1/405. Median sternotomy for parathyroid adenoma.Most mediastinal parathyroid tumours lie within the thymus gland and may be retrieved when cervical thymectomy is carried out in the course of neck exploration for primary hyperparathyroidism (HPT). We report 4 patients, each of whom required sternotomy for removal of a true mediastinal parathyroid adenoma. Subtraction isotope scintigraphy suggested the presence of a mediastinal tumour prior to cervical exploration in 2 individuals and prior to re-exploration in a third. When localisation before initial exploration for HPT suggests a parathyroid tumour within the chest, consideration should be given to proceeding to sternotomy, at first operation if a comprehensive neck exploration, including cervical thymectomy, fails to uncover the adenoma. Uniquely, one of our patients underwent sternotomy for HPT when 23 weeks pregnant.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/405. Mediastinal lymph node metastasis of colon cancer: report of a case.We herein describe a patient with mediastinal lymph node metastases which occurred after both a primary sigmoid colon cancer and metachronous ovarian metastasis had been resected. The most likely route of metastases to the mediastinum in this case is the paravertebral venous plexus probably connected to the ovarian metastasis, or so-called remetastasis. This case illustrates that the mediastinum is thus a possible metastatic site in patients with colon cancer. Surgeons should therefore pay attention to the mediastinum as well as the lung fields when checking chest X-ray films during a follow-up of patients after a resection of colon cancer.- - - - - - - - - - ranking = 1.0431623654972keywords = chest, plexus (Clic here for more details about this article) |
3/405. Ewing's sarcoma presenting as a posterior mediastinal mass: a lesson learned.Thoracic vertebral body hemicorpectomy and chest wall resection was performed in a 17-year-old male patient with a posterior mediastinal tumor thought to be neurogenic in origin. No preoperative tissue diagnostic endeavor was made. Final pathologic diagnosis showed this tumor to be Ewing's sarcoma. This communication alerts the thoracic surgeon to the need for definitive diagnosis of posterior mediastinal masses with vertebral body involvement, particularly in children. induction chemotherapy is the accepted standard of management of these sarcomas.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/405. Primary mediastinal seminoma.Four new cases of primary mediastinal seminoma are presented, and the 103 previously reported cases reviewed. All of the tumors occurred in the anterior mediastinum, and generally appeared as lobulated noncalcified masses on chest radiography. Most patients were in the third and fourth decades, and about 30% were asymptomatic at the time of initial diagnosis. Although mediastinal seminoma is not commonly considered a cause of superior vena caval obstruction, about 10% of patients experience it. The tumors are radiosensitive and potentially radiocurable. A striking reduction in size of the tumor may be noted after radiation therapy. prognosis is generally good, with a 5-year survival rate of 75%. The controversy surrounding histogenesis of this tumor is reviewed, and the pathologic criteria for making the diagnosis presented.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/405. Giant cervico-mediastinal lipoma. A clinical case.The lipoma is a circumscribed mesenchymal tumour originating from adipose tissue. The lesion is usually small and asymptomatic, and is most frequently located in the neck region. The case of a 77-year-old woman with chronic extrasystolic arrhythmia caused by a non-specified ischemic cardiopathy is reported. The woman presented a swelling at the front of her neck, observed for the first time about 6 months previously. This swelling progressively increased in size, provoking dysphagia, dysphonia, persistent cough, dyspnea, light jugular turgor and palpitations. Chest x-rays showed and opaque area at the front of the neck, which extended beyond the jugular incisure by about 2 cm. NMR of the neck showed a gross lipomatous formation at the front, mainly of the left, continuing in the front mediastinal region; the trachea was dislocated to the right and compressed at the back; the vasculo-nervous fasciculus, especially on the left, was compressed and enveloped by the adipose formation. The Holter test confirmed the presence of ventricular and supra-ventricular extrasystoles. Surgery was carried out under local anaesthesia because the displacement of the laryngo-tracheal axes precluded intubation. Histological analysis of the 9 x 4 x 2.2 cm mass confirmed the diagnosis of lipoma. After removal of the mass all the symptoms, which had been provoked by compression, as well as the cardiac arrhythmias disappeared. The prompt disappearance of the latter was particularly surprising. The possibility of the external compression of the nervous structures of the neck should be taken into consideration in cases of ventricular arrhythmia of unknown origin, and systematic study of the region carried out.- - - - - - - - - - ranking = 0.0064207425123221keywords = area (Clic here for more details about this article) |
6/405. Hodgkin's disease presenting as a parasternal chest wall mass.A 53 year-old Moroccan woman presented with a tender parasternal mass. Computerized tomography showed a mediastinal mass protruding through the sternum. Cytologic examination of fluid collected from the mass repeatedly showed acute inflammation. Tuberculostatics were started. Since patient did not improve on tuberculostatics, a small supraclavicular lymph node was removed. Histologic examination showed Morbus Hodgkin of the nodular sclerosing type. Ultimately, cytologic examination of fluid from the parasternal mass showed atypical cells. Response on chemotherapy was excellent with complete disappearance of the parasternal mass. This is a very unusual extranodal presentation of Hodgkin's disease.- - - - - - - - - - ranking = 4keywords = chest (Clic here for more details about this article) |
7/405. Successful surgical treatment of the brachial plexus paresis in leiomyosarcoma of the subclavian artery.Described here is a unique case of surgical treatment of brachial plexus paresis in a 63-year-old female patient. The paretic condition was considerably improved by excision of a tumor in the upper mediastinum, growing from the left subclavian artery, and classified as leiomyosarcoma.- - - - - - - - - - ranking = 0.21581182748587keywords = plexus (Clic here for more details about this article) |
8/405. A new observation of the Carney's triad with long follow-Up period and additional tumors.The etiology of the Carney's triad (gastrointestinal stromal tumors, pulmonary chondromas, and paragangliomas) is unknown, and only 57 cases have been reported since its identification in 1977. We report the clinical course of a female with the complete triad and some additional tumors. Bilateral vagal paragangliomas were treated surgically and with radiotherapy between the ages of 24 and 26 years. Subsequently she underwent surgery for a gastric leiomyosarcoma (27 years), a pleomorphic adenoma of the parotid gland (49 years) and a multifocal breast cancer with axillary spread (50 years). A calcified lesion was also noticed in the left lung, the radiologic diagnosis of which was consistent with chondroma. A mediastinal paraganglioma, detected at 56 years on a control X-ray of the chest, was partially excised at 63 years. At the last control, performed at 66 years, the patient was alive with residual cervical and mediastinal paraganglioma. Her younger brother was affected by Hirschsprung's disease and died at 54 years of rectal cancer. Her daughter is 33 and has been suffering since birth with severe constipation. In conclusion, this is one of the longest followed-up patients with Carney's triad. Her case illustrates the need for early recognition of the setting in order to detect the component tumors at a stage when surgery may be curative, and careful and life-long follow-up, both because the multicentricity of the classic components tends to manifest metachronously and because of the tendency to develop other tumors, some of which may be malignant. Furthermore, the presence of Hirschsprung's disease in the patient's family, coupled with the alleged common origin of two component lesions from derivatives of the neural crest, open new avenues for the understanding of this disorder.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/405. Malignant mesothelioma presenting as pulmonary metastasis ahead of growth of primary tumour.A 59-year-old woman was admitted to Houju Memorial Hospital, Ishikawa, japan, because of cough and fever on 30 March 1997. A diagnosis of pneumonia was made and she was given antibiotics. Her symptoms improved but failed to resolve completely on antibiotic therapy. On 9 September 1997, she revisited the hospital because of bodyweight loss and malaise. There was no history of exposure to asbestos. The chest roentgenogram revealed infiltrative shadows with vague and indistinct margins suggesting inflammatory processes, which were more extensive than those investigated on her last visit. One month later, a giant tumour was detected rapidly growing from the mediastinum and open biopsy was performed. The histological examination confirmed that the tumour was a malignant mesothelioma and the intrapulmonary nodules were its metastases. This is a rare case of pulmonary metastasis being present for several months before an appearance of primary mesothelioma.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
10/405. Polymorphous hemangioendothelioma.Polymorphous hemangioendothelioma is a rare vascular tumor; only 5 patients have been previously described. Half of all cases described have occurred in the thoracic cavity, all being discovered on chest radiologic studies obtained for other reasons. This report presents the case of a female patient with polymorphous hemangioendothelioma and a brief review of the current literature.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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