Robotic surgery has become increasingly adopted in minimally invasive thoracic procedures because of its advantages, including three-dimensional intraoperative visualization, reduced tissue trauma, and reduced intraoperative bleeding. In line with Enhanced Recovery After Surgery (ERAS) principles, drainless surgical approaches have recently gained attention as they may help reduce postoperative pain and support earlier discharge. In this case series, we describe retrospective cases of three patients who underwent drainless robotic resection of mediastinal lesions at our institution. With careful patient selection, this approach may offer several potential benefits, including reduced postoperative pain, shorter hospital stay, and faster recovery. Nevertheless, close postoperative monitoring remains essential, and the potential need for thoracic drainage should always be kept in mind.

Thymic lymphoepithelial carcinoma is a rare neoplasm in children, with histological features similar to those of nasopharyngeal carcinoma and a frequent association with the Epstein-Barr virus (EBV). Diagnosis is challenging due to clinical and imaging overlaps with lymphomas and mediastinal germ cell tumors. We present the case of a 12-year-old patient with a mediastinal mass, supraclavicular lymphadenopathy, and pulmonary metastases, histologically diagnosed as EBV-positive thymic lymphoepithelial carcinoma. He received chemotherapy with cisplatin and gemcitabine, immunotherapy with pembrolizumab, and radiation therapy, and achieved complete remission. The literature reports few pediatric cases, with a poor prognosis and a median survival of less than 24 months. However, the addition of anti-PD-1 immunotherapy in EBV-positive tumors appears to offer clinical benefit. This case highlights the importance of a multidisciplinary approach and the potential benefits of combination therapies, including immunotherapy, in EBV-positive mediastinal tumors in children.

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm, most commonly occurring in children and young adults. It is typically locally aggressive and rarely metastasizes. Adult-onset IMTs with extensive metastasis are exceedingly uncommon, particularly with large pulmonary involvement, and can mimic sarcoma or sarcomatoid carcinoma on imaging and histology. Anaplastic lymphoma kinase (ALK) positivity aids diagnosis and provides a potential therapeutic target. A 56-year-old male presented with progressively worsening dyspnea, nonproductive cough, and right-sided chest pain. Computed tomography revealed a 9-cm right hilar and upper lobe mass causing complete obstruction of the right upper lobe bronchus, with extensive mediastinal lymphadenopathy. Bronchoscopic biopsy demonstrated a malignant spindle cell neoplasm with sarcomatoid and myxoid features. Immunohistochemistry was positive for ALK-1, CD68, and vimentin, and negative for epithelial, smooth muscle, neural, and melanocytic markers (AE1/3, p40, TTF-1, CK7, CK20, CDX2, SMA, desmin, SOX10, S100, and calretinin). Staging imaging revealed a mesenteric mass adjacent to the ascending colon. Biopsy of the colonic lesion showed morphologically and immunohistochemically similar features, supporting a diagnosis of metastatic IMT confirmed by multidisciplinary pathology review. The patient's clinical course was rapidly progressive, and he died two months after initial presentation. Adult-onset ALK-positive IMT with extensive pulmonary involvement and multiorgan metastases is exceedingly rare. This case highlights the diagnostic challenges posed by sarcomatoid morphology and underscores the importance of integrating histopathology, immunohistochemistry, and clinical correlation, with ALK testing providing both diagnostic confirmation and a potential therapeutic target.

Malignant mesothelioma is an aggressive neoplasm arising from mesothelial cells, typically presenting with pleural thickening, pleural effusions, or respiratory symptoms. Dysphagia as a presenting symptom is extremely uncommon, and esophageal involvement is rare. We report a 71-year-old male with an 18-month history of progressive dysphagia and significant weight loss. Initial gastroscopy was unremarkable, but repeat endoscopy revealed a smooth lower esophageal stricture. Contrast-enhanced CT demonstrated a well-circumscribed esophageal mass with minimal pleural thickening, and PET-CT confirmed high FDG uptake in the mass and subtle anterior and posterior mediastinal pleural foci. Endoscopic ultrasound-guided fine-needle aspiration of the esophageal lesion revealed epithelioid cells positive for mesothelial markers (CK5, D2-40, WT1, Calretinin, CK7) with loss of BAP1 and MTAP, consistent with epithelioid mesothelioma. The patient was commenced on immunotherapy but lost to follow-up. This case represents an unusual manifestation of localized malignant mesothelioma presenting primarily as an esophageal mass, with minimal pleural disease. The diagnosis was established via endoscopic ultrasound-guided fine-needle aspiration, highlighting the utility of minimally invasive techniques in atypical presentations. It underscores the importance of considering mesothelioma in the differential diagnosis of unexplained esophageal or mediastinal masses, even in the absence of classic pleural findings. Mesothelioma can rarely present with dominant esophageal involvement. Awareness of this atypical presentation facilitates timely diagnosis, appropriate management, and may prevent diagnostic delays in patients presenting with dysphagia.

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We present the case of a 33-year-old female with a 4.3 × 3.2 cm high-density mass in the apical segment of the right upper lobe, detected on non-contrast chest CT, which showed suspected invasion of the chest wall and other tissues. CT-guided lung biopsy confirmed lung adenocarcinoma, and genetic testing revealed an EGFR exon 19 deletion. The patient received neoadjuvant therapy with oral Osimertinib combined with chemotherapy. After 4 months of treatment, she underwent thoracoscopic right upper lobectomy, mediastinal lymph node dissection, and pleural adhesion lysis. Postoperative management included anti-infection therapy, expectorants, nebulization, and analgesia. The patient recovered well and was discharged on postoperative day five, with good general condition at follow-up. This case illustrates that neoadjuvant targeted therapy combined with chemotherapy can convert locally unresectable lung cancer to a resectable status and improve operative feasibility, thus offering valuable insights for clinical management.

Objective: To evaluate coronary artery bypass grafting (CABG) in Jiangsu Provinc registry database from 2019 to 2024. Methods: This is a multicenter retrospective registry study. Data of the CABG registry database in Jiangsu Province from January 2019 to December 2024 were retrospectively collected. A total of 7 475 patients who underwent isolated CABG from 16 medical centers. There were 5 484 males and 1 991 females, with an age of (66.7±9.2) years (range: 23 to 92 years) and a body mass index of (24.6±3.2) kg/m[2] (range:15.5 to 39.6 kg/m[2]).Preoperative risk factors, medical history, cardiac function were analyzed (New York Heart Association classification), coronary artery disease, European Heart Surgery Risk Assessment System Ⅱ(EuroSCORE Ⅱ) score, whether CPB was used, whether arterial bridge was used, the number and flow of bridge vessels, postoperative stroke, myocardial infarction and mediastinal infection were analyzed. Independent sample t-test and χ[2] test were used to compare the differences in clinical data between patients undergoing on-pump coronary artery bypass grafting (ONCABG) and off-pump coronary artery bypass grafting (OPCAB). Results: Left main coronary artery disease was present in 2 181 cases (29.18%), three-vessel disease in 6 212 cases (83.10%), and left main coronary artery disease combined with three-vessel disease in 1 987 cases (26.58%). Left ventricular ejection fraction (LVEF)<50% was observed in 1 544 cases (20.66%), cardiac function class Ⅲ to Ⅳ in 2 654 cases (35.51%), and the EuroSCORE Ⅱ score was (M(IQR)) 1.28% (1.8%) (range: 0.8% to 39.4%). There were a total of 5 214 cases of ONCABG (69.75%) and 2 261 cases of OPCAB (30.25%). The left internal mammary artery (LIMA) was used in 6 407 cases (85.71%), with skeletonized LIMA in 2 949 cases (46.0%) and pedicled LIMA in 3 458 cases (53.9%). Sixteen centers used the radial artery as conduit material. The number of grafts per patient was 3.1±1.1 (range:1 to 7). The intraoperative cardiopulmonary bypass time was (106.0±34.9) min (range:22 to 310 min), and the aortic cross-clamp time was (76.9±26.2) min (range:20 to 205 min). There were 168 in-hospital deaths (2.25%). Reoperations in 110 cases (1.47%), including 86 cases of re-sternotomy for hemostasis and 24 cases of repeat revascularization. Perioperative complications: myocardial infarction 36 cases (0.48%), stroke 73 cases (0.98%), 274 cases of acute kidney injury after operation (3.67%), 100 cases (1.34%) of renal failure requiring dialysis 134 cases (1.79%) of mediastinal infection 6 450 cases were discharged for secondary prevention compared with OPCAB group, ONCABG group had a higher proportion of patients with smoking history, higher proportion of patients with hyperlipidemia, chronic lung disease, carotid artery stenosis, cardiac function Ⅲ to Ⅳ, history of Percutaneous Coronary Intervention higher EuroSCORE Ⅱ score, more left main trunk with three vessels disease, lower LVEF, higher proportion of intraoperative red suspension infusion; Postoperative acute kidney injury, new renal failure dialysis, secondary thoracotomy, stroke, poor incision healing, and in-hospital mortality were all increased (all P<0.05). Conclusions: CABG registry database in Jiangsu Province generally operated well from 2019 to 2024. Compared with OPCAB group, ONCABG group patients had more severe preoperative conditions, higher postoperative complications and in-hospital mortality. Overall perioperative complications in Jiangsu Province were controlled close to or better than international advanced levels.

Combined small-cell lung carcinoma is a rare and heterogeneous lung cancer characterized by the coexistence of small-cell and non-small-cell components. Concurrent epidermal growth factor receptor mutation and anaplastic lymphoma kinase rearrangement in combined small-cell lung carcinoma is extremely uncommon and presents diagnostic and therapeutic challenges. We report a 63-year-old man presenting with cough and right-sided chest pain. Imaging revealed a right lower lobe mass with mediastinal lymphadenopathy. Initial biopsy showed adenocarcinoma without actionable mutations. Following a limited response to neoadjuvant chemotherapy, right lower lobectomy was performed. Histopathological examination revealed combined small-cell carcinoma and adenocarcinoma, while molecular analysis identified concurrent epidermal growth factor receptor exon 19 deletion and anaplastic lymphoma kinase rearrangement. Lymph nodes were negative for metastasis. Postoperative targeted therapy was initiated, and follow-up imaging showed no evidence of recurrence. This case highlights tumour heterogeneity and the importance of comprehensive pathological and molecular evaluation in guiding personalized therapy.

Introduction Extranodal presentation of non-Hodgkin's lymphoma (NHL) poses a diagnostic challenge due to its diverse clinical, morphological, and pathological features. These lymphomas arise in organs other than lymph nodes. Immunohistochemistry (IHC) plays a crucial role in the confirmation and subtyping of these lesions. Objective The aim of this study was to identify different patterns of extranodal involvement in NHL and to list the common sites of involvement. Materials and methods This retrospective case series included eight cases of atypical extranodal presentations of NHL across organs diagnosed by the Department of Pathology of Sri Ramachandra Institute of Higher Education and Research, Chennai, India, between 2019 and 2025. Results The cases involved extranodal lymphomas of the cervix (Burkitt's lymphoma), stomach (B-cell lymphoma), rectum (diffuse large B-cell lymphoma (DLBCL)), paratesticular mass (B-cell lymphoma), ileum (T-cell lymphoma), mediastinum (DLBCL), soft tissue of the thumb (mantle cell lymphoma), and breast (B-cell lymphoma). Each case demonstrated distinct clinicopathological features, emphasizing the need for different diagnoses and treatment approaches. Conclusion This case series highlights eight cases of NHL from various organs. Awareness of such atypical presentations is essential for early diagnosis and management.

Late saphenous vein graft (SVG) pseudoaneurysm is a rare but life-threatening complication of coronary artery bypass graft surgery. An 80-year-old man presented with dyspnea and chest pain two decades after CABG (LIMA-LAD, SVG-RCA). Coronary angiography revealed SVG occlusion with contrast extravasation and mass formation adjacent to the right heart chambers. CT angiography confirmed a 39 mm mediastinal pseudoaneurysm from proximal SVG rupture, compressing the right heart chambers and lung, with consequent left ventricular dysfunction (EF 45%), elevated pulmonary pressures, and orthostatic hypotension. Following Heart Team discussion, the patient underwent successful pseudoaneurysm resection with right coronary artery revascularization using a left radial artery graft. Symptoms and cardiac function improved at one-month follow-up. This case highlights the importance of clinical suspicion for SVG pseudoaneurysm in patients with prior CABG, and the central role of CT angiography and multidisciplinary decision-making in management.