Eosinophilic granuloma (EG) is the unifocal osseous form of Langerhans cell histiocytosis (LCH), which usually affects the skull and long bones. Although it most commonly affects the pediatric age group, it can rarely be seen in adults. Skeletal involvement is common in adult patients, but isolated rib involvement is extremely rare. Differential diagnosis includes other osteolytic lesions such as Ewing’s sarcoma, tuberculosis, multiple myeloma, lymphoma, and primary bone malignancy. The diagnosis must be confirmed histopathologically. In addition to pathological Langerhans cells, inflammatory cells such as lymphocytes, eosinophils, and macrophages are observed in microscopy. Immunohistochemically, CD1a, S-100, and Langerin positivity are observed in biopsy and/or surgical excision material. Treatment options may vary depending on the localization and extent of the disease. In unifocal EG, close observation of the patient may be preferred, as well as surgical excision, radiotherapy, and intra-lesional steroid administration. The prognosis in patients with a single bone lesion is quite good compared to other groups. In this case report, we present a metachronous EG of rib developed in two different ribs by an interval of seven years, which were both surgically treated. In this mild variant of LCH, surgical resection with clean margins has a favorable outcome without the need for additional adjuvant therapy. Metachronous tumors may develop in isolated unifocal bone EGs, and long-term follow-up is mandatory.

Tension gastrothorax is a very rare but potentially fatal clinical condition in which the stomach that herniates through a diaphragmatic defect into the thorax is massively distended by trapped air. It leads to severe symptoms due to the compression of the lung and mediastinum. A 27-year-old female, who had no prior trauma history, applied to the emergency service with the complaint of respiratory disorder, and was consulted by the department of thoracic surgery. Thorax CT revealed presence of gastrothorax in the left hemithorax. Thus, the patient went into cardiopulmonary arrest and was resuscitated. Emergency thoracotomy was performed, abdominal organs were reduced and diaphragmatic defect was repaired. She was discharged on the fifth postoperative day without any complications.

Background and Objective The posterior mediastinum is a potential space along the paravertebral sulci or between the posterior aspect of the pericardium and the vertebrae. This compartment is classically the most frequent location site of neurogenic tumors. Whereas neurofibroma and schwannoma are neurogenic tumors that commonly arise from peripheral nerves, sympathetic nerves are the origin of ganglioneuroma, neuroblastoma, ganglioneuroblastoma, and neuroectodermal cells closely associated with autonomic nerves are the origin of paragangliomas and pheochromocytomas. Additionally, tumors from the esophagus, tumors of mesenchymal origin, lymphoma, ectopic goiter, and diseases with lymph node hyperplasia may also settle on this compartment. The objectives are to identify term “giant posterior mediastinal tumor” and the etiology, clinical features, diagnostic methods, pathological types, surgical methods applied, and technical details of these methods for the treatment of these tumors. Methods In this review, the term “giant tumor” was used to define tumors larger than 10 cm settled in the posterior mediastinum. PubMed database was searched with keywords “posterior mediastinum, giant mass” or “posterior mediastinum, tumor, giant” limited to English language and full-text available studies published between years 1984–2021. Key Content and Findings As a result of the literature review with the relevant terms, 23 case reports were found in accordance with the inclusion criteria. We detected the most common giant posterior mediastinum tumors were neurogenic origin (schwannoma, ganglioneuroma, ganglioneuroblastoma, triton tumor) in that review. The most common surgical approach was posterolateral thoracotomy. Treatment response to surgical total excision was good in most of cases. Conclusions The definitive diagnosis and treatment of giant posterior mediastinal tumors is made by surgical excision. Diagnostic procedures and subsequent surgical planning may vary depending on the origin and localization. Adjuvant treatment and follow-up should be conducted on the histopathological features.

Uzun süreli schwannomda anjiosarkom gelişimi oldukça nadir olup İngilizce literatürde sadece birkaç olgu bildirilmiştir. Vagus, siyatik sinir veya adrenal sinir kökenli tümörlerin yanı sıra boyun, ayak ve böbrekte gelişen tümörler de tanımlanmıştır. Bildiğimiz kadarıyla, bu yazıda, 53 yaşında bir kadın hastada uzun süreli schwnannomda gelişen ilk mediastinal olgu sunuldu. Hasta ciddi solunum güçlüğü ve çarpıntı ile kliniğimize başvurdu. Tıbbi öyküsünde ilk olarak 2002'de tanı konulan, progresif, sağ taraflı bir paramediastinal kitle olduğu görüldü. 2002, 2015 ve 2016'da uygulanan üç transtorasik iğne biyopsisi tanısal değil idi. 2002'den beri ameliyat önerilmekte, fakat hasta kabul etmemekte idi. Toraks bilgisayarlı tomografi ve manyetik rezonans görüntülemede sağ hemitoraksı neredeyse tamamen dolduran büyük bir mediastinal kitle izlendi. Son transtorasik biyopsi ile "malign iğsi hücreli tümör" tanısı konuldu ve posterolateral torakotomi yoluyla total cerrahi rezeksiyon uygulandı. Tümör mikroskopik olarak iki bileşenden oluşmakta idi: benign schwannom ve epitelioid anjiosarkom. Endotelyal ve nöral hücre farklılaşmaları immünhistokimyasal olarak teyit edildi.

Background The use of anesthetics and analgesic drugs and techniques in combination yields a multimodal effect with increased efficiency. In this case series, we aimed to evaluate the anesthetic effect of the thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) combination in patients, who underwent non-intubated video-assisted thoracoscopic surgery (NIVATS). Methods Medical records of 16 patients, who underwent NIVATS for wedge resection under the combination of ESPB and TPVB were reviewed retrospectively. Demographic data of patients, duration of the sensory block, amount of the anesthetic agent used for premedication and sedo-analgesia, any presence of perioperative cough, operative times, postoperative visual analog scale (VAS) scores in the postoperative follow-up period, the need for additional analgesia, and patient satisfaction were reviewed. Results Of the patients included in the study, 12 were men and 4 were women. The mean age was 48.6 years and the mean BMI was 24.7 kg/m2. The mean time needed for the achievement of the sensorial block was 14 min and the mean skin-to-skin operative time was 21.4 min. During the procedure, patients received 81.5 ± 27.7 mg of propofol and 30 ± 13.6 micrograms of remifentanil infusions, respectively. The mean dose of ketamine administered in total was 58.1 ± 12.2 mg. Only 2 patients needed an extra dose of remifentanil because of recurrent cough. No patients developed postoperative nausea vomiting. During the first 24 h, the VAS static scores of the patients were 3 and below, while VAS dynamic scores were 4 and below. Morphine consumption in the first postoperative 24 h was 13.2 mg. Conclusions In conclusion, combined ESPB and TPVB with added intravenous sedo-analgesia in the presence of good cooperation between the surgical team and the anesthesiologist in the perioperative period can provide optimal surgical conditions including the prevention of cough in NIVATS. It is not sufficient to state that this combination is superior to alone ESPB or alone TPVB, as it is a preliminary study with a limited number of cases.