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Shigenobu T, Suzuki T, Hayashi H, Yoshizu A. Thymic MALT lymphoma associated with Sjögren's syndrome with postoperative cardiac tamponade and acute pleuritis: a case report. World J Surg Oncol 2024; 22:160. [PMID: 38902721 PMCID: PMC11191212 DOI: 10.1186/s12957-024-03442-1] [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: 03/29/2024] [Accepted: 06/16/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren's syndrome (SjS). SjS is rarely accompanied by serositis. Here, we describe the first case of postoperative cardiac tamponade and acute pleuritis in a patient with thymic MALT lymphoma associated with SjS. CASE PRESENTATION A 33-year-old woman with SjS presented with an anterior mediastinal mass on chest computed tomography, which was performed for further examination of the condition. Suspecting a thymic MALT lymphoma or thymic epithelial tumor, total thymectomy was performed. The mediastinal mass was histopathologically diagnosed as a thymic MALT lymphoma. The patient was discharged with a good postoperative course but visited the hospital 30 days after surgery for dyspnea. Cardiac tamponade was observed and drainage was performed. Four days after pericardial drainage, chest radiography revealed massive left pleural effusion, and thoracic drainage was performed. The patient was diagnosed with serositis associated with SjS and treated with methylprednisolone, which relieved cardiac tamponade and pleuritis. CONCLUSIONS Surgical invasion of thymic MALT lymphomas associated with SjS may cause serositis. Postoperative follow-up should be conducted, considering the possibility of cardiac tamponade or acute pleuritis due to serositis as postoperative complications.
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Affiliation(s)
- Takao Shigenobu
- Department of Thoracic Surgery, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan.
| | - Takahiro Suzuki
- Department of Thoracic Surgery, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan
| | - Hiroyuki Hayashi
- Department of Pathology, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan
| | - Akira Yoshizu
- Department of Thoracic Surgery, Yokohama Municipal Citizen's Hospital, 1-1, Mitsuzawanishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan
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2
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Dumitru AV, Țăpoi DA, Halcu G, Munteanu O, Dumitrascu DI, Ceaușu MC, Gheorghișan-Gălățeanu AA. The Polyvalent Role of CD30 for Cancer Diagnosis and Treatment. Cells 2023; 12:1783. [PMID: 37443818 PMCID: PMC10341339 DOI: 10.3390/cells12131783] [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: 06/09/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
CD30, also known as TNFRSF8 (tumor necrosis factor receptor superfamily member 8), is a protein receptor that is heavily glycosylated inside the Golgi apparatus, as well as a tumor marker that is found on the surface of specific cells in the body, including certain immune cells and cancer ones. This review aims to shed light on the critical importance of CD30, from its emergence in the cell to its position in diagnosing various diseases, including Hodgkin lymphoma, where it is expressed on Hodgkin and Reed-Sternberg cells, as well as embryonal carcinoma, anaplastic large cell lymphoma (ALCL), and cutaneous T-cell lymphoma (CTCL). In addition to its role in positive diagnosis, targeting CD30 has been a promising approach treating CD30-positive lymphomas, and there is ongoing research into the potential use of CD30-targeted therapies for autoimmune disorders. We aim to elaborate on CD30's roles as a tumor marker, supporting thus the hypothesis that this receptor might be the aim of cytostatic treatment.
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Affiliation(s)
- Adrian Vasile Dumitru
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.V.D.); (M.C.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Dana Antonia Țăpoi
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.V.D.); (M.C.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Georgian Halcu
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.V.D.); (M.C.C.)
- Department of Pathology, Colțea Clinical Hospital, 030171 Bucharest, Romania
| | - Octavian Munteanu
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Obstetrics and Gynecology, University Emergency Hospital, 050098 Bucharest, Romania
| | - David-Ioan Dumitrascu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mihail Constantin Ceaușu
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.V.D.); (M.C.C.)
- Department of Pathology, Alexandru Trestioreanu Institute of Oncology, 022328 Bucharest, Romania
| | - Ancuța-Augustina Gheorghișan-Gălățeanu
- Department of Cellular and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
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3
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Zhou MX, Chen YY, Liu L, Wang GG, Zhang JQ, Zhao K, Li SQ. Mucosa-associated lymphoid tissue lymphoma in thymus: a SEER analysis. Expert Rev Anticancer Ther 2022; 22:1349-1355. [PMID: 36373901 DOI: 10.1080/14737140.2022.2146582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The present study explores an extremely rare disease, thymic mucosa-associated lymphoid tissue (MALT) lymphoma, for its characteristics and prognostic factors by analyzing the Surveillance, Epidemiology, and End Results (SEER) database. METHODS From 2000 to 2018, cases with a diagnosed thymic MALT lymphoma were extracted. Clinical characteristics, treatments, and survival patterns of these cases were analyzed. RESULTS Thymic MALT lymphoma (n = 26) accounted for 0.09% of all MALT lymphomas. With a sex ratio of 0.53 (male/female), 68% white population was affected. Most cases were diagnosed with Ann Arbor stage I (50%), yet advanced-stage did not show worse prognosis (p = 0.236). Different treatment protocols did not influence the overall prognosis (p > 0.99). The 5- and 10- year overall survival rates were 83.1% and 78.2%, respectively. Older than 70 years may be an independent risk factor for overall survival (HR = 7.166 [95% CI 1.173-43.756], p = 0.033). CONCLUSION Thymic MALT lymphoma is a highly rare disease with a favorable prognosis. Ann Arbor staging might not be appropriate to classify severity of this disease or its treatment. Older people may have worse survival. A standardized treatment mode needs to be established, and surgery could remain as the mainstay.
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Affiliation(s)
- Meng-Xin Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ye-Ye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Gui-Ge Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jia-Qi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ke Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shan-Qing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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4
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Kitamura W, Asada N, Tabata T, Shibata R, Nishi T, Kato Y, Takasuka H, Fujiwara H, Ennishi D, Nishimori H, Fujii N, Matsuoka KI, Kiura K, Yoshino T, Maeda Y. Transformed diffuse large B-cell lymphoma from marginal zone lymphoma in the anterior mediastinum: A case report and review of the literature. J Clin Exp Hematop 2021; 62:35-40. [PMID: 34840205 PMCID: PMC9010493 DOI: 10.3960/jslrt.21010] [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] [Indexed: 11/17/2022] Open
Abstract
Marginal zone lymphoma (MZL) arising from the anterior mediastinum is rare. In the majority of reported cases, the tumor was incidentally discovered, reflecting its indolent clinical features. We present a 38-year-old woman who had no medical history, and presented with a bulky anterior mediastinal tumor complicated by life-threatening compression of the vasculature and bronchi. Biopsy specimens of the neoplasm suggested transformed diffuse large B-cell lymphoma (DLBCL) from MZL. To our best knowledge, this is the first case report of anterior mediastinum MZL associated with an aggressive clinical course and life-threatening complications likely due to transformation to DLBCL.
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Affiliation(s)
- Wataru Kitamura
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Tetsuya Tabata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Rei Shibata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tatsuya Nishi
- Department of Respiratory and Allergy, Okayama University Hospital, Okayama, Japan
| | - Yuka Kato
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroki Takasuka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Hideaki Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Daisuke Ennishi
- Center for Comprehensive Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Nobuharu Fujii
- Department of Transfusion Medicine, Okayama University Hospital, Okayama, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Katsuyuki Kiura
- Department of Respiratory and Allergy, Okayama University Hospital, Okayama, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
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Abstract
Lymphoproliferative disorders comprise 50% to 60% of all mediastinal malignancies in both children and adults. Primary mediastinal involvement is rare (∼5%), whereas secondary mediastinal involvement by systemic disease is more common (10% to 25%). Primary mediastinal disease is defined as involvement by a lymphoproliferative disorder of mediastinal lymph nodes, the thymus, and/or extranodal mediastinal organs without evidence of systemic disease at presentation. In this review, the clinical, radiologic, histopathologic, immunohistochemical, and genetic features of some of the most characteristic mediastinal lymphoproliferative disorders are presented. The entities discussed here include: classic Hodgkin lymphoma with emphasis on nodular sclerosis and mixed cellularity types, and non-Hodgkin lymphomas, including primary mediastinal (thymic) large B-cell lymphoma, mediastinal gray zone lymphoma, mediastinal diffuse large B-cell lymphoma, thymic marginal zone lymphoma, mediastinal plasmacytoma, T-lymphoblastic lymphoma, and anaplastic large cell lymphoma. Although not a malignant process, hyaline vascular Castleman disease is also discussed here as this disorder commonly involves the mediastinum. Despite multiple advances in hematopathology in recent decades, the day-to-day diagnosis of these lesions still requires a morphologic approach and a proper selection of immunohistochemical markers. For this reason, it is crucial for general pathologists to be familiar with these entities and their particular clinicoradiologic presentation.
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Affiliation(s)
- Sergio Pina-Oviedo
- Department of Pathology and Laboratory Services, University of Arkansas for Medical Sciences, Little Rock, AR
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6
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Hashimoto Y, Omura H, Tokuyasu Y, Nakamoto S, Tanaka T. Successful Management of Primary Mediastinal Large B-cell Lymphoma during Pregnancy. Intern Med 2019; 58:3455-3459. [PMID: 31391392 PMCID: PMC6928502 DOI: 10.2169/internalmedicine.3129-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We experienced a pregnant woman with superior vena cava syndrome at 15 weeks of pregnancy who was diagnosed with primary mediastinal large B-cell lymphoma and given chemotherapy. In this case, the clinical courses of both the mother and infant were favorable without any serious complications because of close multidisciplinary cooperation. Based on a retrospective review of this case, the administration of CHOP-like regimens during the second and third trimesters appears relatively safe. Because pregnancy and continuation of pregnancy are rare in patients with hematopoietic malignancies, the accumulation of detailed information is important.
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Affiliation(s)
| | - Hiromi Omura
- Department of Hematology, Tottori Prefectural Central Hospital, Japan
| | - Yusuke Tokuyasu
- Department of Pathology, Tottori Prefectural Central Hospital, Japan
| | - Shu Nakamoto
- Department of Pathology, Tottori Prefectural Central Hospital, Japan
| | - Takayuki Tanaka
- Department of Hematology, Tottori Prefectural Central Hospital, Japan
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Primary Mediastinal Nodal and Extranodal Non-Hodgkin Lymphomas: Current Concepts, Historical Evolution, and Useful Diagnostic Approach: Part 2. Adv Anat Pathol 2019; 26:371-389. [PMID: 31567129 DOI: 10.1097/pap.0000000000000248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary mediastinal non-Hodgkin lymphomas (PM-NHLs) represent ∼5% of all non-Hodgkin lymphomas (NHLs) and comprise lymphomas of B-cell and T-cell origin. PM-NHLs are defined as involvement of mediastinal lymph nodes, thymus, and/or mediastinal organs (heart, lung, pleura, pericardium) by NHL without evidence of systemic disease at presentation. The clinical scenario is variable and depends on the lymphoma subtype. The radiologic presentation is also variable ranging from a mediastinal mass with or without superior vena cava syndrome, a pleural or a cardiac mass associated with effusion, or as an effusion only. The diagnosis of PM-NHLs can only be established by microscopic evaluation, and therefore, general pathologists should be aware of these tumors and familiar with their diagnostic approach. The most common anterior mediastinal NHLs (90% to 95%) are primary mediastinal (PM) large B-cell lymphoma and T-lymphoblastic lymphoma. Thymic marginal zone lymphoma and mediastinal gray zone lymphoma are very rare. The remainder PM-NHLs involving middle or posterior mediastinum include diffuse large B-cell lymphoma (DLBCL) and rare cases of T-cell lymphoma, including anaplastic large cell lymphoma and breast implant-associated anaplastic large cell lymphoma extending to the anterior mediastinum. Primary pleural and cardiac NHLs are mostly DLBCLs. Other rare subtypes of PM-NHLs include DLBCL associated with chronic inflammation/pyothorax-associated lymphoma, fibrin-associated DLBCL (both Epstein-Barr virus positive), and pleural and/or pericardial primary effusion lymphoma (human herpesvirus-8 positive/Epstein-Barr virus positive). We review the historical aspects, epidemiology, clinicoradiologic features, histopathology, immunohistochemistry, differential diagnosis, and relevant cytogenetic and molecular features of the remaining mediastinal B-cell lymphomas, including primary thymic marginal zone lymphoma of the mucosa-associated lymphoid tissue type, other PM small B-cell lymphomas, PM plasmacytoma, and the most relevant PM T-cell lymphomas.
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8
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Mlika M, Khanfir D, Braham E, Meddeb B, Mezni F. Diagnostic Challenges of Lymphoblastic Lymphomas of the Mediastinum. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190214160509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Lymphoblastic lymphomas (LL) of the mediastinum are rare tumours that
present a challenging diagnosis. The positive diagnosis is based on microscopic findings. Our aim
was to highlight the diagnostic difficulties in such situations.
Methods:
We conducted a descriptive retrospective study including 31 patients presenting
mediastinal LL.
Results:
Radiologic features consisted in all cases in a mediastinal infiltrating mass. Microscopic
examination showed in all cases a crowded tumour with many artefacts made of diffuse tumour cells.
Immunohistochemial study was performed in all cases. It was quite difficult to interprete in the
samples used for extemporaneous examination and repeated in 10 cases.
Conclusion:
The diagnosis of LL is based on the microscopic examination which is usually
performed on small samples with crowding artefacts. Thus, this pathology must be managed by a
trained team that is used to deal with such a specimen in order to avoid repeating the biopsy and
inducing diagnostic delay.
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Affiliation(s)
- Mona Mlika
- Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
| | - Donia Khanfir
- Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
| | - Emna Braham
- Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
| | | | - Faouzi Mezni
- Department of Pathology, Abderrahman Mami Hospital, Tunis, Tunisia
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Szolkowska M, Szczepulska-Wojcik E, Maksymiuk B, Burakowska B, Winiarski S, Gatarek J, Rudzinski P, Orlowski T, Langfort R. Primary mediastinal neoplasms: a report of 1,005 cases from a single institution. J Thorac Dis 2019; 11:2498-2511. [PMID: 31372287 DOI: 10.21037/jtd.2019.05.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background This study was an epidemiological analysis of all primary mediastinal neoplasms (PMNs) diagnosed between 2000 and 2016 at the National Tuberculosis and Lung Diseases Research Institute, Poland. Methods All patients with any mediastinal abnormality were included in the analysis. The patients' age and gender were obtained from the institutional database. Results From a cohort of 5,108 patients, 3,691 primary mediastinal lesions were found, including 1,005 (19%) PMNs: lymphomas (533, 53% of PMNs), thymomas (215, 21%), neurogenic tumors (NTs) (100, 10%), germ cell tumors (GCTs) (62, 6%), soft tissue tumors (STTs) (47, 5%) and thymic carcinomas/thymic neuroendocrine tumors (TCs/TNETs) (37 in total, 4%). The most frequent lymphomas were classical Hodgkin lymphomas [256] and primary mediastinal large B-cell lymphomas [163]. Type AB [73] predominated in thymomas and squamous cell carcinomas [9] and carcinoids [10] in TCs/TNETs. NTs encompassed mainly schwannomas [49], ganglioneuromas [21] and neurofibromas [10]. The most frequent STTs were hemangiomas [13] and lymphangiomas [11]. Lymphomas, thymomas and NT were more often in women, TCs/TNETs in men (P<0.001). Lymphomas predominated between the 2nd and 4th decade of life, NTs under the 3rd decade and thymic epithelial tumors between the 6th and 8th decade (P<0.001). There was no correlation between the subtypes of thymomas and the patients' gender (P=0.389) but it was found between histology and patients' age: in patients <30 years of age type B2 and B3 thymomas and >70 years of age AB type and micronodular thymomas with lymphoid stroma (P<0.001) predominated. In the group of GCTs half of them were malignant and these were noted exclusively in men. No correlation between subtypes of NTs or TCs/TNETs and patients' age and gender was found (P>0.05). Conclusions PMNs are rare conditions thus awareness of basic epidemiology may be very helpful for final diagnosis.
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Affiliation(s)
- Malgorzata Szolkowska
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Ewa Szczepulska-Wojcik
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Beata Maksymiuk
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Barbara Burakowska
- Department of Radiology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Sebastian Winiarski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Juliusz Gatarek
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Piotr Rudzinski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Tadeusz Orlowski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Renata Langfort
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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10
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Kane L, Savas H, DeCamp MM, Bharat A. Utility of minimally invasive thoracoscopy for assessment of residual mediastinal lymphoma. Surgery 2018; 164:825-830. [PMID: 30077390 DOI: 10.1016/j.surg.2018.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/12/2018] [Accepted: 05/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients with primary mediastinal lymphomas frequently present with a residual mass after completion of first-line therapy. Although a positron emission tomography scan is usually recommended, it fails to distinguish between persistent lymphoma and inflammation. Although percutaneous biopsy may have a high diagnostic yield for the initial diagnosis of mediastinal lymphomas, this biopsy has poor accuracy for detecting persistent disease in a residual mass given the heterogeneity of these residual masses. Because persistent disease has important therapeutic implications, we evaluated the role of operative biopsy in detecting lymphoma in the residual mass. METHODS Between 2009 and 2015, consecutive patients (n = 77) undergoing tissue biopsy for initial diagnosis as well as for a positron emission tomography-positive residual mass were included. Tissue biopsy for a residual mass was repeated until frozen section was diagnostic or at least the mass on the ipsilateral hemi-mediastinum was resected. RESULTS Of the initial 77 patients, 34 underwent operative restaging for a residual mass after chemotherapy, while 43 had a complete response. In these 34 patients, operative biopsy revealed the presence of lymphoma in 53%, predominantly Hodgkin's disease and diffuse large B-cell lymphoma. There was no significant difference in tumor volume (51% versus 39%) and a decrease in the positron emission tomography-standardized uptake valuemax (68% vs 60%) in patients with or those without persistent lymphoma. There were no surgical complications and the duration of stay for all patients undergoing thoracoscopy was <24 hours. Residual lymphoma was treated with second-line therapy guided by the pathologic analysis. CONCLUSION A large proportion of patients with residual positron emission tomography-avidity after first-line chemotherapy of mediastinal lymphomas have residual disease that can be detected safely using minimally invasive thoracoscopy.
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Affiliation(s)
- Liam Kane
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hatice Savas
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Malcolm M DeCamp
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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