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Unusual lesions of the mediastinum.

Shamsuddin F, Khadilkar UN, Saha D - Lung India (2015 Nov-Dec)

Bottom Line: Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location.A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Malabar Medical College and Research Center, Kozhikode, Kerala, India.

ABSTRACT

Objectives: To study unusual lesions in the mediastinum, which do not originate from the thymus, lymph nodes, neural tissues or germ cells, and tissues that normally engender pathologic lesions in the mediastinum.

Materials and methods: Of the 65 cases seen, 12 unusual lesion were encountered in a 5½ year period from 2006 to 2011.

Results: Two cases of nodular colloid goiter and one each of the mediastinal cyst, undifferentiated carcinoma, and Langerhans cell histiocytosis (LCH) affected the anterosuperior mediastinum. In the middle mediastinum, one case each of the mesothelioma, malignant gastrointestinal stromal tumor (GIST), squamous cell carcinoma (SCC), solitary fibrous tumor (SFT), and pleomorphic sarcoma (PS) was seen. One case of meningeal melanocytoma (Mme) and primary pleural liposarcoma (PL) involved the posterior mediastinum. Persistent disease was seen in LCH after 2 years. Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.

Conclusion: The cases of primary and SCC, LCH, melanocytoma, liposarcoma and PS, and GIST are unexpected and very rarely have paradigms in the mediastinum. Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location. A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan - large heterogenous mass lesion in anterosuperior mediastinum contiguous with small nodule in the inferior left lobe of thyroid
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Figure 2: Computed tomography scan - large heterogenous mass lesion in anterosuperior mediastinum contiguous with small nodule in the inferior left lobe of thyroid

Mentions: LCH was presumptively diagnosed in an 18-month-old child on CT-guided fine-needle aspiration (FNA) [Figure 2] of the mediastinal mass followed by confirmation with Trucut biopsy and IHC for S100 protein. Biopsy of the liver demonstrated concentric periductal fibrosis resembling primary sclerosing cholangitis but Langerhans cells were inconspicuous. Biopsy from a few skin lesions revealed unequivocal histology of LCH. The bone marrow examination did not disclose any evidence of involvement. At 2 years of follow-up, the child had received three cycles of chemotherapy but there was persistent hepatosplenomegaly.


Unusual lesions of the mediastinum.

Shamsuddin F, Khadilkar UN, Saha D - Lung India (2015 Nov-Dec)

Computed tomography scan - large heterogenous mass lesion in anterosuperior mediastinum contiguous with small nodule in the inferior left lobe of thyroid
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663858&req=5

Figure 2: Computed tomography scan - large heterogenous mass lesion in anterosuperior mediastinum contiguous with small nodule in the inferior left lobe of thyroid
Mentions: LCH was presumptively diagnosed in an 18-month-old child on CT-guided fine-needle aspiration (FNA) [Figure 2] of the mediastinal mass followed by confirmation with Trucut biopsy and IHC for S100 protein. Biopsy of the liver demonstrated concentric periductal fibrosis resembling primary sclerosing cholangitis but Langerhans cells were inconspicuous. Biopsy from a few skin lesions revealed unequivocal histology of LCH. The bone marrow examination did not disclose any evidence of involvement. At 2 years of follow-up, the child had received three cycles of chemotherapy but there was persistent hepatosplenomegaly.

Bottom Line: Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location.A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Malabar Medical College and Research Center, Kozhikode, Kerala, India.

ABSTRACT

Objectives: To study unusual lesions in the mediastinum, which do not originate from the thymus, lymph nodes, neural tissues or germ cells, and tissues that normally engender pathologic lesions in the mediastinum.

Materials and methods: Of the 65 cases seen, 12 unusual lesion were encountered in a 5½ year period from 2006 to 2011.

Results: Two cases of nodular colloid goiter and one each of the mediastinal cyst, undifferentiated carcinoma, and Langerhans cell histiocytosis (LCH) affected the anterosuperior mediastinum. In the middle mediastinum, one case each of the mesothelioma, malignant gastrointestinal stromal tumor (GIST), squamous cell carcinoma (SCC), solitary fibrous tumor (SFT), and pleomorphic sarcoma (PS) was seen. One case of meningeal melanocytoma (Mme) and primary pleural liposarcoma (PL) involved the posterior mediastinum. Persistent disease was seen in LCH after 2 years. Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.

Conclusion: The cases of primary and SCC, LCH, melanocytoma, liposarcoma and PS, and GIST are unexpected and very rarely have paradigms in the mediastinum. Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location. A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.

No MeSH data available.


Related in: MedlinePlus