Debatable results of surgery for lung cancer in a patient with long existing pulmonary metastases from differentiated thyroid carcinoma

Introduction: The appropriate following treatment in a patient with a new presented non-small cell lung cancer (NSCLC) and history of chronic lung metastases of thyroid origin has never been reported. In such cases, the presence of long­standing thyroid metastatic disease with proven “limited malignant potential” could be considered as a minor treatment problem justifying one’s the decision to focus on the primary lung carcinoma as the only serious threat for the patient’s life.Case report: We report the surgical treatment of a new presented NSCLC in a patient with chronic lung metastases of thyroid origin and we present all the diagnostic, staging and treatment problems.Conclusion: The therapeutic results of our surgical approach were not encouraging. This could be owed to our staging prob­lems of NSCLC and the well documented limited immunological response of such patients with multiple neoplasms

A huge posteromedial mediastinal cyst complicated with vertebral dislodgment

BACKGROUND: Mediastinal cysts compromise almost 20% of all mediastinal masses with bronchogenic subtype accounting for 60% of all cystic lesions. Although compression of adjoining soft tissues is usual, spinal complications and neurological symptoms are outmost rare and tend to characterize almost exclusively the neuroenteric cysts. CASE PRESENTATION: A young patient with intermittent, dull pain in his back and free medical history presented in the orthopaedic department of our hospital. There, the initial clinical and radiologic evaluation revealed a mediastinal mass and the patient was referred to the thoracic surgery department for further exploration. The following computed tomography (CT) and magnetic resonance imaging (MRI) shown a huge mediastinal cyst compressing the T4-T6 vertebral bodies. The neurological symptoms of the patient were attributed to this specific pathology due to the complete agreement between the location of the cyst and the nervous rule area of the compressed thoracic vertebrae. Despite our strongly suggestions for surgery the patient denied any treatment. CONCLUSION: In controversy with the common faith that the spine plays the role of the natural barrier to the further expansion of cystic lesions, our case clearly indicates that, exceptionally, mediastinal cysts may cause severe vertebral complications. Therefore, early excision should be considered especially in young patients or where close follow up is uncertain