Mediastinum biopsies

Mediastinum. Biopsies in the mediastinum have to be performed with special respect to vascular structures (Fig. 37.3). For planning of the biopsy procedure, a contrast-enhanced CT is performed in order to rule out vascular abnormalities like aneurysms, and to visualize... 

FIGURE 11.4 (A) This dense fibroinflammatory mass in the mediastinum has the appearance of a tumefactive fibroinflammatory lesion (fibrosing mediastinitis). However, biopsy of an adjacent lymph node (B) demonstrated classic Reed-Sternberg cells (labeled for CD30), which established a diagnosis of the total obliterative nodular sclerosing subtype of Hodgkin disease. 

Heilo A. Tumors in the mediastinum Ultrasound-guided histologic core-needle biopsy. Radiology. 1993 189 143-146. 

Powers CN, Silverman JF, Geisinger KR, et al. Fine needle aspiration biopsy of the mediastinum A multiinstitutional analysis. Am J Clin Pathol. 1996 105 168-173. 

The first case involved a 48-year-old male suffering from a small-cell bronchial carcinoma. The diagnosis was made by MRT (magnetic resonance tomography) and verified by histopathological examination of biopsy specimen. The size of the tumor was 6 to 8cm in diameter in September 2001 when the patient visited one of the authors (G.B.). The report of the University of Amsterdam indicated that the tumor was inoperable due to its localization very close to the mediastinum. The patient had received radiotherapy followed by chemotherapy before he came for a visit to one of the authors... 

Given that mesothelioma is a locally aggressive tumor, invasion of the chest wall, the mediastinum, and the diaphragm are frequent. Chest wall invasion may manifest as an obliteration of the extrapleural fat planes, as invasion of intercostal muscles, as displacement of ribs, or as destruction of bones (Fig. 9.7). Despite the high frequency of these latter findings, irregularities of the interface between the chest wall and the tumor are not reliable in predicting chest wall invasion (Patz et al. 1992). Mesothelioma has also been reported to be able to extend into the chest wall via the tracks of biopsy needles, via... 

Blood sample, sputum and skin lesion swabs should be cultured, preferably before starting antibiotics. Polymerase chain reaction (PCR) may be more rapid. Dermatological referral and biopsy may also be indicated for skin lesions. Patients with systemic anthrax may demonstrate low arterial blood gas Pifi2, a raised white cell coimt, h5 onatraemia, raised liver transaminases and low serum albumin. Chest radiography (and/or computed tomography (CT) scan) may show a widened mediastinum, pleural effusions and pulmonary infiltrates. 

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