Assuntos
Miastenia Gravis/complicações , Síndromes Paraneoplásicas do Sistema Nervoso/complicações , Timoma/complicações , Neoplasias do Timo/complicações , Anticonvulsivantes/uso terapêutico , Inibidores da Colinesterase/uso terapêutico , Eletroencefalografia , Seguimentos , Levetiracetam , Imageamento por Ressonância Magnética , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico , Síndromes Paraneoplásicas do Sistema Nervoso/tratamento farmacológico , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Brometo de Piridostigmina/uso terapêutico , Convulsões/etiologia , Timectomia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Mediastinal lymphangioma is one of the rarest benign mediastinal masses. We report the successful minimally invasive surgical treatment of multiple cystic lymphangiomas in a middle-aged man with a familial history of lung cancer. This case report describes cystic lymphangioma as a rare differential diagnosis for a mediastinal mass in an adult.
Assuntos
Linfangioma Cístico/cirurgia , Neoplasias do Mediastino/cirurgia , Cirurgia Torácica Vídeoassistida , Humanos , Linfangioma Cístico/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Neoplasias do Mediastino/diagnóstico , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: The current staging system provides an anatomical classification of lung tumors; its secondary purpose is to allow the prognostic stratification of patients into homogeneous groups after surgery. In this work, intratumoral perineural invasion, lymphatic and blood vessel invasion together with the necrosis content of the tumor exclusive of the non-small cell cancer staging system were studied. METHODS: During a 4-year period, 152 patients operated for non-small cell lung cancer (NSCLC) at our hospital were analyzed. Mean age of patients was 55.7 +/- 10.1 years. RESULTS: Overall 5-year survival was 42.2 %. Mediastinal lymph node involvement, tumor size, incomplete resection, pneumonectomy, presence of necrosis and perineural invasion were significant prognosticators ( P = 0.03, 0.04, 0.0001, 0.046, 0.0246, < 0.0001, respectively). Multivariate analysis revealed that N status, perineural invasion, and the presence of necrosis were independent prognostic factors ( P = 0.006, P = 0.001, P = 0.001, respectively). Patients who had stage I tumor with necrosis and perineural invasion had a lower survival rate than those with stage IIIA tumor without these histopathological features ( P = 0.04). The presence of these histopathological characteristics in stage IIIA patients was a sign of a poorer prognosis ( P = 0.0001). CONCLUSIONS: Perineural invasion and the presence of necrosis independently indicated a dismal prognosis and their prognostic power is comparable to those of the TNM classification. These factors could be candidates for better survival stratification and the indicators of the need for adjuvant therapy in early stage lung cancer patients.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Nervos Periféricos/patologia , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Necrose , Invasividade Neoplásica , Estadiamento de Neoplasias , Pneumonectomia , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
We report the case of a pulmonary sclerosing haemangioma radiologically presenting as a cystic lesion. The patient was found to have specific anti-echinococcus immunoglobulin E and therefore the preoperative diagnosis was that of pulmonary hydatid cyst. A surgical resection was performed. Although rarely encountered, pulmonary sclerosing haemangioma may show radiological and serological similarities to a pulmonary hydatid cyst. Both entities necessitate complete removal of the lesion without parenchymal resection.
Assuntos
Equinococose Pulmonar/diagnóstico por imagem , Hemangioma Esclerosante Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Animais , Biomarcadores Tumorais/análise , Diagnóstico Diferencial , Equinococose Pulmonar/cirurgia , Echinococcus/imunologia , Feminino , Humanos , Imunoglobulina E/sangue , Pulmão/patologia , Masculino , Pneumonectomia , Hemangioma Esclerosante Pulmonar/patologia , Hemangioma Esclerosante Pulmonar/cirurgiaAssuntos
Dor no Peito/etiologia , Tosse/etiologia , Hemoptise/etiologia , Doença de Hodgkin/complicações , Redução de Peso , Adulto , Diagnóstico Diferencial , Doença de Hodgkin/diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Abscesso Pulmonar/diagnóstico , Masculino , RadiografiaRESUMO
BACKGROUND: The efficacy of mediastinal lymph node examination using cervical mediastinoscopy in operable non-small cell lung cancer patients without radiological nodal involvement on computerized tomography (CT) has been elusive. METHODS: The value of mediastinoscopy as a staging modality for assessing the mediastinal lymph node status was evaluated in 79 patients with presumed resectable non-small-cell lung cancer (NSCLC) with mediastinal nodes smaller than 1 cm (NO) form the CT scan. Sixty-one patients who did not have nodal involvement at mediastinoscopy and had complete medical records underwent complete resection. RESULTS: Negative predictive value (NPV) of the CT scan according to mediastinoscopy was 92.4 %. Histopathological examination of the surgical specimen showed the NPV of mediastinoscopy to be 93.4 %. Only 4 patients (3 patients with N2, 1 patient with N3 disease) were not correctly staged using CT scanning and mediastinoscopy. According to the pathological examination, the NPV of CT was found to be lower (76.5 %) in patients with adenocarcinoma, but the difference was not statistically significant (p > 0.128) CONCLUSION: Although the likelihood of surgical-pathological N2 is slightly higher in patients with adenocarcinoma, radiological examination of patients with cNO NSCLC disease can be as accurate as mediastinoscopy in appropriately staging mediastinal lymph node involvement.