Primary Pulmonary Mucinous (Colloid) Adenocarcinoma that Arose in the Cavernomyoplasty Area in a Patient with Tuberculosis: A Rare Case Report.

Primary pulmonary mucinous (colloid) adenocarcinoma is a rare type of lung cancer. Its arising in the cavernomyoplasty area has not been reported before. We here describe a sixty-year-old man with a previous history of multidrug-resistant and surgically-treated tuberculosis who was diagnosed as primary mucinous adenocarcinoma in the cavernomyoplasty site. We discuss the relevant literature on this rare entity.

Tratamiento acelerado del empiema y cáncer de pulmón concomitantes mediante cirugía toracoscópica videoasistida / Accelerated treatment of concomitant empyema and lung cancer by video-assisted thoracoscopic surgery

INTRODUCCIÓN: La causa más frecuente de los empiemas pleurales son los derrames paraneumónicos, siendo el cáncer de pulmón el origen de los mismos en muy pocas ocasiones. EL objetivo de nuestro trabajo es analizar los resultados del tratamiento del empiema por vía toracoscópica previo al tratamiento oncológico definitivo. MÉTODOS: Estudio descriptivo retrospectivo en el que se recogen las diferentes variables clínicas durante el tratamiento de 332 pacientes entre 2002 y 2010. RESULTADOS: En 332 pacientes con empiema, la etiología de esta enfermedad fue el cáncer de pulmón en 11 casos. Entre ellos había 10 varones y una mujer (mediana de edad, 57,9 años; rango: 46-76). El tratamiento inicial fue la colocación de un tubo de toracostomía en 8 pacientes y la cirugía toracoscópica videoasistida en 3 pacientes. Se llevó a cabo un desbridamiento toracoscópico en 4 pacientes en los que el resultado del tubo de toracostomía no fue satisfactorio debido a un drenaje insuficiente. Se llevó a cabo una resección quirúrgica en 7 pacientes cuyas características eran apropiadas tras el control de la infección. Se produjo una fístula broncopleural y un empiema postoperatorio tras la neumectomía en un caso. No se observó mortalidad operatoria. La media de supervivencia fue de 32,8 meses en los pacientes tratados con resección. CONCLUSIONES: El empiema puede ser una forma de presentación muy poco frecuente del cáncer de pulmón cuyo abordaje puede realizarse por toracoscopia, si bien el mismo tiene sus limitaciones

BACKGROUND: The most common cause of pleural empyema are parapneumonic effusions, and lung cancer is a rare cause of empyema. The aim of the present study is to analyse the results of the thoracoscopic treatment of empyema before definitive oncological treatment. METHODS: Retrospective descriptive study of 332 patients including different clinical variables between 2002 and 2010. RESULTS: Among 332 patients with empyema, the etiology of this disease was lung cancer in 11 patients. Ten of these patients were male and one was female (median age, 57.9 years; range, 46-76). The initial treatment was tube thoracostomy in 8 patients and video-assisted thoracoscopic surgery in 3 patients. Thoracoscopic debridement was performed in 4 patients whose tube thoracostomy underperformed because of insufficient drainage. The methods used for diagnosis of lung cancer were fiberoptic bronchoscopy and video-assisted thoracoscopic surgery. Surgical resection was performed on 7 suitable patients following infection control. Postoperative bronchopleural fístula and empyema occurred after pneumonectomy in one case. No operative mortality was observed. The mean survival time was 32.8 months for patients undergoing resection. CONCLUSIONS: Empyema could be a rare presentation of lung cancer and those suitable for surgical treatment should undergo standard treatment with reasonable results

Accelerated treatment of concomitant empyema and lung cancer by video-assisted thoracoscopic surgery.

BACKGROUND: The most common cause of pleural empyema are parapneumonic effusions, and lung cancer is a rare cause of empyema. The aim of the present study is to analyse the results of the thoracoscopic treatment of empyema before definitive oncological treatment. METHODS: Retrospective descriptive study of 332 patients including different clinical variables between 2002 and 2010. RESULTS: Among 332 patients with empyema, the etiology of this disease was lung cancer in 11 patients. Ten of these patients were male and one was female (median age, 57.9 years; range, 46-76). The initial treatment was tube thoracostomy in 8 patients and video-assisted thoracoscopic surgery in 3 patients. Thoracoscopic debridement was performed in 4 patients whose tube thoracostomy underperformed because of insufficient drainage. The methods used for diagnosis of lung cancer were fiberoptic bronchoscopy and video-assisted thoracoscopic surgery. Surgical resection was performed on 7 suitable patients following infection control. Postoperative bronchopleural fístula and empyema occurred after pneumonectomy in one case. No operative mortality was observed. The mean survival time was 32.8 months for patients undergoing resection. CONCLUSIONS: Empyema could be a rare presentation of lung cancer and those suitable for surgical treatment should undergo standard treatment with reasonable results.

Lung cancer and pregnancy.

Lung cancer in the pregnant woman is a very rare and dramatic coincidence with poor prognosis. Treatment depends on the gestational week of the pregnancy, patient's medical status, social, personal, familial, and even religious beliefs. We present a case of adenocarcinoma of the lung in a 34-year-old pregnant patient whose initial complaints were cough, dyspnea, fever and fatigue. She was diagnosed with pneumonia at another hospital, and antibiotic therapy was administered. Meanwhile, at 28 weeks she delivered a preterm low-birth-weight baby. Chest X-ray and thorax CT revealed a mass lesion in the upper left lung lobe. After admission to our clinic, needle aspiration of left supraclavicular lymph node and bronchoscopic biopsy from upper lobe bronchus showed a non-small lung cancer; adenocarcinoma. Brain MRI was normal. PET CT revealed multiple bone metastases. Multidisciplinary Tumor Committee at our hospital referred her to the Oncology Department as an advanced stage IV disease. Chemotherapy was administered with paclitaxel and carboplatin for a total of 12 weeks. Reassessment of the patient revealed new bone metastases and crizotinib was administered since her tumor was found positive for EML4-ALK mutations. The treatment was well tolerated. During a follow up period of 6 months her clinical condition was stable and no adverse events were encountered.

Palpable lesions as a diagnostic tool in patients with thoracic pathology.

Palpable lesion(s) noticed in a patient with thoracic disease may be a useful diagnostic tool and it often gives a clue for further management. In this study, we searched the diagnostic value of palpable lesions in patients with thoracic pathology suspected clinically and/or radiologically. We prospectively examined the correlations of clinical/radiologic and pathologic findings of 72 palpable lesions from 68 patients who presented with suspect for a thoracic disease from two tertiary medical centers. Thirty-two lesions (44.4%) were diagnosed as malignant either by fine-needle aspiration (FNA) only or FNA with confirmatory biopsy. The most common malignancy was non-small-cell carcinoma (10) followed by adenocarcinoma (6), and small-cell carcinoma (5). The most common localization of the palpable lesions was cervical region (20.8%) followed by left supraclavicular (13.8%) and anterior chest wall (13.8%). FNA was effective in obtaining an accurate diagnosis in 66.6% of the patients. Tissue confirmation of FNA was performed in 54 patients. The sensitivity, specificity, negative predictive value, and positive predictive value of FNA in distinguishing a malignant lesion from a benign disease for these palpable lesions were 75, 97, 96, and 80, respectively. One false negativity and one false positivity were also found. Abnormal radiologic features were not correlated with having a malignant palpable lesion. Evaluation of the palpable lesions by FNA and tissue biopsy together is effective for initial triage of the patients with suspect for a thoracic pathology. FNA alone is a convenient and easy method for this purpose especially when the material is immediately assessed for specimen adequacy.

Primary lymphoepithelioma-like carcinoma of the lung: report of a rare case and review of the literature.

Primary lymphoepithelioma-like carcinoma of the lung is a rare type of non-small cell lung carcinoma. In this study, we aimed to present a 62-year-old smoker male with a primary lymphoepithelioma-like carcinoma of the hilar region of the left lung. The patient underwent left pneumonectomy and no adjuvant therapy was given. There were no other abnormalities on whole body PET/CT scan including the nasopharyngeal region. The patient showed seropositivity for EBV IgG but immunohistochemistry and PCR amplification studied on paraffin-embedded tissue sections of the tumor failed to show any sign of EBV infection within the tumor cells. He is alive and disease-free four months after the operation. Although primary lymphoepithelioma-like carcinoma of the lung is usually reported in young females with no history of tobacco use and the tumor cells are infected with EBV, it may rarely be seen in elderly males with a history of tobacco use and the tumor cells not infected with EBV.

Extrinsic allergic alveolitis as an uncommon diagnostic pitfall in lung cytology.

House paints, the industrial products of toxic chemicals are known to be linked with severe respiratory disturbances especially in inadequately ventilated places. In this study, we aimed to report a biopsy-proven case of extrinsic allergic alveolitis (EAA) who presented with nonspecific respiratory symptoms 1 month after having her whole house interior painted. At CT scanning, we observed the ground glass opacities and the micronodular pattern typical for EAA and also a solid, consolidative lung area, highly suggestive of malignancy. The case initially was misinterpreted as a malignant tumor both radiologically and cytologically at CT-guided transthoracic fine needle aspiration biopsy. The final pathologic diagnosis was given as EAA on frozen section performed during thoracotomy operation. The patient received short-term steroid treatment and has been doing well for the last 7 months after her operation. As a conclusion, when assessing a cytologic material from a patient who has got a solid lung mass and also a history of chemical dye exposure, consolidative mass formation which is a rare form of EAA should always be kept in mind. Another final point is that the appropriate ventilation should be achieved if the exposure with the house paint chemicals is inevitable.

Pneumorrhachis associated with bronchial asthma, subcutaneous emphysema and pneumomediastinum.

Pneumorrhachis is defined as the presence of air in the epidural space or subarachnoid space. The air may migrate along fascial planes from the posterior mediastinum, through the neural foramina, and into the epidural space. Pneumorrhachis is rare, and even more so in the paediatric population. Pneumorrhachis in itself usually is asymptomatic, does not tend to migrate and reabsorbs spontaneously. The combination of pneumomediastinum with epidural pneumorrhachis without thoracic trauma has rarely been reported in the literature. The present case report describes the presence of pneumomediastinum, subcutaneous emphysema, and pneumorrhachis in a child asthmatic patient who had a history of fever, violent cough.

Approach to empyema necessitatis.

BACKGROUND: Thoracic empyema is a collection of pus in the pleural space. Empyema necessitatis is a rare complication of empyema, characterized by the dissection of pus through the soft tissues of the chest wall and eventually through the skin. We present nine cases of empyema necessitatis, including etiology, duration, and characteristics of clinical history, kind of surgery used, and treatment choices. METHODS: In a 4-year period nine patients were treated for empyema necessitatis. Six were male and 3 female with an age range of 13-89 years (median=40 years). RESULTS: Empyema necessitatis was treated with drainage and antibiotherapy or antituberculosis therapy in three patients with the diagnosis of tuberculosis or nonspecific pleuritis. Decortication of the thoracic cavity was used in three patients successfully. Others were treated with open drainage. Final diagnoses were tuberculous empyema in five patients, chronic fibrinous pleuritis in three, and squamous cell carcinoma in one. Except for two patients, one with multisystem failure and one with squamous cell carcinoma, all were discharged with no complications. CONCLUSION: Surgery plays a critical role in the management of empyema necessitatis in selected patients. Tube drainage, open drainage, and decortication are the choices in variable conditions for obliterating the cavity and regenerating pulmonary function.

Pneumonectomy in children for destroyed lung: evaluation of 18 cases.

BACKGROUND: Destroyed lung is an uncommon condition; it describes a nonfunctional lung and is most often caused by inflammatory diseases. Surgical resection is used to resolve or prevent complications and improve quality of life. We reviewed our experience in surgery for destroyed lung in children. METHODS: The records of 18 children aged 16 years and younger who had undergone pneumonectomy for destroyed lung between 1991 and 2007 were analyzed retrospectively. RESULTS: Eighteen children, 10 males (55.5%) and 8 females, aged 5 to 16 years, with a mean age of 12.3 underwent pneumonectomy. Cough was the major presenting symptom (n = 18, 100%). The median preoperative period for symptoms was 6 years. Radiologic diagnostic methods included chest radiograph, computed tomography, bronchoscopy, and bronchography. Bronchiectasis (n = 13), tuberculosis (n = 4), and aspergillosis (n = 1) were the main pathologies. Five patients had tuberculosis history, and tuberculosis culture was positive in 2 patients. Pneumonectomy was applied to the left side in 14 and right side in 4 patients. There was no mortality. Complication occurred in 3 patients (atelectasis [n = 1], fistula and empyema [n = 1], and wound infection [n = 1]). Atelectasis was treated with bronchoscopy and stoma was needed for another patient for empyema. The mean follow-up was 64.9 months (range, 19 to 164 months). In their follow-up period, scoliosis was found in 1 patient. CONCLUSIONS: The morbidity and mortality rates of pneumonectomy are acceptable for selected and well prepared children. Antibiotics and antituberculosis treatment in certain cases and good timing in pneumonectomy are essential. Children grew and developed normally after pneumonectomy.

The role of integrated positron emission tomography and computed tomography in the assessment of nodal spread in cases with non-small cell lung cancer.

Integrated positron emission tomography and computed tomography (PET/CT) scanning has become the standard for oncologic imaging. We sought to determine the role of PET/CT in mediastinal non-small cell lung cancer staging. One hundred and twenty-seven consecutive patients were enrolled in the study where PET/CT was performed due to pathologically defined non-small cell carcinoma from a single center. They all underwent complete resection with a thoracotomy and systemic lymph node dissection (SLND) between October 2005 and January 2007. Postoperative pathology results of lymph node stations regarding the nodal spread and stage were compared with clinical stage obtained by PET/CT. The sensitivity, specificity, accuracy, negative predictive value (NPV) and positive predictive value (PPV) of PET/CT in N2 cases were determined to be 72.0%, 94.4%, 92.7%, 97.7% and 49.2%, respectively. Maximum standard uptake (SUV(max)) cut-off value for mediastinal N2 involvement in PET/CT was obtained by applying 'receiver operating characteristic' (ROC) analysis that was set to 5.2. Correct stage with PET/CT was established in 76.3% of cases. Staging of non-small cell lung cancer (NSCLC), according to the PET/CT for which we determined 97.79% NPV, we consider that thoracotomy without preoperative mediastinal invasive staging in cases of negative mediastinal involvement in PET/CT can be certainly performed.

Malignant invasive thymoma in the posterior mediastinum.

We present a rare case of malignant invasive thymoma (type A) arising from the posterior mediastinum. A 17-year-old girl was referred to our clinic after detection of a mass on a chest roentgenogram. Thoracoscopy showed a lobulated, pale yellowish mass located in the posterior compartment together with several foci in the lung parenchyma. The tumor and parenchymal foci were totally resected through a left minithoracotomy. Postoperative pathology revealed malignant invasive thymoma type A.

Bronchogenic cysts of the lung: report of 29 cases.

BACKGROUND: Intrapulmonary bronchogenic cysts are congenital anomalies of the tracheobronchial tree and foregut. The aim of this retrospective study was to review the diagnosis, clinical and histological features, operative techniques, outcomes and follow-up of intrapulmonary bronchogenic cysts treated in a single institute. METHODS: Twenty-nine patients with intrapulmonary bronchogenic cysts were treated surgically between 1990 and 2005. There were 17 female and 12 male patients and their ages ranged from 7 to 68 years. Patients were divided into two groups according to surgical procedure. Resection (lobectomy or wedge resection) was performed on Group I (n=18), and partial excision with de-epithelisation was performed on Group II (n=11). RESULTS: Twenty-five patients (86.2%) were symptomatic. Cough and sputum were the most common symptoms. Twenty-four of the 29 BCs were simple cysts (82.7%) whereas 5 (17.3%) were complicated cysts. Postoperative hospital stay was 4.55+/-0.86 days in group I and 6.54+/-3.34 days in group II (P=0.172). Complications in Group I were pneumonia in one case and wound infection in two cases; prolonged air leakage were observed in two cases of Group II. No statistical difference was determined between the complication rates of the two groups (P=0.91). However a significant difference was determined between the complication rates of simple and complicated cysts (P=0.026). Two cases in Group II showed recurrence, whereas no recurrence occurred in Group I. (P=0.065) No postoperative mortality was observed in any of the groups. CONCLUSIONS: All bronchogenic cysts should be treated surgically. We believe that partial excision with de-epithelisation may be an alternative to resection in symptomatic patients with limited respiratory capacity.

Video-assisted thoracoscopy for spontaneous pneumothorax after pneumonectomy.

In this paper, we present 3 patients who had previously undergone pneumonectomy and then presented with a spontaneous pneumothorax. The indication for pneumonectomy was tuberculosis and NSCLC in 2 and 1 patient, respectively. The interval between the surgery and development of pneumothorax was 2, 4, and 11 years. On admission, 2 of the 3 patients were in extreme respiratory distress requiring urgent chest tube insertion. In all patients we undertook elective video-assisted thoracoscopy with complete preparation for cardiopulmonary support on the side. Bullectomy and/or diathermy ablation for apical bullae and blebs were performed concomitantly with total parietal pleurectomy. The postoperative course was uneventful in the patients, and they remain on routine follow-up for up to 6-12 months without any complaints. Our experience suggests that emphysematous changes in the remaining lung should be carefully inspected during long-term follow-up after pneumonectomy. Video-assisted thoracoscopic (VAT) pleurectomy appears to be a good option for the management of spontaneous pneumothorax only if it is performed by a dedicated multidisciplinary team with various cardiopulmonary support facilities on the side.

Videothoracoscopic approach to recurrence primary spontaneous pneumothorax: using of electrocoagulation in small bulla/blebs.

OBJECTIVE: To evaluate the effectiveness of electrocoagulation of bullae/blebs and apical pleurectomy via videothoracoscopic approach. METHODS: We reviewed 42 patients who underwent Videoassisted thoracoscopy (VATS) procedure for recurrence primary spontaneous pneumothorax (PSP) from 200022006. There were 30 male and 12 female patients with a median age of 30 years. The percentage of pneumothorax was calculated median of 60% (British Thoracic Society Guideline - 2003). Thirty-two (76.2%) bullae/blebs were observed with the median diameter of 15 mm (5-30). RESULTS: Bulla ablation via cauterisation and apical pleurectomy was performed in 32 patients. Ten patients underwent only apical pleurectomy/abrasion because in this group there was not any either bulla or bleb could be found. The median duration of drainage time was 3 days. There was no mortality and complications occurred in five (11.9%) patients. Only two (4.76%) recurrence occurred during the 52 months (5 to 76) median follow-up period. CONCLUSION: Videothoracoscopic bulla ablation with apical pleurectomy is a safe method for recurrence PSP. Especially, if the bulla or bleb is smaller than 20 mm the ablation via cauterisation reduces the expenses of VATS procedure by avoiding the use of stapler devices.

Squamous cell carcinoma in a postpneumonectomy cavity.

A 55-year-old woman was referred to our department with the diagnosis of a bronchopleural fistula and empyema. Her medical history revealed that she had undergone a left pneumonectomy 25 years prior due to a destroyed lung associated with tuberculosis. Open drainage and a biopsy was performed because of the large mass detected on thoracic computed tomography. Postoperative pathology revealed squamous cell carcinoma.

[The role of video-assisted thoracoscopic surgery in the treatment of pleural empyema]. / Plevral ampiyemlerin tedavisinde videoyardimli torakoskopik cerrahinin rolü

Pleural empyema is a serious problem which affects any age group and still there is no standard approach. Our purpose in this study was to assess the safety, feasibility and efficacy of the video-assisted thoracoscopic surgery (VATS). Between 1997 and 2004 83 patients with empyema were enrolled in this study. Fifty-four patients were male, 29 females and the mean age was 39.4. The mean duration time of symptoms before VATS was 27.3 days. Twenty-two patients were in group-5, 44 in group-6 and 17 in group-7 according to Light's classification of parapneumonic effusions and empyema. Twenty-one patients underwent chest tube before VATS because of their conditions. VATS was converted to thoracotomy in 13 patients. All patients underwent debridement and irrigation during VATS. The cure was achieved in 58 (69.9%) patients with the mean 7.63 days drainage time. Twelve patients were underwent open decortication in the follow-up period. Ten of them were group-7 and 2 in group-6 (p= 0.006). The diagnosis was achieved in 60 (72.3%) patients as nonspecific pleuritis, tuberculosis in 19 and various diagnosis in 4. There was no mortality and minor complications occured in 14 patients. VATS is a safety and efficacy procedure in the treatment of early stage empyema. Use of VATS in early period of multiloculary empyema, prevents patients from unnecessary thoracotomies.

Effect of capitonnage and cystotomy on outcome of childhood pulmonary hydatid cysts.

OBJECTIVE: In this clinical retrospective study cystotomy and capitonnage were compared in patients with childhood pulmonary hydatid cysts with regard to postoperative period. METHODS: Between 1990 and 2004, 60 children with pulmonary hydatid cysts were treated surgically. There were 33 boys and 27 girls aged from 3 to 16 years. Cystotomy and closure of bronchial openings were performed in all patients. The patients were divided into 2 groups. While the residual cyst cavity was closed by means of capitonnage in group A (n = 37), cystotomy was applied in group B (n = 23). RESULTS: There was no mortality in either group. Chest tubes were removed after 3.59 +/- 1.04 days in group A and 5.83 +/- 2.84 days in group B. The hospital stay was 4.86 +/- 1.43 days for group A and 7.22 +/- 3.34 days for group B. Prolonged air leak was found in 2 children in group A and 7 children in group B. There was a significant difference between group A and group B with regard to chest tube removal time (P = .001), hospital stay (P = .003), development of prolonged air leak (P = .004), and all complications (P = .031). Follow-up information was available for 49 children, ranging from 13 to 86 months (mean, 56 months). Recurrence was seen in 2 children of group A and 1 child of group B during the follow-up period (P = .698). CONCLUSION: Capitonnage for pulmonary hydatid cysts is superior to cystotomy because it reduces morbidity (especially prolonged air leak) and hospital stay.