Tumor fibroso pleural ¿son realmente benignos? ¿Cuándo deben operarse? / Pleural fibrous tumor, are they really benign? When should they have operation?

El tumor fibroso pleural es un tumor habitualmente asintomático, benigno y de lento crecimiento, que en un pequeño porcentaje de los casos tiene un comportamiento más agresivo. Para definir los criterios de malignidad es necesario un análisis inmunohistoquímico. El tratamiento de elección es la resección quirúrgica completa con márgenes de seguridad ya sea por toracotomía o por videotoracoscopia en función del tamaño. Se encuentra en estudio la utilización de terapia adyuvante radioterápica o quimioterápica que en el momento actual no cuenta con resultados significativos. Presentamos dos casos que fueron tratados de forma quirúrgica, con extirpación completa siendo el primero definido como maligno según los criterios histológicos y el segundo benigno, pero de alto riesgo. Solo uno de ellos recibió terapia adyuvante. (AU)

Solitary fibrous pleural tumor is a usually asymptomatic, benign and slow-growing tumor, which in a small percentage of cases has a more aggressive behavior. To define the malignancy criteria, an immunohistochemical analysis is necessary. The gold standard treatment is a complete surgical resection with safety margins either by thoracotomy or by videothoracoscopy depending on the size. The use of radiotherapy or chemotherapy as an adjuvant therapy is under study, which at the present time does not have significant results. We present two cases that were treated surgically, with complete removal, one being classified as malignant according to histological criteria and the other benign but high risk. Only one of them received adjuvant therapy. (AU)

Hemotórax catamenial por implantes endometriales diafragmáticos y pulmonares / Catamenial hemothorax due to diaphragmatic and pulmonary endometrial implants

La endometriosis torácica afecta principalmente a mujeres jóvenes y es originada por la migración de tejido endometrial a la cavidad torácica. Se suele presentar como neumotórax, hemoptisis, hemotórax o nódulos pulmonares. El tratamiento hormonal es el enfoque de primera línea. La cirugía actúa como herramienta diagnóstico-terapéutica y sin embargo el diagnóstico definitivo es histológico. Presentamos el caso de una mujer con diagnóstico de endometriosis pélvica en tratamiento médico a quien se le detecta hemotórax, siendo tratada con cirugía que permitió visualizar implantes pulmonares y diafragmáticos. (AU)

Thoracic endometriosis mainly affects young women and is caused by the migration of endometrial tissue into the thoracic cavity. It usually presents as pneumothorax, hemoptysis, hemothorax, or pulmonary nodules. Hormone treatment is the first line approach. Surgery acts as a diagnostic-therapeutic tool and yet the definitive diagnosis is histological. We present the case of a woman with a diagnosis of pelvic endometriosis undergoing medical treatment who was detected with a hemothorax, being treated with surgery that allowed the visualization of pulmonary and diaphragmatic implants. (AU)

Quimioterapia basada en el perfil genético en carcinoma brocongénico en estadio IV / No disponible

OBJETIVOS: Evaluar los resultados del tratamiento quimioterá picoindividualizado, basado en marcadores genéticos, en el cáncer de pulmón con metástasis a distancia (M1). PACIENTES Y MÉTODO: Estudio piloto. 40 pacientes con carcinoma pulmonar no microcítico estadio IV, tratados con quimioterapia y seguidos entre octubre de 2006 y diciembre de 2007.En cada pieza tumoral se estudia la existencia de mutaciones del gen EGFR y los niveles del gen BCRA1. Análisis estadístico Kapplan Meier. RESULTADOS: El lugar donde más frecuentemente se produjeron metástasis fue: pulmón/pleura (20 casos), adenopatías más allá del territorio N3 (12 casos), hueso (11 casos), suprarrenal (7casos), hígado (3 casos) y peritoneo (2 casos). Se pudo realizar tratamiento quimioterápico basado en el perfil genómico, debido a que las muestras fueron viables para el estudio, en 26 pacientes. En14 enfermos la muestra no fue viable y se realizó tratamiento convencional(cisplatino + gemcitabina). Con una mediana de seguimiento de 259 días (117-474), el grupo tratado con perfil genómico tuvo una respuesta del 61% (16/26) y el empírico del 14% (2/14).La mediana del tiempo a la progresión de la enfermedad del grupo genómico fue de 203 días y la del empírico de 64 días (P<0,0001).La mediana de supervivencia del grupo genómico aún no se había alcanzado al final del estudio (más de la mitad continuaban vivos),mientras que la del grupo empírico fue de 140 días (P<0,0002). CONCLUSIONES: Los primeros resultados confirman que el tratamiento quimioterápico basado en el perfil genómico del paciente, mejora de manera significativa la supervivencia de éstos respecto de la quimioterapia clásica (AU)

OBJECTIVES. To evaluate the results of the personalised chemotherapeutic treatment, based on genetic markers, in lung cancer with remote metastasis (M1). PATIENTS AND METHOD. Pilot study. 40 patients with stage IV non small cell pulmonary carcinoma, treated with chemotherapy and monitored between October 2006 and December 2007.The existence of mutations of the EGFR gene and the levels of theBCRA1 gene were studied in each tumour sample. Kaplan-Meier statistical analysis was performed. RESULTS. The most frequently metastasis site was: lung/pleura(20 cases), adenopathies beyond the N3 level (12 cases), bone (11cases), suprarenal (7 cases), liver (3 cases) and peritoneum (2cases). A chemotherapeutic treatment could be made based on the genomic profile, because the samples were viable for the study in 26patients. In 14 patients the sample was not viable and conventional treatment was made (cisplatin + gemcitabine). With an average follow-up of 259 days (117-474), the group treated with genomic profile had a response of 61% (16/26) and the empirical group a response of 14% (2/14). The average time to the progression of the disease in the genomic group was 203 days and 64 days (P<0.0001)in the empirical group. The average survival of the genomic group is not yet determined as the end of the study has not been reached(more than half are still alive), whereas that of the empirical group was 140 days (P<0.0002). CONCLUSIONS. The first results confirm that chemotherapeutic treatment based on the genomic profile of the patient, significantly improved the survival of these patients with respect to the classic chemotherapy (AU)

Exploración quirúrgica del mediastino: mediastinoscopia y mediastinotomía / No disponible

La mediastinoscopia y la mediastinotomía son técnicas quirúrgicas ideadas para la exploración del mediastino. Su principal indicación es diagnóstica. Permiten la biopsia de los ganglios mediastínicos y así la correcta estadificación del carcinoma broncogénico. Son técnicas seguras con un índice de complicaciones mínimo (AU)

No disponible

Tratamiento quirúrgico en mediastinitis aguda necrotizante descendente / Surgical treatment in acute descending necrotizing mediastinitis

FUNDAMENTO: Analizar los resultados obtenidos en nuestraexperiencia en el tratamiento quirúrgico de la mediastinitis agudanecrotizante descendente (MAND).MÉTODO: Análisis retrospectivo, descriptivo, transversal yobservacional de los casos consecutivos registrados durante el períodocomprendido entre 1996 y 2003.RESULTADOS: Edad media de los pacientes: 43 años (rango:27-71). Sexo: 7 hombres (87’5%) y 1 mujer (12’5%). Origen: 2abscesos sublinguales (25%), 2 abscesos retrofaríngeos (25%), 1absceso odontógeno (12’5%), 1 flemón laríngeo (12’5%) y 2 sinfoco infeccioso aparente. Seis pacientes (75%) fueron diagnosticadosy tratados en menos de 24 horas y dos (25%) pasadas las primeras24 horas. La TAC de tórax fue la prueba de imagen que confirmóel diagnóstico en todos los casos registrados. En todos loscasos se realizó toracotomía posterolateral estándar, y en ningúncaso fue necesaria la retoracotomía. Excepto en dos pacientes enlos que el cultivo del líquido pleural fue negativo, en el resto de loscasos se cultivó un Estreptococo, siendo el más frecuentemente aisladoel S. Viridans. Dos casos cursaron sin ningún tipo de complicacionesen el postoperatorio. En el resto de casos, las complicacionespostoperatorias más frecuentes, de mayor a menor frecuencia,fueron: neumonía asociada a ventilación mecánica, atelectasia,derrame pleural y shock séptico. La estancia hospitalaria postoperatoriaentre los pacientes que sobrevivieron fue de 32 días. De losocho pacientes, dos (25%) fallecieron en el postoperatorio.CONCLUSIONES: La mortalidad global en nuestro servicioes del 25%, porcentaje que coincide con la literatura revisada.Nuestros datos apuntan hacia la conveniencia de una indicaciónquirúrgica precoz antes de 24 horas después del diagnóstico, condesbridamiento quirúrgico completo del mediastino, que en nuestraserie se ha realizado a través de toracotomía estándar. El abordajevideotoracoscópico puede ser una buena alternativa en manosexperimentadas y siempre que se lleve a cabo precozmente

OBJECTIVE: To analyze the results obtained from our experiencein the surgical treatment of acute descending necrotizingmediastinitis (ADNM).METHOD: Retrospective, descriptive, cross-sectional andobservational analysis of the consecutive cases registered duringthe period covered between 1996 and 2003.RESULTS: Average age of the patients: 43 years (range: 27-71). Sex: 7 men (87.5 %) and 1 woman (12.5 %). Origin: 2 sublingualabscesses (25 %), 2 retropharyngeal abscesses (25 %), 1 odontogenicabscess (12.5 %), 1 laryngeal abscess (12.5 %) and 2without apparent infectious focus. Six patients (75 %) were diagnosedand treated in less than 24 hours and two (25 %) after thefirst 24 hours. (The) Diagnoses were confirmed by thoracic CATscan. In all (the) cases standard posterolateral thoracotomy wasperformed, with none of the cases requiring rethoracotomy. Streptococcuswas cultivated in all but two cases which gave negativeresults with pleural fluid culture. The most frequent isolate bacteriain (the) positive cultures was S. Viridans. Two cases had no postoperativecomplications of any kind. In the rest of the cases, themost frequent postoperative complications, from higher to lowerfrequency, were: pneumonia associated with mechanical ventilation,atelectasis, pleural effusion and septic shock. The postoperativehospitable stay among (the) surviving patients was 32 days.There were two (25 %) postoperative deaths among the eightpatients.CONCLUSIONS: (The) Global mortality in our Service is 25%, which coincides with the reviewed literature. Our data pointtowards the advisability of an early surgical intervention within 24hours of diagnosis, with complete surgical debridement of themediastinum which in our series was achieved through standardthoracotomy. The videothoracoscopic approach can be a goodalternative in experienced hands and with early intervention

[Diffuse thoracic lymphangiomatosis: diagnosis and treatment]. / Linfangiomatosis torácica difusa: diagnóstico y tratamiento.

Histologically, lymphangiomatosis is a rare type of benign neoplasm caused by abnormal development and proliferation of the lymphatic system. Thoracic lymphangiomatosis can present in a localized (lymphangioma) or diffuse form (lymphangiomatosis). In most cases the disease progresses to serious morbidity or even death. The treatment of choice for localized disease is usually surgery or, less frequently, local injection of sclerosing agents (streptococcus antigen OK-432). However, in diffuse forms there is a gelatinous infiltrate without defined limits. In these cases the main treatment option is radiotherapy. We report 2 cases of diffuse thoracic lymphangiomatosis with pulmonary infiltrate. In both cases radiotherapy in appropriate doses successfully eliminated pulmonary infiltrates, pleural effusion, dyspnea, and general discomfort. Surgery was needed to resolve complications of the disease and for diagnosis.

[Bronchiolitis obliterans organizing pneumonia and bronchogenic carcinoma coexisting in different parts of the lungs]. / Coexistencia de bronquiolitis obliterante con neumonía organizada y carcinoma broncogénico en zonas pulmonares distantes.

Bronchiolitis obliterans organizing pneumonia (BOOP) coexisting with nonsmall cell lung cancer in a separate part of the lungs is rare. We report the case of a man diagnosed with BOOP by video-assisted thoracoscopic lung biopsy; the patient also had adenocarcinoma in a different part of the lungs. The BOOP was treated with corticosteroids and the carcinoma was surgically resected. Outcome and clinical course were good after both procedures. The possibility of BOOP associated with bronchogenic carcinoma at a distant part of the lungs, although rare, must be taken into account in the differential diagnosis of radiographic alterations that may present in either of the 2 diseases.

Coexistencia de bronquiolitis obliterante con neumonía organizada y carcinoma broncogénico en zonas pulmonares distantes / Bronchiolitis obliterans organizing pneumonia and bronchogenic carcinoma coexisting in different parts of the lungs

La coexistencia en un paciente de una bronquiolitis obliterante con neumonía organizada (BONO) y un carcinoma pulmonar no microcítico en zonas pulmonares distantes es un hecho muy infrecuente. Presentamos el caso de un paciente con diagnóstico mediante biopsia pulmonar por videotoracoscopia de BONO, que tenía asociado en una zona pulmonar alejada un adenocarcinoma pulmonar. La BONO recibió tratamiento corticoideo y el carcinoma se resecó quirúrgicamente. Ambos procesos presentaron una buena evolución.La posibilidad de que se presenten asociados una BONO y un carcinoma broncogénico en zonas pulmonares distantes, aunque muy infrecuente, deberá tenerse en cuenta en el diagnóstico diferencial de las alteraciones radiológicas que se puedan presentar en cualquiera de estas entidades patológicas (AU)

[Pancreatic cystic metastasis from pulmonary carcinoma. Report of a case]. / Metastasi cistica pancreatica da carcinoma polmonare. Presentazione di un caso.

We report the case of a patients with a metachronous cystic pancreatic metastasis from an undifferentiated large cell lung carcinoma two years after the primary tumor had been surgically removed. Clinically, he presented with epigastric pain, fever, weakness and anorexia. The patient was operated and a palliative cystogastrostomy was performed after an intraoperative biopsy had been informed as positive for carcinoma. Six months later the patient died. Pancreatic metastases from lung carcinoma are found in approximately 7-9% of patients deceased of this neoplasm. Clinical and radiological findings simulate primary pancreatic tumors, being epigastric pain, jaundice and upper digestive bleeding the most frequent symptoms. They represent stages of advanced systemic disseminated tumoral disease, and because of this reason total or partial surgical curative resections will only be performed in a few cases of patients with isolated metastasis, criteria of resectability and without evidence of extended disease to other organs or systems. In the most of the cases, the treatment will only be palliative, even medical or surgical.

[Pulmonary sequestration: 2 cases (intralobar and extralobar) in surgically treated adults]. / Secuestro pulmonar: dos casos (intralobar y extralobar) en adultos, intervenidos quirúrgicamente.

We present two cases of pulmonary sequestration, one intralobar and the other extrapulmonary, in young adults. The diagnoses were obtained after surgical resection in both cases. The cases are of interest in that the first (intralobar sequestration) started with massive hemoptysis requiring emergency treatment, and the second (extrapulmonary sequestration) involved an unusual location in the upper mediastinum, requiring surgery by video assisted thoracoscopy.

[Primary tumors of the thoracic wall (1991-1994)]. / Tumores primitivos de pared torácica (1991-1994).

Between 1991 and 1994, 582 operations were performed in our service; 19 (3.26%) were on primitive tumors of the chest wall. We analyze the data for these patients, including age, sex, clinical findings, chest images, diagnoses, therapy and course. Ten tumors were benign and 9 were malignant. The most frequent clinical findings were pain and/or tumor. Diagnosis was achieved before surgery in only 2 cases. Except when there are clear macroscopic and X-ray signs that the tumor is benign, we performed broad exeresis of the chest wall, sometimes also resecting adjacent structures. The defect was repaired directly in 12 cases. The defects were covered by prostheses and/or muscle plasty in the remaining patients. The most frequent tumor was chondrosarcoma (3 cases), followed by 2 cases of osteoblastoma and osteochondroma. Only 1 each of the following tumors were found: plasmocytoma, chondroma, fibrous dysplasia, eosinophilic granuloma, osteosarcoma, Ewing's tumor, epithelioid sarcoma, fibrosarcoma, hemangioma, benign neurilemmoma, desmoid tumor and liposarcoma. Two patients with chondrosarcoma were operated on for recurrences and there was also recurrence in the patient with Ewing's tumor. We conclude that: 1) chest wall tumors are infrequent, 2) radical exeresis is the treatment of choice and prosthesis is often necessary, and 3) chondrosarcoma, with poor outcome in our patients, is the most frequent tumor.