Thymic Tumours in Children

Thymomas are very rare neoplasms in children and they represent less than 1% of mediastinal tumours in the paediatric population. The aim of our study was to assess the long-term treatment results of children with thymic tumours. A total number of eight children (four boys and four girls) with thymic tumours were identified. Median age at diagnosis was 7 years. In seven of them, thymoma was diagnosed; in one, a thymic carcinoma was diagnosed. In five of them, the WHO type was assessed: in two of them, the B1 type was found; in one, B2 was found; in one, AB was found, and in one, C was found. In all but one, surgery was the first-line treatment, but six patients had only partial resection. One patient started treatment with chemotherapy and four others received chemotherapy after the surgery. Radiotherapy was applied in six patients, with a median total dose of 37.5 Gy. Follow-up ranged from 8.5 to 273.5 months, with a median of 6.1 years. During this time, four patients died: one due to progression of the disease, and in the other three, the reason for death was unknown. In all evaluated patients, complete regression was observed (100% local control). Two-, 5- and 10-year OS and PFS were 85% and 72%, 51% and 54%, 51% and 54%, respectively. Combined treatment could provide satisfactory results in thymoma patients. There is a need for further, larger studies, which could help to establish optimal management strategies.

Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach

The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently requiring a multidisciplinary approach. Age and sex represent important information, which need to be integrated with imaging and laboratory findings. In addition, the location of the mediastinal lesion is fundamental; indeed, we propose to illustrate mediastinal diseases based on the compartment of origin. We consider that this structured approach may serve as hint to the diagnostic modalities and management of mediastinal diseases. In this review, we present primary mediastinal tumours in the evolving context of new diagnostic and therapeutic tools, with recently described entities, based on our own experience with >900 cases encountered in the past 10 years.

Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature

Background First described in 1955 Primary mediastinal seminomas are rare. Only 1–4% of mediastinal tumours are germ cell tumors; majority of which are teratomas. They typically present in men aged between 20 and 40 years. Very few cases are reported in the literature. Florid follicular lymphoid hyperplasia can obscure the malignant cells and is a rarer finding still. We present a rare case of a 48 year old man with a primary mediastinal seminoma with florid follicular lymphoid hyperplasia; found following excision of a clinically presumed thymoma. Case presentation A 48 year old man was referred for excision of a thymic mass. The presumed diagnosis was a thymoma; following preoperative investigations. The mass was incidentally found on a radiological imaging. However, the patient did report mid-sternal discomfort on lying flat and breathlessness. The patient underwent a thymectomy via a partial median sternotomy with good recovery. Histological assessment was that the mass was in fact a primary mediastinal seminoma with florid follicular lymphoid hyperplasia. A primary testicular malignancy was excluded and the patient required no further oncological treatment. Conclusions Only 11 cases have previously been reported of primary mediastinal seminoma with florid follicular lymphoid hyperplasia. Although rare, a primary mediastinal seminoma should be considered as a differential diagnosis for presentations with a thymic mass. Tumour markers can be helpful, however are only positive in third of cases. Ultrasound imaging of the gonads is essential to exclude a primary gonadal lesion. Pure seminomas are radiotherapy and chemotherapy sensitive however the mainstay treatment of primary mediastinal seminomas remains surgical excision. Radiotherapy is reserved postoperatively for incomplete surgical margins.

Thymoma and Tuberculoma: Unexpected Coexistence

Mediastinal tumours can be incidental findings on chest x-ray or present with systemic symptoms and/or direct effect of the mediastinal mass. We report the case of a woman with symptomatic thymoma B1 and simultaneous thymus tuberculosis.

Sternal Involvement in Anterior Mediastinal Seminoma - A Rare Presentation

Primary malignant extra gonadal germ cell tumours (GCT) of mediastinum are very rare tumours, comprising 1 - 4 % of all mediastinal tumours.1 Even though they are rare tumours of mediastinum, they should always be considered in the differential diagnosis of mediastinal tumours in young adults. Primary malignant GCT can be divided into 2 groups: Seminomatous and non-seminomatous tumours. Mature teratomas (non-seminomatous) are the most common primary malignant germ cell tumours of mediastinum.2 Non-seminomatous tumours tend to be more aggressive than seminomatous tumours present as heterogeneous masses with areas of necrosis and show local invasion. Seminomas usually present as lobulated homogeneous masses and rarely show signs of local invasion. These tumours usually present with asymptomatic lesions or with symptoms due to compression of adjacent structures and usually have a better prognosis than non-seminomatous tumours. Here, we present a case of primary malignant extra gonadal seminoma with sternal involvement.

Robotic Surgery for the Thoracic and Vascular Surgeon

In the last two decades, robotic-assisted approaches have gained popularity as alternatives to conventional open and minimal-invasive surgery (MIS). The robotic approach combines the concepts of the traditional MIS with the latest technological advancements, enabling the surgeon to control the instrumentation using a robotic device connected to a remote console. With this approach, the surgeon obviates the known drawbacks of conventional MIS, such as the reduced in-depth perception and hand-eye coordination. Since its introduction, numerous robotic-assisted procedures have been developed and tested across nearly all surgical fields. Data from previous studies have shown that a great majority of these techniques are feasible and have favourable treatment outcomes. In the field of thoracic and vascular surgery, two disciplines often combined in Belgium, robotic approaches have been implemented in the treatment of a wide array of disorders including lung cancer, mediastinal tumours, thoracic outlet syndrome, diaphragmatic paralysis, sympathectomy, aortobifemoral bypass surgery and division of the arcuate ligament for median arcuate ligament syndrome (MALS). Despite this increasing popularity, there are still a number of controversies regarding robotic surgery. There are only limited data on the cost-effectiveness of robotic surgery and its objective proven benefit over conventional MIS. In this review, we summarise the latest data on robotic approaches for the most relevant thoracic and vascular disorders.

An anaesthesiologists concern in a patient with posterior mediastinal mass

Large mediastinal masses may cause life threatening cardiorespiratory collapse depending on their location. An 18 years old female underwent ganglioneuroma excision. She had a 15×9.4×9.1 cm left sided cervico-thoracic mass surrounded by major blood vessels with mild encasement of left vertebral artery and left subclavian artery. After placing thoracic epidural, mask ventilation was confirmed with sevoflurane induction, and succinylcholine was given for intubation. Invasive monitoring of blood pressure was obtained with intravenous access in upper and lower limbs. For lung isolation, coopdech bronchial blocker was inserted into left main bronchus. Intraoperatively she was maintained on atracurium infusion, sevoflurane in oxygen air mixture. With a left hemiclamshell incision, mass was carefully separated from surrounding blood vessels and removed en bloc. After surgery patient was extubated and shifted to intensive care unit for observation. Patient was pain free and comfortable. Though our patients anaesthesia management and surgery was uneventful, we would like to discuss the potential complications that may arise with posterior mediastinal tumours as there are few articles discussing about the anaesthetic management of posterior mediastinal tumours.