Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didn't find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. / Seudotumor inflamatorio y tumor miofibroblástico inflamatorio. Criterios diagnósticos y diferencias pronósticas.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didnt find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

Prognostic significance of histopathological factors in survival and recurrence of atypical carcinoid tumours.

OBJECTIVES: Atypical carcinoids are neuroendocrine neoplasms of intermediate degree and low frequency. The aim of this study is to analyse their clinical characteristics and the importance of different histopathological factors in their prognosis. METHODS: Multicentre cooperative group EMETNE prospectively reviewed 153 patients operated on between 1998 and 2016 with diagnosis of atypical carcinoids. Clinical variables and histopathological features were assessed. RESULTS: Mean age was 54.36 years, similar for both genders. Concerning pathological study, mean tumour size was 31.7 mm. Rosettes were presented in 17% of the cases and tumoural necrosis in 23.3%. The cell proliferation factor Ki-67 index was 10.7%. The 2- and 5-year overall survival rates were 95.8% and 88.9%, respectively. In the univariate study, statistically significant differences in survival were found for each of the categories of T, N and M factors. Mitotic index and quantification of expression of Ki-67 showed influence in overall survival, although without statistical significance. In the multivariate analysis, factors N, M and mitotic index behaved as independent prognostic factors related to survival. Median disease-free interval in the series was 163.35 months. In cases with loco-regional recurrence, 53% had positive hiliar or mediastinal nodal involvement at the time of the surgery. In the univariate analysis, we observed statistically significant differences in disease-free interval in patients with nodal involvement (P = 0.024) and non-anatomical resections (P = 0.04). Histological characteristics showed no statistically significant differences in disease-free interval. CONCLUSIONS: Lymph node involvement, the development of distant metastasis and mitotic index, more than Ki-67 determination, were shown as independent prognostic factors related to survival of these patients.

Enzymatic mediastinitis as a fearsome complication of pancreatic necrosectomy

Several types of thoracic complications can be associated with severe acute pancreatitis. Some are very common, such as pleural effusion, whilst some others are very rare although life threatening, such as enzymatic mediastinitis (EM). Only a few cases of EM (when related to acute pancreatitis) have been described in the literature. Here we describe the case of a 76-year-old female who developed acute respiratory failure and atrial fibrillation during the postoperative period after an open pancreatic necrosectomy, due to an EM episode. The mediastinal collection was drained by thoracotomy, following an improvement of the patient's general condition. This is the first case of EM following surgical management for acute necrotizing pancreatitis. EM is a rare but life threatening complication that usually requires surgery

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Enzymatic mediastinitis as a fearsome complication of pancreatic necrosectomy.

Several types of thoracic complications can be associated with severe acute pancreatitis. Some are very common, such as pleural effusion, whilst some others are very rare although life threatening, such as enzymatic mediastinitis (EM). Only a few cases of EM (when related to acute pancreatitis) have been described in the literature. Here we describe the case of a 76-year-old female who developed acute respiratory failure and atrial fibrillation during the postoperative period after an open pancreatic necrosectomy, due to an EM episode. The mediastinal collection was drained by thoracotomy, following an improvement of the patient's general condition. This is the first case of EM following surgical management for acute necrotizing pancreatitis. EM is a rare but life threatening complication that usually requires surgery.

Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms? / ¿Es la edad un factor predisponente de complicaciones postoperatorias en las resecciones pulmonares por neoplasias pulmonares primarias?

INTRODUCTION: Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. METHODS: A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. RESULTS: The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. CONCLUSION: Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications.

Es la edad un factor predisponente de complicaciones postoperatorias en las resecciones pulmonares por neoplasias pulmonares primarias / Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms?

INTRODUCCIÓN: La edad del paciente ha sido clásicamente interpretada como un factor condicionante de la aparición de complicaciones postoperatorias en cirugía de resección pulmonar por carcinoma broncogénico. El Grupo de Estudio de Complicaciones Postoperatorias de la Sociedad Española de Cirugía Torácica promovió un registro que permitiera analizar este hecho. MÉTODOS: Se recogieron de forma consecutiva, sistemática y prospectiva los datos de un total de 3.307 pacientes tratados con algún tipo de resección quirúrgica por carcinoma broncogénico en las 24 unidades que forman parte del grupo. Fueron analizadas variables relativas a la comorbilidad y la edad del paciente, así como a las complicaciones postoperatorias acaecidas. RESULTADOS: La edad media de los pacientes intervenidos fue de 65,44 años. La población masculina en la serie era significativamente mayor que la femenina. La complicación más frecuente fue la fuga aérea prolongada, que ocurrió en más de un tercio de los pacientes. En el estudio univariante, la aparición de fugas aéreas y de atelectasias posquirúrgicas mostraron asociación estadística con la edad de los enfermos, analizada por grupos etarios. En el análisis multivariante, la edad se presentó como un factor pronóstico independiente en relación con la aparición de fugas aéreas posquirúrgicas, no así en cuanto a las atelectasias posresección. CONCLUSIÓN: La edad es un factor predisponente para el desarrollo de complicaciones postoperatorias tras resección pulmonar en nuestro medio, si bien otros factores asociados condicionan también la aparición de estas complicaciones

INTRODUCTION: Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. METHODS: A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. RESULTS: The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. CONCLUSION: Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications

Timolipoma gigante: presentación de un caso de tumor mediastínico inusual / Giant Thymolipoma: Case Report of an Unusual Mediastinal Tumor

El timolipoma es una neoplasia benigna infrecuente del timo, formada por tejido tímico y tejido adiposo maduro. El diagnóstico de timolipoma debe considerarse en presencia de una masa mediastínica con densidad de tejido adiposo, sobre todo si está entremezclada con bandas de atenuación de tejido blando en las imágenes de tomografía computarizada. Sin embargo, a veces resulta difícil diferenciar radiológicamente entre un timolipoma y otros tumores adiposos mediastínicos. Presentamos aquí el caso de un paciente con una masa mediastínica enorme que resultó ser un timolipoma (AU)

Thymolipoma is an uncommon benign neoplasm of the thymus composed of mature adipose and thymic tissue. The diagnosis of thymolipoma should be considered in the case of a mediastinal mass with fat density, especially if it is interspersed with strands of soft tissue attenuation on computed tomography scans. However, it is sometimes difficult to differentiate radiologically between a thymolipoma and other mediastinal fatty tumors (AU)

Giant thymolipoma: case report of an unusual mediastinal tumor.

Thymolipoma is an uncommon benign neoplasm of the thymus composed of mature adipose and thymic tissue. The diagnosis of thymolipoma should be considered in the case of a mediastinal mass with fat density, especially if it is interspersed with strands of soft tissue attenuation on computed tomography scans. However, it is sometimes difficult to differentiate radiologically between a thymolipoma and other mediastinal fatty tumors. Here we present a patient with a huge mediastinal mass that proved to be a thymolipoma.

Primary pulmonary angiosarcoma, an exceptional neoplasm with a poor prognosis: reports of two cases and review of the literature.

Primary pulmonary angiosarcoma is a rare type of malignant vascular tumour characterised by proliferation of tumour cells with endothelial features. Up to date, only sixteen cases have been reported in English Literature. Treatment modalities vary from none to surgery, chemotherapeutic regimens, radiotherapy or immunotherapy, but none of them have been shown to be effective. Unfortunately, these tumours are usually very aggressive and overall mortality is very high. We present two cases of patients with a diagnosis of primary pulmonary angiosarcoma, the largest case series ever described, and a review of the scientific literature.

[Influence of delay of surgery on the survival of patients with bronchogenic carcinoma]. / Influencia de la demora quirúrgica en la supervivencia de los pacientes intervenidos por carcinoma broncogénico.

OBJECTIVE: Bronchogenic carcinoma is the main cause of tumor-related deaths among men in Spain. The British Thoracic Society recommends that no longer than 4 weeks should pass from the moment a patient s name is placed on a waiting list until surgery takes place. We analyzed the influence of time until surgery on survival in patients with lung cancer. PATIENTS AND METHODS: We operated on 108 patients diagnosed with bronchogenic carcinoma between January 1, 2001 and December 31, 2002. The time until surgery was defined by the date of application for care in our department until the moment of surgery. RESULTS: The mean time on the waiting list was 56.87 days. No significant differences in mean wait-list times could be found in relation to tumor stage, type of surgery, patient age, or complete resection rate. The median survival in this patient series was 35 months. No significant differences in survival were found in relation to time until surgery in either the univariate or multivariate analysis. Pathologic stage, complete resection of the tumor, and patient age were prognostic factors. CONCLUSIONS: We found no evidence that delaying surgery affects survival in lung cancer patients. However, efforts should be made to reduce surgical wait-list times to bring them into line with the recommendations of scientific societies.

Influencia de la demora quirúrgica en la supervivencia de los pacientes intervenidos por carcinoma broncogénico / Influence of delay of surgery on the survival of patients with bronchogenic carcinoma

Objetivo: La primera causa de muerte de origen neoplásico en varones en nuestro medio es el carcinoma broncogénico. La British Thoracic Society recomienda que el tiempo de demora quirúrgica desde el momento de inclusión en una lista de espera hasta la cirugía ha de ser menor de 4 semanas. Analizamos la influencia de la espera quirúrgica en la supervivencia de estos pacientes. Pacientes y métodos: Entre el 1 de enero de 2001 y el 31 de diciembre de 2002 se intervino en nuestro servicio a 108 pacientes con el diagnóstico de carcinoma broncogénico. El tiempo de espera quirúrgica se consideró desde la fecha de solicitud de asistencia en nuestro servicio hasta el momento de la cirugía. Resultados: La media de los tiempos de espera fue de 56,87 días. No se hallaron diferencias significativas en las medias de los tiempos de espera según el estadio tumoral, el tipo de cirugía practicada, la edad del paciente o el índice de resección completa. La mediana de supervivencia de la serie fue de 35 meses. No se apreciaron diferencias significativas en la supervivencia en relación con la demora quirúrgica en el estudio univariante ni en el multivariante. El estadio patológico, la resección completa del tumor y la edad del paciente demostraron ser factores pronósticos. Conclusiones: No hemos encontrado evidencia de que nuestra demora quirúrgica influya en la supervivencia de estos pacientes. No obstante, nuestros esfuerzos deben dirigirse a la reducción de estos tiempos de espera quirúrgica hasta que se aproximen a las recomendaciones de las sociedades científicas

Objective: Bronchogenic carcinoma is the main cause of tumor-related deaths among men in Spain. The British Thoracic Society recommends that no longer than 4 weeks should pass from the moment a patient´s name is placed on a waiting list until surgery takes place. We analyzed the influence of time until surgery on survival in patients with lung cancer. Patients and methods: We operated on 108 patients diagnosed with bronchogenic carcinoma between January 1, 2001 and December 31, 2002. The time until surgery was defined by the date of application for care in our department until the moment of surgery. Results: The mean time on the waiting list was 56.87 days. No significant differences in mean wait-list times could be found in relation to tumor stage, type of surgery, patient age, or complete resection rate. The median survival in this patient series was 35 months. No significant differences in survival were found in relation to time until surgery in either the univariate or multivariate analysis. Pathologic stage, complete resection of the tumor, and patient age were prognostic factors. Conclusions: We found no evidence that delaying surgery affects survival in lung cancer patients. However, efforts should be made to reduce surgical wait-list times to bring them into line with the recommendations of scientific societies