Patients Undergoing Wedge Resection Research Articles

Diagnosis and Treatment of Abnormally Calcified Renal Masses (3 Case Reports)

Object Improve the diagnosis and treatment of calcified renal masses. Method We respectively reviewed 3 cases of abnormally calcified renal masses admitted to our hospital. We evaluated the clinical manifestations in the patients we treated and reviewed the literature regarding the diagnosis and treatment of calcified renal masses. Case 1, a 21 year old male, was evaluated for a right renal space-occupying lesion found incidentally on physical examination. CT imaging revealed a space-occupying lesion in the middle lower pole of the right kidney with peripheral circular calcifications and irregular calcifications. The lesion was low density on CT. Case 2, a 44 year old male, presented with right flank swelling pain and discomfort for 10 days. KUB and CT imaging demonstrated an abnormal round calcification in the dorsal midpole of the left kidney. Case 3, a 53 year old female, presented with dull left flank pain for more than 2 years. KUB and CT showed a round calcified lesion in the upper pole of the left kidney. Results The diagnosis of renal cancer was made before surgery in patient 1 and radical nephrectomy was carried out. The pathological diagnosis was papillary renal cell carcinoma. The patient was followed for 27 months and wasfree of recurrence and metastases. The preoperative diagnosis of patient 2 was benign renal tumor. The patient underwent enucleation of the renal tumor. Pathologic examination revealed clear cell renal carcinoma. A radical nephrectomy was then performed. The patient was followed for 37 months and was free of recurrence and metastases. The preoperative diagnosis in patient 3 was left renal calyceal stones. The patient underwent wedge resection of left renal parenchyma. Pathologic examination revealed an abnormal left renal calcification with inflammatory cell infiltration. The patient was followed for 39 months and remained in good health. Conclusion Calcified renal masses are rare manifestations of renal cancer. It is difficult to make the diagnosis before surgery, but the prognosis is favorable. Nephron sparing surgery (NSS) is the choice of treatment.

Detection of blebs and bullae in patients with primary spontaneous pneumothorax by multi-detector CT reconstruction using different slice thicknesses.

The aim of this study was to compare the diagnostic performances of multi-detector computed tomography (MDCT) reconstruction at two different slice thicknesses (1 mm, 'high resolution' vs. 5 mm, 'routine') with respect to the detection of blebs and bullae (BBs) in patients with primary spontaneous pneumothorax (PSP). Thirty-one patients underwent wedge resection of BBs (29 unilateral and 2 bilateral) for PSP from January 2010 to January 2013. Two observers assessed the presence and locations of BBs independently using high-resolution CT (HRCT) and routine CT reconstruction, and compared the sensitivities of each reconstruction method for BB detection using operative findings as a standard reference. In addition, the number of BBs in each CT image set was recorded and inter-observer agreements were evaluated. Sensitivity for the detection of BBs was significantly better for HRCT than routine CT (97.0% vs. 63.6% for observer 1 and 94.0% vs. 57.6% for observer 2, respectively, both P-values < 0.001). On a per-bleb and a per-bulla basis, inter-observer agreements regarding BBs by HRCT were good and very good (k = 0.66 and 0.94, respectively) and superior to those determined by routine CT (k = 0.59 and 0.60, respectively). Different slice thickness reconstructions influence the diagnostic efficacy of MDCT for the detection of BBs in patients with PSP. High-resolution thin slice CT reconstruction was found to have a significantly greater sensitivity than routine thicker slice thickness reconstruction for the detection of BBs.

Quantifying the Safety Benefits of Wedge Resection: A Society of Thoracic Surgery Database Propensity-Matched Analysis

Wedge resection is often used instead of anatomic resection in an attempt to mitigate perioperative risk. In propensity-matched populations, we sought to compare the perioperative outcomes of patients undergoing wedge resection with those undergoing anatomic resection. The Society of Thoracic Surgery database was reviewed for stage I and II non-small cell lung cancer patients undergoing wedge resection and anatomic resection to analyze postoperative morbidity and mortality. Propensity scores were estimated using a logistic model adjusted for a variety of risk factors. Patients were then matched by propensity score using a greedy 5- to 1-digit matching algorithm, and compared using McNemar's test. Between 2009 and 2011, 3,733 wedge resection and 3,733 anatomic resection patients were matched. The operative mortality was 1.21% for wedge resection versus 1.93% for anatomic resection (p=0.0118). Major morbidity occurred in 4.53% of wedge resection patients versus 8.97% of anatomic resection patients (p<0.0001). A reduction was noted in the incidence of pulmonary complications, but not cardiovascular or neurologic complications. There was a consistent reduction in major morbidity regardless of age, lung function, or type of incision. Mortality was reduced in patients with preoperative forced expiratory volume in 1 second less than 85% predicted. Wedge resection has a 37% lower mortality and 50% lower major morbidity rate than anatomic resection in these propensity-matched populations. The mortality benefit is most apparent in patients with forced expiratory volume in 1 second less than 85% predicted. These perioperative benefits must be carefully weighed against the increase in locoregional recurrence and possible decrease in long-term survival associated with the use of wedge resection for primary lung cancers.

Clinical outcome of subcentimeter non-small cell lung cancer after surgical resection: single institution experience of 105 patients.

The detection of subcentimeter lung cancers has significantly improved with advances in computed tomography and the emergence of screening protocols. We reviewed the clinicopathological features and surgical outcomes of patients with subcentimeter non-small cell lung cancer (NSCLC) in our institution. A total of 105 patients who underwent lobectomy or sublobar resection for subcentimeter NSCLCs were retrospectively reviewed. Clinicopathological characteristics and survival were analyzed statistically using Student's t-test for continuous variables, Fisher's exact for categorical variables and Cox regression for multivariable analysis. A total of 105 patients (35 male, 70 female; mean age 61.4, range 38-77 years) were analyzed. Patients underwent lobectomy (n = 71), segmentectomy (n = 19), or wedge resection (n = 15). The overall 5-year survival was 91.3%. No significant differences were observed in overall and recurrence-free survival after segmentectomy or lobectomy; patients undergoing wedge resection had shorter survival compared to those who underwent lobectomy. Elevated preoperative serum CEA levels and positive nodal status correlated with poorer survival, and were identified as independent prognostic factors in multivariate analysis. Systematic nodal dissection is recommended for patients with subcentimeter NSCLC. Segmentectomy offers comparable oncologic results to lobectomy. Elevated preoperative serum CEA level implies shorter survival for patients with these tiny tumors.

Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non–small cell lung cancer

Successful pulmonary wedge resection for early-stage non-small cell lung cancer requires a pathologically confirmed negative margin. To date, however, no clear evidence is available regarding whether an optimal margin distance, defined as the distance from the primary tumor to the closest resection margin, exists. Toward addressing this gap, we investigated the relationship between the margin distance and local recurrence risk. We reviewed all adult patients who had undergone wedge resection for small (≤2 cm) non-small cell lung cancer from January 2001 to August 2011, with follow-up through to December 31, 2011. The exclusion criteria included other active noncutaneous malignancies, bronchoalveolar carcinomas, lymph node or distant metastases at diagnosis, large cell cancer, adenosquamous cancer, multiple, multifocal, and/or metastatic disease, and previous chemotherapy or radiotherapy. Using Cox regression analysis, we examined the relationship between the margin distance and interval to local recurrence, adjusting for chronic obstructive pulmonary disease, forced expiratory volume in 1 second, smoking, diabetes, tumor size, tumor location, surgeon, open versus video-assisted thoracoscopic surgery, and whether the lymph nodes were sampled. Of 557 consecutive adult patients, 479 met our inclusion criteria. The overall, unadjusted 1- and 2-year local recurrences rate was 5.7% and 11.0%, respectively. From the adjusted analyses, an increased margin distance was significantly associated with a lower risk of local recurrence (P=.033). Patients with a 10-mm margin distance had a 45% lower local recurrence risk than those with a 5-mm distance (hazard ratio, 0.55; 95% confidence interval, 0.35-0.86). Beyond 15 mm, no evidence of additional benefit was associated with an increased margin distance. In wedge resection for small non-small cell lung cancer, increasing the margin distance ≤15 mm significantly decreased the local recurrence risk, with no evidence of additional benefit beyond 15 mm.

Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test.

BackgroundHypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP).MethodsIn total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began.ResultsPreemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P < 0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during OLV, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P < 0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P < 0.05).ConclusionsPreemptive ARS can improve arterial oxygenation during OLV. Furthermore, a 6 ml/kg tidal volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.

S110 Experience with suspected cancer referrals from the UK lung screen trial

Introduction Early diagnosis of lung cancer improves survival and strategies to facilitate this include screening high risk populations. The ongoing UK Lung Screen Trial (UKLS) is investigating this with low-dose CT scans, and positive screens are referred to clinical services for further investigation and treatment. We report the outcome for such cases referred to our large lung cancer unit. Methods The UKLS reporting radiologists code scans according to their abnormality: local patients with features suspicious for malignancy (category 4) are referred to our MDT, where following counselling they undergo appropriate investigation. Results We have received 37 referrals (mean age68 [range 61–75], median performance status 1, mean FEV1 78% predicted [33–107], 27 male) during the first 14 months of the trial. In 23 cases (62%) subsequent investigation confirmed malignancy (11 adenocarcinoma, 8 squamous cell carcinoma, 3 small cell carcinoma, 1 mesothelioma). In 14 cases where malignancy was not confirmed all had been referred for additional investigations (including 3 PET-CT scans, 5 bronchoscopies and 8 CT scans):1 patient underwent wedge resection of a PET positive lesion (granulomatous process) and 13 remain under follow-up for nodule surveillance. Twenty of those with malignancy (87%) were potentially operable (median stage 1A, mean age 68 [range 61–74], median performance status 1, mean FEV1 80% predicted [33–107], 13 male), including 2 with limited stage small cell carcinoma. Overall, 19 patients were treated by lobectomy with curative intent. The remaining 4 cases all received oncological management. Discussion The UKLS is the first large randomised controlled trial to assess a CT-based screening protocol for lung cancer in the United Kingdom. We have shown that the majority of referrals from this programme were confirmed as cases of lung cancer of which nearly all were operable. Such screening programmes will help us improve the prognosis in this previously late-diagnosed and often incurable disease.

Isolated Pulmonary Metastasis Presenting with an CEA Elevation Five Years After Radical Prostatectomy.

A 60-year-old man with prostate cancer (PC) was admitted to our hospital in October 2009 for follow up visit. He underwent radical prostatectomy for PC five years ago. The patient's physical examination and complete blood count, biochemical investigations, and chest x-ray were within normal limits. The patient's carcinoembryonic antigen (CEA) and prostate-specific antigen (PSA) levels were 529 ng/mL (normal, <3 ng/mL) and 7.5 ng/mL (normal, <4 ng/mL) respectively. Cranial, thoracic, and abdominal computerized tomography (CT) and whole body bone scan were done. The patient's chest CT scan revealed irregular, 18 mm nodule of the right lower lobe of lung. The cranial and abdominal CT and whole body bone scan revealed no abnormality. The endoscopic evaluation of upper and lower gastrointestinal system was normal. Since there was no evidence of metastatic site other than lung in workup, the patient underwent wedge resection of the lung lesion at December 2009 and histopathologic examination revealed the diagnosis of malignant epithelial tumor. The immunohistochemical examination showed strong staining of tumor cells with PSA, PAP and CEA but CK7, CK20, TTF-1 and SPA were negative (Figure 1). So the isolated lung metastasis of prostate adenocarcinoma was considered and bicalutamide and leuprolide acetate were started. One month later PSA and CEA level were 1.14 and 473 ng / ml, respectively, and treatment was continued with leuprolide. In March 2012, he was admitted for follow up visit. The patient's CEA and PSA levels were 639 ng/mL and 1.86 ng/mL respectively.

Thoracoscopy Without Lung Isolation Utilizing Single Lumen Endotracheal Tube Intubation and Carbon Dioxide Insufflation

This study evaluated the feasibility of performing thoracoscopy without lung isolation employing single lumen endotracheal tube (SLET) intubation and carbon dioxide insufflation. Eighty-two patients underwent a variety of thoracoscopic procedures without lung isolation using SLET intubation and carbon dioxide (CO2) insufflation between January and December 2012. Sixty-five of these patients underwent wedge resections and were isolated for analysis. Operations were accomplished using percutaneously placed laparoscopic trocars and insufflation up to 15 mm Hg. Operative times, length of stay, and vital signs were compared with 52 patients who underwent thoracoscopic wedge resections with double lumen endotracheal tube (DLET) intubation. A retrospective analysis was performed on 65patients (30 females, mean age 58) who underwent thoracoscopic wedge resections with SLET intubation compared with 52 patients undergoing the same procedure with DLET intubation. Operating room time (111 ± 4.74 minutes), time to incision (49 ± 1.91 minutes), and operative time (48 ± 2.89 minutes) were significantly decreased in the SLET group (p < 0.05). Intraoperative hemodynamic parameters showed no significant aberrations. Two postoperative complications (3.1%) were identified in the SLET group. Length of stay was similar (3 ± 0.49 days versus 3 ± 0.23 days). Single lumen endotracheal tube intubation is a feasible and safe airway management alternative for thoracoscopic procedures. This method resulted in shorter operative times, no aberrant hemodynamic shifts, low complication rates, and similar hospital stays as compared with traditional DLET intubation.

Thoracoscopic resection of congenital cystic adenomatoid malformation in an adolescent

Congenital cystic adenomatoid malformation (CCAM) in adolescents or adults is extremely rare. In this case study, a 17-year-old boy was admitted to our clinic for the treatment of a giant bulla in the lower lobe of the right lung. Preoperative imaging studies led to the diagnosis of cystic lung disease. The patient underwent wedge resection of the right lower lobe with VATS, and histological examination confirmed the presentation of type 1 CCAM. A thoracoscopic lobectomy was performed after the second surgery because of postoperative air leakage.Herein, we report a case of CCAM in an adolescent. VATS was a suitable procedure for the operation. Between the parenchyma-saving resection and lobectomy for CCAM, we believe that the lobectomy is the better treatment option when the extent of the disease cannot be determined clearly or it is extremely large. Therefore, strategies for deciding between parenchyma-saving resection and lobectomy for the treatment of CCAM should be developed.

Laparoscopic management for non-traumatic colon perforation in children

Although recent reports have seen an increase in acceptance of laparoscopic surgery as treatment for traumatic colon injury, its role in the management of non-traumatic colon perforation in children has not been reported. In this study, we review our experience in laparoscopic non-resectional management for children who presented with non-traumatic colonic perforation. Between October 2003 and May 2011, 15 children who had been diagnosed with colonic perforation and underwent laparoscopic surgery were included in the study. Their medical records were reviewed for analysis. The clinical manifestation of non-traumatic colon perforation in children was non-specific. The most likely aetiology was infective colitis. Solitary perforation at the caecum was the most common finding. The exact perforation site could not be identified in 3 patients. Nine patients had primary closure while 3 patients underwent wedge resection. The single trocar laparoscopic surgery was successful in 12 patients. The mean postoperative hospital stay was 7.3days. For children presenting with suspected non-traumatic colon perforation, laparoscopic management is the desirable approach. The peritoneal lavage, wedge excision and primary repair can be performed with single trocar techniques and is associated with minimal morbidity. Future prospective studies are needed to compare this minimally invasive approach with conventional open surgery.

OC-124 Centralisation of OG services in the west of Scotland: are we matching the outcomes of the UK national OG audit?

IntroductionThe SAGOC report (1997–2000) highlighted the high morbidity and mortality of oesophageal and gastric resections in Scotland. Since then, centralisation into higher volume units has only slowly occurred in Scotland....

In-hospital Clinical and Economic Consequences of Pulmonary Wedge Resections for Cancer Using Video-Assisted Thoracoscopic Techniques vs Traditional Open Resections: A Retrospective Database Analysis

The objective of this study was to compare the safety, use, and cost profiles of open thoracotomy vs video-assisted thoracoscopic surgery (VATS) for wedge resection in lung cancer performed by thoracic surgeons in the United States.The Premier database, which contains complete patient billing, hospital cost, and coding histories from > 25 million inpatient discharges and > 175 million hospital outpatient visits, was used for this analysis. Eligible patients were those who underwent wedge resection by a thoracic surgeon for cancer diagnosis or treatment through open thoracotomy or VATS in 2007 or 2008. Multivariable logistic regression analyses were run for binary outcomes, and ordinary least squares regressions were used for continuous outcomes. All models were adjusted for patient demographics, comorbid conditions, and hospital characteristics.Of 8,228 eligible procedures, 2,051 patients underwent wedge resections by a thoracic surgeon using the open technique (n = 999) or VATS (n = 1,052). Hospital costs remained significantly higher for open wedge resections than for VATS ($17,377 vs $14,795, P = .000). Surgery time was significantly longer for open resections vs VATS (3.16 vs 2.82 h). Length of stay was 6.34 days for open vs 4.44 days for VATS. Adverse events were significant in the multivariable analysis, with an OR of 1.57 (95% CI, 1.29-1.91) in favor of VATS.Although this retrospective database analysis could not address the issue of oncologic outcome equivalence, a clear advantage of VATS over open wedge lung cancer resection was found for both acute clinical outcomes and hospital costs.

Postoperative analgesia after minimally invasive thoracoscopy: What should we do?

Many of the thoracic operations that previously required a thoracotomy incision can now be performed with several small incisions and video-assisted thoracic surgery (VATS). Although there have been reports of less pain and less impairment of pulmonary function with VATS compared with thoracotomy, 1 many VATS patients report significant acute and chronic postoperative pain. Treating thoracoscopic pain effectively and minimizing the later development of chronic pain requires familiarity with a wide spectrum of analgesic techniques. An important variable in the analgesic plan for VATS is the likelihood of converting to an open thoracotomy. Conversion may be due to technical difficulties, inadequate lung separation, or bleeding, and may be more likely when the surgeon has less experience with VATS. The likelihood of conversion to an open procedure must be assessed preoperatively. If a VATS procedure is converted to a thoracotomy and analgesia (such as an epidural) is not in place, the patient’s recovery may be impaired. If not wellcontrolled, postoperative thoracic pain can lead to splinting and may impair the patient’s ability to take deep breaths following thoracic surgery. It is difficult to state precisely the incidence of pain following thoracoscopy, as the extent and severity varies according to surgical technique, patient sensitivity, and anesthetic pain management. In a recent survey of Dutch thoracic surgery patients, 47% of the VATS patients reported chronic pain. 2 In an earlier study, the incidence of chronic pain was reported to be 36% in VATS patients undergoing wedge resection. 3 It might seem intuitive that performing the surgery by thoracoscopy, which utilizes small incisions, would lead to less postoperative pain. However, the introduction of trocars during thoracoscopy may injure intercostal nerves, and additional manipulation of these instruments during the surgery may traumatize these nerves further by compression against ribs. 4 If a lobectomy is being performed, an incision will need to be enlarged in order to extract the specimen, and a rib retractor may be required. Also, the duration of the surgery may be greater using VATS. Ipsilateral shoulder pain is a common complaint following VATS, and in one study, it was reported to be chronic in 10% of patients. 5

Gasless Laparoscopy-Assisted Versus Open Resection for Gastrointestinal Stromal Tumors of the Upper Stomach: Preliminary Results

Gastrointestinal stromal tumors (GISTs) are rare neoplasms with malignant potential. Surgery is the definitive management for resectable nonmetastatic lesions. Although minimally invasive resection has been established for GISTs, it is still considered unfeasible when tumors are near the esophagogastric junction. This study aimed to compare the relative efficacy of gasless laparoscopy-assisted (GLA) and open approaches for resection of GISTs. Between January 2006 and December 2008, 28 consecutive patients undergoing surgery for upper GIST were reviewed retrospectively. Among these patients, 15 underwent GLA procedures and 13 underwent open surgeries. Patient demographics, comorbidities, and tumor characteristics (mean tumor size and prognosis) were similar for both groups. All patients underwent wedge resection. The mean operating time (129.6 versus 110.8 minutes), mean estimated blood loss (35.5 versus 40.3 mL), mean day of first flatus (2.7 versus 3.2 days), mean tumor size (2.5 versus 2.6 cm), and tumor prognosis or complication rate (13.3% versus 7.7%) between the GLA and open surgery groups were not significantly different. The length of maximal wound (P < 0.001), visual analog scale on postoperative days 1 (P = 0.001), 2 (P = 0.001), and 3 (P = 0.001), the mean time for resuming oral intake (P = 0.028), and the length of hospital stay (P = 0.005) in the GLA group were significantly lesser than the corresponding values in the open surgery group. None of the patients had dysphagia or died. GLA method is a safe and feasible procedure for resecting GISTs of the upper stomach. In addition, it offers better cosmetic results, less pain, and faster recovery.

Anatomic Lung Resection for Clinical Stage I Non-small Cell Lung Cancer (NSCLC): Equivalent Outcomes Following Anatomic Segmentectomy and Lobectomy

PURPOSE: There is increasing enthusiasm with the use of anatomic segmentectomy as definitive surgical management for pathologic stage I NSCLC. Many reports focusing on the role of sublobar resection for stage I lung cancer have focused on pathologic stage, which may bias the perceived oncologic value of sublobar resection for clinical stage I disease. As surgical decision-making is based upon clinical stage, we compared the outcomes of patients undergoing wedge resection (n=130), anatomic segmentectomy (n=235), or lobectomy (n=728) for clinical stage I NSCLC.

Clinical Features and Treatment of Bronchogenic Cyst in Adults

To investigate the clinical features and management of bronchogenic cyst in the adults. We retrospectively reviewed 50 patients admitted to our hospital with histopathologically proved bronchogenic cyst from January 1983 to December 2007. Of all the patients, 28 were male and 22 were female, with an average age of 36.9 (range, 18 to 64) years. The symptoms, location of the cysts, imaging evaluation, surgical treatment manner, and outcome of these patients were analyzed. Symptoms were present in 33 of the 50 patients, and cough was the most common symptom. Thirteen patients presented with complications: hemoptysis, infected cyst, dysphagia, paralysis, and hoarseness. The locations of the cysts included the mediastinum (28 cases), pulmonary parenchyma (12 cases), hilar area (3 cases), visceral pleura (1 case), and some rare locations including the intestinal mesentery (1 case), retroperitoneum (1 case), adrenal gland (1 case), neck (2 cases), and dura matter of the cervical vertebrae (1 case). Chest X-ray was performed in 36 patients and computed tomography (CT) was performed in 41 patients. The bronchogenic cyst in CT was characterized as a round, well circumscribed, unilocular mass, with density ranging from that of water to high density (0-50 Hu). As for treatment, complete resection of the bronchogenic cyst was performed in 47 (94%) patients, subtotal resection was performed in 3 (6%) patients. Open surgery was performed in 45 (90%) patients, and thoracoscopy (video-assisted thoracic surgery) was performed in 5 (10%) paitients. Of the 12 patients with intrapulmonary cyst, 11 patients underwent lobectomy and 1 patient underwent wedge resection. Postoperative sequelae occurred in 2 patients, 1 with persistent air leakage and 1 with hoarseness. All patients were proved with bronchogenic cyst pathologically. The average follow-up period was 6.5 years (range, 4 months to 10 years), and no late sequelae or recurrence of the cyst occurred. The clinical and imaging presentations of bronchogenic cyst in adults are variable. Surgical resection is the best way for diagnosis and treatment. Both open surgery and thoracoscopy are appropriate for the selected candidates.

Sclerosing hemangioma, presenting as a pneumonic pattern with mucinous adenomatous hyperplasia of the lung

Pulmonary sclerosing hemangioma is generally considered a rare neoplasm presenting as a solitary benign nodule. During routine medical examination multiple abnormal nodular shadows were detected in the right lower lung field on chest X-ray in a 48-year-old asymptomatic woman. The patient underwent wedge resection for the pulmonary lesion. The resected lung had numerous scattered tiny nodules and small nodules congregated together, forming larger nodules. All of these lesions had typical features of sclerosing hemangioma. The authors call this unusual growth pattern of sclerosing hemangioma a 'pneumonic pattern'. Adjacent to the largest lesion, a relatively well-defined small mucinous lesion composed of mucinous tall columnar cells and basaloid squamous cells was detected. Because this lesion did not have expression of thyroid transcription factor-1, it is described as mucinous adenomatous hyperplasia.

Cytology of bronchial associated lymphoid tissue lymphoma

A 69-year-old man sought medical care because of persistent cough. Imaging work up revealed multiple nodules involving both lungs. Fine needle aspiration biopsy (FNA) of the right lower lobe mass was performed and revealed atypical alveolar cells in a lymphoid background. The initial cytologic interpretation was "atypical alveolar cells, probably reactive." The patient underwent wedge resection of the right lower lobe. Intraoperative touch preparation revealed an atypical lymphoid proliferation. Histologic findings revealed multiple nodules of small and medium-sized lymphocytes replacing the lung parenchyma; lymphoepithelial lesions, and type II pneumocytes hyperplasia were also noted. Flow cytometry demonstrated the presence of a monoclonal B-cell population. A diagnosis of bronchial associated lymphoid tissue (BALT) lymphoma was established. The patient was treated with rituximab and was disease free 2 years after initial diagnosis.

Pulmonary resection for metastasis from renal cell carcinoma

The treatment of metastatic renal cell carcinoma still represents a widely debated issue due to the introduction of several immunotherapies. To confirm again a role for resection of pulmonary metastases for such tumors, we reviewed our institutional experience. Between 1992 and 2007, eight patients with pulmonary metastases from renal cell carcinoma underwent complete pulmonary resection. All patients had undergone curative resection of their primary renal cell carcinomas and also had obtained or had obtainable locoregional control of their primaries. Various perioperative variables were investigated retrospectively. Disease-free interval varied from 25 to 156 months, with a median of 73 months. In three patients, lung metastases were found to be unilateral and solitary. Four patients presented two metastases in the unilateral lungs. One patient showed five metastases in the bilateral lungs. Six patients underwent wedge resection or segmentectomy, while two patients underwent more than lobectomy. Five patients showed recurrence after pulmonary metastasectomy. Five-year and 10-year overall survival rate was 83.3% and 41.7%, respectively, while 3-year and 5-year disease-free survival rate was 35.0% and 17.5%, respectively. Our study suggested that pulmonary metastasectomy for renal cell carcinoma might be well justified.