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Pulmonary malignant lymphoma presents diverse imaging findings, thus making an imaging-based diagnosis difficult. Furthermore, because of the low histological diagnostic rate of approximately 30% based on transbronchial lung biopsy, there are difficulties in the early diagnosis of pulmonary malignant lymphoma. We report a case of pulmonary malignant lymphoma that was difficult to diagnose until a surgical biopsy was performed. A 72-year-old female was referred to our hospital with an abnormal chest shadow on a medical examination. Chest computed tomography(CT) scan demonstrated groundglass opacity and consolidation in both lung fields. Bronchoscopy was performed but a histological definitive diagnosis could not be obtained. We suspected organized pneumonia and initiated steroid therapy that resulted in improvement in the chest shadow. However, new multiple lung nodules and mediastinal lymphadenopathy were noticed on CT scan performed 9 months after the initiation of steroid therapy, and a lung biopsy and mediastinal lymph node biopsy were performed. Finally, the diagnosis was malignant lymphoma with pulmonary infiltrates.
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Neoplasias Pulmonares , Linfoma , Idoso , Biópsia , Broncoscopia , Feminino , Humanos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: We investigated the role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) in predicting the effect of induction therapy in patients with thymic epithelial tumors. METHODS: Fourteen patients with thymic epithelial tumors who underwent PET-CT before and after induction therapy were retrospectively analyzed. The relationship between the change in the maximum standardized uptake value (SUVmax) in PET-CT, the response evaluation criteria in solid tumors and the pathologic response (Ef0, no necrosis of tumor cells; Ef1, some necrosis of tumor cells with more than one-third of viable tumor cells; Ef2, less than one-third of tumor cells were viable; and Ef3, no tumor cells were viable) was analyzed. RESULTS: The study cohort consisted of 5 males and 9 females. Nine of the patients had thymoma, and 5 had thymic carcinoma. The induction therapy included chemotherapy in 9 cases, chemoradiation therapy in 4 cases and radiation therapy in 1 case. Among the 8 patients with a pathologic response of Ef0/1, 5 were clinically evaluated as having stable disease (SD), while 3 were found to have had a partial response (PR). The SUVmax was elevated in 2 cases, unchanged in 1 and decreased in 5. On the other hand, 3 of the 6 patients with a pathologic response of Ef2, 3 were classified as having SD, while the other 3 had a PR. The SUVmax decreased in all of the patients. CONCLUSIONS: In comparison with CT, PET-CT seems to be useful for predicting the pathologic response to induction therapy in patients with thymic epithelial tumors.
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Neoplasias Epiteliais e Glandulares/terapia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias do Timo/terapia , Adulto , Idoso , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Neoplasias Epiteliais e Glandulares/patologia , Estudos Retrospectivos , Timoma/terapia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologiaRESUMO
We sought to determine the short- and long-term prognoses among 'marginal-risk' non-small cell lung cancer patients who have a predicted postoperative- (ppo) forced expiratory volume in the first second (FEV1) of 30-60% and/or a ppo-diffusing capacity of the lung for carbon monoxide (DLCO) of 30-60%. The present study included 73 'marginal-risk' and 318 'normal-risk' patients who underwent anatomical resection for clinical stage I lung cancer between 2008 and 2012. The rates of postoperative morbidity, prolonged hospital stay, and overall survival were assessed. Postoperative morbidity occurred in 35 (48%) 'marginal-risk' patients and 66 (21%) 'normal-risk' patients, and 17 (23%) 'marginal-risk' patients and 20 (6%) 'normal-risk' patients required a prolonged hospital stay. The three- and five-year survival rates were 79% and 64% in the 'marginal-risk' patients and 93% and 87% in the 'normal-risk' patients, respectively. A 'marginal-risk' status was a significant factor in the prediction of postoperative morbidity (odds ratio [OR] 2.97, p < 0.001), the rate of prolonged hospital stay (OR 3.83, p < 0.001), and overall survival (hazard ratio 2.07, p = 0.028). In conclusion, 'Marginal-risk' patients, who are assessed based on ppo-values, comprise a subgroup of patients with poorer short- and long-term postoperative outcomes.
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Neoplasias Pulmonares/fisiopatologia , Pulmão/fisiopatologia , Idoso , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Pulmão/cirurgia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Testes de Função Respiratória , Taxa de Sobrevida , Resultado do TratamentoRESUMO
This study was designed to elucidate the predictive usefulness of the response evaluation criteria in solid tumors (RECIST), a volume response (VR; a > 50% reduction in the tumor volume) and the post-neoadjuvant therapy maximum standardized uptake value (post-SUVmax) in patients with non-small cell lung cancer (NSCLC) after neoadjuvant therapy. Between December 2006 and June 2012, 33 patients with clinical stage II and III NSCLC who underwent pulmonary resection following neoadjuvant therapy were enrolled. The relationships between the variables and a pathological complete response (pCR), the disease-free survival (DFS) and the overall survival (OS) were analyzed. As neoadjuvant therapy, 24 patients received chemoradiotherapy, five patients received chemotherapy and four patients were given radiation therapy. Based on the RECIST, 12 tumors were classified as having a partial response and 21 tumors were classified as stable disease. Twenty-one tumors showed a VR and 12 did not. Twenty-five tumors had a post-SUVmax ≤7.5 and eight had a post-SUVmax >7.5. Eight tumors had a pCR. In the multivariate Cox regression analysis, both a non-VR and a post-SUVmax >7.5 were significant variables predicting the DFS (p = 0.0422 and 0.0127, respectively), but either was not for OS. The post-SUVmax was also a significant variable for the pCR rate (p = 0.0067). The post-treatment SUVmax can be a valid alternative variable that can be used to predict the effect of neoadjuvant therapy and the survival of patients with stage II and III NSCLC.
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OBJECTIVE: Ligation is a widely used wound closure method after chest drain removal in thoracic surgery. Knotless suture, which does not require ligation or suture removal, has been developed and is currently used in our institution. This study compared the efficacy of the drain wound closure method between knotless suture and our previous mattress suture. METHODS: We examined the clinical performance of knotless suture for chest drain wound closure in 117 patients who underwent surgery following this method in our department from October 2020 to April 2021. We compared outcomes with those of mattress suture using 2-0 nylon in 115 patients who underwent thoracic surgery at our institution between October 2018 and April 2019. Hydrocolloid dressing is applied to the drain wound after chest drain removal in a knotless suture. We conducted an analysis of both groups based on the condition of wound closure and drain wound complication. RESULTS: Appropriate wound closure was obtained and no patient required a prolonged hospital stay because of incomplete wound closure in both methods. The rate of chest drain wound infection for knotless suture (0.0%, 0/117 patient) was significantly lower than that of mattress suture (5.2%, 6/115 patients) at the outpatient follow-up (p = 0.01). The rate of delayed drain wound healing was also significantly lower than that of mattress suture (0.9% vs. 7.0%; p = 0.02). CONCLUSIONS: The results of knotless closure were better than those of conventional mattress suture regarding wound complications. Moreover, knotless suturing requires no suture removal, indicating its usefulness.
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Técnicas de Sutura , Suturas , Tubos Torácicos , Coloides , Humanos , Técnicas de Sutura/efeitos adversos , Resultado do TratamentoRESUMO
INTRODUCTION: Thoracoscopic surgery is performed for refractory or recurrent primary spontaneous pneumothorax (PSP). To reduce postoperative recurrence, additional treatment is occasionally adopted during surgery after bulla resection. However, the most effective method has not been fully elucidated. Furthermore, the preference for additional treatment varies among countries, and its efficacy in preventing recurrence must be evaluated based on settings tailored for the conditions of a specific country. The number of registries collecting detailed data about PSP surgery is limited. Therefore, to address this issue, a prospective multicentre observational study was performed. METHODS AND ANALYSIS: This multicentre, prospective, observational study will enrol 450 participants aged between 16 and 40 years who initially underwent PSP surgery. Data about demographic characteristics, disease and family history, surgical details, and CT scan findings will be collected. Follow-up must be conducted until 3 years after surgery or in the event of recurrence, whichever came first. Patients without recurrence will undergo annual follow-up until 3 years after surgery. The primary outcome is the rate of recurrence within 2 years after surgery. A multivariate analysis will be performed to compare the efficacy of different surgical options. Then, adverse outcomes correlated with various treatments and the feasibility of treatment methods will be compared. ETHICS AND DISSEMINATION: This study was approved by the local ethics committee of all participating centres. The findings will be available in 2025, and they can be used as a basis for clinical decision-making regarding appropriate options for the initial PSP surgery. TRIAL REGISTRATION NUMBER: NCT04758143.
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Pneumotórax , Adolescente , Adulto , Humanos , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Pneumotórax/prevenção & controle , Pneumotórax/cirurgia , Estudos Prospectivos , Recidiva , Projetos de Pesquisa , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Human 8-oxoguanine DNA glycosylase 1 (hOGG1) has a major role in the repair of 8-hydroxyguanine, a major promutagenic DNA lesion. The genetic polymorphism rs1052133, which leads to substitution of the amino acid at codon 326 from Ser to Cys, shows functional differences, namely a decrease in enzyme activity in hOGG1-Cys326. Although several studies have investigated the association between rs1052133 and lung cancer susceptibility, the effect of this locus on lung cancer according to histology remains unclear. We therefore conducted a case-control study with 515 incident lung cancer cases and 1030 age- and sex-matched controls without cancer, and further conducted a meta-analysis. In overall analysis, the homozygous Cys/Cys genotype showed a significant association with lung cancer compared to Ser allele carrier status (odds ratio (OR)=1.31, 95% confidence interval (CI)=1.02-1.69). By histology-based analysis, the Cys/Cys genotype showed a significantly positive association with small-cell carcinoma (OR=2.40, 95% CI=1.32-4.49) and marginally significant association with adenocarcinoma (OR=1.32, 95% CI=0.98-1.77). A meta-analysis of previous and our present study revealed that this polymorphism is positively associated with adenocarcinoma, although suggestive associations were also found for squamous- and small-cell lung cancers. These results indicate that rs1052133 contributes to the risk of adenocarcinoma of lung.
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Adenocarcinoma/genética , Carcinoma de Células Pequenas/genética , Carcinoma de Células Escamosas/genética , DNA Glicosilases/genética , Neoplasias Pulmonares/genética , Polimorfismo de Nucleotídeo Único , Adenocarcinoma/patologia , Adulto , Idoso , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Estudos de Casos e Controles , Cisteína/genética , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Humanos , Neoplasias Pulmonares/patologia , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Análise Multivariada , Mutação de Sentido Incorreto , Razão de Chances , Fatores de Risco , Serina/genética , FumarRESUMO
BACKGROUND AND OBJECTIVES: The distinction of primary lung from metastatic breast cancer is crucial in patients presenting with a solitary pulmonary nodule after mastectomy, because treatment strategies are completely different. Definitive diagnosis of these nodules, however, is often difficult. We assessed the feasibility of our diagnostic approach for these nodules and estimated the frequency of primary lung cancer occurrence in patients after mastectomy. METHODS: We evaluated solitary pulmonary nodules appearing in 48 patients after mastectomy. For histological examination, CT-guided needle aspiration biopsy (CT-NAB) or trans-bronchial lung biopsy (TBLB) was performed. Besides conventional morphopathological examination, differential diagnosis was performed by immunohistochemical examination and evaluation using a molecular marker (mammaglobin 1). RESULTS: Biopsy specimens were obtained using minimally invasive methods, namely CT-NAB and TBLB, in 91.7% of patients. From 48 patients, differential diagnosis was obtained by morphopathological methods alone in 32, and by immunohistochemical and molecular marker examination in the remaining 16. Final diagnosis was metastatic breast and primary lung cancer in 40 (83.3%) and 8 patients (16.7%), respectively. CONCLUSIONS: Our results show the clinical feasibility of our stepwise approach to the differential diagnosis of primary lung cancer and breast cancer relapse presenting as a solitary nodule in patients after mastectomy.
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Neoplasias da Mama/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Nódulo Pulmonar Solitário/diagnóstico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos/metabolismo , Biomarcadores Tumorais/metabolismo , Biópsia por Agulha Fina , Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Humanos , Imuno-Histoquímica , Pulmão/patologia , Neoplasias Pulmonares/mortalidade , Mamoglobina A , Mastectomia , Pessoa de Meia-Idade , Proteínas de Neoplasias/metabolismo , Recidiva Local de Neoplasia/diagnóstico , Proteínas Nucleares/imunologia , Proteína B Associada a Surfactante Pulmonar/imunologia , Radiografia Intervencionista , Receptores de Estrogênio/imunologia , Fator Nuclear 1 de Tireoide , Tomografia Computadorizada por Raios X , Fatores de Transcrição/imunologia , Uteroglobina/metabolismoRESUMO
An asymptomatic 59-year-old female was admitted with an abnormal shadow on her chest radiography. Chest computed tomography (CT) revealed a mass measuring 20 mm in the anterior mediastinum. At the arterial phase on dynamic contrast-enhanced CT (dynamic CT), the pattern of "peripheral puddles", defined as discrete well-defined peripheral enhancing globles, was found in the mass. The tumor was completely resected via a median sternotomy, and was histopathologicaly diagnosed as hemangioma. In this case, dynamic CT was very useful for the preoperative diagnosis, and then the enhancement pattern of "peripheral puddles" on dynamic CT may be a conclusive finding for the diagnosis of mediastinal hemangiomas.
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Hemangioma/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Feminino , Hemangioma/patologia , Hemangioma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Pessoa de Meia-Idade , Radiografia TorácicaRESUMO
BACKGROUND: Late pulmonary metastasis from urothelial carcinoma (UC) of the upper urinary tract is extremely rare. CASE PRESENTATION: A 76-year-old man was referred to our hospital due to an abnormal shadow on chest X-ray. He had a history of left nephrectomy with a diagnosis of UC in the renal pelvis 29 years previously. Computed tomography showed a mass lesion in the right middle lobe of the lung that measured 4.9 cm in diameter. A transbronchial biopsy revealed the tumor to be metastatic pulmonary UC, and he underwent right middle lobectomy of the lung. CONCLUSION: Long-term postoperative follow-up of patients with UC might be necessary after radical nephrectomy.
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OBJECTIVE: Accurate preoperative evaluation of lymph nodes can provide optimal treatment for patients. However, in patients with clinical N1 disease (cN1) non-small cell lung cancer (NSCLC), no suitable predictor has been identified for hilar/intrapulmonary lymph node metastasis (pathological N1 disease; pN1). The purpose of this study was to identify pN1 in cN1 NSCLC patients. METHODS: We retrospectively reviewed the clinicoradiological features of 109 patients with a discrete type of cN1 NSCLC who had undergone complete resection at our institution from 2004 to 2015. The association between clinicoradiological variables and nodal status was analyzed to identify predictors for pN1. RESULTS: The cohort consisted of 77 males and 32 females, ranging in age from 39 to 84 years. The breakdown by pathological N category was 40 (37%) pN0, 41 (38%) pN1, and 28 (25%) pN2 patients. Maximum lymph node diameter was identified as a significant predictor for pN1, with an odds ratio of 1.25 (P = 0.010). When limited to 63 patients who underwent positron emission tomography (FDG-PET) at our institution, the maximum standardized uptake value (SUVmax) of the lymph node was an independent predictor, with an odds ratio of 1.91 with logistic regression analysis (P = 0.004). The size of lymph node and the SUVmax were significant factors for pN1, with optimal cut-off values of 13 mm and 4.28, respectively. CONCLUSIONS: Among the patients with cN1, maximum lymph node size and SUVmax of the FDG-PET were significant predictors for pN1.
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Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Imageamento por Ressonância Magnética/métodos , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Pulmão , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pneumonectomia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos RetrospectivosRESUMO
OBJECTIVES: The diffusing capacity of the lung for carbon monoxide (DLCO) is an indicator of lung damage. We sought to determine whether DLCO is associated with the aggressiveness of lung adenocarcinoma using histopathological indexes, such as tumour differentiation, scar grade, nuclear atypia and the mitotic index. METHODS: Fifty-seven patients with low DLCO (≤80% of predicted) and 466 patients with normal DLCO (>80% of predicted) who underwent R0 resection of lung adenocarcinoma between 2005 and 2012 were retrospectively reviewed. The relationships between the DLCO status and each histopathological index as well as the overall survival were evaluated. RESULTS: Low DLCO had significant relationships with moderate/poor differentiation (79% vs 57% [low DLCO vs normal DLCO]), scar grade 3/4 (37% vs 18%), nuclear atypia 3 (65% vs 30%) and the mitotic index 3 (26% vs 8%). After adjusting for the age, sex, forced expiratory volume in 1 s, smoking status and tumour size, a low DLCO still showed a significant correlation with the histopathological indexes. These histopathological indexes were all significant factors for the overall survival on log-rank tests. In a multivariable Cox regression analysis with 13 clinicopathological variables, moderate/poor differentiation and nuclear atypia Grade 3 were significant histopathological factors for the overall survival (hazard ratios: 2.16 and 1.84; 95% confidence intervals: 1.10-4.51 and 1.06-3.21; P = 0.024 and 0.029, respectively). CONCLUSIONS: Our findings regarding the relationship between DLCO and the histopathological indexes of lung adenocarcinoma suggest that lung damage may be associated with carcinogenesis and progression.
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Adenocarcinoma , Monóxido de Carbono/metabolismo , Neoplasias Pulmonares , Pulmão/metabolismo , Adenocarcinoma/epidemiologia , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Adenocarcinoma de Pulmão , Idoso , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
There were a few reports of patients with lung cancer developing at the wall of giant bullae complicated with hemorrhage. A 40-year-old male with complaints of hemoptysis was referred to our hospital, and a solitary pulmonary mass was pointed out on his chest roentgenogram. Computed tomography (CT) demonstrated a well-circumscribed solid mass measuring 7.0 × 6.5 × 6.0 cm in the right upper lobe of the lung. At the chest CT 1 year before, only a giant bulla without mass was found. From the interval change of CT findings with his clinical course, the mass was suspected as acute hemorrhage in the giant bulla. A right upper lobectomy of the lung was performed to control his hemoptysis. The surgical specimen showed the giant bulla filled with blood clot, and a partial wall of the bulla was irregularly thickened. Pathological examination revealed that the thickened wall was composed of large-cell carcinoma. In patients with bullous diseases complicated with hemorrhage, we should be aware of a possibility of developing lung cancer in the bullae.
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BACKGROUND: Conditional survival (CS) is defined as living some additional time predicated on living to a certain time point. This study aimed to evaluate the usefulness of CS analyses for postoperative follow-up of surgically treated patients with lung cancer. METHODS: We retrospectively analyzed survival and clinicopathologic data from 859 patients with non-small cell lung cancer who underwent complete resection. CS is the probability of surviving additional time (y), after an individual has already survived for some time (x), and can be calculated from the following formula: CS(y|x) = S(x + y)/S(x), where S is the overall survival at a specific time. RESULTS: The 5-year cumulative overall survival rate was 75%. The additional 5-year survival rates at 1, 2, 3, and 4 years after operation (5Y-CS) were 75%, 77%, 77%, and 81%, respectively. The likelihood of surviving for a total of 5 years, 3 years after surgery was 89%. Age less than or equal to 70 years, female sex, no or light smoking, adenocarcinoma histologic type, pathologic stage I, and normal serum carcinoembryonic antigen levels were the clinicopathologic features associated with a high cancer-specific CS. For patients with favorable factors, the 2Y recurrence-free CS (3) reached 100%, whereas 5Y-CS did not change. CONCLUSIONS: Estimates of CS probabilities may provide more meaningful information than traditional cumulative survival. Even in patients with favorable factors, a postoperative follow-up visit after 3 postsurgical years may be required.
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Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
OBJECTIVES: The T descriptor of thymic epithelial tumours proposed by the International Association for the Study of Lung Cancer and the International Thymic Malignancy Interest Group as well as the Masaoka-Koga system is defined by the anatomical extent of primary tumours, regardless of their size. However, the prognostic significance of tumour size in thymic epithelial tumours has not been fully elucidated. METHODS: We evaluated the prognostic significance of tumour size in 154 consecutive patients with thymic epithelial tumours including 124 thymomas, 21 thymic carcinomas and 9 neuroendocrine tumours, who underwent complete resection between 2001 and 2014. RESULTS: Among all tumours, the median tumour size was 4.9 cm. The median thymoma, thymic carcinoma and neuroendocrine tumour sizes were 4.8, 5.7 and 5.8, respectively, although the differences were not significant. In survival analysis, the 5- and 10-year overall survival (OS) and recurrence-free survival (RFS) rates for all patients were 91 and 81%, and 80 and 69%, respectively. Under the stratification of tumour size, no trend was observed for OS, whereas RFS showed stepwise deterioration as tumour size increased. For 119 patients with Stage I disease, RFS showed deterioration as tumour size increased. Multivariate analysis revealed that tumour size >4.0 cm was an independent prognostic factor for worsening RFS (P = 0.03). CONCLUSIONS: Patients with tumours >4.0 cm showed significantly worse outcomes in RFS compared with those with smaller tumours. This relationship was also noted in patients with Stage I disease.
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Neoplasias Epiteliais e Glandulares/cirurgia , Timo/patologia , Neoplasias do Timo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Epiteliais e Glandulares/diagnóstico , Neoplasias Epiteliais e Glandulares/mortalidade , Neoplasias Epiteliais e Glandulares/patologia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Prognóstico , Análise de Sobrevida , Timoma/diagnóstico , Timoma/mortalidade , Timoma/patologia , Timoma/cirurgia , Timo/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/mortalidade , Neoplasias do Timo/patologia , Adulto JovemRESUMO
OBJECTIVES: The tumour-node-metastasis classification has been widely used as a guide for estimating prognosis, and is the basis for treatment decisions in patients with malignant tumours. The International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee and the International Thymic Malignancy Interest Group have proposed a new staging system for thymic malignancies. However, its validity has not been fully established. In this study, we assessed the system's utilities and drawbacks. METHODS: We reviewed 154 consecutive patients with thymic epithelial tumours who underwent complete resection at our institution, and compared their characteristics and outcomes when classified according to the proposed system with those when classified under the Masaoka-Koga system. RESULTS: The proportion of patients with Stage I disease increased remarkably to 77.3% when using the proposed system because of the reclassification of Masaoka-Koga stages II and III diseases. Among 69 patients with Type A, AB or B1 thymoma, 68 tumours (98%) were reclassified as Stage I disease. Moreover, the proportion of Stage III and IV tumours increased in concordance with Types B2, B3 thymomas and thymic carcinoma. Under the proposed new system, the recurrence-free survival rates showed significant deterioration with increasing stage, while the overall survival curves did not. CONCLUSIONS: The newly proposed classification for thymic malignancies does not serve as a prognostic prediction model for overall survival but served as a significant imbalance of stage distribution in our cohort. However, it appears to be beneficial, especially in clinical settings and recurrence-free survival analysis.
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Neoplasias Epiteliais e Glandulares/patologia , Neoplasias do Timo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Epiteliais e Glandulares/mortalidade , Neoplasias Epiteliais e Glandulares/cirurgia , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Timoma/mortalidade , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/mortalidade , Neoplasias do Timo/cirurgiaRESUMO
Aortic cannulation is a difficult technique for young cardiovascular surgeons. A convenient training method for this procedure is introduced in this paper. After two gloves are worn on a hand, they are removed together, then a piece of mandarin-orange peel is inserted between the gloves. The inner glove is filled with water and the mouth of the inflated gloves is securely tied with a strong ligature. Then this "glove balloon" is set inside a container to stabilize it. Purse-string stitches are placed on the orange peel. After the center of the purse string is incised with a number 11 blade, a cannula is introduced. This "glove-and-peel method" will help young cardiovascular surgeons to become accustomed to aortic cannulation.
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Aorta/cirurgia , Cateterismo/métodos , Luvas Cirúrgicas , Capacitação em Serviço , Técnicas de Sutura , Competência Clínica , HumanosRESUMO
We present a very rare case of simultaneous thymic carcinoids with similar size, one of which showed spontaneous regression. A 68-year-old man was admitted to the hospital because of two similar abnormal masses at his anterior mediastinum on chest computed tomography, one of which had decreased from 25 to 16 mm in diameter. A total thymectomy was performed and the pathologic examinations revealed that both tumors were atypical carcinoids. There have been seldom reports of multiple thymic carcinoids, and this case might suggest that total thymectomy is the best way to treat thymic carcinoid because of the possibility of multicentric origins.
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Tumor Carcinoide/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias do Timo/patologia , Idoso , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Humanos , Masculino , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgiaRESUMO
Spontaneous regression (SR) of cancer is a rare phenomenon. SR is recognized as complete or partial disappearance of the disease after inadequate or no treatment. Although reports of this phenomenon have been documented for several malignancies, it is rare in patients with lung cancer. In most documented cases, diagnoses of SR were made based on only the radiologic findings. We herein report a case of complete SR of non-small cell lung cancer (NSCLC) that was pathologically proven using a resected specimen. Moreover, despite the local complete SR, the patient subsequently experienced an adrenal metastasis after surgery. To the best of our knowledge, this is the first report of a patient with NSCLC in whom complete regression of the primary site was observed, but in whom a distant metastasis became apparent. Both phenomena were pathologically proven. Our report suggests that both SR and tumor progression can proceed simultaneously.
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Neoplasias das Glândulas Suprarrenais/secundário , Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Pulmonares/patologia , Regressão Neoplásica Espontânea , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Primary lung cancer metastasizes to various organs, but rarely metastasizes to the breast. We report a case of breast metastasis from primary lung cancer, which was confirmed by the detection of the same epidermal growth factor receptor (EGFR) gene mutation.