Mediastinal Lymph Node Lesions Research Articles

Utility of needle biopsy in centrally located lung cancer for genome analysis: a retrospective cohort study

BackgroundIt is essential to collect a sufficient amount of tumor tissue for successful next-generation sequencing (NGS) analysis. In this study, we investigated the clinical risk factors for avoiding re-biopsy for NGS analysis (re-genome biopsy) in cases where a sufficient amount of tumor tissue could not be collected by bronchoscopy.MethodsWe investigated the association between clinical factors and the risk of re-genome biopsy in patients who underwent transbronchial biopsy (TBB) or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and required re-genome biopsy in cases enrolled in LC-SCRUM Asia, a prospective nationwide genome screening project in Japan. We also examined whether the frequency of re-genome biopsy decreased between the first and second halves of the enrolment period.ResultsOf the 572 eligible patients, 236 underwent TBB, and 134 underwent EBUS-TBNA. Twenty-four TBBs required re-genome biopsy, and multivariate analysis showed that the risk of re-genome biopsy was significantly increased in lesions where the tumor lesion was centrally located. In these cases, EBUS-TBNA should be utilized even if the lesion is a pulmonary lesion. However, it should be noted that even with EBUS-TBNA, lung field lesions are at a higher risk of re-canalization than mediastinal lymph node lesions. It was also found that even when tumor cells were detected in rapid on-site evaluation, a sufficient amount of tumor tissue was not always collected.ConclusionsFor centrally located pulmonary mass lesions, EBUS-TBNA, rather than TBB, can be used to obtain tumor tissues that can be analyzed by NGS.

Value of needle confocal laser microendoscopy combined with endobronchial ultrasound bronchoscopy in the diagnosis of hilar and mediastinal lymph node lesions.

Endobronchial ultrasound bronchoscopy (EBUS) and needle confocal laser endomicroscopy (nCLE) are techniques for screening benign and malignant lesions of the hilar and mediastinal lymph node (HMLN). This study investigated the diagnostic potential of EBUS, nCLE, and combined EBUS and nCLE in HMLN lesions. We recruited 107 patients with HMLN lesions who were examined by EBUS and nCLE. A pathological examination was performed, and the diagnostic potential of EBUS, nCLE, and combined EBUS-nCLE approach was analyzed according to the results. Among the 107 cases of HMLN lesions, 43 cases were benign and 64 cases were malignant on pathological examination, 41 cases were benign and 66 cases were malignant on EBUS examination; 42 cases were benign and 65 cases were malignant on nCLE examination; 43 cases were benign and 64 cases were malignant on combined EBUS-nCLE examination. The combination approach had 93.8% sensitivity, 90.7% specificity, and 0.922 area under the curve, which was higher than those of EBUS (84.4%, 72.1%, and 0.782, respectively) and nCLE diagnosis (90.6%, 83.7%, and 0.872, respectively). The combination approach had a higher positive predictive value (0.908), negative predictive value (0.881), and positive likelihood ratio (10.09) than that of EBUS (0.813, 0.721, and 3.03, respectively) and nCLE (0.892, 0.857, and 5.56, respectively), whereas, the negative likelihood ratio was lower than that for EBUS (0.22) and nCLE (0.11). No serious complications occurred in patients with HMLN lesions. To summarize, the diagnostic efficacy of nCLE was better than EBUS. The EBUS-nCLE combination is a suitable approach for diagnosing HMLN lesions.

CT features, Pathological findings and Clinical data of Follicular Dendritic Cell Sarcoma in the Mediastinum: Case Report and Literature Review

Follicular dendritic cell sarcoma (FDC sarcoma) is an uncommon neoplasm with few reported cases. We investigated the Computed Tomography (CT) appearance and pathological findings in a 43years-old lady diagnosed with mediastinal FDC sarcoma using pathological tests. It's usually confused with lymphoma. The literature was reviewed for previous FDC sarcoma reports. FDC sarcoma should be considered in asymptomatic patients with mediastinal lymph node lesions with a diameter of more than 1 cm and appear as an ill-defined mass with an arborizing pattern of necrosis. CD21(+) is a specific immunohistochemically marker for determining the pathological diagnosis of FDC sarcoma.

サルコイドーシスの組織診断を目的とした縦隔リンパ節生検法 : 当院におけるEBUS-TBNAと縦隔鏡検査件数の変遷

サルコイドーシスの組織診断を目的とした縦隔リンパ節生検法 : 当院におけるEBUS-TBNAと縦隔鏡検査件数の変遷

Complete genome sequence of Corynebacterium pseudotuberculosis biovar ovis strain P54B96 isolated from antelope in South Africa obtained by rapid next generation sequencing technology.

The Actinobacteria, Corynebacterium pseudotuberculosis strain P54B96, a nonmotile, non-sporulating and a mesophile bacterium, was isolated from liver, lung and mediastinal lymph node lesions in an antelope from South Africa. This strain is interesting in the sense that it has been found together with non-tuberculous mycobacteria (NTMs) which could nevertheless play a role in the lesion formation. In this work, we describe a set of features of C. pseudotuberculosis P54B96, together with the details of the complete genome sequence and annotation. The genome comprises of 2.34 Mbp long, single circular genome with 2,084 protein-coding genes, 12 rRNA, 49 tRNA and 62 pseudogenes and a G+C content of 52.19%. The analysis of the genome sequence provides means to better understanding the molecular and genetic basis of virulence of this bacterium, enabling a detailed investigation of its pathogenesis.

Deaths and complications associated with respiratory endoscopy: A survey by the Japan Society for Respiratory Endoscopy in 2010

In order to survey the current status of the use and complications associated with respiratory endoscopy, the Japan Society for Respiratory Endoscopy conducted a nationwide postal questionnaire survey. The survey was mailed to all 538 facilities certified by the society. The subjects were patients who underwent respiratory endoscopy in 2010. The numbers of procedures, and associated complications and deaths were investigated according to lesion and procedure using a specific inventory. The inventory was completed by 483 facilities (89.8%). The total number of diagnostic flexible bronchoscopy procedures performed was 103 978, and four patients died (0.004%). The complication rate according to lesion ranged from 0.51% to 2.06%, with the highest rate being observed in patients with diffuse lesions. The complication rate according to procedure ranged from 0.17% to 1.93%, with the highest rate being observed in patients who underwent forceps biopsy. The complication rate after forceps biopsy of solitary peripheral pulmonary lesions was 1.79% (haemorrhage: 0.73%, pneumothorax: 0.63%), and that after endobronchial ultrasound-guided transbronchial needle aspiration of hilar and/or mediastinal lymph node lesions was 0.46%. Therapeutic bronchoscopy was performed in 3020 patients; one patient (0.03%) died due to haemorrhage induced by insertion of an expandable metallic stent. The complication rate according to procedure was highest for foreign body removal (2.2%). Medical pleuroscopy was performed in 1563 patients. The highest complication rate was for biopsy without electrocautery (1.86%). A total of 228 facilities (47.2%) experienced breakage of bronchoscopes and/or devices. Respiratory endoscopy was performed safely, but education regarding complications caused by new techniques is necessary.

Sedation With Meperidine for Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become increasingly available and more widely used for the diagnosis of mediastinal lymph node lesions, there are few reports regarding methods of anesthesia. We conducted a retrospective study assessing the efficacy of meperidine (MP) for EBUS-TBNA. Sixty cases that underwent EBUS-TBNA between January 2006 and December 2009 at the Kameda Medical Center were retrospectively analyzed. We classified them into 2 groups: cases that were performed under sedation with intravenous MP cases (n=31) and cases with general anesthesia (GA cases: n=29). Furthermore, we also classified the MP cases into 2 groups: patients above 65 years of age (elderly patients) and the others (young patients) to assess the safety of MP for the elderly. MP of 35 mg was administered just before EBUS-TBNA. Mean age, weight, physical status (American Society of Anesthesiologists grade), the size of the lesions, and examination time were not different between the MP and GA cases. Although the mean number of centesis for the MP cases was less than that of the GA cases (2.7 vs. 3.2 times; P<0.05), accurate diagnostic rates and sensitivity and specificity of each disorder were not different. Although the lowest saturation of peripheral oxygen during examination of the MP cases was lower than that of the GA cases (93.6% vs. 97.6%; P<0.05), GA cases required more vasopressor for a decline in the blood pressure than MP cases. Finally, none of the cases had any complications during or after the examination. In comparison between the elderly and young patients, the physical status, examination time, and the frequency or degree of complications were not different either. EBUS-TBNA under the intravenous sedation by MP was as feasible and safe as that under GA. It has a possibility to be one of the effective drugs for sedation during EBUS-TBNA regardless of age, and we should analyze its safety and efficacy in prospective studies henceforth.

Factors that influence the results of salvage surgery in patients with chemorefractory germ cell carcinomas with elevated tumor markers: Habuchi T, Kamoto T, Hara I, Kawai K, Nakao M, Nonomura N, Kobayashi T, Ogawa O, Kamidono S, Akaza H, Okuyama A, Kato T, Miki T, Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Cancer 2003;98:1635–42 Background A standard concept for the integration of surgery into the chemotherapy-based treatment of patients with advanced germ cell carcinoma has been that surgery should be avoided in patients with serum tumor markers (alpha-fetoprotein [AFP] and human chorionic gonadotropin [HCG]) that remain elevated. However, some patients may benefit from resection under such chemorefractory conditions. The objective of this retrospective study was to clarify the outcome and clinical prognostic variables of salvage surgery in patients with disseminated (AJCC Stage II or III) testicular germ cell carcinoma or extragonadal germ cell carcinoma who had elevated serum markers. Methods The authors reviewed the clinical records of 24 patients who underwent salvage surgery with elevated serum AFP and/or HCG levels after at least 3 courses of cisplatin-based, systemic chemotherapy between January, 1985 and December, 2000. The survival rates were compared between the subgroups with regard to preoperative and postoperative clinical parameters using the Kaplan-Meier method and a Cox proportional hazards model. Results Ten of 24 patients (41.7%) were rendered free of disease and alive without disease after the surgery with or without adjuvant therapy at a median follow-up of 74 months (range, 24–207 months). Among the preoperative parameters, high HCG levels were associated with significantly poorer survival (hazard ratio [HR], 8.321; 95% confidence interval [95% CI], 1.0753–64.553; P = 0.043 and P = 0.016, respectively; log-rank test). In addition, patients who had visceral lesions at resection had a significantly poorer prognosis compared with patients who had retroperitoneal and/or mediastinal lymph node lesions ( P = 0.038; log-rank test). Among postoperative parameters, incomplete resection and persistently high HCG levels were associated significantly with poor survival, with a risk of death from disease of 12.516-fold (95% CI, 1.786–87.781) and 9.311-fold (95% CI, 1.796–48.256), respectively. Conclusions Salvage surgery in patients with high serum tumors markers resulted in long-term disease free status in approximately 40% of patients in a small subset with advanced germ cell carcinoma. Patients with elevated AFP levels alone (i.e., normal HCG levels) or with lymph node lesions alone seem to be good candidates for such surgery. Complete resection of target lesions and normalization of HCG levels after surgery are mandatory to achieve long-term disease free status.

Factors that influence the results of salvage surgery in patients with chemorefractory germ cell carcinomas with elevated tumor markers.

A standard concept for the integration of surgery into the chemotherapy-based treatment of patients with advanced germ cell carcinoma has been that surgery should be avoided in patients with serum tumor markers (alpha-fetoprotein [AFP] and human chorionic gonadotropin [HCG]) that remain elevated. However, some patients may benefit from resection under such chemorefractory conditions. The objective of this retrospective study was to clarify the outcome and clinical prognostic variables of salvage surgery in patients with disseminated (AJCC Stage II or III) testicular germ cell carcinoma or extragonadal germ cell carcinoma who had elevated serum markers. The authors reviewed the clinical records of 24 patients who underwent salvage surgery with elevated serum AFP and/or HCG levels after at least 3 courses of cisplatin-based, systemic chemotherapy between January, 1985 and December, 2000. The survival rates were compared between the subgroups with regard to preoperative and postoperative clinical parameters using the Kaplan-Meier method and a Cox proportional hazards model. Ten of 24 patients (41.7%) were rendered free of disease and alive without disease after the surgery with or without adjuvant therapy at a median follow-up of 74 months (range, 24-207 months). Among the preoperative parameters, high HCG levels were associated with significantly poorer survival (hazard ratio [HR], 8.321; 95% confidence interval [95% CI], 1.0753-64.553; P = 0.043 and P = 0.016, respectively; log-rank test). In addition, patients who had visceral lesions at resection had a significantly poorer prognosis compared with patients who had retroperitoneal and/or mediastinal lymph node lesions (P = 0.038; log-rank test). Among postoperative parameters, incomplete resection and persistently high HCG levels were associated significantly with poor survival, with a risk of death from disease of 12.516-fold (95% CI, 1.786-87.781) and 9.311-fold (95% CI, 1.796-48.256), respectively. Salvage surgery in patients with high serum tumors markers resulted in long-term disease free status in approximately 40% of patients in a small subset with advanced germ cell carcinoma. Patients with elevated AFP levels alone (i.e., normal HCG levels) or with lymph node lesions alone seem to be good candidates for such surgery. Complete resection of target lesions and normalization of HCG levels after surgery are mandatory to achieve long-term disease free status.

Immunophenotypical Characterization of the Lymphocyte Infiltrate in Caprine Pulmonary Tuberculosis

A study was made of the immunophenotype of the lymphocytes associated with natural caprine pulmonary tuberculosis at four stages of the disease. Regardless of the stage, CD4+and CD8+T lymphocytes predominated in lung and mediastinal lymph node lesions, but γ/δ T and B (IgM+) cells were seen only rarely. At the primary complex stage, CD4+cells outnumbered CD8+cells. At the stage of generalized tuberculosis, however, and still more at the post-primary stage, CD8+cells outnumbered CD4+cells. At the final stage (tuberculous pneumonia), CD4+and CD8+cells were present in low but approximately equal numbers.

Fatal encephalitis caused byOchroconis gallopavumin a domestic cat (Felis domesticus)

Ochroconis gallopavum was identified as the causal agent of fatal encephalitis in a young, short-hair, domestic cat. The cat initially developed an ulcerated mass on the left side of the tongue and signs of pain in the abdomen. The tongue lesion was surgically removed and exploratory abdominal surgery revealed abnormalities suggestive of pancreatitis and peritonitis. During the month after surgery, the cat's health declined, manifested by sluggishness, loss of appetite and abnormal behaviour. Following a final rapid deterioration, the cat became non-responsive and was euthanized. Histologic examination of the brain, lung and mediastinal lymph node lesions revealed large numbers of pigmented, septate, branched, hyphal elements with swollen intercalary and terminal vesicles, and short chains of moniliform hyphal cells. Cultures of the mediastinal lymph nodes yielded a dematiaceous, thermotolerant fungus that was identified as O. gallopavum. This report describes the first well-documented infection in a cat caused by O. gallopavum.

Evaluation of 178 mediastinoscopies (author's transl)

Of the 178 consecutive mediastinoscopies performed at the Istituto Nazionale per lo Studio e la Cura dei Tumori of Milan from 1967 to 1974 145 were performed for diagnostic purposes and 33 for the pre-operative evaluation of resectability in cases of proven lung carcinoma. Mediastinoscopy is a very useful procedure for obtaining a definite pathological diagnsis in indeterminate mediastinal and pulmonary lesions. In succases, mediastinoscopy should precede any attempt at therapy, as 1/3 primary mediastinal lymph node lesions are benign and about 30% of suspected mediastinal tumors or lymphomas are actually misdiagnosed lung cancers (mainly oat-cell carcinomas). As to the role of mediastinoscopy in the assessment of lung cancer resectability, the current view is that it plays a part together with tomography and bronchoscopy in the clinical staging of this neoplasm, but it is no longer relied upon alone. It is mandatory in every case of suspected or probable mediastinal invasion and the criteria for inoperability are the following: spread to high paratracheal or contralateral nodes, direct invasion of the mediastinal fat, fixity of the neoplasm to the trachea or vertebral bodies. In such cases mediastinoscopy will prevent a useless exploratory thoracotomy.