malignant pheochromocytoma in the anterior mediastinum with sternal invasion a case report mingzhi song资料.pdf


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该【malignant pheochromocytoma in the anterior mediastinum with sternal invasion a case report mingzhi song资料 】是由【四婆子】上传分享,文档一共【8】页,该文档可以免费在线阅读,需要了解更多关于【malignant pheochromocytoma in the anterior mediastinum with sternal invasion a case report mingzhi song资料 】的内容,可以使用淘豆网的站内搜索功能,选择自己适合的文档,以下文字是截取该文章内的部分文字,如需要获得完整电子版,请下载此文档到您的设备,方便您编辑和打印。202-209CaseReportMalignantpheochromocytomaintheanteriormediastinumwithsternalinvasion:acasereportMingzhiSong1,2*,KebinSun3*,TianXia4,LeiZhou4,YangyangLi4,ZheSun4,YuchiZhang4,XianbinZhang5,RanSun6,7,BoChen8,QingweiTan41DepartmentofOrthopaedics,TheFirstAffiliatedHospitalofDalianMedicalUniversity,Dalian116011,China;2DepartmentofOrthopaedics,TheThirdAffiliatedHospitalofDalianMedicalUniversity,Dalian116200,China;3CollegeofInformationEngineering,DalianUniversity,Dalian116622,China;4DepartmentofThoracicSurgery,5DepartmentofHepatobiliarySurgery,6DepartmentofNursing,7OperationRoom,8DepartmentofNuclearMedicine,TheFirstAffiliatedHospitalofDalianMedicalUniversity,Dalian116011,China*:,TheFirstAffiliatedHospitalofDalianMedicalUniversity,Dalian116011,:drdavid_******@.Abstract:Pheochromocytomasarecatecholamine--year-,-up,,,-termfollow-upisnecessary,:Pheochromocytoma;sternum;surgery;three-dimensional(3D)reconstruction;thoracicwallSubmittedSep23,,:.:http://dx./.(5).Themalignantonesaccountforapproximately10%ofallpheochromocytomasPrimarilyarisingfromneuralcrest-derivedtumors(6,7).Patientswhosufferfrompheochromocytomasincludingtheadrenalmedullaandsympatheticparaganglia,plainofhypertension,headache,sweating,pheochromocytomasconsistofchromaffincellsthatmaypalpitation,apprehension,tremor,pallororflushingoftheproduce,store,metabolizeandsecretecatecholamines(1-3).face,nauseaandvomiting,chestpain,abdominalpain,ormonlyoriginatefromapproximatelylimbparesthesias(8,9).Thesesymptomsareregardedas80–85%ofcasesfromintra-adrenalchromaffintissuesandtheresultoftheincreasedsecretionofepinephrineandfromapproximately15–20%ofcasesfromextra-(4).Astheraredisease,morethanEctopicpheochromocytomasalwaysoriginatefromthe40%ofpheochromocytomasareassociatedwithgermlineextra-adrenalparaganglionsystem,whichcanbeeitherbenign?;9(3):E202-E209JournalofThoracicDisease,Vol9,No3March2017E203ormalignant,,abdomenCTanddual-adrenalglands,urinthesourceCTcoronaryarteryimagingrevealednothingorganofZuckerkandlandparaganglia(10).,-99levelofurinecatecholamineanditsderivativescanalsobeconjugatedwithmethylenediphosphonate(99TcMDP),notallextra-,somepatientsmesosternum,,,theradiologistcouldnotexcludebonedate,theresectionofpheochromocytomasremainsasthemetastases(Figure1D).Serumcytokeratin19-(normal:0–).PheochromocytomaintheanteriormediastinumisveryCatecholaminelevelsincludingfastingtotalplasmarare,especiallythosethatthatinvadethesternum(11).catecholamines,noradrenaline,,othersans,includingwerewithin-normalrangesincludingbloodroutine,serumthebone,,electrolytes,coagulogram,hepaticfunction,renalfunction,diagnosticprocedures,andtherapeuticstrategiesarethyroidfunction,serumcarcinoembryonicantigen,,three-dimensional(3D)reconstructionofthetumor,Casepresentationsternum,adjacentcostalcartilageandribswasperformedA51-year-oldfemalepresentedwitha2-(Figure1E,F,G).Thevideooftheofamasswithpinchingpainontheanteriorthoracicwallreconstructedmodelrevealedthepositionofthetumor,(Figure2).pletionofdiagnosticsandinterdisciplinarypheochromocytomain2008atanotherhospital(detailsconsultations,thepatientwasqualifiedfor?surgicalwereunclear).-,(BP)for10years,andthehighestAlongtheloweredgeoftherightbreast,an?,herBPisstablearcincision(approximately25cm),(140/90mmHg)-mesosternumexamination,atenderandfirm30mm×30mmhard(approximately10cm).Next,theskinandsubcutaneousmasswaspalpatedinfrontoftherightthirdribcartilagetissuewascut,followedbytheupwardpushingoftherightandmiddle-,thethirdtotheseventhribwasexposedheadache,dizziness,tachycardia,××,andonlyinvadedanddamagedAfteradmission,relatedauxiliaryexaminationandthesternum(Figure3A).,whichwaspossiblynourishingthe(ECG),branchblockandST-,cuttingoffidentalatrialprematurebeatsand591oftherightforthtoseventhcostalcartilage,,cuttingoffoftheleftfifthtoeighthcostalcartilageAdditionally,paroxysmalT--putedtomography(CT),pletelyscanrevealedasofttissuemass(×removed,leavinganirregularcirculardefectzone(×)ontheanteriormediastinumandanteriordiameterwasapproximately8cm)(Figure3B).Thereturnthoracicwall(Figure1A,B,C).Themasswaslikelytobeaofintraoperativefrozenpathologycouldnotexceptfor?;9(3):E202-,bonescintigraphyand3Dreconstruction:(A,B,C)asofttissuemass(××);(D)bonescintigraphyrevealedanuclidefocusonthedistalmesosternum,,theseabnormallocationsweresuspectedtobebonemetastases;(E,F,G)(Figure2).,aclosedthoracicavity,×(Figure3C,D).Eventually,modelofmalignant▲,KebinSun,TianXia,LeiZhou,YangyangLi,,YuchiZhang,XianbinZhang,RanSun,BoChen,QingweiTan*HistologicalstudyofthebiopsiedspecimensdisclosedDepartmentofThoracicSurgery,TheFirstAffiliatedpheochromocytomasinvadingtheadjacentboneandHospitalofDalianMedicalUniversity,Dalian116011,,thesetumorcellswithatypicalnucleoluswereroundorovate,possessinganFigure2Thedynamicdisplayofthereconstructedmodelofabundantcytoplasmarrangedinnests(Figure4A,B).malignantpheochromocytoma(12).Immunohistochemistryresultsdemonstratedthatneuron-Availableonline:icles/1427specificenolase(NSE),chromogranin-A(CHGA),-inhibitin,synaptophysinandS-100proteinwerepositive;whileki-67proteinwasexpressedin15%ofthesetumorsα?;9(3):E202-E209JournalofThoracicDisease,Vol9,No3March2017E205ABCDFigure3Grossspecimenofthetumorandsurgeryprocedures.(A)Theresectedtumor(anteriorandlateralview)××;(B,C,D),atitaniummeshwasselectedandusedtorepairthedefectofthethoracicwall.(Figure4C,D).Combinedwithclinicalhistory,ountsfor5%ofectopicpheochromocytomas(13).,,thepatienthadsuddenmalignancywithsternumdestructionhasbeenpreviouslypaniedwithwhitesputum,andcouldnotliereported(11).,monsymptomsofpheochromocytomasaflatT--type-areheadache,blurredvision,sweating,heartpalpitation,,andflushing(8,9).Whenpheochromocytomasappearinarespiratoryphysicianandcardiologistwereinvitedtothemediastinum,plainofpalpitation,,oralindapamideheadache,nausea,vomiting,chestpain,orchesttightnesswasreplacedbytelmisartanandmetoprololtartratetobetter(14-17).However,(18).aseswerealsoplicationsuchatrachealfoundinmediastinalpheochromocytomapatients(19,20).compression,tracheomalacia,paredwithpublishedcases,,sheasymptomaticpheochromocytoma(someofthemediastinalwasdischargedandstayedhomeonthe13thdayafterthepheochromocytomacasesareshowninTable1).,hospital,,icresonanceimagingpostoperative,thepatientwasfreeofsymptoms,withno(MRI),,,-adrenalpheochromocytoma,Withthedevelopmentofradiologicaltechniques,MRIhaswhichwasfoundwithintheanteriormediastinumofabeenregardedasaveryreliableexaminationfordetecting51-year-

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