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一种独特的儿童胸部肿瘤:纵隔尤因肉瘤病例报告

A unique pediatric thoracic tumor: A case report of mediastinal Ewing sarcoma.

作者信息

Shaker Kamar, Alomar Khaled, Alabed Zaher, Rastanawi Alhasan, Alkhayer Ghuroub, Alkader Mohammed Abd

机构信息

Damascus University, University pediatrics Hospital, Damascus, Syria.

Children's Hospital, University of Damascus, Syria.

出版信息

Int J Surg Case Rep. 2025 Jan;126:110699. doi: 10.1016/j.ijscr.2024.110699. Epub 2024 Dec 3.

Abstract

INTRODUCTION AND SIGNIFICANCE

Ewing's sarcoma is a rare tumor occurring in the mediastinum. It is a malignant, aggressive, and rapidly growing tumor that often lacks distinctive clinical or radiological features. Diagnosis is primarily made through histological and immunocytochemical examination. Complete surgical excision followed by chemotherapy is the preferred treatment.

CASE PRESENTATION

We present a case of a child who initially presented with mild respiratory distress. The condition rapidly progressed, leading to an external misdiagnosis and the placement of a chest defibrillator due to misinterpreted findings. The child was referred to our institution, where a large mediastinal mass was diagnosed and surgical intervention was undertaken to completely resect the mass and confirm the diagnosis of Ewing's sarcoma.

CLINICAL DISCUSSION

It is crucial for medical practitioners, especially surgeons, to include Ewing's sarcoma in the differential diagnosis of mediastinal lesions. This consideration is essential for developing an appropriate surgical intervention plan and subsequent follow-up.

CONCLUSION

Our case highlights several important points in clinical practice. It emphasizes the need to avoid relying solely on non-contrast CT scans when a mass is suspected. Additionally, fine-needle aspiration (FNA) should be considered for mass lesions to establish a diagnosis before surgical intervention, as some conditions, such as lymphoma, may not require surgery. Our case also demonstrates the successful removal of a large chest mass through a posterior lateral thoracic approach.

摘要

引言与意义

尤因肉瘤是一种罕见的发生于纵隔的肿瘤。它是一种恶性、侵袭性且生长迅速的肿瘤,通常缺乏独特的临床或影像学特征。诊断主要通过组织学和免疫细胞化学检查来进行。首选的治疗方法是完整手术切除后进行化疗。

病例介绍

我们报告一例患儿,最初表现为轻度呼吸窘迫。病情迅速进展,由于检查结果被误判,导致外部误诊并植入了胸内除颤器。该患儿被转诊至我们机构,在此诊断出一个巨大的纵隔肿块,并进行了手术干预以完全切除肿块并确诊为尤因肉瘤。

临床讨论

对于医生,尤其是外科医生而言,将尤因肉瘤纳入纵隔病变的鉴别诊断至关重要。这种考虑对于制定合适的手术干预计划及后续随访至关重要。

结论

我们的病例突出了临床实践中的几个要点。它强调当怀疑有肿块时,避免仅依赖非增强CT扫描的必要性。此外,对于肿块性病变,在手术干预前应考虑进行细针穿刺抽吸(FNA)以明确诊断,因为某些疾病,如淋巴瘤,可能不需要手术。我们的病例还展示了通过后外侧胸壁入路成功切除巨大胸部肿块。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e0b/11664144/55551092712b/gr1.jpg

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