Lung Tumor Resection Research Articles

Primary pulmonary neoplasia in cats: assessment of computed tomography findings and survival.

To identify variables with a preoperative computed tomography scan that influence survival of cats undergoing surgical removal of a primary lung tumour. A secondary objective was to determine whether histologic type and or grade of feline pulmonary tumours affects long term survival. Medical records were retrospectively reviewed for cats with preoperative computed tomography scans and surgical resection of primary lung tumours. Pulmonary carcinomas were reviewed for histologic diagnosis using two different approaches, histologic grade as well as major histologic pattern. Median survival time of all (n = 28) cats was 156 days. Median survival time for cats with lymph node enlargement was 65 days versus 498 days for cats without lymph node enlargement on preoperative computed tomography scan. Median survival time for cats with preoperative pleural effusion was 2 · 5 days versus 467 days for cats without pleural effusion. Cats with low or intermediate grade tumours had a median survival time of 730 days versus 105 days for cats with high grade tumours. Cats with preoperative lymph node enlargement and pleural effusion have shorter survival times than cats without.

A challenging case of tracheal bronchus with concurrent tracheal stenosis for one lung ventilation

BackgroundTracheal bronchus is a rare congenital anomaly that may remain asymptomatic or present with symptoms that mimic other respiratory diseases. We present a particularly challenging case of tracheal bronchus combined with tracheal stenosis that had remained asymptomatic until it was diagnosed incidentally. ObjectiveTo describe our findings in a 66-year-old lady who presented for an elective resection of lung tumour. MethodsThe medical and surgical records plus biomedical images were reviewed together with a literature search on the subject. ResultsWe describe a patient found to have tracheal stenosis with a large tracheal bronchus during right lower lobectomy. Attempts to isolate and collapse the right lung failed with both double lumen tube (DLT) and bronchial blocker. A CT Scan done preoperatively showed a right upper lobe bronchus originating high in the trachea and interestingly a reconstructed three dimensional (3-D) image later, revealed an unusually large tracheal bronchus with a stenotic remnant of the trachea before the true carina begins. ConclusionThere are many anatomical variations of tracheal bronchus but none so far describes an entirely asymptomatic anomaly with concurrent tracheal stenosis. Specific CT imaging to reconstruct tracheobronchial anomalies in a 3-D view is suggested whenever the diagnosis is detected during staging CT. A plain description on its own would not suffice in estimating the depth or parameters of the structures involved to allow adequate pre operative planning of any airway intervention especially when ventilating one lung is the strategy.

Precise navigation surgery of tumours in the lung in mouse models enabled by in situ fluorescence labelling with a killer-reporter adenovirus

BackgroundCurrent methods of image-guided surgery of tumours of the lung mostly rely on CT. A sensitive procedure of selective tumour fluorescence labelling would allow simple and high-resolution visualisation of the...

Increased expression of transcription factor EB (TFEB) is associated with autophagy, migratory phenotype and poor prognosis in non-small cell lung cancer.

We investigated the role of lysosomal biogenesis and hydrolase activity in the clinical behavior and postoperative outcome of lung cancer. Using immunohistochemistry we investigated the expression of the transcription factor EB (TFEB) which orchestrates lysosomal biogenesis, the lysosome membrane protein LAMP2a and of the lysosomal hydrolase cathepsin D in a series of 98 non-small cell lung carcinomas (NSCLC) treated with surgery alone. In vitro experiments with the A549 and H1299 lung cancer cell lines were also performed. Overexpression of TFEB, LAMP2a and Cathepsin D was noted in 47/98 (47.9%), 43/98 (43.9%) and 39/98 (39.8%) cases, respectively, and were significantly correlated with each other and with adenocarcinomas. High LAMP2a was related to high histology grade. Linear regression analysis confirmed significant association of TFEB with BNIP3 (p=0.0003, r=0.35) and LC3A with LAMP2a expression (p=0.0002, r=0.37). An inverse association of Cathepsin D expression with stone-like structures (SLS) was recorded (p=0.02, r=0.22). On univariate analysis all three lyososomal variables were associated with poor prognosis (p=0.05, 0.04 and 0.01, for TFEB, Cathepsin D and LAMP2a, respectively). Multivariate analysis showed that the SLS number (p=0.0001, HR5.37), Cathepsin D expression (p=0.01, HR=2.2) and stage (p=0.01, HR=1.5) were independent prognostic variables. Silencing of TFEB with siRNAs in the A549 and H1299 lung cancer cell lines did not affect proliferation but resulted in reduced migration ability. Lysosomal biogenesis is linked to autophagosomal protein expression in NSCLC and characterizes subgroups of high risk patients after complete surgical lung tumor resection.

A Novel Serum 4-microRNA Signature for Lung Cancer Detection.

The aim of this study was to identify differentially-expressed miRNAs in the serum of non-small cell lung cancer (NSCLC) patients that might be a clinically-useful tool for lung cancer early detection. We performed miRNA expression profile analysis using TaqMan OpenArray Human panel in a discovery set of 70 serum samples obtained at lung tumor resection and 22 non-cancer subjects (NC). Selected serum miRNAs were then validated by quantitative PCR using an independent validation set of serum samples from LC patients (n = 84) and NC (n = 23). Sixty miRNAs were significantly up-regulated and 31 were down-regulated in the serum from NSCLC patients versus NC (adjusted p < 0.001). Four miRNAs (miR-193b, miR-301, miR-141 and miR-200b) were selected for validating their diagnostic value in an independent cohort. In the discovery set, the ROC plot derived from the combination of these miRNAs yielded an area under the curve (AUC) of 0.985 (95% CI 0.961–1.000, p < 0.001). In the test set, this miRNA signature exhibited an AUC of 0.993 (95% CI 0.979–1.000, p < 0.001). In conclusion, we identified a serum 4-miRNA signature that discriminated with high accuracy lung cancer patients from NC. Further prospective validation of this miRNA signature is warranted.

Robotic video-assisted thoracoscopic lung resection for lung tumors: a community tertiary care center experience over four years.

After its initial description in 1990, video-assisted thoracoscopic surgery (VATS) has emerged as the minimally invasive approach for lung resection in early lung cancer. A retrospective review of prospectively collected data on patients who underwent robotic pulmonary resection for cancer by a single surgeon, between years 2009 and 2013, was performed. Age, gender, type and duration of surgery, length of stay, estimated blood loss, early and late complications, follow-up time, and local recurrence were reviewed and analyzed descriptively. Three hundred and thirty-one patients underwent the procedure for pulmonary neoplasm. Two hundred and fifty-nine (79%) patients underwent anatomic lobectomies, 56 (17%) patients had wedge resection, while five (1.5%) patients underwent pneumonectomy. In 11 patients, no pulmonary resection was performed for different reasons. Most common neoplasm was adenocarcinoma (185, 56%). All procedures involved a systematic mediastinal and hilar lymph node exploration and removal of suspicious nodes. Twenty-six (6.9%) procedures were converted to open thoracotomy. Mean duration of surgery was 185.63 min. Mean length of hospital stay was 5.52 days. Mean estimated blood loss (EBL) was 47.85 ml. Mean follow-up was 249.41 days (20-1550 days), and five (1.5%) patients developed local recurrence. Early complications were seen in 29 patients (8.8%), most commonly cardiac arrhythmias (20, 6%). Robotic video-assisted thoracoscopic surgery is feasible in lung lesions, with all the advantages of VATS in terms of decreased length of stay and decreased blood loss with local recurrence rate and complication rate comparable to open procedures. There is a clear need for more studies comparing the apparent advantages of robotic-assisted surgery with increased cost of technology.

247P - Validation of a Serum 4-Microrna Signature for Lung Cancer Detection

ABSTRACT Aim: Lung cancer (LC) screening using low-dose CT demonstrated a 20% reduction in lung cancer mortality in heavy smokers. However, this strategy has several limitations including high false-positive rates, over-diagnosis, cost and the potential harm associated with radiation exposure. The aim was to identify differentially-expressed miRNAs in the serum of LC patients that might be a clinically-useful tool for LC early detection. Methods: miRNA expression profile analysis using TaqMan OpenArray Human microRNA panel was performed in 70 serum samples obtained at lung tumor resection and 22 non-cancer subjects (NC). The discovery set included 86% adenocarcinoma (AC) and 14% squamous cell carcinoma (SCC). Selected serum miRNAs were validated by quantitative PCR in an independent set of serum samples from LC patients (n = 85) and NC (n = 23). The test set included 65% of patients with lung AC and 35% with lung SCC. In both sets, most patients were stage I (discovery, 57%; test, 67%) and LC patients and NC were age and gender matched. Results: By class-comparison analysis, 55 miRNAs were found significantly up-regulated and 34 down-regulated in the serum from LC patients versus NC (adjusted p-value Conclusions: We identified a serum 4-miRNA signature that discriminated with high accuracy LC patients from NC. Although this miRNA signature was validated in an independent cohort, further prospective validation in warranted in additional cohorts of subjects at high risk of LC. Disclosure: All authors have declared no conflicts of interest.

Outcome and prognostic indicators in 20 cats with surgically treated primary lung tumors.

The purpose of this retrospective study of 20 client-owned cats was to describe the clinical signs, surgical interventions, histological features, stage and treatments of primary lung tumors removed by surgical excision, and to determine which factors significantly influence survival. Any cat that underwent surgical resection of a primary lung tumor between 2000 and 2007 was included in the study. Patient records were reviewed and signalment, clinical signs, preoperative diagnostics, surgical findings and histopathological results recorded. Histological reports were reviewed and scored using World Health Organization criteria. The Kaplan-Meier test was used to evaluate each potential prognostic factor with survival. Twenty cats met the inclusion criteria. The presence of clinical signs (such as dyspnea) at the time of diagnosis (P = 0.032), pleural effusion (P = 0.046), stage M1 (P = 0.015), and moderately and poorly differentiated tumors on histopathology (P = 0.011) were factors that were significantly correlated with reduced survival times. The median survival time of the 20 cats was 11 days. Cats presenting with no clinical signs had a median survival time of 578 days post-surgery vs 4 days post-surgery when presented with clinical signs. Cats staged T1N0M0 lived longer than cats at other stages (P = 0.044). Of the cats that survived to the time of suture removal, median survival time was 64 days. The results indicate that the presence of clinical signs, pleural effusion, moderately and poorly differentiated tumors on histopathology, evidence of metastasis and any stage beyond T1N0M0 are negative prognostic indicators for cats with primary lung tumors. The findings demonstrate that cats that presented with clinical signs, pleural effusion, any stage other than T1N0M0, or moderately and poorly differentiated tumors on histopathology had a poor prognosis. Therefore, extensive preoperative diagnostics, including computed tomography scans, should be performed before considering surgical intervention in these cats. These findings may be used to guide therapeutic decision-making in cats diagnosed with primary lung tumors.

Extraskeletal Myxoid Chondrosarcoma-like Features in Metastasizing Lung Adenocarcinoma: Unique Morphological Changes after Chemo-radiotherapy

Lung cancer closely resembling Extraskeletal Myxoid Chondrosarcoma (EMC), called “primary pulmonary myxoid sarcoma (PPMS),” is an extremely rare tumor. This report is presented here of a unique case showing EMC-like changes only in metastases from conventional lung adenocarcinoma in an 81-year-old man. After lung tumor resection and chemo-radiotherapy, he underwent the resection of right adrenal metastasis composed of carcinomatous and EMC-like components. There were multifocal transitions between these components. He was treated with additional chemo-radiotherapy for newly developed liver and brain metastases, but he died 3.3 years after the initial surgery. Autopsy revealed EMC-like tumors, with or without minute adenocarcinomatous components, extensively involving widespread organs. Reverse transcription-polymerase chain reaction did not detect EWSR1- CREB1 fusion in the primary tumor or metastases. These features indicated that the current tumor was different from PPMS characterized by EWSR1-CREB1 fusion. We concluded that such EMC-like features represent morphological changes of metastatic lung adenocarcinoma. We believe that this possible occurrence should be recognized for accurate diagnosis of metastatic lung carcinoma.

Surgical treatment for non-small cell lung cancer patients with synchronous solitary brain metastasis

背景与目的非小细胞肺癌脑转移较多见，常用的治疗方法有放疗、化疗等，但预后不佳。本研究拟了解手术在非小细胞肺癌同步单发脑转移综合治疗中的作用。方法回顾性分析46例非小细胞肺癌同步单发脑转移患者的临床资料。所有患者接受肺部肿瘤切除，术后行全脑放疗及化疗。其中13例患者行脑转移瘤切除，33例患者行脑部立体定向放射治疗。结果本组患者总的中位生存期为16.8个月，1年、2年和3年生存率分别为76.1%、20.9%和4.7%。脑转移瘤手术组和立体定向治疗组的中位生存期分别为18.3个月和15. 8个月（P=0.091, 2）。结论手术切除肺部原发肿瘤及脑转移瘤对改善非小细胞肺癌单发脑转移患者的预后具有一定作用。脑转移瘤手术切除或立体定向治疗对患者的生存期未见有影响。

Ten cases of resected solitary pulmonary metastases arising from gastric cancer.

Because carcinomatous lymphangitis and carcinomatous pleuritis are the usual forms of metastasis associated with gastric cancer, resection of solitary pulmonary metastases arising from gastric cancer is rarely performed. To clarify the characteristics of pulmonary metastases from gastric cancer, we investigated patients who underwent resection of metastatic solitary lung tumors arising from gastric cancer. Between October 2003 and October 2012, 10 patients underwent pulmonary metastasectomy for metastatic gastric cancer at our institution. We retrospectively evaluated features of the primary gastric cancer and the clinicopathological features of the pulmonary metastases in these cases. 70% of the patients had stage II disease. Lymphatic invasion was observed in all cases of primary gastric cancer. The method of pulmonary resection was partial resection in 5 cases, segmentectomy in 1, and lobectomy in 4. On histopathological examination, immunohistochemical staining was negative for thyroid transcription factor-1 and napsin A in all cases. Patients who underwent resection of pulmonary metastases arising from gastric cancer had a good prognosis: the 4-year survival rate was 75%. Carefully chosen patients have a good opportunity to obtain benefits from resection of pulmonary metastases arising from gastric cancer.

Evaluation of short-term outcome after lung lobectomy for resection of primary lung tumors via video-assisted thoracoscopic surgery or open thoracotomy in medium- to large-breed dogs

To describe clinicopathologic features of dogs that underwent lung lobectomy for resection of primary lung tumors via video-assisted thoracoscopic surgery (VATS) or open thoracotomy (OT) and to compare short-term outcomes for dogs following these procedures. Retrospective cohort study. 46 medium- to large-breed dogs with primary lung tumors. Medical records of dogs that underwent a lung lobectomy via VATS (n = 22) or OT (24) for resection of primary lung tumors between 2004 and 2012 were reviewed. Dogs were included if they weighed > 10 kg (22 lb) and resection of a primary lung tumor was confirmed histologically. Tumor volumes were calculated from preoperative CT scans where available. Surgical time, completeness of excision, time in the ICU, indwelling thoracic drain time, postoperative and total hospitalization time, incidence of major complications, and short-term survival rate were evaluated. VATS was performed with a 3-port (n = 12) or 4-port (10) technique and 1-lung ventilation (22). In 2 of 22 (9%) dogs, VATS was converted to OT. All dogs survived to discharge from the hospital. There were no significant differences between the VATS and OT groups with regard to most variables. Surgery time was significantly longer for VATS than for OT (median, 120 vs 95 minutes, respectively). In medium- to large-breed dogs, short-term outcomes for dogs that underwent VATS for lung lobectomy were comparable to those of dogs that underwent OT. Further studies are required to evaluate the effects of surgical approach on indices of postoperative pain and long-term outcomes.

Video-assisted thoracoscopic surgery with posterior spinal reconstruction for the resection of upper lobe lung tumors involving the spine

Video-assisted thoracoscopic surgery (VATS) is associated with less morbidity and recovery time compared with traditional open thoracotomy (OT) for the resection of early stage non-small cell lung cancer (NSCLC). Local invasion of NSCLC into adjacent vertebrae confers a TNM T status of T4. Anatomical lobectomy by VATS with simultaneous posterior spinal reconstruction (PSR), as a single procedure, offers advantages to selected patients judged as suitable candidates for resection. To report the preliminary results of a novel, multidisciplinary surgical technique for the treatment of upper lobe lung cancers with direct extension to the spine. Consecutive case series. Eight adults who underwent PSR with either VATS or OT for the treatment of a T4 (vertebral body invasion) NSCLC. Total operative time, estimated blood loss, length of hospital stay, postoperative tumor recurrence and metastasis, survival, reoperations, and any other intraoperative or postoperative complication. Eight consecutive patients who underwent instrumented PSR with corpectomy for the treatment of an upper lobe NSCLC at a single institution were identified. Either VATS (n=4) or OT (n=4) was performed at the time of the reconstruction in each patient. All tumors were stage III NSCLC without metastasis. Patients who underwent VATS and OT were aged 54±11 and 54±2.9 years, respectively. Mean operative time and blood loss were similar between the groups: VATS: 367±117 minutes versus OT: 518±264 minutes; VATS: 813±463 mL versus OT: 1,250±1,500 mL. Mean follow-up was 16±13 months after surgery. Complications occurred in all eight patients. One OT patient had wound dehiscence requiring a tissue flap, and another suffered from a septic shock. No wound complications developed after VATS. Death secondary to tumor recurrence occurred once in each group. For the six surviving patients, 23±15 months (range, 4.5-43 months) have elapsed since surgery. Video-assisted thoracoscopic surgery with PSR is a novel and viable method for the complete resection of T4 NSCLC.

Parcours de soins des patients atteints de cancer bronchique traités chirurgicalement

The aim of the study is to describe the hospital management of patients undergoing pulmonary resection for lung cancer in France. Data from patients who underwent resection for "malignant neoplasm of bronchus and lung" in 2008 were analyzed from French PMSI database. Hospitalizations, chemotherapy and radiotherapy sessions were analyzed one year before and after the procedure. In 2008, 9161 patients were hospitalized for a resection of lung tumor. Sex ratio was 2.8 (n=6736 men) and average age was 62.8 years. During hospitalization for surgery, 3.5% of patients (n=323) died. In the year before the procedure, 10% of patients (n=961) received neoadjuvant chemotherapy (mean number: 5.2 sessions per patient). In the year after the procedure, 41% of patients (n=3796) received adjuvant chemotherapy (6.6 sessions per patient), 9% (n=812) received adjuvant radiotherapy (16.8 sessions per patient), 6% (n=562) were re-hospitalized for surgery for an additional procedure. In France, pulmonary resection for lung cancer was associated for about half of patients in a multimodal treatment with combination between chemotherapy and/or radiotherapy.

Incidental Finding of a Left-over Guide-Wire on a Positron Emission Tomography.

The Seldinger technique is commonly used to cannulate vessels for radiographical procedures [1]. Loss of a guide-wire into the circulation is a rare and preventable complication [2]. It is often noticed by chance during routine radiographs [2]. However, there is a lack of reported cases of incidental findings of leftover guide-wire on a PET scan. An intravascular foreign body should be retrieved as soon as the diagnosis is made, to prevent complications such as embolisation or vascular damage by fractured wires [1]. Interventional radiology is the method of choice for retrieval [2]. We report a rare case of the coincidental finding of a lost guide-wire on a PET scan. A 37-year-old man presented with psychotic episodes, thigh weakness, weight gain, increased appetite and leg cramps. He was subsequently diagnosed with Cushing Syndrome secondary to ectopic adrenocorticotropic secretion from a right lung tumour. He subsequently underwent a staging positron emission tomography (PET) scan (Fig. 1a). The lung tumour had no uptake on PET but had increased activity uptake on octeotride scanning (Fig. 1b, marked in red). These appearances were suggestive of with carcinoid tumour. The PET scan also revealed an incidental finding of a leftover guide-wire used during peripheral inserted central catheter (PICC) recently (Fig. 1a, arrows).The wire extended from right atrium to inferior vena cava. It also showed a high uptake in the adrenal glands, indicating hyperplasia, which was most likely due to adrenocorticotropic hormone stimulation (Fig. 1a, labelled A). He underwent a percutaneous wire retrieval via the right femoral vein in a cardiac catheterisation laboratory and was transferred to a thoracic surgical unit for lung tumour resection. Fig. 1 a PET shows the guide-wire (arrows) and high uptake of adrenal glands (A). b Lung tumour with increased activity uptake on octeotride scanning (marked in red), suggesting carcinoid tumour

A nanomaterial-based breath test for short-term follow-up after lung tumor resection

In this case study, we demonstrate the feasibility of nanomaterial-based sensors for identifying the breath-print of early-stage lung cancer (LC) and for short-term follow-up after LC-resection. Breath samples were collected from a small patient cohort prior to and after lung resection. Gas-chromatography/mass-spectrometry showed that five volatile organic compounds were significantly reduced after LC surgery. A nanomaterial-based sensor-array distinguished between pre-surgery and post-surgery LC states, as well as between pre-surgery LC and benign states. In contrast, the same sensor-array could neither distinguish between pre-surgery and post-surgery benign states, nor between LC and benign states after surgery. This indicates that the observed pattern is associated with the presence of malignant lung tumors. The proof-of-concept presented here has initiated a large-scale clinical study for post-surgery follow-up of LC patients. From the Clinical EditorMonitoring for tumor recurrence remains very challenging due to post-surgical and radiation therapy induced changes in target organs, which often renders standard radiological identification of recurrent malignancies inaccurate. In this paper a novel nanotechnology-based sensor array is used for identification of volatile organic compounds in exhaled air that enable identification of benign vs. malignant states.

Increased Interleukin-8 in Epithelial Lining Fluid of Collapsed Lungs During One-Lung Ventilation for Thoracotomy

The present study was designed to evaluate inflammatory changes in collapsed lungs during one-lung ventilation using the assistance of a bronchoscopic microsampling probe. Serial albumin and interleukin (IL)-8 concentrations in epithelial lining fluid (ELF) were measured in seven patients undergoing resection of lung tumors. The samples were taken after induction of anesthesia (baseline), 30min after one-lung ventilation was started (point 2), just before resuming two-lung ventilation (point 3), and 30min after two-lung ventilation was restarted (point 4). The albumin and IL-8 concentrations in ELF were significantly increased at point 2 and point 3, respectively, and remained to be high, compared to the baseline. The increase in IL-8 at point 3 was correlated with the interval of one-lung ventilation; however, none developed specific acute lung injury. These findings suggest that inflammatory changes can occur on the epithelium of a collapsed lung even in patients who underwent successful and standard thoracic surgery.

Complete surgical resection of lung tumor decreases exhalation of mutated KRAS oncogene

Exhaled breath condensate (EBC) contains extracellular DNA that may originate from pathological lesions of the respiratory tract and can be a genetic marker of pulmonary malignancy. We tested whether complete surgical excision of lung cancer will decrease exhalation of mutated KRAS oncogene. Fifty seven patients with clinical diagnosis of lung cancer and detectable KRAS mutations in pre-surgery EBC-DNA were qualified for surgical treatment. Point mutations at codon 12 of KRAS oncogene were detected using mutant-enriched PCR technique in DNA from pre-surgery blood, EBC collected before, 7 and 30 days after surgery and from specimens of resected tumor and normal pulmonary parenchyma. The ratio of mutated to wild type KRAS DNA (R mut/wild KRAS) was calculated for each specimen after electrophoresis and densitometry of the final amplification and digestion product. In 46 patients non-small cell lung cancer (NSCLC) and in 11 benign lesion (BL) were confirmed. All blood and tumor specimens were positive for KRAS mutations, while 41 specimens of normal pulmonary parenchyma were negative. In NSCLC patients pre-surgery EBC R mut/wild KRAS of 0.20 ± 0.03 decreased by 1.3- and 3.7-times (p < 0.001) at 7th and 30th day and 10 EBC specimens at day 30th became negative. The highest R mut/wild KRAS was found in NSCLC specimens - 1.36 ± 0.29 while the lowest in pulmonary parenchyma - 0.02 ± 0.03 (p < 0.001). R mut/wild KRAS in EBC did not correlate with the blood and cancer ratios. Determination of mutated KRAS oncogene in EBC can be potentially helpful in the follow-up of surgical treatment of pulmonary malignancy.

A Primary Pulmonary Glomus Tumor: A Case Report and Review of the Literature

A case of a glomus tumor originating from the lung is reported. A 43-year-old female had undergone resection of a right lung tumor following a clinical diagnosis of carcinoid, sclerosing hemangioma, or other sarcoma. Histologically, the tumor comprised uniform small round to oval cells with centrally located nucleus, a clear cytoplasm, and apparent cell borders. The tumor also showed a focally hemangiopericytomatous pattern with irregularly branching or dilated vessels. Electron microscopy revealed smooth muscle differentiation of the tumor cells. Immunostaining further revealed that the tumor cells expressed smooth muscle actin, h-caldesmon, muscle specific actin (HHF-35), but not cytokeratin, epithelial membrane antigen, synaptophysin, or chromogranin A. Based on these findings, a diagnosis of primary pulmonary glomus tumor was established. Glomus tumors of the lung are very rare and only 21 cases have been reported to date. The histological features of the present tumor and the relevant literature are discussed.

Vulvar yolk sac tumor mixed with embryonal carcinoma in a peri-pubertal girl: A case report

Objective Vulvar cancer is rare in Eastern females, especially in pre- and peripubertal girls. The prognosis of vulvar cancer is poor and treatment is variable. Case Report A 14-year-old girl suffered from a left vulvar tenderness mass and underwent excision of the mass. The diagnosis of the pathology was vulvar yolk tumor with an embryonal carcinoma. After the vulvectomy, inguinal area lymph node dissection, chemotherapy (bleomycin, etoposide and cisplatin) treatment and radiotherapy, metastasis to lung was also noted after eight months. Resection of lung tumor was performed. She received chemotherapy with a combination of paclitaxel, ifosphamide and cisplatin (TIP) and received peripheral blood stem cell transplantation (PBSCT) twice and chemotherapy treatment of gemitabine and oxaliplatin (GEMOX). Up until now, the patient has been free of disease. Conclusion High-dose TIP and GEMOX chemotherapy plus PBSCT for bone marrow rescues could be considered to treat patients with metastatic malignant vulvar germ cell tumor after failed first-line chemotherapy and radiation.