148 results on '"Subcarinal Lymph Node"'
Search Results
2. Prediction of lymph node status in completely resected IIIa/N2 small cell lung cancer: importance of subcarinal station metastases
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Rong Qiao, Runbo Zhong, Jianlin Xu, Yanwei Zhang, Bo Zhang, Shuyuan Wang, Yuqing Lou, Dongfang Chen, Qing Chang, Yizhuo Zhao, and Baohui Han
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Small cell lung cancer ,N2 disease ,Subcarinal lymph node ,Prognostic factors ,Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background The aim of this study was to determine the prognostic value of lymph node status in patients with pathologic N2 (pN2) stage IIIA small cell lung cancer (SCLC). Methods A total of 163 consecutive pN2 stage IIIA SCLC patients who underwent pulmonary resections and systematic lymphadenectomies at Shanghai Chest Hospital between January 2006 and June 2014 were enrolled. We retrospectively analyzed the potential clinicopathologic factors that influenced survival, including the node levels (single or multiple-station) and the node-spreading patterns (skip N2 or non-skip N2). The prognostic significance was examined by Cox regression analysis. Results The median overall survival (OS) was 23.7 months. Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement (p = 0.003). Skip metastasis did not appear to influence survival (p = 0.099). With respect to the station of lymph node metastasis, the OS was only related to the involvement of the subcarinal node, regardless of tumor location (p
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- 2019
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3. Robotic Lung Resection
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Paul, D. Ian, Park, Bernard J., Wang, Jun, editor, and K. Ferguson, Mark, editor
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- 2017
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4. Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA)
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Witte, Biruta, Wolf, Michael, Hürtgen, Martin, Zieliński, Marcin, editor, and Rami-Porta, Ramón, editor
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- 2014
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5. A Difficult Case of Pyrexia of Unknown Origin
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Tanu Singhal, Abhijit Raut, Meenal S. Hastak, Namita Davar, and Santanu Sen
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Male ,medicine.medical_specialty ,Adolescent ,Fever ,medicine.diagnostic_test ,business.industry ,Mycobacterium tuberculosis ,Lung biopsy ,medicine.disease ,Sensitivity and Specificity ,Lymphoma ,Subcarinal Lymph Node ,medicine.anatomical_structure ,Bronchoscopy ,Drug Resistance, Bacterial ,Pediatrics, Perinatology and Child Health ,Biopsy ,medicine ,Humans ,Histopathology ,Radiology ,business ,Antibiotics, Antitubercular ,Lymph node ,Empiric therapy - Abstract
This is the case of a 15-y-old boy who presented with fever and back pain with MRI features of spondylitis. A CT-guided vertebral biopsy showed acute and chronic inflammatory cells and grew Pseudomonas aeruginosa on aerobic culture. The child was treated for 2 wk with antibiotics with no response. Meanwhile, he developed new lung, liver, and splenic lesions on CT imaging. Empiric antitubercular therapy was then started and continued for 8 wk during which time there was progressive clinical deterioration. At this time the patient underwent bronchoscopy with lavage and endoscopic ultrasound-guided subcarinal lymph node and lung biopsy. The Xpert MTB/Rif ULTRA was "trace positive" in the bronchoscopic lavage with indeterminate rifampicin resistance, while it was negative in lymph node and lung biopsy. The lymph node and lung biopsy histopathology showed nonspecific inflammatory changes with no granulomas or malignant cells. In view of the positive Xpert ULTRA with indeterminate rifampicin resistance and no response to first-line drugs, treatment with second-line antitubercular drugs was initiated. The clinical condition continued to deteriorate; here the imaging findings were reviewed again and repeat aspiration cytology and biopsy from intra-abdominal nodes was carried out. This yielded the diagnosis of Hodgkin lymphoma. The patient had stage IVB disease. He responded well to standard chemotherapy and is currently in remission. The case illustrates the need to avoid empiric therapy, repeat invasive procedures if so needed, choose the site/method of biopsy appropriately and interpret results of investigations carefully when evaluating a patient with pyrexia of unknown origin.
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- 2021
6. Hepatocellular Carcinoma with Distant Metastasis Cured by 20-Day Sorafenib Treatment
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Seok Bae Kim
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Sorafenib ,medicine.medical_specialty ,complete remission ,Sorafenib treatment ,RC799-869 ,Metastasis ,Case and Review ,distant metastasis ,medicine ,neoplasms ,business.industry ,Extended right hepatectomy ,Gastroenterology ,Complete remission ,Distant metastasis ,hepatocellular carcinoma ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,digestive system diseases ,cure ,Subcarinal Lymph Node ,Hepatocellular carcinoma ,sorafenib ,Radiology ,business ,medicine.drug - Abstract
There are only 13 cases of complete remission after sorafenib use in advanced hepatocellular carcinoma (HCC) worldwide. We herein report a rarer case in which the patient was cured after only 20 days of sorafenib use. A 61-year-old male patient was diagnosed with a huge HCC. The mass occupied almost the whole of the right hepatic lobe and a portion of segment 4. We performed extended right hepatectomy for cure. However, 3.5-cm-sized subcarinal lymph node metastasis was detected at 15 months after operation. We prescribed sorafenib 400 mg bid for palliative treatment. The patient had severe fever, pain, and blisters on the hands and feet, so the patient stopped taking it after 20 days. Subcarinal lymph node disappeared on chest computed tomography after 3 months, and there was no evidence of recurrence for a year.
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- 2021
7. Evaluation of the significance of subcarinal lymph node dissection in stage IB non‑small cell lung cancer.
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Wang, Feng, Yu, Xiangyang, Han, Yi, Zhang, Lanjun, and Liu, Shuku
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NON-small-cell lung carcinoma , *LYMPHADENECTOMY , *LYMPH node surgery , *PROPORTIONAL hazards models , *PROPENSITY score matching , *ONCOLOGIC surgery - Abstract
Lymph node dissection is used to treat early-stage lung cancer. The present study aimed to investigate if resecting the subcarinal lymph nodes affects prognosis of patients with stage IB non-small cell lung cancer (NSCLC). A total of 597 patients with stage IB NSCLC who underwent lung cancer surgery at Sun Yat-Sen University Cancer Center from January 1999 to December 2009 were included in the present study. The potential prognostic factors were evaluated using the Cox proportional hazard regression model. A total of 252 cases were obtained following propensity score matching (PSM). To compare overall survival (OS) and recurrence-free survival (RFS), Kaplan-Meier method and log-rank test were used. Among the 597 cases included, 185 did not undergo subcarinal lymph node resection, whereas 412 did. There were statistically significant differences between the two groups in terms of bronchial invasion, number of resected lymph node stations and resected lymph node numbers (P<0.05). Age, family history of cancer and the number of resected lymph nodes were prognostic factors for OS, whereas age and the number of resected lymph nodes were prognostic factors for RFS (P<0.05). Resection of subcarinal lymph nodes was not associated with OS and RFS. After PSM, survival analysis was recalculated using the Kaplan-Meier method and log-rank test; subcarinal lymph node resection was not statistically associated with OS and RFS. (P>0.05). For stage IB NSCLC, there was no statistically significant association between subcarinal lymph node resection and OS and RFS. Subcarinal lymph node resection in surgery of stage IB NSCLC may be considered optional. [ABSTRACT FROM AUTHOR]
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- 2023
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8. Evaluation of subcarinal lymph node dissection and metastasis in transmediastinal radical esophagectomy
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Jun Shibamoto, Yusuke Yamamoto, Hiroki Shimizu, Hisashi Ikoma, Takuma Ohashi, Yoshiaki Kuriu, Takeshi Kubota, Atsushi Shiozaki, Eigo Otsuji, Kazuma Okamoto, Ryo Morimura, Hirotaka Konishi, Hitoshi Fujiwara, and Tomohiro Arita
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medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Esophageal cancer ,Subcarinal lymph node dissection ,Metastasis ,medicine ,Humans ,Esophagus ,Lymph node ,Retrospective Studies ,Lymph node metastasis ,business.industry ,Transmediastinal esophagectomy ,Gastroenterology ,medicine.disease ,Subcarinal Lymph Node ,Esophagectomy ,medicine.anatomical_structure ,Subcarinal ,Lymph Node Excision ,Original Article ,Lymph ,Radiology ,Lymph Nodes ,business ,Predictive factor - Abstract
Background The aim of the present study was to evaluate subcarinal lymph node dissection in transmediastinal radical esophagectomy and subcarinal lymph node metastasis in patients with esophageal cancer. Methods Three hundred and twenty-three patients with primary esophageal cancer who underwent transmediastinal or transthoracic esophagectomy with radical two- or three-field lymph node dissection were retrospectively investigated. The clinicopathological characteristics of patients with subcarinal lymph node metastasis were analyzed in detail. Results The median of dissected subcarinal lymph nodes in transmediastinal and transthoracic esophagectomy groups was 6 and 7, respectively, and there was no significant difference between the two groups (p = 0.12). Of all patients, 26 (8.0%) were pathologically diagnosed as positive for subcarinal lymph node metastasis, whereas only 7 (26.9%) of those with metastasis were preoperatively diagnosed as positive. In addition, all patients with subcarinal lymph node metastasis had other non-subcarinal lymph node metastasis. By univariate analysis, subcarinal lymph node metastasis was found in larger (≥ 30 mm) and deeper (T3/T4a) primary lesions (p = 0.02 and 0.02, respectively), but it was not found in 49 patients with the primary lesion located in the upper thoracic esophagus. Conclusions Subcarinal lymph nodes can be dissected in transmediastinal esophagectomy, almost equivalent to transthoracic esophagectomy. The tumor size, depth, and location may be predictive factors for subcarinal lymph node metastasis.
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- 2021
9. Direct Intraesophageal Growth from Metastatic Mediastinal Lymphadenopathy in Thymic Carcinoma
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Mai Iwaya, Takashi Kobayashi, Tomonobu Koizumi, Hiroki Kanazawa, Toshirou Fukushima, Shintaro Kanda, and Nobukazu Sasaki
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Male ,medicine.medical_specialty ,Mediastinal lymphadenopathy ,Thymoma ,mediastinal tumor ,Mediastinal tumor ,Lymphadenopathy ,Case Report ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,medicine ,Mediastinal Diseases ,Humans ,Esophagus ,ADOC chemotherapy ,Thymic carcinoma ,Aged ,esophagus ,Mass/lesion ,subcarinal lymph node ,business.industry ,General Medicine ,Esophageal lumen ,Thymus Neoplasms ,medicine.disease ,Dysphagia ,Subcarinal Lymph Node ,medicine.anatomical_structure ,Carcinoma, Squamous Cell ,030211 gastroenterology & hepatology ,Radiology ,medicine.symptom ,business - Abstract
We herein report a case of thymic carcinoma that initially exhibited dysphagia and an intraesophageal mass lesion. A 68-year-old man was admitted to our hospital because of dysphagia. An endoscopic examination revealed a mass on the middle esophagus. Chest computed tomography (CT) showed a huge anterior mediastinal mass and subcarinal lymph node swelling, directly invading into the esophageal lumen. An immunohistological examination of the esophageal and anterior mediastinal masses revealed squamous cell carcinoma originating from the thymus. This is the first report of a thymic carcinoma spreading into the esophageal lumen and forming a mass lesion.
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- 2020
10. Coexisting of COX7A2L–ALK, LINC01210–ALK, ATP13A4–ALK and Acquired SLCO2A1–ALK in a Lung Adenocarcinoma with Rearrangements Loss During the Treatment of Crizotinib and Ceritinib: A Case Report
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Yaling Long, Meijuan Huang, Chengzhi Cai, and Yanying Li
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Lung ,Crizotinib ,Ceritinib ,business.industry ,medicine.disease ,respiratory tract diseases ,Subcarinal Lymph Node ,medicine.anatomical_structure ,Oncology ,hemic and lymphatic diseases ,Cancer research ,Medicine ,Adenocarcinoma ,Missense mutation ,Pharmacology (medical) ,business ,Lung cancer ,Tyrosine kinase ,medicine.drug - Abstract
ALK rearrangements account for ~5% of non-small-cell lung cancer (NSCLC). Numerous rearrangement partners have been discovered. Here, we describe a 53-year-old nonsmoker with NSCLC, in whom we identified four novel rearrangements. The patient was diagnosed as adenocarcinoma in the right middle lobe of lung, with metastases in subcarinal lymph node, ipsilateral lung, pleura and contralateral rib (cT4N2M1, stage IV). Next-generation sequencing (NGS) identified three baseline ALK fusions: COX7A2L-ALK (C[intragenic]:A20), LINC01210-ALK (L[intergenic]:A20) and ATP13A4-ALK (A9:A19). The patient exhibited 12 months of progression-free survival (PFS) and a partial response (PR) to first-line crizotinib therapy. We then discovered a new SLCO2A1-ALK fusion (S[intergenic]:A18) and a missense mutation C1156Y after resistance developed. Sequential ceritinib resulted in further 8 months of PFS, after which NGS results demonstrated the loss of ATP13A4-ALK and SLCO2A1-ALK. This is the first description a NSCLC patient harbors four ALK fusions and was sensitive to tyrosine kinase inhibitors (TKIs). Acquisition and loss of ALK fusions after ALK inhibitors may account for resistance.
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- 2020
11. Tetraplegia sikeres multidiszciplináris kezelése mellkassebészeti műtéttel. Unicentrikus mediastinalis Castleman-betegség esete
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Tibor Géczi, György Lázár, Balázs Pécsy, Katalin Sas, Anna Rieth, Valéria Kiss, Tamás Zombori, Tibor Németh, József Furák, László Szpisjak, László Tiszlavicz, and Ferenc Szőnyegi
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medicine.medical_specialty ,business.industry ,Castleman disease ,medicine.medical_treatment ,General Medicine ,medicine.disease ,Dysphagia ,Hypotonia ,Surgery ,Subcarinal Lymph Node ,03 medical and health sciences ,0302 clinical medicine ,medicine ,030211 gastroenterology & hepatology ,Lymphadenectomy ,medicine.symptom ,business ,Surgical incision ,Tetraplegia ,Paresis - Abstract
Absztrakt: A Castleman-betegség egy ritka, lymphoproliferativ betegség, melynek pontos oka ismeretlen. Diagnosztikájának alapja az adekvát szövettani vizsgálat. Míg az unilocularis formánál a betegség a leggyakrabban a mellkast érinti, és az épben történő sebészi eltávolítás a tünetek megszűnését eredményezheti, addig a multilocularis formánál egyéb kezelési formák egészíthetik ki vagy válthatják fel a műtéti eltávolítást. Munkánkban egy Castleman-betegség miatt multidiszciplináris kezelésen átesett beteg esetét mutatjuk be. Az 56 éves férfi betegnél kivizsgálása előtt 18 héttel, egy felső légúti infekciót követően beszédnehezítettség, nyelészavar, felső és alsó végtagi progresszív paresis jelentkezett. Plazmaferézisre a beteg panaszai átmenetileg megszűntek ugyan, de a sebészi mintavételek a mellkas-CT-n látott mediastinalis lymphadenomegalia eredetét nem tudták igazolni. Így az 5 cm-es subcarinalis nyirokcsomó eltávolítása vagy mintavételezése miatt került a beteg osztályunkra. Átvételkor mind a négy végtagon jelentős atrófia, hipotónia, tetraplegia volt látható, és testszerte areflexia igazolódott. Osztályunkon posterolateralis thoracotomiából eltávolítottuk az 5,5 × 3,5 cm-es subcarinalis nyirokcsomó-konglomerátumot. A szövettani vizsgálat Castleman-betegséget jelzett. 3 nappal a műtét után a végtagok mozgása megindult, a 9. napon már járókerettel járóképessé vált, ezt követően neurológiai rehabilitációs osztályra került. Ekkor a felső végtagokban közel megtartott, míg az alsó végtagokban 4/5-ös izomerőt észleltek. Ezt követően a beteg metilprednizolon-, B1-vitamin-, kalcium-citrát- és famotidinkezelésben részesült; 2 héttel átvétele után otthonába bocsátották, ekkor már járókeret nélkül biztonságosan közlekedett. Tünetei 3 hónappal a műtét után csaknem teljes mértékben megszűntek. A Castleman-betegség diagnosztikája és kezelése multidiszciplináris feladat. Ha a páciens műtéti teherbíró képessége engedi, akkor az unilocularis Castleman-betegség terápiás eszköztárában a sebészeti eltávolításnak kiemelt szerepe kell, hogy legyen. OrvHetil. 2020; 161(1): 33–38.
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- 2020
12. Three-dimensional computed tomography image-oriented successful thoracoscopic subtotal esophagectomy for an esophageal cancer patient with an anomalous right superior pulmonary vein: A case report
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Noriyuki Hirahara, Nariyasu Tabara, Yoshitsugu Tajima, Hideki Tabara, Hitomi Zotani, and Takeshi Matsubara
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3D-CT, three-dimensional contrast-enhanced computed tomography ,medicine.medical_specialty ,medicine.medical_treatment ,Esophageal cancer ,Case Report ,SCC, squamous cell carcinoma ,RSPV, right superior pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Right superior pulmonary vein ,VATS-E, video-assisted thoracoscopic surgery-esophagectomy ,medicine ,Esophagus ,Bronchus ,business.industry ,Aberrant V2 ,MDCT, multidetector-row computed tomography ,medicine.disease ,Subcarinal Lymph Node ,Dissection ,medicine.anatomical_structure ,Subcarinal lymphadenectomy ,Esophagectomy ,030220 oncology & carcinogenesis ,Subcarinal ,3D-CT ,030211 gastroenterology & hepatology ,Surgery ,Lymphadenectomy ,Radiology ,business - Abstract
Highlights • Case of esophageal cancer associated with an aberrant V2. • Used preoperative 3D-CT for performing safe VATS-E. • Preoperative contrast-enhanced 3D-CT clearly depicted the aberrant V2., Background Subcarinal lymphadenectomy is an essential procedure in curative esophagectomy for esophageal cancer. The right superior pulmonary vein (RSPV) and its branches are usually located in front of the right main or intermediate bronchus. However, an anomalous posterior branch (aberrant V2) of RSPV passes behind the right intermediate bronchus, where the aberrant V2 may be embedded in the subcarinal nodal packet. This can lead to unanticipated bleeding when dissecting the subcarinal lymph node. We present a case study on the use of preoperative three-dimensional contrast-enhanced computed tomography (3D-CT) for performing a safe video-assisted thoracoscopic surgery-esophagectomy in lower thoracic esophageal cancer. Case presentation A 77-year-old man had esophageal cancer associated with an aberrant V2 passing behind the right intermediate bronchus. Esophagogastroduodenoscopy revealed a type 1 tumor in the lower thoracic esophagus. Contrast-enhanced and 3D-CT scans showed a space-occupying lesion with contrast enhancement and an aberrant V2 passing behind the right intermediate bronchus, respectively. The patient was then diagnosed with lower thoracic esophageal cancer (cT2cN1cM0 cStage II). As per the patient’s request, he underwent a surgery-first approach followed by adjuvant chemotherapy. The patient underwent video-assisted thoracoscopic surgery-esophagectomy (VATS-E) with three-field lymphadenectomy, and a large aberrant V2 involving the subcarinal nodal packet was recognized behind the right intermediate bronchus. After the thoracoscopic subtotal esophagectomy with three-field lymph node dissection, laparoscopy-assisted reconstruction of the esophagus was performed with elevation of the gastric conduit to the neck. Recurrent laryngeal nerve palsy was not observed. He started to receive rehabilitation for swallowing on day 3 and resumed oral intake on day 10 after surgery. The final pathological diagnosis was squamous cell carcinoma of the esophagus (pT3N1M0 pStageIII). Conclusions Preoperative contrast-enhanced 3D-CT clearly depicted the aberrant V2, which enabled us to perform a safe VATS-E with three-field lymphadenectomy. Thorough understanding of the anatomical configuration of the pulmonary vessels and bronchus is important for avoiding unexpected bleeding during subcarinal lymphadenectomy. 3D-CT imaging study is useful for recognizing the anomalous RSPV before surgery.
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- 2020
13. Endobronchial Ultrasound in Evaluating Mediastinal Lymphadenopathy
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Y Sunil Kumar, Nandakishore Baikunje, and Giridhar Belur Hosmane
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medicine.medical_specialty ,Tuberculosis ,Lung ,Mediastinal lymphadenopathy ,business.industry ,Caseous necrosis ,medicine.disease ,Stain ,Subcarinal Lymph Node ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,030212 general & internal medicine ,Lymph ,Radiology ,business ,Epithelioid cell - Abstract
Tuberculosis can involve most of the body parts, and tubercular lymphadenitis is common. But isolated involvement of mediastinal lymph nodes without lung parenchymal involvement is rare in adults. A 45-year-old lady presented with subcarinal lymph node enlargement. A conventional transbronchial needle aspiration done at a local hospital was inconclusive. Endobronchial ultrasound-guided transbronchial needle aspiration was done. Cytology showed epithelioid histiocytes and caseous necrosis. Stain for acid-fast bacilli and cartridge-based nucleic acid amplification test for tuberculosis were positive. Endobronchial ultrasound-guided transbronchial needle aspiration is a minimally invasive bronchoscopic technique to visualize and sample mediastinal lymph nodes. However, its availability is limited to specific centers and expertise is required to interpret images and take diagnostic samples.
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- 2021
14. Thoracoscopic esophagectomy with subcarinal lymph node dissection in the prone position for esophageal cancer with a right superior pulmonary vein anomaly: a case report
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Takuro Konno, Shota Maruyama, Chiaki Sato, Kai Takaya, Takashi Kamei, Michiaki Unno, Tadashi Sakurai, Hiroshi Okamoto, Makoto Hikage, Yu Onodera, and Yusuke Taniyama
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medicine.medical_specialty ,medicine.medical_treatment ,Thoracoscopic esophagectomy ,lcsh:Surgery ,Case Report ,Pulmonary vein ,Prone ,03 medical and health sciences ,0302 clinical medicine ,Subcarina ,Thoracoscopy ,Medicine ,medicine.diagnostic_test ,business.industry ,Dissection ,Mediastinum ,lcsh:RD1-811 ,Esophageal cancer ,medicine.disease ,Subcarinal Lymph Node ,Prone position ,Anomaly ,medicine.anatomical_structure ,Esophagectomy ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,Virtual thoracoscopy ,business - Abstract
Background Superior posterior pulmonary vein anomaly in the right upper lobe (anomalous V2), which is one of the anomalies of the right superior pulmonary vein (RSPV), runs behind the right main or intermediate bronchus. Although this rarely occurs, attention should be given to this venous anomaly during thoracoscopic esophagectomy with subcarinal lymph node dissection. Here, we report a case of thoracoscopic esophagectomy with subcarinal lymph node dissection in the prone position for lower thoracic esophageal cancer with anomaly of the superior posterior pulmonary vein in the right lobe (anomalous V2). Case presentation A 61-year-old man was diagnosed as having lower esophageal cancer with swelling of multiple lymph nodes in the mediastinum and abdomen. His clinical diagnosis based on the eighth TNM classification system was cT3 N2 M0 stage IIIB. In addition, an anomalous V2 was recognized on preoperative computed tomography imaging before the operation. The vein ran behind the intermediate bronchus and drained into the RSPV located at the area of the subcarinal lymph node. We performed preoperative simulation by using virtual thoracoscopic imaging with the same view as that during operation to help us better dissect the lymph nodes. As a result, thoracoscopic esophagectomy and subcarinal lymph node dissection were performed in the prone position without injuring the anomalous V2. Severe complications did not occur in the postoperative course except for paralysis of the left recurrent laryngeal nerve. The patient was discharged on postoperative day 17. Conclusions Injury to an anomalous V2 can cause severe hemorrhage during subcarinal lymph node dissection in esophagectomy. Preoperative simulation by using virtual thoracoscopic imaging is useful to avoid this complication in patients with an anatomical anomaly.
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- 2019
15. Is Routine Subcarinal Lymph Node Dissection Necessary in Superficial Esophageal Squamous Cell Carcinoma? A Propensity Score Matching Analysis
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Yaxing Shen, Qun Wang, Lijie Tan, Hao Wang, Yong Fang, Jun Yin, and Han Tang
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medicine.medical_specialty ,recurrence ,medicine.medical_treatment ,complication ,survival ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,superficial esophageal squamous cell carcinoma ,medicine ,Survival analysis ,business.industry ,subcarinal lymph node dissection ,medicine.disease ,Subcarinal Lymph Node ,Dissection ,Oncology ,Esophagectomy ,030220 oncology & carcinogenesis ,Subcarinal ,030211 gastroenterology & hepatology ,Lymph ,Radiology ,business ,Complication ,Research Paper - Abstract
Background: The purpose of this study was to investigate the impact of subcarinal lymph node dissection on short-term and long-term outcomes after esophagectomy in patients with superficial esophageal squamous cell carcinoma (ESCC). Methods: From January 2010 to December 2015, 490 patients with pT1 ESCC were enrolled in the study. Patients in subcarinal dissection or non-dissection group were matched randomly in a 2:1 ratio, eventually, 255 patients were selected for further statistical analysis. Results: The metastasis rate of subcarinal lymph nodes in superficial ESCC was 1.24% and significantly lower than the other stations (7.14-9.96%). Compared with dissection group, non- dissection group had shorter operation time (193±35 vs. 204±39, P=0.016), less blood loss (157±48 vs. 178±29, P=0.011) as well as lower incidence of pulmonary complications (9.4 vs. 20%, P=0.032). At a median follow-up of 46 months, the recurrent rate in each group was similar (16.5 vs. 15.3%, P=0.809). Survival analysis revealed no overall survival (P=0.992) and disease-free survival (P=0.665) reductions in non-dissection group. In univariate and multivariate analyses, subcarinal lymph node dissection was not a predictive factor of overall and disease-free survival in superficial ESCC. Conclusion: Subcarinal lymph node dissection was not beneficial and could be omitted in superficial ESCC.
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- 2019
16. Subcarinal Lymph Node Dissection in Solo Robot-assisted Thoracic Surgery
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Atsushi Watanabe, Ryunosuke Maki, Kodai Tsuruta, and Masahiro Miyajima
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Pulmonary and Respiratory Medicine ,Suction (medicine) ,Lung cancer surgery ,medicine.medical_specialty ,business.industry ,Mediastinum ,Thoracic Surgery ,Dissection (medical) ,Robotics ,Traction Method ,medicine.disease ,body regions ,Subcarinal Lymph Node ,surgical procedures, operative ,Cardiothoracic surgery ,Subcarinal ,medicine ,Humans ,Lymph Node Excision ,Surgery ,Radiology ,Lymph Nodes ,Cardiology and Cardiovascular Medicine ,business - Abstract
The surgical instruments used in robot-assisted thoracic surgery are flexible to enable the surgeon to approach the surgical field from any direction. However even in robot-assisted thoracic surgery subcarinal lymph node dissection requires a precise technique suitable for a small area surrounded by important organs. We present a method of subcarinal node dissection with solo robot-assisted thoracic surgery using a bronchial traction method and a metal basket suction device, the Dobon (Senko Medical Instrument Mfg, Tokyo, Japan).
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- 2021
17. Multimodality Treatment of Stage IIIA/N2 Non-Small Cell Lung Cancer: When YES to Surgery
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Sean All and David J. Sher
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medicine.medical_specialty ,business.industry ,Multimodality Treatment ,medicine.disease ,Surgery ,Subcarinal Lymph Node ,Locally advanced disease ,Cohort ,medicine ,Non small cell ,Stage IIIa ,Stage (cooking) ,Lung cancer ,business - Abstract
Stage III non-small cell lung cancer (NSCLC) is comprised of a heterogeneous cohort of patient presentations that are broadly considered as “locally advanced disease,” but stage IIIA/N2 further selects a subset of this category with a potentially improved prognosis. These individuals may have ipsilateral mediastinal and/or subcarinal lymph node involvement, varying tumor size (up to 7 cm), and possible invasion of surrounding mediastinal structures. Multimodality treatment is universally accepted as the standard-of-care for their management, and historically, definitive concurrent chemoradiotherapy (CRT) has been the preferred paradigm. However, because it has been long recognized that long-term survival is feasible in a small but non-trivial and growing group of these patients, there has been considerable controversy about intensifying their local therapy by using surgical resection. In fact, there are some data that support improved locoregional control and hence progression-free and even overall survival with trimodality therapy potentially warranting the increase in morbidity. This chapter will focus on reviewing the published evidence supporting the incorporation of surgery into the multimodality treatment of stage IIIA/N2 NSCLC patients.
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- 2021
18. Predictive factors of cough after uniportal video-assisted thoracoscopic pulmonary resection
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Wen-Yi Wang, Liu-Ying Pan, Jun Zhao, Xin-Yu Zhu, Li-Ping Peng, Cheng Ding, Chang Li, Chun Xu, and Jun Chen
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Univariate analysis ,Visual analogue scale ,business.industry ,Incidence (epidemiology) ,Reflux ,Surgery ,Subcarinal Lymph Node ,03 medical and health sciences ,Dissection ,0302 clinical medicine ,030228 respiratory system ,030220 oncology & carcinogenesis ,medicine ,Original Article ,Risk factor ,business ,Prospective cohort study - Abstract
BACKGROUND: Cough is one of the shared complications after lung surgery. In this study, a prospective analysis was conducted for exploring the risk factors of persistent cough after uniportal video-assisted thoracoscopic pulmonary resection. METHODS: One hundred thirty-five patients with pulmonary nodules who underwent surgical treatment in the same surgical group from November 2019 to January 2020 were enrolled in this prospective study. The severity of cough and its impact on patients’ quality of life before and after surgery were assessed by the Mandarin Chinese version of the Leicester cough questionnaire (LCQ-MC), and postoperative cough was tested by the cough visual analog scale (VAS) and cough symptom score (CSS). Risk factors of cough after pulmonary resection (CAP) were determined by univariate and multivariate logistic regression analysis. RESULTS: The incidence of postoperative cough was 24.4% (33 of 135 patients). Univariate analysis showed that gender (female), the surgical site (upper right), the resection (lobectomy), subcarinal lymph node dissection, postoperative acid reflux, length of hospitalization contributed to the development of CAP resection. Multivariate logistic regression analysis showed that the resection (lobectomy) (OR 3.590, 95% CI: 0.637–20.300, P=0.017), subcarinal lymph node dissection (OR 4.420, 95% CI: 1.342–14.554, P=0.001), postoperative acid reflux (OR 13.55, 95% CI: 3.186–57.633, P
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- 2020
19. Pattern of subcarinal lymph node metastasis and dissection strategy for thoracic esophageal cancer
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Wei-Peng Hu, Yu-Shang Yang, Yun-Cang Wang, Qi-Xin Shang, and Long-Qi Chen
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,medicine.disease ,Metastasis ,Subcarinal Lymph Node ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Esophagectomy ,030220 oncology & carcinogenesis ,Subcarinal ,medicine ,Original Article ,Radiology ,Lymph ,Esophagus ,business ,Lymph node ,Survival rate - Abstract
BACKGROUND: This study aimed to assess the role of subcarinal lymph nodes in lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC) and to investigate the adequate range of lymph node dissection during esophagectomy. METHODS: This study included 782 thoracic ESCC patients who underwent esophagectomy between July 2008 and December 2010. The metastatic rate of subcarinal lymph nodes and their influencing factors were investigated. The outcome of subcarinal lymph node dissection was assessed using the efficacy index (the incidence of metastasis to a lymph node station (%) multiplied by the 5-year survival rate (%) of patients with metastasis to that lymph node station and divided by 100). Additionally, postoperative complications were compared between the subcarinal lymph node resection and reservation groups. RESULTS: The metastatic rates of subcarinal lymph nodes in the upper, middle, and lower thoracic ESCC were 8.3% (4/48), 19.1% (79/414), and 16.2% (23/142), respectively (χ(2)=3.669, P>0.05) and in T1, T2, T3, and T4 tumors were 0% (0/71), 4% (4/100), 22.2% (85/383), and 34% (17/50), respectively (χ(2)=42.859, P0.05), and pulmonary, 10.3% and 7.3%, respectively (P>0.05). The efficacy indexes of lymph node dissection at the upper, middle, and lower third esophagus were 0%, 7.6%, and 27.5%, respectively. CONCLUSIONS: Dissection of subcarinal lymph nodes, which does not increase postoperative complications, should be performed routinely in lower thoracic ESCC after submucosal invasion of tumor; meanwhile, tumors larger than 3cm should also result in subcarinal lymph node dissection in patients with a tumor located in the upper esophagus and T1-T2 ESCC.
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- 2020
20. An usefulness of combined endobronchial and endoscopic ultrasound-guided needle aspiration in the diagnosis of sarcoidosis: a prospective, multicenter trial
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Maciej Gnass, Artur Szlubowski, Anna Filarecka, Adam Ćmiel, Damian Czyżewski, Jacek Wojtacha, Jerzy Soja, Wojciech Zajęcki, Juliusz Pankowski, and Arkadiusz Joks
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Subcarinal Lymph Node ,medicine.anatomical_structure ,Multicenter trial ,Biopsy ,Subcarinal ,Medicine ,Lymph ,Sarcoidosis ,Radiology ,business ,Lymph node - Abstract
Introduction: Needle biopsy of enlarged lymph nodes is accepted method for the diagnosis of sarcoidosis, but there is still place for investigating the optimal endosonography guided approach. Objectives: The aim of this study was to assess the relative diagnostic yield of the combination (CUS-b-NA) of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound fine-needle aspiration (EUS-b-FNA) but also a role of cell blocks (CB) and lymph node localization for the diagnosis of sarcoidosis. Methods: This was a prospective, multicenter study including consecutive patients with clinical diagnosis of stage I or II sarcoidosis. CUS-b-NA with smears and CB technique was performed within all group. If sarcoidosis was not confirmed invasive diagnostics was scheduled and 6 months follow-up was continued. Results: Since Nov 2017 to Sep 2019 fifty patients were enrolled for the final analysis. The overall sensitivity of EBUS-TBNA, EUS-b-FNA and CUS-b-NA was 76.6%, 70.2% and 91.7%, respectively. There were no significant differences between EBUS-TBNA and EUS-b-FNA (P=0.52) but CUS-b-NA had significantly higher yield (P=0.005 and P=0.001). No serious complications after all biopsies were observed. Adding CB to smear technique (P=0.008) and biopsy of the subcarinal lymph nodes (P=0.001) significantly increases the diagnostic yield. Conclusions: A diagnostic yield of CUS-b-NA is higher than endosonographic techniques alone in stage I and II of sarcoidosis. The preparation of cytological material including CB technique and the biopsy of subcarinal lymph node station increases diagnostic efficacy.
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- 2020
21. Metastases from tracheal adenoid cystic carcinoma
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Andrew Li, Ju Ee Seet, Pyng Lee, and Voon Shiong Ronnie Tan
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Pulmonary and Respiratory Medicine ,Thorax ,Adult ,medicine.medical_specialty ,Lung Neoplasms ,Adenoid cystic carcinoma ,Stridor ,Tracheal Adenoid Cystic Carcinoma ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Bronchoscopy ,otorhinolaryngologic diseases ,medicine ,Humans ,030212 general & internal medicine ,Thyroid Neoplasms ,medicine.diagnostic_test ,business.industry ,Nodule (medicine) ,respiratory system ,medicine.disease ,Carcinoma, Adenoid Cystic ,Combined Modality Therapy ,Subcarinal Lymph Node ,030228 respiratory system ,Lymphatic Metastasis ,Subcarinal ,Female ,Tracheal Neoplasms ,Radiology ,medicine.symptom ,business ,Tomography, X-Ray Computed - Abstract
A 32-year-old female never smoker presented with dyspnoea and stridor. CT thorax showed a polypoidal mass obstructing the trachea. Bronchoscopy revealed a circumferential nodular tumour 4 cm from the vocal cords, removed using electrosurgical snare and thereby re-establishing trachea patency (figure 1A,B). Histology showed adenoid cystic carcinoma (ACC). She underwent tracheal resection; as the resection margins showed ACC with perineural and fascia invasion, she received adjuvant radiation therapy 72 Gy. Yearly CT chest was performed for surveillance and CT 8 years after surgery showed enlarged subcarinal lymphadenopathy, bilateral pulmonary nodules and a left thyroid nodule (figure 1C,D). Thyroid ultrasound fine-needle aspiration confirmed 1 cm hypoechoic nodule due to ACC. Endobronchial ultrasound-guided transbronchial needle aspiration of subcarinal lymph node revealed metastatic ACC (figure 2), but no recurrence in the trachea. Figure 1 (A) Malignant polypoidal tracheal tumour with 80% obstruction (B) CT coronal view showed polypoidal …
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- 2020
22. Usefulness of combined endobronchial and endoscopic ultrasound-guided needle aspiration in the diagnosis of sarcoidosis : a prospective multicenter trial
- Author
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Adam Ćmiel, Juliusz Pankowski, Anna Filarecka, Wojciech Zajęcki, Arkadiusz Joks, Jerzy Soja, Damian Czyżewski, Artur Szlubowski, Jacek Wojtacha, and Maciej Gnass
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,bronchoscopy ,Sarcoidosis ,Endosonography ,Bronchoscopy ,Multicenter trial ,Biopsy ,Internal Medicine ,medicine ,Humans ,Prospective Studies ,sarcoidosis ,Prospective cohort study ,Lymph node ,Ultrasonography, Interventional ,medicine.diagnostic_test ,business.industry ,endosonography ,medicine.disease ,cell block ,Subcarinal Lymph Node ,medicine.anatomical_structure ,Radiology ,business - Abstract
Introduction Needle biopsy of enlarged lymph nodes is an accepted method for the diagnostic workup of sarcoidosis, but the optimal endosonography‑guided approach is yet to be determined. Objectives The aim of our study was to assess the relative diagnostic yield of combined ultrasound‑guided needle aspiration (CUS‑b‑NA), which includes endobronchial ultrasound‑guided transbronchial needle aspiration (EBUS‑TBNA) with endoscopic ultrasound fine‑needle aspiration (EUS‑b‑FNA), as well as the role of the cell block (CB) technique and lymph node localization in the diagnostic workup of sarcoidosis. Patients and methods This was a prospective multicenter study including consecutive patients with clinical suspicion of stage I or II sarcoidosis. CUS‑b‑NA with smears and CB technique were performed in the whole study group. If a biopsy result was not conclusive, an invasive diagnostic workup and a 6-month follow‑up were scheduled. Results Out of 77 screened patients, 54 signed written consent and 50 were enrolled for the final analysis. The overall sensitivity of EBUS‑TBNA, EUS‑b‑FNA, and CUS‑b‑NA was 76.6%, 70.2%, and 91.7%, respectively. There were no differences between EBUS‑TBNA and EUS‑b‑FNA (P = 0.52) but CUS‑b‑NA had a higher diagnostic yield (P = 0.005 and P = 0.001, respectively). Adding the CB method to smear technique (P = 0.008) and biopsy of the subcarinal lymph nodes increased the diagnostic yield (P = 0.001). Conclusions: The diagnostic yield of CUS‑b‑NA is higher than that of endosonographic techniques alone in the diagnostic workup of stage I and II sarcoidosis. The preparation of cytological material including CB and the choice of the subcarinal lymph node station for the biopsy increase the diagnostic efficacy.
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- 2020
23. Blastomatoid pulmonary carcinosarcoma: A rare case report and review of the literature
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Keisuke Yokota, Hideo Hattori, Takuya Watanabe, Katsuhiro Okuda, Hiroshi Haneda, Tadashi Sakane, Ryoichi Nakanishi, Hiroshi Inagaki, Tsutomu Tatematsu, and Risa Oda
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,business.industry ,Fetal adenocarcinoma ,General Medicine ,medicine.disease ,Metastasis ,Subcarinal Lymph Node ,Pulmonary Blastoma ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Carcinosarcoma ,medicine ,Adenocarcinoma ,Chondrosarcoma ,business ,Lymph node - Abstract
A 65-year-old never-smoking woman presented to a local hospital, because an abnormal shadow was detected at the right lower lung field by annual chest X-ray. Computed tomography (CT) revealed a 5-cm tumor in segment 6 of her right lung and an enlarged subcarinal lymph node, suggesting metastasis. The lung tumor was diagnosed as adenocarcinoma by a CT-guided percutaneous needle biopsy. She was referred to our hospital and underwent right lower lobectomy with lymph node dissection (ND2a-2). A histopathological examination of the tumor showed a biphasic proliferation made of carcinomatous and sarcomatous components. The carcinomatous component consisted of glandular structures of atypical cells that possessed chromatin-rich nuclear and clear cytoplasm, confirming high-grade fetal adenocarcinoma. The sarcomatous component consisted of immature spindle cells that differentiated into chondrosarcoma. Immunohistochemically, the glandular structures expressed membranous beta-catenin, and the ultimate diagnosis was blastomatoid variant of pulmonary carcinosarcoma. She received four courses of cisplatin plus vinorelbine as adjuvant chemotherapy and remained alive with neither recurrence nor distant metastasis at two and a half years after the operation. We experienced a rare case of blastomatoid pulmonary carcinoasarcoma.
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- 2018
24. P221 THE ROLE OF SUBCARINAL LYMPH NODE DISSECTION IN ESOPHAGECTOMY - A 5-YEAR SINGLE CENTER EXPERIENCE
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Theodore Liakakos, Ilias Vagios, Dimitrios Schizas, Constantinos G Zografos, Eleandros Kyros, Spyridon Davakis, Adamantios Michalinos, Maria Mpoura, Alexandros Charalabopoulos, and Eustratia Mpaili
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Subcarinal Lymph Node ,medicine.medical_specialty ,business.industry ,Esophagectomy ,medicine.medical_treatment ,Gastroenterology ,Medicine ,General Medicine ,Radiology ,Dissection (medical) ,business ,Single Center ,medicine.disease - Abstract
Aim To evaluate the involvement of subcarinal lymph node dissection (SLND) in the surgical treatment of esophageal cancer, as well as its impact on surgical outcomes following esophagectomy. Background & Methods Data on patients that underwent esophagectomy from 01/03/2014 to 01/03/2019 were prospectively collected and retrospectively reviewed. Based on the medical records, the following parameters were collected and analyzed: patient demographics, histopathological parameters, surgical- oncological outcomes. All patients were staged according to the AJCC 8th edition. Results A total of 79 patients underwent Ivor Lewis or McKeown esophagectomy for either squamous cell carcinoma (n= 7 patients) or adenocarcinoma of the esophagus or gastroesophageal junction (n= 72 patients). In 26 cases, esophagectomy was performed without SLND, while 53 cases underwent SLND. Among the 53 patients, 50 (94.3%) were men, and 3 (5.7 %) were women. Mean age was 61.4 years, (range 34-78). Mean nodal harvest was 34.7 lymph nodes per patient. Lymph node invasion was noted in 33 patients (62.2%), with a mean of 9 positive lymph nodes per patient. Subcarinal lymph nodes were involved in 5 out of 53 patients (9.4%). The ratio of positive subcarinal lymph nodes to resected ones was 1/2 (50%), 3/3 (100%), 1/2 (50%), 1/2 (50%) and 1/1 (100%) for each patient. Final histopathological report showed adenocarcinoma of moderate or poor differentiation (G2 2/5, G3 3/5) in all five patients (100%). Four out of 5 patients had not received neoadjuvant treatment and their pathological staging was T3N3M0. One patient had received neoadjuvant chemotherapy and his final staging was ypT3N2M0. Noteworthy, the seven patients diagnosed with squamous carcinoma, were subjected to SLND and were 100% negative for invasion histologically. Conclusion Subcarinal lymph nodes were infiltrated in 9.4% of patients operated for esophageal cancer. In the squamous cell cancer group, the relative infiltration rate was notably 0%. It seems that omission of subcarinal lymph node dissection during transthoracic esophagectomy cannot be justified.
- Published
- 2019
25. Tuberculosis Presenting as Cutaneous Erythema Nodosum on 18F-FDG PET/CT
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Tarun Kumar Jain
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medicine.medical_specialty ,Tuberculosis ,Mediastinal lymphadenopathy ,Lymphadenopathy ,Disease distribution ,Erythema Nodosum ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,skin and connective tissue diseases ,Skin ,Erythema nodosum ,integumentary system ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Subcarinal Lymph Node ,Female ,Fdg pet ct ,Lymph Nodes ,Radiology ,Radiopharmaceuticals ,business ,Skin lesion - Abstract
The present article presented a 47-year-old woman with areas of nodular swelling and discoloration involving bilateral lower limbs since 12 months. Biopsy from skin lesions revealed erythema nodosum. As erythema nodosum can be secondary to multiple etiologies, whole-body F-FDG PET/CT was performed to assess the disease distribution and guide the site of biopsy. F-FDG PET/CT revealed metabolically active mediastinal lymphadenopathy in addition to the skin lesions. Endobronchial ultrasound-guided biopsy from subcarinal lymph node revealed tuberculosis.
- Published
- 2019
26. Prediction of lymph node status in completely resected IIIa/N2 small cell lung cancer: importance of subcarinal station metastases
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Qiao, Rong, Zhong, Runbo, Xu, Jianlin, Zhang, Yanwei, Zhang, Bo, Wang, Shuyuan, Lou, Yuqing, Chen, Dongfang, Chang, Qing, Zhao, Yizhuo, and Han, Baohui
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- 2019
- Full Text
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27. Transbronchial needle aspiration cytology of subcarinal lymph nodes for the staging procedure in the diagnosis of lung cancer.
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Aono, Hiromi, Okamoto, Hiroaki, Kunikane, Hiroshi, Nagatomo, Akira, Watanabe, Koshiro, and Nagai, Atsushi
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- *
LUNG cancer , *TOMOGRAPHY , *LYMPH nodes , *METASTASIS , *NEEDLE biopsy , *BRONCHOSCOPY - Abstract
Objective and background: The aim of this study was to improve the staging of lung cancer with or without lymphadenopathy on chest CT by using transbronchial aspiration cytology (TBAC). Methods: TBAC of the subcarinal lymph nodes was performed on 153 consecutive patients with lung cancer, with or without subcarinal lymphadenopathy on chest CT. Results: Thirty-four patients had enlargement of the subcarinal lymph nodes (>1 cm). Eighteen of these had TBAC confirmation of metastases. Another seven patients with no mediastinal involvement on CT were positive for metastases on TBAC. TBAC was the only way to confirm lung cancer in two patients. Therefore, routinely performed subcarinal TBAC contributed to an improved non-operative staging of the patients and diagnosis in 16% (25/153) of the patients with lung cancer. Forty-nine patients with NSCLC had surgical resection of the tumour. Surgical procedure revealed metastases to the subcarinal lymph nodes in three patients in whom the preoperative TBAC diagnosis was normal. No significant complications due to TBAC occurred in any of the patients. Conclusion: TBAC of the subcarinal lymph nodes is a minimally invasive technique for staging of lung cancer and can provide useful information for the diagnosis of metastases to the subcarinal lymph nodes. [ABSTRACT FROM AUTHOR]
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- 2006
- Full Text
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28. Pulmonary Sarcoidosis That Developed During the Treatment of a Patient With Crohn Disease by Using Infliximab
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Sun Hyung Kang, Hyun Yong Jeong, Hee Seok Moon, Jae Kyu Sung, Hyuk Soo Eun, and Tae Kyun Kim
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Adverse event ,0301 basic medicine ,medicine.medical_specialty ,Sarcoidosis ,Case Report ,Inflammatory bowel disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Biopsy ,Tumor necrosis factor-alpha ,Medicine ,Adverse effect ,030203 arthritis & rheumatology ,Lung ,medicine.diagnostic_test ,business.industry ,Crohn disease ,medicine.disease ,Ulcerative colitis ,Infliximab ,Subcarinal Lymph Node ,030104 developmental biology ,medicine.anatomical_structure ,Surgery ,business ,medicine.drug - Abstract
For inflammatory bowel disease (IBD), antitumor necrosis factor treatment offers a new direction for both patients and medical doctors. This treatment has dramatically improved the quality of life for patients with ulcerative colitis and Crohn disease (CD). However, with increasing usage and longer follow-up periods, a wider range of possible adverse effects may be encountered. We report an unusual case of pulmonary sarcoidosis developed during the treatment of a patient with CD by using infliximab. A 30-year-old male who had been treated for CD with infliximab for 18 months was admitted due to abnormal opacities on chest radiography. Chest computed tomography displayed clustered small nodules in both lobes and enlarged multiple lymph nodes. The patient was diagnosed with sarcoidosis from the results of a biopsy of the subcarinal lymph node. Lung lesions were improved five months after infliximab was stopped.
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- 2017
29. The Successful Removal of a Broken Needle as an Unusual Complication of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA): A Case Report and Literature Review
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Kazuki Sakagami, Takashi Kido, Yoko Hirano, Kei Yamasaki, Hiroshi Mukae, Kazuhiro Yatera, and Keigo Uchimura
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Bronchoscopist ,Ebus tbna ,Male ,medicine.medical_specialty ,Lung Neoplasms ,Lymphadenopathy ,Bronchi ,Tracheal tube ,03 medical and health sciences ,0302 clinical medicine ,Swallowing ,Bronchoscopy ,Mediastinal Diseases ,Medicine ,Humans ,Medical history ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Aged, 80 and over ,business.industry ,Public Health, Environmental and Occupational Health ,General Medicine ,Foreign Bodies ,Subcarinal Lymph Node ,Treatment Outcome ,Needles ,030220 oncology & carcinogenesis ,Right Main Bronchus ,Equipment Failure ,Radiology ,business ,Complication ,030217 neurology & neurosurgery - Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is recommended for the diagnosis of mediastinal lymph nodes by the American College of Chest Physicians guidelines; however, the guidelines state that this procedure should only be performed by a trained bronchoscopist. Complications related to needle malfunction during the EBUS-TBNA procedure have recently been reported. We herein describe a rare case involving the successful management of a needle breakage that occurred as an unusual complication of EBUS-TBNA. An 81-year-old male patient with a medical history of myocardial infarction was introduced to our institution to undergo an evaluation for mediastinal and right hilar lymphadenopathy on chest computed tomography (CT). We performed EBUS-TBNA in a 14×10 mm subcarinal lymph node station using a 22 G aspiration needle (NA-201SX-4022, Vizishot®, Olympus, Japan) for diagnosing and staging of the patient's lung cancer. After the second aspiration, we noticed that the needle tip was broken and that it was stuck in the right main bronchus. We immediately removed the broken needle tip from the right main bronchus by flexible bronchoscopy using an ID 8.5 mm tracheal tube without cuff inflation. The length of the needle tip was 13 mm and it was considerably bent. The EBUS scope did not suffer any apparent damage. The patient did not have any other procedure-related complications. Needle breakage during EBUS-TBNA is rare; however, inhaling or swallowing of a broken needle tip has the potential to cause serious complications. Bronchoscopists should therefore be aware of the possibility of needle breakage, which is an important complication during EBUS-TBNA.
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- 2019
30. Endoscopic lymph node dissection for thymic malignancies: lateral thoracic intercostal and subxiphoid approaches
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Takashi Suda
- Subjects
Pulmonary and Respiratory Medicine ,robotic ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Medicine (miscellaneous) ,lymph node dissection ,Dissection (medical) ,Review Article ,Video-assisted thoracoscopic surgery (VATS) ,Subxiphoid approach ,medicine ,Radiology, Nuclear Medicine and imaging ,Lymph node ,business.industry ,Paratracheal lymph nodes ,medicine.disease ,Thymectomy ,subxiphoid ,Subcarinal Lymph Node ,medicine.anatomical_structure ,Oncology ,Median sternotomy ,Subcarinal ,Lymph ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The significance of lymph node dissection for thymic malignancies is currently unclear. Recently, endoscopic surgery has been indicated for the surgical treatment of thymic malignancies. We discussed the range of possible lymph node metastasis following surgery for thymic malignancies, depending on whether the lateral thoracic intercostal or the subxiphoid approach was used. While the video-assisted thoracoscopic surgery (VATS) lateral approach cannot be used for lymph nodes in the anterior region on the opposite side, it is simple enough to be used for deep-region lymph nodes. Taking an approach from the right facilitates paratracheal lymph node dissection. Taking an approach from the left may facilitate para-aortic and subaortic lymph node dissection. In addition, placing the patient in the lateral decubitus position also facilitates subcarinal lymph node dissection. The advantages of the subxiphoid approach are that a good field of vision of the cervical region can be obtained with a camera inserted from the midline of the body and the phrenic nerve on both sides can be confirmed. Accordingly, anterior lymph node dissection can be performed in a manner similar to median sternotomy. Deep-region lymph node dissection is more difficult via the subxiphoid approach than via the lateral thoracic intercostal approach. While paratracheal lymph nodes can be dissected to some extent, it is difficult to dissect subcarinal lymph nodes. If one prioritizes thorough anterior region lymph node dissection, either the subxiphoid or the bilateral lateral thoracic region approach needs to be taken. The subxiphoid approach offers the same view from the body midline as median sternotomy. Therefore, it is superior to the VATS lateral approach with regard to region lymph node dissection.
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- 2019
31. Propionibacterium acnes Causing Mediastinal Infection following Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration
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Katherine Janssen, Joseph C. Keenan, Roy Cho, and Erhan H. Dincer
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medicine.medical_specialty ,Standard of care ,biology ,business.industry ,lcsh:R ,lcsh:Medicine ,Case Report ,General Medicine ,030204 cardiovascular system & hematology ,biology.organism_classification ,medicine.disease ,Mediastinitis ,Subcarinal Lymph Node ,03 medical and health sciences ,Propionibacterium acnes ,Mediastinal infection ,0302 clinical medicine ,medicine ,Radiology ,Lymph ,Endobronchial ultrasound ,Complication ,business ,030217 neurology & neurosurgery - Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is now a standard of care to sample mediastinal lymph nodes and masses with high diagnostic accuracy and low complication rates. However, the procedure has potential complications that might be life-threatening. Here, we present the first case of Propionobacterium acnes (P. acnes) causing mediastinitis following EBUS-TBNA of a subcarinal lymph node.
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- 2019
32. Prediction of lymph node status in completely resected IIIa/N2 small cell lung cancer: importance of subcarinal station metastases
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Yanwei Zhang, Dongfang Chen, Jianlin Xu, Shuyuan Wang, Baohui Han, Yizhuo Zhao, Qing Chang, Runbo Zhong, Yuqing Lou, Rong Qiao, and Bo Zhang
- Subjects
Pulmonary and Respiratory Medicine ,Oncology ,Adult ,Male ,medicine.medical_specialty ,Lung Neoplasms ,lcsh:Surgery ,030204 cardiovascular system & hematology ,Prognostic factors ,Metastasis ,lcsh:RD78.3-87.3 ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Lymph node ,Aged ,Neoplasm Staging ,Retrospective Studies ,Subcarinal lymph node ,Small cell lung cancer ,business.industry ,Proportional hazards model ,Hazard ratio ,General Medicine ,lcsh:RD1-811 ,Middle Aged ,medicine.disease ,Small Cell Lung Carcinoma ,Confidence interval ,Subcarinal Lymph Node ,Survival Rate ,Trachea ,medicine.anatomical_structure ,030228 respiratory system ,Cardiothoracic surgery ,lcsh:Anesthesiology ,Lymphatic Metastasis ,Subcarinal ,N2 disease ,Lymph Node Excision ,Surgery ,Female ,Lymph Nodes ,Cardiology and Cardiovascular Medicine ,business ,Research Article - Abstract
Background The aim of this study was to determine the prognostic value of lymph node status in patients with pathologic N2 (pN2) stage IIIA small cell lung cancer (SCLC). Methods A total of 163 consecutive pN2 stage IIIA SCLC patients who underwent pulmonary resections and systematic lymphadenectomies at Shanghai Chest Hospital between January 2006 and June 2014 were enrolled. We retrospectively analyzed the potential clinicopathologic factors that influenced survival, including the node levels (single or multiple-station) and the node-spreading patterns (skip N2 or non-skip N2). The prognostic significance was examined by Cox regression analysis. Results The median overall survival (OS) was 23.7 months. Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement (p = 0.003). Skip metastasis did not appear to influence survival (p = 0.099). With respect to the station of lymph node metastasis, the OS was only related to the involvement of the subcarinal node, regardless of tumor location (p
- Published
- 2018
33. Small cell carcinoma of the lung in a patient with previously treated synchronous adenocarcinoma and squamous cell carcinoma
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Samantha Mattox, Rohit Munagala, Diana Kozman, Nikhil Patel, Pranjal Mishra, Kanwar Singh, Jayanth Keshavamurthy, and Asad Ullah
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung ,RC705-779 ,business.industry ,Chronic obstructive pulmonary disease ,Case Report ,Combination chemotherapy ,medicine.disease ,Small-cell carcinoma ,Metastasis ,small cell lung carcinoma ,Subcarinal Lymph Node ,Diseases of the respiratory system ,non-small cell lung carcinoma ,medicine.anatomical_structure ,multiple primary lung cancers ,left upper lobe ,medicine ,Adenocarcinoma ,right middle lobe ,Small Cell Lung Carcinoma ,Radiology ,business ,Lymph node - Abstract
A 66-year-old Caucasian female with a 40-pack-year history of smoking and chronic obstructive pulmonary disease presented for follow-up of synchronous multiple primary lung cancers: Stage IB left upper lobe adenocarcinoma and Stage IA right middle lobe (RML) squamous cell carcinoma. The patient was treated with left upper lobectomy and RML pulmonary wedge resection 5 years prior. Surveillance chest computed tomography showed an increase in the size of the subcarinal lymph node and right lymph node conglomerate encasing the right upper lobe pulmonary artery, consistent with metastasis. Fine-needle aspiration of level 4R lymph nodes was performed. Histology and immunohistochemical staining confirmed the diagnosis of small cell carcinoma. Consequently, the patient was placed on cisplatin/etoposide combination chemotherapy.
- Published
- 2021
34. A case of primary malignant melanoma of the lung responded to anti-PD-1 antibody therapy
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Ikuko Hirai, Takeru Funakoshi, Keiji Tanese, and Shoko Obata
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Pathology ,medicine.medical_treatment ,Metastasis ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Lymph node ,medicine.diagnostic_test ,business.industry ,Melanoma ,medicine.disease ,Surgery ,Subcarinal Lymph Node ,Radiation therapy ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Nivolumab ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Primary malignant melanoma of the lung (PMML) is an exceedingly rare type of melanoma. Here, we report a case of an 86-year-old Japanese woman who was diagnosed as PMML with subcarinal lymph node metastasis. She was treated with intravenous administration of programmed cell death-1 (PD-1) inhibitor, nivolumab. After the treatment, lymph node lesion regressed. The size of primary lesion was also controlled in combination with radiotherapy. In this case, two histological features were noted in the biopsy specimen that supported a response to nivolumab: membranous expression of programmed death ligand-1 (PD-L1) in tumor cells and dense scattered infiltration of CD8+ TILs. The clinical course of this case suggests that certain PMML cases may also respond to anti-PD-1 therapy.
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- 2017
35. Subcarinal lymph node: is it better evaluated by endobronchial ultrasound or endoscopic ultrasound?
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Dalia E. El-Sharawy, Yomna A. Zamzam, Ayman M ElSaqa, and Mohamed Hantera
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Group ii ,Significant difference ,General Engineering ,Subcarinal Lymph Node ,Tolerability ,Subcarinal ,medicine ,General Earth and Planetary Sciences ,Lymph ,Endobronchial ultrasound ,Radiology ,business ,General Environmental Science - Abstract
Introduction Mediastinal endosonography-guided aspiration has anteceded surgical staging as the step of choice for the diagnosis of mediastinal tissue disorders. Aim This study aimed to evaluate the diagnostic efficacy and safety of either endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA) or transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-FNA-B/E) in evaluating and biopsying the subcarinal region (station 7). Patients and methods Seventy-seven patients with enlarged subcarinal lymph nodes ‘short axis more than or equal to 1 cm’ as a preliminary station were divided randomly into two groups: group I included patients evaluated by EBUS-TBNA and group II included patients evaluated by EUS-FNA-B/E. The specimens were examined using the Rapid On Site Evaluation technique and then confirmed by the final histopathological and immunohistochemical evaluation. Results Fifty-one men and 26 women, mean±SD age (51.12±10.15 years), were divided into two groups. In group I, the mean±SD time spent during the procedure was 32.49±9.48 min, the mean±SD number of aspirations was 3.07±0.72, and the mean±SD O2 saturation was 83.59±4.34%; therefore, the mean±SD supplementary oxygen was 3.78±1.04 l/min. However, in group II, these values were 22.05±6.39 min, 2.00±0.67, 91.66±3.09%, and 1.71±1.19 l/min, respectively, with a significant difference. The sensitivity, negative predictive value, and diagnostic accuracy of EBUS-TBNA in diagnosing malignant lesions were 88, 67, and 90%, which were significantly less than those of EUS-FNA-B/E: 93, 86, and 95%, respectively. No severe complications were encountered with the use of both techniques. Conclusion The study recommends the usage of EUS-FNA-B/E than EBUS-TBNA in evaluating and biopsying the subcarinal region because of its better tolerability, higher diagnostic yield, and lower complication rate.
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- 2020
36. EBUS guided Transbronchial needle biopsy (EBUS TBNB) of subcarinal lymph nodes – a Pilot study
- Author
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Prince James, Barney Isaac, Balamugesh Thangakulam, and Richa Gupta
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Lymphoma ,Subcarinal Lymph Node ,Cytology ,Biopsy ,Subcarinal ,medicine ,Radiology ,Sarcoidosis ,Lymph ,Lung cancer ,business - Abstract
In cases of hard rubbery lymph nodes like in Sarcoidosis and Lymphoma, it is sometimes difficult to obtain optimum cytology samples during EBUS TBNA (Transbronchial needle aspiration cytology) and thus the diagnostic yield of EBUS TBNA samples drops down to 60%. An EBUS TBNB sample from such lymph nodes can help to increase the diagnostic yield. Methods: We did a Pilot study in patients presenting with hard rubbery lymph nodes during EBUS TBNA, EBUS guided Transbronchial biopsy of the subcarinal lymph node was done with small size biopsy forceps. Diagnostic yield of biopsy samples was compared with EBUS TBNA cytology results. Results: Over a period of 6 months, 11 patients underwent EBUS guided transbronchial biopsy of Subcarinal lymph node. 9 patients were male and the average age was 46 years (Range 19 to 65 years). EBUS guided TBNB sample could be successfully obtained in 9 patients. In 2 patients (final diagnosis was Sarcoidosis and Lung cancer respectively), biopsy needle failed to pierce the subcarinal lymph node. TBNB samples provided the diagnosis in all 9 patients (Sarcoidosis in 3 patients, Tuberculosis in 4 patients, Lung cancer in 1 patients and Acute myeloid leukaemia in one patient). But in all these 9 patient EBUS TBNA samples were also diagnostic of the same pathology. EBUS TBNB did not increase the diagnostic yield of EBUS guided procedure in this pilot study with only 11 patients. However, the study proves that it is feasible to do EBUS TBNB. It is a promising new technique and may help in increasing the diagnostic yield in a prospective trial with a large number of patients, especially when Pulmonologist finds it hard to obtain an adequate cytology sample with EBUS TBNA.
- Published
- 2018
37. NUT carcinoma: a rare and devastating neoplasm
- Author
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George Ferzli and Shinban Liu
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Lung Neoplasms ,Images In… ,Constitutional symptoms ,Translocation, Genetic ,03 medical and health sciences ,0302 clinical medicine ,Fatal Outcome ,Bronchoscopy ,Carcinoma ,medicine ,Biomarkers, Tumor ,Humans ,Hilar Mass ,Oncogene Proteins ,Bronchus ,Lung ,medicine.diagnostic_test ,business.industry ,Nuclear Proteins ,General Medicine ,respiratory system ,Middle Aged ,medicine.disease ,respiratory tract diseases ,Neoplasm Proteins ,Subcarinal Lymph Node ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Subcarinal ,Female ,Radiology ,business - Abstract
A 45-year-old woman with no significant medical history had 1 month of productive cough empirically treated with azithromycin and dyspnoea on exertion. She was never a smoker and denied any constitutional symptoms, including unexpected weight loss. A CT of the chest was performed after she developed haemoptysis, which demonstrated a 6.3×4.6 cm right hilar mass with hilar, subcarinal and cardiophrenic adenopathy (figure 1A). She underwent bronchoscopy which revealed complete occlusion of the right middle lobe by a tumour extending into the bronchus intermedius. Debridement of this mass was performed, with re-establishment of airway patency to the right lower lobe. Pathology from the debrided tumour as well as the subcarinal lymph node was consistent with poorly differentiated non-small cell lung carcinoma with Thyroid Transcription Factor 1 (TTF-1) and Programmed Death-Ligand 1 (PD-L1) negativity. …
- Published
- 2018
38. Lung Carcinoids: Long-Term Surgical Results and the Lack of Prognostic Value of Somatostatin Receptors and Other Novel Immunohistochemical Markers
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Gregory Kaltsas, Apostolos V. Tsolakis, Kjell Öberg, and Kosmas Daskalakis
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Lung Neoplasms ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Disease ,Carcinoid Tumor ,Gastroenterology ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Endocrinology ,Predictive Value of Tests ,Internal medicine ,medicine ,Biomarkers, Tumor ,Humans ,Receptors, Somatostatin ,Stage (cooking) ,Aged ,Retrospective Studies ,Aged, 80 and over ,Lung ,Relative survival ,Endocrine and Autonomic Systems ,business.industry ,Somatostatin receptor ,Middle Aged ,Prognosis ,Immunohistochemistry ,Survival Analysis ,Subcarinal Lymph Node ,030104 developmental biology ,medicine.anatomical_structure ,Cross-Sectional Studies ,Treatment Outcome ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,Female ,business ,Follow-Up Studies - Abstract
Background/Aims: Lung carcinoids (LCs) are often diagnosed at an early stage and surgical intervention becomes the next phase of treatment. To date, there is lack of long-term follow-up data after surgery and prognostication based on WHO classification criteria and evolving prognostic markers, particularly the expression of somatostatin receptors (SSR). Methods: We included 102 consecutive patients (72 women; age at baseline 51 ± 16 years [mean ± SD]) with LCs, who underwent thoracic surgery (n = 99) and/or laser treatment (n = 8). Hospital charts were reviewed for clinico-pathological parameters. Immunohistochemical (IHC) expression of SSR1–5 and other novel markers were studied with regard to their prognostic value. Results: Five- and 10-year overall survival (OS) was 96 and 83% respectively; relative survival (RS) was 101 and 93% respectively; and event-free survival (EFS) was 80 and 67% respectively. Independent prognostic factors for OS, RS and/or EFS were age at diagnosis, histopathological type and the presence of ipsilateral mediastinal subcarinal lymph node metastases. Macro-radicality of resective surgery and its extent were associated with increased OS and EFS. The IHC expression of SSR1–5 and other novel markers was not associated with OS or EFS. Conclusion: The long-term outcome of surgically treated patients with LCs is favourable. Age, histopathological type and ipsilateral mediastinal subcarinal lymph node status at baseline were independent prognostic factors for survival and disease recurrence or progression. The extent of surgery and operative macro-radicality also had an impact on prognosis. None of the IHC markers tested appeared to be associated with disease prognosis.
- Published
- 2018
39. Lymph node cancer of the mediastinum with a putative necrotic primary lesion in the lung: a case report
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Yujiro Yokoyama, Toshio Oyama, Rumi Higuchi, Taichiro Goto, Daichi Shikata, and Takahiro Nakagomi
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Male ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,lcsh:Surgery ,Case Report ,lcsh:RC254-282 ,Mediastinal Neoplasms ,Lymph node cancer ,03 medical and health sciences ,Necrosis ,Immunohistology ,0302 clinical medicine ,medicine ,Carcinoma ,Humans ,Lung cancer ,Mediastinal cancer ,Lymph node ,business.industry ,Mediastinum ,Cancer ,lcsh:RD1-811 ,Unknown primary site ,Middle Aged ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,Subcarinal Lymph Node ,medicine.anatomical_structure ,030228 respiratory system ,Oncology ,030220 oncology & carcinogenesis ,Mediastinal lymph node ,Lymphatic Metastasis ,Adenocarcinoma ,Surgery ,business - Abstract
Background Although mediastinal lymph node cancer is presumed to originate in the lung, the primary site is usually unidentified, so the pathological course remains unclear. We recently encountered a case of mediastinal lymph node cancer having a putative primary lesion remaining in the lung as a necrotic focus. Case presentation The patient was a 56-year-old man who visited our department because computed tomography screening had revealed a nodular shadow in the lingular segment. However, on positron emission tomography, fluorine-18 deoxyglucose accumulation was detected in a subcarinal lymph node and not in the nodule in the lingular segment. Biopsy of the lung tumor and the lymph node was performed via minimal thoracotomy. Intraoperative pathologic examination showed necrosis alone and no malignant findings in the lung tumor. By contrast, carcinoma was detected in the lymph node. Additional subcarinal lymph node dissection was performed. Results of postoperative histopathologic examination indicated poorly differentiated adenocarcinoma of the subcarinal lymph node. Meanwhile, the nodule in the lingular segment was speculated to be a spontaneously resolved primary focus of lung cancer. Conclusions In this case, the primary lung cancer focus resolved spontaneously after lymph node metastasis, explaining the pathogenesis underlying mediastinal lymph node cancer of unknown primary site. For similar cases of malignancy, aggressive treatment, including surgery, is effective.
- Published
- 2017
40. The Prognostic Relevance of Subcarinal Lymph Node Dissection in Esophageal Squamous Cell Carcinoma
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Goro Nakayama, Hideki Takami, Suguru Yamada, Mitsuro Kanda, Masashi Hattori, Yasuhiro Kodera, Naoki Iwata, Chie Tanaka, Hiroyuki Sugimoto, Michitaka Fujiwara, Masahiko Koike, Masamichi Hayashi, Daisuke Kobayashi, Tsutomu Fujii, and Yukiko Niwa
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pathology ,Esophageal Neoplasms ,medicine.medical_treatment ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Carcinoma ,Humans ,Esophagus ,Lymph node ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Esophagectomy ,Survival Rate ,Subcarinal Lymph Node ,medicine.anatomical_structure ,Oncology ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Subcarinal ,Carcinoma, Squamous Cell ,Lymph Node Excision ,Female ,030211 gastroenterology & hepatology ,Surgery ,Lymph Nodes ,Radiology ,Lymph ,business ,Follow-Up Studies - Abstract
The objective of this study was to evaluate the prognostic relevance of subcarinal lymph node dissection in patients with esophageal squamous cell carcinoma (ESCC) and to identify a subset of patients in whom subcarinal lymph node dissection can be omitted. We retrospectively analyzed 342 consecutive patients with thoracic ESCC who underwent R0 subtotal esophagectomy. All patients underwent subcarinal lymph node dissection. The efficacy index (frequency of metastasis to a particular lymph node station multiplied by the 5-year disease-specific survival rate of patients with metastasis to the station) was calculated for the subcarinal lymph node station, and the prognostic impact of dissecting this station was estimated with reference to the main tumor location. Independent predictive factors for pathological subcarinal lymph node metastasis were analyzed using a proportional hazards model. The overall frequency of metastasis to the subcarinal lymph nodes was 7.0 % (2.4, 8.9, and 5.8 % in patients with upper, middle, and lower thoracic ESCC, respectively). The efficacy index for the middle thoracic esophagus was 2.9, and that for the upper and lower thoracic esophagus was 0.0. The 5-year disease-free survival rate was significantly lower in patients with pathological subcarinal lymph node metastasis than those without (23.1 vs. 67.5 %, respectively; log-rank p
- Published
- 2015
41. Mediastinal Nodal Involvement in Patients with Clinical Stage I Non–Small-Cell Lung Cancer: Possibility of Rational Lymph Node Dissection
- Author
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Junji Yoshida, Masahiro Tsuboi, Tomohiro Miyoshi, Hiroshige Nakamura, Genichiro Ishii, Keiju Aokage, Kanji Nagai, Tomohiro Haruki, and Tomoyuki Hishida
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,Mediastinal lymph node metastasis ,Metastasis ,Carcinoembryonic antigen ,Carcinoma, Non-Small-Cell Lung ,medicine ,Consolidation-to-tumor ratio ,Humans ,Lung cancer ,Lymph node ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Solid-predominant ,Selective lymph node dissection ,biology ,business.industry ,Non–small-cell lung cancer ,Mediastinum ,Middle Aged ,medicine.disease ,Prognosis ,Primary tumor ,Subcarinal Lymph Node ,medicine.anatomical_structure ,Oncology ,Mediastinal lymph node ,Lymphatic Metastasis ,biology.protein ,Adenocarcinoma ,Lymph Node Excision ,Female ,Lymph Nodes ,business - Abstract
BackgroundThe aim of this study is to elucidate the optimal candidate of selective lymph node dissection (LND) that reduces the extent of mediastinal LND according to clinical information including radiological evaluation in primary non–small-cell lung cancer (NSCLC) patients.MethodsEight hundred and seventy-six patients with clinical(c)-stage I NSCLC (adenocarcinoma and squamous cell carcinoma), who underwent complete surgical resection between January 2003 and December 2009 were included in this study. We elucidated the lymph node metastatic incidence and distribution according to the primary tumor lobe location and extracted the associated clinicopathological factors, especially thin-section computed tomographic findings, with mediastinal lymph node involvement.ResultsThe total incidence of mediastinal lymph node metastasis was 9.1%. There were no cases with hilar and mediastinal lymph node metastasis in ground glass opacity-predominant tumors. There was no significant association of clinical factors with subcarinal lymph node metastasis in right upper-lobe and left upper-division adenocarcinoma. An elevated preoperative serum carcinoembryonic antigen level (p < 0.001) showed significant associations with upper mediastinal lymph node metastasis in the patients with bilateral lower-lobe primary lung adenocarcinoma.ConclusionsIt would be acceptable to perform selective LND in patients with c-stage I NSCLC with ground glass opacity- predominant tumor. Elevated serum carcinoembryonic antigen was associated with upper mediastinal lymph node involvement in lower-lobe primary lung adenocarcinoma with radiologically solid-predominant tumor. We should be careful when applying selective LND to patients with solid-predominant tumor, especially located in the lower lobe.
- Published
- 2015
- Full Text
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42. Endobronchial Ultrasound-guided Sheath Placement to Guide Transbronchial Biopsy of Mediastinal Lymphadenopathy and Lung Mass
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Daniel H. Sterman, Kassem Harris, and Jamie L. Bessich
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,Mediastinal lymphadenopathy ,Adenocarcinoma of Lung ,Adenocarcinoma ,Mediastinal Diseases ,Humans ,Medicine ,Sampling (medicine) ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Lymphatic Diseases ,Lymph node ,Aged ,Lung ,business.industry ,Mediastinum ,Middle Aged ,medicine.disease ,Lymphoproliferative Disorders ,Liver Transplantation ,Subcarinal Lymph Node ,Hepatitis, Autoimmune ,medicine.anatomical_structure ,Subcarinal ,Lymph Nodes ,Lymph ,Radiology ,Neoplasm Recurrence, Local ,business - Abstract
A patient with a history of lung adenocarcinoma, which was treated with chemoradiation, presented to our interventional pulmonology clinic for suspicion of recurrent lung cancer. The patient had a PET-avid right upper-lobe mass and subcarinal lymphadenopathy. We performed a curvilinear endobronchial ultrasound (CP-EBUS) with transbronchial needle aspiration (TBNA), followed by transbronchial EBUS-guided biopsies (TBB) of the subcarinal lymph node using miniforceps. The EBUS needle sheath was inserted over the needle through the bronchial wall and advanced into the lymph node. The EBUS-guided placement of the transbronchial sheath facilitated the miniforcep insertion and the performance of multiple transbronchial biopsies. Given success with this method, we further developed this technique in a second patient with a right lower-lobe mass. In an effort to obtain adequate tissue and minimize repeated efforts at miniforcep guidance into the lesion, we inserted a radial EBUS guide sheath through the curvilinear EBUS scope and guided it into the lesion using the miniforceps. We therefore used the radial sheath as a placeholder while obtaining repeated TBB using miniforceps as described. These modifications of previously described techniques allow for maximal and expeditious sampling of target lymph nodes and masses, with sufficient material obtained for histopathologic analysis.
- Published
- 2015
43. Detection of an embolized central venous catheter fragment with endobronchial ultrasound
- Author
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Samjot Singh Dhillon, Kassem Harris, Anthony Picone, and Abdul Hamid Alraiyes
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Lumen (anatomy) ,Peripherally inserted central catheter ,Subcarinal Lymph Node ,03 medical and health sciences ,0302 clinical medicine ,Bronchoscopy ,030220 oncology & carcinogenesis ,Subcarinal ,medicine ,Immunology and Allergy ,030211 gastroenterology & hepatology ,Tomography ,Radiology ,Endobronchial ultrasound ,business ,Genetics (clinical) ,Central venous catheter - Abstract
An 84-year-old woman underwent Convex-probe Endobronchial Ultrasound (CP-EBUS) for 18 F-fluorodeoxyglucose avid subcarinal lymphadenopathy on Positron Emission Tomogram (PET) scan. Endobronchial ultrasound-guided transbronchial needle aspiration of the subcarinal lymph node revealed squamous cell lung carcinoma. A small hyperechoic rounded density was noted inside the lumen of the azygous vein. Based on chest computed tomography findings and her clinical history, this was felt to be a broken fragment of a peripherally inserted central catheter, which was placed for intravenous antibiotics, a few months prior to this presentation. To the best of our knowledge, this is the first ever CP-EBUS description of a broken fragment of central venous catheter.
- Published
- 2016
44. Reply
- Author
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Jens Eckardt, Erik Jakobsen, and Peter B. Licht
- Subjects
Pulmonary and Respiratory Medicine ,Subcarinal Lymph Node ,medicine.medical_specialty ,business.industry ,medicine ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
45. Uncommon features of surgically resected ALK-positive cavitary lung adenocarcinoma: a case report
- Author
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Takashi Seto, Shinkichi Takamori, Masafumi Yamaguchi, Fumihiko Hirai, Kaname Nosaki, Shinichiro Shimamatsu, Kenichi Taguchi, Yukito Ichinose, Ryo Toyozawa, Mitsuhiro Takenoyama, and Makoto Edagawa
- Subjects
medicine.medical_specialty ,Pathology ,Pleural effusion ,Case Report ,Radiological feature ,Cavitary mass ,Vinorelbine ,030218 nuclear medicine & medical imaging ,Metastasis ,03 medical and health sciences ,Anaplastic lymphoma kinase ,0302 clinical medicine ,medicine ,Lung ,business.industry ,medicine.disease ,respiratory tract diseases ,Subcarinal Lymph Node ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Mediastinal lymph node ,Adenocarcinoma ,Radiology ,business ,medicine.drug - Abstract
Some features found on chest computed tomography (CT), such as central tumor location, large pleural effusion, and the absence of a pleural tail, and a patient age of less than 60 years, have been suggested to be useful in predicting anaplastic lymphoma kinase (ALK) rearrangement in patients with non-small cell lung cancer (NSCLC). A 68-year-old female patient with a history of gynecological treatment was found to have a cavitary mass in the right lower lobe on an annual chest roentgenogram. The tumor was located in the peripheral area with a pleural tail showing no pleural effusion. In addition, two pure ground-glass-opacity nodules (p-GGNs) in the right upper lobe of the lung were detected on consecutive chest CT scans. The patient underwent right lower lobectomy, partial resection of the right upper lobe, and hilar mediastinal lymph node dissection for complete resection of each tumor. The pathological diagnosis was invasive mucinous adenocarcinoma with signet-ring cells for the cavitary mass in the right lower lobe and invasive adenocarcinoma for the rest of the p-GGNs; subcarinal lymph node metastasis was also detected. The ALK rearrangement was detected by fluorescence in situ hybridization from the cavitary mass. The patient underwent four cycles of cisplatin and vinorelbine chemotherapy as standard adjuvant chemotherapy for pStage III NSCLC. The ALK fusion gene status of NSCLC with atypical CT features should also be investigated.
- Published
- 2017
46. Robotic Lung Resection
- Author
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D. Ian Paul and Bernard J. Park
- Subjects
Pulmonary hilum ,Subcarinal Lymph Node ,medicine.medical_specialty ,business.industry ,Lung resections ,medicine ,Radiology ,Video technology ,Lung resection ,Posterolateral thoracotomy ,business - Abstract
The traditional approach for performing anatomic lung resections has been via posterolateral thoracotomy. This incision allows generous exposure and access to pulmonary hilum at a cost of significant post-operative pain and morbidity. With the rapid improvement in video technology in the 1980s and development of more sophisticated endoscopic staplers, there has be a shift toward a minimally invasive approach to lung resections.
- Published
- 2017
47. EBUS-FNA of a station seven lymph node: An unusual presentation of a young nonsmoker male with hemoptysis and subcarinal lymphadenopathy
- Author
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Sepi Mahooti and Brett Matthew Lowenthal
- Subjects
education.field_of_study ,Pathology ,medicine.medical_specialty ,Histology ,Mediastinal lymphadenopathy ,medicine.diagnostic_test ,business.industry ,Population ,General Medicine ,medicine.disease ,Malignancy ,Pathology and Forensic Medicine ,Lymphoma ,Subcarinal Lymph Node ,medicine.anatomical_structure ,Fine-needle aspiration ,Subcarinal ,medicine ,education ,business ,Lymph node - Abstract
Endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) is a safe and minimally invasive bronchoscopic technique that allows both visualization and cytologic sampling with a high diagnostic yield in a patient with mediastinal lymphadenopathy. Besides the most common indication of staging for a patient with a primary lung carcinoma, EBUS-FNA can be used to identify benign infectious and noninfectious processes as well as lymphoma and malignancy of unknown primary. Triaging of procured specimen for diagnostic, prognostic, and therapeutic ancillary studies requires appropriate clinical information at the time of rapid on site evaluation (ROSE) of smears. This case report demonstrates a young, previously healthy nonsmoker presenting clinically with cough, hemoptysis, and a 1.7 cm enlarged subcarinal lymph node by imaging. EBUS-FNA obtained smears from the lymph node revealed a pleomorphic population of smaller cells with a low nuclear to cytoplasmic ratio and prominent nucleoli, and larger cells had nuclei with bizarre shapes, mitoses, multinucleation, enlarged nucleoli, and pigmentation in a background of lymphocytes. The cytomorphologic and immunohistochemical workup of this case confirmed the unexpected diagnosis of metastatic melanoma. This result was a complete surprise to the clinical team managing the patient and prompted a thorough clinical workup. Subcarinal lymphadenopathy with metastatic malignant melanoma as the cause is rare. This case report highlights how ROSE and appropriate triaging of specimen were crucial in appropriately working up this case. We also survey the literature to review the reported unusual presentations of metastatic melanoma.
- Published
- 2014
48. Disseminated Nocardia paucivorans infection in an immunocompetent host
- Author
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M. Hammoud, K. S. Gregg, C. Chenoweth, Casey T. Kraft, and Johannes Pulst-Korenberg
- Subjects
Adult ,Male ,Microbiology (medical) ,Michigan ,Pathology ,medicine.medical_specialty ,Nocardia paucivorans ,medicine.drug_class ,Antibiotics ,Nocardia Infections ,Biology ,Nocardia ,RNA, Ribosomal, 16S ,Biopsy ,medicine ,Humans ,Confusion ,medicine.diagnostic_test ,General Medicine ,Anti-Bacterial Agents ,Subcarinal Lymph Node ,Treatment Outcome ,Infectious Diseases ,16s rrna gene sequencing ,Brain lesions ,Iliopsoas ,medicine.symptom - Abstract
Nocardia paucivorans is a recently discovered species that has been shown to have a predilection for CNS involvement in cases of disseminated infection. We present a 50-year-old man with one year of weight loss admitted to the hospital with cough and confusion. Imaging revealed pulmonary and iliopsoas masses as well as innumerable ring-enhancing brain lesions. N. paucivorans was eventually identified in a subcarinal lymph node biopsy. The diagnosis was expedited by utilizing 16s rRNA gene sequencing on the biopsy tissue, resulting in species-level identification several weeks prior to culture positivity. He was treated with 12 months of parenteral and oral antibiotics, with resolution of pulmonary and brain lesions on repeat imaging.
- Published
- 2014
49. Extrapulmonary tuberculosis presenting as a cavernous sinus syndrome: Case report with review of existing literature
- Author
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Amee Patrawalla and Shashi Kapadia
- Subjects
medicine.medical_specialty ,Tuberculosis ,Lymph node biopsy ,Case Report ,Infectious and parasitic diseases ,RC109-216 ,Prednisone ,medicine ,Tuberculoma ,FDG-PET ,Extrapulmonary tuberculosis ,CNS tuberculosis ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Surgery ,Subcarinal Lymph Node ,Regimen ,Infectious Diseases ,Granuloma ,Cavernous sinus ,business ,Cavernous sinus syndrome ,medicine.drug - Abstract
Tuberculoma involving the cavernous sinus is a rare presentation of CNS disease, with only twelve cases reported in previous literature. We report a case of a 48 year old woman who presented with a right cavernous sinus syndrome of 2 months duration. MRI showed a mass in the right cavernous sinus, and serologic workup revealed an elevated sedimentation rate and positive Quantiferon®-GOLD testing. 18-FDG PET-CT demonstrated a hypermetabolic 3cm subcarinal lymph node, and lymph node biopsy showed caseating granuloma. Culture of lymphatic tissue grew drug-sensitive M. tuberculosis. The patient was treated with a non-standard 4-drug regimen and prednisone, with rapid improvement of symptoms and radiologic abnormalities. Total length of treatment was 12 months. In addition, we review the 12 cases found in literature, and discuss clinical features, diagnostic dilemmas, and approaches to treatment.
- Published
- 2014
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50. Subcarinal Lymph Node Importance Revisited
- Author
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Alex Arame, Marc Riquet, and Ciprian Pricopi
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Mediastinum ,030204 cardiovascular system & hematology ,Subcarinal Lymph Node ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,medicine ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
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