Malignant neoplasm cancer
The most common causes of anterior mediastinal mass include the following: thymoma; teratoma; thyroid disease; and lymphoma. Masses of the middle mediastinum malignant neoplasm cancer typically congenital cysts, including foregut and pericardial cysts, while those that arise in the posterior mediastinum are often neurogenic tumors1.
Gold malignant neoplasm cancer cheloo outfit mediastial tumor diagnosis is computerized tomography CT with or without intravenous i. We present you a case of a young caucasian man, recently diagnosticated with myastenia gravis, that had a CT scan and discovered a mediastinal tumor, probably a thymoma. Surprisingly in operation, the tumor was invasive, with a high tendency of bleeding, and probably malignant.
A paliative operation was carried out, a prosthetic bypass from left venous brahiocefalic trunk to superior vena cava SVC. The patient had an malignant neoplasm cancer recovery period and was discharged after 7 days. The pathology finding was atypical lipomatous tumor, a liposarcoma. Keywords: mediastinal tumor, liposarcoma, atypical lipomatous tumor. Abstract: Malignant neoplasm cancer reprezintă o zonă complexă ce cuprinde mai multe organe interconectate anatomic şi funcţional.
Cele mai frecvente tipuri de tumori mediastinale sunt următoarele: timomul, teratomul, guşa tiroidiană multinodulară, limfomul. Tumorile din mediastinul mediu sunt, de obicei, chisturi congenitale, dezvoltate din canalul alimentar anterior sistemul digestiv superior şi din ţesut pericardic, în timp ce tumorile din mediastinul posterior sunt frecvent neurogenice.
Atypical mediastinal tumor
Vă prezentăm cazul unui pacient tânăr, caucazian, diagnosticat recent cu miastenia gravis, la care s-a evidenţiat o formaţiune la nivelul mediastinului anterior în urma examenului CT. Principala suspiciune a fost de timom.
Surprinzător, intraoperator, tumora era invazivă, cu tendinţă la sângerare, probabil malignant neoplasm cancer.
S-a efectuat o intervenţie paliativă, un by-pass de la nivelul trunchiului venos brahiocefalic stâng la vena cavă superioară VCS cu o proteză vasculară. Pacientul a evoluat favorabil postoperator şi a fost externat la 7 zile de la interventie. Diagnosticul anatomo-patologic a fost de tumoră lipomatoasă atipică, liposarcom.
Tumorile mediastinale atipice au un prognostic rezervat, dar această tumoră localizată în mediastin este foarte rară. Aşa că, din păcate, nu există date suficiente despre această patologie, şi malignant neoplasm cancer se poate estima supravieţuirea acestui pacient. This area is limited anterior — by the sternum, posterior — the spinal column, laterally — the mediastinal pleura, inferiorlly — the diafragm, superior by a plan that crosses inferior to the clavicules.
Clinically we devided mediastinum in 4 compartments: by the plan that crosses between manubrium and sternal body in superior mediastinum which contains proximal segment of tracheea, esofagus, the thymic gland, aortic arch, left and right brachiocefalic veins, nervesand inferior mediastinum which is divided in 3: anterior distal part of thymic gland, fat tissue, lymph malignant neoplasm cancer href="http://evenimente-corporate.ro/5739-respiratory-papillomatosis-risk.php">respiratory papillomatosis risk intrapericardial heart vessels, pericardium, the heart, tracheal byfurcation, pulmonary arteries and veins, lymph nodesand posterior esofagus, thoracic descending aorta, thoracic duct, sympathetic and parasympathetic nerves, lymph nodes.
Mediastinal tumors classification The most common causes of anterior mediastinal mass include the following: thymoma; teratoma; thyroid disease; and lymphoma. Masses of the middle mediastinum are typically congenital cysts, including foregut and pericardial cysts, while those that arise in the posterior mediastinum are often neurogenic tumors1,2.
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Symptoms Patients with mediastinal tumors can have specific clinical findings, depending on organ compresion or invasion, but frequently is not specific. Diagnosis A standard chest radiography can show enlargement of mediastinal opacity1,3. This malignant neoplasm cancer can have different caracteristics depending on the tumor, a profile chest radiography is mandatory so we can see in which mediastinal compartement is the tumor.
Lymph nodes can easily be identified and analized.
CT scan is also very useful for guiding future invasive investigations video assisted thoracoscopy-VATS, thoracic puncture, byopsy. Malignant neoplasm cancer scintigraphy is indicated for intrathoracic thyroid tumor2,4,5. Byopsy invasive tests are very usefull, but have limited indicationd due to their important risks.
Some of them are: mediastinoscopy, transthoracic byopsy aspiration, ultrasound or CT guided fine needle byopsy, VATS 6. Most of mediastinal tumors have a slow growth rate. Rarely patients have also myasthenia gravis, low Gama globulins, medullary aplasia, especially for red line, and some other immune problems2,4,6.
CT scan revealed non homogeneous nodular tumor at the anterosuperior mediastinum with compression effect on adjacent vascular structures, without invasiveness Figure 3. Also two small nodular lesions in the left upper lung lobe were found. Physical examination was in normal parameters.
There were no pathologic findings in echocardiography or radiography scan. Blood tests were normal.
He was scheduled for operation. The chest was opened through median sternotomy. The tumor had a high consistency.
A tumor fragment was excised and sent to Pathology. A serious tendency for bleeding was noticed, the tumor had important vascularization. Considering the age of the patient, the tendency for bleeding and the malignant aspect of the tumor, we decided not to excise any more of it and to make a venous-venous by pass from left venous trunk to proximal SVC.
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The venous by-pass was made with a vascular Gore-Tex prosthesis no 8. This was made in knowledge of the poor prognosis and natural history of the disease, considering the state of the tumor invading already vascular structures. Sternoraphy was made using Ti-Cron 5 sutures.
Light microscopy examination showed a tumor growth made of spindle cells with large, elongated, hyper chromatic nuclei, embedded in a myxoid and fibrillar collagen matrix. A moderate inflammatory infiltrate was identified within the lesion.
Note the malignant neoplasm cancer of areas of bone differentiation heterologous differentiation. Histopathology and immunohistochemistry tests confirmed the diagnosis of differentiated liposarcoma atypical lipomatous tumor.
Patient had an uneventful recovery, stayed 3 days in ICU intensive care unit and was discharged 7 days after surgical intervention.
He was malignant neoplasm cancer to Oncology Department for additional medical treatment. Surgical excision of the tumor is the optimal treatment for a mediastinal liposarcoma, as in other sites. If the entire tumor cannot be excised, surgical debulking often results in symptomatic relief. Radiotherapy and chemotherapy may be added as adjuncts to surgical excision but liposarcoma seem to have low sensitivity2,5,6.
Recurrence is common in deep-seated liposarcoma and it becomes detectable within the first 6 months in most cases, but it may be delayed for 5 or 10 years following the initial excision. Recurrence is directly related to the incomplete excision, tumor tissue left behind and invasiveness of the tumor in adjacent blood vessels, at the time of surgery.
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Therefore a close follow up is strongly recommended Conflict of interest: none declared. References 1. David H. Zipes, Peter Libby, W. Saunders London, Beau V.