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to dr heinrik

Hi,
the case invovles a mass found away from the heart. Would it be best to do a biopsy and a mediastinoscopy at the same time? would a CT scan suffice or a PET scan?
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Avatar_m_tn
Hi,

IF the mass in question is in the periphery, metastasis to the nodes generally appears in the hilum (the space between the lobes of a lung) before it moves to the middle area near the heart. For these cases, the odds of finding cancer in the central area (near the heart) would be small, and so verification with a scan may be sufficient. Of course, if the finding on the imaging suggests that there might be disease in the lung, then the situation changes, and a biopsy may then become suggestive. Stay positive
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Avatar_m_tn
the biopsy may be suggested I mean
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Avatar_n_tn
is it possible that the lesion in the periphery doesn't really come from the lung but from the muscles of the chest or the bone?
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Avatar_n_tn
do you mean the medistinoscopy is not necessary? Is the imaging therefore enough? who then should undergo a mediastinoscopy?
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Avatar_m_tn
Hi,

Patients who have more advanced disease tend to have nodes in the mediastinum. On imaging, if this appears positive, it does not always represent cancer. So, if this patient is a surgical candidate, the finding of a positive scan needs to be verified with a mediastinoscopy in order to make sure that a potentially curative option is not eliminated based on the scan. Stay positive.
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Avatar_m_tn
On the source being outside the lung:

Yes, it is possible. Bone cancers tend to go to the lung, but these rarely involve ribs as primaries. Primary muscle cancers are also very rare. The lining of the lung (pleura) may also get a cancer called mesothelioma – but this usually spreads locally so there would be more cancer seen on the scan. Finally, it may also be a metastatic cancer – but this usually presents with multiple nodules.
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