Germ cell tumors (GCTs) represent a well-recognized group of heterogeneous neoplasms with diverse clinical, histopathological, diagnostic, and prognostic characteristics. We present a rare case of a locally aggressive, chemotherapy-resistant immature mediastinal teratoma with a peculiar histological finding of a multilineage somatic-type malignant degeneration. A 21-year-old male patient presented with a 3-week history of persistent, blood-tinged productive cough and shortness of breath. A contrast-enhanced computed tomography (CT) scan of the chest showed a heterogeneous mass occupying the right hemithorax and abutting on adjacent structures. CT-guided biopsy was consistent with immature teratoma. Combination chemotherapy with bleomycin, etoposide, and cisplatin was initiated, albeit without success; the mass showed interval progression in size, and surgical resection through clamshell incision was performed. Histological assessment of the resected mass confirmed the diagnosis of immature teratoma and revealed an extensive multilineage malignant differentiation into sarcomatous, carcinomatous, and melanomatous components. The patient underwent an uneventful recovery but presented 2 months later with extensive liver and bone melanomatous metastases. In this report, relevant findings from the literature are also highlighted. Despite being exceptionally rare, such tumors carry poor prognosis. Understanding the clinicopathological characteristics and biological behavior of such tumors may provide an insight into interventions tailored to improve the otherwise dismal disease outlook.

Pulmonary hydatid cysts are recognized to have high rate of rupture compared to those in other affected organs. To identify risk factors associated with endobronchial rupture, we prospectively assessed 32 patients with hydatid cysts. There were 21 males and 11 females, with a mean age of 32 ± 15 years (range 9 to 65 years). All patients undergoing thoracotomies for hydatid cysts were included. Demographic data, site, size, and whether cysts were ruptured or intact, were reviewed. Intraoperatively, bronchial fistula diameters were measured. A stepwise multiple logistic regression model was used to analyze the results. Seventeen (53.1%) patients presented with ruptured cysts (group 1) and 15 with intact cysts (group 2). There was a significant difference in mean fistula diameter between groups: 6.16 ± 2 mm in group 1 vs. 0.34 ± 0.19 mm in group 2 (p ≤ 0.0001), which was identified as the only significant risk factor associated with cyst rupture. At the fistula site, the intracystic pressure is unopposed, leading to herniation of the endocyst membrane, disruption of its integrity, and rupture. Therefore, we postulate that this scenario in combination with other coexisting factors could be the possible mechanism for cyst rupture in group 1. This concept may also explain the pathogenesis of the high rate of rupture of pulmonary hydatid cysts. Accordingly, we consider these cysts a naturally occurring model for rupture, which should be treated surgically as soon as the diagnosis is made, to avoid complications.

Minimal invasive thoracic surgery is growing rapidly and may become the standard of care for certain diseases. Its benefits over traditional surgery, including reduced morbidities and hospital stay, have been well established in several reports. We herein report a case of midesophageal leiomyoma in a patient with MEN I syndrome successfully enucleated by thoracoscopy highlighting the technical details of the procedure.

Background: Transplanting lungs from donors with positive blood cultures has not been shown to adversely affect survival. There is limited evidence for potential effects on other outcomes, such as hospital course, graft function, and transmission of infection.Methods: This retrospective cohort study included adult patients who underwent lung‐only transplantation for the first time between March 2010 and December 2022. Outcomes of patients whose donors had positive blood cultures within 72 h of transplant were compared to patients whose donors had negative blood cultures.Results: Twenty‐five (10.8%) of 232 donors had positive blood cultures, including a single, unexpected case with candidemia. The most commonly isolated bacteria were Enterobacter cloacae (n = 5), Klebsiella pneumoniae (n = 5), Acinetobacter baumannii (n = 3), Pseudomonas aeruginosa (n = 3), and Staphylococcus aureus (n = 3). Eleven donors had identical bacteria in their respiratory cultures. All patients who were transplanted from donors with positive blood cultures survived beyond 90 days. Positive donor blood cultures were not associated with longer hospital stay, in‐hospital complications, acute cellular rejection, or the achievement of 80% predicted forced expiratory volume in the first second. Probable transmission of donor bacteremia occurred in only two cases (both with S. aureus). These two donors had positive respiratory cultures with the same organism.Conclusion: The study did not find an increased risk of adverse events when transplanting lungs from donors with positive blood cultures. Allograft cultures may be more predictive of the risk of transmitting infections. image