Objective To describe a case of giant asymptomatic neurilemmoma of mediastinum. Methods The clinical, radiographic and pathological characteristics of a patient admitted to Changhai Hospital Affiliated to Second MilitaryMedical University in May 2009 presenting with large shadow on chest radiograph was analyzed, and related literature was reviewed. Results Radiographic examination revealed a large mass occupying the right thoracic cavity. Then the pathological issue was obtained bypercutaneous CT-guided needle biopsy. Neurilemmoma was proved by pathological study. Conclusions The low morbidity of giant neurilemmoma of mediastinum, with most of the cases remaining asymptomatic, is prone to misdiagnosis. The large mediastinal mass in the thoracic cavity increases the risk of thoracotomy. It can bepathologically diagnosed through percutaneous image-guided needle biopsy or surgical biopsy.
Abstract： Objective To introduce the new procedure of endobronchial ultrasoundguided transbronchial needle aspiration (EBUSTBNA) for staging lung cancer and diagnosing thoracic diseases, in order to determine its value in the evaluation of thoracic diseases. Methods We retrospectively reviewed the data of all patients examined with EBUSTBNA our institution between September 2009 and May 2010. Among the patients, there were 75 males and 31 females with an average age of 62.3 years old. Based on their primary indication, we divided all the 106 patients into three categories. (1) There were 76 patients with known or bly suspected lung cancer. Enlarged mediastinal lymph nodes on radiographic examination of the chest (≥1.0 cm) were detected in all the patients. (2) There were 22 patients with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin. (3) There were 8 patients with pulmonary mass located close to the central airways. Results (1) 76 patients underwent EBUSTBNA for known or bly suspected lung cancer. Among them, 58 patients were confirmed to have mediastinal lymph nodes metastasis on EBUSTBNA. Sixteen in the 18 patients with negative EBUSTBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection. Postoperative pathology confirmed that 12 patients did not have metastatic nodes, 2 patients had metastatic nodes and 2 other patients had benign lesions within the lung. The diagnostic sensitivity, specificity and accuracy of EBUSTBNA for the mediastinal staging of lung cancer were 96.66%(58/60), 100.00%(12/12) and 97.22%(70/72), respectively. (2) 22 patients underwent EBUSTBNA for the evaluation of mediastinal adenopathy or mass in the absence of any identifiable pulmonary lesion. Among them, 7 had malignancy, 13 had benign diseases on EBUSTBNA and the sensitivity of EBUSTBNA in distinguishing malignant mediastinal diseases was 87.50% (7/8). (3) 8 patients with pulmonary mass located close to the central airways were accessed by EBUSTBNA. Definite diagnosis was achieved in 7 patients, and lung cancer was detected in 6 patients. The sensitivity and the diagnostic accuracy of EBUSTBNA for the diagnosis of unknown pulmonary mass was 85.71%(6/7) and 87.50%(7/8), respectively. All the procedures were uneventful, and there were no complications. Conclusion EBUSTBNA is a highly effective and safe procedure. We believe that EBUSTBNA should be used routinely in the diagnosis and staging of thoracic diseases.
Preoperative mediastinal lymph node staging for non-small cell lung cancer (NSCLC) can be divided into non-invasive imaging techniques staging and invasive surgery techniques staging . Noninvasive imaging techniques are not sufficiently reliable in many situations. Computed tomography (CT) has been used as a routine inspection due to the anatomical images it provides. Magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) have not been widely applied. As the most accurate technique of noninvasive staging, positron emission tomographycomputed tomography (PET-CT) still has a higher rate of false negative. Invasive staging technique is safe and effective in mediastinal lymph node staging. Mediastinoscopy is the gold standard for invasive mediastinal staging till today. Endoscopic ultrasound-needle aspiration techniques and video-assisted thoracoscopic surgery (VATS) are also safe and effective. Invasive staging technique is the first choice of the re-staging in patients after induction therapy.
ObjectiveTo study the clinicopathological features of mediastinum nodular sclerosis Hodgkin lymphoma (NSHL) in order to improve the recognition of it. MethodsThe clinical data of 3 cases of mediastinum NSHL between 2003 and 2012 were collected. Then we analyzed the carcinoma pathologic samples by pathomorphology, immunophenotypic phenotype, related gene rearrangement and situ hybridization with EBER. ResultsThe pathomorphologic results showed that broad fibrotic bands subdivided the lymphoid parenchyma into large nodules, the tumoral cells had distinct boundary with empty cytoplasm and small-to-medium-sized nucleoli, and the nodules contained inflammatory cell components. The immunophenotypic phenotype of the tumoral cells were CD15, CD30, PAX-5 and CD20 partly, but anaplastic lymphoma kinase, CD45, cytokeratin, CD79α and S-100 were not expressed. T cell receptor γ and IgH gene were no rearranged, and EBER in situ hybridization was not detected. ConclusionVarious lymphomas occur in the mediastinum and mediastinum NSHL is just one of them. Mastering its distinctive pathomorphology and immunophenotypic phenotype is highly significant for diagnosis, differential diagnosis and treatment of the disease.