Pathology of the Mediastinum

Author: Alberto M. Marchevsky; Mark R. Wick  

Publisher: Cambridge University Press‎

Publication year: 2014

E-ISBN: 9781316169377

P-ISBN(Paperback): 9781107031531

Subject: R36 Pathology

Keyword: 病理学

Language: ENG

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Pathology of the Mediastinum

Description

This book provides a comprehensive, up-to-date review of the pathology of the neoplastic and non-neoplastic diseases that occur in the mediastinum. The pathologic and relevant clinical features are discussed, and detailed diagnostic criteria for various diseases are given, along with information about the most relevant laboratory tests. The features of thymomas, thymic carcinomas, neuroendocrine carcinomas and germ cell tumors are discussed in detail, including the utilization of immunostains and other ancillary tests in diagnosing these diseases. An algorithmic approach to the differential diagnosis of mediastinal lymphomas is given, and a novel clinico-pathologic classification helps readers diagnose and treat thymomas. Cardiac lesions, mesothelioma and other intrathoracic lesions are also reviewed. The book features more than 650 images, and downloadable copies of these are included on a CD-ROM, packaged with the print book. Pathology of the Mediastinum will be of interest to practising surgical pathologists, thoracic surgeons, oncologists and radiologists.

Chapter

Pathology

Treatment

Chronic mediastinitis

Sclerosing mediastinitis

Etiology

Pathogenesis

Clinical findings

Pathology

Prognosis and treatment

Sclerosing mediastinitis in IgG4-related sclerosing disease

Pathogenesis

Clinical manifestations

Pathology

Prognosis and treatment

Mediastinal hemorrhage

References

Chapter 4 The thymus gland

Anatomy

Embryology

Ectopic thymic tissue

Histology

Thymic cortex

Thymic medulla

Thymic vasculature: perivascular spaces

Thymic innervation

lymphocytes in the thymus

Other cell types in the thymus

Thymic hormones

The thymus and immunity

T-cell development in the thymus: thymopoiesis

The thymus and immunologic self-tolerance

Thymic involution

References

Chapter 5 Pathology of non-neoplastic conditions of the thymus

Thymic involution

Thymic hyperplasia

True or simple thymic hyperplasia

True thymic hyperplasia with massive enlargement

True thymic hyperplasia after chemotherapy and other conditions

Lymphoid or follicular thymic hyperplasia

The thymus in immunodeficiency syndromes

The thymus in congenital immunodeficiency syndromes

Thymic dysplasia

Thymic abnormalities in acquired immune deficiency syndrome and other conditions

The thymus in myasthenia gravis

Congenital myasthenia syndromes

Thymoma, follicular hyperplasia of the thymus and other abnormalities in myasthenia gravis

References

Chapter 6 Low-grade and intermediate-grade malignant epithelial tumors of the thymus: thymomas

Epidemiology

Location

Clinical features

Thymoma and other diseases

Thymoma and myasthenia gravis

Pathogenesis of myasthenia gravis in thymoma patients

Thymomas and other neurologic disorders

Thymoma and hematologic disorders

Thymoma and immune deficiency syndromes

Epstein-Barr virus infection and thymoma

Thymomas associated with skin diseases and autoimmune disorders

Thymoma and renal disorders

Thymoma and other neoplasms

Thymoma and bone disorders

Thymoma and endocrine disorders

Diagnosis of thymomas using imaging techniques

Detection of serum autoantibodies in thymoma patients with myasthenia gravis

Pathologic features of thymomas: gross pathology

Clinico-pathological classification of thymomas and other malignant epithelial neoplasms of the thymus

Low-grade malignant thymic epithelial neoplasms

Spindle cell thymoma (WHO A)

Lymphocyte-rich thymoma (WHO B1)

Lymphocyte-rich thymoma with spindle cells (WHO AB)

Lymphocyte-rich thymoma with atypia (WHO B2)

Intermediate-grade malignant thymic epithelial lesions

Spindle cell thymoma with atypia (not in 2004 WHO classification)

Lymphocyte-depleted thymoma with atypia (WHO B3)

Heterologous thymomas

Combined thymoma-thymic carcinoma

Unusual thymoma variants

Thymoma with pseudosarcomatous stroma (WHO metaplastic thymoma)

Micronodular thymoma (WHO micronodular thymoma)

Rhabdomyomatous thymoma (not included in WHO)

Sclerosing thymoma (WHO sclerosing thymoma)

Thymoma with prominent glandular differentiation (not included in WHO)

Spindle cell thymoma with prominent papillary and pseudo-papillary features (not in WHO)

Other thymic lesions

Lipofibroadenoma (WHO lipofibroadenoma)

Thymomas with ``monster´´ atypical cells (not in WHO)

Thymomas in myasthenia gravis patients

Degenerative changes in thymomas

Ultrastructural features of thymomas

Secretory activities of thymomas

Hormone receptors in thymomas

Analysis of nuclear DNA content in thymomas

Cytogenetic and molecular studies in thymomas

Diagnosis of malignant thymic epithelial lesions on small biopsy specimens

Clinico-pathological staging of patients with malignant thymic epithelial lesions

Treatment and prognosis of thymoma patients

Thymomas in children

References

Chapter 7 High-grade malignant epithelial tumors of the thymus: primary thymic carcinomas

Definitions, presentations, and etiologies for primary thymic carcinomas

Specific histologic forms of primary thymic carcinoma

Keratinizing squamous cell carcinoma of the thymus

Non-keratinizing squamous cell thymic carcinoma

Lymphoepithelioma-like thymic carcinoma

Adenosquamous and mucoepidermoid thymic carcinomas

Clear-cell carcinoma of the thymus

Papillary adenocarcinoma of the thymus

Basaloid squamous cell carcinoma of the mediastinum

Sarcomatoid thymic carcinoma

Anaplastic carcinoma of the thymus

Rhabdoid thymic carcinoma

Mucinous carcinoma of the thymus

Micronodular lymphoid-rich thymic carcinoma

Thymic carcinomas arising from pre-existing lesions

Cytopathologic features of thymic carcinomas

Adjunctive pathological findings in thymic carcinomas

Differential diagnosis of thymic carcinomas

Metastatic mediastinal carcinomas

Germ-cell tumors and malignant lymphomas

Malignant melanomas

Sarcomas

Mesotheliomas

Staging of thymic carcinomas

Management of thymic carcinomas

References

Chapter 8 Neuroendocrine carcinomas of the thymus

Classification of thymic neuroendocrine carcinomas

Thymic neuroendocrine carcinomas grades I and II

Typical and atypical carcinoid tumors

Imaging findings

Pathology

Histochemical and immunohistochemical features

Ultrastructural features

Differential diagnosis

Treatment and prognosis

Unusual variants of NEC grades I and II (typical and atypical carcinoid tumors)

Spindle cell carcinoid

Pigmented carcinoid

Carcinoid with mucinous stroma

Oncocytic carcinoid

Angiomatoid carcinoid

Neuroendocrine carcinoma grade III

Small cell carcinoma variant

Large cell neuroendocrine carcinoma

Treatment and prognosis of thymic neuroendocrine carcinoma grade III, large cell neuroendocrine carcinoma variant

Neuroendocrine carcinoma with heterologous grades I-III features

Neuroendocrine carcinoma combined with other tumors

Carcinoid with sarcomatoid changes

Thymic neuroendocrine carcinoma combined with thymoma

Goblet cell carcinoid combined with a mature teratoma

Carcinoid combined with a thymolipoma

Neuroendocrine carcinoma grade III of the thymus with other thymic carcinoma components

References

Chapter 9 Germ cell tumors of the mediastinum

Introduction and general features

Location

Clinical features and diagnostic techniques

Theories regarding pathogenesis

Epidemiology

Genetics

Distribution of histologic subtypes of mediastinal germ cell tumors

Mediastinal germ cell tumors in postpubertal male patients

Mediastinal germ cell tumors in postpubertal female patients

Mediastinal germ cell tumors in prepubertal patients

Staging of mediastinal germ cell tumors

Individual tumor types

Seminoma

Differential diagnosis

Immunohistochemistry

Teratoma

Mature teratoma

Immature teratoma

Teratomatous components in mixed germ cell tumors

Somatic-type malignancy of germ cell tumor origin

Differential diagnosis

Yolk sac tumor

Sarcomatoid yolk sac tumor and sarcoma of germ cell tumor origin

Hematopoietic neoplasms

Differential diagnosis and immunohistochemistry

Embryonal carcinoma

Differential diagnosis and immunohistochemistry

Choriocarcinoma

Differential diagnosis and immunohistochemistry

Other tumors

Metastatic germ cell tumor to the mediastinum

Acknowledgments

References

Chapter 10 Parathyroid lesions, paragangliomas, thyroid tumors, and pleomorphic adenomas of the mediastinum

Parathyroid tumors of the mediastinum

Historical considerations

Clinical features

Radiographic findings

Macroscopic features

Histologic and cytological characteristics

Cytogenetic findings in parathyroid lesions

Mediastinal paragangliomas

Historical considerations

Clinical characteristics

Radiographic findings

Macroscopic features

Histological characteristics

Composite paraganglioma-neuroblastoma

Genetic findings associated with paragangliomas

Ultrastructure of parathyroid and paraganglionic tumors

Immunohistology of parathyroid and paraganglionic tumors

Prognosis and therapy of mediastinal parathyroid and paraganglionic tumors

Intramediastinal thyroid neoplasms

Pleomorphic adenoma of the mediastinum

References

Chapter 11 Hematopoietic neoplasms of the mediastinum

Low-grade lymphomas

Primary mediastinal large B-cell lymphoma

Hodgkin´s lymphoma

Gray zone having intermediate features between classical Hodgkin´s lymphoma and large cell non-Hodgkin´s lymphoma

Burkitt lymphoma

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (BL)

EBV-positive diffuse large B-cell lymphoma

Plasmablastic lymphoma

Primary effusion lymphoma

Lymphoblastic lymphoma

Anaplastic large cell lymphoma

Peripheral T-cell lymphomas

Myeloid sarcoma

Langerhan cell histiocytosis

References

Chapter 12 Cystic lesions of the mediastinum

Congenital cystic lesions

Embryologic information

The thymus and parathyroid

Respiratory organs

Foregut

Pleuropericardial membranes

Specific pathologic entities

Parathyroid cysts and unilocular thymic cysts

Bronchogenic cysts

Enteric cysts

Pericardial cysts

Meningocele

Acquired mediastinal cystic lesions

Infectious and post-inflammatory cystic lesions

Multilocular thymic cysts and secondary thymic cysts

Mullerian cysts of the posterior mediastinum

Primary cystic neoplasms of the mediastinum

Vascular lesions

Mesothelial neoplasms

Cystic germ cell tumors

Cystic change in predominantly ``solid´´ mediastinal neoplasms

References

Chapter 13 Mesenchymal tumors of the mediastinum

Background

Tumors of peripheral nerve sheath differentiation

Schwannoma (neurilemmoma)

Neurofibroma

Malignant peripheral nerve sheath tumors

Tumors of neuroectodermal tissue

Neuroblastoma

Ganglioneuroma

Ewing sarcoma family of tumors (ESFT) / extraskeletal Ewing sarcoma (EES) / primitive neuroectodermal tumor (PNET)

Ependymoma

Lymphatic/vascular tumors

Lymphangiomas

Hemangiomas

Borderline and malignant vascular tumors

Epithelioid hemangioendothelioma

Kaposiform hemangioendothelioma

Kaposi sarcoma

Angiosarcoma

Fibroblastic, myofibroblastic and ``fibrohistiocytic´´ tumors

Desmoid-type fibromatosis

Fibrosarcoma and related lesions

Pleomorphic undifferentiated sarcoma (previously included under malignant fibrous histiocytoma (MFH))

Congenital infantile fibrosarcoma

Inflammatory myofibroblastic tumor

Tumors of adipose tissue

Lipoma variants

Hibernomas

Lipoblastoma

Myelolipomas

Liposarcomas

Myogenic neoplasms

Rhabdomyosarcoma

Rhabdomyoma variants

Smooth muscle tumors

Tumors with osteochondroid differentiation

Extraskeletal mesenchymal chondrosarcoma

Extraskeletal myxoid chondrosarcoma (EMC)

Extraosseous osteosarcoma (EOS)

Other mediastinal soft tissue neoplasms

Solitary fibrous tumor-hemangiopericytoma

Synovial sarcoma

Desmoplastic small round cell tumor

Alveolar soft part sarcoma

Chordoma

Melanocytic and myomelanocytic tumors

Lymphangiomyoma/PEComa/angiomyolipoma

Clear cell sarcoma of soft tissue

Sarcomatoid malignant melanoma

Sarcoma arising in germ cell neoplasms

Other mediastinal lesions

Soft tissue neoplasms of the thymus

Thymolipoma

Thymoliposarcoma

Other thymic mesenchymal neoplasms

Differential diagnostic considerations and use of immunohistochemistry

References

Chapter 14 Tell me what you need, so I´ll know what to say

Introduction

Strategy to approach to anterior mediastinal tumors

Making a clinical diagnosis

When is a biopsy needed?

Specific differential diagnoses

Easy situations

More difficult situations

Conclusion

References

Chapter 15 Clinical pathology of disorders of the mediastinum

Introduction

Adult MG panel

Pediatric MG panel

Thymoma MG panel

MG/Lambert-Eaton syndrome panel

References

Chapter 16 Surgical pathology of the heart

Endomyocardial biopsy

Introduction

Myocarditis

Idiopathic dilated cardiomyopathy (DCM)

Hypertrophic cardiomyopathy (HCM)

Idiopathic restrictive cardiomyopathy (RC)

Arrhythmogenic right ventricular cardiomyopathy (ARVC)

Peripartum cardiomyopathy (PPCM)

Storage diseases

Muscular dystrophies

Mitochondrial cardiomyopathies (MICs)

Löffler endocarditis (LE)/endomyocardial fibrosis (EMF)

Cardiac sarcoidosis

Cardiac amyloidosis

Iron overload

Cardiac tumors

Drug toxicity/hypersensitivity reactions

Allograft rejection

Cardiac valves

Introduction

Normal anatomy of the valves

Gross examination and sectioning

Histochemical stains

Examination of different valves

Semilunar valves

Atrioventricular valves

Aortic valve disease

Aortic stenosis (AS)

Bicuspid aortic valve (BAV)

Unicuspid aortic valve

Aortic regurgitation (AR)

Mitral valve disease

Mitral stenosis (MS)

Mitral regurgitation (MR)

Mitral valve prolapse (MVP)

Mitral annular calcification (MAC)

Tricuspid valve diseases

Tricuspid stenosis (TS)

Tricuspid regurgitation (TR)

Pulmonary valve disease

Pulmonary stenosis

Pulmonary regurgitation

Endocarditis

Carcinoid heart disease

The explanted heart

Prostheses/devices

Substitute cardiac valves

Ventricular assist devices

Other medical devices

References

Chapter 17 Morphologic alterations of serous membranes of the mediastinum in reactive and neoplastic settings

Introduction

Mesothelium: structure, function, repair

Both epithelial and mesenchymal characteristics of mesothelial cells

Inflammatory/reactive lesions of the serosal membranes

Cystic lesions of the serosal membranes

Neoplastic lesions of the serosal membranes

Diffuse malignant mesothelioma

Localized malignant mesothelioma of the pleura, pericardium, and mediastinum

Other tumors of mesothelial origin (benign mesothelial tumors and mesothelial tumors of uncertain malignant potential) of the pleura and pericardium

Metastases to the pleura and pericardium

References

Index

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