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Background and Aim: Esophageal duplication cysts (EDCs) are rare congenital malformations, often discovered incidentally during endoscopy or on computed tomography (CT) scans. The role of endoscopic ultrasound (EUS) and CT scan in the diagnosis of these lesions and indications for surgical treatment are underreported. The aim of this study was to investigate these topics in a cohort of patients. Materials and Methods: Between January 2001 and October 2020, 82 patients had a suspicion of esophageal duplication cyst on endoscopic ultrasound. Thirty four of these patients were referred for surgical enucleation of the lesion, but three patients were lost to follow-up. At the end, 31 patients, who underwent surgical treatment for their suspected EDC were included in this study. Clinical features, EUS findings, CT images, surgical treatment, and outcome were collected from hospital health records. CT images were re-evaluated by a chest radiologist. Type of surgery, surgical complications, and final histological diagnosis were reported. Results and Conclusion: The patients referred for surgery were younger (p = 0.0001) and had larger lesions (> 2 cm; p = 0.005) than the patients who had non-operative follow-up. From thirty-one operated patients, eighteen (58%) had post-operative histological diagnosis of duplication cyst. On EUS the final histological diagnosis was correct in 58% (18/31) of all the operated cases and on CT scan 57% (17/30). CT scan misdiagnosed three of the EDCs but found two leiomyomas correctly. None of these patients developed malignancy. According to this study, neither EUS without fine-needle biopsy nor CT scan alone can differentiate EDCs from other mediastinal masses. [ABSTRACT FROM AUTHOR]

We report the clinical case of a patient with acute myocardial infarction due to coronary stent compression as first manifestation of a large thymoma. The patient underwent a coronarography and thrombus aspiration + plain old balloon angioplasty restoring the stent patency. The mass resection was performed through left robotic‐assisted thoracic surgery (RATS), resulting in a type A thymoma pT1a, IIb Masaoka‐Koga. An uncommon presentation led to early diagnosis and treatment of a thymoma with both oncological and functional significance. [ABSTRACT FROM AUTHOR]

Simple Summary: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating mediastinal tumors. In equivocal cases, cine magnetic resonance imaging (cine-MRI) and magnetic resonance imaging (MRI)/T1-weighted spin echo sequences (T1TSE) may be additionally performed. We retrospectively analyzed patients undergoing surgical resection of mediastinal tumors (benign and malignant) with prior CT, cine-MRI, and T1TSE for (re-)evaluation and comparison to the intraoperative findings and postoperative histology reports, which were defined as a gold standard. Unclear CT cases were further investigated. A total of 47 patients were included in the study. Cine-MRI is of crucial benefit in unclear CT findings compared with T1TSE, especially when infiltration into the large central vessels and atria is suspected. Background/Objectives: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating the extent of mediastinal tumors. If tumor infiltration into the large central thoracic vessels, the pericardium, or the myocardium is suspected, cine magnetic resonance imaging (cine-MRI) can provide additional valuable information. Methods: We conducted a retrospective study of patients with mediastinal tumors who were staged with CT, cine-MRI, and a T1-weighted turbo spin echo (T1TSE) prior to surgical resection. Imaging was re-evaluated regarding tumor infiltration into the pericardium, myocardium, superior vena cava, aorta, pulmonary arteries, and atria and compared with intraoperative findings and postoperative histopathological reports (gold standard). Unclear CT findings were further investigated. Results: Forty-seven patients (29 female and 18 male patients; median age: 58 years) met the inclusion criteria. Cine-MRI was able to predict infiltration of the aorta in 86%, pulmonary arteries in 85%, and atria in 80% of unclear CT cases. Aortic tumor infiltration in unclear CT cases was significantly more often correctly diagnosed with cine-MRI than with T1TSE sequence. Conclusions: Additional cine-MRI is of crucial benefit in unclear CT cases. We recommend performing cine-MRI if infiltration into the large central vessels and atria is suspected. T1TSE sequence is of very limited additional value. [ABSTRACT FROM AUTHOR]

Herein, we report a case of a 16-year-old girl who presented with an episode of shortness of breath while playing sports. Upon radiologic workup, she was found to have a large multicystic anterior mediastinal mass. The cystic appearance of mass and lack of constitutional symptoms contributed to favoring a benign cystic process and deferring surgical resection until the end of sport season. When surgery was performed 3 months later, microscopic examination showed findings diagnostic of classic Hodgkin lymphoma arising in a thymic cyst. Despite the rarity of such cases, it is important to remember that the cystic nature of an anterior mediastinal mass does not exclude lymphoma. Definitive diagnosis is not possible without examination of representative tissue. [ABSTRACT FROM AUTHOR]

Abstract We report the clinical case of a patient with acute myocardial infarction due to coronary stent compression as first manifestation of a large thymoma. The patient underwent a coronarography and thrombus aspiration + plain old balloon angioplasty restoring the stent patency. The mass resection was performed through left robotic‐assisted thoracic surgery (RATS), resulting in a type A thymoma pT1a, IIb Masaoka‐Koga. An uncommon presentation led to early diagnosis and treatment of a thymoma with both oncological and functional significance.

Mature mediastinal teratoma is a rare benign tumor in children. Few cases have been reported in the literature. Moreover, this tumor is often characterized by slow growth, reaching a large volume and frequently causing nonspecific symptoms, making its diagnosis more difficult. It raises the question of differential diagnosis with malignant mediastinal tumors in pediatric patients, requiring histological confirmation by biopsy or excision. The purpose of this article is to report an atypical clinical finding characterized by spinal deformity, and to contribute to medical knowledge concerning this uncommon pediatric tumor.

Background: Primary mediastinal B cell lymphoma (PMBCL) is a rare type of non-Hodgkin's lymphoma, and prompt diagnosis and initiation of chemotherapy are necessary to limit compression of cardiovascular structures. Case report: A 13-year-old patient was diagnosed with PMBCL, resulting in acute hypoxemic respiratory failure and cardiogenic shock with clinical pericardial tamponade. Chemotherapy was initiated after veno-arterial extracorporeal membrane oxygenation and subsequent endovascular stenting of the superior vena cava (SVC) to optimize cardiac output due to malignant SVC syndrome. Conclusion: We discuss the challenges of diagnosis and emergency management of pediatric patients with PMBCL and review the existing relevant literature for SVC syndrome secondary to PMBCL.

Type IV hiatal hernia is a mixed type of hiatal hernia characterized by the herniation of visceral organs other than the stomach into the mediastinum. It is the least common type of hiatal hernia. We report a case of a 4-month-old male infant who presented with shortness of breath and persistent vomiting. Initial chest X-ray suggested a mediastinal mass, but further evaluation with chest computed tomography (CT) scan revealed herniation of the stomach and duodenum through the hiatal oesophagus into the thoracic cavity. Radiological imaging was crucial in confirming the diagnosis of hiatal hernia.

Leukemic masses are a known complication in patients with hematologic malignancies. Here we present a case regarding a patient with recently diagnosed B-acute lymphoblastic leukemia (B-ALL) who presented with multiple sites of extramedullary involvement including an anterior mediastinal mass. This mass persisted despite multiple rounds of multiagent cytotoxic therapy. In this report, we summarize the literature regarding mediastinal masses in the setting of B-ALL and illustrate that such masses in patients with leukemias may have surprising etiology, separate from the primary disease.

Background: Lymphoblastic Lymphoma (LBL) is a rare neoplasm which represents 1-2% of all Non-Hodgkin’s Lymphomas (NHLs). Objectives: To present challenges in diagnostic of a rare case in limited resources setting Case Presentation: A 36-year-old male came to Dr. Soetomo hospital with shortness of breath, facial edema and chest pain. Physical examination revealed a decreased breath sound and dull percussion in the right chest. CT scan showed solid mass 10.4 x 5.9 x 14.6 cm in the anterior - medius of mediastinum. Fine needle aspiration biopsy guided by CT scan showed the spread of lymphoid cells, big in size, anaplastic, rounded and hyperchromatic nuclei. Core biopsy showed diffuse and monotonous pattern of pleomorphic cells, round to oval and hyperchromatic nuclei. Immunostaining were positive for CD3 and Tdt, high Ki67 proliferation index 98%, and negative for CD20. Conclusion: T-LBL is a rare neoplasm, that generally occurs in adolescents and young adults, and is most common in males. It is an aggressive neoplasm, which can involve mediastinal mass and cause superior vena cava syndrome. Immunostaining would be positive for Tdt, and variably express CD1a, CD2, CD3, CD4, CD5, CD7, and CD8. The prognosis was poor due to the aggressiveness and the relapse.

Abstract Background Giant anterior mediastinal masses in infants are one of the most challenging cases faced in pediatric anesthesia practice. They can pose unique challenges for resection such as cardiovascular collapse on induction of anesthesia and injury to surrounding structures that maybe compressed or displaced. Principles that must be followed and kept in mind during removal of giant mediastinal mass include appropriate diagnostic imaging to define mass extent, airway control during induction, a multidisciplinary team approach including cardiothoracic for sternotomy, cannulation to institute cardiopulmonary bypass, otolaryngology for rigid bronchoscopy, preservation of neurovascular structure, and complete resection whenever possible. Our patient had a mass that weighed twice his whole body weight. Case presentation Here we present a 3-month-old Middle Eastern infant weighing 3.2 kg with a large congenital teratoma who presented to the emergency room with cyanosis and respiratory distress. During his hospital course, he underwent three procedures, two of them under light-to-moderate sedation: a diagnostic computer tomography scan followed by mass content drainage by interventional radiology (Figs. 1, 2). On the third day, he had a thoracotomy with complete tumor resection under general anesthesia with the help of an epidural for pain control (Fig. 3). The resected tumor weighed 2.5 kg, which was equal to twice the patient’s total body weight (Fig. 4). After the surgery, he was extubated in the operating room and discharged home 3 days later. Fig. 1 Anterior–posterior chest x-ray showing the anterior mediastinal mass (AMM) Fig. 2 Cross-section computed tomography (CT) showing large anterior mediastinal mass (AMM) Fig. 3 Gross anatomy of the tumor before resection Fig. 4 Gross anatomy of the removed tumor Conclusion Anterior mediastinal mass patients can be challenging for the anesthesiologist. They need meticulous thorough perioperative assessment to determine the extent of compression on major intramediastinal structures and to predict the complications. Planning by multidisciplinary team and discussion with the family is important. These types of cases should be preferably operated on by an experienced team in a well-equipped operation room in tertiary care institutes.

Abstract Myocardial revascularization in patients presenting with an anterior mediastinal mass poses considerable challenges. In this report, we outline two cases involving patients with anterior mediastinal masses who underwent surgical resection alongside concurrent myocardial revascularization. One patient underwent coronary artery bypass graft surgery, while the other was treated by percutaneous coronary intervention with drug‐eluting stent placement. Both patients fully recovered from the relative procedures and were discharged within two weeks post‐surgery, ultimately diagnosed with thymoma. The concomitant intervention offered the advantage of promptly addressing both conditions, and it was performed safely through a collaborative multidisciplinary effort.

Abstract Background In a sedated patient, airway compression by a large mediastinal mass can cause acute fatal cardiopulmonary arrest. Extracorporeal membrane oxygenation (ECMO) has been investigated to protect the airway and provided cardiopulmonary stability. The use of ECMO in the management of mediastinal masses was reported, however, the management complicated by cardiopulmonary arrest is poorly documented. Case presentation 32-year-old female presented with acute onset of left arm swelling and subacute onset of dry cough. Further investigation showed a deep venous thrombosis in left upper extremity as well as a large mediastinal mass. She underwent mediastinoscopy with biopsy of the mass which was complicated by cardiopulmonary arrest secondary to airway obstruction by the mediastinal mass. Venoarterial ECMO was initiated, while concurrently treating with a chemotherapy. The mediastinal mass responded to the chemotherapy and reduced in size during 2 days of ECMO support. She was extubated successfully and decannulated after 2 days of ECMO and discharged later. Conclusions Extracorporeal membrane oxygenation can serve as a viable strategy to facilitate cardiopulmonary support while concurrently treating the tumor with chemotherapy, ultimately allowing for the recovery of cardiopulmonary function, and achieving satisfactory outcomes.

Background: Giant anterior mediastinal masses in infants are one of the most challenging cases faced in pediatric anesthesia practice. They can pose unique challenges for resection such as cardiovascular collapse on induction of anesthesia and injury to surrounding structures that maybe compressed or displaced. Principles that must be followed and kept in mind during removal of giant mediastinal mass include appropriate diagnostic imaging to define mass extent, airway control during induction, a multidisciplinary team approach including cardiothoracic for sternotomy, cannulation to institute cardiopulmonary bypass, otolaryngology for rigid bronchoscopy, preservation of neurovascular structure, and complete resection whenever possible. Our patient had a mass that weighed twice his whole body weight. Case presentation: Here we present a 3-month-old Middle Eastern infant weighing 3.2 kg with a large congenital teratoma who presented to the emergency room with cyanosis and respiratory distress. During his hospital course, he underwent three procedures, two of them under light-to-moderate sedation: a diagnostic computer tomography scan followed by mass content drainage by interventional radiology (Figs. 1, 2). On the third day, he had a thoracotomy with complete tumor resection under general anesthesia with the help of an epidural for pain control (Fig. 3). The resected tumor weighed 2.5 kg, which was equal to twice the patient's total body weight (Fig. 4). After the surgery, he was extubated in the operating room and discharged home 3 days later. Conclusion: Anterior mediastinal mass patients can be challenging for the anesthesiologist. They need meticulous thorough perioperative assessment to determine the extent of compression on major intramediastinal structures and to predict the complications. Planning by multidisciplinary team and discussion with the family is important. These types of cases should be preferably operated on by an experienced team in a well-equipped operation room in tertiary care institutes. [ABSTRACT FROM AUTHOR]

While excision for parathyroid cysts remains as the standard of management, surgical approach in the context of massive cervicomediastinal parathyroid cysts can be challenging. We report a rare giant parathyroid cyst in anterior mediastinum successfully resected from a simple standard Kocher's collar incision. Various surgical approach will also be deliberated. [ABSTRACT FROM AUTHOR]

Myocardial revascularization in patients presenting with an anterior mediastinal mass poses considerable challenges. In this report, we outline two cases involving patients with anterior mediastinal masses who underwent surgical resection alongside concurrent myocardial revascularization. One patient underwent coronary artery bypass graft surgery, while the other was treated by percutaneous coronary intervention with drug‐eluting stent placement. Both patients fully recovered from the relative procedures and were discharged within two weeks post‐surgery, ultimately diagnosed with thymoma. The concomitant intervention offered the advantage of promptly addressing both conditions, and it was performed safely through a collaborative multidisciplinary effort. [ABSTRACT FROM AUTHOR]

Thymoma is one of the thymic epithelial tumors arising from the thymic epithelial cells of a variety of animal species including cat, cattle, dog, goat, horse, and pig. The cancer cells of thymoma are always localized within thymus. Feline thymoma was usually identified in the cranial mediastinum of elder cats. In this report, we present the full diagnostic characteristics of a young cat with a cranial mediastinal mass diagnosed as a cystic type B1 thymoma. A 3-yearold male neutered domestic short-haired cat was referred for further diagnosis due to the shortness of breath and pleural accumulation. One single cystic extra-pericardial mass was seen and the boundary between the mass and the surrounding tissue was clearly demarcated in three-view thoracic radiographs. Ultrasound showed pleural effusion and intra-thoracic mass. Pleural fluid biochemistry showed high level of triglycerides and complete blood count revealed the elevated number of basophils and high level of feline serum amyloid A (fSAA). Pleural effusion sediment cytology showed a large number of round cells, mainly small lymphocytes, as well as a moderate number of neutrophils and a small number of large lymphocytes. The high level of triglycerides in pleural fluid instead of serum and high level of fSAA seem to provide informative clues to the diagnosis of thymoma and are worthy of further investigation. [ABSTRACT FROM AUTHOR]

Synovial sarcoma, a rare subtype of soft-tissue sarcomas, typically manifests in the extremities of young individuals. Mediastinal occurrences are exceedingly uncommon, with sparse cases documented. This article details the atypical presentation of a mediastinal synovial sarcoma in a 68-year-old female patient, diverging from the common demographic and anatomical predilections. Initial symptoms of a dry cough and fatigue led to the discovery of a mediastinal mass via chest CT scan. Subsequent pathological examination confirmed the diagnosis of mediastinal synovial sarcoma. Despite the identification of this rare tumor, the patient’s condition progressed rapidly, resulting in her demise within two months post-diagnosis. This case underlines the critical need for increased awareness and research into the mediastinal variant to improve diagnostic accuracy and treatment efficacy. Despite synovial sarcoma being predominantly identified in the extremities, occurrences in the mediastinum present unique diagnostic dilemmas and therapeutic hurdles due to limited literature and atypical clinical presentations. The utilization of advanced imaging modalities, immunostaining techniques, and multimodal treatment approaches is essential in the management of mediastinal synovial sarcoma. [ABSTRACT FROM AUTHOR]

A 49-year-old lady presented to the OPD with complaints of cough associated with breathlessness for 4 days and one episode of hemoptysis. She also had an anterior neck swelling for the past 2 years. The swelling did not cause any dysphagia. On examination, the patient had a smooth, diffusely enlarged swelling in the anterior region of her neck. There was no lymphadenopathy. She was found to be euthyroid by blood investigations. An anti-thyroperoxidase titer was sent because of the thyroid swelling, which was elevated. FNAC of the swelling showed benign hyperplasia of thyroid-Bethesda stage 2. Chest X-ray showed a widened mediastinum, and a contrast CT showed two well-defined heterogenous mediastinal lesions with central areas of necrosis located posterior to the superior vena cava. A Technetium-99 m pertechnetate radionucleotide scan did not show any uptake. She was planned for an anterior thoracotomy for an excision biopsy of the mass. Histopathology revealed thyroid tissue with heavy lymphocytic infiltration suggestive of Hashimoto's thyroiditis. No cases of ectopic Hashimoto's thyroiditis in the middle mediastinum with elevated Anti-TPO have been reported. Here, we report a case of ectopic thyroid tissue at a very unusual location behind the superior vena cava showing features of Hashimoto's thyroiditis. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Anterior mediastinal mass often is serious and its diagnosis requires a comprehensive evaluation involving imaging studies, pathological analysis and consultation with a multidisciplinary team involving radiologist, thoracic surgeons, and oncologist. [ABSTRACT FROM AUTHOR]

Introduction: Large masses in the pleural cavity or mediastinum in pediatric patients may present an operative challenge, not only in terms of obtaining adequate space in the small chest for safe dissection, but in attaining adequate chest closure. Case series: Three adolescent males presented with large masses in the mediastinum or thoracic cavity. Their presenting signs were primarily chronic cough and chest pain. Patient 1 was a 13-year-old male with a history of spina bifida and a 12 × 10 × 9 cm malignant germ cell tumor in the mediastinum/right chest. Patient 2 was an 18-year-old male with a 24 × 15 × 11 cm right thoracic synovial sarcoma in the posterior mediastinum/right hemithorax. Patient 3 was a 14-year-old male with a 19 × 14 × 10 cm lymphovascular malformation in the posterior mediastinum/right hemithorax. In all three patients, after the resection of the tumor via a clamshell throacotomy, sternal plating was employed for sternal wound closure. Post operative complications included a superficial surgical site infection and a chyle leak, but no wound dehiscence or breakdown. Conclusion: The bilateral clamshell thoracotomy is a suitable approach for the resection of extensive mediastinal and thoracic masses in adolescents. The use of a sternal plate leads to adequate sternal healing.

Thyroglossal duct cysts (TGDCs) are congenital anomalies that originate from the embryonic thyroglossal duct. Here, we present an atypical case of a thyroglossal cyst of the superior mediastinum with a small cervical extension. A male patient presenting with vague symptoms of retrosternal discomfort and cough was evaluated with computed tomography (CT) thorax. It was revealed to be a mediastinal mass. An excision biopsy of the mass under general anesthesia revealed it to be a thyroglossal duct cyst. TGDC of the mediastinum is extremely rare. To the best of our knowledge, this is the first case reported in a patient of Indian origin and the fifth such case reported worldwide. [ABSTRACT FROM AUTHOR]

Abstract Background Ectopic cervical thymoma (ECT) is an extremely rare tumor, especially in association with myasthenia gravis (MG). Case presentation We report a case of myasthenia gravis with an ectopic thymoma in the neck, whose myasthenic symptoms significantly improved after complete removal of the mass. A 55-year-old woman with generalized myasthenia gravis (MG) experienced worsening neuromuscular weakness after abruptly discontinuing pyridostigmine. Testing revealed acetylcholine receptor-antibody (AChR-Ab) positivity and a cervical mass initially thought to be thyroid or parathyroid was identified as a thymoma, type A. Post-surgery and radiation therapy, her myasthenic symptoms improved significantly with less prednisone and pyridostigmine requirements over time and no need for additional immunotherapies. Conclusions Diagnosing ECTs is challenging due to rarity, atypical locations, and inconclusive fine needle aspiration cytology (FNAC) results, often misinterpreted as thyroid or parathyroid lesions. As proper management of patients with MG, including thymectomy, offers favorable clinical outcomes such as significant improvement in myasthenic complaints and reduced immunosuppressive medication requirements, clinicians should be vigilant of the ectopic locations of thymomas to ensure timely diagnosis and intervention.

Abstract Background Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease, is a rare, self-limiting disease that predominantly affects children and young adults. Moreover, the disease is characterized by painless bilateral cervical lymphadenopathy in 95% of the patients. However, few reports are available on the Rosai-Dorfman disease of the thymus. Case presentation We report a rare case of thymic Rosai-Dorfman disease detected using computed tomography. During a medical examination, a 50-year-old man underwent a chest computed tomography scan, which revealed an anterior mediastinal single mass with fat in the thymus. A thymectomy was performed to completely remove the tumor using a thoracoscopic technique due to a clinical suspicion of thymoma. Furthermore, Rosai-Dorfman disease was confirmed using histological and immunohistochemical analyses. Conclusions To the best of our knowledge, this is the sixth case of thymus-affecting solitary Rosai-Dorfman disease with histological and immunohistochemical evidence. Fat in the thymus, as was present in this case, has never been described in Rosai-Dorfman disease previously. Our results highlight the challenge of diagnosing this uncommon tumor before surgery, and more cases need to be reported to help with the preoperative diagnosis of such a rare tumor.

Abstract Background Superior vena cava (SVC) syndrome is an urgent condition arising from restricted blood flow through the SVC, often linked to factors like malignancy, thrombosis, or infections. Typically, confirmation of the diagnosis involves computed tomography. However, many patients experience respiratory distress and cannot lie supine. Given the increasing integration of point-of-care ultrasound in emergency medicine, it is important to be familiar with findings that are suggestive of this important condition. Case report In this case report, we highlight a young patient presenting to the emergency department with superior vena cava syndrome symptoms, successfully diagnosed using point-of-care ultrasound. Conclusion This case highlights the utility of point-of-care ultrasound based diagnosis of SVC syndrome and upper arm deep venous thrombosis in a patient with underlying malignancy which ultimately led to early involvement of relevant speciality for initiation of treatment.

Anaplastic thyroid carcinoma is a rare, aggressive form of thyroid carcinoma with a mean survival of less than 6 months. Ectopic thyroid tissue can be present in the mediastinum due to faulty embryogenesis with improper descent. Primary thyroid malignancies may arise from this ectopic tissue. A 90-year-old male with a history of prostatic adenocarcinoma, hypothyroidism, and occupational and therapeutic exposure to radiation presented with a rash on his chest. A review of the dermatopathology and excised mediastinal specimen revealed rare papillary foci that tested positive for thyroid markers from a background of poorly differentiated components. Molecular analysis confirmed a BRAF V600E mutation in the specimen. The final diagnosis was anaplastic thyroid carcinoma of the giant-cell type. Given the atrophic cervical thyroid tissue in the patient's neck with no evidence of previous surgery, this carcinoma was believed to arise from ectopic mediastinal tissue associated with cutaneous and bony metastasis. In conclusion, anaplastic thyroid carcinoma is an aggressive and rare thyroid malignancy that can arise from ectopic thyroid tissue in the mediastinum and should be considered in the differential diagnosis of primary undifferentiated mediastinal malignancies with bony involvement.

Background: Ectopic cervical thymoma (ECT) is an extremely rare tumor, especially in association with myasthenia gravis (MG). Case presentation: We report a case of myasthenia gravis with an ectopic thymoma in the neck, whose myasthenic symptoms significantly improved after complete removal of the mass. A 55-year-old woman with generalized myasthenia gravis (MG) experienced worsening neuromuscular weakness after abruptly discontinuing pyridostigmine. Testing revealed acetylcholine receptor-antibody (AChR-Ab) positivity and a cervical mass initially thought to be thyroid or parathyroid was identified as a thymoma, type A. Post-surgery and radiation therapy, her myasthenic symptoms improved significantly with less prednisone and pyridostigmine requirements over time and no need for additional immunotherapies. Conclusions: Diagnosing ECTs is challenging due to rarity, atypical locations, and inconclusive fine needle aspiration cytology (FNAC) results, often misinterpreted as thyroid or parathyroid lesions. As proper management of patients with MG, including thymectomy, offers favorable clinical outcomes such as significant improvement in myasthenic complaints and reduced immunosuppressive medication requirements, clinicians should be vigilant of the ectopic locations of thymomas to ensure timely diagnosis and intervention. [ABSTRACT FROM AUTHOR]

Tumor lysis syndrome (TLS) is a life-threatening hemato-oncological emergency in which the patient presents with severe metabolic derangements that include hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia. However, very rarely, a highly aggressive neoplasm such as acute lymphoblastic leukemia (ALL) or Burkitt lymphoma can present with spontaneous TLS. Preventive actions can reduce its prevalence and severity. Here, we present a male patient who was admitted to the intensive care unit with unspecific symptoms and hidden malignancy. On further evaluation, the patient had hyperphosphatemia, hyperuricemia, a large mediastinal mass, pericardial effusion, and left-sided massive pleural effusion and was also found to be in spontaneous TLS. On further evaluation, the patient was diagnosed with acute T-cell lymphoblastic leukemia. [ABSTRACT FROM AUTHOR]

Background: Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease, is a rare, self-limiting disease that predominantly affects children and young adults. Moreover, the disease is characterized by painless bilateral cervical lymphadenopathy in 95% of the patients. However, few reports are available on the Rosai-Dorfman disease of the thymus. Case presentation: We report a rare case of thymic Rosai-Dorfman disease detected using computed tomography. During a medical examination, a 50-year-old man underwent a chest computed tomography scan, which revealed an anterior mediastinal single mass with fat in the thymus. A thymectomy was performed to completely remove the tumor using a thoracoscopic technique due to a clinical suspicion of thymoma. Furthermore, Rosai-Dorfman disease was confirmed using histological and immunohistochemical analyses. Conclusions: To the best of our knowledge, this is the sixth case of thymus-affecting solitary Rosai-Dorfman disease with histological and immunohistochemical evidence. Fat in the thymus, as was present in this case, has never been described in Rosai-Dorfman disease previously. Our results highlight the challenge of diagnosing this uncommon tumor before surgery, and more cases need to be reported to help with the preoperative diagnosis of such a rare tumor. [ABSTRACT FROM AUTHOR]

Background: Superior vena cava (SVC) syndrome is an urgent condition arising from restricted blood flow through the SVC, often linked to factors like malignancy, thrombosis, or infections. Typically, confirmation of the diagnosis involves computed tomography. However, many patients experience respiratory distress and cannot lie supine. Given the increasing integration of point-of-care ultrasound in emergency medicine, it is important to be familiar with findings that are suggestive of this important condition. Case report: In this case report, we highlight a young patient presenting to the emergency department with superior vena cava syndrome symptoms, successfully diagnosed using point-of-care ultrasound. Conclusion: This case highlights the utility of point-of-care ultrasound based diagnosis of SVC syndrome and upper arm deep venous thrombosis in a patient with underlying malignancy which ultimately led to early involvement of relevant speciality for initiation of treatment. [ABSTRACT FROM AUTHOR]

Introduction: Mediastinal teratomas are rare in children and adolescents; however, they often present diagnostic and therapeutic challenges, given their potential for malignancy. Rapid intervention, particularly surgical excision, is crucial for large, life-threatening masses following clinical stabilization. Case presentation: A 9-year-old female presented with progressive left costal pain and dyspnea on exertion, culminating in acute respiratory failure prior to admission. Examination revealed a hypopigmented square patch in the left lower quadrant of the abdomen. Initial chest x-ray (CXR) showed complete opacification of the left lung with mediastinal shift to the right. Subsequent chest CT scan confirmed a 14.2cm × 11.2cm x 14.5cm complex, multiloculated, multiseptated mass suggestive of neoplasia. Local mass effect resulted in the obliteration of the left mainstem bronchi, left upper and lower lobe bronchi, lung atelectasis, and a large left pleural effusion. Surgical excision was planned following consultation with Pediatric Anesthesiology and Intensivist. The patient underwent left posterolateral thoracotomy through the fifth intercostal space, during which a large complex cystic mass (17.5 cm × 16.8 cm x 7.7 cm) arising from the thymus was excised after careful dissection from surrounding lung parenchyma and pericardium. Postoperatively, she recovered well in the Pediatric Intensive Care Unit (PICU) and was discharged on postoperative day #8 after pathology confirmed a benign teratoma. Conclusion: Mediastinal teratomas in pediatric patients presenting with life-threatening signs and symptoms necessitate early recognition, involvement of a multidisciplinary team, and prompt surgical excision to ensure optimal outcomes.

Key Clinical Message Anterior mediastinal mass often is serious and its diagnosis requires a comprehensive evaluation involving imaging studies, pathological analysis and consultation with a multidisciplinary team involving radiologist, thoracic surgeons, and oncologist.

Introduction: Size is a predictor factor of a patient’s prognosis and metastasis in solid tumors. This study determined the relationship between thymoma size and distant metastasis. Methods: A cohort retrospective study using medical record data was conducted at Dr. Moewardi General Hospital, Surakarta, from January 2019 to August 2021. Of 1,430 thoracic oncology patients, 150 (10%) had mediastinal mass with thymoma as the majority (48.6%). About 73 thymoma patients were included. The size of the thymoma was the dependent variable, and the metastasis (distant and non-distant) was the independent variable. The cut-off point of thymoma size was determined with receiver operating characteristic (ROC) analysis. The correlation of thymoma size with distant metastasis was analyzed with the Chi-Square test, and p < 0.05 was considered significant. Results: Thymoma was predominated by males (53.4%), the mean age was 43 ± 16 years old, and dyspnea was the most common symptom. Metastatic lesions were found in 87.7% of the patients, and the most common metastatic sites were intrathoracic (79.5%), followed by axillary lymph nodes (49.3%), bone (21.9%), liver (20.5%), and brain (1.4%). The cut-off value of thymoma size was 8.25 cm, indicating that >8.25 cm was categorized as large thymoma. Distant metastasis was found in 86.0% of large thymoma patients. The large tumors tend to spread into various sites (OR = 5.39; 95% CI 2.8-32.6; p = 0.002). Conclusion: Thymoma must be taken into account when there are male patients in their forties presented with dyspnea and mediastinal mass. The cut-off point of 8.25 cm for the thymoma size can predict distant metastasis.

To compare the learning curve of mediastinal mass resection between robot-assisted surgery and thoracoscopic surgery. Retrospective perioperative data were collected from 160 mediastinal mass resection cases. Data included 80 initial consecutive video-assisted thoracoscopic surgery (VATS) resection cases performed from February 2018 to February 2020 and 80 initial consecutive robotic-assisted thoracic surgery (RATS) resection cases performed from March 2020 to March 2023. All cases were operated on by a thoracic surgeon. The clinical characteristics and perioperative outcomes of the two groups were compared. The operation time in both the RATS group and VATS group was analyzed using the cumulative sum (CUSUM) method. Based on this method, the learning curves of both groups were divided into a learning period and mastery period. The VATS group and the RATS group crossed the inflection point in the 27th and 21st case, respectively. Subsequently, we found that the learning period was longer than the mastery period with statistically significant differences in terms of the operating time, and postoperative hospital stay in the VATS group and the RATS group. A certain amount of VATS experience can shorten the learning curve for RATS. [ABSTRACT FROM AUTHOR]

An 8‐year‐old male Yorkshire terrier was presented to the Tufts Veterinary Hospital for evaluation of increased respiratory effort. A mediastinal mass composed of a spindle‐cell thymoma within a bronchogenic cyst was diagnosed with computed tomography thoracic imaging, ultrasound‐guided fine‐needle aspirate biopsy, and histopathologic evaluation after surgical removal. Histologic evaluation showed a multilocular cyst structure as well as a mass characterized by spindle to polygonal thymic epithelial cells. The cyst was characterized by a lining of ciliated pseudostratified respiratory epithelium. To the authors' knowledge, this is the first report of a spindle‐cell thymoma being associated with a mediastinal bronchogenic cyst in a dog. [ABSTRACT FROM AUTHOR]

Primary mediastinal large B-cell lymphoma (PMBCL) is a rare subtype of lymphoma with female predominance. Lymphomas are divided into Hodgkin's lymphoma (accounts for 10% of all lymphomas) and nonHodgkin's lymphoma. Pulmonologist often comes across lymphoma which can present as a mediastinal mass. PMBCL is an example of such a condition which represents 2%–3% of nonHodgkin lymphoma cases. This case report is about two male patients with PMBCL who presented with mediastinal mass, which was diagnosed by histopathological examination.

Background: The realm of diagnosing intrathoracic lesions involves a spectrum of imaging methodologies, among which computed tomography (CT)-scan and magnetic resonance imaging (MRI) stand prominent. In the context of Iran, where there is no study comparing the efficacy of CT-scan and MRI for evaluating intrathoracic lesions, our study endeavors to bridge this gap. Mindful of the nuanced advantages and drawbacks inherent in each method, we aim to conduct a comprehensive comparative analysis of CT-scan and MRI in diagnosing intrathoracic lesions, focusing on patients seeking care at Firoozgar Hospital's pulmonary clinic. Methods: Embarking on a cross-sectional exploration at Firoozgar Hospital Pulmonary Clinic in Tehran, Iran, our investigative journey unfolded between April 2020 and March 2021. Thirty patients, spanning ages 21 to 69, presenting with intra-thoracic lesions encompassing mediastinal and chest wall anomalies, underwent simultaneous CT scan and MRI examinations. In pursuit of diagnostic certainty, histopathology was ordained as the gold standard, and the ensuing results underwent meticulous scrutiny and analysis utilizing SPSS 23 statistical software. Results: Our study cohort comprised 30 patients, averaging 44.83 years (SD=12.71), with males constituting 60% of the population. Delving into the histological reports, CT-scan and MRI accurately diagnosed 25 (83.3%) and 28 (93.3%) cases, respectively, in retrospective analysis. The Kappa matching coefficient for CT-scan stood at 0.783, while for MRI, it soared to 0.912. A notable revelation surfaced as the Kappa matching coefficient for both CT-scan and MRI maintained a robust 0.783 (P

We present a rare case of mediastinal capillary hemangioma in a 54-year-old female. She presented with back pain in the left suprascapular region, and the chest radiograph revealed left pleural effusion. On further workup with high-resolution computed tomography (CT) chest, a hypervascular pleural-based neoplastic lesion in the left upper hemithorax with gross left pleural effusion and subtotal collapse of the left lung was identified. 18F-fluorodeoxyglucose positron emission tomography/CT was suggestive of a weakly metabolic well-defined pleural-based soft tissue lesion in the left upper hemithorax along the mediastinal side. Neuroendocrine tumor was suspected. 68Ga-DOTATATE PET/CT was advised, which showed intense uptake in the lesion. The mass was resected completely. Histopathological examination established the final diagnosis as benign vascular tumor consistent with a capillary hemangioma. [ABSTRACT FROM AUTHOR]

Retrosternal goiter is an enlargement of the thyroid gland and a progressive mass that grows insidiously in the chest cavity over a long time. Unlike typical retrosternal goiters, ectopic mediastinal goiters are extremely rare occurring in less than 1% of all goiters. This image presents a 51-year-old woman with a posterior mediastinal goiter in which the left thyroid lobe extends into the retrosternal mediastinum and ectopic thyroid tissue in the anterior mediastinum. [ABSTRACT FROM AUTHOR]

Mediastinal masses present a diagnostic challenge due to their similar imaging characteristics, making distinguishing between noninfectious and infectious processes or malignancies difficult. A mediastinal abscess can result in severe life-threatening infections if left untreated. Traditional treatment approaches involve surgical debridement and drainage; however, emerging endobronchial techniques, such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), offer a less-invasive means of diagnosing and managing abscesses. Herein, we describe a case of a young male patient who exhibited nonspecific symptoms, including pleuritic chest pain, shortness of breath, and fever. Imaging revealed a mediastinal mass with granuloma formation. EBUS-TBNA successfully drained the abscess, and microbiology analysis confirmed the growth of Streptococcus intermedius. Subsequently, his symptoms resolved, and follow-up imaging demonstrated the resolution of the mass and associated calcifications. Further research is warranted to assess the role of EBUS-TBNA in benign mediastinal masses with granuloma formation. [ABSTRACT FROM AUTHOR]

Introduction:In recent years, robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) has been more frequently preferred in the surgical treatment of mediastinal masses. The number of studies comparing VATS with RATS is limited. In our study comparing the surgical outcomes of RATS and VATS procedures, we tried to determine the ideal treatment method.Methods:Between 2016 and 2022, fifty-two patients who underwent minimally invasive surgical resection (VATS or RATS) for mediastinal mass were retrospectively analyzed.Results:Mediastinal mass resection was performed by RATS (n=29) or VATS (n=23). 57.7% (n=30) of the mediastial masses were localized in the anterior mediastinum. The most common postoperative pathology was thymoma (27%, n=14). There was no surgical mortality. Grade 1 and 2 complications developed in 6 (11.5%) patients according to the Clavien-Dindo classification. Conversion to open surgery was required in a total of 5 patients [VATS group (n=3), 13% versus RATS group (n=2), 6.9%, p=0.644]. The median length of hospital stay was five days [VATS; 4 days interquartile range (IQR): 3-6] versus RATS; 5.5 days (IQR: 4-8), p=0.081]. The median drainage time was four days [VATS; 3 (2-5) versus RATS; 4.5 (3-7), p=0.133], and the mean drainage amount was 110 mL (70-190) (p=0.162). There was no significant difference between the duration of the operation (for VATS; 75.7±18.4 min, for RATS; 73.5±18.0 min, p=0.674). Postoperative pain scores were similar [median 2.19 (1-3) for RATS and 2.20 (1-3) for VATS, p=1.00].Conclusion:RATS and VATS are reliable procedures offering many advantages in treating mediastinal masses. Both procedures have similar results in terms of the complication rate, the length of the hospital stay, and duration of surgery.

Abstract Background Mediastinal lesions are diagnosed sometimes by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Wet-heparinized suction technique has been used to improve the quality of abdominal solid tumor samples obtained by EUS-FNA. The aim of the study is to assess the effect of wet-heparinized suction on the quality of mediastinal solid tumor samples and to evaluate the safety of the method. Methods The medical records, EUS-FNA records, pathologic data, and follow-up data between the patients who suspected mediastinal lesions with wet-heparinized suction and conventional suction were retrospectively and comparatively analyzed. Adverse events at 48 h and 1 week after EUS-FNA were evaluated. Results Wet-heparinized suction contributed to more tissue specimens (P 0.05). There was no complication after discharge in both groups. Conclusion Wet-heparinized suction can improve the quality of mediastinal lesion samples obtained by EUS-FNA and increase the success rate of sampling. In addition, it will not aggravate blood contamination in paraffin sections while ensuring a safe puncture.

The mediastinum, located between the pleural sacs, has three compartments. The anterior mediastinum spans anteriorly from the sternum to the pericardium and brachiocephalic vessels posteriorly. Common lesions in this area include thymomas, lymphomas, teratomatous neoplasms, and thyroid masses. A mediastinal mass in the setting of tuberculous meningoencephalitis is an uncommon presentation of tuberculosis. We present a case of a 20-year-old girl with fever and headache diagnosed with tuberculous meningoencephalitis. A thorough workup revealed an anterior mediastinal mass, histopathologically diagnosed as tubercular in origin. Treatment involved surgery and antituberculosis therapy. Tuberculosis can manifest uniquely, and an isolated mediastinal mass, especially in an immunocompetent individual, is unusual. Treatment typically involves a combination of antimicrobial medications, and in some cases, surgical intervention may be necessary to address complications or persistent masses. This case emphasizes the importance of considering tuberculosis as a diagnosis when a patient presents with a mass in the anterior mediastinum.

ANTECEDENTES: El carcinoma de timo es una neoplasia muy poco frecuente y con pronóstico adverso; forma parte de las neoplasias epiteliales del timo, en las cuales también se incluye el timoma. CASO CLÍNICO: Paciente masculino de 75 años de edad, remitido al servicio de medicina interna para valoración preoperatoria para artroplastia de rodilla; durante la anamnesis se refirieron síntomas B, la radiografía de tórax mostró ensanchamiento mediastinal sin desplazamiento. En la tomografía computada se corroboró una lesión ocupativa de 9.2 x 7.0 x 8.1 cm en el mediastino anterior. CONCLUSIONES: Este caso es interesante al ser una afección poco frecuente en la bibliografía mundial, ya que en Estados Unidos se reporta una prevalencia menor al 2% de todas las neoplasias malignas. Existen 13 subtipos de carcinoma tímico, de los que el 70% corresponde al subtipo de células escamosas. BACKGROUND: Thymus carcinoma is a very rare neoplasm with adverse prognosis, it is part of the epithelial neoplasms of the thymus, which also includes thymoma. CLINICAL CASE: A 75-year-old male patient, referred to the internal medicine service for preoperative evaluation for knee arthroplasty, during the anamnesis the presence of B symptoms was referred, the chest X-ray showed mediastinal widening without displacement. Computed tomography showed an occupational lesion of 9.2 × 7.0 × 8.1 cm in the anterior mediastinum. CONCLUSIONS: This case is interesting as it is a rare entity in the world literature since in the United States a prevalence lesser than 2% of all malignant neoplasms is reported. There are 13 subtypes of thymic carcinoma, 70% of which correspond to the squamous cell subtype. [ABSTRACT FROM AUTHOR]