Influence of delays on survival in the surgical treatment of bronchogenic carcinoma.

The objective of the study was to find out whether the delay in time from when bronchogenic carcinoma is diagnosed until a therapeutic thoracotomy is performed affects patient survival. The population analysed comprised 1082 patients with clinical stage I and II, non-small cell lung cancer (NSCLC), who had been operated on between October 1993 and September 1997, and were registered in the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S). In this series, the median therapeutic delay was 35 days (1-154), with a median survival rate of 52 months (45.6-58.3). A statistical study was developed that, in addition to the delay, included the variables of age, histology, clinical stage, and pathological stage of the disease. Therapeutic delay was included in the multivariable analysis as a quantitative and qualitative variable and a comparison among the different intervals of delay in days (1-20 vs. 21-40 vs. 41-60 vs. > 60) was performed in order to ascertain its influence on survival. Univariate and multivariate Cox's regression analyses showed that age (> 70 years), clinical stage (I vs. II), and pathological stage influence survival. As for the histology and the delay, no significant differences were observed in the survival of any of the intervals even when compared against the intervals at the extremes (1-20 vs. > 60). In conclusion we found no influence of delay upon the survival.

[Localized fibrous tumor in the parenchyma. Report of 2 cases, one of them multiple and bilateral]. / Tumor fibroso localizado intraparenquimatoso. A propósito de dos casos, uno de ellos múltiple y bilateral.

Localized fibrous tumor is an uncommon neoplasm that is usually located in the visceral pleura. Histologically these tumors are composed of randomly arranged fascicles or networks of fusiform cells, among which there is a varying amount of collagen. Most authors consider that these cells originate in submesothelial mesenchymal cells. The condition is normally silent, though hypoglycemia, hypertrophic osteoarthropathy or other symptoms sometimes result. The treatment of choice is total resection and imaging techniques are extremely helpful for establishing surgical strategy, even though surgery is often performed before a histopathologic diagnosis is available. We present 2 patients with intrapulmonary fibromas that were histologically identical to localized fibrous pleural tumors. These tumors are rarely found in the parenchyma and multiple bilateral presentation is exceptional, having been described only once in the literature. One of our patients had a single pulmonary node that happened to be noticed on an X-ray. The other had multiple bilateral nodes that required several surgical procedures; the intraparenchymatous location for this type of tumor has not been described to date. We discuss clinical, therapeutic and histopathological aspects of these tumors and review the literature.

Ectopic goiters of the mediastinum: presentation of two cases and review of the literature.

Two cases of ectopic goiters located in the anterior mediastinum are presented. These comprise 5.1 per cent of our cases of intrathoracic goiters and 1.3 per cent of mediastinal tumors. These benign tumors have been rarely reported in the literatures, however, excision by thoracotomy is the surgical procedure advocated for these cases and the diagnosis is generally established operatively. Angiography and tomography have proved useful in diagnosing and localising these lesions prior to the surgical procedure.

Hemothorax as rare presentation of intralobar pulmonary sequestration.

In a patient with intralobar pulmonary sequestration the presenting feature was severe hemothorax caused by rupture of the anomalous artery. Only one previous case with this presentation was found in the literature. During operation for intralobar sequestration, the blood vessels of the anomaly must be clearly visualized, in order to avoid further complications. When the condition is suspected, angiography is mandatory for establishment of the diagnosis.

Primary choriocarcinoma of the lung. Presentation of a case and review of the literature.

A 67-year-old man with persistent haemoptysis was found to have primary choriocarcinoma of the lung. Only previous cases were found in the international literature. Hyperprolanuria B would seem to be the most important factor for early diagnosis. The recommended treatment is surgery in accordance with the oncologic criteria for bronchopulmonary cancer.