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The value of core needle biopsy in differential diagnosis of mediastinal T lymphoblastic lymphoma and type B1 thymoma
Lu SUN,Huai-yin SHI,Mei LIU,Li-xin WEI
Medical Journal of Chinese People's Liberation Army , 2012,
Abstract: Objective To analyze the clinical and pathological characteristics of T lymphoblastic lymphoma (T-LBL) and type B1 thymoma in the mediastinum, and to improve the accuracy of differential diagnosis between two diseases. Methods  Pathology of consecutive 34 cases of T-LBL and 10 cases of type B1 thymoma were reviewed in this study. All the initial diagnosis was made with core needle biopsy specimens of mediastinal masses and confirmed by subsequent chemotherapy and/or excision biopsy specimens. The clinical and pathological features of T-LBL and type B1 thymoma were compared by reviewing clinical records and analysis of HE and immunohistochemical staining sections. The chi-square test was used for statistic analysis. Results The mean age of the patients with type B1 thymoma was 43 years, and the ratio of male to female was 2:3, while the patients with T-LBL were much younger (with mean age of 25, 73% of them younger than 30 years old) and the male to female ratio was 3.3:1. All the T-LBL cases presented symptoms including chest tightness, shortness of breath and cough. Three patients of thymoma complained of chest tightness and shortness of breath, and 2 cases presented symptoms of myasthenia gravis. Imaging examination showed solitary mass in anterior mediastinum in patients of both groups, 88% of the T-LBL patients had mass>10cm, while accounting for 50% in B1 thymoma patients. Concurrent pleural effusion was only observed in the T-LBL patients. Histopathologically, T-LBL and thymoma showed significant differences, including the infiltration of tumor cells in fibrous tissue (65% in T-LBL vs 0% in thymoma), invasion of peripheral fat tissue (59% vs 20%), invasion of skeletal muscle (41% vs 0%), tumor necrosis (21% vs 0%), and remaining of thymus lobular structure was found in only 3% of T-LBL. Intact cytokeratin network was shown in B1 thymoma (100%) by immunohistochemical staining. Conclusions Patients' gender, age, clinical features and imaging features, especially pathological characteristics were remarkable different between T-LBL and type B1 thymoma. Combining clinical manifestations and pathological changes will help to improve the accuracy of core needle biopsy in differential diagnosis of T-LBL and thymoma.
One Case about Primary Mediastinal Primary Mediastinal Tumor ?with Mediastinal Sarcoma and Literature Review  [PDF]
Jinchen DU, Qingxin LI, Dong CHAO, Yulian BAN, Qunqun LI
- , 2016, DOI: : 10.3779/j.issn.1009-3419.2016.09.13
Abstract: Primary mediastinal seminoma is a kind of germ cell malignancy outside the gonads, and it’s rarer with sarcoma component. This disease which has no special clinical manifestations and imaging characteristics is difficult to identify with other mediastinal tumors and mediastinal type lung cancer. This paper reported a case of primary mediastinal seminoma with mediastinal sarcoma. Through the analysis of the diagnosis and treatment process in this patient, we will make a comprehensive review of the disease.
Imaging Investigation of Mediastinal Abnormalities in Children
A. Hekmatnia,S. Etezazian,B. Tavakoli,F. Naghshineh
Iranian Journal of Radiology , 2008,
Abstract: A review of mediastinal abnormalities is important for several reasons:"n1. The mediastinum is the common location for thoracic masses in children."n2. The type and frequency of masses differ in children compared with adults."n3. Anatomic variations can be misinterpreted as mediastinal masses."nThis article is summation of several texts and articles that has been studied and interpreted. The mediastinum in children can be a difficult area to assess on chest radiograph; even the normal thymus can give the impression of a mediastinal mass lesion. Ultrasound, CT scan and MRI help to characterize the lesion, define its extent, and detect complications. Abnormal mediastinal contours can be caused by congenital or acquired masses and congenital anomalies of the mediastinal vessels."nMediastinal masses in children are a heterogeneous group of asymptomatic to life threatening congenital, infectious, or neoplastic lesions. Classification of the masses, according to the involved compartment (anterior, middle, and posterior), facilitates differentiation of the variety of mediastinal disorders. The main purpose of this study is review of mediastinal abnormalities and their imaging in children.
Mediastinal goiter diagnosed by functional imaging
G Michels, M Dietlein, C Kobe, R Pfister
Libyan Journal of Medicine , 2012,
Abstract: A 63-year-old asymptomatic woman with cured Hodgkin diseases presented for restaging. The chest computed tomography showed a mass at the right side of the upper mediastinum. The benignity and the origin of the tissue were unknown. First, we performed a bronchoscopy-guided biopsy but without success. In the next step, we initiated radionuclide imaging with technetium-99m pertechnetate (Tc-99m) and radioiodine (I-123). Low uptake of Tc-99m and intense accumulation of I-123 after 2 and 24 h to the mediastinal mass suggested that the mass was a mediastinal goiter. Based on iodine uptake and the fact that our patient had no symptoms of tracheal compression, we decide to go for a radioiodine therapy.
Subcutaneous fat necrosis in a newborn
Maria dos Anjos Mesquita,Nadya Suely Gon?alves Matsuda,Sabrina de Castro Siqueira,Honória Virginia Brom Santos
Einstein (S?o Paulo) , 2006,
Abstract: We report the case of an asphyxiated newborn with subcutaneousfat necrosis and a favorable outcome up to the present. Somepathophysiological, clinical and therapeutic aspects of thiscondition are discussed.
Imaging lung manifestations of HIV/AIDS  [cached]
Allen Carolyn,AL-Jahdali Hamdan,Irion Klaus,Al Ghanem Sarah
Annals of Thoracic Medicine , 2010,
Abstract: Advances in our understanding of human immunodeficiency virus (HIV) infection have led to improved care and incremental increases in survival. However, the pulmonary manifestations of HIV/acquired immunodeficiency syndrome (AIDS) remain a major cause of morbidity and mortality. Respiratory complaints are not infrequent in patients who are HIV positive. The great majority of lung complications of HIV/AIDS are of infectious etiology but neoplasm, interstitial pneumonias, Kaposi sarcoma and lymphomas add significantly to patient morbidity and mortality. Imaging plays a vital role in the diagnosis and management of lung of complications associated with HIV. Accurate diagnosis is based on an understanding of the pathogenesis of the processes involved and their imaging findings. Imaging also plays an important role in selection of the most appropriate site for tissue sampling, staging of disease and follow-ups. We present images of lung manifestations of HIV/AIDS, describing the salient features and the differential diagnosis.
Anterior Mediastinal Fat Changes in Idiopathic Pulmonary Fibrosis: A Preliminary Study  [PDF]
Wafaa Ali Hassan, Eman Abo-Elhamd
Open Journal of Respiratory Diseases (OJRD) , 2014, DOI: 10.4236/ojrd.2014.41003
Abstract:
Background: The mediastinum is composed primarily of fatty tissue that is surrounded by the lungs bilaterally.
There is a lack in the published literature in studying changes in mediastinal fat in idiopathic pulmonary fibrosis
(IPF). The purpose of this study was to determine whether the shape and dimensions of the anterior mediastinal fat in patients with IPF are different from that of a normal control group and to correlate the changes with disease severity. Design and Setting: This prospective case control study was done at the chest department of Assiut University Hospital on IPF patients from May 2010-September 2012. A questionnaire containing questions such as age, sex, clinical findings, high resolution computerized tomography (HRCT) score and pulmonary function tests (PFTs) was filled for patients and normal controls. Results: The IPF retrosternal AP dimension was significantly shorter (p = 0.03) and the transverse dimension was longer (p = 0.001) than that in the normal control group. The convex shape of the anterior mediastinum was predictive of IPF (p = 0.001), whereas concave shape was predictive of normal controls (p = 0.001). The change in anteroposterior diameter (AP) and transverse diameters showed significant correlation with the changes in FVC, DLCO and HRCT score. Conclusions: IPF patients had reduced retrosternal AP and increased transverse dimensions than those of the controls with convex shape of their anterior mediastinal fat. Changes in anterior mediastinal fat dimensions are correlated with lower FVC, DLCO and higher HRCT score. A larger sample size, better multicenteric study is needed to confirm the results of this study.
Posttraumatic Fat Necrosis Presented as Cellulitis of the Leg
Einat Haikin Herzberger,Shraga Aviner,Evgenia Cherniavsky
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/672397
Abstract: Cellulitis, a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin, is a common lesion in children, usually responsive to systemic antibiotic therapy. However, an unusual course of healing or some nontypical features should call the treating physician to consider and investigate for other diagnoses that might prevent unnecessary treatment and alleviate parental stress. We present a case of posttraumatic fat necrosis, demonstrating some pitfalls in the process of diagnosis.
Manifestations of Pulmonary Tuberculosis in CT Imaging
"S. Zahirifard,M. Mirsaidi,K. Mohajer,M. BAkhshyashkaram
Iranian Journal of Radiology , 2005,
Abstract: Introduction & Background: In recent years, imaging techniques have offered valuable information to medical staff. These new modalities have markedly improved and facilitated diagnosis. CT scan has made a revolution in the diagnosis of pulmonary diseases. In this study, we examined radiological findings in smear positive TB patients using computerized tomo-graphy. Patients & Methods: During the first 6 months of the year 2002, 97 suspected cases of pulmonary TB, whose diagnosis were confirmed by positive sputum mycobacteriologic study, were included. Thoracic CT scans were performed and results were separately re-ported by 2 radiologists. None of the mentioned cases had previous history of treatment for pulmonary TB or any other pulmonary diseases including immune deficiency syndromes. Results: Among 97 patients, 85 cases (87%) had nodu-lar infiltrations which were bilateral in 64 cases (66%). Consolidation was detected in 79 cases (81%) which was unilateral in 52 cases and bilateral in 27 cases. Pulmonary fibrosis was noted in 29 cases (30%) which was mostly unilateral. In 26 cases (26.8%) atelectasis was detected which was unilateral in 25 cases (96.2%). Pleural thickening was visualized in 58 cases (60%) which was unilateral in 77% and locally present in 83%. Pleural effusion was seen in 20 pa-tients (21%), which was unilateral in all of them. Mediastinal and hilar lymph-adenopathies were de-tected in 63%, which were bilateral in 61%. In 50% of cases, detected lymph nodes were less than 10mm in short axis. In 5 patients (5%), pericardial thicken-ing was noted; 70 patients (72%) had cavitary lesions. Conclusion: CT scan represents more precise and de-tailed information about pulmonary involvement of pulmonary tuberculosis; thus, it can guide us toward early detection and diagnosis of pulmonary tubercu-losis.
Posttraumatic Fat Necrosis Presented as Cellulitis of the Leg  [PDF]
Einat Haikin Herzberger,Shraga Aviner,Evgenia Cherniavsky
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/672397
Abstract: Cellulitis, a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin, is a common lesion in children, usually responsive to systemic antibiotic therapy. However, an unusual course of healing or some nontypical features should call the treating physician to consider and investigate for other diagnoses that might prevent unnecessary treatment and alleviate parental stress. We present a case of posttraumatic fat necrosis, demonstrating some pitfalls in the process of diagnosis. 1. Introduction Posttraumatic fat necrosis of the subcutaneous fat tissue can occur following a fall, blunt injury, surgery, and minor procedures such as injections [1]. It is more prevalent in women and usually appears on the shins, thighs, arms, breasts, and buttocks [2]. In children the most common site is the cheek following injury to the face. Usually a hematoma develops at the site of injury to be followed by a deeper induration [3]. It may appear as an incidental palpation of a lump, local depression, discoloration of the skin, or as a painful region [1]. As a history of injury is absent in many cases, the clinical picture may resemble a manifestation of a neoplastic disorder [1]. 2. Case Presentation A 9-year-old girl was admitted to the Emergency Department 4 days after a blunt trauma in her left leg. On admission the patient had no fever. On physical examination, there was an area of edema, warmth, erythema, and tenderness with indistinctive margins on the anteromedial aspect of the left leg. The rest of the physical examination was normal except for obesity and her history was unremarkable. X-ray of the leg was normal. She was clinically diagnosed as having cellulitis and was discharged with oral amoxicillin/clavulonic acid. However, edema, warmth, erythema, and tenderness of the leg persisted for 2 more days, denoting no improvement and the patient was readmitted 2 days later to the Pediatrics Department. Oral antibiotic was replaced with intravenous therapy (amoxicillin/clavulanic acid 75?mg/kg/day). Laboratory findings were white blood cell count 13.6 × 103/μL (neutrophils 74.4%, lymphocytes 17.8%, monocytes 6.8%, eosinophils 0.8%), hemoglobin 13.0?g/dL, platelets 292 × 103/μL, C-reactive protein 94.1?mg/dL, erythrocyte sedimentation rate 67?mm at 1 hour, blood chemistry: normal. The antibiotic therapy was changed 4 days later to cloxacillin (100?mg/kg/day) and ampicillin (100?mg/kg/day) because of unsatisfying improvement. Gradual improvement occurred over the next two days; edema, warmth and erythema became
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