Search

Background Complexities in TNM staging in epithelioid malignant pleural mesothelioma (MPM) may lead to errors in treatment selection, leading to major surgical interventions in patients with low survival expectations. Methods Sixty-nine stage I epithelioid MPM patients, including 27 patients treated with pleurectomy/decortication (P/D) and multimodal therapy (MMT) (the P/D [MMT] group), and 42 patients treated with chemotherapy or chemoradiotherapy (the CRT group), were included in the study. After an initial evaluation of overall survival, all patients were grouped in terms of histopathological parameters and treatment types, and then, a secondary survival evaluation was performed for the groups. Results Forty-one patients were male, the mean age was 61.8 years. The median survival time was 26 months in the P/D (MMT) group, and 19.6 months in the CRT group, but the difference was not statistically significant. After grouping according to pathological criteria, a median survival time of 32.4 ± 2.9 months in the P/D (MMT) group and 21.9 ± 3.2 months in the CRT group was obtained among patients with histopathological low-grade tumors. Among patients with high-grade tumors, the median survival time was 18.3 ± 2.6 months in the P/D (MMT) group and 17 ± 4.4 months in the CRT group. Among patients with low-grade tumors, the P/D (MMT) group had longer survival. Median survival times were similar among patients with high-grade tumors. Conclusion In epithelioid MPM, histopathological grading by video-assisted thoracic surgery pleural biopsy can prove accurate in selecting patients for P/D and MMT.

OBJECTIVE: This study aims to retrospectively evaluate the survival criteria of 39 patients operated on for thymoma concerning age, sex, symptoms, smoking history, operation type, presence of MG, thymic pathology, length of hospital stay, the diameter of the mass, stage, RT and/or KT, and complications according to WHO classification and Masaoka staging.MATERIAL AND METHODS: In this study, 50 patients who were operated on for thymoma in Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital between 2000 and 2010 were examined. 11 patients were excluded from the study because 3 patients refused postoperative treatment; 3 patients discontinued treatment, and the information about 5 patients was not available. As a result, 39 patients (25 males, 14 females) were included in the study. Complete resection was performed in 35 cases, and incomplete resection was performed in 2 cases. Besides, surgical diagnostic procedures were performed in 2 cases. Medial sternotomy was performed in 30 cases (76.9%), right thoracotomy in 6 cases (15.4%) and left thoracotomy in 3 cases (7.7%).RESULTS: The patients’ ages ranged from 23 to 88 years. The mean age of the patients was 51.3 ± 15.3 (years). 25 (64.1%) of them were male and 14 (35.9%) of them were female. Postoperative complications occurred in 6 patients (15.4%) (1 patient had hoarseness due to recurrent nerve injury; 4 patients had atelectasis, and 1 patient had pneumothorax on the 6th postoperative day). One patient died due to intraoperative myocardial infarction. In our WHO histopathological classification cases, 8 (20.5%) type A, 5 (12.8%) type AB, 4 (10.3%) type B1, 1 (2.6%) type B1 / B2, 9 (23.1%) type B2, 4 (10.3%) type B2 / B3, 5 (12.8%) B3, 3 (7.7%) C were determined respectively. 9 (23.1%) type B2 and 8 (20%, 5) type A were the most common groups. Masaoka clinical stage was 11 (28.2%) stage 1, 10 (25.6%) stage 2A, 8 (20.5%) stage 2B, 8 (20.5%) stage 3, 2 (5.1%) stage 4. The 3-year, 5-year and 8-year survival rates were as follows; 96.5%, 75.1%and 67.6% of the patients. The mean life expectancy was 102.8months. Crude mortality rate was 20.5% (8/39). In our study,according to Masaoka staging, type 1 and 2A were the mostcommon while type B2 and type A were the most common according to WHO classification. The 3, 5 and 8-year survival rates of the patients were found as follows; 96.5%, 75% and 67.6%CONCLUSIONS: The best results in thymoma are obtained through total surgical resection. There was no positive effect of incomplete resection on survival. Prognosis is related to stage, histology and whether the surgical resection is complete. Prognosis is very promising in early-stage tumors., AMAÇ:Bu çalışmanın amacı timoma nedeniyle opere edilen 39 hastanın retrospektif olarak, cinsiyet, yaş, sigara içme hikayesi, semptom, operasyon şekli, Myastenia Graves (MG) varlığı, timik patoloji, hastanede kalış süresi, kitlenin çapı, evre, Radyoterapi (RT) ve/veya kemoterapi (KT) alma durumu, komplikasyon, WHO sınıflamasına ve Masaoka evrelemelerine göre sağkalım sürelerini incelemektir.GEREÇ VE YÖNTEM: Bu çalışmada Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi 2000-2010 yılları arasında timoma nedeniyle opere edilen 50 hasta incelendi. 3 hastanın postoperatif tedaviyi red etmesi, 3 hastanın tedaviyi yarım bırakması, 5 hastanın da bilgilerine ulaşılamaması nedeniyle çalışmadan çıkarıldı ve 39 (25 erkek, 14 bayan) hasta çalışmaya dahil edildi. Olguların 35’ine komplet rezeksiyon, 2 olguya inkomplet rezeksiyon uygulandı, 2 olguda ise sadece cerrahi ile tanısal işlem yapılabildi. 30 olguya (%76,9) median sternotomi yapılırken, 6 olguya (%15,4) sağ torakotomi, 3 olguya (%7,7) ise sol torakotomi yapıldı.BULGULAR: Hastaların yaşları 23 ile 88 arasında, ortalaması 51,3±15,3 (yıl) idi. 25’i (%64,1) erkek, 14’ü (%35,9) kadındı. Olguların 6’sında (%15,4) cerrahi sonrasında komplikasyon gelişti (1 hastada rekürren sinir yaralanmasına bağlı ses kısıklığı, 4 hastada atalektazi, 1 hastada postoperatif 6. günde pnömotoraks meydana geldi). 1 hasta intraoperatif myokard enfarktüsü sonucu exitus oldu. WHO histopatolojik sınıflama olgularımızda sırasıyla: 8 (%20,5) tip A, 5 (%12,8) tip AB, 4 (%10,3) tip B1, 1 (%2,6) tip B1/B2, 9 (%23,1) tip B2, 4 (%10,3) tip B2/B3, 5 (%12,8) B3, 3 (%7,7) C olup, 9 (%23,1) tip B2 ve 8 (%20,5) tip A en sık rastlanan gruptu. Masaoka klinik evre ise 11 (%28,2) evre 1, 10 (%25,6) evre 2A, 8 (%20,5) evre 2B, 8 (%20,5) evre 3, 2 (%5,1) evre 4 şeklindedir. Olguların 3 yıllık, 5 yıllık ve 8 yıllık sağkalım hızları sırasıyla; %96,5, %75,1 ve %67,6 olarak saptandı. Ortalama yaşam süresi ise 102,8 ay olarak tespit edildi. Kaba ölüm oranı ise %20,5 (8/39) olarak saptandı.SONUÇ: Timomada öncelikli olarak komplet cerrahi rezeksiyon yapılmalıdır. İnkomplet rezeksiyonun sağkalım üzerinde olumlu bir etkisi bulunmamaktadır. Prognozda evresi, histolojik tipi ve cerrahinin şekli belirleyicidir. Erken evre tümörlerde prognoz oldukça iyidir. Çalışmamızda Masaoka evrelemesine göre en sık evre 1 ve 2A, WHO sınıflamasına göre de en sık tip B2 ve tip A tespit edildi. Olguların 3, 5 ve 8 yıllık sağkalım hızları sırasıyla; %96,5, %75 ve %67,6 olarak bulundu.

Nearly one-third of the patients with interstitial lung disease (ILD) require surgical biopsy for a definite diagnosis. Video-assisted thoracoscopic surgical (VATS) biopsy has replaced open lung biopsy, but the number of biopsy required to achieve an accurate diagnose is controversial.Our study aims to show that a well-planned single VATS biopsy is as effective as multiple biopsies for the accurate diagnosis of ILD by reduced days of hospital stay.We included 111 patients with suspected ILD who underwent VATS biopsy in our study. Patients were separated into three groups according to the number of biopsies obtained. The differences between groups for diagnostic yield, mean time for chest tube removal, perioperative complications, and approximate volume per biopsy were analyzed statistically.Eighteen single, 74 double, and 19 triple biopsies were made. Mean times of chest tube removal and hospital stay for single, double, and triple biopsy were 3.5, 4.8, and 6.1 days respectively. The number of biopsy and length of hospital stay was strongly related (Although classical knowledge suggests multiple biopsies from different locations of the lung are essential, recent reports have shown that the site and the number of biopsy are not as effective as previously thought in achieving the diagnosis for ILD. Our results show that a "single" biopsy, decided with multidisciplinary evaluation, is an effective and safe diagnostic tool, with lesser days of hospital stay.1. The classical knowledge that multiple biopsies should be taken from different regions of the lung in the diagnosis of interstitial lung diseases has changed over time.2. Diagnostic concordance between multiple biopsy specimens is above 85%.3. A "single" biopsy, decided with multidisciplinary evaluation, is an effective and safe diagnostic tool with lower days of hospital stay.

Objectives: This study aimed to evaluate 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) findings in the differential diagnosis of pulmonary carcinoids and pulmonary hamartomas. Methods: 18F-FDG PET/CT findings of 34 patients with pulmonary carcinoids (12 atypical, 22 typical) and 32 patients with pulmonary hamartomas were retrospectively evaluated. Both mean diameter and mean maximum standardized uptake value (SUVmax) of hamartomas and carcinoids were compared by Mann-Whitney U and Kruskall-Wallis H tests. Results: The mean longest diameter of atypical carcinoids (3.5±1.7 cm) was higher than that of hamartomas (2.1±1 cm) (p=0.038). No significant difference was found between the mean diameter of typical carcinoids and mean diameter of hamartomas (p=0.128). The mean SUVmax of atypical carcinoids (5.97±3.7) and typical carcinoids (4.22±1.7) were higher than those of hamartomas (1.65±0.9) (p=0.002 and p=0.003, respectively). There were collapse/consolidation in 55.8%, bronchiectasis or mucoid impaction in 47%, and air trapping in 14.7% in the peripheral parenchyma of the 34 carcinoids. Collapse/consolidation was detected in a patient with endobronchial hamartoma, and other finding was not found in the parenchyma around hamartomas. Conclusion: The 18F-FDG uptake of pulmonary carcinoids can vary from minimal to intense. 18F-FDG uptake can be seen in pulmonary hamartomas. However, the mean SUVmax of atypical carcinoids and typical carcinoids were higher compared to hamartomas. Pulmonary carcinoid must be suspected in cases with accompanying bronchial obstruction findings in the periphery of the mass.

Objective: Among the primary salivary gland tumors of the tracheo-bronchial system, the most common ones are adenoid cystic carcinoma and mucoepidermoid carcinomas. In this study, it is aimed to evaluate the clinicopathological differences between these 2 tumors. Material and Methods: The study was conducted retrospectively in our clinic between January 2009 and December 2019, according to the World Health Organization 2015 classification 14 cases of primary salivary gland tumors of the tracheo-bronchial system and diagnosed with surgically resected adenoid cystic carcinoma and mucoepidermoid carcinoma were included in the study.Results: In the study the average age of 14 cases is 37. Eight of the patients are female and 6 of them are male. Nine of the cases were mucoepidermoid carcinoma and 5 were adenoid cystic carcinoma. While 2 of the 14 patients included in the study were being died, 12 of them were being followed up and treated. The diagnosis of 2 patients who were died was adenoid cystic carcinoma.Conclusion: Primary salivary gland tumors of the tracheo-bronchial system are rarely seen, usually presented in the literature as case reports. The most common tumors in this group are adenoid cystic carcinoma and mucoepidermoid carcinoma. Complete lung resection with negative surgical margins for the primary salivary gland tumors of the tracheo-bronchial system is an effective treatment method. The most important factor affecting survival rates is whether the surgical margins in complete lung resection for adenoid cystic carcinoma are negative or not, whereas in mucoepidermoid carcinoma case it is the grade of the tumor, Amaç: Trakeo-bronşiyal sisteminin primer tükürük bezi tümörleri içerisinde en sık görülen adenoid kistik karsinom ve mukoepidermoid karsinomlardır. Bu çalışmada, bu 2 tümör arasındaki klinikopatolojik farkların değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Retrospektif olarak yapılan çalışmaya kliniğimizde Ocak 2009 ile Aralık 2019 tarihleri arasında Dünya Sağlık Örgütü 2015 sınıflamasında, trakeo-bronşiyal sisteminin primer tükürük bezi tümörlerinden olan ve cerrahi olarak rezeke edilmiş adenoid kistik karsinom ve mukoepidermoid karsinom tanısı alan 14 olgu çalışmamıza dâhil edildi. Bulgular: Çalışmadaki 14 olgunun yaş ortalaması 37’dir. Hastaların 8’i kadın 6’sı erkektir. Olguların 9’u mukoepidermoid karsinom 5’i ise adenoid kistik karsinom idi. Araştırmaya dâhil edilen 14 olgunun 2’si eksitus olurken, 12’sinin takip ve tedavileri devam etmektedir. Eksitus olan 2 olgunun tanısı adenoid kistik karsinom idi.Sonuç: Trakeo-bronşiyal sisteminin primer tükürük bezi tümörleri genellikle olgu sunumları şeklinde nadir bulunmaktadır. Bu grupta yer alan en sık tümörler adenoid kistik karsinom ve mukoepidermoid karsinomdur. Trakeo-bronşiyal sisteminin primer tükürük bezi tümörleri için etkin tedavi yöntemi cerrahi sınırlar negatif olacak şekilde komplet akciğer rezeksiyonudur. Sağ kalım oranlarını en çok etkileyen faktör adenoid kistik karsinom için komplet akciğer rezeksiyonunda cerrahi sınırların negatif olup olmaması iken mukoepidermoid karsinomda ise tümörün derecesidir

Benign metastasizing leiomyoma is exceedingly rare. Pulmonary benign metastasizing leiomyoma is defined as the metastasis of leiomyoma to the lung tissue. It has a benign histological character, but the presence of metastasis is contradictory. First reported in 1937, it is generally seen among women of young reproductive age and premenopausal women who have undergone uterine leiomyoma or hysterectomy, and the most common site of metastasis is the lung. The prognosis is generally very favorable, and it rarely undergoes a malignant transformation. However, various studies suggest that pulmonary and pleural leiomyoma may cause acute respiratory failure. Radiological findings have a wide spectrum ranging from primary malignant neoplasms to metastatic diseases. Benign metastasizing leiomyoma is usually incidentally found on chest x-rays, and it appears as nodules arising from the benign proliferation of smooth muscles. Here, we present a 46-year-old patient who had a hysterectomy 15 years ago due to uterine leiomyoma and was recently diagnosed with benign leiomyoma which metastasized to the lung. It should be kept in mind that benign leiomyomas with pulmonary metastasis may rarely undergo malignant transformation.

BACKGROUND/AIM Large-cell neuroendocrine carcinoma (LCNEC) of the lung is a relatively uncommon and aggressive subset of pulmonary neuroendocrine tumors, which include typical and atypical carcinoid, and small-cell lung cancer. LCNEC of the lung accounts for no more than 1% of all lung cancers. LCNECs show features of high-grade neuroendocrine tumors and patients with LCNEC have a very poor prognosis. MATERIALS AND METHODS Twenty-five patients (22 males and 3 females; mean years 60.7; range 48 to 77 years) who underwent pulmonary resection for large-cell neuroendocrine carcinoma between January 2004 and December 2014 were investigated retrospectively. RESULTS Type of surgery, pathologic TNM stage, adjuvant chemotherapy, time of recurrence, site of recurrence, response to treatment, and long-term results were evaluated. The longest patient follow-up period was 83 months. One-, two-, and three-year survival rates of these patients were, respectively, 80.95%, 76.47%, and 50%. CONCLUSION Complete surgical resection is the treatment of choice for early-stage LCNEC and chemotherapy after radical surgical treatment improves survival. Follow-up periods after surgery adjuvant chemotherapy will prevent recurrence and patients may survive for many years if complete surgical resection and adjuvant chemotherapy are possible.

A 78-years-old man presented with weight loss, dyspnea, cough and hemoptysis. He was an ex-smoker with a smoking history of 30 pack-years. Imaging studies revealed an endoluminal carinal mass and a tumoral mass arising from the posterior wall of the trachea was observed bronchoscopically. Endoscopic argon plasma coagulation was performed to take biopsies and to regain the airway passage. Recanalisation of the right and left main bronchi and the trachea was achieved together with resection of more than 90% of the tumoural mass. Microscopically, the tumor was composed of fascicular pattern of spindle cells with atypical mitotic figures and nuclear pleomorphism, positively reactive to epithelial membrane antigen supporting a diagnosis of tumour with epithelial differentiation. These findings supported the diagnosis of a spindle cell sarcomatoid carcinoma of trachea. Spindle cell carcinoma cases are reported in many sites, such as head and neck region, larynx, digestive tract, breast, kidney, genital tract, skin and lung, but to our knowledge, not in trachea. Primary malignant tracheal tumours consist mainly of squamous cell carcinoma and adenoid cystic carcinoma and generally have an aggressive course with poor prognosis. We report the first presentation of a spindle cell sarcomatoid carcinoma of trachea together with the clinical course of the patient.

Amaç: Bu çalışmanın amacı pür bronkioloalveolar akciğer karsinomlu (BAK) hastalarda patolojik ve radyolojik bulgular arasındaki ilişkiyi değerlendirmektir. Yöntem ve Gereç: Pür BAK’lı hastaların patolojik ve radyolojik bulguları retrospektif olarak incelendi. Bulgular:Üç yılda pür BAK tanısı alan 26 hastanın dosyası, patolojik örnekleri ve bilgisayarlı filmleri incelendi. Musinöz patoloji ile diffüz radyolojik patern, non-musinöz patoloji ile soliter nodül/kitle/kavitasyon arasında istatistiksel olarak anlamlı ilişki vardı (X2 = 15,143, P = 0,004). Radyolojk lezyonla tümörün lenfositik infiltrasyonu arasında istatistiksel olarak anlamlı ilişki bulunmadı (X2 = 10,057, P = 0,122). Radyolojik bulgularla ile patolojik olarak skleroz varlığı arasında istatistiksel olarak anlamlı ilişki vardı (X2 = 6,229, P = 0,044). Skleroz varlığında radyolojik olarak soliter nodül/kitle/ kavitasyon daha sık izlendi. Sonuç: Çalışmamızda bronkioloalveolar karsinomun müsinöz subtipi radyolojik olarak diffüz paternle korele iken, non-müsinöz subtipi ve sklerozis varlığı soliter nodül/kitle/kavitasyonla ilişkili bulundu. Ancak aralarında yüzde yüz ilişki yoktur. Bu nedenle hastalığın biyolojik davranışını daha iyi anlamak için moleküler ve genetik çalışmalar gerekmektedir. Aim: To assess the correlation between pathological and radiological findings in patients with pure bronchioloalveolar carcinoma (BAC). Materials and Methods:We retrospectively evaluated the pathological and radiological findings in patients with pure BAC. Results: We reviewed the case records, pathological specimens, and computer files of 26 patients with a pathologic diagnosis of pure BAC during a 3-year period. There was a statistically significant relationship between pathological and radiological findings (X2 = 15.143, P = 0.004). There was a correlation between mucinous pathology and diffuse pattern, as well as between non-mucinous pathology and solitary nodule/mass/cavitation. A statistically significant relationship between lymphocytic infiltration of the tumor and radiological findings was not observed (X2 = 10.057, P = 0.122). A statistically significant relationship between the presence of sclerosis and radiological findings was observed (X2 = 6.229, P = 0.044). In the presence of sclerosis, solitary nodule/ mass/cavitation radiological findings were seen more frequently. Conclusions: A diffuse radiological pattern was correlated with BAC mucinous subtype, while solitary nodule/mass/cavitation was correlated with non-mucinous pathology and the presence of sclerosis; however, we could not define a 100% relationship between them. In order to understand the biological nature of the disease, additional molecular and genetic studies are required.

Sixty-seven year old male patient has attended with cough and sputum complaint. He had been operated because of transitional cell urinary bladder carcinoma four years ago. He had previous medical history of pulmonary tuberculosis 27 years ago. In chest X-ray, multiple cavitary appearances were present. In computerized tomography (CT) of the thorax, bilateral multiple cavities were seen. Sputum smear examinations for acido resistant bacilli (ARB) were negative for nine times. CT guided fine needle aspiration biopsy was performed and he was diagnosed as "pulmonary metastasis of transitional cell urinary bladder cancer". This patient is presented because of the interesting radiological appearance and rare presentation of the case.

Twenty seven years old woman was admitted to our hospital with dyspnea, severe hemoptysis and iron deficiency anemia. The chest X-ray showed bilateral interstitial markings with homogenous infiltration at right costodiafragmatic sinus. The patient was investigated for all alveolar hemorrhagic syndromes. The diagnosis of idiopathic pulmonary haemosiderosis (IPH) was made by open lung biopsy. IPH usually presents in infancy or within the first decade of life and is unknown aetiology. It is most common between ages 1-17 and exceedingly rare in adults. Clinical presentation of IPH varies from an insidious onset with anemia, cough, dyspnea to a fulminant onset with recurrent acute hemoptysis. Histological confirmation with open lung biopsy is often necessary for definite diagnosis.

A 63-year-old woman was admitted to our clinic with arthralgia, microhematuria and a pleural based solid mass in lower lobe basal segment of right lung seen in computerised tomogram of thorax. She was diagnosed as Wegener's granulomatosis by histopathological findings of right thoracotomy, wedge resection and decortication. The patient had positive antineutrophil cytoplasmic antibodies (c-ANCA) in serum and tissue specimens. Histopathologic examination of the renal biopsy specimen revealed the diagnosis of tubulointerstitial nephritis. We report this case because of the unusual histologic type of renal involvement by reviewing the literature.