Search

Objective: This report reviews the pattern of neuroendocrine (NE) differentiation, lymph-node involvement, extension of surgery, and survival in 125 NE lung tumor patients. Methods: Standard diagnostic workup included CT scan, bronchoscopy, bronchial biopsy or Fine Needle Aspiration Biopsy, 111In-pentetreotide scan (OctreoScan) and mediastinoscopy in selected patients. NE differentiation was assessed based on the morphology and immunohistochemical reactivity for pan-neuroendocrine markers NSE, CGA, and Synaptophysin. For small cell carcinoma (SCC), only clinical stage I and II patients underwent surgery. Several different surgical procedures were utilized, from limited resections to lobectomy, pneumonectomy, and bronchoplastic procedures. Survival was assessed using Kaplan-Meyer method at 5 years. Results: There were 79 typical carcinoid (TC), eight atypical carcinoid (AC), 18 large cell carcinoma (LCC) and 20 SCC patients. Mean age at diagnosis was 54.6±15.2 (ranges from 16 to 77 years) for TC, 68.5±9.1 (range 53-81) for AC, 68.7±4.6 (range 58-77) for LCC, 64.6±7.9 (range 48-82) for SCC. Male/female ratio was 1/1 for TC and AC, 2.6/1 for LCC and 9/1 for SCC. Lymph-node involvement was present in 14% of TC, 0% of AC, 31.5% of LCC, and 45% of SCC. Cancer specific survival was 96% for TC, 87.5% for AC, 37.5% for LCC, and 30% for SCC at 5 years from surgery. Presenting symptoms were invariably of respiratory-related. None had the carcinoid syndrome. History of tobacco abuse ranged from 46% for TC to 100% in SCC. Survival ranged from a minimum of 1 month for SCC to a maximum of 168 months with no evidence of disease for TC. Synchronous multicentric forms were found in 14% of TC. Twenty-one percent (4/19) of the patients with SCC treated by induction therapy and surgery, and in few cases by surgery and adjuvant chemotherapy are alive without the evidence of the disease for 5 years. Conclusions: Due to the high percentage of lymph-node involvement and multicentric forms found in our series lobectomy with radical lymph-node dissection appears, in our opinion, the most appropriate surgical treatment in well-differentiated forms, while more limited resection appears sub-optimal. Also, due to the finding of recurrences many years after surgery, the follow-up must be accurate and protracted in this subgroup. Only Small Cell Lung Carcinoma patients in clinical stage I and II underwent surgery with good long-term results. © 2004 Elsevier B.V. All rights reserved.

Introduction: Oesophageal duplication (OD) is a rare congenital abnormality that arises during the third week of embryonic life. Between 25–30% of patients remain undiagnosed until adulthood. The most common site is in the middle oesophagus. Methods: A 35-year-old woman was admitted complaining of dysphagia, epigastric pain and vomiting. Chest CT showed mid- oesophageal pseudodiverticulum with oesophageal double lumen from the thoracic inlet to the diverticulum. Oesophagoscophy revealed a true oesophageal lumen and pseudodiverticulum. Oesophagogram showed double lumen extending to the diaphragm. Bronchoscopy and abdominal ultrasound were normal. Results: Surgical findings confirmed OD. Adhesions to mediastinal organs were present. The oesophagus was isolated, pseudodiverticulum with the mucosal duplication resected and the muscle coat reconstructed. The postoperative recovery was swift, discharge in 10 days. Follow-up at one year with a chest X-ray confirmed normal oesophageal lumen. The patient remains symptom-free. Discussion: With OD the primary oesophagus and duplication are in the same muscle sheath and may communicate. Malignant degeneration has been reported. Two-thirds present with dysphagia and chest pain. Mediastinal mass and oesophageal diverticulum are the differential diagnoses. Chest radiograph reveals a mediastinal mass, oesophagogram shows abnormal oesophageal transit and some- times double lumen if communicating with the oesophagus. CT scan is the gold standard. Oesophagoscopy occasionally might show the inlet and the possible outlet between duplication and oesophagus. Biopsy is contraindicated. Treatment, in symptomatic patients, is surgical and consists in the excision of the duplication with preservation of the muscular layer. Results are good with complete resolution of symptoms.

Introduction: Primary pulmonary lymphoma is an uncommon lung neoplasm. Methods: From July 2000 to April 2006 we have observed three cases of primary lymphoma. 3 patients (2 F, 1 M; mean age 34.3 years, range 27–40) were examined with chest X-ray, CT scan and bron- choscopy. Most common symptoms were cough, fever, asthenia, weight loss and clubbing. Radiological findings were similar to primary pul- monarycarcinoma.Bronchoscopyrevealedbronchialstenosis(2)and no abnormal findings (1). Definitive diagnosis was possible by patho- logic and immunohistochemical examination of the lung tissue obtained at surgery in 2 cases, in the remaining a preoperative diagnosis was attained by transbronchial biopsy. Tumor localization was in left upper lobe (2) and middle lobe (1). Two patients underwent radical pneumonectomy and 1 left upper lobectomy. Surgical specimens were histologically proven to be Hodking’s lymphoma in all cases. All patients received postoperative chemotherapy and 1 also preoperative. Results: No perioperative mortality and morbidity with regular postoperative course. All patients are alive without evidence of dis- ease at 27, 15 and 13 months. Discussion: Primary pulmonary lymphoma is a rare type of malignant lung neoplasm without characteristic clinical features. Preoperative diagnosis is difficult because of the lack of specific characteristics and similarity to primary lung cancer. Treatment modalities include surgical treatment, radiotherapy and chemotherapy.

Introduction: Solitary fibrous tumors (SFT) of the pleura are rare and potentially malignant (5% of pleural neoplasm). Methods: From June 1988 to April 2006 18 patients underwent 21 surgical procedures. 6 males and 12 females; median age was 60 years (range 39–72). Predominant clinical symptoms were dyspnoea, chest pain and cough in 12 cases, hypoglycemia in 2, 6 patients were asymptomatic. Surgical approach was through posterolateral thoracotomy in 11 patients, lateral thoracotomy in 4 and VATS in 6. 14 tumours arose from visceral pleura, 7 from mediastinal, diaphrag- matic and parietal pleura. Removal of the tumor alone was possible in 1 case, in the remaining extended resection involving adjacent structures was performed (1 bilobectomy, 3 lobectomies, 14 wedge and 1 chest-wall resection, 4 diaphragmatic resections). In all cases radical surgical excision was achieved. Results: There was no perioperative mortality or morbidity. All surgical specimens were histologically proven to be a localized benign tumor of the pleura. Immunohistochemical reactions were in 16 patients positive for CD34, negative for vimentin, S100, cytoker- atin. Follow up was performed in 17 patients (range 17 years–10 months). Local recurrences occurred in 3 cases, in which sarcomatous degeneration was observed. 14 patients are still alive without evi- dence of disease, 3 are dead of disease. Discussion: Even though the majority of SFT are benign, they should be considered as potentially malignant neoplasms. Radical resection as well as clinical and radiological follow up are highly recommended because of the potentially malignant biological behaviour and the lack of radical treatment options.

To determine the prevalence of neuroendocrine differentiation in human thymic neoplasms, which are unusual tumours that may range from well-differentiated to overtly malignant, poorly differentiated lesions, an immunohistochemical study was conducted in 23 thymic neoplasms re-classified on the basis of the new 1999 WHO classification. Immunohistochemical evidence of neuroendocrine differentiation in the form of reactivity to the markers synaptophysin, neuron-specific enolase and chromogranin A was found in 6 of 23 tissues (26%). Two of 3 patients with thymic carcinoids (or well-differentiated thymic neuroendocrine carcinoma) were affected by multiple endocrine neoplasia type 1 (MEN-1). Myasthenia gravis was present in 2/6 patients with neuroendocrine differentiation. This study demonstrates the high prevalence of neuroendocrine markers in human thymic neoplasms. Whether and in what percentage of cases immunohistochemical reactivity may be correlated with clinical behaviour and outcome remains a controversial issue. Finally, the association between thymic carcinoids and MEN-1 is a strong indication for clinical and possibly genetic screening of all patients presenting this feature, just as all MEN-1 patients have to undergo thoracic imaging and prophylactic thymectomy in selected cases.