014-01-01

    Introduction Progress in the development of surgical techniques has led to the growing use of video-assisted thoracoscopic surgery (VATS) techniques in mediastinal cyst treatment. Aim To present our experience of treating mediastinal cysts with the minimally invasive technique. Material and methods Fifty patients with mediastinal cysts were treated from 2001 to 2011. There were 32 women and 18 men. The age of the patients ranged from 17 to 72, the mean age being 42 years. All patients underwent basic preoperative diagnostic tests of the chest: X-ray, computed tomography (CT), bronchoscopy and spirometry; 4 patients underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and 3 fine needle aspiration biopsy (FNAB) of the described lesions. Results The VATS was performed in each case. Conversion was carried out due to superior mediastinal location in 10 cases and pleural adhesions in 3 cases. The partial resection of a cyst was performed in 3 patients. One patient was treated conservatively due to heart failure. In that patient the transthoracic needle aspiration of a cyst under ultrasound guidance using alcoholisation with 76% ethanol with a good effect was performed twice. Cyst recurrence was observed in 1 case. Conclusions The surgical access depends on the location of a cyst. The VATS resection of a superior mediastinal cyst is not always feasible. Surgery of mediastinal cysts is both diagnostic and curative. PMID:25337163

  10. Magnetic resonance imaging of mediastinal and hilar masses: comparison with CT

    SciTech Connect

    Levitt, R.G.; Glazer, H.S.; Roper, C.L.; Lee, J.K.T.; Murphy, W.A.

    1985-07-01

    Magnetic resonance imaging (MRI) was compared to computed tomography (CT) of the mediastinum and/or hila in 37 patients with bronchogenic carcinoma (35 unresectable for cure) and 11 patients with other masses. Spin-echo pulse sequences using a short pulse repetition rate (TR) and short echo delay (TE) were most helpful for detection of abnormal soft-tissue mediastinal and hilar masses. The accuracy of MRI and CT in staging bronchogenic carcinoma for curative resectability/nonresectability was comparable. Several pitfalls in MRI evaluation of the mediastinum were identified. By MRI the esophagus may be misinterpreted as an enlarged retrotracheal lymph node unless serial scans are studied. Small adjacent lymph nodes shown individually by CT may appear as a single enlarged lymph node by MRI due to partial-volume averaging. Because of the requirement for patient selection and the identified pitfalls of MRI, CT remains the radiologic procedure of choice in the staging of patients with bronchogenic carcinoma and the evaluation of other mediastinal and hilar masses at present. However, because of the ability to show blood vessels without an intravascular contrast agent, MRI is useful in evaluating patients with potential contrast allergy and solving diagnostic problems not solved by CT.

  11. Spontaneous Retropharyngeal and Mediastinal Emphysema.

    PubMed

    Cho, Do-Yeon; Aaron, Geoffrey P; Shepard, Kimberly G

    2016-06-01

    A 14-year-old girl with no significant medical history presented at Emergency Department with sore throat and odynophagia after one episode of nonviolent coughing. She denied any respiratory distress, voice change, foreign body ingestion, retching, substance abuse, dental procedures, or trauma. She was afebrile with normal oxygen saturation and physical examination including the head and neck was unremarkable with the exception of bilateral neck crepitus without tenderness on palpation. Fiberoptic laryngoscopy revealed a patent laryngeal airway with normal vocal fold movement. Lateral neck X-ray demonstrated a linear air-column in the retropharyngeal space and computed tomography confirmed emphysema involving the retropharyngeal space and mediastinum with no evidence of fluid collection or abscess formation. Spontaneous retropharyngeal and mediastinal emphysema are clinical entities where free air is present within the confines of retropharyngeal space and mediastinum without obvious cause. It is benign and self-limited in nature and allows for conservative management. This case is presented with a review of literature. PMID:27090269

  12. Propionibacterium acnes isolated from lymph nodes of patients with sarcoidosis.

    PubMed

    de Brouwer, Bart; Veltkamp, Marcel; Wauters, Carla A; Grutters, Jan C; Janssen, Rob

    2015-01-01

    Propionibacterium acnes has been repeatedly suggested as a candidate causative agent of sarcoidosis. It is the only microorganism that has been isolated from sarcoid lesions by bacterial culture so far and this has been described in Japanese patients only. We report two non-Japanese patients in whom mediastinoscopy was performed in order to obtain lymph node tissue for histopathology, which was suggestive for sarcoidosis. Bacterial culture of these uncontaminated mediastinal lymph nodes revealed P. acnes in both patients. As shown in these two cases, P. acnes can be isolated from sterile biopsied sarcoid lymph nodes of non-Japanese patients and supports the belief that there is an etiologic link between P. acnes sarcoidosis. Further elucidation could provide an opening to novel strategies using antibiotics for treating sarcoidosis.

  13. Propionibacterium acnes isolated from lymph nodes of patients with sarcoidosis.

    PubMed

    de Brouwer, Bart; Veltkamp, Marcel; Wauters, Carla A; Grutters, Jan C; Janssen, Rob

    2015-01-01

    Propionibacterium acnes has been repeatedly suggested as a candidate causative agent of sarcoidosis. It is the only microorganism that has been isolated from sarcoid lesions by bacterial culture so far and this has been described in Japanese patients only. We report two non-Japanese patients in whom mediastinoscopy was performed in order to obtain lymph node tissue for histopathology, which was suggestive for sarcoidosis. Bacterial culture of these uncontaminated mediastinal lymph nodes revealed P. acnes in both patients. As shown in these two cases, P. acnes can be isolated from sterile biopsied sarcoid lymph nodes of non-Japanese patients and supports the belief that there is an etiologic link between P. acnes sarcoidosis. Further elucidation could provide an opening to novel strategies using antibiotics for treating sarcoidosis. PMID:26422574

  14. [Ingenuity of Lymph Node Dissection Reduction for Minimally Invasive Lung Cancer Surgery].

    PubMed

    Konno, Hayato; Minamiya, Yoshihiro

    2016-07-01

    Systematic lymph node dissection in radical operation for lung cancer is recognized as an operative procedure which is accurate staging. In clinical early-stage non-small cell lung cancer (NSCLC), if the nodes are negative, complete mediastinal lymph node dissection might be omitted. Selective mediastinal dissection for clinico-surgical stage I NSCLC proved to be as effective as complete dissection. When lymph node metastasis was observed, segmentectomy was converted to lobectomy. Sentinel node( SN) identification is useful to determine the final indication of minimally invasive surgery by targeting the lymph nodes needed for intraoperative frozen section diagnosis. Many evidences suggest that prognosis of NSCLC with lymph node micrometastases (LNMM) is poor compared with those without LNMM. Evaluation of micrometastases of all dissected lymph nodes may be substituted by evaluating micrometastases of SNs. SN identification is important to the efficiency of micrometastases detection of intraoperative diagnosis. To perform a minimally invasive surgery, evaluation of lymph nodes micrometastases in SN is required. PMID:27440033

  15. [The diagnostics and treatment of the postoperative mediastinitis].

    PubMed

    Kokhan, E P; Aleksandrov, A S

    2011-01-01

    Treatment results of 48 patients with mediastinitis after the open cardiac surgery were analyzed. The main mediastinitis risk factors were: the chronic obstructive lung desease, diabetes mekkitus, severe cardiac insufficiency, prolonged operation, the use of artificial blood circulation and sterna instsbility. Major infective agents of mediastinitis were the Gram-positive cocci. The treatment options varied from the prolonged antibiotic therapy to plastic reconstructive surgery, which were determined by the severity of mediastinitis. PMID:22413155

  16. Systematic Endobronchial Ultrasound-guided Mediastinal Staging Versus Positron Emission Tomography for Comprehensive Mediastinal Staging in NSCLC Before Radical Radiotherapy of Non-small Cell Lung Cancer: A Pilot Study.

    PubMed

    Steinfort, Daniel P; Siva, Shankar; Leong, Tracy L; Rose, Morgan; Herath, Dishan; Antippa, Phillip; Ball, David L; Irving, Louis B

    2016-02-01

    Despite known limitations of positron emission tomography (PET) for mediastinal staging of non-small cell lung cancer (NSCLC), radiation treatment fields are generally based on PET-identified disease extent. However, no studies have examined the accuracy of FDG-PET/CT on a per-node basis in patients being considered for curative-intent radiotherapy in NSCLC.In a prospective trial, patients with NSCLC being considered for definitive thoracic radiotherapy (± systemic chemotherapy) underwent minimally invasive systematic mediastinal evaluation with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) following noninvasive staging with integrated PET-CT.Thirty patients underwent EBUS-TBNA, with TBNA performed from a mean 2.5 lymph node (LN) stations per patient (median 3, range 1-5). Discordant findings between PET-CT and EBUS-TBNA were observed in 10 patients (33%, 95% CI 19%-51%). PET-occult LN metastases were demonstrated by EBUS in 4 patients, whereas a lesser extent of mediastinal involvement, compared with FDG-PET, was demonstrated by EBUS in 6 patients, including 2 patients downstaged from cN3 to pN2. LNs upstaged by EBUS were significantly smaller than nodes downstaged by EBUS, 7.5 mm (range 7-9) versus 12 mm (range 6-21), P = 0.005.A significant proportion of patients considered for definitive radiotherapy (+/-chemotherapy) undergoing systematic mediastinal evaluation with EBUS-TBNA in this study have an extent of mediastinal NSCLC involvement discordant with that indicated by PET-CT. Systematic EBUS-TBNA may aid in defining the extent of mediastinal involvement in NSCLC patients undergoing radiotherapy. Systematic EBUS-TBNA has the potential to contribute significantly to radiotherapy planning and delivery, by either identifying occult nodal metastases, or demonstrating FDG-avid LNs to be disease-free. PMID:26937894

  17. Mediastinitis by Actinomyces meyeri after oesophageal stent placement.

    PubMed

    Branquinho, Diogo Ferreira; Andrade, Daniel Ramos; Almeida, Nuno; Sofia, Carlos

    2014-06-05

    Actinomyces meyeri is a Gram-positive anaerobic forming bacterium of the genus Actinomyces, part of the oral cavity's flora, and its classification remains an unresolved issue. It is an extremely rare cause of disease, occurring in middle-aged immunocompetent patients and frequently misdiagnosed as malignancy or lung abscess. A 56-year-old man diagnosed with oesophageal squamous cell carcinoma had an endoscopically placed stent to palliate his dysphagia. Two weeks later he presented with thoracalgia and fever, interpreted as a common lung infection. Owing to lack of improvement, additional examinations were undertaken revealing mediastinum involvement. Unlike the good prognosis usually associated with this infection, the patient eventually died, reflecting the aggressive nature of his underlying condition. To our knowledge, this is the first report of mediastinitis by A. meyeri, supporting the described propensity of this agent to disseminate, particularly to the thoracic cavity, although probably in this case with an iatrogenic contribution.

  18. Descending Necrotizing Mediastinitis Treated with Tooth Extractions following Mediastinal and Cervical Drainage

    PubMed Central

    Fukuchi, Minoru; Suzuki, Okihide; Nasu, Daisuke; Koizumi, Kazue; Muta, Yu; Imaizumi, Hideko; Ishiguro, Toru; Kumagai, Youichi; Ishibashi, Keiichiro; Mochiki, Erito; Ishida, Hideyuki

    2015-01-01

    Descending necrotizing mediastinitis (DNM) is a rare condition in which oropharyngeal infection spreads to the mediastinum via the cervical fascia. Delayed diagnosis and surgery result in a high mortality rate among patients with DNM. We present a case of DNM resulting from odontogenic infection treated successfully with tooth extraction following mediastinal and cervical drainage. A 43-year-old, previously healthy Japanese man was admitted to our hospital for treatment of acute mediastinitis. Computed tomography revealed gas collection around the mid-thoracic esophagus and bilateral pleural effusion. We performed mediastinal drainage via right thoracotomy. Cervicotomy was performed on postoperative day 14 to drain a residual cervical abscess. The patient required the extraction of ten teeth over three procedures to address primary odontogenic infection before his fever resolved on postoperative day 40. Prompt diagnosis, aggressive drainage and removal of the source of infection can improve survival among patients with this life-threatening disease. PMID:26600767

  19. Echocardiographic features of a mediastinal pancreatic pseudocyst.

    PubMed Central

    Aroney, C N; Nicholson, M R; Shevland, J E

    1985-01-01

    Cross sectional echocardiography detected a mediastinal pancreatic pseudocyst which caused extracardiac compression in a 49 year old man. Computed tomography confirmed the presence of a cystic lesion lying behind the heart and extending from the pancreas to above the carina. Surgical decompression resulted in resolution of the clinical and echocardiographic findings. Images PMID:3994874

  20. [Descendending necrotizing mediastinitis single center experience].

    PubMed

    Kovacić, Ivan; Kovacić, Marijan

    2014-01-01

    The descending necrotizing mediastinitis is a rare but life-threatening inflammation, and occurs as a complication of deep inflammation of the neck. The mortality rate is still high by 40% despite the use of a variety of potent antimicrobial drugs. We describe 7 patients with the descending necrotizing mediastinitis treated in our hospital during the last 12 years. The primary site of infection in 5 patients were tonsils and pharynx, and in the other two patients odontogenic inflammation of the lower molars. Most of the patients belonged to the risk groups (diabetes mellitus, alcoholism), the average age of 60.4 years. After the diagnosis with computed tomography (CT), we surgically intervened in all patients. Deep neck infections are treated with aggressive surgical cervicotomy and high quality mediastinal drainage was performed with transcervical approach in all patients. Perioperative tracheotomy (n=3) was performed for the upper airway edema and postoperative tracheostomy for extended intubation (n = 1).Only in one case, we subsequently conducted a secondary surgical procedure, lateral thoracotomy because of pleural decortication. All patients were successfully cured with an average length of hospitalization was 24.6 days. For successful treatment of the descending necrotizing mediastinitis diagnosis must be set as early as possible and with the use of computed tomography scanning. Treatment requires the simultaneous application of potent antimicrobial drugs, aggressive surgical debridement of the neck and high-quality drainage of the mediastinum, which can be achieved through the transcervical approach.

  1. Primary mediastinal lymphoma: diagnosis and treatment options.

    PubMed

    Martelli, Maurizio; Di Rocco, Alice; Russo, Eleonora; Perrone, Salvatore; Foà, Robin

    2015-04-01

    Primary mediastinal large B-cell lymphoma (PMBCL) is a unique B-cell lymphoma variant that arises from a putative thymic medulla B cell. It constitutes 2-4% of non-Hodgkin lymphomas and occurs most frequently in young females. PMBCL is characterized by a diffuse proliferation of medium-to-large B cells associated with sclerosis. Molecular analysis shows that PMBCL is a distinct entity compared to other types of diffuse large B-cell lymphomas. PMBCL is characterized by a locally invasive anterior mediastinal bulky mass. The combination of rituximab with CHOP/CHOP-like regimens followed by mediastinal radiation therapy (RT) is associated with a 5-year progression-free survival of 75-85%. However, the role of consolidation RT still remains uncertain. More intensive regimens, such as DA-EPOCH-R without mediastinal RT, have shown very promising results. The conclusive role of PET-CT scan requires prospective studies and there is hope that this may allow to de-escalate RT and accordingly yield reliable prognostic information.

  2. Intralobar pulmonary sequestration and mediastinal bronchogenic cyst.

    PubMed Central

    Grewal, R. G.; Yip, C. K.

    1994-01-01

    A patient with a bronchogenic cyst and intralobar pulmonary sequestration is presented. Chest radiography showed a posterior mediastinal mass and a computed tomographic scan of the chest revealed, in addition, an abnormality suggestive of pulmonary sequestration. This was confirmed by an aortogram. It is important to be aware of the coexistence of these anomalies to make a diagnosis preoperatively. Images PMID:8016803

  3. Anterior mediastinal fat in Behçet's disease: qualitative and quantitative CT analysis.

    PubMed

    Lee, Sang Yub; Lee, Jongmin; Lee, Hui Joong; Choi, Sun Ju; Hahm, Myong Hun; Yoon, Sung Won

    2013-12-01

    The fat-rich anterior mediastinum could be a sensitive window for monitoring minute changes in vascularity induced by systemic vasculitis. To evaluate this hypothesis, an analysis of anterior mediastinal fat in patients with Behçet's disease and a control group was conducted. This study included 43 patients diagnosed with Behçet's disease within the last 11 years who underwent CT scan; 55 patients were selected as a control population. Mediastinal fat was classified according to CT morphology. Comparison of serum inflammatory markers was performed for evaluation of disease activity according to morphologic types, and average Hounsfield unit of the anterior mediastinum was measured. Significantly higher mean CT attenuation was observed in the Behçet's disease group, compared with the control group (-48.5 ± 33.5 vs. -67.7 ± 18.7, respectively, P < 0.05). Mediastinal fat types were classified as follows: pure fatty tissue (2 vs. 31 % [Behçet's disease vs. control group]), diffuse soft tissue infiltration (16 vs. 29 %), tubular structures (21 vs. 4 %), mixed infiltration with tubular structures (42 vs. 15 %), and evident thymic tissue (19 vs. 22 %). The value for mean mediastinal attenuation was significantly higher in the group with a high level of C-reactive protein than in the normal level group. The mean CT attenuation of anterior mediastinal fat is significantly higher in the Behçet's disease group, compared with the normal group. Although pathologic confirmation is needed, the cause is postulated to be either inflammatory neovascularization or minimal thymic hyperplasia induced by Behçet's disease.

  4. Mediastinal Yolk Sac Tumor Producing Protein Induced by Vitamin K Absence or Antagonist-II.

    PubMed

    Akutsu, Noriyuki; Adachi, Yasushi; Isosaka, Mai; Mita, Hiroaki; Takagi, Hideyasu; Sasaki, Shigeru; Yamamoto, Hiroyuki; Arimura, Yoshiaki; Ishii, Yoshifumi; Masumori, Naoya; Endo, Takao; Shinomura, Yasuhisa

    2015-01-01

    Extragonadal yolk sac tumors (YSTs) are rare. We herein report the case of a 66-year-old man with mediastinal, lung and liver tumors. The largest mass was located in the liver and contained a high concentration of protein induced by vitamin K absence or antagonist-II (PIVKA-II) and alpha-fetoprotein. Therefore, the lesion was difficult to distinguish from hepatocellular carcinoma. Finally, YST was diagnosed based on the results of a liver biopsy. Although chemotherapy was effective, the patient died of respiratory failure. The autopsy revealed primary mediastinal YST. In the current report, we describe this case of PIVKA-II-producing YST and review previous cases of PIVKA-II-producing tumors other than hepatoma.

  5. Mediastinal Yolk Sac Tumor Producing Protein Induced by Vitamin K Absence or Antagonist-II.

    PubMed

    Akutsu, Noriyuki; Adachi, Yasushi; Isosaka, Mai; Mita, Hiroaki; Takagi, Hideyasu; Sasaki, Shigeru; Yamamoto, Hiroyuki; Arimura, Yoshiaki; Ishii, Yoshifumi; Masumori, Naoya; Endo, Takao; Shinomura, Yasuhisa

    2015-01-01

    Extragonadal yolk sac tumors (YSTs) are rare. We herein report the case of a 66-year-old man with mediastinal, lung and liver tumors. The largest mass was located in the liver and contained a high concentration of protein induced by vitamin K absence or antagonist-II (PIVKA-II) and alpha-fetoprotein. Therefore, the lesion was difficult to distinguish from hepatocellular carcinoma. Finally, YST was diagnosed based on the results of a liver biopsy. Although chemotherapy was effective, the patient died of respiratory failure. The autopsy revealed primary mediastinal YST. In the current report, we describe this case of PIVKA-II-producing YST and review previous cases of PIVKA-II-producing tumors other than hepatoma. PMID:26073245

  6. Cervical lymph node diseases in children

    PubMed Central

    Lang, Stephan; Kansy, Benjamin

    2014-01-01

    The lymph nodes are an essential part of the body’s immune system and as such are affected in many infectious, autoimmune, metabolic and malignant diseases. The cervical lymph nodes are particularly important because they are the first drainage stations for key points of contact with the outside world (mouth/throat/nose/eyes/ears/respiratory system) – a critical aspect especially among children – and can represent an early clinical sign in their exposed position on a child’s slim neck. Involvement of the lymph nodes in multiple conditions is accompanied by a correspondingly large number of available diagnostic procedures. In the interests of time, patient wellbeing and cost, a careful choice of these must be made to permit appropriate treatment. The basis of diagnostic decisions is a detailed anamnesis and clinical examination. Sonography also plays an important role in differential diagnosis of lymph node swelling in children and is useful in answering one of the critical diagnostic questions: is there a suspicion of malignancy? If so, full dissection of the most conspicuous lymph node may be necessary to obtain histological confirmation. Diagnosis and treatment of childhood cervical lymph node disorders present the attending pediatric and ENT physicians with some particular challenges. The spectrum of differential diagnoses and the varying degrees of clinical relevance – from banal infections to malignant diseases – demand a clear and considered approach to the child’s individual clinical presentation. Such an approach is described in the following paper. PMID:25587368

  7. Peritoneal malignant mesothelioma metastatic to supraclavicular lymph nodes.

    PubMed

    Zannella, Stefano; Testi, Maria Adele; Cattoretti, Giorgio; Pelosi, Giuseppe; Zucchini, Nicola

    2014-09-01

    Distinguishing between malignant mesothelioma and reactive mesothelial hyperplasia is often inestimable, but may be a challenging gauntlet for pathologists. A 62-year-old man underwent appendectomy after the identification of a peritoneal mass and the histological examination showed mesothelial proliferation along the appendix surface with no clear images of infiltration. After a few months the patient developed mediastinal and supraclavicular lymphadenopathies, and a nodal biopsy showed mesothelial cell proliferation invading lymphatic sinuses, consistent with the cells seen in the abdominal cavity. Since overt morphologic criteria for malignancy were lacking and reactive mesothelial cell deposits have been documented in lymph nodes, a molecular investigation of the CDKN2A (henceforth simply p16) gene status via fluorescence in situ hybridization was performed, which showed homozygous deletion in 100% tumor cells. These data ruled out the hypothesis of reactive mesothelial cells inclusion in lymph nodes, thus confirming the diagnosis of epithelioid malignant mesothelioma.

  8. Radiotherapy of unicentric mediastinal Castleman's disease

    PubMed Central

    Li, Yue-Min; Liu, Peng-Hui; Zhang, Yu-Hai; Xia, Huo-Sheng; Li, Liang-Liang; Qu, Yi-Mei; Wu, Yong; Han, Shou-Yun; Liao, Guo-Qing; Pu, Yong-Dong

    2011-01-01

    Castleman's disease is a slowly progressive and rare lymphoproliferative disorder. Here, we report a 55-year-old woman with superior mediastinal Castleman's disease being misdiagnosed for a long term. We found a 4.3 cm mass localized in the superior mediastinum accompanied with severe clinical symptoms. The patient underwent an exploratory laparotomy, but the mass failed to be totally excised. Pathologic examination revealed a mediastinal mass of Castleman's disease. After radiotherapy of 30 Gy by 15 fractions, the patient no longer presented previous symptoms. At 3 months after radiotherapy of 60 Gy by 30 fractions, Computed tomography of the chest showed significantly smaller mass, indicating partial remission. Upon a 10-month follow-up, the patient was alive and free of symptoms. PMID:21527068

  9. DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO RETROPHARYNGEAL ABSCESS.

    PubMed

    Kovacić, Marijan; Kovacić, Ivan; Dželalija, Boris

    2015-12-01

    Descending necrotizing mediastinitis secondary to a nontraumatic retropharyngeal abscess is very rare. This form of mediastinitis in the era of potent antibiotics often ends up with lethal outcome. It usually occurs in immunocompromised patients and requires intensive multidisciplinary treatment approach. We report a case of nontraumatic retropharyngeal abscess complicated by descending necrotizing mediastinitis in a 70-year-old man with insulin dependent diabetes mellitus. The patient was admitted to our hospital after clinical and radiological diagnosis of retropharyngeal abscess. During treatment for retropharyngeal abscess with antibiotic therapy and transoral incision, the patient showed mild clinical improvement but his condition suddenly aggravated on day 4 of hospital stay. He had high fever, chest pain with tachypnea, tachycardia, hypotension, and showed signs of occasional disorientation. Emergency computed tomography (CT) scan of the neck and thorax showed inflammation in the retropharyngeal space, as well as thickening of the upper posterior mediastinum fascia with the presence of air. Emergency surgery including cervicotomy and drainage of the retropharyngeal space and posterior mediastinum was performed. The patient promptly recovered with improvement of the clinical status and laboratory findings. After 16 days of treatment he was discharged from the hospital in good condition. Descending necrotizing mediastinitis can be a serious and life threatening complication of deep neck infection if the diagnosis is not quickly established. Besides inevitable application of antimicrobial drugs, good drainage of the mediastinum is necessary. We believe that transcervical approach can achieve high-quality drainage of the upper mediastinum, especially if it is done timely as in this case. Its efficacy can be verified by intensive monitoring of the patient clinical condition, by CT scan of the thorax, and by laboratory tests. In the case of inefficacy of this type

  10. DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO RETROPHARYNGEAL ABSCESS.

    PubMed

    Kovacić, Marijan; Kovacić, Ivan; Dželalija, Boris

    2015-12-01

    Descending necrotizing mediastinitis secondary to a nontraumatic retropharyngeal abscess is very rare. This form of mediastinitis in the era of potent antibiotics often ends up with lethal outcome. It usually occurs in immunocompromised patients and requires intensive multidisciplinary treatment approach. We report a case of nontraumatic retropharyngeal abscess complicated by descending necrotizing mediastinitis in a 70-year-old man with insulin dependent diabetes mellitus. The patient was admitted to our hospital after clinical and radiological diagnosis of retropharyngeal abscess. During treatment for retropharyngeal abscess with antibiotic therapy and transoral incision, the patient showed mild clinical improvement but his condition suddenly aggravated on day 4 of hospital stay. He had high fever, chest pain with tachypnea, tachycardia, hypotension, and showed signs of occasional disorientation. Emergency computed tomography (CT) scan of the neck and thorax showed inflammation in the retropharyngeal space, as well as thickening of the upper posterior mediastinum fascia with the presence of air. Emergency surgery including cervicotomy and drainage of the retropharyngeal space and posterior mediastinum was performed. The patient promptly recovered with improvement of the clinical status and laboratory findings. After 16 days of treatment he was discharged from the hospital in good condition. Descending necrotizing mediastinitis can be a serious and life threatening complication of deep neck infection if the diagnosis is not quickly established. Besides inevitable application of antimicrobial drugs, good drainage of the mediastinum is necessary. We believe that transcervical approach can achieve high-quality drainage of the upper mediastinum, especially if it is done timely as in this case. Its efficacy can be verified by intensive monitoring of the patient clinical condition, by CT scan of the thorax, and by laboratory tests. In the case of inefficacy of this type

  11. Mediastinal paraganglioma causing spinal cord compression.

    PubMed Central

    Reyes, M G; Fresco, R; Bruetman, M E

    1977-01-01

    An invasive paraganglioma of the posterior mediastinum caused spinal cord compression in a 31 year old women. Electron microscopic examination of the paraganglioma invading the epidural space revealed numerous dense-cored granules in the cytoplasm of the tumour cells. We are reporting this case to present the ultrastructure of mediastinal paraganglioma, and to call attention to an unusual cause of spinal cord compression. Images PMID:886352

  12. Intramammary lymph nodes.

    PubMed

    Egan, R L; McSweeney, M B

    1983-05-15

    Radiographic, gross, and histopathologic studies on 158 whole breasts with primary operable carcinoma revealed intramammary lymph nodes in 28%, and of these breasts, 10% contained a metastatic deposit of carcinoma. Cancerous and noncancerous nodes were found in all quadrants of the breast with the positive ones being in the same quadrant as the carcinoma only 50% of the time. There was no demonstrable connection with the usual lymphatic drainage of the breast. With Stage II carcinoma, positive intramammary lymph nodes had no direct effect on prognosis, merely representing advanced disease and indicating a greater likelihood of axillary metastatic disease. There was a trend toward poorer prognosis in Stage I lesions with positive intramammary lymph nodes. This may indicate the Stage I carcinomas that have a similar prognosis as Stage II tumors. Conceivably, a Stage Ia, positive intramammary lymph node(s) but normal axillary lymph nodes, could be defined and used.

  13. Sick sinus syndrome as a complication of mediastinal radiation therapy

    SciTech Connect

    Pohjola-Sintonen, S.; Toetterman, K.J.K.; Kupari, M. )

    1990-06-01

    A 33-year-old man who had received mediastinal radiation therapy for Hodgkin's disease 12 years earlier developed a symptomatic sick sinus syndrome requiring the implantation of a permanent pacemaker. The sick sinus syndrome and a finding of an occult constrictive pericarditis were considered to be due to the previous mediastinal irradiation. A ventricular pacemaker was chosen because mediastinal radiotherapy also increases the risk of developing atrioventricular conduction defects.

  14. Report: workshop on mediastinal grey zone lymphoma.

    PubMed

    Poppema, Sibrand; Kluiver, Joost L; Atayar, Cigdem; van den Berg, Anke; Rosenwald, Andreas; Hummel, Michael; Lenze, Dido; Lammert, Hetty; Stein, Harald; Joos, Stephan; Barth, Thomas; Dyer, Martin; Lichter, Peter; Klein, Uwe; Cattoretti, Giorgio; Gloghini, Annunziata; Tu, Yuhai; Stolovitzky, Gustavo A; Califano, Andrea; Carbone, Antonino; Dalla-Favera, Ricardo; Melzner, Ingo; Bucur, Alexandra J; Brüderlein, Silke; Dorsch, Karola; Hasel, Cornelia; Barth, Thomas F E; Leithäuser, Frank; Möller, Peter

    2005-07-01

    There are several indications that classical Hodgkin lymphoma (cHL) and at least a proportion of cases of Primary Mediastinal B cell Lymphoma (PMBL) are derived from B cells at similar stages of differentiation and share common pathogenic mechanisms. The first indication was the existence of mediastinal grey zone lymphomas as identified in the 4th International Symposium on HL, with clinical, histological and immunohistochemical features intermediate between cHL and PMBL. Second, both tumor types resemble a cell that is developmentally situated in-between the germinal center reaction and a plasma cell. Third, cHL and PMBL were found to have similar gene expression profiles, including the lack of immunoglobulin expression and low levels of B cell receptor signalling molecules, and the secretion of molecules like the chemokine TARC and the prominent expression of IL-13 receptors. Fourth, both entities were found to have common genomic aberrancies, notably in 2p15 and 9p24, the sites of the REL oncogene and the tyrosine kinase gene JAK2, respectively. Further comparison of both lymphoma types may provide further insight in the pathogenic mechanisms and allow the design of diagnostic algorithms to sort out the small number of so-called mediastinal grey zone lymphomas, that appear to be intermediate between PMBL and cHL. PMID:16007868

  15. Primary mediastinal B-cell lymphoma and mediastinal gray zone lymphoma: do they require a unique therapeutic approach?

    PubMed Central

    Dunleavy, Kieron

    2015-01-01

    Primary mediastinal B-cell lymphoma (PMBL) is a subtype of diffuse large B-cell lymphoma (DLBCL) that is putatively derived from a thymic B cell. Accounting for up to 10% of cases of DLBCL, this subtype predominantly affects women in the third and fourth decades of life. Its clinical and molecular characteristics are distinct from other subtypes of DLBCL and, in fact, closely resemble those of nodular sclerosing Hodgkin lymphoma (NSHL). Recently, mediastinal lymphomas with features intermediate between PMBL and NSHL, called mediastinal gray-zone lymphomas, have been described. The optimal management of PMBL is controversial, and most standard approaches include a combination of immunochemotherapy and mediastinal radiation. Recently, the recognition that mediastinal radiation is associated with significant long-term toxicities has led to the development of novel approaches for PMBL that have shown excellent efficacy and challenge the need for routine mediastinal radiation. PMID:25499450

  16. A Case of Nocardia farcinica Pneumonia and Mediastinitis in an Immunocompetent Patient

    PubMed Central

    Kim, Jinyoung; Kang, Minkyu; Kim, Juri; Jung, Sohee; Park, Junhung; Lee, Dongkyu

    2016-01-01

    Nocardia species are aerobic, gram-positive pathogens found worldwide in soil. Nocardia is considered an opportunistic pathogen, and its infection mostly occurs in immunocompromised patients. We report a case of Nocardia farcinica induced mediastinitis and pneumonia that occurred in a 64-year-old male patient who had no significant medical history except for hypertension. He visited another hospital with a complaint of dyspnea and left chest wall pain. The symptoms arose 7 days ago without any trauma and they worsened. A mediastinal mass was found on computed tomography scan. After being transferred to our hospital for further evaluation, he was diagnosed with mediastinitis and pneumonia. As N. farcinica was found to be the causative organism by 16S rRNA sequencing, proper antibiotic therapy including trimethoprim/sulfamethoxazole was initiated immediately. After this, the patient improved and he was discharged. If an infection has a disseminating course, nocardiosis cannot be excluded even in immunocompetent patients. Once the diagnosis is established, prompt antibiotic therapy should be performed based on the severity. PMID:27066088

  17. Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment

    PubMed Central

    2012-01-01

    Background The aim of the present study is to compare negative pressure wound therapy versus conventional treatment outcomes at postoperative mediastinitis after cardiac surgery. Methods Between January 2000 and December 2011, after 9972 sternotomies, postoperative mediastinitis was diagnosed in 90 patients. The treatment modalities divided the patients into two groups: group 1 patients (n = 47) were initially treated with the negative pressure wound therapy and group 2 patients (n = 43) were underwent conventional treatment protocols. The outcomes were investigated with Kaplan-Meier method, log-rank test, Student’s test and Fisher’s exact test. Results The 90-days mortality was found significantly lower in the negative pressure wound group than in the conventionally treated group. Overall survival was significantly better in the negative pressure wound group than in the conventionally treated group. Conclusion Negative pressure wound therapy is safe and reliable option in mediastinitis after cardiac surgery, with excellent survival and low failure rate when compared with conventional treatments. PMID:22784512

  18. Tuberculosis-associated Fibrosing Mediastinitis: Case Report and Literature Review.

    PubMed

    Tan, Ronald; Martires, Joanne; Kamangar, Nader

    2016-01-01

    Fibrosing mediastinitis is a rare condition defined by the presence of fibrotic mediastinal infiltrates that obliterate normal fat planes. It is a late complication of a previous granulomatous infection, such as histoplasmosis or tuberculosis (TB). Due to its rarity, fibrosing mediastinitis is often under-recognized, and the clinical presentation is variable and dependent on the extent of infiltration or encasement of structures within the mediastinum. We present a case of fibrosing mediastinitis in a man with a prior history of TB, who presented with progressive dyspnea and was found to have chronic mediastinal soft tissue opacities and pulmonary hypertension. His diagnosis was delayed due to the lack of recognition of this clinical/radiographic entity. Fibrosing mediastinitis is a rare entity usually caused by granulomatous disease. Most cases develop as a late complication of histoplasmosis or TB. The presence of calcified mediastinal soft tissue infiltrates on advanced chest imaging can be diagnostic of fibrosing mediastinitis in patients with a prior history of a granulomatous infection once active processes such as malignancy are excluded. PMID:27625898

  19. Tuberculosis-associated Fibrosing Mediastinitis: Case Report and Literature Review

    PubMed Central

    Tan, Ronald; Martires, Joanne; Kamangar, Nader

    2016-01-01

    Fibrosing mediastinitis is a rare condition defined by the presence of fibrotic mediastinal infiltrates that obliterate normal fat planes. It is a late complication of a previous granulomatous infection, such as histoplasmosis or tuberculosis (TB). Due to its rarity, fibrosing mediastinitis is often under-recognized, and the clinical presentation is variable and dependent on the extent of infiltration or encasement of structures within the mediastinum. We present a case of fibrosing mediastinitis in a man with a prior history of TB, who presented with progressive dyspnea and was found to have chronic mediastinal soft tissue opacities and pulmonary hypertension. His diagnosis was delayed due to the lack of recognition of this clinical/radiographic entity. Fibrosing mediastinitis is a rare entity usually caused by granulomatous disease. Most cases develop as a late complication of histoplasmosis or TB. The presence of calcified mediastinal soft tissue infiltrates on advanced chest imaging can be diagnostic of fibrosing mediastinitis in patients with a prior history of a granulomatous infection once active processes such as malignancy are excluded. PMID:27625898

  20. Descending Mediastinitis in Epstein-Barr Virus Infection

    PubMed Central

    van Driel, E. M.; Janssen, M. J. F. M.

    2015-01-01

    Our case report describes a previously healthy 34-year-old male who develops a descending mediastinitis as a complication of an Epstein-Barr virus (EBV) infection. The mediastinitis was suspected to have developed by a breakthrough of a peritonsillar abscess through the space between the alar and prevertebral space. PMID:25740774

  1. Pediatric Mediastinal Tumors and Tumor-Like Lesions.

    PubMed

    Singh, Achint K; Sargar, Kiran; Restrepo, Carlos S

    2016-06-01

    This article reviews the imaging findings of pediatric mediastinal tumors and tumor-like lesions. The classification of the mediastinum is discussed with normal imaging appearance of the thymus in pediatric age group followed by a discussion on multiple mediastinal lesions in different compartments with emphasis on their imaging characteristics.

  2. Tuberculosis-associated Fibrosing Mediastinitis: Case Report and Literature Review

    PubMed Central

    Tan, Ronald; Martires, Joanne; Kamangar, Nader

    2016-01-01

    Fibrosing mediastinitis is a rare condition defined by the presence of fibrotic mediastinal infiltrates that obliterate normal fat planes. It is a late complication of a previous granulomatous infection, such as histoplasmosis or tuberculosis (TB). Due to its rarity, fibrosing mediastinitis is often under-recognized, and the clinical presentation is variable and dependent on the extent of infiltration or encasement of structures within the mediastinum. We present a case of fibrosing mediastinitis in a man with a prior history of TB, who presented with progressive dyspnea and was found to have chronic mediastinal soft tissue opacities and pulmonary hypertension. His diagnosis was delayed due to the lack of recognition of this clinical/radiographic entity. Fibrosing mediastinitis is a rare entity usually caused by granulomatous disease. Most cases develop as a late complication of histoplasmosis or TB. The presence of calcified mediastinal soft tissue infiltrates on advanced chest imaging can be diagnostic of fibrosing mediastinitis in patients with a prior history of a granulomatous infection once active processes such as malignancy are excluded.

  3. [X-ray computed tomography in the diagnosis of mediastinitis].

    PubMed

    Abakumov, M M; Barmina, T G; Ishmukhametov, A I

    2001-01-01

    Results of X-ray computed tomography (RCT) use in 21 patients treated for acute mediastinitis in N.V. Sklifosovsky Emergency Care Research Institute have been analyzed retrospectively. RCT proved able to defect accurate location, spreading and sizes of inflammatory disorders in the mediastinum are demonstrated. Semiotics of mediastinitis depending on location, spreading and phase of inflammatory process is presented.

  4. Mediastinal teratoma in a free-ranging American black bear (Ursus americanus).

    PubMed

    Munk, Brandon A; Turner, J Chris; Keel, M Kevin

    2013-12-01

    A 2.75-yr-old female American black bear (Ursus americanus) was found emaciated and unable to rise. It was euthanized due to the perceived poor prognosis. An approximately 18 x 8 x 10-cm, multiloculated, well-demarcated mass that extended from the bifurcation of the trachea, laterally displacing the lung lobes and caudally displacing the heart. The mass contained fibrous connective tissue, cartilage, bone, nervous tissue, smooth muscle, and a variety of epithelial structures. A mediastinal teratoma was diagnosed based on the microscopic features of the neoplasm. PMID:24450083

  5. Mediastinal paragangliomas related to SDHx gene mutations

    PubMed Central

    Ćwikła, Jarosław; Prejbisz, Aleksander; Kwiatek, Paweł; Szperl, Małgorzata; Michalski, Wojciech; Wyrwicz, Lucjan; Kuśmierczyk, Mariusz; Januszewicz, Andrzej; Maciejczyk, Anna; Roszczynko, Marta; Pęczkowska, Mariola

    2016-01-01

    Introduction Paragangliomas (PGLs) related to hereditary syndromes are rare mediastinal tumors. Paragangliomas are caused by mutations in genes encoding subunits of succinate dehydrogenase enzyme (SDH). Aim To evaluate clinical, anatomical and functional characteristics of mediastinal paragangliomas related to SDHx gene mutations. Material and methods Retrospective analysis of 75 patients with confirmed SDHx gene mutations (24 patients with SDHB, 5 SDHC, 46 with SDHD mutations) was performed. Patients underwent evaluation using computed tomography (CT), somatostatin receptor scintigraphy (SRS) (99mTc-[HYNIC,Tyr3]-octreotide), 123I mIBG scintigraphy and urinary excretion of total methoxycatecholamines. Results Out of 75 patients, 16 (21%) patients (1 SDHB, 15 SDHD mutations) had 17 PGLs localized in the mediastinum. Fourteen PGLs were localized in the middle mediastinum (intrapericardial) and 3 PGLs in the posterior mediastinum. The median diameter of paragangliomas measured on the axial slice was 24.3 mm (interquartile range (IQR): 14.7–36.6), and the median volume was 2.78 ml (IQR: 0.87–16.16). Twelve out of 16 patients (75%) underwent SRS, and 11 of them (92.3%) had pathological uptake of the radiotracer. Eleven (68.75%) out of 16 patients underwent 123 I mIBG, with only 3 positive results. Symptoms of catecholamine excretion were observed in 3 patients with PGLs localized in the posterior mediastinum. All PGLs were benign except in 1 patient with the SDHB mutation and PGL detected in the posterior mediastinum, who had a metastatic disease. Conclusions Most mediastinal paragangliomas were related to SDHD gene mutations. They were asymptomatic, localized in the medial mediastinum, intrapericardially. PMID:27785149

  6. [A case of mediastinal cavernous hemangioma].

    PubMed

    Maebeya, S; Nishimura, O; Yokoi, H; Shimizu, T; Yoshimasu, T; Naito, Y

    1990-03-01

    A 6-year-old boy had an abnormal shadow on the chest X-ray film. It showed a tumor shadow with calcification on the right hilum. The plain CT scan showed an anterior mediastinal mass and its density was similar to that of large vessels. On the angio CT scan the lesion displayed a much lower enhancement than large vessels. The tumor was resected completely by median sternotomy. It was 5.6 X 3.6 X 3.0 cm in size and contained a phlebolith 5 mm in diameter. The histological diagnosis was cavernous hemangioma. PMID:2348129

  7. Mediastinal mature teratoma in a child- A case report.

    PubMed

    Liew, W X; Lam, H Y; Narasimman, S; Navarasi, S; Mohd Hamzah, K

    2016-02-01

    Mediastinal teratoma is an infrequent germ cell tumour and comprises of 1 to 5% of all mediastinal tumours. We report a case of mediastinal mature teratoma in a 12 year old boy who presented to us with persistent non-productive cough, fever and dyspnoea for the past 7 months. Computed tomographic scan of thorax revealed a large anterior mediastinal mass measuring 11.2x9.9x14cm with calcification within. He subsequently underwent a median sternotomy with left subcostal extension (L-incision) and excision of tumour. Histopathology of the tumour revealed a mature cystic teratoma. We would like to report a case of successful surgical management of a large mediastinal mature teratoma in a child. PMID:27130743

  8. [A case of surgical treatment for solitary lymph node recurrence of hepatocellular carcinoma simultaneously developed in the mediastinum and abdominal cavity].

    PubMed

    Uchinami, Hiroshi; Abe, Yuki; Kikuchi, Isao; Yoshioka, Masato; Kume, Makoto; Sato, Tsutomu; Yamamoto, Yuzo

    2009-07-01

    We report a surgically treated case of lymph node recurrence from hepatocellular carcinoma (HCC) that occurred simultaneously but individually in the mediastinum and abdominal cavity with no metastasis. A 52-year-old man had undergone left lateral segmentectomy for poorly differentiated HCC. Three months after surgery, abdominal computed tomography revealed an enlarged solitary lymph node along the common hepatic artery. Another isolated mediastinal lymph node was also positive on whole body 18F-fluorodeoxyglucose positron emission tomography. Because no other metastatic lesions were identified, we resected these two lymph nodes under a diagnosis of lymph node metastases from HCC. Histopathologically, both of them were classified as poorly differentiated HCC with solid growth. No further recurrence has been found during 20-month follow-up period. Our experience suggested that even though metastatic lymph nodes of HCC were present in the mediastinum and abdominal cavity, resection may provide survival benefit if each metastasis is individually solitary.

  9. POMB/ACE chemotherapy for mediastinal germ cell tumours.

    PubMed

    Bower, M; Brock, C; Holden, L; Nelstrop, A; Makey, A R; Rustin, G J; Newlands, E S

    1997-05-01

    Mediastinal germ cell tumours (MGCT) are rare and most published series reflect the experiences of individual institutions over many years. Since 1979, we have treated 16 men (12 non-seminomatous germ cell tumours and 4 seminomas) with newly diagnosed primary MGCT with POMB/ACE chemotherapy and elective surgical resection of residual masses. This approach yielded complete remissions in 15/16 (94%) patients. The median follow-up was 6.0 years and no relapses occurred more than 2 years after treatment. The 5 year overall survival in the non-seminomatous germ cell tumours (NSGCT) is 73% (95% confidence interval 43-90%). One patient with NSGCT developed drug-resistant disease and died without achieving remission and 2 patients died of relapsed disease. In addition, 4 patients with bulky and/or metastatic seminoma were treated with POMB/ACE. One died of treatment-related neutropenic sepsis in complete remission and one died of relapsed disease. Finally, 4 patients (2 NSGCT and 2 seminomas) referred at relapse were treated with POMB/ACE and one was successfully salvaged. The combination of POMB/ACE chemotherapy and surgery is effective management for MGCT producing high long-term survival rates.

  10. Primary mediastinal large B-cell lymphoma: a single-center experience in Korea

    PubMed Central

    Ahn, Heui June; Yoon, Dok-Hyun; Kim, Shin; Lee, Kyoungmin; Kang, EunHee; Huh, Jooryung; Park, Chan-Sik

    2014-01-01

    Background Primary mediastinal large B-cell lymphoma (PMBL) is a distinct subtype of non-Hodgkin lymphoma, which has no consensus for its ideal treatment or prognosis. Methods We reviewed the clinicopathologic features and clinical outcomes of 25 PMBL cases diagnosed at a single institution between 1993 and 2009 and compared them with 588 cases of non-mediastinal, diffuse large B-cell lymphoma (DLBCL, control group) diagnosed during the same period. Results Thirteen (52.0%) PMBL patients had Ann Arbor stage III or IV disease, and 10 (40.0%) had B symptoms. Thirteen (52%) PMBL patients were classified as high-intermediate/high-risk according to the International Prognostic Index. There was a significant prevalence of young (median: 31 years; range, 15-78 years; P<0.001), female (68%; P=0.014) patients in the PMBL group compared to the control group (median: 56 years; range, 15-85 years; 43.2% female). Bulky disease and elevated levels of lactate dehydrogenase (LDH) were more frequent in the PMBL group (P<0.001 and P=0.003, respectively). Nineteen (76%) PBML patients achieved complete remission, and 18 were alive at the last follow-up (median: 43 months; range, 1-92 months). There was no difference in the 3-year, overall survival rate (72%, 95% confidence interval [CI]: 54.0-83.0 versus 70.1%, 95% CI, 109.0-126.0; P=0.686) between PMBL and control patients, respectively. Conclusion Compared to patients with non-mediastinal DLBCL, Korean patients with PMBL are predominantly young women with bulky disease and high LDH levels but with no significant difference in survival. PMID:24724065

  11. Human mediastinal adipose tissue displays certain characteristics of brown fat

    PubMed Central

    Cheung, L; Gertow, J; Werngren, O; Folkersen, L; Petrovic, N; Nedergaard, J; Franco-Cereceda, A; Eriksson, P; Fisher, R M

    2013-01-01

    Background: The amount of intra-thoracic fat, of which mediastinal adipose tissue comprises the major depot, is related to various cardiometabolic risk factors. Autopsy and imaging studies indicate that the mediastinal depot in adult humans could contain brown adipose tissue (BAT). To gain a better understanding of this intra-thoracic fat depot, we examined possible BAT characteristics of human mediastinal in comparison with subcutaneous adipose tissue. Materials and methods: Adipose tissue biopsies from thoracic subcutaneous and mediastinal depots were obtained during open-heart surgery from 33 subjects (26 male, 63.7±13.8 years, body mass index 29.3±5.1 kg m−2). Microarray analysis was performed on 10 patients and genes of interest confirmed by quantitative PCR (qPCR) in samples from another group of 23 patients. Adipocyte size was determined and uncoupling protein 1 (UCP1) protein expression investigated with immunohistochemistry. Results: The microarray data showed that a number of BAT-specific genes had significantly higher expression in the mediastinal depot than in the subcutaneous depot. Higher expression of UCP1 (24-fold, P<0.001) and PPARGC1A (1.7-fold, P=0.0047), and lower expression of SHOX2 (0.12-fold, P<0.001) and HOXC8 (0.14-fold, P<0.001) in the mediastinal depot was confirmed by qPCR. Gene set enrichment analysis identified two gene sets related to mitochondria, which were significantly more highly expressed in the mediastinal than in the subcutaneous depot (P<0.01). No significant changes in UCP1 gene expression were observed in the subcutaneous or mediastinal depots following lowering of body temperature during surgery. UCP1 messenger RNA levels in the mediastinal depot were lower than those in murine BAT and white adipose tissue. In some mediastinal adipose tissue biopsies, a small number of multilocular adipocytes that stained positively for UCP1 were observed. Adipocytes were significantly smaller in the mediastinal than the

  12. Management of large mediastinal masses: surgical and anesthesiological considerations

    PubMed Central

    van Boven, Wim Jan P.; Annema, Jouke T.; Eberl, Susanne; Klomp, Houke M.; de Mol, Bas A.J.M.

    2016-01-01

    Large mediastinal masses are rare, and encompass a wide variety of diseases. Regardless of the diagnosis, all large mediastinal masses may cause compression or invasion of vital structures, resulting in respiratory insufficiency or hemodynamic decompensation. Detailed preoperative preparation is a prerequisite for favorable surgical outcomes and should include preoperative multimodality imaging, with emphasis on vascular anatomy and invasive characteristics of the tumor. A multidisciplinary team should decide whether neoadjuvant therapy can be beneficial. Furthermore, the anesthesiologist has to evaluate the risk of intraoperative mediastinal mass syndrome (MMS). With adequate preoperative team planning, a safe anesthesiological and surgical strategy can be accomplished. PMID:27076967

  13. Mediastinal sarcoidosis mimicking lymph malignancy recurrence after anti-neoplastic therapy.

    PubMed

    El Hammoumi, Massine; El Marjany, Mohamed; Moussaoui, Driss; Doudouh, Aberahim; Mansouri, Hamid; Kabiri, El Hassane

    2015-07-01

    The aim of our work is to promote the awareness about the development of sarcoidosis after antineoplastic therapy in order to avoid diagnostic errors with FDG-PET/CT findings. We report the observation of three women with breast, cervix and stomach treated cancers who developed a sarcoidosis after the end of anti-neoplastic therapy. The utility of FDG-PET/CT is in pinpointing the organs candidates for diagnostic biopsy and not distinguishing between the malignancy and granulomatous or inflammatory diseases.

  14. Variations in lung lymphatic drainage into the inferior tracheobronchial lymph nodes junction: Applications in lung cancer.

    PubMed

    Ndiaye, Assane; Dimarino, Vincent; Ndiaye, Aïnina; Gaye, Magaye; Ba, Papa Salmane; Nazarian, Serge

    2016-10-01

    The group of inferior tracheobronchial lymph nodes (ITB) is a lymphatic junction through which the lymph from both lungs is carried. Lymphatic activity in this area can be used to assess the lymphatic spreading of lung cancers. Our aim was to quantify lymph drainage from the lung segments towards the ITB group and to determine the direction of the lymph flow into other mediastinal and abdominal lymph nodes. We injected dye directly into the subpleural lymphatic vessels in 100 lung segments of 25 fresh cadaver subjects; the cadavers were then dissected. Thirty-eight segments (38%) drained into the ITB group in 18 subjects. The drainage into the ITB group involved 15.6% of the upper lobe segments, 87.5% of the middle lobe segments, and 70.6% of the lower lobe segments in the right lung. On the left, 6.9% of the upper lobe segments and 83.3% of the lower lobe segments were drained into the ITB group. For three subjects, the dye did not pass beyond the ITB group. The efferent vessels of the ITB group drained towards the right paratracheal and tracheoesophageal chains in 12 subjects and through the left ascending recurrent chain in five subjects. For six subjects, the efferent channels reached the abdominal lymph nodes. A contralateral drainage involved 14 segments (36%). The size and variety of the segments that drain into the ITB group, coupled with the efferent contralateral mediastinal and abdominal pathways, account for the severity of metastasis to this area. Clin. Anat. 29:955-962, 2016. © 2016 Wiley Periodicals, Inc. PMID:27480071

  15. Molecular analysis of sarcoidosis lymph nodes for microorganisms: a case–control study with clinical correlates

    PubMed Central

    Robinson, Lary A; Smith, Prudence; SenGupta, Dhruba J; Prentice, Jennifer L; Sandin, Ramon L

    2013-01-01

    Introduction Sarcoidosis is an incurable, chronic granulomatous disease primarily involving the lungs and lymph nodes of unknown aetiology, treated with non-specific anti-inflammatory/immunosuppressive drugs. Persistently symptomatic patients worsen with a disabling, potentially fatal clinical course. To determine a possible infectious cause, we correlated in a case-control study the clinical information with the presence of bacterial DNA in sarcoidosis mediastinal lymph nodes compared with control lymph nodes resected during cancer surgery. Methods We retrospectively studied formalin-fixed, paraffin-embedded, mediastinal lymph nodes from 30 patients with sarcoidosis and 30 control patients with lung cancer. Nucleic acids were extracted from nodes, evaluated by ribosomal RNA PCR for bacterial 16S ribosomal DNA and the results were sequenced and compared with a bacterial sequence library. Clinical information was correlated. Results 11/30 (36.7%) of lymph nodes from patients with sarcoidosis had detectable bacterial DNA, significantly more than control patient lymph nodes (2/30, 6.7%), p=0.00516. At presentation, 19/30 (63.3%) patients with sarcoidosis were symptomatic including all patients with detectable bacterial DNA. Radiographically, there were 18 stage I and 12 stage II patients. All stage II patients were symptomatic and 75% had PCR-detectable bacteria. After a mean follow-up of 52.8±32.8 months, all patients with PCR-detectable bacteria in this series were persistently symptomatic requiring treatment. Discussion 36.6% of patients with sarcoidosis had detectable bacterial DNA on presentation, all of these patients were quite symptomatic and most were radiographically advanced stage II. These findings suggest that bacterial DNA-positive, symptomatic patients have more aggressive sarcoidosis that persists long term and might benefit from antimicrobial treatment directed against this presumed chronic granulomatous infection. PMID:24366580

  16. [Primary mediastinal B-cell lymphoma].

    PubMed

    Coso, D; Rey, J; Bouabdallah, R

    2010-02-01

    Primary mediastinal B-cell lymphoma (PMBL) is a clinicopathological entity among the world health organization classification of lymphoid neoplasms. PMBL often concerns young adults, and the disease remains a localized disease in the majority of cases. The outcome of patients with PMBL is variable and unlike diffuse large cell lymphomas, the international prognostic index seems to be less applicable to such disease. The combination of rituximab and chemotherapy is the gold standard treatment of patients with good prognosis features and allows high cure rates. However, high-dose chemotherapy supported by peripheral blood stem cell support is often warranted in poor-prognosis patients. The use of positrons emission tomography examination is more and more used in such situations to select the best therapeutic strategy. PMID:20207294

  17. Three cases of mediastinal pancreatic pseudocysts

    PubMed Central

    Fujihara, Yoshio; Maeda, Kazunori; Okamoto, Masaru; Yanagitani, Atsushi; Tanaka, Kiwamu; Nakamura, Kazuhiko; Ogawa, Toshihide

    2016-01-01

    A rare complication of acute or chronic pancreatitis is the formation of a mediastinal pancreatic pseudocyst (MPP), which is caused by tracking of pancreatic fluids through anatomical openings of the diaphragm into the mediastinum. Herein, we report the imaging characteristics of three cases of this condition. Our results revealed three features in common: (i) the connection between the mediastinum and the pancreatic cystic lesion; (ii) the presence of pleural effusions; and (iii) imaging findings consistent with chronic pancreatitis, such as pancreatic atrophy and calcifications and dilatation and/or stricture of main pancreatic duct (MPD). Serial diameter changes of the MPD and of the adjacent pseudocysts were necessary for the determination of the therapeutic strategy used in each case. PMID:27330827

  18. Newly Diagnosed?

    MedlinePlus

    ... Suggestions Examine Your Skin Newly Diagnosed? Understanding Your Pathology Biopsy: The First Step Sentinel Node Biopsy Melanoma ... start this journey: Get a copy of your pathology report. We can help you understand the report ...

  19. Swollen lymph nodes

    MedlinePlus

    ... fingers) include: Groin Armpit Neck (there is a chain of lymph nodes on either side of the front of the neck, both sides of the neck, and down each side of the back of the neck) Under the jaw and chin Behind the ears On the back of the head

  20. The inflatable thymus herniation of the normal mediastinal thymus: A case report and review of the literature.

    PubMed

    Stuut, Marijn; van Zwieten, Gusta; Straetmans, Jos M; Lacko, Martin; Stumpel, Constance T R M

    2016-04-01

    Anterior neck masses in young children can be a diagnostic challenge for otolaryngologists and radiologists. We present a rare case of herniation of normal mediastinal thymus in a four-year-old girl. Additional medical features as an inguinal hernia and trochlear nerve paresis raised the question whether there is a causal relationship or an association. A connective tissue disorder could not be diagnosed as possible causal factor to the abnormal movement of the mediastinal thymus. Awareness and recognition of this benign phenomenon is important in order to avoid unnecessary biopsy or surgery. Diagnosis can be confirmed by ultrasonography. Magnetic Resonance Imaging might be valuable in order to obtain more information about the extension of the mass. PMID:26968057

  1. Troubleshooting thoracoscopic anterior mediastinal surgery: lessons learned from thoracoscopic lobectomy

    PubMed Central

    Hirji, Sameer A.; Balderson, Scott S.; Berry, Mark F.

    2015-01-01

    Video-assisted thoracoscopic surgery (VATS) lobectomy is safe, oncologically effective, and increasingly utilized for lung cancer resection. Lessons from VATS lobectomy experience can guide the use of a VATS approach to resect mediastinal masses. Exposure and dissection when using VATS to resect anterior mediastinal masses has unique challenges. Several maneuvers acquired from experience with VATS lobectomy can reduce the technical difficulty and often prevent conversion to an open approach. In this troubleshooting guide, we offer ‘tips’ to both avoid and manage numerous intra-operative technical difficulties that commonly arise during VATS anterior mediastinal procedures. Avoiding an open approach may improve outcomes, although conversion for safety or complete resection can be necessary. Techniques and experiences derived from VATS lobectomy can facilitate VATS resection of mediastinal masses. PMID:26693151

  2. A patient with combined mediastinal, mesenteric and retroperitoneal fibrosis.

    PubMed

    Graal, M B; Lustermans, F A

    1994-06-01

    We report a patient with combined mediastinal, mesenteric and retroperitoneal fibrosis who first presented with signs of a superior vena cava syndrome. She was successfully treated with corticosteroids. The aetiology, clinical picture, and possible therapy of idiopathic fibrosclerosis are discussed.

  3. Accurate diagnosis of axillary lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid

    PubMed Central

    MATSUZAWA, FUMIHIKO; EINAMA, TAKAHIRO; ABE, HIRONORI; SUZUKI, TAKASHI; HAMAGUCHI, JUN; KAGA, TERUMI; SATO, MAMI; OOMURA, MASAKO; TAKATA, YUMIKO; FUJIBE, AYAKO; TAKEDA, CHIE; TAMURA, ETSUYA; TAKETOMI, AKINOBU; KYUNO, KENICHI

    2015-01-01

    Axillary lymph node enlargement following sentinel lymph node biopsy (SLNB) is often difficult to accurately diagnose. In keeping with the characteristically tortuous and aberrant pattern of tumor neovasculature, metastatic lymph nodes exhibit peripheral and mixed vascularity, resulting in a microvasculature that is often difficult to visualize. Contrast-enhanced ultrasonography (CEUS) with Sonazoid, a new generation contrast agent for ultrasonography, allows for the visualization of lymph node microvessels and may enable a more accurate evaluation of lymph node metastasis. This is a case report of axillary lymph node enlargement following SLNB, in which CEUS with Sonazoid resulted in an accurate diagnosis. On the basis of our experience with this case, we have initiated a clinical trial to evaluate the detection of lymph node metastasis through the use of CEUS in breast cancer patients. PMID:25798257

  4. Sheep lymph-nodes as a biological indicator of environmental exposure to fluoro-edenite.

    PubMed

    Ledda, Caterina; Loreto, Carla; Pomara, Cristoforo; Rapisarda, Giuseppe; Fiore, Maria; Ferrante, Margherita; Bracci, Massimo; Santarelli, Lory; Fenga, Concettina; Rapisarda, Venerando

    2016-05-01

    A significantly increased incidence of pleural mesothelioma in Biancavilla (Sicily, Italy) has been attributed to exposure to fluoro-edenite (FE), a fibrous amphibole extracted from a local stone quarry. The lymph-nodes draining the pulmonary lobes of sheep grazing around the town were examined, to gain insights into fibre diffusion. The pasture areas of six sheep flocks lying about 3km from Biancavilla were located using the global positioning system. The cranial tracheobronchial and one middle mediastinal lymph-node as well as four lung tissue samples were collected from 10 animals from each flock and from 10 control sheep for light and scanning electron microscopy (SEM) examination. The lymph-nodes from exposed sheep were enlarged and exhibited signs of anthracosis. Histologically, especially at the paracortical level, they showed lymph-follicle hyperplasia with large reactive cores and several macrophages (coniophages) containing grey-brownish particulate interspersed with elements with a fibril structure, forming aggregates of varying dimensions (coniophage nodules). Similar findings were detected in some peribronchiolar areas of the lung parenchyma. SEM examination showed that FE fibres measured 8-41µm in length and 0.4-1.39µm in diameter in both lymph-nodes and lung tissue. Monitoring of FE fibres in sheep lymph-nodes using appropriate techniques can help set up environmental pollution surveillance. PMID:26855127

  5. The lymph node neutrophil.

    PubMed

    Hampton, Henry R; Chtanova, Tatyana

    2016-04-01

    Secondary lymphoid organs provide a specialized microenvironment tailored to foster communication between cells of the innate and adaptive immune systems. These interactions allow immune cells to coordinate multilayered defense against pathogens. Until recently dendritic cells and macrophages were thought to comprise the main innate immune cell subsets responsible for delivering signals that drive the adaptive immune response, while the function of neutrophils was largely confined to the innate immune system. However, the discovery of neutrophils in lymph nodes has raised the question of whether neutrophils might play a more extensive role not only in innate immunity per se, but also in coordinating the interactions between innate and adaptive immune responses. In this review we discuss the mechanisms and consequences of neutrophil recruitment to lymph nodes and how this recruitment influences subsequent immune responses both in situ and at distant sites. PMID:27025975

  6. Diagnosing Flu

    MedlinePlus

    ... your symptoms and their clinical judgment. Will my health care provider test me for flu if I have flu-like ... flu symptoms do not require testing because the test results usually do not change how you are treated. Your health care provider may diagnose you with flu based on ...

  7. Choose the best route: ultrasound-guided transbronchial and transesophageal needle aspiration with echobronchoscope in the diagnosis of mediastinal and pulmonary lesions.

    PubMed

    Mondoni, M; D'Adda, A; Terraneo, S; Carlucci, P; Radovanovic, D; DI Marco, F; Santus, P

    2015-10-01

    Nodal mediastinal staging is a crucial part of the diagnostic workup of patients with non-small-cell lung cancer (NSCLC) for planning optimal treatment. Transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and real-time endobronchial ultrasounds transbronchial needle aspiration (EBUS-TBNA) are accurate, minimally invasive and safe diagnostic techniques for mediastinal staging. Because of the different accessibility to the mediastinum, they are considered complementary and their combination increases the diagnostic yield as compared with the either alone. Recent studies have shown that endosonography represents the best initial test for invasive mediastinal evaluation in NSCLC. Endoscopic ultrasound (with bronchoscope)-guided fine needle aspiration (EUS-B-FNA) is a recently introduced procedure consisting of a transesophageal needle aspiration using an ultrasound bronchoscope. It allows to perform both transbronchial and transesophageal needle sampling with the same instrument, in the same session and by one operator only, thus maximizing time and costs savings. In a recent study Oki et al. randomized 110 patients with hilar/mediastinal adenopathies or lung abnormalities adjoining both the esophagus and the bronchi, to undergo EBUS-TBNA or EUS-FNA performed by pulmonologists with an echobronchoscope. The Authors demonstrated that both procedures provide a high diagnostic yield, without any difference in the number of adverse events and a good comparable tolerance. Nevertheless, the transesophageal approach guaranteed a significantly lower dose of anesthetics and sedatives, a shorter procedural time, fewer oxygen desaturations, a significantly lower cough score and a higher operator satisfaction. In this review our aim was to discuss the findings by Oki et al. in the context of medical literature, highlighting the importance of the EUS-B needle aspiration technique in diagnosing mediastinal and lung lesions, when EBUS-TBNA is deemed less

  8. Immature mediastinal teratoma with unusual histopathology

    PubMed Central

    Mustafa, Osama M.; Mohammed, Shamayel F.; Aljubran, Ali; Saleh, Waleed N.

    2016-01-01

    Abstract Germ cell tumors (GCTs) represent a well-recognized group of heterogeneous neoplasms with diverse clinical, histopathological, diagnostic, and prognostic characteristics. We present a rare case of a locally aggressive, chemotherapy-resistant immature mediastinal teratoma with a peculiar histological finding of a multilineage somatic-type malignant degeneration. A 21-year-old male patient presented with a 3-week history of persistent, blood-tinged productive cough and shortness of breath. A contrast-enhanced computed tomography (CT) scan of the chest showed a heterogeneous mass occupying the right hemithorax and abutting on adjacent structures. CT-guided biopsy was consistent with immature teratoma. Combination chemotherapy with bleomycin, etoposide, and cisplatin was initiated, albeit without success; the mass showed interval progression in size, and surgical resection through clamshell incision was performed. Histological assessment of the resected mass confirmed the diagnosis of immature teratoma and revealed an extensive multilineage malignant differentiation into sarcomatous, carcinomatous, and melanomatous components. The patient underwent an uneventful recovery but presented 2 months later with extensive liver and bone melanomatous metastases. In this report, relevant findings from the literature are also highlighted. Despite being exceptionally rare, such tumors carry poor prognosis. Understanding the clinicopathological characteristics and biological behavior of such tumors may provide an insight into interventions tailored to improve the otherwise dismal disease outlook. PMID:27367976

  9. Primary Mediastinal B-Cell Lymphoma

    PubMed Central

    Pileri, Stefano A.; Gaidano, Gianluca; Zinzani, Pier Luigi; Falini, Brunangelo; Gaulard, Philippe; Zucca, Emanuele; Pieri, Federica; Berra, Eva; Sabattini, Elena; Ascani, Stefano; Piccioli, Milena; Johnson, Peter W. M.; Giardini, Roberto; Pescarmona, Edoardo; Novero, Domenico; Piccaluga, Pier Paolo; Marafioti, Teresa; Alonso, Miguel A.; Cavalli, Franco

    2003-01-01

    Although primary mediastinal (thymic) large B-cell lymphoma has been primarily studied, its precise phenotype, molecular characteristics, and histogenesis are still a matter of debate. The International Extranodal Lymphoma Study Group collected 137 such cases for extensive pathological review. Histologically, the lymphomatous growth was predominantly diffuse with fibrosis that induced compartmentalized cell aggregation. It consisted of large cells with varying degrees of nuclear polymorphism and clear to basophilic cytoplasm. On immunohistochemistry, the following phenotype was observed: CD45+, CD20+, CD79a+, PAX5/BSAP+, BOB.1+, Oct-2+, PU.1+, Bcl-2+, CD30+, HLA-DR+, MAL protein+/−, Bcl-6+/−, MUM1/IRF4+/−, CD10−/+, CD21−, CD15−, CD138−, CD68−, and CD3−. Immunoglobulins were negative both at immunohistochemistry and in situ hybridization. Molecular analysis, performed in 45 cases, showed novel findings. More than half of the cases displayed BCL-6 gene mutations, which usually occurred along with functioning somatic IgVH gene mutations and Bcl-6 and/or MUM1/IRF4 expression. The present study supports the concept that a sizable fraction of cases of this lymphoma are from activated germinal center or postgerminal center cells. However, it differs from other aggressive B-cell lymphomas in that it shows defective immunoglobulin production despite the expression of OCT-2, BOB.1, and PU.1 transcription factors and the lack of IgVH gene crippling mutations. PMID:12507907

  10. [Mediastinal cystic teratoma. Review of two cases].

    PubMed

    Fuenmayor-M, Carmen Elena; García-R, Maryori; Gómez, Denis; Quintiliani-Gamboa, María; Altamiranda, Cleyzer

    2007-12-01

    Extragonadal teratomas are more frequent in the mediastinum and sacrococcygeal region. In this work, two cases of mature mediastinal teratoma, that simulated infection processes are reported. These cases appeared during the last semester of the year 2000 and represent the casuistry of the University Hospital of The Andes (IAHULA) between 1996 and 2005. Two patients, one ten-year-old and the other eight-month-old were admitted at the hospital with a diagnosis of bronchopneumonia and pulmonary abscess with clinical manifestations of cough, dyspnea and chest pain. During surgery, a multicystic tumor composed of fat, sebaceous and mucinous materials, hair, mineralized elements and blood was found in both cases. A histological examination revealed the presence of neoplastic cells derived from more than one germinal strata. Teratomas are infrequent, but the diagnosis must be considered in children with respiratory symptoms. A full histological examination was required to reach a definitive diagnosis. The histological diagnosis was easily performed by conventional light microscopic examination. No additional techniques were necessary. Surgical resection should thus be the first choice for treatment. Four years later, there is no evidence of tumor recurrence. PMID:18271395

  11. Effective treatment for malignant mediastinal teratoma.

    PubMed

    Parker, D; Holford, C P; Begent, R H; Newlands, E S; Rustin, G J; Makey, A R; Bagshawe, K D

    1983-12-01

    Primary malignant mediastinal teratoma is a rare tumour previously regarded as inevitably fatal. In a series of eight male patients with a mean age of 24 years five remain alive and well. All patients showed raised serum concentrations of human chorionic gonadotrophin or alpha fetoprotein. The patients were treated with intermittent combination chemotherapy that included cisplatin. Six patients responded to chemotherapy with a fall in human chorionic gonadotrophin or alpha fetoprotein to near normal levels and they then had radical excision of the remaining tumour. Living malignant tumour was found in four of the specimens and these patients received postoperative chemotherapy. One patient died after eight months and the remaining five patients are alive and well 13-136 months after the start of treatment. The two patients who did not undergo surgery died at one month and 15 months. Intermittent combination chemotherapy and carefully timed radical excision of these tumours would appear to have produced better results than have been reported in other series.

  12. Effective treatment for malignant mediastinal teratoma.

    PubMed Central

    Parker, D; Holford, C P; Begent, R H; Newlands, E S; Rustin, G J; Makey, A R; Bagshawe, K D

    1983-01-01

    Primary malignant mediastinal teratoma is a rare tumour previously regarded as inevitably fatal. In a series of eight male patients with a mean age of 24 years five remain alive and well. All patients showed raised serum concentrations of human chorionic gonadotrophin or alpha fetoprotein. The patients were treated with intermittent combination chemotherapy that included cisplatin. Six patients responded to chemotherapy with a fall in human chorionic gonadotrophin or alpha fetoprotein to near normal levels and they then had radical excision of the remaining tumour. Living malignant tumour was found in four of the specimens and these patients received postoperative chemotherapy. One patient died after eight months and the remaining five patients are alive and well 13-136 months after the start of treatment. The two patients who did not undergo surgery died at one month and 15 months. Intermittent combination chemotherapy and carefully timed radical excision of these tumours would appear to have produced better results than have been reported in other series. Images PMID:6198739

  13. Sarcoidal granuloma in cervical lymph nodes.

    PubMed

    Chen, Hsin-Chien; Kang, Bor-Hwang; Lai, Chuan-Tsai; Lin, Yaoh-Shiang

    2005-07-01

    Sarcoidosis is a multiorgan granulomatous disease, the most common head and neck manifestation of which is cervical lymphadenopathy. Only the presentation of sarcoidal granuloma in cervical lymph nodes without typical manifestations of systemic sarcoidosis poses a diagnostic difficulty. We describe the case of a 39-year-old male who had a 2-month history of a progressively increasing mass with soreness in his right neck. The biopsy from the neck mass demonstrated non-caseating epithelioid cell granuloma of the lymph nodes. The differential diagnoses of mycobacterial or fungal infections were excluded. Thoracic evaluations, including chest X-ray and high-resolution computed tomography, revealed no abnormal findings. Treatment with systemic corticosteroids resulted in improved clinical symptoms. No recurrence of the neck mass or other signs of systemic sarcoidosis were noted during 1.5 years of follow-up. Although our patient's definitive diagnosis could not be determined, the case highlights 2 important issues: sarcoidal granuloma in lymph nodes may be a precursor of sarcoidosis, even in the absence of pulmonary or other systemic involvement; and regular follow-up is recommended in such cases.

  14. Isolated mediastinal necrotizing granulomatous lymphadenopathy due to cat-scratch disease.

    PubMed

    Lovis, A; Clerc, O; Lazor, R; Jaton, K; Greub, G

    2014-02-01

    We report a patient suffering from cat-scratch disease limited to mediastinal lymphadenitis. Although rare, cat-scratch disease should be considered in the differential diagnosis of mediastinal lymphadenitis, especially when patients were exposed to cats.

  15. Nomogram to Predict Occult N2 Lymph Nodes Metastases in Patients With Squamous Nonsmall Cell Lung Cancer.

    PubMed

    Jiang, Long; Jiang, Shanshan; Lin, Yongbin; Yang, Han; Xie, Zehua; Lin, Yaobin; Long, Hao

    2015-11-01

    For nonsmall cell lung cancer (NSCLC) patients without distant metastases, occult involvement of N2 lymph nodes would be of the utmost importance in determining both treatment and survival. The key to optimal treatment strategies relied on accurate diagnosis, in particular accurate clinical tumor staging. Patients with clinical N0 or N1 staging preoperatively had a sizeable risk to have occult N2 lymph nodes metastases.From November 2004 to March 2007, the entire database in a tertiary hospital of all patients with a pathologic diagnosis of squamous NSCLC underwent anatomical pulmonary resection and systematic mediastinal lymph node dissection were retrospectively collected and reviewed. A nomogram was developed on the basis of a multivariable logistic regression model with a combination of all potential variables. In order to surmount the potential of overestimating predictive performance, both bootstrapping for internal validation and an independent external validation set were employed.A nomogram incorporating the significant risk factors was created to predict the probability of occult N2 lymph nodes metastases. The calibration plot for the probability of occult N2 lymph nodes metastases showed an optimal agreement between the predicted probabilities by nomogram and actual observed probabilities. An objective and accurate nomogram predictive model for occult N2 lymph nodes metastases was drawn up and validated internally and externally in patients with squamous NSCLC.The nomogram model, as a robust tool in predicting occult N2 lymph nodes involvement, could be involved in a cost-effective application of specific diagnostic and therapeutic strategies.

  16. Disseminated necrotic mediastinitis spread from odontogenic abscess: our experience

    PubMed Central

    Filiaci, Fabio; Riccardi, Emiliano; Mitro, Valeria; Piombino, Pasquale; Rinna, Claudio; Agrillo, Alessandro; Ungari, Claudio

    2015-01-01

    Summary Aims Deep neck infections are rare but potentially fatal complication of pulpal abscess of the teeth. If an infection can progress rapidly from a toothache to a life threatening infection, then it is critical that dentists be able to recognize the danger signs and identify the patients who are at risk. Mediastinitis is a severe inflammatory process involving the connective tissues that fills the intracellular spaces and surrounds the organs in the middle of the chest. This pathology has both an acute and a chronic form and, in most cases, it has an infectious etiology. This study want to expose the experience acquired in the Oral and Maxillo-facial Sciences Department, Policlinico Umberto I, “Sapienza” University of Rome, regarding two clinical cases of disseminated necrotizing mediastinitis starting from an odontogenic abscess. Methods We report two clinical cases of disseminated necrotic mediastinitis with two different medical and surgical approaches. The radiographic and photographic documentation of the patients was collected in the pre-and post-operatively. All patients underwent a CT scan and MRI. Results Mediastinitis can result from a serious odontogenic abscess, and the extent of its inflammation process must be never underestimated. Dental surgeons play a key role as a correct diagnosis can prevent further increasing of the inflammation process. Conclusions A late diagnosis and an inadequate draining represent the major causes of the elevated mortality rate of disseminated necrotizing mediastinitis. PMID:26330907

  17. Evaluation of magnetic resonance sequences in imaging mediastinal tumors

    SciTech Connect

    Webb, W.R.; Gamsu, G.; Stark, D.D.; Moon, K.L. Jr.; Moore, E.H.

    1984-10-01

    Ten patients having a mediastinal tumor were studied with magnetic resonance imaging (MRI) using from two to four imaging sequences. Seven had bronchial carcinoma and three had benign lesions. The sequences included the spin-echo technique with repetition time (TR) values of 0.5, 1.0, and 2.0 sec and echo time (TE) values of 28 and 56 msec, and the inversion-recovery technique. The signal-intensity ratios of the mediastinal mass and mediastinal fat, which are a measure of image contrast, were compared for the different imaging sequences. Also signal-to-noise ratios were measured relative to both mediastinal fat and mediastinal mass. With spin-echo imaging, decreasing the TR value resulted in an increase in mass/fat contrast in all patients, making the masses easier to detect, but this also resulted in decreased signal-to-noise ratios. Inversion-recovery imaging with the sequence used resulted in a greatly increased mass/fat contrast, because of a relative decrease in signal from the mass. Spin-echo imaging with both short and long TR values provides good tissue contrast and good signal-to-noise ratios.

  18. [US-guided transhepatic drainage of a mediastinal abscess].

    PubMed

    Simón-Yarza, I; Viteri-Ramírez, G; García-Lallana, A; Benito, A

    2014-01-01

    Anastomoses often leak after esophageal surgery; if they are not detected in time, leaks can give rise to complications like fluid collections, superinfections, and mediastinitis. Although these complications usually require surgical treatment, different series of patients successfully treated with conservative or minimally invasive approaches have been reported. We present the case of a patient who developed a mediastinal abscess after epiphrenic diverticulectomy. We treated the abscess with US-guided percutaneous transhepatic drainage to avoid surgical reintervention. Although other cases of a transhepatic approach to thoracic lesions have been reported, to our knowledge this is the first report of this technique in mediastinal abscesses. We recommend that transhepatic drainage be considered a therapeutic option in the management of these complications. PMID:22464798

  19. Aspergillus Mediastinitis after Orthotopic Heart Transplantation: A Case Report.

    PubMed

    El-Sayed Ahmed, Magdy M; Almanfi, Abdelkader; Aftab, Muhammad; Singh, Steve K; Mallidi, Hari R; Frazier, O H

    2015-10-01

    A 55-year-old woman was admitted for orthotopic heart transplantation. Her medical history was notable for multiple cardiovascular problems, including ischemic cardiomyopathy that necessitated circulatory support with a left ventricular assist device. Five weeks after undergoing orthotopic heart transplantation, she developed Aspergillus calidoustus mediastinitis, for which she underwent a prolonged course of antifungal treatment that comprised (in sequence) posaconazole for 11 days, voriconazole for 10 days, and amphotericin B for 42 days. During this period, she also underwent repeated mediastinal drainage and sternal débridement, followed by sternal wiring and coverage with bilateral pectoralis advancement flaps. Four months postoperatively, she was discharged from the hospital with a successfully controlled infection and a healed sternum. To our knowledge, only 3 previous cases of Aspergillus mediastinitis after orthotopic heart transplantation have been reported in the literature, none of which was Aspergillus calidoustus.

  20. International association for the study of lung cancer map, Wang lymph node map and rapid on-site evaluation in transbronchial needle aspiration

    PubMed Central

    Liu, Qing-Hua; Arias, Sixto

    2016-01-01

    The invaluable role of transbronchial needle aspiration (TBNA) in the diagnosis and staging of mediastinal adenopathy and lung cancer has been well established. Different lymph nodes regional nomenclatures and maps had been described over the years. The international association for the study of lung cancer (IASLC) and Wang’s maps complement each other benefiting patients with lung cancer. In this article we briefly reviewed the roles of IALSC, Wang’s maps and ROSE in TBNA. PMID:27747023

  1. Craniocervical necrotizing fasciitis of odontogenic origin with mediastinal extension.

    PubMed

    Edwards, John D; Sadeghi, Nader; Najam, Farzad; Margolis, Mark

    2004-08-01

    We review an interesting case of craniocervical necrotizing fasciitis with thoracic extension in an immunocompetent 44-year-old man. The patient underwent aggressive medical and surgical management during a long hospitalization. Multiple surgical debridements, including transcervical mediastinal debridement, and eventually a thoracotomy for mediastinal abscess were required. The patient eventually recovered, and 3 months later he showed no sign of complications or recurrence. Craniocervical necrotizing fasciitis is a fulminant soft-tissue infection, usually of odontogenic origin, that requires prompt identification and treatment to ensure survival. Broad-spectrum intravenous antibiotics, aggressive surgical debridement and wound care, hyperbaric oxygen, and good intensive care are the mainstays of treatment.

  2. Video-assisted thoracoscopic surgery for complex mediastinal mass resections

    PubMed Central

    DeMarchi, Lorenzo; Emerson, Dominic A.; Holzner, Matthew L.

    2015-01-01

    Minimally invasive surgery has changed the way operative procedures are performed in many specialties. As surgeons have become progressively facile with these techniques, the opportunities to use them have expanded. In thoracic surgery, many surgeons now use minimally invasive techniques to resect small, uncomplicated pathologies of the mediastinum as well as to perform thymectomy for myasthenia gravis. Experience with these techniques has allowed new knowledge to be gained and expansion of the use of these techniques for more complicated mediastinal pathology. This keynote address will outline the instrumentation and techniques that we have adopted over a decade of using these techniques for more complicated mediastinal pathology. PMID:26693146

  3. [Lymph node metastasis of osteosarcomas].

    PubMed

    Vasil'ev, N V

    2016-01-01

    Lymph node metastasis of osteosarcomas is a rather rare phenomenon; according to different authors, the incidence of lymph node metastasis is 4 to 11%. The detection of lymph node metastases in osteosarcoma is associated with a significant reduction in the 5-year survival of patients and allows its classification as clinical stage IV tumor. The risk factors for lymph node metastases in patients with bone sarcomas are age (≥64 years), gender (female), nosological entity (undifferentiated pleomorphic sarcoma, osteosarcoma, chondrosarcoma), tumor depth (muscle, bone), and the size of primary tumor (>5 сm). The mechanism of lymph node metastasis of osteosarcomas seems to be related to mesenchymal-to-epithelial transition. PMID:27600784

  4. [Loss of appetite, night sweats, eczema, and axillary and inguinal lymph node swelling in a 28-year-old man].

    PubMed

    Wahl, U; Stranzenbach, R; Tischoff, I; Tannapfel, A; Stadler, R; Ernst, F

    2014-03-01

    A 28-year-old man presented with loss of appetite, night sweats, eczema, and axillary and inguinal lymph node swelling. The tentative diagnosis of malignant lymphoma was made. To confirm the diagnosis, extirpation of a lymph node and a skin biopsy were performed. Systemic treatment with methylprednisolone resulted in an improvement of eczema and lymph node swelling. Because of the histological findings and clinical course, we diagnosed dermatopathic lymphadenopathy, also known as Pautrier-Woringer syndrome.

  5. Mediastinal Tuberculosis in an Adult Patient with Cystic Fibrosis▿

    PubMed Central

    Morand, Philippe C.; Burgel, Pierre-Régis; Carlotti, Agnès; Desmazes-Dufeu, Nadine; Farhi, David; Martin, Clémence; Kanaan, Reem; Mangialavori, Luigi; Palangié, Estelle; Dusser, Daniel; Poyart, Claire; Hubert, Dominique

    2011-01-01

    Tuberculosis (TB) is rarely observed in cystic fibrosis (CF) patients. We report the first case of mediastinal TB, associated with leg pain and skin rash, in an adult patient with CF, and discuss factors suggestive of TB in the course of CF. PMID:21106788

  6. A prospective study of mediastinal gray-zone lymphoma

    PubMed Central

    Pittaluga, Stefania; Nicolae, Alina; Camphausen, Kevin; Shovlin, Margaret; Steinberg, Seth M.; Roschewski, Mark; Staudt, Louis M.; Jaffe, Elaine S.; Dunleavy, Kieron

    2014-01-01

    Mediastinal B-cell lymphomas present in the mediastinum and are most frequent in young patients. Nodular sclerosis Hodgkin lymphoma (NSHL) and primary mediastinal B-cell lymphoma (PMBL) are the common types, whereas mediastinal gray-zone lymphoma (MGZL) is extremely rare and has pathological features intermediate between NSHL and PMBL. The indeterminate pathobiology of MGZL has led to uncertainty regarding therapeutic strategy, and its clinical characteristics and treatment have not been characterized. We conducted a prospective study of infusional dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH-R) and filgrastim in untreated MGZL. We analyzed biomarkers of outcome and compared their clinical and biological characteristics to PMBL. Twenty-four MGZL patients had a median age of 33 years (range, 14 to 59 years), and 46% had mediastinal masses ≥10 cm. At 59 months median follow-up, the event-free survival and overall survival were 62% and 74%, respectively. The serum absolute lymphocyte count, the presence of tumor-infiltrating dendritic cells, CD15 expression on the malignant cells, and tumor morphology were biomarkers of outcome in MGZL. Compared with PMBL, MGZL patients were more likely to be male, express CD15, have lower expression of CD20, and have a worse outcome. DA-EPOCH-R alone is effective in MGZL. The trial was registered at ClinicalTrials.gov (NCT00001337). PMID:25024303

  7. A prospective study of mediastinal gray-zone lymphoma.

    PubMed

    Wilson, Wyndham H; Pittaluga, Stefania; Nicolae, Alina; Camphausen, Kevin; Shovlin, Margaret; Steinberg, Seth M; Roschewski, Mark; Staudt, Louis M; Jaffe, Elaine S; Dunleavy, Kieron

    2014-09-01

    Mediastinal B-cell lymphomas present in the mediastinum and are most frequent in young patients. Nodular sclerosis Hodgkin lymphoma (NSHL) and primary mediastinal B-cell lymphoma (PMBL) are the common types, whereas mediastinal gray-zone lymphoma (MGZL) is extremely rare and has pathological features intermediate between NSHL and PMBL. The indeterminate pathobiology of MGZL has led to uncertainty regarding therapeutic strategy, and its clinical characteristics and treatment have not been characterized. We conducted a prospective study of infusional dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH-R) and filgrastim in untreated MGZL. We analyzed biomarkers of outcome and compared their clinical and biological characteristics to PMBL. Twenty-four MGZL patients had a median age of 33 years (range, 14 to 59 years), and 46% had mediastinal masses ≥10 cm. At 59 months median follow-up, the event-free survival and overall survival were 62% and 74%, respectively. The serum absolute lymphocyte count, the presence of tumor-infiltrating dendritic cells, CD15 expression on the malignant cells, and tumor morphology were biomarkers of outcome in MGZL. Compared with PMBL, MGZL patients were more likely to be male, express CD15, have lower expression of CD20, and have a worse outcome. DA-EPOCH-R alone is effective in MGZL. The trial was registered at ClinicalTrials.gov (NCT00001337). PMID:25024303

  8. Invasive Esophageal Candidiasis with Chronic Mediastinal Abscess and Fatal Pneumomediastinum

    PubMed Central

    Aghdam, Mohammad Reza F.; Sund, Ståle

    2016-01-01

    Patient: Male, 68 Final Diagnosis: Invasive esophageal candiasis Symptoms: Chest discomfort Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Unusual clinical course Background: Invasive candidiasis is a potential problem for patients receiving long-term immunosuppressive treatment. Psoriatic arthritis is one of many chronic diseases that can be successfully treated with immunosuppressive drugs, in spite of a documented and accepted risk for infectious complications. Critical awareness of possible infection must be part of the surveillance of such patients. Case Report: This is the case of a 68-year-old Norwegian male, treated with long-term immunosuppression for psoriatic arthritis, hospitalized with acute subcutaneous and mediastinal emphysema of unknown cause. He died of acute respiratory failure with circulatory collapse shortly after admission. The autopsy revealed mediastinal and subcutaneous emphysema and a mediastinal abscess containing Candida with probable entrance from the esophagus. Conclusions: We consider invasive candidiasis of the esophagus to be the cause of both the chronic abscess and the acute mediastinal emphysema. This case illustrates the importance of awareness of invasive candidiasis as a possible complication in a patient with long-term immunosuppression. PMID:27389822

  9. [Shock secondary to extrinsic compression of the right atrium by postoperative mediastinal hematoma. Pseudotumor echocardiography image in right atrium].

    PubMed

    Jordán, A J; García, M; Santos, F; González, M; Gómez, J; García De Burgos, F

    2001-03-01

    We present the case of a 64 year-old patient in whom an aortic Saint Jude prosthesis, a Cosgrove's mitral annulus and triple coronary artery by-pass graft were implanted, and who presented with shock related to extrinsic compression of the right atrium by a mediastinal hematoma within the first postoperative month. Transthoracic echocardiogram showed a right atrial , hampering right atrium drainage. The extrapericardial location of the hematoma is of note and was diagnosed with the aid of thoracic computerized tomography. We present the case of a 64 year-old patient in whom an aortic Saint Jude prosthesis, a Cosgrove's mitral annulus and triple coronary artery by-pass graft were implanted, and who presented with shock related to extrinsic compression of the right atrium by a mediastinal hematoma within the first postoperative month. Transthoracic echocardiogram showed a right atrial , hampering right atrium drainage. The extrapericardial location of the hematoma is of note and was diagnosed with the aid of thoracic computerized tomography.

  10. Cytoclasmosis in central lymph production.

    PubMed

    Shields, J W

    1979-06-01

    Electron microscopic observations and ancillary data are reviewed to show that lymphatic organs produce quantities of central lymph by releasing cytoplasm-depleted cells into colloidal hydrosols produced by cell fragmentation (cytoclasmosis).

  11. A random forest classifier for lymph diseases.

    PubMed

    Azar, Ahmad Taher; Elshazly, Hanaa Ismail; Hassanien, Aboul Ella; Elkorany, Abeer Mohamed

    2014-02-01

    Machine learning-based classification techniques provide support for the decision-making process in many areas of health care, including diagnosis, prognosis, screening, etc. Feature selection (FS) is expected to improve classification performance, particularly in situations characterized by the high data dimensionality problem caused by relatively few training examples compared to a large number of measured features. In this paper, a random forest classifier (RFC) approach is proposed to diagnose lymph diseases. Focusing on feature selection, the first stage of the proposed system aims at constructing diverse feature selection algorithms such as genetic algorithm (GA), Principal Component Analysis (PCA), Relief-F, Fisher, Sequential Forward Floating Search (SFFS) and the Sequential Backward Floating Search (SBFS) for reducing the dimension of lymph diseases dataset. Switching from feature selection to model construction, in the second stage, the obtained feature subsets are fed into the RFC for efficient classification. It was observed that GA-RFC achieved the highest classification accuracy of 92.2%. The dimension of input feature space is reduced from eighteen to six features by using GA. PMID:24290902

  12. Substantial within-Animal Diversity of Salmonella Isolates from Lymph Nodes, Feces, and Hides of Cattle at Slaughter

    PubMed Central

    Loneragan, Guy H.; Nightingale, Kendra K.; Brichta-Harhay, Dayna M.; Ruiz, Henry; Elder, Jacob R.; Garcia, Lyda G.; Miller, Markus F.; Echeverry, Alejandro; Ramírez Porras, Rosa G.; Brashears, Mindy M.

    2013-01-01

    Lymph nodes (mandibular, mesenteric, mediastinal, and subiliac; n = 68) and fecal (n = 68) and hide (n = 35) samples were collected from beef carcasses harvested in an abattoir in Mexico. Samples were analyzed for Salmonella, and presumptive colonies were subjected to latex agglutination. Of the isolates recovered, a subset of 91 was characterized by serotyping, pulsed-field gel electrophoresis (PFGE), and antimicrobial susceptibility phenotyping. Salmonella was isolated from 100% (hide), 94.1% (feces), 91.2% (mesenteric), 76.5% (subiliac), 55.9% (mandibular), and 7.4% (mediastinal) of samples. From the 87 typeable isolates, eight Salmonella enterica serotypes, including Kentucky (32.2%), Anatum (29.9%), Reading (17.2%), Meleagridis (12.6%), Cerro (4.6%), Muenster (1.1%), Give (1.1%), and Mbandaka (1.1%), were identified. S. Meleagridis was more likely (P = 0.03) to be recovered from lymph nodes than from feces or hides, whereas S. Kentucky was more likely (P = 0.02) to be recovered from feces and hides than from lymph nodes. The majority (59.3%) of the Salmonella isolates were pansusceptible; however, multidrug resistance was observed in 13.2% of isolates. Typing by PFGE revealed that Salmonella strains generally clustered by serotype, but some serotypes (Anatum, Kentucky, Meleagridis, and Reading) were comprised of multiple PFGE subtypes. Indistinguishable PFGE subtypes and, therefore, serotypes were isolated from multiple sample types, and multiple PFGE subtypes were commonly observed within an animal. Given the overrepresentation of some serotypes within lymph nodes, we hypothesize that certain Salmonella strains may be better at entering the bovine host than other Salmonella strains or that some may be better adapted for survival within lymph nodes. Our data provide insight into the ecology of Salmonella within cohorts of cattle and offer direction for intervention opportunities. PMID:23793628

  13. Occult distal urethral carcinoma presenting as metastatic carcinoma in the inguinal lymph nodes.

    PubMed

    Hammer-Hansen, Niels; Høyer, Søren; Jensen, Jørgen Bjerggaard

    2015-02-01

    A 65-year-old man presented with metastatic squamous cell carcinoma in the inguinal lymph nodes from an unknown primary tumour. The initial work-up lacked clinical examination of the glans penis, in part due to the patient having phimosis. More than a year after presentation, a primary tumour, located distally on the penis, was diagnosed. A discussion of urethral carcinoma as well as inguinal lymph-node metastasis of unknown primary tumour is presented. PMID:25313619

  14. Perforation of esophagus and subsequent mediastinitis following mussel shell ingestion

    PubMed Central

    Park, Il Hwan; Lim, Hyun Kyo; Song, Seung Woo

    2016-01-01

    Esophageal perforation is a very rare occurrence because accidental swallowing of foreign bodies is uncommon in adults. Thus, perforation due to swallowing of a foreign body and subsequent development of mediastinitis is rarely encountered by physicians. We experienced such a case and described an adult male patient who had perforated esophagus after accidentally swallowing a mussel shell. The patient visited our emergency department complaining of painful dysphagia for 4 days. A review of history revealed that he consumed a spicy seafood noodle soup containing mussel shells 4 days ago. Computed tomography (CT) of the chest showed the foreign body in the esophagus and pneumomediastinum was identified. We removed the mussel shell fragment using rigid esophagoscopy; explo-thoracotomy, debridement of mediastinal abscess and irrigation were performed. PMID:27621902

  15. [Mediastinal fibrosis associated with Riedel's thyroiditis. Apropos of a case].

    PubMed

    Sembach, N; Benhamou, D; Girault, C; Testard, J; Ozenne, G; Muir, J F

    1995-01-01

    The authors describe a case of mediastinal fibrosis in a 53 year old woman which presented with a superior venacaval syndrome ten years after the diagnosis of a Riedel's thyroiditis. The clinical and laboratory evidence did not reveal anything to suggest other fibrosing disorders (such as retroperitoneal fibrosis, extra-hepatic biliary fibrosis or orbital fibrosis) which could be associated either simultaneously or successively with this multi-focal fibrosis. The physiology of this disorder currently remains imprecise. A current hypothesis is that there is an immunological reaction in the periarterial area leading to lipid components make atheromatous plaques. The therapeutic means are limited and depend on the localisation of the fibrous tissue and of their functional repercussions. Currently, the benefit of corticosteroids on the mediastinal fibrotic lesions has not been demonstrated. PMID:7899673

  16. Giant Mediastinal Germ Cell Tumour: An Enigma of Surgical Consideration

    PubMed Central

    Ali, Nurayub Mohd; Azizan, Nornazirah; Zakaria, Andee Dzulkarnaen; Rahman, Mohd Ramzisham Abdul

    2016-01-01

    We present a case of 16-year-old male, who was referred from private centre for dyspnoea, fatigue, and orthopnea. The chest radiograph revealed complete opacification of left chest which was confirmed by computed tomography as a large left mediastinal mass measuring 14 × 15 × 18 cm. The diagnostic needle core biopsy revealed mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma. After 4 cycles of neoadjuvant BEP regime, there was initial response of tumour markers but not tumour bulk. Instead of classic median sternotomy or clamshell incision, posterolateral approach with piecemeal manner was chosen. Histology confirmed mixed germ cell tumour with residual teratomatous component without yolk sac or embryonal carcinoma component. Weighing 3.5 kg, it is one of the largest mediastinal germ cell tumours ever reported. We describe this rare and gigantic intrathoracic tumour and discuss the spectrum of surgical approach and treatment of this exceptional tumour. PMID:27807495

  17. Paravertebral mediastinal Mullerian cyst resected by video assisted thoracoscopic surgery.

    PubMed

    Chon, Soon-Ho; Im, Ui Jae; Song, Dong Seop

    2015-03-01

    Ever since Hattori et al. had described the mediastinal Mullerian cyst in 2005 there has been several new cases described in the literature. We report a 51-year-old woman with an incidentally found 2 cm × 3 cm mass in her left paravertebral mediastinum. She underwent thoracoscopic removal with the impression of a neurogenic tumor and was unexpectedly found with a ciliated cyst of Mullerian origin.

  18. An unusual case of non-traumatic pneumococcal mediastinal abscess.

    PubMed

    Lotan, C; Boneh, A; Tamir, I; Goitein, K J

    1985-01-01

    A 16-month old baby developed severe respiratory failure because of acute laryngitis and required mechanical ventilation. Intubation was complicated by aspiration and development of chemical pneumonia. Following 4 days of treatment the child was successfully extubated. Thirty six hours after extubation the patient again developed respiratory failure and on chest X-ray pneumomediastinum was seen and later evidence of a mediastinal abscess. Conservative treatment, with antibiotics, effected complete cure.

  19. Giant Chordoma of the Upper Thoracic Spine with Mediastinal Involvement: A Surgical Challenge

    PubMed Central

    Rena, Ottavio; Allegra, Giuliano; Casadio, Caterina; Turello, Davide

    2014-01-01

    Thoracic chordomas are very rare malignant tumours originating from notochordal remnants. These tumours develop within a vertebral body and enlarge involving the mediastinal compartment. Because of their slow-growing attitude, they become symptomatic only when they invade or compress the spinal cord and/or mediastinal organs. We present a rare case of a thoracic spine chordoma presenting with increasing paraparesis with a huge mediastinal component which was surgically debulked to decompress the spinal cord and medistinal organs. PMID:24967050

  20. Complete transthoracic resection of giant posterior mediastinal goiter: case report and review of surgical strategies

    PubMed Central

    Zhao, Honglin; Ren, Dian; Liu, Yi; Li, Xin; Wu, Yi; Chen, Gang; Chen, Jun

    2016-01-01

    Intrathoracic goiters generally occupy anterior mediastinum, rarely involving the posterior mediastinal space. Reported herein is a 54-year-old female with a giant posterior mediastinal mass that was successfully resected via right posterolateral thoracotomy. The final pathologic diagnosis was giant posterior mediastinal goiter. This patient has done well postoperatively, with no evidence of local recurrence at 12-month follow-up. Related surgical strategies in past publications are summarized. PMID:27217766

  1. Supradiaphragmatic Hodgkin's disease: significance of large mediastinal masses

    SciTech Connect

    Prosnitz, L.R.; Curtis, A.M.; Knowlton, A.H.; Peters, L.M.; Farber, L.R.

    1980-07-01

    In order to assess the significance of large mediastinal masses in patients with Hodgkin's disease, we analyzed all patients with pathological stage (PS) IA or IIA disease evaluated and treated at Yale between 1969 and 1978. There were 131 such patients treated initially with radical radiotherapy only, combination chemotherapy being reserved for those who failed radiation. Actuarial 5 and 10 year survivals were 95%. The presence of a mediastinal mass regardless of size did not affect survival. Relapse-free survival was 77% at 5 years, 74% at 10 years in the entire group. Patients with any mediastinal involvement had a 65% relapse-free survival, 72% if the mass was < 33% of transverse chest diameter, 55% if the mass was > 33%. These differences are suggestive of a greater tendency of such patients to fail radiotherapy but the differences were not statistically significant. Patients who did fail radiotherapy were for the most part successfully retreated with combined modality therapy (chemotherapy and radiation), accounting for the most part successfully retreated with combined modality therapy (chemotherapy and radiation), accounting for the overall survival of 95%. Only 6 patients died of causes related to Hodgkin's disease and 2 of these deaths were related to combined modality therapy complications. Because of the serious potential long term consequences of combined modality treatment, it should be used with great caution and on an individual basis only in PSIA and IIA patients.

  2. Mediastinal Hibernoma: A Rare Case with Radiologic-Pathologic Correlation

    PubMed Central

    Dasyam, Anil; Then, Matthew; Varma, Kavita; Borhani, Amir A.

    2016-01-01

    Hibernomas, especially located in the mediastinum, are extremely rare benign tumors, which are important to consider in the differential diagnosis of a heterogeneously enhancing mass with areas of fat attenuation on imaging of an often incidentally discovered mass. Other common possibilities in the differential include malignant tumors, such as liposarcoma, hence histopathology is usually required to confirm the diagnosis. Hibernomas often follow the distribution of sites of persistence of brown fat in adults, and intrathoracic locations are unusual. We present a very rare case of a mediastinal hibernoma in a 53-year-old woman. She presented to the emergency department with severe, progressive right neck and shoulder pain with radiation down her arm and was found to have a right apical posterior mediastinal mass on imaging. Initial radiographs of the shoulder showed a soft tissue mass within the apical right hemithorax. Further imaging with CT revealed a well circumscribed, heterogeneously enhancing mass with areas of fat attenuation. Pathology confirmed the diagnosis of mediastinal hibernoma, and the mass was completely excised. Fourteen months after surgery, the patient had a normal chest radiograph, and thirty-two months after surgery, she remains asymptomatic. PMID:27651970

  3. Mediastinal Hibernoma: A Rare Case with Radiologic-Pathologic Correlation.

    PubMed

    Darke, Maxine; Dasyam, Anil; Then, Matthew; Varma, Kavita; Borhani, Amir A; Varma, Rakesh

    2016-01-01

    Hibernomas, especially located in the mediastinum, are extremely rare benign tumors, which are important to consider in the differential diagnosis of a heterogeneously enhancing mass with areas of fat attenuation on imaging of an often incidentally discovered mass. Other common possibilities in the differential include malignant tumors, such as liposarcoma, hence histopathology is usually required to confirm the diagnosis. Hibernomas often follow the distribution of sites of persistence of brown fat in adults, and intrathoracic locations are unusual. We present a very rare case of a mediastinal hibernoma in a 53-year-old woman. She presented to the emergency department with severe, progressive right neck and shoulder pain with radiation down her arm and was found to have a right apical posterior mediastinal mass on imaging. Initial radiographs of the shoulder showed a soft tissue mass within the apical right hemithorax. Further imaging with CT revealed a well circumscribed, heterogeneously enhancing mass with areas of fat attenuation. Pathology confirmed the diagnosis of mediastinal hibernoma, and the mass was completely excised. Fourteen months after surgery, the patient had a normal chest radiograph, and thirty-two months after surgery, she remains asymptomatic. PMID:27651970

  4. A case report of mediastinal ectopic parathyroid adenoma presented as parathyroid crisis localized by SPECT/CT

    PubMed Central

    Zhou, Weibin; Chen, Min

    2016-01-01

    Abstract Introduction: Parathyroid crisis due to ectopic parathyroid adenomas can pose diagnostic and management challenges, since it is quite rare in clinical practice. Clinical Findings/Patient Concerns: A 67-year-old Chinese male presented as a parathyroid crisis due to an ectopic mediastinal parathyroid adenoma with his serum calcium and PTH markedly increased in short time. An ultrasonography and computed tomography (CT) scan of the neck did not reveal any parathyroid adenoma. Thoracic CT detected a contrast-enhanced mass in the mediastinum. Although the ectopic location is difficult to appreciate on anterior planar technetium-99m-sestamibi scintigraphy views but has been accurately localized with single photon-emission computed tomography/computed tomography. After fluid resuscitation, loop diuretic, and calcitonin treatment, a thoracoscope surgery was performed. The histopathology of the mediastinal nodule was consistent with a parathyroid adenoma. Hypocalcemia due to hungry bone syndrome occurred after surgery and was resolved quickly with large-dose calcium and calcitriol supplementation. He is asymptomatic and has normal serum calcium and PTH levels on regular follow-up. Diagnoses: The ultrasonography, CT, sestamibi, and single photon-emission computed tomography/computed tomography provide limited sensitivity in the detecting ectopic parathyroid adenomas alone. The combination of these techniques has incremental value in localizing ectopic parathyroid adenomas over either technique alone. Conclusion: Any parathyroid crisis without parathyroid adenoma in the neck should alert physicians to search for ectopic locations through combination of imaging techniques. PMID:27741147

  5. Breast cancer recurrence after sentinel lymph node biopsy

    PubMed Central

    AlSaif, Abdulaziz

    2015-01-01

    Objective: To look into the pattern of breast cancer recurrence following mastectomy, breast conservative surgery and radiotherapy or chemotherapy after SLNB at our institution. Methods: Between January 2005 and December 2014, all patients diagnosed with breast cancer with clinically negative axilla, underwent SLNB. We reviewed their medical records to identify pattern of cancer recurrence. Results: The median follow-up was 35.5 months. Eighty five patients (70.8%) had a negative sentinel lymph node (SLN) and subsequently had no further axillary treatment, one of them (1.2%) developed axillary recurrence 25 months postoperatively. Twenty five patients (20.8%) had a positive SLN (macrometastases) and subsequently had immediate axillary lymph node dissection (ALND). Ten patients (8.3%) had a positive SLN (micrometastases). In the positive SLN patients (macrometastases and micrometastases), there were two ipsilateral breast recurrences (5.7%), seen three and four years postoperatively. Also in this group, there was one (2.9%) distant metastasis to bone three years postoperatively. Conclusion: In this series, the clinical axillary false negative rate for SLNB was 1.2% which is in accordance with the published literature. This supports the use of SLNB as the sole axillary staging procedure in breast cancer patients with negative SLNB. Axillary lymph node dissection can be safely omitted in patients with micrometastases in their sentinel lymph node(s). PMID:26870109

  6. A case of anterior mediastinitis and bilateral multiple lung abscesses occurring after trans-subxiphoid video-assisted thoracoscopic extended thymectomy for thymoma with myasthenia gravis

    PubMed Central

    Zhang, Hanlu; Geng, Yingcai; Zheng, Yu

    2016-01-01

    A 68-year-old female was admitted to our hospital with an acute episode of chest pain, progressive cough and fever. She underwent trans-subxiphoid video-assisted thoracoscopic extended thymectomy (TsVATET) for thymoma with myasthenia gravis (MG) 9 days ago. Chest computed tomography (CT) showed anterior mediastinal oedema, and infiltrative findings involved bilateral lung. Physical examination revealed the subxiphoid wound suppuration. We diagnosed subxiphoid incision infection, anterior mediastinitis and concomitant bilateral pneumonia. Using antibiotics intravenously combined with anterior mediastinum irrigation and drainage, she felt well but bilateral multiple lung abscesses were discovered on the 12th day of hospitalisation. After conservative treatment with antibiotics and wound care, the recovery was satisfactory and she discharged home. In our experience, because the subxiphoid incision, the anterior mediastinum and the bilateral thoracic cavity communicated directly after TsVATET, we should be aware of the risk of anterior mediastinitis, the infection of bilateral pleural cavity, pneumonia and multiple lung abscesses following subxiphoid incision infection. PMID:27747038

  7. Thymic carcinoma diagnosed by using endoscopic ultrasound with fine-needle aspiration.

    PubMed

    Patel, Pragnesh; Guider, Julie; Rahimi, Erik; Guha, Sushovan; Zhang, Songlin; Thosani, Nirav

    2016-01-01

    There is a paucity of literature on the use of endoscopic ultrasound (EUS) for evaluating superior mediastinal structures, especially the thymus gland. We report a case of thymic carcinoma diagnosed by using EUS elastography with strain ratio and fine-needle aspiration (FNA). A 64-year-old woman presented with altered mental status and was diagnosed with autoimmune encephalitis. Further work-up suggested a superior mediastinal mass, for which she underwent EUS. A hypoechoic mass was found in the superior mediastinum at the level of the aortic arch. Real-time EUS elastography showed a predominantly blue hue to the mass concerning for malignancy. FNA of the mass was performed, which revealed numerous large neoplastic cells under a background of a small lymphoid infiltrate. Immunohistochemistry was strongly positive for PAX8, pancytokeratin, and CAM5.2. The pathologic and immunohistochemical stains were consistent with thymic carcinoma. PMID:27386480

  8. How Is Pneumonia Diagnosed?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Pneumonia Diagnosed? Pneumonia can be hard to diagnose because it may ... than these other conditions. Your doctor will diagnose pneumonia based on your medical history, a physical exam, ...

  9. Disrupted NOS signaling in lymphatic endothelial cells exposed to chronically increased pulmonary lymph flow.

    PubMed

    Datar, Sanjeev A; Gong, Wenhui; He, Youping; Johengen, Michael; Kameny, Rebecca J; Raff, Gary W; Maltepe, Emin; Oishi, Peter E; Fineman, Jeffrey R

    2016-07-01

    Associated abnormalities of the lymphatic circulation are well described in congenital heart disease. However, their mechanisms remain poorly elucidated. Using a clinically relevant ovine model of a congenital cardiac defect with chronically increased pulmonary blood flow (shunt), we previously demonstrated that exposure to chronically elevated pulmonary lymph flow is associated with: 1) decreased bioavailable nitric oxide (NO) in pulmonary lymph; and 2) attenuated endothelium-dependent relaxation of thoracic duct rings, suggesting disrupted lymphatic endothelial NO signaling in shunt lambs. To further elucidate the mechanisms responsible for this altered NO signaling, primary lymphatic endothelial cells (LECs) were isolated from the efferent lymphatic of the caudal mediastinal node in 4-wk-old control and shunt lambs. We found that shunt LECs (n = 3) had decreased bioavailable NO and decreased endothelial nitric oxide synthase (eNOS) mRNA and protein expression compared with control LECs (n = 3). eNOS activity was also low in shunt LECs, but, interestingly, inducible nitric oxide synthase (iNOS) expression and activity were increased in shunt LECs, as were total cellular nitration, including eNOS-specific nitration, and accumulation of reactive oxygen species (ROS). Pharmacological inhibition of iNOS reduced ROS in shunt LECs to levels measured in control LECs. These data support the conclusion that NOS signaling is disrupted in the lymphatic endothelium of lambs exposed to chronically increased pulmonary blood and lymph flow and may contribute to decreased pulmonary lymphatic bioavailable NO.

  10. Utility and diagnostic accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration cytology of mediastinal lesions: Saudi Arabian experience

    PubMed Central

    Raddaoui, Emad; Alhamad, Esam H; Zaidi, Shaesta Naseem; Al-Habeeb, Fatmah F; Arafah, Maha

    2014-01-01

    Objective: The objective of this study is to evaluate the cytological accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TFNA) of the mediastinal mass/nodular lesions. Study Design: Over 3½ years from inception at King Khalid University Hospital, a retrospective analysis of the cytological diagnoses of all the EBUS-TFNA procedures performed in 80 patients who had mediastinal mass/nodular enlargement. Cytology results were reviewed and correlated with the histologic follow-up. Results: Of the 80 patients who underwent EBUS-TFNA, 15 cases (18.75%) were positive for malignancy, 48 cases (60%) negative for malignancy and 17 cases (21.25%) unsatisfactory. Of the 48 cases, which were negative for malignancy, 24 (50%) cases were of granulomatous inflammation. The overall diagnostic yield of our EBUS-TFNA specimen was 78.75%. Forty-seven cases (58.75%) of 80 cases had histological follow-up biopsies. Among them, 32 cases (68%) had the same cytological and histological diagnosis and 15 cases (31.09%) had discordance between the cytology and the follow-up histological diagnosis. The sensitivity, specificity, and positive and negative predictive values for diagnosing granulomas by EBUS-TFNA are 77%, 82%, 83%, and 75% and for diagnosing malignancy are 71%, 100%, 100%, and 82%, respectively. Conclusion: Preliminary results show that cytological samples obtained through EBUS-TFNA are accurate and specific in making a diagnosis of the mediastinal mass/nodular lesions. Its optimum use depends on the effective collaboration between the cytotechnologist, pathologist, and the bronchoscopist. PMID:25191512

  11. [Extracorporeal shockwave lithotripsy and lymph node calcification].

    PubMed

    Higashihara, E; Fujime, M; Niijima, T

    1987-05-01

    A female patient with calculi in the left kidney and calcified lymph nodes in the vicinity of the left renal pelvis was treated successfully with extracorporeal shock wave lithotripsy. The simultaneous action of the shock waves on the calcified lymph nodes did not cause any alteration of the lymph node structure. Thus a shock-wave treatment can be carried out even in the presence of a calcified lymph node without complications.

  12. Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

    PubMed Central

    2015-01-01

    Background: Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA) is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution. Methods: Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated. Results: The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were “duration of preoperative hospitalization” and “preoperative MRSA colonization,” intraoperative factors were “Aristotle basic complexity score,” “operation time,” “cardiopulmonary bypass circuit volume” and “lowest rectal temperature.” And postoperative factor was “blood transfusion volume.” Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis. Conclusions: SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries. PMID:25641035

  13. Pre-operative mediastinal evaluation in primary bronchial carcinoma--a review of staging investigations.

    PubMed Central

    Elliott, J. A.

    1984-01-01

    A review of staging investigations in the preoperative evaluation of mediastinal involvement in primary bronchial carcinoma is presented. The following conclusions are offered as guidelines for the use of mediastinal staging procedures in clinical practice: Surgical staging methods have the over-riding advantage of superior specificity over indirect imaging techniques. Where 67Ga-imaging or CT scanning are not available, routine pre-operative mediastinoscopy or, when appropriate, mediastinotomy will identify most patients with non-resectable disease but this approach entails a high proportion of true negative examinations. Radioisotope ventilation and perfusion lung imaging has no place in the pre-operative staging of lung cancer. Where the techniques are available, 67Ga-imaging and CT scanning have a use in selecting patients for mediastinal exploration. A negative mediastinal 67Ga scan or a negative CT examination suggest that mediastinal exploration will be unrewarding in the vast majority of cases and may be omitted prior to thoracotomy. A positive mediastinal 67Ga scan or the demonstration of abnormal mediastinal nodes by CT is an indication for mediastinal exploration which, if negative should be followed by thoracotomy. PMID:6369288

  14. Pathogenic characterization of a cervical lymph node derived from a patient with Kawasaki disease

    PubMed Central

    Katano, Harutaka; Sato, Seiichi; Sekizuka, Tsuyoshi; Kinumaki, Akiko; Fukumoto, Hitomi; Sato, Yuko; Hasegawa, Hideki; Morikawa, Shigeru; Saijo, Masayuki; Mizutani, Tetsuya; Kuroda, Makoto

    2012-01-01

    Kawasaki disease (KD) is the most common cause of multisystem vasculitis in childhood. Although cervical lymphadenitis is one of the major symptoms in KD, lymph node biopsy is rarely performed, because KD is usually diagnosed by clinical symptoms. A cervical lymph node biopsy was taken from a girl aged 1 year and 8 months who had suspected lymphoma, but she was diagnosed with KD after the biopsy. The cervical lymph node specimen was analyzed with multivirus real-time PCR that can detect >160 viruses, and unbiased direct sequencing with a next-generation DNA sequencer to detect potential pathogens in the lymph node. Histologically, focal necrosis with inflammatory cell infiltration, including neutrophils and macrophages, was observed in the marginal zone of the cervical lymph node, which was compatible with the acute phase of KD. Multivirus real-time PCR detected a low copy number of torque teno virus in the sample. Comprehensive direct sequencing of the cervical lymph node biopsy sample sequenced more than 8 million and 3 million reads from DNA and RNA samples, respectively. Bacterial genomes were detected in 0.03% and 1.79% of all reads in DNA and RNA samples, respectively. Although many reads corresponded to genomes of bacterial environmental microorganisms, Streptococcus spp. genome was detected in both DNA (77 reads) and RNA (2,925 reads) samples. Further studies are required to reveal any association of microbial or viral infection with the pathogenesis of KD. PMID:23071864

  15. Predictive factors for lymph node metastasis in early gastric cancer

    PubMed Central

    Sung, Chang-Mu; Hsu, Chen-Ming; Hsu, Jun-Te; Yeh, Ta-Sen; Lin, Chun-Jung; Chen, Tse-Ching; Su, Ming-Yao; Chiu, Cheng-Tang

    2010-01-01

    AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gastrectomy and lymph node dissection, 556 were diagnosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumors with LNM. Univariate analysis found that female gender, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC. PMID:21049560

  16. Axillary lymph node analysis using Raman spectroscopy

    NASA Astrophysics Data System (ADS)

    Smith, Jenny; Christie-Brown, Jonathan; Sammon, Alastair; Stone, Nicholas

    2004-07-01

    Raman Spectroscopy is an optical diagnostic technique applied in this study to classify axillary lymph nodes from breast cancer patients as positive or negative for metastases. The mapping technique in this study is 81% sensitive and 97% specific for the correct classification of positive lymph nodes. Raman spectral images of lymph node sections are constructed to facilitate interpretation of tissue features.

  17. [Acute suppurative mediastinitis in heart surgery performed under extracorporeal circulation].

    PubMed

    Amrein, C; Guibourt, P; Garcia, A; Benizri, A; Trinquier, R; Vaudron, E; Gomez, F; Deloche, A; Carpentier, A; Passelecq, J

    1984-10-01

    The incidence of acute suppurative mediastinitis after open heart cardiac surgery in a 5 year retrospective study was found to be 1.56%. The commonest causal agent was the DNAse + coagulase + staphylococcus (68.8%). All cases were treated with bactericidal antibiotics and local measures (dosed chest irrigation-drainage in 1 or 2 stages). Adult men, early and/or late reoperation, immediate postoperative complications (cardiovascular collapse, haemorrhage) were positive risk factors. On the other hand, the type of underlying cardiac disease, the duration of surgery and bypass time, emergency surgery, and protocols of prophylactic antibiotic therapy did not seem to influence this risk. No sources of exogenous contamination, no notions of epidemics or periodicity were discovered in this study. The clinical course may be complicated, especially by renal failure. Thirty-two of the 109 patients studied died. However, the prognosis has improved in the last 5 years in relation to technical advances in intensive care and, above all, to adoption of 1 stage dosed chest irrigation-drainage: the mortality rate has fallen from 37.2% in the first period to 20% more recently. When a cure is obtained, it is complete and there are no sequellae. Nevertheless, irrespective of the adoption of draconian measures of asepsis and protocols of prophylactic antibiotic therapy, the risk of acute postoperative mediastinitis persists. This suggests that the efficacy of the patient's local (and general) anti-infective immunity defenses may vary in the presence of constant mediastinal bacterial contamination despite aleatory preventive measures, due to the remenance of the skin flora.

  18. Mediastinal large-cell lymphoma with sclerosis (MLCLS).

    PubMed Central

    Rohatiner, A. Z.; Whelan, J. S.; Ganjoo, R. K.; Norton, A. J.; Wilson, A.; Lister, T. A.

    1994-01-01

    In a retrospective analysis encompassing a 14 year period (1978-92), 22 patients (age range 19-71, median 30 years) were identified as having mediastinal large-cell lymphoma with sclerosis on the basis of clinical and pathological features. At presentation, 15/22 had 'bulky' disease and 11/22 had evidence of superior vena caval obstruction. Thirteen patients had stage II disease (6,II; 7,IIE), nine presented with stage IV disease. Complete remission (CR) was achieved in only 4/22 patients with the initial adriamycin-containing regimen. 'Good partial remission' (no clinical evidence of disease, minimal abnormalities of uncertain significance on radiological investigation) was achieved in a further seven patients and 'poor partial remission' (a reduction in measurable disease > 50%) in four, giving an overall response rate of 15/22 (68%). One patient died within 48 h of arrival at the hospital; 16 of the 17 remaining patients in whom anything less than CR was achieved subsequently received additional, alternative treatment (one chemotherapy, six mediastinal radiotherapy, nine both treatment modalities) but in only 2/16 did this result in any further degree of response. With a median follow-up of 5 1/2 years, 10/22 patients remain well without progression between 6 months and 14 years (5/6 in whom CR was eventually achieved and 5/11 in whom only partial remission was ever documented). The seven patients in whom the initial treatment demonstrably failed have all died. These results suggest that a proportion of patients with this rare subtype of high-grade B-cell lymphoma may be cured by chemotherapy alone and that the presence of a residual mediastinal mass after treatment does not necessarily imply treatment failure. However, patients in whom the initial chemotherapy fails have a very grave prognosis. PMID:8123496

  19. Surgical debridement, vacuum therapy and pectoralis plasty in poststernotomy mediastinitis.

    PubMed

    Ennker, I C; Pietrowski, D; Vöhringer, L; Kojcici, B; Albert, A; Vogt, P M; Ennker, J

    2009-11-01

    In cardiac surgery poststernotomy mediastinitis continues to be a serious cause of morbidity and mortality. We report our experience with vacuum-assisted closure (VAC) therapy followed by reconstruction with M. pectoralis muscle flaps as treatment for deep sternal wound infections. Our group performed a retrospective analysis of 3630 consecutive cardiac surgical patients using median sternotomy from 11/2004 to 11/2007. After removing sternal wires, necrotic debris and potentially infective material, restabilisation of the sternum was performed and VAC therapy was employed. Wound closure and subsequent reconstruction were performed using a bilateral pectoralis muscle plasty. Of the analysed patients 16 female and 29 male patients suffered from deep sternal wound infections and were treated with VAC. The most common risk factors were diabetes mellitus odds ratio (OR 3.5), chronic obstructive pulmonary disease (COPD) (OR 2.9), use of bilateral mammarian artery (OR 2.0) and obesity (1.8). The median age of patients with deep sternal infections was similar to control patients. Staphylococcus epidermis was the most common pathogen (37.8%) followed by Enterococcus faecilis (22.2%) and Staphylococcus aureus (17.8). In 22.2% no pathogen could be detected. The 30 day mortality was 0%, the in-hospital mortality was 15.6%. The results of our studies demonstrate that vacuum therapy in conjunction with early and aggressive debridement is an effective strategy for treating poststernotomy mediastinitis. We consider pectoralis major muscle flap reconstruction as a safe technique and regard it as the primary choice for wound closure in poststernotomy mediastinitis. PMID:18996074

  20. [Early diagnosis of a newborn with a mediastinal mass].

    PubMed

    Flores-Hernández, Salomón Sergio; Ahumada Mendoza, Héctor; Santana-Montero, Blanca Lilia; González Flores, María de Lourdes

    2005-01-01

    Neuroblastoma is an embryonal tumour that evolves from the neural crest cell. This neoplasm may arise at any site in the sympathetic nervous system, including the brain, the cervical region, the posterior mediastinum, the para-aortic sympathetic ganglia, the pelvis, and the adrenal medulla. The clinical presentation in neonatal age is rare and the differential diagnosis includes congenital lung malformations, pneumoniae, atelectasia, etc. The case of a newborn with a mediastinal neuroblastoma is presented. This case illustrates how a patient with an X-ray image compatible with a thoracic tumor should be studied. PMID:16381510

  1. A Three-Dimensional Mediastinal Model Created with Rapid Prototyping in a Patient with Ectopic Thymoma

    PubMed Central

    Nakada, Takeo; Inagaki, Takuya

    2014-01-01

    Preoperative three-dimensional (3D) imaging of a mediastinal tumor using two-dimensional (2D) axial computed tomography is sometimes difficult, and an unexpected appearance of the tumor may be encountered during surgery. In order to evaluate the preoperative feasibility of a 3D mediastinal model that used the rapid prototyping technique, we created a model and report its results. The 2D image showed some of the relationship between the tumor and the pericardium, but the 3D mediastinal model that was created using the rapid prototyping technique showed the 3D lesion in the outer side of the extrapericardium. The patient underwent a thoracoscopic resection of the tumor, and the pathological examination showed a rare middle mediastinal ectopic thymoma. We believe that the construction of mediastinal models is useful for thoracoscopic surgery and other complicated surgeries of the chest diseases. PMID:24633133

  2. Benign salivary gland tissue inclusion in a pulmonary hilar lymph node from a patient with invasive well-differentiated adenocarcinoma of the lung: a potential misinterpretation for the staging of carcinoma.

    PubMed

    Lewis, Annisa L; Truong, Luan D; Cagle, Philip; Zhai, Qihui Jim

    2011-06-01

    Benign epithelial and nonepithelial inclusions have been found in lymph nodes in multiple body sites. These inclusions have been seen in cervical, axillary, mediastinal, abdominal, and pelvic lymph nodes. They appear as benign epithelial, parathyroid, decidual, mesothelial, angiolipomatous, nevus cells, or Tamm-Horsfall protein. Although heterotopic salivary gland tissue is not infrequent in paraparotid lymph nodes, it has only been described in lymph nodes of the pulmonary hilum once. A 68-year-old woman with gastric lymphoma now in remission presented for routine follow-up and was found to have a lung mass. After a fine needle aspiration biopsy diagnosis of adenocarcinoma, lobectomy and lymph node dissection were performed. Histological sections of lung demonstrated a well-differentiated adenocarcinoma and one lymph node, which displayed a subcapsular nest of well-formed salivary glands occupying approximately one third of the nodal tissue. The inclusion was composed of acinar cells of both serous and mucinous types, but ductal type of cells were not seen. Identification of heterotopic tissue in lymph nodes is of great importance for patient management. Misdiagnosing benign glandular inclusions for metastasis could potentially lead to incorrect tumor staging. Benign salivary gland tissue inclusions should be considered in the differential diagnosis when evaluating for metastatic adenocarcinoma. The salivary gland inclusion in pulmonary hilar lymph node may be histogenetically related to the minor salivary glands, which are located within the bronchial submucosa.

  3. 2D view aggregation for lymph node detection using a shallow hierarchy of linear classifiers.

    PubMed

    Seff, Ari; Lu, Le; Cherry, Kevin M; Roth, Holger R; Liu, Jiamin; Wang, Shijun; Hoffman, Joanne; Turkbey, Evrim B; Summers, Ronald M

    2014-01-01

    Enlarged lymph nodes (LNs) can provide important information for cancer diagnosis, staging, and measuring treatment reactions, making automated detection a highly sought goal. In this paper, we propose a new algorithm representation of decomposing the LN detection problem into a set of 2D object detection subtasks on sampled CT slices, largely alleviating the curse of dimensionality issue. Our 2D detection can be effectively formulated as linear classification on a single image feature type of Histogram of Oriented Gradients (HOG), covering a moderate field-of-view of 45 by 45 voxels. We exploit both max-pooling and sparse linear fusion schemes to aggregate these 2D detection scores for the final 3D LN detection. In this manner, detection is more tractable and does not need to perform perfectly at instance level (as weak hypotheses) since our aggregation process will robustly harness collective information for LN detection. Two datasets (90 patients with 389 mediastinal LNs and 86 patients with 595 abdominal LNs) are used for validation. Cross-validation demonstrates 78.0% sensitivity at 6 false positives/volume (FP/vol.) (86.1% at 10 FP/vol.) and 73.1% sensitivity at 6 FP/vol. (87.2% at 10 FP/vol.), for the mediastinal and abdominal datasets respectively. Our results compare favorably to previous state-of-the-art methods. PMID:25333161

  4. Number and Location of Positive Nodes, Postoperative Radiotherapy, and Survival After Esophagectomy With Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma

    SciTech Connect

    Chen Junqiang; Pan Jianji; Zheng Xiongwei; Zhu Kunshou; Li Jiancheng; Chen Mingqiang; Wang Jiezhong; Liao Zhongxing

    2012-01-01

    Purpose: To analyze influences of the number and location of positive lymph nodes and postoperative radiotherapy on survival for patients with thoracic esophageal squamous cell carcinoma (TE-SCC) treated with radical esophagectomy with three-field lymphadenectomy. Methods and Materials: A total of 945 patients underwent radical esophagectomy plus three-field lymph node dissection for node-positive TE-SCC at Fujian Provincial Tumor Hospital between January 1993 and March 2007. Five hundred ninety patients received surgery only (S group), and 355 patients received surgery, followed 3 to 4 weeks later by postoperative radiotherapy (S+R group) to a median total dose of 50 Gy in 25 fractions. We assessed potential associations among patient-, tumor-, and treatment-related factors and overall survival. Results: Five-year overall survival rates were 32.8% for the entire group, 29.6% for the S group, and 38.0% for the S+R group (p = 0.001 for S vs. S+R). Treatment with postoperative radiotherapy was particularly beneficial for patients with {>=}3 positive nodes and for those with metastasis in the upper (supraclavicular and upper mediastinal) region or both the upper and lower (mediastinal and abdominal) regions (p < 0.05). Postoperative radiotherapy was also associated with lower recurrence rates in the supraclavicular and upper and middle mediastinal regions (p < 0.05). Sex, primary tumor length, number of positive nodes, pathological T category, and postoperative radiotherapy were all independent predictors of survival. Conclusions: Postoperative radiotherapy was associated with better survival for patients with node-positive TE-SCC, particularly those with three or more positive nodes and positive nodes in the supraclavicular and superior mediastinal regions.

  5. Decellularized Lymph Nodes as Scaffolds for Tissue Engineered Lymph Nodes

    PubMed Central

    Cuzzone, Daniel A.; Albano, Nicholas J.; Aschen, Seth Z.; Ghanta, Swapna

    2015-01-01

    Abstract Background: The lymphatic system is commonly injured during cancer treatment. However, despite the morbidity of these injuries, there are currently no options for replacing damaged lymphatics. The purpose of this study was to optimize methods for decellularization of murine lymph nodes (LN) and to determine if these scaffolds can be used to tissue engineer lymph node-like structures. Methods and Results: LNs were harvested from adult mice and subjected to various decellularization protocols. The degree of decellularization and removal of nuclear material was analyzed histologically and quantitatively using DNA isolation. In addition, we analyzed histological architecture by staining for matrix proteins. After the optimal method of decellularization was identified, decellularized constructs were implanted in the renal capsule of syngeneic or allogeneic recipient mice and analyzed for antigenicity. Finally, to determine if decellularized constructs could deliver lymphocytes to recipient animals, the matrices were repopulated with splenocytes, implanted in submuscular pockets, and harvested 14 days later. Decellularization was best accomplished with the detergent sodium dodecyl sulfate (SDS), resulting in negligible residual cellular material but maintenance of LN architecture. Implantation of decellularized LNs into syngeneic or allogeneic mice did not elicit a significant antigenic response. In addition, repopulation of decellularized LNs with splenocytes resulted in successful in vivo cellular delivery. Conclusions: We show, for the first time, that LNs can be successfully decellularized and that these matrices have preserved extracellular matrix architecture and the potential to deliver leukocytes in vivo. Future studies are needed to determine if tissue engineered lymph nodes maintain immunologic function. PMID:25144673

  6. Convective diffusion of nanoparticles from the epithelial barrier toward regional lymph nodes.

    PubMed

    Dukhin, Stanislav S; Labib, Mohamed E

    2013-11-01

    Drug delivery using nanoparticles as drug carriers has recently attracted the attention of many investigators. Targeted delivery of nanoparticles to the lymph nodes is especially important to prevent cancer metastasis or infection, and to diagnose disease stage. However, systemic injection of nanoparticles often results in organ toxicity because they reach and accumulate in all the lymph nodes in the body. An attractive strategy would be to deliver the drug-loaded nanoparticles to a subset of draining lymph nodes corresponding to a specific site or organ to minimize systemic toxicity. In this respect, mucosal delivery of nanoparticles to regional draining lymph nodes of a selected site creates a new opportunity to accomplish this task with minimal toxicity. One example is the delivery of nanoparticles from the vaginal lumen to draining lymph nodes to prevent the transmission of HIV in women. Other known examples include mucosal delivery of vaccines to induce immunity. In all cases, molecular and particle transport by means of diffusion and convective diffusion play a major role. The corresponding transport processes have common inherent regularities and are addressed in this review. Here we use nanoparticle delivery from the vaginal lumen to the lymph nodes as an example to address the many aspects of associated transport processes. In this case, nanoparticles penetrate the epithelial barrier and move through the interstitium (tissue) to the initial lymphatics until they finally reach the lymph nodes. Since the movement of interstitial liquid near the epithelial barrier is retarded, nanoparticle transport was found to take place through special foci present in the epithelium. Immediately after nanoparticles emerge from the foci, they move through the interstitium due to diffusion affected by convection (convective diffusion). Specifically, the convective transport of nanoparticles occurs due to their convection together with interstitial fluid through the

  7. Lymph node staging in prostate cancer.

    PubMed

    Sankineni, Sandeep; Brown, Anna M; Fascelli, Michele; Law, Yan Mee; Pinto, Peter A; Choyke, Peter L; Turkbey, Baris

    2015-05-01

    Nodal staging is important in prostate cancer treatment. While surgical lymph node dissection is the classic method of determining whether lymph nodes harbor malignancy, this is a very invasive technique. Current noninvasive approaches to identifying malignant lymph nodes are limited. Conventional imaging methods rely on size and morphology of lymph nodes and have notoriously low sensitivity for detecting malignant nodes. New imaging techniques such as targeted positron emission tomography (PET) imaging and magnetic resonance lymphography (MRL) with iron oxide particles are promising for nodal staging of prostate cancer. In this review, the strengths and limitations of imaging techniques for lymph node staging of prostate cancer are discussed.

  8. Primary mediastinal large B-cell lymphoma and its mimickers: a rare case report with literature review.

    PubMed

    Win, T T; Kamaludin, Z; Husin, A

    2016-08-01

    Primary mediastinal large B-cell lymphoma (PMLBL) is an uncommon non-Hodgkin lymphoma with a distinct clinicopathological entity in the WHO classification of lymphoid malignancies. It is known to originate from B-cells of the thymus. It mimics thymic neoplasms and other lymphomas clinically and histopathologically. We reported a 33-year-old obese man who presented with shortness of breath off and on for 4 years. Radiologically, there was a huge anterior mediastinal mass. Tru-cut biopsy was initially diagnosed as type-A thymoma. Histopathological examination of the excised specimen revealed PMLBL with stromal fibrosis and sclerosis which created a diagnostic difficulty. The neoplastic cells varied from medium-sized to large pleomorphic cells, including mononuclear cells with centroblastic and immunoblastic features as well as bi-lobed Reed Sternberg (RS)-like cells and horse-shoe like hallmark cells. Some interlacing spindle cells and epithelioid cells were also present. Immunohistochemically, tumour cells expressed diffuse positivity for LCA, CD20, CD79a, CD23, Bcl2, MUM-1 and heterogenous positivity for CD30 and EMA, and were negative for CD10, CD15 and ALK. Ki67 scoring was very high. Tumour cells infiltrated into peri-thymic fat and pericardium. No malignant cells were detected in the pleural fluid and there was no bone marrow infiltration. The patient showed partial response to 6 cycles of RICE chemotherapy, and was planned for second line chemotherapy using hyper-CVAD regimen followed by autologous stem cell transplantation. This case illustrates the importance of thorough sampling and immunohistochemistry in differentiating PMLBL from its differential diagnoses. PMID:27568673

  9. Unusual finding of a mediastinal T-cell lymphoma in a 13-year-old patient - a case report.

    PubMed

    Bălănescu, Radu Ninel; Bălănescu, Laura; Cordoş, Ioan; Sfrijan, Doiniţa; Pop, Florinel; CaragaŢă, Florentina-Ruxandra; Mălăescu, Gheorghe Dan

    2015-01-01

    T-cell lymphoblastic lymphoma is an aggressive malignancy that represents 85% of all lymphoblastic lymphomas. It usually occurs in late childhood, adolescence and young adulthood with a 2:1 male preponderance and it presents with pleural effusion and respiratory symptoms and in rare cases vena cava syndrome can be encountered. We present the case of a 13-year-old patient who was referred to our clinic from a local hospital where he was diagnosed with a mediastinal tumor. The patient presented with thoracic pain, fever, coughing and fatigability for a month prior to admission, after having underwent surgery for abdominal pain (appendectomy). On admission to our hospital, a thoracic computed tomography (CT) scan was performed and showed the presence of an anterior mediastinal mass measuring 109/76/140 mm, well defined, which came in close contact with the superior vena cava, the ascending aorta and the pulmonary artery, right pleural effusion and a collapsed lung on the right side. The decision was taken to perform a tumor biopsy and a right pleural drain was placed. The patient's post-operative evolution was favorable with the remission of the respiratory symptoms. The histopathological result showed the presence of T-cell lymphoblastic lymphoma and the patient was then transferred to the oncology ward where he underwent chemotherapeutic treatment, with a favorable outcome. T-cell lymphoblastic lymphoma is an aggressive type of lymphoma and it is usually hard to diagnose considering the fact that the symptoms are often vague. It is essential to establish the diagnosis without delay and start appropriate chemotherapeutic treatment. PMID:26743307

  10. Racial patterns of patients with primary mediastinal large B-cell lymphoma: SEER analysis.

    PubMed

    Liu, Pan-Pan; Wang, Ke-Feng; Xia, Yi; Bi, Xi-Wen; Sun, Peng; Wang, Yu; Li, Zhi-Ming; Jiang, Wen-Qi

    2016-07-01

    The aim of this study is to investigate the incidence and clinical outcomes of primary mediastinal large B-cell lymphoma (PMBL).Here we did a retrospective analysis using the surveillance, epidemiology, and end results (SEER) database to analyze the incidences and survival of patients with PMBL diagnosed during 2001-2012 among major ethnic groups.During 2001-2012, a total of 426 PMBL patients were identified, including 336 whites, 46 blacks, and 44 others. The incidence rates of female to male ratios in white, black, and other were 1.4938, 1.1202, and 1.7303 respectively, suggesting that the female-prominent disease occurrence was seen only in whites and others, but not in black population. Compared to white, the other had a worse 5-year overall survival (OS); however, factors including age, race, socioeconomic status, and stage associated with OS showed no significant difference among ethnic groups; thus, biology factors should be explored to explain the racial difference in OS.In conclusion, our findings revealed diversities in demographic features and prognosis among different racial groups. PMID:27399089

  11. Probability of mediastinal involvement in non-small-cell lung cancer: a statistical definition of the clinical target volume for 3-dimensional conformal radiotherapy?

    SciTech Connect

    Giraud, Philippe . E-mail: philippe.giraud@curie.net; De Rycke, Yann; Lavole, Armelle; Milleron, Bernard; Cosset, Jean-Marc; Rosenzweig, Kenneth E.

    2006-01-01

    Purpose: Conformal irradiation (3D-CRT) of non-small-cell lung carcinoma (NSCLC) is largely based on precise definition of the nodal clinical target volume (CTVn). A reduction of the number of nodal stations to be irradiated would facilitate tumor dose escalation. The aim of this study was to design a mathematical tool based on documented data to predict the risk of metastatic involvement for each nodal station. Methods and Materials: We reviewed the large surgical series published in the literature to identify the main pretreatment parameters that modify the risk of nodal invasion. The probability of involvement for the 17 nodal stations described by the American Thoracic Society (ATS) was computed from all these publications. Starting with the primary site of the tumor as the main characteristic, we built a probabilistic tree for each nodal station representing the risk distribution as a function of each tumor feature. Statistical analysis used the inversion of probability trees method described by Weinstein and Feinberg. Validation of the software based on 134 patients from two different populations was performed by receiver operator characteristic (ROC) curves and multivariate logistic regression. Results: Analysis of all of the various parameters of pretreatment staging relative to each level of the ATS map results in 20,000 different combinations. The first parameters included in the tree, depending on tumor site, were histologic classification, metastatic stage, nodal stage weighted as a function of the sensitivity and specificity of the diagnostic examination used (positron emission tomography scan, computed tomography scan), and tumor stage. Software is proposed to compute a predicted probability of involvement of each nodal station for any given clinical presentation. Double cross validation confirmed the methodology. A 10% cutoff point was calculated from ROC and logistic model giving the best prediction of mediastinal lymph node involvement. Conclusion

  12. Cat scratch disease and lymph node tuberculosis in a colon patient with cancer.

    PubMed

    Matias, M; Marques, T; Ferreira, M A; Ribeiro, L

    2013-12-12

    A 71-year-old man operated for a sigmoid tumour remained in the surveillance after adjuvant chemotherapy. After 3 years, a left axillary lymph node was visible on CT scan. The biopsy revealed a necrotising and abscessed granulomatous lymphadenitis, suggestive of cat scratch disease. The patient confirmed having been scratched by a cat and the serology for Bartonella henselae was IgM+/IgG-. Direct and culture examinations for tuberculosis were negative. The patient was treated for cat scratch disease. One year later, the CT scan showed increased left axillary lymph nodes and a left pleural effusion. Direct and cultural examinations to exclude tuberculosis were again negative. Interferon-γ release assay testing for tuberculosis was undetermined and then positive. Lymph node and pleural tuberculosis were diagnosed and treated with a good radiological response. This article has provides evidence of the importance of continued search for the right diagnosis and that two diagnoses can happen in the same patient.

  13. Simultaneous occurrence of Hodgkin's disease and tubercular lymphadenitis in the same cervical lymph node: a rare presentation.

    PubMed

    Mahajan, Kunal; Gupta, Gunjan; Singh, Davinder Pal; Mahajan, Aditi

    2016-01-01

    Concomitant presentation of tuberculosis (TB) and lymphoma is a rare entity. A primary malignancy such as Hodgkin's disease (HD) may cause suppression of the cell-mediated immunity, which predisposes to a concomitant TB infection. We report a case of an 18-year-old man, who presented with fever and was found to have pallor, generalised lymphadenopathy, hepatosplenomegaly, ascites and pedal oedema. Ultrasound of the abdomen revealed enlarged lymph nodes in the para-aortic and peripancreatic region. On chest contrast-enhanced CT, calcified mediastinal lymph nodes were seen. A surgical biopsy of a cervical lymph node was performed, which revealed caseous necrosis surrounded by epithelioid cells along with diffuse nodal architectural effacement by large atypical lymphoid cells. Numerous Reed Sternberg cells were also seen. Immunohistochemistry confirmed diagnosis of Hodgkin's lymphoma. The same lymph node came out to be positive for mycobacterium TB on polymerised chain reaction. The patient was given antitubercular therapy concomitantly with chemotherapy for HD, and improved with treatment. PMID:26740271

  14. State of the art in surgery for early stage NSCLC-does the number of resected lymph nodes matter?

    PubMed

    Vielva, Laura Romero; Jaen, Manuel Wong; Alcácer, José A Maestre; Cardona, Mecedes Canela

    2014-04-01

    Surgery is the treatment of choice in patients with early stage NSCLC. However, the results remain poor in these patients. Lymph node involvement is the main prognostic factor in patients with NSCLC, but there is still no clear definition of the number of nodes required to consider a lymphadenectomy as complete. Although there is no defined minimum number of lymph nodes required for a complete lymphadenectomy, there are some recommendations to perform this procedure, published by different scientific societies. Current practice in thoracic surgery regarding lymphadenectomy, differs on some points from the guidelines recommendations, with data regarding patients with no mediastinal assessment between 30-45% according to some of the published data. Different studies have probed the fact that the probability of finding a positive node increases with the number of lymph nodes analyzed. Therefore, a complete lymphadenectomy provides proper staging, which helps to identify the patient's real prognosis. Several nonrandomized studies and retrospective series have shown that survival increases in the group of patients with a higher number of lymph nodes removed. There is no contraindication to performing a complete lymphadenectomy. The increase in survival in patients with a complete lymphadenectomy may be due to more accurate staging. Therefore, complete lymphadenectomy should be mandatory even in early stage patients.

  15. Acute neck cellulitis and mediastinitis complicating a continuous interscalene block.

    PubMed

    Capdevila, Xavier; Jaber, Samir; Pesonen, Pertti; Borgeat, Alain; Eledjam, Jean-Jacques

    2008-10-01

    We report a case of acute neck cellulitis and mediastinitis complicating a continuous interscalene brachial plexus block. A 61-yr-old man was scheduled for an elective arthroscopic right shoulder rotator cuff repair. A continuous interscalene block was done preoperatively and 20 mL of 0.5% bupivacaine and 20 mL of 2% mepivacaine were injected through the catheter. Postoperative analgesia was provided by a continuous infusion of bupivacaine, 0.25% at 5 mL/h for 39 h using a 240-mL elastomeric disposable pump. The day after surgery, the patient complained of neck pain. The analgesic block was not fully effective. He was discharged home. Three days later, the patient was readmitted with neck edema and erythema, fever and fatigue. Neck ultrasonography and computed tomographic scan revealed an abscess of the interscalene and sternocleidomastiod muscles and cellulitis, as well as acute mediastinitis. Two blood cultures and surgical samples were positive for Staphylococcus aureus. The infection was treated with surgery, the site was surgically debrided, and a 2-mo course of vancomycin, imipenem, and oxacilline. The technique of drawing local anesthetic from the bottle and filling the elastomeric pump was the most likely cause of infection. This case emphasizes the importance of strict aseptic conditions during puncture, catheter insertion, and management of the local anesthetic infusate. PMID:18806062

  16. The anaesthetic management of children with anterior mediastinal masses.

    PubMed

    Hack, H A; Wright, N B; Wynn, R F

    2008-08-01

    Children with anterior mediastinal masses may experience serious complications during general anaesthesia. We retrospectively surveyed the records of children with an anterior mediastinal mass who had been admitted to our hospital over a 7 year period. The presence of pre-operative symptoms or signs, findings of any special investigations performed and the anaesthetic outcome were noted. All radiological investigations were studied and tracheal compression measured. The majority of patients presented with severe clinical signs. There was a poor relationship between clinical signs and size of tumour or tracheal compression on CT scan. Corticosteroids were used prior to diagnosis in 33% of patients, all of whom were considered high risk. A clear diagnosis was made in 95% of these patients. The overall complication rate was 20% and 5% of patients had a serious complication related to anaesthesia. Stridor was the only sign that predicted an anaesthetic complication. Peri-operative respiratory complications were confined to patients with an isolated tracheal cross-sectional area less than 30% normal or less than 70% and associated with bronchial compression.

  17. Belatacept and mediastinal histoplasmosis in a kidney transplant patient

    PubMed Central

    Trimarchi, Hernán; Rengel, Tatiana; Andrews, José; Paulero, Matías; Iotti, Alejandro; Forastiero, Agustina; Lombi, Fernando; Pomeranz, Vanesa; Forrester, Mariano; Iriarte, Romina; Agorio, Iris

    2016-01-01

    Background: In transplantation immunosuppression enhances the appearance of opportunist infections. An ideal balance between the prevention of rejection, the lowest risk of infections and the highest rates of graft survival is a continuous challenge. Lower doses of immunosuppression may diminish the risk of infections, metabolic and hemodynamic complications or even of malignancy, but may expose patients to episodes of acute rejection. New drugs are being developed to improve graft survival at the lowest risk of side effects. Belatacept has recently been introduced in kidney transplantation to inhibit the co-ligand signal of T cell stimulation. It is a drug with a safe profile, is well-tolerated and appears to improve long-term survival of kidney grafts. However, there may be an increase in opportunistic infections which may be facilitated by T cell depression, as Aspergillus sp., Cryptococcus neoformans or tuberculosis. Case Presentation: We describe a 59-year-old female who developed fever, clinical wasting and a mediastinal mass 31 months after receiving a living non-related kidney transplant while on belatacept therapy. A mediastinal node biopsy disclosed the presence of Histoplasma capsulatum. Infection successfully resolved after appropriate antifungal treatment. Conclusions: To our knowledge, this is the first reported case of Histoplasma capsulatum in a kidney transplanted patient on belatacept therapy PMID:27152295

  18. Use of high frequency ultrasound to monitor cervical lymph node alterations in mice.

    PubMed

    Walk, Elyse L; McLaughlin, Sarah; Coad, James; Weed, Scott A

    2014-01-01

    Cervical lymph node evaluation by clinical ultrasound is a non-invasive procedure used in diagnosing nodal status, and when combined with fine-needle aspiration cytology (FNAC), provides an effective method to assess nodal pathologies. Development of high-frequency ultrasound (HF US) allows real-time monitoring of lymph node alterations in animal models. While HF US is frequently used in animal models of tumor biology, use of HF US for studying cervical lymph nodes alterations associated with murine models of head and neck cancer, or any other model of lymphadenopathy, is lacking. Here we utilize HF US to monitor cervical lymph nodes changes in mice following exposure to the oral cancer-inducing carcinogen 4-nitroquinoline-1-oxide (4-NQO) and in mice with systemic autoimmunity. 4-NQO induces tumors within the mouse oral cavity as early as 19 wks that recapitulate HNSCC. Monitoring of cervical (mandibular) lymph nodes by gray scale and power Doppler sonography revealed changes in lymph node size eight weeks after 4-NQO treatment, prior to tumor formation. 4-NQO causes changes in cervical node blood flow resulting from oral tumor progression. Histological evaluation indicated that the early 4-NQO induced changes in lymph node volume were due to specific hyperproliferation of T-cell enriched zones in the paracortex. We also show that HF US can be used to perform image-guided fine needle aspirate (FNA) biopsies on mice with enlarged mandibular lymph nodes due to genetic mutation of Fas ligand (Fasl). Collectively these studies indicate that HF US is an effective technique for the non-invasive study of cervical lymph node alterations in live mouse models of oral cancer and other mouse models containing cervical lymphadenopathy. PMID:24955984

  19. Diagnosing Tic Disorders

    MedlinePlus

    ... Other Websites Information For... Media Policy Makers Diagnosing Tic Disorders Language: English Español (Spanish) Recommend on Facebook ... or postviral encephalitis). Persistent (Chronic) Motor or Vocal Tic Disorder For a person to be diagnosed with ...

  20. How Is Sarcoidosis Diagnosed?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Sarcoidosis Diagnosed? Your doctor will diagnose sarcoidosis based on ... Content: NEXT >> Featured Video Living With and Managing Sarcoidosis 05/18/2011 This video—presented by the ...

  1. Mediastinal solitary fibrous tumor with right diaphragm invasion: report of a case.

    PubMed

    Xue, Xingyang; Chen, Jun; Ma, Wei; Zhu, Daxing; Zhang, Weiguo; Chen, Gang; Wei, Sen; Zhou, Qinghua

    2009-01-01

    Mediastinal solitary fibrous tumors (SFTs) are rarely found in adults and there are few reports describing primary mediastinal SFT invading the diaphragm. We report the case of a 47-year-old woman with a large right inferior mediastinal SFT. Magnetic resonance imaging showed the tumor invading the right lower lobe of the lung and the right hemidiaphragm, with displacement of the inferior vena cava (IVC) and right lobe of the liver. Angiogram showed IVC stenosis. To our knowledge, this is the first report of complete resection of the tumor combined with right lower lobectomy of the lung and partial resection and reconstruction of the right diaphragm with a Dacron flap.

  2. Anesthetic management of a large mediastinal mass for tracheal stent placement.

    PubMed

    Rajagopalan, Suman; Harbott, Mark; Ortiz, Jaime; Bandi, Venkata

    2016-01-01

    The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.

  3. Preoperative Embolization of a Posterior Mediastinal Lipid-Poor Angiolipoma Mimicking a Paravertebral Nerve Sheath Tumor.

    PubMed

    Gorospe, Luis; García-Poza, Javier; González-Gordaliza, María Cristina; Cabañero-Sánchez, Alberto; Muñoz-Molina, Gemma María; Saldaña-Garrido, David

    2015-08-01

    Mediastinal angiolipomas are extremely rare tumors within the thorax, and only 6 cases have been previously reported in the literature. We describe the case of a lipid-poor angiolipoma within the posterior mediastinum of a 63-year-old man who complained of chest pain. Interestingly, initial imaging of the posterior mediastinal mass of our patient suggested a nerve sheath tumor. A specimen from a percutaneous transthoracic core needle biopsy confirmed an angiolipoma. We decided to preoperatively embolize the posterior mediastinal mass to reduce intraoperative bleeding and to facilitate the excision of the tumor.

  4. Clinical utilities and biological characteristics of melanoma sentinel lymph nodes

    PubMed Central

    Han, Dale; Thomas, Daniel C; Zager, Jonathan S; Pockaj, Barbara; White, Richard L; Leong, Stanley PL

    2016-01-01

    An estimated 73870 people will be diagnosed with melanoma in the United States in 2015, resulting in 9940 deaths. The majority of patients with cutaneous melanomas are cured with wide local excision. However, current evidence supports the use of sentinel lymph node biopsy (SLNB) given the 15%-20% of patients who harbor regional node metastasis. More importantly, the presence or absence of nodal micrometastases has been found to be the most important prognostic factor in early-stage melanoma, particularly in intermediate thickness melanoma. This review examines the development of SLNB for melanoma as a means to determine a patient’s nodal status, the efficacy of SLNB in patients with melanoma, and the biology of melanoma metastatic to sentinel lymph nodes. Prospective randomized trials have guided the development of practice guidelines for use of SLNB for melanoma and have shown the prognostic value of SLNB. Given the rapidly advancing molecular and surgical technologies, the technical aspects of diagnosis, identification, and management of regional lymph nodes in melanoma continues to evolve and to improve. Additionally, there is ongoing research examining both the role of SLNB for specific clinical scenarios and the ways to identify patients who may benefit from completion lymphadenectomy for a positive SLN. Until further data provides sufficient evidence to alter national consensus-based guidelines, SLNB with completion lymphadenectomy remains the standard of care for clinically node-negative patients found to have a positive SLN. PMID:27081640

  5. Indication for Endoscopic Resection of Submucosal Colorectal Carcinoma: Special Reference to Lymph Node Metastasis

    PubMed Central

    Tsuruta, Osamu; Tsuji, Yuichiroh; Kawano, Hiroshi; Miyazaki, Shiroh; Watanabe, Masahide; Nakahara, Keita; Tateishi, Hideo; Fujita, Mitsutake; Ban, Shigeki; Sata, Michio; Toyonaga, Atsushi; Morimatsu, Minoru

    2000-01-01

    We investigated the relationship between histological factors and lymph node metastasis in 77 lesions with submucosally invasive colorectal carcinomas to establish useful criteria for lesions in which endoscopic treatment alone results in cure of malignancy. There were positive correlations between histological factors, including the level of invasion, the histologic grade, presence or absence of lymphatic invasion, presence or absence of budding, and lymph node metastasis (p < 0.05, p < 0.05, p < 0.005, p < 0.01). The presence or absence of venous invasion did not influence lymph node metastasis. Laparoscopic surgery involving lymph node dissection should be indicated for sm1 carcinoma lesions with unfavorable histological factors. In lesions diagnosed as sm2 or sm3 prior to resection, intestinal resection involving lymph node dissection by laparoscopic surgery should be directly performed without endoscopic resection. In treating submucosally invasive colorectal carcinomas, the level of invasion can be clinically diagnosed, consequently endoscopic resection should be initially performed when lesions are evaluated as sm1 prior to resection. When histological investigation reveals sm1 carcinoma with histologic grade I (well-differentiated) or II (moderately-differentiated), and the absence of lymphatic invasion and budding, endoscopic treatment alone is sufficient. PMID:18493513

  6. Propolis-induced descending necrotizing mediastinitis and aspiration pneumonia.

    PubMed

    Wu, Jeng-Yuan; Hsu, Nan-Yung

    2013-04-01

    Propolis is a resinous substance collected by bees as a sealant for their hives. It is also used in traditional medicine as an antioxidant and antiinflammatory agent to treat ulcers, superficial burns, and microbial diseases. In this report, a 40-year-old woman who took liquid propolis for relief of her common cold experienced severe sore throat, dysphagia, and easy choking followed by fever and chills. Descending necrotizing mediastinitis and concomitant aspiration pneumonia were evident on the image studies. We performed video-assisted thoracoscopic surgery to achieve immediate and adequate drainage, and the patient resumed normal deglutition 2 months later. Early diagnosis and prompt video-assisted thoracoscopic surgery intervention are paramount to manage this life-threatening situation.

  7. [Kodamaea ohmeri infection in a newborn with a mediastinal mass].

    PubMed

    Alvarado Socarras, Jorge; Rojas Torres, Juan P; Vargas Soler, José A; Guerrero, Carlos

    2016-10-01

    Invasive fungal infections are a considerable cause of morbidity, mortality, increased hospital stay durations, and high health care costs, during neonatal period. In this period, the premature infants are the most affected. Candida species are the leading cause of invasive fungal infections. The majority of neonatal Candida infections are caused by C. albicans, C. parapsilosis, C. glabrata and C. tropicalis, although other fungus species are being reported. One such emerging pathogen is K. ohmeri. This organism has been reported as a pathogen in the neonatal period, principally in premature infants. The risk factors associated with fungal infection are central line, immunosuppression, prolonged hospital stay, endotracheal intubation and exposure to antibiotics. We present a term baby with a mediastinal mass, who required several procedures, as pericardiocentesis, central catheters, mechanical ventilation, antibiotics. During his evolution, he presented infection by K. ohmeri. The baby was treated with amphotericin B, with satisfactory clinical course. PMID:27606654

  8. [Kodamaea ohmeri infection in a newborn with a mediastinal mass].

    PubMed

    Alvarado Socarras, Jorge; Rojas Torres, Juan P; Vargas Soler, José A; Guerrero, Carlos

    2016-10-01

    Invasive fungal infections are a considerable cause of morbidity, mortality, increased hospital stay durations, and high health care costs, during neonatal period. In this period, the premature infants are the most affected. Candida species are the leading cause of invasive fungal infections. The majority of neonatal Candida infections are caused by C. albicans, C. parapsilosis, C. glabrata and C. tropicalis, although other fungus species are being reported. One such emerging pathogen is K. ohmeri. This organism has been reported as a pathogen in the neonatal period, principally in premature infants. The risk factors associated with fungal infection are central line, immunosuppression, prolonged hospital stay, endotracheal intubation and exposure to antibiotics. We present a term baby with a mediastinal mass, who required several procedures, as pericardiocentesis, central catheters, mechanical ventilation, antibiotics. During his evolution, he presented infection by K. ohmeri. The baby was treated with amphotericin B, with satisfactory clinical course.

  9. Mediastinal and retroperitoneal teratoma with focal gastrointestinal adenocarcinoma.

    PubMed

    Chang, Y-L; Wu, C-T; Lee, Y-C

    2006-09-01

    We report an unusual case of gastrointestinal adenocarcinoma arising in a giant posterior mediastinal mature cystic teratoma extending into the retroperitoneum, which was treated by complete excision with a good outcome for more than 2 years. Teratomas with malignant transformation are rare non-germ cell malignant tumors arising from a preexisting mature teratoma. Histological examination revealed that the cyst wall was composed of mature ectodermal, mesodermal, and endodermal elements. Neoplastic glands with a cribriform pattern were found in a small, solid nodule. Strong cytokeratin 20 cytoplasmic immunostaining of the tumor cells supported the diagnosis of gastrointestinal adenocarcinoma. In this report, we describe the potential aggressiveness of a giant mature cystic teratoma with adenocarcinoma and suggest that complete surgical resection without adjuvant chemotherapy be considered as a therapy in the treatment of teratoma with focal malignant transformation.

  10. [Mediastinal seminoma. Is it an entity to be treated differently?].

    PubMed

    Ruffié, P; Droz, J P

    1992-01-01

    The evolution of the therapeutic concepts of non seminomatous tumours (T) has chemotherapy as the preponderant treatment, and has also led to a different approach for mediastinal seminomas. In effect the traditional attitude for as complete an excision as possible followed by radiotherapy is in the process of changing. Certainly in 20% of cases a complete excision is possible. Post operative radiotherapy (30-50 grays) does not seem to change the survival and may be questioned in the management of invasive T. The radical debulking surgery of varying degrees no longer has a place. The standard treatment of inoperable T has remained for some time radiotherapy (35-40 grays). The survival at 5 years for these patients is around 60%, very close to the stage IIB seminoma of the testicles. If the seminoma seems to be radiosensitive it is also chemo-sensitive with an RC less than 80% in advance seminomas and of 90% in mediastinal seminomas. Thus there appears to be a contradictory debate; in the absence of precise staging of "thymic type" tumour and of randomised trials made difficult by the small number of cases one can envisage the following option: In the case of an inoperable T radiotherapy alone, excepting in the very bulky forms (diameter greater than 50% of the chest) or metastases where primary chemotherapy (CT) (4 cycles of VP16-platine) has a place: The treatment of the residual mass after CT depends on the size of the latter: less than 3 or equal to 3 cm by complementary treatment and greater than 3 cm by secondary surgery and if the seminoma is active complementary.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Anesthetic management in a case of congenital sternal cleft diagnosed incidentally on the operating table

    PubMed Central

    Gupta, Priyamvada; Kumar, Alok; Jethava, D. D.; Jethava, Durga

    2014-01-01

    Congenital absence of sternum, also known as sternal cleft, is a rare anomaly. It is due to impaired organogenesis leading to nonfusion of sternal bars. It may be of two types- complete or incomplete. It may be associated with other congenital malformations viz., cardiac, anorectal etc., or may be a part of Cantrell's pentalogy. Besides cosmetic concerns, mediastinal structures are at increased risk to damage in case of trauma to the anterior chest wall. Due to restricted mediastinal space, there may be restrictive pulmonary dysfunctions and unstable hemodynamics. It usually presents in the neonatal period or early infancy, rarely in adult age. The defect should be surgically closed as early as possible. If cardiac arrest occurs due to any reason, the only option is open cardiac massage. We report a case of complete congenital sternal cleft accidentally diagnosed on the operation table, while preparing the patient for diagnostic laparotomy. The patient was retrospectively assessed for the presence of other congenital malformations. PMID:25886344

  12. Evaluation of the potential for lymph node metastasis using CRP 1846C>T genetic polymorphism in invasive breast cancer.

    PubMed

    Terata, Kaori; Motoyama, Satoru; Kamata, Shuichi; Hinai, Yudai; Miura, Masatomo; Sato, Yusuke; Yoshino, Kei; Ito, Aki; Imai, Kazuhiro; Saito, Hajime; Minamiya, Yoshihiro

    2014-06-01

    Lymph node status is a key indicator of the best approach to treatment of invasive breast cancer. However, the accuracy with which lymph node metastasis is diagnosed is not currently satisfactory. New and more reliable methods that enable one to know who has a greater potential for lymph node metastasis would be highly desirable. We previously reported that lymph node involvement in esophageal and lung cancer may have a genetic component: C-reactive protein (CRP) 1846C>T genetic polymorphism. Here we examined the diagnostic value of CRP 1846C>T polymorphism for assessing the risk of lymph node metastasis in cases of invasive breast cancer. The study participants were 185 women with invasive breast cancer who underwent curative surgery with lymph node dissection. Using DNA from blood samples and polymerase chain reaction-restriction fragment length polymorphism, the utility of CRP genetic 1846C>T polymorphism (rs1205) for assessing the risk of lymph node metastasis was evaluated. Fifty-two (28 %) patients had lymph node metastasis. After the patients were divided into two groups based on their CRP 1846 genotypes (C/C+C/T and T/T), the clinical characteristics did not differ between the groups, but there was a significantly greater incidence of lymph node metastasis among patients in the T/T group. Moreover, the odds ratio for lymph node involvement in patients carrying the 1846 T/T genotype was more than 2.2 in multivariate logistic regression models. CRP genetic polymorphism may be a novel predictor of the risk of lymph node metastasis in invasive breast cancer.

  13. The history of the management of sternal osteomyelitis and mediastinitis - from Hippocrates until today.

    PubMed

    Ennker, Ina Carolin; Ennker, Jürgen C

    2014-01-01

    Even during the time of Hippocrates, Galen and their colleagues recognized mediastinal affections. However, they were not considered with the surgical treatment. First progress in the treatment options of this severe disease, still denoted as 'terra incognita', over to today's gold standard are pictured. The mediastinitis-registry which was founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in 2011 and the recent establishment of the study group to adopt a guideline 'diagnosis and therapy of postoperative mediastinitis/sternal osteomyelitis following cardiac surgery' are attempts to a standardization of the treatment. Substantial advancement in the treatment of postoperative mediastinitis could be achieved in the past. The mortality dropped as low as less than 10%. With these implementations more benefit for the patients' outcome can be expected. PMID:26504718

  14. Initial experience in a cancer hospital in Nepal with sentinel lymph node mapping and biopsy for evaluation of axillary lymph node status in palpable invasive breast cancer.

    PubMed

    Lamichhane, Nirmal; Pradhan, Manohar; Neupane, Prakash Raj; Shrestha, Bhakta Man; Dhakal, Hari Prasad; Thakur, Binay Kumar; Cox, Charles Evandor

    2007-03-01

    To evaluate the performance and feasibility of sentinel lymph node biopsy in early breast cancer patients using patent blue dye. From March 2004, we are consecutively enrolling breast cancer patients with tumor size less than 5 cm with no clinically palpable axillary lymph nodes in this feasibility study. So far, 21 patients underwent sentinel lymph node biopsy using 1.0% patent blue dye injection around the tumor followed by axillary dissection. Sentinel lymph node biopsy was compared with axillary dissection for its ability to accurately reflect the final pathological status of the axillary nodes. Age of patients ranged form 32-67 years old with mean age of 46.72 years. Fifty seven percent of patients were postmenopausal. Patients with T1 lesions were 8 and T2 were 13. The sentinel lymph node/s were successfully identified in 20 out of 21 patients (95.0%). The number of sentinel lymph nodes ranged from 1 to 5 (average 2.0) and non-sentinel nodes ranged from 5-22 (average 12.0). Infiltrating ductal carcinoma was diagnosed in 15 patients, DCIS with early invasion in 4 patients, invasive lobular carcinoma in 1 and medullary carcinoma in 1 patient. Of the 20 patients in whom sentinel lymph nodes were successfully identified, nodes were positive in 35.0% (7/20) of patients. All the positive nodes were detected in group with T2 lesions. SLNs were the only positive nodes in 2 patients. There were no false negative patients, yielding an accuracy of 100.0%. Lymphatic mapping using patent blue dye alone is technically feasible for patients with small (T1 or T2) palpable breast tumors. The sentinel node can be reliably identified in the majority of these patients, and its histology reflects that of the axilla with a high degree of accuracy. This method is very useful in economically backward countries as it involves less expensive material.

  15. Ultrasound-guided biopsy as a diagnostic aid in three horses with a cranial mediastinal lymphosarcoma.

    PubMed

    De Clercq, D; van Loon, G; Lefère, L; Deprez, P

    2004-06-01

    An ultrasound examination of the thorax of three horses which were performing poorly or had mild signs of colic showed that they had a cranial mediastinal mass and a pleural effusion. A cytological examination of the pleural fluid showed that it did not contain neoplastic cells. A histological examination of an ultrasound-guided core biopsy of the cranial mediastinal mass showed that in each of the three horses it was a lymphosarcoma. PMID:15214516

  16. Disseminated cryptococcosis presenting as mediastinal and hilar lymphadenopathy in an immunocompetent patient

    PubMed Central

    Oki, Masahide; Saka, Hideo; Kajikawa, Shigehisa; Murakami, Ayuka; Ishida, Akane

    2016-01-01

    Abstract We herein report a rare case of disseminated cryptococcosis presenting as mediastinal and hilar lymphadenopathy in a young immunocompetent man. A previously healthy 26‐year‐old man presented with persistent headache and nonproductive cough. Chest computed tomography indicated mediastinal and hilar lymphadenopathy. Cryptococcal lymphadenitis and meningitis was confirmed by endobronchial ultrasound‐guided transbronchial needle aspiration and central spinal fluid examination, respectively. He received liposomal amphotericin B and flucytosine followed by fluconazole and finally improved. PMID:27512567

  17. Prognostic significance of pleural or pericardial effusion and the implication of optimal treatment in primary mediastinal large B-cell lymphoma: a multicenter retrospective study in Japan

    PubMed Central

    Aoki, Tomohiro; Izutsu, Koji; Suzuki, Ritsuro; Nakaseko, Chiaki; Arima, Hiroshi; Shimada, Kazuyuki; Tomita, Akihiro; Sasaki, Makoto; Takizawa, Jun; Mitani, Kinuko; Igarashi, Tadahiko; Maeda, Yoshinobu; Fukuhara, Noriko; Ishida, Fumihiro; Niitsu, Nozomi; Ohmachi, Ken; Takasaki, Hirotaka; Nakamura, Naoya; Kinoshita, Tomohiro; Nakamura, Shigeo; Ogura, Michinori

    2014-01-01

    The prognosis of patients with primary mediastinal large B-cell lymphoma has improved over recent years. However, the optimal treatment strategy including the role of radiotherapy remains unknown. We retrospectively analyzed the clinical outcomes of 345 patients with newly diagnosed primary mediastinal large B-cell lymphoma in Japan. With a median follow up of 48 months, the overall survival at four years for patients treated with R-CHOP (n=187), CHOP (n=44), DA-EPOCH-R (n=9), 2nd- or 3rd-generation regimens, and chemotherapy followed by autologous stem cell transplantation were 90%, 67%, 100%, 91% and 92%, respectively. Focusing on patients treated with R-CHOP, a higher International Prognostic Index score and the presence of pleural or pericardial effusion were identified as adverse prognostic factors for overall survival in patients treated with R-CHOP without consolidative radiotherapy (IPI: hazard ratio 4.23, 95% confidence interval 1.48–12.13, P=0.007; effusion: hazard ratio 4.93, 95% confidence interval 1.37–17.69, P=0.015). Combined with the International Prognostic Index score and the presence of pleural or pericardial effusion for the stratification of patients treated with R-CHOP without radiotherapy, patients with lower International Prognostic Index score and the absence of effusion comprised approximately one-half of these patients and could be identified as curable patients (95% overall survival at 4 years). The DA-EPOCH-R regimen might overcome the effect of these adverse prognostic factors. Our simple indicators of International Prognostic Index score and the presence of pleural or pericardial effusion could stratify patients with primary mediastinal large B-cell lymphoma and help guide selection of treatment. PMID:25216682

  18. Unusual involvement of scalp and bilateral kidneys in an aggressive mediastinal diffuse large B cell lymphoma: documentation by FDG-PET imaging.

    PubMed

    Basu, Sandip; Ramani, S K; Lad, S

    2009-09-01

    In the present communication, an unusual combination of scalp soft tissue and underlying brain involvement with intact skull bone coupled with bilateral renal involvement from a mediastinal diffuse large B cell lymphoma (DLBL) is presented. A 45-year-old man, a diagnosed case of mediastinal DLBL with bilateral lung involvement, was treated with conventional 6 cycles of chemotherapy and local external radiotherapy with initial good treatment response evidenced by considerable regression in mass size and regression in pulmonary lesions. Three months later, he returned with complaints of soft tissue swelling over the scalp; one of them in the high parietal bone and the other over the occipital region. A whole body FDG-PET at this time showed 2 moderate-sized foci in the scalp (with preservation of both tables of skull bone) and corresponding large foci in the brain parenchyma beneath, a superior mediastinal focus, a few foci in the apical and lower zone of left lung, extensive irregular uptake in the right pleura and the right lung parenchyma coupled with a loculated effusion in its lower zone and studded foci of hypermetabolism throughout the bilaterally enlarged kidneys. CT of the head confirmed the FDG-PET findings and histopathology of the biopsy from the scalp swelling was suggestive of DLBL. Ultrasound imaging of the abdomen showed lobulated bilaterally enlarged kidneys with multiple hypoechoic areas within them. The patient underwent palliative local external radiotherapy to the brain and systemic chemotherapy with poor clinical results with raised serum beta-2 microglobulin and serum LDH levels and deranged renal function. The patient died within a month after the FDG-PET study. The event of scalp and bilateral renal involvement from DLBL is rare in lymphoma literature and this report highlights that such unusual events can occur as part of widespread dissemination and underscores the importance of whole-body imaging with FDG-PET. PMID:19692836

  19. Recent Advance in Lymph Dynamic Analysis in Lymphatics and Lymph Nodes

    PubMed Central

    2012-01-01

    Lymphatics are a unidirectional transport system that carries fluid from the interstitial space and back into the blood stream. Initial lymphatics take up not only fluid but also high-molecular-weight substances, such as plasma proteins and hyaluronan; immune cells, such as lymphocytes, macrophages, and dendritic cells; and colloidal particles, such as carbon particles, bacteria, and tattoo dye. Interstitially injected colloidal particles are known to accumulate in the regional lymph nodes. This phenomenon is applied to find sentinel lymph nodes in cancer patients. Lymph flow rate and composition are influenced by interstitial fluid, lymphatic pump activity, and intra-lymphatic pressure. Lymph composition is changed during its flow downstream. In this review, the main focus is on the mechanisms of lymph formation at the initial lymphatics and lymph transport through the collecting lymphatics and lymph nodes. (*English Translation of J Jpn Coll Angiol, 2008, 48: 113-123.) PMID:23555523

  20. [Ectopic mediastinal parathyroid tumor resected by video-assisted thoracic surgery with intraoperative methylene blue infusion; report of a case].

    PubMed

    Okagawa, Takehiko; Hiramatsu, Yoshinori

    2014-03-01

    We report a surgical case of ectopic mediastinal parathyroid tumor resected by video-assisted thoracic surgery with intraoperative methylene blue infusion. It is often difficult to detect ectopic mediastinal parathyroid tumor during the operation because the tumor is soft, small and buried under mediastinal tissue. After methylene blue 4 mg/kg intravenously administration, the tumor was gradually dyed blue and easily detected and resected by video-assisted thoracic surgery. It is useful of methylene blue for detection of ectopic mediastinal parathyroid tumor.

  1. Diagnostic value of CYFRA 21-1 and CEA for predicting lymph node metastasis in operable lung cancer.

    PubMed

    Chen, Feng; Yan, Cui-E; Li, Jia; Han, Xiao-Hong; Wang, Hai; Qi, Jun

    2015-01-01

    Tumour markers are used extensively for the management of lung cancer, including diagnosis, evaluating effectiveness of treatments, monitoring recurrence after therapy and for predicting prognosis. However, there exists a knowledge gap regarding potential quantitative correlations between tumour marker levels and the extents of lymph node involvement in primary lung cancer. The current study is comprised of 139 lung cancer patients scheduled to undergo surgical operation. Of the 139 patients, 107 were subsequently diagnosed with lung cancer without lymph node involvement and 32 were diagnosed with malignant disease with lymph node involvement by histological examination. Preoperative tumour marker levels were quantified in each patient. The median tumour marker levels were statistically higher in lung cancer patients with malignant lymph nodes than in those who suffered either benign lung disease or carcinoma in situ (Kruskal-Wallistest; P = 0.001). Tumour marker levels were significantly correlated with clinical stage (ANOVA; P = 0.009). When examined as a dichotomous variable (CYFRA 21-1 ≤ 5.0 and CEA ≤ 5.0 group and CYFRA 21-1 > 5.0 or CEA > 5.0 group), elevated tumour marker levels correlated strongly with the presence of positive lymph nodes (χ(2) test; P = 0.000). This correlation suggests that the tumour marker levels are clinical predictors for the malignant involvement of lymph nodes in operable lung cancer patients. PMID:26309663

  2. Implication of 18F-fluorodeoxyglucose uptake by affected lymph nodes in cases with differentiated thyroid cancer

    PubMed Central

    Fujii, Takaaki; Yajima, Reina; Tatsuki, Hironori; Kuwano, Hiroyuki

    2016-01-01

    In this study, we evaluated the usefulness of positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) to detect metastatic lymph nodes in differentiated thyroid cancer. We also investigated whether certain factors, including the size of the metastasis to the lymph nodes, are associated with FDG avidity. A total of 22 consecutive patients with differentiated thyroid cancer who underwent FDG-PET preoperatively were enrolled in this study. Lymph node metastasis was diagnosed in the final pathology in 10 of the 22 patients (45.5%). The mean maximum standardized uptake value of the metastatic lymph nodes was 4.53 (range, 0–23.5). The 22 cases with differentiated thyroid cancer were divided into two groups based on lymph node metastasis. Clinicopathological variables other than FDG uptake of metastatic lymph nodes were not predictors of lymph node metastasis of thyroid cancer. The sensitivity, specificity, overall accuracy and false-negative rates of preoperative FDG-PET in the prediction of lymph node status were 40.0, 100, 72.7 and 60.0%, respectively. The false-positive rate of FDG-PET evaluation was 0%. The mean largest dimension of metastasis was 23.0 mm for FDG-positive cases and 10.9 mm for FDG-negative cases. There was a marked difference in the size of metastases between FDG-positive and -negative cases; however, even in patients with node metastasis >10 mm, the false-negative rate was 50.0%. Therefore, FDG-PET imaging was not found to be sufficient for the evaluation of lymph node status, particularly in cases with small metastases. Our findings indicate that preoperative FDG-PET evaluation of the lymph nodes cannot be considered predictive of the final pathology. PMID:27600496

  3. Utility of Thyroglobulin measurement in fine-needle aspiration biopsy specimens of lymph nodes in the diagnosis of recurrent thyroid carcinoma

    PubMed Central

    Baloch, Zubair W; Barroeta, Julieta E; Walsh, Janet; Gupta, Prabodh K; LiVolsi, Virginia A; Langer, Jill E; Mandel, Susan J

    2008-01-01

    Introduction The most common site for the metastasis of papillary carcinoma of the thyroid (PTC) is regional lymph nodes. Ultrasound (US) imaging may identify abnormal appearing lymph nodes, suspicious for PTC recurrence. Although fine needle aspiration biopsy (FNAB) of abnormal lymph nodes is often diagnostic of recurrence, small or cystic lymph nodes may be non-diagnostic due to lack of tumor cells. The measurement of thyroglobulin (TG) levels in FNAB specimens from lymph nodes suspicious for recurrent PTC can serve as an adjunct to the cytologic diagnosis. Materials and methods 115 abnormal appearing lymph nodes were aspirated under ultrasound guidance in 89 patients with history of thyroid carcinoma. In addition to obtaining material for cytologic interpretation, an additional aspirate was obtained by FNAB and rinsed in 1 ml of normal saline for TG level measurements. Results The cytologic diagnoses included: 35 (30%) reactive lymph node, no tumor seen (NTS), 39 (34%) PTC, 23 (20%) inadequate for evaluation due to lack of lymphoid or epithelial cells (NDX) 15 (13%) atypical/suspicious for PTC, and 3 (3%) other (e.g. paraganglioma, poorly differentiated carcinoma and carcinoma not otherwise specified). TG levels were markedly elevated (median 312 ng/ml; normal < 10 ng/ml) in 28 (72%) cases of PTC lymph node recurrence identified on cytology. TG measurements were also elevated in 5 lymph nodes classified as NTS and 4 NDX on cytology which resulted in 5 and 3 carcinoma diagnoses respectively on histological follow-up. Of the 9 atypical/suspicious cases with elevated TG levels all resulted in carcinoma diagnoses on follow-up. Conclusion The measurement of TG in FNAB specimens from lymph node in patients with history of PTC is useful in detecting recurrent disease, especially in cases when the specimen is known to be or likely to be inadequate for cytologic evaluation. PMID:18237420

  4. Tattoo-pigmented cervical lymph node that masqueraded as the sentinel lymph node in oral squamous cell carcinoma.

    PubMed

    Pinto, Amith; Wieshmann, Hulya; Triantafyllou, Asterios; Shaw, Richard

    2015-11-01

    We describe a case of a pigmented cervical lymph node mimicking the sentinel node during sentinel lymph node biopsy (SLNB) on a patient with oral squamous cell carcinoma (OSCC). The patient had extensive tattoos on his neck. This pigmented lymph node was not identified to be the sentinel lymph node using static and dynamic lymphoscintigraphy. Subsequent histological analysis revealed tattoo pigment within this lymph node. It is important during cervical SLNB to be aware that cutaneous tattoos can pigment lymph nodes. PMID:26188933

  5. Peculiarities of lymph flow in microvessels

    NASA Astrophysics Data System (ADS)

    Galanzha, Ekateryna I.; Brill, Gregory E.; Ulyanov, Sergey S.; Tuchin, Valery V.; Solov'eva, Anastasiya V.; Sedykh, Alexey V.

    2000-05-01

    In the present study the characteristics of lymph flow in microvessels are investigated in vivo by the speckle- interferometrical and biomicroscopic methods. Two parameters of the lymph flow velocity are determined. The first frequency-weighted spectral moment of Doppler signal (M1) was calculated. This parameter is proportional to lymph flow velocity. In the same regions of lymphatics the velocity of translational motion of the signal lymphocytes in the flow is assessed. The value of velocity and the parameter M1 essentially varied. The temporary dynamics of M1 indicated that the lymph flow had the alternating- translational character. Simultaneously the diameter of lymph microvessel, the amplitude and the rate of phasic contraction and the rate of valve functioning are registered. NG-nitro-L-arginine (L-NNA, 10-4 M), an inhibitor of nitric oxide synthase, is topically applied during 15 min. The application of L-NNA provoked the modulation of alternating-translational motion of lymph flow, the changes of diameters and rate of valve function and the stimulating of phasic contractions and the correlation between parameters of lymph microcirculation.

  6. Mediastinal radiation and adverse outcomes after heart transplantation.

    PubMed

    Uriel, Nir; Vainrib, Alan; Jorde, Ulrich P; Cotarlan, Vlad; Farr, Maryjane; Cheema, Faisal H; Naka, Yoshifuma; Mancini, Donna; Colombo, Paolo C

    2010-03-01

    Orthotopic heart transplantation (OHT) may represent the only treatment option for patients with end-stage cardiovascular disease due to mediastinal radiation therapy (MRT). The primary aim of this study was to evaluate the safety and efficacy of OHT in this patient population. We conducted a retrospective, single-center cohort study of patients with MRT-associated cardiovascular disease who underwent OHT between January 1987 and September 2008. Nine patients (3 men), aged 46 +/- 11 years at the time of their OHT, were identified. Time from MRT to OHT was 26 +/- 11 years. Lymphoma was the indication for MRT in all patients. Five patients had non-ischemic dilated cardiomyopathy, 2 had ischemic cardiomyopathy and 2 had constrictive pericarditis. Three patients expired in the peri-operative period, whereas another patient died 3 years post-transplant from lung carcinoma. Two additional patients developed a secondary malignancy post-transplant. Five patients are still alive at a mean follow-up of 10 +/- 8 years. Early survival rate is poor in patients who undergo OHT for MRT-associated end-stage cardiovascular disease. In addition, long-term follow-up shows an elevated incidence of malignancies. Our results raise concern about the safety and efficacy of performing OHT in patients with MRT-associated cardiovascular disease.

  7. Infection-induced type I interferons activate CD11b on B-1 cells for subsequent lymph node accumulation

    PubMed Central

    Waffarn, Elizabeth E.; Hastey, Christine J.; Dixit, Neha; Choi, Youn Soo; Cherry, Simon; Kalinke, Ulrich; Simon, Scott I.; Baumgarth, Nicole

    2016-01-01

    Innate-like B-1a lymphocytes rapidly redistribute to regional mediastinal lymph nodes (MedLN) during influenza infection to generate protective IgM. Here we demonstrate that influenza infection-induced type I interferons directly stimulate body cavity B-1 cells and are a necessary signal required for B-1 cell accumulation in MedLN. Vascular mimetic flow chamber studies show that type I interferons increase ligand-mediated B-1 cell adhesion under shear stress by inducing high-affinity conformation shifts of surface-expressed integrins. In vivo trafficking experiments identify CD11b as the non-redundant, interferon-activated integrin required for B-1 cell accumulation in MedLN. Thus CD11b on B-1 cells senses infection-induced innate signals and facilitates their rapid sequester into secondary lymphoid tissues, thereby regulating the accumulation of polyreactive IgM producers at sites of infection. PMID:26612263

  8. Near infrared imaging to identify sentinel lymph nodes in invasive urinary bladder cancer

    NASA Astrophysics Data System (ADS)

    Knapp, Deborah W.; Adams, Larry G.; Niles, Jacqueline D.; Lucroy, Michael D.; Ramos-Vara, Jose; Bonney, Patty L.; deGortari, Amalia E.; Frangioni, John V.

    2006-02-01

    Approximately 12,000 people are diagnosed with invasive transitional cell carcinoma of the urinary bladder (InvTCC) each year in the United States. Surgical removal of the bladder (cystectomy) and regional lymph node dissection are considered frontline therapy. Cystectomy causes extensive acute morbidity, and 50% of patients with InvTCC have occult metastases at the time of diagnosis. Better staging procedures for InvTCC are greatly needed. This study was performed to evaluate an intra-operative near infrared fluorescence imaging (NIRF) system (Frangioni laboratory) for identifying sentinel lymph nodes draining InvTCC. NIRF imaging was used to map lymph node drainage from specific quadrants of the urinary bladder in normal dogs and pigs, and to map lymph node drainage from naturally-occurring InvTCC in pet dogs where the disease closely mimics the human condition. Briefly, during surgery NIR fluorophores (human serum albumen-fluorophore complex, or quantum dots) were injected directly into the bladder wall, and fluorescence observed in lymphatics and regional nodes. Conditions studied to optimize the procedure including: type of fluorophore, depth of injection, volume of fluorophore injected, and degree of bladder distention at the time of injection. Optimal imaging occurred with very superficial injection of the fluorophore in the serosal surface of the moderately distended bladder. Considerable variability was noted from dog to dog in the pattern of lymph node drainage. NIR fluorescence was noted in lymph nodes with metastases in dogs with InvTCC. In conclusion, intra-operative NIRF imaging is a promising approach to improve sentinel lymph node mapping in invasive urinary bladder cancer.

  9. Initial experience of single-port video-assisted thoracoscopic surgery sleeve lobectomy and systematic mediastinal lymphadenectomy for non-small-cell lung cancer

    PubMed Central

    Chen, Hao; Xu, Guobing; Zheng, Bin; Zheng, Wei; Zhu, Yong; Guo, Zhaohui

    2016-01-01

    Background In this study, we evaluate the feasibility and safety of single-port video-assisted thoracoscopic surgery (VATS) sleeve lobectomy (SL) and systematic mediastinal lymphadenectomy and summarize our surgical experience. Methods From October 2014 to December 2015, eight cases of single-port VATS SL [seven male patients and one female patient, median age 56.0 (range, 38–63) years] were performed by a single group of surgeons in Fujian Medical University Fujian Union Hospital. The median tumor size was 2.7 cm. Types of resection included four right upper, one right lower, and three left upper sleeve lobectomies. Systematic mediastinal lymphadenectomy was performed in all patients. A modified anastomosis technique developed by the author (Chen’s technique) was applied for bronchial anastomosis. Postoperative outcome and short-term follow-up data were recorded and analyzed. Results All eight operations were completed uneventfully with no conversion to thoracotomy or reoperation required. No perioperative death was observed. Major results (medians or percentages) were as follows: operative duration, 234.5 [185–345] min; bronchial anastomosis duration, 38.0 [30–43] min; blood loss, 65.0 [50–200] mL; number of lymph node dissected, 22.5 [18–37]. The postoperative complication rate was 37.5% (three of eight cases, including two pulmonary infections and one atrial fibrillation). All patients recovered and were discharged uneventfully with symptomatic therapy. Pathology showed squamous cell carcinoma in seven patients and adenocarcinoma in one patient; two patients were in TNM stage IB, three in stage IIA, one in stage IIB, and two in stage IIIA. The mean follow-up was 7.5 [2–15] months. There were no tumor recurrences or bronchial anastomotic complications. Conclusions Single-port VATS SL and mediastinal lymphadenectomy are safe and feasible. Improvements in operating procedures can help facilitate single-port VATS. The application of Chen’s technique

  10. Initial experience of single-port video-assisted thoracoscopic surgery sleeve lobectomy and systematic mediastinal lymphadenectomy for non-small-cell lung cancer

    PubMed Central

    Chen, Hao; Xu, Guobing; Zheng, Bin; Zheng, Wei; Zhu, Yong; Guo, Zhaohui

    2016-01-01

    Background In this study, we evaluate the feasibility and safety of single-port video-assisted thoracoscopic surgery (VATS) sleeve lobectomy (SL) and systematic mediastinal lymphadenectomy and summarize our surgical experience. Methods From October 2014 to December 2015, eight cases of single-port VATS SL [seven male patients and one female patient, median age 56.0 (range, 38–63) years] were performed by a single group of surgeons in Fujian Medical University Fujian Union Hospital. The median tumor size was 2.7 cm. Types of resection included four right upper, one right lower, and three left upper sleeve lobectomies. Systematic mediastinal lymphadenectomy was performed in all patients. A modified anastomosis technique developed by the author (Chen’s technique) was applied for bronchial anastomosis. Postoperative outcome and short-term follow-up data were recorded and analyzed. Results All eight operations were completed uneventfully with no conversion to thoracotomy or reoperation required. No perioperative death was observed. Major results (medians or percentages) were as follows: operative duration, 234.5 [185–345] min; bronchial anastomosis duration, 38.0 [30–43] min; blood loss, 65.0 [50–200] mL; number of lymph node dissected, 22.5 [18–37]. The postoperative complication rate was 37.5% (three of eight cases, including two pulmonary infections and one atrial fibrillation). All patients recovered and were discharged uneventfully with symptomatic therapy. Pathology showed squamous cell carcinoma in seven patients and adenocarcinoma in one patient; two patients were in TNM stage IB, three in stage IIA, one in stage IIB, and two in stage IIIA. The mean follow-up was 7.5 [2–15] months. There were no tumor recurrences or bronchial anastomotic complications. Conclusions Single-port VATS SL and mediastinal lymphadenectomy are safe and feasible. Improvements in operating procedures can help facilitate single-port VATS. The application of Chen’s technique

  11. Mechanobiological oscillators control lymph flow

    PubMed Central

    Kunert, Christian; Baish, James W.; Liao, Shan; Padera, Timothy P.; Munn, Lance L.

    2015-01-01

    The ability of cells to sense and respond to physical forces has been recognized for decades, but researchers are only beginning to appreciate the fundamental importance of mechanical signals in biology. At the larger scale, there has been increased interest in the collective organization of cells and their ability to produce complex, “emergent” behaviors. Often, these complex behaviors result in tissue-level control mechanisms that manifest as biological oscillators, such as observed in fireflies, heartbeats, and circadian rhythms. In many cases, these complex, collective behaviors are controlled—at least in part—by physical forces imposed on the tissue or created by the cells. Here, we use mathematical simulations to show that two complementary mechanobiological oscillators are sufficient to control fluid transport in the lymphatic system: Ca2+-mediated contractions can be triggered by vessel stretch, whereas nitric oxide produced in response to the resulting fluid shear stress causes the lymphatic vessel to relax locally. Our model predicts that the Ca2+ and NO levels alternate spatiotemporally, establishing complementary feedback loops, and that the resulting phasic contractions drive lymph flow. We show that this mechanism is self-regulating and robust over a range of fluid pressure environments, allowing the lymphatic vessels to provide pumping when needed but remain open when flow can be driven by tissue pressure or gravity. Our simulations accurately reproduce the responses to pressure challenges and signaling pathway manipulations observed experimentally, providing an integrated conceptual framework for lymphatic function. PMID:26283382

  12. How Is Lymphocytopenia Diagnosed?

    MedlinePlus

    ... of lymphocytes—T cells, B cells, and natural killer cells. The test can help diagnose the underlying ... cause low levels of B cells or natural killer cells. Tests for Underlying Conditions Many diseases and ...

  13. How Is Endocarditis Diagnosed?

    MedlinePlus

    ... can get detailed pictures of the heart's structures. EKG An EKG is a simple, painless test that detects your ... signals as they pass through your heart. An EKG typically isn't used to diagnose IE. However, ...

  14. Mesenteric lymph node cavitation in coeliac disease.

    PubMed Central

    Holmes, G K

    1986-01-01

    A patient with coeliac disease and mesenteric lymph node cavitation is reported. This is a rare occurrence and has received very little attention in the English literature. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:3721297

  15. Recurrence rate in regional lymph nodes in 737 patients with follicular or Hürthle cell neoplasms

    PubMed Central

    Vogrin, Andrej; Besic, Hana; Besic, Nikola

    2016-01-01

    Abstract Background Preoperative ultrasound (US) evaluation of central and lateral neck compartments is recommended for all patients undergoing a thyroidectomy for malignant or suspicious for malignancy cytologic or molecular findings. Our aim was to find out how frequent was recurrence in regional lymph nodes in patients with follicular or Hürthle cell neoplasm and usefulness of preoperative neck US investigation in patients with neoplasm. Patients and methods Altogether 737 patients were surgically treated because of follicular or Hürthle cell neoplasms from 1995 to 2014 at our cancer comprehensive center, among them 207 patients (163 females, 44 males; mean age 52 years) had thyroid carcinoma. Results Carcinoma was diagnosed in follicular and Hürthle cell neoplasm in 143/428 and 64/309 of cases, respectively. A recurrence in regional lymph nodes occurred in 12/207 patients (6%) during a median follow-up of 55 months. Among patients with carcinoma a recurrence in regional lymph nodes was diagnosed in follicular and Hürthle cell neoplasms in 2% and 14%, respectively (p = 0.002). Recurrence in regional lymph nodes was diagnosed in 3/428 of all patients with follicular neoplasm and 9/309 of all patients with Hürthle cell neoplasm. Conclusions Recurrence in lymph nodes was diagnosed in 0.7% of patients with a preoperative diagnosis of follicular neoplasm and 3% of patients with a Hürthle cell neoplasm. A recurrence in regional lymph nodes is rare in patients with carcinoma and preoperative diagnosis of follicular neoplasm. Preoperative neck ultrasound examination in patients with a follicular neoplasm is probably not useful, but in patients with Hurtle cell neoplasm it may be useful.

  16. Fulminant mediastinitis due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: atypical presentation and spreading following cardiac surgery†

    PubMed Central

    Valenzuela, Horacio; Carrascal, Yolanda; Maroto, Laura; Arce, Nuria

    2013-01-01

    Mediastinitis due to Klebsiella pneumoniae, related to thoracic wall contamination after cardiac surgery, has rarely been described. We aim to report a case of fulminant mediastinitis due to extended-spectrum beta-lactamase-producing K. pneumoniae, secondary to a disseminated concomitant pulmonary infection. The patient remained pauci-symptomatic until clinical manifestations of sepsis acutely appeared. PMID:23416348

  17. [Regional lymph nodes at a distance].

    PubMed

    Kroon, B B R; Hoefnagel, C A; Valdés Olmos, R A; Nieweg, O E

    2008-09-13

    In 3 patients, two men aged 22 years and 38 years with melanoma, and one woman aged 46 years with breast cancer, local tumour growth recurred following regional lymph node dissection. All three developed metastasis in new distant regional basins, which were once more dissected. The first melanoma patient died from haematogenous metastasis, 2 years after the excision of his primary melanoma. The other melanoma patient was alive, without evidence of disease, 8 years after the treatment of his primary tumour. The breast cancer patient, who underwent contralateral axillary lymph node dissection, was also alive, without evidence of disease, 27 years after the treatment of her primary tumour. Diversion of lymphatic flow as a result of regional lymph node dissection for cancer may lead to metastasis to a distant lymph node basin if tumour growth recurs in the original area. Knowledge of this usually unknown phenomenon is important since metastasis to these new regional basins can still be treated curatively, in the form of another lymph node dissection. These distant lymph node basins must therefore be carefully checked during follow-up monitoring.

  18. [Regional lymph nodes at a distance].

    PubMed

    Kroon, B B R; Hoefnagel, C A; Valdés Olmos, R A; Nieweg, O E

    2008-09-13

    In 3 patients, two men aged 22 years and 38 years with melanoma, and one woman aged 46 years with breast cancer, local tumour growth recurred following regional lymph node dissection. All three developed metastasis in new distant regional basins, which were once more dissected. The first melanoma patient died from haematogenous metastasis, 2 years after the excision of his primary melanoma. The other melanoma patient was alive, without evidence of disease, 8 years after the treatment of his primary tumour. The breast cancer patient, who underwent contralateral axillary lymph node dissection, was also alive, without evidence of disease, 27 years after the treatment of her primary tumour. Diversion of lymphatic flow as a result of regional lymph node dissection for cancer may lead to metastasis to a distant lymph node basin if tumour growth recurs in the original area. Knowledge of this usually unknown phenomenon is important since metastasis to these new regional basins can still be treated curatively, in the form of another lymph node dissection. These distant lymph node basins must therefore be carefully checked during follow-up monitoring. PMID:18825884

  19. Molecular characterization of primary mediastinal B cell lymphoma.

    PubMed

    Tsang, P; Cesarman, E; Chadburn, A; Liu, Y F; Knowles, D M

    1996-06-01

    Primary mediastinal B cell lymphoma (PMBL) is a diffuse large B cell lymphoma (DLCL) postulated to arise from noncirculating thymic B lymphocytes. Because of its distinctive clinical and morphological features and putative unique cellular origin, PMBL is generally considered a distinct clinicopathological entity. Little is known, however, about the molecular characteristics of PMBL. Therefore, we analyzed 16 PMBLs for molecular alterations involving the bcl-1, bcl-2, bcl-6, c-myc, H-ras, K-ras, N-ras, and p53 genes and for Epstein-Barr virus infection, which are commonly involved in lymphoid neoplasia. Employing a combination of Southern blotting and/or polymerase chain reaction and single-strand conformation polymorphism assays, we detected genetic alterations in 7 of the 16 (44%) PMBLs. Whereas the bcl-6 gene is rearranged in up to 45% of DLCLs, rearrangement of the bcl-6 gene was detected in only 1 of these 16 (6%) PMBLS. Point mutations of the 5' noncoding region of the c-myc gene were demonstrated in 3 other cases (19%), although c-myc gene rearrangements were not seen by Southern blotting. Missense point mutations of the p53 gene were identified in 3 additional PMBLs (19%). Alterations of the bcl-1, bcl-2, or ras genes and evidence of Epstein-Barr virus infection were not observed. In conclusion, a variety of molecular lesions occur in PMBLs and may be involved in their pathogenesis. This molecular genetic pattern bears little resemblance to that known for other B cell malignancies, including DLCL. In particular, the infrequent occurrence of bcl-6 gene rearrangement in PMBLs distinguishes them from other DLCLs of B cell origin, suggesting that PMBLs do not represent a distinct subtype of DLCL. PMID:8669486

  20. Molecular characterization of primary mediastinal B cell lymphoma.

    PubMed Central

    Tsang, P.; Cesarman, E.; Chadburn, A.; Liu, Y. F.; Knowles, D. M.

    1996-01-01

    Primary mediastinal B cell lymphoma (PMBL) is a diffuse large B cell lymphoma (DLCL) postulated to arise from noncirculating thymic B lymphocytes. Because of its distinctive clinical and morphological features and putative unique cellular origin, PMBL is generally considered a distinct clinicopathological entity. Little is known, however, about the molecular characteristics of PMBL. Therefore, we analyzed 16 PMBLs for molecular alterations involving the bcl-1, bcl-2, bcl-6, c-myc, H-ras, K-ras, N-ras, and p53 genes and for Epstein-Barr virus infection, which are commonly involved in lymphoid neoplasia. Employing a combination of Southern blotting and/or polymerase chain reaction and single-strand conformation polymorphism assays, we detected genetic alterations in 7 of the 16 (44%) PMBLs. Whereas the bcl-6 gene is rearranged in up to 45% of DLCLs, rearrangement of the bcl-6 gene was detected in only 1 of these 16 (6%) PMBLS. Point mutations of the 5' noncoding region of the c-myc gene were demonstrated in 3 other cases (19%), although c-myc gene rearrangements were not seen by Southern blotting. Missense point mutations of the p53 gene were identified in 3 additional PMBLs (19%). Alterations of the bcl-1, bcl-2, or ras genes and evidence of Epstein-Barr virus infection were not observed. In conclusion, a variety of molecular lesions occur in PMBLs and may be involved in their pathogenesis. This molecular genetic pattern bears little resemblance to that known for other B cell malignancies, including DLCL. In particular, the infrequent occurrence of bcl-6 gene rearrangement in PMBLs distinguishes them from other DLCLs of B cell origin, suggesting that PMBLs do not represent a distinct subtype of DLCL. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:8669486

  1. Sonographic findings in horses with mediastinal lymphosarcoma: 13 cases (1985-1992).

    PubMed

    Garber, J L; Reef, V B; Reimer, J M

    1994-11-15

    Sonographic findings correlated with necropsy findings in 8 of 9 horses in which the cranial portion of the mediastinum was evaluated by use of both methods. Cranial mediastinal masses were imaged as multilobular and homogeneously hypoechoic; a complex echogenic pattern was observed with necrosis within the mass. Pleural effusion was a common finding in horses with mediastinal lymphosarcoma. Cytologic evaluation of pleural fluid samples was useful in diagnosis of lymphosarcoma in 10 of 12 horses that had thoracentesis. Sonographic examination of the thorax and cranial portion of the mediastinum can aid in the diagnosis of mediastinal lymphosarcoma in horses. Such examination should be performed in horses with clinical signs of cranial vena cava obstruction in which pleural effusion is detected, or when thoracic lymphosarcoma is suspected. PMID:7698925

  2. Mediastinal mature teratoma with rupture into pleural cavity due to blunt trauma.

    PubMed

    Miyazawa, Masahisa; Yoshida, Kazuo; Komatsu, Kazunori; Kobayashi, Nobutaka; Haba, Yoshiaki

    2012-03-01

    We report a rare case of mediastinal mature teratoma with rupture due to blunt trauma. A 15-year-old boy had received a strong head-butt in the left upper chest wall and was admitted with the sudden onset of left-sided severe chest pain and dyspnea. Chest computed tomography (CT) scan on admission revealed a heterogeneous mass lesion in the anterior mediastinum. The contrast-enhanced CT scans obtained 2 days after admission showed not only mediastinal mass lesion but also left pleural effusion. On the radiologic finding at 5 months later, the lesion became larger and was thought to be a typical mediastinal mature teratoma. The patient underwent extirpation of the tumor. Microscopically, the tumor was typically composed of adult-type tissues and was confirmed to be mature teratoma.

  3. Hodgkin’s disease presenting as discharging neck sinuses and a mediastinal mass

    PubMed Central

    Zolotar, Meira; Olaleye, Oladejo; Sherif, Ali; Howe, Rachael; Mathews, John

    2011-01-01

    A 23-year-old Asian lady presented with a hard indurated midline neck swelling of 2 months duration without any upper aerodigestive tract or systemic symptoms of note. Her inflammatory markers were elevated and she was commenced on antibiotics. Ultrasound scan and fine needle aspiration cytology (FNAC) were inconclusive. A CT scan showed an ill-defined soft tissue mass anterior to and not well demarcated from the thyroid, and contiguous with a superior and anterior mediastinal mass. Incisional biopsy revealed necrosis and pockets of purulent material. Microbiology suggested a chronic pyogenic abscess negative for acid fast bacilli. She was treated with antituberculous therapy without resolution. She developed a discharging lateral neck mass with progressive increase of the mediastinal mass. She subsequently required a neck exploration and mediastinoscopy. Repeat mediastinal biopsies confirmed the diagnosis of Hodgkin’s disease and no organisms on culture. She was commenced on chemotherapeutic treatment with a satisfactory outcome. PMID:22689859

  4. The surprising outcome of a giant primary mediastinal synovial sarcoma treated with neoadjuvant chemotherapy

    PubMed Central

    Balieiro, Marcos Alexandre; Costa, Bruno Pinheiro; Veras, Gustavo Perissé Moreira; Perelson, Paulo Sergio; Acatauassú Nunes, Rodolfo; Saito, Eduardo Haruo

    2013-01-01

    There are only a few cases of primary mediastinal synovial sarcoma in the literature. Normally, they do not respond well to chemotherapy. In our case, a 30-year-old patient was admitted due to thoracic pain, dyspnea, orthopnea, cough, hoarseness and weight loss over a 3-month period as well as a dramatic worsening a week before the admission. A chest radiography showed a completely white left hemithorax and contralateral mediastinal shift; in addition, a chest tomography revealed a giant heterogeneous mediastinal mass, lung atelectasia and a small pleural effusion. The patient was submitted to Chamberlain procedure (biopsy) under local anesthesia and the diagnosis of a synovial sarcoma was obtained after immunohistochemical analysis. Due to his poor general condition, he received chemotherapy first, with a dramatic response, after what, the mass that had been reduced was removed surgically. After a 5-year- follow-up period there are no signs of disease recurrence. PMID:23372956

  5. The surprising outcome of a giant primary mediastinal synovial sarcoma treated with neoadjuvant chemotherapy.

    PubMed

    Balieiro, Marcos Alexandre; Lopes, Agnaldo José; Costa, Bruno Pinheiro; Veras, Gustavo Perissé Moreira; Perelson, Paulo Sergio; Acatauassú Nunes, Rodolfo; Saito, Eduardo Haruo

    2013-02-01

    There are only a few cases of primary mediastinal synovial sarcoma in the literature. Normally, they do not respond well to chemotherapy. In our case, a 30-year-old patient was admitted due to thoracic pain, dyspnea, orthopnea, cough, hoarseness and weight loss over a 3-month period as well as a dramatic worsening a week before the admission. A chest radiography showed a completely white left hemithorax and contralateral mediastinal shift; in addition, a chest tomography revealed a giant heterogeneous mediastinal mass, lung atelectasia and a small pleural effusion. The patient was submitted to Chamberlain procedure (biopsy) under local anesthesia and the diagnosis of a synovial sarcoma was obtained after immunohistochemical analysis. Due to his poor general condition, he received chemotherapy first, with a dramatic response, after what, the mass that had been reduced was removed surgically. After a 5-year- follow-up period there are no signs of disease recurrence. PMID:23372956

  6. Core needle biopsies and surgical excision biopsies in the diagnosis of lymphoma-experience at the Lymph Node Registry Kiel.

    PubMed

    Johl, Alice; Lengfelder, Eva; Hiddemann, Wolfgang; Klapper, Wolfram

    2016-08-01

    Current guidelines of the European Society of Medical Oncology recommend surgical excision biopsies of lymph nodes for the diagnosis of lymphoma whenever possible. However, core needle biopsies are increasingly used. We aimed to understand the common practice to choose the method of biopsy in Germany. Furthermore, we wanted to understand performance of surgical excision and core needle biopsies of lymph nodes in the diagnosis of lymphoma. The files of 1510 unselected, consecutive lymph node specimens from a consultation center for lymphoma diagnosis were analyzed. Core needle biopsies were obtained frequently from lymph nodes localized in mediastinal, abdominal, retroperitoneal, or thoracic regions. Patients undergoing core needle biopsies were significantly older and suffered significantly more often from lymphoma than patients undergoing surgical excision biopsies. Although more immunohistochemical tests were ordered by the pathologist for core needle biopsies specimens than for surgical excision biopsies specimens, core needle biopsies did not yield a definite diagnosis in 8.3 % of cases, compared to 2.8 % for SEB (p = 0.0003). Restricting the analysis to cases with a final diagnosis of follicular lymphoma or diffuse large B-cell lymphoma, core needle biopsies identified a simultaneous low- and high-grade lymphoma (transformation) in 3.3 % of cases, compared to 7.6 % for surgical excision biopsies (p = 0.2317). In Germany, core needle biopsies are preferentially used in elderly patients with a high likelihood of suffering from lymphoma. Core needle appeared inferior to surgical excision biopsies at providing a definite diagnosis and at identifying multiple lymphoma differentiations and transformation. PMID:27236576

  7. Core needle biopsies and surgical excision biopsies in the diagnosis of lymphoma-experience at the Lymph Node Registry Kiel.

    PubMed

    Johl, Alice; Lengfelder, Eva; Hiddemann, Wolfgang; Klapper, Wolfram

    2016-08-01

    Current guidelines of the European Society of Medical Oncology recommend surgical excision biopsies of lymph nodes for the diagnosis of lymphoma whenever possible. However, core needle biopsies are increasingly used. We aimed to understand the common practice to choose the method of biopsy in Germany. Furthermore, we wanted to understand performance of surgical excision and core needle biopsies of lymph nodes in the diagnosis of lymphoma. The files of 1510 unselected, consecutive lymph node specimens from a consultation center for lymphoma diagnosis were analyzed. Core needle biopsies were obtained frequently from lymph nodes localized in mediastinal, abdominal, retroperitoneal, or thoracic regions. Patients undergoing core needle biopsies were significantly older and suffered significantly more often from lymphoma than patients undergoing surgical excision biopsies. Although more immunohistochemical tests were ordered by the pathologist for core needle biopsies specimens than for surgical excision biopsies specimens, core needle biopsies did not yield a definite diagnosis in 8.3 % of cases, compared to 2.8 % for SEB (p = 0.0003). Restricting the analysis to cases with a final diagnosis of follicular lymphoma or diffuse large B-cell lymphoma, core needle biopsies identified a simultaneous low- and high-grade lymphoma (transformation) in 3.3 % of cases, compared to 7.6 % for surgical excision biopsies (p = 0.2317). In Germany, core needle biopsies are preferentially used in elderly patients with a high likelihood of suffering from lymphoma. Core needle appeared inferior to surgical excision biopsies at providing a definite diagnosis and at identifying multiple lymphoma differentiations and transformation.

  8. Convective diffusion of nanoparticles from the epithelial barrier towards regional lymph nodes

    PubMed Central

    Dukhin, Stanislav S; Labib, Mohamed E.

    2013-01-01

    Drug delivery using nanoparticles as drug carriers has recently attracted the attention of many investigators. Targeted delivery of nanoparticles to lymph nodes is especially important to prevent cancer metastasis or infection, and to diagnose disease stage. However, systemic injection of nanoparticles often results in organ toxicity because they reach and accumulate in all the lymph nodes in the body. An attractive strategy would be to deliver the drug-loaded nanoparticles to a subset of draining lymph nodes corresponding to a specific site or organ to minimize systemic toxicity. In this respect, mucosal delivery of nanoparticles to regional draining lymph nodes of a selected site creates a new opportunity to accomplish this task with minimal toxicity. One example is the delivery of nanoparticles from the vaginal lumen to draining lymph nodes to prevent the transmission of HIV in women. Other known examples include mucosal delivery of vaccines to induce immunity. In all cases, molecular and particle transport by means of diffusion and convective diffusion play a major role. The corresponding transport processes have common inherent regularities and are addressed in this review. Here we use nanoparticles delivery from the vaginal lumen to lymph nodes as an example to address the many aspects of associated transport processes. In this case, nanoparticles penetrate the epithelial barrier and move through the interstitium (tissue) to the initial lymphatics until they finally reach the lymph nodes. Since the movement of interstitial liquid near the epithelial barrier is retarded, nanoparticles transport was found to take place through special foci present in the epithelium. Immediately after nanoparticles emerge from the foci, they move through the interstitium due to diffusion affected by convection (convective diffusion). Specifically, the convective transport of nanoparticles occurs due to their convection together with interstitial fluid through the interstitium

  9. Convective diffusion of nanoparticles from the epithelial barrier toward regional lymph nodes.

    PubMed

    Dukhin, Stanislav S; Labib, Mohamed E

    2013-11-01

    Drug delivery using nanoparticles as drug carriers has recently attracted the attention of many investigators. Targeted delivery of nanoparticles to the lymph nodes is especially important to prevent cancer metastasis or infection, and to diagnose disease stage. However, systemic injection of nanoparticles often results in organ toxicity because they reach and accumulate in all the lymph nodes in the body. An attractive strategy would be to deliver the drug-loaded nanoparticles to a subset of draining lymph nodes corresponding to a specific site or organ to minimize systemic toxicity. In this respect, mucosal delivery of nanoparticles to regional draining lymph nodes of a selected site creates a new opportunity to accomplish this task with minimal toxicity. One example is the delivery of nanoparticles from the vaginal lumen to draining lymph nodes to prevent the transmission of HIV in women. Other known examples include mucosal delivery of vaccines to induce immunity. In all cases, molecular and particle transport by means of diffusion and convective diffusion play a major role. The corresponding transport processes have common inherent regularities and are addressed in this review. Here we use nanoparticle delivery from the vaginal lumen to the lymph nodes as an example to address the many aspects of associated transport processes. In this case, nanoparticles penetrate the epithelial barrier and move through the interstitium (tissue) to the initial lymphatics until they finally reach the lymph nodes. Since the movement of interstitial liquid near the epithelial barrier is retarded, nanoparticle transport was found to take place through special foci present in the epithelium. Immediately after nanoparticles emerge from the foci, they move through the interstitium due to diffusion affected by convection (convective diffusion). Specifically, the convective transport of nanoparticles occurs due to their convection together with interstitial fluid through the

  10. Post-surgical mediastinitis due to carbapenem-resistant Enterobacteriaceae: Clinical, epidemiological and survival characteristics.

    PubMed

    Abboud, C S; Monteiro, J; Stryjewski, M E; Zandonadi, E C; Barbosa, V; Dantas, D; Sousa, E E; Fonseca, M J; Jacobs, D M; Pignatari, A C; Kiffer, C; Rao, G G

    2016-05-01

    Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE), including polymyxin-resistant (PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life-threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE, including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE (PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carried blaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received at least one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higher in patients infected with PR-CRE (17% vs. 53%; P=0.06). In conclusion, mediastinitis due to CRE, including PR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a high mortality, particularly those infected with PR-CRE.

  11. Feline mediastinal lymphoma: a retrospective study of signalment, retroviral status, response to chemotherapy and prognostic indicators.

    PubMed

    Fabrizio, Francesca; Calam, Amy E; Dobson, Jane M; Middleton, Stephanie A; Murphy, Sue; Taylor, Samantha S; Schwartz, Anita; Stell, Anneliese J

    2014-08-01

    Historically, feline mediastinal lymphoma has been associated with young age, positive feline leukaemia virus (FeLV) status, Siamese breed and short survival times. Recent studies following widespread FeLV vaccination in the UK are lacking. The aim of this retrospective multi-institutional study was to re-evaluate the signalment, retroviral status, response to chemotherapy, survival and prognostic indicators in feline mediastinal lymphoma cases in the post-vaccination era. Records of cats with clinical signs associated with a mediastinal mass and cytologically/histologically confirmed lymphoma were reviewed from five UK referral centres (1998-2010). Treatment response, survival and prognostic indicators were assessed in treated cats with follow-up data. Fifty-five cases were reviewed. The median age was 3 years (range, 0.5-12 years); 12 cats (21.8%) were Siamese; and the male to female ratio was 3.2:1.0. Five cats were FeLV-positive and two were feline immunodeficiency-positive. Chemotherapy response and survival was evaluated in 38 cats. Overall response was 94.7%; complete (CR) and partial response (PR) rates did not differ significantly between protocols: COP (cyclophosphamide, vincristine, prednisone) (n = 26, CR 61.5%, PR 34.0%); Madison-Wisconsin (MW) (n = 12, CR 66.7%, PR 25.0%). Overall median survival was 373 days (range, 20-2015 days) (COP 484 days [range, 20-980 days]; MW 211 days [range, 24-2015 days] [P = 0.892]). Cats achieving CR survived longer (980 days vs 42 days for PR; P = 0.032). Age, breed, sex, location (mediastinal vs mediastinal plus other sites), retroviral status and glucocorticoid pretreatment did not affect response or survival. Feline mediastinal lymphoma cases frequently responded to chemotherapy with durable survival times, particularly in cats achieving CR. The prevalence of FeLV-antigenaemic cats was low; males and young Siamese cats appeared to be over-represented.

  12. Identification of Primary Mediastinal Large B-cell Lymphoma at Nonmediastinal Sites by Gene Expression Profiling.

    PubMed

    Yuan, Ji; Wright, George; Rosenwald, Andreas; Steidl, Christian; Gascoyne, Randy D; Connors, Joseph M; Mottok, Anja; Weisenburger, Dennis D; Greiner, Timothy C; Fu, Kai; Smith, Lynette; Rimsza, Lisa M; Jaffe, Elaine S; Campo, Elias; Martinez, Antonio; Delabie, Jan; Braziel, Rita M; Cook, James R; Ott, German; Vose, Julie M; Staudt, Louis M; Chan, Wing C

    2015-10-01

    Mediastinal involvement is considered essential for the diagnosis of primary mediastinal large B-cell lymphoma (PMBL). However, we have observed cases of diffuse large B-cell lymphoma (DLBCL) with features of PMBL but without detectable mediastinal involvement. The goal was to assess our previously established gene expression profiling (GEP) signature for PMBL in classifying these cases. In a large series of DLBCL cases, we identified 24 cases with a GEP signature of PMBL, including 9 cases with a submission diagnosis of DLBCL consistent with PMBL (G-PMBL-P) and 15 cases with a submission diagnosis of DLBCL. The pathology reviewers agreed with the diagnosis in the 9 G-PMBL-P cases. Among the other 15 DLBCL cases, 11 were considered to be PMBL or DLBCL consistent with PMBL, 3 were considered to be DLBCL, and 1 case was a gray-zone lymphoma with features intermediate between DLBCL and classical Hodgkin lymphoma. All 9 G-PMBL-P and 9 of the 15 DLBCL cases (G-PMBL-M) had demonstrated mediastinal involvement at presentation. Interestingly, 6 of the 15 DLBCL cases (G-PMBL-NM) had no clinical or radiologic evidence of mediastinal involvement. The 3 subgroups of PMBL had otherwise similar clinical characteristics, and there were no significant differences in overall survival. Genetic alterations of CIITA and PDL1/2 were detected in 26% and 40% of cases, respectively, including 1 G-PMBL-NM case with gain of PDL1/2. In conclusion, PMBL can present as a nonmediastinal tumor without evidence of mediastinal involvement, and GEP offers a more precise diagnosis of PMBL. PMID:26135560

  13. Post-surgical mediastinitis due to carbapenem-resistant Enterobacteriaceae: Clinical, epidemiological and survival characteristics.

    PubMed

    Abboud, C S; Monteiro, J; Stryjewski, M E; Zandonadi, E C; Barbosa, V; Dantas, D; Sousa, E E; Fonseca, M J; Jacobs, D M; Pignatari, A C; Kiffer, C; Rao, G G

    2016-05-01

    Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE), including polymyxin-resistant (PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life-threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE, including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE (PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carried blaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received at least one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higher in patients infected with PR-CRE (17% vs. 53%; P=0.06). In conclusion, mediastinitis due to CRE, including PR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a high mortality, particularly those infected with PR-CRE. PMID:27155944

  14. Management of descending necrotizing mediastinitis complicated with empyema by video-assisted thoracoscopic surgery.

    PubMed

    Chen, I-Chen; Hsu, Jong-Hau; Dai, Zen-Kong

    2016-05-01

    Descending necrotizing mediastinitis (DNM) is an uncommon disease that can cause significant morbidity and mortality. Herein, we report a 17-month-old girl of DNM with an initial normal chest radiograph followed by rapid clinical deterioration during a period of 4 days, from deep neck infection to mediastinitis and then complicated empyema. She was managed successfully with intravenous antibiotics and surgical debridement by video-assisted thoracic surgery (VATS) and cervical drainage. Early recognition and meticulous intensive care of patients with DNM are important to minimize morbidity and mortality. VATS is an effective and minimally invasive therapeutic strategy in children with DNM. PMID:26716737

  15. Emergent Airway Management of an Uncooperative Child with a Large Retropharyngeal and Posterior Mediastinal Abscess.

    PubMed

    Diep, Jack; Kam, David; Kuenzler, Keith A; Arthur, Jill F

    2016-02-01

    Retropharyngeal abscesses are deep neck space infections that can lead to life-threatening airway emergencies and other catastrophic complications. Retropharyngeal abscesses demand prompt diagnosis and early establishment of a definitive airway when there is airway compromise. This can be difficult in an uncooperative patient. We present the case of a 12-year-old girl with mediastinitis and tracheal compression and anterior displacement from a large retropharyngeal and posterior mediastinal abscess secondary to traumatic esophageal perforation, who received successful awake nasal fiberoptic intubation. Anesthesiologists must be prepared for airway emergencies in uncooperative patients, especially children, but there is controversy concerning the use of sedation. PMID:26599735

  16. Traumatic Rupture of A Posterior Mediastinal Teratoma following Motor-Vehicle Accident.

    PubMed

    Bell, Christopher; Domingo, Fernando; Miller, Ashley D; Smith, Jeremiah S; Headrick, James R

    2016-01-01

    We report a case of a posterior mediastinal mature cystic teratoma with rupture secondary to blunt chest trauma in a 20-year-old male involved in a motor-vehicle accident. Initial treatment was guided by Advanced Trauma Life Support and a tube thoracostomy was performed for presumed hemothorax. The heterogeneous collection within the thoracic cavity was discovered to be the result of a ruptured cystic mass. Pathologic findings confirmed the mass consistent with a mature cystic teratoma. As mediastinal teratomas are most commonly described arising from the anterior mediastinum, the posterior location of the teratoma described in this report is exceedingly rare. PMID:27660731

  17. Candida famata mediastinitis. A rare complication of open heart surgery. Case report and brief review.

    PubMed

    Sanchez Betancourt, Alfredo Alonso; Sibaja Alvarez, Pablo; Camacho, Rolando Arguedas; Guevara Espinoza, Edward

    2016-01-01

    Candida mediastinitis is a rare complication of open heart surgery with high mortality and morbidity usually associated with C. albicans. We are reporting the case of a 57 year old male who after having a triple coronary artery bypass graft procedure, had mediastinitis caused by Candida famata, a yeast, that had only been reported once before as the causal agent of this condition. It is of vital importance, that future cases be reported, due to the fact that both reported cases have led to patient demise. PMID:27419075

  18. Treatment of thoracic hemorrhage due to rupture of traumatic mediastinal hematoma.

    PubMed

    Yu, Hui-Jie; Zhang, Ling-Fang; Cao, Wei-Zhong

    2016-01-01

    Patients in traffic accidents are usually presented with pain and bleeding due to fractures or soft tissue injury. On some occasions, more severe complications may be triggered by the trauma. A review of the published English language literature reveals no survival case once the traumatic mediastinal hematoma is ruptured. In our case, a 54-year-old man suffering motorcycle accident was admitted to emergency department. Computed tomography scan revealed subdural hematoma combined with posterior mediastinal hematoma. The patient was saved and discharged with a satisfactory outcome. Here we hope to share our treatment experience in dealing with the patient with severe multiple trauma. PMID:27033275

  19. Traumatic Rupture of A Posterior Mediastinal Teratoma following Motor-Vehicle Accident

    PubMed Central

    Bell, Christopher; Domingo, Fernando; Smith, Jeremiah S.; Headrick, James R.

    2016-01-01

    We report a case of a posterior mediastinal mature cystic teratoma with rupture secondary to blunt chest trauma in a 20-year-old male involved in a motor-vehicle accident. Initial treatment was guided by Advanced Trauma Life Support and a tube thoracostomy was performed for presumed hemothorax. The heterogeneous collection within the thoracic cavity was discovered to be the result of a ruptured cystic mass. Pathologic findings confirmed the mass consistent with a mature cystic teratoma. As mediastinal teratomas are most commonly described arising from the anterior mediastinum, the posterior location of the teratoma described in this report is exceedingly rare. PMID:27660731

  20. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review.

    PubMed

    van Wingerden, Jan J; Ubbink, Dirk T; van der Horst, Chantal M A M; de Mol, Bas A J M

    2014-01-01

    Early recognition and, where possible, avoidance of risk factors that contribute to the development of poststernotomy mediastinitis (PSM) form the basis for successful prevention. Once the presence of PSM is diagnosed, the known risk factors have been shown to have limited influence on management decisions. Evidence-based knowledge on treatment decisions, which include the extent and type of surgical intervention (other than debridement), timing and others is available but has not yet been incorporated into a classification on management decisions regarding PSM. Ours is a first attempt at developing a classification system for management of PSM, taking the various evidence-based reconstructive options into consideration. The classification is simple to introduce (there are four Types) and relies on the careful establishment of two variables (sternal stability and sternal bone viability and stock) prior to deciding on the best available reconstructive option. It should allow better insight into why treatment decisions fail or have to be altered and will allow better comparison of treatment outcomes between various institutions.

  1. Understanding Prostate Cancer: Newly Diagnosed

    MedlinePlus

    ... Wellness PCF Spotlight Glossary African American Men Understanding Prostate Cancer Newly Diagnosed Newly Diagnosed Staging the Disease Issues ... you care about has recently been diagnosed with prostate cancer, this section will help guide you through the ...

  2. How Are Genetic Conditions Diagnosed?

    MedlinePlus

    ... Consultation How are genetic conditions diagnosed? How are genetic conditions diagnosed? A doctor may suspect a diagnosis ... and advocacy resources. For more information about diagnosing genetic conditions: Genetics Home Reference provides information about genetic ...

  3. Pathobiology of primary mediastinal B-cell lymphoma.

    PubMed

    Pileri, Stefano A; Zinzani, Pier L; Gaidano, Gianluca; Falini, Brunangelo; Gaulard, Philippe; Zucca, Emanuele; Sabattini, Elena; Ascani, Stefano; Rossi, Maura; Cavalli, Franco

    2003-01-01

    Controversy still exists over the response to therapy and prognosis of patients with primary mediastinal B-cell lymphoma (PMBL). Recent data from the International Extranodal Lymphoma Study Group (IELSG) suggest that a MACOP-B (methotrexate, adriamycin, cyclophosphamide, vincristine, prednisone, bleomycin) chemotherapy regimen followed by radiotherapy may be a better induction strategy than other previously used treatments. Although the pathobiology of PMBL has been widely studied, its precise histology, phenotype, and molecular characteristics are still not clear. To date, phenotypic analysis has revealed the following phenotype: positivity for CD45 and CD20, but negativity for CD3, CD10, CD21, Class I/II major histocompatibility antigens, and a variety of other immunohistochemical markers. CD79a is generally detected, despite an absence of surface immunoglobulins (Igs). CD30 staining is observed in most cases, but is weaker and less homogeneous than in classic Hodgkin's lymphoma or anaplastic large cell lymphoma. BCL-2 protein is usually expressed but there are few data describing the expression of MUM1/IRF4, PAX5/BSAP, BCL-6, or the B-cell transcription factors BOB.1, Oct-2, and PU.1. Cytogenetic studies reveal gains in segments of chromosome 9p, including amplification of the REL proto-oncogene and the tyrosine kinase gene JAK2. Other molecular findings include: C-myc mutations or rearrangements, p53 mutations, IgV(H), gene mutations, and bcl-2 and mal over-expression. bcl-6 mutations and bcl-2 gene rearrangements are generally absent, suggesting that PMBL is of pre-germinal center (GC) origin. However, two recent reports show isotype-switched Ig genes with a high frequency of somatic hypermutations as well as variants in the 5' noncoding region of the bcl-6 gene. The IELSG collected 137 PMBL cases for extensive pathologic review. Histologically, the lymphomatous growth was predominantly diffuse with sclerosis that induced compartmentalized cell aggregation. It

  4. Primary mediastinal large B-cell lymphoma, classic Hodgkin lymphoma presenting in the mediastinum, and mediastinal gray zone lymphoma: what is the oncologist to do?

    PubMed

    Grant, Cliona; Dunleavy, Kieron; Eberle, Franziska C; Pittaluga, Stefania; Wilson, Wyndham H; Jaffe, Elaine S

    2011-09-01

    In recent years, an overlap in biologic and clinical features has been identified between classic Hodgkin lymphoma (CHL) and primary mediastinal large B-cell lymphoma (PMBL). Further strengthening this relationship is the identification of lymphomas with clinical and morphologic features transitional between the two, known as gray zone lymphomas (GZL). However, this diagnostic gray zone is not just of theoretical interest: it presents a practical problem, as the treatment approaches for CHL traditionally differ from those for aggressive B-cell lymphomas. This article reviews the treatment approach for mediastinal lymphomas, including CHL of the nodular sclerosis subtype (CHL-NS), PMBL, and mediastinal GZL. Though several trials have evaluated different regimens with or without radiation in PMBL and CHL-NS, there is a lack of prospective experience in treating GZL because of the rarity of these tumors. Historical data indicate that they have done poorly with traditional approaches developed for the treatment of either CHL or diffuse large B-cell lymphoma. PMID:21590365

  5. Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

    PubMed Central

    Lin, Dao-zhe; Qu, Ning; Shi, Rong-liang; Lu, Zhong-wu; Ji, Qing-hai; Wu, Wei-li

    2016-01-01

    The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with

  6. Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma.

    PubMed

    Lin, Dao-Zhe; Qu, Ning; Shi, Rong-Liang; Lu, Zhong-Wu; Ji, Qing-Hai; Wu, Wei-Li

    2016-01-01

    The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with

  7. Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

    PubMed Central

    Lin, Dao-zhe; Qu, Ning; Shi, Rong-liang; Lu, Zhong-wu; Ji, Qing-hai; Wu, Wei-li

    2016-01-01

    The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with

  8. Diagnosing and Managing Violence

    PubMed Central

    2011-01-01

    Available categorization systems for violence encountered in medical practice do not constitute optimal tools to guide management. In this article, 4 common patterns of violence across psychiatric diagnoses are described (defensive, dominance-defining, impulsive, and calculated) and management implications are considered. The phenomenologic and neurobiological rationale for a clinical classification system of violence is also presented. PMID:22295257

  9. Diagnosing ADHD in Adolescence

    ERIC Educational Resources Information Center

    Sibley, Margaret H.; Pelham, William E., Jr.; Molina, Brooke S. G.; Gnagy, Elizabeth M.; Waschbusch, Daniel A.; Garefino, Allison C.; Kuriyan, Aparajita B.; Babinski, Dara E.; Karch, Kathryn M.

    2012-01-01

    Objective: This study examines adolescent-specific practical problems associated with current practice parameters for diagnosing attention-deficit/hyperactivity disorder (ADHD) to inform recommendations for the diagnosis of ADHD in adolescents. Specifically, issues surrounding the use of self- versus informant ratings, diagnostic threshold, and…

  10. Quantification of incidental mediastinal and hilar irradiation delivered during definitive stereotactic body radiation therapy for peripheral non-small cell lung cancer

    SciTech Connect

    Martin, Kate L.; Gomez, Jorge; Nazareth, Daryl P.; Warren, Graham W.; Singh, Anurag K.

    2012-07-01

    To determine the amount of incidental radiation dose received by the mediastinal and hilar nodes for patients with non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Fifty consecutive patients with NSCLC, treated using an SBRT technique, were identified. Of these patients, 38 had a prescription dose of 60 Gy in 20-Gy fractions and were eligible for analysis. For each patient, ipsilateral upper (level 2) and lower (level 4) paratracheal, and hilar (level 10) nodal regions were contoured on the planning computed tomography (CT) images. Using the clinical treatment plan, dose and volume calculations were performed retrospectively for each nodal region. SBRT to upper lobe tumors resulted in an average total ipsilateral mean dose of between 5.2 and 7.8 Gy for the most proximal paratracheal nodal stations (2R and 4R for right upper lobe lesions, 2L and 4L for left upper lobe lesions). SBRT to lower lobe tumors resulted in an average total ipsilateral mean dose of between 15.6 and 21.5 Gy for the most proximal hilar nodal stations (10R for right lower lobe lesions, 10 l for left lower lobe lesions). Doses to more distal nodes were substantially lower than 5 Gy. The often substantial incidental irradiation, delivered during SBRT for peripheral NSCLC of the lower lobes to the most proximal hilar lymph nodes may be therapeutic for low-volume, subclinical nodal disease. Treatment of peripheral upper lobe lung tumors delivers less incidental irradiation to the paratracheal lymph nodes with lower likelihood of therapeutic benefit.

  11. Thoracoscopic resection with intraoperative use of methylene blue to localize mediastinal parathyroid adenomas.

    PubMed

    Adachi, Yoshin; Nakamura, Hiroshige; Taniguchi, Yuji; Miwa, Ken; Fujioka, Shinji; Haruki, Tomohiro

    2012-03-01

    We report a case of thoracoscopic resection of mediastinal parathyroid adenomas using methylene blue to localize the tumors during the operation. After methylene blue 4 mg/kg was injected intravenously, we easily identified methylene blue-stained parathyroid glands and successfully resected them with sufficient surgical margins. The use of methylene blue for detection of parathyroid adenoma is a useful technique.

  12. Accurate localization of supernumerary mediastinal parathyroid adenomas by a combination of structural and functional imaging.

    PubMed

    Mackie, G C; Schlicht, S M

    2004-09-01

    Reoperation for refractory or recurrent hyperparathyroidism following parathyroidectomy carries the potential for increased morbidity and the possibility of failure to localize and remove the lesion intraoperatively. Reported herein are three cases demonstrating the combined use of sestamibi scintigraphy, CT and MR for accurate localization of mediastinal parathyroid adenomas.

  13. Cranial vena cava syndrome secondary to cryptococcal mediastinal granuloma in a cat

    PubMed Central

    Letendre, Jo-Annie; Boysen, Søren

    2015-01-01

    The successful management of cranial vena cava syndrome with suspected secondary chylothorax due to mediastinal cryptococcal granuloma in a 4-year-old male domestic shorthair cat is described. Treatment included long-term antifungal medication, short-term corticosteroids, intermittent thoracocentesis, rutin, octreotide, and enalapril. PMID:25829555

  14. A Case of Descending Necrotizing MediastinitisPenetrating to the Esophagus

    PubMed Central

    Inaba, Yuichiro; Tokano, Hisashi; Ohtsu, Atsushi; Kitamura, Ken

    2010-01-01

    Here, we present the case of a 78-year-old man with a deep neck infection that caused descending necrotizing mediastinitis that extended from the pharynx to the stomach and was accompanied by two large esophageal fistulas and multiple gastric ulcers. We believe that the series of lesions were the signs of a hidden carcinoma. PMID:25648975

  15. Inguinal Lymph Node Anthracosis: A Case Report.

    PubMed

    Biguria, Rafael; Soto, Carlos Alberto

    2016-07-01

    Anthracosis is defined as black, dense pigments in tissues, usually carbon deposits. We, as surgeons, have to make decisions during surgery to the best of our knowledge and based on what the literature provides us. We present the case of a 30-year-old female patient who underwent abdominoplasty. During surgery, bilateral inguinal pigmented and enlarged lymph nodes were seen. Biopsy of the nodes was done to rule out any malignancy. The results showed tattoo pigments on all lymph nodes. We present this case as tattoo pigment migration, which has been rarely described. PMID:27536493

  16. Inguinal Lymph Node Anthracosis: A Case Report

    PubMed Central

    Soto, Carlos Alberto

    2016-01-01

    Summary: Anthracosis is defined as black, dense pigments in tissues, usually carbon deposits. We, as surgeons, have to make decisions during surgery to the best of our knowledge and based on what the literature provides us. We present the case of a 30-year-old female patient who underwent abdominoplasty. During surgery, bilateral inguinal pigmented and enlarged lymph nodes were seen. Biopsy of the nodes was done to rule out any malignancy. The results showed tattoo pigments on all lymph nodes. We present this case as tattoo pigment migration, which has been rarely described. PMID:27536493

  17. Urachal Carcinoma with Choroidal, Lung, Lymph Node, Adrenal, Mammary, and Bone Metastases and Peritoneal Carcinomatosis Showing Partial Response after Chemotherapy Treatment with a Modified Docetaxel, Cisplatin and 5-Fluorouracil Regimen

    PubMed Central

    Dekeister, Kathleen; Viguier, Jean Louis; Martin, Xavier; Nguyen, Anh Minh; Boyle, Helen; Flechon, Aude

    2016-01-01

    Urachal carcinoma (UC) is a rare tumor mainly affecting middle-aged males. Metastases occur most frequently in lymph nodes and the lungs. There are no standard adjuvant and metastatic treatments. We report the case of a 36-year-old female with UC treated with partial cystectomy who relapsed 3 years after surgery with left choroidal, lung, mediastinal lymph node, right adrenal, mammary, and bone metastases as well as peritoneal carcinomatosis. She obtained a partial response after 10 cycles of chemotherapy with a modified docetaxel, cisplatin and 5-fluorouracil (mTPF) regimen. This is the first report on the use of the mTPF regimen in UC and on the existence of choroidal, adrenal, and mammary metastases. PMID:27194981

  18. Dose-Adjusted EPOCH-Rituximab Therapy in Primary Mediastinal B-Cell Lymphoma

    PubMed Central

    Dunleavy, Kieron; Pittaluga, Stefania; Maeda, Lauren S.; Advani, Ranjana; Chen, Clara C.; Hessler, Julie; Steinberg, Seth M.; Grant, Cliona; Wright, George; Varma, Gaurav; Staudt, Louis M.; Jaffe, Elaine S.; Wilson, Wyndham H.

    2015-01-01

    BACKGROUND Primary mediastinal B-cell lymphoma is a distinct subtype of diffuse large-B-cell lymphoma that is closely related to nodular sclerosing Hodgkin’s lymphoma. Patients are usually young and present with large mediastinal masses. There is no standard treatment, but the inadequacy of immunochemotherapy alone has resulted in routine consolidation with mediastinal radiotherapy, which has potentially serious late effects. We aimed to develop a strategy that improves the rate of cure and obviates the need for radiotherapy. METHODS We conducted a single-group, phase 2, prospective study of infusional dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH-R) and filgrastim without radiotherapy in 51 patients with untreated primary mediastinal B-cell lymphoma. We used results from a retrospective study of DA-EPOCH-R from another center to independently verify the outcomes. RESULTS The patients had a median age of 30 years (range, 19 to 52) and a median tumor diameter of 11 cm; 59% were women. During a median of 5 years of follow-up, the event-free survival rate was 93%, and the overall survival rate was 97%. Among the 16 patients who were involved in the retrospective analysis at another center, over a median of 3 years of follow-up, the event-free survival rate was 100%, and no patients received radiotherapy. No late morbidity or cardiac toxic effects were found in any patients. After follow-up ranging from 10 months to 14 years, all but 2 of the 51 patients (4%) who received DA-EPOCH-R alone were in complete remission. The 2 remaining patients received radiotherapy and were disease-free at follow-up. CONCLUSIONS Therapy with DA-EPOCH-R obviated the need for radiotherapy in patients with primary mediastinal B-cell lymphoma. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00001337.) PMID:23574119

  19. Mediastinal transposition of the omentum reduces infection severity and pharmacy cost for patients undergoing esophagectomy

    PubMed Central

    Ye, Peng; Cao, Jin-Lin; Li, Qiu-Yuan; Wang, Zhi-Tian; Yang, Yun-Hai; Lv, Wang

    2016-01-01

    Background The greater omentum has been found to be immunologically competent in protecting abdominal organs from inflammation. Anastomotic omentoplasty has been used and proven effective in preventing anastomotic leaks after an esophagectomy. However, pulmonary complications are still a substantial problem after an esophagectomy. This study investigated the benefits of mediastinal transposition of the omentum, a modification of the conventional omental wrapping technique, in controlling overall postoperative intrathoracic complications. Methods From January 2010 to March 2015, 208 consecutive patients receiving an open Ivor-Lewis esophagectomy at our institution were retrospectively reviewed. One hundred twenty-one patients with omentum mediastinal transposition were assigned to the transposition group and 87 patients without omental transposition were placed in the non-transposition group. The patients’ demographics, postoperative short-term outcomes, and in-hospital cost were documented and analyzed. Results Mediastinal transposition of the omentum led to a shorter postoperative hospital stay (14 vs. 16 d, P=0.038) and a lower intrathoracic infection rate (30.6% vs. 48.3%, P=0.009). Intrathoracic infection was milder in the transposition group (P=0.005), though a non-significant was found in overall complications (P=0.071). The multivariate logistic regression analyses identified omentum mediastinal transposition (P=0.007, OR=0.415) as an independent protective factor for postoperative intrathoracic infection. The total in-hospital cost was comparable in both groups (P>0.05), whereas the pharmacy cost was lower in the transposition group than in the non-transposition group (¥21,668 vs. ¥27,012, P=0.010). Conclusions Mediastinal transposition of the omentum decreases the rate and severity of postoperative intrathoracic infection following an open Ivor-Lewis esophagectomy. This result in decreased pharmacy costs, rather than resulting in an increased economic

  20. Feasibility of thoracoscopic approach for retrosternal goitre (posterior mediastinal goitre): Personal experiences of 11 cases

    PubMed Central

    Bhargav, Panchangam Ramakanth; Amar, Vennapusa; Mahilvayganan, Sabaretnam; Nanganandadevi, Vimala

    2016-01-01

    INTRODUCTION: Posterior mediastinal goitres constitute of a unique surgical thyroid disorder that requires expert management. Occasionally, they require thoracic approach for the completion of thyroidectomy. In this paper, we describe the feasibility and utility of a novel thoracoscopic approach for such goitres. MATERIALS AND METHODS: This is a retrospective study conducted at a tertiary care endocrine surgery department in South India over a period of 5 years from January 2010 to December 2014. We developed a novel thoracoscopic technique for posterior mediastinal goitres instead of a more morbid thoracotomy or sternotomy. All the clinical, investigative, operative, pathological and follow-up data were collected from our prospectively filled database. Statistical analysis was done with SPSS 15.0 version. Descriptive analysis was done. OPERATIVE TECHNIQUE OF THORACOSCOPIC THYROIDECTOMY: Single lumen endotracheal tube (SLETT) was used of anaesthetic intubation and general inhalational anaesthesia. Operative decubitus was supine with extension and abduction of the ipsilateral arm. Access to mediastinum was obtained by two working ports in the third and fifth intercostal spaces. Mediastinal extension was dissected thoracoscopically and delivered cervically. RESULTS: Out of 1,446 surgical goitres operated during the study period, 72 (5%) had retrosternal goitre. Also, 27/72 (37.5%) cases had posterior mediastinal extension (PME), out of which 11 cases required thoracic approach. We utilised thoracoscopic technique for these 11 cases. The post-operative course was uneventful with no major morbidity. There was one case of recurrent laryngeal nerve (RLN) injury and hoarseness of voice in the third case. Histopathologies in 10 cases were benign, out of which two had subclinical hyperthyroidism. One case had multifocal papillary microcarcinoma. CONCLUSIONS: We opine that novel thoracoscopic technique is a feasibly optimal approach for posterior mediastinal goitre

  1. Evaluation of lymph node metastasis in lung cancer: who is the chief justice?

    PubMed

    Xia, Yang; Zhang, Bin; Zhang, Hao; Li, Wen; Wang, Ko-Pen; Shen, Huahao

    2015-12-01

    Accurate determination of the diagnosis and the stage of lung cancer play a critical role to ensure that patients are provided the optimal treatment. However, the process is usually beyond complex. Early studies have suggested lymph nodes (LNs) >1.0 cm in size on computed tomography (CT) are considered as metastatic nodes, while the sensitivity of this criterion is not satisfied. Subsequently, positron emission tomography-computed tomography (PET-CT) was shown to be superior to CT alone on assessment of nodal involvement and was widely used to estimate suitability for resection with curative intent, but the dependability also remains controversial. Furthermore, transbronchial needle aspiration (TBNA) with and without endobronchial ultrasound (EBUS), as a well-accepted minimally invasive approach for LN biopsy, has been documented as an efficient tool in evaluation of CT and PET-CT negative LNs. Additionally, radiographic features including ground-glass/solid nodules ratio, referring as imaging biomarker, were indicated to be correlated with metastasis. Hence, we highlight the importance of comprehensive estimation of mediastinal and hilar LNs, and we suggested the judgment of LNs by radiographic tools alone might not be reliable and TBNA is indispensable in certain circumstances.

  2. Lymph nodes tuberculosis: a retrospective study on clinical and therapeutic features

    PubMed Central

    Benjelloun, Amine; Darouassi, Youssef; Zakaria, Yasser; Bouchentouf, Rachid; Errami, Noureddine

    2015-01-01

    Lymph nodes tuberculosis represents 30 percent of extra pulmonary tuberculosis in Morocco. We report here the experience of the pulmonology unit of the Avicenne Military Hospital in Marrakech for a period of 4 years. Our study interested 30 patients (15 males and 15 females) with an average age of 29 years old (10 to 62 years old). Tuberculosis has interested a single site in 28 patients, the other two patients had multiple but unilateral involvement. For the single sites, locations were jugulo-carotidian (20 patients), supra-calvicular (2 patients), axillary (2 patients), sub-mandibular (2 patients), spinal (2 patients) and mediastinal (2 patients). For the multiple locations, the involvement was jugulo-carotidian, sub-mandibular, spinal and sub-clavicular for one patient; and jugulo-carotidian and sub-clavicular for the other. Diagnosis was made by surgical biopsy and histology for all the patients. A six-month anti-tuberculous treatment was given afterward, with relapses in two patients. PMID:26090023

  3. Evaluation of lymph node metastasis in lung cancer: who is the chief justice?

    PubMed Central

    Xia, Yang; Zhang, Bin; Zhang, Hao; Li, Wen

    2015-01-01

    Accurate determination of the diagnosis and the stage of lung cancer play a critical role to ensure that patients are provided the optimal treatment. However, the process is usually beyond complex. Early studies have suggested lymph nodes (LNs) >1.0 cm in size on computed tomography (CT) are considered as metastatic nodes, while the sensitivity of this criterion is not satisfied. Subsequently, positron emission tomography-computed tomography (PET-CT) was shown to be superior to CT alone on assessment of nodal involvement and was widely used to estimate suitability for resection with curative intent, but the dependability also remains controversial. Furthermore, transbronchial needle aspiration (TBNA) with and without endobronchial ultrasound (EBUS), as a well-accepted minimally invasive approach for LN biopsy, has been documented as an efficient tool in evaluation of CT and PET-CT negative LNs. Additionally, radiographic features including ground-glass/solid nodules ratio, referring as imaging biomarker, were indicated to be correlated with metastasis. Hence, we highlight the importance of comprehensive estimation of mediastinal and hilar LNs, and we suggested the judgment of LNs by radiographic tools alone might not be reliable and TBNA is indispensable in certain circumstances. PMID:26807270

  4. [Role of sentinel lymph nodes and lymphatic mapping of colorectal cancer].

    PubMed

    Ivanov, K; Kolev, N; Ignatov, V; Temelkov, T; Madzhov, R

    2005-01-01

    The accuracy of staging of colorectal cancer is dependable of number of lymph nodes, colected and investegated from the pathologist. Moreover 50% of newfounded cases with colorectal cancer are diagnosed as I or II stage of the desease. Between 15% and 20% of these patients develop regional or distant metastases around 5 years after the examination, despite of the radical surgery. This may be due to pathological "understaging" (decrease of the stage), becouse of missed micrometastases, which size often is smaller than 5 mm. High accurate and specific pathologoanatomical methods for "ultrastaging" are cost-expensive, therefore their selective application to labeled sentinel lymph nodes has a economical benefit and saves a time. Moreover it is decreasing the understaging effect, assosiated with convectional pathologoanatomical investigaton. In the future, the technical progress will develop the intensive competiton between the sentinel lymph node mapping and the improved imaging diagnostic techniques as flurodeoxyglucose (18FDG), positron emision tomography (PET), or the other molecular imaging techniques. Unfortunately, the limited spatial resolution of these techniques, do not allow to be used for tumor staging as sentinel lymph node techniques. Therefore the sentinel lymphnode mapping become the choice of the lymphnode staging technique. PMID:18693514

  5. Imaging of Metastatic Lymph Nodes by X-ray Phase-Contrast Micro-Tomography

    PubMed Central

    Jensen, Torben Haugaard; Bech, Martin; Binderup, Tina; Böttiger, Arvid; David, Christian; Weitkamp, Timm; Zanette, Irene; Reznikova, Elena; Mohr, Jürgen; Rank, Fritz; Feidenhans’l, Robert; Kjær, Andreas; Højgaard, Liselotte; Pfeiffer, Franz

    2013-01-01

    Invasive cancer causes a change in density in the affected tissue, which can be visualized by x-ray phase-contrast tomography. However, the diagnostic value of this method has so far not been investigated in detail. Therefore, the purpose of this study was, in a blinded manner, to investigate whether malignancy could be revealed by non-invasive x-ray phase-contrast tomography in lymph nodes from breast cancer patients. Seventeen formalin-fixed paraffin-embedded lymph nodes from 10 female patients (age range 37–83 years) diagnosed with invasive ductal carcinomas were analyzed by X-ray phase-contrast tomography. Ten lymph nodes had metastatic deposits and 7 were benign. The phase-contrast images were analyzed according to standards for conventional CT images looking for characteristics usually only visible by pathological examinations. Histopathology was used as reference. The result of this study was that the diagnostic sensitivity of the image analysis for detecting malignancy was 100% and the specificity was 87%. The positive predictive value was 91% for detecting malignancy and the negative predictive value was 100%. We conclude that x-ray phase-contrast imaging can accurately detect density variations to obtain information regarding lymph node involvement previously inaccessible with standard absorption x-ray imaging. PMID:23349784

  6. [Lymph node staging in gastrointestinal cancer. Combination of methylene blue-assisted lymph node dissection and ex vivo sentinel lymph node mapping].

    PubMed

    Märkl, B; Arnholdt, H

    2012-11-01

    The histopathological lymph node staging is of crucial importance for the prognosis estimation and therapy stratification in gastrointestinal cancer. However, the recommended numbers of lymph nodes that should be evaluated are often not reached in routine practice. Methylene blue assisted lymph node dissection was introduced as a new, simple and efficient technique to improve lymph node harvest in gastrointestinal cancer. This method is inexpensive, causes no delay and needs no toxic substances. All studies performed revealed a highly significantly improved lymph node harvest in comparison to the conventional technique. Moreover, this technique can be combined with a new ex vivo sentinel lymph node mapping that for the first time is based on histological sentinel lymph node detection. The success rate of this method is similar to conventional techniques and it enables an efficient application of extended investigation methods, such as immunohistochemistry or the polymerase chain reaction.

  7. Lung ventilation contributes to vertical lymph movement in anurans.

    PubMed

    Hedrick, Michael S; Drewes, Robert C; Hillman, Stanley S; Withers, Philip C

    2007-11-01

    Anurans (frogs and toads) generate lymphatic fluid at 10 times the rate in mammals, largely as a consequence of their very 'leaky' vasculature and high interstitial compliance. Lymph is ultimately pumped into the venous system by paired, dorsally located lymph hearts. At present, it is unclear how lymphatic fluid that accumulates in central body subcutaneous lymph sacs is moved to the anterior and posterior lymph hearts in the axillary regions and how lymph is moved, against gravity, to the dorsally located lymph hearts. In this study, we tested the hypothesis that lung ventilation, through its consequent effects on lymph sac pressure, contributes to the vertical movement of lymphatic fluid in the cane toad (Chaunus marinus) and the North American bullfrog (Lithobates catesbeiana). We measured pressure in the dorsal, lateral and subvertebral lymph sacs of anesthetized cane toads and bullfrogs during artificial lung inflation and deflation. We also measured pressure in the subvertebral lymph sac, which adheres to the dorsal surface of the lungs, simultaneously with brachial (forelimb) and pubic (posterior) sac pressure during ventilation in freely behaving animals. There were highly significant (P<0.001) relationships between lung pressure and lymph sac pressures (r(2)=0.19-0.72), indicating that pulmonary pressure is transmitted to the highly compliant lymph sacs that surround the lungs. Subvertebral sac pressure of resting animals was not significantly different between L. catesbeiana (518+/-282 Pa) and C. marinus (459+/-111 Pa). Brachial sac compliance (ml kPa(-1) kg(-1)) also did not differ between the two species (33.6+/-5.0 in L. catesbeiana and 37.0+/-9.4 in C. marinus). During expiration (lung deflation), reductions in expanding subvertebral sac pressure are communicated to the brachial lymph sac. Changes in brachial and pubic lymph sac pressures were correlated almost entirely during expiration rather than inspiration. The change in brachial sac pressure

  8. Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis

    PubMed Central

    Liu, Feng‐Hsuan; Kuo, Sheng‐Fong; Hsueh, Chuen; Chao, Tzu‐Chieh

    2015-01-01

    Background and Objectives : The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis. Methods : The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow‐up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra‐thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis. Results : Compared with the intra‐thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease‐specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow‐up period of 16.9 ± 0.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors. Conclusions : In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra‐thyroid tumor group. J. Surg. Oncol. 2015 111:149–154. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc. PMID:26175314

  9. Small renal tumor with lymph nodal enlargement: A histopathological surprise

    PubMed Central

    Thottathil, Mujeeburahiman; Verma, Ashish; D’souza, Nischith; Khan, Altaf

    2016-01-01

    Renal cancer with lymph nodal mass on the investigation is clinically suggestive of an advanced tumor. Small renal cancers are not commonly associated with lymph nodal metastasis. Association of renal cell carcinoma with renal tuberculosis (TB) in the same kidney is also rare. We report here a case of small renal cancer with multiple hilar and paraaortic lymph nodes who underwent radical nephrectomy, and histopathology report showed renal and lymph nodal TB too. PMID:27453671

  10. New-onset haematoproteinuria in a 63-year-old man with intraperitoneal lymph node enlargement.

    PubMed

    Minakawa, Akihiro; Hisanaga, Shuichi; Sato, Yuji; Fujimoto, Shouichi

    2016-01-01

    A 63-year-old man was referred to our hospital because of renal dysfunction with haematoproteinuria. Intraperitoneal lymph node enlargement was also noted. M protein was not detected by electrophoresis of his serum and urine; however, an increase in the κ/λ ratio was detected by free light-chain assay. Percutaneous kidney biopsy was performed, and the patient was diagnosed with proliferative glomerulonephritis with monoclonal immunoglobulin deposits. Lymph node biopsy showed follicular lymphoma. Urinalysis findings improved after treatment of the lymphoma. Proliferative glomerulonephritis with monoclonal immunoglobulin deposits is rarely considered to be associated with haematological disease. We report a case of lymphoma-associated proliferative glomerulonephritis with monoclonal immunoglobulin deposits with light-chain abnormality detected by free light-chain assay, but not by electrophoresis. PMID:26907822

  11. Lymph flow, lymph protein concentration, and protein output from rat small intestine.

    PubMed

    Lee, J S

    1985-06-01

    Lymph flow (JL), lymph protein concentration (CL), and protein output (JP) from the main intestinal lymph duct were determined. The basal JL from the mesenteric pedicle alone was the same as that from the mesenteric pedicle attached with a segment of the nonabsorbing intestine, indicating that the basal JL does not originate from the intestine but is totally from the region of the mesenteric pedicle. The basal CL was 3.5-3.8 g/100 ml. When the intestine was absorbing water, JL increased and CL decreased, but JP increased above the basal JP in the initial 20 min of water absorption and then decreased progressively with time. Furthermore, it was estimated that CL in the "excess lymph" (formed during water absorption) was 1.4 +/- 0.2 g/100 ml in the initial 10 min of water absorption and was zero or nearly so in the later periods. From this and other evidence, it is concluded that under various conditions without net water absorption rat small intestine does not produce lymph and that during water absorption there is no significant increase in capillary permeability or capillary filtration. Therefore, the excess lymph could be mostly derived from the fluid absorbed from the lumen of the intestine.

  12. Retroperitoneal lymphocele formation after selective laparoscopic retroperitoneal lymph node sampling.

    PubMed

    Goh, M; Kantoff, P; Kavoussi, L R

    1994-06-01

    Laparoscopic retroperitoneal lymph node sampling is being evaluated at several institutions as a minimally invasive alternative to evaluate pathologically retroperitoneal lymph nodes in cases of clinical stage A testis tumor. We report on the development of a symptomatic lymphocele after selective laparoscopic retroperitoneal lymph node sampling.

  13. Thymus and Mediastinal Node Involvement in Childhood Langerhans Cell Histiocytosis: Long-Term Follow-Up From the French National Cohort

    PubMed Central

    Ducassou, Stephane; Seyrig, Fanny; Thomas, Caroline; Lambilliotte, Anne; Marec-Berard, Perrine; Berger, Claire; Plat, Genevieve; Brugiere, Laurence; Ouache, Marie; Barkaoui, Mohamed; Armari-Alla, Corinne; Lutz, Patrick; Leverger, Guy; Rialland, Xavier; Mansuy, Ludovic; Pacquement, Helene; Jeziorski, Eric; Gandemer, Virginie; Chalard, François; Chateil, Jean François; Tazi, Abdellatif; Emile, Jean François; Donadieu, Jean

    2013-01-01

    Background Mediastinal involvement (MI) in Langerhans cell histiocytosis (LCH) has been rarely reported. Here, we describe the clinical, radiological, and biological presentation, and the outcome of childhood LCH with MI. Method From the French LCH register, which includes 1,423 patients aged less than 18 years, we retrieved the medical charts of patients with mediastinal enlargement detected on chest X-rays. Results Thirty-seven patients were retrieved, including 18 males; median age of diagnosis was 0.7 years, and median follow-up time was 6.2 years. The prevalence of MI varied with the age at diagnosis, ranging from 7% below 1 year old to less than 1% at >5 years. Thirteen cases (35%) were diagnosed because of MI-related symptoms, including respiratory distress (N = 4), superior venous cava syndrome (N = 2), and/or cough and polypnea (N = 10). CT scans performed in 32 cases at diagnosis showed tracheal compression (N = 5), cava thrombosis (N = 2), and/or calcification (N = 16). All patients presented multi-system disease at LCH diagnosis, and 35/37 were initially treated with vinblastine and corticosteroids. Death occurred in five cases, due to MI (N = 1) or hematological refractory involvement (N = 4). The overall 5-year survival was 87.1%, and immunodeficiency was not detected as a sequel. Conclusions MI in LCH mainly occurs in young children, and diagnosis was based on CT showing thymus enlargement and calcifications. Pediatr Blood Cancer 2013;60:1759–1765. © 2013 Wiley Periodicals, Inc. PMID:23813854

  14. Rapid diagnosis of lymph node metastasis in breast cancer using a new fluorescent method with γ-glutamyl hydroxymethyl rhodamine green

    PubMed Central

    Shinden, Yoshiaki; Ueo, Hiroki; Tobo, Taro; Gamachi, Ayako; Utou, Mitsuaki; Komatsu, Hisateru; Nambara, Sho; Saito, Tomoko; Ueda, Masami; Hirata, Hidenari; Sakimura, Shotaro; Takano, Yuki; Uchi, Ryutaro; Kurashige, Junji; Akiyoshi, Sayuri; Iguchi, Tomohiro; Eguchi, Hidetoshi; Sugimachi, Keishi; Kubota, Yoko; Kai, Yuichiro; Shibuta, Kenji; Kijima, Yuko; Yoshinaka, Heiji; Natsugoe, Shoji; Mori, Masaki; Maehara, Yoshihiko; Sakabe, Masayo; Kamiya, Mako; Kakareka, John W.; Pohida, Thomas J.; Choyke, Peter L.; Kobayashi, Hisataka; Ueo, Hiroaki; Urano, Yasuteru; Mimori, Koshi

    2016-01-01

    Sentinel lymph node biopsy is performed as a standard procedure in breast cancer surgery, and the development of quick and simple methods to detect metastatic lesions is in high demand. Here, we validated a new fluorescent method using γ-glutamyl hydroxymethyl rhodamine green to diagnose metastatic lymph nodes in breast cancer. One hundred and forty-nine lymph nodes from 38 breast cancer patients were evaluated in this study. Comparison of fluorescent and pathological images showed that this fluorescent method was successful for visualizing breast cancer cells in lymph nodes. This method had a sufficiently high sensitivity (97%), specificity (79%) and negative predictive value (99%) to render it useful for an intraoperative diagnosis of cancer. These preliminary findings suggest that this novel method is useful for distinguishing non-cancerous specimens from those in need of careful examination and could help save time and cost for surgeons and pathologists. PMID:27277343

  15. Comparison of the copy numbers of bovine leukemia virus in the lymph nodes of cattle with enzootic bovine leukosis and cattle with latent infection.

    PubMed

    Somura, Yoshiko; Sugiyama, Emi; Fujikawa, Hiroshi; Murakami, Kenji

    2014-10-01

    To establish a diagnostic index for predicting enzootic bovine leukosis (EBL), proviral bovine leukemia virus (BLV) copies in whole blood, lymph nodes and spleen were examined by quantitative real-time PCR (qPCR). Cattle were divided into two groups, EBL and BLV-infected, based on meat inspection data. The number of BLV copies in all specimens of EBL cattle was significantly higher than those of BLV-infected cattle (p < 0.0001), and the number of BLV copies in the lymph nodes was particularly large. Over 70 % of the superficial cervical, medial iliac and jejunal lymph nodes from EBL cattle had more than 1,000 copies/10 ng DNA, whereas lymph nodes from BLV-infected cattle did not. These findings suggest that the cattle harboring more than 1,000 BLV copies may be diagnosed with EBL.

  16. How Is Cystic Fibrosis Diagnosed?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Cystic Fibrosis Diagnosed? Doctors diagnose cystic fibrosis (CF) based on ... to see whether the baby has CF. Cystic Fibrosis Carrier Testing People who have one normal CFTR ...

  17. How Is Muscular Dystrophy Diagnosed?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How is muscular dystrophy diagnosed? Skip sharing on social media links Share this: Page Content The first step in diagnosing muscular dystrophy (MD) is a visit with a health care ...

  18. How Is Pulmonary Hypertension Diagnosed?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Pulmonary Hypertension Diagnosed? Your doctor will diagnose pulmonary hypertension (PH) ... To Look for the Underlying Cause of Pulmonary Hypertension PH has many causes, so many tests may ...

  19. A new 2.5D representation for lymph node detection using random sets of deep convolutional neural network observations.

    PubMed

    Roth, Holger R; Lu, Le; Seff, Ari; Cherry, Kevin M; Hoffman, Joanne; Wang, Shijun; Liu, Jiamin; Turkbey, Evrim; Summers, Ronald M

    2014-01-01

    Automated Lymph Node (LN) detection is an important clinical diagnostic task but very challenging due to the low contrast of surrounding structures in Computed Tomography (CT) and to their varying sizes, poses, shapes and sparsely distributed locations. State-of-the-art studies show the performance range of 52.9% sensitivity at 3.1 false-positives per volume (FP/vol.), or 60.9% at 6.1 FP/vol. for mediastinal LN, by one-shot boosting on 3D HAAR features. In this paper, we first operate a preliminary candidate generation stage, towards -100% sensitivity at the cost of high FP levels (-40 per patient), to harvest volumes of interest (VOI). Our 2.5D approach consequently decomposes any 3D VOI by resampling 2D reformatted orthogonal views N times, via scale, random translations, and rotations with respect to the VOI centroid coordinates. These random views are then used to train a deep Convolutional Neural Network (CNN) classifier. In testing, the CNN is employed to assign LN probabilities for all N random views that can be simply averaged (as a set) to compute the final classification probability per VOI. We validate the approach on two datasets: 90 CT volumes with 388 mediastinal LNs and 86 patients with 595 abdominal LNs. We achieve sensitivities of 70%/83% at 3 FP/vol. and 84%/90% at 6 FP/vol. in mediastinum and abdomen respectively, which drastically improves over the previous state-of-the-art work.

  20. [Particular features of lymph dissection in operations for gastric cancer].

    PubMed

    Iaitskiĭ, A N; Danilov, I N

    2008-01-01

    In order to optimize the technique of lymph dissection, a method of intraoperative mapping of lymph outflow tracts was used with a lymphotropic dye Blue patente V. It allowed better orientation during lymphodissection in operations for gastric cancer. The detection and investigation of the "signal" lymph node as the most probable object of lymphogenic metastazing can improve the accuracy of postoperative staging of gastric cancer. Visualization of the lymph nodes in the preparation made it possible to increase the number of lymph nodes sent for histological investigation. PMID:18522180

  1. [Particular features of lymph dissection in operations for gastric cancer].

    PubMed

    Iaitskiĭ, A N; Danilov, I N

    2008-01-01

    In order to optimize the technique of lymph dissection, a method of intraoperative mapping of lymph outflow tracts was used with a lymphotropic dye Blue patente V. It allowed better orientation during lymphodissection in operations for gastric cancer. The detection and investigation of the "signal" lymph node as the most probable object of lymphogenic metastazing can improve the accuracy of postoperative staging of gastric cancer. Visualization of the lymph nodes in the preparation made it possible to increase the number of lymph nodes sent for histological investigation.

  2. Facial, Cervical, and Mediastinal Emphysema of the Clarinet Player: Case Report

    PubMed Central

    Biçer, Yusuf Özgür; Kesgin, Selcan; Tezcan, Erkan; Köybaşı, Serap

    2014-01-01

    Background: Cervicofacial emphysema may arise due to the leakage of air from a defect in the aerodigestive tract to the fascial layers of neck and face. Rarely, it may be caused by insufflation of air through the Stensen’s duct. Case Report: We present a case with diffuse facial, cervical and mediastinal emphysema due to playing a wind instrument immediately after a facial trauma. There was no mucosal defect or laceration noticed by examination which could explain the origin of the emphysema. Despite the widespread cervicofacial emphysema with mediastinal involvement, the patient significantly improved within 48 hours without any intervention. Conclusion: Even though cervicofacial emphysema ameliorates spontaneously, increased care must be taken, especially when there is pneumomediastinum and/or pneumothorax. PMID:25667794

  3. Late cardiac effect of radiation therapy on a young woman with mediastinal Hodgkin's lymphoma.

    PubMed

    Kodama, Ken; Takami, Hiroshi; Izumi, Masahiro; Hiramoto, Yoshimune; Yoshida, Kyotaro; Nishioka, Kiyonori; Higashiyama, Masahiko

    2016-01-01

    We experienced an excision of the mediastinal tumor located in left anterior mediastinum found in a 21-year-old woman. The histologic diagnosis of Hodgkin's lymphoma was obtained. After operation, she was treated with mantle field radiotherapy (total 42 Gy) followed by chemotherapy. At 43-year old, she developed constrictive pericarditis and heart failure resulted in the late cardiac effects of mediastinal irradiation. Despite pericardiectomy followed by medical treatment, her cardiac symptoms gradually worsened and she died at 51-year old. At autopsy, her heart was smaller than normal person. The residual pericardium and the surface of the myocardium had fibrous degeneration with tight adhesion and thickness that were dominant at the right atrium and ventricle. Likewise, we demonstrated that pericardiectomy scarcely led to a favorable outcome in this patient. These facts might be based on the radiation-associated cardiac effects involving any components of the cardiac structure. PMID:24852447

  4. A Case of Mediastinal Granular Cell Tumor with Horner’s Syndrome

    PubMed Central

    Shikatani, Yoshinobu; Sakao, Nobuhiko; Yukumi, Shungo; Shigematsu, Hisayuki; Kitazawa, Sohei; Sano, Yoshifumi

    2015-01-01

    Granular cell tumor (GCT) is found in various organs but is rare in the mediastinum. We report a case of mediastinal GCT in a 19-year-old woman who presented with left ptosis and miosis. CT and MRI revealed a 29-mm well-circumscribed tumor located close to the first thoracic vertebra with features suggesting a neurogenic tumor. The tumor was completely excised using single-port video-assisted thoracoscopic surgery. Histopathological and immunohistochemical analysis revealed that the tumor was a benign GCT. Postoperatively, left ptosis and miosis had improved slightly. To our knowledge, this is the first report regarding mediastinal GCT presenting with preoperative Horner’s syndrome. PMID:26041255

  5. Best approach for posterior mediastinal goiter removal: transcervical incision and lateral thoracotomy.

    PubMed

    Ojanguren Arranz, Amaya; Baena Fustegueras, Juan Antonio; Ros López, Susana; Santamaría Gómez, Maite; Ojanguren Arranz, Iñigo; Olsina Kissle, Jorge Juan

    2014-06-01

    Surgical removal of intrathoracic goiter can be performed by a cervical approach in the majority of patients. Review of literature shows that experienced surgeons need to perform an extracervical approach in 2-3% of cases. In spite of surgical management of substernal goiter is well defined, there is little available information about surgical approach of intrathoracic goiters extending beyond the aortic arch into the posterior mediastinum. We report two cases and propose combination of cervical incision and muscle-sparing lateral thoracotomy for posterior mediastinal goiter removal. In such cases, we do not favour sternotomy as posterior mediastinum is inaccessible due to the presence of heart and great vessels anterior to the thyroidal mass that would lead to perform a perilous blind dissection. Based in our experience, transcervical and thoracotomy approach is indicated for a complete and safe posterior mediastinal goiter removal.

  6. Diverticula in association with the proximal left subclavian artery: a cause of mediastinal mass lesions.

    PubMed

    Stanford, W; Knauf, D G; Hudson, R E; Tucker, A R

    1979-01-01

    The case reports of 5 patients with an aortic arch diverticulum associated with the proximal left subclavian artery are presented. In 3 patients, the left subclavian artery arose from a diverticulum off a right aortic arch and traversed the retroesophageal area to the opposite arm. In 1 patient, the left subclavian artery arose from a diverticulum off a left aortic arch; this represents the second instance of this anomaly to be reported in the literature. In 1 patient, the left subclavian artery was not attached to the aorta, and a diverticulum was present in the expected area of attachment. Confusion of these anomalies with solid mediastinal mass lesions and with aortic aneurysms may occur. Treatment is predicted on symptomatology, and resection is usually not indicated. It is necessary to remain cognizant of aortic diverticula and to differentiate them from other mediastinal mass lesions.

  7. Diagnosable structured logic array

    NASA Technical Reports Server (NTRS)

    Whitaker, Sterling (Inventor); Miles, Lowell (Inventor); Gambles, Jody (Inventor); Maki, Gary K. (Inventor)

    2009-01-01

    A diagnosable structured logic array and associated process is provided. A base cell structure is provided comprising a logic unit comprising a plurality of input nodes, a plurality of selection nodes, and an output node, a plurality of switches coupled to the selection nodes, where the switches comprises a plurality of input lines, a selection line and an output line, a memory cell coupled to the output node, and a test address bus and a program control bus coupled to the plurality of input lines and the selection line of the plurality of switches. A state on each of the plurality of input nodes is verifiably loaded and read from the memory cell. A trusted memory block is provided. The associated process is provided for testing and verifying a plurality of truth table inputs of the logic unit.

  8. A fatal case of descending necrotizing mediastinitis as a complication of odontogenic infection. A case report

    PubMed Central

    Lewandowski, Bogumił; Wołek, Wojciech; Jednakiewicz, Mariusz; Nicpoń, Jakub

    2014-01-01

    This paper presents the case of a 26-year-old female patient in whom descending necrotizing mediastinitis (DNM) developed as a complication of an odontogenic purulent infection of the mouth. Despite the efforts of a multidisciplinary treatment team, the patient died with symptoms of septic shock and multiple organ failure. According to the literature, and as confirmed by our own observations, successful treatment requires early tomographic diagnosis, radical surgery, combination antibiotic therapy, and intensive care. PMID:26336443

  9. [Anterior Mediastinal Bronchogenic Cyst Associated with paroxysmal supraventricular tachycardia ; Report of a Case].

    PubMed

    Mega, Seiji

    2015-09-01

    We experienced a rare case of anterior mediastinal bronchogenic cyst. A 55-year-old female was admitted to our hospital because of paroxysmal supraventricular tachycardia (PSVT) and an abnormal shadow on the chest computed tomography. She had a 5.5 cm tumor at anterior mediastinum. The tumor was surgically removed completely by video assisted thoracoscopic surgery, and the diagnosis of bronchogenic cyst was established pathologically. After surgery, PSVT has disappeared.

  10. [Aspergillus fumigatus mediastinitis in an immunocompetent pediatric patient after heart surgery].

    PubMed

    Acuña, Mirta; Farfán, Felipe; Cofré, Fernanda; Benadof, Dona

    2016-02-01

    Postsurgical aspergillosis occurs primarily in immunocompetent patients whose main predisposing factor is the loss of skin and mucosal integrity during surgery. Local infection tends to be destructive and refractory to treatment and relapses are common. It is important to consider aspergillosis in the differential diagnosis of slowly progressive and destructive surgical site infections with negative bacterial cultures. We present the case of a child who developed Aspergillus fumigatus mediastinitis months after heart surgery.

  11. Incidentally Detected Mediastinal Vascular Anatomical Variants on PET-CT: A Pictorial Essay.

    PubMed

    Paidipati, Kathyayini Gopalkrishna Murthy; Kashyap, Raghava; Tadimeti, Hima; Peyyeti, Mahidhar

    2015-01-01

    Positron emission tomography with computed tomography (PET-CT) is an integral part of oncology practice in the current-day scenario. The hybrid anatomical and metabolic imaging information in this imaging modality provides access to a wealth of incidental findings which can have implications in the management of the patient, especially when surgical options are being considered. In this pictorial essay, we present incidentally detected mediastinal vascular anomalies on PET-CT, along with a review of associated literature.

  12. Clinical Significance of Serum Biomarkers in Pediatric Solid Mediastinal and Abdominal Tumors

    PubMed Central

    Sandoval, John A.; Malkas, Linda H.; Hickey, Robert J.

    2012-01-01

    Childhood cancer is the leading cause of death by disease among U.S. children between infancy and age 15. Despite successes in treating solid tumors such as Wilms tumor, disappointments in the outcomes of high-risk solid tumors like neuroblastoma have precipitated efforts towards the early and accurate detection of these malignancies. This review summarizes available solid tumor serum biomarkers with a special focus on mediastinal and abdominal cancers in children. PMID:22312308

  13. Thoracoscopic resection of middle mediastinal noninvasive thymoma: report of a case.

    PubMed

    Nakamura, Hiroshige; Adachi, Yoshin; Fujioka, Shinji; Miwa, Ken; Haruki, Tomohiro; Taniguchi, Yuji

    2007-01-01

    We performed thoracoscopic resection of a middle mediastinal noninvasive thymoma in a 69-year-old woman. Chest computed tomography on admission showed a tumor, 75 x 48 x 32 mm in size, and pathological examination revealed a spindle-cell, noninvasive thymoma, of type A according to the World Health Organization classification, and stage I according to the Masaoka staging system. Thymomas are prone to ectopic occurrence, and should be considered in the differential diagnosis of middle mediastinum tumors. PMID:17713734

  14. Post extubation negative pressure pulmonary edema due to posterior mediastinal cyst in an infant.

    PubMed

    Dubey, Prakash Kumar

    2014-01-01

    A 3-month-old male child underwent uneventful inguinal herniotomy under general anesthesia. After extubation, airway obstruction followed by pulmonary edema appeared for which the baby was reintubated and ventilated. The baby made a complete recovery and extubated after about 2 h. A post-operative computed tomography scan revealed a posterior mediastinal cystic mass abutting the tracheal bifurcation. Presumably, extrinsic compression by the mass on the tracheal bifurcation led to the development of negative pressure pulmonary edema.

  15. Concurrent Myelomatous Pleural Effusion and Extramedullary Mediastinal Involvement as an Initial Manifestation of Multiple Myeloma.

    PubMed

    Williams, George; Kadaria, Dipen; Sodhi, Amik

    2016-01-01

    BACKGROUND Myelomatous pleural effusion (MPE) is a rare occurrence in patients with multiple myeloma (MM). Fewer than 20 cases of MPE have been reported as an initial manifestation of MM. Extramedullary plasmacytoma (EMP) occurs in fewer than 5% patients with MM, and mediastinal EMP is even rarer, with only about 80 cases reported in the literature. We present a case study involving a patient with concurrent MPE and mediastinal EMP as an initial manifestation of MM. CASE REPORT The patient was a 74-year-old nonsmoking female with a 3-month history of exertional dyspnea and back pain. On exam, the patient was afebrile (temperature 37.2°C), blood pressure was 160/74 mm Hg, heart rate was 92 bpm, respiratory rate was 22/min, and oxygen saturation was 87% on room air. Patient was in mild distress and had decreased breath sounds over right lung fields about halfway up with dullness to percussion. Computed tomography of the chest showed a moderate-sized right pleural effusion and an anterior mediastinal mass. Thoracentesis showed a lymphocyte-predominant exudate. Cytology showed numerous plasma cells including immature forms. Stains for CD138 were positive, confirming plasma cell origin of cells. The anterior mediastinal mass was also biopsied and showed diffuse infiltrate of lymphocytes with plasma cell features that were also positive for CD138. Systemic protein electrophoresis showed a monoclonal immunoglobulin G kappa spike, and bone marrow biopsy was consistent with MM. CONCLUSIONS MPE and EMP are extremely rare manifestations in MM. In addition, it is extremely rare for these to be the presenting features of MM. We report concurrently occurring MPE and EMP in a patient as her initial manifestation of MM. PMID:27396960

  16. Incidentally Detected Mediastinal Vascular Anatomical Variants on PET-CT: A Pictorial Essay

    PubMed Central

    Paidipati, Kathyayini Gopalkrishna Murthy; Kashyap, Raghava; Tadimeti, Hima; Peyyeti, Mahidhar

    2015-01-01

    Positron emission tomography with computed tomography (PET–CT) is an integral part of oncology practice in the current-day scenario. The hybrid anatomical and metabolic imaging information in this imaging modality provides access to a wealth of incidental findings which can have implications in the management of the patient, especially when surgical options are being considered. In this pictorial essay, we present incidentally detected mediastinal vascular anomalies on PET–CT, along with a review of associated literature. PMID:25883859

  17. Concurrent Myelomatous Pleural Effusion and Extramedullary Mediastinal Involvement as an Initial Manifestation of Multiple Myeloma

    PubMed Central

    Williams, George; Kadaria, Dipen; Sodhi, Amik

    2016-01-01

    Patient: Female, 72 Final Diagnosis: Myelomatous pleural effusion Symptoms: Dyspnea Medication: — Clinical Procedure: Thoracentesis Specialty: Pulmonology Objective: Rare disease Background: Myelomatous pleural effusion (MPE) is a rare occurrence in patients with multiple myeloma (MM). Fewer than 20 cases of MPE have been reported as an initial manifestation of MM. Extramedullary plasmacytoma (EMP) occurs in fewer than 5% patients with MM, and mediastinal EMP is even rarer, with only about 80 cases reported in the literature. We present a case study involving a patient with concurrent MPE and mediastinal EMP as an initial manifestation of MM. Case Report: The patient was a 74-year-old nonsmoking female with a 3-month history of exertional dyspnea and back pain. On exam, the patient was afebrile (temperature 37.2°C), blood pressure was 160/74 mm Hg, heart rate was 92 bpm, respiratory rate was 22/min, and oxygen saturation was 87% on room air. Patient was in mild distress and had decreased breath sounds over right lung fields about halfway up with dullness to percussion. Computed tomography of the chest showed a moderate-sized right pleural effusion and an anterior mediastinal mass. Thoracentesis showed a lymphocyte-predominant exudate. Cytology showed numerous plasma cells including immature forms. Stains for CD138 were positive, confirming plasma cell origin of cells. The anterior mediastinal mass was also biopsied and showed diffuse infiltrate of lymphocytes with plasma cell features that were also positive for CD138. Systemic protein electrophoresis showed a monoclonal immunoglobulin G kappa spike, and bone marrow biopsy was consistent with MM. Conclusions: MPE and EMP are extremely rare manifestations in MM. In addition, it is extremely rare for these to be the presenting features of MM. We report concurrently occurring MPE and EMP in a patient as her initial manifestation of MM. PMID:27396960

  18. High-frequency Ultrasound Imaging of Mouse Cervical Lymph Nodes

    PubMed Central

    Weed, Scott A.

    2015-01-01

    High-frequency ultrasound (HFUS) is widely employed as a non-invasive method for imaging internal anatomic structures in experimental small animal systems. HFUS has the ability to detect structures as small as 30 µm, a property that has been utilized for visualizing superficial lymph nodes in rodents in brightness (B)-mode. Combining power Doppler with B-mode imaging allows for measuring circulatory blood flow within lymph nodes and other organs. While HFUS has been utilized for lymph node imaging in a number of mouse  model systems, a detailed protocol describing HFUS imaging and characterization of the cervical lymph nodes in mice has not been reported. Here, we show that HFUS can be adapted to detect and characterize cervical lymph nodes in mice. Combined B-mode and power Doppler imaging can be used to detect increases in blood flow in immunologically-enlarged cervical nodes. We also describe the use of B-mode imaging to conduct fine needle biopsies of cervical lymph nodes to retrieve lymph tissue for histological  analysis. Finally, software-aided steps are described to calculate changes in lymph node volume and to visualize changes in lymph node morphology following image reconstruction. The ability to visually monitor changes in cervical lymph node biology over time provides a simple and powerful technique for the non-invasive monitoring of cervical lymph node alterations in preclinical mouse models of oral cavity disease. PMID:26274059

  19. High-frequency Ultrasound Imaging of Mouse Cervical Lymph Nodes.

    PubMed

    Walk, Elyse L; McLaughlin, Sarah L; Weed, Scott A

    2015-01-01

    High-frequency ultrasound (HFUS) is widely employed as a non-invasive method for imaging internal anatomic structures in experimental small animal systems. HFUS has the ability to detect structures as small as 30 µm, a property that has been utilized for visualizing superficial lymph nodes in rodents in brightness (B)-mode. Combining power Doppler with B-mode imaging allows for measuring circulatory blood flow within lymph nodes and other organs. While HFUS has been utilized for lymph node imaging in a number of mouse  model systems, a detailed protocol describing HFUS imaging and characterization of the cervical lymph nodes in mice has not been reported. Here, we show that HFUS can be adapted to detect and characterize cervical lymph nodes in mice. Combined B-mode and power Doppler imaging can be used to detect increases in blood flow in immunologically-enlarged cervical nodes. We also describe the use of B-mode imaging to conduct fine needle biopsies of cervical lymph nodes to retrieve lymph tissue for histological  analysis. Finally, software-aided steps are described to calculate changes in lymph node volume and to visualize changes in lymph node morphology following image reconstruction. The ability to visually monitor changes in cervical lymph node biology over time provides a simple and powerful technique for the non-invasive monitoring of cervical lymph node alterations in preclinical mouse models of oral cavity disease. PMID:26274059

  20. The Lymph Self-Antigen Repertoire

    PubMed Central

    Clement, Cristina C.; Santambrogio, Laura

    2013-01-01

    The lymphatic fluid originates from the interstitial fluid which bathes every parenchymal organ and reflects the “omic” composition of the tissue from which it originates in its physiological or pathological signature. Several recent proteomic analyses have mapped the proteome-degradome and peptidome of this immunologically relevant fluid pointing to the lymph as an important source of tissue-derived self-antigens. A vast array of lymph-circulating peptides have been mapped deriving from a variety of processing pathways including caspases, cathepsins, MMPs, ADAMs, kallikreins, calpains, and granzymes, among others. These self peptides can be directly loaded on circulatory dendritic cells and expand the self-antigenic repertoire available for central and peripheral tolerance. PMID:24379811

  1. Anatomic Distribution of Fluorodeoxyglucose-Avid Para-aortic Lymph Nodes in Patients With Cervical Cancer

    SciTech Connect

    Takiar, Vinita; Fontanilla, Hiral P.; Eifel, Patricia J.; Jhingran, Anuja; Kelly, Patrick; Iyer, Revathy B.; Levenback, Charles F.; Zhang, Yongbin; Dong, Lei; Klopp, Ann

    2013-03-15

    Purpose: Conformal treatment of para-aortic lymph nodes (PAN) in cervical cancer allows dose escalation and reduces normal tissue toxicity. Currently, data documenting the precise location of involved PAN are lacking. We define the spatial distribution of this high-risk nodal volume by analyzing fluorodeoxyglucose (FDG)-avid lymph nodes (LNs) on positron emission tomography/computed tomography (PET/CT) scans in patients with cervical cancer. Methods and Materials: We identified 72 PANs on pretreatment PET/CT of 30 patients with newly diagnosed stage IB-IVA cervical cancer treated with definitive chemoradiation. LNs were classified as left-lateral para-aortic (LPA), aortocaval (AC), or right paracaval (RPC). Distances from the LN center to the closest vessel and adjacent vertebral body were calculated. Using deformable image registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution. Results: We identified 72 PET-positive para-aortic lymph nodes (37 LPA, 32 AC, 3 RPC). All RPC lymph nodes were in the inferior third of the para-aortic region. The mean distance from aorta for all lymph nodes was 8.3 mm (range, 3-17 mm), and from the inferior vena cava was 5.6 mm (range, 2-10 mm). Of the 72 lymph nodes, 60% were in the inferior third, 36% were in the middle third, and 4% were in the upper third of the para-aortic region. In all, 29 of 30 patients also had FDG-avid pelvic lymph nodes. Conclusions: A total of 96% of PET positive nodes were adjacent to the aorta; PET positive nodes to the right of the IVC were rare and were all located distally, within 3 cm of the aortic bifurcation. Our findings suggest that circumferential margins around the vessels do not accurately define the nodal region at risk. Instead, the anatomical extent of the nodal basin should be contoured on each axial image to provide optimal coverage of the para-aortic nodal compartment.

  2. Lymph formation, composition and circulation: a proteomics perspective.

    PubMed

    Hansen, Kirk C; D'Alessandro, Angelo; Clement, Cristina C; Santambrogio, Laura

    2015-05-01

    During the last 20 years a deeper understanding of the lymphatic circulatory system, lymph formation and composition has emerged. This review will examine the current knowledge on the organization of the lymphatic vascular tree, the formation of lymph from the extracellular fluid, lymph circulation and the lymph proteomic composition during physiological and pathological conditions. Formation of the lymph fluid is dependent on pressure gradients in the capillary beds and the composition of the endothelial cell glycocalyx, which acts as a molecular sieve. Fluid propulsion toward the draining node is dependent on the intrinsic pumping mechanism of the lymphangions and their unidirectional valves. The lymph 'omics' composition is dependent on the ultrafiltration of plasma proteins as well as proteins and molecules derived from the metabolic and catabolic activities of each parenchymal organ from which the lymph drains. Altogether, these new insights have brought about a new awareness of the importance of the lymphatic system in human physiology and pathology.

  3. Sentinel Lymph Node Biopsy in Colon Cancer

    PubMed Central

    Bembenek, Andreas E.; Rosenberg, Robert; Wagler, Elke; Gretschel, Stephan; Sendler, Andreas; Siewert, Joerg-Ruediger; Nährig, Jörg; Witzigmann, Helmut; Hauss, Johann; Knorr, Christian; Dimmler, Arno; Gröne, Jörn; Buhr, Heinz-Johannes; Haier, Jörg; Herbst, Hermann; Tepel, Juergen; Siphos, Bence; Kleespies, Axel; Koenigsrainer, Alfred; Stoecklein, Nikolas H.; Horstmann, Olaf; Grützmann, Robert; Imdahl, Andreas; Svoboda, Daniel; Wittekind, Christian; Schneider, Wolfgang; Wernecke, Klaus-Dieter; Schlag, Peter M.

    2007-01-01

    Introduction: The clinical impact of sentinel lymph node biopsy (SLNB) in colon cancer is still controversial. The purpose of this prospective multicenter trial was to evaluate its clinical value to predict the nodal status and identify factors that influence these results. Methods: Colon cancer patients without prior colorectal surgery or irradiation were eligible. The sentinel lymph node (SLN) was identified intraoperatively by subserosal blue dye injection around the tumor. The SLN underwent step sections and immunohistochemistry (IHC), if classified free of metastases after routine hematoxylin and eosin examination. Results: At least one SLN (median, n = 2) was identified in 268 of 315 enrolled patients (detection rate, 85%). Center experience, lymphovascular invasion, body mass index (BMI), and learning curve were positively associated with the detection rate. The false-negative rate to identify pN+ patients by SLNB was 46% (38 of 82). BMI showed a significant association to the false-negative rate (P < 0.0001), the number of tumor-involved lymph nodes was inversely associated. If only slim patients (BMI ≤24) were investigated in experienced centers (>22 patients enrolled), the sensitivity increased to 88% (14 of 16). Moreover, 21% (30 of 141) of the patients, classified as pN0 by routine histopathology, revealed micrometastases or isolated tumor cells (MM/ITC) in the SLN. Conclusions: The contribution of SLNB to conventional nodal staging of colon cancer patients is still unspecified. Technical problems have to be resolved before a definite conclusion can be drawn in this regard. However, SLNB identifies about one fourth of stage II patients to reveal MM/ITC in lymph nodes. Further studies must clarify the clinical impact of these findings in terms of prognosis and the indication of adjuvant therapy. PMID:17522509

  4. Rationale for and Preliminary Results of Proton Beam Therapy for Mediastinal Lymphoma

    SciTech Connect

    Li Jing; Dabaja, Bouthaina; Reed, Valerie; Allen, Pamela K.; Cai, Haihong; Amin, Mayankkumar V.; Garcia, John A.; Cox, James D.

    2011-09-01

    Purpose: To evaluate the potential of three-dimensional proton beam therapy (3D-PBT) for reducing doses to normal structures in patients with mediastinal lymphomas compared with conventional photon radiation therapy (RT). Methods and Materials: We treated 10 consecutive patients with mediastinal masses from lymphomas with 3D-PBT between July 2007 and February 2009 to 30.6-50.4 cobalt-Gray equivalents (CGE). Of those patients, 7 had primary refractory or recurrent disease, and 8 had Hodgkin lymphoma. Dosimetric endpoints were compared with those from conventional RT plans. Results: PBT delivered lower mean doses to the lung (6.2 vs. 9.5 Gy), esophagus (9.5 vs. 22.3 Gy), and heart (8.8 vs. 17.7 Gy) but not the breasts (5.9 vs. 6.1 Gy) than did conventional RT. Percentages of lung, esophagus, heart, and coronary artery (particularly the left anterior descending artery) volumes receiving radiation were consistently lower in the 3D-PBT plans over a wide range of radiation doses. Of the 7 patients who had residual disease on positron emission tomography before PBT, 6 (86%) showed a complete metabolic response. Conclusions: In patients with mediastinal lymphomas, 3D-PBT produced significantly lower doses to the lung, esophagus, heart, and coronary arteries than did the current conventional RT. These lower doses would be expected to reduce the risk of late toxicities in these major organs.

  5. An unusual recurrent bilateral posterior mediastinal goiter after subtotal thyroidectomy: Case report

    PubMed Central

    Aziret, Mehmet; Topçuoğlu, Mehmet Şah; Özçelik, Cemal; Özkaya, Muharrem

    2014-01-01

    INTRODUCTION Surgical treatment of benign thyroid diseases need to be followed up closely, since recurrent thyroid nodules can be seen after subtotal thyroidectomy. Intrathoracic goiter (ITG) occurs in 10–30% of patients following subtotal thyroidectomy. In general these goiters are benign, having a malignant rate of only 2–22%. ITG grows slowly but steadily and in its process of development, it narrows the thoracic inlet by compressing the surrounding structures. Most of these can not located in the anterior mediastinum, others located in posterior retrovascular area. Bilateral posterior retrovascular goiters are very rare. PRESENTATION OF CASE We report a case involving a 61-year-old woman with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. She had undergone bilateral thyroid lobectomy for a cervical goiter 10 years ago. The mass was removed successfully via median sternotomy without complication. The patient recovered well and was discharged in 1 week. DISCUSSION Most anterior mediastinal goiters can be resected through a transcervical approach, but if those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy. CONCLUSION Bilateral recurrent posterior mediastinal and retrovascular large goiters are better resected via sternotomy rather than lateral thoracotomy. The reason for that are the possibility of injury to large vascular structures and the difficulty of their management through lateral thoracotomy when cardiopulmonary bypass needed. PMID:24973529

  6. Total mechanical stapled oesophagogastric anastomosis on the neck in oesophageal cancer - prevention of postoperative mediastinal complications.

    PubMed

    Zieliński, Jacek; Jaworski, Radosław; Irga-Jaworska, Ninela; Haponiuk, Ireneusz; Jaśkiewicz, Janusz

    2015-12-01

    Oesophagogastric anastomosis after oesophagus resection is commonly performed on the neck. Even though a few different techniques of oesophagogastric anastomosis have been previously detailed, both manual and mechanical procedures have been burdened with leakages and strictures. Our simple technique of oesophagogastric anastomosis is a modification of mechanical anastomosis with the use of a circular stapler in order to prevent postoperative leak and concomitant mediastinal complications. Since 2008, we have performed nine oesophagogastric anastomoses following oesophagus resection. The mean age of the operated patients was 54 years. There was no mortality among the operated patients in the early post-operative period. The mean follow-up period for the patients operated on in our department was 17 months until the time of the analysis. None of the patients showed any leakage or stricture, and no mediastinal complications were reported in the group. Following our own experience, mechanical anastomosis with the use of a circular stapler seems to decrease the time of the operation as well as significantly reducing the incidence of leakages from the anastomosis. This type of anastomosis may decrease the number of postoperative strictures and the most dangerous mediastinal infections.

  7. Complete atrioventricular block following mediastinal irradiation: A report of six cases

    SciTech Connect

    Slama, M.S.; Le Guludec, D.; Sebag, C.; Leenhardt, A.R.; Davy, J.M.; Pellerin, D.E.; Drieu, L.H.; Victor, J.; Brechenmacher, C.; Motte, G. )

    1991-07-01

    Complete atrioventricular block (AVB) following radiotherapy has been reported rarely, usually after high dose mediastinal irradiation for Hodgkin's disease or lung or breast carcinoma. The authors report six new cases of episodic complete infranodal AVB, requiring permanent pacemaker implantation. The mean age was 48-years old (ranging from 25-60) at the first Adams Stokes attack, mean delay was 12 years after irradiation (10-18), and mean radiation dose was 5,200 rads (4,000-6,500). All patients had abnormal interval electrocardiograms (right bundle branch block in two, left bundle branch block in three, alternating left and right bundle branch block in one). Electrocardiograms during the episode of AVB or Holter recordings were consistent with infranodal block in all patients; electrophysiological study performed in five patients confirmed infranodal AVB in four, and one was normal. Pericardial disease was constant, which included pericardial constriction in four patients. Two patients died after failure of pericardiectomy to improve congestive heart failure, due to epicardial, myocardial, and endocardial involvement. Noncardiac mediastinal lesions were present in four cases. Since this delayed complication may occur in patients of such age that the relation between the AVB and the chest irradiation is questionable, they propose the following etiologic criteria; high radiation dose (over 4,000 rads); delay of 10 years or more; abnormal interval tracings; pericardial involvement; and associated cardiac or mediastinal radiation-induced lesions.

  8. Proposal for a recovery prediction method for patients affected by acute mediastinitis

    PubMed Central

    2012-01-01

    Background An attempt to find a prediction method of death risk in patients affected by acute mediastinitis. There is not such a tool described in available literature for that serious disease. Methods The study comprised 44 consecutive cases of acute mediastinitis. General anamnesis and biochemical data were included. Factor analysis was used to extract the risk characteristic for the patients. The most valuable results were obtained for 8 parameters which were selected for further statistical analysis (all collected during few hours after admission). Three factors reached Eigenvalue >1. Clinical explanations of these combined statistical factors are: Factor1 - proteinic status (serum total protein, albumin, and hemoglobin level), Factor2 - inflammatory status (white blood cells, CRP, procalcitonin), and Factor3 - general risk (age, number of coexisting diseases). Threshold values of prediction factors were estimated by means of statistical analysis (factor analysis, Statgraphics Centurion XVI). Results The final prediction result for the patients is constructed as simultaneous evaluation of all factor scores. High probability of death should be predicted if factor 1 value decreases with simultaneous increase of factors 2 and 3. The diagnostic power of the proposed method was revealed to be high [sensitivity =90%, specificity =64%], for Factor1 [SNC = 87%, SPC = 79%]; for Factor2 [SNC = 87%, SPC = 50%] and for Factor3 [SNC = 73%, SPC = 71%]. Conclusion The proposed prediction method seems a useful emergency signal during acute mediastinitis control in affected patients. PMID:22574625

  9. Gray zone lymphoma: better treated like hodgkin lymphoma or mediastinal large B-cell lymphoma?

    PubMed

    Dunleavy, Kieron; Grant, Cliona; Eberle, Franziska C; Pittaluga, Stefania; Jaffe, Elaine S; Wilson, Wyndham H

    2012-09-01

    Although primary mediastinal large B-cell lymphoma (PMBL) and classic Hodgkin lymphoma of the nodular sclerosis type (CHL-NS) are distinct diseases, they share several clinical characteristics and biologic features. Given that, it is not surprising that there exist mediastinal lymphomas that do not fit well into either category but have clinical and morphologic features overlapping and transitional between PMBL and CHL-NS. The term mediastinal gray zone lymphoma (MGZL) has been used for these tumors, which are included in the World Health Organization classification as "B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classic Hodgkin lymphoma." Although several studies have evaluated different therapeutic strategies in PMBL and CHL-NS, there is a paucity of prospective experience treating MGZL, given its rarity and relatively recent recognition. Historically, diseases that today would be categorized as MGZL were probably called "anaplastic large-cell lymphoma Hodgkin-like," and their outcome with standard approaches was poor, with short overall survivals. In this review-following a discussion of the biology and clinical features of MGZL, and how they compare to PMBL and CHL-NS-we outline how the treatment of PMBL and CHL-NS has evolved in recent years, and how we believe MGZL should be approached therapeutically. PMID:22833351

  10. Primary malignant mediastinal germ cell tumours: improved prognosis with platinum-based chemotherapy and surgery.

    PubMed Central

    Childs, W. J.; Goldstraw, P.; Nicholls, J. E.; Dearnaley, D. P.; Horwich, A.

    1993-01-01

    A retrospective analysis was performed of 18 patients with primary malignant germ cell tumours of the mediastinum treated with platinum-based chemotherapy between 1977 and 1990. All seven patients with pure seminoma were treated initially with chemotherapy and four of these patients received additional mediastinal radiotherapy. Only one patient relapsed; his initial therapy had included radiotherapy and single-agent carboplatin and he was successfully salvaged with combination chemotherapy. With a follow-up of 11 to 117 months (median 41 months) all seven patients with seminoma remain alive and disease free giving an overall survival of 100%. Eleven patients had malignant non seminoma; following chemotherapy eight of these had elective surgical resection of residual mediastinal masses. Complete remission was achieved in nine (82%) patients, however, one of these patients died from bleomycin pneumonitis. With a follow-up of 12 to 113 months (median 55 months) eight of 11 (73%) patients with malignant mediastinal teratoma remain alive and disease free. PMID:8494705

  11. Sentinel lymph node biopsy in breast cancer

    PubMed Central

    Alsaif, Abdulaziz A.

    2015-01-01

    Objectives: To report our experience in sentinel lymph node biopsy (SLNB) in early breast cancer. Methods: This is a retrospective study conducted at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between January 2005 and December 2014. There were 120 patients who underwent SLNB with frozen section examination. Data collected included the characteristics of patients, index tumor, and sentinel node (SN), SLNB results, axillary recurrence rate and SLNB morbidity. Results: There were 120 patients who had 123 cancers. Sentinel node was identified in 117 patients having 120 tumors (97.6% success rate). No SN was found intraoperatively in 3 patients. Frozen section results showed that 95 patients were SN negative, those patients had no immediate axillary lymph node dissection (ALND), whereas 25 patients were SN positive and subsequently had immediate ALND. Upon further examination of the 95 negative SN’s by hematoxylin & eosin (H&E) and immunohistochemical staining for doubtful H&E cases, 10 turned out to have micrometastases (6 had delayed ALND and 4 had no further axillary surgery). Median follow up of patients was 35.5 months and the mean was 38.8 months. There was one axillary recurrence observed in the SN negative group. The morbidity of SLNB was minimal. Conclusion: The obtainable results from our local experience in SLNB in breast cancer, concur with that seen in published similar literature in particular the axillary failure rate. Sentinel lymph node biopsy resulted in minimal morbidity. PMID:26318461

  12. The lymph node in chronic lymphocytic leukemia.

    PubMed

    Dick, F R; Maca, R D

    1978-01-01

    Lymph nodes were examined from 41 cases of typical chronic lymphocytic leukemia (CLL). Degree of immaturity was graded as absent to minimal (Grade I), moderate (Grade II) and marked (Grade III). A moderate degree of immaturity was found in the lymph node in 14 of 41 cases even though the cells seen on the initial bone marrow and peripheral blood smears obtained from these patients were essentially all mature. The morphology of these nodes could be confused with poorly differentiated lymphocytic or mixed lymphocytic-histiocytic lymphoma in terms of the degree of immaturity present. A marked degree of immaturity present. A marked degree of immaturity was found in 5 cases; the morphology of these cases resembled histiocytic lymphoma. In the remaining 22 cases immaturity was essentially absent. The morphology of these cases was similar to that of diffuse well differentiated lymphocytic lymphoma. Our studies suggest that a moderate degree of immaturity in the lymph node of patients with CLL does not indicate that these patients will have a marked shortening of their survival. PMID:580071

  13. Sentinel Lymph Nodes for Breast Carcinoma A Paradigm Shift

    PubMed Central

    Maguire, Aoife; Brogi, Edi

    2016-01-01

    Context Sentinel lymph node biopsy has been established as the new standard of care for axillary staging in most patients with invasive breast carcinoma. Historically, all patients with a positive sentinel lymph node biopsy result underwent axillary lymph node dissection. Recent trials show that axillary lymph node dissection can be safely omitted in women with clinically node negative, T1 or T2 invasive breast cancer treated with breast-conserving surgery and whole-breast radiotherapy. This change in practice also has implications on the pathologic examination and reporting of sentinel lymph nodes. Objective To review recent clinical and pathologic studies of sentinel lymph nodes and explore how these findings influence the pathologic evaluation of sentinel lymph nodes. Data Sources Sources were published articles from peer-reviewed journals in PubMed (US National Library of Medicine) and published guidelines from the American Joint Committee on Cancer, the Union for International Cancer Control, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network. Conclusions The main goal of sentinel lymph node examination should be to detect all macrometastases (>2 mm). Grossly sectioning sentinel lymph nodes at 2-mm intervals and evaluation of one hematoxylin-eosin–stained section from each block is the preferred method of pathologic evaluation. Axillary lymph node dissection can be safely omitted in clinically node-negative patients with negative sentinel lymph nodes, as well as in a selected group of patients with limited sentinel lymph node involvement. The pathologic features of the primary carcinoma and its sentinel lymph node metastases contribute to estimate the extent of non–sentinel lymph node involvement. This information is important to decide on further axillary treatment. PMID:27472237

  14. Lymph node revealing solution: a new method for lymph node sampling: results in gastric adenocarcinoma.

    PubMed

    Koren, R; Kyzer, S; Levin, I; Klein, B; Halpern, M; Rath-Wolfson, L; Paz, A; Melloul, M M; Mishali, M; Gal, R

    1998-01-01

    Staging of gastric carcinoma depends on exact lymph node status. However, very small nodes are not easily found as they are obscured by the surrounding adipose tissue. The purpose of the present study was to demonstrate the usefulness of a Olymph node revealing solutionO (LNRS) in gastric cancer. The perigastric adipose tissue of ten OproblematicO cases of gastric carcinoma, in which <10 lymph nodes were found using the traditional method, was immersed in LNRS for 6-12 h. Subsequently, the lymph nodes stood out as white chalky nodules. They were excised and processed routinely. The traditional method yielded a total of 30 lymph nodes with a mean size of 6.69 +/- 3.43 mm. The LNRS revealed 89 additional nodes with a mean size of 3.03 +/- 3.43 mm, which was significantly smaller. The Node (N) stage was changed in four cases from Nx to N0, in one case from N1 to N2, and in one case from N0 to N2. LNRS seems to be the technique of choice for staging of patients with gastric adenocarcinoma in whom <10 lymph nodes were found with the traditional method and accurate staging was not possible. PMID:9468553

  15. Mediastinal ectopic benign colloid goitre detected using iodine-131 whole body scintigraphy and single-photon emission computed tomography-computed tomography.

    PubMed

    Kamaleshwaran, Koramadai Karuppusamy; Rajan, Firoz; Asokumar, Premkumar; Mohanan, Vyshak; Shinto, Ajit Sugunan

    2015-01-01

    Ectopic thyroid tissue primarily occurs along the course of the embryologic migration of the thyroid gland. Mediastinal thyroid may be differentiated into primary and secondary form. Primary mediastinal goiters are quite rare, occurring in <1% of all goiters. We present findings of 29-year-old female, case of papillary carcinoma of the thyroid who underwent iodine-131 whole body scintigraphy after total thyroidectomy showed a primary mediastinal mass lesion along with residual thyroid. She underwent mediastinal mass excision through sternotomy and biopsy confirmed as ectopic nodular colloid goiter with no malignancy.

  16. Mediastinal ectopic benign colloid goitre detected using iodine-131 whole body scintigraphy and single-photon emission computed tomography-computed tomography

    PubMed Central

    Kamaleshwaran, Koramadai Karuppusamy; Rajan, Firoz; Asokumar, Premkumar; Mohanan, Vyshak; Shinto, Ajit Sugunan

    2015-01-01

    Ectopic thyroid tissue primarily occurs along the course of the embryologic migration of the thyroid gland. Mediastinal thyroid may be differentiated into primary and secondary form. Primary mediastinal goiters are quite rare, occurring in <1% of all goiters. We present findings of 29-year-old female, case of papillary carcinoma of the thyroid who underwent iodine-131 whole body scintigraphy after total thyroidectomy showed a primary mediastinal mass lesion along with residual thyroid. She underwent mediastinal mass excision through sternotomy and biopsy confirmed as ectopic nodular colloid goiter with no malignancy. PMID:25829745

  17. Lymph node metastasis and lymph vascular space invasion in microinvasive squamous cell carcinoma of the uterine cervix.

    PubMed

    Lee, K B M; Lee, J M; Park, C Y; Lee, K B; Cho, H Y; Ha, S Y

    2006-01-01

    The objective of this study was to determine whether the depth of invasion was related to lymph vascular space invasion (LVSI) and lymph node metastasis and whether there was a correlation between LVSI and lymph node metastasis in stage IA cervical cancer. The medical records, including surgical notes and pathologic reports, of 202 patients with microinvasive squamous cell carcinoma of the uterine cervix were reviewed retrospectively. There was a positive correlation between the depth of invasion and the LVSI, and the incidence of lymph node metastasis was slightly higher than those reported hitherto for stage IA1 cervical cancer, especially in the depth of invasion of 1-3 mm group. However, among four patients with lymph node metastasis, only two patients had positive LVSI. There was no definite correlation between LVSI and lymph node metastasis. LVSI could not identify the patients with high risk for lymph node metastasis.

  18. [Anaphylactic shock after injection of patent blue for sentinel lymph node biopsy].

    PubMed

    van der Horst, J C; de Bock, M J; Klinkenbijl, J H

    2001-10-27

    After being diagnosed with a melanoma, an 18-year-old woman developed anaphylactic shock following an intracutaneous injection of patent blue during a sentinel lymph node biopsy procedure. Intracutaneous allergy tests revealed positive reactions with patent blue (Bleu patenté V 'Guerbet') as well as with several anaesthetics and morphine. It was concluded that patent blue was the most probable causative agent for the anaphylactic reaction and that the possibility of such a reaction should be taken into consideration during sentinel node procedures. After a few days the operation was completed under epidural anaesthesia with technetium Tc 99m sulphur colloid being used to detect the sentinel node. PMID:11715597

  19. [Anaphylactic shock after injection of patent blue for sentinel lymph node biopsy].

    PubMed

    van der Horst, J C; de Bock, M J; Klinkenbijl, J H

    2001-10-27

    After being diagnosed with a melanoma, an 18-year-old woman developed anaphylactic shock following an intracutaneous injection of patent blue during a sentinel lymph node biopsy procedure. Intracutaneous allergy tests revealed positive reactions with patent blue (Bleu patenté V 'Guerbet') as well as with several anaesthetics and morphine. It was concluded that patent blue was the most probable causative agent for the anaphylactic reaction and that the possibility of such a reaction should be taken into consideration during sentinel node procedures. After a few days the operation was completed under epidural anaesthesia with technetium Tc 99m sulphur colloid being used to detect the sentinel node.

  20. A rare case of secretory breast carcinoma in a male adult with axillary lymph node metastasis.

    PubMed

    Ding, Jinhua; Jiang, Li; Gan, Yongli; Wu, Weizhu

    2015-01-01

    Secretory breast carcinoma is a rare tumor originally described in children but occurring equally in adult population, especially in women. This unusual subtype has a generally favorable prognosis, although several cases have been described in adults with increased aggressiveness and a risk of metastases even death. So far, merely ten cases of secretory breast carcinoma with metastatic axillary lymph node in male were reported. Here, we describe the eleventh case, a 24-years-old male who presented with a painless mass in the right breast was diagnosed to be "secretary breast carcinoma", and subsequently underwent modified radical mastectomy and adjuvant chemotherapy.

  1. The Effect of Extent of Surgery and Number of Lymph Node Metastases on Overall Survival in Patients with Medullary Thyroid Cancer

    PubMed Central

    Hughes, David T.; Yin, Huiying; Banerjee, Mousumi; Haymart, Megan R.

    2014-01-01

    Context: Total thyroidectomy with central lymph node dissection is recommended in patients with medullary thyroid cancer (MTC). However, the relationship between disease severity and extent of resection on overall survival remains unknown. Objective: The aim of the study was to identify the effect of surgery on overall survival in MTC patients. Methods: Using data from 2968 patients with MTC diagnosed between 1998 and 2005 from the National Cancer Database, we determined the relationship between the number of cervical lymph node metastases, tumor size, distant metastases, and extent of surgery on overall survival in patients with MTC. Results: Older patient age (5.69 [95% CI, 3.34–9.72]), larger tumor size (2.89 [95% CI, 2.14–3.90]), presence of distant metastases (5.68 [95% CI, 4.61–6.99]), and number of positive regional lymph nodes (for ≥16 lymph nodes, 3.40 [95% CI, 2.41–4.79]) were independently associated with decreased survival. Overall survival rate for patients with cervical lymph nodes resected and negative, cervical lymph nodes not resected, and 1–5, 6–10, 11–16, and ≥16 cervical lymph node metastases was 90, 76, 74, 61, 69, and 55%, respectively. There was no difference in survival based on surgical intervention in patients with tumor size ≤ 2 cm without distant metastases. In patients with tumor size > 2.0 cm and no distant metastases, all surgical treatments resulted in a significant improvement in survival compared to no surgery (P < .001). In patients with distant metastases, only total thyroidectomy with regional lymph node resection resulted in a significant improvement in survival (P < .001). Conclusions: The number of lymph node metastases should be incorporated into MTC staging. The extent of surgery in patients with MTC should be tailored to tumor size and distant metastases. PMID:24276457

  2. [A Case of Cystic Cervical Lymph Node Metastasis of HPV-positive Tonsil Cancer, Being Discriminated as the Branchiogenic Carcinoma].

    PubMed

    Kambara, Rumi; Tamai, Masamitsu; Horii, Arata

    2016-02-01

    In recent years, human papillomavirus (HPV)-positive oropharyngeal carcinomas have been increasing. The first manifestation of these tumors is frequently as cystic metastasis to cervical lymph nodes that may precede recognition of the primary tumor, so, they often result in misdiagnosis as branchial cleft cysts. We report a case of cystic cervical lymph node metastasis of HPV-positive tonsil cancer. The patient was a 70-years-old man who noticed a mass on his left neck. The tumor was large and soft, and it was diagnosed as benign in fine-needle aspiration cytology. We diagnosed the tumor as a branchial cleft cyst and undertook surgery. The histopathological diagnosis was squamous cell carcinoma arising from a branchiogenic cyst. However, because it did not satisfy the diagnostic criteria, we diagnosed the tumor as an unknown primary tumor. One year later, left tonsil cancer was suspected based on PET-CT imaging and a left tonsillectomy was undertaken, whereafter tonsil cancer was found. In p16 immunostaining, it was positive in both cystic mass and tonsil. The cervical mass was cystic lymph node metastasis of HPV-positive tonsil cancer. It is important to investigate the oropharynx, when we found cystic cervical mass, because HPV-positive oropharyngeal carcinoma frequently results in cystic neck metastasis.

  3. Diagnosing mucopolysaccharidosis IVA.

    PubMed

    Wood, Timothy C; Harvey, Katie; Beck, Michael; Burin, Maira Graeff; Chien, Yin-Hsiu; Church, Heather J; D'Almeida, Vânia; van Diggelen, Otto P; Fietz, Michael; Giugliani, Roberto; Harmatz, Paul; Hawley, Sara M; Hwu, Wuh-Liang; Ketteridge, David; Lukacs, Zoltan; Miller, Nicole; Pasquali, Marzia; Schenone, Andrea; Thompson, Jerry N; Tylee, Karen; Yu, Chunli; Hendriksz, Christian J

    2013-03-01

    Mucopolysaccharidosis IVA (MPS IVA; Morquio A syndrome) is an autosomal recessive lysosomal storage disorder resulting from a deficiency of N-acetylgalactosamine-6-sulfate sulfatase (GALNS) activity. Diagnosis can be challenging and requires agreement of clinical, radiographic, and laboratory findings. A group of biochemical genetics laboratory directors and clinicians involved in the diagnosis of MPS IVA, convened by BioMarin Pharmaceutical Inc., met to develop recommendations for diagnosis. The following conclusions were reached. Due to the wide variation and subtleties of radiographic findings, imaging of multiple body regions is recommended. Urinary glycosaminoglycan analysis is particularly problematic for MPS IVA and it is strongly recommended to proceed to enzyme activity testing even if urine appears normal when there is clinical suspicion of MPS IVA. Enzyme activity testing of GALNS is essential in diagnosing MPS IVA. Additional analyses to confirm sample integrity and rule out MPS IVB, multiple sulfatase deficiency, and mucolipidoses types II/III are critical as part of enzyme activity testing. Leukocytes or cultured dermal fibroblasts are strongly recommended for enzyme activity testing to confirm screening results. Molecular testing may also be used to confirm the diagnosis in many patients. However, two known or probable causative mutations may not be identified in all cases of MPS IVA. A diagnostic testing algorithm is presented which attempts to streamline this complex testing process.

  4. Diagnosing pulmonary embolism

    PubMed Central

    Riedel, M

    2004-01-01

    Objective testing for pulmonary embolism is necessary, because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious. No single test has ideal properties (100% sensitivity and specificity, no risk, low cost). Pulmonary angiography is regarded as the final arbiter but is ill suited for diagnosing a disease present in only a third of patients in whom it is suspected. Some tests are good for confirmation and some for exclusion of embolism; others are able to do both but are often non-diagnostic. For optimal efficiency, choice of the initial test should be guided by clinical assessment of the likelihood of embolism and by patient characteristics that may influence test accuracy. Standardised clinical estimates can be used to give a pre-test probability to assess, after appropriate objective testing, the post-test probability of embolism. Multidetector computed tomography can replace both scintigraphy and angiography for the exclusion and diagnosis of this disease and should now be considered the central imaging investigation in suspected pulmonary embolism. PMID:15192162

  5. Intraoperative fluorescence imaging to localize tumors and sentinel lymph nodes in rectal cancer.

    PubMed

    Handgraaf, Henricus J M; Boogerd, Leonora S F; Verbeek, Floris P R; Tummers, Quirijn R J G; Hardwick, James C H; Baeten, Coen I M; Frangioni, John V; van de Velde, Cornelis J H; Vahrmeijer, Alexander L

    2016-01-01

    Tumor involvement at the resection margin remains the most important predictor for local recurrence in patients with rectal cancer. A careful description of tumor localization is therefore essential. Currently, endoscopic tattooing with ink is customary, but visibility during laparoscopic resections is limited. Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) could be an improvement. In addition to localize tumors, ICG can also be used to identify sentinel lymph nodes (SLNs). The feasibility of this new technique was explored in five patients undergoing laparoscopic low anterior resection for rectal cancer. Intraoperative tumor visualization was possible in four out of five patients. Fluorescence signal could be detected 32 ± 18 minutes after incision, while ink could be detected 42 ± 21 minutes after incision (p = 0.53). No recurrence was diagnosed within three months after surgery. Ex vivo imaging identified a mean of 4.2 ± 2.7 fluorescent lymph nodes, which were appointed SLNs. One out of a total of 83 resected lymph nodes contained a micrometastasis. This node was not fluorescent. This technical note describes the feasibility of endoscopic tattooing of rectal cancer using ICG:nanocolloid and NIR fluorescence imaging during laparoscopic resection. Simultaneous SLN mapping was also feasible, but may be less reliable due to neoadjuvant therapy.

  6. Diagnostic assessment of enlarged superficial lymph nodes by fine needle aspiration.

    PubMed

    Pilotti, S; Di Palma, S; Alasio, L; Bartoli, C; Rilke, F

    1993-01-01

    Two hundred eighty-five consecutive outpatients with enlarged superficial lymph node either clinically suspicious (152) or with a previous diagnosis of a malignant tumor (133) underwent fine needle aspiration (FNA) followed by excisional biopsy. Cytologic and/or cytologic-immunophenotypic diagnoses made on direct smears were compared with subsequent histologic findings. The comparison demonstrated (1) a high rate of conclusive cytologic diagnoses in the assessment of metastatic malignancies, with an overall accuracy rate of 99.1% and a typing accuracy rate of 96.5%; (2) a high rate of conclusive diagnoses in the assessment of high grade non-Hodgkin's lymphomas and Hodgkin's disease, with the exception of the lymphocytic predominance variant of the latter; and (3) significant limitations in the assessment of low grade non-Hodgkin's lymphomas because of the high rate of false-negative diagnoses in cases with a substantial nonmalignant cell component. This was particularly evident in follicular centroblastic-centrocytic lymphomas. Immunocytochemistry appeared to be of limited value in the distinction between centroblastic-centrocytic follicular lymphomas and reactive follicular hyperplasia. The results confirmed the diagnostic value of fine needle aspiration as the first step in the workup of patients with nodal enlargement suspicious for malignancy. In the area of low grade non-Hodgkin's lymphomas, morphologic and immunocytochemical methods need to be supplemented by molecular techniques in order to achieve conclusive diagnoses.

  7. Lymph node revealing solution: a new method for detection of minute axillary lymph nodes in breast cancer specimens.

    PubMed

    Koren, R; Kyzer, S; Paz, A; Veltman, V; Klein, B; Gal, R

    1997-11-01

    The staging and prognosis of patients with breast cancer is related to the presence or absence of axillary lymph node involvement. However, in some cases no lymph nodes or too small a number of lymph nodes are revealed by the traditional method of palpating and sectioning the axillary fat. In the present study we demonstrate the usefulness of the lymph node revealing solution (LNRS) in breast cancer. Specimens from 13 patients, in whom <10 lymph nodes were identified in the axilla by the traditional method, were included in the study. After excising the lymph nodes by the traditional method, axillary tissue was immersed in LNRS for 6-12 hours. Additional lymph nodes, which stood out as white chalky nodules, were excised and processed as usual. The LNRS increased the mean number of nodes per case from 6.0+/-2.5 found by the traditional method to 12.54+/-4.61 nodes per case (p < 0.01). The size of the nodes identified by the LNRS was significantly smaller (p < 0.01) than those detected by the traditional method. The LNRS changed the lymph node stage of the disease in four of the studied cases (30%). LNRS seems to be the technique of choice for detection of axillary lymph nodes in cases where the number of detected lymph nodes by the traditional method is too small for accurate staging. PMID:9351579

  8. Alternative staging of regional lymph nodes in gastric cancer

    PubMed Central

    Szczepanik, Antoni M.; Paszko, Agata; Szura, Miroslaw; Scully-Horner, Thecla; Kulig, Jan

    2016-01-01

    The TNM pN stage based on the number of metastatic lymph nodes is an independent prognostic factor in gastric cancer. Many studies have highlighted the phenomenon of stage migration and problems in comparing groups of patients with different numbers of total lymph nodes harvested within TNM staging. The current version of UICC/AJCC and JGCA TNM classifications postulates a minimal number of 16 lymph nodes as the base for N stage determination. Alternative systems such as lymph node ratio (LNR), positive to negative lymph node ratio (PNLNR), and LOGODDS (or LODDS), were implemented to increase the quality of LN assessment. These methods have reached the background in the literature, but to date no standard approach according to the cut-offs for the stages has been implemented. LOGODDS is the method that most reflects the number of harvested lymph nodes. The rationale for alternative staging methods, their correlations, and limitations are presented. PMID:27713774

  9. Mediastinitis after cardiac surgery: improvement of bacteriological diagnosis by use of multiple tissue samples and strain typing.

    PubMed

    Tammelin, Ann; Hambraeus, Anna; Ståhle, Elisabeth

    2002-08-01

    The diagnosis of postsurgical mediastinitis (PSM) among patients with sternal wound complication (SWC) after cardiac surgery is sometimes difficult, as fever, elevated C-reactive protein levels, and chest pain can be caused by a general inflammatory reaction to the operative trauma and/or sternal dehiscence without infection. The definitions of PSM usually used emphasize clinical signs and symptoms easily observed by the surgeon. The aim of the study was to investigate whether the use of standardized multiple tissue sampling, optimal culturing methods, and strain typing, together with a microbiological criterion for infection, could identify more infected patients than clinical assessment alone. Patients reexplored due to SWC after cardiac artery bypass grafting (CABG) or heart valve replacement (HVR) with or without CABG performed at the Department for Cardio-Thoracic Surgery at the Uppsala University Hospital between 10 March 1998 and 9 September 2000 were investigated prospectively. Tissue samples were taken from the sternum or adjacent mediastinal tissue, preferably before the administration of antibiotics. Culturing was performed both directly (on agar plates) and using enrichment broth. Species identification was performed by standard methods, and strain typing was performed by pulsed-field gel electrophoresis. A total of 41 cases with at least five tissue samples each were included in the study group. Of these patients, 32 were infected according to the microbiological criterion (i.e., the same strain was found in >/=50% of the samples). Staphylococcus epidermidis was the primary pathogen in 38% of the cases (12/32), S. aureus was the primary pathogen in 31% (10/32), P. acnes was the primary pathogen in 25% (8/32), and S. simulans and S. haemolyticus were the primary pathogens in 3% (1/32) each. All cases of S. aureus infection and 86% (12/14) of coagulase-negative staphylococcus (CoNS) infections were identified from primary cultures. All cases fulfilling

  10. Transbronchial aspiration of subcarinal lymph nodes.

    PubMed

    Blainey, A D; Curling, M; Green, M

    1988-04-01

    Transbronchial needle aspiration of subcarinal lymph nodes has been undertaken in 60 consecutive patients with pulmonary malignancies undergoing routine fibreoptic bronchoscopy. Four aspirates from the subcarinal nodes contained malignant cells; three squamous cell carcinoma and one adenocarcinoma. Four of 40 (10%) of patients with non-small-cell carcinoma of the lung had a positive aspirate. We have not confirmed the high positive rate previously reported, but nevertheless transbronchial needle aspiration provided useful staging information in some patients. The technique is rapid, safe and simple, and can easily be applied in a routine bronchoscopy service for all patients with suspected cancer, or selected patients under active consideration for surgery. PMID:3166928

  11. Black sentinel lymph node and 'scary stickers'.

    PubMed

    Yang, Arthur S; Creagh, Terrence A

    2013-04-01

    An unusual case is presented of a young adult patient with two black-stained, radio-nucleotide tracer-active sentinel lymph nodes biopsied following her primary cutaneous melanoma treatment. This was subsequently confirmed to be secondary to cutaneous tattoos, averting the need of an elective regional node dissection. History of tattooing and tattoo removal should therefore be obtained as a routine in all melanoma patients considered for sentinel node biopsy (SLN). SLN biopsy and any subsequent completion node dissection should be strictly staged so that proper histologic diagnosis of the sentinel node is available for correct decision making and treatment. PMID:23010587

  12. Greater auricular nerve masquerading as lymph node

    PubMed Central

    Saxena, Shilpi; Deb, Prabal; Nijhawan, Vijay Shrawan; Kharayat, Veena; Verma, Rajesh

    2015-01-01

    Hansen's disease is on the verge of being eliminated from India and often missed by clinicians due to low index of suspicion. We present an unusual case in which greater auricular nerve thickening masqueraded as enlarged lymph node in the neck. The patient was referred for fine needle aspiration cytology, which revealed epithelioid cell granulomas suggestive of Hansen's disease. Further clinical examination and investigations including the skin biopsy confirmed the disease, highlighting the role of pathologist in the management of such unusual presentation of a common disease. PMID:26229249

  13. Hemangioendothelioma of the lymph node: a case report.

    PubMed

    Goldstein, J; Bartal, N

    1985-04-01

    Primary benign vascular tumors of lymph nodes are very rare. Various forms of lymph nodal vascular transformations defined as hemangiomatoid lesions, pannodal vasodilatation, or nodal angiomatosis have been described. We present a patient who was thought to have an epithelial salivary gland tumor, but instead was found to have an hemangioendothelioma of an adjacent enlarged lymph node in the region of the left submandibular gland.

  14. Detection of Lymph Node Metastases with SERRS Nanoparticles

    PubMed Central

    Spaliviero, Massimiliano; Harmsen, Stefan; Huang, Ruimin; Wall, Matthew A.; Andreou, Chrysafis; Eastham, James A.; Touijer, Karim A.; Scardino, Peter T.; Kircher, Moritz F.

    2016-01-01

    Purpose The accurate detection of lymph node metastases in prostate cancer patients is important to direct treatment decisions. Our goal was to develop an intra-operative imaging approach to distinguish normal from metastasized lymph nodes. We therefore developed and tested gold-silica surface-enhanced resonance Raman spectroscopy (SERRS) nanoparticles that demonstrate high uptake within normal lymphatic tissue, and negligible uptake in areas of metastatic replacement. Procedures We evaluated the ability of SERRS nanoparticles to delineate lymph node metastases in an orthotopic prostate cancer mouse model using PC-3 cells transduced with mCherry fluorescent protein. Tumor bearing mice (n = 6) and non-tumor bearing control animals (n = 4) were injected intravenously with 30 fmol/g SERRS nanoparticles. After 16–18 hours, the retroperitoneal lymph nodes were scanned in situ and ex vivo with a Raman imaging system and a hand-held Raman scanner and data corroborated with fluorescence imaging for mCherry protein expression and histology. Results The SERRS nanoparticles demonstrated avid homing to normal lymph nodes, but not to metastasized lymph nodes. In cases where lymph nodes were partially infiltrated by tumor cells, the SERRS signal correctly identified, with sub-millimeter precision, healthy from metastasized components within the same lymph node. Conclusions This study serves as a first proof-of-principle that SERRS nanoparticles enable high precision and rapid intraoperative discrimination between normal and metastasized lymph nodes. PMID:26943129

  15. Increased malignancy of oral squamous cell carcinomas (oscc) is associated with macrophage polarization in regional lymph nodes – an immunohistochemical study

    PubMed Central

    2014-01-01

    Background It is largely accepted that specific immunological parameters in solid malignancies are associated with patient’s prognosis. Recently a correlation of macrophage polarization with histomorphological parameters could also be shown in oral squamous cell carcinoma (oscc). The observed tumor derived peripheral immune tolerance could be associated with the macrophage polarization in regional tumor draining lymph nodes. So far there are no studies analyzing the macrophage polarization in cervical lymph nodes of oscc patients. In the present study we aimed to correlate macrophage polarization in different anatomical lymph node compartments of patients diagnosed with oscc with histopathologic parameters of the primary tumor (T-, N-, L-, V-, Pn-status, grading). Methods Tumor free (n = 37) and metastatic (n = 17) lymph nodes of T1 and T2 oscc patients were processed for immunohistochemistry to detect CD68, CD11c, CD163 and MRC1 positive cells. Samples were digitized using whole slide imaging and the number of cells expressing the aforementioned markers in the region of interest quantitatively analyzed. Results The malignancy of the primary tumor (defined by T-, L-, Pn-status, grading) correlated with the lymph node macrophage polarization. L1 and Pn1 tumor cases displayed a significantly (p < 0.05) decreased M1 and increased M2 polarization in the sinus of the lymph nodes. G3 cases presented a significantly (p < 0.05) increased M2 polarization in the sinus compared to G2 cases. T2 tumors had significantly (p < 0.05) increased M2 polarization in the interfollicular zone of regional lymph nodes compared to T1 tumors. Metastatic and non-metastatic lymph nodes did not differ regarding their macrophage polarization. Conclusions The current study revealed for the first time an influence of oscc on the macrophage polarization in regional lymph nodes. Markers of malignant behavior in the primary tumor were associated with a shift of macrophage

  16. T-cell activation in pulmonary lymph nodes of mice exposed to ozone

    SciTech Connect

    Dziedzic, D.; White, H.J.

    1985-12-01

    Groups of Cd-1 female mice were exposed to ozone at 0.3, 0.5, and 0.7 ppm, 20 hr per day, 7 days per week for 1-28 days. The effect of ozone exposure on lymphoid cells was determined by studying mediastinal lymph nodes at various times of exposure. It was found that lymphocyte numbers underwent a dose-dependent, four-phased change:cellular depletion (Days 1-2), followed by rapid hyperplasia (Days 3-4), incremental cell number reduction (Days 5-7), and a subsequent subacute phase of elevated lymphocyte numbers (Days 8-28). Using tritiated thymidine it was determined that cells underwent a rapid burst of division by Day 3 of exposure and that mitosis subsequently declined to near baseline values by 2 weeks of exposure. Autoradiographic analysis of histologic sections revealed that the paracortical T-cell areas of the nodes were particularly involved. In addition to the increase in thymidine uptake, several morphologic changes were evident in affected cells. By comparison, the B cells from ozone-exposed animals were virtually unaffected with respect to cell division or morphological alterations. Prior treatment of ozone-exposed animals with a monoclonal antibody that is cytotoxic for T cells eliminated the hyperplastic response. Immunologic aspects of T-cell reactivity were studied. T-cell responsiveness to mitogenic stimulation with concanavalin A showed little alteration during the first days of exposure; however, by Day 14 an increase in reactivity was observed. This change indicated that functional lymphocyte stimulation occurred during ozone exposure.

  17. Detection and clinical significance of lymph node micrometastasis determined by reverse transcription-polymerase chain reaction in patients with esophageal carcinoma.

    PubMed

    Kijima, F; Natsugoe, S; Takao, S; Aridome, K; Baba, M; Yoshifumi, M; Eizuru, Y; Aikou, T

    2000-01-01

    We investigated micrometastasis in lymph nodes by detecting carcinoembryonic antigen (CEA) mRNA. A total of 400 lymph nodes obtained from 21 patients with esophageal carcinoma were examined by CEA-specific reverse transcription-polymerase chain reaction (RT-PCR). Serial sections of positive lymph nodes were reexamined histologically and immunohistologically. Twenty-seven lymph nodes of 11 patients were diagnosed as being positive by conventional histologic examination. CEA-mRNA positivity was found in 18 of 21 patients. Among 373 histologically negative nodes, 79 (21.2%) were positive for CEA mRNA. Of these, micrometastasis was detected in 2 by histological reexamination and in 11 by immunohistochemical staining using cytokeratin antibody. Two of 6 RT-PCR-positive patients (33.3%) had recurrent disease. Four of 11 patients (36.4%) whose nodal involvement was discovered by routine histological examination also had recurrent cancer. CEA-specific RT-PCR detected micrometastasis in lymph nodes at a higher rate than histological or immunohistochemical analysis of serial sections. Since the incidence of CEA-mRNA positivity is high in the lymph nodes of esophageal cancer patients except for those with early cancer, these patients should be treated with adjuvant therapy.

  18. Magnetic resonance imaging of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma: Patterns of spread

    SciTech Connect

    Liu Lizhi; Zhang Guoyi; Xie Chuangmiao; Liu Xuewen; Cui Chunyan; Li Li . E-mail: lililixj@hotmail.com

    2006-11-01

    Purpose: To investigate the incidence, distribution, and spread pattern of retropharyngeal lymph node (RLN) involvement in patients with nasopharyngeal carcinoma (NPC) by using magnetic resonance imaging (MRI). Methods and Materials: The MR images of 275 patients with newly diagnosed NPC were reviewed retrospectively. Nodes were classified as metastatic based on size criteria, the presence of nodal necrosis, and extracapsular spread. Results: Retropharyngeal lymph node involvement was detected in 175 (63.6%) patients. Metastatic RLNs were seen at the following levels: occipital bone, 24 (9.6%) nodes; C1, 157 (62.5%) nodes; C1/2, 40 (15.9%) nodes; C2, 27 (10.8%) nodes; C2/3, 1 (0.4%) node; and C3, 2 (0.8%) nodes. The incidence of RLN involvement was equal to the incidence of cervical lymph node involvement (81.4% vs. 81.4%) in 215 patients with nodal metastases. A significantly higher incidence of metastatic RLNs was observed in the presence of oropharynx, prestyloid parapharyngeal space, post-styloid parapharyngeal space, longus colli muscle, medial pterygoid muscle, levator muscle of velum palatini, tensor muscle of velum palatini, Level II node, Level III node, and Level V node involvement. A significantly lower incidence of metastatic RLNs was found in T1, N0, and Stage I disease. Conversely, no significant difference in the incidence of metastatic RLNs was observed between T1, 2, and, 3; N2 and N3; or Stage II, III, and IV disease. Conclusions: There is an orderly decrease in the incidence of metastatic lateral RLNs from the C1 to C3 level. Metastatic RLNs associate well with involvement of certain structures in early stage primary tumors and lymph node metastases of the upper jugular chain (Level II, Level III nodes) and the posterior triangle (Level V nodes). Both RLNs and cervical Level II nodes appear to be the first-echelon nodes in NPC.

  19. How Is Aplastic Anemia Diagnosed?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Aplastic Anemia Diagnosed? Your doctor will diagnose aplastic anemia based on your medical and family histories, a ... your primary care doctor thinks you have aplastic anemia, he or she may refer you to a ...

  20. Social temperament and lymph node innervation

    PubMed Central

    Sloan, Erica K.; Capitanio, John P.; Tarara, Ross P.; Cole, Steve W.

    2008-01-01

    Socially inhibited individuals show increased vulnerability to viral infections, and this has been linked to increased activity of the sympathetic nervous system (SNS). To determine whether structural alterations in SNS innervation of lymphoid tissue might contribute to these effects, we assayed the density of catecholaminergic nerve fibers in 13 lymph nodes from 7 healthy adult rhesus macaques that showed stable individual differences in propensity to socially affiliate (Sociability). Tissues from Low Sociable animals showed a 2.8-fold greater density of catecholaminergic innervation relative to tissues from High Sociable animals, and this was associated with a 2.3-fold greater expression of nerve growth factor (NGF) mRNA, suggesting a molecular mechanism for observed differences. Low Sociable animals also showed alterations in lymph node expression of the immunoregulatory cytokine genes IFNG and IL4, and lower secondary IgG responses to tetanus vaccination. These findings are consistent with the hypothesis that structural differences in lymphoid tissue innervation might potentially contribute to relationships between social temperament and immunobiology. PMID:18068331

  1. Surgery for gallbladder cancer in the US: a need for greater lymph node clearance

    PubMed Central

    Nissen, Nicholas N.

    2015-01-01

    Background Gallbladder cancer (GBC) is a rare malignancy with a dismal prognosis. Often identified incidentally after laparoscopic cholecystectomy for presumably benign biliary disease, reoperation with partial hepatic resection and periportal lymph node dissection (LND) is frequently performed. The impact of lymph node (LN) clearance for GBC remains unclear. Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients diagnosed with GBC between 1988 and 2009. Survival was calculated using Kaplan-Meier method and compared using log-rank test. Multivariate analysis was performed to identify predictors of survival. Results A total of 11,815 patients diagnosed with GBC were identified. Cancer-directed surgery was performed in 8,436 (71.3%) patients. Optimal LN clearance (defined as ≥4 LNs) is associated with young age, advanced T-stage, no radiation therapy, and radical surgery (all <0.001). Greater LND improves survival for all stages (P<0.001). After adjusting for confounding factors, multivariable analysis of patients with node-negative disease demonstrated that early stage, greater LND, and radical surgery were strong independent predictors of survival. Conclusions Extensive lymphadenectomy correlates with longer survival even in node negative patients. Extensive LND should be performed in patients with GBC as many patients in the USA are undertreated. PMID:26487937

  2. Response of the mediastinal and thoracic viscera of the dog to intraoperative radiation therapy (IORT)

    SciTech Connect

    Barnes, M.; Pass, H.; DeLuca, A.; Tochner, Z.; Potter, D.; Terrill, R.; Sindelar, W.F.; Kinsella, T.J.

    1987-03-01

    IORT may be a potentially useful adjunctive treatment combined with surgery and/or external beam irradiation in treating locally advanced lung and esophageal tumors. To begin investigation of this modality, the tolerance of intact mediastinal structures to IORT was studied using adult American Foxhounds (wt. 25-30 kg). Groups of six animals received IORT to doses of 20, 30, or 40 Gy to two separate intrathoracic ports, using 9 MeV electrons to treat a portion of the collapsed right upper lobe, and 12 MeV electrons to treat the mediastinal structures. A group of three dogs received thoracotomy with sham irradiation. Two dogs from each treatment dose group, as well as one sham-irradiated control, were sacrificed electively at 1, 3, and 12 months following IORT. There were no acute nor late IORT related mortalities. Post-operative weight loss was minimal (average 4.5% of pre-operative weight) for all dogs. Serial esophagrams showed no inflammation or ulceration. No cardiac nor pulmonary changes were noted clinically. At autopsy, the irradiated lung showed evidence of acute pneumonitis at 1 month with progressive fibrosis at 3 months and 1 year. Esophageal reactions were minimal, with only two dogs (one 30 Gy and one 40 Gy) demonstrating histologically confirmed esophagitis at 1 month. Tracheal changes were minimal. Cardiac damage was evident in the right atrial tissues. In several dogs, this cardiac damage ranged from myocardial vascular changes to frank ischemic necrosis noted at 1 and 3 months, and dense fibrosis at 1 year. The phrenic nerves showed normal function, but had evidence of perineural fibrosis. The large vessels demonstrated only mild histologic evidence of irradiation. The results of this large animal study suggest that intact mediastinal structures will tolerate small volume IORT to doses of 20 Gy without significant clinical sequellae. (Abstract Truncated)

  3. Cardiac Magnetic Resonance Imaging Findings in 20-year Survivors of Mediastinal Radiotherapy for Hodgkin's Disease

    SciTech Connect

    Machann, Wolfram; Beer, Meinrad; Breunig, Margret; Stoerk, Stefan; Angermann, Christiane; Seufert, Ines; Schwab, Franz; Koelbl, Oliver; Flentje, Michael; Vordermark, Dirk

    2011-03-15

    Purpose: The recognition of the true prevalence of cardiac toxicity after mediastinal radiotherapy requires very long follow-up and a precise diagnostic procedure. Cardiac magnetic resonance imaging (MRI) permits excellent quantification of cardiac function and identification of localized myocardial defects and has now been applied to a group of 20-year Hodgkin's disease survivors. Methods and materials: Of 143 patients treated with anterior mediastinal radiotherapy (cobalt-60, median prescribed dose 40 Gy) for Hodgkin's disease between 1978 and 1985, all 53 survivors were invited for cardiac MRI. Of those, 36 patients (68%) presented for MRI, and in 31 patients (58%) MRI could be performed 20-28 years (median, 24) after radiotherapy. The following sequences were acquired on a 1.5-T MRI: transversal T1-weighted TSE and T2-weighted half-fourier acquisition single-shot turbo-spin-echo sequences, a steady-state free precession (SSFP) cine sequence in the short heart axis and in the four-chamber view, SSFP perfusion sequences under rest and adenosine stress, and a SSFP inversion recovery sequence for late enhancement. The MRI findings were correlated with previously reconstructed doses to cardiac structures. Results: Clinical characteristics and reconstructed doses were not significantly different between survivors undergoing and not undergoing MRI. Pathologic findings were reduced left ventricular function (ejection fraction <55%) in 7 (23%) patients, hemodynamically relevant valvular dysfunction in 13 (42%), late myocardial enhancement in 9 (29%), and any perfusion deficit in 21 (68%). An association of regional pathologic changes and reconstructed dose to cardiac structures could not be established. Conclusions: In 20-year survivors of Hodgkin's disease, cardiac MRI detects pathologic findings in approximately 70% of patients. Cardiac MRI has a potential role in cardiac imaging of Hodgkin's disease patients after mediastinal radiotherapy.

  4. Anesthetic management for anterior mediastinal mass and mediastinoscopy: a case study.

    PubMed

    McKeown, T J

    1991-08-01

    A 27-year-old white male was scheduled for a mediastinoscopy of an anterior mediastinal mass. The patient was induced with thiopental and succinylcholine, in anticipation of possible difficulty managing the airway. There was no distortion of the airway, and he was easily intubated with a No. 8.5 anode tube and given 20 mg of atracurium. The extent of tumor growth was greater than expected and, as a result, biopsies of the neck were taken without the need for mediastinoscopy. The atracurium was reversed with atropine and edrophonium. Although respirations were being assisted, the SaO2 decreased significantly, and end-tidal CO2 was greatly increased. When the drapes were removed, the patient was found to be cyanotic, with vein distention in the neck and upper extremities. All anesthetic agents were discontinued, the patient was hyperventilated with 100% oxygen, 100 mg of lidocaine was given for coughing and breath-holding, and the patient was placed in the reverse Trendelenburg position. The SaO2 then increased, and the end-tidal CO2 decreased. Respirations were spontaneous, and the patient could be extubated. The probable cause of this episode was obstruction of the superior vena cava by the anterior mediastinal mass. When the muscle relaxant was reversed, the increase in intrathoracic pressure caused the mass to compress the superior vena cava. The compression was released by placing the patient in a reverse Trendelenburg position, which caused the mass to shift. In addition to superior vena cava compression, other complications of anterior mediastinal masses include airway obstruction, distortion of anatomy, impaired cerebral circulation and myasthenic syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Microscopically diagnosed head and neck cancers in the University Hospital, Kuala Lumpur.

    PubMed

    Jayalakshmi, P; Pathmanathan, R; Raman, R; Prasad, U

    1989-03-01

    A retrospective study of 1000 cases of microscopically diagnosed head and neck cancers in the University Hospital, Kuala Lumpur was done. Head and neck neoplasms comprise 7.1% of all tumours diagnosed in this Hospital and the commonest sites of involvement are the nasopharynx (29.1%), cervical lymph nodes (22.6%), oral cavity (10.2%), thyroid (8.2%) and skin (6.5%). Histologically, 87% of tumours are epithelial in nature. The results of this study show that nasopharyngeal carcinoma is commonest in Chinese males, while oral and laryngeal malignancies occur more frequently in Indians.

  6. Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

    PubMed Central

    Kim, Yoon Kyung; Lee, Kyung Won; Yi, Chin A; Koo, Jin Mo; Jung, Soon-Hee

    2016-01-01

    Objective To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). Materials and Methods The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. Results Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. Conclusion Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD. PMID:27390546

  7. Tumor cell entry into the lymph node is controlled by CCL1 chemokine expressed by lymph node lymphatic sinuses

    PubMed Central

    Das, Suvendu; Sarrou, Eliana; Podgrabinska, Simona; Cassella, Melanie; Mungamuri, Sathish Kumar; Feirt, Nikki; Gordon, Ronald; Nagi, Chandandeep S.; Wang, Yarong; Entenberg, David; Condeelis, John

    2013-01-01

    Lymphatic vessels are thought to contribute to metastasis primarily by serving as a transportation system. It is widely believed that tumor cells enter lymph nodes passively by the flow of lymph. We demonstrate that lymph node lymphatic sinuses control tumor cell entry into the lymph node, which requires active tumor cell migration. In human and mouse tissues, CCL1 protein is detected in lymph node lymphatic sinuses but not in the peripheral lymphatics. CCR8, the receptor for CCL1, is strongly expressed by human malignant melanoma. Tumor cell migration to lymphatic endothelial cells (LECs) in vitro is inhibited by blocking CCR8 or CCL1, and recombinant CCL1 promotes migration of CCR8+ tumor cells. The proinflammatory mediators TNF, IL-1β, and LPS increase CCL1 production by LECs and tumor cell migration to LECs. In a mouse model, blocking CCR8 with the soluble antagonist or knockdown with shRNA significantly decreased lymph node metastasis. Notably, inhibition of CCR8 led to the arrest of tumor cells in the collecting lymphatic vessels at the junction with the lymph node subcapsular sinus. These data identify a novel function for CCL1–CCR8 in metastasis and lymph node LECs as a critical checkpoint for the entry of metastases into the lymph nodes. PMID:23878309

  8. Giant pulmonary bulla with mediastinal shift in a 12 1/2 year old girl.

    PubMed

    Fatimi, Saulat Hasnain; Jafferani, Asif; Ashfaq, Awais

    2012-05-01

    Pulmonary bulla in children represent interesting entities. Mostly congenital bronchopulmonary foregut malformations and acquired cysts like pneumatocoeles have also been described. We present a case of a 12 1/2 years old girl with acute onset respiratory distress symptoms harbouring a huge pulmonary cyst exhibiting mass effects, resulting in mediastinal deviation. Following initial workup, cyst excision was carried out which revealed presence of fungal hyphae that was susceptible to Fluconazole therapy post operatively. The case points out how a pulmonary cyst can present in older children with symptoms of respiratory distress and mass effects.

  9. Excision of middle mediastinal parathyroid adenoma by videoscopic assisted mediastinoscopy (VAM)

    PubMed Central

    McMullen, Todd; Bédard, Eric L. R.

    2016-01-01

    We report a case involving a female patient with primary hyperparathyroidism arising from a middle mediastinal parathyroid adenoma. Initial diagnosis was made based on a history of polyuria and recurrent renal colic. At the age of 77 she underwent videoscopic assisted mediastinoscopy (VAM) for resection of the adenoma which was localized using single-photon emission computed tomography (SPECT/CT). This case illustrates the importance for accurate pre-operative localization and intra-operative monitoring to ensure complete surgical removal in order to improve postoperative normocalcemia success rates. PMID:27747020

  10. Progressive Dyspnea in a 40-Year-Old Man Caused by Giant Mediastinal Thymolipoma

    PubMed Central

    Rad, Kamelia

    2016-01-01

    Thymolipomas are rare tumors of the anterior mediastinum containing both thymic stroma and an abundance of fat. We present a 40-year-old man with no underlying disease who presented with cough and progressive dyspnea. Clinical evaluation revealed a giant mass of lipid density filling almost the entire left hemithorax with mediastinal shift. Total excision of the 40 × 33 × 8 cm mass weighing 4 kg was performed via a left thoracotomy and the histopathologic diagnosis of the mass was reported as thymolipoma. The patient remains alive and disease-free, twelve months after the intervention. PMID:27293949

  11. Multiple Ascending Aortic Mural Thrombi and Acute Necrotizing Mediastinitis Secondary to Acute Pancreatitis

    PubMed Central

    Chong, Byung Kwon; Yun, Jae Kwang; Kim, Joon Bum; Park, Do Hyun

    2016-01-01

    The formation of aortic thrombi is an extremely rare complication of acute pancreatitis. Here we report a case of acute pancreatitis complicated by a paraesophageal pseudocyst, necrotizing mediastinitis, and the formation of multiple thrombi in the ascending aorta. The patient was successfully treated by surgical therapy, which included extensive debridement of the mediastinum and removal of the aortic thrombi under cardiopulmonary bypass. Although esophageal resection was not carried out concomitantly, the lesions were resolved and the patient remained free of complications over 2 years of follow-up care. PMID:27734004

  12. Treatment of stage i and ii mediastinal Hodgkin disease: a comparison of involved fields, extended fields, and involved fields followed by MOPP in patients stage by laparotomy

    SciTech Connect

    Hagemeister, F.B.; Fuller, L.M.; Sullivan, J.A.; North, L.; Velasquez, W.; Conrad, F.G.; McLaughlin, P.; Butter, J.J.; Shullenberger, C.C.

    1981-12-01

    Three treatment programs for Stage I and II mediastinal Hodgkin disease (established by laparotomy) were compared. Involved-field radiotherapy + MOPP gave a disease-free survival rate of 97%, significantly different from 62% and 55% for involved and extended fields, respectively. Corresponding survival figures of 97%, 88%, and 84% were not signiticantly different statistically due to salvage with radiotherapy and/or chemotherapy. Among patients given radiotherapy alone, the survival figure of 94% for limited mediastinal disease was significantly better than 63% for extensive mediastinal and hilar disease; corresponding disease-free figures of 72% and 35% were also significantly different. Constitutional symptoms were an important prognostic factor in disease-free survival following the use of involved fields; hilar disease was important only with large mediastinal masses. Most relapses were intrathoracic; MOPP alone salvaged only 47%. Treatment of State I and II Hodgkin disease should be based on symptoms, extent of mediastinal disease, and hilar involvement.

  13. The diagnostic value of 1.5-T diffusion-weighted MR imaging in detecting 5 to 10 mm metastatic cervical lymph nodes of nasopharyngeal carcinoma

    PubMed Central

    Jin, Guan Qiao; Yang, Jun; Liu, Li Dong; Su, Dan Ke; Wang, Duo Ping; Zhao, Sheng Fa; Liao, Zhi Ling

    2016-01-01

    Abstract The aim of the study was to prospectively assess the diagnostic accuracy of 1.5 T diffusion-weighted imaging (DWI) for 5 to 10 mm metastatic cervical lymph nodes of patients with nasopharyngeal carcinoma (NPC). All patients with histopathologically confirmed NPC underwent DWI with 2 b values of 0 and 800 s/mm2 were enrolled. The shortest axial diameter and mean apparent diffusion coefficient (ADC) value were recorded when lymph nodes with a shortest axial diameter from 5 to 10 mm were measured. The correlation between the pathological diagnoses and mean ADC values in the benign and metastatic lymph nodes were compared using the Z test. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of DWI. Three hundred fourteen nodes of 52 patients with NPC consisted of 46.5% (146/314) metastatic lymph nodes and 53.5% (168/314) benign lymph nodes. The mean ADC value (×10–3 mm2/s) of benign lymph nodes was (1.110 ± 0.202), which was significantly higher than that of metastatic nodes (0.878 ± 0.159) (P < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value, accuracy for differentiating metastatic from benign lymph nodes using a cutoff ADC value of 0.924 × 10–3 mm2/s was 83.56%, 82.74%, 80.79%, 85.28%, and 82.80%, respectively. The area under the ROC curve was 0.851 (95% confidence intervals: 0.807–0.889). This study demonstrated that DWI is helpful in detecting 5 to 10 mm metastatic lymph nodes of patients with NPC. PMID:27512841

  14. Downsized Contegra graft as a right ventricle-to-pulmonary artery conduit in the setting of mediastinitis.

    PubMed

    MacIver, Robroy H; Permut, Lester C; McMullan, David M

    2013-09-01

    Polytetrafluoroethylene (PTFE) grafts are commonly used for construction of the right ventricle-to-pulmonary artery conduit in the modified Norwood procedure. Dehiscence of a PTFE conduit in the setting of purulent mediastinitis presents a challenging clinical problem because of limited availability of appropriately sized replacement vascular homografts. The Contegra bovine jugular vein graft is an alternative to placing another PTFE graft in an infected space when a homograft of appropriate size is not available. We describe the use of a downsized Contegra conduit to replace an infected PTFE right ventricle-to-pulmonary artery graft in a neonate with life-threatening purulent mediastinitis. PMID:23992706

  15. Mediastinal irradiation in a patient affected by lung carcinoma after heart transplantation: Helical tomotherapy versus three dimensional conformal radiotherapy

    PubMed Central

    Iorio, Vincenzo; Cammarota, Fabrizio; Toledo, Diego; Senese, Rossana; Francomacaro, Ferdinando; Muto, Matteo; Muto, Paolo

    2016-01-01

    Abstract Patients who have undergone solid organ transplants are known to have an increased risk of neoplasia compared with the general population. We report our experience using mediastinal irradiation with helical tomotherapy versus three‐dimensional conformal radiation therapy to treat a patient with lung carcinoma 15 years after heart transplantation. Our dosimetric evaluation showed no particular difference between the techniques, with the exception of some organs. Mediastinal irradiation after heart transplantation is feasible and should be considered after evaluation of the risk. Conformal radiotherapy or intensity‐modulated radiotherapy appears to be the appropriate treatment in heart‐transplanted oncologic patients. PMID:27148425

  16. Mediastinal irradiation in a patient affected by lung carcinoma after heart transplantation: Helical tomotherapy versus three dimensional conformal radiotherapy.

    PubMed

    Giugliano, Francesca M; Iorio, Vincenzo; Cammarota, Fabrizio; Toledo, Diego; Senese, Rossana; Francomacaro, Ferdinando; Muto, Matteo; Muto, Paolo

    2016-04-26

    Patients who have undergone solid organ transplants are known to have an increased risk of neoplasia compared with the general population. We report our experience using mediastinal irradiation with helical tomotherapy versus three-dimensional conformal radiation therapy to treat a patient with lung carcinoma 15 years after heart transplantation. Our dosimetric evaluation showed no particular difference between the techniques, with the exception of some organs. Mediastinal irradiation after heart transplantation is feasible and should be considered after evaluation of the risk. Conformal radiotherapy or intensity-modulated radiotherapy appears to be the appropriate treatment in heart-transplanted oncologic patients.

  17. Salmonella in lymph nodes of cattle presented for harvest

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Introduction: Salmonella can invade and survive within host immune cells. Once internalized, these pathogens have the potential to disseminate throughout the lymphatic system and reside within lymph nodes. If so, because some lymph nodes are located within muscle and fat tissues, Salmonella-positiv...

  18. Novel method and applications for labeling and identifying lymph nodes

    NASA Astrophysics Data System (ADS)

    Kiraly, Atilla P.; Naidich, David P.; Guendel, Lutz; Zhang, Li; Novak, Carol L.

    2007-03-01

    The lymphatic system comprises a series of interconnected lymph nodes that are commonly distributed along branching or linearly oriented anatomic structures. Physicians must evaluate lymph nodes when staging cancer and planning optimal paths for nodal biopsy. This process requires accurately determining the lymph node's position with respect to major anatomical landmarks. In an effort to standardize lung cancer staging, The American Joint Committee on Cancer (AJCC) has classified lymph nodes within the chest into 4 groups and 14 sub groups. We present a method for automatically labeling lymph nodes according to this classification scheme, in order to improve the speed and accuracy of staging and biopsy planning. Lymph nodes within the chest are clustered around the major blood vessels and the airways. Our fully automatic labeling method determines the nodal group and sub-group in chest CT data by use of computed airway and aorta centerlines to produce features relative to a given node location. A classifier then determines the label based upon these features. We evaluate the efficacy of the method on 10 chest CT datasets containing 86 labeled lymph nodes. The results are promising with 100% of the nodes assigned to the correct group and 76% to the correct sub-group. We anticipate that additional features and training data will further improve the results. In addition to labeling, other applications include automated lymph node localization and visualization. Although we focus on chest CT data, the method can be generalized to other regions of the body as well as to different imaging modalities.

  19. Lymph flow pattern in the intact thoracic duct in sheep.

    PubMed

    Onizuka, M; Flatebø, T; Nicolaysen, G

    1997-08-15

    1. To study the lymph flow dynamics in the intact thoracic duct, we applied an ultrasound transit-time flow probe in seven anaesthetized and four unanaesthetized adult sheep (approximately 60 kg). In unanaesthetized non-fasting animals we found that lymph flow in the thoracic duct was always regular pulsatile (pulsation frequency, 5.2 +/- 0.8 min-1) with no relation to heart or respiratory activity. At baseline the peak level of the thoracic duct pulse flow was 11.6-20.7 ml min-1 with a nadir of 0-3.6 ml min-1. Mean lymph flow was 5.4 +/- 3.1 ml min-1. The flow pattern of lymph in the thoracic duct was essentially the same in the anaesthetized animals. 2. In both the anaesthetized and unanaesthetized animals, the lymph flow response to a stepwise increase in the outflow venous pressure showed interindividual variation. Some were sensitive to any increase in outflow venous pressure, but others were resistant in that lymph flow did not decrease until outflow venous pressure was increased to higher levels. This resistance was also observed in the high lymph flow condition produced by fluid infusion in the anaesthetized animal and mechanical constriction of the caudal vena cava in the unaesthetized animals. Pulsation frequency of the thoracic duct flow initially increased and then decreased with a stepwise increase in the outflow venous pressure. This initial increase might be a compensatory response to maintain lymph flow against elevated outflow venous pressure. 3. To test the effect of long-term outflow venous pressure elevation in unanaesthetized sheep, outflow venous pressure was increased by inflation of a cuff around the cranial vena cava for 1, 5 or 25 h. The cuff was inflated to a level where lymph flow was reduced. Lymph flow remained low or decreased further during the entire cuff-inflation period. We calculated the lymph debt caused by the outflow venous pressure elevation and the amount 'repaid' when venous pressure returned to normal. Lymph debt for 25 h

  20. Lymph flow pattern in the intact thoracic duct in sheep.

    PubMed Central

    Onizuka, M; Flatebø, T; Nicolaysen, G

    1997-01-01

    1. To study the lymph flow dynamics in the intact thoracic duct, we applied an ultrasound transit-time flow probe in seven anaesthetized and four unanaesthetized adult sheep (approximately 60 kg). In unanaesthetized non-fasting animals we found that lymph flow in the thoracic duct was always regular pulsatile (pulsation frequency, 5.2 +/- 0.8 min-1) with no relation to heart or respiratory activity. At baseline the peak level of the thoracic duct pulse flow was 11.6-20.7 ml min-1 with a nadir of 0-3.6 ml min-1. Mean lymph flow was 5.4 +/- 3.1 ml min-1. The flow pattern of lymph in the thoracic duct was essentially the same in the anaesthetized animals. 2. In both the anaesthetized and unanaesthetized animals, the lymph flow response to a stepwise increase in the outflow venous pressure showed interindividual variation. Some were sensitive to any increase in outflow venous pressure, but others were resistant in that lymph flow did not decrease until outflow venous pressure was increased to higher levels. This resistance was also observed in the high lymph flow condition produced by fluid infusion in the anaesthetized animal and mechanical constriction of the caudal vena cava in the unaesthetized animals. Pulsation frequency of the thoracic duct flow initially increased and then decreased with a stepwise increase in the outflow venous pressure. This initial increase might be a compensatory response to maintain lymph flow against elevated outflow venous pressure. 3. To test the effect of long-term outflow venous pressure elevation in unanaesthetized sheep, outflow venous pressure was increased by inflation of a cuff around the cranial vena cava for 1, 5 or 25 h. The cuff was inflated to a level where lymph flow was reduced. Lymph flow remained low or decreased further during the entire cuff-inflation period. We calculated the lymph debt caused by the outflow venous pressure elevation and the amount 'repaid' when venous pressure returned to normal. Lymph debt for 25 h

  1. Regenerating a kidney in a lymph node.

    PubMed

    Francipane, Maria Giovanna; Lagasse, Eric

    2016-10-01

    The ultimate treatment for end-stage renal disease (ESRD) is orthotopic transplantation. However, the demand for kidney transplantation far exceeds the number of available donor organs. While more than 100,000 Americans need a kidney, only 17,000 people receive a kidney transplant each year (National Kidney Foundation's estimations). In recent years, several regenerative medicine/tissue engineering approaches have been exploited to alleviate the kidney shortage crisis. Although these approaches have yielded promising results in experimental animal models, the kidney is a complex organ and translation into the clinical realm has been challenging to date. In this review, we will discuss cell therapy-based approaches for kidney regeneration and whole-kidney tissue engineering strategies, including our innovative approach to regenerate a functional kidney using the lymph node as an in vivo bioreactor.

  2. Endoscopic ultrasound: Elastographic lymph node evaluation.

    PubMed

    Dietrich, Christoph F; Jenssen, Christian; Arcidiacono, Paolo G; Cui, Xin-Wu; Giovannini, Marc; Hocke, Michael; Iglesias-Garcia, Julio; Saftoiu, Adrian; Sun, Siyu; Chiorean, Liliana

    2015-01-01

    Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives. PMID:26374575

  3. Endoscopic ultrasound: Elastographic lymph node evaluation

    PubMed Central

    Dietrich, Christoph F.; Jenssen, Christian; Arcidiacono, Paolo G.; Cui, Xin-Wu; Giovannini, Marc; Hocke, Michael; Iglesias-Garcia, Julio; Saftoiu, Adrian; Sun, Siyu; Chiorean, Liliana

    2015-01-01

    Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives. PMID:26374575

  4. [Intraoperative detection of the sentinel lymph nodes in lung cancer].

    PubMed

    Akopov, A L; Papayan, G V; Chistyakov, I V

    2015-01-01

    An analysis of the scientific data was made. It was used the literature devoted to the intraoperative visualization of the sentinel lymph nodes in patients with lung cancer. Correct detection of such lymph nodes with following pathologic investigation allowed limiting the volume of lympho-dissection in a number of patients. There is the possibility of maximal in-depth study of the sentinel lymph nodes by purposeful application of most sensible pathologic and molecular methods for detection their micrometastatic lesions. At the same time the treatment strategy and prognosis could be determined. The authors present the results of an application of dye techniques, radioactive preparation and fluorescence imaging for sentinel lymph node detection. Advantages and disadvantages of the methods are shown in the article. There are validated the prospects of technical development, study of information value of new applications and the most perspective method of fluorescence indocyanine green visualization by lymph outflow. PMID:25962306

  5. Clinical implications of contralateral axillary sentinel lymph nodes.

    PubMed

    Carmon, Moshe; Mintz, Alexander; Hain, Daniel; Olsha, Oded

    2006-04-01

    Extra-axillary sentinel lymph nodes can only be detected if radioactive tracer is used and pre-operative scans are carried out. The presence of metastatic sentinel lymph nodes in most extra-axillary sites will upstage patients if the ipsilateral axillary sentinel lymph node is normal. Paradoxically, the presence of metastatic sentinel lymph nodes in the contralateral axilla has the potential to prevent upstaging to stage IV, but only if detected as a sentinel node at the initial surgery rather than as a systemic recurrence at some later time. We describe a case of bilateral axillary sentinel lymph nodes detected by pre-operative lymphoscintigraphy in a patient with a medial quadrant breast cancer and discuss the possible implications of such a finding. PMID:16005230

  6. Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection

    PubMed Central

    Cook, Kyung Hoon; Park, Myong Chul; Lim, Seong Yoon; Jung, Yong Sik

    2016-01-01

    Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation. PMID:27064862

  7. Delayed hypersensitivity in the guinea-pig to a protein—hapten conjugate and its relationship to in vitro transformation of lymph node, spleen, thymus and peripheral blood lymphocytes

    PubMed Central

    Oppenheim, J. J.; Wolstencroft, R. A.; Gell, P. G. H.

    1967-01-01

    Guinea-pig delayed hypersensitivity to purified protein derivative (PPD) and guinea-pig albumin-orthanilic acid (AO) was produced in the absence of detectable antibody formation to the conjugate. Ten days after sensitization the guinea-pig peripheral leucocytes, lymph nodes, spleen and thymus cell suspensions were cultured from 1 to 5 days with various concentrations of immunizing antigens, unconjugated hapten, a hapten—ovalbumin conjugate or phytohaemagglutinin (PHA). All the cultures of `draining' lymph node cells, and about 40 per cent of the spleen and peripheral leucocyte cultures manifested increased lymphocyte transformation on radioautographs, and by total tritiated thymidine incorporation when stimulated by PPD or AO. In addition all the cultures responded well to PHA. However, lymphocytes from the mediastinal and cervical lymph nodes from the immunized, and most of the lymphoid organ cultures from unimmunized guinea-pigs were not stimulated by antigens but responded only to PHA. Cultured guinea-pig thymocytes did not respond to any stimulus. The in vitro lymphocyte proliferation was carrier specific. It did not occur in response to unconjugated hapten. However, the response to AO was partially inhibited in the presence of the hapten. The in vitro kinetics and morphological changes in the cultures also were investigated, and the immunological significance and specificity of lymphocyte transformation are discussed. PMID:6017286

  8. An unusual mediastinal parathyroid carcinoma coproducing PTH and PTHrP: A case report

    PubMed Central

    CAO, CHUANGJIE; DOU, CHENGYUN; CHEN, FUQIN; WANG, YAN; ZHANG, XIAOLI; LAI, HONG

    2016-01-01

    Parathyroid carcinoma (PTCA) is a rare disease, and ectopic PTCA is particularly rare. Parathyroid hormone-related protein (PTHrP) expression in PTCA has not been previously described in the relevant literature to the best of our knowledge. The present study reports a unique case with a mediastinal parathyroid carcinoma producing parathyroid hormone (PTH) and PTHrP. A 53-year-old man presented with hyperparathyroidism symptoms, including fatigue, chest pain, dizziness, muscular soreness, polyuria, night sweats and renal stones. However, neck ultrasound revealed no significantly abnormal thyroid or parathyroid nodules. Tc99m methoxyisobutylisonitrile (Tc99m-MIBI) scintigraphy scanning indicated an ectopic mediastinal parathyroid adenoma. Histopathological examination revealed PTCA, and the tumor tissue was coproducing PTH and PTHrP. The patient underwent successful surgical operation. Serum calcium and PTH levels remained within normal ranges, and there was no tumor recurrence observed at a 3-year follow-up appointment. Although rare, ectopic parathyroid glands may lead to malignant disease. Clinical symptoms, biochemical tests, ultrasound and Tc99m-MIBI scintigraphy scanning may assist with the diagnosis of this disease. Hypersecretion of PTHrP and PTH contributed collaboratively to the pathogenesis of hypercalcemia due to PTCA. Complete surgical resection with microscopically negative margins is the recommended treatment for PTCA and offers the best chance of a cure. PMID:27313750

  9. Fatal massive hemorrhage caused by nasogastric tube misplacement in a patient with mediastinitis.

    PubMed

    Wu, Pei-Yu; Kang, Ting-Jui; Hui, Chung-Kun; Hung, Ming-Hui; Sun, Wei-Zen; Chan, Wei-Hung

    2006-01-01

    Nasogastric tube insertion is a routine procedure in medical care. However, misplacement of the tube can cause a variety of complications, which can be life threatening in some instances. We report a case of fatal hemorrhagic shock immediately after nasogastric tube insertion in a patient undergoing debridement by video-assisted thoracoscopic surgery for mediastinitis. Emergency endoscopy showed that the bleeding came from the nasogastric tube which had perforated the esophagus and possibly tore an intrathoracic large vessel. The nasogastric tube insertion was considered to have directly produced the perforation because no esophageal perforation had been found on preoperative endoscopy. Factors contributing to the risk of esophageal perforation in this case included coexisting mediastinitis, surgical manipulation, endotracheal intubation, inability to cooperate during general anesthesia, and repetitive advancement of the nasogastric tube. Prompt clamping of the nasogastric tube or delayed insertion after failed attempts might have improved the outcome. This report illustrates the complication of massive bleeding that can occur immediately after misplaced insertion of a nasogastric tube. Extraordinary care should be taken to avoid misplacement of the nasogastric tube during insertion.

  10. Diagnosing Dementia—Positive Signs

    MedlinePlus

    ... this page please turn Javascript on. A new blood test offers promise in the early detection of Alzheimer's. By Mary Best What if there were an easy, affordable blood test that could accurately diagnose Alzheimer's disease (AD)—even ...

  11. How Are Uterine Fibroids Diagnosed?

    MedlinePlus

    ... Clinical Trials Resources and Publications How are uterine fibroids diagnosed? Skip sharing on social media links Share ... probably won’t know that you have uterine fibroids. Sometimes, health care providers find fibroids during a ...

  12. How Is Lactose Intolerance Diagnosed?

    MedlinePlus

    ... following tests also can help diagnose lactose intolerance: Hydrogen breath test. For this test, a person drinks ... beverage that has lactose in it. Then, the hydrogen level in the breath is measured at set ...

  13. How Is Atrial Fibrillation Diagnosed?

    MedlinePlus

    ... too much thyroid hormone). Diagnostic Tests and Procedures EKG An EKG is a simple, painless test that records the ... the most useful test for diagnosing AF. An EKG shows how fast your heart is beating and ...

  14. How Is Bone Cancer Diagnosed?

    MedlinePlus

    ... Topic How is bone cancer staged? How is bone cancer diagnosed? A patient’s symptoms, physical exam, and results ... and other imaging tests. Imaging tests to detect bone cancer X-rays Most bone cancers show up on ...

  15. How Is Penile Cancer Diagnosed?

    MedlinePlus

    ... These might include a biopsy and imaging tests. Biopsy A biopsy is needed to diagnose penile cancer. ... depends on the nature of the abnormality. Incisional biopsy For an incisional biopsy only a part of ...

  16. Characterization of sheep lung lymph lipoproteins: chemical and physical properties

    SciTech Connect

    Forte, T.M.; Cross, C.E.; Gunther, R.A.; Kramer, G.C.

    1983-01-01

    The authors have determined the composition and distribution of plasma and lung lymph lipoproteins from unanesthetized ewes. Cholesterol, triglyceride, and phospholipid levels in lung lymph were 45%, 50%, and 50%, respectively, of those in plasma. Lipoproteins from both lymph and plasma were separated into two major fractions: d < 1.063 g/ml or LDL, and d 1.063-1.21 g/ml or HDL. HDL was the major lipoprotein species in the plasma and lymph. Gradients gel electrophoresis of HDL on 4-30% gels showed that, in lymph, HDL particles were shifted to larger sizes; in addition to a peak at 8.5 nm, which was similar to plasma HDL, there were two additional components of larger size, one at 9.2 nm and the other at 12 nm. Electron microscopy revealed that lymph HDL contained two new particles not seen in plasma: large, round particles, 13.6 nm diameter, and discoidal particles, 18.7 by 4.9 nm, long and short axis, respectively. Compositional analysis of lymph HDL revealed a relative enrichment in free cholesterol as well as an enrichment in apolipoprotein E. Lymph LDL on gradient gel electrophoresis was extremely heterogeneous. Several peaks were evident in the 23-30 nm size range (similar to plasma LDL), but a supplementary component at approximately 15-16 nm was also present. Whereas plasma LDL on electron microscopy contained only round particles 26 nm in diameter, lymph contained an additional, unusual particle which was close-packed, with square geometry, and was 15 nm in diameter. Changes in the physical and chemical properties of lung lymph lipoproteins suggest that these particles are metabolically modified.

  17. Comparison of clinicopathological characteristics of lymph node positive and lymph node negative breast cancer

    PubMed Central

    Hadi, Naila Irum; Jamal, Qamar

    2016-01-01

    Objective: To record various clinicopathological characteristics of breast cancer (BC) in our population and to find an association between these characteristics and axillary nodal metastasis. Methods: This cross-sectional study included 150 BC patients from two tertiary care centers in Karachi from 15th February, 2013 to 31st March, 2015. Frequencies, percentages, and odds ratio were estimated to find out an association between various clinicopathological characteristics and lymph node status using SPSS version 20. Results: Approximately 75.4% patients had axillary lymph node metastasis (‘1-3’ LN = 34.4% and ‘>3’ LN = 44%). Menopausal status (p <0.013), tumor grades (‘II’ p <0.03; ‘III’ p <0.01), and stages (‘III’ p <0.002; ‘IV’ p <0.0001), tumor sizes (‘T2’ p <0.014; ‘T3’ p <0.002), perineural invasion (PNI) (p <0.007), lymphovascular invasion (LVI) (p <0.0001), and skin and nipple invasion (p <0.024) were significant predictors for ‘>3’ LN metastasis. Association of these variables with ‘1-3’ LN involvement was insignificant. Conclusion: Clinical spectrum of BC remains unchanged in 2016 with most of the patients presenting with high-grade, late-stage advanced disease. Moreover, clinicopathological variables, especially primary tumor size, tumor stage and lymphovascular invasion were significant predictors of >3 lymph node metastasis with high accuracy. PMID:27648029

  18. Single Institutional Experience in the Treatment of Primary Mediastinal B Cell Lymphoma Treated with Immunochemotherapy in the Setting of Response Assessment by 18Fluorodeoxyglucose Positron Emission Tomography

    PubMed Central

    Pinnix, Chelsea C.; Dabaja, Bouthaina; Ahmed, Mohamed Amin; Chuang, Hubert H.; Costelloe, Collen; Wogan, Christine F.; Reed, Valerie; Romaguera, Jorge E; Neelapu, Sattva; Oki, Yasuhiro; Rodriguez, M. Alma; Fayad, Luis; Hagemeister, Frederick B.; Nastoupil, Loretta; Turturro, Francesco; Fowler, Nathan; Fanale, Michelle A.; Nieto, Yago; Khouri, Issa F.; Ahmed, Sairah; Medeiros, L. Jeffrey; Davis, Richard Eric; Westin, Jason

    2015-01-01

    Purpose Excellent outcomes obtained after infusional dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (R-EPOCH) alone have led some to question the role of consolidative radiation (RT) in the treatment of primary mediastinal B cell lymphoma (PMBL). We reviewed outcomes of patients treated with one of three rituximab-containing regimens (cyclophosphamide, doxorubicin, vincristine, prednisone [R-CHOP]; hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone [R-HCVAD], or R-EPOCH) with or without RT, as well as the ability of positron emission tomography-computed tomography (PET-CT) to identify patients at risk of relapse. Materials/Methods We retrospectively identified 97 patients diagnosed with stage I/II PMBCL treated at our institution between 2001–2013. Clinical characteristics, treatment outcomes and toxicity were assessed. We analyzed whether post-chemotherapy PET-CT could identify patients at risk for progressive disease according to 5 point scale (5PS) Deauville score assigned. Among 97 patients (median follow-up time 57 months), the 5-year overall survival rate was 99%. Of patients treated with R-CHOP, 99% received RT; R-HCVAD, 82%; and R-EPOCH, 36%. Of 68 patients with evaluable end-of-chemotherapy PET-CT scans, 62% had a positive scan (avidity above that of the mediastinal blood pool [Deauville 5-point scale {5PS} =3]), but only 9 patients experienced relapse (n=1) or progressive disease (n=8), all with a 5PS of 4-5. Of the 25 patients who received R-EPOCH, 4 experienced progression, all with 5PS of 4-5; salvage therapy (RT and autologous stem cell transplant) was successful in all cases. Conclusion Combined modality immunochemotherapy and radiation is well tolerated and effective for treatment of PMBCL. A post-chemotherapy 5PS of 4-5, rather than 3-5, can identify patients at high risk of progression who should be considered for therapy beyond chemotherapy alone after R-EPOCH. PMID

  19. Prediction of additional lymph node involvement in breast cancer patients with positive sentinel lymph nodes.

    PubMed

    Pohlodek, K; Bozikova, S; Meciarova, I; Mucha, V; Bartova, M; Ondrias, F

    2016-01-01

    Axillary lymph node dissection (ALND) has traditionally been the principal method for evaluating axillary lymph node status in breast cancer patients. In the past decades sentinel lymph nodes biopsy after lymphatic mapping has been used to stage the disease. The majority of sentinel lymph nodes (SLN) positive patients do not have additional metastases in non-sentinel nodes (non-SLN) after additional ALND. These patients are exposed to the morbidity of ALND without any benefit from additional axillary clearence. In the present study we would like to asses the criteria for selecting those patients, who have high risk for non-SLN metastases in the axilla in cases of positive SLN. In this retrospective analysis, clinical and pathologic data from 163 patients who underwent SLN biopsy followed by ALND were collected. Following clinical and pathological characteristics were analyzed to predict the likehood of non-SLN metastases: age, staging, histologic type and grading of the tumors, hormonal receptor status, HER-2 receptor status and Ki-67 protein, angioinvasion, metastases in SLN and non-SLN. Relative frequencies of individual characteristics between sample groups were statistically tested by Chi-square test at significance level p=0.5, when sample sizes in groups were small (≤5) by Fisher´s exact test. Metastasis in SLN were present in 67 (41%) of patients, 48 patients (29,4%) had metastasis also in non-SLN. The ratio between non-SLN positive / non-SLN negative lymph nodes in patients with positive SLN increases with the stage of the disease, the difference between values for the pT1c and pT2 stadium was statistically significant (p = 0.0296). The same applies to grading, but the differences were not significant (p>0.05). We could not find significant differences for angioinvasion of the tumor, probably for small number of patients with angioinvasion (p>0.05).Only the stage of the tumor was shown to be significant in predicting the metastasis in non-SLN in our

  20. A Unique Case of Erdheim-Chester Disease with Axial Skeleton, Lymph Node, and Bone Marrow Involvement.

    PubMed

    Lim, Jin; Kim, Ki Hwan; Suh, Koung Jin; Yoh, Kyung Ah; Moon, Jin Young; Kim, Ji Eun; Roh, Eun Youn; Choi, In Sil; Kim, Jin-Soo; Park, Jin Hyun

    2016-01-01

    Erdheim-Chester disease is a rare non-Langerhans-cell histiocytosis with bone and organ involvement. A 76-year-old man presented with low back pain and a history of visits for exertional dyspnea. We diagnosed him with anemia of chronic disease, cytopenia related to chronic illness, chronic renal failure due to hypertension, and hypothyroidism. However, we could not determine a definite cause or explanation for the cytopenia. Multiple osteosclerotic axial skeleton lesions and axillary lymph node enlargement were detected by computed tomography. Bone marrow biopsy revealed histiocytic infiltration, which was CD68-positive and CD1a-negative. This report describes an unusual presentation of Erdheim-Chester disease involving the bone marrow, axial skeleton, and lymph nodes.

  1. Bilateral Breast Enlargement: An Unusual Presentation of Superior Vena Cava Obstruction in a Hemodialysis Patient with Fibrosing Mediastinitis

    SciTech Connect

    Goo, Dong Erk Kim, Yong Jae; Choi, Deuk Lin; Kwon, Kui Hyang; Yang, Seung Boo

    2011-02-15

    A 67-year-old woman with end-stage renal disease presented with profound edema of both breasts. The presence of a patent hemodialysis basilic transposition fistula and superior vena cava obstruction (SVC), due to fibrosing mediastinitis, was demonstrated by the use of fistulography. Endovascular treatment with a balloon and stent caused immediate resolution of the breast edema.

  2. Lymph transport in rat mesenteric lymphatics experiencing edemagenic stress

    PubMed Central

    Rahbar, Elaheh; Akl, Tony; Coté, Gerard L.; Moore, James E.; Zawieja, David C.

    2014-01-01

    Objective To assess lymphatic flow adaptations to edema, we evaluated lymph transport function in rat mesenteric lymphatics under normal and edemagenic conditions in situ. Methods Twelve rats were infused with saline (intravenous infusion, 0.2 ml/min/100g body weight) to induce edema. We intravitally measured mesenteric lymphatic diameter and contraction frequency, as well as immune cell velocity and density before, during and after infusion. Results A 10-fold increase in lymph velocity (0.1–1 mm/s) and a 6-fold increase in flow rate (0.1–0.6 μL/min), were observed post-infusion, respectively. There were also increases in contraction frequency and fractional pump flow 1-minute post-infusion. Time-averaged wall shear stress increased 10 fold post-infusion to nearly 1.5 dynes/cm2. Similarly, maximum shear stress rose from 5 dynes/cm2 to 40 dynes/cm2. Conclusions Lymphatic vessels adapted to edemagenic stress by increasing lymph transport. Specifically, the increases in lymphatic contraction frequency, lymph velocity, and shear stress were significant. Lymph pumping increased post-infusion, though changes in lymphatic diameter were not statistically significant. These results indicate that edemagenic conditions stimulate lymph transport via increases in lymphatic contraction frequency, lymph velocity and flow. These changes, consequently, resulted in large increases in wall shear stress, which could then activate NO pathways and modulate lymphatic transport function. PMID:24397756

  3. Biologically active low density lipoprotein in human peripheral lymph.

    PubMed Central

    Reichl, D; Myant, N B; Brown, M S; Goldstein, J L

    1978-01-01

    We have compared the ability of human serum and peripheral lymph to suppress the activity of 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA reductase), to activate cholesteryl ester synthesis, and to compete with 125I-labeled low density lipoprotein (LDL) for binding to LDL receptors in cultured human fibroblasts. Whole lymph was active in all three tests and the activity per unit volume in lymph was approximately equal to 1/10th that in serum. All three biologic activities in lymph were confined to the d less than 1.063 g/ml fraction. Whole lymph had no significant effect on HMG-CoA reductase activity in fibroblasts from a patient with homozygous familial hypercholesterolemia, whose cells lack LDL receptors. The LDL-like biologic activity per unit mass of immunologically active apoprotein B was approximately the same in lymph as in serum. The current data indicate that functionally active LDL is present in lymph and that the concentration of this lipoprotein is approximately equal to 1/10th that in serum. PMID:201669

  4. Extended lymph node dissection in robotic radical prostatectomy: Current status

    PubMed Central

    Chopra, Sameer; Alemozaffar, Mehrdad; Gill, Inderbir; Aron, Monish

    2016-01-01

    Introduction: The role and extent of extended pelvic lymph node dissection (ePLND) during radical prostatectomy (RP) for prostate cancer patients remains unclear. Materials and Methods: A PubMed literature search was performed for studies reporting on treatment regimens and outcomes in patients with prostate cancer treated by RP and extended lymph node dissection between 1999 and 2013. Results: Studies have shown that RP can improve progression-free and overall survival in patients with lymph node-positive prostate cancer. While this finding requires further validation, it does allow urologists to question the former treatment paradigm of aborting surgery when lymph node invasion from prostate cancer occurred, especially in patients with limited lymph node tumor infiltration. Studies show that intermediate- and high-risk patients should undergo ePLND up to the common iliac arteries in order to improve nodal staging. Conclusions: Evidence from the literature suggests that RP with ePLND improves survival in lymph node-positive prostate cancer. While studies have shown promising results, further improvements and understanding of the surgical technique and post-operative treatment are required to improve treatment for prostate cancer patients with lymph node involvement. PMID:27127352

  5. [Resection of a left obturator lymph node recurrence five years five months after surgery for rectal cancer].

    PubMed

    Takenoya, Takashi; Kobayashi, Yukari; Suda, Kouichi; Shimizu, Kazuki; Kikuichi, Masahiro

    2014-11-01

    A 62-year-old man with lower rectal cancer underwent abdominoperineal resection and dissection of the lateral pelvic lymph nodes. The cancer was staged at pT3pN0cM0, pStage II and did not show recurrence. Two years later, the patient had dysphagia and was diagnosed with esophageal cancer based on upper gastrointestinal endoscopy. Positron emission tomography-computed tomography (PET/CT) performed to detect distant metastasis revealed fluorodeoxyglucose (FDG) uptake in the left obturator lymph nodes, indicating rectal cancer recurrence. The patient received radiation therapy (60.4 Gy) for the recurrence. A PET/CT scan obtained 2 years 6 months after the initial rectal cancer resection revealed no FDG uptake. Uraciltegafur plus Leucovorin (UFT+LV) was started and continued for 6 months, but tumor enlargement was noted. Treatment was changed to LV, 5-fluorouracil, and irinotecan (FOLFIRI), but after 4 courses, the patient's carcinoembryonic antigen (CEA) levels rose. The patient then received 4 courses of bevacizumab plus FOLFIRI. A CT scan revealed tumor shrinkage, so the patient received 4 more courses of this regimen. Five years postoperatively, the patient's CEA levels rose again. A PET/CT scan 4 months later revealed FDG uptake in the left obturator lymph nodes, indicative of rectal cancer recurrence. One month later, the lymph nodes were resected. The patient was subsequently recurrence free. Tumor marker measurement and PET/CT helped to assess the patient's condition. When cancer recurs in the lateral pelvic lymph nodes with no involvement of the pelvis and R0 resection is possible, resection should be considered if the patient is capable of undergoing surgery.

  6. Isolated axillary lymph node tuberculosis in ultrasonography. A case report

    PubMed Central

    Urbańska-Krawiec, Dagmara; Kajor, Maciej; Stefański, Leszek

    2012-01-01

    We present a rare case of isolated axillary lymph node tuberculosis. A 66-year-old patient was admitted in order to perform the diagnostics of a painless tumor of the left armpit. Blood biochemistry tests and chest X-ray did not show any abnormalities. In the ultrasound examination a solid structure of the dimensions of 1.8×1 cm of irregular outline with adjacent hypoechogenic lymph nodes was visualized. The diagnosis of tuberculosis was based on histopathologic examination of the excised tumor. In the latter years an increase in extrapulmonary type of tuberculosis has been observed. Extrapulmonary tuberculosis may appear in practically each organ, nevertheless it affects pleura most often. Lymph node tuberculosis is the second, when it comes to the prevalence rate, type of extrapulmonary tuberculosis. In the majority of cases of lymph node tuberculosis it affects superficial lymph nodes. In the ultrasound examination a packet of pathological, enlarged and hypoechogenic lymph nodes is stated. In 1/3 of cases the central part of the nodes is hyperechogenic which indicates its caseation necrosis. Lymph nodes have a tendency to be matted and they have blurred outline. We observed this type of lymph node image in the presented patient. This image may be a diagnostic hint. Nevertheless, in the differentiation diagnostics one should take many other disease entities into consideration, inter alia: sarcoidosis, lymphomas, fungal infections, neoplastic metastases; the latter ones have an image most similar to tuberculosis lymph nodes. Tuberculosis ought to be considered in differential diagnosis of atypical masses. PMID:26674808

  7. Predictive Factors and Value of ypN+ after Neoadjuvant Chemotherapy in Clinically Lymph Node-Negative Breast Cancer

    PubMed Central

    Fukada, Ippei; Araki, Kazuhiro; Kobayashi, Kokoro; Shibayama, Tomoko; Takahashi, Shunji; Horii, Rie; Akiyama, Futoshi; Iwase, Takuji; Ohno, Shinji; Hatake, Kiyohiko; Hozumi, Yasuo; Sata, Naohiro; Ito, Yoshinori

    2016-01-01

    Background Pathological complete response (pCR) with neoadjuvant chemotherapy (NAC) has been regarded as a surrogate endpoint for disease-free survival (DFS) and overall survival (OS) of patients with breast cancer. No consensus regarding the definition of pCR has been established; there are several definitions according to a variety of classifications. Eradication of cancer cells in both breast and lymph nodes has been better associated with improved prognosis than in the breast alone. Even in patients diagnosed as having clinically node-negative cancer before NAC, postoperative pathological examination often shows axillary lymph node metastases. Patients and Methods Of the 771 patients with breast cancer who underwent NAC in the Cancer Institute Hospital between January 2000 and May 2009, 146 patients preoperatively diagnosed as having node-negative breast cancer were retrospectively evaluated. We have made the definition of clinically lymph node-negative (N0) as follows: first, ultrasonography before NAC did not show any lymphadenopathy. Second, a cytological procedure confirmed negative study for each patient when ultrasonography suggested lymphadenopathy. Results The median observation period was 79.7 months, and the median age of the subjects was 51 years. Pathological examination at the time of the surgery showed lymph node metastases (ypN+) in 46 patients (31.5%). Histological therapeutic effects revealed ypT0/is in 9 patients (6.2%) and ypTinv in 137 (93.8%). Multivariate analysis demonstrated that younger age (49>), large tumor size, NG3, and ypN+ were significant poor prognostic factors for DFS (p = 0.020, p = 0.008, P = 0.022 and p = 0.010, respectively). Moreover, ypN+ was the only significant poor prognostic factor for OS (p = 0.022). The predictive factors of ypN+ in clinically lymph node–negative breast cancer were ypTinv (p = 0.036) and the luminal type (HR+ and HER2-) (p = 0.029). Conclusion The prognosis of clinically lymph node negative breast

  8. Mucoepidermoid carcinoma arising in an intraparotid lymph node.

    PubMed

    Smith, A; Winkler, B; Perzin, K H; Wazen, J; Blitzer, A

    1985-01-15

    A well-differentiated mucoepidermoid carcinoma that was confined to, and apparently arose within, an intraparotid lymph node is reported. Salivary gland ducts and acini often are found within intraparotid lymph nodes, and occasionally within extraparotid nodes. Salivary gland tumors, both benign and malignant, can develop within this ectopic salivary tissue. When a malignant salivary-gland-type neoplasm is found within an intraparotid or periparotid lymph node, the possibility exists that the tumor has arisen within the node and does not necessarily represent a metastasis from some other occult site.

  9. Sentinel lymph node biopsy in clinically detected ductal carcinoma in situ

    PubMed Central

    Al-Ameer, Ahmed Yahia; Al Nefaie, Sahar; Al Johani, Badria; Anwar, Ihab; Al Tweigeri, Taher; Tulbah, Asma; Alshabanah, Mohmmed; Al Malik, Osama

    2016-01-01

    AIM: To study the indications for sentinel lymph node biopsy (SLNB) in clinically-detected ductal carcinoma in situ (CD-DCIS). METHODS: A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy (CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital. The accuracy of performing SLNB in CD-DCIS, the rate of sentinel and non-sentinel nodal metastasis, and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed. The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion. We excluded any patient with evidence of microinvasion or invasion. There were two cases of mammographically detected DCIS and 18 cases of CD-DCIS. All our patients were diagnosed by an image-guided CNB except two patients who were diagnosed by fine needle aspiration (FNA). All patients underwent breast surgery, SLNB, and axillary lymph node dissection (ALND) if the SLN was positive. RESULTS: Twenty patients with an initial diagnosis of pure DCIS underwent SLNB, 2 of whom had an ALND. The mean age of the patients was 49.7 years (range, 35-70). Twelve patients (60%) were premenopausal and 8 (40%) were postmenopausal. CNB was the diagnostic procedure for 18 patients, and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate. Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis. Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%. The false negative rate was 0%. Only 2 patients had a positive SLNB (10%) and neither had additional metastasis following an ALND. After definitive surgery, 3 patients were upstaged to invasive ductal carcinoma (3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion (3/18 = 16.6%). Therefore the histologic underestimation rate of invasive disease was 33

  10. Detection of an early adult T-cell leukemia-lymphoma clone in lymph nodes with anaplastic lymphoma kinase-negative anaplastic large cell lymphoma involvement.

    PubMed

    Tokunaga, Masahito; Yoshida, Noriaki; Nakano, Nobuaki; Kubota, Ayumu; Takeuchi, Shogo; Takatsuka, Yoshifusa; Seto, Masao; Utsunomiya, Atae

    2016-04-01

    A 58-year-old man was admitted to our hospital with systemic lymphadenopathy and was diagnosed with anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (ALCL) by lymph node biopsy. Although he was a human T-cell leukemia virus type I (HTLV-1) carrier, Southern blot analysis of the lymph node did not show monoclonal integration of HTLV-1 provirus deoxyribonucleic acid (DNA). He achieved complete remission after chemotherapy and subsequently, autologous peripheral blood stem cell transplantation (auto-PBSCT) was performed. Fifteen months after the auto-PBSCT, abnormal lymphocytes in the peripheral blood gradually increased. Southern blot analysis revealed monoclonal integration of HTLV-1 provirus DNA and monoclonal rearrangement of TRB. He was diagnosed with chronic type adult T-cell leukemia-lymphoma (ATL), which immediately progressed to the acute type. He died of tumor progression despite intensive chemotherapy. We analyzed genomic alterations of the ALCL and ATL cells using array comparative genomic hybridization. We found that the genomic alteration pattern differed between the two diseases. T-cell receptor clonality analysis using polymerase chain reaction (PCR) showed that the T-cell clone of the ATL was present in the lymph nodes with ALCL involvement, but not in peripheral blood. This finding suggests that lymph nodes can serve as a niche for ATL development.

  11. [Lymph node preparation in colorectal cancer. Ex vivo methylene blue injection as a novel technique to improve lymph node visualization].

    PubMed

    Märkl, B; Kerwel, T; Jähnig, H; Anthuber, M; Arnholdt, H

    2008-07-01

    The UICC requires investigation of a minimum of 12 lymph nodes for adequate lymph node staging in colorectal cancer. Despite that, many authors recommend investigation of a larger number, and different techniques, such as fat clearance, have therefore been developed. In this study we introduce a novel technique involving ex vivo lymph node staining with intraarterial methylene blue injection in colon cancer. We compared 14 cases in which methylene injection was used with 14 cases from our records in which conventional investigation techniques were applied. The lymph node harvest differed highly significantly (p<0.001) between the two groups, with average numbers of 28+/-7 and 14+/-3 in the methylene blue group and the unstained group, respectively. The largest difference occurred in the size group 2-4 mm (191 vs 70 lymph nodes). In 6 cases in the unstained group additional embedding of fatty tissue was necessary to reach an adequate number of investigated lymph nodes. Methylene blue injection is a novel and highly effective method that will improve lymph node preparation in colorectal cancer.

  12. A Case of Gastric Cancer with Residual Tumor Only in the Para-Aortic Lymph Nodes after Systemic Chemotherapy followed by Conversion Surgery

    PubMed Central

    Tsutsuyama, Masayuki; Ito, Seiji; Ito, Yuichi; Misawa, Kazunari; Kawakami, Jiro; Natsume, Seiji; Uemura, Norihisa; Kinoshita, Takashi; Kimura, Kenya; Senda, Yoshiki; Abe, Tetsuya; Komori, Koji; Yatabe, Yasushi; Niwa, Yasumasa; Shimizu, Yasuhiro; Kinoshita, Taira

    2015-01-01

    We report the case of a 60-year-old male who was diagnosed with gastric cancer. Upper gastrointestinal endoscopy indicated advanced cancer in the posterior wall of the gastric body. Biopsy revealed poorly differentiated adenocarcinoma. Abdominal computed tomography demonstrated thickening of the gastric wall and enlargement of the regional lymph nodes and of the para-aortic lymph nodes (PAN). The involvement of the PAN extended from the celiac axis to the caudal area of the inferior mesenteric artery [cT3N3aH0P0M1(LYM), stage IV]. Systemic chemotherapy was initiated. After 3 courses of S-1 plus cisplatin combination chemotherapy, the primary lesion and the enlarged lymph nodes revealed marked regression except for a minute residual lesion in the lymph nodes. Upon obtaining informed consent, open distal gastrectomy, D2 lymphadenectomy with PAN dissection, and Roux-en-Y reconstruction were performed. The patient was discharged from the hospital 35 days after the operation. Histopathological examination of the resected samples revealed malignant cells only in the PAN, not in the stomach or in the regional lymph nodes [ypT0N0M1(LYM), stage IV]. Currently, the patient is undergoing postoperative adjuvant chemotherapy with S-1 and has remained well without any recurrence after 6 months following surgery. PMID:26351440

  13. Diagnosing and Treating Hantavirus Pulmonary Syndrome (HPS)

    MedlinePlus

    ... CDC.gov . Hantavirus Share Compartir Diagnosing and Treating Hantavirus Pulmonary Syndrome (HPS) Diagnosing HPS Diagnosing HPS in ... of patients that develop HPS from New World Hantaviruses recover completely. No chronic infection has been detected ...

  14. Genetic alterations in primary mediastinal B-cell lymphoma: an update.

    PubMed

    Scarpa, A; Moore, P S; Rigaud, G; Menestrina, F

    2001-03-01

    Primary mediastinal B-cell lymphoma (PMBL) is a distinct clinical entity among non-Hodgkin's lymphoma. The malignancy has received little attention from a standpoint of basic research due in part to its rarity. However, based on recent studies consistent trends are beginning to emerge regarding the molecular and chromosomal alterations commonly observed in this disease. By both CGH and AP-PCR, genetic gains involving chromosomes 2, 5, 7, 9p, 12, and Xq are among the most frequently observed events. From a molecular standpoint, alterations in the c-myc, p16(INK4) and p53 genes have been observed in up to 30% of cases. This information along with the well-established histological, immunological, and clinical features should convince the few remaining disbelievers that PMBL is a distinct pathological entity among non-Hodgkin's lymphomas. PMID:11342356

  15. [Transmanubrial Osteomuscular-sparing Approach for Resection of Superior Mediastinal Schwannoma].

    PubMed

    Aragaki, Masato; Iimura, Yasuyuki; Sato, Nagato; Fukuda, Naoya; Miyazaki, Dai; Umemoto, Kazufumi; Yoshida, Yusuke; Hasegawa, Naoto

    2016-08-01

    Various approaches can be applied to resect superior mediastinal tumor. It is important to choose the procedure according to the location, size, and characteristics of the tumor in order to perform safe procedure surgery because of distinctive anatomy of this site. We hereby report on a case of Schwannoma of the superior mediastinum resected by the transmanubrial approach. A 67-year-old woman was referred to our department to examine an abnormal chest shadow found at a regular health checkup. Computed tomography revealed a tumor 58×52 mm in size extending from the left supraclavicular fossa to the upper border of the aortic arch. The surgery was performed under the diagnosis of neurogenic tumor using the transmanubrial approach. The tumor was resected safely and the pathological diagnosis was a Schwannoma. Transmanubrial approach was found to be quite useful in securing an adequate visual field and enabling the safe separation of blood vessels and nerves from the tumor. PMID:27476565

  16. [Video-assisted thoracic surgery, lung transplantation and mediastinitis: major issues in thoracic surgery in 2010].

    PubMed

    Borro, José M; Moreno, Ramón; Gómez, Ana; Duque, José Luis

    2011-01-01

    We reviewed the major issues in thoracic surgery relating to the advances made in our specialty in 2010. To do this, the 43(rd) Congress of the Spanish Society of Pneumology and Thoracic Surgery held in La Coruña and the articles published in the Society's journal, Archivos de Bronconeumología, were reviewed. The main areas of interest were related to the development of video-assisted thoracic surgery, lung transplantation and descending mediastinitis. The new tumor-node-metastasis (TNM) classification (7(th) edition), presented last year, was still a topical issue this year. The First Forum of Thoracic Surgeons and the Update in Thoracic Surgery together with the Nurses' Area have constituted an excellent teaching program. PMID:21300211

  17. Predicting axillary lymph node metastasis from kinetic statistics of DCE-MRI breast images

    NASA Astrophysics Data System (ADS)

    Ashraf, Ahmed B.; Lin, Lilie; Gavenonis, Sara C.; Mies, Carolyn; Xanthopoulos, Eric; Kontos, Despina

    2012-03-01

    The presence of axillary lymph node metastases is the most important prognostic factor in breast cancer and can influence the selection of adjuvant therapy, both chemotherapy and radiotherapy. In this work we present a set of kinetic statistics derived from DCE-MRI for predicting axillary node status. Breast DCE-MRI images from 69 women with known nodal status were analyzed retrospectively under HIPAA and IRB approval. Axillary lymph nodes were positive in 12 patients while 57 patients had no axillary lymph node involvement. Kinetic curves for each pixel were computed and a pixel-wise map of time-to-peak (TTP) was obtained. Pixels were first partitioned according to the similarity of their kinetic behavior, based on TTP values. For every kinetic curve, the following pixel-wise features were computed: peak enhancement (PE), wash-in-slope (WIS), wash-out-slope (WOS). Partition-wise statistics for every feature map were calculated, resulting in a total of 21 kinetic statistic features. ANOVA analysis was done to select features that differ significantly between node positive and node negative women. Using the computed kinetic statistic features a leave-one-out SVM classifier was learned that performs with AUC=0.77 under the ROC curve, outperforming the conventional kinetic measures, including maximum peak enhancement (MPE) and signal enhancement ratio (SER), (AUCs of 0.61 and 0.57 respectively). These findings suggest that our DCE-MRI kinetic statistic features can be used to improve the prediction of axillary node status in breast cancer patients. Such features could ultimately be used as imaging biomarkers to guide personalized treatment choices for women diagnosed with breast cancer.

  18. How Is Melanoma Skin Cancer Diagnosed?

    MedlinePlus

    ... medicine doctor injects a small amount of a radioactive substance into the area of the melanoma. After ... one or more sentinel lymph nodes. Once the radioactive area has been marked, the patient is taken ...

  19. Randomized Clinical Trial to Assess the Efficacy of Radiotherapy in Primary Mediastinal Large B-Lymphoma

    SciTech Connect

    Aviles, Agustin; Neri, Natividad; Fernandez, Raul; Huerta-Guzman, Judith; Nambo, Maria J.

    2012-07-15

    Purpose: We developed a controlled clinical trial to assess the efficacy and toxicity of adjuvant-involved field radiotherapy (IFRT) in patients with primary mediastinal B-cell lymphoma that achieved complete response after the patients were treated with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab (R-CHOP-14). Methods and Materials: Between January 2001 and June 2004, 124 consecutive patients who were in complete remission after dose dense chemotherapy and rituximab administration (R-CHOP14) were randomly assigned to received IFRT (30 Gy). Sixty-three patients received IFR, and 61 patients did not (control group). Results: The study aimed to include 182 patients in each arm but was closed prematurely because in a security analysis (June 2004), progression and early relapse were more frequent in patients that did not received IFRT. Patients were followed until March 2009, at which point actuarial curves at 10 years showed that progression free-survival was 72% in patients who received IFR and 20% in the control group (p < 0.001), overall survival was 72% and 31%, respectively (p < 0.001). Acute toxicity was mild and well tolerated. Discussion: Adjuvant radiotherapy to sites of bulky disease was the only difference to have an improvement in outcome in our patients; the use of rituximab during induction did not improve complete response rates and did affect overall survival; patients who received rituximab but not IFRT had a worse prognosis. Conclusions: The use of IFRT in patients with primary mediastinal B-cell lymphoma who achieved complete response remain as the best treatment available, even in patients that received rituximab during induction.

  20. Is post-sternotomy mediastinitis still devastating after the advent of negative-pressure wound therapy?

    PubMed

    De Feo, Marisa; Della Corte, Alessandro; Vicchio, Mariano; Pirozzi, Francesco; Nappi, Gianantonio; Cotrufo, Maurizio

    2011-01-01

    In this study, we reviewed a 15-year experience with the treatment of a severe sequela of cardiac surgery: post-sternotomy mediastinitis. We compared the outcomes of conventional treatment with those of negative-pressure wound therapy, focusing on mortality rate, sternal reinfection, and length of hospital stay.We reviewed data on 157 consecutive patients who were treated at our institution from 1995 through 2010 for post-sternotomy mediastinitis after cardiac surgery. Of these patients, 74 had undergone extensive wound débridement followed by negative-pressure wound therapy, and 83 had undergone conventional treatment, including primary wound reopening, débridement, closed-chest irrigation without rewiring, topical application of granulated sugar for recurrent cases, and final plastic reconstruction with pectoral muscle flap in most cases.The 2 study groups were homogeneous in terms of preoperative data and operative variables (the primary cardiac surgery was predominantly coronary artery bypass grafting). Negative-pressure wound therapy was associated with lower early mortality rates (1.4% vs 3.6%; P = 0.35) and significantly lower reinfection rates (1.4% vs 16.9%; P = 0.001). Significantly shorter hospital stays were also observed with negative pressure in comparison with conventional treatment (mean durations, 27.3 ± 9 vs 30.5 ± 3 d; P = 0.02), consequent to the accelerated process of wound healing with negative-pressure therapy.Lower mortality and reinfection rates and shorter hospital stays can result from using negative pressure rather than conventional treatment. Therefore, negative-pressure wound therapy is advisable as first-choice therapy for deep sternal wound infection after cardiac surgery.

  1. [Paraneoplastic limbic encephalitis with positive anti-RI antibodies and mediastinal seminoma].

    PubMed

    Launay, M; Bozzolo, E; Venissac, N; Delmont, E; Fredenrich, A; Thomas, P

    2008-01-01

    We report the case of a 49-year-old man who was admitted for progressive behaviorial disorders with frontal elements. There was no sensorial nor motor deficiency. Clinical examination revealed android obesity, cutaneous and mucous paleness, pubic and axillary depilation and gynecomastia. Encephalic MRI found a lesion of the left amygdalian region with high T2 intensity and low T1 intensity associated with gadolinium-enhancement. Cerebrospinal fluid analysis showed a lymphocytic meningitis. Panhypopituitarism was found on the endocrine investigations. Anti-RI antibodies were positive, leading to the diagnosis of paraneoplastic limbic encephalitis. The CT-scan showed a node of the lower part of the thymic area. Surgical resection revealed an ectopic mediastinal seminoma. The evolution consisted of paraneoplastic fever and crossed-syndrome with right hemiparesia and left common oculomotor nerve paralysis. Treatment was completed by two cycles of carboplatin, corticosteroids and substitutive opotherapy. Paraneoplastic fever disappeared, but behavioral disorders and palsy remain unchanged. The patient died two years later in a bedridden state. This case of paraneoplastic limbic encephalitis associated with positive anti-RI antibodies and mediastinal seminoma is exceptional and has not to our knowledge been described in the literature. Cancers usually associated with anti-RI antibody are breast and lung cancer. Paraneoplastic limbic encephalitis is not the classical clinical presentation, which usually is brainstem encephalitis. Hypothalamic involvement, uncommon in paraneoplastic limbic encephalitis is mainly associated with positive antineuronal anti-Ma2 antibodies. Finally, the gadolinium enhancement on encephalic MRI is unusual in paraneoplastic limbic encephalitis. PMID:18565362

  2. Nanoparticle transport from mouse vagina to adjacent lymph nodes.

    PubMed

    Ballou, Byron; Andreko, Susan K; Osuna-Highley, Elvira; McRaven, Michael; Catalone, Tina; Bruchez, Marcel P; Hope, Thomas J; Labib, Mohamed E

    2012-01-01

    To test the feasibility of localized intravaginal therapy directed to neighboring lymph nodes, the transport of quantum dots across the vaginal wall was investigated. Quantum dots instilled into the mouse vagina were transported across the vaginal mucosa into draining lymph nodes, but not into distant nodes. Most of the particles were transported to the lumbar nodes; far fewer were transported to the inguinal nodes. A low level of transport was evident at 4 hr after intravaginal instillation, and transport peaked at about 36 hr after instillation. Transport was greatly enhanced by prior vaginal instillation of Nonoxynol-9. Hundreds of micrograms of nanoparticles/kg tissue (ppb) were found in the lumbar lymph nodes at 36 hr post-instillation. Our results imply that targeted transport of microbicides or immunogens from the vagina to local lymph organs is feasible. They also offer an in vivo model for assessing the toxicity of compounds intended for intravaginal use. PMID:23284844

  3. How Is Fanconi Anemia Diagnosed?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Fanconi Anemia Diagnosed? People who have Fanconi anemia (FA) are born with the disorder. They may ... questions about: Any personal or family history of anemia Any surgeries you’ve had related to the ...

  4. Associations among Major Psychiatric Diagnoses.

    ERIC Educational Resources Information Center

    Wolf, Abraham W.; And Others

    1988-01-01

    Examined the frequency and associations of multiple diagnoses in 205 psychiatric inpatients, assessing past and current episodes of illness. Over one-half of the sample received more than one diagnosis. Alcoholism, antisocial personality, and drug dependence formed one group; primary depression, primary mania, and secondary affective disorder,…

  5. How Is an Aneurysm Diagnosed?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is an Aneurysm Diagnosed? If you have an aortic aneurysm but no symptoms, your doctor may find it ... a routine physical exam. More often, doctors find aneurysms during tests done for other reasons, such as ...

  6. Assessment of lymph node involvement in colorectal cancer.

    PubMed

    Ong, Mark L H; Schofield, John B

    2016-03-27

    Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node metastasis staging system. Patients with node-negative disease have 5-year survival rates of 70%-80%, implying a significant minority of patients with occult lymph node metastases will succumb to disease recurrence. Enhanced staging techniques may help to identify this subset of patients, who might benefit from further treatment. Obtaining adequate numbers of lymph nodes is essential for accurate staging. Lymph node yields are affected by numerous factors, many inherent to the patient and the tumour, but others related to surgical and histopathological practice. Good lymph node recovery relies on close collaboration between surgeon and pathologist. The optimal extent of surgical resection remains a subject of debate. Extended lymphadenectomy, extra-mesenteric lymph node dissection, high arterial ligation and complete mesocolic excision are amongst the surgical techniques with plausible oncological bases, but which are not supported by the highest levels of evidence. With further development and refinement, intra-operative lymphatic mapping and sentinel lymph node biopsy may provide a guide to the optimum extent of lymphadenectomy, but in its present form, it is beset by false negatives, skip lesions and failures to identify a sentinel node. Once resected, histopathological assessment of the surgical specimen can be improved by thorough dissection techniques, step-sectioning of tissue blocks and immunohistochemistry. More recently, molecular methods have been employed. In this review, we consider the numerous factors that affect lymph node yields, including the impact of the surgical and histopathological techniques. Potential future strategies, including the use of evolving technologies, are also discussed. PMID:27022445

  7. Assessment of lymph node involvement in colorectal cancer

    PubMed Central

    Ong, Mark L H; Schofield, John B

    2016-01-01

    Lymph node metastasis informs prognosis and is a key factor in deciding further management, particularly adjuvant chemotherapy. It is core to all contemporary staging systems, including the widely used tumor node metastasis staging system. Patients with node-negative disease have 5-year survival rates of 70%-80%, implying a significant minority of patients with occult lymph node metastases will succumb to disease recurrence. Enhanced staging techniques may help to identify this subset of patients, who might benefit from further treatment. Obtaining adequate numbers of lymph nodes is essential for accurate staging. Lymph node yields are affected by numerous factors, many inherent to the patient and the tumour, but others related to surgical and histopathological practice. Good lymph node recovery relies on close collaboration between surgeon and pathologist. The optimal extent of surgical resection remains a subject of debate. Extended lymphadenectomy, extra-mesenteric lymph node dissection, high arterial ligation and complete mesocolic excision are amongst the surgical techniques with plausible oncological bases, but which are not supported by the highest levels of evidence. With further development and refinement, intra-operative lymphatic mapping and sentinel lymph node biopsy may provide a guide to the optimum extent of lymphadenectomy, but in its present form, it is beset by false negatives, skip lesions and failures to identify a sentinel node. Once resected, histopathological assessment of the surgical specimen can be improved by thorough dissection techniques, step-sectioning of tissue blocks and immunohistochemistry. More recently, molecular methods have been employed. In this review, we consider the numerous factors that affect lymph node yields, including the impact of the surgical and histopathological techniques. Potential future strategies, including the use of evolving technologies, are also discussed. PMID:27022445

  8. Automatic FDG-PET-based tumor and metastatic lymph node segmentation in cervical cancer

    NASA Astrophysics Data System (ADS)

    Arbonès, Dídac R.; Jensen, Henrik G.; Loft, Annika; Munck af Rosenschöld, Per; Hansen, Anders Elias; Igel, Christian; Darkner, Sune

    2014-03-01

    Treatment of cervical cancer, one of the three most commonly diagnosed cancers worldwide, often relies on delineations of the tumour and metastases based on PET imaging using the contrast agent 18F-Fluorodeoxyglucose (FDG). We present a robust automatic algorithm for segmenting the gross tumour volume (GTV) and metastatic lymph nodes in such images. As the cervix is located next to the bladder and FDG is washed out through the urine, the PET-positive GTV and the bladder cannot be easily separated. Our processing pipeline starts with a histogram-based region of interest detection followed by level set segmentation. After that, morphological image operations combined with clustering, region growing, and nearest neighbour labelling allow to remove the bladder and to identify the tumour and metastatic lymph nodes. The proposed method was applied to 125 patients and no failure could be detected by visual inspection. We compared our segmentations with results from manual delineations of corresponding MR and CT images, showing that the detected GTV lays at least 97.5% within the MR/CT delineations. We conclude that the algorithm has a very high potential for substituting the tedious manual delineation of PET positive areas.

  9. Gamma-probe guided localization of lymph nodes.

    PubMed

    Alex, J C; Krag, D N

    1993-01-01

    The initial draining lymph node (Sentinel node) of a tumour may reflect the status of the tumours spread to the remaining lymphatic bed. The sentinel node, which has been reported to predict metastatic melanoma, has recently been localized by a new invasive technique [1]. The goal of our pre-clinical trial was to test a non-invasive technique to localize the sentinel node. Gamma-probe guided localization was used to identify and then surgically remove the first draining lymph node(s) in 16 inguinal lymphatic basins of eight cats. This method was found to be comparable to an invasive method using a blue dye. Gamma-probe localization has several potential advantages in that it can: (a) precisely locate on the surface of the skin the position of an underlying lymph node, (b) intraoperatively guide the surgeon to the lymph node during dissection, (c) verify that the correct node has been biopsied, (d) determine the possible presence of residual lymph nodes, (e) allow lymph nodes to be harvested through a small incision as opposed to raising a skin flap, and (f) be rapidly and easily performed.

  10. Fluorescence imaging to study cancer burden on lymph nodes

    NASA Astrophysics Data System (ADS)

    D'Souza, Alisha V.; Elliott, Jonathan T.; Gunn, Jason R.; Samkoe, Kimberley S.; Tichauer, Kenneth M.; Pogue, Brian W.

    2015-03-01

    Morbidity and complexity involved in lymph node staging via surgical resection and biopsy calls for staging techniques that are less invasive. While visible blue dyes are commonly used in locating sentinel lymph nodes, since they follow tumor-draining lymphatic vessels, they do not provide a metric to evaluate presence of cancer. An area of active research is to use fluorescent dyes to assess tumor burden of sentinel and secondary lymph nodes. The goal of this work was to successfully deploy and test an intra-nodal cancer-cell injection model to enable planar fluorescence imaging of a clinically relevant blue dye, specifically methylene blue along with a cancer targeting tracer, Affibody labeled with IRDYE800CW and subsequently segregate tumor-bearing from normal lymph nodes. This direct-injection based tumor model was employed in athymic rats (6 normal, 4 controls, 6 cancer-bearing), where luciferase-expressing breast cancer cells were injected into axillary lymph nodes. Tumor presence in nodes was confirmed by bioluminescence imaging before and after fluorescence imaging. Lymphatic uptake from the injection site (intradermal on forepaw) to lymph node was imaged at approximately 2 frames/minute. Large variability was observed within each cohort.

  11. A Parapharyngeal Soft Tissue Chordoma Presenting with Synchronous Cervical Lymph Node Metastasis: An Unusual Presentation.

    PubMed

    Khurram, S A; Biswas, D; Fernando, M

    2016-09-01

    A 63 year old male presented with a three month history of dysphagia, neck swelling and an oropharyngeal swelling on examination. Initial fine needle aspiration cytology and magnetic resonance imaging (done at a peripheral hospital) suggested a salivary gland neoplasm with lymph node metastasis. An infra-temporal approach was employed to excise the tumour mass and a modified radical neck dissection undertaken to remove the cervical metastasis. Histopathological examination with immunohistochemistry confirmed this to be a soft tissue chordoma. To the best of our knowledge, this is the first documented report of an extra-axial soft tissue chordoma presenting with synchronous metastatic disease. Though rare, this adds to the list of differential diagnoses for complex parapharyngeal lesions. A multidisciplinary approach between head and neck surgery, histopathology, radiology and sarcoma teams is paramount for arriving at the correct diagnosis and to deliver optimal treatment.

  12. An image analysis system for near-infrared (NIR) fluorescence lymph imaging

    NASA Astrophysics Data System (ADS)

    Zhang, Jingdan; Zhou, Shaohua Kevin; Xiang, Xiaoyan; Rasmussen, John C.; Sevick-Muraca, Eva M.

    2011-03-01

    Quantitative analysis of lymphatic function is crucial for understanding the lymphatic system and diagnosing the associated diseases. Recently, a near-infrared (NIR) fluorescence imaging system is developed for real-time imaging lymphatic propulsion by intradermal injection of microdose of a NIR fluorophore distal to the lymphatics of interest. However, the previous analysis software3, 4 is underdeveloped, requiring extensive time and effort to analyze a NIR image sequence. In this paper, we develop a number of image processing techniques to automate the data analysis workflow, including an object tracking algorithm to stabilize the subject and remove the motion artifacts, an image representation named flow map to characterize lymphatic flow more reliably, and an automatic algorithm to compute lymph velocity and frequency of propulsion. By integrating all these techniques to a system, the analysis workflow significantly reduces the amount of required user interaction and improves the reliability of the measurement.

  13. Increased 18F-FDG Uptake in the Spleen and Multiple Lymph Nodes in Dengue Fever.

    PubMed

    Jinguji, Megumi; Kajiya, Yoriko; Nakajo, Masatoyo; Nakajo, Masayuki; Yoshiura, Takashi

    2016-05-01

    A 62-year-old man underwent a whole-body FDG PET/CT for annual cancer screening. By an interview, he had an epigastric pain, and his body temperature was 37.0°C on the day. He just came back home from a travel to Southeast Asia 1 week ago and had presented with chill, high fever (temperature, 39.6°C), arthralgia, myalgia, and skin rash a few days before. Dengue fever was diagnosed by detecting dengue virus type 1 genome and antibody to the virus accompanied by thrombocytopenia and leukopenia. PET/CT examination revealed increased FDG uptake in the spleen and multiple lymph nodes. PMID:26825211

  14. Quantification of microvessels in canine lymph nodes.

    PubMed

    Tonar, Zbynĕk; Egger, Gunter F; Witter, Kirsti; Wolfesberger, Birgitt

    2008-10-01

    Quantification of microvessels in tumors is mostly based on counts of vessel profiles in tumor hot spots. Drawbacks of this method include low reproducibility and large interobserver variance, mainly as a result of individual differences in sampling of image fields for analysis. Our aim was to test an unbiased method for quantifying microvessels in healthy and tumorous lymph nodes of dogs. The endothelium of blood vessels was detected in paraffin sections by a combination of immunohistochemistry (von Willebrand factor) and lectin histochemistry (wheat germ agglutinin) in comparison with detection of basal laminae by laminin immunohistochemistry or silver impregnation. Systematic uniform random sampling of 50 image fields was performed during photo-documentation. An unbiased counting frame (area 113,600 microm(2)) was applied to each micrograph. The total area sampled from each node was 5.68 mm(2). Vessel profiles were counted according to stereological counting rules. Inter- and intraobserver variabilities were tested. The application of systematic uniform random sampling was compared with the counting of vessel profiles in hot spots. The unbiased estimate of the number of vessel profiles per unit area ranged from 100.5 +/- 44.0/mm(2) to 442.6 +/- 102.5/mm(2) in contrast to 264 +/- 72.2/mm(2) to 771.0 +/- 108.2/mm(2) in hot spots. The advantage of using systematic uniform random sampling is its reproducibility, with reasonable interobserver and low intraobserver variance. This method also allows for the possibility of using archival material, because staining quality is not limiting as it is for image analysis, and artifacts can easily be excluded. However, this method is comparatively time-consuming.

  15. Mediastinal Packing for Intractable Coagulopathy in Acute Aortic Dissection (Types 1 and 2 DeBakey): A Life-Saving Technique—Report of Experiences

    PubMed Central

    Moeinipour, Aliasghar; Fathi, Mehdi; Sepehri Shamloo, Alireza; Amini, Shahram; Hoseinikhah, Hamid; Kianinejad, Akram

    2015-01-01

    Nonsurgical bleeding after complex thoracic aortic procedures (such as aortic dissection and aortic aneurysm) is a great challenge for cardiac surgeons because of severe coagulopathy, exsanguinous bleeding, and inevitable death. Temporary mediastinal packing (with sponge) in such cases is the only life-saving technique with good result in most cases. Herein, we presented three cases with acute aortic dissection with intractable bleeding that was successfully managed with mediastinal packing. PMID:26435855

  16. Single-Institution Experience in the Treatment of Primary Mediastinal B Cell Lymphoma Treated With Immunochemotherapy in the Setting of Response Assessment by {sup 18}Fluorodeoxyglucose Positron Emission Tomography

    SciTech Connect

    Pinnix, Chelsea C.; Dabaja, Bouthaina; Ahmed, Mohamed Amin; Costelloe, Colleen; Wogan, Christine F.; Reed, Valerie; Romaguera, Jorge E.; Neelapu, Sattva; Oki, Yasuhiro; Fayad, Luis; Hagemeister, Frederick B.; Nastoupil, Loretta; Turturro, Francesco; Fowler, Nathan; Fanale, Michelle A.; and others

    2015-05-01

    Purpose: Excellent outcomes obtained after infusional dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (R-EPOCH) alone have led some to question the role of consolidative radiation therapy (RT) in the treatment of primary mediastinal B cell lymphoma (PMBL). We reviewed the outcomes in patients treated with 1 of 3 rituximab-containing regimens (cyclophosphamide, doxorubicin, vincristine, prednisone [R-CHOP]; hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone [R-HCVAD], or R-EPOCH) with or without RT. We also evaluated the ability of positron emission tomography–computed tomography (PET-CT) to identify patients at risk of relapse. Methods and Materials: We retrospectively identified 97 patients with diagnoses of stage I/II PMBCL treated at our institution between 2001 and 2013. The clinical characteristics, treatment outcomes, and toxicity were assessed. We analyzed whether postchemotherapy PET-CT could identify patients at risk for progressive disease according to a 5 point scale (5PS) Deauville score assigned. Results: Among 97 patients (median follow-up time, 57 months), the 5-year overall survival rate was 99%. Of patients treated with R-CHOP, 99% received RT; R-HCVAD, 82%; and R-EPOCH, 36%. Of 68 patients with evaluable end-of-chemotherapy PET-CT scans, 62% had a positive scan (avidity above that of the mediastinal blood pool [Deauville 5PS = 3]), but only 9 patients experienced relapse (n=1) or progressive disease (n=8), all with a 5PS of 4 to 5. Of the 25 patients who received R-EPOCH, 4 experienced progression, all with 5PS of 4 to 5; salvage therapy (RT and autologous stem cell transplantation) was successful in all cases. Conclusion: Combined modality immunochemotherapy and RT is well tolerated and effective for treatment of PMBCL. A postchemotherapy 5PS of 4 to 5, rather than 3 to 5, can identify patients at high risk of progression who should be considered for therapy beyond

  17. Radiotherapy for Early Mediastinal Hodgkin Lymphoma According to the German Hodgkin Study Group (GHSG): The Roles of Intensity-Modulated Radiotherapy and Involved-Node Radiotherapy

    SciTech Connect

    Koeck, Julia; Abo-Madyan, Yasser; Lohr, Frank; Stieler, Florian; Kriz, Jan; Mueller, Rolf-Peter; Wenz, Frederik; Eich, Hans Theodor

    2012-05-01

    Purpose: Cure rates of early Hodgkin lymphoma (HL) are high, and avoidance of late complications and second malignancies have become increasingly important. This comparative treatment planning study analyzes to what extent target volume reduction to involved-node (IN) and intensity-modulated (IM) radiotherapy (RT), compared with involved-field (IF) and three-dimensional (3D) RT, can reduce doses to organs at risk (OAR). Methods and Materials: Based on 20 computed tomography (CT) datasets of patients with early unfavorable mediastinal HL, we created treatment plans for 3D-RT and IMRT for both the IF and IN according to the guidelines of the German Hodgkin Study Group (GHSG). As OAR, we defined heart, lung, breasts, and spinal cord. Dose-volume histograms (DVHs) were evaluated for planning target volumes (PTVs) and OAR. Results: Average IF-PTV and IN-PTV were 1705 cm{sup 3} and 1015 cm{sup 3}, respectively. Mean doses to the PTVs were almost identical for all plans. For IF-PTV/IN-PTV, conformity was better with IMRT and homogeneity was better with 3D-RT. Mean doses to the heart (17.94/9.19 Gy for 3D-RT and 13.76/7.42 Gy for IMRT) and spinal cord (23.93/13.78 Gy for 3D-RT and 19.16/11.55 Gy for IMRT) were reduced by IMRT, whereas mean doses to lung (10.62/8.57 Gy for 3D-RT and 12.77/9.64 Gy for IMRT) and breasts (left 4.37/3.42 Gy for 3D-RT and 6.04/4.59 Gy for IMRT, and right 2.30/1.63 Gy for 3D-RT and 5.37/3.53 Gy for IMRT) were increased. Volume exposed to high doses was smaller for IMRT, whereas volume exposed to low doses was smaller for 3D-RT. Pronounced benefits of IMRT were observed for patients with lymph nodes anterior to the heart. IN-RT achieved substantially better values than IF-RT for almost all OAR parameters, i.e., dose reduction of 20% to 50%, regardless of radiation technique. Conclusions: Reduction of target volume to IN most effectively improves OAR sparing, but is still considered investigational. For the time being, IMRT should be considered for

  18. FINE-NEEDLE ASPIRATION CYTOLOGY OF HEAD AND NECK LYMPH NODES IN A TEN-YEAR PERIOD - SINGLE CENTER EXPERIENCE.

    PubMed

    Vasilj, Ankica; Katović, Sandra Kojić

    2015-09-01

    A wide spectrum of diseases including reactive processes, infections, lymphomas and metastatic tumors can cause enlargement of lymph nodes. The present study on 4062 patients with lymphadenopathy was conducted in the Department of Cytology, Sestre milosrdnice University Hospital Center, Zagreb, during a 10-year period. Of 4062 patients with lymphadenopathy, 1624 were males and 2438 were females, age range from several months to 85 years. Of 4062 fine needle aspiration procedures, 232/4062 (5.7%) samples were nondiagnostic. Lymph node aspirates were benign in 2640/3830 (69%) and malignant in 1190/3830 (31%) cases. Hematologic disease (Hodgkin lymphoma and non-Hodgkin lymphoma) was diagnosed in 482/1190 (40.5%) and metastases in 708/1190 (59.5%) cases. Of 482 patients with hematologic disease, 48/482 (10%) had Hodgkin lymphomas and 434/482 (90%) non-Hodgkin lymphomas. In the group of malignant lymphadenopathy, there were 212/708 (30%) metastatic squamous cell carcinomas, 177/708 (25%) metastatic adenocarcinomas, 149/708 (21%) metastases of other carcinomas, and 170/708 (24%) metastases of other malignant tumors. The present study confirmed the fine needle aspiration cytology of enlarged head and neck lymph nodes to be an excellent first-line method to investigate the nature of the lesions. PMID:26666101

  19. Occult Mediastinal Great Vessel Trauma: The Value of Aortography Performed During Angiographic Screening for Blunt Cervical Vascular Trauma

    SciTech Connect

    Ray, Charles E. Bauer, Jason R.; Cothren, C. Clay; Turner, James H.; Moore, Ernest E.

    2005-05-15

    Purpose. To determine the value of aortography in the assessment of occult aortic and great vessel injuries when routinely performed during screening angiography for blunt cerebrovascular injury (BCVI). Methods. One hundred and one consecutive patients who received both aortography and screening four-vessel angiography over 4 years were identified retrospectively. Angiograms for these patients were evaluated, and the incidence of occult mediastinal vascular injury was determined. Results. Of the 101 patients, 6 (6%) had angiographically documented traumatic aortic injuries. Of these 6 patients, one injury (17%) was unsuspected prior to angiography. Four of the 6 (67%) also had BCVI. One additional patient also had an injury to a branch of the subclavian artery. Conclusion. Routine aortography during screening angiography for BCVI is not warranted due to the low incidence (1%) of occult mediastinal arterial injury. However, in the setting of a BCVI screening study and no CT scan of the chest, aortography may be advantageous.

  20. Concurrent Nontuberculous Mycobacteria Infection and High-Grade Anterior Mediastinal Extraskeletal Osteosarcoma (ESOS): Is There a Connection?

    PubMed

    Faz, Gabriel T; Eltorky, Mahmoud; Karnath, Bernard

    2016-01-01

    BACKGROUND Extraskeletal osteosarcomas (ESOS) of the mediastinum are extremely rare and may present with concurrent nontuberculous mycobacteria infection. CASE REPORT We present the second documented case of high-grade anterior mediastinal extraskeletal osteosarcoma in a 59-year-old man with a history of treated, latent tuberculosis (TB). Sputum samples grew Mycoplasma avium complex and Mycobacterium fortuitum. Imaging showed a right-sided 7.6 cm mass with compression of the main bronchus. Subsequent biopsy with vimentin staining established the diagnosis of ESOS. Due to the patient's rapidly declining performance status, he was not deemed a candidate for surgery or chemotherapy. He subsequently expired within one month of presentation. CONCLUSIONS We present a unique case of high-grade anterior mediastinum ESOS and a review of the literature regarding all documented cases of ESOS to date. We suggest there is a possible link between mediastinal masses and nontuberculous mycobacteria infection. PMID:27539718