ABSTRACT
<p><b>BACKGROUND</b>According to the international standard in TNM staging of pulmonary carcinoma, pulmonary carcinoma complicated with diffuse pleural metastasis and malignant pleural effusion belongs to IIIB stage. In the past, non-operative therapy was employed, but both the therapeutic efficacy and the quality of life of patients were poor. The purpose of this study is to find out a complex treatment for this disease.</p><p><b>METHODS</b>Total pleuro-pneumonectomy was performed in 55 cases of patients with pulmonary carcinoma complicated with diffuse pleural metastasis and malignant pleural effusion from December 1978 to February 2003. The patients were followed up postoperatively, and the quality of life and survival period of them were observed.</p><p><b>RESULTS</b>In all the cases, only 2 patients died of operation. Satisfactory recovery and remarkable relief of symptoms such as short breath, dyspnea and chest pain were found in all the other patients. After a follow-up period of 1-25 years, local recurrence was found in 6 cases (11.3%), and distant metastasis in 42 cases (79.2%). A total of 48 patients died of tumor, with survival period ranging from 5-40 months (average survival period: 15 months; median survival period: 14 months), and 5 patients were still alive in good health.</p><p><b>CONCLUSIONS</b>(1) Patients appropriated for operation should be carefully selected in case that postoperative complications influence their smooth recovery; (2) Tumor tissues should be removed as clear as possible; (3) During the operation, close attention should be paid to the protection of incisions; (4) Removal of the tumor tissues can reduce the tumor load, effectively clean the immunosuppressive factors in malignant pleural effusion, and break the immunity block status, which provides basis for the following comprehensive therapy; (5) The quality of life of the patients can be improved and the median survival period can be prolonged by the operation; (6) The long-term survival rate of patients is still unsatisfactory.</p>
ABSTRACT
Four cases of primary malignant fibrous histiocytoma of the thorax, arising from the mediastinum, trachea, esophagus and lung respectively are reported. Primary malignant fibrous histiocytoma is rare in those regions, but more commonly in deep fascia and skeletal muscles of the extremities and in the retroperitoneum. It is a distinct form of sarcoma and has been considered to be of primitive mesenchy-mal cell origin. Most of the tumors contain both fibroblast-like and histiocyte-like cells; some contain pleomorphic giant cells and inflammatory celts. They are often confused with other sarcomas. It is impossible to make correct diagnosis preoperatively. Excision is the treatment of choice for malignant fibrous histiocytoma. Radiation and chemotherapy appear to be useful adjuncts to surgical therapy.