1,721,006 research outputs found
What is the role of surgery in relapsed thymic tumors? An overview of a very debated issue.
No full textRecurrent thymic neoplasms are still a debated issue: some
authors, including ourselves, in general advocate for repeated
surgical procedures [1, 2], whereas others prefer treatment
alternatives to operation [3]. The recent report from Bott and
coworkers [4] concludes that repeated surgical procedures
should be indicated only in very selected cases of recurrent
thymic neoplasms. We wish to challenge what seems to us a
too-conservative attitude, albeit we completely agree that the
indication (or not) for operation in recurrent thymic neoplasms
is so far based on insubstantial and unsubstantiated evidence
malignant solitary fibrous tumor of the esophagus
No full textSolitary fibrous tumor (SFT) of the esophagus has been very rarely reported in literature. Herein, we report a case of a successful surgically treated malignant solitary fibrous tumor of the esophagus. A 36-year-old woman was admitted at our hospital with an erroneous ultrasound-based diagnosis of cervico-mediastinal goiter. Surprisingly, the preoperative diagnostic work-up, including a computed tomographic chest scan, endoscopy, and endoscopic ultrasonography, revealed a pedunculated intraluminal mass in the esophagus. The tumor was radically removed through left antero-lateral cervicotomy. Pathologic and immunohistochemical examination was concluded for a malignant SFT, a rare variant not previously described in relation to the esophagus. The patient underwent adjuvant radiotherapy and is alive with no signs of tumor recurrence 32 months after surgery
Idiopathic lipoid pneumonia successfully treated with prednisolone
No full textLipoid pneumonia (LP) is a rare type of pneumonia that is radiologically characterized by lung infiltrates, although imaging alone may not be diagnostic. We describe an unusual 61-year-old patient with idiopathic LP presenting as a solitary pulmonary nodule mimicking lung cancer because of its rapid growth. After treatment with oral prednisone, a control chest radiogram indicated complete normalization of the radiologic features. This case shows that LP should be considered in the diagnostic assessment of any undefined pulmonary mass, after malignancy has been pathologically excluded
Induction therapy followed by surgery for t3-t4/n0 non-small cell lung cancer: long-term results.
No full textBACKGROUND:
The aim of this study was to analyze the impact of the induction chemoradiotherapy (IT) on the survival pattern in T3/T4-N0 non-small cell lung cancer (NSCLC) patients.
METHODS:
The data of 71 patients treated from January 1992 to May 2007 were reviewed. Of these, 31 patients received IT prior to surgery (IT group: T3, 20 patients; and T4, 11 patients), and 40 directly underwent surgery (S group: T3, 34 patients; and T4, 6 patients). Survival rates were compared using the Kaplan-Meier analysis and the Cox proportional hazards models.
RESULTS:
Mean ages were 62.5 ± 9.9 years in the IT group and 67.7 ± 7.1 in the S group. All patients but 1 completed the IT treatment and 27 patients (87%) were operated. A radical resection was possible in 21 patients (78%). In the IT group a complete pathologic response was obtained in 6 patients (22%), where 8 patients ended up in pI stage, 7 in pII stage, and 6 in pIII stage. The overall 5-year survival (long-term survival [LTS]) and disease-free 5-year survival (DFS) for the entire cohort were 40% and 34%, respectively. No significant differences were found when LTS in the IT group (44%) and in the S group (37%) were compared. At multivariate analysis, the completeness of resection was the only independent predictive factor (hazard ratio [HR] = 5.18; 95% confidence interval [CI] = 2.55 to 10.28) while Cox multivariate analysis (on the IT group only) confirmed the critical role of the pathologic downstaging (HR = 4.62; 95% CI = 1.54 to 13.89).
CONCLUSIONS:
A multimodal strategy with IT treatment followed by surgery is a safe and reasonable treatment in T3/T4-N0 NSCLC patients, but no clear evidence of prognostic improvement may be assumed at the present time. Nevertheless, patients with radical resection and complete pathologic response have a very rewarding surviva
Transoesophageal endoscopic ultrasound-guided fine-needle aspiration of pleural effusion for the staging of non-small cell lung cancer
No full textOBJECTIVES: The efficacy of endoscopic ultrasound (EUS) for evaluating mediastinal adenopathy in lung cancer is nowadays proven. However, its accuracy for detection of malignant pleural effusion per se has not been yet investigated. Herein we report our experience with EUS for detecting pleural effusion during the staging procedure of non-small cell lung cancer (NSCLC) patients.
METHODS: Between January 2009 and December 2011, we performed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) on 92 selected NSCLC patients to evaluate the T and N factors and to acquire bioptic material and when this was detected, to sample the pleural effusion.
RESULTS: In 10 patients (8 males and 2 females, mean age 66.9±9.2 years) a pleural effusion was detected and sampled. In 7 out of the 10 cases, the cytological examination of the fluid obtained by EUS-FNA tested positive for malignant cells, thereby upgrading the case to Stage IV, irrespective of T and N statuses. In 3 cases the cytology on the EUS-FNA material was proven to be negative for malignancy thereby allowing patients to be treated with curative intent without further delay.
CONCLUSIONS: EUS-FNA of the pleural fluid is a safe and simple procedure. Our data, albeit stemming from a limited study population, show that it can be efficient in selected NSCLC cases for obtaining useful material and information with significant impact on the staging and, therefore, on the planning of the optimum therapeutic strategy
Time-trend analysis of the pulmonary function after surgical treatment for esophageal cancer
No full textOBJECTIVE: To evaluate, in function of time, the modification of pulmonary function after radical esophagectomy with the aim of identifying clinical and/or surgical predictors of functional worsening.
PATIENTS AND METHODS: Data of 57 patients operated from 01/06 to 06/11 were retrospectively reviewed. Thirty-eight patients (67%) underwent transhiatal cervico-laparotomic (CL-Group) and 19 (33%) a Mc-Keown cervico-thoraco-laparotomic esophagectomy (CTL-Group). The pulmonary function has been evaluated before and one month after surgery. The outcome has been benchmarked with demographic/clinical characteristics, the type of operation and the presence of post-operative pulmonary complications (POPCs).
RESULTS: Mean age and male/female distribution were 66.6±10.6 yrs and 39/18, respectively. A total of 14 (24% of total sample) POPCs occurred with a significantly higher occurrence in the CTL-Group (71% vs 28%, p < 0.001) and in those patients with a pre-operative concurrent pathological condition (64% in COPD patients vs 36% in patients without COPD, p = 0.021). A global worsening of the spirometric parameters (expressed as the baseline percentage change, Δ) emerged, but this decrease was significantly higher in the CTL-Group in terms of Δ-FVC (p = 0.005) and Δ-FEV1 (p = 0.005). Similarly, those patients who have experienced a POPC, showed a higher reduction of the pulmonary function regardless of the surgical approach when compared with those who did not (Δ-FVC: p = 0.053 and Δ-FEV1%: p = 0.015).
CONCLUSIONS: In the context of a global reduction of pulmonary function, patients who underwent trans-thoracic esophagectomy or experienced a POPC showed a significantly worse pattern. These patients could be the "best target" for therapeutic rehabilitative strategies in the pre-operative and/or post-operative setting. This assumption is to be proven through prospective clinical trial
Prognostic grading after complete resection for thymic malignancies
No full textOBJECTIVE:
Despite the World Health Organization (WHO) and Masaoka classifications have been widely accepted as the main describers of prognosis determinants in thymic malignancies, so far, these have been considered independently from one another. We have reviewed our single-centre 40-year results after surgical treatment of thymic malignancies evaluating the inter-relationships between the clinical, surgical and pathological variables and investigating their prognostic impact in completely resected patients.
PATIENTS AND METHODS:
A surgical series of 347 patients was reviewed and, of these, 305 with complete resection enrolled. Long-term and disease-free survival (LTS, DFS) analyses were performed. Kaplan-Meir curves for WHO histotypes and Masaoka-stages were inspected and matched with the log-rank test; the Cox regression analysis was adopted in a multivariable approach.
RESULTS:
Considered independently, the WHO-histotypes did not differentiate clearly from one to another in terms of LTS and DFS; however, types A-AB-B1-B2 and B3-C clustered in 2, statistically different, malignancy groups (LTS, DFS: Cox-p < 0.001). Masaoka staging was confirmed to be a relevant prognostic determinant, even if no evident difference between stages I vs II and stages III vs IV emerged when the Masaoka-classification was factored in. Thus, when investigating 13 surgical and pathological factors of invasiveness, these showed a clustering in 2 groups according to the presence/absence of pathological proven infiltration in the peri-thymic structures (LTS, DFS: Cox-p < 0.001). By matching the WHO-malignancy clusters and infiltration clusters, 4 classes may be identified, which proved to have a distinct prognostic significance: (LTS-Cox: stage-I vs stage-II, p = 0.003; III: p < 0.001, IV: p < 0.001; DFS-Cox: stage-I vs stage-II, p < 0.001; III: p < 0.001; IV: p < 0.001).
CONCLUSIONS:
When analyzing the long-term outcome of patients underwent complete resection for thymic malignancies, the combination between pathological and surgical variables showed accurate prognosis predictabilit
Long-term results in patients with pathological complete response after induction radiochemotherapy followed by surgery for locally advanced non-small-cell lung cancer
No full textOBJECTIVES: The outcome of locally advanced non-small-cell lung cancer (NSCLC) patients with pathological complete response (pCR)-pT0N0 -after induction chemoradiotherapy (IT) followed by surgery has, to date, only rarely been investigated. The long-term results in this highly selected subset of patients were evaluated and reported here to identify any predictive factors associated with prognosis. METHODS: From January 1992 to December 2009, 195 consecutive locally advanced (T1-T4/N0-2/M0) NSCLC patients underwent IT, and after clinical restaging, 137 were operated upon with radical intent. Among these, 37 (19% of the overall and 27% of the surgical cohort) showed a pCR status and were included in this retrospective analysis. Survival rates and prognostic factors were analysed by the Kaplan-Meier, the log-rank and Cox regression analyses. RESULTS: The mean age and male/female ratio were 61.9 ± 9.8 years and 33/4, respectively. Before starting IT, the clinical staging was IIb in 2 (5%) patients, IIIa in 20 (54%) and IIIb in 15 (41%). Morbidity and 30-day mortality rates were 27 and 3%, respectively. The overall 3- and 5-year long-term survivals (LTSs) and disease-free survival (DFS) were 67 and 64% and 68 and 71%, respectively. Overall, 17 patients (46%) experienced a recurrence, occurring more frequently in a distant site (32%) than locally (19%). The analysis of the 5-year LTS suggests that (i) the initial single N2 station involvement (P = 0.010); (ii) the resection to a lesser extent than pneumonectomy (P = 0.005) and (iii) the adjuvant therapy (P = 0.005) are all positive prognostic factors. In particular, a 5-year hazard ratio of 8.21 (95% confidence interval 2.16-31.16, P = 0.002) was estimated by Cox regression analysis for subjects who did not undergo adjuvant therapy vs those who did. CONCLUSIONS: After induction radiochemotherapy followed by surgery in locally advanced NSCLC, a pCR is achieved in a remarkable proportion of cases (27% in our experience). In such patients, a rewarding LTS (64% at 5 years) could be expected, especially when a single N2 station is involved at diagnosis or when an adjuvant treatment is administered. Nevertheless, recurrences after surgery are quite common (46%) and this evidence deserves further investigations and deeper analysis
Bronchial Oncocytoma With High 18F-Fluorodeoxyglucose Uptake Revealed by Nephrotic Syndrome.
No full textNot Availabl
Pathologic Findings and Long-Term Results After Surgical Treatment for Pulmonary Sarcomatoid Tumors: A Multicenter Analysis
No full textBackground: Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small cell lung cancer (NSCLC). The aim of this study was to clarify the pathologic characteristics and long-term survival after surgical treatment in patients with PSC. Methods: From January 2003 to December 2013, we retrospectively reviewed the clinical findings, surgical notes, and pathologic and follow-up data from 148 consecutive patients who underwent curative resection for PSC in 5 institutions. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used. Results: Mean age and male to female ratio were 66.6 ± 9.9 years and 120:28, respectively. Surgical resection (pneumonectomy in 8 patients, bilobectomy in 132 patients, and sublobar resection in 8 patients) was complete in 142 cases (96%). At pathologic evaluation, 36 patients (24%) had stage I, 69 patients (47%) had stage II, 33 patients (22%) had stage III, and 10 patients (7%) had stage IV disease. A "biphasic tumor" (PSC with an NSCLC component) was observed in 77 patients (52%). We detected a high rate of vascular emboli in the surgical specimens (overall, 68%; 57% in pathologic stage I tumors), whereas lymphatic emboli were found in 30% of cases (5% of pathologic stage I tumors). Overall median and 5-year long-term survival (LTS) was 19 months and 12.6% (LTS, 16.3% in pathologic stage I), respectively. Distant recurrences frequently occurred after surgical treatment (81%), even in pathologic stage I tumors that underwent R0 resection (62%). Multivariable survival analysis identified R+ resection (hazard ratio [HR],12.3; 95% confidence interval [CI], 3.67-41.28; . p < 0.0001), advanced pathologic stage (HR, 5.75; 95% CI, 2.55-12.98; . p < 0.0001), and the presence of vascular emboli (HR, 1.67; 95% CI, 1.05-2.67; . p = 0.0327) as independent negative prognostic factors. Conclusions: PSCs have very aggressive behavior and high metastatic potential even in early stages. R+ resection, pathologic TNM status, and the presence of vascular emboli are independent prognostic factors
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