Mediastinal Cyst

纵隔囊肿
  • 文章类型: Journal Article
    介绍心包囊肿(PC)很少见,非恶性,和先天性异常。PC的识别和治疗仍然是一个重大挑战,对手术管理的研究有限。方法回顾性分析2002年2月至2022年12月在新疆医科大学第一附属医院接受手术治疗的PC患者。结果在研究期间,共有55例患者因PC而接受了手术治疗。31名女性,24名男性。患者的平均年龄为44.7±12.9(6至63岁)。在50例(90.9%)患者中,PC位于右半胸,在5例(9.1%)患者中,PC位于左半胸。方法采用电视胸腔镜手术(VATS)43例(78.2%),开胸手术11例(20%),1例(1.8%)胸骨正中切开术。术后平均住院时间为5.6天(2至14天)。3例患者出现术后并发症(2例胸腔积液,一种肺炎),而没有观察到任何患者因手术而死亡。41例(74.5%)患者术后随访3个月至8年,在此期间没有发现复发性囊肿。结论在这项单中心回顾性研究中,根据囊肿的特点,我们证明了心包囊肿的治疗是一种合适的手术。VATS已被证明对患有PC的患者非常有效和安全,提供有效降低术后发病率的优势。
    Introduction Pericardial cysts (PCs) are infrequent, non-malignant, and congenital abnormalities. The identification and treatment of PCs remain a significant challenge, with limited research on surgical management. Methods We performed a retrospective study of patients with PCs who underwent surgical intervention at the First Affiliated Hospital of Xinjiang Medical University from February 2002 to December 2022. Results A total of 55 patients underwent surgery due to PCs during the study period. Thirty-one were females and 24 were males. The average age of the patients was 44.7 ± 12.9 (six to 63 years old). PCs were located in the right hemithorax in 50 (90.9%) patients and left hemithorax in five (9.1%) patients. Approach methods were video-assisted thoracoscopic surgery (VATS) in 43 (78.2%) cases; thoracotomy in 11 (20%) cases, and median sternotomy in one (1.8%) cases. The average postoperative hospitalization period was 5.6 days (two to 14 days). Three patients developed postoperative complications (two pleural effusion, one pneumonia), whereas no mortality was observed in any patient due to the operation. Forty-one patients (74.5%) were followed up for three months to eight years postoperatively, during which no recurrent cysts were detected. Conclusion In this single-center retrospective study, we demonstrated that pericardial cyst cure is an appropriate operation according to cyst characteristics. VATS has been shown to be highly effective and safe in patients with PCs, offering the advantage of reducing postoperative morbidity efficiently.
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  • 文章类型: Case Reports
    颈部肿块常见于儿童。鉴别诊断包括传染性,先天性和肿瘤性病变。我们报告了一例罕见的胸腺颈部肿块的男孩,在他的童年中期,有左前外侧颈部肿块的病史,与发烧无关。吞咽困难或呼吸急促。放射学评估显示有一张胸腺咽管囊肿的照片。胸腺残留和胸腺咽管囊肿是由闭塞失败引起的,在儿童中可能表现为颈外侧肿块。最有效的治疗方法是全手术切除。这种特殊情况凸显了临床医生在评估患有颈部肿块的儿科患者时,对广泛的鉴别诊断有高度怀疑的重要性。此外,我们强调始终将咽部囊肿作为鉴别诊断的重要性.
    Neck masses are frequently seen in children. The differential diagnosis includes infectious, congenital and neoplastic lesions. We report a case of rare thymic neck mass in a boy in his middle childhood presented with a history of a left anterolateral neck mass not associated with fever, dysphagia or shortness of breath. The radiographic evaluation showed a picture of a thymopharyngeal duct cyst. Thymic remnant and thymopharyngeal duct cyst are caused by the failure of obliteration and might appear as a lateral neck mass in children. The most effective treatment for a thymopharyngeal duct cyst is total surgical excision. This particular case highlights the importance for clinicians to have a high index of suspicion for a broad differential diagnosis when evaluating paediatric patients who present with neck mass. Additionally, we emphasise the importance of consistently considering thymopharyngeal cyst as differential diagnosis.
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  • 文章类型: Case Reports
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  • 文章类型: Case Reports
    该病例报告详细介绍了一种罕见的胸腺基底细胞样癌,最初被误解为纵隔畸胎瘤,强调了这种肿瘤带来的诊断挑战。一名71岁的女性在常规健康检查中偶然发现了无症状的前纵隔肿瘤。手术干预,随后进行病理和免疫组织化学分析,包括CK-pan,p63、p40和CD117分子,导致对胸腺基底细胞样癌的明确诊断。该病例强调了纵隔病变鉴别诊断的重要性,尤其是胸部CT表现为多房性胸腺囊肿的患者。剑突下电视胸腔镜手术可实现完整的肿瘤切除,创伤最小,术后预后良好。患者选择不进行进一步的放疗或化疗,她已经存活了八个月以上,没有复发。此病例报告有助于人们对胸腺基底细胞样癌的认识,一种罕见且潜在侵袭性的胸腺癌亚型。它强调了精确的外科技术和增强心胸外科医生和肿瘤学家的诊断敏锐度的必要性。
    This case report details a rare thymic basaloid carcinoma initially misinterpreted as a mediastinal teratoma, underscoring the diagnostic challenges posed by such tumors. A 71-year-old female presented with an asymptomatic anterior mediastinal tumor discovered incidentally during a routine health examination. Surgical intervention, followed by pathological and immunohistochemical analysis including CK-pan, p63, p40, and CD117 molecules, led to a definitive diagnosis of basaloid carcinoma of the thymus. This case highlights the critical importance of differential diagnosis in mediastinal lesions, especially those presenting with multilocular thymic cysts on chest CT. The subxiphoid video-assisted thoracoscopic surgery enabled complete tumor resection with minimal trauma and favorable postoperative outcomes. The patient opted against further radiotherapy or chemotherapy and she has survived for over eight months without recurrence. This case report contributes to the growing understanding of thymic basaloid carcinoma, a rare and potentially aggressive thymic carcinoma subtype. It emphasizes the necessity for precise surgical techniques and enhanced diagnostic acumen among cardiothoracic surgeons and oncologists.
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  • 文章类型: Case Reports
    背景:纵隔畸胎瘤是一种罕见的疾病,然而,它们代表了最常见的纵隔生殖细胞肿瘤。它可能会默默地生长几年,并且在并发症发生之前仍未被诊断。
    目的:本文的主要目的是说明70多年来前纵隔畸胎瘤的无症状演变,而没有出现任何明显的并发症。
    方法:我们介绍一个70岁的女性,因高血压而接受治疗,转诊至我们部门管理大量纵隔肿块,由全科医生在胸部X光检查中偶然发现。回忆与胸痛无关,咳嗽,呼吸困难也不咯血。临床检查,特别是胸膜肺,平淡无奇。检查(胸部X线和CT扫描)显示以牺牲右纵隔胸膜为代价的大量胸膜肿块,圆形,钙化壁和液体含量。血液检查没有显示嗜酸性粒细胞增多,包虫IgG血清学阴性。血清人绒毛膜促性腺激素(hCG)和甲胎蛋白(AFP)水平正常。患者随后接受了右后外侧开胸手术,切除了病变。非常仔细地解剖了肿块,然后全部切除。宏观和微观组织学检查显示成熟的囊性畸胎瘤。手术切除是一种适当的治疗方法,患者的预后良好。
    结论:囊性成熟畸胎瘤是罕见的胸部肿瘤,通常通过放射学检查来识别。这篇文章涉及畸胎瘤可能具有的沉默进化,以及它可能出现的症状的晚期。
    BACKGROUND: Mediastinal teratoma is an uncommon disease, nevertheless they represent the most common mediastinal germ cell tumors. It may grow silently for several years and remain undiagnosed until the occurrence of a complication.
    OBJECTIVE: The main aim of this article is to illustrate the silent evolution of an anterior mediastinal teratoma for over 70 years without presenting any notable complications.
    METHODS: We present the case of a 70-year-old female, treated for hypertension referred to our department for managing a voluminous mediastinal mass, discovered fortuitously by a general practitioner in a chest X-ray. The anamnesis didn\'t relate any chest pain, cough, dyspnea nor hemoptysis. The clinical examination, in particular pleuropulmonary, was unremarkable. The workup (Chest X-Ray and CT scan) demonstrated a voluminous pleural mass at the expense of the right mediastinal pleura, rounded in shape, with calcified wall and fluid content. Blood tests did not demonstrate eosinophilia, and hydatid IgG serology was negative. serum human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP) levels were found to be normal. The patient subsequently underwent a right posterolateral thoracotomy with resection of the lesion. The mass was dissected very carefully and then resected in toto. The macroscopic and microscopic histological examination demonstrated a mature cystic teratoma. Surgical resection was an adequate treatment and the prognosis was excellent for the patient.
    CONCLUSIONS: Cystic mature teratomas are rare thoracic tumors, often recognized by radiological examination. This article relates the silent evolution that a teratoma could have, and the late appearance of symptoms that it could have.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    纵隔囊肿(MC)是罕见的病变,可由各种纵隔结构的胚胎残留物引起。MC通常是狗和猫的偶然发现;然而,它们可以达到块状外观。在狗的CT上对MC的描述是有限的。这次回顾,单中心,描述性,描述性患病率研究旨在确定犬纵隔囊肿(PMC)的患病率,并评估其CT特征.包括从2019年1月至2021年8月接受胸部CT扫描的狗。由两名诊断成像实习生评估CT图像中是否存在PMCs,去年有两名诊断影像住院医师,还有一个委员会认证的兽医放射科医生.编号,location,边距,形状,volume,尺寸,质量效应,并评估了PMC的衰减值。共审查了866次CT扫描,并确定了49家PMC。犬PMC的患病率为5.66%。英国斗牛犬和混血犬在主观上被高估了;但是,不能排除人口偏倚的可能性.在雄性狗中主观上更频繁地观察到PMC。PMC主要是圆形的,小,孤立性充满液体的发现位于颅腹纵隔,有明确的边距,均匀衰减,没有对比度增强。中值衰减值为6.32HU(范围:-20.16至23.45HU)对比前和7.58HU(范围:-2.45至20.79HU)对比后,中位体积为1.19cm3(范围:0.02-45.32cm3)。尽管我们的样本人群中PMC的患病率很低,研究结果支持对具有上述影像学特征的犬优先进行偶发PMC的鉴别诊断.
    Mediastinal cysts (MCs) are rare lesions that can arise from embryonic remnants of various mediastinal structures. MCs usually are incidental findings in dogs and cats; however, they can reach a mass-like appearance. The description of MCs on CT in dogs is limited. This retrospective, single-center, descriptive, prevalence study aimed to determine the prevalence of presumed mediastinal cysts (PMCs) in dogs and assess their CT characteristics. Dogs that underwent a thoracic CT scan from January 2019 to August 2021 were included. CT images were evaluated for the presence of PMCs by two diagnostic imaging interns, two last year diagnostic imaging residents, and a board-certified veterinary radiologist. Number, location, margins, shape, volume, size, mass effect, and attenuation values of PMCs were assessed. A total of 866 CT scans were reviewed, and 49 PMCs were identified. The prevalence of PMCs in dogs was 5.66%. English Bulldog and mixed-breed dogs were subjectively overrepresented; however, the possibility of population bias could not be excluded. PMCs were subjectively more frequently observed in male dogs. The PMCs were predominantly round, small, solitary fluid-filled findings localized in the cranioventral mediastinum, with well-defined margins, homogeneous attenuation, and no contrast enhancement. The median attenuation value was 6.32 HU (range: -20.16 to 23.45 HU) precontrast and 7.58 HU (range: -2.45 to 20.79 HU) postcontrast, and the median volume was 1.19 cm3 (range: 0.02-45.32 cm3). Although the prevalence of PMCs was low in our sample population, findings supported prioritizing a differential diagnosis of incidental PMC for dogs with the above imaging characteristics.
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  • 文章类型: Journal Article
    心包囊肿(PC)或胸膜心包囊肿是罕见的先天性纵隔病变,发病率约为100000人中的1人。通常,他们是无症状的,在常规胸部成像检查或尸检检查中偶然发现。该研究包括对为期6年的PC系列临床病理结果的回顾性评估,在肺病诊所接受治疗,Iaši,罗马尼亚。一组五例PC,四女一男,进行了评估。所有患者都表现出不同的症状,如呼吸困难,胸痛,慢性咳嗽,疲劳,心悸,和上腹痛。囊性病变位于左、右心膈角,在四个案例中,在一个病例中位于中央纵隔。病变的液体含量和最大直径介于35和95毫米之间。手术切除组织的显微镜检查显示薄的结缔组织壁,没有任何相关的平滑肌细胞。疏松的结缔组织带衬有一层间皮细胞,无细胞异型,显示离散的乳头状突起,在一个案例中。尽管PC是罕见的偶然发现,在纵隔囊肿的鉴别诊断中应该考虑它们,尤其是与非特异性症状有关。此外,考虑到发生严重并发症的可能性,应彻底探索PC,以进行合适的患者管理。
    Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are asymptomatic, being incidentally discovered during a routine chest imaging examination or an autopsy exam. The study involved a retrospective evaluation of clinicopathological findings in a 6-year series of PCs, treated in the Clinic of Pulmonary Diseases, Iaşi, Romania. A group of five cases of PCs, four females and one male, were evaluated. All patients displayed different symptoms, such as dyspnea, chest pain, chronic cough, fatigue, palpitation, and epigastric pain. The cystic lesions were located in the right and left cardiophrenic angle, in four cases, and in the central mediastinum in a single case. The lesions had a fluid content and a maximum diameter that ranged between 35 and 95 mm. The microscopic examination of the surgical resection tissues revealed a thin connective tissue wall without any associated smooth muscle cells. The loose connective tissue band was lined by a layer of mesothelial cells with no cellular atypia, which displayed discrete papillary projections, in one case. Although PCs are rare incidental findings, they should be considered in differential diagnoses of mediastinal cysts, especially as they are associated with non-specific symptoms. Furthermore, considering the possibility of development of severe complications, PCs should be thoroughly explored for suitable patients\' management.
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    文章类型: Case Reports
    我们在超声心动图上报告了非常罕见的巨大心包囊肿伴左心室压迫的病例。一名61岁的男子因胸闷来我院就诊。心脏病专家排除了患者的心脏病,并将其转诊给我们,以检查和治疗胸部X射线上的异常左肺视野阴影。胸部计算机断层扫描(CT)显示与心脏和隔膜连接的16×7.5cm囊性肿块。超声心动图显示囊性肿块压迫左心室。通过电视辅助胸腔镜手术(VATS)尝试手术切除。我们抽吸了囊肿中的浆液内容物,并切除了除心脏侧以外的部分囊肿壁。在确认囊肿不是心包憩室后,我们完全切除了它的残墙.他的术后过程并不复杂。经病理诊断为心包囊肿。
    We report a very rare case of giant pericardial cyst with left ventricular compression on echocardiography. A 61-year-old man visited our hospital with a feeling of chest tightness. A cardiologist ruled out cardiac diseases of the patients and he was referred to us for examination and treatment of an abnormal left lung field shadow on chest x-ray. Chest computed tomography (CT) showed a 16×7.5 cm cystic mass in connect with the heart and diaphragm. Echocardiography showed that the cystic mass was compressing the left ventricle. Surgical resection was attempted by video-assisted thoracoscopic surgery (VATS). We aspirated serous liquid contents in the cyst and partially resected the cyst wall excepting cardiac side. After confirming the cyst was not a pericardial diverticulum, we completely resected its residual wall. His postoperative course was uncomplicated. The cyst was pathologically diagnosed as a pericardial cyst.
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  • 文章类型: Case Reports
    多房胸腺囊肿(MTC)是由炎症引起的获得性多房囊肿。这种病变的稀有性和缺乏认识使得诊断和治疗困难。在这里,我们介绍了多房性纵隔囊肿的经验,该囊肿在13年的时间内导致了胸腺癌的发展并转移。计算机断层扫描结果显示,一名49岁男性的前纵隔肿块被怀疑是MTC。质量在7年的时间内逐渐缩小;然而,在最初检测后10年观察到生长。在被发现13年后,诊断为胸腺癌伴多发肺转移。在随访期间建议切除,但病人拒绝治疗.多房壁和位置是指示MTC的因素。然而,即使没有做出明确的诊断,由于确定术前诊断困难,应考虑切除多房前纵隔囊肿。然而,我们的病例表明肿瘤与囊肿共存是可能的,并且存在恶性肿瘤发展的潜力。
    Multilocular thymic cysts (MTC) are acquired multilocular cysts caused by inflammation. The rarity of such lesions and a lack of recognition make diagnosis and treatment difficult. Herein, we present our experience with a multilocular mediastinal cyst that resulted in the development of thymic cancer with metastasis over a period of 13 years. Computed tomography findings revealed an anterior mediastinal mass that was suspected to be an MTC in a 49-year-old man. The mass shrank gradually over a period of 7 years; however, growth was observed at 10 years after initial detection. At 13 years after detection, thymic carcinoma with multiple lung metastases was diagnosed. Resection was recommended during the follow-up period, but the patient refused treatment. A multilocular wall and location are factors that indicate MTC. However, even if a definitive diagnosis is not made, resection of multilocular anterior mediastinal cysts should be considered as determining the preoperative diagnosis is difficult. Nevertheless, our case suggests that the coexistence of tumors with cysts is possible, and the potential for malignant tumor development exists.
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