This chapter primarily deals with one of the classic four terrible “T’s” in the differential diagnosis of anterior mediastinal masses, namely, thymic epithelial tumors. Given the rarity of these malignancies, with an estimated 390 cases per year in the USA, management of these entities is primarily guided by several retrospective analyses. This chapter focuses on the clinical presentation, associated autoimmune disease, staging, and role of radiation in the management of thymoma and thymic carcinoma.

Tumors of the Mediastinum

https://onlinelibrary.wiley.com/doi/pdf/10.1111/resp.14124

Letter from Turkey: Impact of COVID-19 on respiratory diseases.

The coronavirus 2019 (COVID-19) pandemic had an enormous impact on healthcare delivery globally. We conducted a cross-sectional online survey in Turkey to evaluate the impact of COVID-19 on healthcare services in Turkey. A 35-item anonymized online survey was completed by HCPs (medical doctors, MD) who continued their clinical practice during the COVID-19 pandemic in Turkey, regardless of their specialties or degrees. Overall, 209 HCPs participated in the study. Forty-two percent of the participants stated that their current workload intensity has been increased compared with the pre-pandemic era. More than half of the participants (54.6%) were using telemedicine services during their clinical practice, however, the effectiveness of telemedicine for first-time patients and follow-up patients was rated as low. The majority of participants (59.3%) reported that during the peak period of the pandemic, they encountered only a small variety of cases, other than COVID-19. Fifty-two percent of the participants agreed that they occasionally had patients who received misdiagnosis in the first admission due to the suspicion of a possible COVID-19 infection predominating the diagnostic process (eg., not excluding COVID-19 even though the PCR test is negative). For the distribution of possible late-diagnosed diseases, 25.8% of HCPs selected chest diseases, followed by infectious diseases, heart diseases, and cancer. In general, participants agreed that there was an increase in the negligence in the follow-up of various diseases and/or complication rates due to COVID-19 pandemic. Sixty percent of the HCPs agreed that HCPs are being much more rigorous to diagnose/treating COVID-19 than other important diseases. Fifty-seven percent of the participants stated that the diagnosis and follow-up of chronic diseases are affected, while 57.9% of the HCPs stated that some diseases that show similar signs and symptoms as COVID-19 are not diagnosed correctly during COVID-19 pandemic. Findings from this study emphasize that COVID-19 pandemic has significantly caused delayed diagnoses and interruption in the management of chronic diseases, and also increased the risk of missing out the diagnosis of non-COVID-19 diseases. The study genuinely aims to yield the floor to a permanent improvement in post-pandemic clinical management and it also shows the need for a focused approach in distinct areas of medical care. Policymaking is required to drive changes to better support HCPs in Turkey.

/pdf/a-glance-into-healthcare-delivery-during-covid-19-pandemic-a-2zxlqmap.pdf

A Glance Into Healthcare Delivery During COVID-19 Pandemic: A Survey Among Turkish Medical Doctors

Introduction Thymoma is an epithelial tumor that commonly lies in the anterior mediastinum. It rarely extends to the pleural cavities. There is no standard approach for resecting similar giant thymomas. Case presentation An eighteen-year-old woman presented with a six-month history of progressive exertional dyspnea, weight loss, and loss of appetite. Radiological imaging demonstrated a giant mediastinal mass extending to both pleural cavities, a transthoracic needle biopsy was then performed, which indicated thymic hyperplasia. Clinical discussion The tumor was completely resected using a two-step approach, starting with a median sternotomy then extending it to a hemiclamshell incision, which provided better exposure of the tumor and caused less morbidity. The left part of the thymoma was resected using a median sternotomy, which took a relatively long time and caused significant blood loss. Then the incision was extended to a hemiclamshell incision through the pleural cavity to remove the right part of the tumor. This approach helped us to visualize the tumor better and did not cause any significant blood loss. The removed mass measured 36 × 29 × 10 cm and weighed 4500 g. Pathologic diagnosis indicated a type B1 tumor with no capsular invasion according to the World Health Organization classification. Conclusion The hemiclamshell approach is superior to the median sternotomy incision in resecting giant thymomas extending to the pleural cavity, as it saves time and causes less morbidity.

Giant thymoma presenting as a large bilateral intrathoracic mass: A case report and a comparison between median sternotomy and hemiclamshell approach.

A case of giant intrapulmonary thymoma

Pathologic diagnosis of thymic tumors (TTs) can be made by surgical or nonsurgical procedures. About 20% of TTs had been diagnosed by pretreatment biopsy methods while the rest had gone to surgery for diagnosis and treatment. However, in the last two decades there was an increase in pretreatment procedures for optimal management of locally advanced or metastatic TTs. Pretreatment tissue diagnosis of a noninvasive TT is not a standard option but is required if there is suspect or atypical clinical presentation and imaging, an invasive tumor requiring a nonsurgical approach or preoperative chemotherapy or chemo-radiotherapy, strong possibility of lymphoma or unclear differential diagnosis between lymphoma or other solid tumor by imaging studies, or suspicion of a metastatic lesion. In surgical diagnosis anterior mediastinotomy, video-assisted thoracic surgery or mediastinoscopy can be chosen for invasive TTs whereas total resection is performed for small, noninvasive tumors. Nonsurgical diagnosis can be made by transthoracic fine or core needle biopsies (TTFNA, TTCNB), conventional bronchoscopy, endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) or medical thoracoscopy depending on procedural amenability according to tumor extension. TTFNA and TTCNB have been the most frequently used nonsurgical methods. However, there is an upward trend in using conventional bronchoscopy, EBUS-TBNA, EUS-FNA and medical thoracoscopy recently. To increase the diagnostic performance of these procedures in TTs, recommendations are (I) obtaining histologic specimens, (II) combining smears or liquid based cytology preparations and cell blocks, (III) obtaining multiple sufficient samples, (IV) combining histologic and cytologic specimens, (V) performing morphologic, immunohistochemical and molecular analyses on all specimens, (VI) using rapid onsite evaluation for cytologic specimens, (VII) correlating pathologic, clinical and radiologic findings, (VIII) consulting experienced pathologists.

/pdf/how-to-obtain-adequate-biopsy-specimen-in-suspected-thymic-587yhiuav7.pdf

How to obtain adequate biopsy specımen in suspected thymic tumors

Setting: Endobronchial tuberculosis (EBTB) is a chronic, often unrecognized form of the disease with a complicated clinical course and significant airway complications.

Objective: The aim of this study was to evaluate common clinical features amongst individuals with bronchoscopic biopsy proven EBTB during a 20 year period in Serbia.

Design: An observational study of 212 patients with bronchoscopic biopsy proven EBTB between January 1993 and December 2012. Retrospective case note review was undertaken, including all clinical, microbiological and radiological evidence, at the University Hospital of Pulmonology, Belgrade.

Results: All patients were caucasian and HIV-negative, with a male to female ratio of 1.28:1. Every patient had an abnormal chest X-ray. The most common endoscopic features were oedematous hypereamic (39.2%) and nonspecific bronchitis (35.8%). Microbiological culture rate was 64.6%. Sputum culture was positive in 55.2%, bronchial washing culture positive in 36.8%, and both in 27.4%.

Conclusion: Most patients with EBTB have concurrent pulmonary lesions. Bronchoscopy is an essential diagnostic tool for EBTB. Early diagnosis and early onset of therapy is of crucial importance to prevent the development of bronchostenosis.

https://www.longdom.org/open-access/endobronchial-tuberculosis-in-serbia-over-a-20-year-period-analysis-and-review-of-current-literature-2161-1068-1000271.pdf

Endobronchial Tuberculosis in Serbia over a 20 Year Period: Analysis and Review of Current Literature

/pdf/revealing-the-mysteries-of-thymoma-3otkqtruzs.pdf

Revealing the mysteries of thymoma.

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How to obtain adequate biopsy specımen in suspected thymic tumors

Letter from Turkey: Impact of COVID-19 on respiratory diseases.

Endobronchial Tuberculosis in Serbia over a 20 Year Period: Analysis and Review of Current Literature

Revealing the mysteries of thymoma.