Misdiagnosis of giant pulmonary mucinous adenocarcinoma in a posterior mediastinum mass: a case description and literature analysis.
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SUBMITTER: Wu F
PROVIDER: S-EPMC10585517 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Misdiagnosis of giant pulmonary mucinous adenocarcinoma in a posterior mediastinum mass: a case description and literature analysis.
Wu Fa F Jiang Rui R Zhu Wei W Zuo Zhiwei Z Du Feizhou F Yun Hailong H Wang Peng P
Quantitative imaging in medicine and surgery 20230829 10
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Project description:Background and objectiveThe posterior mediastinum is a potential space along the paravertebral sulci or between the posterior aspect of the pericardium and the vertebrae. This compartment is classically the most frequent location site of neurogenic tumors. Whereas neurofibroma and schwannoma are neurogenic tumors that commonly arise from peripheral nerves, sympathetic nerves are the origin of ganglioneuroma, neuroblastoma, ganglioneuroblastoma, and neuroectodermal cells closely associated with autonomic nerves are the origin of paragangliomas and pheochromocytomas. Additionally, tumors from the esophagus, tumors of mesenchymal origin, lymphoma, ectopic goiter, and diseases with lymph node hyperplasia may also settle on this compartment. The objectives are to identify term "giant posterior mediastinal tumor" and the etiology, clinical features, diagnostic methods, pathological types, surgical methods applied, and technical details of these methods for the treatment of these tumors.MethodsIn this review, the term "giant tumor" was used to define tumors larger than 10 cm settled in the posterior mediastinum. PubMed database was searched with keywords "posterior mediastinum, giant mass" or "posterior mediastinum, tumor, giant" limited to English language and full-text available studies published between years 1984-2021.Key content and findingsAs a result of the literature review with the relevant terms, 23 case reports were found in accordance with the inclusion criteria. We detected the most common giant posterior mediastinum tumors were neurogenic origin (schwannoma, ganglioneuroma, ganglioneuroblastoma, triton tumor) in that review. The most common surgical approach was posterolateral thoracotomy. Treatment response to surgical total excision was good in most of cases.ConclusionsThe definitive diagnosis and treatment of giant posterior mediastinal tumors is made by surgical excision. Diagnostic procedures and subsequent surgical planning may vary depending on the origin and localization. Adjuvant treatment and follow-up should be conducted on the histopathological features.
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Project description:BackgroundExtramedullary hemopoiesis (EMH) is a rare condition characterized by abnormal blood cell production outside the bone marrow, commonly occurring in the liver, spleen, lymph nodes, and less frequently in the mediastinum.Case presentationThis case involves a 68-year-old male patient who was found to have a posterior mediastinal mass upon examination. A surgical biopsy was performed, and pathological examination confirmed it to be extramedullary hemopoiesis (EMH). Further investigation revealed that the patient also suffered from hemolytic anemia.ConclusionsThe report presents a case of a large posterior mediastinal mass, which was confirmed to be extramedullary hemopoiesis (EMH) upon surgical pathology. It is challenging to differentiate posterior mediastinal tumors from EMH, and the possibility of EMH should be considered in patients with posterior mediastinal masses that have similar CT findings and laboratory test results.
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Project description:Liposarcoma is a carcinomatous mesenchymal tumor with various histologic features and is the most common soft tissue sarcoma originating in adipose tissue. Liposarcoma commonly occurs in the lower extremities and retroperitoneum but rarely in the mediastinum, specially extending into the thoracic cavity. We report a giant primary liposarcoma of the posterior mediastinum in a 63-year-old female who complained of cough, sputum, and pain in the right chest wall. A computed tomography scan of the chest showed a giant mass of 24 × 15 × 24 cm in the posterior mediastinum of the right thoracic cavity. After a thorough examination, no suspected lipomatous lesions were found elsewhere in the patient's body. The patient underwent a thoracotomy to remove the mediastinal mass through a right thoracic approach. Subsequently, hematoxylin-eosin staining revealed dedifferentiated liposarcoma (DDL), immunohistochemistry showed positive expression of cyclin-dependent kinase 4, and murine double minute 2 (MDM2), in addition, fluorescence in situ hybridization for the MDM2 gene was also positive, which suggested DDL. The patient was discharged without any complications, and no metastasis or recurrence was observed after 19 months of follow-up. To provide a reference for clinical diagnosis and treatment, we reviewed and discussed the literature on primary liposarcoma of the mediastinum.
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Project description:BackgroundYolk sac tumor is the most common malignant nonseminomatous germ-cell tumor in children characterized by elevated level of α-fetoprotein (AFP), accounting for 70%-80% of all cases. However, giant yolk sac tumors that involve the entire testicle may be misdiagnosed by color Doppler ultrasonography as orchitis. Therefore, we described a case of a 2-year-old pediatric patient with a giant testicular yolk sac tumor that was misdiagnosed by ultrasonography as orchitis, in order to evaluate the role of measuring AFP levels in the initial diagnosis to aid in the accuracy of the definitive diagnosis of testicular yolk sac tumor.Case presentationA 2-year-old boy received outpatient visits for unintentional swelling of the right scrotum for 7 days. Physical examination showed a rubbery swelling of the right scrotum with rejective touch. Then, the patient underwent perineal color Doppler ultrasonography in outpatient visits. The result showed a right testicle size of 29 mm × 22 mm × 20 mm with heterogeneous echogenicity and abundant blood flow, supporting the initial diagnosis of orchitis. However, the initial surgeon was skeptical of the ultrasonography diagnosis. Thus, the patient was admitted to the Department of Andrology on day 2 for further serological and imaging examination. The serum AFP level on day 3 was 323.77 ng/ml. The results of CT and MRI showed a giant tumor of the right testis (26 mm × 21 mm × 29.6 mm) with multiple lymphoid hyperplasia in the inguinal region bilaterally. The patient received radical orchidectomy without lymph node dissection on day 9. The results of postoperative pathological examination confirmed giant testicular yolk sac tumor (T1N0M0S1, Stage Is) and was positive for AFP and SALL4 in immunohistochemistry staining. The patient received three courses of bleomycin-etoposide-cisplatin chemotherapy in the Department of Pediatrics after multidisciplinary team meeting on postoperative days 14, 37, and 58, respectively. During chemotherapy and follow-up, the patient's AFP and lactate dehydrogenase levels continued to decline, and eventually remained within normal range on postoperative day 84.ConclusionMeasuring the AFP level was necessary for initial diagnosis and follow-up in pediatric cases of testicular enlargement. Radical orchidectomy combined with postoperative bleomycin-etoposide-cisplatin adjuvant chemotherapy was an effective treatment strategy for pediatric giant testicular yolk sac tumors.
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Project description:Angiosarcoma of the Posterior Mediastinum is a rare entity. We herein report a case of a giant posterior mediastinal Angiosarcoma. A 54-year female presented with a one-year history of epigastric pain. Her upper gastrointestinal tract endoscopy revealed no abnormality. Chest x-Ray showed a shadow in the hilar area. A computed tomographic scan of the Thorax (CT) and MRI Scan showed a mass in the Posterior Mediastinum. CT-guided biopsy revealed the tumor of vascular origin. The tumor was completely resected. Post-operative recovery was uneventful. After 14 months follow up patient is disease-free, and a CT scan of the chest showed no recurrence.
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Project description:Mucinous adenocarcinoma of the kidney is rarely reported in the literature. We present a previously unreported mucinous adenocarcinoma arising from the renal parenchyma. A 55-year-old male patient with no complaints showed a large cystic hypodense lesion in the upper left kidney on contrast-enhanced computed tomography (CT) scan. A left renal cyst was initially considered, and a partial nephrectomy (PN) was performed. During the operation, a large amount of jelly-like mucus and bean-curd-like necrotic tissue was found in the focus. The pathological diagnosis was mucinous adenocarcinoma, and further systemic examination revealed no clinical evidence of primary disease elsewhere. Then the patient underwent left radical nephrectomy (RN), and the cystic lesion was found in the renal parenchyma, while neither the collecting system nor the ureters were involved. Postoperative sequential chemotherapy and radiotherapy were administered, and no signs of disease recurrence were observed over 30 months of follow-up. Based on a literature review, we summarize the lesion with rarity and the associated dilemma in preoperative diagnosis and treatment. Given the high degree of malignancy, a careful history analysis accompanied by dynamic observation of imaging and tumor markers is recommended for the diagnosis of the disease. Comprehensive treatment based on surgery may improve its clinical outcomes.
| S-EPMC10200912 | biostudies-literature
Project description:BackgroundPulmonary mucinous adenocarcinoma (PMA), a rare type of adenocarcinoma, remains controversial in terms of its associated prognosis. We conducted this study to compare the oncological outcomes of lobectomy and sublobectomy for peripheral small-sized PMA.MethodsThis retrospective observational study included all patients with peripheral small-sized (≤2 cm) clinical stage IA1-A2 PMA who underwent lobectomy or sublobectomy (with margin distances ≥2 cm or greater than tumor diameter) between January 2015 and December 2018. Recurrence-free survival (RFS) and overall survival (OS) were compared between the lobectomy and sublobectomy groups with Kaplan-Meier curves and log-rank tests.ResultsThis study examined 279 patients, with 176 cases in the lobectomy group and 103 cases in the sublobectomy group. Recurrence occurred in 8 patients, and 6 patients died. Before and after propensity score matching (PSM), log-rank tests showed no statistical differences between the lobectomy and sublobectomy groups in terms of 5-year RFS (before PSM: 97.0% vs. 98.9%; after PSM: 94.6% vs. 98.9%) or 5-year OS (before PSM: 96.9% vs. 98.8%; after PSM: 94.8% vs. 98.8%), and the recurrence patterns were also similar between the two groups. The incidence of postoperative complications, such as bronchopleural fistula, hydrothorax requiring redrainage, chylothorax, respiratory failure, and pulmonary embolism, also did not differ between the two groups.ConclusionsFor peripheral small-sized PMA, sublobectomy yielded an RFS and OS comparable to those of lobectomy.
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Project description:BackgroundGangliocytoma is an uncommon disease. In this report, we report a patient who was admitted to the hospital with a mediastinal tumor which is giant rarely.Case descriptionA 30-year-old male patient was found to have a mediastinal mass 2 weeks ago during a routine examination. The patient occasionally had chest pain before 1 month. Computed tomography of the chest showed a mass occupying the posterior mediastinum and located anterior to the spine, above the diaphragm. The mass is removed by thoracoscopic surgery. In the surgical field of view, the tumor was loosely adhered to the surrounding organs and was freed by blunt-sharp combination Histologically confirmed mediastinal gangliocytoma with a size of 9.5 cm × 6.0 cm × 3.0 cm. The surgery was successful, and the patient's symptoms were completely relieved after the surgery. The patient underwent chest X-ray review at the 6th month after discharge, and no recurrence was found.ConclusionsGangliocytomas are rare tumors of the peripheral nervous system. However, most of these tumors are retroperitoneal and are more common in children and young adults. Ganglioneuromas arise from neural crest cells. Most of these tumors are asymptomatic, but some may develop high blood pressure and flushing. Surgery is the best way to treat such tumors, and attention should be paid to protecting the normal tissue around the tumor during surgery to prevent postoperative complications.
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Project description:BackgroundAccording to the latest the World Health Organization (WHO) classification in 2015, invasive mucinous adenocarcinoma (IMA) is defined as a new pathological subtype of lung adenocarcinoma (LUAD). However, whether this rare subtype of lung pathology has any difference in prognosis than conventional LUAD is debatable. Our study attempted to compare clinical characteristics and prognosis of IMA vs. noninvasive mucinous adenocarcinomas (NMA).MethodsA total of 1,857 patients with LUAD who underwent radical resection were screened from 2010 to 2015 at Zhejiang Cancer Hospital. Patients with pulmonary IMA were matched 1:1 by using propensity scores with LUAD adjusted for clinicopathological characteristics. After follow-up, overall survival (OS) and disease-free survival (DFS) were explored by Kaplan-Meier and Cox regression analyses. Forest plots were used for subgroup analyses.ResultsFollowing screening, 499 patients with LUAD were enrolled, with 97 IMA and 402 NMA. Compared to NMA of the lung, IMA was proportionately lower in women (50.5% vs. 63.4%; P=0.026) and nonsmokers (P<0.001). IMA was also associated with earlier tumor stage I (68.0% vs. 55.5%; P=0.033) and lower frequency of upper lobe tumors compared to NMA (P=0.007). Following propensity score matching, 97 pairs were selected, among which we found that patients with pulmonary IMA had a longer OS than those with NMA (P=0.014). According to the subgroup analysis, improved OS in the IMA cohort versus the NMA cohort was observed across various factors, including the absence of lymphovascular invasion or perineural invasion.ConclusionsIn this study, we found that resectable IMA patients had a better OS than NMA patients. This study contributes to the understanding of IMA in depth, but it needs to be validated through additional multicenter studies.
| S-EPMC8988085 | biostudies-literature
Project description:Pulmonary invasive mucinous adenocarcinoma (IMA) has unique histological patterns. This study aimed to comprehensively evaluate the clinicopathological features, prognosis, and survival outcomes of IMAs. We retrospectively identified 77 patients with pulmonary IMA and reviewed their clinical and pathological features. Another 520 patients with non-IMA-type ADC were retrieved for comparison with patients with IMA. A new two-tier grading system (high-grade and low-grade IMAs) modified from the pancreatic intraepithelial neoplasia classification system was used for survival analyses. Compared to patients with non-IMA-type ADC, patients with IMA tended to have never smoked (p = 0.01) and had early-stage IMA at initial diagnosis (p < 0.001). For stage I-II diseases, the five-year overall survival (OS) rates were 76% in IMAs and 50% in non-IMA-type ADCs, and a longer OS was observed in patients with IMA (p = 0.002). KRAS mutations were the most commonly detected driver mutations, which occurred in 12 of the 28 (43%) patients. High-grade IMAs were associated with a shorter recurrence-free survival (RFS) for stage I-IIIA diseases (p = 0.010) than low-grade IMAs but not for OS. In conclusion, patients with stage I and II IMA had better OS than those with non-IMA-type ADC. A new two-tier grading system might be useful for predicting RFS in stage I-IIIA IMAs.
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