[A NEW ALKALOID FOR THE TREATMENT OF MALIGNANT LYMPHOGRANULOMA].
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The incidence of mediastinal tumors is increasing throughout North America. The benign variants are usually managed by relatively simple surgical procedures. Malignant mediastinal tumors can be among the most challenging of medical and surgical conditions and may require the expertise of medical, radiation, and surgical oncologists. Thymomas, germ-cell tumors, and lymphomas comprise the majority of the malignant mediastinal neoplasms. Some variants are managed entirely medically while others are extirpated initially. Many require multimodality therapies, either according to an accepted protocol or, more challengingly, off protocol.
A review of the clinical records from 1947 to 1984 of the Istituto Nazionale Tumori of Milan provided 20 cases (14 males and 6 females) of esophageal leiomyoma. Eighteen of the tumors were in the thoracic esophagus and 2 were at the cardiac level. The most frequent symptoms were dysphagia, slight epigastralgia and odynophagia. Differential diagnosis should be made with mediastinic neoplasms and esophageal cancer. Barium swallow and esophagoscopy are the most sensitive procedures for a correct preoperative diagnosis. Surgery is mandatory because of the tendency to a continuous endoluminal growth (in 97% of the cases) and a possible malignant transformation. However, surgery is conservative: extramucosal enucleation of the leiomyoma is the procedure of choice. The long-term results are excellent, and morbidity is acceptable.
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