• Korean Journal of Radiology
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• 제20권5호
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• pp.854-861
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• 2019

Objective: To evaluate quantitative magnetic resonance imaging (MRI) parameters for differentiation of cysts from and solid masses in the anterior mediastinum. Materials and Methods: The development dataset included 18 patients from two institutions with pathologically-proven cysts (n = 6) and solid masses (n = 12) in the anterior mediastinum. We measured the maximum diameter, normalized T1 and T2 signal intensity (nT1 and nT2), normalized apparent diffusion coefficient (nADC), and relative enhancement ratio (RER) of each lesion. RERs were obtained by non-rigid registration and subtraction of precontrast and postcontrast T1-weighted images. Differentiation criteria between cysts and solid masses were identified based on receiver operating characteristics analysis. For validation, two separate datasets were utilized: 15 patients with 8 cysts and 7 solid masses from another institution (validation dataset 1); and 11 patients with clinically diagnosed cysts stable for more than two years (validation dataset 2). Sensitivity and specificity were calculated from the validation datasets. Results: nT2, nADC, and RER significantly differed between cysts and solid masses (p = 0.032, 0.013, and < 0.001, respectively). The following criteria differentiated cysts from solid masses: RER < 26.1%; nADC > 0.63; nT2 > 0.39. In validation dataset 1, the sensitivity of the RER, nADC, and nT2 criteria was 87.5%, 100%, and 75.0%, and the specificity was 100%, 40.0%, and 57.4%, respectively. In validation dataset 2, the sensitivity of the RER, nADC, and nT2 criteria was 90.9%, 90.9%, and 72.7%, respectively. Conclusion: Quantitative MRI criteria using nT2, nADC, and particularly RER can assist differentiation of cysts from solid masses in the anterior mediastinum.

• 대한핵의학회지
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• 제36권1호
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• pp.87-89
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• 2002

A 30 year-old female patient with papillary thyroid carcinoma received her fifth radioiodine ablation therapy after the subtotal thyroidectomy. The scan, which was peformed one week after the last therapy, revealed residual uptake in the thyroid bed and uptake in the anterior mediastinum suggesting metastasis. However, further evaluation of the thorax with chest CT and camera-based FDG PET confirmed normal thymus without metastatic focus. Occasionally thymus remains intact in adult and has avidity for I-131 and FDG. Therefore, normal thymus (instead of metastasis) should be considered in patients with well differentiated thyroid carcinoma and anterior mediastinal radioiodine uptake.

• Journal of Chest Surgery
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• 제18권4호
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• pp.849-854
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• 1985

We have experienced 50 cases of mediastinal tumors and cysts from March, 1979 to August, 1985 at Kyung Hee University Hospital. The results of this cases analysis were as followings; 1. Of all 50 mediastinal tumors and cysts, 26 patients were male and 24 patients were female. There was no sex preference. The age distribution was from 27 months to 64 years, and mean age was 33.5 years old, and also no age preference. 2. The most common mediastinal tumor was benign cysts [12 cases], which comprise 24% of all mediastinal tumors and cysts. The second common mediastinal tumor was teratoma [9 cases-18%], and followed by thymic tumors and tuberculous granuloma [7 cases-14% each], neurogenic tumors [5 cases-10%], and other tumors [10 cases-20%]. 3. The anterior mediastinum was most common tumor location, and followed by middle, superior, and posterior. 4. All 9 teratomas were developed at anterior mediastinum, and 4 of 5 neurogenic tumors were developed at posterior mediastinum. Thymomas were developed at anterior and superior mediastinum. The bronchogenic cysts had no predilection of location. 5. The most common chief complaint at admission was chest pain or discomfort [23 cases-46%], and followed by cough with or without sputum, and exertional dyspnea. Asymptomatic patients were only 7 patients [24%]. 6. Of all 50 cases, 38 cases [76%] received radical tumor resection, 7 mediastinoscopic biopsy, 3 explo thoracotomy and biopsy, and 1 neck mass biopsy. 7. There were 2 hospital deaths, one of which was a patient who suffered malignant thymoma and Myasthenia Gravis. The patient received radical tumor excision, but died at 7th POD. The other patient was a patient with malignant transformation of the benign cystic teratoma. The operative mortality was 4%.

• Journal of Chest Surgery
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• 제23권2호
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• pp.299-308
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• 1990

A review of 50 patients with primary mediastinal tumors or cysts has been done to evaluate clinical and pathological behavior of this heterogeneous group of tumors proved by either excision or biopsy from January 1980 to August 1989 at the cardiovascular department of surgery in Kyungpook National University Hospital. There were 30 males and 20 females in this series. The ages of patients ranged from 4 months to 64 years. The mean age of subjects was 30.4 years. Neurogenic tumors [14 cases, 28%] and teratoma [14 cases, 28%] were most frequently encountered and followed by thymoma [10 cases, 20%] and benign cysts [4 cases, 8%]. The anatomic location of the primary mediastinal tumors or cysts was classified as anterior mediastinum and middle or visceral mediastinum and paravertebral or costovertebral mediastinum on the basis of the Shields’ proposition. In 32 patients[64%], the tumors or cysts were located in anterior mediastinum and in 13 patients[26%], the tumors or cysts were located in paravertebral or costovertebral mediastinum. And the rest 5 patients[10%] had middle or visceral mediastinal tumors or cysts. One of the characteristic features of primary mediastinal tumors or cysts is that some mediastinal tumors or cysts have their own preferred location in the mediastinum. In our series, all of the 14 patients with teratoma and 10 patients with thymoma had the anterior mediastinal location, while 13 of the 14 patients with neurogenic tumors had the paravertebral mediastinal location. 14 patients[28%] were asymptomatic and they all were discovered via so-called “Routine” chest x-ray examination. 39 of 50 patients[78%] were benign. 11 patients[22%] were malignant and they were all symptomatic. 40 patients[80%] were treated with complete resection. 5 patients[10%] were treated with partial resection : 2 of malignant thymoma, 3 of lipoma, neuroblastoma, primary squamous cell carcinoma. The rest 5 patients[10%] were only biopsied: 2 of undetermined malignancy and 3 of hemangioma, lymphoma, primary squamous cell carcinoma. 4 of the 10 patients were treated with combination of irradiation and chemotherapy. Postoperative complications were as followings: Horner’s syndrome [4cases, ado], respiratory failure [3 cases, 6%], pleural effusion[3 cases, 6%], Wound infection[2 cases, 4%] and bleeding, pneumothorax, empyema. There were 5 postoperative deaths [10%]. One patient with neuroblastoma died from intraoperative massive bleeding, 3 patients died early postoperatively from respiratory failure with undetermined malignancy died late postoperatively from congestive heart failure due to direct invasion of the tumor to the heart.

• Journal of Chest Surgery
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• 제25권5호
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• pp.555-561
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• 1992

Endodermal sinus tumor[EST] of the mediastinum is a rare germ cell neoplasm. It usually arises from the ovaries and testes but also arises from multiple extragonadal site including the mediastinum. Characteristically, alpha feto protein level is high and used for monitoring the clinical course. EST of the mediastinum is poor prognosis because of its direct invasion. The patient was 18 month old female with chief complaints of cough and fever. In the chest X-ray and CT, large encapsulated, 7x6cm sized, mass of anterior med-iastinum was found, and we could excise it completely because it was well encapsulated and not invaded but only adhered to aortic arch, pericardium and left upper lung. And confirmed it as EST by histopathology. Pre-operative alpha feto protein[AFP] level as 41,748ng/ml and decreased to 2, 663ng /ml at 14th postoperative day, 644ng /ml at 31th postoperative day. From 17th post-operative day, chemotherapy was started and keep going now.

• Journal of Chest Surgery
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• 제39권9호
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• pp.729-732
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• 2006

외상에 의하여 심장눌림증을 유발한 종격동 양성낭기형종 종격동 기형종은 전체 종격동 종양의 $8\sim13%$ 빈도로 발생하며, 대부분 우연히 발견되지만 드물게 심낭 천공이 발생하여 심장눌림증을 유발하거나, 흉막삼출액을 고이게 한다. 본 증례에서는 전흉벽 타박상을 받은 여자 환자에게서 심장눌림증이 발생하였고, 응급 방사선검사에서 종격전부 종양이 확인되었으며 심장막천자술을 받은 후 활력징후가 회복되어 추후 수술적 절제술로 종양을 적출하였다. 조직검사에서 피지선, 성숙 지방종, 위장관점막, 호흡기도 점막 및 췌장의 조직 등으로 구성된 낭포성 구조물로 관찰되어 양성 낭기형종으로 판정되었다.

• Journal of Chest Surgery
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• 제39권10호
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• pp.802-804
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• 2006

악성 섬유 조직구종은 사지나 후복막의 연부조직에 주로 발생하는 종양으로 종격동에 발생하는 경우는 극히 드물다. 환자는 71세 남자 환자로 전종격동에 발생한 원발성 종양에 대해 종양 제거술을 시행하였고 조직학적으로 악성 섬유 조직구종으로 진단되었다.

• Journal of Chest Surgery
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• 제25권7호
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• pp.719-722
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• 1992

Two cases of benign mediastinal tumor were treated by complete resection under the video-thoracoscopic guidance. The procedure has been performed on the 2 patients, allowing definite treatment and was less invasive than standard surgical treatment. The 2 patients have been benefited by decreased postoperative pain, reduced scarring of the skin and rapid recovery. Two patients had benign mediastinal tumors; teratodermoid on anterior mediastinum and neurilemmoma on posterior mediastinum. There were no operative death and complication, median hospital stay was four days.

• Journal of Chest Surgery
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• 제17권3호
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• pp.470-474
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• 1984

33-year old female was admitted chest surgery department for evaluation of mild chest pain. Chest plain film showed right anterior mediastinal mass and small metastatic daughter mass ipsilateral side. Exploratory thoracotomy was performed 24th Aug. 83 revealed that small nodular parenchymal mass at right middle lobe and large cystic mass at anterior mediastinum which was connected with anterior mediastinal fat. Histological examination confirmed diagnosis as pulmonary hamartoma and thymic cyst individually. We successfully treated these two masses by wedge resection and excision. Although postoperative course was uneventful, the cause and associated relationship between two tumor origin were obscure.

• Journal of Chest Surgery
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• 제11권2호
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• pp.170-174
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• 1978

A case of mediastinal seminoma is presented. A male driver, 27 years old Korean, has been suffered from substernal pain, cough and moderate swallowing difficulty since 5 months prior to this admission. At the time of onset, he visited at a local clinic to find some mass in his anterior mediastinum on chest P-A and lateral X-ray check. Recently, intermittent hiccups with much aggravated dysphagia forced him to visit our hospital, and admitted for radical resection under the impression of anterior superior mediastinal tumor of thymus origin. Median sternotomy was done and total resection of the tumor of 8.0X11.0X3.5cm was done without any specific complication and biopsy of the tumor revealed as primary mediastinal seminoma of the mediastinum. Supplementary prophylactic irradiation therapy was done with a tumor dose of 4,000 rad in 4 weeks after operation. Postoperative hospital course was uneventful and patient was joyful with his occupation for 3 months after discharge.