Mediastinal Carcinoma Research Articles

Cysts and cyst-like formations of the mediastum: clinical and radiological manifestations

. Mediastinal cystic formations are well-shaped, often round formations that contain fluid and are lined with epithelium. The main cystic formations include congenital benign cysts (bronchogenic, duplicating the esophagus, neuroenteric, pericardial and thymic cysts), meningocele, mature cystic teratomas and lymphangiomas. Many tumors (e.g., thymomas, Hodgkin's disease, germ cell tumors, mediastinal carcinomas, lymph node metastases, nerve root tumors) may undergo cystic degeneration, especially after radiation or chemotherapy, and show mixed solid and cystic elements on computed tomography (CT) or magnetic resonance imaging (MRI), as well as acquire the structure of cavity formations during the tumor destruction. If the degeneration is extensive, such tumors may be virtually indistinguishable from con­genital cysts. However, the history of the disease, visualization of the anatomical location of the formation, some details visible on CT or MRI, allow in many cases to make the correct diagnosis. Familiarity with the radiographic features of mediastinal cystic lesions facilitates accurate diagnosis, differentiation from other cystic lesions, and thus ensures optimal treatment of a patienta.

Carcinoma of Unknown Primary in the Middle Mediastinum: Three Case Reports

Carcinoma of unknown primary rarely occurs in the middle mediastinum. Here, we present three cases of carcinoma of unknown primary in the middle mediastinum, which were treated with surgical resection and adjuvant therapy. Positron emission tomography/computed tomography demonstrated high uptake of 18F-fluorodeoxyglucose in the tumors. Regarding the surgical procedure, dissection of the azygos vein was useful to obtain not only a good exposure of the surgical field but also mobilization of the superior vena cava, which led to safe separation of the tumors from the major mediastinal structures. The dissection and reconstruction of the superior vena cava was required due to extranodal invasion of the tumor in one case. Since the middle mediastinal carcinoma of unknown primary may be T0N2M0 NSCLC, the surgery alone seems to be insufficient treatment for this type of tumors. To evaluate whether the adjuvant therapy is associated with an improved prognosis for the patients with middle mediastinal carcinoma of unknown primary, a further accumulation of cases is required.

Research progress on radiation-induced heart damage—basic mechanism

At present, heart has become an important organ at risk during radiotherapy for thoracic, mediastinal and breast carcinoma. Heart is relatively sensitive to radiation because of its anatomical location and structure. The incidence of radiation-induced cardiac adverse events can affect the long-term survival of patients. In this article, the recent progress on the basic research of radiation-induced heart damage was described as follows. Key words: Radiation-induced heart damage; Research progress

Two cases of thyroid gland invasion by upper mediastinal carcinoma

SummaryThe objective this study is to report two cases of thyroid gland invasion by upper mediastinal carcinoma. Mediastinal tumors are uncommon and represent 3% of the tumors seen within the chest. In reports on mediastinal masses, the incidence of malignant lesions ranged from 25 to 49%. The thyroid gland can be directly invaded by surrounding organ cancers. We report these cases contrasting them to the case of a thyroid cancer with mediastinal lesions. Case 1 was a 73-year-old woman who was diagnosed with papillary thyroid carcinoma, and she underwent surgery and postoperative radioactive iodine. Case 2 was a 74-year-old man who was diagnosed with non-small-cell lung carcinoma, favor squamous cell carcinoma, and he underwent chemoradiotherapy. Case 3 was a 77-year-old man who was diagnosed a thymic carcinoma based on pathological findings and referred the patient to thoracic surgeons for surgical management. The images of the three cases were similar, and the differential diagnoses were difficult and required pathological examination. Primary thyroid carcinoma and invading carcinoma originating from the adjacent organs need to be distinguished because their prognoses and treatment strategies are different. It is important to properly diagnose them by images and pathological findings.Learning points:The thyroid gland in the anterior neck can be directly invaded by surrounding organ cancers.Primary thyroid carcinoma and invading carcinoma originating from the adjacent organs need to be distinguished because their prognoses and treatment strategies are different.It is important to properly diagnose by images and pathological findings.

Research progress of radiation-induced heart injury—clinical

At present, the heart has become an important organ at risk during radiotherapy for thoracic, mediastinal and breast carcinoma. Heart is relatively sensitive to radiation because of its anatomical location and structure. Long-term survival of patients have been affected by cardiac adverse effect post-radiotherapy. In this paper, the progress of clinical manifestations, risk factors, screening methods, prevention and treatment of radiation-induced cardiac damage were reviewed as follows. Key words: Radiation-induced heart injury; Research progress

Broncho-Esophageal Fistula: A Rare Complication of Mediastinal Carcinomas Diagnosed by Esophagogram

Broncho-Esophageal Fistula: A Rare Complication of Mediastinal Carcinomas Diagnosed by Esophagogram

広範な術後気管粘膜壊死の回復過程を観察し得た縦隔扁平上皮癌の 1 切除例

広範な術後気管粘膜壊死の回復過程を観察し得た縦隔扁平上皮癌の 1 切除例

Cardiac Relapse of Acute Myeloid Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation

Secondary or metastatic cardiac tumors are much more common than primary benign or malignant cardiac tumors. Any tumor can cause myocardial or pericardial metastasis, although isolated or combined tumor invasion of the pericardium is more common. Types of neoplasia with the highest rates of cardiac or pericardial involvement are melanoma, lung cancer, and breast and mediastinal carcinomas. Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. Initial treatment involves chemotherapy followed by consolidation treatment to reduce the risk of relapse. In high-risk patients, the treatment of choice for consolidation is hematopoietic stem cell transplantation (HSCT). Relapse of AML is the most common cause of HSCT failure. Extramedullary relapse is rare. The organs most frequently affected, called “sanctuaries,” are the testes, ovaries, and central nervous system. We present a case with extramedullary relapse in the form of a solid cardiac mass.

Clinical analysis of cyberknife stereotactic ablative radiotherapy for malignant tumors with metastases of mediastinal lymph nodes

Objective: This work aimed to evaluate the clinical results of the cyberknife stereotactic ablative radiotherapy(SABR) treatment of 39 patients suffering from mediastinal lymph-node metastases of malignant tumors.Methods: Cyberknife SABR was consecutively conducted on 39 cancer patients with 49 mediastinal nodal metastases.Planning target volume ranged from 3.7 ml to 78.5 ml(median: 12.3 ml),and total prescribed dosage ranged from 12 Gv to 60 Gy with 1 fraction to 10 fractions.Results: Follow-up assessment was performed from 3 mos to 67 mos(median: 20).The most commonly observed toxicity was Grade 1/2 tracheal and esophageal injuries,which occurred in 11 of the 39 patients.Grade 3/4 toxicity occurred in 3 of the 39 patients.Patients with dyspnea,superior vena cava syndrome,and chest pain achieved significant improvements in health status(response rate: 83.3%).Total effective rate(complete and partial response) was 90% for the 49 discrete lesions(29 complete responses,15 partial responses,and 5 stable diseases).The 1 and 2 yr overall survival rates were 84.6% and 68.3%,respectively.Patients with metastasized nodes below 3 cm in diameter attained superior overall survival times compared with those with metastasized nodes above 3 cm in diameter(P=0.029).Conclusion: Cyberknife SABR for the mediastinal metastases carcinoma showed a favourable outcome and minimal toxicity.

Abnormal regurgitation in three cows caused by intrathoracic perioesophageal lesions

BackgroundThree Brown Swiss cows with abnormal regurgitation because of a perioesophageal disorder are described.Case presentationThe cows were ill and had poor appetite, salivation and regurgitation of poorly-chewed feed. Collection of rumen juice was successful in one cow, and in another, the tube could be advanced to the level of the 7th intercostal space, and in the third, only saliva could be collected. In one cow, oesophagoscopy revealed a discoloured 10-cm mucosal area with fibrin deposits. Thoracic radiographs were normal. The cows were euthanased and examined postmortem. Cow 1 had a large perioesophageal abscess containing feed material at the level of the thoracic inlet, believed to be the result of a healed oesophageal injury. Cow 2 had an abscess between the oesophagus and trachea 25 cm caudal to the epiglottis with the same presumed aetiology as in cow 1. Cow 3 had a mediastinal carcinoma that enclosed and constricted the oesophagus.ConclusionsAbnormal regurgitation in cattle is usually the result of an oesophageal disorder. Causes of oesophageal disorders vary widely and their identification can be difficult.

Relapsed cervicomediastinal lymph node carcinoma with an unknown primary site treated with TS-1 alone: a case report

BackgroundCervicomediastinal lymph node carcinoma with an unknown primary site is quite rare, and useful treatment of these diseases has not been established. We report here the case of a patient successfully treated with TS-1 alone after the relapse of cervicomediastinal lymph node carcinoma with an unknown primary site.Case presentationA 62-year-old man was referred to our hospital because of cervicomediastinal lymph node swelling and high serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen. Fluorodeoxyglucose-positron emission tomography/computed tomography revealed an accumulation of fluorodeoxyglucose in the left supraclavicular lymph nodes, mediastinal lymph nodes, and the pelvic cavity. Colonoscopy revealed rectal cancer, which was diagnosed by biopsy as a tubular adenocarcinoma. Because metastases from rectal cancer to the cervicomediastinal lymph nodes are rare, the patient underwent thoracoscopic mediastinal lymphadenectomy. A biopsy specimen from the paraaortic lymph nodes demonstrated papillary adenocarcinoma that was pathologically different from the rectal cancer; therefore, a diagnosis of mediastinal carcinoma with an unknown primary site was established. The patient underwent low anterior resection of the rectum for the rectal cancer, and no abdominal lymph node metastasis (pMP, N0/stage I) was found. Although radiotherapy was performed for the cervicomediastinal lymph nodes, the mediastinal carcinoma relapsed after 6 months. Because the patient desired oral chemotherapy on an outpatient basis, TS-1 was administered at a dosage of 80 mg/day for 2 weeks, followed by a 1-week rest. TS-1 treatment resulted in a decrease in the size of the cervicomediastinal lymph nodes, and the serum tumor marker levels decreased to normal after the fourth course. The patient continued TS-1 treatment without adverse events and is currently alive without recurrence or identification of the primary site at the 32nd month after TS-1 treatment.ConclusionThis is the first reported case of relapsed cervicomediastinal lymph node carcinoma with an unknown primary site treated by TS-1 alone. TS-1 treatment for the carcinoma with an unknown primary site may be useful in patients who are not candidates for systemic platinum-based chemotherapy.

Intrathyroid epithelial thymoma (ITET) and carcinoma showing thymus-like differentiation (CASTLE): CD5-positive neoplasms mimicking squamous cell carcinoma of the thyroid.

Carcinoma of possible thymic epithelial origin may occur within the thyroid gland, which was first reported by Miyauchi et al. as intrathyroid epithelial thymoma (ITET). ITET is a rare tumor comprising about 0.08% of all primary thyroid malignancies. It is a low-grade thyroid carcinoma with squamous cell differentiation whose overall survival rate was found to be 71%. Lymph node metastasis at surgery was found in 40% and hematogenous metastases developed in bones, liver and lungs. This tumor grows within the thyroid gland and invades into the thyroid parenchyma as well as into the extrathyroid structures. It is a well-circumscribed solid tumor with a sharp tumor border, but is not capsulated. After fixation, the cut surface of the tumor is gray-white in color and is a solid tumor with lobulation. Tumor calcification was not detected in our 15 cases. The tumor cells show solid sheets of growth with occasional keratinization without follicular or papillary structures. Lymphocytic infiltration in the stroma is one of the most characteristic features of this tumor. The tumor cells are polygonal epithelial cells with distinct nucleoli and ill-defined cell border. Positive immunoreactivity for CD5 is a key feature to differentiate it from undifferentiated carcinoma, poorly differentiated carcinoma, medullary (C cell) carcinoma and high-grade squamous cell carcinoma (so-called primary squamous cell carcinoma) of the thyroid. Negative immunoreactivity for calcitonin, TTF1 and thyroglobulin, and positive immunoreactivity for p63 and KIT are also helpful for differential diagnosis. Nuclear atypia is mild and mitoses are less frequent, with an intermediate proliferation index (MIB-1 labeling index is usually less than 20%), which are also helpful to differentiate it from high-grade primary squamous cell carcinoma of the thyroid. The tumors in our 15 cases demonstrate 3 histological subtypes: keratinizing squamous cell carcinoma type, non-keratinizing basaloid cell carcinoma (lymphoepithelioma-like) type and neuroendocrine carcinoma type, which correspond to subtypes of the mediastinal thymic carcinomas.

NUT Rearrangement is Uncommon in Human Thymic Epithelial Tumors

Thymic carcinomas represent the most aggressive histotype of thymic epithelial tumors (TETs). The 2004 World Health Organization classification has assigned a subgroup of thymic carcinomas as t(15;19) carcinomas based on the presence of t(15;19), a translocation found in poorly differentiated and highly aggressive NUT midline carcinomas. These tumors are characterized byrearrangement of the NUT (nuclear protein in testis) gene on chromosome 15q14, which in most cases fuses to the bromodomain containing 4 (BRD4) gene on chromosome 19 p13.1 through reciprocal t(15;19) translocation, resulting in constitutive BRD4-NUTfusion protein expression. To our knowledge, NUT translocation has been reported only in four thymic carcinomas. Due to the rarity of TETs, the prevalence of NUT rearrangement in TETs has however never been systematically explored. Formalin-fixed paraffin-embedded samples of histologically confirmed TETs were evaluated for NUT expression and rearrangement by immunohistochemistry and fluorescence in situ hybridization, respectively. A series of 148 TETs (37 carcinomas and 111 thymomas) were examined for NUT expression and rearrangement. Only one thymic carcinoma (2.7% of thymic carcinomas or 0.68% of TETs) was found positive for NUT expression and rearrangement. Rearrangement of NUT is infrequent in TETs. We propose that caution should be taken to distinguish t(15;19) thymic carcinoma from other mediastinal carcinomas, as NUT midline carcinomas are often associated with dreadful prognosis or overt lethality.

Primary Thymic Mucinous Adenocarcinoma: A Case Report

Primary thymic mucinous adenocarcinoma is an extremely rare aggressive subtype of thymic carcinoma. With a review of literatures, only nine cases have been reported up to present. A 36-year-old woman was admitted for further evaluation and treatment of a mediastinal mass. The patient had no medical history of cancer. The clinicoradiological examination disclosed no tumor elsewhere. After the surgical excision of mediastinal mass, it was grossly a round semi-solid mass with mucin-filled cystic areas. Microscopically solid areas showed cords, small nests and dilated glands infiltrating the fibrotic parenchyma, while the cystic areas were lined by mucinous epithelium with tumor cells floating in extracellular-mucin pools. Some cystic walls underwent malignant transformation of the benign thymic epithelium. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7, CK20, CD5, and CDX-2, and negative for thyroid transcription factor-1. In conclusion, the mucinous thymic adenocarcinoma should be recognized as a separate histopathological entity and considered in the differential diagnosis of mediastinal carcinomas.

Cranial mediastinal carcinomas in nine dogs*

Nine dogs were diagnosed with cranial mediastinal carcinomas. Based on histological and immunohistochemical analysis, four dogs were diagnosed with ectopic follicular cell thyroid carcinomas, one dog with ectopic medullary cell thyroid carcinoma, two dogs with neuroendocrine carcinomas and two dogs with anaplastic carcinomas. Clinical signs and physical examination findings were associated with a space-occupying mass, although one dog was diagnosed with functional hyperthyroidism. Surgical resection was attempted in eight dogs. The cranial mediastinal mass was invasive either into the heart or into the cranial vena cava in three dogs. Resection was complete in six dogs and unresectable in two dogs. All dogs survived surgery, but four dogs developed pulmonary thromboembolism and two dogs died of respiratory complications postoperatively. Adjunctive therapies included pre-operative radiation therapy (n=1) and postoperative chemotherapy (n=3). Three dogs had metastasis at the time of diagnosis, but none developed metastasis following surgery. The overall median survival time was 243 days. Local invasion, pleural effusion and metastasis did not have a negative impact on survival time in this small case series.

Case Report: Thymic Carcinoma Metastatic to Small Bowel

Thymomas are the most common primary anterior mediastinal tumor and account for 15% to 20% of all mediastinal masses.(1, 3, 4) Although the majority of thymomas appear histologically benign, some may behave like invasive epithelial malignancies, invading local structures or metastasizing to distant organs.(2) However, extrathoracic direct invasion or distant metastasis are extremely rare and only a few cases have been reported previously. Even fewer cases of gastrointestinal tract invasion of thymomas have been documented in the English literature.(5, 6) This is the first clinical report of mediastinal thymic carcinoma metastatic to proximal small bowel.

Extended Resection of Mediastinal Undifferentiated Carcinoma After Chemosensitivity Test-Guided Induction Treatment: Report of a Case

We performed extended resection of primary mediastinal undifferentiated carcinoma, together with the superior vena cava and the upper lobe of the right lung, after effective induction chemoradiation therapy based on the results of a chemosensitivity test. Pathological examination of the resected specimen revealed that almost all of the tumor cells had died. The patient received adjuvant chemotherapy and has remained free from disease progression for 27 months since his operation. Our experience supports the effectiveness of an aggressive approach, in the form of chemosensitivity test-guided induction therapy, to treat this high-grade malignant disease, despite the risk of cancer dissemination.

Imaging of cystic masses of the mediastinum.

Cystic masses of the mediastinum are well-marginated round lesions that contain fluid and are lined with epithelium. Major cystic masses include congenital benign cysts (ie, bronchogenic, esophageal duplication, neurenteric, pericardial, and thymic cysts), meningocele, mature cystic teratoma, and lymphangioma. Many tumors (eg, thymomas, Hodgkin disease, germ cell tumors, mediastinal carcinomas, metastases to lymph nodes, nerve root tumors) can undergo cystic degeneration-especially after radiation therapy or chemotherapy-and demonstrate mixed solid and cystic elements at computed tomography (CT) or magnetic resonance (MR) imaging. If degeneration is extensive, such tumors may be virtually indistinguishable from congenital cysts. A mediastinal abscess or pancreatic pseudocyst also appears as a fluid-containing mediastinal cystic mass. However, clinical history and manifestations, anatomic position, and certain details seen at CT or MR imaging allow correct diagnosis in many cases. Familiarity with the radiologic features of mediastinal cystic masses facilitates accurate diagnosis, differentiation from other cystlike lesions, and, thus, optimal patient treatment.

Biopsy of Mediastinal Tumors: Needle Biopsy versus Mediastinoscopy

Biopsy of Mediastinal Tumors: Needle Biopsy versus Mediastinoscopy

Extended operation for lung cancer invading the aortic arch and superior vena cava

Extended operation for lung cancer and mediastinal carcinoma involving the aortic arch or superior vena cava was performed in six patients. In three patients with lung cancer invading the right side of the mediastinum, sleeve pneumonectomy (two patients) or sleeve lobectomy was followed by resection and reconstruction of the superior vena cava with ringed polytetrafluoroethylene grafts. One patient with squamous cell carcinoma and T4 N1 M0 disease was alive and free of disease more than 34 months after the operation. The other patients with adenocarcinoma (T4 N1 M0) and adenosquamous cell carcinoma (T4 N2 M0) died 18 and 5 months after the operation of systemic metastases. In two patients with invasion of lung cancer into the left side of the mediastinum, resection and reconstruction of the aortic arch and left common carotid artery were performed by a femoro-femoral bypass. These patients had adenocarcinoma (T4 N2 M0) and large cell carcinoma (T4 N1 M0) and died of systemic metastases and bleeding during reoperation 12 and 4 months after the initial operation. In one patient with mediastinal squamous cell carcinoma, resection and reconstruction of the aortic arch and left subclavian artery were performed by application of a temporary bypass graft between the ascending and descending aorta. This patient was alive and free of disease more than 17 months after the operation.