What percentages of chest wall masses are malignant?
Patients with chest wall tumors, regardless of etiology, typically complain of a slowly enlarging palpable mass (50-70%), chest wall pain (25-50%), or both. Interestingly, growing masses are often not noticed by the patient until they suffer a trauma to the area. Pain from a chest wall mass is typically localized to the area of the tumor; it occurs more often and more intensely with malignant tumors, but it can also be present in up to one-third of patients with benign tumors. With Ewing sarcoma, fever and malaise may also be present. Benign chest wall tumors tend to occur in younger patients (average age 26 years), whereas malignant tumors tend to be found in older patients (average age 40 years). Overall, between 50 and 80% of chest wall tumors are malignant.
The population most at risk for developing active tuberculosis is:
Tuberculosis is a widespread problem that affects nearly onethird of the world's population. Between 8.3 and 9 million new cases of tuberculosis and 12 million prevalent cases (range 10-13 million) were estimated worldwide in 2011 according to the World Health Organization. Only 10,52 1 new cases were reported to the World Health Organization in the United States in 2011. Human immunodeficiency virus (HIV) infection is the strongest risk factor for developing active tuberculosis. The elderly, minorities, and recent immigrants are the most common populations to have clinical manifestations of infection, yet no age group, sex, or race is exempt from infection. In most large urban centers, reported cases of tuberculosis are more numerous among the homeless, prisoners, and drug-addicted populations. Immunocompromised patients additionally contribute to an increased incidence of tuberculosis infection, often developing unusual systemic as well as pulmonary manifestations.
The fungi associated with the highest mortality rate due to invasive mycoses in the United States is:
The genus Aspergillus comprises over 150 species and is the most common cause of mortality due to invasive mycoses in the United States. It is typically acute in onset and life threatening and occurs in the setting of neutropenia, chronic steroid therapy, or cytotoxic chemotherapy. It can also occur in the general intensive care unit population of critically ill patients, including patients with underlying chronic obstructive pulmonary disease (COPD), postoperative patients, patients with cirrhosis or alcoholism, and postinfluenza patients, without any of these factors present. The species most commonly responsible for clinical disease include A. fumigatus, A. flavus, A. niger, and A. terreus. Aspergillus is a saprophytic, filamentous fungus with septate hyphae. Spores (2.5-3 flm in diameter) are released and easily inhaled by susceptible patients; because the spores are microns in size, they are able to reach the distal bronchi and alveoli.
A patient presenting with a history and findings of dyspnea, wheezing, hemoptysis, and a mediastinal mass in the visceral compartment yields a diagnosis of :
Signs and symptoms suggestive of various diagnoses in the setting of a mediastinal mass:
A patient with an anterior mediastinal mass and elevated serum a-fetoprotein (AFP) most likely has:
The use of serum markers to evaluate a mediastinal mass can be invaluable in some patients. For example, nonseminomatous and seminomatous germ-cell tumors can frequently be diagnosed and often distinguished from one another by the levels of a-fetoprotein (AFP) and human chorionic gonadotropin (hCG). In over 90% of nonseminomatous germ-cell tumors, either the AFP or the hCG level will be elevated. Results are close to 100% specific if the level of either AFP or hCG is greater than 500 ng/mL. Some centers institute chemotherapy based on this result alone, without biopsy confirmation of the diagnosis. In contrast, the AFP level in patients with mediastinal seminoma is always normal; only 10% will have elevated hCG, which is usually less than 100 ng/mL. Other serum markers, such as intact parathyroid hormone level for ectopic parathyroid adenomas, may be useful for diagnosing and also for intraoperatively confirming complete resection. After successful resection of a parathyroid adenoma, this hormone level should rapidly normalize.
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