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Huang K, Li P, Deng H, Tang X, Zhou Q. En bloc resection of an extremely giant mediastinal immature teratoma with somatic-type malignancy: A case report with a brief review of the literature. Clin Case Rep 2024; 12:e8344. [PMID: 38161647 PMCID: PMC10753629 DOI: 10.1002/ccr3.8344] [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: 10/06/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Primary mediastinum immature teratoma with somatic-type malignant transformation (SM) is extremely rare, and the clinical prognosis is poor. Immature teratoma with SM is difficult to eradicate by chemotherapy due to poor sensitivity; therefore, surgical resection is recommended whenever possible because it may offer better survival.
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Affiliation(s)
- Kai‐li Huang
- Lung Cancer Center, West China HospitalSichuan UniversityChengduChina
| | - Pengfei Li
- Lung Cancer Center, West China HospitalSichuan UniversityChengduChina
| | - Han‐Yu Deng
- Lung Cancer Center, West China HospitalSichuan UniversityChengduChina
| | - Xiaojun Tang
- Lung Cancer Center, West China HospitalSichuan UniversityChengduChina
| | - Qinghua Zhou
- Lung Cancer Center, West China HospitalSichuan UniversityChengduChina
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2
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Mikail N, Khalil A, Rouzet F. Mediastinal Masses: 18F-FDG-PET/CT Features Based on the International Thymic Malignancy Interest Group Classification. Semin Nucl Med 2020; 51:79-97. [PMID: 33246542 DOI: 10.1053/j.semnuclmed.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Imaging plays a key role in the management of mediastinal masses. In an effort to standardize the analysis of the mediastinum, the International Thymic Malignancy Interest Group (ITMIG) has proposed a three compartments-based diagnostic classification, intended for clinicians and radiologists. Several articles have documented its usefulness to guide the diagnosis using cross-sectional imaging. Similarly, fluorine-18-radiolabeled fluorodeoxyglucose positron emission tomography combined to computed tomography (18F-FDG-PET/CT) can be useful in this setting, either as a first-line diagnostic technique, or in addition to cross-sectional imaging. In this article, which is thought as an aid for nuclear medicine physicians and radiologists, we aim to present, based on the ITMIG classification, the main mediastinal pathologies that can be observed with 18F-FDG-PET/CT, and the additional diagnostic value that can be expected from this technique. For this purpose, we segmented the mediastinum according to the ITMIG classification, and reviewed the available literature for each of the corresponding organs and/or disease. Given the importance of the clinical context for the interpretation of PET imaging, we presented each of the diseases according to: (1) their suggestive clinical context; (2) the suggestive features on nonenhanced CT (which is the standard in PET imaging); and (3) the typical 18F-FDG characteristics. The purpose of this article is to depict the main features of the most common mediastinal diseases that can be encountered with 18F-FDG-PET/CT, and to highlight its diagnostic value in this setting, alone or in combination with other imaging modalities.
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Affiliation(s)
- Nidaa Mikail
- Department of nuclear medicine, Bichat universitary hospital, Paris, France.
| | - Antoine Khalil
- Department of radiology, Bichat universitary hospital, Paris, France
| | - François Rouzet
- Department of nuclear medicine, Bichat universitary hospital, Paris, France
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3
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Inui M, Nitadori JI, Tajima S, Yoshioka T, Hiyama N, Watadani T, Shinozaki-Ushiku A, Nagayama K, Anraku M, Sato M, Fukayama M, Nakajima J. Mediastinal seminoma associated with multilocular thymic cyst. Surg Case Rep 2017; 3:7. [PMID: 28054283 PMCID: PMC5215007 DOI: 10.1186/s40792-016-0278-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 12/16/2016] [Indexed: 11/28/2022] Open
Abstract
An asymptomatic 26-year-old man received an annual medical check-up, and chest X-ray showed a protrusion of the aortopulmonary window. Chest computed tomography (CT) revealed an anterior mediastinal tumor and cysts with thin wall and septum enhancement. The preoperative diagnosis was cystic thymoma or malignant lymphoma. We performed total resection of the tumor through a median sternotomy. The pathological findings revealed seminoma, positive for c-kit stain, and multilocular thymic cysts. Cysts were lined by normal squamous epithelium and no seminoma cells were located on their surface. So, cysts were probably secondary changes caused by seminoma cells themselves or inflammatory stimulations. No invasion to adjacent structures was seen. After the surgery, testicular ultrasound imaging and abdominal, pelvic, and cerebral CT showed no apparent tumor or enlarged lymph nodes; however, an abnormal uptake in the right mesenteric lymph node was pointed out by 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scan. The patient received four courses of bleomycin, etoposide, and cisplatin (BEP) as adjuvant chemotherapy. Follow-up PET scan revealed no uptake in the right mesenteric lymph node. To date, no recurrence or metastasis has been identified for 16 months.
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Affiliation(s)
- Masato Inui
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. .,Department of Thoracic Surgery, School of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Jun-Ichi Nitadori
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shogo Tajima
- Department of Pathology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takahusa Yoshioka
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Noriko Hiyama
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takeyuki Watadani
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Aya Shinozaki-Ushiku
- Department of Pathology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kazuhiro Nagayama
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaki Anraku
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masashi Fukayama
- Department of Pathology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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4
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杜 进, 李 庆, 晁 栋, 班 玉, 李 群. [One Case about Primary Mediastinal Primary Mediastinal Tumor
with Mediastinal Sarcoma and Literature Review]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:636-40. [PMID: 27666557 PMCID: PMC5972958 DOI: 10.3779/j.issn.1009-3419.2016.09.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/28/2016] [Accepted: 06/02/2016] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- 进臣 杜
- />730050 兰州,兰州军区兰州总医院胸外科Department of Thoracic Surgery, General Hospital of Lanzhou Army, Lanzhou 730050, China
| | - 庆新 李
- />730050 兰州,兰州军区兰州总医院胸外科Department of Thoracic Surgery, General Hospital of Lanzhou Army, Lanzhou 730050, China
| | - 栋 晁
- />730050 兰州,兰州军区兰州总医院胸外科Department of Thoracic Surgery, General Hospital of Lanzhou Army, Lanzhou 730050, China
| | - 玉莲 班
- />730050 兰州,兰州军区兰州总医院胸外科Department of Thoracic Surgery, General Hospital of Lanzhou Army, Lanzhou 730050, China
| | - 群群 李
- />730050 兰州,兰州军区兰州总医院胸外科Department of Thoracic Surgery, General Hospital of Lanzhou Army, Lanzhou 730050, China
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Tian L, Liu LZ, Cui CY, Zhang WD, Kuang YL. CT findings of primary non-teratomatous germ cell tumors of the mediastinum—A report of 15 cases. Eur J Radiol 2012; 81:1057-61. [DOI: 10.1016/j.ejrad.2011.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
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[Management of anterior mediastinal masses in adults]. Rev Mal Respir 2012; 29:138-48. [PMID: 22405109 DOI: 10.1016/j.rmr.2011.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 04/19/2011] [Indexed: 11/23/2022]
Abstract
The discovery of an anterior mediastinal mass requires careful management with specific consideration of the pathology. More than 50% of all mediastinal masses seen in adults are in the anterior mediastinum. The most frequent diagnoses are thymoma, lymphoma, teratoma and benign thyroid tumours. 60% of cases are malignant. Often the clinical and radiological findings do not allow a definitive diagnosis and a histological diagnosis is often required to select the optimal treatment modality. The choice of biopsy technique depends on the localization of the lesion, clinical factors, and the availability of special techniques and equipment. Biopsy may be obtained by trans-thoracic puncture under computed tomography or ultrasound guidance, or by a surgical approach (mediastinotomy or thoracoscopy).
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Rivera C, Poingt M, Vandenbossche F, Jougon J. A mediastinal germ cell tumor mimicking an ectopic pregnancy. J Gynecol Oncol 2012; 22:288-91. [PMID: 22247806 PMCID: PMC3254848 DOI: 10.3802/jgo.2011.22.4.288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 10/20/2010] [Accepted: 11/03/2010] [Indexed: 11/30/2022] Open
Abstract
The objective is to report the case of a 36 year-old female with a primary mediastinal germ cell tumor mimicking an ectopic pregnancy. The patient under birth control pill presented, at seven weeks of amenorrhea, a β-human chorionic gonadotropin (β-hCG) level of 850 UI and uterine vacuity with left lateral uterine heterogeneous mass but no bleeding and no pain. She received left adnexectomy, uterine curettage and further treatment by methotrexate because of persistent high β-hCG markers. Computed tomography scan finally permitted to discover a voluminous anterior mediastinal tumor. We may recommend investigating patients with a simple chest X-ray that present with persistent increased β-hCG despite efficient ectopic pregnancy treatment.
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Affiliation(s)
- Caroline Rivera
- Department of Thoracic Surgery, Haut Lévêque Hospital, Victor Segalen Bordeaux 2 University, Bordeaux, France
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Lin MW, Chang YL, Wu CT, Lee YC. Video-assisted thoracoscopic surgery for a cystic seminoma of the mediastinum. Ann Thorac Surg 2010; 90:2041-4. [PMID: 21095363 DOI: 10.1016/j.athoracsur.2010.04.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/04/2010] [Accepted: 04/23/2010] [Indexed: 11/19/2022]
Abstract
Mediastinal seminomas are uncommon primary mediastinal neoplasms, and most are solid in appearance. Cystic mediastinal seminoma is an unusual type of extragonadal germ cell tumor that has rarely been reported in the literature. Here we describe a 36-year-old man with a 7.5-cm cystic mediastinal seminoma. The tumor was excised successfully by video-assisted thoracoscopic surgery. No recurrence was noted during 28 months of follow-up.
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Affiliation(s)
- Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
Tumors of the mediastinum represent a wide diversity of disease states. The location and composition of a mass is critical to narrowing the differential diagnosis. The most common causes of an anterior mediastinal mass include the following: thymoma; teratoma; thyroid disease; and lymphoma. Masses of the middle mediastinum are typically congenital cysts, including foregut and pericardial cysts, while those that arise in the posterior mediastinum are often neurogenic tumors. The clinical sequelae of mediastinal masses can range from being asymptomatic to producing symptoms of cough, chest pain, and dyspnea. This article will review the anatomy of the mediastinum as well as the different clinical, radiographic, and prognostic features, and therapeutic options of the most commonly encountered masses.
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Affiliation(s)
- Beau V Duwe
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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10
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Barton B. Is this a calcified mediastinal germ cell tumour I see before me? Radiography (Lond) 2005. [DOI: 10.1016/j.radi.2005.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Michel M, Pratt JW. Anterior mediastinal nonseminomatous germ cell tumor with malignant transformation: a case report. ACTA ACUST UNITED AC 2005; 61:576-9. [PMID: 15590027 DOI: 10.1016/j.cursur.2004.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We report a case of a 21-year-old man who presented with the unusual symptoms of heart failure and was found to have an anterior mediastinal yolk sac tumor. METHODS A review of the literature using the Ovid search engine was performed. RESULTS The patient was treated with the current standard of neoadjuvant chemotherapy: bleomycin, etoposide, and cisplatin (BEP) with marked reduction in tumor size, followed by en bloc surgical resection. The final pathology revealed teratoma with malignant change: chondrosarcoma, adenocarcinoma, and poorly differentiated sarcoma. CONCLUSIONS This is a rare initial presentation of an anterior mediastinal germ-cell tumor with treatment consisting of neoadjuvant therapy and surgical resection. In addition, we present the adverse and extremely rare malignant degeneration of this tumor.
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Affiliation(s)
- Michael Michel
- Division of Cardiothoracic Surgery, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS 39534, USA.
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