Thoracic Mass Research Articles

Thoracic muscle mass predicts survival among patients with locally advanced esophageal cancer.

Thoracic muscle mass predicts survival among patients with locally advanced esophageal cancer.

NF1 with Ewing’s Sarcoma and Thoracopulmonary PNET with Gastrointestinal Neoplasm: A Case Report of Synchronous Malignancies

Synchronous malignancies are rare and pose significant diagnostic and therapeutic challenges due to their complex presentations and diverse aetiologies. This report highlights two unique cases emphasising the importance of a multidisciplinary approach to management. The first case involves a 24-year-old male with Neurofibromatosis type 1 (NF1), presenting with Ewing’s sarcoma affecting the rib and lung. NF1, a genetic disorder caused by mutations in the NF1 gene, predisposes individuals to various malignancies, including sarcomas. This patient exhibited characteristic NF1 features such as café-au-lait spots, multiple neurofibromas, and Lisch nodules. Imaging revealed a destructive thoracic mass and histopathology, supported by immunohistochemistry, confirmed the diagnosis of Ewing’s sarcoma. The patient underwent surgical resection followed by chemotherapy, resulting in a favourable outcome. The second case describes a 75-year-old chronic smoker who presented with thoracopulmonary Primitive Neuroectodermal Tumour (PNET) and a high-grade dysplastic adenomatous polyp in the cecum. Imaging and histological evaluations confirmed the coexistence of these malignancies. The thoracic tumour was surgically resected and treated with a chemotherapy regimen, while the gastrointestinal lesion required a hemicolectomy. The patient’s postoperative course was uneventful, and follow-up assessments revealed no residual disease. These cases underscore the pivotal role of integrating advanced imaging, targeted biopsies, and molecular diagnostics to accurately identify and manage synchronous malignancies. Genetic predispositions, such as NF1, and environmental factors, including smoking, highlight the interplay of inherited and acquired risk factors in multifocal tumourigenesis. Multidisciplinary collaboration and individualised treatment strategies are critical for optimising patient outcomes, particularly in complex cases like these.

Management of a Rare Giant Thoracic Leiomyosarcoma: Case Report and Review of Literature

Thoracic wall sarcomas account for less than 20% of all soft tissue sarcomas, with leiomyosarcomas comprising only 1% to 4%. We report a case of a giant leiomyosarcoma of the thoracic wall in a 67-year-old patient presenting with a thoracic wall mass. Imaging revealed a large tumor involving the thoracic wall, and histopathological analysis confirmed leiomyosarcoma. Staging examinations excluded distant metastases. The patient underwent surgical resection followed by adjuvant therapy with close follow-up. Early diagnosis and multimodal management significantly improve the prognosis of thoracic leiomyosarcomas.

Intrathoracic Lipoblastoma: A Rare Occurrence in a Child

ABSTRACT Lipoblastoma is a rare benign tumor arising from embryonic fat tissue, primarily affecting children under 3 years of age, and is exceptionally uncommon in the thoracic cavity. We report a case involving a 4-year-old boy with intrathoracic lipoblastoma. The mass was entirely removed through a left posterolateral thoracotomy, and histopathological examination confirmed the diagnosis. Despite its rarity, lipoblastoma should be considered in the differential diagnosis of thoracic masses in children.

Management of blastic plasmacytoid dendritic cell neoplasm: a case series from Chile

Blastic plasmacytoid dendritic cell neoplasms (BPDCNs) are a rare hematologic malignancy characterized by an aggressive clinical course, short survival following chemotherapy, and poor prognosis. Clinical manifestations most commonly involve the skin; however, lymph nodes, liver, peripheral blood, and the meninges can also be affected. The optimal therapeutic approach remains undetermined, hindering the design and implementation of clinical trials. Nevertheless, hematopoietic stem cell transplantation (HSCT) is widely recognized as crucial for achieving prolonged remission and potential cure. We present two BPDCN cases treated with HSCT and a brief literature review, marking the first published report of this disease in our country, Chile. In the first case, a 33-year-old male with a thoracic mass and cutaneous nodules was diagnosed via immunohistochemistry (CD56, CD123, CD4, BCL-2, Ki-67 45%, and CD68). He received five cycles of chemotherapy, achieved complete remission, and underwent autologous stem cell transplantation. One year later, he relapsed with rapid leukemic progression and died of refractory disease. The second case involves a 17-year-old female presenting with severe headaches, anemia, thrombocytopenia, and 48% blasts in peripheral blood; BPDCN with central nervous system involvement was confirmed. After induction chemotherapy (cytarabine and daunorubicin) plus intrathecal treatment, she achieved remission and underwent four cycles of high-dose cytarabine. A successful haploidentical transplant from her father followed, and she remained in remission for two years post-transplant without significant complications. These cases underscore the pivotal role of HSCT in BPDCN management. They also highlight the urgent need for prospective research to establish definitive treatment protocols, emphasizing the importance of ongoing research.

Association of body composition with left ventricular remodeling and outcomes in diabetic heart failure with reduced ejection fraction: assessment of sarcopenic obesity using cardiac MRI

BackgroundObesity is common in the heart failure (HF) population and is regarded as an important risk factor for developing HF. Greater skeletal muscle mass has shown to be the underlying protective factor against cardiac failure. Since diabetic mellitus (DM) can impair muscle protein metabolism, leading to skeletal muscle wasting, accompanied by adipose tissue accumulation, sarcopenic obesity (SO) may be a high-risk phenotype with poor outcomes in this specific population, especially in HF with reduced ejection fraction (HFrEF). Thus, the aim of this study was to clarify the clinical profiles, left ventricular (LV) remodeling, and prognostic implications of SO in patients with HFrEF and DM.MethodsA total of 283 patients who underwent cardiac MRI were included. Thoracic skeletal muscle index (SMI) was served as a surrogate of skeletal muscle mass. Patients were stratified according to the median thoracic SMI (42.75 cm2/m2) and body mass index (25 kg/m2). Obesity in conjunction with a SMI lower than the median is referred to as SO. The LV volume and function, as well as the systolic strain, were measured. The clinical characteristics and cardiovascular outcomes (heart failure readmission, cardiovascular mortality and heart transplantation) were recorded.ResultsPatients with SO had a greater level of amino-terminal pro-B-type natriuretic peptide and were more likely than nonsarcopenic patients with obesity to present with hypoproteinemia. Among patients with obesity, those with sarcopenia displayed greater LV expansion and more profound LV dysfunction, together with an increase in LV mass. During a median follow-up duration of 35.1 months, a total of 73 (25.8%) subjects reached the composite endpoint, with a worst outcome in the group of patients with SO (log-rank P = 0.04). Multivariable Cox analysis revealed that patients with SO had an approximately 3-fold greater risk of experiencing adverse outcomes than did those with neither sarcopenia nor obesity (hazard ratio: 3.03, 95% confidence interval: 1.39 to 6.63; P = 0.005).ConclusionsSO is a potentially high-risk phenotype with adverse LV remodeling and poor clinical outcomes in diabetic patients with HFrEF that may require more attention.

Apparent diffusion coefficient values in differentiating benign and malignant thoracic masses in children and young adults.

BackgroundIn children and young adults, tumors in the chest and thoracic wall exhibit a wide variety of types, making it challenging to differentiate between benign and malignant cases before invasive histopathological examination.PurposeTo evaluate the utility of apparent diffusion coefficient (ADC) for discriminating malignant thoracic masses in children and young adults.Material and MethodsThis retrospective study included chest magnetic resonance imaging (MRI) scans in patients aged <30 years. Patients' age and sex, tumor location (mediastinum or thoracic wall), tumor size, MR characteristics including necrosis or hemorrhage, and ADC values were assessed.ResultsMalignant masses were found in older patients (mean age = 18.0 ± 8.1 vs. 10.6, ± 9.1 years; P = 0.008), had lower mean ADC values (0.765 ± 0.298 vs. 2.051 ± 0.855 × 10-3 mm2/s; P < 0.001), and showed more internal hemorrhage (6/12 vs. 17/86; P = 0.031) compared to benign masses. Univariate and multivariate regression analyses also showed significant differences in age, tumor size, and ADC values. In the diagnostic performance analysis, age (area under the receiver operating characteristic curve [AUC] = 0.723, 95% confidence interval [CI] = 0.624-0.809; P = 0.004) and ADC mean value (AUC = 0.941, 95% CI = 0.874-0.978, P < 0.001) were significant. The optimal cutoff values were 13 years for age (sensitivity = 83.3%, specificity = 61.6%) and an ADC mean of 1.196 × 10-3 mm²/s (sensitivity = 100%, specificity = 86.1%) for discriminating malignant from benign thoracic masses.ConclusionWhen evaluating thoracic masses in children and young adults, older age and lower ADC values help identify malignancy.

The outcomes of concomitant off-pump coronary artery bypass grafting and pulmonary operations

Background: This study aims to analyze the early- and long-term outcomes of concomitant off-pump coronary artery bypass grafting and pulmonary resection for lung cancer or a thoracic mass. Methods: Twenty-three patients (17 females, 6 males; mean age: 69.7±6.5 years; range, 59 to 83 years) who underwent concomitant off-pump coronary artery bypass grafting and thoracic surgery procedures for lung cancer or a thoracic mass between March 2018 and February 2024 were included in the retrospective study. The surgical approach was median sternotomy for off-pump coronary artery bypass grafting, and video-assisted thoracoscopic surgery was preferred for lung tumor resections. Mortality, major adverse cardiac events, cerebrovascular events, and duration of hospital stay were evaluated. Results: There were no postoperative deaths or perioperative myocardial infarctions. None of the patients experienced pneumothorax or atelectasis. None of the patients sustained excessive blood loss requiring reoperation. Arterial grafts were the first choice during coronary artery bypass grafting. Wedge resections, lobectomies, segmentectomies were performed in the subsequent video-assisted thoracic surgery. All patients were followed for six to 86 months. Four patients died during the postoperative one-year period, and one patient died at postoperative 29 months due to cancer relapse. The overall one-year survival rate was 86.5%, and three- and five-year survival rates were 74% and 74%, respectively. Conclusion: The video-assisted thoracoscopic surgery approach provides a more favorable perspective for pulmonary resection and mediastinal lymph node dissection, which has importance in patients’ final diagnosis, than the sternal view due to more ample, wider workspace. Combined off-pump coronary artery bypass grafting and pulmonary resection in patients with lung cancer is safe and effective and reduces possible complications of a second major surgery.

Thoracic mass as a manifestation of bifid rib.

Thoracic mass as a manifestation of bifid rib.

Low thoracic skeletal mass index, a novel marker to predict recurrence of aspiration pneumonia in the elderly stroke patients.

We investigated whether thoracic skeletal muscle mass index at the diagnosis of aspiration pneumonia (AP) is a predictor for AP recurrence and explored predicting factors for AP recurrence in patients with stroke. This study retrospectively reviewed data of patients with AP who were diagnosed with stroke and who had full medical follow-up data from January 2014 to July 2020 in the Catholic University of Korea Bucheon St. Mary's Hospital. AP was defined based on clinical signs and/or symptoms suggestive of pneumonia and radiologic findings of pneumonic infiltrations in the dependent portions of the lung. We measured thoracic muscle volume using the cross-sectional area (CSA) of the erector spinae muscle (ESMCSA, cm2) at the 12th vertebral region. Computed tomography scans at the time of AP diagnosis during the acute stroke period were used for analysis and respective CSAs were divided by height squared (m2) to yield the muscle index at T12 (T12MI, cm2/m2) to normalize for stature. Multivariate logistic regression models were used to investigate relationships between clinical parameters and AP recurrence. During the study period, a total of 268 stroke patients with dysphagia who developed AP were analyzed. The mean T12MI of patients with and without recurrence of AP was 622.3±184.1 cm2/m2 and 708.1±229.9 cm2/m2, respectively (P = 0.001). Multivariate logistic regression revealed that lower T12MI (P = 0.038) and older age (P = 0.007) were independent predictors of AP recurrence in patients with stroke and dysphagia. Low thoracic muscle index at the diagnosis of initial AP after stroke can predict subsequence AP recurrence.

Fine-needle aspiration and effusion cytology of thoracic SMARCA4-deficient undifferentiated tumor and SMARCA4-deficient non-small cell lung carcinoma: A multi-institutional experience with 27 patients.

Thoracic switch/sucrose nonfermentable-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4)-deficient (SD) malignancies, including SD undifferentiated tumor (SD-UT) and SD non-small cell lung carcinoma (SD-NSCLC), have been recently described. The cytologic features of these neoplasms in fine-needle aspiration (FNA) and effusion specimens have rarely been reported in the literature. This study aimed to describe and compare the spectrum of cytologic, immunohistochemical, and clinical features ofthese high-grade malignancies recently encountered at the participating institutions. This study documented clinical and imaging characteristics of tumors from 27 patients. Sixteen cytomorphologic features and immunohistochemical findings were compared between SD-UT and SD-NSCLC samples. Twenty three FNAs, two bronchial brushings, and two pleural fluids were evaluated, including 17 SD-UT cases (mean patient age, 70 years) and 10 SD-NSCLC cases (mean patient age, 62 years). Both malignancies presented with large thoracic masses and/or hilar/mediastinal lymphadenopathy. All SD-UT cytologic samples had a discohesive or mixed cohesive-discohesive architecture, and most (13 of 17) showed predominant rhabdoid or mixed rhabdoid-epithelioid features. Most SD-NSCLC cytologic samples (nine of 10) were either cohesive or mixed cohesive-discohesive and had a predominantly epithelioid morphology (eight of 10). Keratins and claudin-4 were negative or focally positive in SD-UT samples, whereas they were diffusely positive in SD-NSCLC samples. Both malignancies were negative for TTF-1 and p40/p63 and showed loss of expression of SMARCA4. Although there is considerable clinical and cytopathologic overlap between SD-UT and SD-NSCLC, some key features allow for their distinction. SD-UT is mostly discohesive with rhabdoid or mixed rhabdoid-epithelioid features, whereas SD-NSCLC often has cohesive epithelioid morphology. The combination of clinical presentation, cytomorphology, and immunohistochemistry is essential for a definitive diagnosis.

A multiphasic model for determination of mouse ascending thoracic aorta mass transport properties with and without aneurysm.

Thoracic aortic aneurysms (TAAs) are associated with aortic wall remodeling that affects transmural transport or the movement of fluid and solute across the wall. In previous work, we used a Fbln4E57K/E57K (MU) mouse model to investigate transmural transport changes as a function of aneurysm severity. We compared wild-type (WT), MU with no aneurysm (MU-NA), MU with aneurysm (MU-A), and MU with an additional genetic mutation that led to increased aneurysm penetrance (MU-XA). We found that all aneurysmal aortas (MU-A and MU-XA) had lower fluid flux compared to WT. Non-aneurysmal aortas (MU-NA) had higher 4kDa FITC-dextran solute flux than WT, but aneurysmal MU-A and MU-XA aortas had solute fluxes similar to WT. Our experimental results could not isolate competing factors, such as changes in aortic geometry and solid material properties among these mouse models, to determine how intrinsic transport properties change with aneurysm severity. The objective of this study is to use biphasic and multiphasic models to identify changes in transport material properties. Our biphasic model indicates that hydraulic permeability is significantly decreased in the severe aneurysm model (MU-XA) compared to non-aneurysmal aortas (MU-NA). Our multiphasic model shows that effective solute diffusivity is increased in MU-NA aortas compared to all others. Our findings reveal changes in intrinsic transport properties that depend on aneurysm severity and are important for understanding the movement of fluids and solutes that may play a role in the diagnosis, progression, or treatment of TAA.

Liver lobe herniation into the caval foramen in a dog treated surgically by intercostal thoracotomy

AbstractLiver herniation into the caval foramen is a rare condition that can be encountered in dogs and cats. An 8‐year‐old, male neutered, Bichon frise was presented for chronic episodes of inappetence and lethargy. Thoracic and abdominal computed tomography revealed a thoracic mass originating from the liver protruding into the caval foramen. Surgical excision of the liver lobe was performed via an intercostal thoracotomy, and histopathology of the mass was consistent with that of normal hepatic tissue. The dog fully recovered with complete resolution of clinical signs at 2‐week and 6‐month recheck. The present case highlights the first reported case of a liver lobe herniation into the caval foramen treated by intercostal thoracotomy in a dog.

Case Report : Undifferentiated Synovial Sarcoma Presenting as a Large Thoracic Mass: A Rare and Challenging Diagnosis

Background: Undifferentiated synovial sarcoma (USS) is a rare and aggressive subtype of soft tissue sarcoma. Its presentation as a large thoracic mass poses significant diagnostic and therapeutic challenges.  Case Presentation: A 34-year-old male presented with a three-month history of progressive chest pain and hemoptysis. Imaging studies revealed a large, cystic thoracic mass with pleural effusion. Initial serological testing suggested hydatid cyst, but subsequent testing revealed negative Echinococcus (Hydatid) IgG antibodies.  Diagnostic and Therapeutic Interventions: Repeat fine-needle aspiration cytology (FNAC) was deferred due to revised ultrasound findings indicating a solid fibrocystic vascular lesion. Bronchial artery embolization (BAE) was performed to control life- threatening hemorrhage. Thoracotomy and en-bloc mass excision were subsequently undertaken.  Histopathological Diagnosis: Histopathological examination of the resected specimen revealed undifferentiated synovial sarcoma and spindle cell sarcoma.  Clinical Implications: This case highlights the importance of correlating imaging and serological findings, managing vascular complications, and the efficacy of BAE in controlling hemorrhage. The significance of thoracotomy and mass excision in achieving diagnostic clarity and therapeutic success is underscored.  Conclusion: Undifferentiated synovial sarcoma presenting as a large thoracic mass poses significant diagnostic and therapeutic challenges. A multidisciplinary approach, incorporating imaging, serological testing, and surgical intervention, is crucial for achieving optimal patient outcomes.

Sarcomatoid mesothelioma presenting as a mediastinal mass: A case report

Sarcomatoid mesothelioma (SM) is a subtype of mesothelioma, a deadly cancer strongly related to asbestos exposure. Herein, we present the case of a 50-year-old female who presented with back pain and non-specific symptoms for approximately 9 months. The diagnostic investigation revealed a large, centrally necrotic mass in the thorax that appeared to arise from the mediastinum and surrounded vital structures, including the superior vena cava. A biopsy of the thoracic mass revealed SM. The patient developed hematemesis, and emergent endoscopy revealed a gastric ulcer composed of malignant SM cells, a rare finding in pleural mesothelioma. Her disease was too advanced for surgical resection and conventional therapy. She tragically died weeks after diagnosis. The findings of this report highlight the varied presentation of SM to underscore the importance of early diagnosis and treatment of patients in improving overall survival.

Pruritus: An Overlooked Symptom of Spinal Tumors

Background Chronic itch is often associated with pain due to its complex nature. Neuropathic pruritus is defined as a debilitating form of chronic itching, about which not much is known to date. This condition may develop as a result of various neurological events and is associated with damage to the somatosensory nervous system, accounting for approximately 10% of chronic itching cases. Syringomyelia, transverse myelitis, radiculopathies, thoracic spine masses, brain tumors, strokes, and abscesses are among the conditions associated with neuropathic itching to date. Case presentation A 65-year-old female patient, with no known diseases and no regular medication usage, presented with a complaint of itching that had been ongoing for the past two years. Itching initially started in approximately five cm areas on the bilateral below-knee flexor surfaces. The patient, whose complaints persisted, was referred to the internal medicine outpatient clinic by dermatology. On physical examination, erythematous excoriated papules were observed in the areas affected by itching. The patient's blood sugar, liver and kidney function tests, complete blood count, erythrocyte sedimentation rate, thyroid function tests, urinalysis, stool parasitology were all normal or negative. The patient reported a sensation of coldness in the same area, was referred to neurosurgery to investigate the etiology of possible neuropathic itching. The patient's spinal imaging, revealed a spinal mass. She underwent surgery performed by a neurosurgeon, during which the spinal mass was completely removed. She reported that her itching had completely disappeared post-operatively. Conclusions The concept of itching as a variant of pain is not very new. Any damage occurring in the central nervous system or peripheral nervous system that affects the neurons responsible for transmitting and processing itch can lead to neuropathic itching. Focusing on spinal cord pathologies, any condition that damages the spinal cord may cause itching, depending on the level of damage. In cases of itching with dermatomal localization, where pain, hot or cold sensations, and paroxysmal itching are present, additional imaging methods or investigations for etiology should be performed.

Primary pulmonary carcinoma in a dog presenting with hypertrophic osteopathy

AbstractA 9‐year‐old dog was presented for a 2‐month history of bilateral carpal, stifle and tarsal swelling and a large thyroid mass. Carpal radiographs indicated hypertrophic osteopathy, thoracic radiographs revealed an intrathoracic mass, fine‐needle aspirate of the thoracic mass diagnosed carcinoma, and subsequent cervical, thoracic and abdominal computed tomographies revealed widespread hypertrophic osteopathy, bilateral thyroid cystic structures and a soft tissue mass in the right cranial mediastinum or lung. After unilateral thyroidectomy and thoracotomy for a lung lobectomy and mediastinal lymph node extirpation, the dog was diagnosed with a benign cyst of the thyroid and a completely excised grade II pulmonary carcinoma with no metastasis to the mediastinal lymph node. After 135 days of presentation, the dog presented with increased respiratory effort, and pleural effusion was diagnosed. Thoracocentesis was performed, and cytology of the fluid was concerning for carcinoma. The dog further declined rapidly and was euthanased 178 days after the initial presentation.

Opaque Hemithorax in a Young Girl: A Rare Case of Askin’s Tumour

Askin’s tumor is a primitive neuroectodermal tumor primarily affecting the thoracopulmonary region. It typically manifests in children and adolescents, with a notable female preponderance. Histologically, it presents as a malignant small blue cell tumor. Clinical presentation often includes respiratory symptoms such as pain, dyspnoea, and weight loss. Prognosis is generally unfavorable with a median survival of around 8 months and an overall survival rate of approximately 60% at 5 years. This report highlights the case of a 13-year-old female diagnosed with Askin’s tumor. This report highlights the case of a 13-year-old female presented with a 2-month history of back pain, right-sided chest pain, exertional breathlessness, and loss of appetite. Examination revealed dyspnoea, pallor, and bilateral cervical lymphadenopathy. Radiological and histopathological investigations confirmed the diagnosis of Askin’s tumor with malignant pleural effusion and distant metastasis. This case underscores the importance of considering Askin’s tumor in the differential diagnosis of thoracic masses in pediatric patients. Early recognition and a multidisciplinary approach are crucial for optimizing patient outcomes.

Low thoracic skeletal muscle is a risk factor for 6-month mortality of severe community-acquired pneumonia in older men in intensive care unit

BackgroundPatients with severe community-acquired pneumonia (sCAP) admitted to the intensive care unit (ICU) often exhibit muscle catabolism, muscle weakness, and/or atrophy, all related to an increased morbidity and mortality. However, the relationship between thoracic skeletal muscle mass and sCAP-related mortality has not been well-studied. Early recognition of sarcopenia in ICU patients with sCAP would benefit their prognosis.MethodsA retrospective study was conducted in Taizhou Hospital of Zhejiang Province, involving 101 patients with sCAP admitted in the ICU between December 2022 and February 2023. We measured the cross-sectional aera of the pectoralis, intercostal, paraspinal, serratus, and latissimus muscles at the T4 vertebral level (T4CSA) using chest computed tomography. Discriminatory thresholds were established by performing receiver operating characteristic curve analysis, with a designated cutoff value of 96.75 cm2 for male patients. This cohort was classified into mortality and survival groups based on a 6-month post-admission outcome. Univariate and multifactorial logistic regression analyses were performed to validate the correlation between low thoracic skeletal muscle area and prognostic outcomes.ResultsThe mean age of the patients was 75.39 ± 12.09 years, with an overall 6-month mortality of 73.27%. T4CSA of the 6-month survival group was significantly larger than that in the mortality group for overall cohort. The T4CSA in the survival group was significantly larger than that in the mortality group (104.29 ± 23.98cm2 vs. 87.44 ± 23.0cm2, p = 0.008). T4CSA predicted the 6-month mortality from sCAP in males with an AUC of 0.722 (95% confidence interval (CI), 0.582–0.861). The specificity and sensitivity were 71.4% and 71.1%, respectively, (p < 0.05). No significant difference was observed between the two groups in terms of T4CSA.ConclusionsThis study revealed that low thoracic skeletal muscle mass increased the risk of all-cause 6-month mortality in ICU patients with sCAP, particularly among male patients.

Virtual bronchoscopy-guided airway management in a case of a massive thoracic mass causing a mediastinal shift in an infant.

Virtual bronchoscopy-guided airway management in a case of a massive thoracic mass causing a mediastinal shift in an infant.