Are precautions actually a risk factor in the development of bronchopleural fistula after pneumonectomy? A retrospective analysis of 299 cases.

PURPOSE: Bronchopleural fistula most commonly occurs after pneumonectomies, with high morbidity and mortality. A preventive approach is essential. Risk factors can be classified depending on the patient, anatomy, surgical technique, and other causes. METHODS: Patients (n = 370) who underwent pneumonectomy between 2010 and 2020 were evaluated. The digital media and archive files of the patients (n = 299) were reviewed retrospectively. RESULTS: While 271 patients (90.6%) were male, 28 (9.4%) were female. The mean age was 56.63 years. The bronchopleural fistula rate was 14.7% (44/299). Serum protein deficiency, right pneumonectomy, completion pneumonectomy, bronchial manual suturing, advanced stage, prolongation of time after neoadjuvant therapy, length of drain and hospital stay, tissue support for the stump, and short bronchial stump were significant for bronchopleural fistula. Smoking in patients operated on for malignancy and low serum albumin value in benign and chronic infectious diseases were significant in terms of fistula. In patients who developed bronchopleural fistula, the 5-year survival rate was 18.4%. CONCLUSION: The most important risk factors in bronchopleural fistula depend on the surgical technique and so are completely preventable. Contrary to the literature, short stump and tissue support to the stump were found to be risk factors for fistula. In addition, the effect of the time between neoadjuvant therapy and operation should be examined in further studies.

High grade tumor budding is associated with poor survival in pathologic stage I lung adenocarcinoma.

AIM: Tumor budding is a significant prognostic parameter that has been related to aggressive behavior in early-stage tumors of various origins. The aim of this study was to evaluate the clinicopathological significance of tumor budding in pathologic stage (pStage) I lung adenocarcinomas. METHODS: This study comprised 107 patients who underwent curative resection for pStage I lung adenocarcinomas at our hospital between December 2010 and January 2016. We examined tumor budding on routine hematoxylin and eosin (H&E) slides from resected specimens. Tumors were categorized into two groups based on the degree of tumor budding: low grade (grade 0-1) and high grade (grade 2-3). We evaluated the relationship between tumor budding and overall survival (OS), disease-free survival (DFS) and clinicopathological parameters. RESULTS: There is a significant difference (p = 0.002) between the 5-year DFS rates of the high-grade and the low-grade tumor budding group, which were 70 % and 90 %, respectively. High-grade tumor budding positive patients from the same pathological stage (p < 0.001; HR = 2.93 [1.51-5.68]) and clinical stage (p = 0.002) had poorer cumulative survival rates than low grade tumor budding positive patients. High grade tumor budding was positively associated with spread through air spaces (STAS) (p < 0 0.001), lymphovascular invasion (LVI) (p < 0.001), tumor necrosis (p < 0.001), high SUVmax value (SUVmax>3.0) (p < 0.001), and tumor size >20 mm (p = 0.024). High-grade tumor budding was significant prognostic factor of OS (p < 0.006) and DFS (p < 0.001) on univariate Cox regression hazard model analysis. However, it did not show significance in the multivariate analysis (p > 0.05). CONCLUSIONS: High-grade tumor budding is an independent prognostic factor and associated with adverse clinicopathological features and poor survival rates. We proposed that high-grade tumor budding should be recognized as a new prognostic parameter and will be beneficial in predicting the clinical course in pStage I lung adenocarcinomas.

The Differentiation of Metastatic Mediastinal Lymph Nodes From Benign Hypermetabolic Lesions.

Background Anthracosis may cause a positron emission tomography/computed tomography (PET/CT) false positivity in mediastinal and hilar lymph nodes. We aimed to evaluate the radiological features and the maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes with anthracosis or squamous cell lung cancer metastasized. Methodology Patients diagnosed with anthracosis or squamous cell lung cancer with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) between January 1, 2015, and November 15, 2020, in a tertiary hospital were enrolled. The squamous cell subtype of lung cancer was selected due to its association with tobacco use, biomass, and air pollution. Anthracosis may occur due to the same etiologic reasons. Results A total of 190 patients met the study enrollment criteria, of which 86 were diagnosed with anthracosis and 33 with squamous cell lung cancer lymph metastasis. Median values for short axis, long axis, SUVmax, shape features, and presence of calcification were found significantly different between the groups. In receiver operating characteristic (ROC) analysis, the SUVmax cut-off value was calculated as 6.61. With this cutoff value, the negative predictive value (NPV) was 92.5% and the positive predictive value (PPV) was 54% for differentiating anthracosis and malignant lymph nodes metastasis. Conclusions We conclude that the evaluation of the shape and metabolic activities of the anthracotic lymph nodes detected by PET/CT together with EBUS-TBNA granted a more accurate staging of the patients and more cancer patients will benefit from surgical treatment.

Primary pulmonary meningioma mimicking pulmonary metastasis: A rare case report.

Primary pulmonary meningiomas are rare and mostly benign tumors. They usually appear as a solid peripheral pulmonary nodule on chest radiography and computed tomography and are frequently diagnosed incidentally. Herein, we report a 55-year-old female case of primary pulmonary meningioma mimicking pulmonary metastasis.

Immunohistochemical expression profiles of BRAF (V600E/VE1) in serrated colon polyps in Turkish population.

BACKGROUND AND AIM: Colon carcinoma, as one of the most common cancers, has been investigated for genetic alterations. Besides well-known adenoma-carcinoma sequence, it is recently found that BRAF mutation had an important role particularly in early stages of adenocarcinomas with serrated features. There are no any studies concerning immunohistochemical expression status of BRAF V600E (VE1) antibody in serrated polyps in the Turkish population. The objective of this study is to observe the immunohistochemical staining of BRAF V600E (VE1) antibody in colon polyps in the Turkish population and investigate the frequency of presence of mutated BRAF proteins indicating malignant potential. MATERIALS AND METHODS: 59 cases of serrated polyps (27 cases of hyperplastic polyps, 18 cases of sessile serrated adenoma/polyps and 14 cases of traditional serrated adenomas) and 10 tubular adenomas, and 10 samples of normal colonic mucosa were immunohistochemically evaluated for the presence of BRAF V600E mutated proteins with the VE1 antibody. Results were statistically compared. RESULTS: All SSA/Ps; 92.8% of TSAs; 37% of HPs were stained positively. Of the 27 hyperplastic polyps, all GCHPs were negative but 10 of 12 MVHPs (83.3%) were weakly positive with the VE1 antibody. Cases in control groups and tubular adenomas didn't show any cytoplasmic staining. CONCLUSION: Serrated adenoma/polyps have been gaining much more importance because of their malignant potential. Their frequency is also relatively high in the Turkish population and they should be carefully handled. Detection of BRAF V600E status can be easily achieved immunohistochemically by VE1 antibody. It is easily applicable and reproducible method and it might be helpful in identifying serrated lesions of the colon in addition to morphological features.