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Germ-Cell Cancer of the Testis and Related Neoplasms
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Primary mediastinal germ-cell tumors are rare. Mediastinal seminomas do not confer a worse prognosis; however, these make up the minority of mediastinal primaries. Clinically, mediastinal NSGCT behave differently compared with other primary sites; they are often less chemosensitive and associated with poorer prognosis. Mediastinal tumors of seminomatous histology have a long-term chance of cure of approximately 90%, whereas only 45% of patients with mediastinal non-seminomas are alive at 5 years.136 As a non-seminoma mediastinal primary is a poor prognostic feature it should be treated urgently with chemotherapy in the first instance. Following chemotherapy cardiothoracic surgery is often required to remove the residual masses. Viable tumor cells in the mediastinal specimen post-chemotherapy are often predictive for poor outcomes with a hazard ratio of 15 compared to necrosis alone.137
System Imaging in Unexplained Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Mediastinal tumors and infective processes, as well as small parenchymal, peripheral lung or pleural lesions are often not visible on a chest radiograph, but displayed by CT, thus revealing the source of unexplained fever.
The thorax
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Thymoma. This is the most common mediastinal tumour, accounting for 25% of the total, and is derived from the thymus gland (Figure55.25). Thymomas vary in behaviour from benign to aggressively invasive, as reflected in the Masoaka classification system used to stage thymomas (Table55.11). They are often related to mysthenia gravis (MG), a neuromusclar condition which can have a high associated incidence of thymomas, and interestingly may respond to excision of the thymus gland even when the gland has no associated thymoma present. The only reliable indicator of malignancy is capsular invasion. Diagnosis and treatment are best achieved by complete thymectomy, which is usually performed as a median sternotomy. However, if the thymoma is small or when the patient has MG and the thymus is being excised as a treatment, a transcervical approach with or without an additional VATS procedure can be performed.
Molecular imaging in management of colorectal metastases by the interventional oncologist
Published in International Journal of Hyperthermia, 2022
Stephen Hunt, Alireza Zandifar, Abass Alavi
Image registration and fusion has been demonstrated by numerous authors over the past two decades to improve diagnostic yield of biopsy, particularly for lesions which have previously had non-diagnostic sampling or those having a heterogenous treatment response. Tatli and colleagues used fusion of preprocedural PET-CT during biopsy of CT-occult or FDG-heterogenous abdominal masses successfully in 13 out of 14 patients with exception of one patient in whom image registration was unsuccessful due to severe scoliosis [23]. Venkatesan and colleagues combined fusion of preprocedural PET-CT with intraprocedural ultrasound and electromagnetic guidance to successfully biopsy 31 of 36 malignant lesions which were occult on conventional imaging [25]. However, not all tumor types and locations are likely to benefit from the added metabolic information, for example those locations already having high diagnostic accuracy. Yokoyama and colleagues compared the diagnostic accuracy of CT-guided biopsy of mediastinal tumors with and without fusion of pre-procedural PET-CT in 106 patient, and found that diagnostic accuracy was not statistically affected (93% vs 96%, respectively) [26]. In addition, misregistration due to changes in tumor size or morphology in the interval prior to biopsy or intervention or to differences in patient position and motion artifacts can limit the utility of pre-procedural image fusion during biopsy and ablation [27,28].
T-cell lymphoblastic lymphoma involving the ocular adnexa: report of two cases and review of the current literature
Published in Orbit, 2019
Lucy Sun, Alan H. Friedman, Rand Rodgers, Matthew Schear, Giovanni Greaves, Kathryn B. Freidl
The mediastinum is a common site of initial disease involvement and relapse. Given that the majority of patients present with large mediastinal masses, a frequent obstacle to complete remission is residual mediastinal tumors after induction therapy. The routine use of MRT has not been well supported. 5 Some suggest a value in consolidative MRT to treat residual mediastinal disease in adults after induction therapy; however, there is no well-conducted research. 22 MRT in children did not demonstrate a benefit in long-term outcome but rather showed an increase risk of long-term sequelae such as the development of cardiac diseases, radiation pneumonia, and secondary malignancies. 26,27 Therefore, MRT has been eliminated in the pediatric treatment protocols.
Clinical characteristics, risk factors, and outcomes after adjuvant radiotherapy for patients with thymoma in the United States: analysis of the Surveillance, Epidemiology, and End Results (SEER) Registry (1988–2013)
Published in International Journal of Radiation Biology, 2018
Haibo Mou, Qin Liao, Xuehua Hou, Te Chen, Yuping Zhu
Thymoma is a rare cancer that is characterized by epidemiological and prognostic diversity. Although thymoma is the most common type of mediastinal tumor, its comparative incidence is low, from 1.3 to 1.7 cases per million people (Engels and Pfeiffer 2003; Engels 2010; Siesling et al. 2012). The prognosis of thymoma varies greatly depending on disease stage, with 5-year survival ranging from 30% to 100% (Kondo and Monden 2003; Venuta et al. 2010; Guerrera et al. 2015; Scorsetti et al. 2016). This variability in outcomes results in part from a substantial heterogeneity in tumor invasiveness and malignancy. Thymomas are usually diagnosed in middle-aged patients who may be asymptomatic or have symptoms that are localized (chest pain, shortness of breath) or systemic (fever, weight loss) (Travis 2004). Some patients may also present with complications of a paraneoplastic syndrome, a hallmark comorbidity of thymoma and other thymic epithelial tumors (TETs) that results from cross-recognition by anti-tumor antibodies (Toothaker 2009). The most common of these syndromes among patients with a thymic malignancy is myasthenia gravis (MG), with a reported incidence of 20–50% of patients (Guerrera et al. 2015; Weis et al. 2015; Wang et al. 2016). A second clinicopathological feature of thymoma is an increased risk of a second primary malignancy (Engels 2010; Weksler, Nason, et al. 2012; Filosso et al. 2013). Both of these conditions have an impact on the treatment and prognosis of thymoma. Recurrence is a significant problem, not only because of incomplete resection but also due to metastasis to the lymph nodes or other areas (Venuta et al. 2010; van Geffen et al. 2011; Weksler et al. 2015).