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Mediastinal staging

Rachel C Jones, Nidhi Bhatt, Andrew R L Medford
EBUS-TBNA is a recent mediastinal staging and diagnostic technique. We have previously reported superior characterisation with 21G biopsies over 22G biopsies for benign and malignant mediastinal nodes. A new 19G needle now exists but there are limited studies. We hypothesised 19G biopsies would improve both benign and malignant characterisation due to larger samples. We retrospectively analysed sequential patients referred for EBUS-TBNA with unexplained mediastinal adenopathy performed with 19G, 21G and 22G needles respectively (100 patients each)...
June 22, 2018: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Michael Kassirer, Jonathan Wiesen, Karine Atlan, Avital Avriel
Convex endobronchial ultrasound transbronchial needle aspiration (C-EBUS-TBNA) has become an essential modality for diagnosis and staging of hilar, mediastinal, and central pulmonary lesions. A Trans-thoracic pleural biopsy is the accepted practice for diagnosing pleural nodules. However, the diagnostic yield of a pleural biopsy is limited and surgical procedures pose a greater risk. We report a unique case of using a C- EBUS scope for the diagnosis of pleural nodules and mediastinal lymph node metastasis in a man with metastatic renal cell carcinoma...
2018: Respiratory Medicine Case Reports
Santosha Vardhana, Paul A Hamlin, Joanna Yang, Andrew Zelenetz, Craig S Sauter, Matthew J Matasar, Andy Ni, Joachim Yahalom, Craig H Moskowitz
Primary mediastinal (thymic) large B-cell lymphoma is a subtype of diffuse large B-cell lymphoma with distinct clinical, molecular and genetic features, many of which overlap with Hodgkin's lymphoma. Increasingly, initial therapy for these patients has employed dose-dense chemotherapy with or without radiation with excellent results. In patients with relapsed and primary refractory disease, outcomes of second-line therapy followed by consolidation with high-dose therapy and autologous stem cell transplantation remains largely undefined...
June 14, 2018: Biology of Blood and Marrow Transplantation
Peter J Kneuertz, Mohamed K Kamel, Brendon M Stiles, Benjamin E Lee, Mohamed Rahouma, Sebron W Harrison, Nasser K Altorki, Jeffery L Port
BACKGROUND: Pulmonary carcinoid tumors are often considered indolent tumors. The prognostic significance of lymph node (LN) metastases and the need for mediastinal dissection is controversial. We sought to determine the incidence, risk factors, and prognosis of LN metastases in resected carcinoid patients. METHODS: Patients undergoing lung resection for carcinoid and removal of ≥10 LNs were identified in the National Cancer Database form 2004-2014. Typical (TC) and atypical (AC) carcinoids were included...
June 14, 2018: Annals of Thoracic Surgery
Francisco A Almeida, Shameen Salam, Atul C Mehta, Luke Yuhico, Yash Sarda, Humberto Choi, Joseph C Cicenia, Thomas Gildea, Michael Machuzak, Peter Mazzone, Eduardo Oliveira, Sonali Sethi, Xiao-Feng Wang, Jordan P Reynolds
BACKGROUND: The value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the mediastinal staging of lung cancer has been well established. However, data regarding its utility in the diagnosis of intrapulmonary lesions has been sparse. This study assesses the sampling utility of convex probe EBUS-visible intrapulmonary lesions not visualized by the white-light bronchoscopy. METHODS: A retrospective analysis of EBUS-TBNA of EBUS-visible intrapulmonary lesions was performed between January 2010 and March 2015...
June 12, 2018: Journal of Bronchology & Interventional Pulmonology
Miho Yamamoto, Soji Ozawa, Kazuo Koyanagi, Junya Oguma, Akihito Kazuno, Yamato Ninomiya, Kentaro Yatabe, Kazuhito Hatanaka
BACKGROUND: Mixed adenoneuroendocrine carcinoma (MANEC) is a tumor of the gastrointestinal tract that contains both exocrine and endocrine components, with each component exceeding 30% of the total tumor area. Because MANECs are exceedingly rare, no therapeutic strategies have been established yet. CASE PRESENTATION: An 81-year-old man was referred to our hospital with a 5-month history of dysphagia. Esophagogastroduodenoscopy revealed an ulcerated mass in the lower thoracic esophagus, extending up to the esophagogastric junction (33 to 40 cm from the incisors)...
June 14, 2018: Surgical Case Reports
Chelsea C Pinnix, Andrea K Ng, Bouthaina S Dabaja, Sarah A Milgrom, Jillian R Gunther, C David Fuller, Grace L Smith, Zeinab Abou Yehia, Wei Qiao, Christine F Wogan, Mani Akhtari, Osama Mawlawi, L Jeffrey Medeiros, Hubert H Chuang, William Martin-Doyle, Philippe Armand, Ann S LaCasce, Yasuhiro Oki, Michelle Fanale, Jason Westin, Sattva Neelapu, Loretta Nastoupil
Dose-adjusted rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) has produced good outcomes in primary mediastinal B-cell lymphoma (PMBCL), but predictors of resistance to this treatment are unclear. We investigated whether [18 F]fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings could identify patients with PMBCL who would not respond completely to DA-R-EPOCH. We performed a retrospective analysis of 65 patients with newly diagnosed stage I to IV PMBCL treated at 2 tertiary cancer centers who had PET-CT scans available before and after frontline therapy with DA-R-EPOCH...
June 12, 2018: Blood Advances
Salvatore Annunziata, Annarosa Cuccaro, Alessio Rizzo, Silvia Chiesa, Francesco DʼAlò
A 57-year-old man had a diagnosis of a bronchial mucosa-associated lymphoid tissue lymphoma in the left lung and monoclonal gammopathy. The patient underwent whole-body C-methionine PET/CT, in order to evaluate the amino acid avidity of the lesion and to stage the bronchial mucosa-associated lymphoid tissue lymphoma. C-methionine uptake was detected in the lung lesion and in the mediastinal lymph nodes.
June 12, 2018: Clinical Nuclear Medicine
M Djokic, B Plesnik, M Petric, B Trotovsek
INTRODUCTION: Massive splenomegaly is indicated by spleen weight exceeding 1000 g and largest spleen dimension greater than 20 cm Poulin et al. (1998). In many cases, splenectomy is the treatment of choice for massive splenomegaly because it releases the pressure on adjacent organs and also provides a definitive histopathological diagnosis of the underlying cause Iriyama et al. (2010), Radhakrishnan (2018). PRESENTATION OF CASE: Herein we present a clinical case of disseminated diffuse large B - cell lymphoma, clinical stage IV, with massive splenomegaly...
May 29, 2018: International Journal of Surgery Case Reports
Hideharu Tanaka, Norihisa Uemura, Daisuke Nishikawa, Keisuke Oguri, Tetsuya Abe, Eiji Higaki, Takahiro Hosoi, Byonggu An, Yasuhisa Hasegawa, Yasuhiro Shimizu
BACKGROUND: Spontaneous esophageal rupture, also known as Boerhaave syndrome, is a very serious life-threatening benign disease of the gastrointestinal tract. It is typically caused by vomiting after heavy eating and drinking. However, in our patient, because of a combination of hypopharyngeal cancer with stenosis and chemoradiotherapy (CRT), which caused chemotherapy-induced vomiting, radiotherapy-induced edema, relaxation failure, and delayed reflexes; resistance to the release of increased pressure due to vomiting was exacerbated, thus leading to Boerhaave syndrome...
June 8, 2018: Surgical Case Reports
Seth B Krantz, John A Howington, Douglas E Wood, Ki Wan Kim, Andrzej S Kosinski, Morgan L Cox, Sunghee Kim, Michael S Mulligan, Farhood Farjah
BACKGROUND: Prior studies suggest underutilization of invasive mediastinal staging for lung cancer. We hypothesized that Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD) participants would have higher rates of invasive staging compared to previous reports. METHODS: We conducted a retrospective cohort study (2012-2016) of lung cancer patients staged by computed tomography and positron-emission tomography and first treated with an anatomic resection...
June 5, 2018: Annals of Thoracic Surgery
Rajat Thawani, Anna Thomas, Kshitij Thakur
Tracheomediastinal fistula is a rare condition caused by multiple etiologies. We present a case of a patient of lung carcinoma receiving chemotherapy. A 63-year-old woman presented to the emergency room with a two-month history of worsening cough and shortness of breath. She was being treated with pemetrexed and bevacizumab for Stage IV non-small cell lung carcinoma. Chest X-ray showed a mass in the lung with mediastinal adenopathy. Computed tomography (CT) scan showed a perforation, confirmed with bronchoscopy...
April 3, 2018: Curēus
Naoki Kubo, Junichi Yoshizawa, Takaomi Hanaoka
BACKGROUND: Mediastinal lymph node metastases occasionally occur in patients of advanced gastric cancer of the cardia with esophageal invasion, but they rarely occur in patients with gastric cancer of other sites. This report describes a case of a solitary metastasis to t a superior mediastinal lymph node after distal gastrectomy for gastric cancer of the antrum. CASE PRESENTATION: A 70-year-old man underwent curative distal gastrectomy for advanced gastric cancer of the antrum (pT2pN2M0, stage IIB)...
June 4, 2018: BMC Cancer
Aritoshi Hattori, Takeshi Matsunaga, Kazuya Takamochi, Shiaki Oh, Kenji Suzuki
BACKGROUND: It is evident that the frequency of nodal metastasis in part-solid lung adenocarcinoma is significantly low. For those cases, the prognostic impact of the lymph nodal dissection is highly controversial. METHODS: We reviewed 462 clinical-stage I radiological part-solid lung adenocarcinoma patients who underwent lobectomy or segmentectomy with lymphadenectomy. Consolidation tumor ratio (CTR) was evaluated for all patients. Extent of LNDs was classified into systematic/lobe-specific mediastinal-LND (m-LND) and hilar-LND only (h-LND)...
May 28, 2018: Annals of Thoracic Surgery
Shaodong Tong, Zhaohui Qin, Minghui Wan, Longzhen Zhang, Yan Cui, Yuanhu Yao
Background: Non-small cell lung cancer (NSCLC) accounts for 85% to 90% of lung cancer cases. At diagnosis, around 30% of NSCLC patients are already at stage IIIA (N2). One standard treatment for this stage is induction chemotherapy followed by surgery, whether induction chemoradiotherapy is superior to induction chemotherapy remains uncertain. We therefore performed a systematic review and meta-analysis of published randomized control trials to evaluate the therapeutic efficacy and toxicity of induction chemoradiotherapy versus induction chemotherapy for potentially resectable stage IIIA (N2) NSCLC...
April 2018: Journal of Thoracic Disease
Zhitao Gu, Huimin Wang, Teng Mao, Chunyu Ji, Yangwei Xiang, Yan Zhu, Ping Xu, Wentao Fang
Background: Limited resections for early stage lung cancer have been of increasing interests recently. However, it is still unclear to what extent a limited resection could preserve pulmonary function comparing to standard lobectomy, especially in the context of minimally invasive surgery. The purpose of this study was to evaluate postoperative changes of spirometry in patients undergoing video-assisted thoracic surgery (VATS) lobectomy or limited resections. Methods: Spirometry tests were obtained prospectively before and 6 months after 75 VATS lobectomy, 34 VATS segmentectomy, 15 VATS wedge resection...
April 2018: Journal of Thoracic Disease
José-Fernando Val-Bernal, María Martino, Félix Romay, Elena Yllera
Evaluation of mediastinal lymphadenopathy in patients with a previous diagnosis of renal cell carcinoma (RCC) is critical for the determination of further treatment. A minimally invasive method of cytology sampling of mediastinal lymph nodes using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a useful tool in diagnosis. Between January 2010 and April 2018, we performed 1744 EBUS-TBNA studies of mediastinal and hilar lymph nodes for a variety of clinical indications including mediastinal malignancy...
May 22, 2018: Pathology, Research and Practice
Tara Pereiro Brea, Alberto Ruano Raviña, José Martín Carreira Villamor, Antonio Golpe Gómez, Anxo Martínez de Alegría, Luís Valdés
INTRODUCTION: The aim of this study is to assess the diagnostic value of the magnetic resonance imaging (MRI) in differentiating metastasic from non-metastatic lymph nodes in NSCLC patients compared with computed tomography (CT) and fluorodeoxyglucose (FDG) - positron emission tomography (PET) or both combined. METHODS: Twenty-three studies (19 studies and 4 meta-analysis) with sample size ranging between 22 and 250 patients were included in this analysis. MRI, regardless of the sequence obtained, where used for the evaluation of N-staging of NSCLC...
May 23, 2018: Archivos de Bronconeumología
Andeep Ramesh Kukkar, Harsha Panchal, Asha Anand
Primary neuroendocrine tumors of the thymus are unusual anterior mediastinal tumors with a variable prognosis. A retrospective analysis of five patients with primary neuroendocrine tumors of the thymus admitted to the Gujarat Cancer and Research Institute, Ahmedabad, between 2012 and 2016, was done to study the clinical profile and outcome of these patients. The role of various prognostic factors such as surgical resection, histological grade, and Masaoka-Koga staging was also analyzed. Majority of the patients present with signs and symptoms related to a rapidly expanding mediastinal mass, such as breathlessness, facial puffiness, edema over the neck and extremities, chest pain, and other features of superior vena cava (SVC) syndrome...
July 2017: Indian Journal of Cancer
Osamu Imataki, Makiko Uemura
Background: Chronic lymphocytic leukemia (CLL) is a mature lymphoid neoplasm currently categorized as an indolent type of malignant lymphoma. CLL progresses slowly over years, but it eventually transforms to a more aggressive lymphoma such as the diffuse large B-cell (DLBCL) type, also known as Richter's syndrome. Case presentation: We treated a 69-year-old Japanese male who was histologically diagnosed with Richter's syndrome after 6 years of CLL. His lymphadenopathy had systemically progressed for years, with lymphocyte counts of less than 10,000 cells/μL and a disease status of Rai classification stage I and Binet classification B...
2018: BMC Clinical Pathology
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