The disease is characterised by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease. Later stages affect the imune system. When Hodgkin cells are examinated under the microscope, multinucleated Sternberg-Reed cells can be easily found.

The disease occurrence shows two peaks: the first in young adulthood (age 15–35) and the second in those over 55 years old.

Symptoms may include: swelling of the axilar, cervical and inguinal lymph nodes, high fever, weight loss, fatigue, night sweats.

Treatment usually consists of chemo and radio therapy.

This case presents a 26 year old pacient, diagnosed with a mediastinum tumor of unkonwn etiology, altered general status, dyspnea, sternal pain, loss of appetite.

Preoperative CT result shows a well defined tumoral growth with heterogeneous tissue density, size 32/76/60mm, located in the superior and middle anterior mediastinum, with a possible invasion of the right plaeura. Few mediastinal lymph nodes, smaller than 1 cm are also present.

Postoperative ct result shows the disappearance of the tumoral growth with the reduction in size of the mediastinum lymph nodes.

Bronchoscopy exam shows a normal aspect. No localised processes, external compressions or macroscopic alterations.

Spirometry results: VC 104%, PEF 108%

Given the fact that there are no swollen peripheral lymph nodes, the treatment consists of pericardial puncture, revealing clear liquid and mediasninum puncture with a negative result.

The surgical procedure consists of medial sternotomia followed by total excision of the tumor, partial bilateral pulmonary resection and partial plaeurotomia.

Histopathological exam reveals malignant Hodgkin` lymphoma.

This case was later transfered to the oncology clinic for speciality treatment.

CT result shows a solid-necrotic tumoral growth corresponding to the sterno-clavicular articulation line, in the anterior mediastinum. It`s size is 13/11/8 cm, extending downwards to the pulmonary artery ramification. The tumor is wraped around the anterior wall of the ascending aorta, the pulmonary artery and the superior vena cava, having a compressive effect. Swollen lymph node of 1,5cm is also present in the right axila.
Mediastinum puncture exam is negative.
Bronchoscopy result is normal.


Surgical treatment is decided and consists of median sternotomy with total excision of the tumor. The encapsulated, well defined growth, measuring aprox. 15/10 cm does not invade the blood cells. After the complete excision, a small fragment is sent for anatomopathological exam.

After the surgical treatment all symptoms stopped and the pacient was discharged in a better general state.

CT result shows a discretly heretohenous, well defined tumoral formation, presenting mixt densities, having 42/48/95mm in size with a start point in the posterior mediastinum. Signs of external compession are present but without structural invasion.


Surgical procedure consists of left posterolateral thoracotomy followed by the total excision of the tumor.

Histopathological result shows an encapsulated benign tumor composed of adult neurovegetative cells.

Surgical outcome was satisfiing, with improvement in the pacient`s status.

Lab exams: VSH 5/10, Ht. 44, Hb. 15, white cell count 15.300, TGP 16, blood sugar 87, urea 0.55, creatinine 0.8, uric acid 6.1
Spirometry exam: VC 49%, PEF: 52%
Neurologic exam: moderate muscular myasthenia, affecting spinal and facial muscles.


Surgical treatment
Incision by median sternotomia uncovers a remaining thimus in the antero-superior mediastinum, sized 10/6/3 cm. Excision of the thymic tissue, triming and pleural drainage are the steps of the surgical protocol.

Histopahtological result: thymic tumor fragment; lax conjuctive tissue with remaining thymic tissue including cystic cavities, without malignant tumor growth.


Postoperative outcome was favorable and the pacient was discharged with a better general status, surgically healed and without the symptoms earlyer mentioned.

Depending on it`s location, the tumor can produce serious symptoms including blood flow disturbance, motion and sensitive nerve disorder.

This case presents a bening tumoral growth measuring about 11 cm, located in the right axila, producing symptoms earlyer described. After a complete list of investigations, the most important one being a thorax CT scan, these are the results: fatty tumor with well defined edges measuring 11/9,5/8,5cm, located in the subcutaneous tissue, on the right axila. Few axilar lymph nodes, smaller than 1cm having a bening aspect. No other bone or soft tissue lesions.

Surgical treatment is appropriate in this case, consisting of an axilar wedge shaped incision, followed by a total excision of the tumoral mass. After haemostasis and disinfection, the wound is closed using a cutaneous suture.

Dr. Miron Iris - specialist in thoracic surgery

Has Alexandru - student at Medicine and Pharmacy University

The Monaldi drainage is a very old but useful surgical method used in  the thoracic surgery field, on pacients with tubercular and non tubercular lung abcess. Lung resection on these patients is not recommended due to the following reasons:

lesional: unilateral or bilateral expansion ot the lesion;
functional: poor ventilation combined with heart problems;
biological: patients with altered blood samples, decay of general health.

This method is very dangerous if not executed with precision and in certain lesional conditions, normaly:

it is compulsory that a pleuro-pulmonary adherence be created between the lesion (abcess) and the parietal pleura;
the lesion must not be located in the center, away from the thoracic wall (parietal pleura) because serious haemorrhage can occur, leading to exitus through hemoptysis;
generalized subcutaneous emphysema can also occur; this is very hard to contain.

Thenique

Usually, the lesion is located by imagistic guidance. This is the primary starting pointfor penetrating the outer layer of the lesion or healthy lung, causing the symptoms mentioned above.

The anesthesia and incision are done in the same way as in the case of  the pleurotoma (pleural drainage)

A transparietal trocar is introduced in the abcess cavity and,after that, a drainage tube is inserted.

Beside the drainage tube, we also introduced a thin catheter in the abcess cavity, for antibiotic administration.

The tube is fixed on the patient`s skin by conventional suture.

This method may allow an almost complete healing while otherwise it can be considered a preparation for the major surgery (pulmonary resection), after reevaluating the lesional, functional and biological reasons.