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1.
Khirurgiia (Mosk) ; (10): 5-12, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31626233

RESUMO

OBJECTIVE: To analyze immediate and long-term results of anatomical resections for lung cancer with subsequent comparison of the results of segmentectomy and lobectomy in patients with peripheral NSCLC stage IA1-2. MATERIAL AND METHODS: There were 52 sublobular anatomical resections of the lung for peripheral non-small cell carcinoma and carcinoid T1a-bN0M0, IA1-2 stage. 3D-CT reconstruction with separation of bronchial and vascular structures was used to schedule complex segmentectomy. We retrospectively analyzed 200 patients with cT1a-bN0M0 peripheral non-small cell lung cancer (NSCLC) and tumor dimension ≤2 cm who underwent lobectomy (n=148) and segmentectomy (n=52). Mortality, morbidity and overall 5-year survival were compared in two propensity score matched groups (46 pairs, segmentectomy vs. lobectomy). RESULTS: There was no mortality in both groups. Morbidity was similar after segmentectomy and lobectomy (8.69 and 6.52%; p=0.32). 3D-CT with separation of bronchial and vascular structures enabled surgeons to perform atypical segmentectomies and VATS procedures more often (from 13.5 to 31.3%; p>0.05 and from 11.5 to 50.0%; p<0.05). Five-year survival was 82 and 86% (p=0.652) after segmentectomy and lobectomy, respectively. CONCLUSION: Postoperative results and long-term outcome after segmentectomy and lobectomy are comparable in patients with NSCLC cT1a-bN0M0, stage IA1-2. Segmentectomy is advisable surgery in patients with low pulmonary capacity and severe comorbidities.


Assuntos
Tumor Carcinoide/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Humanos , Estudos Retrospectivos
2.
Magy Seb ; 72(3): 98-102, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31544482

RESUMO

Introduction: Authors present their 7-year experience since the introduction of minimal-invasive (VATS) lobectomies for lung cancer in regard to their surgical technique, results and oncological follow-up. Method: 173 VATS lobectomies were performed between June 2011 and December 2017, 105 men and 68 women. The mean age of patients was 64.1 years. Duration of surgery was 130 minutes on average. Results: Conversion to thoracotomy was required in 8 cases (3 bleedings, 3 pulmonary vessel lymph node infiltrations, 2 bronchial suture insufficiencies). Twenty persistent air leaks developed postoperatively, requiring 10 re-drainages and 10 re-operations: 7 re-VATS and 3 thoracotomies. Two hematomas were evacuated by re-VATS, 1 postoperative atrial fibrillation required cardioversion. There were no perioperative deaths. The 164 malignant cases were: 110 adenocarcinomas, 32 squamous cell carcinomas, 6 small cell neuroendocrine carcinomas, 4 undifferentiated carcinomas, 4 carcinoid tumours, 1 synchronous adenocarcinoma and squamous cell carcinoma, 1 synchronous adenocarcinoma and small cell carcinoma, 1 carcinosarcoma and 5 metastasis from other primary tumours. 118 patients received adjuvant chemotherapy. Tumour staging distribution was: IA 40, IB 53, IIA 29, IIB 16 and IIIA 21 cases. During an average follow-up time of 19.5 months, 9 local tumour recurrence and 27 distant metastasis evaluated, of which 11 were pulmonary (3 multiplex), 10 bone, 6 cerebral, 3 hepatic (1 multiplex), and 3 suprarenal gland. Conclusion: Our results correlate with published literature. During the period of this review, VATS lobectomies became a routine surgical technique in our department. Our experience proved that axillary thoracotomy is an advantage to learn the anterior VATS lobectomy technique.


Assuntos
Tumor Carcinoide/cirurgia , Carcinoma de Células Pequenas/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Pulmão/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Toracotomia/métodos , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Analgesia Controlada pelo Paciente , Tumor Carcinoide/patologia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Recidiva Local de Neoplasia , Duração da Cirurgia , Reoperação/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
3.
Ulus Travma Acil Cerrahi Derg ; 25(5): 510-513, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31475334

RESUMO

BACKGROUND: We aim to present the data of patients who underwent appendectomy due to acute appendicitis, and incidental carcinoid tumor was detected on pathology. METHODS: Retrospective analysis of the patient charts between January 1999 and September 2018 were performed. RESULTS: 2778 appendectomy was performed due to acute appendicitis. Appendiceal carcinoid tumor was detected in 12 (0.43%) patients. Eight patients were (66.7%) female. Median age 37.5 years (range: 21-60). The median tumor size was 0.7 cm (range: 0.1-2.5). No perforation was detected. Eleven patients underwent appendectomy, and one patient had right hemicolectomy. The median follow-up period was 41.5 months (range: 22-49). There were no recurrences. CONCLUSION: Appendix carcinoid tumors are quite rare, usually asymptomatic and diagnosed incidentally on histopathological examination after appendectomy. The treatment of carcinoid tumors of the appendix is directly related to the tumor size, localization, presence of lymphovascular and mesoappendix invasion, mitotic activation rate and level of Ki67. Thus, it is important to follow the histopathological results after appendectomy. The prognosis of appendix carcinoid tumors is very good if the appendix is non-perforated.


Assuntos
Neoplasias do Apêndice , Tumor Carcinoide , Neoplasias Intestinais , Adulto , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/epidemiologia , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/cirurgia , Apendicite , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/epidemiologia , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/epidemiologia , Neoplasias Intestinais/patologia , Neoplasias Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
4.
Urology ; 133: 216-218, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31415779

RESUMO

We present an extremely rare case of a 3-year-old child with a primary carcinoid tumor of the prostate. A 3-year-old boy presented with failure to thrive, constipation, recurrent respiratory tract infections, and pain in the genital area. His karyotype was normal and cystic fibrosis and coeliac disease were excluded prior to further investigation. An abdominopelvic computed tomography scan revealed a prostatic mass. Transrectal ultrasound-guided prostate biopsy was therefore performed and pathological examination revealed a carcinoid tumor. A robotic radical prostatectomy was performed. As this is an innovative surgical approach, we describe the surgical technique used.


Assuntos
Tumor Carcinoide/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Pré-Escolar , Humanos , Masculino
5.
Taiwan J Obstet Gynecol ; 58(4): 570-573, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307754

RESUMO

OBJECTIVE: Only a few cases of primary ovarian mucinous carcinoid tumor have been documented in the literature till date. We present a case of primary ovarian mucinous carcinoid tumor, atypical type, and review the reported cases. CASE REPORT: A 33-year-old woman with a left ovarian tumor was diagnosed with primary ovarian mucinous carcinoid tumor, atypical type. She underwent left salpingo-oophorectomy and ipsilateral lymph node dissection. After 5 years, the tumor recurred on the right side, with large para-aortic lymphadenopathy that caused hydronephrosis. Complete surgical staging was performed, followed by nine cycles of weekly paclitaxel and gemcitabine. The tumor progressed after discontinuing the chemotherapy, and the patient died of disease 26 months after recurrence. CONCLUSION: Our patient demonstrated a more aggressive clinical course compared to that reported in previous literature. Based on this experience, complete surgical staging is highly recommended after the patient accomplished her fertility plan. Ovarian carcinoid tumors are relatively chemoresistant compared with epithelial ovarian cancers. The regimen of weekly paclitaxel and gemcitabine stabilized the disease but did not reach remission of the tumor. Further studies are required to determine the appropriate chemotherapy regimen.


Assuntos
Adenocarcinoma Mucinoso/patologia , Tumor Carcinoide/patologia , Recidiva Local de Neoplasia/terapia , Neoplasias Ovarianas/patologia , Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Mucinoso/cirurgia , Adulto , Biópsia por Agulha , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/cirurgia , Quimioterapia Adjuvante , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Imuno-Histoquímica , Recidiva Local de Neoplasia/patologia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Ovariectomia/métodos , Reoperação/métodos , Salpingo-Ooforectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler
8.
Ann Thorac Surg ; 108(3): 859-865, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31059684

RESUMO

BACKGROUND: The role of sublobar resection in the treatment of pulmonary typical carcinoids is controversial. This study aims to compare long-term outcomes between sublobar and lobar resections in patients with peripheral typical carcinoid. METHODS: We retrospectively compared consecutive patients who underwent curative sublobar resection with patients who underwent lobectomy for cT1-3 N0 M0 peripheral pulmonary typical carcinoid in eight centers between 2000 and 2015. Primary outcomes were rates and patterns of recurrence and overall survival. Cox regression modeling was performed to identify factors influencing overall survival and recurrence. Propensity score analysis was done, and overall survival was compared between the two groups. RESULTS: In all, 177 patients were analyzed, consisting of 74 sublobar resections and 103 lobectomies, with a total of 857 person-years of follow-up. The R1 resection rates were 7% and 1% after sublobar resection and lobectomy, respectively (P = .08). One of 5 patients with sublobar R1 resection had recurrence. Recurrence rate was 0.02 (95% confidence interval [CI]: 0.009 to 0.044) per person-year of follow-up after sublobar resection and 0.008 (95% CI: 0.003 to 0.02) after lobectomy (P = .15). Five-year survival rates were 91.7% (95% CI: 78.5% to 96.9%) and 97.4% (95% CI: 90.1% to 99.4%) after sublobar and lobar resection, respectively (P = .08). Extent of resection was not a predictor of recurrence or survival. Propensity score analysis confirmed a similar survival and freedom from recurrence between the two groups. CONCLUSIONS: Sublobar resection of peripheral cT1-3 N0 M0 pulmonary typical carcinoid was not associated with worse short- or long-term outcomes compared with lobectomy. In select patients, sublobar resection may be considered for treatment of peripheral typical carcinoids if an R0 resection is obtained.


Assuntos
Tumor Carcinoide/mortalidade , Tumor Carcinoide/cirurgia , Causas de Morte , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Idoso , Tumor Carcinoide/patologia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Internacionalidade , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Pneumonectomia/mortalidade , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
9.
Anticancer Res ; 39(5): 2513-2517, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092447

RESUMO

BACKGROUND/AIM: The aim of the study was to assess the clinical outcome of patients with malignant transformation of an ovarian mature teratoma. PATIENTS AND METHODS: This study was conducted on 23 patients who underwent primary surgery at three Italian Gynecological Centers. Histologically, nine (39.1%) patients had squamous cell carcinoma, five (21.7%) had a thyroid carcinoma, six (26.1%) had a carcinoid, one (4.3%) patient had papillary renal carcinoma, one (4.3%) had medulloblastoma and one (4.3%) had intestinal-type mucinous adenocarcinoma. RESULTS: All six patients with stage I squamous cell carcinoma had no evidence of disease (NED) after a median time of 141 months. Of the three patients with stage IIb-IIIc squamous cell carcinoma, two had NED after 119 and 154 months, and one died of the disease 9 months after diagnosis. All five women with stage I thyroid carcinoma had NED after a median of 60 months. Of the six patients with stage I carcinoid, five had NED after a median of 168 months, whereas one died due to carcinoid heart disease. The three patients with stage I renal carcinoma, medulloblastoma and mucinous adenocarcinoma had NED after 24, 141 and 149 months, respectively. CONCLUSION: The clinical outcome of early-stage malignancies associated with mature ovarian teratomas is excellent following treatment.


Assuntos
Tumor Carcinoide/epidemiologia , Neoplasias Ovarianas/patologia , Teratoma/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Meduloblastoma/diagnóstico , Meduloblastoma/epidemiologia , Meduloblastoma/patologia , Meduloblastoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/classificação , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Estudos Retrospectivos , Teratoma/diagnóstico , Teratoma/epidemiologia , Teratoma/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia
10.
J Vet Med Sci ; 81(6): 928-932, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-30996205

RESUMO

In an 8-year-old Labrador Retriever with progressive anorexia, constipation, and depression, CT revealed intussusception of the cecum into the ascending colon and a small cecal mass showing strong enhancement on arterial phase. The ileocecocolic junction was surgically resected and histologically diagnosed as cecocolic intussusception with carcinoid tumor. The carcinoid tumor worked as a lead point of intussusception in this case. Dual phasic CT is useful to assess the presence of gastrointestinal tumors as lead points in old dogs with intussusception.


Assuntos
Tumor Carcinoide/veterinária , Doenças do Cão/diagnóstico por imagem , Neoplasias Intestinais/veterinária , Intussuscepção/veterinária , Animais , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/cirurgia , Doenças do Ceco/diagnóstico por imagem , Doenças do Ceco/cirurgia , Doenças do Ceco/veterinária , Angiografia por Tomografia Computadorizada/veterinária , Doenças do Cão/cirurgia , Cães , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/cirurgia , Intussuscepção/diagnóstico por imagem , Masculino
11.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936334

RESUMO

A 52-year-old woman with a background of vaginal hysterectomy for heavy menstrual bleeding underwent an elective laparoscopic adhesiolysis, left salpingo-oophorectomy for left-sided pelvic pain, and a right salpingectomy. Despite a grossly normal appearance, histology revealed a rare presentation of mature teratoma with insular carcinoid tumour arising from the left fallopian tube. Even though the salpingectomy was thought to be curative, the patient underwent a second operation to remove her remaining right ovary as a precaution against malignant spread. In light of limited information in such rare cases, counselling on best management and discussion of risks to guide patient decision making remains challenging.


Assuntos
Tumor Carcinoide/diagnóstico , Tubas Uterinas/patologia , Neoplasias Ovarianas/diagnóstico , Teratoma/diagnóstico , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Feminino , Humanos , Histerectomia , Laparoscopia , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Dor Pélvica/etiologia , Cuidados Pré-Operatórios , Salpingo-Ooforectomia , Teratoma/patologia , Teratoma/cirurgia , Resultado do Tratamento
12.
World J Gastroenterol ; 25(10): 1259-1265, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30886508

RESUMO

BACKGROUND: Local endoscopic resection is an effective method for the treatment of small rectal carcinoid tumors, but remnant tumor at the margin after resection remains to be an issue. AIM: To evaluate the efficacy and safety of resection of small rectal carcinoid tumors by endoloop ligation after cap-endoscopic mucosal resection (LC-EMR) using a transparent cap. METHODS: Thirty-four patients with rectal carcinoid tumors of less than 10 mm in diameter were treated by LC-EMR (n = 22) or endoscopic submucosal dissection (ESD) (n = 12) between January 2016 and December 2017. Demographic data, complete resection rates, pathologically complete resection rates, operation duration, and postoperative complications were collected. All cases were followed for 6 to 30 mo. RESULTS: A total of 22 LC-EMR cases and 12 ESD cases were enrolled. The average age was 48.18 ± 12.31 and 46.17 ± 12.57 years old, and the tumor size was 7.23 ± 1.63 mm and 7.50 ± 1.38 mm, respectively, for the LC-EMR and ESD groups. Resection time in the ESD group was longer than that in the LC-EMR group (15.67 ± 2.15 min vs 5.91 ± 0.87 min; P < 0.001). All lesions were completely resected at one time. No perforation or delayed bleeding was observed in either group. Pathologically complete resection (P-CR) rate was 86.36% (19/22) and 91.67% (11/12) in the LC-EMR and ESD groups (P = 0.646), respectively. Two of the three cases with a positive margin in the LC-EMR group received transanal endoscopic microsurgery (TEM) and tumor cells were not identified in the postoperative specimens. The other case with a positive margin chose follow-up without further operation. One case with remnant tumor after ESD received further local ligation treatment. Neither local recurrence nor lymph node metastasis was found during the follow-up period. CONCLUSION: LC-EMR appears to be an efficient and simple method for the treatment of small rectal carcinoid tumors, which can effectively avoid margin remnant tumors.


Assuntos
Tumor Carcinoide/cirurgia , Ressecção Endoscópica de Mucosa/instrumentação , Neoplasias Intestinais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Proctoscopia/instrumentação , Neoplasias Retais/cirurgia , Adulto , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/patologia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Feminino , Seguimentos , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Mucosa Intestinal/cirurgia , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/patologia , Ligadura/efeitos adversos , Ligadura/instrumentação , Ligadura/métodos , Metástase Linfática/prevenção & controle , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Proctoscopia/efeitos adversos , Proctoscopia/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
Interact Cardiovasc Thorac Surg ; 28(6): 957-960, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753507

RESUMO

Few data are available about radio-receptorial positron emission tomography (PET) results by the use of 68Ga-DOTA-peptides in pulmonary carcinoid tumours. In this study, we retrospectively analysed 68Ga-DOTATOC/PET and 18Fluorodeoxyglucose (FDG) PET diagnostic performances in 62 pulmonary carcinoids (occurring in 57 patients) and interrelationship with histological features. All patients underwent at least 1 PET/computed tomography: 26 patients received 68Ga-DOTATOC, 52 patients had 18F-FDG and 20 patients received both techniques. There were 55 typical carcinoids and 7 atypical carcinoids. 68Ga-DOTATOC/PET recorded an 88.4% overall detection rate (DR) (meanSUVmax: 15.5); 18F-FDG/PET a DR of 53.8% (meanSUVmax: 3.2). When adopted a maximum standardized uptake value-threshold of 1.5, DRs of 68Ga-DOTATOC and 18F-FDG/PET increased to 100% and 80.8%, respectively. Moreover, DRs in both techniques vary considerably according to histology with 68Ga-DOTATOC/PET having better performances in typical carcinoids than in atypical carcinoids (DR: 91.7% vs 50.0%, P = 0.076). We also observed a significant correlation between a low number of mitoses (<2/10 high-power field) and 68Ga-DOTATOC/PET-positivity (P = 0.004), and an association trend (P = 0.076) between necrosis and 68Ga-DOTATOC/PET-negativity. In conclusion, 68Ga-DOTATOC had better diagnostic performances than 18F-FDG/PET in detecting pulmonary carcinoids. DRs of both techniques remarkably varied according to histology with 68Ga-DOTATOC/PET performing at its best in typical carcinoids, whereas 18F-FDG/PET did the same in atypical carcinoids.68Ga-DOTATOC/PET results were presumably associated with the number of mitoses and the presence of necrosis.


Assuntos
Tumor Carcinoide/diagnóstico , Fluordesoxiglucose F18/farmacologia , Neoplasias Pulmonares/diagnóstico , Pulmão/diagnóstico por imagem , Octreotida/análogos & derivados , Compostos Organometálicos/farmacologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Tumor Carcinoide/cirurgia , Feminino , Radioisótopos de Gálio , Humanos , Pulmão/cirurgia , Neoplasias Pulmonares/cirurgia , Masculino , Octreotida/farmacologia , Pneumonectomia/métodos , Compostos Radiofarmacêuticos/farmacologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
15.
BMC Pulm Med ; 19(1): 44, 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777035

RESUMO

BACKGROUND: Postpneumonectomy-like syndrome is a rare condition resulting from unilateral lung disease with severe lung volume loss leading to excessive mediastinal shift and herniation of the healthy lung into the contralateral hemithorax, mimicking the mediastinal shift observed in postpneumonectomy syndrome after pneumonectomy. We report a unique case of postpneumonectomy-like syndrome caused by an atypical bronchial carcinoid completely occluding the left main bronchus. CASE PRESENTATION: A 25-year-old woman presented with symptoms of chronic exertional dyspnea and productive cough. Imaging studies showed complete left lung atelectasis due to a mass occluding the left main bronchus, as well as extreme mediastinal deviation and substantial herniation of the right lung into the left hemithorax. Bronchoscopic biopsy of the tumor and subsequent left pneumonectomy with concurrent lymph node dissection revealed an atypical carcinoid. Sixteen months after surgery the patient has been asymptomatic with repeat imaging studies showing no change in mediastinal shifting. CONCLUSION: Bronchial carcinoids are notorious for causing bronchial obstruction. The present case represents an extreme complication of centrally located bronchial carcinoid, resulting in postpneumonectomy-like syndrome with severe mediastinal shift and herniation of the healthy lung into the diseased hemithorax.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Neoplasias Brônquicas/complicações , Tumor Carcinoide/complicações , Hérnia/etiologia , Pneumopatias/etiologia , Adulto , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/cirurgia , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/cirurgia , Feminino , Hérnia/diagnóstico por imagem , Humanos , Pneumopatias/diagnóstico por imagem , Pneumonectomia , Complicações Pós-Operatórias , Síndrome
16.
BMC Pulm Med ; 19(1): 41, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30767776

RESUMO

BACKGROUND: Pulmonary carcinoids are included in the group of neuroendocrine tumors (NET) and derive from pulmonary neuroendocrine cells. The incidence of these tumors is increasing, but disease awareness remains low among clinicians. The synchronous presentation of lung cancer and mycobacterial infection is well known but the combination of pulmonary carcinoid and mycobacterial infection is rare. CASE PRESENTATION: We treated a 45-year-old female who presented with recurrent pneumonia. Chest X-ray showed a consolidation in the left upper lobe. The patient was treated with various courses of antibiotics without full recovery after six months. Computed tomography (CT) scan demonstrated a central mass in the left upper lobe. Bronchoscopy revealed an endobronchial, well-defined lesion that totally obstructed the left upper lobe bronchus. Bronchial biopsy showed typical carcinoid tumor. Rigid bronchoscopy with electrocautery was attempted, but we were unable to radically remove the tumor. Therefore lobectomy was performed. The surgical pathology specimen showed atypical bronchial carcinoid and consolidations in the lung parenchyma with granulomatous inflammation distally of the bronchial obstruction. Ziehl-Neelsen staining demonstrated acid fast bacilli indicative of mycobacterial infection. CONCLUSIONS: This case history illustrates the importance of careful surgical pathologic examination, not only of the resected tumor, but also of the postobstructive lung parenchyma. Specific postobstructive infections such as tuberculosis or nontuberculous mycobacteria (NTM) can have clinical implications.


Assuntos
Obstrução das Vias Respiratórias/patologia , Neoplasias Brônquicas/patologia , Tumor Carcinoide/patologia , Infecções por Mycobacterium/patologia , Pneumonia Bacteriana/patologia , Obstrução das Vias Respiratórias/etiologia , Biópsia , Neoplasias Brônquicas/complicações , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/cirurgia , Broncoscopia , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/cirurgia , Feminino , Humanos , Pulmão/patologia , Pessoa de Meia-Idade , Mycobacterium , Infecções por Mycobacterium/complicações , Pneumonectomia , Pneumonia Bacteriana/complicações , Tomografia Computadorizada por Raios X
17.
Medicine (Baltimore) ; 98(5): e14315, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702609

RESUMO

RATIONALE: Sclerosing pneumocytoma accompanied with other type of tumor in one patient is very rare. Here, we report a case of a sclerosing pneumocytoma mixed with a typical carcinoid tumor in a same neoplasm. PATIENT CONCERNS: A 55-year-old woman incidentally detected a space-occupying lesion of right lung in routine health examination. The patient was asymptomatic and there were no positive findings in routine laboratory examination, physical examination, and pulmonary function test. Computed tomography revealed a solitary round mass in the middle lobe of the right lung. DIAGNOSIS: The lesion was diagnosed as a sclerosing pneumocytoma accompanied with a typical carcinoid tumor of the right lung. INTERVENTION: The patient underwent thoracoscopic lobectomy in our hospital. OUTCOMES: The postoperative course was uneventful. LESSONS: This case is rare and noteworthy for a lesion containing two different types of neoplasms, which may cause diagnostic difficulties.


Assuntos
Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Hemangioma Esclerosante Pulmonar/complicações , Hemangioma Esclerosante Pulmonar/diagnóstico , Tumor Carcinoide/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Pneumonectomia , Hemangioma Esclerosante Pulmonar/cirurgia , Toracoscopia , Tomografia Computadorizada por Raios X
18.
Kyobu Geka ; 72(2): 160-163, 2019 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-30772886

RESUMO

A 45-year-old woman, who had been treated for bronchial asthma, was referred to our hospital with symptoms of dyspnea. Upon examination, we found the right main bronchus to be almost completely occluded by an endobronchial tumor. For the purpose of diagnosis and relieving the dyspnea, we performed a rigid bronchoscopic tumor resection with a high frequency snare. The tumor was pathologically diagnosed as a typical bronchial carcinoid, and a right upper lobectomy and wedge resection of the right main bronchus was carried out 1 month later.


Assuntos
Neoplasias Brônquicas/cirurgia , Broncoscopia , Tumor Carcinoide/cirurgia , Asma/complicações , Brônquios/cirurgia , Neoplasias Brônquicas/complicações , Neoplasias Brônquicas/diagnóstico , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade
19.
Am J Surg ; 217(5): 937-942, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30686481

RESUMO

BACKGROUND: Gastric carcinoids are rare neuroendocrine tumors of the gastrointestinal tract. They are typically managed according to their etiology. However, there is little known about the impact of surgical strategy on the long-term outcomes of these patients. METHODS: All patients who underwent resection of gastric carcinoids at 8 institutions from 2000 to 2016 were analyzed retrospectively. Tumors were stratified according to subtype (I, II, III, IV) and resection type (local resection, LR or formal gastrectomy, FG). Clinicopathological parameters, recurrence-free (RFS) and overall survival (OS) were compared between groups. RESULTS: Of 79 patients identified with gastric carcinoids, 34 had type I lesions associated with atrophic gastritis, 4 had type II lesions associated with a gastrinoma, 37 had type III sporadic lesions, and 4 had type IV poorly-differentiated lesions. The mean age of presentation was 56 years in predominantly Caucasian (77%) and female (63%) patients. Mean tumor size was 2.4 cm and multifocal tumors were found in 24 (30%) of patients with the majority occurring in those with type I tumors. Lymph node positive tumors were seen in 15 (19%) patients and 7 (8%) had M1 disease; both most often in type IV followed by type III tumors. R0 resection was achieved in 56 (71%) patients while 15 (19%) had R1 resections and 6 (8%) R2 resections. Patients with type I and III tumors were equally likely to have a LR (50% and 43% respectively) compared to FG while those with type II and IV all had FG with one exception. Type IV tumors had the poorest RFS and OS while Type II tumors had the most favorable RFS and OS (p < 0.04 and p < 0.0004, respectively). While there was no difference in RFS in those patients undergoing FG versus LR, OS was worse in the FG group (p < 0.017). This trend persisted when type II and type IV groups were excluded (p < 0.045). CONCLUSION: Gastric carcinoid treatment should be tailored to tumor type, as biologic behavior rather than resection technique is the more important factor contributing to long-term outcomes.


Assuntos
Tumor Carcinoide/mortalidade , Tumor Carcinoide/cirurgia , Gastrectomia , Gastroscopia , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Tumor Carcinoide/patologia , Feminino , Humanos , Complicações Intraoperatórias , Tempo de Internação/estatística & dados numéricos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Estudos Retrospectivos , Neoplasias Gástricas/patologia
20.
Am J Surg ; 217(5): 932-936, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30635207

RESUMO

BACKGROUND: Patients with carcinoid tumors are at risk for profound intraoperative hypotension known as carcinoid crisis, which catecholamines are traditionally believed to trigger. However, data supporting this are lacking. METHODS: Anesthesia records were retrospectively reviewed for carcinoid patients treated with vasopressors. Hemodynamics for those with crisis were compared between those who received ß-adrenergic agonists (B-AA) versus those who did not. RESULTS: Among 293 consecutive operations, 58 were marked by 161 crises. There was no significant difference in the incidence of paradoxical hypotension with B-AA compared to non-B-AA (p = 0.242). The maximum percent decrease in mean arterial pressure following drug administration was significantly greater in those patients treated with non-B-AA than with B-AA (31.6% vs. 12.5%, p < 0.0001). There were no differences in crisis duration (p = 0.257) or postoperative complication rate (p = 0.896). CONCLUSIONS: ß-Adrenergic agonist use was not associated with paradoxical hypotension, prolonged carcinoid crisis, or postoperative complications in patients with intraoperative carcinoid crisis.


Assuntos
Agonistas Adrenérgicos beta/uso terapêutico , Tumor Carcinoide/cirurgia , Hipotensão/tratamento farmacológico , Complicações Intraoperatórias/tratamento farmacológico , Vasoconstritores/uso terapêutico , Neoplasias do Sistema Digestório/cirurgia , Efedrina/uso terapêutico , Epinefrina/uso terapêutico , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Fenilefrina/uso terapêutico , Complicações Pós-Operatórias , Estudos Retrospectivos
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