Aspiration cytology of mediastinal seminoma: report of a case with emphasis on the diagnostic role of aspiration cytology, cell block and immunocytochemistry

BACKGROUND: Medigstinal seminoma ia an uncommon tumor that occurs primarily in young males. We present a case of mediastinal seminoma in an elderly male diagnosed on fine needle aspiration (FNA) tytology. CASE: A 62-year-old male was admitted to our hospital because of anterior chest pain for 2 weeks. Chest computed tomography revealed a huge, lobulated mass in the anterior mediastinum. Aspirate smears were highly cellular. The tumor cells appeared singly or in loose groups of a few cells in a markedly necrotic background without lymphocytic or tigroid characteristics. Well-preserved cells were relatively uniform, large and polygonal, with round or ovoid nuclei, 2 1 prominent nucleoli and a mild to moderate amount of clear, occasionally vacuolated cytoplasm. The chromatin wasfinely granular. Mitotic figures were frequently found. The cell block section showed solid nests of tumor cells with cytologic features similar to those in the smears, supported by loose, fibrous stroma infiltrated by some lymphocytes. Immunocytochemically the tumor showed diffuse reactivity for c-kit and appearedfocally positive for placentalike alkaline phosphatase and was uniformly negative for pancytokeratin, CAM 5.2 low-molecular-weight cytokeratin, CD5, CD30, alpha-fetoprotein and leukocyte common antigen. CONCLUSION: A confident diagnosis of mediastinal seminoma can be established by FNA cytology, cell block and immunocytochemistry.     

球囊辅助栓塞技术治疗未破裂颅内动脉瘤的有效性及安全性分析

目的:探究球囊辅助栓塞技术治疗未破裂颅内动脉瘤的有效性和安全性。方法:选择2014年1月~2019年1月在本院介入诊疗科接受介入治疗的540例患者作为研究对象。根据治疗方案分为两组,球囊辅助栓塞组有340例,单纯栓塞组有200例。回顾性分析研究对象的一般资料、临床资料、手术并发症等情况。结果:球囊辅助栓塞组和单纯栓塞组在性别组成、年龄、颅内动脉瘤性质、位置、Hunt-Hess分级等方面,差异不具有统计学意义(P>0.05);在术后即刻及术后6个月血管造影结果显示,前者栓塞程度明显优于后者,两组差异具有统计学意义(P<0.05);前者改良Rankin量表评分明显优于后者,两组差异具有统计学意义(P=0.005);前者预后良好率明显高于后者,两组差异具有统计学意义(P<0.001);手术过程中,球囊辅助栓塞组发生2例破裂出血、2例脑血管痉挛、1例弹簧圈移位,单纯栓塞组发生2例破裂出血、1例栓塞、2例脑血管痉挛、3例弹簧圈移位。前者并发症发生率明显低于后者,两者差异具有统计学意义(P<0.001)。结论:在治疗未破裂颅内动脉瘤方面,球囊辅助栓塞技术的有效性、安全性明显优于单纯栓塞介入治疗,值得临床推广。     

介入栓塞治疗内脏动脉瘤的临床研究

目的:探讨介入血管腔内栓塞治疗内脏动脉瘤的方法、疗效及安全性。方法:选择内脏动脉瘤患者23例,包括脾动脉瘤13例,肝动脉瘤2例,胃十二指肠动脉瘤3例,肠系膜上动脉瘤4例,肾动脉瘤1例。其中,9例行远近端动脉栓塞术,4例采用支架辅助弹簧圈瘤体内填塞,3例采用弹簧圈瘤体内填塞加瘤体内注胶栓塞术,4例行弹簧圈瘤体内栓塞术,2例行分支动脉颗粒栓塞术,1例行单纯注胶栓塞术。术后1月、3月、6月行超声、CTA或血管造影复查,以后每年复查一次。结果:本组均成功行介入血管腔内栓塞治疗内脏动脉瘤,栓塞治疗后造影示动脉瘤体和/或载瘤动脉闭塞,动脉瘤体内无明显对比剂显影,脾动脉瘤栓塞患者有3例出现发热,脾区疼痛等脾梗塞症状,未见栓塞术相关严重并发症发生。4例消化道出血患者出血均停止。术后随访3~48个月,未见动脉瘤破裂出血、动脉瘤复发或增大,支架置入者,支架内及分支动脉血流均保持通畅。结论:介入血管腔内栓塞是一种治疗内脏动脉瘤的简便、微创、安全有效的方法。     

Mediastinal lymphoma in a badger (Meles meles)

A case of mediastinal lymphoma in a free-living, adult male European badger (Meles meles), from Trento Province (northern Italy) is described. A yellow-red mass delimited by a thick fibrous capsule completely occupied the anterior mediastinum. Based on the histologic and immunohistochemical findings, a diagnosis of mediastinal lymphocytic lymphoma was made. Documentation of neoplasms in free-living species is important for comparison with domestic animals and humans and may give insight into epidemiology of these diseases. To the authors' knowledge, this is the first report of a mediastinal lymphoma in a badger.     

Anaplastic large cell lymphoma of the mediastinum diagnosed by transbronchial scratch cytology. A case report

BACKGROUND: Anaplastic large cell lymphoma (ALCL) is a subtype of non-Hodgkin's lymphoma characterized by CD30 antigen-positive, large neoplastic cells. We describe a case of ALCL suggested by cytologic examination of the tumor cells obtained from bronchial scratch preparations. CASE: A 26-year-old woman had had a dry cough since November 1996. Chest radiography in May 1997 revealed an abnormal shadow in the mediastinum extending to the pulmonary hilar region. The patient was hospitalized in June 1997. Computed tomography revealed a neoplastic lesion in the anterior mediastinum invading the right lung. Transbronchial scratch cytology revealed large, atypical lymphoid cells expressing CD30 and CD3 on immunocytochemical examination. A transcutaneous mediastinal biopsy was performed and a diagnosis of ALCL made. CONCLUSION: Differentiation from Hodgkin's disease was the most difficult point in this case. Detailed cytologic observation and CD3-positive immunocytology led to the correct diagnosis. The cell transfer technique of Sherman et al was very useful for immunocytologic staining. Thus, transbronchial scratch cytology was an especially valuable and effective procedure in this case.     

Multilocular thymic cyst with follicular lymphoid hyperplasia in a male infected with HIV. A case report with fine needle aspiration cytology

BACKGROUND: Multilocular thymic cyst with follicular lymphoid hyperplasia is a rare complication in HIV-infected patients, causing pseudotumorous enlargement of the anterior mediastinum. There have been six reported cases, all with only histologic findings. This paper reports another such case and includes perhaps the first cytologic findings on this rare entity. CASE: A 35-year-old, HIV-infected male intravenous drug abuser, who complained of worsening central chest discomfort and pain on deep inspiration, was found to have a large, septated anterior mediastinal mass. Computed tomography-guided fine needle aspiration biopsy was performed. The cytologic presentation mimicked that of thymoma, with cystic degeneration and a dual population of epithelial cells and lymphocytes as well as large aggregates of "epithelial" cells intermixed with lymphocytes in a background of macrophages and cyst fluid. Histologic examination of the resected mass revealed a multilocular thymic cyst with follicular lymphoid hyperplasia. HIV-1 core protein p24 was localized immunohistochemically in the dendritic follicular cells of the germinal centers. In retrospect, the quantity of epithelium derived from the cyst lining was too scanty for thymoma, and the presence of plasma cells and lymphohistiocytic aggregates suggested follicular lymphoid hyperplasia. CONCLUSION: Multilocular thymic cyst with follicular lymphoid hyperplasia should be considered in the differential diagnosis of an anterior mediastinal mass in HIV-infected patients after lymphoma and tuberculosis.     

可脱球囊栓塞治疗创伤性颈内动脉海绵窦瘘的研究

目的：研究微导管可脱球囊技术治疗创伤性颈内动脉-海绵窦痿（TCCF）的临床意义。方法：4例TCCF患者采用微导管可脱球囊技术进行栓塞治疗,所有患者均随访6月以上。结果：3例TCCF患者一次性成功栓塞瘘口井保持颈内动脉通畅,1例瘘口复杂患者因球囊过早泄漏复发而行2次栓塞治疗闭塞颈内动脉。本组病例来发生严重并发症。结论：微导管可脱球囊技术对TCCF是一种微创、安全、有效的治疗方法。     

Incidental Radiologic Finding of an Anterior Superior Mediastinal Mass Masquerading as Metastatic Thyroid Cancer in Patients with Treated Thyroid Cancer

ObjectiveTo demonstrate that an anterior superior mediastinal mass on radiologic imaging may represent an incidental finding and not metastases in patients with a history of treated well-differentiated thyroid cancer.MethodsWe report the clinical presentation and outcomes of 4 patients with a history of thyroid cancer who were incidentally found to have anterior superior mediastinal masses on imaging. We also review the relevant literature.ResultsFour young adults with a history of stage I papillary thyroid cancer treated with total thyroidectomy and radioiodine were incidentally found to have thymic enlargement on imaging studies within a 3-year posttreatment window. In each case, this enlargement was believed to be secondary to thymic hyperplasia and not metastatic disease, and each patient has exhibited a benign clinical course. Review of the literature revealed few reports of an association between thymic hyperplasia and thyroid cancer.ConclusionsThymic hyperplasia may be discovered on posttreatment imaging studies in patients with a history of well-differentiated thyroid cancer, particularly in young adults who have received radioiodine therapy. Recognition of the possible coexistence of this incidental finding in patients with thyroid cancer may help to avoid unnecessary invasive procedures and treatments. (Endocr Pract. 2011;17:65-69)     

Fine needle aspiration cytology and immunocytochemistry in a case of intrathoracic thyroid goiter

Fine needle aspiration (FNA) was performed in the case of a patient with an anterior mediastinal mass. Examination of the smears revealed individual and groups of benign nondiagnostic cells. Surgical removal and histologic examination indicated that the mass was a true intrathoracic thyroid goiter. Subsequent immunocytochemical studies on the FNA smears showed thyroglobulin in the cytoplasm of the aspirated cells. The cytologic findings are presented; while not diagnostic of a thyroidal origin in this case, they serve as a reminder of the wide range of cytologic appearances of colloid nodules and goiters. This case will hopefully heighten the awareness of cytologists and other physicians to the consideration of the possibility of intrathoracic goiter in the differential diagnosis of mediastinal lesions seen in fine needle aspirates.     

Genomic profiling of plasmablastic lymphoma using array comparative genomic hybridization (aCGH): revealing significant overlapping genomic lesions with diffuse large B-cell lymphoma

Background

Cholestatic jaundice as a presenting symptom of Precursor T-lymphoblastic leukemia (T-ALL)/lymphoma (T-LBL) has never been reported in literature. Similarly, precursor T-ALL/T-LBL is characteristically negative for synaptophysin. We report the first case of a patient with precursor T-ALL/T-LBL who presented with cholestatic jaundice and aberrant tumor expression of synaptophysin.

Case report

42 year old male presented with anorexia, nausea, jaundice, pale stools, dark urine and about 35 pound weight loss over the previous 3 weeks. The initial laboratory work was suggestive of cholestatic jaundice. Markedly elevated LDH (2025 U/L) and CA 19-9 (1778 u/ML) were also noticed. The CT scan of abdomen showed massive hepatomegaly with coarse echotexture with contracted gall bladder and normal sized common bile duct. Chest x-ray revealed a mediastinal mass with mediastinal widening. CT scan of the chest showed anterior mediastinal mass (16 cm × 10 cm). CT guided biopsy of the mass showed malignant lymphoma with diffuse proliferation of medium sized lymphoid cells. The neoplastic cells were positive for CD1a, CD3, CD4, CD5, CD8 and CD43 with aberrant expression of synaptophysin. PET CT scan again showed a large anterior mediastinal mass with diffuse liver involvement and abnormal activity in axial bones. CT guided liver biopsy and bone marrow biopsy revealed the same morphology and immunohistochemistry. Bone marrow aspirate showed 85% lymphoblasts. Thus, the diagnosis of precursor T-ALL/T-LBL was made and jaundice with elevated CA 19-9 were attributed to intrahepatic cholestasis.

Conclusion

Our case illustrates an unusual presentation of hematological malignancies as cholestatic jaundice. It also indicates the non-specific nature of CA 19-9 for pancreaticobiliary malignancies. It is the first case report of neoplastic precursor T cell lymphoblasts with unusual expression of synaptophysin. Tissue biopsy with thorough immunohistochemistry is required to differentiate precursor T-ALL/T-LBL from thymoma and small cell carcinoma.     

Malignant melanoma of mediastinum misdiagnosed as a spindle cell thymoma in a fine needle aspirate: a case report

BACKGROUND: Malignant melanomas in the medastinum are extremely rare. Both primary melanomas and metastatic lesions from a primary elsewhere can occur in the mediastinum. Aspiration biopsy of a melanoma at this unusual site may pose problems in diagnosis. CASE: A 35-year-old woman presented with an anterior mediastinal mass. Cytologic smears were hemorrhaghic and revealed a loosely dispersed population of spindle cells with prominent nucleoli. In view of the location, the possibility of spindle cell thymoma was suggested on cytology. Subsequent histology revealed a malignant melanoma. CONCLUSION: This case stresses that the cytopathologist should keep in mind the remote differential diagnosis of a malignant melanoma while evaluating spindle cell neoplasms of the mediastinum, especially in tumors with prominent cell dispersal and with cells that have prominent nucleoli even without melanin pigment. Accurate diagnosis helps in evaluating patients and avoids unnecessary surgery when the lesion represents a metastasis to the mediastinum from a primary elsewhere.     

手术夹闭与介入栓塞治疗对前交通动脉瘤患者认知功能的影响

目的:探讨前交通动脉瘤手术夹闭与介入栓塞两种治疗方法对前交通动脉瘤患者认知功能的影响。方法:采用简易精神状态量表(MMSE)对206例前交通动脉瘤患者进行分析对照,其中开颅动脉瘤夹闭患者125例,介入栓塞患者81例,另取正常组40例作为对照组。结果:前交通动脉瘤患者术前即有认知功能障碍发生,术后患者认知功能障碍发生率增高(P<0.01)。患者组的术后认知功能障碍发生率明显高于对照组,而患者组中的介入组的术后认知功能障碍发生率明显小于手术夹闭组(P<0.05)。结论:前交通动脉瘤患者术前既有认知功能障碍发生,两种治疗手段对术前即出现的认知功能障碍无改善作用,并且可能增加认知功能障碍的发生率及加重认知功能障碍的程度,而介入栓塞术在认知障碍的发生率及出现认知功能障碍的程度方面都优于开颅动脉瘤夹闭术。     

脾动脉栓塞术后出现严重粘连的脾切除手术体会

目的:探讨脾动脉栓塞术后严重脾粘连脾切除手术技巧,为临床实践提供可借鉴的方法。方法:收集我院2005年4月-2013年6月收治的18例脾动脉栓塞术后严重脾粘连行脾切除术的患者临床资料,分析手术时间、术中出血、术中特殊处理及术后恢复情况等。结果:18例患者均顺利恢复出院,无围手术期死亡,开腹后到脾切除完成平均耗时55 min、出血550 mL。术后并发症为腹水(8例)、肺部感染(1例)、胰瘘(1例)及腹腔内出血(1例)。结论:脾动脉栓塞术后出现严重脾粘连行脾切除术,手术风险较大,手术时间、术中出血较常规脾切除术明显延长、增多。规范手术操作,细致分离脾周粘连,合理处理脾蒂,是安全、有效完成此类脾切除术的关键。     

Optimal Surgical Options for Descending Necrotizing Mediastinitis of the Anterior Mediastinum

The mortality rates from descending necrotizing mediastinitis (DNM) are between 25 and 40 % mainly because of delayed diagnosis and inappropriate surgical treatment. This study was undertaken to examine two surgical options for DNM and determine the optimal surgical option for DNM of the anterior mediastinum. Fifteen cases of DNM of the anterior mediastinum, January 2001 and October 2010, were retrospectively reviewed. Eleven were anterosuperior mediastinitis, with infection located above the tracheal bifurcation and four had infections involving the entire anterior mediastinum. Depending on the location of mediastinitis, open drainage of the submandibular and neck abscesses, in addition to other surgical treatments, was performed. If the infection was anterosuperior, transcervical mediastinal drainage or thoracotomy was performed. If the entire anterior mediastinum was involved, necrotic tissue was removed with thoracoscopic via subxiphoid incision, the bilateral pleurae were opened for drainage, and a tunnel connecting the neck incision and the subxiphoid incision through the whole anterior mediastinum was made for drainage. The anterosuperior mediastinitis cases were treated with either transcervical mediastinal drainage (n = 8) or thoracotomy (n = 3). Patients healed after an average of 24.5 and 20.0 days in the hospital, respectively. For the four other cases, one patient died of septic shock, while the other three patients were healed after and an average of 43.3 days in the hospital. Mortality rate was 6.7 %. The surgical procedure used to treat DNM should be selected according to the location of the infection. DNM involving the anterosuperior mediastinum can be treated by transcervical mediastinal drainage. If anterosuperior mediastinitis spreads to the side of the trachea, open thoracotomy is a suitable therapy. If the entire anterior mediastinum is involved, debridement and drainage of the anterior mediastinum should be performed with a thoracoscope via the subxiphoid incision.     

Long-term results of endovascular treatment of metastatic renal cell cancer

The authors analyse the long-term results of treatment of 106 patients with advanced renal cell carcinoma. The patients were divided in two groups. Group 1 (42 patients) included cases with single metastatic lesion. Patients of group 2 (n = 64) had more than one site of metastases. All patients were treated by nephrectomy, embolization with chemotherapeutic agent or arterial occlusion without cytostatic drug except nine patient of group 2, who has undergone chemo and hormonal therapy. The survival according to method at treatment was studies. After occlusion satisfactory results were obtained in cases with single metastasis lesion and also in cases with many sites of metastases. Oily chemoembolization in renal cell carcinoma with distant metastases has given better results as compared with the embolization without chemodrugs. We conclude that endovascular method of treatment is an alternative to the traditional nephrectomy in palliation of renal cell carcinoma.     

Coil embolization of intralobar pulmonary sequestration - an alternative to surgery: a case report

Background

Pulmonary sequestration is a congenital lung disease characterized by nonfunctioning pulmonary tissue that lacks normal communication with the bronchial tree and is supplied by a nonpulmonary systemic artery. Symptomatic bronchopulmonary sequestration is uncommon, seen more frequently in the pediatric population than in adults. It has traditionally been treated with surgical resection; however, a limited but growing number of cases have been treated with angiographic embolization. Given the inherent risks of cardiothoracic surgery, embolization of the anomalous vessel is an enticing alternative treatment. We present a case of a 56-year-old woman with known, symptomatic, intralobar pulmonary sequestration that was successfully treated with coil embolization.

Case presentation

A 56-year-old Pacific Islander woman with a history of chronic myeloid leukemia was admitted to the hospital with an episode of hemoptysis. Computed tomography of the chest demonstrated left lower lobe intralobar pulmonary sequestration fed by a large tortuous vessel branching off of the descending thoracic aorta. Surgical resection of the sequestration is the current standard treatment strategy of symptomatic intralobar pulmonary sequestration. The cardiothoracic surgeon noted that given the size and location of arterial blood supply, intervention would involve thoracotomy and lobectomy. The interventional radiologist offered embolization of the lesion as an alternative to surgery. Multiple coils, 6–13 mm in size, were used to embolize the sequestration. No considerable flow distal to the coils was noted postembolization.

Conclusions

Intralobar pulmonary sequestration is a rare condition that typically requires surgical management. This case demonstrates the efficacy of coil embolization as an alternative management strategy. To date, limited case reports of adults treated with endovascular embolization exist. Treatment of symptomatic pulmonary sequestration with embolization can be considered as an alternative to surgical resection.

     

CT血管造影联合CT尿路成像在重度闭合性肾损伤患者中的临床应用价值分析

摘要 目的：探讨CT血管造影（CTA）联合CT尿路成像（CTU）检查在重度闭合性肾损伤患者临床处理中应用价值。方法：收集并分析2017年1月-2019年12月我院收治的9例诊断重度闭合性肾损伤患者的临床资料,入院时先行急诊CT平扫检查了解肾挫伤情况,确定重度肾损伤再进一步行CTA联合CTU检查,根据检查结果选择合适的治疗方案（保守治疗、选择性肾动脉介入栓塞治疗、手术治疗）。结果：9例患者均成功救治。保守治疗4例,肾动脉介入栓塞治疗5例（其中有2例行肾动脉介入栓塞后再行手术治疗）。随访3-8个月,患者恢复良好,无明显并发症。结论：肾动脉CTA联合CTU检查,能全面提供肾血管及肾盂、输尿管、邻近脏器等的解剖信息,明确损伤程度,为介入和手术治疗提供良好的术前指导,尤其是结合肾动脉选择性栓塞,能最大限度保留肾脏功能,提高抢救率,具有重要的临床应用价值。     

Esophageal tuberculosis. Endoscopic cytology as a diagnostic tool

OBJECTIVE: To study the utility of endoscopic cytology in the diagnosis of esophageal tuberculosis in clinically unsuspected cases. STUDY DESIGN: During a period of four years, endoscopic cytology of esophageal lesions was performed on 228 patients. In eight (3.5%) the cytologic diagnosis of esophageal tuberculosis was suggested on smears. Upon endoscopic examination, the sites of involvement were mid esophagus (five cases), upper esophagus (two cases) and lower esophagus (one case). Linear ulcer was seen in six cases; growth and narrowing of the lumen were seen in one case each. Endoscopic brush smears in seven cases and fine needle aspiration cytology smear in one case were collected. Air-dried smears stained by Giemsa stain were reviewed for detailed cytologic assessment. RESULTS: Smears showed well-defined granulomas with necrosis in five cases and granulomas without necrosis in three. Cytologic evidence of concurrent poorly differentiated squamous cell carcinoma was observed in one case. Tubercle bacilli were demonstrated in five cases. Endoscopic biopsy showed granulomas in three cases and tubercle bacilli in one case. In six cases there was no clinical or radiologic evidence of tuberculosis at other sites, thereby suggesting the possibility of primary esophageal tuberculosis. The remaining two cases had a past history of tuberculosis; one presented with cervical lymphadenopathy and one mediastinal lymphadenopathy. All patients received antitubercular treatment, and the patient with concurrent malignancy also received radiotherapy. All but one of the patients who succumbed to aspiration pneumonia responded to treatment. CONCLUSION: Endoscopic cytology is a useful modality in the diagnosis of esophageal tuberculosis in clinically unsuspected cases.     

MEDIASTINAL EMPHYSEMA

Mediastinal emphysema may occur due to migration of air from the lungs, from the esophagus or tracheobronchial tree and from the abdomen. Of especial interest is the mechanism starting with the rupture of the perivascular alveoli due to a rapid decrease in intrathoracic pressure from any cause, the development of pulmonary interstitial emphysema and migration of the air into the mediastinum.In one case the patient had severe interstitial emphysema of the left lung, mediastinal emphysema and subcutaneous emphysema without pneumothorax and rapid improvement followed tracheotomy.In another case the patient had interstitial emphysema of the left lung that did not progress to mediastinal emphysema and subcutaneous emphysema. Pneumothorax was not present. Recovery was more rapid than in the first patient.     

Fine needle aspiration biopsy features with histologic correlation in mediastinal hepatoid yolk sac tumor presenting with sternum metastasis: a case report

BACKGROUND: The hepatoid variant of yolk sac tumor (H-YST) is an exceedingly rare and highly malignant neoplasm. We present and discuss our experience with cytologic and histopathologic features of a mediastinal H-YST presenting with sternum metastasis, which to the best of our knowledge has not been previously reported. CASE: A 38-year-old man presented with a large mass on the sternum. Computed tomography of the thorax showed a large anterior mediastinal mass with sternum metastsis and multiple lung metastases. Laboratory examination revealed elevated serum alpha-fetoprotein (60,000 IU/mL). No tumor was found in the other organ systems. A percutaneous fine needle aspiration biopsy and subsequent open surgical biopsy were performed on the sternum metastasis. Cytologically, the tumor was composed of monotonous, large, round to polygonal hepatoid cells forming solid sheets and trabeculae entrapped with endothelial cells resembling hepatocellular carcinoma. Histopathologic sections of tumor showed tumor cells with eosinophilic to clear cytoplasm arranged in a solid, trabecular growth pattern, with some acinar formations. Immunohistochemical study supported the hepatoid origin. CONCLUSION: Fine needle aspiration cytology, together with the characteristic clinical presentations and specific tumor markers, is crucial to the initial diagnosis of H-YST.