Clinical significance of epithelial-mesenchymal transition-related markers expression in the micrometastatic sentinel lymph node of NSCLC.

OBJECTIVES: Metastatic lymph node affectation is the main prognostic factor in localised lung cancer. However, the pathological study of lymph nodes reveals tumour relapse for 20% of patients after oncological curative surgery. Recently, EMT (epithelial-mesenchymal transition) has been established as one of the main factors related to lymphatic dissemination and metastasis. This study evaluated the prognostic value of EMT-related gene expression in micrometastatic sentinel lymph nodes (SLN) of non-small cell lung cancer (NSCLC) patients. METHODS: The presence of genes CDH1, CDH2, VIM, TWIST1, SNAI1, SNAI2, ZEB1, and ZEB2 in mRNA was analysed in tumours and in the SLN of NSCLC patients for whom surgery was planned for treatment. The significant association between the expression level of EMT-related markers and patients' clinicopathological characteristics and relapse was assessed. RESULTS: Of the 96 patients, 56 (58.33%) presented molecular micrometastasis in SLN, which showed higher CDH1, CDH2, and VIM expressions than non-micrometastatic ones. An association linking a low CDH1/CDH2 ratio in SLN with molecular micrometastasis, adenocarcinoma, and non-smoking patients was found. The multivariate Cox regression analysis proved the prognostic accuracy of the CDH1/CDH2 ratio in SLN. CONCLUSIONS: The molecular EMT status of SLN could be used as an independent prognosis predictor in early stage NSLCL patients, and as a new tool to better stratify and predict patient outcomes.

Topography of the sentinel node according to the affected lobe in lung cancer

Purpose. The objective of this study is to describe the anatomic location of the sentinel lymph node (SLN) of patients with lung carcinoma and to analyze its relationship with the characteristics of the tumor. Patients and methods. 98 Stage I lung cancer patients were included in the study. SLN was marked just after performing the thoracotomy by injecting peritumorally 0.25 mCi of nanocolloid of albumin (Nanocol1) labeled with Tc-99 m in 0.3 ml, and later, it was resected. For SLN micrometastasis analysis, CEACAM5, BPIFA1, and CK7 gene expression at mRNA level was studied. Possible relation between tumor characteristics and SLN location was analyzed. Results. While most of the SLN were located in hilar area, we find a significantly higher number of SLN located in mediastinal stations when the lesion is in the left upper lobe (LUL). This difference disappears in the group of SLN with a positive result in the micrometastasis study. Regarding tumor size, squamous tumors and tumors located in the left lower lobe (LLL) were found significantly larger. Conclusion. The location of the SLN in patients with stage I lung cancer is predominantly hilar, being less consistent in the left hemithorax. The tumor size or histological type is not variables that affect this distribution. The distribution of SLNs with a positive result in the analysis of micrometastasis suggests further spread to the hilar areas when the lesion is in the LUL and to the mediastinal zones when it is in the LLL (AU)

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Topography of the sentinel node according to the affected lobe in lung cancer.

PURPOSE: The objective of this study is to describe the anatomic location of the sentinel lymph node (SLN) of patients with lung carcinoma and to analyze its relationship with the characteristics of the tumor. PATIENTS AND METHODS: 98 Stage I lung cancer patients were included in the study. SLN was marked just after performing the thoracotomy by injecting peritumorally 0.25 mCi of nanocolloid of albumin (Nanocol1) labeled with Tc-99 m in 0.3 ml, and later, it was resected. For SLN micrometastasis analysis, CEACAM5, BPIFA1, and CK7 gene expression at mRNA level was studied. Possible relation between tumor characteristics and SLN location was analyzed. RESULTS: While most of the SLN were located in hilar area, we find a significantly higher number of SLN located in mediastinal stations when the lesion is in the left upper lobe (LUL). This difference disappears in the group of SLN with a positive result in the micrometastasis study. Regarding tumor size, squamous tumors and tumors located in the left lower lobe (LLL) were found significantly larger. CONCLUSION: The location of the SLN in patients with stage I lung cancer is predominantly hilar, being less consistent in the left hemithorax. The tumor size or histological type is not variables that affect this distribution. The distribution of SLNs with a positive result in the analysis of micrometastasis suggests further spread to the hilar areas when the lesion is in the LUL and to the mediastinal zones when it is in the LLL.

Study of survival in patients with malignant lung lesions treated with radiofrequency

OBJECTIVE: To report on the survival of a series of patients with primary and metastatic lung tumours treated with radiofrequency (RF). Four years ago we published our preliminary experience with the use of this technique. MATERIALS AND METHODS: For a period of 8 years we have treated 59 patients (by means of a total of 70 procedures) with primary or metastatic pulmonary neoplastic lesions, which fulfilled inclusion criteria to perform the technique. They were in all cases non-surgical lesions that had been either previously treated or not. The technique was performed in the radiology suite, under conscious analgo-sedation. We treated primary pulmonary lesions, neoplastic recurrences, or metastases with curative or palliative intention (pain management). RESULTS: Current global survival rate is 19 patients (32 %) with a mean of 26.61 ± 3.17 months (range: 20.38 ± 32.83) and a median of 16.00 ± 3.57 (range: 8.99-23.00). If we establish the difference between primary and metastatic tumours, mean survival is 27.62 ± 4.12 months in primary tumours (median: 16.00) vs. 24.65 ± 4.47 months in metastatic tumours (median: 16.00). When we studied the survival in those cases with a curative intent, mean survival in primary tumours was 30.97 ± 4.57 months (median: 21.00) vs. 25.14 ± 4.68 (median: 16.00) months in metastatic tumours. CONCLUSIONS: RF ablation of lung lesions is a minimally invasive procedure that is useful in primary tumours (especially in stage I) and metastatic ones. RF has proven its usefulness in the multidisciplinary treatment of this pathology due to the low incidence of serious complications and survival obtained, considering that patients are elderly with significant comorbidity (AU)

Study of survival in patients with malignant lung lesions treated with radiofrequency.

OBJECTIVE: To report on the survival of a series of patients with primary and metastatic lung tumours treated with radiofrequency (RF). Four years ago we published our preliminary experience with the use of this technique. MATERIALS AND METHODS: For a period of 8 years we have treated 59 patients (by means of a total of 70 procedures) with primary or metastatic pulmonary neoplastic lesions, which fulfilled inclusion criteria to perform the technique. They were in all cases non-surgical lesions that had been either previously treated or not. The technique was performed in the radiology suite, under conscious analgo-sedation. We treated primary pulmonary lesions, neoplastic recurrences, or metastases with curative or palliative intention (pain management). RESULTS: Current global survival rate is 19 patients (32 %) with a mean of 26.61 ± 3.17 months (range: 20.38 ± 32.83) and a median of 16.00 ± 3.57 (range: 8.99-23.00). If we establish the difference between primary and metastatic tumours, mean survival is 27.62 ± 4.12 months in primary tumours (median: 16.00) vs. 24.65 ± 4.47 months in metastatic tumours (median: 16.00). When we studied the survival in those cases with a curative intent, mean survival in primary tumours was 30.97 ± 4.57 months (median: 21.00) vs. 25.14 ± 4.68 (median: 16.00) months in metastatic tumours. CONCLUSIONS: RF ablation of lung lesions is a minimally invasive procedure that is useful in primary tumours (especially in stage I) and metastatic ones. RF has proven its usefulness in the multidisciplinary treatment of this pathology due to the low incidence of serious complications and survival obtained, considering that patients are elderly with significant comorbidity.

Gastrotórax hipertensivo estrangulado tras herida por arma blanca / Strangulated hypertensive gastrothorax after knife wound

Resumen. La rotura diafragmática es una lesión poco frecuente, presente en el 5-7% de los politraumatizados y en el 10-15% de las lesiones penetrantes en la región torácica inferior. El diagnóstico precoz es fundamental, puesto que su demora conlleva una elevada morbimortalidad. Sin embargo éste se obtiene en menos del 50% de los casos. Presentamos el caso clínico de un paciente que debutó con hernia diafragmática estrangulada como consecuencia de herida por arma blanca un año antes. Asimismo, analizamos el controvertido manejo diagnóstico-terapéutico de las lesiones diafragmáticas (AU)

Summary. Diaphragmatic injury is a slightly frequent pathology, which is present in 5-7 % of polytraumatized pacients and 10-15 % of low thoracic penetrating injuries. An early diagnosis is fundamental, since a delay it’s associated with a high morbimortality. Nevertheless this one is obtained in less than 50 % of the cases. We present the case of a patient with a strangulated diaphragmatic hernia as a consequence of a stab wound one year before. We also analyze the controversial diagnostic and therapeutic management of diaphragmatic injuries (AU)

Sospecha radiológica de rotura diafragmática / No disponible

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Metástasis pulmonar única 23 años después de un carcinoma adenoide quístico de parótida / Single pulmonary metastasis 23 years after an adenoid cystic carcinoma of the parotid

Un nódulo pulmonar solitario no presente en radiografías previas fue descubierto en un paciente varón de forma casual. Veintitrés años antes, el paciente fue operado de carcinoma adenoide quístico de parótida (cirugía radical y radioterapia adyuvante). Los estudios preoperatorios no consiguieron un diagnóstico histológico y se descartó la existencia de enfermedad locorregional. Se le realizó una lobectomía superior derecha y el estudio anatomopatológico indicó una metástasis de parótida. El carcinoma adenoide quístico de parótida puede presentar metástasis a distancia incluso décadas después del tratamiento inicial sin que exista recidiva locorregional. Un seguimiento con radiografías de tórax puede ayudar al diagnóstico de la metástasis pulmonar en estos pacientes (AU)

A solitary pulmonary nodule was discovered on a chest X-ray film in a male patient. The nodule was not present previously. Twenty three years before the patient was operated on of a parotid adenoid cystic carcinoma (radical surgery and adjuvant radiotherapy). Preoperative studies could not get a histological diagnosis. He underwent a right upper lobectomy. Pathological analysis revealed a parotid metastasis. Parotid adenoid cystic carcinoma can give distant metastases even decades after initial treatment and without locoregional recidive. Follow up with chest X-ray films cand help diagnose lung metastasis in such patients (AU)

Fístula broncoesofágica congénita de diagnóstico tardío / Congenital bronchoesophageal fistula of late diagnosis

Presentamos el caso de una mujer de 52 años con el antecedente de infecciones respiratorias de repetición desde la infancia, que presenta una fístula broncoesofágica (FBE) congénita diagnosticada de forma incidental a raíz de la aparición de disfagia en los últimos meses. Los estudios radiológicos y manométricos demuestran la asociación con megaesófago y acalasia. Se confirmó el diagnóstico de FBE en bronquio principal izqdo. gracias a un tránsito con gastrografín, esofagoscopia y fibrobroncoscopia. El tratamiento fue quirúrgico mediante toracotomía posterolateral izquierda, procediendo a la resección del trayecto fistuloso e invaginación del muñón con sutura de muscularis esofágica (AU)

We report the case of a 52-year-old woman with a history of recurrent respiratory infections, which presents a congenitalbronchoesophageal fistula (BEF) incidentally diagnosed after the appearance of dysphagia in the last months. Theradiological and manometric studies demonstrate the association with megaesophagus and achalasia. Diagnosis of BEFm in the left main bronchus was confirmed thanks to an esophagogram, esophagoscopy and fiberoptic bronchoscopy. The surgical treatment was carried out through a left posterolateral thoracotomy, proceeding to resection of the fistula and invagination of the stump with suture of esophageal muscularis (AU)

Hemoptisis como manifestación clínica en el síndrome de Swyer- James / Macleod / Hemoptysis as clinical manifestation in Swyer-James (Macleod) Syndrome

El síndrome de Swyer-James o de MacLeod es una enfermedad infrecuente que asocia hipoperfusión pulmonar y atrapamiento aéreo con enfisema. En la edad adulta suele pasar desaparecido por su escasa sintomatología y puede diagnosticarse tras el hallazgo en una radiografía simple de tórax una imagen de hiperclaridad pulmonar unilateral. Presentamos un caso que destaca por su inhabitual forma de presentación clínica con hemoptisis masiva, no referida en la literaturamédica previamente según nuestra revisión, y que fue controlada con éxito mediante angiografía y embolización de los vasos anómalos. Después de cuatro años de seguimiento en la consulta externa no volvió a ocurrir de nuevo ningún episodio de hemoptisis y la paciente realiza su vida normal

Swyer-James or MacLeod syndrome is an infrequent disease associated with pulmonary hypoperfussion, air trapmentand emphysema. At adult age this disease can pass unnoticed because of its scarce symptoms but can be diagnosed in a plain chest radiograph showing a unilateral pulmonary hyperlucency. We present a case with an unusual clinic debut: massive hemoptysis. Such way of presentation was not refered previously in the medical literature according to our review.The patient was successful managed through angiography and embolization of the anomalous vessels. After four years of follow-up at the outpatient clinic no hemoptysis occurred again, and she can keep a normal activity life1

Plasmocitoma endobronquial / Endobronchial plasmacytoma

El plasmocitoma extramedular se define como untumor poco frecuente de células plasmáticas originadoprimariamente en tejidos blandos (extraóseos)en ausencia de enfermedad generalizada. La localizaciónpulmonar es extremadamente rara, supone el5% de los mismos.Existen pocas aportaciones a la literatura sobreesta entidad. Presentamos un caso clínico de plasmocitomaendobronquial en una mujer de 67 añosque debutó con un cuadro de neumonía y derrameparaneumónico de repetición. Fue tratado con ablacióncon láser mediante broncoscopio rígido. Loscontroles fibrobroncoscópicos posteriores y el seguimientoclínico y analítico posterior confirman laausencia de enfermedad 14 meses después de sudiagnóstico

Extramedullary plasmacytoma is a little frequentplasma cell tumor originating mainly in the softtissues (extramedullary) in the absence ofgeneralized disease. Lung localization is very rare,comprising 5% of the cases.There are few literature contributions about thisentity. We present a clinical case of endobronchialplasmacytoma of a 67 year old woman presentedwith a picture of pneumonia and recurrentparapneumonic efussion. She was treated with laserablation using a rigid bronchoscope. Thesubsequent fibrobronchoscopic controls and theclinical and analytical follow up confirmed theabsence of disease 14 months after the diagnosis

Quimioterapia neoadyuvante en un timoma invasor. Cirugía curativa con neumonectomía izquierda en bloque / Neoadjuvand chemotherapy of an invasive thymoma. Invasive surgery and left side in bloc pneumonectomy

Presentamos un paciente con un timoma invasor como hallazgo en un estudio radiológico por disneaprogresiva. Tras el diagnóstico histológico fue tratado con quimioterapia (Qt) neoadyuvante consiguiendo unareducción del volumen tumoral del 25%. El tratamiento quirúrgico consistió en una exéresis en bloque deltimoma junto con el pulmón izquierdo por afectación de los vasos pulmonares. La combinación de la Qtneoadyuvante con la cirugía posibilitan un tratamiento con intención curativa

We present a patient suffering from an invasive thymoma discovered in a chest roentgenogram because ofprogressive dyspnea. Neoadjuvant chemotherapy was used after histological diagnosis, observing a tumorvolume decrease of 25 %. The surgical treatment consisted of the thymoma en bloc resection, and a left sidepneumonectomy due to affected pulmonary vessels. The combination of neoadjuvant chemotherapy andsurgery is applied as a curative intention therapy