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Fulltext Transbronchial lymph node forceps biopsy as a novel tool in diagnosis of mediastinal lymphadenopathy: a pilot study

Al-Halfawy A, Hussein S, Ashur W, El-Hendawi A, Hussein S

J Cardiothorac Surg, 2024 Feb 07;19(1):69.
PMID: 38326810 DOI: 10.1186/s13019-024-02560-x

BACKGROUND: Differential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to a variety of inflammatory, infectious, or malignant reasons. Therefore, obtaining samples from the affected nodes is crucial for the diagnosis. Usually, these patients are subjected to TBNA (EBUS or conventional) or mediastinoscopy if TBNA is not conclusive. This study evaluated the safety and feasibility of this new technique of transbronchial forceps biopsy for the diagnosis of mediastinal lymphadenopathy.
METHODS: The study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University in the period from December 2019 to December 2020. All patients were subjected to flexible bronchoscopy with conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy (LN-TBFB) from the enlarged mediastinal lymph node in the same procedure.
RESULTS: we found the technique of LN-TBFB safe with no serious complications. We were able to reach a diagnosis in 7/7 (100%) cases of sarcoidosis, 6/7 (85.7%) cases of malignant lymph nodes. We had three cases where the histopathology showed hyperactive follicular hyperplasia, and a single case of tuberculous lymphadenitis. C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, but failed to diagnose the one patient with tuberculous lymphadenitis.
CONCLUSION: Lymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of this minimally invasive technique for diagnosing pathologically enlarged mediastinal lymph nodes, as a last step before mediastinoscopy.

Matched MeSH terms: Mediastinum/pathology
Fulltext Surgical Management of Bulky Mediastinal Metastases in Follicular Thyroid Carcinoma

Adwin Z, Nur A, Suhaimi S, Rahman R

Oman Med J, 2016 Jan;31(1):69-72.
PMID: 26816570 DOI: 10.5001/omj.2016.13

Follicular thyroid adenoma and carcinoma are very common. Benign and malignant lesions are usually indistinguishable from cytology alone and often require confirmatory resection. The spread of follicular carcinoma is usually hematogenous and is treated with surgery and adjuvant radioactive iodine. Very rarely, metastases occur in the mediastinum. Patients usually present with severe compressive symptoms. With proper treatment and follow-up, the prognosis for these type of thyroid malignancies is excellent. In the case presented here, our patient presented to the Universiti Kebangsaan Malaysia Medical Center with a progressively enlarging anterior neck swelling. The swelling had started 10 years before his presentation. We diagnosed him with an advanced thyroid malignancy with bulky mediastinal metastases. After extensive investigations and counseling, we chose to treat the patient with tumor excision and mediastinal metastases resection. Typically, mediastinal resection involves the removal of the sternum and use of an acrylic implant to recreate the sternum. In this case, the sternum and ribs were removed with subsequent myocutaneous flap coverage for the wound defect. Our experience represents an alternative treatment option in cases where implant use is unsuitable.

Matched MeSH terms: Mediastinum
Fulltext Cystic teratoma mimicking recurrent pleural effusion, complicated by Mycobacterium abscessus infection

Mohd Esa NY, Mohd Radzi AA, Bakar NS, Mohd Khalid MS, Ismail AI, Abdul Rani MF

Respirol Case Rep, 2016 May;4(3):e00155.
PMID: 27516884 DOI: 10.1002/rcr2.155

Teratomas of anterior mediastinum are rare. They are often slow growing, asymptomatic, and detected incidentally on chest imaging. Mycobacterium abscessus (M. abscessus) is an acid-fast bacillus that is classified as a pathogenic "rapid growing" non-tuberculous mycobacteria. It is an uncommon cause of human pathology, which may cause skin and soft tissue infection after skin injury following inoculation, minor trauma, and surgery. Here, we present an unusual case of benign cystic teratoma mimicking recurrent pleural effusion, which was subsequently complicated by M. abscessus infection following thoracotomy. Cystic teratoma is rare, but it needs to be considered whenever clinical and investigative work-up fails to provide a convincing diagnosis. A combined clinical, radiological, surgical, and histopathological assessment is important to arrive at the correct diagnosis. Rapidly growing mycobacteria needs to be included in the differential diagnosis of patients with non-resolving infected post-thoracotomy wound and who do not respond to broad-spectrum antibiotics.

Matched MeSH terms: Mediastinum
Fulltext Inflammatory Pseudotumour of Stomach in an old lady: a rare case report

Azhar, A.H., Pasha, M.A., Hassan, S., Zainal, M., Rashidi, A.

International Medical Journal Malaysia, 2009;8(1):45-48.
MyJurnal

Inflammatory pseudotumour (IPT) is a rare benign solid tumor in adults and children. The prevalence, etiology and pathogenesis of this condition are still uncertain. Despite the use of modern laboratory techniques and imaging, it is often difficult to make the diagnosis of IPT. Besides, occasionally the nonspecific morphological appearance and clinical presentation of the mass may mimic other more common primary or secondary neoplasms. IPT is commonly encountered in the lung and mediastinum. Other sites include abdomen (liver, pancreas, stomach, omentum), retroperitoneum, pelvis (bladder) and extremities in children. We report a rare case of gastric inflammatory pseudotumour in a 65-year-old female patient. Clinical presentations and its management along with review of literatures are presented.

Matched MeSH terms: Mediastinum
Fulltext Multimodality diagnostic imaging in Tuberculous Lymphadenitis – a case review

Abdul Jalil Nordin, Suraini Mohd Saini, Hairil Rashmizal Abdul Razak, Noraini Abdul Rahim

Pertanika Journal of Science & Technology, 2011;19(1):141-146.
MyJurnal

The purpose of this article is to demonstrate the appearance of active TB lymphadenitis using multimodality imaging apparatus. Multi-modality diagnostic imaging tools, including chest radiograph, Ultrasound (US), Computed Tomographic Scan (CT), Magnetic Resonance Imaging (MRI), and integrated 18F-FDG Positron Emission Tomography/CT examination, were performed to demonstrate TB lymphadenitis in the neck and superior mediastinum of a 26 year old female patient. There was widening of superior mediastinum on chest radiograph. Meanwhile, the ultrasound carried out detected superficial cystic lesions in the cervical region. The MRI found multiple gadolinium enhanced cervical and mediastinal lymphadenophaties. Contrast enhanced CT found heterogeneous enhancing lymphadenopathies in the same anatomical region. FDG PET/CT demonstrated a high metabolic activity in all lesions, as demonstrated by conventional imaging
modalities. Mycobacterium tuberculosis was isolated from 1ml aspirate using US guidance. Post treatment FDG PET CT scan demonstrated a complete metabolic remission of active lesions FDG PET CT can be used to demonstrate metabolic activity of active TB lesions in addition to guide clinicians in treating TB lesions.

Matched MeSH terms: Mediastinum
Fulltext Huge brachial plexus schwannoma, masking as a cystic neck mass

Kho JPY, Prepageran N

AME Case Rep, 2018;2:41.
PMID: 30363802 DOI: 10.21037/acr.2018.08.01

Schwannomas are solitary, benign tumors arising from the nerve sheaths. They are frequently reported in the thorax predominantly in the posterior mediastinum, but are rarely seen to arise from the brachial plexus. Schwannomas are well demarcated lesions with a slow insidious growth. Presented is a case of a large brachial plexus schwannoma, masking as a cystic lesion in the lateral neck. The patient presented with concerns of a cystic mass progressively increasing in size over a period of four years, initially symptomless, but later caused numbness and tingling sensation over his right forearm, tip of right thumb and index finger. Following histological confirmation via fine needle aspiration and magnetic resonance imaging, the patient underwent surgical excision where by the tumor was dissected from its attachment to the nerve sheath. The patient recovered well, and by the third day post operatively, his neurological symptoms resolved completely. Upon follow up in clinic 1-week post-surgery, the scar had healed well, and his numbness or tingling sensation remained in abeyance. This case illustrates that a schwannoma may present insidiously as a cystic lesion and its possible origin may arise from the brachial plexus.

Matched MeSH terms: Mediastinum
Immigrant Health Study. 9. The chest radiographic changes in an immigrant population - a pilot study. [Abstract]

Basri JJA

JUMMEC, 1998;3:64-64.

With the increasing ease of travel and the passage of peoples between counkies there is a need to ensure that the recipient country is not burdened by the need for care of ilniiiigrant with health problems as well as the increased risk posed to the local population froni exposure to conun~unicabled isease. To assess the chest radiographs of a selected group of inun~igrantsto ascertain the presence of abnormalities especially the presence of tuberculosis. A total of 250 imniigrants were prospectively evaluated by a PA chest radiograph. The chest radiograph was evaluated by two radiologists for the presence of abnormalities of the heart, lungs, mediastinum and bony rib cage. There were 112 Indonesians, 133 Bangladeshis, one Myanmar, three Pakistanis and one others. Males made-up 222 while there were 28 females. The chest radiograph was diagnostic in all cases. There were 13 cases with enlarged hearts but with no evidence of heart failure. There was only a single inlmigrant who had evidence of active TB though there were 6 others who had evidence of old disease. There was evidence of other infections in five. With regard to the mediastinuni there was a single case with enlarged hila probably secondary to increased cardiac output. There were 21 patients with scoliosis of the spine and two with abnormaIities of the ribs. Even though there was a single case with evidence of TB from this pilot study, from unreported data from the UMMC, there were 15,16 and 23 immigrants treated for TB for 1994,1995 and 1996 respectively. This was mainly seen in the Indonesians followed by the Bangladeshis and Myanmar. We attribute this discrepancy to the biased salnpie in this study where probably only the healthy were seen while those who were not well did not want to participate in this study. In addition, this may also be due to the small sample used in this study. We feel that screening of the immigrants out in the field may be able to detect cases of active TB. As for the large hearts we feel that in the absence of any cardiac symptoms and other radiological changes these are probably due to the increased workload on the heart from physical activities. This is a recognised presentation. The changes in the mediastinum and bony rib cage are probably not very significant.

Matched MeSH terms: Mediastinum
Fulltext Salmonella Thyroid Abscess Treated by Serial Aspiration: Case Report and Literature Review

Vengathajalam S, Retinasekharan S, Mat Lazim N, Abdullah B

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):823-826.
PMID: 31742073 DOI: 10.1007/s12070-019-01654-6

Thyroid abscesses are the most rare conditions of the thyroid gland but it could be potentially life threatening. Most patients are immunocompromised or has an underlying chronic thyroid disorder. We report a case of a 58 year-old lady with underlying uncontrolled diabetes mellitus and a long standing uninvestigated goiter who presented with lethargy, a new anterior neck swelling with dysphagia and change of voice. Ultrasound and computed tomography were performed and showed collection with multiple air pockets in the right thyroid lobule extending to the anterior mediastinum. She was started on intravenous antibiotics and underwent serial bedside aspiration. Her symptoms improved and complete resolution was achieved after serial aspirations and antibiotics.

Matched MeSH terms: Mediastinum
Fulltext Cardiac Iodine-123-Meta-Iodo-Benzylguanidine Uptake in Carotid Sinus Hypersensitivity

Tan MP, Murray A, Hawkins T, Chadwick TJ, Kerr SR, Parry SW

PLoS One, 2015;10(6):e0126241.
PMID: 26057525 DOI: 10.1371/journal.pone.0126241

Carotid sinus syndrome is the association of carotid sinus hypersensitivity with syncope, unexplained falls and drop attacks in generally older people. We evaluated cardiac sympathetic innervation in this disorder in individuals with carotid sinus syndrome, asymptomatic carotid sinus hypersensitivity and controls without carotid sinus hypersensitivity.

Matched MeSH terms: Mediastinum/radionuclide imaging
Fulltext Lung cancer staging now and in the future

Liam CK, Andarini S, Lee P, Ho JC, Chau NQ, Tscheikuna J

Respirology, 2015 May;20(4):526-34.
PMID: 25682805 DOI: 10.1111/resp.12489

For a long time lung cancer was associated with a fatalistic approach by healthcare professionals. In recent years, advances in imaging, improved diagnostic techniques and more effective treatment modalities are reasons for optimism. Accurate lung cancer staging is vitally important because treatment options and prognosis differ significantly by stage. The staging algorithm should include a contrast computed tomography (CT) of the chest and the upper abdomen including adrenals, positron emission tomography/CT for staging the mediastinum and to rule out extrathoracic metastasis in patients considered for surgical resection, endosonography-guided needle sampling procedure replacing mediastinoscopy for near complete mediastinal staging, and brain imaging as clinically indicated. Applicability of evidence-based guidelines for staging of lung cancer depends on the available expertise and level of resources and is directly impacted by financial issues. Considering the diversity of healthcare infrastructure and economic performance of Asian countries, optimal and cost-effective use of staging methods appropriate to the available resources is prudent. The pulmonologist plays a central role in the multidisciplinary approach to lung cancer diagnosis, staging and management. Regional respiratory societies such as the Asian Pacific Society of Respirology should work with national respiratory societies to strive for uniform standards of care. For developing countries, a minimum set of care standards should be formulated. Cost-effective delivery of optimal care for lung cancer patients, including staging within the various healthcare systems, should be encouraged and most importantly, tobacco control implementation should receive an absolute priority status in all countries in Asia.

Matched MeSH terms: Mediastinum/pathology
Fulltext Benign teratoma of the liver: a rare cause of cholangitis

Rahmat K, Vijayananthan A, Abdullah B, Amin S

Biomed Imaging Interv J, 2006 Jul;2(3):e20.
PMID: 21614237 MyJurnal DOI: 10.2349/biij.2.3.e20

Teratomas are neoplasms characterised by an abnormal growth of tissues derived from the three germinal layers. The term 'teratoma' is derived from the Greek root 'teratos', meaning monster. Germ cells develop in the embryo and subsequently become the cells that make up the reproductive system. During fetal development, these cells follow a midline path and descend into the pelvis as ovarian cells or the scrotal sac as testicular cells. The presence of germ cells in extragonadal sites is because of the failure of these cells to migrate along the urogenital ridge. Therefore, teratomas occur in order of decreasing frequency in the ovaries, testes, anterior mediastinum, retroperitoneum, sacrococcygeal region and cranium.Liver teratomas are very rare; of the 25 hepatic teratomas described in the literature, only five have occurred in adults. The majority of the cases were in female children below the age of three, mostly arising in the right lobe of liver.We report a case of an adult male with benign mature teratoma arising in the left lobe of liver, compressing the common bile duct and causing obstructive jaundice.

Matched MeSH terms: Mediastinum
Fulltext Anaplastic Large Cell Lymphoma Presenting as a Soft Tissue Mass – A Case Report

Siti-Aishah, M.A., Salwati, S., Idrus, M., Rahimah, R., Salmi, A., Leong, C.F., et al.

Medicine & Health, 2008;3(1):69-74.
MyJurnal

Anaplastic large cell lymphoma (ALCL) is a rare tumour, accounting for approximately 3% of adult non-Hodgkin lymphomas.1 Primary systemic ALCL frequently involves both lymph nodes and extranodal sites. A 44-year-old woman presented with a firm, mobile mass in the left iliac fossa region. Ultrasound findings showed a well defined inhomogenous soft tissue mass, measuring 4x4x2.6cm in the deep subcutaneous region. Histopathological examination revealed that the mass was infiltrated by large lymphoid cells with marked nuclear atypia including kidney-shaped nuclei. These neoplastic cells expressed anaplastic lymphoma kinase (ALK) (both nuclear & cytoplasmic staining), CD30 and EMA but not for T-cell (CD45RO and CD3), and B-cell (CD20 & CD79α) markers. Fluorescence in situ hybridization (FISH) analysis showed a t(2;5)(p23;q35) chromosomal translocation. Subsequently the patient developed shortness of the breath and a thoracic computed tomography (CT) scan showed a mass encasing the right upper lobe bronchus. She also had bilateral axillary lymph nodes, measuring 1 cm in diameter (biopsy was not done). The mediastinum and endobronchial region did not show any abnormalities. She received 6 cycles of CHOP chemotherapy and remained disease free 2 years after diagnosis. ALCL, rarely present as a soft tissue tumour and this disease should be included as a differential diagnosis of any soft tissue mass.

Matched MeSH terms: Mediastinum
Fulltext Case review of sarcoidosis resembling Sjogren's syndrome

Ahmad Y, Shahril NS, Hussein H, Said MS

J Clin Med Res, 2010 Dec 11;2(6):284-8.
PMID: 22043264 DOI: 10.4021/jocmr482w

We would like to report a case of a 29-year-old male patient who presented with multiple lymphadenopathy and vague symptoms of low grade fever, cough, weight loss, rashes, vomiting, dry eyes and dry mouth. Physical examination revealed submandibular lymphadenopathy, vasculitic rashes over both lower limbs, and parotid gland enlargement. Blood investigations showed mild anemia with leukocytosis, predominantly eosinophilia and high erythrocyte sedimentation rate and C-reactive protein. Computed tomography of the neck, thorax and abdomen showed bilateral submandibular, submental adenopathy, mediastinal and para-aortic lymphadenopathy with generalized reticulonodular densities in both lower lobes. There were hepatomegaly and bilateral enlarged kidneys with renal cyst. Histopathological examination from the cervical lymph node later revealed non-caseating granuloma, consistent of sarcoidosis. Patient responded well to prednisolone 50 mg daily with subsequent reduction in the size of cervical lymphadenopathy and parotid swelling.

KEYWORDS: Lymphadenopathy; Granuloma; Sjogren; Sarcoidosis.

Matched MeSH terms: Mediastinum

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