Mediastinal teratoma presenting with hemoptysis and pleuritis misdiagnosed as tuberculosis (empyema)

Association Between Parental Absence and Depressive Symptoms in Adolescence: Evidence From a National Household Longitudinal Survey

Longitudinal evidence demonstrating the association between parental absence and depressive symptoms in adolescence is limited. The present study aimed to explore this relationship in a Chinese national representative sample. This research was based on the China Family Panel Studies and included 1481 subjects. Depressive symptoms were assessed using the self-reported Center for Epidemiologic Studies Depression questionnaire. A multiple logistic regression model with a generalized estimating equation was used to test the association between parental absence and adolescent depressive symptoms. In the baseline year, 2012, 29.03% and 43.75% of adolescents had maternal and paternal absence, respectively. The prevalence of depressive symptoms increased from 23.23% to 28.12% in subsequent years. After controlling for covariates, maternal absence was positively associated with depressive symptoms (odds ratio 1.69, 95% confidence interval 1.06-2.68). Maternal absence led to depression in adolescents. It may be beneficial for adolescents with depression to spend more time with their mothers.

An overview on the principles of management of haemoptysis

Haemoptysis is a frequently encountered presentation in thoracic surgery practice. Most of the patients present with chronic haemoptysis while 5% of them will present with life-threatening acute haemoptysis. Emergency surgery used to be the first-line management in acute life-threatening haemoptysis which resulted in significant morbidity and mortality. With advancements in interventional procedures, most of these acute presentations are now being managed conservatively by interventionists. In a country like India with a high incidence of tuberculosis and other infectious diseases of the lungs, haemoptysis is even more common. While interventional procedures help to tide over the crisis and earn valuable time to stabilise a haemorrhaging patient, surgical resection is the definitive management most of the time. This review will endeavour to establish the definition, aetiology, emergency, and definitive management of a patient who presents with haemoptysis.

A rare case of brain metastatic of primary mediastinal yolk sac tumor

Primary yolk sac tumors are extragonadal germ cell tumors commonly seen in children and young adults. They are more common in men. Germ cells tumor on histopathological characteristics is classified as seminoma and non-seminomatous (NSGC). The rarest form of NSGC is an extragonadal yolk sac tumor of mediastinum. Clinical presentations are not specific and may imitate other chronic disease such as other malignancies or tuberculosis such as chest discomfort, vena cava superior syndrome, fever, weight loss, and chronic cough. Immunohistochemistry showed a positive result in Alpha-fetoprotein and pan-cytokeratin. Due to its rarity, brain metastases' clinical signs and symptoms, anatomical sites, and characteristics are less well documented. However, the metastatic brain process gave similar histological findings to the primary site. Additional radiological and laboratory tests can be carried out to identify other metastatic processes. Standardized treatment of primary mediastinal sac tumors with brain metastasis has not yet been established. Combining chemotherapy, surgery and radiation treatment could improve overall outcomes and prognosis. We present a scarce case of primary mediastinal yolk sac tumor with metastatic brain process in a 32-year-old male with a short survival period.

Spontaneous intrapleural rupture of mediastinal teratoma in child

Introduction

Mediastinal teratomas are rare in children. Nevertheless, they represent the most frequent mediastinal germ cell tumor. Most often, they are discovered incidentally in older children or adolescents on chest X-ray. There are other signs of discovery but less frequent: chest pain, hemoptysis and signs of mediastinal compression. Rupture into pleural space, pericardium or tracheobronchial tree are exceptional.

Case presentation

We report the case of 7-years old girl admitted for chest pain. The chest x-ray showed a mediastinal mass with calcifications and pleural effusion. Chest CT scan revealed a well limited heterogeneous anterior mediastinal mass with calcifications and a left pleural effusion. She underwent a median sternotomy and the tumor was completely excised. Histopathology confirmed the diagnosis of mature teratoma.

Conclusion

Intrapleural rupture is a rare complication of mature teratoma. Calcifications on chest imaging in afebrile children with pleural effusion should be suspected of mediastinal teratoma.

Intrathoracic mass in a 5-month-old infant: fetus in fetu—a case report

Background

The fetu in fetu (FIF) is an extremely rare congenital condition characterized by a 2nd fetus that grows into the body of the healthy twin. Its thoracic location is more exceptional.

Case presentation

We report a case of intrathoracic mass in a 5-month-old female infant, diagnosed after an assessment for respiratory distress. She underwent an emergency left thoracotomy which allowed for the removal of a large thoraco-mediastinal mass inside a membranous sac containing a clear liquid mixed with vernix caseosa. The mass was completely covered with normal skin, three lobes similar to rudimentary outline of the head and limb. It was attached to a single large vascular pedicle. The pathological examination concluded that there was a high possibility of FIF. The postoperative follow-up was uncomplicated, and the child is still in good clinical condition after the 5-month follow-up.

Conclusion

The assessment of the respiratory distress in an infant with a mass centered by an axial skeleton on the chest x-ray and thoracic CT scan may suggest a diagnosis of intrathoracic FIF.

A ruptured giant mediastinal mature teratoma mimicking an encapsulated empyema

A female patient with a right-sided encapsulated pleural effusion was misdiagnosed preoperatively as having an encapsulated empyema. However, a giant mass in the anterior mediastinum was found via thoracoscopy, and a mature teratoma was detected based on the pathological result. Herein we report this case and provide lessons for cardiothoracic surgeons.

Mature cystic teratoma of anterior mediastinum in a 4-month-old infant: a rare case report

Teratomas of anterior mediastinum are rare tumors and are often slow growing, asymptomatic and detected incidentally on chest imaging. We report, a rare case of an anterior mediastinal teratoma occurring in early childhood. A 4-month-old male infant presented to the pediatric unit of our hospital with a 2-week history of a progressive difficulty in breathing and stridor. He had received several courses of oral and intravenous antibiotics for a clinical diagnosis of pneumonia. The baby started to show social smile and hold his head fairly steady. Chest radiography and chest ultrasound revealed a cystic anterior mediastinal mass which was confirmed by a contrasted chest CT. An ultrasound-guided trucut biopsy of the mass was performed and histopathology showed mature cystic teratoma. Surgical removal of the mass was done with excellent post-operative outcome. Occurrence of a mature cystic anterior mediastinal teratoma is uncommon in early infancy. Early and complete surgical resection offers the best possible prognosis.

Is There a Role of Elevated CA 19-9 Levels in the Evaluation of Clinical Characteristics of Mature Cystic Ovarian Teratomas? A Systematic Review and Meta-analysis

The role of preoperative CA 19-9 levels in patients with ovarian mature cystic teratoma (MCT) and the association of elevated levels of the biomarker with patients’ and tumor characteristics were evaluated. Four electronic databases were searched for articles published up to September 2019. Trials that evaluated the significance of elevated CA 19-9 in patients with ovarian MCTs and publications with > 20 patients were considered eligible for inclusion. Seven studies that included 995 patients with an ovarian MCT who were evaluated with elevated (n = 364) or normal (n = 631) CA 19-9 levels were included. Mean tumor size was significantly increased in patients with elevated CA 19-9 levels (p = 0.038). The rate of ovarian torsion was significantly increased in the elevated CA 19-9 group (p = 0.04). The present study highlights the importance of CA 19-9 as a marker in the diagnosis of MCT, and a meta-analysis supports that it could raise a high degree of clinical suspicion of early recognition of torsion and early surgical management due to complications related to increased size. Nonetheless, the diagnostic value of CA 19-9 is still limited and CA 19-9 can still serve only as a supplementary diagnostic tool in patients with MCTs.