Does ischemia-modified albumin level predict severity of obstructive sleep apnea?

OBJECTIVE AND AIM: Ischemia-modified albumin (IMA) is a newly recognized marker of chronic inflammation used to evaluate oxidative stress status in patients with various diseases. We explored the possible relationship between IMA levels and obstructive sleep apnea (OSA). METHODS: In this retrospective study, 169 of 216 sequential patients being evaluated for suspicion of OSAS met inclusion criteria. Polysomnography confirmed OSA in 86 patients (51%) while 81 patients (49%) without OSA were categorized as control subjects. All study participants were tested for blood IMA level, neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP) level, and red blood cell distribution width (RDW). RESULTS: The serum IMA level was significantly higher in patients with OSAS than controls (p = 0.008). The serum IMA level increased significantly as OSAS severity increased (r = 0.50, p < 0.001) and was positively correlated with the AHI (r = 0.41, p < 0.001), CRP level (r = 0.31, p = 0.004), body mass index (r = 0.24, p = 0.022), RDW (r = 0.31, p = 0.03), oxygen desaturation index (ODI) (r = 0.22, p = 0.02), and negatively correlated with the hemoglobin concentration (r = - 0.28, p = 0.04) and minimum hemoglobin oxygen saturation (SpO2) (r = - 0.25, p = 0.02). Receiver operator curve (ROC) analysis showed that the optimal serum IMA, CRP, RDW, and NLR values were not different for predicting OSAS diagnosis (areas under the curves (AUC) = 0.62, 0.59, 0.60, and 0.43, respectively). However, the serum IMA level was superior in reflecting OSAS severity (AUC = 0.78) compared to CRP, RDW, and NLR values (AUC = 0.61, 0.53, and 0.51, respectively) (all p < 0.001). CONCLUSION: Like other markers of inflammation, blood IMA levels were significantly elevated in patients with OSA. However, blood IMA level was a better predictor of disease severity than the other markers.

Bronchial Stump Recurrence after Complete Resection of Lung Cancer: Effect of the Distance between the Tumor and Bronchial Resection Margin.

PURPOSE: The purpose of this study was to evaluate the following parameters after complete resection in established lung cancer patients: the frequency of bronchial stump recurrence (BSR), the effect of the distance between the tumor and bronchial resection margin (DBTM) on BSR, the survival of patients with BSR, and the effect of the DBTM on survival. PATIENTS AND METHODS: We retrospectively evaluated 553 consecutive lung cancer patients who underwent complete lung resection. The patients were classified as DBTM: ≤ 10 mm (group 1), 11 to 20 mm (group 2), and > 20 mm (group 3). RESULTS: We found BSR in eight (1.5%) patients. Six patients were in group 1, and two were in group 2. The difference was found to be statistically significant (p = 0004; groups 1 vs. 3). In multivariable analysis, we observed a trend toward significance for the effect of a DBTM on BSR development (p = 0.1). The DBTM did not significantly affect survival (p = 0.61). The survival of patients who developed BSR was significantly poor compared with those who did not develop BSR (p = 0.001). CONCLUSION: BSR can develop even after complete resection of lung cancer. The DBTM is associated with BSR risk, and the survival of patients who develop BSR is poor.

Squamous cell carcinomas confined to the bronchial wall: the effect of growth patterns.

BACKGROUND: Squamous cell carcinomas confined to the bronchial wall (SCC-CBW) exhibit two distinct patterns of growth: superficially spreading and endobronchial mass lesions. We examined whether differences exist in the histopathological features and prognosis of SCC-CBW exhibiting different growth patterns. MATERIALS AND METHODS: In this study, 37 cases with SCC-CBW were included. Tumors were classified into two groups: superficially spreading squamous cell carcinoma (s-SCC) and nodular squamous cell carcinoma (n-SCC). For each case, the growth pattern, T and N status, lymphovascular and perineural invasions, immunohistochemical expressions of p53 and Ki-67, and survival rates were analyzed. RESULTS: Twenty cases were classified as s-SCC, and 17 cases were classified as n-SCC. There was a significant relationship and correlation between the length of s-SCC in the longitudinal axis and the depth of invasion (p = 0.01, R = 0.557). There was a statistically significant positive relationship between the depth of invasion and the nodal status (N1 involvement) (p < 0.0001, R = 0.71). CONCLUSIONS: SCC-CBW exhibits variable growth patterns. However, despite this variability, there are no biological or histological differences between tumors of different growth patterns, and this variability has very little, if any, effect on survival.

LUNGBANK: a novel biorepository strategy tailored for comprehensive multiomics analysis and P-medicine applications in lung cancer.

Background/aim: LUNGBANK was established as part of Project LUNGMARK, pioneering a biorepository dedicated exclusively to lung cancer research. It employs cutting-edge technologies to streamline the handling of biospecimens, ensuring the acquisition of high-quality samples. This infrastructure is fortified with robust data management capabilities, enabling seamless integration of diverse datasets. LUNGBANK functions not merely as a repository but as a sophisticated platform crucial for advancing lung cancer research, poised to facilitate significant discoveries. Materials and methods: LUNGBANK was meticulously designed to optimize every stage of biospecimen handling, from collection and storage to processing. Rigorous standard operating procedures and stringent quality control measures guarantee the integrity of collected biospecimens. Advanced data management protocols facilitate the efficient integration and analysis of various datasets, enhancing the depth and breadth of research possibilities in lung cancer. Results: LUNGBANK has amassed a comprehensive collection of biospecimens essential for unraveling the intricate molecular mechanisms of lung cancer. The integration of state-of-the-art technologies ensures the acquisition of top-tier data, fostering breakthroughs in translational and histological research. Moreover, the establishment of patient-derived systems by LUNGBANK underscores its pivotal role in personalized medicine approaches. Conclusion: The establishment of LUNGBANK marks a significant milestone in addressing the critical challenges of lung cancer research. By providing researchers with high-quality biospecimens and advanced research tools, LUNGBANK not only supports Project LUNGMARK's objectives but also contributes extensively to the broader landscape of personalized medicine. It promises to enhance our understanding of lung cancer initiation, progression, and therapeutic interventions tailored to individual patient needs, thereby advancing the field towards more effective diagnostic and therapeutic strategies.

Ultrasonographic Applications in the Thorax.

Rapid developments and increasing technological knowledge have changed perspectives on ultrasonography. Previously, ultrasonography was used to evaluate chest wall pathologies, to distinguish between pleural effusion and consolidation, to evacuate pleural effusion, or to evaluate diaphragm movement. Today, it is also used in a wide range of pleural and parenchymal diseases. Ultrasonography is not just used in the emergency department and the intensive care units, it is also utilized in many clinical branches dealing with the respiratory system-due to its ease of use, fast access, price advantage, non-radiation exposure, higher diagnostic sensitivity, and specificity in many clinical situations-and has become a part of the examination. In this review, we have assessed not just transthoracic ultrasonography but also more focal and targeted sonographic applications, such as the endobronchial ultrasound and esophageal ultrasound.

The IL-25/ILC2 axis promotes lung cancer with a concomitant accumulation of immune-suppressive cells in tumors in humans and mice.

Background: Group 2 innate lymphoid cells (ILC2) can be activated by interleukin (IL)-33 or IL-25. IL-25-activated ILC2 cells help protect the host against helminth infection while exacerbating allergic-like inflammation and tissue damage in the lung. In the context of cancer, IL-33-activated ILC2 cells were found to bear anti-tumoral functions in lung cancer while IL-25-activated ILC2 cells promoted tumorigenesis in colorectal cancer. The role of IL-25-activated ILC2 cells in lung cancer remains to be addressed. Methods: We examined the overall survival of human non-small cell lung cancer (NSCLC) patients according to IL25 expression as well as the distribution of ILC2 cells and regulatory T cells (Tregs) in various NSCLC patient tissues and peripheral blood (PB) of healthy donors (HDs). We analyzed the effect of adoptive transfer of IL-25-activated ILC2 cells on tumor growth, metastasis and survival in a heterotopic murine model of lung cancer. Results: We report that human NSCLC patients with high IL-25 expression have reduced overall survival. Moreover, NSCLC patients bear increased frequencies of ILC2s compared to HDs. Frequencies of Tregs were also increased in NSCLC patients, concomitantly with ILC2s. In mice bearing heterotopic lung cancer, adoptive transfer of IL-25-activated ILC2s led to increased tumor growth, increased metastasis and reduced survival. The frequencies of monocytic myeloid-derived suppressor cells (M-MDSCs) were found to be increased in the tumors of mice that received ILC2s as compared to controls. Conclusion: Overall, our results indicate that the IL-25/ILC2 axis promotes lung cancer potentially by recruiting immune-suppressive cells to the tumors both in humans and in mice, and that it may therefore represent a suitable novel target for NSCLC immunotherapeutic development.

Primary pulmonary non-Hodgkin's lymphoma: ten cases with a review of the literature.

INTRODUCTION: Primary pulmonary non-Hodgkin's lymphoma (PPNHL) of the lung occurs very rarely. To clarify clinical features, treatment alternatives and outcomes, we evaluated our surgically diagnosed PPNHL cases. MATERIALS AND METHODS: A retrospective review of PPNHL cases from January 2004 to December 2009 was performed. Demographic and clinical data are presented as means or medians. Overall survival was estimated using the Kaplan-Meier method. Survival rates were compared using the log-rank test. A p value < 0.05 was considered significant. RESULTS: Patients were eight males and two females with a median age of 50 years (range, 29-76 years). In 40% of the patients, antigenic stimulation, immune-suppression or auto-immune disease could not been found. All patients were symptomatic at presentation. Surgical procedures were needed to obtain a diagnosis (nine wedge resections and one pneumonectomy). Eight patients had an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), and two had diffuse large B-cell lymphomas. The patients were treated with observation (pneumonectomy case), chemotherapy (n= 7), and chemotherapy and radiotherapy (n= 1). Five-year survival was 76%. Difference in survival rates of patients with bilateral vs. unilateral disease were not statistically different. CONCLUSIONS: On contrary of the literature, PPNHL can occur with absence of antigenic stimulation, and patients generally have some symptoms. Chemotherapy or surgery can be used to treat PPNHL. Patient survival is good.

Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause?

Aims: We investigated the histopathological features of solitary pulmonary necrotic nodules (NNs) of undetermined cause. We combined our findings with those obtained using other methods to determine how well the etiological factors were explained. Methods: We screened patients who underwent surgery to treat solitary pulmonary granulomatous and nongranulomatous NNs of undetermined cause. The NN sizes and features of both the NNs and adjacent parenchyma were evaluated. Histochemical analyses included Ehrlich-Ziehl-Neelsen (EZN), Grocott, and Gram staining. Polymerase chain reaction (PCR) was used to detect tuberculous and nontuberculous mycobacteria, panfungal DNA, Nocardia, Francisella tularensis types A and B, and actinomycetes. Results: The NNs were granulomatous in 78.9% and nongranulomatous in 21% of the 114 patients included. EZN staining or PCR was positive for Mycobacterium in 53.5% of all NNs: 62.2% of granulomatous and 20.8% of nongranulomatous NNs. We found a weak but significant correlation between granulomatous NNs and Bacillus positivity and a significant correlation between granulomas surrounding the NNs and the presence of multiple necroses. The NN etiology was determined via histopathological, histochemical, and PCR analyses in 57% of patients but remained undetermined in 42.9%. Conclusion: The causes of both granulomatous and nongranulomatous NNs can be determined by pathological examination. Granulomatous necrosis and granulomas in the adjacent parenchyma are important for differential diagnosis. When both features are present, they strongly support a diagnosis of tuberculosis, even in the absence of bacilli.

Role of positron emission tomography in mediastinal lymphatic staging of non-small cell lung cancer.

OBJECTIVE: Positron emission tomography (PET) is used increasingly in staging of non-small cell lung cancer (NSCLC) as a non-invasive tool. The role of the PET in mediastinal lymphatic staging of NSCLC is not clear. We aimed to demonstrate the efficacy of PET in determining mediastinal lymphatic metastasis by comparing the results of PET with mediastinoscopy. PATIENTS AND METHODS: We performed PET preoperatively in 170 patients with clinically operable NSCLC between 2004 and 2006. Stations defined as metastasis by PET (SUV(max) >2.5) were recorded. Mediastinoscopy was performed initially in all patients and a total of 687 stations which can be reached with mediastinoscope were sampled (mean 4.04). Forty-three patients with mediastinal metastasis were referred to the oncology clinic for chemotherapy while lung resection and complete mediastinal lymphatic dissection through thoracotomy was performed in the remaining 127 patients. Involvement of mediastinal lymph nodes was verified to compare the sensitivity and specificity of mediastinoscopy and the related PET results. RESULTS: Histopathologic classification of the tumors revealed 79 squamous carcinomas and 58 adenocarcinomas. False positivity rate of PET was 26% (95% CI: 14-38), false negativity was 25% (95% CI: 18-33), sensitivity was 74% (95% CI: 63-86), specificity was 73% (95% CI: 66-82) and accuracy was 74% in mediastinal staging. Negative predictive value of mediastinoscopy was 94% (95% CI: 89-98), positive predictive value 100%, sensitivity 84% (95% CI: 74-94), specificity 100% and accuracy was 95%. CONCLUSION: PET results do not provide acceptable accuracy rates. Mediastinoscopy still remains the gold standard for mediastinal staging of NSCLC, although it cannot reach to all the mediastinal stations.

[The role of positron emission tomography (PET) in mediastinal staging of non-small cell lung cancer]. / Küçük hücreli disi akciger kanserinin mediastinal evrelemesinde pozitron emisyon tomografisi (PET)'nin rolü.

Mediastinal lymph node metastasis (MLNM) is the most important prognostic factor and guide to the treatment in non-small cell lung cancer (NSCLC) patients with no distant metastasis. As a non invasive method, using of positron emission tomography (PET) to evaluate NSCLC is increasing. We aimed to compare results of PET and mediastinoscopy to reveal effectiveness of PET in the mediastinal staging of NSCLC patients. PET was performed to 100 operable NSCLC patients between 2004 and 2006. Later, standard cervical mediastinoscopy was performed to all of the patients. Twenty-six patients who detected MLNM at mediastinoscopy were referred to oncology clinic for neoadjuvant or definitive chemo-radiotherapy. Other 74 patients underwent thoracotomy and performed lung resection and mediastinal lymphatic dissection. Sensitivity and specificity rates for detecting mediastinal lymphatic metastasis of PET and mediastinoscopy were compared. There were 89 male and 11 female with mean age of 59 years. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates were calculated as 74%, 76%, 59%, 86% and 76% respectively for PET and 83%, 100%, 100%, 93% and 95% respectively for mediastinoscopy. Accuracy rate of PET is not sufficient and mediastinoscopy is still the gold standard to evaluate mediastinal staging of NSCLC, at present.

Staging and resection of lung cancer with minimal invasion of the adjacent lobe.

OBJECTIVE: Correct staging, optimal resection type, and prognosis for non-small cell lung cancer (NSCLC) with invasion of the adjacent lobe through the fissure have seldom been reported. METHODS: We retrospectively evaluated 351 completely resected NSCLC patients between 1994 and 2004. Of these, 152 patients had T2 and 139 had T3 NSCLC confined in one lobe and 60 patients had T2 NSCLC that shows a limited growth through the interlobar fissure into the adjacent lobe (NSCLC-ALI). Types of resections performed in patients who have NSCLC-ALI were: pneumonectomy in 40, bilobectomy in 10, and lobectomy plus partial adjacent lobe resection (LPR) in 10. Survival rates of all patients were determined and factors affecting the survival were evaluated by univariate and multivariate analyses. A multivariate survival analysis of NSCLC-ALI patients including the resection type as a prognostic factor was also performed. RESULTS: Survival of the patients with NSCLC-ALI was not statistically different from those with T3 disease (p=0.67, log rank test) but was significantly poorer than remaining patients with simple T2 disease (p=0.049, log-rank test). T status was found as a prognostic factor at multivariate analysis too (p=0.037). The survival of patients who underwent pneumonectomy was significantly worse than the patient group who underwent bilobectomy or LPR (p=0.04). There was no statistically significant difference between survival of the patients who underwent LPR and the patient group who underwent pneumonectomy or bilobectomy (p=0.16). Hospital mortality was 6.6% (4/60) and they all underwent a pneumonectomy. During follow-up there was no local recurrence encountered in patients in LPR group. CONCLUSIONS: The prognosis of NSCLC with limited invasion of an adjacent lobe was found to be similar with that of T3 tumors. A resection type lesser than a pneumonectomy may be considered in these tumors.

Red Blood Cell Distribution Width in Patients With Chronic Obstructive Pulmonary Disease and Healthy Subjects. / Amplitud de distribución eritrocitaria en pacientes con enfermedad pulmonar obstructiva crónica y en sujetos sanos.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease (CVD). Red blood cell distribution width (RDW) is accepted as a powerful predictor of outcomes in patients with CVD. AIMS: To study RDW in patients with COPD, and to compare the value of this measurement with clinical, echocardiographic, nutritional and laboratory status. Secondly, we aimed to determine the effect of smoking on RDW values in healthy subjects. METHODS: One hundred and seventy-five patients with stable COPD and 210 healthy controls were enrolled in the study. Demographic, clinical, nutritional status, echocardiographic, and laboratory characteristics, RDW values were recorded and compared. RESULTS: RDW values were higher in the COPD group than in controls (15±2.3% vs. 13.8±2.5%, p<0.001). In COPD patients, RDW levels positively correlated with CRP levels (r=0.27, P<.001), albumin levels (r=0.23, P=.04), right ventricular dysfunction (RVD) (r=0.24, P=.001), pulmonary hypertension (PAH) (r=0.1, P=.02), and presence of CVD (r=0.24, P=.02). In multivariable logistic regression suggested that presence of CVD (4.3; 95% CI: 1.3 to 11; P=.01), and presence of RVD (3.1; 95% CI: 1.7 to 8.3; P=.02) were independently related to elevated RDW levels in COPD patients. In the healthy population, correlations analysis showed only a significant correlation between RDW and cigarette smoking years (r=0.57, P<.001). CONCLUSION: RDW is independently associated with CVD and RVD in patients with COPD. In the healthy population, RDW is also associated with smoking status.

Is routine mediastinoscopy indicated for patients with T1 non-small cell lung cancer?

OBJECTIVE: Mediastinoscopy is gold standard in the staging patients with non-small cell lung cancer (NSCLC) patients. Yet, its necessity in every patient is being questioned as new data is being collected. In the present study, we compared pathology reports of the cases with T1 NSCLC both after mediastinoscopy and thoracotomy, and discussed about the necessity of mediastinoscopy. METHODS: We retrospectively reviewed the records of 74 patients (73 patients with pathologic T1 NSCLC patients who underwent pulmonary resection and one patient clinically T1 who did not undergo pulmonary resection), between 1996 and 2002. Clinically 80% of the cases were at T1 stage, and the rest were at T2 stage. The distribution of clinical lymph node status was NO in 85%, 15% N2. RESULTS: Fifty-three (71.6%) cases underwent mediastinoscopy. Mediastinoscopy showed that one patient had contralateral lymph node involvement and the remaining cases had no lymph node metastases. No mortality occurred and morbidity rate was 1.9%. Lobectomy was performed in 60 cases, pneumonectomy in seven, wedge resection in five, and segmentectomy in one. The histopathologic types were; squamous cancer in 40 (55%) cases, adenocarcinoma in 29 (40%), and large cell carcinoma in four (5%). Only two cases (2.7%) who had no detectable lymph node metastases at mediastinoscopy were found to have N2 disease after thoracotomy. In rest of the cases, NO was observed in 48 (66%) and N1 in 23 (31.5%). Five-year survival of the cases was calculated to be 73%. The two cases with N2 disease are alive at seven and four years after the operation. CONCLUSION: Routine mediastinoscopy does not appear to be necessary for patients with clinical T1 non-small cell carcinoma having no enlarged lymph nodes on computerised tomography.

Predictive value of the tuberculin skin test and QuantiFERON-tuberculosis Gold In-Tube test for development of active tuberculosis in hemodialysis patients.

BACKGROUND: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in HD patients. AIM: In our study, we evaluated the value of the TST and QFT-G In-Tube (QFG-IT) test in the development of active tuberculosis (TB), in the HD patients, and in healthy controls. METHODS: The study enrolled 95 HD patients and ninety age-matched, healthy controls. The TST and QFG-IT were performed. All the subjects were followed up 5 years for active TB disease. RESULTS: Compared to the healthy controls, a high prevalence of LTBI was found in the HD patients by QFG-IT (41% vs. 25%). However, no significant difference was detected by TST (32% vs. 31%). Four HD patients and one healthy control progressed to active TB disease within the 5-year follow-up. For active TB discovered subjects, QFG-IT was positive in all, but TST was positive in two (one patient and one healthy control). In HD patients; sensitivity, specificity, positive and negative predictive values of QFG-IT, and TST for active TB was 100% and 25%, 62% and 67%, 10%, and 3%, and 100% and 95%, respectively. Receiver operating curve analysis revealed that the results are significantly different (P = 0.04). CONCLUSION: QFG-IT test is a more useful diagnostic method than TST for detecting those who will progress to active TB in HD patients.

Long-term Outcome of Patients With Undiagnosed Pleural Effusion.

INTRODUCTION: The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed. METHODS: Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study. RESULTS: Forty men and 13 women (mean age 53.9±13.9 years) were included. Median follow-up time was 24 months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P=.004 and .0001, respectively). CONCLUSION: Although the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored.

Scimitar syndrome associated with gallbladder duplication.

Scimitar syndrome is a rare congenital anomaly associated with the venous drainage of the lung to the inferior vena cava through a systemic vein. Chest radiography of an asymptomatic patient, aged 36, showed a linear opacity extending from the pulmonary hilum to the diaphragm, on the right chest (Scimitar sign). Computerized tomography of the thorax exposed that the cause of that image was Scimitar vein. Abdominal ultrasonography revealed duplication in the gallbladder. The literature holds no reports of an association between Scimitar syndrome and gallbladder duplication. Secondary gastrointestinal malformations can also be found in patients suffering from this syndrome.

Relationship between lung adenocarcinoma histological subtype and patient prognosis.

PURPOSE: Lung adenocarcinoma (AC) demonstrates various histological subtypes within the tumour tissue. A panel established jointly by the IASLC, ATS and ERS classified invasive lung ACs based on the predominant histological subtype. We examined the distribution of tumours in lung AC patients according to histological subtype and analysed the effects of this classification on survival. METHODS: The records of patients who had pulmonary resection for lung cancer between January 2000 and December 2009 were reviewed and 226 lung AC patients who fulfilled the inclusion criteria were identified. Histological subtypes of the ACs and their ratios in the tumour tissue were determined. Tumours were classified according to the predominant histological subtype and subsequently graded. The relationship between the predominant histological subtype, grade and survival were analysed. RESULTS: Tumours were predominantly acinar in 99 cases (43.8%), solid in 89 (39.3%), lepidic in 20 (8.8%), and papillary in 11 (4.8%), whereas 7 tumours (3%) were variants of AC. Stage significantly affected survival (p = 0.001); however, the predominant histological subtype had no significant effect. The 5-year survival rate for patients with histologically grade II tumours was 48.6%, whereas that in patients with grade III tumours was 56%. (p = 0.69). CONCLUSION: Invasive lung ACs may be defined by their predominant histological subtype. However, it is not yet possible to conclude that this classification is related to survival.

A hamartoma located in the trachea.

Hamartoma is rarely found to be localized in the trachea. In the literature, only about ten cases have been reported. A 52-year-old male who was being treated for asthma for 15 years applied to our hospital with a progressive dyspnea complaint. During his physical examination, stridor was heard, after which a computed tomography of his chest revealed a tracheal mass. Fiberoptic bronchoscopy revealed a mass which obstructed 80% of the tracheal lumen attached to the posterior tracheal wall with a broad base. The mass was removed surgically with segmentary resection of the trachea. histopathological examination of the lesion indicated that it was a hamartoma. Hamartomas can localize in the trachea very rarely, causing serious obstruction.

Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers.

OBJECTIVE: The presence of synchronous multiple primary non-small-cell lung cancers (SMPLC) is a rare condition and the optimal treatment remains unclear. In this study, the survival of surgically treated SMPLC patients and the factors affecting survival were analyzed. METHODS: Between 2001 and 2008, 26 consecutive patients diagnosed with SMPLC, who had all of their tumors resected, were retrospectively evaluated. Patients, who had bronchoalveolar carcinoma or carcinoid tumors and satellite nodules, were excluded. Prognostic factors were analyzed using univariate and multivariate analyses. RESULTS: The tumors were unilateral in 14 and bilateral in 12 patients. In total, 38 procedures were performed. A complete resection was achieved in 35 (92.1%) procedures. The in-hospital mortality rate was 7.6% (two patients). The overall 5-year survival rate was 49.7%, and the median survival time was 40 months. The 5-year survival rate was 40.6% for unilateral and 62.8% for bilateral SMPLC patients (p = 0.47). Histopathologic tumor type, N1 nodal disease, tumor (T) status, and older age did not influence survival. There was no survival disadvantage for patients, upon whom a sublobar resection had been performed. There was a trend toward poorer survival in patients upon whom a pneumonectomy had been performed (p = 0.12). The 3-year survival rate for patients, who received adjuvant chemotherapy and/or radiotherapy (66.7%), was better than other patients (56.3%). In the multivariate analysis, we found a trend toward poor survival in patients, who received a pneumonectomy, and a trend toward better survival in patients, who received adjuvant therapy (p = 0.05 and p = 0.06). CONCLUSIONS: The survival of SMPLC patients, who were treated surgically, was satisfactory. Pneumonectomy was a poor prognostic factor, whereas adjuvant therapy was a good prognostic factor.