Thigh mass in a patient with malignant pleural mesothelioma: Metastasis at an unusual site.

Soft tissue tumors are a highly heterogeneous group of lesions with varied clinical presentation. The majority is primary tumors and metastatic tumors are very rare. Malignant pleural mesothelioma presenting as a soft tissue mass at a distant site is even rarer and can cause diagnostic challenges both clinically and pathologically. We report a case of malignant pleural mesothelioma presenting as a soft tissue mass in the left thigh. A 59-year-old man, non-smoker, working in a cement factory since 30 years presented with complains of difficulty in walking since 1½ months. Review of his previous medical records revealed malignant pleural mesothelioma, which was diagnosed 9 months before. He had denied chemotherapy and was on Ayurvedic medication. The lesion involved the adjacent intercostal muscles. Few enlarged lymph nodes were noted in mediastinal and cervical regions. Biopsy of left supraclavicular and right cervical lymph nodes showed metastases. Metastasis from malignant pleural mesothelioma to the thigh was confirmed by immunohistochemistry. The tumor was positive for CK5/6, CK7, Calretinin and vimentin and immunonegative for CEA, Napsin A and TTF 1.

Thoracoscopic surgery under local anesthesia for high-risk intractable secondary spontaneous pneumothorax.

OBJECTIVES: To evaluate the outcomes of thoracoscopic surgery for intractable secondary spontaneous pneumothorax (SSP) under local anesthesia in high-risk patients and report intraoperative findings useful for identifying air leakage points. METHODS: We analyzed outcomes of 14 consecutive thoracoscopic operations under local anesthesia for high-risk SSP from 2015 to 2019. Suspicious lesions were determined based on intraoperative direct or indirect detections. Direct detection involved identifying pleural fistulas or air bubbles. Indirect detection involved finding thin and transparent bullae without any other suspicious lesions. Identifications of culprit lesions were confirmed by arrest or significant decrease in air leakage after surgical repair. All surgical repairs were followed by immediate single pleurodesis for a definitive cure and prevention of recurrence. Success was defined as the removal of the thoracic tube by surgical repair combined with immediate postoperative single pleurodesis. RESULTS: The main underlying pulmonary diseases were emphysema (n = 7), carcinoma (n = 3), interstitial pneumonia (IP) (n = 3), and nontuberculous mycobacterial infection (n = 1). A leakage point was identified in 13 cases (six on direct and seven on indirect detections). Success was achieved in nine cases (four on direct and five on indirect detections). Adverse events included one case of acute exacerbation of IP and one case of carbon dioxide narcosis. CONCLUSION: Thoracoscopic surgery under local anesthesia can be the worthwhile definitive modality, among few remaining treatments, for highly fragile patients with SSP. Detecting air leakage directly and the presence of thin and transparent bullae without any other suspicious lesions can be clues for identifying culprit lesions.

[ANALYSIS OF MICROFLORA OF PLEURAL CAVITY IN PLEURAL EMPYEMA].

In the pleural empyema (PE) treatment, not depending on introduction of multiple operative procedures and the medicinal preparations application, some issues remain unsolved, including the infection agents verification, the most rapid bronchial fistula elimination and the lung volume restoration. The EP infection agents spectrum, their sensitivity to preparations were revealed, as well as the enhanced rate of the methicillin-resistant stamms (MRSA) and the microorganisms associations verification. A reduction of the infection agents sensitivity towards "simple" antibacterial preparations was established, so the physicians, treating PE, must prescribe "hard" antibiotics, what enhances its cost.

[A case of successful use of triple approach in a kidney cancer patient with metastatic lesion to the lung and pleural cavity].

Metastasis to the lung is the most common place connected with kidney cancer progression. Wherein metastasectomy is accompanied by satisfactory 5- and 10-year survival achieving 49% and 21% respectively. Pleural lesion due to this tumor develops as a part of systemic metastasis and, as a rule, is a consequence of neoplastic spread from lung parenchyma, which indicates a poor prognosis and is an indication for palliative care.

Chest wall necrosis and empyema resulting from attempting suicide by injection of petroleum into the pleural cavity.

Hydrocarbon poisoning such as that of benzene and petroleum usually occurs accidentally by inhalation or ingestion of these cytotoxic chemical compounds. Intravenous or subcutaneous injection of petroleum compounds with intent of suicide or abuse is an extraordinary event that can result in local damage or systemic toxicity such as tissue necrosis, abscess formation, respiratory system failure and partial damage to the kidneys, the brain and the nervous system. In this article, we describe a 31-year-old man who was admitted in the surgery ward of Besat Hospital. He had widespread necrosis and infection of the chest wall soft tissue and also had empyema after a suicidal attempt by injection of 40 ml of petroleum into the left hemithorax. The patient underwent repeated surgical debridement of the chest wall necrotic tissues. With segmentectomy and flap reconstruction of the chest wall wound, he recovered completely and was discharged. Our report supports early and aggressive surgical debridement of necrotic tissue, thoracotomy tube insertion and special care of respiratory system toxicity after chest wall injection of petroleum. Regarding the basis of clinical findings and paraclinical investigations that measure lung parenchymal necrosis with empyema and fistula formation, thoracotomy and decortication with or without lung tissue resection and also chest wall reconstruction are the standard treatment of these patients.