Miliary mesothelioma: a new clinical and radiological presentation in mesothelioma patients with prolonged survival after trimodality therapy

Malignant pleural mesothelioma is usually a fatal disease and is considered a locally aggressive tumor. Consequently, distant metastases are very rare and a diffuse involvement of the lung is seldom reported. However, due to more efficient chemotherapy protocols and aggressive management strategies including induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation therapy, so called trimodality therapy, survival is prolonged in selected patients. Therefore, new presentations of the disease are appearing with new diagnostic and therapeutic challenges. Herein, we report two cases of treated mesothelioma patients who developed a miliary mesothelioma in the remaining lung 36 and 41 months after undergoing multimodal therapy. Diagnostic assessment and therapeutic strategy are discussed taking into account the different evolutions of each patient.     

Pulmonary Carcinosarcoma with Intracardiac Extension: a Case Report

PRIMARY pulmonary sarcomatoid carcinoma (PSC) is a rare condition, approximately accounting for 0.1%-0.4% of all lung malignancies.1 PSCs consist of 5 major histological variants according to 2004 WHO classification: pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, carcinosar- coma, and pulmonary blastoma.2 PSC patients are predo- minantly male smokers with an average age of 65 years at diagnosis.3 Carcinosarcoma is a biphasic tumor charac- terized by an admixture of both malignant epithelial and mesenchymal components as in well-defined carcinomas and sarcomas.4 In this article, we reported a rare female case of pulmonary carcinosarcoma with intracardiac extension.     

拟诊肺癌而行全肺切除的良性病变

[目的]探讨肺内良性病变诊为肺癌而行全肺切除的原因。[方法]回顾性分析1998年8月-2008年8月因拟诊肺癌而行全肺切除的良性疾病患者14例的临床资料。[结果]14例患者术前均拟诊为肺癌,行左全肺切除术11例,右全肺切除3例。术后病理为肺结核8例（3例伴淋巴结结核）,肺脓肿2例,炎性假瘤2例,炎性肉芽肿1例,错构瘤1例。术后3例出现并发症（肺动脉栓塞2例,ARDS1例）,并发症发生率为21．4％,无围手术期死亡发生。[结论]肺结核、炎性肉芽肿、肺脓肿、炎性假瘤、错构瘤是最易诊为肺癌而行全肺切除的良性疾病,应严格把握肺内良性病变行全肺切除的手术指征。     

Tracheobronchomalacia Post-Pneumonectomy: A Late Complication

An 83-year-old male presented with dyspnoea and stridor. He had undergone pneumonectomy 40 years ago. CT scan revealed gross shift of mediastinum (post-pneumonectomy syndrome) with tortuous trachea kinked at the thoracic inlet. Fibre optic bronchoscopy showed a near total expiratory closure of trachea, right main bronchus, and segmental bronchi confirming tracheobronchomalacia. He was managed with long length, low tracheostomy in view of his poor general condition of permitting more invasive procedures. He showed adequate clinical improvement and was discharged home. Tracheobronchomalacia in post-pneumonectomy syndrome requires emergent management. Its occurrence after 40 years is very rare and may be easily missed. It can be diagnosed with dynamic CT and FOB. Although invasive management with stenting or surgical methods is routinely advised, conservative care can be effective in selected cases.     

Impact of Detecting Occult Pathologic Nodal Disease During Resection for Malignant Pleural Mesothelioma

BackgroundLymph node (LN) involvement is a poor prognostic factor for malignant pleural mesothelioma (MPM). However, to our knowledge, postresection outcomes of node-negative (cN0/pN0), occult pathologic nodal disease (cN0/pN+), and clinical node-positive disease (cN+) have not been compared to date.Patients and MethodsThe National Cancer Data Base was queried for newly diagnosed, resected MPM with known clinical/pathologic LN information. Three cohorts were compared: cN0/pN0, cN+, and cN0/pN+. Multivariable logistic regression examined predictors of pathologic nodal upstaging. Kaplan-Meier analysis with propensity matching assessed overall survival (OS); multivariate Cox proportional hazards modeling examined predictors thereof.ResultsOf 1369 patients, 687 (50%) had cN0/pN0, 457 (33%) cN+, and 225 (16%) cN0/pN+ disease. Median follow-up was 29 months. In patients with cN0 disease, factors associated with pathologic nodal upstaging were younger age, greater number of examined LNs, and nonsarcomatoid histology (P < .05 for all). Relative to pN0 cases, occult LN involvement (65% being pN2) was associated with 51% higher hazard of mortality on multivariate analysis (P = .005). Following propensity matching, the OS of cN0/pN+ was similar to cN+ cases (P = .281). On multivariate analysis, the number of involved LNs (continuous variable, P = .013), but not nodal tumor, node, metastasis (TNM) classification or LN ratio (P > .05 for both), was associated with OS.ConclusionDetecting occult nodal disease during resection for cN0 MPM is associated with poorer prognosis, with similar survival as cN+ cases, underscoring the importance of routine preoperative pathologic nodal assessment for potentially resectable MPM. The number of involved LNs (rather than current location-based classification) may provide more robust prognostic stratification for future TNM staging.     

袖状切除在中央型肺癌中的应用

目的:研究袖状切除在中央型肺癌中的应用价值。方法:将58例中央型期肺癌患者,按手术术式分为观察组和对照组,各29例,观察组患者接受袖状切除术,对照组患者接受全肺切除术,比较两组患者的手术时间、术中出血量、拔除胸管时间、胸液引流量远期疗效以术后卧床时间、(3年和5年)生存率、复发率及肺功能改变。结果:观察组患者手术时间明显长于对照组,术中出血量、拔除胸管时间、胸液引流量、术后卧床时间均明显低于对照组,差异有统计学意义(P<0.05);两组患者3年和5年的生存率、复发率以及存活时间无差异(P>0.05);观察组1s用力呼气容积(FEV1)和用力肺活量(FVC)明显高于对照组,差异有统计学意义(P<0.05)。结论:袖状切除术有助于减小手术创伤,术后恢复快,能较好的保留患者的肺功能,且疗效与全肺切除术相当。     

肺癌心包内结扎血管的全肺切除术32例

目的：探讨心包内处理血管的全肺切除术在提高肺癌手术疗效中的作用。方法：对32例肺癌病人行心包处理血管的全肺切除术进行回顾性总结，此术式占同期全肺切除术42．1％（32／76例）。结果：手术死亡率为0％，主要并发症18．7％，1、3、5年生存率分别为：87．5％（28／32例）。34．3％（11／32例）和28．1％（9／32例）。5例小细胞肺癌无1例生存逾3年。死亡率和并发症与标准全肺切除术相比差异无显著性（P＞0．05），预后与标准全肺切除术亦相近，结论：心包处理血管的全肺切除是安全的，可提高肺癌切除率，改善生活质量，提高3年生存率，在临床上有实用价值。