Hepatoid adenocarcinoma of the lung and the review of the literature.

INTRODUCTION: Hepatoid adenocarcinoma of the lung is an extremely rare type of the non-small cell lung cancer. Treatment principles and prognosis are similar to that of lung adenocarcinoma. CASE REPORT: A 62-year-old female smoker presented with a huge mass in the left upper lobe. After diagnostic biopsy, she underwent left pneumonectomy and mediastinal lymph node dissection. A diagnosis of stage T4N1M0 hepatoid adenocarcinoma of the lung with positive surgical margins was made. MANAGEMENT AND OUTCOME: After the operation, the level of serum alpha fetoprotein was 9010 ng/ml (N: <10). The level of serum alpha fetoprotein was decreased with concurrent chemoradiotherapy and chemotherapy. Disease progression was detected at 11 months after diagnosis. No response was obtained to other therapies. The patient died at 14 months from the time of diagnosis. DISCUSSION: Usually, patients with hepatoid adenocarcinoma of the lung are male smokers. Hepatoid adenocarcinoma tends to settle in the upper lobes of the lung. The most important prognostic factor of the hepatoid adenocarcinoma of the lung is the disease stage at the diagnosis and patients with metastatic disease have poor survival.

Evaluation of pulmonary hydatid cyst cases.

BACKGROUND: The incidence of pulmonary hydatid cyst has been high in developing countries such as Turkey. OBJECTIVE: The aim of this study was to evaluate the clinical presentation, treatment and outcomes of pulmonary hydatid cyst disease at a tertiary centre. METHODS: A total of 138 patients, aged between 9 and 72 years with pulmonary hydatid cyst were diagnosed between 2000 and 2008 in 2nd thoracic surgery clinic at our hospital. Clinical characteristics of patients, epidemiological features, cyst diameters and localizations, laboratory findings, surgical approaches were recorded and analyzed. RESULTS: The most frequent symptoms of pulmonary hydatid cyst were chest pain and cough (44.9%, 37.6%). According to cyst size, there was no difference between younger than twenty and older age groups (p>0.05). Twenty-two patients had complicated cyst cases. Most of them were symptomatic (90.9%). Association of complicated cyst with hepato-pulmonary involvement was significantly higher as compared with single hydatid cyst (p=0.01). Cystectomy was performed in 84.05% of patients and post-operative mortality was seen in only one patient due to pulmonary embolism. CONCLUSION: Association of lung and liver hydatid cyst increased the risk of occurrence of a complicated pulmonary hydatid cyst. Choice of surgical approach had satisfactory results and post-operative mortality was low.

Recurrent pulmonary hydatid disease: analysis of ten cases.

PURPOSE: To investigate the incidence and define the importance of recurrent pulmonary hydatid cysts in developing countries. METHODS: We analyzed the records of 312 patients with pulmonary hydatid cyst disease diagnosed in our center between 1999 and 2005. RESULTS: A recurrent pulmonary hydatid cyst was diagnosed in 10 (3.2%) of the 312 patients [8 men and 2 women, mean age 36.9 (range 20-60) years]. The diagnosis was based on radiographic, clinical, or serological findings, established intraoperatively. The most frequent symptom of recurrent pulmonary hydatid cyst was hemoptysis (60%). The mean interval between diagnosis of the initial hydatid cyst and detection of recurrence was 8.75 (range 3-15) years. Bronchoscopy was performed in all patients, but proved diagnostic in only one. The localization of the initial and recurrent cysts differed in seven patients. A median follow-up period of 5 years revealed second recurrences in only two patients; manifesting as an intrapleural rupture of the cyst in one and as empyema in one. The recurrence was treated by resection in all patients; as cystectomy in eight patients, lobectomy in one patient, and pneumonectomy in one patient. CONCLUSION: Pulmonary hydatid cyst may recur in the same or a different location in the lung. Patients with a pleural lesion must be followed up regularly for any signs of recurrence.