Three-dimensional computed tomography-guided excision of an intrathoracic giant thymoma with elongated thymic vessels

We report the case of an intrathoracic giant thymoma with elongated thymic vessels, which was successfully resected under three-dimensional computed tomography guidance. A large, left-sided intrathoracic mass was incidentally found in a 41-year-old woman during a routine work-up for uterine cancer. Six vessels were noted arising from the tumor, five of which were connected to the anterosuperior mediastinum. The vasculature suggested that the tumor originated from the thymus and grew into the left pleural cavity, which pulled and elongated the associated vessels. Preoperative computed tomography imaging demonstrated that these vessels were located behind the tumor, which increased the risk for catastrophic intraoperative bleeding. We created a detailed surgical plan using our preoperative computed tomography data and successfully excised the tumor using intraoperative three-dimensional computed tomography guidance. Histopathological examination revealed a type AB thymoma without capsular invasion. This case highlighted the role of preoperative planning and intraoperative imaging in resecting an intrathoracic giant thymoma safely. In the video, we demonstrate how we performed the procedure under three-dimensional navigation.

Cranial Mediastinal Thyroglossal Duct Adenocarcinoma in a Dog

ABSTRACT A 7 yr old female spayed Canaan dog was presented for evaluation of a subclinical intrathoracic mass noted during meta-static staging for a digit and lingual mass. Thoracic ultrasound and computed tomography revealed a 6.0 × 5.5 cm mass within the cranial mediastinum. The mass was septated with mixed fluid and soft-tissue structures and no evidence of vascular invasion. Narrow excision of the mass via a sternal thoracotomy was performed. Histopathology of the mass was consistent with a thyroglossal duct cyst adenocarcinoma. This is the first reported case of a thyroglossal duct cyst adenocarcinoma arising in the cranial mediastinum of a dog. There was no evidence of metastasis or recurrence 25 mo after surgery and adjunctive therapy.

Large intrathoracic lipoblastoma

Lipoblastoma is a rare benign tumor of primitive white fat in children, which usually involves the trunk and extremities. It rarely involves retroperitoneum, head, neck, and mediastinum. Herein, the authors introduce a rare presentation of lipoblastoma as a large intrathoracic mass.

Yield of ultrasound guided transthoracic needle aspiration in peripheral intrathoracic mass lesions

In thoracic lesions, early diagnosis and sorting out into malignant- benign is important regarding the therapeutic decisions and prognosis. Ultrasound guided Transthoracic needle aspiration (TTNA) and Corebiopsy (CNB) are described to be safe accurate high yielding means of diagnosis. The study aims to determine the yield and safety of TTNA in peripheral intrathoracic mass lesions. Study was conducted in government teaching institution in Kerala. Patients with intrathoracic peripheral mass lesions which were visualized by USG were subjected to TTNA, and sent for cytopathology. The patients with inconclusive results were subjected to either USG guided or CT guided CNB. The patients were followed up till a conclusive diagnosis obtained. The results were classified as conclusive /definitive or inconclusive. Diagnostic yield and complication rate calculated.USG guided TTNA had an overall diagnostic yield of 65.5%,with 72.15% yield in malignancy. It had high diagnostic yield in lung carcinoma(82.3%) and was a safe procedure with complication rate of 3% only.Combined with USG guided CNB, the overall yield became 86.66% with a cumulative yield of 91.13% in malignancy with no increase in complication rate. Ultrasound guided TTNA is a safe procedure with good yield in peripheral lung malignancies.Ultrasound guided transthoracic needle aspiration and core cut together has a high diagnostic yield in peripheral intrathoracic masses and is accurate in differentiating malignant and benign lesion with a good safety profile.

Role of Computed Tomography Guided Fine-Needle Aspiration Cytology in the Study of Various Thoracic Mass Lesions

BACKGROUND Intrathoracic mass is a problem faced by the clinicians worldwide which is difficult to diagnose correctly. The mediastinum although a small anatomic compartment, the pathologic processes found in it are diverse. Imaging techniques are very helpful for detection and diagnosing these lesions. The current study was conducted for assessing the diagnostic accuracy and efficacy of computed tomography (CT) guided fine-needle aspiration cytology (FNAC) in the evaluation of various thoracic mass lesions and also to compare the histopathological findings of CT guided FNAC for evaluation of the type of thoracic lesions & its prognosis. METHODS Data for the study was collected from 50 patients referred to the Department of Pathology, in a tertiary care hospital for 16 months from December 2015 to March 2017. RESULTS Among 50 patients with intrathoracic mass, there were 37 men (74 %) and 13 women (26 %). The age of patients with intrathoracic masses in this study varied from 31 to 80 years. The mean age was 55 years. Thirty-two patients were found to have malignant tumours and 18 cases were of benign aetiology. The highest frequency of cases in this study were of adenocarcinoma followed by squamous cell carcinoma. CONCLUSIONS Computed tomography (CT) guided fine-needle aspiration cytology (FNAC) is a cost effective, simple, safe, highly sensitive & specific procedure with high diagnostic accuracy in the diagnosis of intrathoracic mass lesions. It has few complications, rarely requiring active management. KEY WORDS Intrathoracic Mass, Fine-Needle Aspiration Cytology, Pneumothorax, Pneumonectomy, Thoracic Mass Lesions

Fetal Lung Interstitial Tumor: Clinicopathologic Analysis of 4 Cases From China

Background: The fetal lung interstitial tumor (FLIT) is a newly identified tumor and is extremely rare, with only five reports published in English. Here, we report 4 cases of FLITs in China and present a literature review, aiming to explore this rare tumor.Methods: The clinical and histological findings, immunophenotype, and ALK FISH of these 4 FLIT cases were evaluated, with a detailed review of the literature.Result: The 4 cases comprised 2 male and 2 female infants. Two cases had a lung or intrathoracic mass during pregnancy, as early as 28 gestational weeks, and tachypnea and groaning shortly after birth. The other two cases received clinical attention because of jaundice and weakness at 3 days and 10 minutes after birth. The two female patients had a high serum AFP level. CT showed a well-circumscribed solid-cystic mass in the lung. Surgical removal was performed at 6 days, 11 days, 18 days and 5 days respective. Grossly, the tumor was a well-0circumscribed, solid-to-spongy cut surface, and the largest diameter was 5.5-6.1 cm. Histological examination revealed an immature airspace and interstitium resembling fetal lung tissue at the canalicular stage (20-24 weeks of gestation). The epithelial cells coexpressed CK, EMA, TTF-1 and b-catenin, while the interstitial cells were strongly and diffusely positive for vimentin, with variable degrees of desmin, SMA, MSA and b-catenin. There was no ALK positivity among the four cases. One of the four cases had an ALK gene fusion by FISH. All four cases were in good condition after surgery.Conclusions: The FLIT is a recently reported type of congenital lung lesion with distinct pathological morphology. Some of the FLIT cases have high AFP levels, which represents an ALK gene fusion and may be related to ALK-positive tumors. The FLIT prognosis is good, and surgery is the preferred treatment. The differential diagnosis should include congenital pulmonary airway malformation (CPAM), pleuropulmonary blastoma (PPB), congenital inflammatory myofibroblastic tumor (CIMT) and pulmonary interstitial glycogenosis (PIG).

Thoracoscopic treatment of a rare bilateral extralobar lung sequestration in a 3-years old girl

Majority of sequestrations fall into two categories: Intra-Lobar (ILS) and Extra-Lobar (ELS). Rarely the abnormal lung could be attached to the gastrointestinal tract, Bronchopulmonary Foregut Malformation (BPFM). We described a case of a girl of 3-years-old with antenatal diagnosis of left intrathoracic mass of the inferior lobe. Postnatal Computed-Tomography (CT) revealed a bilateral ELS with an isthmic bridge crossing the vertebral spine. She follows a MRI follow-up at 18months/30months confirming the lesion. Before surgery, a three-dimensional-CT-angiography was performed to study the mass, its blood supply and to plan surgery. She underwent to thoracoscopic resection. Two aberrant blood vessels were dissected from the thoracic aorta and ligated. The postoperative course was uneventful. She was discharged after 3 days. The rarity of our case is due to the bilateral extension. An appropriate preoperatory imaging study is necessary for the success of surgery while thoracoscopy is particularly appropriate in surgical treatment.