A retroperitoneal bronchogenic cyst clinically mimicking an adrenal mass: three case reports and a literature review

Bronchogenic cysts are a congenital primitive foregut-derived developmental malformation, generally occurring in the posterior mediastinum. Their development in the retroperitoneum is extremely rare. Imaging techniques, such as multidetector computed tomography (MDCT), are typically effective in the detection of these lesions. Here, we describe three cases of a retroperitoneal cyst presenting as a para-adrenal mass. Only one boy presented with abdominal pain, and the other two showed no clinical symptoms. Endocrinological evaluation of all three cases was performed, and no adrenal hormone secretion was detected. All three cases were misdiagnosed preoperatively. Each patient underwent surgery, and one symptomatic patient became asymptomatic after surgery. Pathologic examination confirmed all three masses as bronchogenic cysts. The three cases showed some similar MDCT imaging features, including a complete adrenal structure, a cystic or solid mass in the adrenal region, and no obvious enhancement. Therefore, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal masses, even though accurate preoperative diagnosis remains difficult. A contrast-enhanced MDCT scan may be useful for differentiating hyper-attenuated cysts from other soft tissue masses.

Orthopedic disorders in children suffering from neuroblastoma with intraspinal extension: the experience of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology

Neuroblastoma (NB) is the most common extracranial tumor in children. In 5–15% of cases, the tumor extends into the spinal canal and can potentially cause neurological deficits and orthopedic problems that can develop both at the onset of the disease and at a later time. We analyzed data of 61 patients with NB and intraspinal extension who had been treated at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology over the period from Jan 2012 to Dec 2018. The study was approved by the Independent Ethics Committee and the Scientific Council of the D. Rogachev NMRCPHOI. The treatment was delivered in accordance with the NB-2004 protocol. In all the children, magnetic resonance imaging and/or computed tomography of the CNS were performed to evaluate intraspinal extension of the tumor as well as the degree of spinal cord compression. The presence of scoliosis and its severity were determined at the baseline and at 2 years after the diagnosis using imaging data and Cobb angle measurement. Scoliosis was classified as mild if the Cobb angle was 10–25°, moderate if it was 25–40°, and severe if it exceeded 40°. In our study, 7/61 (12%) patients were diagnosed with scoliosis at the baseline assessment. The median age at diagnosis was 8.0 (2.3–11.8) months. The male to female ratio was 2.5:1. In 4/7 (57%) patients, the primary tumor was located in the retroperitoneum (outside the major organs), and in 3/7 (43%) patients – in the posterior mediastinum. In this group, 4/7 (57%) patients had INSS stage 2 or 3 tumors, 2/7 (29%) patients had stage 4 disease, and 1/7 (14%) had INSS stage 4S. The majority of patients (5/7 (71%)) were stratified into an observation group. In 6/7 (86%) patients, the tumor extended into the spinal canal involving the thoracic spine. In 6/7 (86%) cases, there was evidence of complete obstruction of the spinal canal. Neurosurgery was performed in 4/7 (57%) patients. All these patients were diagnosed with mild scoliosis at the baseline. At 2 years after the diagnosis, imaging data were available for 38/54 (70%) patients who had not had scoliosis at the baseline. This time, scoliosis was diagnosed in 9/38 (24%) cases. The median age at NB diagnosis was 8.2 (0.8–42.3) months, the male to female ratio was 2:1. In 7/9 (78%) patients, the primary tumor was located in the posterior mediastinum. The majority of patients were stratified into an observation group (7/9 (78%)). In 8/9 (89%) patients, the tumor extended into the spinal canal involving the thoracic vertebrae. In the majority of patients (4/9(44%)), the tumor filled 33 to 66% of the spinal canal. Neurosurgery was performed in 6/9 (67%) patients. In this group, 7/9 (78%) patients were diagnosed with mild scoliosis and 2/9 (22%) patients – with moderate scoliosis. NB with intraspinal extension can lead to various orthopedic problems including scoliosis that can be revealed both at the onset of the disease and at a later time, meaning that this condition requires a multidisciplinary approach involving orthopedic specialists.

Mediastinal Extension of a Pancreatic Pseudocyst: A Rare Intrathoracic Complication of Pancreatitis

Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.

To the X-ray characterization of the accessory pulmonary lobe of the azygos vein (lobus azygos)

The occurrence of an anomaly of the upper lobe of the right lung is due to an unusual passage of the azygos vein. In the process of embryonic development, the azygos vein is initially located in the posterior mediastinum to the right of the spine, reaches the level of the IV-V thoracic vertebra, here it bends through the root of the right lung and flows into the superior vena cava.

Primary seminoma arising in the posterior mediastinum: a diagnostic challenge

Primary mediastinal germ cell tumors are a rare finding, and one third of them are seminomas. Seminomas are found in the anterior mediastinum, whereas they are extremely rare within the posterior compartment. Most clinicians would not consider a primary seminoma in the differential diagnosis of a posterior mediastinal mass, as only two cases have been reported in literature. Here we present the case of a 57-year-old male with a primary seminoma arising in the left posterior mediastinum. He was asymptomatic and the mass was an incidental finding. Positron emission tomography (PET) revealed a small area with an avid tracer uptake. Transthoracic needle aspiration led to a non-diagnostic result. Due to the strong suspect of malignancy, a surgical excision was chosen to obtain a diagnosis. He underwent complete excision, and pathology report demonstrated a mediastinal seminoma. Subsequent further staging did not reveal any other location of the disease. Given the complete excision of the primary tumor, active surveillance was the treatment of choice. The patient is free of disease 48 months after diagnosis.

Mediastinal thoracic duct cyst: A rare entity

Thoracic Duct Cysts (TDCs) are exceedingly rare benign masses of the posterior mediastinum. They are thought to arise from congenital or degenerative weakening in the thoracic duct wall. We bring to light an incidentally detected posterior mediastinal cystic lesion that caused dysphagia in our patient and was found to be a thoracic duct cyst.

A case report of a huge euthyroid goiter with retrosternal extension

Massive goiter with retrosternal extension is most frequently found in the anterior mediastinum; however, 10%–15% of the cases are found in the posterior mediastinum. It may induce symptoms caused by tracheal, esophageal, and recurrent laryngeal nerve compression. Surgery for such a huge mass requires a high degree of experience to avoid serious complications, particularly if it weighs >500 g. Herein, we report the case of a 64-year-old man who complained of neck swelling which was gradually increasing in size during the past 19 years and breathing difficulty that worsened during the past years. A 31 × 16 cm heterogeneous enhancing mass that expanded the thyroid gland with retrosternal extension, pushing the main vessels posterolaterally and compressing the trachea, was detected during computed tomography of the neck and chest. Total thyroidectomy was performed safely via a transcervical approach. The recovery period was uneventful, and the patient was discharged 5 days later. Given the rarity of a massive goiter that pushes the main vessels and compresses the trachea in the posterior mediastinum, this case report emphasizes the treatment options and outcome of this condition.

Method of Macromicroscopic Preparation for Determination of Fetal Anatomical Variability of the Thoracic Part of the Aorta

To obtain data about the formation of fetal macroscopic structure and topography of the thoracic part of the aorta, which can be used for age-related mapping, it is necessary to determine a standard sequence of steps during the preparation of these structures. The purpose of the study was to determine the method of the best rational sequence of actions during the preparation of areas of the posterior mediastinum in human fetuses to obtain standard results, useful for comparing in the age aspect. Materials and methods. The study was performed on 35 human fetuses of 4-10 months by macromicroscopic preparation of organs, vessels, and nerves of the posterior mediastinum. Results and discussion. In the study of fetal anatomical variability of branches and nerves of the thoracic aorta in the age aspect, the algorithm of anatomical preparation of the posterior mediastinum becomes a priority. However, in the literary sources available to us, we did not find information about the sequence of actions during the preparation of the posterior mediastinum, including the thoracic aorta in human fetuses. The innervation of the thoracic part of aorta on both sides mainly involves the branches of the II-VI thoracic nodes of the sympathetic trunk, the great visceral nerve, and the branch of the vagus nerve. Adherence to the following sequence of actions during the preparation of the posterior mediastinum, and in particular, the branches and nerves of the thoracic aorta, in human fetuses, provides not only the scientific value of the results but also the rational use of biological material. Conclusion. The proposed and tested method of dissection of nerves, visceral and parietal branches of the thoracic aorta in human fetuses provides a standard for obtaining data about their typical, individual, and age anatomical variability. The innervation of the thoracic aorta mainly involves the branches of the II-VI thoracic nodes of the sympathetic trunk, the great visceral nerve, and the branch of the vagus nerve. Nerve branches leading to the thoracic aorta from various sources enter its wall either together with blood vessels or in isolation. In human fetuses, between the right and left sympathetic trunks and the thoracic part of the aorta, in addition to the intermediate plexus or collateral trunk, a paraaortic plexus is found, the branches of which participate in the innervation of the thoracic aorta. Bilateral asymmetry of the structure and topography of the plexuses of the thoracic aorta was detected. The sequence of actions used during the preparation of the thoracic aorta in human fetuses preserves the natural appearance and relationships between the branches and nerves of the object of the study