Seudotumor inflamatorio y tumor miofibroblástico inflamatorio. Criterios diagnósticos y diferencias pronósticas / Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences

Introducción El seudotumor inflamatorio (PTI) y el tumor miofibroblástico inflamatorio (TMI) son 2 entidades muy poco frecuentes que se incluían antiguamente en la misma categoría; sin embargo, en la actualidad se consideran 2 enfermedades diferentes debido al origen neoplásico del TMI. Nuestro objetivo es compartir nuestra experiencia en el manejo de estos 2 tipos de lesiones que debemos tener en cuenta en el diagnóstico diferencial de masas o nódulos pulmonares. Métodos Fueron estudiados retrospectivamente 13 pacientes con diagnóstico anatomopatológico de PTI o TMI, intervenidos entre los años 2008 y 2019. Registramos la información pre y postoperatoria de cada uno, así como el análisis de supervivencia. Resultados De los 13 pacientes, 8 eran varones y 5 mujeres. La media de edad de presentación fue de 53,5 años. En 6 pacientes se practicó una segmentectomía atípica, en 6 fue necesario realizar una lobectomía y en un caso una neumonectomía. En todos los casos se consiguió una resección completa. El diagnóstico fue posible gracias a la histología, técnicas de inmunohistoquímica (IHQ) y de hibridación fluorescente in situ (FISH) determinando la expresión de IgG4 y el reordenamiento de ALK, respectivamente. Tras una mediana de seguimiento de 49 meses no se observaron datos de recidiva locorregional ni a distancia en los pacientes estudiados. Conclusión El PTI y el TMI son tumores poco frecuentes con muy buen pronóstico. El diagnóstico de ambas entidades se basa principalmente en técnicas anatomopatológicas específicas. La cirugía tiene, en la mayor parte de las ocasiones, un papel tanto diagnóstico como terapéutico (AU)

Introduction Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. Methods Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. Results Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didńt find any loco-regional or distant recurrence in the patients studied. Conclusion IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role (AU)

Atypical carcinoid tumours of the lung: prognostic factors and patterns of recurrence.

BACKGROUND: Atypical carcinoids (AC) of the lung are rare intermediate-grade neuroendocrine neoplasms. Prognostic factors for these tumours are undefined. METHODS: Our cooperative group retrieved data on 127 patients operated between 1980 and 2009 because of an AC. Several clinical and pathological features were studied. RESULTS: In a univariable analysis, T-status (p=0.005), N-status (p=0.021), preoperative M-status (previously treated) (p=0.04), and distant recurrence developed during the outcome (p<0.001) presented statistically significant differences related to survival of these patients. In a multivariable analysis, only distant recurrence was demonstrated to be an independent risk factor for survival (p<0.001; HR: 13.1). During the monitoring, 25.2% of the patients presented some kind of recurrence. When we studied recurrence factors in a univariable manner, sublobar resections presented significant relationship with locoregional recurrence (p<0.001). In the case of distant recurrence, T and N status presented significant differences. Patients with preoperative M1 status presented higher frequencies of locoregional and distant recurrence (p=0.004 and p<0.001, respectively). In a multivariable analysis, sublobar resection was an independent prognostic factor to predict locoregional recurrence (p=0.002; HR: 18.1). CONCLUSIONS: Complete standard surgical resection with radical lymphadenectomy is essential for AC. Sublobar resections are related to locoregional recurrence, so they should be avoided except for carefully selected patients. Nodal status is an important prognostic factor to predict survival and recurrence. Distant recurrence is related to poor outcome.

Surgical lung biopsy for diffuse lung disease. Our experience in the last 15 years.

INTRODUCTION: Surgical lung biopsy is a technique that presents a morbi-mortality rate of considerable importance. We analyze our experience with surgical lung biopsies for the diagnosis of diffuse lung disease and the effect produced on the indications for surgical biopsy in these pathologies after the publication of the consensus of the ATS (American Thoracic Society) and ERS (European Respiratory Society) for Idiopathic Pulmonary Fibrosis (IPF). PATIENTS AND METHODS: We performed a retrospective review of 171 patients operated between January 1997 and December 2011. We divided the series into 2 groups: group 1 (operated between 1997 and 2002) and group 2 (operated between 2003 and 2011). Suspected preoperative diagnosis, respiratory status, pathological postoperative diagnoses, percentage of thoracotomies, mean postoperative stay and perioperative morbidity and mortality were analyzed. RESULTS: Group 1 consisted of 99 patients and group two 72. The most frequent postoperative diagnoses were: usual interstitial pneumonia and extrinsic allergic alveolitis. There were ten (5.84%) deaths. Death was caused by progressive respiratory failure that was related to interstitial lung disease in 7 (70%) of 10 cases, alveolar haemorrhage in 2 (20%) and heart failure in 1 (10%). CONCLUSIONS: Since the publication of the ATS and ERS consensus on the IPF, we have observed a noticeable decrease in the number of indications for surgical lung biopsy. This technique, though simple, has a considerable morbidity and mortality.

Cross-industry standard process for data mining is applicable to the lung cancer surgery domain, improving decision making as well as knowledge and quality management

OBJECTIVES: The aim of this study was to assess the applicability of knowledge discovery in database methodology, based upon data mining techniques, to the investigation of lung cancer surgery. METHODS: According to CRISP 1.0 methodology, a data mining (DM) project was developed on a data warehouse containing records for 501 patients operated on for lung cancer with curative intention. The modelling technique was logistic regression. RESULTS: The finally selected model presented the following values: sensitivity 9.68%, specificity 100%, global precision 94.02%, positive predictive value 100% and negative predictive value 93.98% for a cut-off point set at 0.5. A receiver operating characteristic (ROC) curve was constructed. The area under the curve (CI 95%) was 0.817 (0.740- 0.893) (p < 0.05). Statistical association with perioperative mortality was found for the following variables [odds ratio (CI 95%)]: age over 70 [2.3822 (1.0338-5.4891)], heart disease [2.4875 (1.0089-6.1334)], peripheral arterial disease [5.7705 (1.9296-17.2570)], pneumonectomy [3.6199 (1.4939-8.7715)] and length of surgery (min) [1.0067 (1.0008-1.0126)]. CONCLUSIONS: The CRISP-DM process model is very suitable for lung cancer surgery analysis, improving decision making as well as knowledge and quality management (AU)

Pulmonar collision tumor: metastatic adenoid cystic carcinoma and lung adenocarcinoma.

We report an extraordinary case of collision tumor consisting of a lung adenocarcinoma and a metastatic adenoid cystic carcinoma in a 56 year-old man. He was diagnosed with a pulmonary nodule 11 years after treatment of an adenoid cystic carcinoma of the right maxillary sinus. A non-small cell carcinoma was observed when a transbronchial biopsy was performed. The other component of the nodule was only diagnosed with pathological examination of the resection specimen.

Bronchogenic carcinoma in patients under 50 years old.

INTRODUCTION: Lung cancer in young patients is increasing in frequency. Its clinical course seems to be more aggressive than in the elderly. Our objective is to assess the clinicopathologic characteristics and survival of patients with bronchogenic carcinoma who underwent surgery at our department, comparing people younger than 50 years to older patients. MATERIALS AND METHODS: We present a retrospective study of 610 patients diagnosed with non-small-cell lung cancer operated on between 1997 and 2006. They were classified into two groups: under 50 (n=60) and equal to or over 50 (n=550). RESULTS: The proportion of women, smokers and adenocarcinoma were significantly higher in young patients. There were no significant differences in survival rate between the two groups. CONCLUSIONS: In our series, despite the differences in sex, smoking history and histology, the behaviour of the disease is similar in both age groups.

Bronchogenic carcinoma in patients under 50 years old

INTRODUCTION: Lung cancer in young patients is increasing in frequency. Its clinical course seems to be more aggressive than in the elderly. Our objective is to assess the clinicopathologic characteristics and survival of patients with bronchogenic carcinoma who underwent surgery at our department, comparing people younger than 50 years to older patients. MATERIALS AND METHODS: We present a retrospective study of 610 patients diagnosed with non-small-cell lung cancer operated on between 1997 and 2006. They were classified into two groups: under 50 (n=60) and equal to or over 50 (n=550). RESULTS: The proportion of women, smokers and adenocarcinoma were significantly higher in young patients. There were no significant differences in survival rate between the two groups. CONCLUSIONS: In our series, despite the differences in sex, smoking history and histology, the behaviour of the disease is similar in both age groups (AU)

[Pericardial effusion as the only first clinical manifestation of systemic lupus erythematosus]. / Derrame pericárdico como manifestación clínica única de lupus eritematoso sistémico.

Pericarditis is the most frequent cardiac manifestation of systemic lupus erythematosus (SLE), but pericardial effusion rarely occurs as the only first clinical manifestation of SLE. We report the case of a male patient whose initial manifestation of lupus was a pericardial effusion. We comment on its clinical course and we reviewed in the medical literature different presenting features in SLE.

Derrame pericárdico como manifestación clínica única de lupus eritematoso sistémico / Pericardial effusion as the only first clinical manifestation of systemic lupus erythematosus

La afectación del pericardio es la manifestación cardíaca más frecuente del lupus eritematoso sistémico (LES). Sin embargo, es infrecuente que el derrame pericárdico sea la forma de presentación del LES. Describimos el caso de un paciente varón con LES que debutó clínicamente con derrame pericárdico, comentamos su curso clínico y revisamos en la bibliografía médica distintas formas de presentación del LES

Pericarditis is the most frequent cardiac manifestation of systemic lupus erythematosus (SLE), but pericardial effusion rarely occurs as the only first clinical manifestation of SLE. We report the case of a male patient whose initial manifestation of lupus was a pericardial effusion. We comment on its clinical course and we reviewed in the medical literature different presenting features in SLE

[Surgical treatment of recurrent spontaneous pneumothorax: what is the optimal timing?]. / Cirugía del neumotórax espontáneo de repetición: cuándo indicarla?

OBJECTIVES: To analyze the impact on the outcome of video-assisted thoracoscopic surgery (VATS) of delaying surgery in patients with previous episodes of pneumothorax. MATERIAL AND METHODS: We studied 57 surgical procedures for recurrent primary spontaneous pneumothorax. The cases were grouped according to the medical history. One group comprised patients treated surgically at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax. The second group comprised patients treated surgically at the third or successive episode. We compared the 2 groups as to number of thoracotomies, number of conversions from VATS to thoracotomy, presence of adhesions, and length of postoperative hospital stay. RESULTS: Of the total number of procedures, 13.9% were performed during the third or successive episode. In this group the number of pleuropulmonary adhesions and the percentage of thoracotomies (whether initially indicated or conversions from VATS) was significantly higher (P<.05). However, there was no difference between the 2 groups in length of postoperative stay. CONCLUSIONS: VATS is the technique of choice for the surgical treatment of recurrent primary spontaneous pneumothorax. Such treatment should be performed at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax since delayed surgery gives rise to a higher incidence of technical difficulties that entail thoracotomies.

Tumor pulmonar neuroendocrino tipo I: recidiva local con afectación mediastínica / Type I Neuroendocrine Pulmonary Tumor: local recurrence with mediastinal involvement

No disponible

[Thymectomy in myasthenia gravis]. / Timectomía en la miastenia gravis.

OBJECTIVE: To analyze outcome after thymectomy in patients with myasthenia gravis (MG). MATERIAL AND METHODS: Thirty-five patients with MG underwent surgery in our service between June 1987 and June 1998. Ten had associated thymomas. Preoperative Osserman classification showed 2 at level I, 20 at level IIA, 11 at level IIB and 2 at level III. Extended thymectomy through a medial sternotomy was performed in all. RESULTS: Postoperative complications developed in three patients (1 medullary aplasia, 1 postoperative reintubation, 1 myasthenic crisis). Mean follow-up was 89 months, with 22.8% achieving complete remission and 97.1% reporting improvements. The results were similar in the 10 patients with thymomas (20% full remission and 90% showing improvement). By DeFilippi classification, 22.8% were in class 1, 22.8% in class 2, 51.4% in class 3 and 2.8% in class 4. By Osserman classification, 9 were in the same category before and after surgery, 12 had improved one level, 10 had improved 2 levels, 3 had improved 3 levels and 1 patient had improved 4 levels. CONCLUSION: Thymectomy is an appropriate therapeutic procedure in the multidisciplinary treatment of patients with MG and it is the approach of choice for patients with associated thymomas. The intra- and post-operative complication rate is low and the rate of clinical improvement is high.

Timectomía en la miastenia gravis / Thymectomy in myasthenia gravis

OBJETIVO: Analizar los resultados de la timectomía en pacientes con miastenia gravis. MATERIAL Y MÉTODOS: Entre junio de 1987 y junio de 1998, se intervinieron en nuestro servicio 35 pacientes con miastenia gravis, en 10 de los cuales se asociaban timomas. Los pacientes se clasificaron en el preoperatorio según la clasificación de Osserman (dos grado I, 20 grado IIA, 11 grado IIB y dos grado III). En todos se realizó timectomía ampliada por esternotomía media. RESULTADOS: En 3 pacientes hubo complicaciones postoperatorias (una aplasia medular, una reintubación postoperatoria y una crisis miasténica). Tras una mediana de seguimiento de 89 meses, el 22,8 por ciento estaba en remisión completa y el 97,1 por ciento había mejorado. Los resultados son similares en los 10 pacientes con timoma (un 20 por ciento de remisiones completas y un 90 por ciento de mejorías). Según la clasificación de DeFilippi un 22,8 por ciento se encontraba en clase 1; un 22,8 por ciento, en clase 2; un 51,4 por ciento, en clase 3, y un 2,8 por ciento, en clase 4. Según la clasificación de Osserman, 9 pacientes presentaban el grado previo a la cirugía, 12 habían mejorado un grado, 10 habían mejorado 2 grados, 3 habían mejorado 3 grados y un paciente había mejorado 4 grados. CONCLUSIÓN: La timectomía es una opción terapéutica adecuada en el tratamiento multidisciplinario de los pacientes con miastenia gravis y es el tratamiento de elección en los pacientes en que se asocian timomas. El porcentaje de complicaciones intra y postoperatorias es bajo, y se obtiene un índice elevado de mejorías clínicas (AU)

[Malignant pleural effusions: a description of an alternative method of external drainage with a fine-caliber catheter]. / Derrames pleurales malignos: descripción de un método alternativo de drenaje externo con catéter fino.

We describe the results of treating symptomatic pleural effusion by implanting a Pleurocath-type small-caliber catheter connected to a three-way valve for external evacuation. The method was used in 6 patients with advanced neoplastic disease and dyspnea related to pleural effusion that could not be treated with the usual methods of pleurodesis. Dyspnea disappeared or was significantly relieved in 5 of the 6 patients, such that follow-up could be continued on an outpatient basis for 3. Catheters remained in position for periods of time ranging from 14 days to 10 months. Survival varied from 14 days to 14 months. The only important complication was one case of infection in the area of catheter insertion. We describe the extremely simple technique used and the results that have encouraged us to continue using the method in cases that meet the necessary conditions.