RESUMEN
Background: In this study, we aimed to investigate the relationship between bronchiectasis criteria, scores, and indices used today and surgical interventions due to bronchiectasis. Methods: Between January 2009 and December 2018, a total of 106 patients (53 males, 53 females; mean age: 39.1±12.3 years; range, 14 to 68 years) with non-cystic fibrous bronchiectasis were retrospectively analyzed. We determined symptom improvement and complications as main factors. We divided the patients into two main groups: those who had symptom improvement after pulmonary resection (Group 1, n=89) and those who did not (Group 2, n=17). We further analyzed patients who had postoperative complications (n=27) with those who did not (n=79). The following scores and criteria were used in this study: modified Reiff score, Gudbjerg criteria, Naidich criteria, Bronchiectasis Severity Index, and FACED scoring. Results: There was a statistically significant difference between the groups in terms of the modified Reiff scores and FACED scores. As the modified Reiff score increased, there was a higher rate of symptom relief (p=0.04). Contrary to this, an increase in the FACED score predicted a poorer postoperative outcome (p=0.03). Considering complications, a significant difference was observed in the Gudjberg criteria, and higher grade suggested a higher risk of complication (p=0.02). Conclusion: The grading and scoring systems related to bronchiectasis may have some predictive value in terms of surgical outcomes. A high modified Reiff score and a low FACED score can predict postoperative success, whereas Gudbjerg criteria can indicate postoperative complications.
RESUMEN
BACKGROUND: This study examined the effect of metastatic mediastinal lymph node involvement on the prognosis of patients with malignant pleural mesothelioma (MPM) who underwent extrapleural pneumonectomy (EPP) or extended pleurectomy (E/P) and also to assess the effect of metastatic mediastinal lymph node involvement on the prognosis of patients with MPM in these group of patients. METHODS: This retrospective study included 84 patients with MPM (66 men [78.6%] and 18 women [21.4%]) who underwent EPP (n = 44) or E/P (n = 40) at our institution between January 2001 and July 2019. Survival analyses were performed according to histopathology, nodal status, and surgical approach. RESULTS: In the EPP group, patients with T2-N2 status had a significantly better mean survival (17 ± 2.1 months) than patients with T3-N2 (7.3 ± 1.6 months) or T4-N2 (3.2 ± 1.1 months) status (p = .001). In the E/P group, patients with T2-N2 status had a mean survival of 18 ± 1.1 months, while patients with T3-N2 and T4-N2 status had mean survival durations of 6.6 ± 1.6 and 4.8 ± 1.2 months, respectively (p = .159). In both treatment groups, the survival rates of patients with epithelial tumors were better than those of patients with non-epithelial tumors, independent of N status. None of the patients with N2 disease survived until 5 years postoperatively. CONCLUSION: In summary, our results suggested that mediastinal lymph node metastasis negatively influenced the prognosis of patients with T3 MPM, regardless of treatment by EPP or E/P. Under these circumstances, preoperative cervical mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration may be considered for patients with high-stage MPM who are scheduled for surgery with curative intent. In our study, N2 status was spotted as a significant factor affecting survival, nevertheless its significance in survival of pleural mesothelioma patients should be analyzed in multi-centered studies.
Asunto(s)
Mesotelioma Maligno , Mesotelioma , Neoplasias Pleurales , Masculino , Humanos , Femenino , Mesotelioma Maligno/patología , Mesotelioma Maligno/cirugía , Estudios Retrospectivos , Neoplasias Pleurales/cirugía , Ganglios Linfáticos/patología , Neumonectomía/métodos , Resultado del TratamientoRESUMEN
Background: This study aims to evaluate the surgical results for high-grade neuroendocrine carcinomas and to identify factors that influence prognosis. Methods: Between January 2009 and December 2017, a total of 71 patients (58 males, 13 females; mean age: 62±9.6 years; range, 38 to 78 years) with a high-grade neuroendocrine carcinoma of the lung were retrospectively analyzed. Overall survival and five-year overall survival rates were evaluated. Results: The mean overall survival was 60.7±6.9 months with a five-year survival rate of 44.3%. The mean overall survival and five-year overall survival rates according to disease stage were as follows: Stage 1, 67±10.8 months (46%); Stage 2, 61.4±10.8 months (45%); and Stage 3, 33.2±8.6 months (32%) (p=0.02). The mean overall survival and five-year overall survival rate according to histological types were as follows: in large cell neuroendocrine carcinoma, 59.4±9.2 months (45%); in small cell neuroendocrine carcinoma, 68.6±12.2 months (43%); and in combined-type neuroendocrine carcinoma, 40.9±10.1 months (35%) (p=0.34). Conclusion: Thoracic surgeons should be very selective in performing pulmonary resection in patients with Stage 3 high-grade neuroendocrine carcinomas and combined cell subtype tumors.
RESUMEN
OBJECTIVES: In this study, we aimed to establish risk factors for primary spontaneous pneumomediastinum associated with Coronavirus disease 2019 (COVID-19) and reveal those which are significant. METHODS: The study included 62 patients with primary spontaneous pneumomediastinum who presented to our hospital between 11 March 2020, the date of the first-reported COVID-19 case in our country, and 3 January 2021. Of these, 14 patients (22.6%) had COVID-19 and 48 patients (77.4%) did not have COVID-19. RESULTS: Of the 62 patients included in the study, 41 (66.1%) were male and 21 (33.9%) were female. The mean age was 28.90 ± 16.86 (range, 16-84) years. The most common symptom at admission was chest pain (54.8%). The mean age of the patients with COVID-19 was 39.35 ± 23.04 years and that of the patients without COVID-19 was 25.85 ± 13.45 years (P < 0.001). In receiver-operating characteristic curve analysis, the area under the curve for age was 0.785 (95% confidence interval: 0.648-0.922) and the optimal cut-off value was 24 years for COVID-19-positive patients. The highest sensitivity and specificity values were 0.857 and 0.729. Twelve (85.79%) of the COVID-19-positive primary spontaneous pneumomediastinum patients were aged 24 years or older (P < 0.001). Five patients (8.1%) had positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test but no abnormal findings on computed tomography. CONCLUSIONS: Having an age of more than 24 years was associated with a higher prevalence of pneumomediastinum in COVID-19 patients and emerged as an important risk factor. Multicentre studies with more cases are needed to determine whether pneumomediastinum is associated with additional other risk factors related to COVID-19.
Asunto(s)
COVID-19 , Enfisema Mediastínico , Adolescente , Adulto , COVID-19/complicaciones , Niño , Femenino , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/epidemiología , Enfisema Mediastínico/etiología , Persona de Mediana Edad , Pandemias , Factores de Riesgo , SARS-CoV-2 , Adulto JovenRESUMEN
A 37-year-old male patient was admitted to our hospital with recurrent hemoptysis, 50 mL per day. Thoracic computed tomography showed no pathology responsible for hemoptysis. Bronchoscopy revealed mucosal infiltrations and 2 to 3-mm blotch in the lateral wall of the right lower lobe. After punch biopsy of the suspected area, massive bleeding occurred. Right lower bilobectomy was performed urgently. A bronchovascular fistula was noticed at the specimen. Pathological examination result was compatible with clinically suspected Behçet"s disease. The patient was given high-dose steroid and cyclophosphamide treatment and received azathioprine maintenance treatment for 18 months. He has been symptom-free for three-year follow-up.
RESUMEN
BACKGROUND: In our study, since the operative histopathological distinction of new malignant pulmonary lesions as either a primary lung cancer or a pulmonary metastasis is difficult, we aimed to identify the clinical variables which might allow distinction between a new lung cancer and a pulmonary metastasis, and the appropriate surgical management. METHODS: We divided 55 cases into two groups: patients with new lung cancer (NLC, n = 32) and patients with pulmonary metastases (PM, n = 23). Based on the primary organ, the previous malignancy was classified into four categories: head and neck, colorectal, genitourinary, and breast cancer. The parameters included in the study were age, sex, smoking history, a family history of cancer, disease-free interval, primary organ, treatments for previous malignancies, size, and SUV max of the lung lesion on 18F-fluorodeoxyglucose positron emission tomography scan and high-resolution computed tomography findings of the lung lesion. RESULTS: A predisposition for larger lesions was found in the NLC group. In addition, in the NLC group, disease-free interval was noted to be longer, patients were significantly older and SUV-max values of solitary pulmonary lesions were significantly higher than in the PM group. Pulmonary lesions in patients with prior head and neck cancers were more likely to develop NLC. No significant difference in statistical analysis was observed between the groups in terms of sex, smoking, a family history of cancer, a history of adjuvant therapy, radiological pulmonary lesions signs, and localization. CONCLUSION: PL monitoring on CT surveillance is essential, particularly in patients with previous head and neck cancers, who appear to have a higher risk for NLC. If pathological MLN accompanies PL in a patient with previous extrapulmonary malignancy, cervical mediastinoscopy may help acquire a possible PL diagnosis besides mediastinal staging. Intraoperative frozen section may have difficulty in distinguishing between PM and NLC when the lesion is of the same histological type as the previous malignancy. When precise distinction cannot be achieved by frozen section, we speculate that DFI, age, and radiological findings of the PL may help thoracic surgeons take initiative peroperatively while designating the subsequent surgical intervention. Lastly, pulmonary segmentectomy is also better be considered along with lobectomy in NLC cases.
Asunto(s)
Fluorodesoxiglucosa F18 , Neoplasias Pulmonares , Humanos , Pulmón , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Tomografía de Emisión de Positrones , Radiofármacos , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: In this study, we aimed to reveal the prognostic differences between skip and non-skip metastasis mediastinal lymph node (MLN) metastasis. METHODS: A total of 202 patients (179 males and 23 females; mean age, 59.66 ± 9.89 years; range: 29-84 years) who had ipsilateral single-station MLN metastasis were analyzed in two groups retrospectively between January 2009 and December 2017: "skip ipsilateral MLN metastasis" group (sN2) (n = 55,27.3%) [N1(-), N2(+)], "non-skip ipsilateral MLN metastasis" group (nsN2) (n = 147,72.7%) [N1(+), N2(+)]. RESULTS: The mean follow-up was 42.63 ± 34.91 months (range: 2-117 months). Among all patients, and in the sN2 and nsN2 groups, the median overall survival times were 63.5 ± 4.56, 68.8 ± 7, and 59.3 ± 5.35 months, respectively, and the 5-year overall survival rates were 38.2%, 46.3%, and 36.4%. CONCLUSION: Skip metastasis did not take its rightful place in TNM classification; thus, further studies will be performed. To detect micrometastasis, future studies on skip metastasis should examine non-metastatic hilar lymph nodes (LNs) through staining methods so that heterogeneity in patient groups can be avoided, that is, to ensure that only true skip metastasis cases are included. Afterwards, more accurate and elucidative studies on skip metastasis can be achieved to propound its prognostic importance in the group of N2 disease.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Metástasis Linfática , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Femenino , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: This study aims to investigate the effects of transcutaneous electrical nerve stimulation on early-stage postoperative pain and long-term quality of life in patients undergoing thoracotomy. METHODS: Between January 2019 and September 2019, a total of 100 patients (76 males, 24 females; mean age: 57.9±11.9 years; range, 51 to 79 years) who underwent thoracotomy due to benign or malignant lesions were included. The patients were divided into two groups: 50 patients who received transcutaneous electrical nerve stimulation (Group 1) and a control group of 50 patients who did not receive transcutaneous electrical nerve stimulation (Group 2). The Short Form-36 life quality scale was used to evaluate patients' quality of life at one month before and after surgery. RESULTS: The mean length of hospital stay was 4.9±3.1 days in Group 1 and 6.2±4.6 days in Group 2 (p=0.008). There were no statistically significant differences in early-stage postoperative pain scores between the groups (p>0.05). Compared to Group 2, Group 1 had significantly lower pain scores and higher life quality scores pre- and postoperatively (p<0.05). CONCLUSION: Transcutaneous electrical nerve stimulation is an effective method to manage chronic pain in the postoperative period. On the other hand, it does not effectively reduce early-stage postoperative pain or affect complication rates. The prevention of chronic postoperative pain by transcutaneous electrical nerve stimulation improves long-term quality of life of patients.
RESUMEN
BACKGROUND: This study aims to compare the short-term quality of life of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy. METHODS: A total of 96 patients (58 males, 38 females; mean age 58.4±11.7 years; range, 18 to 80 years) who underwent video-assisted thoracoscopic surgery or thoracotomy in our hospital between March 2018 and March 2019 were retrospectively analyzed. Demographic and clinical characteristics and comorbidities of the patients were recorded. Quality of life of the patients was evaluated using the Short Form-36 health survey at the first postoperative month. RESULTS: Of the patients, 43 (44.8%) were treated by video-assisted thoracoscopic surgery and 53 (55.2%) by thoracotomy. Complications occurred in nine (20.9%) patients following video-assisted thoracoscopic surgery and in 12 (22.6%) patients following thoracotomy (p=0.840). At one month postoperatively, the patients in the video-assisted thoracoscopic surgery group had a better quality of life than those in the thoracotomy group (p<0.05). CONCLUSION: Our study results suggest that both recovery and short-term quality of life seem to be better in patients undergoing video-assisted thoracoscopic surgery than in those treated by thoracotomy.
RESUMEN
BACKGROUND: Carinal resections for non-small cell lung cancer (NSCLC) invading the carina are challenging cases that require a therapeutic strategy. The aim of this study was to compare the oncologic outcomes and complications of patients who underwent carinal resection. METHODS: Sixty-four patients who underwent carinal resection between 2005 and 2016 were evaluated. Data were retrospectively reviewed for indications, complications, and factors influencing long-term survival. RESULTS: The study included 51 patients (79.7%) who underwent sleeve pneumonectomy (sP) and 13 patients who underwent carinal sleeve lobectomy (csL) as a curative therapy. Nine patients (14.1%) received induction chemotherapy. Complications were observed in 31 patients (48.8%), including 24 patients (47.1%) in the sP group and 7 patients (53.8%) in the csL group (p = 0.662). Six patients (9.4%) developed bronchopleural fistula. The 30-day mortality rate was 10.9% (n = 7). The 5- and 10-year survival rates were 42.2 and 23.1%, respectively. N2 and R1 were identified as factors affecting survival (p = 0.029 and p = 0.047). CONCLUSION: Carinal resections have acceptable morbidity, mortality, and long-term survival outcomes in central NSCLC. The main factors affecting survival are complete resection and nodal status. The results of csL were similar to those of sP. Therefore, we believe that csL should be performed in all eligible patients.
Asunto(s)
Bronquios/cirugía , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía , Tráquea/cirugía , Adulto , Anciano , Bronquios/patología , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neumonectomía/efectos adversos , Neumonectomía/mortalidad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Tráquea/patología , Resultado del TratamientoRESUMEN
OBJECTIVE: To assess the diagnostic value of video-assisted thoracoscopic surgery in exudative pleural effusions, and to evaluated the frequency of malignancy development with long term follow-up of patients defined as nonspecific pleuritis after surgery. . METHODS: The retrospective study was conducted at Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, and comprised data of patients with undiagnosed exudative pleural effusions seen between January 2008 and December 2013. Data related to clinical, radiological, thoracoscopical, histopathological and follow-up periods were obtained from the hospital records. SPSS 15 was used for data analysis. RESULTS: Of the 229 patients, 145(63.3%) were males and 84(36.7%) were females. The overall mean age was 54.5 }15.1 years. Malignancy was found in 84 (36.6%) patients, and tuberculosis in 26(11.4%). The remaining 119(52%) patients had nonspecific pleuritis and their mean follow-up period was 29.2}27.1 months (range: 1-103 months). Video-assisted thoracoscopic surgery was repeated in 3(2.52%) patients in the 1st, 4th and 16th months of followup period due to the recurrence of pleural effusion. Tuberculosis and mesothelioma were diagnosed in 1(0.8%) and 2(1.7%) cases, respectively. CONCLUSIONS: Video-assisted thoracoscopic surgery was found to be a valuable diagnostic procedure in patients with undiagnosed exudative pleural effusion.
Asunto(s)
Neoplasias Pulmonares/diagnóstico , Linfoma/diagnóstico , Mesotelioma/diagnóstico , Derrame Pleural/etiología , Neoplasias Pleurales/diagnóstico , Pleuresia/diagnóstico , Tuberculosis Pleural/diagnóstico , Adulto , Anciano , Biopsia , Exudados y Transudados , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , Linfoma/complicaciones , Linfoma/patología , Masculino , Mesotelioma/complicaciones , Mesotelioma/patología , Persona de Mediana Edad , Neoplasias Pleurales/complicaciones , Neoplasias Pleurales/patología , Neoplasias Pleurales/secundario , Pleuresia/complicaciones , Pleuresia/patología , Estudios Retrospectivos , Toracocentesis , Cirugía Torácica Asistida por Video , Tuberculosis Pleural/complicaciones , Tuberculosis Pleural/patología , TurquíaRESUMEN
OBJECTIVES: Cervical mediastinoscopy may become essential in patients with pathological lymph nodes at mediastinum after laryngectomy. However, having had a previous tracheostomy has been reported to be a contraindication for cervical mediastinoscopy. METHODS: Between January 2010 and December 2017, cervical mediastinoscopy was performed for lung cancer staging in 1985 patients at the Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey. Eighteen of these patients (1%) had a permanent tracheostomy after total laryngectomy and cervical radiotherapy due to laryngeal carcinoma. RESULTS: Cervical mediastinoscopy was performed in 18 patients with a permanent tracheostomy after total laryngectomy. The negative predictive value of cervical mediastinoscopy was 13/14 (93%). The average operative time was 63 min (SD 12.0, range 50-90 min). The negative predictive value of endobronchial ultrasonography was 4/7 (57%). Positron emission tomography-computed tomography had a positive predictive value of 3/15 (20%) and a negative predictive value of 2/3 (67%). CONCLUSIONS: Contrary to the claims of 2 textbooks, cervical mediastinoscopy is a viable method for patients with a tracheostomy after laryngectomy. The negative predictive values of standard cervical mediastinoscopy and mediastinoscopy for patients with a tracheostomy after total laryngectomy are approximately equivalent. Our results indicate that cervical mediastinoscopy is a feasible method in patients with a permanent tracheostomy when applied by experienced thoracic surgeons in specialized hospitals.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Mediastinoscopía/métodos , Mediastino/patología , Estadificación de Neoplasias/métodos , Traqueostomía/métodos , Anciano , Carcinoma de Pulmón de Células no Pequeñas/secundario , Estudios de Factibilidad , Humanos , Laringectomía , Ganglios Linfáticos/patología , Metástasis Linfática/diagnóstico , Masculino , Persona de Mediana Edad , Cuello , TurquíaRESUMEN
In this article, we present a 59-year-old male patient who was admitted to our hospital with right pleural effusion and right-sided chest pain and diagnosed as malignant pleural mesothelioma with thoracentesis and pleural biopsy. After the patient was determined to be operable, right parietal pleurectomy + pericardial resection + diaphragmatic resection were performed and four cycles of cisplatin and pemetrexed combination as adjuvant treatment were added. The patient was followed-up without any problem for three and a half years. At this time, left-sided chest pain and leftsided effusion were noticed. Tumor was negative in thoracentesis and pleural biopsy. Then, video-assisted thoracoscopic surgery was applied, which resulted in Stage 1a malignant pleural mesothelioma. Thoracoscopic parietal pleurectomy was performed with success. Four cycles of pemetrexed single-agent therapy was performed as an adjuvant treatment. The patient died of chronic obstructive pulmonary disease and heart failure in 57th month of the first and 21st month of the second operation while he was tumor free. To the best of our knowledge, this case is the first operated bilateral metachronous primary malignant pleural mesothelioma in the literature.
RESUMEN
PURPOSE: The purpose of this study was to evaluate the following parameters after complete resection in established lung cancer patients: the frequency of bronchial stump recurrence (BSR), the effect of the distance between the tumor and bronchial resection margin (DBTM) on BSR, the survival of patients with BSR, and the effect of the DBTM on survival. PATIENTS AND METHODS: We retrospectively evaluated 553 consecutive lung cancer patients who underwent complete lung resection. The patients were classified as DBTM: ≤ 10 mm (group 1), 11 to 20 mm (group 2), and > 20 mm (group 3). RESULTS: We found BSR in eight (1.5%) patients. Six patients were in group 1, and two were in group 2. The difference was found to be statistically significant (p = 0004; groups 1 vs. 3). In multivariable analysis, we observed a trend toward significance for the effect of a DBTM on BSR development (p = 0.1). The DBTM did not significantly affect survival (p = 0.61). The survival of patients who developed BSR was significantly poor compared with those who did not develop BSR (p = 0.001). CONCLUSION: BSR can develop even after complete resection of lung cancer. The DBTM is associated with BSR risk, and the survival of patients who develop BSR is poor.
Asunto(s)
Bronquios/patología , Bronquios/cirugía , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia , Neumonectomía , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Humanos , Estimación de Kaplan-Meier , Modelos Lineales , Neoplasias Pulmonares/mortalidad , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Análisis Multivariante , Neumonectomía/efectos adversos , Neumonectomía/mortalidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
We report the case of a 47-year-old woman who presented with the unique asymptomatic malformation of an extralobar pulmonary sequestration communicating with a bronchogenic cyst. Despite computed tomography and magnetic resonance imaging of the chest, the diagnosis could not be established before a left thoracotomy was performed. The sequestrated lobe and bronchogenic cyst were then successfully resected.
Asunto(s)
Quiste Broncogénico/diagnóstico , Quiste Broncogénico/cirugía , Secuestro Broncopulmonar/diagnóstico , Secuestro Broncopulmonar/cirugía , Toracotomía , Quiste Broncogénico/diagnóstico por imagen , Quiste Broncogénico/patología , Secuestro Broncopulmonar/diagnóstico por imagen , Secuestro Broncopulmonar/patología , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Procedimientos Quirúrgicos Pulmonares/métodos , Tomografía Computarizada por Rayos XRESUMEN
Granular cell tumour (GCT), which is a rare benign soft tissue neoplasm, is mostly found in the skin and soft tissue but may develop anywhere in the body. There are less than 10 reported cases of mediastinal GCTs in the current literature. Furthermore, colonic GCTs have recently gained attention due to the increased public awareness on the importance of colonoscopy screening. We report a case of a 52-year-old woman diagnosed incidentally with synchronous GCTs of the mediastinum and the hepatic flexure on her routine screening for post-operative follow-up for status-post right modified radical mastectomy due to a T2N1M0, Stage 2B breast cancer.
RESUMEN
PURPOSE: Lung adenocarcinoma (AC) demonstrates various histological subtypes within the tumour tissue. A panel established jointly by the IASLC, ATS and ERS classified invasive lung ACs based on the predominant histological subtype. We examined the distribution of tumours in lung AC patients according to histological subtype and analysed the effects of this classification on survival. METHODS: The records of patients who had pulmonary resection for lung cancer between January 2000 and December 2009 were reviewed and 226 lung AC patients who fulfilled the inclusion criteria were identified. Histological subtypes of the ACs and their ratios in the tumour tissue were determined. Tumours were classified according to the predominant histological subtype and subsequently graded. The relationship between the predominant histological subtype, grade and survival were analysed. RESULTS: Tumours were predominantly acinar in 99 cases (43.8%), solid in 89 (39.3%), lepidic in 20 (8.8%), and papillary in 11 (4.8%), whereas 7 tumours (3%) were variants of AC. Stage significantly affected survival (p = 0.001); however, the predominant histological subtype had no significant effect. The 5-year survival rate for patients with histologically grade II tumours was 48.6%, whereas that in patients with grade III tumours was 56%. (p = 0.69). CONCLUSION: Invasive lung ACs may be defined by their predominant histological subtype. However, it is not yet possible to conclude that this classification is related to survival.
Asunto(s)
Adenocarcinoma/patología , Adenocarcinoma/cirugía , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Neumonectomía , Adenocarcinoma/mortalidad , Adenocarcinoma del Pulmón , Adulto , Anciano , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Neumonectomía/efectos adversos , Neumonectomía/mortalidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Squamous cell carcinomas confined to the bronchial wall (SCC-CBW) exhibit two distinct patterns of growth: superficially spreading and endobronchial mass lesions. We examined whether differences exist in the histopathological features and prognosis of SCC-CBW exhibiting different growth patterns. MATERIALS AND METHODS: In this study, 37 cases with SCC-CBW were included. Tumors were classified into two groups: superficially spreading squamous cell carcinoma (s-SCC) and nodular squamous cell carcinoma (n-SCC). For each case, the growth pattern, T and N status, lymphovascular and perineural invasions, immunohistochemical expressions of p53 and Ki-67, and survival rates were analyzed. RESULTS: Twenty cases were classified as s-SCC, and 17 cases were classified as n-SCC. There was a significant relationship and correlation between the length of s-SCC in the longitudinal axis and the depth of invasion (p = 0.01, R = 0.557). There was a statistically significant positive relationship between the depth of invasion and the nodal status (N1 involvement) (p < 0.0001, R = 0.71). CONCLUSIONS: SCC-CBW exhibits variable growth patterns. However, despite this variability, there are no biological or histological differences between tumors of different growth patterns, and this variability has very little, if any, effect on survival.
Asunto(s)
Bronquios/patología , Carcinoma de Células Escamosas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Estadificación de Neoplasias , Anciano , Biomarcadores de Tumor/biosíntesis , Biomarcadores de Tumor/genética , Broncoscopía , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/mortalidad , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Antígeno Ki-67/biosíntesis , Antígeno Ki-67/genética , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidad , Masculino , Mediastinoscopía , Persona de Mediana Edad , Invasividad Neoplásica , Tomografía de Emisión de Positrones , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Tomografía Computarizada por Rayos X , Proteína p53 Supresora de Tumor/biosíntesis , Proteína p53 Supresora de Tumor/genética , Turquía/epidemiologíaRESUMEN
PURPOSES: Since radiation and chemotherapy have limitations as therapies for malignant pleural mesothelioma (MPM). The type of surgery [extrapleural pneumonectomy (EPP), extended pleurectomy (E/P), and pleurectomy/decortication (P/D)] remains controversial. METHODS: This study involves 76 consecutive patients. 58 of the cases were males (76%) with a median age of 53.17±10.93 years. EPP, E/P, and P/D were performed in 31, 20, and 25 cases, respectively. RESULTS: The median survival time was 20 months in all patients. Overall, five-year survival rate was 14.3%. The survival rate was significantly better in epithelioid mesothelioma (P=0.049). For EPP cases, the median survival rate was 17 months, and the three-to-five year survival rates were 21% and 17%, respectively. For E/P cases, the median survival rate was 27 months and the three-year and four-year survival rates were 34% and 30%, respectively. For P/D cases, the median survival rate was 15 months and the three-to-five year survival rate was 13% and 0%. There were no statistically significant differences between the three surgical techniques (P=0.088). A comparative analysis indicates only a statistically significant difference in the E/P and P/D comparison (P=0.032). Hospital mortality showed a higher trend in EPP group (EPP: 12.9%, E/P: 0% and P/D: 4%, P=0.145). N2 cases, there were no cases of two-year survival. The survival rate in N2 was comparatively much lower, which was statistically significant (P=0.005). In multivariate analysis, only P/D (OR 0.3, 95% CI: 0.1-0.9, P=0.049) and N2 (OR 1.6, 95% CI: 0.9-2.6, P=0.090) were found to be poor prognostic factors. CONCLUSIONS: E/P could be encouraged to EPP with lower mortality rate and better survival trend in MPM. N2 diseases were negative prognostic factors in MPM.
RESUMEN
Every patient undergoing curative treatment for primary lung cancer is a candidate for metachronous lung cancer, with a reported risk of 5% per year. The majority of cases are stage I patients. Patients who undergo resection for lung cancer should be followed regularly. A metachronous lung cancer that develops as bilateral synchronous lung cancer is very rare.