Two cases of left recurrent laryngeal nerve paralysis after right superior mediastinal node dissection

Background Ipsilateral recurrent laryngeal nerve paralysis is one of the rare complications during the superior mediastinal node dissection for lung cancer. However, very few reports of contralateral recurrent laryngeal nerve paralysis during the procedure are available. Case presentation Two women aged 74 and 80 years developed hoarseness after undergoing right upper lobectomy and right superior mediastinal node dissection for primary lung cancer. Postoperative laryngoscopy in the two patients confirmed left vocal cord paralysis. Conclusion Node dissection is performed in the standard procedure for right upper lobe lung cancer. At this time, care must be taken not to cause damage not only to the recurrent laryngeal nerve on the ipsilateral side but also to the recurrent laryngeal nerve on the contralateral side.

Histomorphological Spectrum of Mediastinal Masses with Special Emphasis on Rare Lesions

Introduction: Mediastinal lesions are not frequently observed in routine clinical practice. A wide variety of disease process can occur within the mediastinum. Tissue from needle biopsies forms the major diagnostic material. There is need for detailed studies to make pathologists aware of the wide histological spectrum and to know the unusual lesions that can be encountered during diagnosis. Aim: To describe the histomorphological spectrum of various mediastinal lesions and to highlight the rare lesions that posed a diagnostic challenge. Materials and Methods: This was a retrospective study done on all mediastinal masses over a period of two years from January 2016 to December 2018. The clinical data and imaging findings were collected from the test request forms and patients’ files for all the cases. Haematoxylin and eosin stained slides of all cases and immunohistochemistry markers and cytochemical stains wherever done were reviewed and analysed. Mean, median and percentage were used for statistical analysis. Results: Thirty-four cases of mediastinal lesions were included in the study. Of these, 28 cases (82.4%) presented as anterior mediastinal masses, three cases (8.8%) each in the middle and posterior mediastinum. Thymoma (n=15) followed by lymphoma (n=4) were the most frequent neoplasms reported. There were five lesions which were rare in the mediastinum with unusual presentation that posed diagnostic difficulties. These lesions included Primitive neuroectodermal tumour in an adult, Primary Mediastinal B Cell Lymphoma (PMBCL), Malignant Peripheral Nerve Sheath Tumour (MPNST) with nodal metastasis, Seminoma deposits in mediastinal node occurring as late relapse and dedifferentiation of thyroid carcinoma in mediastinal node metastasis without an obvious primary. Conclusion: Primary mediastinal tumours were more frequent than metastasis. Although thymomas and lymphomas are dealt extensively in literature, this article highlights the fact that pathologists must be aware of those lesions that don’t display the classical histological and/or clinical features as observed in this study.

Dual time PET-CT for mediastinal nodal staging in patients diagnosed with non-small cell lung cancer in an area with high prevalence of infectious granulomatous disease (LACOG-0114).

e20083 Background: The role of dual-time-point PET/CT acquisition for mediastinal node staging in non-small cell lung cancer (NSCLC) is still controversial. Interpretation of PET/CT results is challenging in areas with high prevalence of infectious granulomatous diseases, whereas the use of dual-time PET/CT could reduce the false-positive results. This study aims to evaluate the performance of dual-time PET-CT for mediastinal node staging in patients with NSCLC in an area with high prevalence of infectious granulomatous diseases (i.e. 99 cases of tuberculosis per 100.000 habitants). Methods: Patients diagnosed with clinical stages I-III NSCLC performed dual-time-point PET/CT (images acquired in hour 1 and 2) followed by mediastinal lymph node biopsy. Different cut-offs for SUV were evaluated to test accuracy in each time-point. Results: One hundred patients were enrolled, of which 85 had mediastinal node biopsy after PET-CT. Median age was 65 years (range 47-80), 49 (58%) were male, 80 (94%) were current or former smokers, and 1 (1.2%) had history of tuberculosis. Dual-time-point acquisition results were similar to those in single-time-point (Table 1). The highest sensitivity (87%) and NPV (90%) was achieved when a cut-off SUV > 0 was used. Conclusions: Dual-time point PET/CT did not improve accuracy of PET/CT-based LN staging in NSCLC in an area with high prevalence of infectious granulomatous diseases. [Table: see text]