The importance of coordination in preventing overdiagnosis: a retrospective analysis of unabsorbed oxidized regenerated cellulose.

BACKGROUND: Oxidized regenerated cellulose (ORC) is commonly used to control small intraoperative bleedings in lung cancer surgery. However, difficulties in its absorption may lead to complications that can mimic malignancy recurrence in the affected areas, and may require further examination. METHODS: Between 2015 and 2022, patients who underwent malignant tumour resection and lymph node dissection and were subsequently evaluated for suspected lymph node recurrence and underwent EBUS-guided needle biopsy were included in the study. Pathology reports of these patients showed an ORC-related foreign body type granulomatous reaction. Such reactions, caused by delayed absorption of ORC, can mimic malignancy recurrence and result in unnecessary biopsies. RESULTS: In a total of 13 patients (10 males), pathology was observed in 18 lymph node areas after malignant resection and lymph node dissection, and ORC was detected in subcarinal and inferior paratracheal lymph node areas in all patients. The average age of the patients was calculated as 63.1 years (range 51-74). The mean SUVmax value observed in these lymph node areas on PET/CT was 5.22 (range 0-14.36). Although the SUVmax value decreased as the time between surgery and EBUS increased, no statistically significant difference was observed (p = 0.100). CONCLUSION: The study suggests that in cases of suspected unexpected lymph node recurrence in postoperative follow-up of lung cancer, it is important for clinicians to communicate with the surgeon and re-evaluate the use of ORC by reviewing the operative notes. This may help in determining an appropriate further investigation strategy.

Pulmonary Langerhans cell histiocytosis; characteristics of 11 cases.

INTRODUCTION: Pulmonary Langerhans cell histiocytosis (PLCH) is a rarely seen disease of younger population. Almost all of the patients were smoker. In this study we aimed to evaluate the characteristics, diagnosis, treatment modalities and prognosis of 11 cases with PLCH. MATERIALS AND METHODS: We retrospectively reviewed our case series of eleven patients who were pathologically diagnosed as PLCH. The median age was 35 years (19-51) and male to female ratio (M/F) was 5/6. All of the patients were symptomatic. The most common symptoms were dyspnea (81.8%) and dry cough (72.7%). Mean duration of the symptoms was 10.8 months. All patients except two of them were smoker (81.8%). All patients were also passive smokers. RESULTS: Bilateral cystic appearance (n= 9, 81.8%), interstitial findings [septal and peribronchovascular thickening (72.7%) and nodular pattern (54.5%)] were common radiological findings. Spontaneous pneumothorax was present in two cases. All patients were diagnosed with surgical biopsies (90.9%) or transbronchial parenchymal biopsy (9.1%). Smoking cessation (81.8%) and immunosupression therapy (methylprednisolone) were the treatment modalities. Mean follow-up period was 5.40 ± 1.78 years. Generally, symptoms were improved with smoking cessation or methylprednisolone therapy. One patient was readmitted to our clinic with recurrent pneumothorax. In conclusion, it should be kept in mind that passive smoking is also responsible in the pathogenesis of PLCH. CONCLUSION: Exact consensus for PLCH treatment was not present except a few recommendations. In the future, with the understanding of the pathogenesis of the disease, new therapeutic agents will be discovered for this rare condition.

An extremely rare case of multiple calcifying tumor of the pleura.

Calcifying fibrous tumors are uncommon lesions. These lesions are made up of hyalinized collagenous fibrotic tissues interspersed with lymphoplasmacytic infiltrates and extensive dystrophic calcifications mimicking psammomatous features. Calcifying tumor of pleura is rarely presented. Multiple calcifying tumor of pleuras have been reported extremely seldom. Forty-year-old male patient was admitted to our clinic with complaints of dyspnea. Because of the multiple soft tissue formations at the pleural region with the largest diameter of 2 cm on thorax computed tomography, surgical intervention was planed. Frozen sections of pleural biopsies that were taken during video-assisted thoracoscopic surgery were reported as calcifying fibrous tumor. Because of the presence of multiple lesions and pleural adhesions, curative pleural decortication was performed. This case is presented with extremely rare entity of multiple calcifying tumor of plevras.

Pulmonary involvement in sea-blue histiocytosis.

Sea-blue histiocytosis is one of the six types of Niemann-Pick disease. It is characterized by childhood onset of hepatosplenomegaly, lack of neurological involvement and diminished sphingomyelinase activity. Pulmonary system is rarely involved sea-blue histiocytosis. In this paper, we present a 39-years-old male who had previously diagnosed as sea-blue histiocytosis at the age of 15. He was admitted to our clinic due to productive cough, hemoptysis, fever and weight loss. His symptoms did not resolve with the antibiotic treatment and further investigations revealed pulmonary involvement of sea-blue histiocytosis. After diagnostic bronchoalveolar lavage, his symptoms were improved, interestingly. This rare entity was discussed with literature survey.

Small cell osteosarcoma of rib: diagnosis and treatment of the rare case.

Small cell osteosarcomas are very rare tumors which are classified as the component of Ewing's sarcoma family. Although the tumor generally is seen on long bones, short bone involvement is rare. Moreover, rib localization is quite uncommon and to the best of our knowledge, only one case has been reported so far. Herein, we described a case of rib-localized small cell osteosarcomas which was only presented with localized left sided pain. Resection surgery followed by adjuvant chemotherapy was performed. Clinico-pathological features and therapeutic approach are discussed in the light of the relevant literature.

Factors affecting the life expectancy in malignant pleural mesothelioma: Our 10 years of studies and experience.

Malignant pleural mesothelioma (MPM) is an aggressive tumor with a poor prognosis. In our study, we aimed to investigate the specific clinical, laboratory, and radiological features of the tumor and the prognostic effect of SUVmax (maximum standardized uptake values) according to PET/CT (positron emission tomography). Demographic, therapeutic, clinical, and survival information of patients diagnosed with histologically-validated pleural mesothelioma in our hospital between January 2010 to December 2019 will be retrospectively scanned from the hospital records. A total of 116 patients, 61 men (52.6%), and 55 women (47.4%), were analyzed. Thirty five patients (30.2%) were over the age of 65. Percentage of patients over 65 years of age, neutrophil count, and PET SUV Max values, asbestos exposure and pleural thickening rate were significantly higher in the deceased patients' group than in the living patients' group (P = .042, P = .039, P = .002, P = .004, P = .037). T stage (tumor stage), N stage (lymph nodes stage), metastasis stage, and Grade distribution were significantly higher in the deceased patients' group than in the living patients' group (P < .000, P < .000, P = .003, P < .000). The rates of chemotherapy and surgical treatment, right lung location, and epithelioid pathology were significantly lower in the deceased patients' group compared to the living patients' group (P = .016, P = .030, P = .018, P = .008). The mean follow-up time was 13 months. Key determinants of survival in MPM include age, male gender, neutrophil increase, pleural thickening, high PET SUV max values, stage, histological type, asbestos exposure, and treatment regimen.

Programmed death ligand-1 expression levels, clinicopathologic features, and survival in surgically resected sarcomatoid lung carcinoma.

AIM: To determine the programmed death ligand-1 (PD-L1) expression rates in sarcomatoid lung carcinomas and to compare clinicopathologic features and survival rates of PD-L1-positive and negative patients. METHODS: PD-L1 expression was evaluated in 65 surgically resected sarcomatoid carcinomas. The clinicopathologic features of cases with PD-L1-positive and negative tumors were compared. Kaplan-Meier survival analysis was performed. Multiple Cox proportional hazard regression analysis was performed to determine independent predictors of overall survival. RESULTS: PD-L1 antibody positivity was found in 72.3% of surgically resected sarcomatoid lung carcinomas. Regarding histopathologic subtypes, PD-L1 expression was positive in 80.4% of pleomorphic carcinomas, 62.5% of spindle- and/or giant-cell carcinomas, and 16.7% of carcinosarcomas. Pleural invasion was observed in 68.1% of PD-L1-positive cases and 27.8% of PD-L1-negative cases (P = 0.008). No difference in survival was found between PD-L1-positive and -negative tumors. The only factor significantly associated with poor survival was the pathological stage of the tumor. CONCLUSIONS: This study reveals a high rate of PD-L1 positivity in a large number of sarcomatoid lung carcinoma cases with pleomorphic carcinoma, spindle- and/or giant-cell carcinoma, and carcinosarcoma subtypes. The only significantly different clinicopathologic feature in PD-L1-positive cases is pleural invasion. PD-L1 positivity is not a significant predictor of survival in sarcomatoid lung carcinomas.

Sleeve resections for squamous cell carcinoma of the lung.

BACKGROUND: Sleeve resection is an advanced technique that was developed as an alternative to pneumonectomy. This study evaluated our cases of sleeve resection for squamous cell carcinoma of the lung and compared the outcomes with the literature reports. METHODS: In total, 26 bronchial, 5 bronchovascular, and 3 vascular sleeve lobectomies were performed between January 2000 and July 2005 in our clinic. Age, gender, operations, postoperative diagnosis and staging, and postoperative morbidity and mortality were evaluated. RESULTS: Sleeve resections were performed in 34 patients. All patients were male, with a mean age of 59.4 years. The operations consisted of 16 right upper, 14 left upper, and 1 left lower sleeve lobectomies and 3 superior sleeve bilobectomies. The most common postoperative pathological staging group was stage IIb (32.3%). Operative mortality was 5.9% (n=2). Postoperative morbidity was 20.5% (n=7), including 4 prolonged air leaks plus empyema, 1 prolonged air leak, 1 postoperative bleeding needing revision, and 1 severe bronchostenosis; of these, 6 had persistent atelectasis. The local tumour recurrence rate was 11.7% (n=4). The median survival time and 5-year survival were 36 months and 42%, respectively. CONCLUSIONS: Sleeve resection proved to be good therapy for lung cancer and has a lower morbidity and mortality than standard pneumonectomies and results in better lung function and quality of life. The anastomosis-related complications are experience-related technical complications and training thoracic surgeons to perform SRs at experienced centres will reduce the morbidity associated with SRs.

Erdosteine modulates radiocontrast-induced hepatotoxicity in rat.

It has been suggested that reactive oxygen species (ROS) plays an important role in radio contrast media (RCM)-induced ischemia reperfusion tissue injury although antioxidants may have protective effects on the injury. We investigated the effects of erdosteine as an antioxidant agent on RCM-induced liver toxicity in rats by evaluation of lipid peroxidation (as TBARS), catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH) and glutathione peroxidase (GSH-Px) values and histological evaluation. Twenty-one rats were equally divided into three groups as follows: control, RCM, and RCM plus erdosteine. RCM was intraperitoneally administered for 1 day. Erdosteine was administered orally for 2 days after RCM administration. Liver samples were taken from the rats and they homogenized in a motor-driven tissue homogenizer. TBARS levels were significantly (p < 0.005) higher in RCM group than in control although SOD activities significantly (p < 0.05) decreased in RCM group. TBARS levels were lower in RCM plus erdosteine group than in control although SOD activity and GSH level increased (p < 0.05) in liver as compared to RCM alone. Erdosteine showed also histopathological protection (p < 0.0001) against RCM induced hepatotoxicity. GSH-Px and CAT activities were not statistically changed by the erdosteine. According to our results, it can be concluded that radiocontrast media can induce oxidative stress in liver as suggested by previous studies. Erdosteine seems to be protective agent on the radiocontrast media-induced liver toxicity by inhibiting the production of ROS via the enzymatic antioxidant system.

Surgical treatment of pulmonary arteriovenous malformations.

BACKGROUND/AIM: Pulmonary arteriovenous malformations (PAVMs) are direct communications between the branches of pulmonary arteries and veins. This study evaluates surgically treated cases of pulmonary arteriovenous malformations. MATERIALS AND METHODS: We retrospectively examined 41 cases of PAVM that were operated in our clinic between 1995 and 2012. We obtained the clinical, radiological, and surgical data of the patients from their files. RESULTS: The 41 cases comprised 27 males and 14 females. Their mean age at diagnosis was 39.8 years (range: 9-71). The symptoms were hemoptysis in 28 cases, dyspnea in five, cough in three, and epistaxis in two; three patients were asymptomatic. Twenty-three right and 19 left posterolateral thoracotomies were performed, including one case which was operated bilaterally. Lower lobectomy was performed in 17 patients, lower lobectomy and lingulectomy in two, upper lobectomy in ten, middle lobectomy in two, segmentectomy in seven, and wedge resection in four. Postoperative histopathology was arteriovenous malformation in all cases. CONCLUSION: PAVMs are rare clinical conditions. Surgery remains the first choice when embolization treatment cannot be performed or is not successful, in symptomatic and complicated patients with PAVM, and/or in cases where the PAVM diagnosis cannot be established.

Don't miss it, it might be a hydatid cyst in the gluteus.

Hydatid cyst is one of the five most diagnosed zoonotic diseases in the Mediterranean region. However, intramuscular localisation is very rare. It is reported that muscular involvement constitutes 1-5.4% of all Echinococcus infections. Here we would like to report an unusual case of hydatid cyst in the gluteus muscle, which had been treated with both surgical and medical treatment.

A Large Posteriorly Located Prostatic Mass Lesion Challenging the Robotic Surgeon: Prostate Leiomyoma.

Background: Prostatic leiomyoma is a benign and rare condition of the prostate. Robotic surgery is increasingly being applied in the surgical management of prostate cancer. Case Presentation: Herein, a mass lesion that was located in the posterior part of the prostate between seminal vesicles that was identified during robotic surgery is presented. This lesion further challenged the console surgeon during performing a robotic radical prostatectomy procedure for a 200 g large prostate with prostate cancer. Conclusion: Prostatic leiomyomas that are benign mesenchymal smooth muscle tumors might present as a posteriorly located mass lesion between seminal vesicles that could challenge the surgeon during surgery, which should be kept in mind.

Rare cause of pleural nodularity: Splenosis.

Splenosis is a rare condition described as ectopic splenic tissue implantation generally after a splenic rupture. A 35-year-old male patient who had a history of splenectomy operation due to gunshot wound seven years ago was referred to our hospital with complaints, including exhaustion, sweating and shortness of breath. Thoracic computed tomography of the patient showed nodular pleural thickenings at the level of the left lower lobe, which proved to be unrelated with the presenting symptoms. The patient underwent a minithoracotomy for diagnosis and treatment. During the intraoperative observation, dark-colored, soft, multiple nodular lesions with a biggest size of 2 cm inside the visceral pleura over an area of 5 x 10 cm in dimension were observed. Also, a few tiny nodules in the lung parenchyma approximately 1-cm deep to the pleural nodules were palpated. The lesions were excised. The histopathological examination of the specimen showed splenic tissue in the lung parenchyma and pleura, so the lesions were accepted as splenosis. Pleuropulmonary splenosis, which develops generally after simultaneous rupture of the diaphragma and spleen, is a very rare condition. Most of the patients are asymptomatic and the lesions are detected accidentally. If the diagnosis can be made preoperatively, surgical excision is not needed.

Thromboembolic Events in Malignant Pleural Mesothelioma.

AIM: Malignant pleural mesothelioma (MPM) increases the risk of thromboembolic events (TEEs). In this retrospective study, we aimed to determine the rate of TEEs in MPM and investigate its relationship with the presence of thrombocytosis, the disease stage, and the tumor histopathology. METHODS: The study included 178 patients who were histopathologically diagnosed as MPM between the years January 2008 and June 2014. RESULTS: The mean age was 58.7 ± 11.8 years, and the median follow-up time was 8 months. Seventy-one patients (39.9%) had thrombocytosis (>350 × 10(3)/mL). In total, 14 (7.9%) TEEs were identified: 6 (3.4%) pulmonary thromboembolism, 6 (3.4%) deep venous thrombosis, and 2 (1.1%) myocardial infarctions. Although 5 (2.8%) of the TEEs preceded the diagnosis of MPM, 1 (0.6%) occurred simultaneously with the diagnosis of MPM and 8 (4.5%) followed the diagnosis of MPM. Thromboembolic event rates were not statistically different based on the presence of thrombocytosis (P = .51), disease stage (P = .14), and histopathology (P = .38). CONCLUSION: The rate of TEEs was 7.9%. Presence of thrombocytosis, disease stage, and histopathology did not affect the incidence of TEEs.

Squamous Cell Cancer of The Lung with Synchronous Renal Cell Carcinoma.

Coexistence of two or more primary cancers is a relatively rare case. Not with standing that the coexistence of multiple primary cancers is often discussed in the literature, there is a small number of publications concerning the coexistence of squamous cell lung carcinoma and renal cancer. In this case report, detection of both squamous cell lung carcinoma and primary renal cancer in one male patient is going to be discussed.

Diagnosis and Management of Parathyroid Cysts: Description with Two Cases.

Parathyroid cysts are unilocular, thin-walled cysts, and they are seen very rarely. Their formation mechanisms are not clear. They are usually localized in the cervical region, and mediastinal settlements are rare. They are usually asymptomatic, but cysts that have settled in the neck may be symptomatic, such as tracheal pressure symptoms. There are two types-namely, functional cysts and non-functional cysts-depending on their hormonal characteristics. There are still difficulties in the diagnosis, and they can be mistaken by thyroid pathology. Treatment is surgery. We discussed two cases of parathyroid cysts that we surgically excised.

Vitamin E modulates lung oxidative stress, serum copper, zinc, and iron levels in rats with pulmonary contusion.

BACKGROUND/AIM: To evaluate the effects of oxidant/antioxidant mechanisms and levels of trace elements on trauma-stimulated moderate pulmonary contusions after vitamin E administration. MATERIALS AND METHODS: Sixty-three male Sprague Dawley rats were used. Animals were studied in 4 groups. Vitamin E (150 mg/kg) was injected intraperitoneally 30 min after trauma and on the first and second days. Blood samples were obtained for nitric oxide (NO) levels and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities. Zinc (Zn+2), copper (Cu+2), and iron (Fe+3) were measured in serum. RESULTS: Lung contusion increased serum and tissue NO levels and SOD activities and decreased GSH-Px activities (P < 0.05). Vitamin E significantly (P < 0.05) decreased NO levels and SOD activities and increased GSH-Px. Serum Zn+2, Cu+2, and Fe+3 levels were statistically significantly influenced by the administration of vitamin E (P < 0.05). Group 4 had lower scores compared to Group 3 (P < 0.05) and no difference compared to Group 1 (P > 0.05). CONCLUSION: These results suggest that treatment with vitamin E reduces lung oxidative stress and related mechanisms in isolated lung contusion as demonstrated by an experimental rat model.

Pulmonary Benign Metastasizing Leiomyoma: An Extremely Rare Case.

Benign metastasizing leiomyoma is typically seen in young premenopausal women after a mean period of 15 years following uterine leiomyoma or hysterectomy surgery. They are usually incidentally seen on chest x-rays and are nodular lesions that appear as bilateral nodules with a benign appearance and consist of smooth muscle proliferation. A 44-year-old female presented at her healthcare institution for backache for the last 9 months. Multiple nodules (largest 15 mm) scattered in both lungs and consistent with metastases were detected on computed tomography. The PET-CT results revealed multiple nodular densities with increased metabolic activity (SUVmax: 1.92) in both lungs, with the largest one measuring approximately 15 mm and located in the lower lobe superior segment of the right lung. A benign metastasizing leiomyoma was diagnosed with open wedge biopsy of the lung. We present this case due to its interesting clinical presentation and rarity and emphasize the pathogenesis.

Pulmonary lymphangioleiomyomatosis: a rare case.

Lymphangioleiomyomatosis is an uncommon lung disease primarily affecting women of childbearing age. It is characterized by the progressive proliferation and infiltration of smooth muscle-like cells, which lead to cystic destruction of the lung parenchyma; obstruction of airways, blood vessels, and lymphatics; and loss of pulmonary function. We present the case of a 46-year-old female patient with chest pain, cough, sputum, and dyspnea on exertion for three weeks. Minimal pneumothorax was noted, and the patient was referred to our center for further investigation and treatment. High-resolution computed tomography revealed numerous bilateral thin-walled air cysts and interstitial thickening affecting the central and peripheral part of the upper zone of the lung. We performed an open-lung biopsy to confirm lymphangioleiomyomatosis. Our aim is to discuss the pathogenesis and other lesions noted in the differential diagnosis of this rare disease.

Vitamin C as an antioxidant: evaluation of its role on pulmonary contusion experimental model.

BACKGROUND/AIM: To analyze the protective activity of vitamin C on the lungs by assessing biochemical and histopathological analysi after performing an experimental isolated lung contusion model. MATERIALS AND METHODS: Fifty-four male Sprague-Dawley male rats were used. The rats were randomly separated into 4 groups Vitamin C (200 mg/kg) was injected intraperitoneally 30 min after trauma. Blood samples were obtained for myeloperoxidase (MPO) glutirthione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT) activities and malondialdehyde (MDA) levels Blood gas analysis and bronchoalveolar lavage was performed. The lung tissue was also extracted for histopathological examination. RESULTS: The lung contusion enhanced MDA, SOD, CAT, and MPO and diminished GSH-Px. Vitamin C administration after th pulmonary contusion was found to diminish the level of MDA and the activities of SOD, CAT, and MPO and to enhance the level of GSH-Px (P < 0.05). Contusion-induced disrupted gas analysis and leukocyte infiltration were both resolved by the vitamin C. CONCLUSION: The present results indicate that vitamin C administration attenuated the oxidative damage and morphological change induced by pulmonary contusion in an experimental rat study.