1
|
Belayachi B, Fenane H, Msougar Y. Surgical management of mediastinal mature cystic teratoma of the elderly remaining asymptomatic. J Cardiothorac Surg 2024; 19:28. [PMID: 38281986 PMCID: PMC10822176 DOI: 10.1186/s13019-024-02503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/14/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Mediastinal teratoma is an uncommon disease, nevertheless they represent the most common mediastinal germ cell tumors. It may grow silently for several years and remain undiagnosed until the occurrence of a complication. AIM The main aim of this article is to illustrate the silent evolution of an anterior mediastinal teratoma for over 70 years without presenting any notable complications. CASE PRESENTATION We present the case of a 70-year-old female, treated for hypertension referred to our department for managing a voluminous mediastinal mass, discovered fortuitously by a general practitioner in a chest X-ray. The anamnesis didn't relate any chest pain, cough, dyspnea nor hemoptysis. The clinical examination, in particular pleuropulmonary, was unremarkable. The workup (Chest X-Ray and CT scan) demonstrated a voluminous pleural mass at the expense of the right mediastinal pleura, rounded in shape, with calcified wall and fluid content. Blood tests did not demonstrate eosinophilia, and hydatid IgG serology was negative. serum human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) levels were found to be normal. The patient subsequently underwent a right posterolateral thoracotomy with resection of the lesion. The mass was dissected very carefully and then resected in toto. The macroscopic and microscopic histological examination demonstrated a mature cystic teratoma. Surgical resection was an adequate treatment and the prognosis was excellent for the patient. CONCLUSION Cystic mature teratomas are rare thoracic tumors, often recognized by radiological examination. This article relates the silent evolution that a teratoma could have, and the late appearance of symptoms that it could have.
Collapse
Affiliation(s)
- Badreddine Belayachi
- Department of Thoracic surgery, Mohammed VI University Hospital, Marrakesh, Morocco.
| | - Hicham Fenane
- Department of Thoracic surgery, Mohammed VI University Hospital, Marrakesh, Morocco
| | - Yassine Msougar
- Department of Thoracic surgery, Mohammed VI University Hospital, Marrakesh, Morocco
| |
Collapse
|
2
|
den Bakker MA, Weissferdt A. Neurogenic tumours of the posterior mediastinum and differential diagnosis considerations. Histopathology 2024; 84:238-252. [PMID: 37771117 DOI: 10.1111/his.15045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
The mediastinal compartment harbours vital organs and structures, including the heart, great vessels, major airways, and thymus. These structures are embedded in and associated with soft-tissue elements consisting of adipose and fibro-collagenous tissue in which soft-tissue tumours may develop. A detailed inventory of soft-tissue tumours that may be encountered in the mediastinum based on the WHO 2013 classification was published in 2015. In addition, several comprehensive reviews on mediastinal soft-tissue pathology are available, including reviews focusing specifically on a single tumour type. This review will focus on primary neurogenic and spindle cell tumours of the somatic soft tissue of the posterior mediastinum and provide a discussion of the pertinent differential diagnoses.
Collapse
Affiliation(s)
- Michael A den Bakker
- Department of Pathology, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Pathology, Erasmus MC, Rotterdam, the Netherlands
| | - Annikka Weissferdt
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
3
|
Kundu U, Gan Q, Donthi D, Sneige N. The Utility of Fine Needle Aspiration (FNA) Biopsy in the Diagnosis of Mediastinal Lesions. Diagnostics (Basel) 2023; 13:2400. [PMID: 37510144 PMCID: PMC10378189 DOI: 10.3390/diagnostics13142400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Fine needle aspiration is a minimally invasive, low-morbidity, and cost-efficient technique for the sampling of mediastinal lesions. Additionally, ancillary testing on FNA samples can be used for the refinement of diagnoses and for treatment-related purposes (flow cytometry, cytogenetics, immunohistochemistry, and molecular diagnostics). Mediastinal lesions, however, can show a variety of lineages and morphologic features, giving rise to diagnostic dilemmas. As a result, the differential diagnosis can vary widely and becomes especially challenging due to the smaller sample size on FNA and the variability in component sampling. For appropriate patient management and to determine the correct treatment strategies, accurate pathologic diagnoses are paramount. In this review, we present the cytomorphologic features together with the immunophenotypic findings of mediastinal lesions, with emphasis on the diagnostic challenges and pitfalls in FNA cytology samples, including smears and cell block sections.
Collapse
Affiliation(s)
- Uma Kundu
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Qiong Gan
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Deepak Donthi
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nour Sneige
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
4
|
Ascione A, Martino G, Di Donato F, Casini B, Covello R, Ascani S. CIC-rearranged sarcoma presenting with superior vena cava syndrome: case report. Pathologica 2023; 115:97-100. [PMID: 37114626 PMCID: PMC10462994 DOI: 10.32074/1591-951x-784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/10/2022] [Indexed: 04/29/2023] Open
Abstract
CIC-rearranged sarcomas are rare mesenchymal neoplasms belonging to the family of undifferentiated small round cell sarcomas. This report details the case of a 45-year-old man presenting with symptoms of mediastinal compression, radiological diagnosis of a mediastinal mass and rapid evolution to full-blown superior vena cava syndrome. The emergency was successfully managed with a pharmacological approach. Formulation of a pathological diagnosis of CIC-rearranged sarcoma was initially supported by fluorescence in situ hybridisation findings and later validated by next-generation sequencing, which showed CIC-DUX4 gene fusion. A chemotherapy regimen was started with immediate benefits for the patient. The spectrum of pathological entities able to cause superior vena cava syndrome is wide, and recognition of rare causes is important to tailor the therapeutic approach to the specific disease. This is, to the best of our knowledge, the first report of CIC-rearranged sarcoma presenting with superior vena cava syndrome.
Collapse
Affiliation(s)
- Andrea Ascione
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera “Santa Maria” di Terni, Terni, Italy
| | | | - Beatrice Casini
- Department of Research, Diagnosis and Innovative Technology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Renato Covello
- Department of Pathology, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera “Santa Maria” di Terni, Terni, Italy
| |
Collapse
|
5
|
Muramoto M, Kanda S, Kobayashi T, Tamada H, Fukazawa A, Koiwai K, Koizumi T. A case of mediastinal mesenchymal tumor with pericytic neoplasm feature that responded to radiation therapy. Thorac Cancer 2023; 14:1204-1207. [PMID: 36965153 PMCID: PMC10151134 DOI: 10.1111/1759-7714.14855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/27/2023] Open
Abstract
Here, we report a case of mediastinal mesenchymal tumor with a pericytic neoplasm feature that responded to radiation therapy. A 43-year-old man visited our hospital with a complaint of esophageal obstruction and chest pain. Chest computed tomography revealed a middle mediastinal tumor and a mesenchymal tumor was diagnosed with a pericytic neoplasm feature by video-assisted thoracoscopic biopsy. The definitive treatment for soft tissue tumor is surgical resection; however, the mediastinal tumor was unresectable because of esophageal and tracheal invasion. Radiation therapy was administered and there was a partial tumor response and 2 years disease-free status. With a review of the literature, we discuss the clinical and pathological characteristics of this rare tumor and its treatment.
Collapse
Affiliation(s)
- Miho Muramoto
- Department of Respiratory Medicine, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Shintaro Kanda
- Department of Hematology and Medical Oncology, Shinshu University Graduate School of Medicine School of Medicine, Nagano, Japan
| | - Takashi Kobayashi
- Department of Hematology and Medical Oncology, Shinshu University Graduate School of Medicine School of Medicine, Nagano, Japan
| | - Hisashi Tamada
- Department of Laboratory Medicine, Shinshu University Graduate School of Medicine School of Medicine, Nagano, Japan
| | - Ayumu Fukazawa
- Department of Radiology, Shinshu University Graduate School of Medicine School of Medicine, Nagano, Japan
| | - Keiichirou Koiwai
- Department of Radiology, Shinshu University Graduate School of Medicine School of Medicine, Nagano, Japan
| | - Tomonobu Koizumi
- Department of Hematology and Medical Oncology, Shinshu University Graduate School of Medicine School of Medicine, Nagano, Japan
| |
Collapse
|
6
|
Sreedher G, Tadros SS, Janitz E. Pediatric mediastinal masses. Pediatr Radiol 2022; 52:1935-1947. [PMID: 35674800 DOI: 10.1007/s00247-022-05409-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/21/2022] [Accepted: 05/14/2022] [Indexed: 12/01/2022]
Abstract
Mediastinal masses are categorized based on the International Thymic Malignancy Interest Group (ITMIG) classification into prevascular, visceral and paravertebral compartments. The schema is based on cross-sectional imaging, mainly CT, and helps with generating a differential diagnosis based on location of the mass. Up to half of all pediatric mediastinal tumors are malignant. In this review we describe mediastinal masses that are relevant to the pediatric population, as well as the role of MR imaging of mediastinal masses and its advantages.
Collapse
Affiliation(s)
- Gayathri Sreedher
- Department of Radiology, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA. .,Department of Pediatric Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Sameh S Tadros
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Emily Janitz
- Department of Radiology, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA
| |
Collapse
|
7
|
Gao PT, Lin SL, Fu PY, Liu XY, Li QL, Chen WF, Zhou PH. Natural orifice transluminal endoscopic mediastinal surgery: NOTEMS, a promising field for endotherapy. Endoscopy 2022; 54:E357-E359. [PMID: 34374046 DOI: 10.1055/a-1540-5732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Ping-Ting Gao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sheng-Li Lin
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pei-Yao Fu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin-Yang Liu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-Feng Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
8
|
Yang X, Zhao K, Mei J, Wei S, Xia L, Pu Y, Liu L. Primary Mediastinal Nonseminomas: A Population-Based Surveillance, Epidemiology, and End Results Analysis. J Surg Res 2021; 267:25-36. [PMID: 34126390 DOI: 10.1016/j.jss.2021.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/26/2021] [Accepted: 04/10/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to determine the disease characteristics and prognosis of patients with primary mediastinal nonseminomas (PMNS) in a Surveillance, Epidemiology, and End Results (SEER) analysis. MATERIALS AND METHODS Demographic, treatment, and survival outcome data of cases with PMNS from 1975 to 2016 were retrieved. Cases with unknown variables mentioned in the analysis were excluded. Relative statistical methods were applied to analyze clinical characteristics and prognosis. RESULTS A total of 587 PMNS patients met the selection criteria, 526 of whom were men. The mean age of patients was 28 (1-85) y. A total of 511 PMNS patients had validated subtypes, including 172 mixed germ cell tumors, 117 yolk sac tumors, 111 malignant teratomas, 70 choriocarcinomas, and 41 embryonal carcinomas. Patients with yolk sac tumors had the highest 3-y cancer-specific survival (CSS) rate (66.9%), while those with choriocarcinoma and embryonal carcinoma showed the worst prognosis. Surgery + chemotherapy (46.2%) was the most common and effective treatment for each subtype of PMNS. Multivariate Cox proportional hazards analysis identified embryonal carcinoma, malignant teratoma, choriocarcinoma, tumor size >15 cm, nodal metastasis, and distant stage as risk factors. In contrast, surgery-based care and younger age were protective factors. Propensity score matching analysis revealed significant improvement in the 5-y CSS rate from 35.8% to 60.3% with surgery (P < 0.001). However, radiotherapy (P = 0.436) and chemotherapy (P = 0.978) showed no survival benefits. CONCLUSIONS 10 percent of the PMNS patients were female. Choriocarcinomas and embryonal carcinomas had the worst prognosis. Surgery was demonstrated to be the only way to prolong survival time. Chemotherapy and radiotherapy had minimal effects on prognosis.
Collapse
Affiliation(s)
- Xudong Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Kejia Zhao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Shiyou Wei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Liang Xia
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Yi Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China.
| |
Collapse
|
9
|
Beg A, Parikh J, Janu A, Kaushal RK. Malignant giant solitary fibrous tumour of the mediastinum; masquerading Triton tumour. SURGICAL AND EXPERIMENTAL PATHOLOGY 2021. [DOI: 10.1186/s42047-021-00098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Malignant Solitary fibrous tumour (SFT) is an uncommon mesenchymal tumour with aggressive clinical behaviour as compared to its benign counterpart. There are only a handful of reports of extra-pleural malignant SFT arising from the mediastinum.
Case presentation
A 68-year-old male, presented with a history of cough and breathlessness for 2 weeks. Computed tomography (CT) scan revealed a large 11.6 × 11.3x18cm anterior mediastinal mass with extension to right hemithorax. The patient underwent excision of the mass after a biopsy confirmation of mesenchymal tumour. Histological examination of resection specimen revealed a spindle cell tumour with hypo and hypercellular areas, arranged in fascicular, focal storiform and hemangio-pericytomatous vasculature pattern. Moderate to marked nuclear atypia, frequent mitosis and areas of necrosis were noted. On immunohistochemistry (IHC), the tumour cells were positive for CD34, Bcl2, MIC2 (dot-like) and focally for S100 and Desmin. Although, the possibility of a malignant peripheral nerve sheath tumour with heterologous rhadomyosarcomatous differentiation (Triton tumour) was considered, however IHC for STAT6 confirmed it to be a malignant SFT. The patient developed recurrence within 1 year after surgery and despite multi-modality treatment (Re-excision, Chemotherapy and Radiotherapy) succumbed within 14 months from point of presentation.
Conclusion
Malignant SFT is a rare aggressive tumour that should be considered as a differential diagnosis in the mediastinum and a broad panel of IHC markers including STAT6 may be required to confirm the diagnosis.
Collapse
|
10
|
Xu H, Fan F, Gong Y, Jing X, Lin X, Wang H, Lin F, Li Z. Diagnostic Challenges in Fine-Needle Aspiration Cytology of Mediastinal Tumors and Lesions. Arch Pathol Lab Med 2021; 146:960-974. [PMID: 34402861 DOI: 10.5858/arpa.2021-0108-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Mediastinal tumors/lesions are frequently encountered in daily cytopathology practice. These lesions are accessible through endoscopic/endobronchial ultrasound-guided or computed tomography-guided fine-needle aspiration cytology and represent a wide range of primary and metastatic tumors. This often poses diagnostic challenges because of the complexity of the mediastinal anatomic structures. Tumors metastatic to mediastinal lymph nodes represent the most common mediastinal lesions and must be differentiated from primary lesions. OBJECTIVE.— To provide an updated review on the fine-needle aspiration cytology of mediastinal tumors/lesions, with an emphasis on diagnostic challenges. This review encompasses thymic epithelial neoplasms, mediastinal lymphoproliferative disorders, germ cell tumors, neuroendocrine tumors, soft tissue tumors, and metastatic tumors. Differential diagnoses; useful ancillary studies, including targeted immunohistochemical panels; and diagnostic pitfalls are discussed. DATA SOURCES.— Data were gathered from a PubMed search of peer-reviewed literature on mediastinal tumors. Data were also collected from the authors' own practices. CONCLUSIONS.— Fine-needle aspiration cytology plays a vital role in evaluation of mediastinal lesions. Being familiar with the clinical and cytomorphologic features of these lesions, appropriately triaging the diagnostic material for ancillary testing, and correlating with radiologic findings are important in arriving at correct diagnoses and guiding management.
Collapse
Affiliation(s)
- Huihong Xu
- From the Department of Pathology, Boston VA Healthcare System, Boston University, Boston, Massachusetts (Xu)
| | - Fang Fan
- the Department of Pathology, University of Kansas Medical Center, Kansas City (Fan)
| | - Yun Gong
- the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Gong)
| | - Xin Jing
- the Department of Pathology, University of Michigan, Ann Arbor (Jing)
| | - Xiaoqi Lin
- the Department of Pathology, Northwestern University, Chicago, Illinois (X. Lin)
| | - He Wang
- the Department of Pathology, Yale University, New Haven, Connecticut (Wang)
| | - Fan Lin
- the Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania (F. Lin)
| | - Zaibo Li
- the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Li)
| |
Collapse
|
11
|
Calabrese F, Fortarezza F, Pezzuto F, Lunardi F, Comacchio G, Sbaraglia M, Pasello G, Marulli G, Dei Tos AP, Rea F. The Rarest of Rare Thymic Lesions: A 10-Year Surgical Pathology Experience. Cancers (Basel) 2021; 13:4056. [PMID: 34439210 PMCID: PMC8392427 DOI: 10.3390/cancers13164056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
The thymus is a specialized primary lymphoid organ located in the midline pre-vascular mediastinum. The organ is the site of various pathological processes, neoplastic and not, whose rarity has not allowed in-depth studies on clinical or histological features of rarest and unusual variants. Herein, we report a 10-year Padova experience in the surgical pathology of the thymus, focusing on the pathological description of nonneoplastic lesions and rare epithelial and mesenchymal tumors recorded in our database, which comprises over 600 thymectomies. The extrapolated rare cases have been categorized into four groups that included 15 cysts, 18 carcinomas, 5 neuroendocrine tumors, and 2 soft tissue tumors. The cases are described from a clinical and pathological point of view and discussed in dedicated sections with a review of the most important literature. In this case, review series, we aim to update the epidemiology of these rare entities, improve diagnostic awareness, and finally, promote a collaborative network between referral centers.
Collapse
Affiliation(s)
- Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Francesco Fortarezza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Francesca Lunardi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Giovanni Comacchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| | - Marta Sbaraglia
- Department of Medicine, University of Padova, 35121 Padova, Italy; (M.S.); (A.P.D.T.)
| | - Giulia Pasello
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, 35121 Padova, Italy;
| | - Giuseppe Marulli
- Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Angelo Paolo Dei Tos
- Department of Medicine, University of Padova, 35121 Padova, Italy; (M.S.); (A.P.D.T.)
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (F.F.); (F.P.); (F.L.); (G.C.); (F.R.)
| |
Collapse
|
12
|
Amălinei C, Grigoraş A, Balan RA, Rîşcanu LA, Giuşcă SE, Căruntu ID. Thymolipoma - the frontier between hamartoma and neoplasia? ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2021; 62:651-661. [PMID: 35263392 PMCID: PMC9019679 DOI: 10.47162/rjme.62.3.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
Thymolipoma is an uncommon benign thymus lesion, with a partially deciphered etiopathogeny, being most frequently diagnosed in young patients, regardless of gender. Incidentally diagnosed in asymptomatic patients, larger thymolipomas lead to symptoms related to neighboring mediastinal structures compression, with an intensity which is correlated with the mass size. Our review presents the main epidemiological, pathogenic, clinicopathological and morphological characteristics of this rare pathology. Sometimes, thymolipomas may be associated with paraneoplastic syndromes, which are alleviated by the mass complete surgical resection. Imagistics may orientate the diagnosis, which is certified by the microscopic examination of the resection specimens. Extensive thymectomy remains the current therapeutic option and new tools have been developed to increase the accuracy of the surgical procedure to avoid incidental lesions of the important elements of the anterior mediastinum. Although rare, thymolipomas should be considered in the differential diagnosis of mediastinal masses and of paraneoplastic syndromes.
Collapse
Affiliation(s)
- Cornelia Amălinei
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
- Department of Histopathology, Institute of Legal Medicine, Iaşi, Romania
| | - Adriana Grigoraş
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
- Department of Histopathology, Institute of Legal Medicine, Iaşi, Romania
| | - Raluca Anca Balan
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Laura Adriana Rîşcanu
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
- Department of Histopathology, Institute of Legal Medicine, Iaşi, Romania
| | - Simona Eliza Giuşcă
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Irina-Draga Căruntu
- Department of Morphofunctional Sciences I, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| |
Collapse
|
13
|
Ahari K, Vijayan N, Garg MK, Shukla R, Choudhary R. Tumour-induced osteomalacia due to thymolipoma. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:189-190. [PMID: 34825545 DOI: 10.25259/nmji_272_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Kamlesh Ahari
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Neerja Vijayan
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - M K Garg
- Department of Medicine and Endocrinology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravindra Shukla
- Department of Endocrinology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ramkaran Choudhary
- Department of Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
14
|
Biswas B, Dabkara D, Sengupta M, Ganguly S, Ghosh J, Arunsingh S M, Sen S. Multimodality treatment outcome in patients with primary malignant mediastinal germ cell tumor in adults. Cancer Rep (Hoboken) 2021; 4:e1306. [PMID: 33029924 PMCID: PMC7941572 DOI: 10.1002/cnr2.1306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/29/2020] [Accepted: 09/23/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Malignant mediastinal germ cell tumor (MGCT) is rare and has poor outcomes even after multimodality treatment. Data from resource-poor countries are scarce in the literature. AIMS To evaluate the clinicopathologic features and treatment outcome of primary malignant MGCT at our center. METHODS AND RESULTS Single institutional data review of patients aged ≥18 years, treated with a diagnosis of malignant MGCT between Nov'2013 and Nov'2019. Risk stratification was done as per International Germ Cell Cancer Collaborative Group (IGCCCG) classification. Patients were treated with platinum based chemotherapy and surgical resection for the residual disease was performed in non-seminomatous histology.28 patients had MGCT with a median age of 25 years (range:18-36) and all were male. Seven patients had superior vena cava obstruction (SVCO) at diagnosis and pre-treatment histological diagnosis was available in 23 (82%) patients. Seven (25%) patients had seminoma histology, all were of good risk as per IGCCCG risk criteria, whereas others had non-seminoma histology with poor-risk group. Seven patients with seminoma histology achieved a complete response after initial treatment. Six patients with non-seminoma histology underwent complete resection of residual disease post-chemotherapy and five revealed residual viable tumors. After a median follow-up of 10.8 months (range:2.9-75), 3-year progression-free survival (PFS) and overall survival (OS) estimate was 61.2% and 94.7% in the whole cohort, respectively and 3-year PFS and OS estimate was 100% in patients with seminoma histology. CONCLUSIONS This is the largest data set of MGCT patients' outcomes reported from India with multi-modality treatment. All patients were male and one-fourth had SVCO at presentation. Seminoma histology patients had a 100% outcome after initial platinum based chemotherapy. But, those with non-seminoma histology had a poor outcome even with chemotherapy and surgery.
Collapse
Affiliation(s)
- Bivas Biswas
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | - Deepak Dabkara
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | | | - Sandip Ganguly
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | - Joydeep Ghosh
- Department of Medical OncologyTata Medical CenterKolkataIndia
| | | | - Saugata Sen
- Department of RadiodiagnosisTata Medical CenterKolkataIndia
| |
Collapse
|
15
|
Suzuki T, Sato T, Hasumi T. Resection of a giant mediastinal atypical lipomatous tumor involving the esophagus. J Surg Case Rep 2021; 2021:rjaa561. [PMID: 33505654 PMCID: PMC7816792 DOI: 10.1093/jscr/rjaa561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 12/02/2022] Open
Abstract
Liposarcoma is one of the common soft tissue tumors but barely arises from the mediastinum. Complete surgical resection with a negative surgical margin is required for the treatment; however, mediastinal liposarcomas tend to be large due to its slow-growing nature. A 57-year-old man was referred to us for having an abnormal mediastinal shadow in a chest X-ray. Computed tomography scanning revealed a giant posterior mediastinal tumor, completely involving the esophagus. Because of the unusual size and location of the tumor, we took a bilateral video-assisted thoracoscopic approach. First, the soft lipomatous compartment of the tumor was dissected from the esophagus and the descending aorta via the left thoracic cavity complete thoracoscopic procedure. Then, the patient was placed in the left lateral position, and the solid part of the tumor was completely resected using 13 cm of right-side thoracotomy. There was no complication or local recurrence in the first 26 months of follow-up.
Collapse
Affiliation(s)
- Takaya Suzuki
- Department of Thoracic Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Taku Sato
- Department of Thoracic Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Tohru Hasumi
- Department of Thoracic Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| |
Collapse
|
16
|
Anbardar MH, Amirmoezi F, Amirian A. Thymoangiolipoma: A rare histologic variant of thymolipoma in a patient with myasthenia gravis. Rare Tumors 2020; 12:2036361320979215. [PMID: 33489056 PMCID: PMC7768564 DOI: 10.1177/2036361320979215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
Thymoangiolipoma is a rare, slow-growing, benign thymic neoplasm that arises from the
anterior mediastinum. A 61-year-old man with the chief complaint of right eye ptosis and
high serum acetylcholine receptor antibody level is presented here. The spiral computed
tomography of the chest revealed a hypodense mass in the anterior mediastinum. Microscopic
examination showed admixture of adipose tissue, thymic tissue and blood vessels with the
diagnosis of thymoangiolipoma. Thymoangiolipoma is a rare histologic variant of
thymolipoma which can be associated with myasthenia gravis and must be considered as a
differential diagnosis in anterior mediastinal mass with fat density in radiologic
evaluation.
Collapse
Affiliation(s)
| | - Fatemeh Amirmoezi
- Student Research Committee, Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Amirian
- Department of Surgery, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
17
|
Primary Mediastinal Germ Cell Tumors-The University of Western Ontario Experience. ACTA ACUST UNITED AC 2020; 28:78-85. [PMID: 33704177 PMCID: PMC7816187 DOI: 10.3390/curroncol28010010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022]
Abstract
Extragonadal germ cell tumors account for 2–5.7% of germ cell tumors (GCTs). Of these, primary mediastinal GCTs (PMGCTs) are responsible for 16–36% of cases. Given the rarity of these tumors, specific treatment strategies have not been well defined. We report our experience in treating these complex patients. In total, 318 men treated at our institution with chemotherapy for GCTs between 1980 and 2016 were reviewed. PMGCT was defined as clinically diagnosed mediastinal GCT with no evidence of testicular GCT (physical exam/ultrasound). We identified nine patients diagnosed with PMGCT. All patients presented with an anterior mediastinal mass and no gonadal lesion; four patients also had metastatic disease. Median age at diagnosis was 30 years (range, 14–56) and median mass size at diagnosis was 9 cm (range, 3.4–19). Eight patients had non-seminoma and one had pure seminoma. All patients received cisplatin-based chemotherapy initially. Surgical resection was performed in four patients; three patients had a complete resection and one patient was found to have an unresectable tumor. At a median follow-up of 2 years (range, 3 months–28 years) six patients had progressed. Progression-free survival was short with a median of 4.1 months from diagnosis (range 1.5–122.2 months). Five patients died at a median of 4.4 months from diagnosis. One and 5-year overall survivals were 50% and 38%, respectively. PMGCT are rare and aggressive. Our real-life Canadian experience is consistent with current literature suggesting that non-seminoma PMGCT has a poor prognosis despite prompt cisplatin-based chemotherapy followed by aggressive thoracic surgery.
Collapse
|
18
|
Kumar N, Madan R, Dracham CB, Chandran V, Elangovan A, Khosla D, Yadav BS, Kapoor R. Primary mediastinal germ cell tumors: Survival outcomes and prognostic factors - 10 years experience from a tertiary care institute. Rare Tumors 2020; 12:2036361320972220. [PMID: 33282160 PMCID: PMC7682202 DOI: 10.1177/2036361320972220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/19/2020] [Indexed: 11/23/2022] Open
Abstract
Primary Mediastinal Germ Cell Tumor (PMGCT) is a rare and heterogeneous entity. These tumors are typically diagnosed in young adults and carry a poor prognosis. We conducted this study to evaluate the role of radiotherapy on treatment outcomes and prognostic factors in PMGCT that may allow a more adapted treatment strategy to improve survival. Case records of patients who presented with PMGCT over a period of 10-years from January-2009 to December-2019 were retrospectively evaluated. Survival analyses were calculated using Kaplan-Meier (Log-rank) method. Poor prognostic factors for survival were evaluated with Multivariate analysis using Cox-regression method. A total of 46-patients data was analyzed, the majority of the patients were males (95.7%) with a median age of 25-years (range, 17–62). Non-seminomatous histology was predominant (60.9%). Sixteen-patients (34.7%) presented with complications at their initial presentation. Majority of the patients were treated with multimodality approach using chemotherapy, surgery, and/or radiotherapy. At a median follow-up of 40.8 months, the 1, 3, and 5-year overall survival (OS) was 69.6%, 52.2%, and 44.7% respectively. Patients who received radiotherapy in first-line treatment showed significant improvement in 5-year OS (72% vs 30%, p = 0.004) and disease-free survival (70% vs 24%, p = 0.007) in comparison with patients who did not receive. Multivariate analysis revealed that radiotherapy, chemotherapy, surgery, and complications at presentation were independent prognostic factors for OS. PMGCTs are aggressive neoplasms especially in patients presenting with disease-related complications. Dual modality management (radiotherapy as local therapy along with chemotherapy) had shown improvement in survival.
Collapse
Affiliation(s)
| | | | - Chinna Babu Dracham
- Chinna Babu Dracham, Radiotherapy, Senior resident, Department of Radiotherapy & Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Room no: 4, Radiotherapy office, Sector-12, Chandigarh 160012, India.
| | | | | | | | | | | |
Collapse
|
19
|
Gao P, Li Q, Hu J, Xu J, Lin S, Cai M, Ma L, Chen W, Zhang Y, Chen SY, Zhong Y, Yao L, Zhou P. Transoesophageal endoscopic removal of a benign mediastinal tumour: a new field for endotherapy? Gut 2020; 69:1727-1729. [PMID: 32532893 PMCID: PMC7497581 DOI: 10.1136/gutjnl-2020-321128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Pingting Gao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Quanlin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jianwei Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jiaxin Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Shengli Lin
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mingyan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Lili Ma
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Weifeng Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yiqun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Shi-Yao Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yunshi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Liqing Yao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China
| |
Collapse
|
20
|
Paral K, Krausz T. Vascular tumors of the mediastinum. MEDIASTINUM (HONG KONG, CHINA) 2020; 4:25. [PMID: 35118293 PMCID: PMC8794384 DOI: 10.21037/med-20-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/16/2020] [Indexed: 01/09/2023]
Abstract
Vascular tumors represent only a sliver of all tumors affecting the mediastinum, but they pose diagnostic challenges due to significant overlap among entities, ever-evolving classification schemes, and the exquisite rarity of some of the entities not only in the mediastinum but in pathology practice as a whole. Most of the vascular tumors are better known to the practice of soft tissue pathology, from which some of the knowledge of clinical behavior can be extrapolated. For example, the stratification of epithelioid hemangioendothelioma (EHE) into two biologically separate categories has effectively translated from the somatic soft tissues to the thorax. For other entities, the effective validation of soft tissue parameters is hindered by the small numbers of reported mediastinal cases. Many of the treatment modalities have also transferred over, with the key differences resting on the difficulty in achieving complete surgical resection for mediastinal tumors as opposed to those in the somatic soft tissues. Accordingly, systemic drug therapies have emerged as attractive options for some of the mediastinal vascular tumors, such as kaposiform hemangioendothelioma (KHE) and Kaposi sarcoma (KS). The categories presented herein mirror the classification scheme set forth by the 5th Edition WHO Classification of Soft Tissue and Bone Tumors. This review focuses on the biologically aggressive vascular neoplasms while limiting discussion of the benign entities to relevant comparisons in the differential diagnoses. While distinguishing among the benign entities has academic importance, in practice, the stakes are far higher for diagnosing the biologically aggressive tumors given their marked heterogeneity in clinical outcomes. Practical advice for problem areas in pathology will be reviewed alongside tumor pathobiology, including the latest in molecular diagnostics.
Collapse
Affiliation(s)
- Kristen Paral
- Section of Dermatopathology, Consolidated Pathology Consultants, Libertyville, IL, USA
| | - Thomas Krausz
- Department of Pathology, University of Chicago, Chicago, IL, USA
| |
Collapse
|
21
|
Furlan K, Miller I, Rohra P, Mir F, Ocampo Gonzalez FA, Gattuso P. Well-differentiated liposarcoma primary from thymic stroma: Case report and literature review. Exp Mol Pathol 2020; 116:104517. [PMID: 32791064 DOI: 10.1016/j.yexmp.2020.104517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/30/2020] [Accepted: 08/07/2020] [Indexed: 11/16/2022]
Abstract
Primary liposarcoma of thymic stroma is an exceptionally rare tumor. Histological findings are often definitive for diagnosis, however due to the variability of nuclear atypia and the overlapping with other adipocytic tumors, ancillary techniques are helpful as confirmatory tools. Currently, Fluorescent in situ hybridization for MDM2 is the gold standard for diagnosis of well-differentiated and dedifferentiated liposarcomas, however a panel of immunohistochemical stainings, including MDM2, CDK4 and p16 is available as alternative method, helping to distinguish liposarcoma from its benign counterpart lipoma, especially in borderline cases. We describe the case of a young female diagnosed with a well-differentiated lipomatous tumor primary of thymic stroma with near cut-off result for MDM2-FISHand positive immunohistochemical staining for the panel described above. We discuss the challenges in the diagnosis of this rare entity andpresent an updated literature review.
Collapse
Affiliation(s)
- Karina Furlan
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America.
| | - Ira Miller
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Fernando A Ocampo Gonzalez
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| |
Collapse
|
22
|
Rosti G, Secondino S, Necchi A, Fornarini G, Pedrazzoli P. Primary mediastinal germ cell tumors. Semin Oncol 2019; 46:107-111. [DOI: 10.1053/j.seminoncol.2019.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/05/2019] [Accepted: 04/11/2019] [Indexed: 11/11/2022]
|
23
|
Engelhardt KE, DeCamp MM, Yang AD, Bilimoria KY, Odell DD. Treatment Approaches and Outcomes for Primary Mediastinal Sarcoma: Analysis of 976 Patients. Ann Thorac Surg 2018; 106:333-339. [PMID: 29729268 DOI: 10.1016/j.athoracsur.2018.03.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary mediastinal sarcomas are rare and deadly. Our objective was to describe the clinicopathological features, treatment strategies, and overall survival outcomes for a contemporary cohort of patients diagnosed with primary mediastinal sarcoma in the United States. METHODS We queried the National Cancer Database for cases of mediastinal sarcoma diagnosed from 2004 to 2012. Five-year overall survival (OS) was examined using the Kaplan-Meier method. Differences in OS were assessed using log-rank analysis and Cox proportional hazards regression. RESULTS The mean age of diagnosis was 53 years (range, 0 to 90) with a male predominance (59.2%). The most common histological subtype was hemangiosarcoma (27.1%). Fewer than half of patients underwent surgery (48.9%), and 19.7% of patients had no treatment. For all patients, OS was 14.8%. The best unadjusted OS was seen in patients treated with surgery and radiation (40.1%); untreated patients had the worst unadjusted OS (4.2%). Of those who underwent surgery (n = 477, 48.9%), OS was significantly better for those who achieved an R0 resection (30.1% versus 18.9%; p = 0.002). In multivariable analysis, surgery combined with radiation therapy was again associated with the best survival (HR, 0.24; 95% CI, 0.16 to 0.36). Other factors associated with improved OS included younger age, fewer comorbidities, and leiomyosarcoma histology. Worse OS was associated with poorly differentiated or undifferentiated grade, metastases, treatment in the New England region, and having Medicaid or no insurance. Sex and tumor size had no effect on OS. CONCLUSIONS The 5-year OS for primary mediastinal sarcoma is poor. Surgical resection can be successful and should be considered whenever possible.
Collapse
Affiliation(s)
- Kathryn E Engelhardt
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Malcolm M DeCamp
- Division of Thoracic Surgery, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Anthony D Yang
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Division of Surgical Oncology, Northwestern University, Chicago, Illinois; Center for Healthcare Studies, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Division of Surgical Oncology, Northwestern University, Chicago, Illinois; Center for Healthcare Studies, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - David D Odell
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, Illinois; Division of Thoracic Surgery, Northwestern University, Chicago, Illinois; Center for Healthcare Studies, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
| |
Collapse
|
24
|
Morosco DT, Cline CR, Owston MA, Kumar S, Dick EJ. Spontaneous mediastinal myeloid sarcoma in a common marmoset (Callithrix jacchus) and review of the veterinary literature. J Med Primatol 2017; 46:42-47. [PMID: 28145579 DOI: 10.1111/jmp.12253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Myeloid sarcoma is a rare manifestation of myeloproliferative disorder defined as an extramedullary mass composed of myeloid precursor cells. A 9-month old, female, common marmoset (Callithrix jacchus) had increased respiratory effort. METHODS A complete necropsy with histology and immunohistochemistry was performed. RESULTS The thymus was replaced by a firm, gray-tan mass with a faint green tint, filling over 50% of the thoracic cavity. Sheets of granulocytes, lymphoid cells, nucleated erythrocytes, megakaryocytes, and hematopoietic precursors of indeterminate cell lineage replaced the thymus, perithymic connective tissue, mediastinal adipose tissues, epicardium, and much of the myocardium. The cells demonstrated diffuse strong cytoplasmic immunoreactivity for lysozyme, and strong, multifocal membranous immunoreactivity for CD117. CONCLUSION We report the first case of a myeloid sarcoma in a common marmoset (C. jacchus), similar to reported human cases of mediastinal myeloid sarcoma, and present a review of myeloproliferative diseases from the veterinary literature.
Collapse
Affiliation(s)
- Danielle T Morosco
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Curtis R Cline
- Veterinary Pathology Services, The Joint Pathology Center, Silver Spring, MD, USA
| | - Michael A Owston
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Shyamesh Kumar
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Edward J Dick
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
| |
Collapse
|