Pleural lymphoma combined with pleural sarcoidosis.

A patient with sarcoidosis was found to have a massive left pleural effusion. Her chest computed tomography showed small nodules in the lung parenchyma and swelling of the hilar lymph nodes, with normal visceral and parietal pleura. Thoracoscopy showed white nodules on the visceral pleura and normal parietal pleura, which were resected. Epithelioid granulomas were seen in the visceral pleura and lung parenchyma. Surprisingly, in the parietal pleura, abnormal cells that were positive for the leukocyte common antigen, CD20, and CD79a were found, leading to the diagnosis of malignant B-cell lymphoma.

Is the Preoperative Prognostic Nutritional Index a Useful Marker for the Decision to Perform Limited Resection in High-risk Patients With Stage I Non-small Cell Lung Cancer?

BACKGROUND/AIM: The indications for limited resection in high-risk patients with stage I non-small cell lung cancer (NSCLC) remain controversial. The purpose of this study was to evaluate the prognostic impact of the preoperative prognostic nutritional index (PNI) in high-risk patients undergoing limited resection. PATIENTS AND METHODS: High-risk patients undergoing limited resection for stage I NSCLC in our institution from 2005 to 2020 were retrospectively reviewed. Patients with clinical/pathological Tis/minimally invasive adenocarcinoma and multiple NSCLC were excluded. A multivariate Cox regression analysis was conducted to identify factors associated with overall survival (OS). RESULTS: Ninety eligible patients were included in this study. Grade ≥2 postoperative complications were significantly more frequent in the low-PNI group (6 cases, 16.6% vs. 7 cases, 12.9%; p=0.03). The rate of death due to other diseases was significantly higher in the low-PNI group than in the high-PNI group (14 cases, 50.0% vs. 11 cases, 25.0%; p=0.002). The multivariate analysis showed that male sex, Brinkman index ≥400, preoperative low PNI and pathological T factor ≥T1c/T2a were independent prognostic factors for OS. CONCLUSION: In high-risk patients undergoing limited resection for stage I NSCLC, low PNI was a poor prognostic factor, especially in relation to death from other diseases and lung cancer. The results may support thoracic surgeons in decision-making in relation to the indications for surgery.

[Fixation of Flail Chest with Bioabsorbable Plate].

A 57-year-old man presented to our hospital with multiple rib fractures and pleural effusion caused by a traffic accident. We inserted a chest tube and diagnosed him with hemothorax. We performed damage control surgery with right thoracotomy in the emergency room to confirm the bleeding point. The main sources of bleeding were multiple rib fractures and lung injury. We performed partial lung resection and gauze packing into the thoracic cavity and confirmed the stability of the patient's hemodynamics. The next day, we performed a second-look operation at which we fixed the rib fractures and confirmed hemostasis. When fixing the ribs, we used a bioabsorbable plate instead of a metal plate. It has been reported that bioabsorbable plates are less susceptible to infection than metal plates. After the operation, the patient's respiratory condition stabilized, and no signs of infection were noted. In our experience, rib fixation using absorbent plates is useful in surgery that requires attention to infection.

[Two-Stage Surgery for a Patient with Concomitant Lung Cancer and Abdominal Aortic Aneurysm].

An 85-year-old man was admitted to our hospital because of an abnormal shadow on chest X-ray. Chest and abdominal computed tomography (CT) revealed abdominal aortic aneurysm (AAA) in addition to a mass in the right lower lobe. Since both the AAA and lung mass needed surgical treatment, we performed endovascular aortic repair (EVAR) for the AAA, followed by right lower lobectomy 26 days after the surgery for AAA. There were no complications following either operation, and the patient left the hospital on the 10th day after pulmonary resection.

Completion Pneumonectomy for Second Primary/Primary Lung Cancer and Local Recurrence Lung Cancer.

BACKGROUND: Completion pneumonectomy (CP) for second primary/primary lung cancer (SPLC) and local recurrence lung cancer (LRLC) is still controversial. Although several case series on such a practice exist, the oncological benefit is under debate. The purpose of this study was to review available literatures on CP for SPLC and LRLC and evaluate postoperative and long-term outcomes. METHODS: MEDLINE, SCOPUS, and Web of Science were reviewed for eligible studies in January 2021. Studies were included if they indicated outcomes of patients with lung cancer undergoing CP. Overall survival (OS) was defined as the primary endpoint; secondary endpoints included operative morbidity and 30-day mortality. Random-effects meta-analysis based on a binomial distribution was used to create pooled estimates. RESULTS: Thirty-two eligible studies including 1157 patients were identified. These studies were uniformly retrospective reports. Pooled estimates for 3-year and 5-year OS were 50.6% (95% confidence interval [CI], 34.7%-66.5%) and 38.9% (95% CI, 32.2%-46.1%) in SPLC patients. When the SPLC was a stage I tumor, pooled 5-year OS was favorable with 60.7% (95% CI, 43.2%-75.9%). In LRLC, pooled 3-year and 5-year OS were 47.6% (95% CI, 36.1%-59.4%) and 33.8% (95% CI, 26.8%-41.5%), respectively. Pooled morbidity and 30-day mortality was reported in 38.2% (95% CI, 32.0%-44.9%), and 10.0% (95% CI, 8.1%-12.3%), respectively. CONCLUSIONS: CP for SPLC and LRLC is a challenging procedure with significant perioperative morbimortality. However, published evidence indicates good long-term survival for selected patients. Further studies are needed to identify patient subgroups which benefit most from CP.

Idiopathic eosinophilic pleurisy: A practical diagnostic approach.

A 37-year-old man with fever, cough, and dyspnea with no medical history developed an eosinophilic pleural effusion and blood eosinophilia. No evidence of malignancy or pathogens was detected in the pleural effusion, and the pleural specimen obtained by thoracoscopy showed eosinophilic infiltration with inflammatory granulation tissue without fibrinoid necrosis or malignant cells. Since a myeloproliferative disorder was also excluded, the diagnosis was idiopathic eosinophilic pleurisy. Corticosteroid treatment was started and then slowly tapered, and the eosinophilic pleural effusion resolved. Considering the various etiologies of eosinophilic pleurisy, a practical clinical approach to the investigation and diagnosis of eosinophilic pleurisy is presented.

MiR-21 in Lung Transplant Recipients With Chronic Lung Allograft Dysfunction.

Background: Micro-RNA-21 (miR-21) is a post-translational regulator involved in epithelial-to-mesenchymal transition (EMT). Since EMT is thought to contribute to chronic lung allograft dysfunction (CLAD), we aimed to characterize miR-21 expression and distinct EMT markers in CLAD. Methods: Expression of miR-21, vimentin, Notch intracellular domain (NICD) and SMAD 2/3 was investigated in explanted CLAD lungs of patients who underwent retransplantation. Circulating miR-21 was determined in collected serum samples of CLAD and matched stable recipients. Results: The frequency of miR-21 expression was higher in restrictive allograft syndrome (RAS) than in bronchiolitis obliterans syndrome (BOS) specimens (86 vs 30%, p = 0.01); Vimentin, NICD and p-SMAD 2/3 were positive in 17 (100%), 12 (71%), and 7 (42%) BOS patients and in 7 (100%), 4 (57%) and 4 (57%) RAS cases, respectively. All four markers were negative in control tissue from donor lungs. RAS patients showed a significant increase in serum concentration of miR-21 over time as compared to stable recipients (p = 0.040). Conclusion: To the best of our knowledge this is the first study highlighting the role miR-21 in CLAD. Further studies are necessary to investigate the involvement of miR-21 in the pathogenesis of CLAD and its potential as a therapeutic target.

Solid predominant subtype in lung adenocarcinoma is related to poor prognosis after surgical resection: A systematic review and meta-analysis.

BACKGROUND: Recent studies have indicated that solid predominant (SP) subtype of lung adenocarcinoma (LADC) may be associated with early recurrence and worse prognosis. Hence, a systematic review and meta-analysis were performed to evaluate the association between LADC subtype and survival. METHODS: The MEDLINE, SCOPUS, Web of Science and Cochrane Libraries were reviewed for eligible studies in December 2017. Studies were included if they compared outcomes of patients with and without SP subtype in resection specimens of LADC patients after surgical treatment by using multivariate Cox regression analysis. A meta-analysis for overall survival (OS) and disease-free survival (DFS) was performed. The hazard ratios (HR) or odds ratios with 95% confidence intervals (CIs) from each study were used to calculate pooled HRs. Statistical analyses were performed using Review Manager 5.3. RESULTS: In total, 14 eligible studies including 12,137 LADC patients were identified, which assessed the impact of SP subtype on OS and DFS in patients treated with pulmonary resection. SP subtype was reported in 1246 (10.2%) patients and was associated with significantly worse OS (pooled HR, 1.51; 1.29-1.75) and DFS (pooled HR, 1.26; 1.14-1.40). CONCLUSIONS: SP subtype is associated with significantly worse OS and DFS in patients with LADC after pulmonary resection. These data provide evidence for the integration of the distinct histological LADC subtyping into prognostic tools and guidelines for adjuvant treatment after complete surgical resection.

Pneumothorax in teenagers: reducing recurrence through resection of superior segment of lower lobe.

BACKGROUND: Spontaneous pneumothorax in young patients is characterized by a high recurrence rate. We retrospectively investigated causes of recurrence and effective surgical methods to improve this statistic, in particular through resection of the superior segment of the lower lung lobe (S6a). METHODS: From April 2011 to September 2017, we performed 146 operations for 126 lateral side pneumothoraces in patients 20 years of age or younger (105 males and 7 females, mean age 17.2 years) at our institution. Two groups-one with patients who underwent both apical bullectomy and S6a resection (the S6a group), and the other with patients who underwent only apical bullectomy with apical reinforcement using an absorbable mesh sheet (the AB group)-were statistically compared in terms of recurrence rate. RESULTS: A significant difference was found between the S6a group and the AB group in terms of the number of S6a recurrences (0 vs. 8 cases, respectively; P=0.025), although there was no significant difference between the two groups in terms of the total recurrence rate (16.1% vs.18.6%, respectively). Pathological examination revealed that 55 of the 56 (98.2%) S6a specimens already contained asymptomatic, non-ruptured bullae or microscopic bullous lesions at the time of the initial operation. CONCLUSIONS: In addition to the apex, the S6a often involves lesions responsible for pneumothorax recurrence. To reduce this recurrence in teenage patients, we suggest that S6a resection be concomitantly performed in the initial operation-even if there are no macroscopically visible blebs on the S6a.