Primary bronchial Ewing sarcoma.

INTRODUCTION: Primary bronchial Ewing sarcoma (ES) is a rare endobronchial tumor. PRESENTATION OF CASE: A 65-year-old male presented with six-month history of progressive shortness of breath. Flexible bronchoscopy showed an endobronchial polypoid tumor in the left main stem bronchus about 2 cm from the carina. The tumor was resected by a left bronchial sleeve resection using a right postero-lateral thoracotomy approach. Pathology showed complete tumor resection with negative margins. The morphological and immune-phenotypical features of the resected specimen were compatible with ES. He had an uneventful post-operative recovery. He did not receive adjuvant radiation or chemotherapy and remains disease free at 9 months follow up. DISCUSSION: A review of the literature identified six other cases of primary bronchial ES. In addition, there were three reported cases of primary ES involving the trachea and thirteen involving the lung parenchyma. Bronchial ES appeared to have a relatively better prognosis than ES involving the trachea or the lung. Our case demonstrates that primary bronchial ES may be treated safely with limited resection, lung preservation and without the need for adjuvant therapy if negative margins can be achieved. CONCLUSION: Sleeve resection without adjuvant therapy may be a safe treatment option for primary bronchial ES.

Role of inositol polyphosphates in programmed cell death.

The role of inositol polyphosphates (InsPs) in the mediation of cellular apoptosis was investigated in mouse MC3T3 osteoblastic cell line. Extracellular administration of InsP(4), InsP(5), and InsP(6) increased apoptosis in a dose-dependent manner. InsP(6) was more potent than InsP(5) and InsP(4) in promoting apoptosis. Inositol hexasulfate (InsS(6)), a structural analog of InsP(6), was used to determine specificity of InsP(6)-induced apoptosis as measured by acridine orange/ethidium bromide, flow cytometry, and DNA degradation. In order to study the effects of endogenous InsPs on apoptosis, we used NaF and antimycin A as treatment agents to manipulate intracellular levels of InsPs. NaF is known to increase levels of higher InsPs by inhibiting InsPs phosphatases, a process that is reversed by antimycin A because InsPs kinases are inhibited as a result of depletion of cellular ATP pools. Apoptosis was induced in MC3T3 cells in a NaF dose- and time-dependent manner. Approximately 50% apoptosis was observed at 1 mM NaF in 8 h. Prior treatment with 10 microM antimycin A for 30 min significantly reduced the NaF-induced apoptosis as compared with its control. Additionally, we measured changes in AKT phosphorylation, cleavage of caspase-3 and caspase-9, and release of cytochrome C from mitochondria into cytosol. These changes coincided with total cellular InsPs under similar conditions. The data indicated that NaF-induced changes in apoptotic markers could be due to an increased endogenous InsPs that were partially reversed by antimycin A treatment.

Case of the month. A case report of human pulmonary dirofilariasis in Arkansas.

Our patient, a resident of Arkansas, presented with a solitary pulmonary nodule for lung resection to rule out primary lung cancer. However, pathologic examination showed the lung nodule to be a granuloma secondary to dirofilariasis. Human pulmonary dirofilariasis is a rare zoonotic disease caused by Dirofilariasis immitis (dog heartworm) that is usually transmitted from dogs to human by mosquito bite. To our knowledge, human pulmonary dirofilariasis has previously not been reported in Arkansas. In addition, awareness of this entity in the appropriate clinical and epidemiologic setting is important in the differential diagnosis of solitary pulmonary nodules.

Successful management of a nonmalignant esophageal perforation with a coated stent.

This case report details our experience in the management of an iatrogenic perforation that recurred after two surgical repairs. A self-expanding coated stent was eventually placed to seal the esophageal perforation with significant improvement in the clinical condition of the patient. At 1-year follow-up, the patient is tolerating an oral diet with no evidence of esophageal leak or gastroesophageal reflux. This case report and a literature review suggest that self-expanding coated stents may be a useful salvage option in the management of inveterate nonmalignant esophageal perforations.