Pulmonary malacoplakia

We report a case of a 76-year-old man with bilateral pulmonary and pleural nodules and type 2 diabetes mellitus. Laboratory investigations revealed no sign of immunodeficiency. Pleural, pulmonary and diaphragmatic biopsies were taken through a mini-thoracotomy. Pathology showed Michaelis-Gutmann inclusion bodies and diagnosis of malacoplakia was made. Malacoplakia masquerading as bilateral tumour masses was thought to be noteworthy especially in an immunocompetent patient

Accuracy of positron emission tomography in mediastinal node assessment in coal workers with lung cancer

The purpose of this study was to explore the accuracy of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in the assessment of mediastinal lymph node in coal workers who had non-small cell lung cancer. We retrospectively reviewed 42 retired coal workers who had lung cancer without distant metastasis, between May 2007 and May 2010. Regarding the mediastinal lymph nodes, when the standard uptake value was greater than 2.5, it was considered "malignancy positive." After histological examination of the mediastinal lymph nodes, anthracotic and metastatic ones were detected. The results of PET/CT were analyzed to determine its accuracy. Of these 42 patients, PET/CT detected 47 positive mediastinal lymph nodes in 24 patients with a mean SUV maximum of 6.2 (2.6-13.8). One hundred and thirty-one mediastinal lymph node foci were dissected. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT in detecting nodal metastases were 84% (16/19), 65% (15/23), 66% (16/24), 83% (15/18), and 74% (31/42) on a per-patient basis, respectively. Mediastinal node staging with FDG-PET/CT in coal workers is insufficient due to the high false-positive rates due to the presence of pneumoconiosis. In these patients, an invasive technique such as mediastinoscopy seems mandatory for confirmation of ipsilateral or contralateral mediastinal lymph node metastasis. © Springer Science+Business Media, LLC 2011

Prognostic significance of surgical-pathologic multiple-station N1 disease in non-small cell carcinoma of the lung

Objectives: The surgical outcome of pathologic N1 disease in resectable, non-small cell lung carcinoma (NSCLC) is controversial. The prognosis of the patients with multiple/bulky N2 disease was invariably dismal. However, the prognostic significance of tumor involvement in more than one hilar or intralobar lymph node station has not been fully described. Methods: From 1996 to 2002, 181 patients with NSCLC had complete resection. Four levels of N1 nodes and N2 nodes were identified using the new regional lymph node classification for lung cancer staging. There were 67 patients (37%) with no nodal disease (NO), 43 patients (24%) with N1 and 71 patients (39%) with N2 disease. The N1 subgroup cases were reviewed. The prognostic significances of single and multiple N1 diseases were tested. Results: The cumulative postoperative survival at 3 and 5 years was 57 and 29%, respectively. The survival associated with single-station N1 disease was significantly better than that of multiple-station N1 disease (45 vs 32% at 5 years; P = 0.03). Five-year survival was similar in patients with multiple N1 disease and patients with single-station N2 involvement (32 vs 31% at 5 years; P = 0.84). However, no patient survived when tumor was detected in more than one mediastinal station (i.e. multiple N2 disease). Conclusions: It was suggested that N1 disease is a compound of two subgroups: one involving in one node and the other (multiple N1 disease) in which the postoperative prognosis was not statistically different from that of N2 disease. (C) 2003 Elsevier B.V. All rights reserved

Very Important Histopathological Factors in Patients with Resected Non-Small Cell Lung Cancer: Necrosis and Perineural Invasion

Background: The current staging system provides an anatomical classification of lung tumors; its secondary purpose is to allow the prognostic stratification of patients into homogeneous groups after surgery. In this work, intratumoral perineural invasion, lymphatic and blood vessel invasion together with the necrosis content of the tumor exclusive of the non-small cell cancer staging system were studied

Is lobe-specific lymph node dissection appropriate in lung cancer patients undergoing routine mediastinoscopy?

Background: The extent and the necessity of lymph node dissection has yet to be defined after resectional surgery for lung cancer. We aimed to analyze the lobe-specific extent of lymph node positivity in patients who underwent preoperative mediastinoscopy as a routine strategy. Methods: A total of 280 patients with non-small cell lung cancer with negative mediastinoscopy were operated on in our center between January 1997 and June 2003. Hilar and mediastinal lymphadenectomy was performed in every patient. Results: The most commonly involved lymph nodes were found to be paratracheal station lymph nodes (n = 83; 96.5%) for right upper lobe tumors, subcarinal station lymph nodes (n = 52; 88.1%) for right lower lobe carcinomas, aorticopulmonary lymph nodes (n = 62; 92.5%) for left upper lobe and subcarinal station lymph nodes (n = 49; 96.0%) for left lower lobe tumors. In the patients with right upper lobe, right lower lobe and left lower lobe tumors, the presence of a tumor at these stations was found to be an indicator for poor prognosis (p = 0.033, p = 0.0038 and p = 0.0016, respectively). Patients with multiple station N2 disease did not survive beyond 3 years. Conclusions: In patients who underwent routine mediastinoscopy, lobe-specific lymph node dissection could be recommended. Patients with multilevel N2 involvement did not seem to benefit from resectional surgery

Lactate dehydrodgenase levels predict pulmonary morbidity after lung resection for non-small cell lung cancer

Objective: The prevention of pulmonary complication after pulmonary resection for non-small cell lung cancer may minimize postoperative mortality rates and hospitalization period. The purpose of this study was to identify preoperative factors associated with the development of pulmonary complications after lung resections to help predict which patients are at increased risk for morbidity. Methods: From January 2000 to June 2003, 108 consecutive pulmonary resections were performed for non-small cell lung cancer in our institution. The following information was recorded: demographic, clinical, functional, and surgical variables. We evaluated all complications, which arose after pulmonary resection during hospitalization. The risk of complication was evaluated using univariate and multiple logistic regression analysis to estimate odds ratio. Results: Sixty-six lobectomies, 31 pneumonectomies, 11 bilobectomies and four wedge resections were done. Forty-nine complications were realized in all patients. A logistic regression analysis on relevant variables showed that only the increased serum lactate dehydrogenase (LDH) levels (>320 U/l) was a significant predictor of a pulmonary complication (P = 0.03). Age, side of resection, low FEV1, stage of the disease, low partial arterial oxygen pressure, low partial arterial carbon dioxide pressure, cigarette smoking and concomitant disease were not significant predictors of morbidity. Conclusion: Patients who have higher serum LDH levels are at increased risk for developing postoperative morbidity. Postoperative physical therapy and medical care might be intensified in those patients at high risk. (C) 2004 Elsevier B.V. All rights reserved