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Papers by Emmanuel Contreras

Chest, 2018

Follicular dendritic cell sarcoma (FDCS) was first described in 1986 by Monda et al. It is a low ... more Follicular dendritic cell sarcoma (FDCS) was first described in 1986 by Monda et al. It is a low grade or intermediate malignant neoplasm, which typically involves lymph nodes; mainly cervical nodes, but it can also involve extranodal sites, especially the liver, spleen, and lungs. FDCS generally appears as a slow growing mass; asymptomatic or painful. Paraneoplastic pemphigus associated or not with myasthenia gravis has been reported, where it can anticipate FDCS diagnosis and negatively influence the outcome. Tumors usually occur sporadically but a subset of cases are associated with Castleman disease and Epstein Barr virus. FDCS has no gender predilection, and may affect any age, although most of the cases have been reported in the middle age. CASE PRESENTATION: A 59-year-old man presented with oral ulcers characteristic of pemphigus for 5 months, so he started deflazacort and azathioprine treatment. He complained about progressive dysphagia and odynophagya, without fever or weight loss. A contrast enhanced CT images of the chest revealed a well-defined mass (5.1 x 3.3cm) in the esophagogastric junction, no compression of the trachea or esophagus, and no regional lymphadenopaties were observed. Trasnesophageal endoscopic ultrasound showed a 5 x 5 cm mass in the posterior mediastinum, furthermore fine needle aspiration biopsy showed inconclusive results. The patient underwent video-assisted thoracoscopic surgery for the complete excision of the mass. The tumor diameter was 5.2 x 5 x 4.8 cm, immunohistochemical staining results were positive for CD21, CD35, and HLA-DR and negative for CD23, CD11C, CD68, CD20, S100, and HHV8. All these findings were compatible with follicular dendritic cell sarcoma. The patient received 1 cycle of Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. A PET scan was performed 3 months after his surgery and there has been no evidence of recurrence. He actually is under surveillance and receiving treatment for pemphigus.

Chest, 2018

INTRODUCTION: Mediastinal soft tissue tumors are rare, with an estimated incidence between 2 and ... more INTRODUCTION: Mediastinal soft tissue tumors are rare, with an estimated incidence between 2 and 6% of all mediastinal neoplasms. Mediastinal hemangiomas account for 0.5% of all mediastinal tumors. Definite diagnosis is often possible only after surgical resection. We herein report the case of a posterior mediastinal hemangioma that was successfully treated using a videoassisted thoracoscopic approach. CASE PRESENTATION: A 70-year-old woman with unremarkable medical history, presented with 6-month history of progressive dysphagia, unintentional weight loss and anorexia. A computed tomography revealed a 3.6 cm diameter mass located in the posterior mediastinum, which had arterial and venous enhancement with hipodense content, suggesting necrosis and no calcifications were found. It was in contact with the lateral and posterior margin of the aorta, but preserving adequate interface. No infiltration to surrounding organs was observed.We used a left video-assisted thoracoscopic approach with segmental rib resection. We found a 5cm, rounded and highly vascularized tumor. With circumferential dissection the tumor was freed from the pericardium and pulmonary vein, clipping feeding vessels, which depended from intercostal arteries. Due to firm adhesion to the descending thoracic aorta we obtained vascular control and complete resection was successfully performed. Pathological examination showed a 5.5x3.7x2.3cm cystic lesion without evidence of malignancy. The tumor was diagnosed to be a cavernous hemangioma.

Chest, 2018

Follicular dendritic cell sarcoma (FDCS) was first described in 1986 by Monda et al. It is a low ... more Follicular dendritic cell sarcoma (FDCS) was first described in 1986 by Monda et al. It is a low grade or intermediate malignant neoplasm, which typically involves lymph nodes; mainly cervical nodes, but it can also involve extranodal sites, especially the liver, spleen, and lungs. FDCS generally appears as a slow growing mass; asymptomatic or painful. Paraneoplastic pemphigus associated or not with myasthenia gravis has been reported, where it can anticipate FDCS diagnosis and negatively influence the outcome. Tumors usually occur sporadically but a subset of cases are associated with Castleman disease and Epstein Barr virus. FDCS has no gender predilection, and may affect any age, although most of the cases have been reported in the middle age. CASE PRESENTATION: A 59-year-old man presented with oral ulcers characteristic of pemphigus for 5 months, so he started deflazacort and azathioprine treatment. He complained about progressive dysphagia and odynophagya, without fever or weight loss. A contrast enhanced CT images of the chest revealed a well-defined mass (5.1 x 3.3cm) in the esophagogastric junction, no compression of the trachea or esophagus, and no regional lymphadenopaties were observed. Trasnesophageal endoscopic ultrasound showed a 5 x 5 cm mass in the posterior mediastinum, furthermore fine needle aspiration biopsy showed inconclusive results. The patient underwent video-assisted thoracoscopic surgery for the complete excision of the mass. The tumor diameter was 5.2 x 5 x 4.8 cm, immunohistochemical staining results were positive for CD21, CD35, and HLA-DR and negative for CD23, CD11C, CD68, CD20, S100, and HHV8. All these findings were compatible with follicular dendritic cell sarcoma. The patient received 1 cycle of Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. A PET scan was performed 3 months after his surgery and there has been no evidence of recurrence. He actually is under surveillance and receiving treatment for pemphigus.

Chest, 2018

INTRODUCTION: Mediastinal soft tissue tumors are rare, with an estimated incidence between 2 and ... more INTRODUCTION: Mediastinal soft tissue tumors are rare, with an estimated incidence between 2 and 6% of all mediastinal neoplasms. Mediastinal hemangiomas account for 0.5% of all mediastinal tumors. Definite diagnosis is often possible only after surgical resection. We herein report the case of a posterior mediastinal hemangioma that was successfully treated using a videoassisted thoracoscopic approach. CASE PRESENTATION: A 70-year-old woman with unremarkable medical history, presented with 6-month history of progressive dysphagia, unintentional weight loss and anorexia. A computed tomography revealed a 3.6 cm diameter mass located in the posterior mediastinum, which had arterial and venous enhancement with hipodense content, suggesting necrosis and no calcifications were found. It was in contact with the lateral and posterior margin of the aorta, but preserving adequate interface. No infiltration to surrounding organs was observed.We used a left video-assisted thoracoscopic approach with segmental rib resection. We found a 5cm, rounded and highly vascularized tumor. With circumferential dissection the tumor was freed from the pericardium and pulmonary vein, clipping feeding vessels, which depended from intercostal arteries. Due to firm adhesion to the descending thoracic aorta we obtained vascular control and complete resection was successfully performed. Pathological examination showed a 5.5x3.7x2.3cm cystic lesion without evidence of malignancy. The tumor was diagnosed to be a cavernous hemangioma.