Mediastinoscopy has long been the mainstay of mediastinal lymph node sampling. The diag- nostic accuracy of mediastinoscopy is high and complications are rare [24, 25]. However, it is also difficult to perform this procedure a sec- ond time in patients. The reach of the proce- dure is limited, as lymph nodes may not be accessible. Ernst et al. compared mediastinos- copy to EBUS-TBNA in patients with suspected lung cancer and mediastinal lymphadenopathy, finding that the diagnostic yield of EBUS-TBNA was higher than that of mediastinoscopy. They concluded that EBUS-TBNA was preferred in the histologic sampling in patients with lung cancer . Mediastinoscopy is currently the gold standard for cancer staging, perhaps because comparative studies of EBUS-TBNA and mediastinoscopy are rare and there is a substantial learning curve effect for EBUS- TBNA. EBUS-TBNA could be the first choice for histologic sampling of paratracheal and sub- carinal mediastinal lymphadenopathy.
Background: Mediastinoscopy is the gold standard procedure for the patho- logical staging and diagnosis of mediastinal diseases. The aim of the study is to describe the significance of anterior cervical Mediastinoscopy in evaluating patients with mediastinal lymphadenopathy and lung parenchymal disease. Material and Methods: From January 2014 until June 2017 we conducted a retrospective study of 52 consecutive patients with mediastinal lymphadeno- pathy and lung parenchymal disease who underwent anterior cervical Medias- tinoscopy. The main indications for cervical Mediastinoscopy were isolated mediastinal lymphadenopathy, undetermined lung mass with mediastinal lymphadenopathy, and the clinical staging of patients with lung cancer. Re- sults: The study subjects consisted of 37 men and 15 women, aged 13 to 87 (mean age 50.8). Eight patients had mediastinoscopy for staging lung cancer, 27 patients had mediastinoscopy to diagnose isolated mediastinal lymphade- nopathy, and 17 patients had mediastinoscopy for an undetermined lung pa- renchymal mass. Among the patients with isolated mediastinal lymphadeno- pathy, sarcoidosis was diagnosed in 6, tuberculosis in 9, reactive lymph nodes in 4, metastasis in 5 and lymphoma in 3. Lymph node metastasis (N2, N3) was found in 5 patients with lung cancer. There was no surgical-related mortality or morbidity. Conclusions: Mediastinoscopy is a safe and reliable procedure in diagnosing mediastinal diseases and is still the first choice among the inves- tigative modalities in the clinical staging of bronchogenic carcinoma.
In conclusion, our series re-iterates safety, feasibility and success of EUS-B-FNA with the currently available EBUS scope in pediatric patients with mediastinal lymphadenopathy, and reviews the current literature on the concept. The procedure has a good diagnostic yield and excellent safety profile, and can potentially circumvent invasive procedures such as mediastinoscopy/VATS. EUS-B-FNA extends the ability of the current EBUS scope to sample MLN in the younger age group safely and effectively. A suggested decision tree for the use of EBUS-TBNA vs EUS-B-FNA in pediatric MLN sampling is outlined in Figure 4. Further studies are required to more precisely define the role of this entity in pediatric MLN sampling.
In increasing in the mediastinal lymph nodes, video surgery was performed to clarify the nature of the changes identified through noninvasive instrumental examination, such as x-rays, ultrasound, MDCT, MRI. Videothoracoscopy showed high effectiveness and informative in the diagnosis of lymphoproliferative diseases of the mediastinum. Contraindications to the diagnostic operations are the presence of adhesions in the pleural cavity, severe condition of patients. CONSENT
Endoscopy may show ulceroproliferative growth mimicking a neoplastic process . When biopsy from these lesion shows chronic inflammation and caseating or non caseating granuloma then we should suspect tuberculosis 16,17 . In our series, endoscopy showed a ulcerovegetative lesion 13 patients (41.9%) distributed in the Upper Third (n=6) and middle third esophagus (n=7). Extrinsic compression was noted in 10 patients (n=10, 32.2%) most commonly in the middle third due to mediastinal lymphadenopathy (n=6).
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Because of the absence of a clear aspiration event, computed tomographic (CT) scans of the chest were obtained; they showed extensive hilar and mediastinal lymphadenopathy, resulting in obstruction of the left bronchus (Fig 2). A Mantoux skin test was performed for the infant. Bronchoscopy revealed a cheesy granu- lomatous mass in the left mainstem bronchus, which was ball- valving into the upper bronchus (Fig 3). Removal resulted in improvement of the patient’s respiratory status. Pathology, bron- chial lavage, and gastric aspirate specimens were smear positive and culture positive for acid-fast bacilli, consistent with M tuber- culosis infection. In addition, the Mantoux skin test developed ⬎ 10 mm of induration. The patient began standard 4-drug therapy with isoniazid, rifampin, ethambutol, and pyrazinamide and was discharged from the hospital with directly observed therapy.
Abstract: Scleromyxedema is part of a group of cutaneous mucinoses, characterized by a generalized papular eruption, dermal mucin deposition, and an increase in dermal collagen. This condition can be localized as discrete papular lichen myxedematous skin or as a systemic condition usually associated with paraproteinaemia. To date, there is no unifying treatment and is limited by rarity, small number of case reports, and the lack of randomized controlled trials. We describe the case of a 56-year-old gentleman with features of scleromyxedema who had cutaneous and cardiac involvement, and significant mediastinal lymphadenopathy without monoclonal gammopathy.
Patient 5 came to the hospital after being trou- bled by backache for 2 weeks. Abdominal ultra- sound showed a mass located near the right adrenal gland, and thoracic CT and MRI scan revealed a 7.0 cm × 5.5 cm mass in the left posterior mediastinum and enlarged spleen. Preoperative blood test showed the patient had 93 g/L hemoglobin. A diagnosis of mediastinal malignant neurogenic tumor with adrenal metastasis was made, and the patient under- went laparoscopy and thoracotomy. Postop- erative pathologic examination showed ML and the hematopoietic tissue proportion was 65% for both the adrenal and mediastinal masses. Considering the patient’s low hemo- globin, splenomegaly and low fat tissue propor- tion, the final diagnosis was EMH of two differ- ent sites.
irradiation were performed, mediastinal lymphoma was found in the patient. The patient ultimately died of lymphoma. To the best of our knowledge, this is the first report of a concurrent medulloblastoma and primitive neuroectodermal tumor and the fourth report of multiple café-au-lait spots in a patient with Gorlin syndrome. This report is also the first account of the development of mediastinal lymphoma after spinal irradiation in a patient with Gorlin syndrome. Conclusions: Chemotherapy should be the first-line treatment for medulloblastoma patients with Gorlin syndrome. Young patients with medulloblastoma of the desmoplastic subtype and multiple café-au-lait spots should be thoroughly examined for Gorlin syndrome.
AIDS: The human immunodeficiency virus type 1 (HIV-1) is a lymphotropic virus which gains access to cells by way of the CD4 surface protein normally found on T helpers cells as well as most monocytes and other macrophages. Infection with HIV- 1 is associated with several clinical and pathological syndromes. Some patients develop fever, weight loss, diarrhea and generalixed lymph node enlargement (lymphadenopathy) in which there is generalized follicular hyperplasia. In patients with full-blown immunodeficient state of AIDS, lymph nodes commonly show loss of follicles, lymphocyte depletion, vascular proliferation and fibrosis.
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prognoses of AEGs and primary proximal gastric car- cinomas following the same operative procedure, and to compare their recurrence patterns. In addition, we propose that it is worth considering a tailored strategy that total gastrectomy without mediastinal lymphade- nectomy might produce favorable outcome in early AEG and, in advanced AEG, the acquisition of a greater length of proximal margin with removal of mediastinal lymph nodes might be helpful. A better controlled pro- spective trial is required to prove the benefit of this strategy.
CHM is a rare disease of mediastinal benign lesion originat- ing from vascular endothelial cells which is caused by abnor- mal vascular development during embryonic period and composed of masses with varying sizes and dilated cavernous sinus pathologically. The inner wall is lined with vascular endothelium, and the blood sinus cavity is congestive or filled with some phleboliths (calcified thrombosis) . Eighteen cases in this group (18/19) were solitary lesions, and few multiple cases were reported in the previous studies, which may be the characteristic of this disease. The literature re- ports that the average age of CHM is about 35 years old [2, 3]. Most of the patients in this group were middle- and old- aged patients over 50 years old, which may be related to the
This was a retrospective cross sectional chart review study of 470 patients who underwent thyroid surgery between 2003 and 2007 at our referral hospital. There were 60 patients who presented with mediastinal masses and were evaluated in this study. All surgeries were performed by thoracic surgeons. There were 53 (88%) females and 7 (12%) males, and patients were in the age range of 19 to 70 years (mean 46.77 ±10.77 years). The indications for surgery are listed in Table 1. Most cases were benign. Different types of surgeries performed are demonstrated in Table 2. One patient was excluded from the study because he did not meet the criteria required for general anesthesia. All patients underwent partial or total thyroidectomy with or without node dissections for their substernal masses. A total of 59 patients enrolled in this study. We reviewed patients’ medical records for recurrent goiter, identification of recurrent laryngeal nerve or
Abstract: Primary mediastinal synovial sarcoma (PMSS) is a rare malignant soft tissue tumor with a poor progno- sis. Because of its rarity, the misdiagnosis rate remains high. To raise awareness of this disease, the current study presents a case of PMSS with atypical CT features. A 26-year-old male presented with a 3-day history of chest pain. Chest CT scans showed multi fusion masses with an ill-defined margin. After the mass was partially resected, patho- logical and immunochemistry examinations were performed. The patient was diagnosed with biphasic synovial sar- coma. Summary analysis was then conducted of clinical, histopathological, and CT details of cases reported in the literature (English only). Based on results, PMSS should be considered when a solitary mass in the mediastinum is observed in a man with chest pain. Moreover, PMSS is indicated when the mass measures greater than 4 cm and appears as a heterogenous mass with necrosis/cystic changes and heterogenous patterns. Prognosis of PMSS can be improved by early diagnosis.
The histopathological feature of lymph node in our pa- tient was epithelioid granuloma admixed with several eosinophils, lymphocytes and plasma cells along with other areas showing features of reactive lymphadenitis. Earlier reports described non-caseating epithelioid cell granulomas consisting of central zone of epithelioid cells surrounded by dense infiltrate of histiocytes without giant cells in necropsy specimens of patients with SLE [3,4]. Similarly several granulomas consisting of large ep- ithelioid cells and histiocytes with granular and fibrinoid appearance in the center without caseation were ob- served in a pleural biopsy of a patient with SLE . The presence of granuloma in lymph node biopsy and FNAC is suggestive of tuberculosis which is highly prevalent in our geographical region. However there was no caseous necrosis or Langhan type of multinucleated giant cells that are usually seen in tubercular lymph node histo- pathology. Furthermore, Ziehl Neelsen stain for AFB and AFB cultures were negative in this patient. Hence tuberculosis was considered unlikely and sequential evo- lution of features confirmed SLE in this patient. How- ever, there are cases where anti-tubercular treatment has been initiated in patient with lupus lymphadenopathy when there was a sequential absence of symptoms . Lupus nephritis is considered a risk factor for tubercu- losis and some patients develop disseminated tubercu- losis even before use of corticosteroids . This patient did not receive anti-tubercular treatment and did not develop flare up of symptoms in spite of corticosteroid treatment. Therefore, the possibility of tuberculosis was considered highly unlikely in this patient.
for extrapulmonary TB including peripancreatic lymph nodes [10–12]. Though, this method highly depends on the experience of operator, its clinical availability remains relatively limited. Percutaneous (US/CT-guided) biopsy is also useful technique, but small or deep lesions are diﬃcult to sample, false-negative value of percutaneous FNA has been reported around 58% , which is also problematic. Laparoscopic biopsy is an alternative choice for abdominal lymphadenopathy. This technique, a less invasive procedure than a laparotomy, can approach deep lymphatic tissue and obtain the entire lymph nodes [14, 15]. To avoid inappropriate invasive procedures, preoperative definitive diagnosis should be established as much as possible .
The management of pneumomediastinum depends on the clinical severity and the underlying etiology. Sponta- neous pneumomediastinum has a benign course, resolv- ing on its own. The management of this condition is usu- ally supportive, with reassurance, observation, treatment of underlying condition, and oxygen therapy. In rare cas- es, surgery may be required to correct pneumomediasti- num when caused by severe tracheobronchial disruption. However, occasional deaths from splinting of great ves- sels and the trachea by mediastinal emphysema have also been reported, demanding careful vigilance of this condition (10). The lack of pneumothorax in our patient, which is often a secondary complication of pneumomedi- astinum, combined with the lack of any identifiable lesion and hemodynamic stability, allowed for conservative management.
This is to certify that this clinical work, A Dissertation on a Comprehensive Study on Cervical Lymphadenopathy is the original and bonafide work done by Dr. M. SIVAKAMI in the Department of Surgery, Govt. Kilpauk Medical College Hospital, Chennai, during the tenure of her course MS General Surgery from June 2004 to March 2007 under the regulation of The Tamilnadu Dr. M.G.R. Medical University, Chennai.
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The final diagnosis of each LN was determined using all available cytological and histological findings from three EBUS-TBNA procedures. The primary outcomes of the trial were the cytological specimen adequacy rate and the diagnostic yield for malignant lymphadenopathy. A sample size of 225 LNs would provide sufficient power for a 10% non-inferiority margin upon performing non- inferiority analysis. The secondary outcomes were tissue- core acquisition rate, procedural time and amount of bleeding during each procedure. The amount of bleeding was categorized on the basis of the following scores: 0 (major hemorrhage, resulting in termination of subse- quent procedure); 1 (light hemorrhage that could be stopped using cold saline or norepinephrine); 2 (no or little hemorrhage occurred, even without treatment).
The gold standard for diagnosis is a tissue biopsy of an involved site demonstrating noncaseating granulo- mas. Typically the most accessible site of disease involvement is biopsied first to minimize morbidity. In our patient, this was the mediastinal lymphadenopa- thy. Attempts to sample these lymph nodes via endos- copy and mediastinoscopy yielded nondiagnostic results. Ultimately, a brain biopsy was required to arrive at the final pathologic diagnosis of necrotizing sarcoid granulomatosis. The differential diagnosis of necrotizing granulomas involving the CNS is extensive, and in- cludes numerous infectious agents (particularly fungi and mycobacteria) and noninfectious processes, such as Wegener granulomatosis and necrotizing sarcoid granulomatosis. 6 To the authors ’ knowledge, there are