Easier node dissection after chemoradiotherapy for lung cancer with collagen insertion at mediastinoscopy

Objective: Induction chemoradiotherapy followed by anatomical resection is a current therapeutic strategy for non-small-cell lung cancer with mediastinal node involvement. Dense peritracheal fibrosis and sclerosis after chemoradiotherapy cause difficult mediastinal node dissection. We evaluated a novel technique to make the mediastinal node dissection easier after induction therapy. Methods: At the end of mediastinoscopic node biopsy for staging of lung cancer, cotton-type collagen was inserted anterior and lateral to the trachea in patients with pathologically confirmed mediastinal node involve-ment (n=45). The induction therapy consisted of concurrent use of platinum-based chemotherapy and hyperfractionated radiotherapy. After the chemoradiotherapy all patients underwent a pulmonary resection with complete mediastinal node dissection 7–12 weeks after the collagen insertion. Surgical findings of the mediastinum and the time for node dissection were compared with those without collagen insertion at mediastinoscopy after chemoradiotherapy (n=5). Results: All five patients without collagen insertion showed sclerotic and fibrotic change of mediastinal nodes with severe adhesion to the trachea. In 42 of 45 patients with collagen insertion (93.3%) the collagen remained unabsorbed and separated the mediastinal nodes from the trachea. Mediastinal node dissection was easily accomplished by removing mediastinal tissues lateral and anterior to the collagen. The rate of mediastinal node separation was significantly higher with collagen insertion than without (p< 0.0001). The times for node dissection in patients with and without collagen insertion showed no significant difference. Conclusion: Cotton-type collagen insertion at staging mediastinoscopy for lung cancer separates the mediastinal nodes from the trachea and makes the node dissection easier after induction chemoradiotherapy.     

外科治疗纵隔原发神经源性肿瘤的手术径路评价

目的　探讨外科治疗原发纵隔神经源性肿瘤的手术径路。方法　 1963年 3月至2 0 0 3年 9月外科治疗原发纵隔神经源性肿瘤 91例。所有病例均于术前行X线胸片检查 ,其中 65例行CT或磁共振检查。根据肿瘤的大小、部位及其是否向椎管内延伸选择不同的手术入路 ,其中胸后外侧切口 84例 ,半哈壳状切口 2例 ,高位胸后侧切口 4例 ,胸后外侧加脊柱旁切口 1例。所有病例均经病理证实并行 6个月～ 15年的术后随访。结果　本组手术切除率 97.8% ( 89/91) ,术后并发症发生率 4.4% ( 4 /91) ,无手术死亡病例。术后病理诊断良性肿瘤 79例 ( 86.8% ) ,恶性肿瘤12例 ( 13 .4% )。 1例神经纤维瘤 2年后复发经再次手术切除治愈 ;恶性肿瘤平均生存 3 8.1个月。结论　适当的手术径路是提高纵隔原发神经源性肿瘤切除率的关键。     

Image features of two rare mediastinal tumors: schwannoma of intrathoracic phrenic nerve and clear cell chondrosarcoma of the rib

The current report focuses on two patients of the same age who presented similar appearances on initial anteroposterior chest images. Follow-up images showed superoanterior and superoposterior mediastinal lesions. The first patient with noninvasive cystic thymoma was suspected before surgery, while the pathologic diagnosis was intrathoracic phrenic nerve schwannoma. The second patient was with an asymmetric, dumbbell-shaped paravertebral tumor over T3 and T4 on the left side. The preoperative…     

Intrapulmonary Schwannoma

A 58-year-old woman was admitted due to an abnormal shadow on chest X-ray, without any symptoms. Chest computed tomography showed a round mass in the anterior segment of the right upper lobe. Segmentectomy was performed and histopathological examination revealed a primary neurogenic tumor of Schwann cell origin. Immunohistochemical staining demonstrated the presence of S-100 protein in the tumor cells. We present a case of intrapulmonary schwannoma and review 62 cases of primary schwannoma of the lung.     

Ga67显像评估纵隔大B细胞淋巴瘤治疗预后的研究

目的:本研究旨在评价纵隔大B细胞淋巴瘤Ga67显像预测疗效的临床价值。方法:39例病人中女24例,男15例,平均年龄(48±5.6)岁,临床病史及组织病理学诊断为纵隔大B细胞淋巴瘤。分别在化疗前、化疗结束后1个月和放疗结束后3个月进行常规的Ga67 SPECT和CT显像,图像分析采用常规的定性方法。结果:Ga67显像结果:在39例病人治疗结束后,有32例病人肿瘤Ga67显像结果为阴性,提示治疗完全有效,随访证实阴性预测率为94%(30/32);7例病人治疗后Ga67显像阳性,表示治疗部分有效或治疗无效。随访证实阳性预测率为86%(6/7),提示Ga67显像阴性的病人预后很好,而治疗后Ga67显像阳性预后很差。CT扫描结果:39例病人进行了治疗前后的胸、腹和盆腔CT扫描,其阴性预测率为83%;而阳性预测率只有25%。结果提示与Ga67显像相比,CT预测疗效的结果难于区分治疗有效、部分有效或无效。结论:Ga67显像在评价纵隔大B细胞淋巴瘤病人治疗反应中明显优于CT扫描。     

Mediastinal lymphadenopathy: a variant of incomplete Kawasaki disease

A 14-month-old girl presented with a 4-d history of fever and generalized exanthema. Four characteristic symptoms of incomplete Kawasaki disease (KD) were present on admission (fever, rash, non-purulent conjunctival injection, oropharyngeal changes) and then followed by oedema of the hands and feet and mild plantar desquamation. The typical laboratory features of KD, such as elevated erythrocyte sedimentation rate, leukocytosis, thrombocytosis, and positive C-reactive protein were also seen. Ultrasound examination of the mediastinum revealed the presence of a lymph node, 30 mm in diameter, below the tracheal carina. Thoracic CT scan confirmed the mediastinal lymph node. The patient was treated with aspirin and intravenous γ -globulin. Ultrasound study of the mediastinum, which was carried out 6 weeks after hospital discharge, showed that the lymph node had disappeared. This case illustrates that lymph nodes other than cervical lymphadenopathy should be sought when the diagnosis of classical or atypical KD is suspected.     

纵隔镜检查在胸部疑难疾病诊断中的作用

目的：临床观察纵隔镜检查在胸部疑难疾病诊断中的作用。方法：使用德国STORZ公司生产的纵隔镜，对17例临床不能确诊的影像学检查发现的纵隔肿物或淋巴结施行标准的经颈纵隔镜检查术。结果：本组均获得了明确的病理诊断,其中良性病变88．2％（15／17），包括结节病9例，淋巴结结核5例，巨大淋巴结增生症1例，而2例恶性肿物均为肺小细胞未分化癌。结论：纵隔镜对原因不明的纵隔肿物或结节的诊断有着重要意义，可使一些结节病或淋巴结结核的患者得到及时正确的诊断，使这部分患者避免了盲目的试验性放、化疗或开胸探查所带来的痛苦。     

Right pneumonectomy syndrome: Report of two cases

We report herein the cases of two infants who developed right pneumonectomy syndrome, both of whom were born with gross C-type esophageal atresia (EA/TEF), and a hypoplastic right lung arising from the lower esophagus, being a bronchopulmonary foregut malformation (BPFM). Appropriate and well-timed treatments for a variety of sequelae primarily caused by the mediastinal shift must be considered after right pneumonectomy in early childhood.     

Idiopathic mediastinal fibrosis: Report of a case

(Received for publication on Nov. 14, 1996; accepted on May 12, 1997)     

Fine-needle aspiration of a primary mediastinal large B-cell lymphoma: a case report with cytologic, histologic, and flow cytometric considerations

Fine-needle aspiration (FNA) cytology and immunophenotyping by flow cytometry (FCM) are increasingly being used for diagnosing and subclassifying lymphoma in the REAL/WHO classification. Herein, we report a case of primary mediastinal large B-cell lymphoma (PMBL), a subtype of diffuse large B-cell lymphoma in the WHO classification, diagnosed by FNA cytology in conjunction with FCM. This, to our knowledge, has not previously been reported. A 57-yr-old woman presented with bilateral axillary lymphadenopathy and intermittent shortness of breath. CT scan revealed a 5-cm anterior mediastinal mass and mediastinal lymphadenopathy. Endoscopic ultrasound-guided FNA of a 4.5-cm subcarinal lymph node showed medium to large atypical lymphocytes with scant to moderate finely vacuolated cytoplasm. Nuclei were enlarged, cleaved, noncleaved, lobulated, and hyperchromatic. The background showed lymphoglandular bodies. Malignant large cell lymphoma was cytologically diagnosed. FCM, performed on a portion of the FNA specimen, demonstrated large B cells devoid of surface immunoglobulin expression, the characteristic immunophenotype of PMBL. The histologic diagnosis was PMBL. Touch-imprint cytology of the histologic specimen showed large cells with a narrow rim of clear cytoplasm and prominent outer cell border. Nuclear features were similar to the FNA specimen. In the presence of a mediastinal mass, FNA cytology in conjunction with FCM can effectively diagnose PMBL in the appropriate clinical setting.