Development of Bronchopleural Fistula Complicated by Empyema Fifteen Years After Right Lower Lobe Lobectomy: A Case Report.

BACKGROUND Bronchopleural fistula formation is a rare complication of lobectomy surgery, with a frequency reported ranging from 0.5% to 1%. A post-lobectomy bronchopleural fistula usually presents within 14 days of surgery. To our knowledge, it is extremely rare for a bronchopleural fistula to develop many years after an operation. CASE REPORT We present the case of a 55-year-old male smoker with history of a right lower lobe lobectomy 15 years prior who presented to the Emergency Department with complaints of worsening back pain, shortness of breath, and cough productive of sputum. He was found to have a right bronchopleural fistula with right-sided empyema. He was taken to the operating room a few days after initial admission for right thoracoscopic chest exploration, right chest debridement, right chest wall resection, and window procedure with creation of pleurocutaneous fistula. Ultimately, he required a right completion pneumonectomy and buttress of bronchial stump with transdiaphragmatic omental flap. CONCLUSIONS We diagnosed a rare case of post-lobectomy bronchopleural fistula complicated by an empyema that demonstrates bronchopleural fistulas can appear 15 years postoperatively and present with subacute clinical signs and symptoms.

Status of TMPRSS2-ERG fusion in prostate cancer patients from India: correlation with clinico-pathological details and TMPRSS2 Met160Val polymorphism.

BACKGROUND: Prostate cancer (PCa) shows considerable clinical heterogeneity that has been primarily attributed to variable molecular alterations. TMPRSS2-ERG fusion is one such molecular subtype that has been associated with predominantly poor prognosis. More recently, a single nucleotide polymorphism (SNP) in the TMPRSS2 gene rs12329760 C>T (Met160Val) has been shown to positively correlate with the fusion status and also to be associated with increased risk for PCa. The aim of the present study is to determine the frequency of TMPRSS2-ERG fusion and association of rs12329760 in Indian PCa patients with fusion status. METHODS: TMPRSS2-ERG fusion by fluorescence in situ hybridization was determined in 102 of 150 PCa biopsy-proven cases. Genotyping for rs12329760 was performed on the entire cohort of 150 cases by Sanger sequencing. RESULTS: TMPRSS2-ERG fusion was seen in 27 of 102 (26%) cases. Fusion-positive patterns in this study showed fusion by translocation in nine of 27 cases (33.5%), by deletion in six of 27 (22%) cases, and by insertion in 12 of 27 cases (44.5%). No association of the fusion status with Gleason Score, pattern, or perineural invasion was seen. The TMPRSS2 SNP rs12329760 'T' allele was prevalent with a frequency of 0.27 in the PCa patients. The SNP was significantly associated with fusion [odds ratio (OR) = 2.176, 95% confidence interval (CI) = 1.012-4.684, P = 0.04], more specifically fusion by deletion (P = 0.04). CONCLUSION: The results provided here determine the frequency of TMPRSS2-ERG fusions (26%) in a fairly large cohort of Indian PCa cases and also the association of rs12329760 SNP with TMPRSS2-ERG fusion. No association with other clinico-pathological features was observed. Future studies with clinical outcomes are warranted in this population.