Mediastinum (Hong Kong, China)最新文献

{"title":"AB008. Activated pathways of Thymic Epithelial Tumors: a RYTHMIC study","authors":"J. Benítez, B. Job, V. Thomas de Montpréville, Juan-David Florez-Arango, L. Lacroix, P. Saulnier, R. Arana, O. Lambotte, S. Mussot, O. Mercier, E. Fadel, J. Scoazec, T. Molina, N. Girard, B. Besse","doi":"10.21037/med-22-ab008","DOIUrl":"https://doi.org/10.21037/med-22-ab008","url":null,"abstract":"Background Thymic epithelial tumors (TETs) are rare malignancies of the anterior mediastinum with a high histopathological diversity from thymoma A to thymic carcinoma (TC). The biology of TETs is poorly understood and knowledge of the transcriptomic fingerprint of thymoma and TC is limited. Up to 30% of patients will develop associated autoimmune disorders, mainly myasthenia gravis (MG). We aimed to characterize main cancer activation pathways of TET subgroups. Methods We selected a representative balanced set of thymoma and TCs to analyze 24 main cancer activation pathways using gene expression throughout Oncology biomarker panel (2,562 genes). Tumor representative paraffin-embedded blocks were macrodissected. Then, we merged data with The Cancer Genome Atlas (TCGA) data (profiles with >30% tumor cellularity kept). We correlated epidemiologic, clinical and pathological characteristics of patients with genes expression based on cancer Hallmarks and immunedeconv (v2.0.4). Results Three hundred and fourteen patients were included, including 120 from TCGA. Median-age at diagnosis was 52 (10–84). Fifty two percent were women. Eighty four out of 314 (26.7%) reported MG, mostly in thymoma B2 (11,4%) and B3 (8%) but none for TC. AB was the most frequent thymoma subtype (n=70, 22.3%), followed by B2, B1, B3, A and TC. RNA expression analysis identified 3 main molecular subgroups or clusters, distribution of histological subtypes among them was diverse (P<0.0001). Cluster 1 was represented meanly by thymic carcinoma, cluster 2 was associated to thymoma type B and Cluster 3 to thymoma type A and AB. Activated pathways of histological subtypes were as follows: thymoma A showed activation of angiogenesis, Hedgehog and Notch hallmarks, as for thymoma AB; thymoma B1 and B2 showed cell cycle checkpoint factors activated pathway; thymoma B3 protein secretion pathway and; TC Epithelial to mesenchymal transition (EMT), MTOR1 and MYC pathways. Then, we analyzed activated pathways of the 3 molecular subgroups: cluster 1, with the worst prognostic, was associated to inflammatory signaling, MTOR1, KRAS and EMT pathways; cluster 2, with the best prognostic, showed activated cell control transcription factors hallmark and; cluster 3, showed cell differentiation activated pathway. We found a difference in the presence of B and T-cells among clusters and thymoma subtypes. Cluster 1, thymoma A and TC showed higher representation of B-cells (P<0.0001, respectively) and regulation T-cells (Treg) (P<0.0001, respectively); in contrast, cluster 2 and thymomas AB and B a higher proportion of CD8+ T-cells (P<0.0001, respectively). Interestingly, non-regulatory CD4+ T-cells did not show significantly results in any subset. Of note, Macrophages M1 were presented in cluster 1 and M2 in cluster 3 (P<0.0001, respectively). Median follow-up was 35 months [95% confidence interval (CI): 27.03–42.96 months]. Median-OS was 350 months (NR- NR). Cluster 1 showed a poorer prognostic (median-","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45196983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-iatrogenic esophageal trauma: a narrative review.","authors":"Dean P Schraufnagel,&nbsp;Mujtaba Mubashir,&nbsp;Daniel P Raymond","doi":"10.21037/med-21-41","DOIUrl":"https://doi.org/10.21037/med-21-41","url":null,"abstract":"<p><strong>Background and objective: </strong>Non-iatrogenic esophageal trauma is a rare entity that has a high morbidity and mortality. The diagnosis can often be quite challenging, however is critical to perform in a timely manner. The workup and management of non-iatrogenic trauma continues to evolve, with new innovative approaches available for both diagnosis and treatment. The aim of this narrative review is to comprehensively describe the incidence, presentation, workup, treatment approaches and outcomes of non-iatrogenic esophageal trauma.</p><p><strong>Methods: </strong>A thorough literature review was performed using full length articles available in English via PubMed between January 1, 1960 to September 30, 2021, focusing on the epidemiology, workup and treatment of non-iatrogenic esophageal trauma, including current surgical techniques.</p><p><strong>Key content and findings: </strong>Injuries to the cervical esophagus are more common than injuries to the thoracic esophagus, occurring more in young males, with significant racial disparity. Penetrating trauma via gunshot wounds are the most common forms of injury, followed by stab wounds and blunt trauma. Workup is multimodal and involves a combination of plain radiographs, computed tomography (CT) scans, endoscopy and fluoroscopy depending of the stability of the patient and associated injuries.</p><p><strong>Conclusions: </strong>Workup and management of non-iatrogenic esophageal trauma depends on the location and extent of esophageal injury, and can include observation, debridement and drainage, esophageal diversion, endoscopic approaches or esophagectomy, with indications, techniques and outcomes described in further detail in this review.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8c/ec/med-06-23.PMC9385875.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between thymic output and disease severity in critically ill COVID-19 patients: extended abstract.","authors":"Amira Marouf,&nbsp;Pelagia Cuvelier,&nbsp;Hélène Roux,&nbsp;Anne Couëdel-Courteille,&nbsp;Jacques Dutrieux,&nbsp;Cécile Naudin,&nbsp;Bénédicte Charmeteau de Muylder,&nbsp;Rémi Cheynier,&nbsp;Pierre Squara,&nbsp;Stefano Marullo","doi":"10.21037/med-22-5","DOIUrl":"https://doi.org/10.21037/med-22-5","url":null,"abstract":"","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/c2/med-06-30.PMC9385869.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic injuries to the trachea and bronchi: a narrative review.","authors":"Ioana Antonescu,&nbsp;Vishnu R Mani,&nbsp;Suresh Agarwal","doi":"10.21037/med-21-21","DOIUrl":"https://doi.org/10.21037/med-21-21","url":null,"abstract":"<p><strong>Objective: </strong>In this narrative review, we aim to provide a definition of traumatic tracheo-bronchial injuries as well as an approach to their diagnosis and management, including operative and non-operative strategies.</p><p><strong>Background: </strong>Traumatic tracheo-bronchial injuries are relatively uncommon, but are associated with a high mortality, both at the scene and among patients who survive to hospital. Management often requires an emergency airway, usually intubation over a flexible bronchoscope, followed by definitive repair.</p><p><strong>Methods: </strong>The published literature on the diagnosis and management of traumatic airway injuries was searched through PubMed. Additional references were identified from the bibliography of relevant publications identified. The evidence was then summarized in a narrative fashion, incorporating the authors' knowledge, experience, and perspective on the topic.</p><p><strong>Conclusions: </strong>Definitive diagnosis of traumatic tracheo-bronchial injuries usually involves direct visualization through liberal use of bronchoscopy in addition to cross-sectional imaging to evaluate for associated injuries, notably to the great vessels and esophagus. Important considerations for management include concerns for airway obstruction, uncontrolled air leak, and mediastinitis. Early repair of injuries recognized acutely is favored in attempts to prevent the development of airway stenosis. Key operative principles include exposure, conservative debridement to preserve length when possible, creation of a tension-free anastomosis, preservation of the blood supply, and creation of a tracheostomy, particularly in polytrauma patients. An interposition muscle flap is also required, specifically in the setting of combined esophageal and airway injuries. Patients with penetrating injuries tend to have more favorable outcomes, possibly on account of fewer concomitant injuries. Selective non-operative management is also an option in the subset of patients with iatrogenic injuries to the posterior membranous wall of the trachea, and includes broad-spectrum antibiotics and surveillance bronchoscopy.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/19/med-06-22.PMC9385878.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of venous reconstruction options for the mediastinum.","authors":"Kostantinos P Poulikidis,&nbsp;Jon O Wee","doi":"10.21037/med-20-70","DOIUrl":"https://doi.org/10.21037/med-20-70","url":null,"abstract":"<p><p>Major vessels of the mediastinum such as the superior vena cava (SVC) and bilateral innominate veins can occasionally become involved with aggressive tumors or the mediastinum, including non-small cell lung cancer and thymoma. This may result in partial or complete obstruction. With presentation of these tumors symptoms can often be debilitating and would otherwise be treated with palliative therapy. A select population of patients are candidates for tumor resection. The ability to perform an adequate resection will depend on the ability to create a durable reconstruction of the SVC and bilateral innominate veins. Pre-operative and intra-operative considerations will allow for a safe surgery with few complications to the patient. Furthermore, depending on the extent of resection, there are a variety of techniques for reconstruction. These can range from a primary repair of a partial venous wall resection to a complex replacement of both the SVC and one or both innominate veins. Multiple options exist for the use of these conduits, such as polytetrafluoroethylene, homograft, autologous vein, and bovine or porcine pericardium. Depending on the type of conduit used, the post-operative outcomes will differ. In order to perform this operation safely, proper knowledge and experience is required. We review a variety of strategies used to manage these rare but complex scenarios.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f3/b0/med-06-21.PMC9385873.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinguishing between thymic carcinoma and lung carcinoma: a medical oncologist's perspective.","authors":"Arun Rajan,&nbsp;Cristina Mullenix,&nbsp;Meredith J McAdams","doi":"10.21037/med-22-1","DOIUrl":"https://doi.org/10.21037/med-22-1","url":null,"abstract":"","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/d8/med-06-29.PMC9385871.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant mediastinal teratoma in a young infant: a case report.","authors":"Raelina S Howell,&nbsp;Margret S Magid,&nbsp;Keith A Kuenzler,&nbsp;T K Susheel Kumar","doi":"10.21037/med-21-45","DOIUrl":"https://doi.org/10.21037/med-21-45","url":null,"abstract":"<p><strong>Background: </strong>Giant mediastinal tumors in the pediatric population can pose unique challenges for resection such as cardiovascular collapse on induction of anesthesia and injury to surrounding structures that may be compressed, displaced, or invaded by the mass. Principles that must be borne in mind during removal of giant mediastinal masses include: appropriate cross-sectional imaging to define extent of mass; airway control during induction of anesthesia; a multidisciplinary collaborative approach including cardiothoracic surgery; preparation for urgent sternotomy; plan for peripheral cannulation to institute cardiopulmonary bypass if needed; preservation of neurovasculature structures during dissection; complete resection whenever possible. While complete resection is desirable and results in an excellent prognosis, it may not be achievable especially if the tumor encases coronary arteries, and it is acceptable to leave small amounts of tumor behind.</p><p><strong>Case description: </strong>Here we present a case describing surgical management of a giant mediastinal teratoma in a two-month-old female. The patient was found to have a large mediastinal mass during workup for cough and noisy breathing. She underwent preoperative echocardiogram demonstrating normal cardiac function followed by uncomplicated, open resection of the mass.</p><p><strong>Conclusions: </strong>Giant mediastinal tumors give rise to unique challenges for resection in small infants. The principles of airway control, preparation for urgent sternotomy, preparation for peripheral cardiopulmonary bypass cannulation, and preservation of neurovasculature during dissection must be borne in mind.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/9c/med-06-25.PMC9385876.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on the TNM 8th Edition-staging of thymic epithelial tumors, a pathologist's perspective.","authors":"Thierry Jo Molina","doi":"10.21037/med-21-63","DOIUrl":"https://doi.org/10.21037/med-21-63","url":null,"abstract":"","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/21/med-06-28.PMC9385870.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ITMIG 2021 Tumor Board: a case of a 37-year-old man with TNM stage IVA thymoma.","authors":"Marcin Zielinski,&nbsp;Anja C Roden,&nbsp;Mylene T Truong,&nbsp;Dirk Van Raemdonck,&nbsp;Ritsuko Komaki,&nbsp;Heather Wakelee,&nbsp;Malgorzata Szolkowska","doi":"10.21037/med-22-3","DOIUrl":"https://doi.org/10.21037/med-22-3","url":null,"abstract":"","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f3/c1/med-06-26.PMC9385874.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation strategy and techniques for metastatic pleural disease from thymic malignancies: extended abstract.","authors":"Annemarie F Shepherd,&nbsp;Andreas Rimner","doi":"10.21037/med-21-61","DOIUrl":"https://doi.org/10.21037/med-21-61","url":null,"abstract":"","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":" ","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2022-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f2/72/med-06-27.PMC9385872.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40376844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}