Cystic tumors of mediastinum]

Nine of twenty-four mediastinal tumors showed cystic lesions were operated at Kinki University Hospital. These nine mediastinal cysts included 5 of thymic cysts, 3 teratomas and one pericardial cyst. By the preoperative imagings, thymic cysts showed a smooth wall and homogenous content with water density. Teratoma consisted of cystic and solid parts, and the irregular thickness of the wall was found. One of these teratomas was ruptured into the pleural cavity, it has been proposed that digestive enzyme derived from pancreatic tissue with Langerhans island caused autolysis and necrosis with result in rupture. Pericardial cyst located at cardiophrenic angle mostly and which is useful on diagnosis.     

Cystic adenomatoid malformation of the lung presenting in adulthood

Cystic adenomatoid malformation is an uncommon embryonic developmental abnormality usually diagnosed in neonates and infants. Its presentation in adulthood is rare, with only 27 cases reported up to now. Due to its rarity, it is seldom suspected and adult physicians are not familiar with its clinical and radiologic features. We report two cases of cystic adenomatoid malformation presenting in adults, one as a recurrent pneumonia, and another as a coincidental finding on a chest roentgenogram. We describe the clinical features, radiologic and computed tomographic findings, and the histopathologic characteristics in this article, along with a review of the literature.     

Cystic adenomatoid malformation volume ratio predicts outcome in prenatally diagnosed cystic adenomatoid malformation of the lung

Background/Purpose: Cystic adenomatoid malformation of the lung (CAM) diagnosed in utero has a variable natural history that may result in hydrops in up to 40% or regress in up to 15%. No criteria have been available to determine which lesions would grow and develop hydrops versus those whose growth would stabilize or regress. To better understand the natural history of CAM the authors developed a measure of tumor volume normalized for gestation age, the CAM volume ratio, or CVR. The results of an initial retrospective review of CVR at presentation suggested its usefulness as a predictor of outcome in CAM. The authors now report the results of prospective use of the CVR both to track tumor growth and regression during gestation and confirm its predictive value in fetuses with CAM. Methods: In the retrospective review performed between November 1998 and August 1999, 32 fetuses with CAM were reviewed and divided into those with hydrops and those in whom hydrops never developed. The CVR was determined by measuring 3 dimensions of the CAM using the formula for the volume of an ellipse and dividing by the head circumference to correct for differences in gestational age. Of the 32 fetuses in the retrospective study, the 8 that had hydrops had a significantly higher CVR (3.1 [plusmn] 1.1) compared with hydropic fetuses (0.74 [plusmn] 0.48; P [lt ] .001). The mean of the nonhydropic fetus's CVR plus 2 standard deviations (0.74 + 0.96 = 1.7) was used as a cutoff in the subsequent prospective study. From September 1, 1999 through March 1, 2001, the authors evaluated prospectively 58 patients with CAM by CVR measurement. These patients were followed up with serial ultrasound scans, and CVR at presentation correlated with the development of hydrops, survival, need for fetal intervention, and the need for ventilatory support or extracorporeal membrane oxygenation (ECMO), and length of hospital stay postnatally. The indication for fetal intervention was the development of hydops. Results: The fetuses with CVR [le ]1.6 (n = 42) were considered to be at low risk for the development of hydrops, and those with CVR greater than 1.6 (n = 16) were considered at increased risk for developing hydrops. Of the 42 fetuses in the low-risk group, 7 (16.7%) developed hydrops, and all but 1 had a dominant cyst. If CAMs with a dominant cyst are excluded, only 1 of 36 (2.8%) of CAMs with CVR [le ] 1.6 developed hydrops (P [lt ] .001). In fetuses with CVR at presentation more than 1.6, 12 of 16 (75%; P [lt ] .005) developed hydrops. Seventeen fetuses underwent fetal treatment (8 CVR [le ] 1.6; 9 CVR [gt ] 1.6): 7 patients required open fetal surgery (survival rate, 2 of 7), 6 patients thoracoamniotic shunting (survival rate, 6 of 6); and 4 patients cyst aspiration (survival rate, 4 of 4). All survivors of fetal intervention required at a least brief period of ventilatory support; none required ECMO. Conclusions: A CVR of greater than 1.6 at presentation accurately predicts increased risk of hydrops developing in CAM. A CVR of [le ]1.6 at presentation suggests that the risk of hydrops developing in the absence of a dominant cyst is less than 3%. The CVR is a useful sonographic indicator of fetuses at risk for hydrops who require close ultrasound observation and possible fetal intervention.     

Vascular tumor in the mediastinum

Mediastinal venous hemangioma is a very rare neoplasm. Here, we describe our experience in treating a patient demonstrating such a tumor. The patient, a 23-year-old man, was admitted to our hospital because of a mediastinal cyst. A biopsy of the cystic wall was performed by Video-Assisted-Thoracic-Surgery, in April 1999. Clear serous fluid was found in the cyst, and it was thus incorrectly diagnosed to be a thymic cyst. The cyst continued to increase in size, and the patient began to show an increased temperature after being discharged. A resection of the tumor was performed in June 1999. The cyst was filled with bloody fluid and, according to the pathological analysis, was diagnosed to be a mediastinal venous hemangioma.     

Solitary fibrous tumor of the mediastinum

An 18-year-old man was referred to our hospital for further evaluation of a right anterior mediastinal tumor that measured 6 cm in diameter. Computed tomography-guided transcutaneous aspiration biopsy was performed, but no definitive diagnosis could be obtained. Because the tumor did not appear to be a high-grade malignant tumor, we undertook resection of the tumor to obtain a definitive diagnosis and provide appropriate treatment. Total thymectomy with tumor resection was performed through a median sternotomy. The tumor was solid, measuring 5.2 × 4.2 × 3.5 cm. The histological diagnosis was solitary fibrous tumor (SFT) arising from the mediastinum. Most extrathoracic SFTs appear to pursue a benign course, although careful long-term follow-up of these patients is necessary because the tumors have been reported to recur or metastasize in some cases.     

Cystic lymphangioma confined to mediastinum in an adult

Mediastinal lymphangiomas are very rare tumors among the slow-growing mediastinal masses in the literature. We present the successful resection of a 52-year-old woman who was referred to our hospital. Past medical history consisted of surgical treatment for cervical mass and pathological diagnosis of lymphoma nine years earlier. She underwent postoperative radiotherapy. Preoperative chest roentgenogram and computed tomogram of the chest showed a cystic mass in the anterior mediastinum. The tumor was completely resected. The preoperative diagnosis was never questioned until the histopathological examination confirmed that the lesion was a cystic lymphangioma. Cystic lymphangiomas are benign tumors with the evidence of progression in tumor size and invasion into the vital structures. As our case shows, the tumor involvement with the vital structures causes difficulty in removal.     

Suprarenal occurrence of an adenomatoid tumor

Adenomatoid tumors are rare, benign mesotheliomas that usually are associated with genito-urinary tract. The suprarenal occurrence of this tumor is uncommon. We present such a case and review the origin of the adenomatoid tumor.     

Sonography of intrascrotal adenomatoid tumor.

A case is reported of an adenomatoid tumor of the epididymis. A discussion of the appropriate differential of mass of the epididymis as well as a review of adenomatoid tumors per se and their occurrence in the scrotum are presented.     

Gastrointestinal stromal tumor of the posterior mediastinum

Gastrointestinal stromal tumor (GIST) is a rare, but potentially aggressive tumor. We present an asymptomatic 64-year-old man with an incidental 9-cm GIST that arose in the posterior mediastinum. Wide surgical excision was performed with rotation of an intercostal muscle flap to buttress a surgically created esophageal wall defect. The patient is now free of disease 26 months postoperative. This tumor is defined by the carcinogenic over-expression of KIT-protein, a tyrosine kinase receptor. Accurate diagnosis of gastrointestinal stromal tumor is imperative, as specific medical therapy is now available for potential control of recurrent or metastatic disease.     

Cystic tumor of the mediastinum of digestive origin. Apropos of a new case. Diagnostic and pathogenic hypotheses]

An incidental discovery of a posterior and inferior mediastinal cyst-like opacity allowed us to diagnose a pulmonary sequestration in a 45-year old woman. The operative findings showed an hour-glass tumor of the inferior mediastinum with an abdominal prolongation attached by a stalk onto the top of the stomach. These findings made us change our diagnosis in favour of an abdomino-thoracic gastric duplication. This new hypothesis was not confirmed by the results of the pathological report which revealed two kinds of tissue; intestinal in the abdomen and broncho-pulmonary in the chest. Two diagnoses where then proposed: complex hamartoma or mediastinal bronchogenic cyst. The pathogenic interpretation in such cases is still very controversial. English authors are prone to classify them as broncho-pulmonary foregut malformations. Macroscopic and microscopic data of the specimen led us to consider our case-report to be a foregut malformation.