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Pediatric cystic lung lesions have long been a source of confusion for clinicians, radiologists, and pathologists. They encompass a wide spectrum of entities with variable prognostic implications, including congenital lung malformations, pulmonary neoplasms, and hereditary conditions. As our understanding of the developmental and genetic origins of these conditions has evolved, revised nomenclature and classifications have emerged in an attempt to bring clarity to the origin of these lesions and guide clinical management. This review discusses cystic lung lesions and the current understanding of their etiopathogenesis.

Introduction Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. Methods A total of 3307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. Results The mean age of patients was 65.44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. Conclusion Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications.

Sclerosing pneumocytoma (previously called pulmonary sclerosing hemangioma) is a very rare benign pulmonary neoplasm. Diagnosis of this tumor can be problematic especially on the small biopsy specimens. Here, we report a massive 13.5 cm sclerosing pneumocytoma in a 61-year-old female who presented with progressive shortness of breath and underwent lobectomy procedure. Radiological findings, gross and histological features, immunohistochemical staining profile as well as differential diagnoses are discussed in detail. The purpose of this case study is to increase awareness of this entity among physicians and to further aid in proper clinical management.

Purpose To determine the minimal follow-up time point to predict therapeutic response to radiofrequency (RF) ablation of lung tumors. Materials and Methods A retrospective study design was approved by the institutional review board. From January 2008 to January 2010, 78 patients (46 men and 32 women; mean age, 58.9 y) underwent computed tomography (CT)–guided percutaneous RF ablation of pulmonary malignancies. A single RF multitined electrode was used to treat 100 index tumors, 6 primary lesions, and 94 metastatic lesions. CT volumetric measurements of ablated tumors were made before ablation and 24 hours, 3–6 weeks, 3 months, 6 months, 9 months, and 12 months after ablation. An unpaired t test and Spearman rank correlation coefficient were used to analyze the volumetric changes. Results Complete successful ablation was achieved in 80% of index tumors. The mean time to detection of tumor residue or recurrence tumor residue or recurrence was 6.7 months after ablation. In successfully ablated lesions, the mean volume before ablation was 1.81 cm 3 (standard deviation [SD], 1.71); in failed ablation lesions, the mean volume before ablation was 2.58 cm 3 (SD, 2.8) ( P = .42). The earliest statistically significant follow-up time point that showed a difference in the volumetric measurements of failed and successful ablations as well as the earliest significant correlation with the 12-month point was 3 months ( P = .025, Spearman R = 0.72). Secondary tumor control after repeat ablation was statistically significant for lesions ablated at a 3-month interval (four out of five lesions) ( P = .04). Conclusions CT volumetric assessment of ablated tumors revealed that 3 months was the earliest time point that may determine the response of a pulmonary ablation or repeat intervention.

Thoracic tumors are rare in children, and metastatic or malignant conditions must be excluded during the diagnostic evaluation. The majority of primary pulmonary neoplasms in children are malignant; this article primarily addresses benign tumors. Surgical resection is the standard treatment for benign thoracic tumors in children. Thoracotomy is a traditional approach, but the thoracoscopic technique for diagnosis and treatment of thoracic tumors is well established. The term benign tumors can be a misnomer in that although their histology is not malignant, these tumors can be locally aggressive with significant associated morbidity and potential for mortality.

Image-guided thermal ablation therapy has received significant attention for the treatment of many focal primary and metastatic pulmonary neoplasms. This interest has been associated with progressive advances in energy development, approach, technical application and adjuvant therapeutic combinations to improve the outcome results concerning local tumor control, survival rate and symptoms relief. This review provides clinical outline of percutaneous thermal ablation of lung neoplasms using radiofrequency, microwave and laser techniques regarding their principles, theoretical background, devices and techniques, technical problems and recent protocols. Advantages, limitations and technical considerations of each method will be illustrated to provide a practical guideline.

Sclerosing hemangioma of the lung is a rare neoplasm with polymorphic histologic features. Despite various patterns, there are 2 unifying cellular components: "surface cells" and "round cells." Although histogenesis has been debated for decades, most ultrastructural, immunocytochemical, and molecular studies strongly indicate a neoplastic epithelial derivation for both cellular components. Herein, we present a review of sclerosing hemangioma and summarize the essential data regarding histologic, cytologic, and ancillary findings of this distinctive pulmonary neoplasm.

The data presented in this paper have been derived from a carcinogenicity experiment with rats as part of a comprehensive research project focused on experimental studies on the toxicity and carcinogenicity of intratracheally instilled granular dusts [Ernst H, Rittinghausen S, Bartsch W, Creutzenberg O, Dasenbrock C, Gorlitz B-D et al. Pulmonary inflammation in rats after intratracheal instillation of quartz, amorphous SiO 2 , carbon black, and coal dust and the influence of poly-2-vinylpyridine- N -oxide (PVNO). Exp Toxicol Pathol 2002; 54: 109–26; Ernst H, Kolling A, Bellmann B, Rittinghausen S, Heinrich U, Pott F. Pathogenetische und immunbiologische Untersuchungen zur Frage: Ist die Extrapolation der Staubkanzerogenitat von der Ratte auf den Menschen gerechtfertigt? Teil II: Histologie. Abschlussbericht. Umweltforschungsplan des Bundesministeriums fur Umwelt, Naturschutz und Reaktorsicherheit. November 2005. http://www.umweltdaten.de/publikationen/fpdf-l/3033.pdf ]. The results of the standard approach to histological sampling in rodent carcinogenicity inhalation studies were compared to those obtained after supplemental evaluation of step sections at intervals of 250 μm through the entire lung. Seven lung tissue specimens (six sections) each of 251 rats (55 rats of the control group, 53 rats of the group treated with quartz DQ 12, 56 rats of the group treated with quartz DQ 12 and PVNO (poly-2-vinylpyridine- N -oxide), 53 rats of the group treated with amorphous SiO 2 , and 17 rats each of the groups treated with coal dust and carbon black) were evaluated by light microscopy. At least 60 hematoxylin and eosin (H&E)-stained sections per lung were evaluated of 99 female rats (30 rats of the control group, 7 rats each of the groups treated with quartz, quartz and PVNO, and carbon black, 31 rats of the group treated with amorphous SiO 2 , and 17 rats treated with coal dust). For the neoplastic and pre-neoplastic lesions detected in the serial slides an approximate value of the whole tumor volume was calculated. The detection of tumors with a diameter of 0.25 mm was possible. Based on the size distribution of 75 tumor volumes, the probability of detecting a tumor was 86% when using 12 sections. The addition of step sections enhanced the tumor detection rate from 17 to a total number of 44 lung tumors in the quartz-treated rats, from 6 to 10 in the quartz- and PVNO-treated rats, from 4 to 11 in the amorphous SiO 2 -treated rats, and from 4 to 10 in the carbon black-treated rats. Both the tumor multiplicity and the number of rats with pre-neoplastic lesions increased. These additional data corroborated the initial findings in all experimental groups and provided statistically significant results confirming the equivocal evidence of carcinogenic activity of amorphous SiO 2 in female Wistar rats. This technique offered accurate information on the incidence, histological type, size, and location of proliferative lesions in the entire lung, but the benefit must be balanced against the extra financial effort.

El sarcoma sinovial es un tumor pulmonar primario extremadamente raro y con una descripcion basada en un numero limitado de casos, de los que presentamos los hallazgos de dos pacientes diagnosticados por una toracotomia. Uno de los casos fue tratado inicialmente con cirugia, seguido de una recidiva mas tarde controlada con poliquimioterapia y reintervencion tras tres anos de seguimiento, mientras que en el otro la cirugia fue necesaria por presentar una hemoptisis masiva y se asocio a un tratamiento con poliquimioterapia tras el diagnostico de lesiones compatibles con metastasis extrapulmonares.

This paper describes the tomographic appearance of pulmonary lymphomas. We studied the thoracic computed tomographies of ten patients with biopsy-proven diagnoses non-Hodgkin's and Hodgkin's disease. The most common radiologic findings in this series are the alveolar opacities with air bronchograms (n=8). Other manifestations include multiple pulmonary nodules (n=4), thickening of broncho-vascular bundles (n=3) and foci of ground-glass attenuation (n=2). The present series confirms the results published in available literature about the radiographic appearance of the disease.

Chondromas of the lung are rare benign tumors, and fewer than 100 cases with multiple chondromas have been reported since Bateson1 reported the first case. In 1977, J. Aidan Carney from the Mayo Clinic described pulmonary chondroma associated with gastrointestinal stromal tumors (GISTs) and extraadrenal paraganglioma as a syndrome, which was subsequently called the Carney triad.2 Sporadic case reports and a recent analysis demonstrated that the chondromas in the Carney triad usually occur in young women and are multiple, small, peripheral and not endobronchial, and commonly calcified.2,3 As most of the patients with Carney triad are asymptomatic and the pulmonary neoplasm(s) are usually found as incidental lesions on chest radiography, the diagnosis of Carney triad should be considered when multiple pulmonary chondromas are identified. Here, we report a case of Carney triad that initially presented with multiple lesions of the left lung.

Noninvasive papillary endobronchial lesions are among the least common of pulmonary neoplasms. We describe the occurrence of a papillary squamous tumor surrounding an aspirated sunflower seed foreign body, and briefly review the subject of endobronchial papilloma. This tumor should be a red flag for the presence of a foreign body, and foreign body removal may obviate the need for thoracotomy. (Chest 1990; 97:229-30)

One hundred and eighty-eight patients (109 M, 79 F) had transthoracic FNA for radlologlcally-suspected pulmonary neoplasms from Oct.1981 to Dec.1988.Their ages ranged from 2-87 yrs (mean 59.3 yrs). All FNAs were performed by radiologists:guided by X-ray (176) or CT scan (12), with or without the presence of cytotechnldans or cytopathologlsts. Preparation of direct smears and needle washings were divided into 3 groups: (A) prepared by radiologists (56),(B) by cytotechnicians (52).(0 by cytopathologlsts (80 cases since May 1986), followed by immediate staining and interpretation of the samples on site for adequacy of the specimens. The cytologic results of the 188 patients were 108 positive for malignancy, 9 suspicious, 49 negative, 22 Inadequate. Positive results were highest 1n group (C), 70%; compared with 62% and 36% for groups (B) and (A) respectively. However, positive results were unrelated to tumor size. There were no false positive cytologic results but 8 cases reported negative(7) or suspicious(7) were confirmed to be 5 lung ca and 3 metastatic malignancies.FNA showed a sensitivity of 93% and specificity of 100% in the diagnosis of malIgnancy. Primary ca comprised 57% and metastatic malignancy 43% of 116 final malignant diagnoses. FNA also made correct diagnoses of TB in 6 cases which were clinically malignant. Complications included pneumothorax (20%) and hemoptysis (1%). Diagnostic discrepancies and detailed cytologic results will be discussed. We conclude that FNA of lung is effective and provides valuable Information for clinicians. Immediate interpretation of the FNA samples fields the best diagnostic results.

The ulrastruclure of the lung provides a cytomorphologic basis for the identification of unusual pulmonary neoplasms or unusual histologic variants of more common pulmonary lesions. Comparison of tumor cells with bron-chioloalveolar lining cells and with pleural components has aided in the diagnosis of a spindle cell variant of a peripheral neuroendocrine cell tumor (carcinoid) and a tumor composed of cells resembling bronchioloalveolar epithelium (sclerosing hemangioma of lung).

A modified method of transbronchoscopic sponge biopsy is presented and a series of 212 patients is discussed. A diagnostic accuracy rate of 89 per cent was obtained in the 159 cases of proved carcinoma. False-positive and false-negative results are discussed. This technique was found to be an easy, rapid, accurate, and inexpensive method of obtaining samples for cytologic evaluation in the preoperative work-up of patients with suspected pulmonary malignancies.

We report the findings in a patient with severe silent mitral stenosis whose chest X-ray was interpreted to show post obstructive pneumonia due to a subcarinal mass.

Twenty-two patients underwent excision of a primary pulmonary neoplasm and solitary cerebral metastasis. Six patients had metastatic tumor removed on two occasions and there was one operative death in 28 craniotomies. Seven of 22 patients (32 per cent) survived one year following craniotomy and were free of significant symptoms for one year. Survival for at least 9 months and freedom from significant symptoms was achieved in a total of 12 patients (55 per cent). Relief of severe neurologic symptoms for a minimum of 3 months was achieved in 17 patients (77 per cent). The over-all one-year survival rate was 45 per cent and the average survival period is 14 months with 3 patients still living. The following factors had a favorable bearing on the outcome: Stage I lung cancer at pulmonary resection, whole-brain radiation therapy, and a longer interval between pulmonary resection and cerebral metastasis. The experience encourages us to pursue an aggressive surgical approach to pulmonary neoplasm and solitary cerebral metastasis.

In a prospective study of 6,027 older men screened every six months for ten years by means of chest photofluorograms and questionnaires regarding symptoms, 121 developed lung cancer after the first examination. Eighty-five men with lung cancer had the opportunity to be screened eight times before the tumor was detected by chest x-ray film, but only 33 actually reported that often. These 33 men were compared with matched controls for symptoms before the neoplasm was detected radiologically. The common symptoms of expectoration and chronic cough showed a significant increase in frequency over time in the cases of cancer, while only expectoration showed a slight increase in the controls. Uncommon symptoms more suggestive of lung cancer (hemoptysis and worsening cough) occurred in only four men prior to detection of cancer. Symptoms are seldom useful in the detection of occult lung cancer, but the appearance of expectoration and chronic cough in older male smokers should raise a suspicion of this disease.

Although several primary pulmonary neoplasms containing striated muscle fibers have in the past been described as rhabdomyoma or rhabdomyosarcoma, it was not until 1939 that McDonald and Heather described the first acceptable case of this neoplasm. Since then 13 such cases have been reported in the world literature. Previously reported cases of the neoplasm are reviewed and the salient features described. The origin of the striated muscle fibers has been much debated. Some believe that they develop from myoblastic differentiation of primitive mesenchymal cells or metablastic transformation of pleuripotential mesenchymal cells present in the bronchial walls and pulmonary interstitium, whereas others claim that they develop from misplaced striated muscle tissue from the pharyngeal or esophageal region. A case report of the pleomorphic type of primary pulmonary rhabdomyosarcoma with multiple hematogenous metastases is presented as well as a review of the literature with a discussion of the histogenesis.

1)The endoscopic approach to the positive diagnosis of pulmonary neoplasms and tuberculosis is discussed and compared to standard methods. 2)The anatomical, physiological, and pathological mechanisms concerned in the recovery of neoplastic cells and tubercle bacilli are described. 3)A new irrigation-suction cell and tubercle bacillus collector which permits collection from lower subdivisions of the bronchi is described in detail. 4)The apparatus described permits either selective or seriatim irrigation and suction of the lobar bronchi or of the approachable segmental bronchi making possible diagnoses in a more limited anatomical area.

The effect of pulmonary venous ligation on pulmonary artery flow to the ligated segment of lung has been determined both in the laboratory and clinically. The studies indicate that pulmonary arterial flow to a venous ligated segment of lung ceases almost immediately with the application of venous occlusion. The possible importance of this fact as it applies to intraoperative control of hematogenous metastasis from carcinoma of the lung is discussed.

SUMMARY The results of needle aspiration of pulmonary lesions suspected of being neoplasms have been presented. Our experience with 626 procedures in 523 patients over a 21 year period has shown us that, although the method has some hazards, it is relatively safe, easy, and helpful, but should be reserved until all other methods of preoperative study have failed to establish the diagnosis. We believe that the danger of tumor spread along the needle tract has been greatly overemphasized and have seen no such tumor implantation in this large series. The procedure has found a restricted but definite place in our diagnostic approach to suspected pulmonary neoplasms. Evidence has been presented to support this belief that such aspiration biopsy is much safer than the more conventional exploratory biopsy, either incisional or excisional.