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Background: An atypical type A thymoma variant was recently added to the World Health Organization classification of type A thymoma in 2015. This novel form of type A thymoma presents with hypercellularity, increased mitotic activity, and necrosis. In particular, necrosis seems to be related to postoperative recurrence and metastasis, but the clinical significance of these changes still needs to be studied. Case presentation: A 76-year-old man underwent thoracoscopic surgery for tumour resection due to an anterior mediastinal mass. Pathological examination revealed that the tumour invaded the surrounding thymic tissue. Cells were arranged in nest-like and whirl-like patterns, accompanied by prominent comedo-like necrosis, increased cell density, mild atypia, and a mitotic count of 4–6 per 10 high-power fields. Immunohistochemistry revealed positive expression of cytokeratin 19 and P63 in the tumour cells. Lymphocytes in the background were positive for CD3 and CD5, did not express terminal deoxynucleotide transferase, CD20, or CD117, and had an MIB-1 labelling index(LI) value of 15%. On the basis of these findings, the tumour was finally diagnosed as an atypical type A thymoma variant. Conclusions: We report a case of atypical type A thymoma and review the literature to enhance our understanding of and provide accumulated pathological data on this rare disease. [ABSTRACT FROM AUTHOR]

Summary: A 3‐year‐old Quarter Horse gelding originating from Texas presented for fever and inappetence. An encapsulated, mixed echogenic cranial mediastinal mass visible ultrasonographically in the left and right fourth intercostal space that displaced the heart caudally was identified. Histological evaluation of needle biopsies obtained under general anaesthesia revealed a severe pyogranulomatous inflammatory process associated with intralesional round, 15–25 μm in diameter, thick double‐contoured cell wall fungal structures. Sequencing of products obtained from DNA extracted from the paraffin‐embedded biopsy sample and a panfungal PCR assay targeting the large ribosomal unit region had a 99.1% identity to either Coccidioides immitis or C. posadessii. Bronchoscopy revealed purulent exudate in the right primary bronchus. Cytological evaluation of bronchial alveolar lavage fluid (BALF) contained 96% moderately degenerative neutrophils and 4% macrophages. Fungal structures were not appreciated in the BALF. However, the mediastinitis could have resulted from inhalation and dissemination of arthroconidia through lymphatics or directly from the lung parenchyma. Quantitative immunodiffusion of serum for the presence of coccidioidal IgG antibodies yielded a titre of 1:256 suggestive of disseminated coccidioidomycosis. After oral fluconazole for 24 months, the horse's general health and athletic performance had returned to normal and the mediastinal mass was not appreciated sonographically. [ABSTRACT FROM AUTHOR]

Primary undifferentiated high-grade pleomorphic sarcoma (UPS) in the mediastinum is exceptionally rare. This paper reports a unique case of anterior mediastinal UPS in an 84-year-old Asian male presenting with recurrent upper respiratory tract infections and upper abdominal discomfort. Imaging via CT and MRI suggested an invasive thymoma, but postoperative pathology confirmed UPS. Despite radical surgery, local recurrence occurred within three months, and palliative radiotherapy was ineffective. This case provides the first comprehensive imaging data of UPS in the anterior mediastinum, aiming to improve diagnostic accuracy for clinicians and radiologists by summarizing imaging features across various modalities. [ABSTRACT FROM AUTHOR]

Introduction Materials and Methods Results Conclusion Self‐expanding Y‐metal stents (SEMS) are best suited lesions with involvement of the carina and proximal main bronchi; however, Y‐stents can be difficult to place. These difficulties guided us to develop a modification of the classic technique that addresses some of the challenges during positioning. We present the Y reverse technique for Y stent insertion using a combination of rigid and flexible bronchoscopy.This retrospective study included 15 consecutive patients, suffering from tracheal‐carina‐lower main bronchi complex, hospitalized at the Thoracic Surgery Unit of the Vanvitelli University of Naples between October 2021 and October 2023. Inclusion criteria: patients in which the length of the stenosis of the right bronchi was greater than that of the left bronchi, advanced oncological conditions, severe respiratory failure; exclusion criteria: Karnofsky scale with <40 points. All patients were admitted to the hospital and treated with Y‐stent insertion using the modified technique Y reverse.The comparison between the group undergoing the Y reverse technique with the group undergoing the traditional positioning of the Y prosthesis has shown an improvement in respiratory function; prolongation of the mean survival time; improvement in SpO2 in spontaneous breathing; reduction mean time procedure. p < 0.05 was considered as statistically significant.Y Reverse is a safe and effective procedure that provides rapid symptom relief in individuals who have critical central airway obstruction near the distal portion of the trachea, carina, and main right and left bronchi. [ABSTRACT FROM AUTHOR]

Background: The majority of the patients with a solitary fibrous tumor (SFT) of the pleura are asymptomatic, and rupture of an SFT with hemothorax is rare. Case presentation: A 48-year-old man was taken by ambulance to our hospital because of sudden onset of left chest pain. Two months before the referral, a tumor was detected in the left upper lobe of the lung by screening computed tomography at another hospital, and further observation was recommended, because the tumor was suspected to be benign. Our contrast-enhanced computed tomography analysis of the chest revealed a solid tumor (5 cm in diameter) with an irregular enhancement effect close to the pericardium and pleural effusion in the left thoracic cavity. Pleural effusion was not detected in the previous imaging analysis. CT number of the pleural effusion was 40 HU, and the pleural effusion was suspected to be hematogenous. Therefore, rupture of the tumor with bleeding was suspected as the cause of the effusion because of the sudden onset. Preoperative diagnosis was a mediastinal tumor, such as a teratoma, because the tumor was close to the pericardium. Thoracoscopic surgery was performed with the patient in the right lateral decubitus position; bloody pleural effusion was observed and drained. The tumor originated from the visceral pleura of the left upper lobe of the lung and was resected with a surgical stapler. Macroscopic analyses of the resected tumor indicated that bleeding were caused by the rupture of the tumor at the defect of the capsule wall. The operation took 63 min. The postoperative pathological diagnosis was a benign SFT. Hemorrhage was observed just under the capsule wall of the tumor. The postoperative course of the patient was uneventful, and he was discharged 2 days after surgery. Conclusions: Even when an SFT is neither huge nor malignant, rupture can occur, and resection should be considered regardless of the size or malignant characteristics. After an SFT rupture, careful follow-up is needed to monitor for the intrathoracic recurrence or dissemination of the tumor. [ABSTRACT FROM AUTHOR]

The success of deep learning (DL) relies heavily on training data from which DL models encapsulate information. Consequently, the development and deployment of DL models expose data to potential privacy breaches, which are particularly critical in data-sensitive contexts like medicine. We propose a new technique named DiffGuard that generates realistic and diverse synthetic medical images with annotations, even indistinguishable for experts, to replace real data for DL model training, which cuts off their direct connection and enhances privacy safety. We demonstrate that DiffGuard enhances privacy safety with much less data leakage and better resistance against privacy attacks on data and model. It also improves the accuracy and generalizability of DL models for segmentation and classification of mediastinal neoplasms in multi-center evaluation. We expect that our solution would enlighten the road to privacy-preserving DL for precision medicine, promote data and model sharing, and inspire more innovation on artificial-intelligence-generated-content technologies for medicine. [ABSTRACT FROM AUTHOR]

A 41 year old female with stage 5 chronic kidney disease undergoing hemodialysis was admitted to the hospital. Chest CT scan revealed a large mass lesion of approximately 6.0 × 3.5x4.9 cm in size in the anterior superior mediastinum and a ground glass nodule in the upper lobe of the right lung, which increased in size from 9 × 7 mm 1 year and 9 months ago to 11mmx9mm before surgery. We designed a localization method to accurately locate the pulmonary nodule and successfully performed thoracoscopic minimally invasive resection of both thymoma and lung cancer through a subxiphoid approach with the same incision for this patient. With the support of perioperative hemodialysis, the patient's outcome is good. The pathological diagnosis of the anterior mediastinal mass is thymoma (b1 type), and the pathological diagnosis of the right upper lobe nodule is invasive lung adenocarcinoma (acinar type). This report describes the diagnosis and treatment process of the case. [ABSTRACT FROM AUTHOR]

Background: Thymic pathologies represent the most common lesions of the anterior mediastinum. They may be classified as malignant or benign. Current diagnostic pathways recommend an initial assessment with computed tomography (CT) imaging to delineate potentially malignant thymic lesions. Despite this, high rates of non-therapeutic thymectomy continue to be observed. This carries with it significant anaesthetic, operative, and post-operative risks, in addition to healthcare costs. Consequently, there is a growing interest in magnetic resonance imaging (MRI) as a primary diagnostic modality for lesions of the anterior mediastinum. This narrative review outlines the current approaches to the evaluation of thymic lesions, with a discussion of the strengths and limitations of CT and MRI imaging modalities. It also evaluates the current discourse on the use of upfront MRI for thymic and anterior mediastinal lesion assessment. Methods: A narrative review was performed following a search on the Medline database. Articles that were evaluated had explored the role of MRI on the evaluation of thymic and anterior mediastinal lesions. Results: Current work-up for thymic and anterior mediastinal lesions are highly variable and centre around the use of CT. Upfront MRI demonstrates a similar accuracy to CT for various thymic and anterior mediastinal pathologies; however, the efforts to integrate this approach into routine practice remain in their infancy, with no standardised guidelines that exist. Conclusions: This narrative review demonstrates that there is a paucity of evidence relating to the sensitivity and specificity of MRI compared to CT for thymic lesion analysis and their subsequent relationship with non-therapeutic thymectomy. Future prospective trials to assess the role of MRI in thymic lesion determination are required to understand whether MRI can more accurately characterise these lesions to reduce non-therapeutic thymectomy. Additionally, further research efforts are required to characterise best-practice methods for integrating MRI into diagnostic pathways for these lesions in a cost-effective and resource-conscious manner. [ABSTRACT FROM AUTHOR]

Background: Pleuropulmonary Blastoma (PPB) is an extremely uncommon, highly aggressive tumor that arises from either the lungs or pleura. According to Dehner, PPB was classified into three groups: type I (cystic), type II (mixed), and type III (solid). Type I tends to occur more commonly in infants and has a more favorable prognosis compared to types II and III. This tumor is very rare in pediatric age group; hence, there is no consensus on the optimal treatment regimen for it to date. Type I tumors, which resemble congenital lung cysts, can eventually progress to more aggressive type II and type III tumors. This article aims to increase general awareness of this pathology, clinical presentation, and differential diagnosis in order to identify this rare entity early in its course. By presenting 4 such cases, we highlight that PPB can be missed early in diagnosis and it is important to be alert when putting this rare tumor in differential diagnosis of cystic lung lesions. Methods: A retrospective study was conducted between 2015 and 2020 involving patients who had a definitive diagnosis of PPB with emphasis on clinical presentation, preoperative imaging studies, intra-operative findings, pathological reports, ancillary treatment, and outcomes. All patients were followed up every 6 months to monitor local recurrence and distant metastasis by undergoing physical exam and non-contrast enhanced CT of the chest. The primary outcome is to identify the mortality and morbidity (recurrence and distant metastasis) of PPB for cases admitted in our institute. Results: Four children were diagnosed with PPB during the study period. Clinically, patients presented with manifestations ranging from respiratory distress, fever to obstructive shock and radiologically, 2 cases were presented with mediastinal mass and the other 2 presented with pneumothorax. Regrettably, none of the cases were diagnosed pre-operatively. One lesion proved to be type I, 2 were type II and one was type III. All cases underwent chemotherapy using the combination of vincristine, Adriamycin and cyclophosphamide (VAC regimen). Recurrence was detected in a type II case, around 2 years after operation, and the other type II case developed brain metastasis that was discovered 3 years after operation. Type I case showed no local or distant metastasis. Conclusion: A prompt preoperative diagnosis and workup of cases of PPB is crucial to enable optimal intervention intraoperatively and early postoperative treatment. Though it is uncommon, PPB should be considered in the differential diagnosis of cystic lung lesions. [ABSTRACT FROM AUTHOR]

Leiomyosarcoma is a soft‐tissue sarcoma that accounts for less than 1% of all malignant tumors. Furthermore, leiomyosarcoma accounts for 6% of all soft tissue sarcomas, and leiomyosarcoma of azygos vein origin is extremely rare. In this report, we describe a case of leiomyosarcoma derived from an azygos vein that was completely resected. A 78‐year‐old male patient was incidentally found to have a mediastinal mass during a computed tomography (CT) scan performed for the evaluation of prostate cancer. Bronchoscopic needle biopsy revealed the mass to be a leiomyosarcoma. Preoperative contrast‐enhanced CT demonstrated a filling defect in the azygos vein, suggesting the tumor's origin from this structure. Video‐assisted thoracoscopic surgery (VATS) was performed to resect the mediastinal tumor. The tumor was found to have minimal adhesions to surrounding tissues and no evidence of local invasion, although findings suggested it originated from the azygos vein. Consequently, en bloc resection of the azygos vein was performed. Postoperative histopathological examination confirmed the diagnosis of leiomyosarcoma originating from the azygos vein, and complete resection was performed. [ABSTRACT FROM AUTHOR]

Background: Large mediastinum tumors invading the thoracic outlet have consistently been a challenge in thoracic surgery. Due to the large size of the tumor and its proximity to many important tissues, appropriate surgical approaches are crucial for a successful surgery. Case presentations: Here, we present a case of a large neurilemmoma that invaded the thoracic outlet that was resected by a supraclavicular-median sternotomy approach. The case was a 58-year-old woman with a large mass in the right chest cavity that had invaded the thoracic outlet. The preoperative biopsy showed a blood clot with a few fibrous connective tissues covered by a single layer of flat epithelium. There was insufficient evidence to diagnose the mass as a tumor, and imaging examinations suggested a diagnosis of solitary pleural fibroma. For good exposure of the cranial and caudal aspects of the large mass, we devised a median sternotomy combined with a supraclavicular approach and safely achieved complete resection. The patient recovered well and experienced no severe complications or functional restrictions of the upper extremity. The postoperative pathology diagnosis was a neurilemmoma. Conclusions: The supraclavicular-median sternotomy approach could be an optional approach for the complete resection of large mediastinal tumors invading the thoracic outlet. [ABSTRACT FROM AUTHOR]

Gonadotropin-releasing hormone (GnRH(-independent premature puberty in boys, characterized by elevated β-human chorionic gonadotropin (β-hCG) levels, can indicate a secreting germ cell tumor (GCT). These tumors are rare but more common in individuals with Klinefelter syndrome (KS). We present a case of a 7.3-year-old boy with precocious puberty. Physical examination revealed bilateral testicular volumes of 8 to 10 mL and Tanner stage 3 secondary sexual characteristics (genitalia G3, pubic hair P3). His skeletal age was 12 years. Biochemical tests showed suppressed gonadotropin levels, elevated testosterone, and increased β-hCG of 86.6 mIU/mL (86.6 IU/L, reference range: <5 mIU/mL, <5 IU/L). Imaging, including magnetic resonance imaging (MRI), chest x-ray, whole-body computed tomography (CT), and testicular ultrasound, were interpreted as normal except for a small pineal cyst. Karyotype testing confirmed KS. Over 10 months, β-hCG levels fluctuated between 1 to 105 mIU/mL (1-105 IU/L). When β-hCG was 3.6 mIU/mL (3.6 IU/L), a fluorodeoxyglucose positron emission tomography–CT (FDG PET-CT) scan revealed a mediastinal tumor. The tumor was surgically removed and identified as a mature teratoma. This case underscores the importance of karyotype testing and repeated imaging in boys with premature puberty and elevated β-hCG levels, even if β-hCG levels decrease spontaneously and remain low. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present study was to evaluate the efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for the treatment of patients with mediastinal tumors of different body mass indices (BMI). Methods: A retrospective cohort study was used to collect 260 patients with mediastinal tumors admitted to three medical centers in China from December 2020 to March 2024. These patients underwent mediastinal tumor resection by RATS (n = 125) or VATS (n = 135). Propensity score matching (PSM) analysis was performed for the both groups, and further, the patients were divided into the N-BMI group (18.5 kg/m2 ≤ BMI < 25 kg/m2) and the H-BMI group (BMI ≥ 25 kg/m2) based on their BMI to compare patients' surgery-related information. Results: The RATS group had more advantages than the VATS group in terms of intraoperative blood loss, total postoperative drainage, postoperative drainage time, and postoperative hospital stay. As for hospitalization costs, the VATS group was more advantageous. In the H-BMI group, subgroup analysis showed a statistically significant difference in shorter operative time and lower incidence of postoperative complications in the RATS group. Conclusion: RATS has technical and short-term efficacy advantages in comparison with VATS, although it has the drawback of high costs associated with the treatment of mediastinal tumors. In the patients with mediastinal tumors of H-BMI, RATS can achieve better short-term outcomes and safety, especially in the reduction of the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

ABSTRACT Medullary thyroid carcinoma (MTC) is an uncommon neuroendocrine tumour that is usually asymptomatic at its onset and therefore may not present clinically until the patient has developed advanced or metastatic disease. Common metastatic sites include cervical lymph nodes, liver, bone and lung. This is the case of a patient who presented with an incidental posterior mediastinal mass. Because the posterior mediastinum is an unusual location for MTC, MTC was not a consideration and preliminary histopathological testing did not include calcitonin, which would have been diagnostic. This case highlights the importance of testing for calcitonin more regularly when encountering a mass of unknown origin with neuroendocrine morphology, which may lead to earlier detection of MTC and thus improved prognosis. [ABSTRACT FROM AUTHOR]

Background: Thymomas complicated with myasthenia gravis are conventionally treated during thoracic surgery. Particularly, invasive thymomas are resected alongside the surrounding organs. Here, we present a case where surgical and perioperative management was performed under the presumption of thymoma with myasthenia gravis. However, definitive pathology revealed the co-occurrence of B3 thymoma and thymic squamous cell carcinoma. This case highlights the unique presentation and exceptional rarity of thymomas that are complicated by myasthenia gravis and thymic carcinoma. Case presentation: A 65-year-old female presented with eyelid ptosis at our hospital. Following a comprehensive examination, the patient was diagnosed with myasthenia gravis. Her computed tomography (CT) scan revealed an anterior mediastinal tumor suggestive of a thymoma, prompting a referral to the Department of Thoracic Surgery. Moreover, preoperative assessment could not definitively exclude pericardial invasion. She subsequently underwent an extended thymectomy via a longitudinal sternal incision. The tumor exhibited partial invasion of the pericardium, necessitating resection and reconstruction. Definitive pathological examination confirmed the co-occurrence of B3 thymoma and thymic squamous cell carcinoma. Positive lymph node metastasis classified the patient as stage IVa according to the Union for International Cancer Control (UICC) TNM Classification of Malignant Tumors, 8th Edition, and she was started on adjuvant radiotherapy postoperatively. Currently, the patient remains under observation, with follow-up CT scans showing no signs of recurrence. Conclusions: This report describes an extremely rare case of thymoma complicated with myasthenia gravis and thymic squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Adult-onset immunodeficiency (AOID) mediated by anti-interferon-γ autoantibodies (AIGA) is a rare condition, particularly prevalent in Southeast Asia and southern China. We present a case study of a 62-year-old female with AOID who developed a severe pulmonary infection caused by Talaromyces marneffei (TM), leading to acute respiratory failure, generalized rash, multiple lymphadenopathies, bone destruction, and a mediastinal mass. Treatment included mechanical ventilation, antifungal medication, and corticosteroids, resulting in complete recovery and discharge. This case underscores the challenges of managing complex infections in AOID patients and highlights the importance of early diagnosis through metagenomic next-generation sequencing (mNGS) and appropriate intervention to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating mediastinal tumors. In equivocal cases, cine magnetic resonance imaging (cine-MRI) and magnetic resonance imaging (MRI)/T1-weighted spin echo sequences (T1TSE) may be additionally performed. We retrospectively analyzed patients undergoing surgical resection of mediastinal tumors (benign and malignant) with prior CT, cine-MRI, and T1TSE for (re-)evaluation and comparison to the intraoperative findings and postoperative histology reports, which were defined as a gold standard. Unclear CT cases were further investigated. A total of 47 patients were included in the study. Cine-MRI is of crucial benefit in unclear CT findings compared with T1TSE, especially when infiltration into the large central vessels and atria is suspected. Background/Objectives: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating the extent of mediastinal tumors. If tumor infiltration into the large central thoracic vessels, the pericardium, or the myocardium is suspected, cine magnetic resonance imaging (cine-MRI) can provide additional valuable information. Methods: We conducted a retrospective study of patients with mediastinal tumors who were staged with CT, cine-MRI, and a T1-weighted turbo spin echo (T1TSE) prior to surgical resection. Imaging was re-evaluated regarding tumor infiltration into the pericardium, myocardium, superior vena cava, aorta, pulmonary arteries, and atria and compared with intraoperative findings and postoperative histopathological reports (gold standard). Unclear CT findings were further investigated. Results: Forty-seven patients (29 female and 18 male patients; median age: 58 years) met the inclusion criteria. Cine-MRI was able to predict infiltration of the aorta in 86%, pulmonary arteries in 85%, and atria in 80% of unclear CT cases. Aortic tumor infiltration in unclear CT cases was significantly more often correctly diagnosed with cine-MRI than with T1TSE sequence. Conclusions: Additional cine-MRI is of crucial benefit in unclear CT cases. We recommend performing cine-MRI if infiltration into the large central vessels and atria is suspected. T1TSE sequence is of very limited additional value. [ABSTRACT FROM AUTHOR]

Background: Video-assisted thoracic surgery (VATS) is widely used for thoracic lesions in pediatric patients. VATS is also applied to pediatric mediastinal tumors if there is no adhesion or invasion between the tumor and adjacent neuronal and cardiovascular structures. Here, we present a pediatric case of mediastinal teratoma in which the tumor adhered to the superior vena cava, and resection was safely completed using assisted VATS, an integrated surgical approach comprising mini-thoracotomy with video assistance. Case presentation: A 9 year-old girl presented with right shoulder pain. Chest radiography and computed tomography revealed a 5.4 × 5.1 × 5.8 cm mass in the right upper anterior mediastinum. She was presumed with a mature teratoma, and resection was performed by assisted VATS with muscle sparing axillar skin crease incision (MSASCI) for a mini-thoracotomy. The procedure was safely completed, with the patient discharged on postoperative day 5. At 1 year postoperatively, there was no recurrence with excellent motor and cosmetic results. Conclusions: The combination of MSASCI and VATS would be useful not only for mediastinal teratomas but also for other mediastinal tumors and almost all other thoracic lesions in pediatric patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES The da Vinci single-port system is a novel robotic system that has gained popularity and demonstrated favourable outcomes in various surgical fields. Nevertheless, its application in thoracic surgery is relatively rare. In this study, we report our initial experiences with the da Vinci single-port system via a subxiphoid approach in patients with an anterior mediastinal mass. METHODS We retrospectively reviewed patients with an anterior mediastinal mass who underwent surgery using the da Vinci single-port system via a subxiphoid approach between October 2020 and April 2024. Clinicopathological, intraoperative, and postoperative data were retrospectively collected. RESULTS A total of 14 patients were included in this study. The median age was 55 years (interquartile range 48–62 years), with 4 (28.6%) patients being male. All patients underwent complete resection without conversion to multiport or open surgery. The median operation time was 135 min (interquartile range 113–155 min). Nine (64.3%) patients were diagnosed with thymoma, and 2 (14.3%) patients had myasthenia gravis. The median pathologic size of the mass was 32.5 mm (interquartile range 25.3–38.0 mm), and the median peak Numerical Rating Scale score was 3 (interquartile range 2–4). The median duration of chest drainage and hospital stay were 2 (interquartile range 1–3) and 3 (interquartile range 2–3) days, respectively. No complications were reported following surgery. CONCLUSIONS The da Vinci single-port system for anterior mediastinal mass was deemed safe and feasible. To expand indications in thoracic surgery, further accumulation of experience and additional technological advancements are necessary. [ABSTRACT FROM AUTHOR]

Objective: To compare the application effects of thoracoscopic assisted anterior mediastinal tumor resection by lateral thoracic approach or subxiphoid approach. Methods: According to the random number table method, 115 patients undergoing thoracoscopic assisted anterior mediastinal tumor resection were divided into group A (n=57, lateral thoracic approach) and group B (n=58, subxiphoid approach). The perioperative related indexes, stress response indexes and inflammatory factors were compared between two groups, and the occurrence of postoperative complications was observed. Results: Compared with group A, group B had longer operation time, less intraoperative blood loss and postoperative drainage volume, shorter postoperative hospital stay and drainage tube indwelling time (P<0.05). 1 day after operation, neuropeptide Y (NPY), 5-hydroxytryptamine (5-HT), substance P (SP) and prostaglandin E2 (PGE2) in two groups increased, but group B were lower than those of group A (P<0.05). 1 day after operation, C-reactive protein (CRP), white blood cell count (WBC) and neutrophils increased in two groups, but group B were lower than those of group A (P<0.05). The total incidence of complications in group A was 12.28%, and that in group B was 6.90%, there was no difference between two groups (P>0.05). Conclusion: During thoracoscopic assisted anterior mediastinal tumor resection, although the subxiphoid approach takes longer than the lateral thoracic approach, which can reduce intraoperative injury, reduce stress response and inflammatory response, and promote postoperative recovery. [ABSTRACT FROM AUTHOR]

Mediastinal masses originate from the structures of the mediastinum or neck organs and can represent primary benign or malignant tumors, as well as metastases. In most cases, they are detected through radiological imaging, such as an X-ray of the enlarged mediastinum. In the differential diagnostic approach, the acronym “the terrible T” (thymoma, teratoma, terrible lymphoma, and thyroid) is useful. A retrosternal goiter with its compressive effect can lead to changes in the voice, difficult speaking, tracheal compression, and potentially superior vena cava syndrome. Additionally, visualization techniques, thyroid hormones, and tumor markers can be helpful in the diagnostic process. We presented a patient who, during a meal, stopped eating, lost consciousness, and experienced asystole. Due to a chest injury sustained during resuscitation, a computerized tomography (CT) scan was performed. The CT scan revealed a nodular formation in the right lobe of the thyroid gland that extends through the upper thoracic aperture behind the sternum, exerting a pronounced compressive effect on the trachea. Based on the examination, it was concluded that the patient has a goiter with retrosternal and mediastinal extension, accompanied by thyrotoxicosis, which was most likely induced by the iodine contrast agent. Thyrostatic therapy was initiated, followed by surgical treatment of the retrosternal goiter. Computed tomography is the most accessible form of imaging for preoperative assessment of goiter position and its extent, while surgery remains the gold standard for treating symptomatic retrosternal goiters. [ABSTRACT FROM AUTHOR]

Herein, we report a case of a 16-year-old girl who presented with an episode of shortness of breath while playing sports. Upon radiologic workup, she was found to have a large multicystic anterior mediastinal mass. The cystic appearance of mass and lack of constitutional symptoms contributed to favoring a benign cystic process and deferring surgical resection until the end of sport season. When surgery was performed 3 months later, microscopic examination showed findings diagnostic of classic Hodgkin lymphoma arising in a thymic cyst. Despite the rarity of such cases, it is important to remember that the cystic nature of an anterior mediastinal mass does not exclude lymphoma. Definitive diagnosis is not possible without examination of representative tissue. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of the present study was to evaluate the efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for the treatment of patients with mediastinal tumors of different body mass indices (BMI). Methods A retrospective cohort study was used to collect 260 patients with mediastinal tumors admitted to three medical centers in China from December 2020 to March 2024. These patients underwent mediastinal tumor resection by RATS (n = 125) or VATS (n = 135). Propensity score matching (PSM) analysis was performed for the both groups, and further, the patients were divided into the N-BMI group (18.5 kg/m2 ≤ BMI

A 39-year-old woman originally from Northeast Africa sought medical attention for positional dyspnea. Computed tomography of the chest revealed an 8.5 cm hypodense anterior mediastinal mass with peripheral calcifications that raised a wide differential diagnosis including infectious and neoplastic lesions. Following surgical resection, a large cavitary necrotizing and calcified granuloma involving the thymus was identified on histopathological examination. The changes were associated with parasitic eggs that based on their morphology suggested infection due to trematode species. The diagnosis was further corroborated by identification of the increased IgG titers for Schistosoma species (ELISA Kit, NovaTec). The patient's symptoms improved following surgery and praziquantel therapy. This unique presentation emphasizes an unusual manifestation of schistosomiasis that can pose a diagnostic challenge, especially in non-endemic regions. It suggests that mediastinal involvement by schistosomiasis is likely due to an ectopic deposition of the parasitic eggs within a definitive host. Suspicion for schistosomiasis should be heightened based on patient demographics and travel to endemic areas. [ABSTRACT FROM AUTHOR]

Background: Giant anterior mediastinal masses in infants are one of the most challenging cases faced in pediatric anesthesia practice. They can pose unique challenges for resection such as cardiovascular collapse on induction of anesthesia and injury to surrounding structures that maybe compressed or displaced. Principles that must be followed and kept in mind during removal of giant mediastinal mass include appropriate diagnostic imaging to define mass extent, airway control during induction, a multidisciplinary team approach including cardiothoracic for sternotomy, cannulation to institute cardiopulmonary bypass, otolaryngology for rigid bronchoscopy, preservation of neurovascular structure, and complete resection whenever possible. Our patient had a mass that weighed twice his whole body weight. Case presentation: Here we present a 3-month-old Middle Eastern infant weighing 3.2 kg with a large congenital teratoma who presented to the emergency room with cyanosis and respiratory distress. During his hospital course, he underwent three procedures, two of them under light-to-moderate sedation: a diagnostic computer tomography scan followed by mass content drainage by interventional radiology (Figs. 1, 2). On the third day, he had a thoracotomy with complete tumor resection under general anesthesia with the help of an epidural for pain control (Fig. 3). The resected tumor weighed 2.5 kg, which was equal to twice the patient's total body weight (Fig. 4). After the surgery, he was extubated in the operating room and discharged home 3 days later. Conclusion: Anterior mediastinal mass patients can be challenging for the anesthesiologist. They need meticulous thorough perioperative assessment to determine the extent of compression on major intramediastinal structures and to predict the complications. Planning by multidisciplinary team and discussion with the family is important. These types of cases should be preferably operated on by an experienced team in a well-equipped operation room in tertiary care institutes. [ABSTRACT FROM AUTHOR]

Background: Cholesterol granuloma (CG) is a benign entity characterized by the presence of cholesterol crystals and foreign body giant cells. This condition can be attributed to cholesterol crystals that are deposited in the tissues and react with foreign body giant cells, resulting in granuloma formation. Lesions commonly develop in the otolaryngeal region, such as the middle ear. However, crystals rarely form in the thymus, accounting for 1% of all mediastinal tumors. Herein, we present five cases of mediastinal CG. Case presentation: The patients were aged 49–61 (mean, 55.4) years. Among them, three were men and two women. One patient had fever, and four patients were asymptomatic. The patients' lesions were detected during follow-up of other diseases or medical examinations showing the presence of abnormal chest shadows. The patients did not have a history of trauma or surgery. All lesions were located within the thymus gland. Three patients presented with multifocal lesions and two with a single lesion. Four patients had contrast effect on computed tomography scan. Four patients had abnormal fluorodeoxyglucose accumulation (mean maximum standardized uptake value, 4.67) on positron emission tomography-computed tomography. Four patients underwent complete surgical resection. The size of the resected lesions ranged from 1.8 to 5.1 (mean, 3.24) cm. Histologically, all patients presented with small nodules with cholesterol clefts and foreign body giant cells and histiocyte infiltration within the thymic tissue. The postoperative course was excellent. None of the patients who underwent complete resection presented with recurrence. Moreover, the patient who underwent partial resection did not have lesion enlargement. Conclusions: CG in the thymus is clinically challenging to differentiate from malignant lesions, and histologic diagnosis via surgical resection is required. [ABSTRACT FROM AUTHOR]

Background: The characterization of pathologically enlarged mediastinal lymph nodes is clinically essential for effective disease management and accurate prognosis. Malignancy (metastases and lymphoma) and granulomatous conditions (sarcoidosis and tuberculosis) are the most common causes. Magnetic resonance imaging (MRI) is a good modality to characterize the mediastinal pathologically enlarged lymph nodes based on the excellent soft tissue contrast. It can save high-risk patients from radiation exposure and hazards of intervention such as general anesthesia and biopsy. Aim of the work: To estimate the accuracy of different advanced MRI quantitative parameters in the differentiation between benign and malignant mediastinal lymphadenopathy. This would involve the lesion-to-cord signal intensity ratio (SIR) in the T2-WI and diffusion weighted image (DWI), the lesion-to-chest wall muscle SIR in T2-WI and DWI, and the mean apparent diffusion coefficient (ADC) values. These values would be correlated with the prospective pathological data and the results of the positron emission tomography (PET-CT). Results: Prospectively, the study was conducted during the period between June 2022 and September 2023 on 45 patients with indeterminate or suspicious mediastinal lymphadenopathy identified by CT. MRI examination, PET-CT, and biopsy were applied for all patients. The intra-class correlation coefficient ranged between 0.89 and 0.95. (A) The lesion-to-cord SIR in T2-WI in the malignant group (1.49 ± 0.30) was higher than that in the benign group (0.83 ± 0.24) with P < 0.001. The statistically calculated cutoff value (> 1.2) estimated 90% sensitivity, 100% specificity, with AUC = 0.989. (B) The lesion-to-chest wall muscle SIR in T2-WI in malignant nodes (3.13 ± 0.84) was significantly higher than that in the benign nodes (1.90 ± 0.80) with P < 0.001. The statistically calculated cutoff value (> 2.4) estimated 86.67% sensitivity, 86.67% specificity, with AUC = 0.88. (C) The lesion-to-cord signal SIR in b500-DWI in the malignant node (1.80 ± 0.54) was higher than that in the benign group (0.75 ± 0.29) with P < 0.001. The statistically calculated cutoff value (> 1.2) estimated 100% sensitivity and specificity with AUC = 1.00. (D) The lesion-to-chest wall SIR in b500-DWI in the malignant node (6.43 ± 1.28) was higher than that in the benign node (2.63 ± 0.94) with P < 0.001. The statistically calculated cutoff value (> 4.1) estimated 96.67% sensitivity, 100% specificity, with AUC = 0.997. € The mean ADC values in the malignant nodes (0.83 ± 0.20 × 10–3 mm2/s) were significantly lower than that in the benign nodes (1.85 ± 0.19 × 10−3 mm2/s) with P < 0.001. The statistically calculated cutoff value (≤ 1.2) estimated 100% sensitivity and specificity with AUC = 1.00. Conclusions: Biopsy remains the main diagnostic modality for the characterization of mediastinal lymphadenopathy despite its hazards and limitations. This study proved that MRI could be accepted as an alternative non-invasive imaging tool that can overcome the PET-CT limitations. The lesion signal-to-cord and to-muscle ratios in both T2-WI and DWI-MRI side by side with the mean ADC value showed high statistical accuracy. [ABSTRACT FROM AUTHOR]

Purpose: An accurate diagnosis of thymic malignancies is important, but challenging due to the broad range of differential diagnoses. This study aims to evaluate the efficacy of PET/CT and tumor markers for diagnosing thymic malignancies. Methods: Patients admitted to our department between January 2012 and December 2021 with primary anterior mediastinal tumors were retrospectively evaluated. We evaluated the relationship between the maximum standardized uptake value (SUVmax), tumor markers, and pathological diagnosis in four groups: thymic carcinoma, thymoma, lymphoma, and others. Results: In total, 139 patients were included in this study. The SUVmax was significantly higher in lymphoma, thymic carcinoma, and thymoma, in that order. The cytokeratin 19 fragment (CYFRA 21-1) was significantly higher in thymic carcinoma than in the other groups. An ROC curve analysis indicated that the optimal cut-off values of SUVmax for thymic carcinoma plus lymphoma and CYFRA 21-1 for thymic carcinoma were 7.97 (AUC = 0.934) and 2.95 (AUC = 0.768), respectively. Using a combination of cut-off values (SUVmax = 8, CYFRA 21-1 = 3), the accuracy rate for diagnosing thymic carcinoma was 91.4%. Conclusions: The SUVmax and CYFRA 21-1 levels are significant indicators for the diagnosis of thymic carcinoma. Combining these indicators resulted in a more accurate diagnosis of thymic malignancies, which could facilitate the decision-making process for determining the optimal treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical features of thymoma with and without myasthenia gravis (MG). Methods: This was a retrospective study. Two hundred and thirty-three patients with mediastinal masses who were initially diagnosed in People’s Hospital of Shijiazhuang, China, between January 2014 and June 2022 and had complete clinical data and underwent surgical treatment at People’s Hospital of Shijiazhuang were retrospectively analyzed. Result: The age of patients with thymoma alone was significantly older than that of thymoma patients complicated with MG. The number of female patients was slightly more than males for both groups. Proportions of type A, AB, B1, B2, and B3 thymomas in Group-A were 0.77, 11.54, 11.51, 33.85, and 31.54%, respectively, and the proportions in Group-B were 9.68, 22.58, 12.90, 32.26, and 22.58%. The size of tumors in patients with thymoma alone was larger than that of patients with thymoma complicated with MG. The proportion of patients with tumor size of more than 10 cm in the thymoma alone group was significantly higher than that in the MG group. There were no relapses in patients with type A disease and relapses were noted in a few patients with type B1, B2 and B3 diseases. The same survival rates were reported for the two groups. Conclusion: MG rarely occurs in type A and type C diseases. The prognosis of thymoma with MG is similar to that of thymoma alone. The main causes of death may be myasthenia crisis in thymoma patients with MG and advanced tumor stage in patients with thymoma alone. [ABSTRACT FROM AUTHOR]

This document provides summaries of various articles on gastrointestinal pathology. The first article discusses the potential use of the TTF1 protein in diagnosing autoimmune gastritis, but further research is needed to confirm these findings. The second article presents a case study demonstrating the usefulness of next-generation sequencing in diagnosing a pancreatic spindle cell lesion. The third article reports a rare case of synchronous leiomyosarcomas in the stomach and large bowel. The fourth article explores the incidental findings of pancreatic acinar tissue in gastric biopsies, suggesting it may be a benign subtype of pancreatic heterotopia. The final article presents a case of ileocaecal valve diverticular disease with pulse granuloma as a possible alternative diagnosis for Crohn's disease. Additionally, the document includes rare cases of gastrointestinal tumors, providing insights into their clinical presentation and management. [Extracted from the article]

While excision for parathyroid cysts remains as the standard of management, surgical approach in the context of massive cervicomediastinal parathyroid cysts can be challenging. We report a rare giant parathyroid cyst in anterior mediastinum successfully resected from a simple standard Kocher's collar incision. Various surgical approach will also be deliberated. [ABSTRACT FROM AUTHOR]

Background: Malignant neoplasms originating from or involving the mediastinum represent a diagnostic and therapeutic challenge when they are in contact with nearby cardiovascular structures. We aimed to test the diagnostic accuracy of cine-magnetic resonance imaging (cine-MRI) in detecting the infiltration of cardiovascular structures in cases with uncertain or equivocal findings from contrast-enhanced Computed Tomography (CT) scanning. Methods: Fifty patients affected by tumors with a suspected invasion of mediastinal cardiovascular structures at the pre-operative chest CT scan stage underwent cine-MRI before surgery at our Institution. Intraoperative findings and the histological post-surgical report were used as a reference standard to define infiltration. Inter- and intra-observer agreement for CT scans and cine-MRI were also computed over a homogenous sample of 14 patients. Results: Cine-MRI had a higher negative predictive value (93% vs. 54%, p < 0.001) than CT scans, higher sensitivity (91% vs. 16%, p < 0.001), as well as greater accuracy (66% vs. 50%, p < 0.001) in detecting cardiovascular invasion. Cine-MRI also showed better inter- and intra-observer agreement for infiltration detection. Conclusions: Cine-MRI outperforms conventional contrast-enhanced chest CT scans in the preoperative assessment of cardiovascular infiltration by mediastinal or pulmonary tumors, making it a useful imaging modality in the preoperative staging and evaluation of patients with equivocal findings at the chest CT scan stage. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This article reports a case of mediastinal lymph node tuberculosis with no obvious symptoms and a concealed focus. This patient, a 33‐year‐old male, suffered from pain behind the sternum after eating. He underwent three gastroscopic examinations and two fine needle punctures guided by ultrasound gastroscopy but was not diagnosed. Chest‐enhanced CT revealed a mediastinal mass compressing the adjacent esophagus, suggesting the possibility of enlarged lymph nodes. Furthermore, T cells from patients infected with tuberculosis tested positive. Ultrasound bronchoscopy revealed enlarged lymph nodes in area 7, and then EBUS‐TBNA was performed in that region. Only a few scattered lymphocytes and necrotic tissue were found under the biopsy microscope. The EBUS‐TBNA biopsy Xpert MTB/RIF showed low positive results, and the EBUS‐TBNA puncture fluid Xpert MTB/RIF was positive. Therefore, he was diagnosed with mediastinal lymph node tuberculosis. After antituberculosis treatment with the 2HREZ/10HRE regimen, the patient's pain behind the sternum gradually alleviated, and the enlarged mediastinal lymph nodes gradually narrowed. [ABSTRACT FROM AUTHOR]

Myocardial revascularization in patients presenting with an anterior mediastinal mass poses considerable challenges. In this report, we outline two cases involving patients with anterior mediastinal masses who underwent surgical resection alongside concurrent myocardial revascularization. One patient underwent coronary artery bypass graft surgery, while the other was treated by percutaneous coronary intervention with drug‐eluting stent placement. Both patients fully recovered from the relative procedures and were discharged within two weeks post‐surgery, ultimately diagnosed with thymoma. The concomitant intervention offered the advantage of promptly addressing both conditions, and it was performed safely through a collaborative multidisciplinary effort. [ABSTRACT FROM AUTHOR]

Context.--: Nuclear protein in testis (NUT) carcinoma is an aggressive carcinoma defined by NUTM1 gene rearrangement. Diagnostic challenges include morphologic overlap with poorly differentiated squamous cell carcinoma, small cell carcinoma, thoracic SMARCA4-deficient undifferentiated tumor, and other small round blue cell tumors. Objective.--: To comprehensively study the immunohistochemistry (IHC) features of a large cohort of NUT carcinomas. Design.--: Fifty-seven NUT carcinoma cases were identified from 2012-2022, including 38 thoracic/mediastinal, 13 head and neck/sinonasal, and 6 from other sites. Pathology reports and available slides were reviewed. Comprehensive IHC studies were performed on available cases. Results.--: Keratin stains showed variable positivity and were entirely negative in 15% (8 of 55) of cases. p40 was only positive in 65% (24 of 37) of cases, implying inferior sensitivity when compared to p63 (87% sensitivity, 20 of 23 cases) and other squamous cell markers. Neuroendocrine markers were focally/weakly positive in few cases; however, INSM1 was positive in 54% (7 of 13) of cases, indicating a possible diagnostic pitfall. TTF-1 was mostly negative with focal positivity in 26% (10 of 38) of cases. Occasional CD34 (15%, 3 of 20 cases) and CD99 (21%, 3 of 14 cases) positivity could also cause potential diagnostic confusion. S100, desmin, CD45, and SALL4 were rarely positive. BRG1 and INI1 were retained in all cases. Ki-67 proliferative index was high (median, 60%). PD-L1 was negative in all tested cases. Conclusions.--: This comprehensive IHC study demonstrates the immunohistochemical spectrum of NUT carcinoma. The findings can help narrow the differential diagnosis and recognize potential pitfalls. [ABSTRACT FROM AUTHOR]

Background: Thymomas are thymic epithelial-derived, most common primary anterior mediastinal masses. Nontuberculous mycobacteria (NTM) are species that do not cause leprosy and belong to species outside the Mycobacterium tuberculosis complex. Methods: With the clinical application of targeted next-generation sequencing (tNGS), we promptly confirmed a case of NTM infection combined with NTM infection after thymoma surgery, and we performed a joint literature analysis of the two diseases to improve clinicians' understanding and recognition of lung infections after thymoma surgery. Results: Chest CT of both lungs showed multiple hyperdense shadows. Sputum bacterial culture and characterization detected Neisseria Dryad and Streptococcus Grass Green. The presence of Mycobacterium abscessus infection was confirmed by alveolar lavage fluid sent for second-generation macro gene sequencing. Conclusions: The body's immune function decreases after thymoma surgery. When empirical anti-infection treatment for recurrent pneumonia in the lungs is ineffective, we should be alerted to the possibility of the presence of pulmonary non-tuberculous mycobacterial infection, and next-generation sequencing should be performed promptly to arrive quickly at a diagnosis. [ABSTRACT FROM AUTHOR]

Aim: In cases where standardized maximum uptake (SUVmax) values in positron emission tomography (PET-CT) were not sufficient to differentiate mediastinal lymphadenopathy and masses from malignant or benign, the contribution of Hounsfield unit (HU) values in thorax computed tomography to the diagnosis was evaluated. Material Method: The study was conducted by evaluating the data of 182 patients between 2019 and 2023. HU values on non-contrast thorax computed tomography and PET-CT SUVmax values of biopsied masses and lymph nodes were compared with histopathological diagnoses. Results: Patients, 58 females (31.9%) and 124 males (68.1%), who underwent EBUS were included in the study. Biopsies were taken from 233 stations (199 lymph nodes, 34 masses) from 182 patients. A total of 135 of the biopsies taken from 233 stations were histopathologically malignant and 98 were benign. While PET-CT SUVmax values of cases with benign histopathology were 4.5 ± 3.5, it was 7.6 ± 4.2 in patients with malignant pathology (p< 0.05). The HU value on non-contrast thorax tomography in patients with benign histopathology was 43.1 ± 15.7, and in patients with malignant histopathology it was 40.5 ± 13.7 (p> 0.05). When HU was compared according to lung cancer type, it was found to be significantly higher in non-small cell lung cancer (p=0.035). A weak (r=0.182) positive and significant relationship (p< 0.01) was found between PET-CT values and HU values in thorax computed tomography. Conclusion: While positron emission tomography maintains its importance in the differentiation of mediastinal lymphadenopathy and masses from malignant to non-malignant, it was concluded that HU values in computed tomography are not sufficient to distinguish malignant/non-malignant. [ABSTRACT FROM AUTHOR]

There is no consensus about whether relatively large mediastinal tumors (≥ 5.0 cm) are suitable for video-assisted thoracoscopic surgery (VATS). Therefore, this study aimed to compare the efficacy and safety of intercostal approach VATS for large-sized anterior mediastinal tumors (5.0–10.0 cm) with no invasion to the surrounding tissues and organs. A total of 129 patients with anterior mediastinal tumors who received surgery in our hospital between January 2018 and July 2022 were consecutively enrolled. Patients were divided into 2 groups based on mediastinal tumor diameter: Group A (tumor size between 1.0 and 4.9 cm) and Group B (tumor size between 5.0 and 10.0 cm). The primary endpoints were operation time, blood loss, and postoperative pain, and the secondary endpoints were the volume of drainage, drainage duration, postoperative hospital stay, and postoperative complications. Significant differences were found in the volume of drainage between the two groups (Group A: 218.4 ± 140.6, Group B: 398.9 ± 369.3, P < 0.001). However, no differences were found in operation time, blood loss, drainage duration, postoperative hospital stay and duration of postoperative oral analgesics (P > 0.05). In addition, there existed no significant differences in the postoperative complications. Intercostal approach VATS is regarded as a feasible and safe surgical method for large-sized anterior mediastinal tumors (5.0–10.0 cm) with no invasion to the surrounding tissues and organs. [ABSTRACT FROM AUTHOR]

Intensified systemic chemotherapy has the highest primary cure rate for advanced-stage, classical Hodgkin lymphoma but this comes with a cost of severe and potentially life long, persisting toxicities. With the new regimen of brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone (BrECADD), we aimed to improve the risk-to-benefit ratio of treatment of advanced-stage, classical Hodgkin lymphoma guided by PET after two cycles. This randomised, multicentre, parallel, open-label, phase 3 trial was done in 233 trial sites across nine countries. Eligible patients were adults (aged ≤60 years) with newly diagnosed, advanced-stage, classical Hodgkin lymphoma (ie, Ann Arbor stage III/IV, stage II with B symptoms, and either one or both risk factors of large mediastinal mass and extranodal lesions). Patients were randomly assigned (1:1) to four or six cycles (21-day intervals) of escalated doses of etoposide (200 mg/m2 intravenously on days 1–3), doxorubicin (35 mg/m2 intravenously on day 1), and cyclophosphamide (1250 mg/m2 intravenously on day 1), and standard doses of bleomycin (10 mg/m2 intravenously on day 8), vincristine (1·4 mg/m2 intravenously on day 8), procarbazine (100 mg/m2 orally on days 1–7), and prednisone (40 mg/m2 orally on days 1–14; eBEACOPP) or BrECADD, guided by PET after two cycles. Patients and investigators were not masked to treatment assignment. Hierarchical coprimary objectives were to show (1) improved tolerability defined by treatment-related morbidity and (2) non-inferior efficacy defined by progression-free survival with an absolute non-inferiority margin of 6 percentage points of BrECADD compared with eBEACOPP. An additional test of superiority of progression-free survival was to be done if non-inferiority had been established. Analyses were done by intention to treat; the treatment-related morbidity assessment required documentation of at least one chemotherapy cycle. This trial was registered at ClinicalTrials.gov (NCT02661503). Between July 22, 2016, and Aug 27, 2020, 1500 patients were enrolled, of whom 749 were randomly assigned to BrECADD and 751 to eBEACOPP. 1482 patients were included in the intention-to-treat analysis. The median age of patients was 31 years (IQR 24–42). 838 (56%) of 1482 patients were male and 644 (44%) were female. Most patients were White (1352 [91%] of 1482). Treatment-related morbidity was significantly lower with BrECADD (312 [42%] of 738 patients) than with eBEACOPP (430 [59%] of 732 patients; relative risk 0·72 [95% CI 0·65–0·80]; p<0·0001). At a median follow-up of 48 months, BrECADD improved progression-free survival with a hazard ratio of 0·66 (0·45–0·97; p=0·035); 4-year progression-free survival estimates were 94·3% (95% CI 92·6–96·1) for BrECADD and 90·9% (88·7–93·1) for eBEACOPP. 4-year overall survival rates were 98·6% (97·7–99·5) and 98·2% (97·2–99·3), respectively. BrECADD guided by PET after two cycles is better tolerated and more effective than eBEACOPP in first-line treatment of adult patients with advanced-stage, classical Hodgkin lymphoma. Takeda Oncology. [ABSTRACT FROM AUTHOR]

Objective This study aims to investigate the feasibility and safety of Da Vinci robotic-assisted thoracoscopy for resecting mediastinal tumors in pediatric patients. Methods From November 2020 to June 2023, a total of 80 pediatric patients undergoing mediastinal tumor resection at Wuhan Children's Hospital were randomly assigned into two groups, with each group consisting of 40 participants. The control group underwent conventional thoracoscopy, while the observation group underwent Da Vinci robotic-assisted thoracoscopy. This study aimed to compare perioperative indicators between the two groups and establish learning curves based on surgical duration and intraoperative blood loss. Additionally, it assessed levels of pain mediators and stress response markers before surgery and at 24 hours post-surgery, as well as postoperative complications. Inflammatory marker levels were evaluated one month after surgery, and the children's quality of life was measured using the Pediatric Quality of Life Inventory(PedsQL) Generic Core Scales before surgery and one month post-surgery. Results The surgical duration for the observation group and the control group was(1.76 ± 0.33) hours and(2.82±0.62) hours, respectively, and the intraoperative blood loss was(49.83 ± 6.39) mL and(71.55 ± 8.19) mL, respectively. Furthermore, the post-operative drainage time, drainage volume, and hospital stay for the observation group were all lower than those for the control group(P < 0.05). After surgery, the levels of BK, 5-HT, NPY, and PGE2 in the observation group were(8.06 ± 1.06) mg/L, (170.20 ± 13.21) ng/L, (201.82 ± 13.52) mg/L, and(241.82 ± 15.32) ng/L, respectively, indicating lower levels of pain mediators, stress response markers, and inflammatory factors compared to the control group(P < 0.05). he overall incidence of complications was 2.50% in the observation group as opposed to 20.00% in the control group. Moreover, there was a statistically significant improvement in quality of life after surgery within the observation group when compared to that within the control group(P < 0.05). Conclusion Da Vinci robotic-assisted thoracoscopy demonstrates enhanced feasibility and safety in pediatric mediastinal tumor resection, thereby justifying its clinical promotion. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pediatric thoracic mass lesions encompass a wide range of pathogenic entities originating from various anatomical compartments within the thorax, such as the mediastinum, lung parenchyma, airways, chest wall, and pleura. While some diseases, like lymphoma, are more prevalent in children compared to adults, pediatric patients often present with a distinct array of uncommon disorders. Despite the critical need for early detection and intervention, our understanding of these lesion s frequency and distribution among pediatric populations remains inadequate, primarily due to the lack of thorough investigations in this area. OBJECTIVE: To assess the frequency and distribution of thoracic mass lesions in pediatric patients presenting in the Diagnostic imaging department of the National Institute of Child Health (NICH), a tertiary care hospital. METHODOLOGY: STUDY DESIGN: Observational, retrospective, cross-sectional study. DURATION OF STUDY: February 2022 to January 2023. SETTING: Diagnostic imaging department of the National Institute of Child Health (NICH), Karachi, Pakistan. A total of 96 children with suspected thoracic mass involving chest, pleuro-pulmonary, trachea, bronchi, and mediastinum, advised for contrast enhanced CT (CECT), with an age group from birth to 16 years, were included in the study. RESULTS: The study findings showed that out of 96 children, 49 (51.0%) were males and 47 (49.0%) were females, with an average age of 62.07 - 46.05 months. The chest findings on CECT revealed that pulmonary involvement exhibited the highest prevalence, encompassing various diseases including 46 (47.9%) cases of tumours, followed by 38 (39.6%) cases located in the mediastinum. Mediastinal lymphomas accounted for 23 (23.9%) of the most prevalent type of thoracic mass, whereas metastatic lesions involving multiple primary sources accounted for 20 (20.8%) of the cases followed by hydatid cysts 15 (15.6%). CONCLUSION: This study identified mediastinal tumors, particularly lymphomas, and pulmonary metastatic lesions as the most frequently encountered chest masses in the pediatric population. These findings highlight the critical importance of advanced imaging modalities and comprehensive radiologic evaluation in the accurate diagnosis and management of suspected chest masses. A thorough radiologic assessment is essential for guiding clinical decisions and optimizing treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC), a novel technique, has been reported to improve the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lesions in recent studies. Current literature suggests that this procedure has greater diagnostic efficacy compared to conventional EBUS-TBNA. This systematic review and meta-analysis aimed to evaluate the diagnostic yield and complications associated with EBUS-TMC in comparison to EBUS-TBNA, thereby exploring the potential of this novel technique in enhancing the diagnostic utility for mediastinal lesions. Methods: A comprehensive literature review was conducted by searching the PubMed, Embase, and Google Scholar databases for articles published from inception to December 31, 2023. The objective of this review was to evaluate the utilization of EBUS-TMC in diagnosing mediastinal disease, while also assessing the quality of each study using the QUADAS-2 tool. The diagnostic yield estimates were subjected to a meta-analysis utilizing inverse variance weighting. Furthermore, a comprehensive analysis of the complications associated with this procedure was performed. Results: The meta-analysis included 10 studies involving a total of 538 patients. The findings of the meta-analysis demonstrated that EBUS-TMC yielded an overall diagnostic rate of 89.59% (482/538), while EBUS-TBNA yielded a rate of 77.13% (415/538). The calculated inverse variance-weighted odds ratio was 2.63 (95% confidence interval, 1.86–3.72; p < 0.0001), and I2 value was 11%, indicating a statistically significant difference between the two techniques. The associated complications consisted of pneumothorax, pneumomediastinum, mediastinitis, and bleeding, with an incidence of 0.74% (4/538), 0.37% (2/538), 0.0% (0/538), and 1.12% (6/538), respectively. Moreover, the funnel plot displayed no discernible publication bias. Further subgroup analysis revealed a notable improvement in the diagnosis value for lymphoma (86.36% vs. 27.27%, p = 0.0006) and benign disorder (87.62% vs. 60.00%, p < 0.0001). Conclusion: This review of the current available studies indicated that EBUS-TMC enhanced overall diagnostic yields compared to EBUS-TBNA, particularly for diagnosing benign disease and lymphoma. This procedure was not associated with any serious complications. [ABSTRACT FROM AUTHOR]

Schwannomas are classified as neurogenic tumors and are the most frequent nerve sheath tumors in the paravertebral mediastinum. Recently, the addition of endobronchial ultrasound‐guided intranodal forceps biopsy (EBUS‐IFB) using standard‐sized biopsy forceps (SBFs) to endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) for metastatic lymph nodes in lung cancer patients reportedly improved the quality and quantity of the obtained specimens without significant complications. However, reports on the usefulness of this technique for benign diseases remain scarce. Here we report a case of schwannoma in the middle mediastinum, which was diagnosed by EBUS‐IFB using SBFs, despite inadequate specimens obtained via EBUS‐TBNA. An 80‐year‐old woman presented with dyspnea and a 5‐cm sized middle mediastinal tumor. EBUS‐TBNA and EBUS‐IFB using SBFs were performed for histological diagnosis. No complications were associated with the bronchoscopy procedure, and schwannoma was solely diagnosed using the EBUS‐IFB specimens. EBUS‐IFB using SBFs is potentially useful for diagnosing benign diseases, including schwannomas, which are often difficult to diagnose with EBUS‐TBNA. [ABSTRACT FROM AUTHOR]

This case report describes the clinical and radiological findings of a rare left ventricle pseudoaneurysm presenting with a systemic embolic phenomenon. The patient had no chest complaints but had presented with epilepsy and limb swelling. The patient also had mild testicular pain. Initial investigations which consisted of an MRI brain revealed multiple acute and chronic embolic infarcts. Scrotal ultrasound showed an infarct of testicular parenchyma. A left calcified mediastinal mass was picked up on a routine chest x-ray. Contrast CT showed a partially thrombosed pseudoaneurysm of the left ventricle. Pseudoaneurysm of the left ventricle is rare and can be fatal if not diagnosed and treated. Patients usually present with recurrent chest pain, dizziness, and breathlessness. A few affected patients with thrombosis present with embolic strokes which has been reported in literature. However, testicular infarct occurring as a complication has not been reported to our knowledge. CLINICAL HISTORY: A 28-year-old male patient presented to OPD with recurrent seizure episodes for one year and bilateral limb swelling for one week. [ABSTRACT FROM AUTHOR]

We report a case of a 69‐year‐old woman with pleural mesothelioma presenting in the posterior mediastinum with a maximum diameter of 25 cm. She had a chronic cough and a pleural effusion was noted on chest X‐ray. The examination of the effusion showed high hyaluronic acid levels, and mesothelioma was suspected. A chest computed tomography scan showed a huge mediastinal mass, which caused rapid progression of respiratory failure and compression of the heart. Sufficient tissue samples could not be obtained before death. The patient died approximately 1 month after the initial visit, and a pathological autopsy was performed. The diagnosis of malignant pleural mesothelioma was made. Malignant pleural mesothelioma with a huge posterior mediastinal mass such as in this case is considerably rare; however, it is a rapidly progressing form of the disease and is reported here as an important differential diagnosis for mediastinal tumours. [ABSTRACT FROM AUTHOR]

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Background: Rosai-Dorfman disease (RDD), known as sinus histiocytosis with massive lymphadenopathy, commonly involves lymph nodes in the neck or mediastinum, although extranodal involvement is observed in approximately 40% of RDD patients. RDD involving only the thymus has rarely been reported. Here, we report a case of RDD originating in the thymus. The lesion was surgically removed, and a cure was finally achieved. There was no recurrence after telephone follow-up for 3 years. Case presentation: A 52-year-old male was accidentally found to have a 7 × 6 cm anterior mediastinum lump by chest computed tomography (CT). The mediastinal lesion was resected by surgery, and postoperative pathology revealed RDD originating from the thymus. Regular telephone follow-up after surgery lasted 3 years and showed that the patient remained in good condition without any relevant symptoms. Conclusions: RDD originating in the thymus cannot be characterized from CT images and is easily misdiagnosed as a traditional mediastinal tumor. This is mainly because there is so little disease in this area that physicians are not aware of it. We report this case with the hope that clinicians will have a better understanding of this disease. According to our follow-up results, surgery is an effective means of treatment. [ABSTRACT FROM AUTHOR]

Background: This manuscript aims to describe the symptoms, demographics, surgical approaches and techniques, the volume of surgical interventions, histological results, intra- and postoperative complications, and postoperative results in patients with anterior mediastinal tumors of thyroid origin (AMTTO). Methods: Twenty patients with AMTTO were operated between 2017 and 2021. Fifteen were women and 5 were men. The mean age was 66.8 years. Results: The most common histology was nodular micro- and macrofollicular goiter (15/20, 75%). Kocher cervicotomy (65%) was the preferred approach. Total thyroidectomy was performed in 95% of patients. Intraoperative complications were identified in 25% (5/20), and in 2 patients a tracheostomy was required. Early postoperative complications were established in 65% and the most common was unilateral transient recurrent nerve paresis or paralysis and dysphonia (25%). Conclusions: Commonly resection of AMTTO is a challenge due to its complexities associated with high-risk cases, emphasizing the need for experienced centers in managing such cases. [ABSTRACT FROM AUTHOR]

Background: Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren's syndrome (SjS). SjS is rarely accompanied by serositis. Here, we describe the first case of postoperative cardiac tamponade and acute pleuritis in a patient with thymic MALT lymphoma associated with SjS. Case presentation: A 33-year-old woman with SjS presented with an anterior mediastinal mass on chest computed tomography, which was performed for further examination of the condition. Suspecting a thymic MALT lymphoma or thymic epithelial tumor, total thymectomy was performed. The mediastinal mass was histopathologically diagnosed as a thymic MALT lymphoma. The patient was discharged with a good postoperative course but visited the hospital 30 days after surgery for dyspnea. Cardiac tamponade was observed and drainage was performed. Four days after pericardial drainage, chest radiography revealed massive left pleural effusion, and thoracic drainage was performed. The patient was diagnosed with serositis associated with SjS and treated with methylprednisolone, which relieved cardiac tamponade and pleuritis. Conclusions: Surgical invasion of thymic MALT lymphomas associated with SjS may cause serositis. Postoperative follow-up should be conducted, considering the possibility of cardiac tamponade or acute pleuritis due to serositis as postoperative complications. [ABSTRACT FROM AUTHOR]

Synovial sarcoma, a rare subtype of soft-tissue sarcomas, typically manifests in the extremities of young individuals. Mediastinal occurrences are exceedingly uncommon, with sparse cases documented. This article details the atypical presentation of a mediastinal synovial sarcoma in a 68-year-old female patient, diverging from the common demographic and anatomical predilections. Initial symptoms of a dry cough and fatigue led to the discovery of a mediastinal mass via chest CT scan. Subsequent pathological examination confirmed the diagnosis of mediastinal synovial sarcoma. Despite the identification of this rare tumor, the patient’s condition progressed rapidly, resulting in her demise within two months post-diagnosis. This case underlines the critical need for increased awareness and research into the mediastinal variant to improve diagnostic accuracy and treatment efficacy. Despite synovial sarcoma being predominantly identified in the extremities, occurrences in the mediastinum present unique diagnostic dilemmas and therapeutic hurdles due to limited literature and atypical clinical presentations. The utilization of advanced imaging modalities, immunostaining techniques, and multimodal treatment approaches is essential in the management of mediastinal synovial sarcoma. [ABSTRACT FROM AUTHOR]