Fluid overload-associated large B-cell lymphoma (FO-LBCL) is a new entity described in the fifth edition of the World Health Organization (WHO) Classification of Hematolymphoid Tumors (WHO-HAEM5). It refers to malignant lymphoma present with symptoms of serous effusions in body cavities (pleural, peritoneal, and/or pericardial) in the absence of an identifiable tumor mass. We present a case of an 82-year-old man with a history of atrial fibrillation and atrial flutter, status post-ablation, essential hypertension (HTN), hyperlipidemia (HLD), and diabetes mellitus (DM) type 2 who was referred to our hospital for shortness of breath due to recurrent pleural effusion. Right video-assisted thoracoscopy with right pleural biopsy was performed. Histopathological examination of the pleural biopsy revealed dense fibrous tissue, chronic inflammation, lymphoid aggregates, and granulation tissue, with no evidence of lymphoma. Cytology of the right pleural fluid revealed large lymphoid cells, which were positive for CD45, CD20, PAX-5, MUM-1, BCL2, BCL6, and MYC protein. They were negative for CD3, CD10, CD138, and HHV-8 by immunohistochemistry (IHC). Epstein–Barr virus (EBV) was negative by in situ hybridization (ISH). Due to the absence of any evidence of lymphoma elsewhere, a diagnosis of fluid overload-associated large B-cell lymphoma (FO-LBCL) was made. We provide a synopsis of the main clinicopathological features of FO-LBCL and the two main differential diagnoses, primary effusion lymphoma (PEL) and diffuse large B-cell lymphoma (DLBCL).

Background: Hiatal hernias are common and often require surgical intervention, particularly in symptomatic patients. Minimally invasive approaches, including laparoscopic and robotic techniques have shown superiority over open surgery. However, data on evolving institutional practices and outcomes remain limited. This study aims to describe perioperative outcomes and evolving surgical practices in patients undergoing minimally invasive hiatal hernia repair (HHR) at a single institution between 2018 and 2024. Methods: A retrospective, chart-based review was conducted on patients who underwent minimally invasive HHR between 2018 and 2024 by a single surgeon at Mount Sinai Medical Center in Miami Beach, Florida. Patient demographics, operative details, and perioperative outcomes—including operative time, length of stay (LOS), readmission rates, complications, and symptom resolution were analyzed. Trends in surgical approach and technique over time were also assessed. Results: The cohort had a mean age of 69 years and a mean body mass index (BMI) of 26.6 kg/m². Most patients underwent elective repair (86%, n=95) and the robotic platform was utilized in 82% (n=91) of cases, reflecting a growing institutional preference over time. The overall mean operative time was 194 minutes, with a downward trend as robotic proficiency increased. Median hospital stay was two days and 83% (n=84) of patients reported complete symptom resolution at 6-month follow-up. Readmission occurred in 10% (n=11) of cases, with no conversions to open surgery or perioperative mortality. Mesh reinforcement was used selectively in only one patient. Conclusions: Minimally invasive HHR is safe and effective, with low complication rates and high rates of symptom resolution. This study highlights a successful institutional transition toward robotic HHR with improvements in operative efficiency and LOS over time.

Duplication cysts are rare congenital anomalies that can occur anywhere along the alimentary tract. Esophageal duplication cysts are intramural lesions that constitute between 0.5% and 2.5% of all esophageal masses. These lesions, when symptomatic, are usually diagnosed in children. Their size and location dictate the clinical presentation. With the increased use of diagnostic imaging, asymptomatic lesions are often times incidentally discovered. They have a characteristic appearance on computed tomography (CT) scans and the diagnosis can be supported with the use of esophagoscopy, endoscopic ultrasound, and an esophagram. Definitive treatment for esophageal duplication cysts is surgical excision. Open surgery has been widely replaced by minimally invasive techniques for the management of benign foregut disease. Both laparoscopy and thoracoscopy have demonstrated to be safe and effective in the excision of esophageal duplication cysts. Recently, the advantages offered by robotic-assisted surgery have gained more attention. The improved ergonomics, visualization and dexterity offered by the robotic platform is of particular interest in esophageal surgery where a precise and meticulous dissection is required. This can be applied to surgery both in the thoracic cavity as well as in the abdomen. Whether a trans-thoracic or trans-abdominal approach is taken, robotic-assisted surgery can be used in the surgical excision of esophageal duplication cysts.

Video 1 Robotic-assisted excision of an infected duplication cyst of the esophagus with gastropexy. Authors: Jessica E. Wahi, Navid Ajabshir, Fernando M. Safdie

Background: Diaphragmatic paralysis is a recognized cause of dyspnea, with surgical plication being the treatment of choice for patients for symptomatic patients. This operation can be approached via transthoracic or trans-abdominal methods and has traditionally been performed in an open fashion. However, minimally invasive techniques, including robotic-assisted approaches, are increasingly favored. The aim of this study was to assess the short-term outcomes of robotic-assisted diaphragmatic plication performed via trans-abdominal and trans-thoracic approaches for patients suffering from diaphragmatic paralysis. Methods: We conducted a retrospective review of 29 patients who underwent robotic-assisted diaphragmatic plication at Mount Sinai Medical Center from 2019 to 2023. In cases where diaphragmatic paralysis was suspected, diagnostic imaging was performed, including chest radiography (CXR), chest computed tomography (CT) and sniff testing. All patients also underwent pulmonary function testing to document lung volumes and diffusing capacity for carbon monoxide. Symptomatic patients with an elevated hemidiaphragm and confirmed diaphragmatic paralysis or paradoxical movement on sniff testing were evaluated for diaphragmatic plication. The primary outcome measure was patient-reported improvement in dyspnea post-operatively. Secondary outcomes included diaphragmatic caudal displacement, hospital length of stay, operative time and intraoperative complications. Patients were approached trans-thoracically (55%) or trans-abdominally (45%) based on prior surgical history and operating surgeon’s discretion. Follow-up assessments were conducted at 2 weeks and 6 months post-surgery utilizing both subjective patient reports and objective radiographic measurements. Results: Results indicated no intraoperative complications or conversions to open surgery. The mean hospital length of stay was 3 days. At the 2-week and 6-month follow-ups, 96% and 94% of patients, respectively, reported improvements in respiratory symptoms. The mean caudal displacement of the diaphragm was 7.3±2.9 cm, with no significant difference in operative time (P=0.56) or diaphragmatic displacement (P=0.55) between the two groups. Conclusions: These findings support diaphragmatic plication is a safe and feasible procedure with encouraging early postoperative outcomes. Both trans-thoracic and trans-abdominal approaches are viable and appeared equally effective in our cohort, providing flexibility in surgical planning based on individual patient factors.