Localized Fibrous Tumors of the Pleura: Experience With 7 Recent Cases

OBJECTIVE: Localized fibrous tumors of the pleura are rare. We report 7 cases and review the literature in order to define the range of clinical characteristics of these tumors, treatment options, and prognosis. METHODS: A retrospective review of 7 cases treated between 1997 and 2003, focusing on clinical presentation, diagnostic tests, and treatment. The tumor was removed surgically in all cases, by thoracotomy in 6 cases and by video-assisted thoracoscopic surgery in 1 patient. RESULTS: All patients recovered fully after surgery, with no postoperative complications. One patient experienced recurrence twice, 33 and 67 months after the initial resection. All are alive at the time of writing, after a mean follow up period of 19 months (range 1 month to 5 years and 10 months). CONCLUSIONS: The treatment of choice for a fibrous tumor of the pleura is full resection and follow up to detect possible late recurrence

Leiomioma esofágico: resección por videotoracoscopia. A propósito de un caso

Leiomyomas are the most common benign tumours of the oesophagus. The most frequent symptoms are dysphagia and epigastric pain, although 50% of patients remain asymptomatic and the tumour is sometimes discovered incidentally. We report a case of oesophageal leiomyoma with emphasis on the operative management by VATS. Traditionally, operative management by transthoracic enucleation is the procedure of choice. In this study we present our experience using a minimally invasive approach

Resultados a medio y largo plazo de la utilización de videotoracoscopia en la cirugía de resección de las metástasis pulmonares

The surgical resection of pulmonary metastases is a method of treatment accepted as habitual in thoracic surgery. However, it continues to be a source of controversy if this resection must be realised by thoracotomy or by modern video-assisted techniques. With the aim of finding a response to this controversy in our work milieu, a review was made of the surgical interventions carried out in order to resect pulmonary metastases. Between January 1997 and December 2001, 56 patients were found whose pulmonary metastases had been resected by videothorascopy out of a total of 252 metastasectomies (22.2%). The primary tumours were classified in 4 groups: sarcoma (n=11); colorectal (n=25); renal (n=5); and others (n=15). Videothoroscopy was carried out on the right hemithorax (n=28), left hemithorax (n=22) or on both at once (n=6). Operational mortality was nil and the only morbidity attributable to the technique was a defect of re-expansion following the removal of the thoracic drainage in one patient. Using the Kaplan-Meier method, the probability of survival in this series of patients was 60.4% after 5 years, with an average survival time of 48 months. All of this data supports the use of videothorascopy in our milieu on patients with pulmonary metastases. However, in the light of the results, it is important in using this technique to place special emphasis on obtaining good margins of resection, due to the real risk of local recurrence on these margins in the medium term

Metástasis torácicas de carcinoma mamario. Estado actual

Breast cancer is a common pathology. It is clinically considered as a localized or regionally developing illness at the time of diagnosis, but the appearance of metastases is a frequent complication. Patients are commonly referred with local or regional recurrence of the disease. Invasive metastatic disease found in the chest can be differentiated according to area as follows: pulmonary parenchyma (nodes and/or carcinomatosis lymphangitis), pleural cavity (pleural effusion and/or tumor), pericardial effusion and the thoracic wall. The appearance of pulmonary parenchymal metastases secondary to breast cancer can be further categorized into three types, neoplastic lymphangitis, multiple and single pulmonary nodes. Pleural effusion is the commonest thoracic affection in patients with this pathology. It is accepted that 46% of patients with disseminating breast cancers will develop pleural metastases where the presentation is pericardial effusion, and possible cardiac tamponade. Finally, metastatic disease may be found localized to within the thoracic wall. Breast cancer can produce diverse problems in the thoracic wall, and local recurrence is most frequent at the mastectomy site

Altered patterns of expression of members of the heterogeneous nuclear ribonucleoprotein (hnRNP) family in lung cancer

hnRNP A2/B1 has been suggested as a useful early detection marker for lung carcinoma. hnRNP A2/B1 is a member of a large family of heterogeneous nuclear ribonucleoproteins (hnRNP proteins) involved in a variety of functions, including regulation of transcription, mRNA metabolism, and translation. In lung cancer, we have evaluated the expression and cellular localization of several members of the hnRNP family, hnRNP A1, A2, B1, C1, C2 and K. 16 cell lines (SCLC and NSCLC) and biopsies from 32 lung cancer patients were analyzed. Our results suggest that, besides hnRNP A2/B1, the expression of other members of the hnRNP family is altered both in SCLC and NSCLC. In the biopsies, negative or low expression of the hnRNP proteins analyzed was observed in normal epithelial cells whereas lung cancer cells showed highly intense nuclear or cytoplasmic immunolocalization. In all the lung cancer cell lines, the mRNA for all the hnRNP proteins was detected. In general, higher levels of hnRNP mRNAs were found in SCLC as compared with NSCLC. Our results also suggest that the expression and processing of each hnRNP protein in lung cancer is independently regulated and is not exclusively related to proliferation status. In SCLC cell lines, hnRNP A1 protein expression correlated with that of Bcl-x(L). In the lung cancer cell lines, hnRNP K protein localization varied with the cellular confluence

Combined surgical approach for sarcoma lung metastasis with atrial involvement

A 20-year-old patient, who had been treated for a femur sarcoma with pulmonary metastases 8 years before, arrived at our institution with a new metastatic hilar lung nodule. During the standard lobectomy procedure an unexpected atrial invasion by the tumor was discovered. Intraoperative transesophageal echocardiography (TEE) showed a big pediculated tumor in the atrium. Cardiopulmonary bypass (CPB) was required in order to safely resect the atrial wall with the tumor. The atrial defect was repaired with a pericardial patch. Postoperative course was uneventful. After 14 months, the patient is asymptomatic and free of disease

Colgajo DIEP de cobertura tras mastectomía de limpieza paliativa en cáncer de mama localmente avanzado

The DIEP reconstruction offers great cutaneous extension. It can be a resource in highly selected cases of locally advanced breast cancer in which surgery becomes the main treatment

ERK1/2 is activated in non-small-cell lung cancer and associated with advanced tumours

Activation of the ERK1/2 pathway is involved in malignant transformation both in vitro and in vivo. Little is known about the role of activated ERK1/2 in non-small cell lung cancer (NSCLC). The purpose of this study was to characterise the extent of the activation of ERK1/2 by immunohistochemistry in patients with NSCLC, and to determine the relationship of ERK1/2 activation with clinicopathological variables. Specimens from 111 patients with NSCLC (stages I-IV) were stained for P-ERK. Staining for epidermal growth factor receptor (EGFR) and Ki-67 was also performed. In all, 34% of the tumour specimens showed activation for ERK1/2, while normal lung epithelial tissue was consistently negative. There was a strong statistical correlation between nuclear and cytoplasmic P-ERK staining and advanced stages (P<0.05 and P<0.001, respectively), metastatic hilar or mediastinal lymph nodes (P<0.01, P<0.001), and higher T stages (P<0.01, P<0.001). We did not find correlation of nuclear or cytoplasmic P-ERK staining with either EGFR expression or Ki-67 expression. Total ERK1/2 expression was evaluated with a specific ERK1/2 antibody and showed that P-ERK staining was not due to ERK overexpression but rather to hyperactivation of ERK1/2. Patients with a positive P-ERK cytoplasmic staining had a significant lower survival (P<0.05). However, multivariate analysis did not show significant survival difference. Our study indicates that nuclear and cytoplasmic ERK1/2 activation positively correlates with stage, T and lymph node metastases, and thus, is associated with advanced and aggressive NSCLC tumours

Early lung cancer detection using spiral computed tomography and positron emission tomography

RATIONALE: Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised. OBJECTIVE: To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (> 7 mm), growing nodules. RESULTS: A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non-small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%. CONCLUSION: A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions