Primary Pulmonary Mucinous Cystadenocarcinoma: A Case Report

Primary pulmonary mucinous cystadenocarcinoma (PMCAC) is an extremely rare cystic neoplasm. A case of a 56-year-old male with a cystic lesion of the right lower lobe is described. Preoperative fine needle aspiration cytology and bronchoscopy were inconclusive. The patient underwent a formal right lower lobectomy and mediastinal lymph node dissection. Diagnosis was established intraoperatively. The biological behavior of primary PMCAC is unknown. Therefore, careful long-term follow-up is considered necessary because of lack of experience globally

Renal Artery Thrombosis following Lobectomy for Lung Cancer

Acute renal arterial thrombosis is a rare but very urgent situation demanding immediate treatment. It is characterized by unspecific symptomatology which often misleads the clinicians. As a result, precious time can be lost until the correct diagnosis is reached. The case of a 53-year-old female who underwent a left upper lobectomy for lung cancer is presented. On the third postoperative day, the patient began to complain of a flank pain located at the lower side of the left hemithorax and the nearby lumbar area. A renal arterial thrombosis was finally diagnosed and subcutaneous low molecular weight heparin was started immediately. The patient was discharged two weeks later and anticoagulation therapy with warfarin was given. Six months later, renal function remains satisfying and the patient is free of any symptoms. This is probably the first case in English literature of renal arterial thrombosis following lobectomy for lung cancer

Primary glomangiosarcoma of the lung: A case report

<p>Abstract</p> <p>Background</p> <p>Glomus tumor is an uncommon neoplasm derived from cells of the neuromyoarterial glomus or glomus body. Most glomus tumours occur in the dermis and subcutaneous tissues. A case of a primary pulmonary glomus tumour originating in the right upper lobe is presented.</p> <p>Case presentation</p> <p>A 74-yr-old male was admitted with siccus cough, dyspnea and right-sided chest pain. Computed tomography of the thorax revealed a 4 cm growth of the right upper lobe. Fiberoptic bronchoscopy demonstrated an endobronchial hypervascular mass causing obstruction of the apical segmental bronchus. Pathology report was consistent with pulmonary glomus tumor. The patient underwent a typical right upper lobectomy with mediastinal lymph node dissection. Twelve months later he is free of disease.</p> <p>Conclusion</p> <p>Occasionally glomus tumors can occur in extracutaneous sites such as the gastrointestinal tract, bone, genitourinary system and respiratory tract. Primary pulmonary glomus tumors are very rare (our case is the 19^thone presented in the international literature) and are often confused with other solid neoplasms such as carcinoids, hemangiopericytomas and tumors belonging to the family of Ewing's sarcoma/primitive neuroectodermal tumours.</p

Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: A case report

<p>Abstract</p> <p>Background</p> <p>Reduction in visual acuity combined with blurred vision is rarely the first sign of lung cancer and very few cases have been announced globally.</p> <p>Case presentation</p> <p>A case of a 46-year-old man who admitted with blurred vision is presented. His medical history, apart from a mild gastritis under treatment was negative. Ocular examination revealed a decrease in visual acuity due to a choroidal tumor. Further image body scans demonstrated a right lung lesion with dissemination to other organs. Diagnosis of a non-small cell lung cancer established after a VATS biopsy carried out.</p> <p>Conclusion</p> <p>Blurred vision due to choroidal metastasis as the primary symptom of lung cancer is very uncommon. A great index of suspicion is essential when a choroidal lesion appears.</p

Facial skin metastasis due to small-cell lung cancer: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer. They are an important finding and are not often the first sign leading to diagnosis.</p> <p>Case presentation</p> <p>We describe the case of a 64-year-old male patient who presented with dyspnea, pleuritic pain, loss of weight and a nodule on his left cheek. A chest X-ray revealed a left upper lobe mass with mediastinal lymphadenopathy. Excision biopsy of the facial nodule revealed small-cell lung carcinoma. Palliative chemo-radiotherapy was administered and the patient survived for 12 months.</p> <p>Conclusion</p> <p>A high index of suspicion is necessary for the early detection of facial cutaneous metastases. Appropriate treatment may prolong patient survival.</p

Paraneoplastic pemphigus regression after thymoma resection

<p>Abstract</p> <p>Background</p> <p>Among human neoplasms thymomas are associated with highest frequency with paraneoplastic autoimmune diseases.</p> <p>Case presentation</p> <p>A case of a 42-year-old woman with paraneoplastic pemphigus as the first manifestation of thymoma is reported. Transsternal complete thymoma resection achieved pemphigus regression. The clinical correlations between pemphigus and thymoma are presented.</p> <p>Conclusion</p> <p>Our case report provides further evidence for the important role of autoantibodies in the pathogenesis of paraneoplastic skin diseases in thymoma patients. It also documents the improvement of the associated pemphigus after radical treatment of the thymoma.</p

Nine years experience in surgical approach of leiomyomatosis of esophagus

<p>Abstract</p> <p>Background</p> <p>Leiomyomas of esophagus, although rare, are the most frequent benign tumors of esophagus. Aim of this study is the presentation of 7 patients with esophageal leiomyomas who underwent surgical treatment during a 9-year period.</p> <p>Methods</p> <p>Epidemiological data (sex, age), the presenting symptoms, diagnostic examinations, tumor location, histopathological findings and the safety and efficacy of surgical resection are analyzed and assessed.</p> <p>Results</p> <p>5 men and 2 women with mean age of 56.9 years were operated. In 3 cases the tumor was located at the lower esophagus, while in the other 4 cases, the leiomyoma was found at the median third of esophagus. 4 patients had severe symptoms related to the leiomyoma, such as dysphagia and epigastric pain. All patients underwent a right postolateral thoracotomy with enucleation of the lesion. None of them received resection of part of the esophagus. The mean diameter of the resected tumors was 4.3 cm. The dimensions of leiomyomas were immediately associated with the symptoms. In no case was detected malignancy or recurrence. All patients were relieved from their symptoms, while postoperative morbidity and mortality did not occur.</p> <p>Conclusions</p> <p>Esophageal leiomyoma is a benign tumor, which causes symptoms only if its size becomes large. Surgical enucleation is considered to be safe and effective, without complications.</p

Cutaneous skull metastasis from uterine leiomyosarcoma: a case report

<p>Abstract</p> <p>Background</p> <p>Cutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer.</p> <p>Case presentation</p> <p>A 52-year-old woman who admitted with a lung and a skull skin nodule is presented. She had a known diagnosis of uterine leiomyosarcoma following an extended total hysterectomy two years ago. Excision biopsy of both nodules revealed metastatic disease.</p> <p>Conclusion</p> <p>The appearance of a cutaneous nodule in a patient with a history of uterine leiomyosarcoma might indicate a metastatic tumor lesion. Biopsy and immunohistochemistry are essential for correct diagnosis.</p

Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: a review of 400 cases

<p>Abstract</p> <p>Background</p> <p>Malignant pleural effusion is a common sequelae in patients with certain malignancies. It represents a terminal condition with short median survival (in terms of months) and the goal is palliation. Aim of our study is to analyze morbidity, mortality and life expectancy following videothoracoscopic talc poudrage.</p> <p>Materials and methods</p> <p>From September 2004 to October 2009, 400 patients underwent video-assisted thoracic surgery (VATS) for malignant pleural effusion. The conditions of patients were assessed and graded before and after treatment concerning morbidity, mortality, success rate of pleurodesis and median survival.</p> <p>Results</p> <p>The median duration of follow up was 40 months (range 4-61 months). All patients demonstrated notable improvement in dyspnea. Intraoperative mortality was zero. The procedure was well tolerated and no significant adverse effects were observed. In hospital mortality was 2% and the pleurodesis success rate was 85%. A poor Karnofsky Performance Status and delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors for in-hospital mortality. The best survival was seen in breast cancer, followed by ovarian cancer, lymphoma and pleural mesothelioma.</p> <p>Conclusions</p> <p>Video-assisted thoracoscopic talc poudrage is an effective and safe procedure that yields a high rate of successful pleurodesis and achieves long-term control with marked dyspnea decrease.</p

Clinical and laboratory study of the minimal in comparison with the conventional extracorporeal circulation in coronary artery bypass grafting

Minimal extracorporeal circulation (MECC) represents a technologicallyadvanced circuit designed to eliminate adverse effects of cardiopulmonarybypass. The aim of this study is to compare minimal (MECC) versusconventional (CECC) extracorporeal circulation in terms of early postoperativeclinical and laboratory outcome, associated major adverse events and inpromoting fast-track recovery in patients undergoing elective coronary arterybypass grafting. This is a prospective randomized controlled trial including 200 patientsoperated for severe coronary artery disease under extracorporeal circulation atthe Cardiothoracic Department, Aristotle University of Thessaloniki. Group Aincluded 100 patients operated on MECC, while group B consisted of 100patients operated with use of conventional extracorporeal circulation.Regarding fast-track recovery trial, 120 patients (60 in each group) fulfilledinclusion criteria. Both groups were similar in terms of demographics andpreoperative characteristics. Perioperative clinical variables were recordedand analyzed, as well as patients’ haematological profile (Hct, Hb, Plt, LDH),coagulation profile (INR, PT, aPTT), markers indicative of myocardial damage(CK, CK-MB, SGOT), hepatic (SGPT) and renal dysfunction (serumcreatinine). Parameters were assessed: preoperatively (T1), immediately afterthe operation (T2), on the first postoperative day (T3) and on the day ofdischarge (T4). The incidence of major adverse events (postoperativemyocardial infarction, renal failure, stroke, death) was calculated in eachgroup, especially in high-risk patients (age > 65 years, ejection fraction ≤ 40%, EuroSCORE II > 5%). Finally, the rates of successful fast-track recovery (earlyextubation during the first 6 hours and discharge from Cardiac Recovery Unitduring the first 24 hours) were compared between the two subgroups. Use of MECC was associated with shorter duration of cardiopulmonarybypass (p 65έτη, κλάσµα εξώθησης ≤ 40%, EuroSCORE II > 5%). Παράλληλα,συγκρίθηκαν οι δύο υποοµάδες ασθενών που συµµετείχαν στο πρωτόκολλοταχείας ανάρρωσης (πρώιµη αποδιασωλήνωση εντός 6 ωρών και µετακίνησηαπό τη Μονάδα εντός 24 ωρών) ως προς το ποσοστό επιτυχίας.Η χρησιµοποίηση του κυκλώµατος MECC διαπιστώθηκε ότισυνδυάζεται µε βραχύτερη διάρκεια καρδιοπνευµονικής παράκαµψης(p<0,001), µειωµένη παραµονή στη Μονάδα (p<0,001), µικρότερη διάρκειαµηχανικού αερισµού (p<0,001), ελαττωµένη συχνότητα εµφάνισης κολπικήςµαρµαρυγής (p=0,016), καθώς και µειωµένη ανάγκη για µετάγγιση αίµατος είτεδιεγχειρητικά (p<0,001) είτε µετεγχειρητικά (p=0,002). Η οµάδα MECCχαρακτηρίστηκε επίσης από σηµαντικά υψηλότερες τιµές αιµατοκρίτηµετεγχειρητικά και αιµοσφαιρίνης, ενώ ο αριθµός των αιµοπεταλίωνδιατηρήθηκε σηµαντικά υψηλότερος. Στην οµάδα ασθενών που υποβλήθηκανσε αορτοστεφανιαία παράκαµψη µε συµβατική Ε/Κ διαπιστώθηκαν σηµαντικάαυξηµένα επίπεδα τιµών της LDH σε όλη τη µετεγχειρητική περίοδο,παράταση του INR, του PT και του aPTT. Παράλληλα, η εφαρµογήκυκλώµατος MECC συσχετίστηκε µε σηµαντικά καλύτερη µυοκαρδιακήπροστασία, η οποία εκφράστηκε µε χαµηλότερα επίπεδα τιµών CK, CK-MBκαι SGOT, ενώ οι ασθενείς στους οποίους χρησιµοποιήθηκε συµβατική Ε/Κ εµφάνισαν σηµαντικά υψηλότερου βαθµού ηπατική δυσπραγία και νεφρικήδυσλειτουργία, όπως µαρτυρούν τα αυξηµένα επίπεδα SGPT και κρεατινίνης.Επιπλέον, η οµάδα MECC παρουσίασε σηµαντικά µειωµένη συχνότηταεµφάνισης µειζόνων ανεπιθύµητων συµβαµάτων (p=0,005), γεγονός το οποίοοφείλεται κυρίως στα ελαττωµένα ποσοστά εµφράγµατος µυοκαρδίου καινεφρικής ανεπάρκειας, ενώ και ο αντίστοιχος σχετικός κίνδυνος εµφάνισηςτους διαπιστώθηκε µειωµένος κατά 77% σε σχέση µε την οµάδα CECC (OR:0,230, p=0,004). Επιπλέον, η χρήση MECC διαπιστώθηκε σηµαντικά ευνοϊκήσε ασθενείς υψηλού χειρουργικού κινδύνου, καθώς βρέθηκε ότι ελαττώνεισηµαντικά τη συχνότητα εµφάνισης µειζόνων ανεπιθύµητων συµβαµάτων. Ησυγκριτική µελέτη της ταχείας ανάρρωσης κατέδειξε ότι η χρησιµοποίηση τουκυκλώµατος MECC αυξάνει την πιθανότητα επιτυχούς ταχείας ανάρρωσηςκατά 4,7 φορές (OR: 4,700, p=0,006) και αποτελεί το µοναδικό ανεξάρτητοθετικό προγνωστικό παράγοντα (OR: 3,800, p=0,011).Συµπερασµατικά, διαπιστώνεται ότι η χρησιµοποίηση κυκλώµατοςMECC υπερτερεί της συµβατικής Ε/Κ ως προς την ελάττωση τωνανεπιθύµητων επιδράσεων στα διάφορα όργανα. Επιπλέον, προστατεύει τουςασθενείς, ειδικά αυτούς που ανήκουν στην οµάδα υψηλού χειρουργικούκινδύνου, µειώνοντας σηµαντικά την εµφάνιση των µετεγχειρητικών µειζόνωνανεπιθύµητων συµβαµάτων, ενώ ταυτόχρονα διευκολύνει µε ασφάλεια τηνταχεία ανάρρωσή τους. Η υπεροχή αυτή µπορεί να αποδοθεί στον προηγµένοτεχνολογικό σχεδιασµό του κυκλώµατος, που αυξάνει τη βιοσυµβατότητα καιελαττώνει την ενεργοποίηση της φλεγµονώδους αντίδρασης