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The vast majority of tumours arising in the bronchopulmonary system are malignant in nature. Benign tumours of the lung are relatively rare and are often incidental findings during clinical investigations for unrelated conditions. These lesions can arise in the bronchial tree or the pulmonary parenchyma and may be of epithelial, mesenchymal, salivary gland-type or unknown differentiation. Although the spectrum of these lesions is wide, the clinical, pathological and immunohistochemical characteristics of the most relevant will be the subject of this review. In addition, the most important features allowing differentiation from malignant pulmonary neoplasms will be discussed.

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.

BACKGROUND Extramedullary plasmacytoma (EMP) is a rare kind of soft tissue plasma cell neoplasm without bone marrow involvement; this type of plasma cell neoplasm involves a lack of other systemic characteristics of multiple myeloma. Primary pulmonary plasmacytoma (PPP), with no specific clinical manifestations, is an exceedingly rare type of EMP. Because of its complexity, PPP is often difficult to diagnose, and there is no report in the literature on cases accompanied by overlap syndrome (OS). CASE SUMMARY A 61-year-old woman without a familial lung cancer history was admitted to our hospital in 2018, for intermittent cough, expectoration, and a stuffy feeling in the chest for 50 years; these symptoms appeared intermittently, especially occurred after being cold, and had been aggravated for the last 10 d. She was diagnosed with pulmonary fibrosis and emphysema, bronchiectasis, OS, and autoimmune hepatic cirrhosis in 2017. A pulmonary examination revealed rough breath sounds in both lungs; other physical examinations found no obvious abnormalities. A routine laboratory work-up showed decreased haemoglobin, increased ESR, and abnormal GGT, ALT, IgG, γ-globulin, κ-light chain, λ-light chain, rheumatoid factor, and autoimmune antibodies. Emission computed tomography demonstrated abnormally concentrated 99mTc-MDP. Chest computed tomography revealed a soft tissue mass in the middle and lower lobes of the right lung. After right middle and inferior lobe resection with complete mediastinal lymph node dissection, immunohistochemical analysis revealed an isolated pulmonary plasmacytoma. The patient received chemotherapy for more than 1.5 years and remains in good general condition. CONCLUSION PPP is a type of EMP, and we report an exceedingly rare presentation of PPP accompanied by OS.

BACKGROUND Phyllodes tumours (PTs) are fibroepithelial breast tumours, which can be classified as benign, borderline or malignant, according to their histological characteristics. While various huge borderline or malignant PTs have been previously described, a benign PT with a pulmonary nodule mimicking malignancy has not yet been reported. In order that doctors may have a comprehensive understanding of super-giant benign PTs (≥ 20 cm), we also performed a literature review to summarize the clinical features, differential diagnosis, and treatment of this disease. CASE SUMMARY A 42-year-old woman with severe anaemia presented with a rapidly enlarging right breast mass, measuring approximately 30 cm × 25 cm × 20 cm that was first noticed 1 year previously. A region of skin ulceration and necrosis (20 cm × 15 cm) was observed on the lateral side of the mass. Computed tomography (CT) of the chest revealed a pulmonary nodule, which initially suggested a diagnosis of metastasis. CT showed that the boundaries between the pectoralis major and the mass were blurred, which was presumed to be due to tumour invasion. However, two core needle biopsies of the mass showed no evidence of malignancy. Following these results, the tumour was removed by mastectomy of the right breast. Interestingly, postoperative pathology finally proved the diagnosis of a benign PT. After 1 year of follow-up, wedge resection of the small pulmonary nodule was performed, and it was confirmed that the lung nodule was actually adenocarcinoma rather than metastatic breast cancer. The patient recovered very well without any postoperative treatment. CONCLUSION This case is unique in that the giant breast mass initially mimicking a malignant clinical presentation was eventually pathologically confirmed to be a benign PT, which misled the diagnosis and complemented the atypical features of benign PTs. The pathological and immunohistochemical results were important in the differential diagnosis. In addition, total mastectomy should be recommended due to difficulty in the precise diagnosis of PTs, especially in large breast masses. In the literature, almost one-half of super-giant benign cases were thought to be malignant tumours before surgery. This finding is a reminder to consider all conditions in order to make an accurate diagnosis and avoid excessive treatment.

RESUMEN Introducción: el cáncer de pulmón es un problema de Salud Pública en el mundo y en nuestro país por su alta mortalidad e incidencia. Los carcinógenos medioambientales y el tabaquismo están directamente relacionados como factores de riesgo. Objetivo: Caracterizar los factores etiológicos de fumador activo y carcinógenos medioambientales de los pacientes con cáncer de pulmón detectados durante 9 años en el Instituto Nacional del Cáncer, Paraguay. Metodología: estudio observacional retrospectivo descriptivo analítico de una base de datos del período 2004-2013. Las variables medidas fueron datos demográficos, carga tabáquica, tabaquismo, la exposición a carcinógenos medioambientales categoría I. Resultados: se incluyeron 478 pacientes con cáncer pulmonar, 88,1% de sexo masculino y 11,9% femenino. La edad promedio del sexo masculino fue 60±10 años y del sexo femenino 58±12 años. La prevalencia de exposición carcinógenos medioambientales categoría I fue 36,90%. La media del índice tabáquico fue 4,48±20. El modelo de regresión lineal múltiple entre exposición ambiental, tabaquismo y tipo histológico para predecir la severidad clínica fue 3,6%. En el análisis de regresión logística de la relación de tipos histológicos con tabaquismo, género y exposición ambiental no mejoran el modelo de predicción. Conclusiones: Los factores etiológicos relacionados con carcinógenos medioambientales estuvieron presentes en más de un tercio de la población, el hábito tabáquico es mayor en hombres que en mujeres. El tipo histológico más frecuente para ambos sexos, con y sin el hábito tabáquico, es el carcinoma de células no pequeñas. ABSTRACT Introduction: Lung cancer is a public health problem in the world and in our country due to its high mortality and incidence. Environmental carcinogens and smoking are directly related as risk factors. Objective: To characterize the etiological factors of active smokers and environmental carcinogens of patients with lung cancer detected during 9 years at the National Cancer Institute, Paraguay. Methodology: Retrospective observational descriptive analytical study of a database for the period 2004-2013. The variables measured were demographic data, smoking load, smoking, exposure to category I environmental carcinogens. Results: Four hundred seventy-eight patients with lung cancer, 88.1% male and 11.9% female were included. The mean age of the male sex was 60±10 years and 58±12 years of the female age. The prevalence of exposure to category I environmental carcinogens was 36.90%. The mean smoking index was 4.48±20. The multiple linear regression model between environmental exposure, smoking and histological type to predict clinical severity was 3.6%. In the logistic regression analysis of the relationship of histological types with smoking, gender and environmental exposure, the prediction model was not improved. Conclusions: The etiological factors related to environmental carcinogens were present in more than one third of the population, and smoking was greater in men than in women. The most frequent histological type for both sexes, with and without the smoking habit, was non-small cell carcinoma.

Background: fever of unknown origin is one of the diagnoses more difficult in our area, because it involves monitoring of a complex algorithm of several procedures to establish its cause and con frequently takes too long before any explanation. Therefore, the objective is to get to your diagnosis etiologic and to do a particular series of steps.Objective: to describe the most frequent causes of classical fever of unknown origin in the hospital setting and make a simplified diagnostic search algorithm for this pathology.Methods: a case-series study of 85 patients admitted to the Hospital Obispo Polanco with a diagnosis of fever of unknown origin conducted from 2013 to 2018 in the therapeutic services except for pediatrics and surgery units. The study variables included age, sex, complementary studies (variables from humoral, microbiological and biopsies), results obtained, diagnosis of each patient, treatment.Results: of all patients, 23 (27 %) had infections, of which 14 (16 %) of respiratory focus, 6 (7 %) of urinary focus, 2 (2 %) of abdominal focus and 1 (1 %) of the skin focus. Seven patients (8 %) had neoplasms, three of which (3 %) of respiratory origin, three of digestive tract (3 %) and one of prostatic origin (1 %). In four patients (5 %) were diagnosed of the rheumatic diseases. In 51 (60 %) patients not be could diagnose any cause of fever of unknown origin.Conclusions: the first cause of fever of unknown origin is diseases of unknown etiology with 60 % (51 cases) without being able to identify the clear focus. Among the known etiologies, the most private pathology is infectious bacterial diseases of the respiratory and urinary tracts (27 % — 23 patients). The third place is occupied by oncological diseases with a predominance of malignant pulmonary neoplasms (8 % — 7 patients). Rheumatological diseases occupy the last place and, in this study, accounted for only 5 % (4 patients).

There are no studies on the risk factors of radiation pneumonitis (RP) after carbon-ion radiotherapy at a dose of 50 Gy (relative biological effectiveness (RBE)) in a single fraction. The objective of this study was to identify factors associated with RP after radiotherapy, including dose–volume parameters. Ninety-eight patients without a history of thoracic radiotherapy who underwent treatment for solitary lung tumors between July 2013 and April 2016 were retrospectively analyzed. Treatment was planned using Xio-N. The median follow-up duration was 53 months, and the median clinical target volume was 32.3 mL. Three patients developed grade 2 RP, and one patient developed grade 3 interstitial pneumonitis. None of the patients developed grade 4 or 5 RP. The dose-volume parameters of the normal lung irradiated at least with 5–30 Gy (RBE), and the mean lung dose was significantly lower in patients with grade 0–1 RP than in those with grade 2–3 RP. Pretreatment with higher SP-D and interstitial pneumonitis were significant factors for the occurrence of symptomatic RP. The present study showed a certain standard for single-fraction carbon-ion radiotherapy that does not increase the risk of RP, however, further validation studies are needed.

Background We aim to assess the learning curve of robotic portal lobectomy with four arms (RPL‐4) in patients with pulmonary neoplasms using prospectively collected data. Methods Data from 100 consecutive cases with lung neoplasms undergoing RPL‐4 were prospectively accumulated into a database between June 2018 and August 2019. The Da Vinci Si system was used to perform RPL‐4. Regression curves of cumulative sum analysis (CUSUM) and risk‐adjusted CUSUM (RA‐CUSUM) were fit to identify different phases of the learning curve. Clinical indicators and patient characteristics were compared between different phases. Results The mean operative time, console time, and docking time for the entire cohort were 130.6 ± 53.8, 95.5 ± 52.3, and 6.4 ± 3.0 min, respectively. Based on CUSUM analysis of console time, the surgical experience can be divided into three different phases: 1–10 cases (learning phase), 11–51 cases (plateau phase), and >51 cases (mastery phase). RA‐CUSUM analysis revealed that experience based on 56 cases was required to truly master this technique. Total operative time (p, The learning curve of RPL‐4 can be divided into three phases. Ten cases were required to pass the learning curve, but the mastery of RPL‐4 for satisfactory surgical outcomes requires experience from at least 56 cases.

Background and Purpose: We aimed to validate the usefulness of prescriptions based on gross tumor volume for stereotactic body radiotherapy for small peripheral lung tumors. Materials and Methods: Radiotherapy treatment planning data of 50 patients with small peripheral lung tumors (adenocarcinoma: 24, squamous cell carcinoma: 10, other: 1, unknown: 15) receiving breath-hold computed tomography-guided stereotactic body radiotherapy at our institution during 2013–2016 were analyzed. For each case, 3 dose prescription methods were applied: one based on 95% (PTVD95%) of the planning target volume, one based on 50% of the gross tumor volume (GTVD50%), and one based on 98% (GTVD98%) of the gross tumor volume. The maximum (GTVDmax), minimum (GTVDmin), and mean gross tumor volume dose (GTVDmean) and the dose covering 98% of the gross tumor volume were calculated to evaluate variations in the gross tumor volume dose. Results: Upon switching to GTVD50%, the variations in GTVDmax and GTVDmean decreased significantly, compared with variations observed for PTVD95% (p < 0.01), but the variation in GTVDmin increased significantly (p < 0.01). Upon switching to the GTVD98%, the variation in GTVDmean decreased significantly compared with that observed for PTVD95% (p < 0.01). Conclusion: Switching from prescriptions based on 95% of the planning target volume to those based on 98% of the gross tumor volume decreased variations among cases in the overall gross tumor volume dose. Overall, prescriptions based on 98% of the gross tumor volume appear to be more suitable than those based on 95% of the planning target volume in cases of small peripheral lung tumors treated with stereotactic body radiotherapy.

Lung nodules are often incidentally discovered on lung imaging and can be solitary, which makes them suspicious for tumors, or multiple, which can be suggestive of an infectious process. A bronchial carcinoid is a rare pulmonary neoplasm, representing 1.2% of all primary pulmonary tumors. We report a case of incidentally discovered multiple lung nodules in an asymptomatic human immunodeficiency virus (HIV) patient, which turned out to be a tumor, necessitating the need for keeping a broad differential, a high degree of clinical suspicion, and long-term follow-up for the optimal management of the patient.

In vivo micro-computed tomography (CT) imaging allows longitudinal studies of pulmonary neoplasms in genetically engineered mouse models. Respiratory gating increases the accuracy of lung tumor measurements but lengthens anesthesia time in animals that may be at increased risk for complications. We hypothesized that semiautomated, volumetric, and linear tumor measurements performed in micro-CT images from non-gated scans would have correlation with histological findings. Primary lung tumors were induced in eight FVB mice with two transgenes (FVB/N-Tg(tetO-Kras2)12Hev/J; FVB.Cg-Tg(Scgb1a1-rtTA)1Jaw/J). Non-gated micro-CT scans were performed and the lungs were subsequently harvested. In the acquired micro-CT scans, measurements of all identified tumors were determined using the following methods: semiautomated three-dimensional (3D) volume, ellipsoid volume, Response Evaluation Criteria in Solid Tumors (RECIST; sum of largest axial (i.e., transverse) diameter from five tumors), sum of largest axial diameters from all tumors (modified RECIST), and average axial diameter. For histological analysis, all five lung lobes were analyzed and the tumor area was summed from measurements made on five histological sections that were 300 µm apart from each other (covering a total depth of 1200 µm). All micro-CT measurement methods had very strong correlation with histological tumor burden (Pearson’s correlation coefficient, 0.87 ( p = 0.0053) −0.98 ( p

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.

Disorders of the lungs and pleura are common in children and are a frequent indication for medical imaging. Over the past decade, a combination of advances in MR imaging scanner technology and increased concern about the effects of ionizing radiation has led to increased utilization of MR imaging in the pediatric population. Despite this general trend, there has been slower adoption of MR imaging to evaluate the lungs and pleura due to technical limitations including motion artifact, low signal-to-noise ratios, and signal dephasing at air-tissue interfaces. As MR imaging technology advances, many of these technical hurdles are being overcome, and MR imaging of the lungs and pleura has begun to be a feasible option for many pediatric pleuropulmonary conditions. Therefore, an up-to-date understanding of these emerging applications is important to practitioners performing MR imaging in infants and children. In this chapter, an overview of MR imaging techniques to evaluate the lungs and pleura in children is discussed. Normal anatomy and development of the lungs and pleura are described, and the MR imaging findings in a spectrum pediatric lung and pleural disease are illustrated.

This chapter opens with how to evaluate the solitary pulmonary nodule, presenting numerous imaging findings that can suggest whether it is benign or malignant. It then describes various benign and malignant pulmonary neoplasms and the three major routes for metastases (hematogenous, lymphangitic, and direct spread).

Pneumocytic adenomyoepithelioma (PAM) was first described in 2007 and was included in the 2015 World Health Organization Classification of lung tumors as a variant of epithelial-myoepithelial tumor. This rare pulmonary neoplasm was reported to show both myoepithelial and duct-like components, with the latter exhibiting pneumocytic differentiation with TTF-1 expression. We present an index case and 6 additional retrospectively-identified cases of pulmonary tumors with prototypical features of PAM. However, with additional clinicoradiologic, histologic, immunohistochemical and cytogenetic data, we were able to reclassify them as myoepithelial neoplasms – both primary and metastatic – with entrapped exuberantly hyperplastic alveolar structures lined by TTF-1 positive pneumocytes. We reviewed the available literature related to PAM and myoepithelial tumors. Our cases suggest that the entity referred to as PAM represents interstitial growth of myoepithelial neoplasms enticing marked proliferation of entrapped pneumocytes rather than a distinct biphasic neoplasm with pneumocytic differentiation.

Pulmonary dirofilaria infection is a rare condition in Australasia. We describe a case with radiographic findings concerning for pulmonary malignancy, with the unexpected pathological diagnosis of dirofilarial infection.

Percutaneous cryoablation of pulmonary tumors at the posterior lung base is challenging due to diaphragmatic motion and the requirement for prone positioning. High-frequency jet ventilation allows oxygenation and ventilation with minimal diaphragmatic movement. In this case report, we describe the use of high-frequency jet ventilation in the prone position to facilitate the cryoablation of a peridiaphragmatic pulmonary neoplasm.

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.

Diethylnitrosamine (DEN) is a chemical broadly used in animal models as a hepatocarcinogen, reported to also cause pulmonary neoplasms in mice. The original objective was to evaluate the impact of a Western diet with or without 10% broccoli on DEN-induced on liver cancer. We administered DEN (45 mg/kg) intraperitoneally to young adult male B6C3F1 mice by 6 weekly injections and evaluated liver cancer 6 months after the DEN treatments. Here, we report unexpected primary tumorigenesis in nasal epithelium, independent of dietary treatment. More than 50% of DEN-treated B6C3F1 mice developed nasal neoplasm-related lesions, not reported previously in the literature. Only one of these neoplasms was visible externally prior to postmortem examination. Intraperitoneal DEN treatment used as a model for liver cancer can have a carcinogenic effect on the nasal epithelium in B6C3F1 mice, which should be carefully monitored in future liver cancer studies.

espanolEl sindrome miastenico de Lambert Eaton es una patologia autoinmune paraneoplasica asociada mayormente a cancer de pulmon, que se manifiesta con afectacion de la union neuromuscular y disfunciones autonomicas. Se presenta el caso de una paciente femenina de 58 anos quien fue diagnosticada con cancer de pulmon de celulas pequenas y que posteriormente presento la triada clasica de sindrome miastenico de Lambert Eaton (debilidad proximal de miembros inferiores, disfuncion autonomica e hiporreflexia). Se abordo mediante pruebas neurofisiologicas (electromiografia), confirmando su diagnostico en asociacion con el cuadro clinico. El caso presentado a continuacion destaca la asociacion de neoplasias pulmonares con el diagnostico de sindrome miastenico de Lambert Eaton y la mejoria de los sintomas gracias al tratamiento sintomatico y oncologico. EnglishLambert Eaton myasthenic syndrome is a paraneoplastic autoimmune pathology mostly associated with lung cancer, which manifests itself with involvement of the neuromuscular junction and autonomic dysfunctions. We present the case of a 58-year-old female patient who was diagnosed with small cell lung cancer and who subsequently presented the classic Lambert Eaton myasthenic syndrome (proximal lower limb weakness, autonomic dysfunction, and hyporeflexia). It was approached through neurophysiological tests (electromyography), confirming its diagnosis in association with the clinical picture. The case presented below highlights the association of pulmonary neoplasms with the diagnosis of Lambert Eaton myasthenic syndrome and the improvement of symptoms thanks to symptomatic and oncological treatment.

RESUMO: Neoplasmas pulmonares primários são pouco frequentes na medicina veterinária, mas a principal espécie afetada é a canina. Acredita-se que o número de neoplasmas pulmonares primários vem aumentando em animais de companhia, em decorrência do aumento da expectativa de vida, da melhora nas técnicas de diagnóstico e pelo maior contato com poluentes atmosféricos. Este estudo foi realizado para identificar, analisar a frequência, e caracterizar achados patológicos e imuno-histoquímicos dos neoplasmas pulmonares primários em cães na região metropolitana de Porto Alegre, Rio Grande do Sul. No período de janeiro de 2003 a junho de 2016 foram submetidos à necropsia 6.307 caninos. Destes, 36 cães tinham diagnóstico de neoplasma pulmonar primário. O neoplasma mais frequente neste estudo foi o adenocarcinoma papilar (30,5%), seguido do carcinoma lepídico (22,2%). A idade dos cães variou de quatro a 16 anos, com média de 11 anos. Observou-se que a frequência de cães machos (63,9%) prevaleceu sobre as fêmeas (36,1%). Na avaliação imuno-histoquímica, todos os neoplasmas epiteliais foram positivos para pancitoqueratina, 70,6% foram positivos para fator de transcrição de tireoide-1 e 23,5% tiveram coexpressão de pancitoqueratina e vimentina. Dois tumores mesenquimais tiveram imunomarcação para vimentina e S-100, foram negativos para a imuno-histoquímica de actina de músculo liso e melan-A e para a técnica histoquímica de tricrômico de Masson e foram diagnosticados como tumor da bainha de nervo periférico maligno, raramente encontrado como tumor primário de pulmão em animais. Quando é difícil estabelecer um diagnóstico apenas com o exame histológico de rotina, é necessário ressaltar a importância da técnica de imuno-histoquímica para o diagnóstico de neoplasmas pulmonares primários em cães. ABSTRACT: Primary pulmonary neoplasms are uncommon in veterinary medicine; but most frequently affected are dogs. It appears that the number of primary pulmonary neoplasms is increasing in companion animals, due to the increase in life expectancy, improvement of diagnostic techniques and greater contact with air pollutants. This study was realized to identify, analyze the frequency, and to characterize pathological and immunohistochemical findings of primary pulmonary neoplasms in dogs of the metropolitan region of Porto Alegre, Rio Grande do Sul. From January 2003 to June 2016, 6,037 necropsies were performed and in 36 of them primary pulmonary neoplasm was found. The most frequent neoplasm in this study was papillary adenocarcinoma (30.5%) followed by lepidic adenocarcinoma (22.2%). The age of affected dogs ranged from 4 to 16 years, with a mean of 11 years. The frequency of male dogs (63.9%) prevailed over females (36.1%). Through immunohistochemical evaluation all epithelial neoplasms were positive for pancytokeratin, 70.6% were positive for thyroid-1 transcription factor and 23.5% had co-expression of pancytokeratin and vimentin. Two mesenchymal tumors showed immunostaining for vimentin and S-100, were negative for smooth-muscle actin and melan-A immunohistochemistry and Masson’s trichrome histochemical technique and were diagnosed as malignant peripheral nerve sheath tumors, rarely found as primary lung tumor in animals. If one has difficulty to establish a diagnosis only through routine histological examination, it is necessary to emphasize the importance of the immunohistochemical technique for the diagnosis of primary pulmonary neoplasms in dogs.

The primary pulmonary lymphoma is very rare, while the extranodal presentation represents the 25 to 50% of the cases of non- Hodgkin's lymphoma. The primary pulmonary commitment represents only 3 to 4% of non-Hodgkin's lymphoma and 0.5 to 1% of the primary pulmonary neoplasms. The prevalence of pulmonary lymphoma within the lung tumors is 13% in adults. Endobronchial presentation as a manifestation of primary pulmonary lymphoma, only occurs in 0.4% of the cases. Is defi ned as primary pulmonary lymphoma, to the prolifera- tion of atypical lymphoid one or both lungs in a patient with undetectable extrapulmonary disease. We report a case of anaplastic lymphoma endobronchial large cell lung primary, ALK-1 positive, which is a prognostic marker of this entity.

Aim: Robotic-assisted thoracic surgery (RATS) has become a promising treatment for pulmonary neoplasms. During RATS, intraoperative ultrasonography can act as an “alternative finger” to “touch” and locate lesions, especially pulmonary nodules. This study was aimed to investigate the efficacy of intraoperative ultrasonographic localization during da Vinci RATS procedures.Material and methods: Patients with pulmonary nodules were randomly divided into an Experimental Group and Control Group in which nodules were respectively located using intraoperative ultrasonography or by the surgeon’s anatomic knowledge. The success rates and relevant localization factors were compared between the groups and analyzed to conclude the efficacy of intraoperative ultrasonography. Additionally, the intraoperative ultrasonography learning curve was analyzed to evaluate each surgeon’s ability to independently perform intraoperative ultrasonography.Results: Thirty-four patients were included in the study (n = 17/group). Respectively, the Experimental Group and Control Group comprised 41.2% and 58.9% women (p= 0.937), and had average ages of 55.5 and 55.8 years. In the Experimental group, ultrasonographic localization for mixed ground-glass nodules with CT values of -500 to -100 Hounsfield units had an efficacy of 87.5%. By contrast, the localization efficacy in Control Group was 20.0% (p=0.032).A single surgeon without prior experience performed intraoperative ultrasonography in 20 cases, and the latter 10 procedures required significantly less time relative to the former 10 procedures (p=0.000).Conclusions: During RATS, the use of intraoperative ultrasonography as an “alternative finger” to “touch” and findthe accurate location of pulmonary nodules, especially mixed ground-glass nodules, is warranted.

Pulmonary neoplasia is rare among wild New World primates. We report the gross, microscopical, and immunohistochemical features of a primary multicentric pulmonary adenosquamous carcinoma in a free-living black capuchin monkey (Sapajus nigritus). Herein, the spectrum of pulmonary neoplasms in non-human primates is widened and briefly reviewed.

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.

Malignant pulmonary neoplasms are the most frequent cause of cancer-related death worldwide (1), accounting for more than 1.8 million newly diagnosed cancers and 1.6 million cancer-related deaths worldwide every year (2).

*Thoracic Surgery, University of Texas Medical Branch, Galveston, TX 77551; Tel.: +1 409 772 0534; iokereke@utmb.edu

Summary Mucoepidermoid carcinoma is a rare pulmonary neoplasm seen in the pediatric population. We report a low grade mucoepidermoid carcinoma in a 12-year-old boy who presented with spontaneous pneumothorax. Pediatr Pulmonol. 2014; 49:E86–E89. © 2013 Wiley Periodicals, Inc.

Background Surgical resection offers the greatest likelihood of cure for appropriately selected patients with pulmonary colorectal carcinoma metastases. We hereby report our experience over the last 19 years at the Austin Hospital, Thoracic Surgery Unit. Methods This is a retrospective study of a consecutive series of patients with pulmonary colorectal cancer metastases. From 1994 to 2012, 66 patients underwent 83 pulmonary metastasectomies for colorectal cancer at the Austin Hospital. Results Seventy per cent of patients were operated on for single pulmonary metastases. The most common procedure performed was a video-assisted thoracoscopic surgery wedge resection. Median follow-up duration was 25 months. Three-, five-, seven- and ten-year survival was 53.4, 39.6, 34.6 and 23.1%, respectively. Conclusion Pulmonary metastasectomy for metastatic colorectal carcinoma continues to offer the greatest survival advantage for appropriately selected patients.

Background: The mechanism of exaggerated airway narrowing in asthma is unclear and there is little to no biological data on whether increased airway smooth muscle (ASM) increases narrowing capacity. Objective: Determine whether increased airway narrowing in asthma is related to increased ASM mass. Methods: Bronchial segments were acquired from subjects undergoing surgery, mostly to remove pulmonary neoplasms. Subjects reported doctor-diagnosed asthma (n=5) or had no history of asthma (n=8). In vitro airway narrowing in response to acetylcholine (3x10-6M to 3x10-3M) was assessed to determine maximal bronchoconstriction and sensitivity. Fixed airway segments were sectioned for measurement of airway wall dimensions, particularly the ASM layer. Results: Airways from the asthma group had increased ASM (P=0.014), greater maximal airway narrowing (P=0.003) but no change in sensitivity. Maximal airway narrowing was positively correlated with the area of the ASM layer (r=0.58, P=0.039) but was not related to any other morphological parameter including inner and outer wall dimensions. Conclusions: Results suggest that greater ASM mass in asthma contributes to increased maximal airway narrowing in vivo. In contrast, properties of the ASM may not determine increased airway sensitivity.

Background: The diagnostic evaluation of patients presenting with possible lung cancer is often complex and time consuming. A rapid outpatient diagnostic program (RODP) including 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and contrast-enhanced computed tomography (CT) as a routine diagnostic tool may improve timeliness, however the diagnostic performance of such a combined approach of RODP remains unclear. Objectives: We evaluated timeliness of care and diagnostic performance of FDG-PET and contrast-enhanced CT (FDG-PET/CT) in an RODP for all patients referred with a chest X-ray suspicious of lung cancer. Methods: Charts of patients referred to the 2-day RODP of our tertiary care university clinic after an abnormal chest X-ray between 1999 and 2009 were reviewed. Between 1999 and 2005 co-registered FDG-PET and CT imaging took place; from September 2005 onwards, a hybrid system was used. We analyzed timeliness of care and diagnostic performance of FDG-PET/CT to differentiate malignant from benign lesions. Results: In 386 patients available for analysis, 260 were diagnosed with lung cancer and 23 had another type of malignancy; in 78 patients benign disease was confirmed, and in another 45 the diagnosis was not pathologically confirmed but a median 24.5-month follow-up confirmed a benign outcome. Sensitivity, specificity, negative and positive predictive values and accuracy of FDG-PET/CT to differentiate lung cancer from benign disease were 97.7, 60.2, 92.5, 84.0 and 85.8%, respectively. Lung cancer patients had a median referral, diagnostic and therapeutic delay of 7, 2 and 19 days, respectively. Conclusions: FDG-PET/CT in an RODP setting for suspected lung cancer has high performance in detecting cancer and facilitates timely care.

Malignant fibrous histiocytoma (MFH) cases are classified within the group of nonclassified sarcomas. The etiopathogenesis is unclear; however, MFH commonly develops in scar tissue and in areas exposed to radiation. MFH is the most common soft tissue sarcoma in adults and may be borne in the lungs, chest wall, mediastinum, or other tissues. Primary MFH of the lung constitutes less than 0.2% of all pulmonary neoplasms; thus, an optimal treatment strategy has not yet been elucidated. We aimed to report a case of MFH of the lung with subsequent treatment administration.

Pulmonary epithelioid hemangioendothelioma is a rare pulmonary neoplasm. No reliably effective systemic chemotherapy for this disease entity has been established yet. Surgery is usually applied for patients with a small number of lesions limited to one lung, while feasibility/efficacy/safety of this modality is controversial for patients with bilateral multiple lung lesions. Presence of cases showing rapid aggravation and those showing very gradual progression makes it difficult to evaluate validity of surgery as a suitable therapeutic approach. Herein, we present a summary on pulmonary epithelioid hemangioendothelioma and discuss the role of surgery in the treatment of this condition.

Pulmonary neuroendocrine tumors (NETs) are an uncommon group of pulmonary neoplasms that are typically characterized by neuroendocrine differentiation with relatively indolent clinical behavior. The spectrum of pulmonary NETs ranges from typical carcinoid tumors, which are relatively benign, to highly aggressive small cell carcinoma. Thymic NETs are uncommon but malignant tumors of the thymus gland which are typically characterized by aggressive behavior and malignant potential. This chapter will emphasize current and emerging knowledge of functional imaging options on pulmonary and thymic NETs.

Hemoptysis is rare in children and adolescents. We describe an 11-year-old girl who presented with hemoptysis, cough, and exertional dyspnea. Radiologic and bronchoscopic assessment revealed a pedunculated mass in the right main stem bronchus with a ball valve effect. Carcinoid or hemangioma was suspected as cause of the mass. The tumor could be excised bronchoscopically, and histologic examination showed a capillary hemangioma. In the literature, bronchial hemangiomas are described in infants and adults. This case demonstrates that bronchial hemangioma should also be taken into consideration as a cause of hemoptysis in adolescents.

Primary pulmonary sarcomas account for less than 0.5% of all thoracic neoplasms. They’re aggressive tumors arising in mesenchymal cells from the bronchial walls, vessels or pulmonary interstitium. The authors present a patient in which the diagnostic pathway ended with the diagnosis of a primary pulmonary leiomyosarcoma. This case was a true challenge, illustrative of the difficulty associated with this type of neoplasm, but also regarding its aggressiveness, considering its rapid and fatal progression.

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.

Primary pulmonary neoplasms are uncommon in children and represent a wide spectrum of pathology from benign to malignant. They are quite different in their histopathologic distribution from that of adults. This study was done to analyze the histopathologic spectrum of primary lung tumors in children. All the resected specimens of lung in children over a period of 5 years were studied and only the cases of primary pulmonary neoplasms were further analyzed. There were two cases of inflammatory myofibroblastic tumor. The patients were boys aged 10 and 12 years, respectively. One case of bronchial carcinoid was diagnosed in a boy of 12 years. There were one case each of pleuropulmonary blastoma (PPB) in a girl of 9 years and pulmonary blastoma (PB) in a girl of 2 years of age. In our study, the two cases of inflammatory myofibroblastic tumor had excellent prognosis. However, the cases of PPB and PB were both associated with poor clinical outcome, whereas the case of bronchial carcinoid has been doing well on follow-up.

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.

Als Standardverfahren zur praoperativen bildmorphologischen Diagnostik bei Patienten mit zentralen malignen Lungentumoren ist das axiale 2-D-Computertomogramm des Thorax akzeptiert und etabliert. Tumorausdehnung, Infiltration von zentralen Strukturen oder segmentaler Bezug sind entscheidende Parameter zur Abklarung der technischen Operabilitat und des Resektionsausmases. Durch computergestutzte Methoden der Segmentierung anatomischer Strukturen in CT-Daten (Fraunhofer MeVis, Bremen) ist erstmals eine selektive dreidimensionale Visualisierung moglich. Im Zeitraum zwischen 08/07 und 06/09 wurden 22 Patienten mit zentralem Lungentumor in der Thoraxchirurgischen Abteilung der Universitat Schleswig-Holstein, Campus Lubeck, behandelt. 15 Manner, 7 Frauen, mittleres Alter bei Diagnosestellung 60,2 Jahre (Spannweite 41–74 Jahre). Lediglich 4 von 22 Patienten waren Nichtraucher gewesen, die ubrigen 18 Patienten hatten eine zum Teil erhebliche Raucheranamnese. 20 Patienten hatten ein primares Bronchialkarzinom, je ein Patient hatte ein Lokalrezidiv nach Tumorlobektomie bzw. eine zentrale Lungenmetastase eines extrapulmonalen Primarius. In allen Fallen wurde praoperativ ein Dunnschicht-MSDCT (Multi-slice detector computer tomogramm) angefertigt. Die Daten wurden mittels computerassistierter Software dreidimensional rekonstruiert und visualisiert. Lungenfunktionstests, geschatzte postoperative Lungenrestfunktion, Bronchoskopiebefund, Allgemeinzustand des Patienten sowie die 3-D-rekonstruierten CT-Datensatze wurden zur individuellen praoperativen Risikoanalyse und Auswahl der Operationstaktik verwendet. Vierzehn der 22 Patienten wurden aufgrund der durchgefuhrten Risikoanalyse operiert, 7 Patienten wurden als funktionell inoperabel eingestuft, ein Patient war technisch inoperabel. Insgesamt wurden 5 Pneumonektomien, 4 Bi-/Lobektomien, 3 erweiterte Lobektomien und jeweils eine atypische Resektion und eine Manschettenresektion durchgefuhrt. 2 Patienten wurden im Stadium I operiert, 7 Patienten im Stadium II und 3 Patienten im Stadium IIIa. Der mediane stationare Aufenthalt betrug 8,5±33,0 Tage. Die Hospitalletalitat betrug bei 0%. Die 3-D-Visualisierung des Tumors sowie der anatomische Bezug zu Nachbarstrukturen waren in allen Fallen exakt moglich. Intraoperativ konnte die 3-D-Rekonstruktion zu 100% validiert werden. Die computerassistierte 3-D-Rekonstruktion eines Thorax-CT ist eine neuartige und vielversprechende Methode zur praoperativen Darstellung und Risikoanalyse von zentralen Lungentumoren. Die 3-D-Visualisierung des Tumors in Kombination mit farbkodierter Lappenzugehorigkeit, beweglich in allen Ebenen, ermoglicht dem Chirurgen eine differenzierte Strategieplanung bei zentralen Lungentumoren.

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.