Sarcoidosis lymphoma syndrome - the value of PET-CT in the diagnosis

We report a 52-year-old patient who developed B-cell non-Hodgkin's lymphoma subsequent to sarcoidosis. Sarcoidosis was diagnosed 16 years ago and remained asymptomatic for 14 years after steroid treatment. She presented with new symptoms of arthralgia, photosensitivity, butterfly erythema, autoimmune antibodies (ANA, chromatin positivity) associated with progression of the known left upper lobe lesion on the chest X-ray suggesting primary autoimmune disease (systemic lupus erythematosus). As steroid treatment was not effective, we started bolus cyclophosphamide therapy after which progression was seen on the chest X-ray. Computed tomography (CT)-guided needle biopsy confirmed malignancy of indefinable origin. Despite of the well-known fluorodeoxyglucose (FDG) avidity in active sarcoidosis, a FDG-positron emission tomography (PET) scan was performed to stage the primary tumour. Intensive FDG uptake was detected in the affected lung segment, with moderate uptake in mediastinal lymph nodes. The patient underwent left upper lobectomy. The histology showed pulmonary mucosa-associated lymphoma (bronchus-associated lymphoid tissue (BALT) lymphoma) in the lung tissue, while only sarcoidosis was present in the mediastinal lymph nodes. Bone marrow biopsy was negative.The association between sarcoidosis and lymphoma is known as sarcoidosis lymphoma syndrome, which is a rare disease. PET-CT was helpful in the differentiation of sarcoidosis and malignancy in this patient. It is important to be aware of the risk of lymphoma in sarcoidosis and FDG-PET, used for adequate purpose, can help the diagnosis

Sustained Air Sealing Efficacy of a Sealing Patch in Pulmonary Lobectomy

Purpose: Postoperative air leakage remains the most common pulmonary complication after resection of the lung. The objective of this study was to evaluate the postoperative efficacy of a new surgical patch for the sealing of alveolar air leakage in patients undergoing elective pulmonary lobectomy. Methods: Patients scheduled for standard lobectomy were included in this prospective, open-label, randomized controlled study, conducted at 12 European university hospitals. Following thoracotomy, lobectomy, and primary stapling, patients with intraoperative air leak grade 1-2 (water submersion test; Macchiarini et al, 1999) were randomized to a sealing patch (SP) or additional standard surgical treatment, i.e., suturing and further stapling (STD). Assessment of postoperative air leakage was performed twice daily until chest drain removal. Results: A total of 301 patients were included and randomized, of whom 299 received trial treatment (SP: 149; STD: 150). Mean age was 64 years (33-83 years), 67% were males and 33% females. Preoperatively, the treatment groups were well-balanced regarding mean BMI (25.8 vs 26.1 kg/m2), mean FEV-1 (2.48 vs 2.50 L), mean TLC (6.17 vs. 6.14 L) and mean RV (2.65 vs 2.61 L) for SP and STD, respectively. At the end of surgery, 68.2% of SP and 42.4% of STD patients were air leak free (OR 5.27 [95% CI: 1.26-21.96]; p=0.022; ITT). The duration of postoperative air leakage was significantly shorter in SP compared with STD patients (p=0.030; log-rank test). The proportions of patients remaining air leak free at discharge from surgical ward were 29.7% and 19.2% for SP and STD patients, respectively (OR 4.93 [95% CI: 1.33- 18.31]; p=0.017; ITT). The occurrence of adverse events was similar for both treatments. Conclusions: The study demonstrated superior efficacy of a sealing patch compared with standard surgical treatment for sustained sealing of postoperative air leakage following pulmonary lobectomy

Efficacy and safety of TachoSil (R) versus standard treatment of air leakage after pulmonary lobectomy

OBJECTIVES: Alveolar air leakage remains a serious problem in lung surgery, being associated with increased postoperative morbidity, prolonged hospital stay and greater health-care costs. The aim of this study was to evaluate the sealing efficacy and safety of the surgical patch, TachoSil\uae, in lung surgery. METHODS: Patients undergoing elective pulmonary lobectomy who had grade 1 or 2 air leakage (evaluated by the water submersion test) after primary stapling and limited suturing were randomised at 12 European centres to open-label treatment with TachoSil\uae or standard surgical treatment (resuturing, stapling or no further treatment at the surgeons' discretion). Randomisation was performed during surgery using a centralised interactive voice response system. Duration of postoperative air leakage (primary end point), reduction of intra-operative air leakage intensity (secondary end point) and adverse events (AEs), including postoperative complications, were assessed. RESULTS: A total of 486 patients were screened and 299 received trial treatment (intent-to-treat (ITT) population: TachoSil\uae, n=148; standard treatment, n=151). TachoSil\uae resulted in a reduction in the duration of postoperative air leakage (p=0.030). Patients in the TachoSil\uae group also experienced a greater reduction in intra-operative air leakage intensity (p=0.042). Median time until chest drain removal was 4 days with TachoSil\uae and 5 days in the standard group (p=0.054). There was no difference between groups in hospital length of stay. AEs were generally similar in both groups, including postoperative complications. CONCLUSIONS: TachoSil\uae was superior to standard surgical treatment in reducing both postoperative air leakage duration and intra-operative air leakage intensity in patients undergoing elective pulmonary lobectomy