Expectancy survival of malignant pleural effusion patients treated with thoracoscopic pleurodesis related to histology

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The International Thymic Malignancy Interest Group Classification of Thymoma Recurrence: Survival Analysis and Perspectives

Introduction: The International Thymic Malignancy Interest Group (ITMIG) classifies thymoma recurrences on the basis of the topographic location, but its effectiveness in prognosis prediction has not been well investigated yet. Aims of this study are to analyze survival outcome of patients surgically treated for thymoma recurrence according to the ITMIG recurrence classification and to investigate possible alternatives. Methods: From January 1, 1990, to January 7, 2017, data on 135 surgically treated patients for thymoma recurrence from three high-volume centers were collected and retrospectively analyzed. Patients were classified according to the ITMIG classification as local, regional, and distant. The ITMIG classification and alternative classifications were correlated to overall survival (OS). Results: According to the ITMIG classification, recurrence was local in 17 (12.5%), regional in 97 (71.8%), and distant in 21 (15.7%) patients, with single localization in 38 (28.2%) and multiple localizations in 97 (71.8%). The 5- and 10-year OS were 79.9% and 49.7% in local, 68.3% and 52.6% in regional, and 66.3% and 35.4% in distant recurrences, respectively, but differences were not statistically significant (p = 0.625). A significant difference in survival was present considering single versus multiple localizations: 5- and 10-year OS of 86.2% and 81.2% versus 61.3% and 31.5% (p = 0.005, hazard ratio = 7.22, 95% confidence interval: 0.147–0.740), respectively. Combining the localization number with the recurrence site, ITMIG locoregional single recurrence had a statistically significant better survival compared with patients with ITMIG locoregional multiple recurrence or ITMIG distant recurrence (p = 0.028). Similarly, a significant difference was present considering intrathoracic single versus intrathoracic multiple versus distant recurrence (p = 0.024). Conclusions: The ITMIG classification for thymoma recurrence did not have significant survival differences comparing local, regional, and distant recurrences. Integrating this classification with the number of the localizations may improve its effectiveness in prognosis prediction

Chest wall reconstruction with a novel titanium mesh after partial sternectomy for chondrosarcoma

Primitive malignant sternal tumours are extremely rare and represent less than 1% of all chest wall tumours. A combination of radical surgery and accurate reconstruction is mandatory to ensure adequate stability and to reduce paradoxical movement. To date, this is one of the few reports on a successful sternal reconstruction using a rigid titanium mesh to restore the skeletal integrity, which was then covered by bilateral muscular flaps

Tree-climbing in search of fruit: an ancient arboreal marsupial megafrugivore from the Miocene of Australia

Diprotodontids, a group of large-bodied wombat-like marsupial herbivores, were broadly distributed in Australasian Cenozoic deposits. While most diprotodontids were terrestrial quadrupeds and are often compared to placental herbivores like rhinoceros and hippopotamuses, the zygomaturine diprotodontid Nimbadon lavarackorum, based on its post-cranial morphology, is thought to have occupied the treetops. Understanding the dietary ecology of N. lavarackorum during the Miocene can help clarify potential motivations for an arboreal lifestyle. Here, we conducted dental microwear texture analysis (DMTA) and stable isotope analysis (SIA) of N. lavarackorum specimens from the Riversleigh World Heritage Area and compared them to analogous extant mammals to assess the likelihood that these tree-dwelling marsupials occupied a unique ecological niche during the Miocene in Australia—arboreal megafrugivores. The DMTA of N. lavarackorum (i.e., low anisotropy and high complexity) is most similar to extant mammals that include a high proportion of fruit in their diet and is inconsistent with and statistically distinct from obligate folivores. Stable carbon isotopes of N. lavarackorum also indicate the consumption of C3 food sources, consistent with the consumption of 13C enriched fruit in a C3 forest environment. Fruits may have been a motivation for this ca 70 kg marsupial moving into or staying in the treetops—an ecological niche that is currently unoccupied in Australia today. Larisa DeSantis [[email protected]], Department of Biological Sciences, Vanderbilt University, Nashville, TN 37232, USA; Department of Earth and Environmental Sciences, Vanderbilt University, Nashville, TN 37240, USA; Michael Archer [[email protected]], Earth and Sustainability Science Research Centre, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, NSW, 2052, Australia; Karen Black [[email protected]], Earth and Sustainability Science Research Centre, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, NSW, 2052, Australia; Suzanne Hand [[email protected]], Earth and Sustainability Science Research Centre, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, NSW, 2052, Australia; Vera Korasidis [[email protected]], Department of Geography, Earth and Atmospheric Sciences, University of Melbourne, Parkville, VIC, 3010, Australia

Which Surgery for Ground Glass Opacity Lung Nodules?

Background Pulmonary ground glass opacity (GGO) nodules represent a significant dilemma in oncology since its diagnosis in clinical practice has increased because of growing application of low dose computed tomography and screening programme. The aim of this study is to analyse the clinical and pathological features, the overall survival (OS) and Disease Free Interval (DFI) in surgically resected solitary ground glass nodules in order to assess the surgical treatment of choice. Method We retrospectively analysed 49 patients (M/F=25/24) with a mean age of 67,7 years (range 40-81) who underwent lung resection for solitary GGO nodules among 570 reviewed CT of patients treated for lung neoplasms between 2010 and 2016. The cohort included 22 pure GGO nodules and 27 part-solid GGOs (also called mixed GGOs). Result Median maximum diameter of GGOs, defined as the largest axial diameter of the lesion on the lung-window setting, was 17 mm (range,5–30). GGO nodules were removed by wedge resection, segmentectomy, or lobectomy in 17 (35%), 9 (18%), and 23 (47%) cases, respectively. Pathology showed minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IA) or multifocal adenocarcinoma (MAC) in 9 (18%), 37 (76%) and 3 (6%) cases, respectively. With a median follow up of 47 months the OS and DFI of the entire cohort was 46,3 and 43 months respectively. The histotype (p=0,008), the size of GGO (p=0,014) and the PET-SUV max (p=0,001) were independent prognostic factors of worse survival. Sex, age, previous lung surgery, type of surgical resection and the mediastinal lymph-node evaluation did not impact on OS and DFI. Analysing the 22 pure GGO nodules, we found a 3-year OS and DFI of 98% and 100% respectively, significantly different from 80% and 75% respectively of part-solid GGOs (log-rank p=0,043 and p=0,011). Conclusion Our data suggest an indolent behaviour of tumours presenting as solitary GGO nodules, especially in case of pure GGOs. In our series wedge resections guarantee the same results in terms of OS and DFI when compared to lobectomies. Sublobar resections without mediastinal lymph-nodes evaluation represent the treatment of choice for pure-GGO. More studies are needed to assess its role for part–solid GGO nodules

New age controls on Oligocene and Miocene sediments in southeastern Australia

The Cenozoic spore-pollen zonation scheme of southeastern Australia is used to constrain the ages of marine and terrestrial strata throughout Australasia. New palynological, strontium isotope and foraminiferal data from the Torquay and Gippsland basins in southeastern Australia are here used to revise and chronologically calibrate the Oligocene and Miocene portions of this scheme. The revised age assigned to the Upper Nothofagidites asperus/Lower Proteacidites tuberculatus zonal boundary is 30.5–31.2 Ma, the Lower/Middle P. tuberculatus zonal boundary is 23.03 Ma, the Middle/Upper P. tuberculatus zonal boundary is approximately 21.1 Ma and the Upper P. tuberculatus/Triporopollenites bellus zonal boundary is 17.54 Ma. This revision confirms that a near-continuous Early Miocene neritic sequence is present in the Torquay Basin. The new ages also suggest that the timing of coal seam deposition in the Latrobe Valley was episodic, rather than continuous as has previously been interpreted. We propose that abrupt changes in moisture content across seam boundaries are associated with stratigraphic gaps. The new age controls facilitate more accurate comparisons of time-equivalent paleobotanical material throughout the southern hemisphere. The refinements presented will improve future Cenozoic paleoclimatic and paleobotanical reconstructions concerning Australia, New Zealand, South America and Antarctica

Nonintubated thoracoscopic pulmonary nodule resection under spontaneous breathing aneshesia with laryngeal mask

Objective: During the past 20 years, the use of video-assisted thoracoscopicsurgery has increasedas an important minimally invasive tool. To further reduce its invasiveness, after a preliminary experience, we decidedtouseanonintubatedspontaneousbreathinggeneralanesthesia, forvideo-assistedthoracoscopicsurgeryresectionoflungnodule,usinga laryngeal mask (LMA). This study aimed to verify the safety and the feasibility of this technique. Methods: Twentyconsecutivepatientswhounderwentthoracoscopic wedgeoflungnoduleunderspontaneousbreathinggeneral anesthesia withLMAarethesubjectsofthisstudy.Clinicaldata,AmericanSociety of Anesthesiologists status, Adult Comorbidity EvaluationY27 score, and Revised Cardiac Risk Index score were recorded for each patient. Generalinhalatoryanesthesia(sevoflurane)wasgiveninallcasesthrough an LMA, without muscle relaxants, thus allowing spontaneous breathing.Allprocedureswereperformedinthelateraldecubitusposition.The maximumandminimumvaluesofend-tidalcarbondioxidetensionand oxygen saturation were recorded during the procedure. The level of technicalfeasibilitywasstratifiedbytheoperatingsurgeonaccordingto four levels: excellent, good, satisfactory, and unsatisfactory. Results: Therewere 13 men and 7 women (mean age, 57 years). The mean induction anesthesia time was 6 minutes, whereas the mean operativetimewas38minutes.Thevaluesofoxygensaturationaswell as minimum and maximum end-tidal carbon dioxide tension were 99.1%, 33.6 mm Hg, and 39.1 mm Hg, respectively. No mask displacement occurred. The mean operative time was 38 minutes (range, 25Y90 minutes). The level of technical feasibility was defined as excellentin19casesandgoodin1case.Nomortalityoccurred.Morbidity consistedof pleural effusion (one case), which was medically resolved. Themeanpostoperativestaywas3.5days.Histopathologicresultswere one squamous cell lung cancer (lung primary), one adenocarcinoma (lung primary), five metastasis from colon cancer, four metastasis from breastcancer, three metastasis from renal cancer, three sarcoidosis,two amartocondroma, and one tuberculosis. Conclusions: Our experience suggests that thoracoscopic wedge resection oflungnodule issafeandfeasibleunder spontaneous breathing anesthesiawithLMA.Thistechniquepermits a confidentmanipulation oflungparenchymaandasafestapler positioning,withoutcough,pain, or panic attack described for awake epidural anesthesia, avoiding the risks related to tracheal intubation and mechanical ventilation

TNM Staging System in Thymoma: A Critical Appraisal?

Thymomas are rare tumors of the anterior mediastinum with peculiar clinical and pathological features. They have been deeply analyzed by pioneer authors, who strictly linked their name to the main pathological and staging classifications. Before the latest edition of the WHO classification of thymic epithelial tumors, the history of thymoma pathological classification inherited the name of the pathologists who systematically addressed the issue, from Levine-Rosai to Muller-Hermelink. Similarly, the thymoma staging system is intimately related to the name of two surgeons, Masaoka and Koga, who historically dealt with this disease. More recently, the traditional tumor-nodes-metastasis (TNM) system has been developed for the staging of this condition, in a rational attempt to put thymomas in conformity with the other solid tumors. The efforts of the International Thymic Malignancies Interest Group (ITMIG) and the Thymic Domain of the Staging and Prognostic Factors Committee (TD-SPFC) of the International Association for the Study of Lung Cancer (IASLC) resulted in the TNM classification of thymic tumors, which have been included in the eighth edition of the American Joint Committee on Cancer’s (AJCC) Cancer Staging Manual. Herein, we report a narrative review of the evolution of the thymic epithelial tumors (TET) staging system and present a critical appraisal of the actual TNM classification compared with the historical Masaoka-Koga classification, with special focus on the proposal for the ninth edition of the TNM, expected in 2024