Search

Hemangiopericytoma is a rare tumor, arising from pericytes. Its outcome is difficult to foretell, as the usual criteria for malignancy are unreliable in this neoplasm. Three cases of primary pulmonary hemangioperi-cytoma are presented and the pathologic and clinical aspects are briefly reviewed. All three patients were surgically treated, and two are still alive after 7 and 18 years without sign of recurrence or metastasis. The third patient, although still alive, has had three recurrences within 22 months and vertebral metastasis.

Summary A 12-year-old fox-terrier dog presented with forelimb lameness of 3-weeks duration. Ultrasonography revealed a mass within the thoracic wall and osteolysis of the left third rib. A squamous cell carcinoma was diagnosed by cytological examination of an ultrasound-guided fine needle aspirate of this mass. As a result of the diagnosis of neoplasia, the dog was euthanatized. Necropsy revealed a solitary expansile mass within the left cranial lung lobe, and a mass within the adjacent thoracic wall. Thickening of the pleura between the two masses was visible, although adhesions were not present. Histology of both masses revealed a well-differentiated squamous cell carcinoma. To the authors’ knowledge, this is the first detailed description of direct invasion of the thoracic wall by a canine lung tumour.

Homem de 37 anos, branco, tabagista, foi internado com tosse seca e dor no hemitórax esquerdo (HE). Ao exame, macicez e murmúrio vesicular diminuído no terço médio do HE. A tomografia axial computadorizada de tórax revelou lesão expansiva nodular do 7º arco costal, projetando-se para o interior do HE, com densidade de parte mole e discreto realce pelo contraste. A histologia e a imuno-histoquímica foram compatíveis com schwannoma benigno. Consideramos que o diagnóstico de schwannoma benigno intercostal deve ser aventado ante toda massa intratorácica posterior ou lateral que curse com escassa sintomatologia e ausência de manifestações clínicas de malignidade.

Learning ObjectivesAfter completing this course, the reader will be able to:Describe the diagnostic work-up for superior sulcus (Pancoast) tumors of the lung. List the major prognostic factors pertaining to outcome in patients with superior sulcus (Pancoast) tumors. Discuss the recent (SWOG 94-16) and current (SWOG-0220) intergroup trials for superior sulcus (Pancoast) tumors.Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.comThe management and outcome for superior sulcus tumors have remained unchanged for 40 years. The rarity of these tumors has led to varying treatment techniques spanning decades, from which no solid conclusions can be drawn. Recent advances in combined-modality therapy have offered the first inkling that a paradigm shift is on the horizon. Here, we review the history and new advances in treating this challenging pulmonary neoplasm.

El blastoma pleuropulmonar (BPP) es un raro y agresivo tumor maligno que afecta a los niños de edad temprana. Se trata de un paciente masculino que a los 3 años de edad se le diagnostica en nuestro hospital (julio de 1995) BPP del pulmón izquierdo, y requirió durante los 6 años de sobreviva de 5 intervenciones quirúrgicas a causa de la tendencia a recidivar de esta variedad de tumor, lo que constituye un reto para el cirujano pediatra. Se ofrece a los pediatras y a los especialistas de medicina general integral, una información sobre las conductas terapéuticas y las tendencias actuales ante un niño con cáncer de largo tiempo de evolución.The pleuropulmonary blastoma (PPB) ia a rare and aggressive tumor affecting children at early ages. The case of a 3-year-old male patient that was diagnosed PPB of the left lung in our hospital (July, 1995) and required 5 operations during the 6 years of survival due to the trend to relapse of this type of tumor, which is a challenge for the pediatric surgeon, is presented. Pediatricians and specialists in general comprehensive medicine are given information on the therapeutic conducts and the current trends in a child with cancer of long time of evolution.

Tl-201 imaging is useful in the diagnostic work-up of tumors. However, Tl-201 uptake is not specific for tumor and is also noted in other conditions. A case is described in which Tl-201 was taken up by a keloid.

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.

Benign endobronchial lung neoplasms are extremely rare. Most such neoplasms are of mesenchymal origin; however, neoplasms of submucosal gland origin and surface epithelial origin also occur. The symptomatology and radiographic features of these tumors are often indistinguishable from those of malignant lung tumors. However, recognition and early diagnosis of these lesions may allow for conservative treatment and excellent patient outcome. The clinicopathologic and radiological features of these pulmonary neoplasms are discussed.

Sir, Pulmonary hamartoma (PH) is a relatively common specimen to be received in the laboratory of Surgical Pathology, and its diagnosis is straightforward in the vast majority of cases. However, some problems may arise when PH is combined with a second neoplasm, a very rare event with a potentially significant impact on prognosis. Both epithelial and mesenchymal tumors have occasionally been described within PH [2, 4]. In this study, we report a hitherto unrecognized association: PH

Plasmacytoma is an uncommon tumor and is rarely encountered as a primary pulmonary neoplasm. Herein we describe the conventional radiographic and computed tomographic findings in a patient with a primary pulmonary plasmacytoma.

PURPOSE: To demonstrate the value of ultrasound (US) guidance during flexible bronchoscopic procedures in a series of patients with known or suspected pulmonary neoplasms. MATERIALS AND METHODS: US-guided bronchoscopy was carried out as an adjunct to conventional bronchoscopy for the diagnosis of mediastinal, hilar, or parenchymal neoplasms in 25 patients with masses previously detected with chest radiography or computed tomography. Miniature transducer-containing catheters were inserted through the biopsy port of the flexible bronchoscope, and cross-sectional real-time US scans of tumors, lymph nodes, and blood vessels were obtained. RESULTS: Among six cases of peripheral masses and 19 cases of central masses, additional information was provided in 18 cases (72%). This information was used to choose the optimal site for transmural biopsy. CONCLUSION: These preliminary results suggest that this US procedure may become an important diagnostic tool during bronchoscopy, due to the ability to identify structu...

Parenchymal pulmonary endometriosis is an extremely rare but well described condition. We present four new cases, and discuss the examination and treatment of these patients. We conclude that the condition may be underdiagnozed, and that it is a relatively harmless disorder. We propose treatment with progesterone as the first choice of treatment. None of our patients needed surgical treatment.

The most intriguing aspect of the endocrinology of the lung is the frequency with which its neoplasms display endocrine differentiation and the diverse ways in which this shows itself. The endocrine element in a pulmonary neoplasm may be subtle, such as when histologically typical squamous and adenocarcinomas express substances indicating a degree of endocrine differentiation unapparent from their appearance. This chapter provides an account of the WHO classifications for pulmonary endocrine neoplasms. The spectrum of pulmonary endocrine tumors or pulmonary endocrine spectrum is a biological continuum in which three zones can be recognized, although the borders among them are distinctly blurred. The best differentiated neoplasms, the carcinoid tumors, occupy the zone at the most benign end of the spectrum. The most poorly differentiated, the small cell, small/large cell, and combined carcinomas, occupy the zone at the most malignant end. Spanning the third zone in between these are the atypical carcinoid tumors. The heterogeneity of pulmonary neoplasms and the variety of ways in which endocrine differentiation can manifest itself have important practical implications.

• Fine-needle aspiration of the lung is now widely utilized to diagnose pulmonary neoplasms, but often serologic techniques or open-lung biopsy is relied on for the diagnosis of infectious pulmonary processes. We report a series of four patients in whom the fine-needle aspiration technique was used to make the rapid cytologic diagnosis of pulmonary aspergillosis. Culture confirmation was also obtained on the aspirated material. A discussion of the available techniques for the laboratory diagnosis of pulmonary aspergillosis is presented and the advantages of fine-needle aspiration cytology are stressed. Our favorable results support expanded use of fine-needle aspiration cytology in the evaluation of lung nodules appearing in immunosuppressed populations. ( Arch Surg . 1991;126:394-396)

A technique for immediate interpretation of transbronchial aspirates at bronchoscopy is described. Comparing 73 aspirates using the technique with 134 routinely processed aspirates, the technique produced a significant increase in the percentage of specimens containing malignant cells, from 31 to 56 percent, and, importantly, a large decrease in the percentage of specimens that were inadequate for diagnosis, from 56 to 18 percent. The technique was equally applicable to central and peripheral lung aspirates and to all types of primary and metastatic pulmonary neoplasms. The use of rapid on-site evaluation significantly improves the diagnostic yield of transbronchial aspirates.

To evaluate the usefulness of transbronchial needle aspiration biopsy (TBNAB) in the primary diagnosis of lung cancer, we undertook a prospective study of this technique, assessing specimens from 124 patients over a 3-yr period. Cytologic and/or histologic material obtained by an alternate technique was available for 105 (84.7%) of the patients. The diagnostic sensitivity of TBNAB was comparable with that of other bronchoscopic techniques; with the addition of TBNAB, the overall sensitivity of bronchoscopy was increased from 54% to 72% (P less than 0.001). Because of its usefulness for diagnosis of submucosal tumors and its safety, we conclude that TBNAB is a useful addition to current methods for the diagnosis of suspicious pulmonary lesions.

In order to evaluate the usefulness of cell-block (CB) from bronchial washing in the diagnosis of pulmonary neoplasms, we examined cytological samples of 1,145 bronchoscopies; CBs could be prepared in 777 cases (67.9%) and 201 cases, positive or suspicious for malignancy, were selected for the study (173/201 smears: 86.1%; 174/201 CBs: 86.6%). CBs were positive in 12 cases while the corresponding smears were negative (10 cases) or suspicious (2 cases); 2 cases had suspicious CBs with negative smears. Thus, the use of CBs increased the positive diagnosis from 173 to 185 cases, for an increase of 6.5%. We can conclude that CB could be a routine, inexpensive method, helpful in pulmonary neoplasm's diagnosis; moreover, CB has the advantage of being an histologic specimen, often the only one, useful for other diagnostic procedures. Diagn Cytopathol 1996;15:191–192. © 1996 Wiley-Liss, Inc.

A 60 year old man had recurrent pneumonia. Bronchoscopy disclosed a necrotic mass in the left lower lobe bronchus, which histological examination showed to contain sulphur granules. The endobronchial mass had disappeared by the second bronchoscopy one week later. The patient was treated with penicillin for one year and was cured. Actinomycosis must be included in the differential diagnosis of an endobronchial mass.

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)

In a 41-year-old, previously healthy man, a pulmonary opacity presented diagnostic difficulties. Thoracotomy with resection of lung and ribs revealed actino-mycosis. Postoperatively the patient responded well to long-term penicillin therapy.

Light microscopy, morphometry, and cytokinetic techniques were used to examine the dynamics of plutonium-induced pulmonary proliferative lesions and neoplasms in rats at several intervals to 450 days after inhalation exposure to aerosols of 239PuO2. Maximal increases in alveolar and bronchiolar epithelial cell labeling were seen at 30 days; decreasing subsequently, the levels remained elevated above control indices. Focal proliferative epithelial lesions developed in the lung by 180 days and before the onset of pulmonary neoplasms. Pulmonary neoplasms, predominantly adenocarcinomas and squamous cell carcinomas, were initially observed at 308 days. The proliferative lesions progressed through a succession of morphological changes leading to the development of neoplasms. The volume density (fraction) and epithelial surface area of foci of alveolar epithelial hyperplasia increased progressively between 180 and 450 days after exposure, in contrast to the other proliferative lesions. We conclude that plutonium-induced pulmonary neoplasms develop through a succession of focal proliferative lesions that represent developmental preneoplastic lesions. Progressive increases in volume and epithelial surface area of the alveolar epithelial hyperplasias suggest that they may be more at risk for neoplastic transformation than the other histological types of proliferative foci.

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.

Over a 6 year period, three cases of pulmonary carcinoma in young men with severe bullous lung disease were seen at Washington University Medical Center. The patients did not have a long cigarette-smoking exposure. It would seem that patients with severe bullous lung disease are at a higher risk for the development of pulmonary neoplasm than the general population. Physicians should be aware of this association to expedite diagnosis and therapy.

A clinical trial has been established to evaluate the use of intralesional bacillus Calmette Guérin (BCG) immunotherapy as an adjunct to surgery in resectable pulmonary neoplasms. BCG was injected percutaneously under fluoroscopic guidance into a single nodule in each of 21 patients with resectable primary and metastatic pulmonary neoplasms. Eighteen of 21 infected nodules increased in size and nine became poorly defined in the 2-4 week interval between BCG administration and resection. There was no change in those nodules that were not injected. The changes in the injected nodules were due to BCG-induced granulomatous inflammation and necrosis. BCG can be administered intralesionally into pulmonary neoplasms without significant complications (pneumothorax in nine, intrapleural injection in one). Preliminary observations suggest an improvement in disease-free interval. A prospective, randomized trial is planned to determine whether BCG immunotherapy will result in significantly improved survival in patients with primary and metastatic pulmonary neoplasms.

The volume doubling time (DT) of human lung neoplasms, determined from sequential, presurgery roentgenograms, was compared with biochemical and histologic observations on biopsy samples of the same tumors obtained during surgery. The DTs of the 16 neoplasms ranged from 24 days in an oat cell carcinoma to over 500 in a pulmonary carcinoid tumor, and showed a statistically significant, inverse correlation to the TK (thymidine kinase) and the UK (uridine kinase) concentration of the biopsy samples per g wet weight or mg DNA. Log DT bore a linear relationship to log TK (r = 0.75, P = 0.0008) and to log UK (r = 0.69, P = 0.0067), and an even better fit to the straight line was found when plotting the log of the standardized average of the two enzymes against log DT. The results demonstrate the feasibility of a biochemical method for determining the unknown DT of the many tumors that are not amenable (on account of shape, location, or lack of prior chest x-rays) to the direct, radiologic determination of this useful, dynamic parameter of clinical malignancy.

One hundred and eighteen doctors who treat pulmonary neoplasms in Ontario were asked how they would wish to be treated if they had non-small cell lung cancer. Four different scenarios were given. The physicians were then asked if they would consent to take part as subjects in one or more clinical trials for which they would be eligible in those situations. The proportion of respondents who would consent to each study ranged from 11% to 64%. Reasons given for refusing to participate as subjects in each trial were varied, but many felt that the trials offered unacceptable options for treatment. Medical oncologists consented to each study more frequently than radiation oncologists, respirologists or thoracic surgeons but all disciplines ranked the 6 studies in the same order of acceptability. It is concluded that some patients with non-oat cell lung cancer currently receive experimental therapies with high risk/benefits ratios which experts in the field would not accept for themselves. It is suggested that the expert surrogate system may be useful as an adjunct to the institutional review board in evaluating new trials before they are activated.