In very rare instances, it has been described in extragenital locations such as adrenal gland, pleura, small intestine, and anterior mediastinum. The tumor cells expressed cytokeratin, calretinin, ...and nuclear WT1 by immunohistochemistry, but were negative for PAX8, TTF1, p53, chromogranin, CD31, and CD34, confirming the morphologic impression of adenomatoid tumor. 3 years post-resection, the patient has been in good health without tumor recurrence.
ZusammenfassungHintergrundLaterale Clavicula-Frakturen können abhängig von der Klassifikation sowohl konservativ oder operativ behandelt werden. Für die operative Versorgung sind verschiedene ...Operationstechniken beschrieben. Die Wahl einer Operationstechnik ist für das funktionelle Outcome und für einen komplikationsarmen Heilungsverlauf ausschlaggebend.FallbeschreibungVorgestellt wird der Fall einer Patientin mit einer sekundären Dislokation zweier K‑Drähte nach K‑Draht-Osteosynthese. Im Rahmen einer sekundären Dislokation kam es zu einem Wandern des Drahtes in das Mediastinum und das Lungengewebe direkt unter den Aortenbogen. Zur Verhinderung weiterer Verletzungen konnte das chirurgische Fremdmaterial über eine uniportale videoassistierte Thorakoskopie geborgen werden.ZusammenfassungBei der Versorgung von lateralen Clavicula-Frakturen sollte auf eine instabile K‑Draht-Osteosynthese unbedingt verzichtet werden. Bei Vorliegen von sicheren Operationsverfahren (Plattenosteosynthese, Hybridversorgungen) sollten diese bevorzugt werden. Bei Durchführung primärer oder additiver K‑Draht-Osteosynthesen ist auf deren Sicherung z. B. durch Umbiegen zu achten, da es bei fehlerhafter Versorgung zu erheblichen Komplikationen, wie Pseudarthrose oder sekundären Dislokation des Materials, kommen kann.
The aim of this study is to analyze the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and the unsuspected (u) N2/3 rates in patients with non–small cell lung cancer (NSCLC) and ...normal mediastinum by integrated positron emission tomography-computed tomography.
Prospective observational single-center study of 603 consecutive VAMLAs from 2010 to 2022. Exclusion criteria: other indications (n = 32), tumors different from NSCLC (n = 91), and clinical (c) N2/3 tumors by positron emission tomography-computed tomography (n = 46). Systematic nodal dissection was the gold standard to validate negative VAMLAs. Those patients with negative VAMLA and missing reference standard test were excluded. uN2/3 rates were analyzed in the global series and in the subgroups of tumors according to their clinical nodal and tumor categories. Pathologic findings were reviewed, and staging values were calculated.
Three hundred eighty-three patients with cN0/1 NSCLC underwent VAMLA. Staging values of VAMLA were: sensitivity, 0.98 (95% CI, 0.92-0.99); negative predictive value, 0.99 (95% CI, 0.98-1); and diagnostic accuracy, 0.99 (95% CI, 0.98-1). The uN2/3 rate for the whole series (N = 383) was 18.8%. The uN2/3 rates according to presurgical nodal and tumor categories determined by positron emission tomography computed tomography were: 3.6% (4 out of 111) in cT1N0; 16.3% (18 out of 110) in cT2N0; 10.25% (4 out of 39) in cT3N0; and 32% (7 out of 22) in cT4N0. Forty-two percent (39 out of 93) in cN1; complication rate was 7%.
This series of NSCLC with normal mediastinum staged by VAMLA demonstrates a high accuracy of this technique and a high rate of uN2/3 disease (specially in cN1 and cT4N0). VAMLA could be considered the reference staging procedure for staging cN0/1 NSCLC.
Display omitted Graphical abstract of our study reporting the study design, end points, and results. VAMLA, Video-assisted mediastinoscopic lymphadenectomy; c, clinical stage; NSCLC, non–small cell lung cancer; PPV, positive predictive value; NPV, negative predictive value; Synchr. tumors, synchronous tumors.
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