Sepsis-like illness with mediastinal involvement after EUS-FNP of mediastinal lymph nodes in a patient with sarcoidosis and a history of esophageal carcinoma

Abstract Background and study aims Significant heterogeneity in geographic distribution regarding the prevalence of mediastinal lymph nodes (MLN) has been documented in autopsy and computed tomography (CT) studies. Awareness of the local prevalence and characteristics of lymph nodes will be relevant when performing endoscopic ultrasonography (EUS) for staging of malignant neoplasias. The aims of this study were to document the prevalence and echo features of MLN in patients undergoing EUS for non-malignant extrathoracic disease and to identify predictive factors for the presence of MLN. Patients and methods A prospective single-center study was performed over 6 months. Mediastinal stations 9, 8, 7, 6, 5, 4 L and 2 were systematically evaluated using a linear echoendoscope in all patients undergoing EUS due to benign extrathoracic pathology and without history of oncologic disease. Demographic, clinical and EUS features of the lymph nodes were analysed. Results Seventy-five patients were included: male/female 32/43; mean age, 63 years. The majority of patients (72 %) had lymph nodes in at least one mediastinal station and 88 % of these were found in stations 7 or 4 L. Overall, 133 MLN were identified: 19 % were hypoechogenic, 6 % had a short-axis diameter > 10 mm, and 6 % were round. The prevalence of lymph nodes was higher in smokers (83 % vs 64 %, P = 0.024), with a higher average number of lymph nodes per patient in this group (2.1 vs 1.6; P = 0.017). By logistic regression analysis, none of the variables analyzed were independently associated with the presence of MLN. Conclusion This prospective Portuguese study documented a higher prevalence of MLN than previously reported in Northern Europe, in patients with no evidence of oncologic disease. This higher prevalence may negatively influence the specificity and positive predictive value for malignancy of MLN (N) staging by EUS.

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MRI and CT Findings of the Paraesophageal Organs and Mediastinal Lymph Nodes with Invasion or Metastasis of Esophageal Carcinoma

Diseases of the Esophagus ◽

10.1007/978-3-642-86432-2_35 ◽

1988 ◽

pp. 149-151

Author(s):

M. Kijima ◽

H. Kubo ◽

F. Nagao ◽

S. Sugimoto ◽

S. Tada

Keyword(s):

Lymph Nodes ◽

Esophageal Carcinoma ◽

Mediastinal Lymph Nodes ◽

Ct Findings

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Frequency and characterization of ancillary chest CT findings in COVID-19 pneumonia

British Journal of Radiology ◽

10.1259/bjr.20200716 ◽

2021 ◽

Vol 94 (1118) ◽

pp. 20200716

Author(s):

Mario Silva ◽

Roberta Eufrasia Ledda ◽

Mark Schiebler ◽

Maurizio Balbi ◽

Sandro Sironi ◽

...

Keyword(s):

Pericardial Effusion ◽

Lymph Nodes ◽

Oxygen Saturation ◽

Respiratory Rate ◽

Chest Ct ◽

Mediastinal Lymph Nodes ◽

Rt Pcr ◽

Ct Findings ◽

Lower Oxygen ◽

History Of

Objectives: Ground-glass opacity and consolidation are recognized typical features of Coronavirus disease-19 (COVID-19) pneumonia on Chest CT, yet ancillary findings have not been fully described. We aimed to describe ancillary findings of COVID-19 pneumonia on CT, to define their prevalence, and investigate their association with clinical data. Methods: We retrospectively reviewed our CT chest cases with coupled reverse transcriptase polymerase chain reaction (rt-PCR). Patients with negative rt-PCR or without admission chest CT were excluded. Ancillary findings included: vessel enlargement, subpleural curvilinear lines, dependent subpleural atelectasis, centrilobular solid nodules, pleural and/or pericardial effusions, enlarged mediastinal lymph nodes. Continuous data were expressed as median and 95% confidence interval (95% CI) and tested by Mann–Whitney U test. Results: Ancillary findings were represented by 106/252 (42.1%, 36.1 to 48.2) vessel enlargement, 50/252 (19.8%, 15.4 to 25.2) subpleural curvilinear lines, 26/252 (10.1%, 7.1 to 14.7) dependent subpleural atelectasis, 15/252 (5.9%, 3.6 to 9.6) pleural effusion, 15/252 (5.9%, 3.6 to 9.6) mediastinal lymph nodes enlargement, 13/252 (5.2%, 3 to 8.6) centrilobular solid nodules, and 6/252 (2.4%, 1.1 to 5.1) pericardial effusion. Air space disease was more extensive in patients with vessel enlargement or centrilobular solid nodules (p < 0.001). Vessel enlargement was associated with longer history of fever (p = 0.035) and lower admission oxygen saturation (p = 0.014); dependent subpleural atelectasis with lower oxygen saturation (p < 0.001) and higher respiratory rate (p < 0.001); mediastinal lymph nodes with shorter history of cough (p = 0.046); centrilobular solid nodules with lower prevalence of cough (p = 0.023), lower oxygen saturation (p < 0.001), and higher respiratory rate (p = 0.032), and pericardial effusion with shorter history of cough (p = 0.015). Ancillary findings associated with longer hospital stay were subpleural curvilinear lines (p = 0.02), whereas centrilobular solid nodules were associated with higher rate of intensive care unit admission (p = 0.01). Conclusion: Typical high-resolution CT findings of COVID-19 pneumonia are frequently associated with ancillary findings that variably associate with disease extent, clinical parameters, and disease severity. Advances in knowledge: Ancillary findings might reflect the broad range of heterogeneous mechanisms in severe acute respiratory syndrome from viral pneumonia, and potentially help disease phenotyping.

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Atypical Carcinoid Tumor of the Mediastinum Presenting as Ectopic Cushing’s Syndrome

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.2028 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A991-A992

Author(s):

Luis Augusto Medina Mora ◽

Raheel Sufian Siddiqui ◽

Ian Landry ◽

Kwan Cheng ◽

David Michael Reich

Keyword(s):

Lymph Nodes ◽

Carcinoid Tumor ◽

Cushing’S Syndrome ◽

Mediastinal Mass ◽

Serum Cortisol ◽

Cushing's Syndrome ◽

Anterior Mediastinal Mass ◽

Atypical Carcinoid ◽

Mediastinal Lymph Nodes ◽

History Of

Abstract Introduction: Ectopic Cushing’s syndrome (ECS) refers to Cushing’s syndrome (CS) that results from extra-pituitary secretion of adrenocorticotropic hormone (ACTH). Neuroendocrine tumors (NETs) are a rare cause of ECS, and their presence in the anterior mediastinum only represents 2-4% of all cases. We report a rare case of ECS in a patient with an atypical mediastinal carcinoid tumor. Case Presentation: A 38-year-old male with a history of depression presented with generalized weakness, fatigue, and myalgia for one month. A one-week history of nausea and slight shortness of breath was reported. Physical exam and vital signs were unremarkable. Labs revealed hyperglycemia, hypokalemia, and metabolic alkalosis. A random serum cortisol was 47.7 mcg/dL (normal: 3-21 mcg/dL) and a 24-hour urine free cortisol was 7405 mcg/24 hours (normal: 3.5-45 mcg/24 hours). The morning serum cortisol after 8 mg dexamethasone at midnight, was 58.7 mcg/dL. Serum aldosterone and plasma renin activity were both undetectable. CT of the chest showed an anterior mediastinal mass measuring 9.0 x 10.3 x 6.1 cm accompanied by two large mediastinal lymph nodes. A PET CT confirmed the anterior mediastinal mass, which showed mild heterogeneous uptake and no evidence of metastatic disease. Core biopsy of mediastinal mass showed grade II neuroendocrine tumor/atypical carcinoid. Potassium, Spironolactone, Ketoconazole, and Metyrapone were used to control hypokalemia and hypercortisolemia. Trimethoprim-sulfamethoxazole (TMP-SMX) was started for Pneumocystis pneumonia prophylaxis. The patient underwent complete resection of the anterior mediastinal mass, thymectomy, and mediastinal lymph nodes dissection. Histopathology confirmed an atypical carcinoid in the mediastinal mass with negative margins. The rest of the thymus tissue and lymph nodes were negative for malignancy. ACTH and cortisol levels dropped significantly after surgery and the patient was discharged on oral hydrocortisone and TMP-SMX. At 4 weeks follow-up in the clinic, the patient was feeling much better and reported complete resolution of symptoms. Discussion: ECS caused by an atypical carcinoid tumor is an extremely rare finding. Mediastinal NETs tend to have a poor prognosis due to their metastatic tendency and recurrence rates. Due to limited evidence in the medical literature, there’s much uncertainty and controversy regarding the best treatment of NETs. Standardized guidelines for the management of these atypical tumors are not well established. The primary mode of treatment is surgical resection of the ACTH-secreting tumor. However, in cases of advanced and metastatic tumors, surgical resection might not be sufficient and medical therapy with adrenal enzyme synthesis inhibitors may be needed. The use of neoadjuvant chemotherapy and/or radiotherapy remains unclear.

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Castleman's Disease Masquerading as Sigmoid Colon Tumor and Hodgkin Lymphoma

Swiss Surgery ◽

10.1024/1023-9332.8.1.7 ◽

2002 ◽

Vol 8 (1) ◽

pp. 7-10 ◽

Cited By ~ 6

Author(s):

Altinli ◽

Pekmezci ◽

Balkan ◽

Somay ◽

M. Akif Buyukbese ◽

...

Keyword(s):

Lymph Nodes ◽

Hodgkin Lymphoma ◽

Sigmoid Colon ◽

Castleman’S Disease ◽

Malignant Potential ◽

Colon Tumor ◽

Rare Entity ◽

Castleman's Disease ◽

Mediastinal Lymph Nodes ◽

Histologic Types

Castleman's disease is a benign lymphoid neoplasm first reported as hyperplasia of mediastinal lymph nodes. Some authors referred to the lesions as isolated tumors, described as a variant of Hodgkin's disease with a possibility of a malignant potential and others proposed that the lymphoid masses were of a hamartomatous nature. Three histologic variants and two clinical types of the disease have been described. The disease may occur in almost any area in which lymph nodes are normally found. The most common locations are thorax (63%), abdomen (11%) and axilla (4%). We report two separate histologic types of Castleman's disease which were rare in the literature, mimicking sigmoid colon tumor and Hodgkin lymphoma. The diagnostic and therapeutic aspects of this rare entity is discussed.

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Prediction of lymph node metastase in NSCLC

Onkologische Welt ◽

10.1055/s-0038-1632899 ◽

2010 ◽

Vol 01 (05) ◽

pp. 219-226 ◽

Cited By ~ 1

Author(s):

F. Beyer ◽

B. Buerke ◽

J. Gerss ◽

K. Scheffe ◽

M. Puesken ◽

...

Keyword(s):

Lymph Nodes ◽

Fdg Pet ◽

Automatic Segmentation ◽

Correlation Coefficients ◽

Mediastinal Lymph Nodes ◽

Intra Class Correlation ◽

Axial Diameter ◽

Pet Ct ◽

Fdg Pet Ct

SummaryPurpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT.Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean

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