Search

Objective: We review our results on surgical treatment of patients with stage I non-small cell lung carcinoma and we attempted to clarify the prognostic significance of some surgical-pathologic variables. Methods: From 1993 to 1999, 667 patients received curative lung resection and complete hilar and mediastinal lymphadenectomy for non-small cell lung cancer. Of these, there were 436 Stage I disease (65%), of whom 144 T1N0 and 292 T2N0. No patients had pre- or postoperative radio- or chemotherapy. Prognostic significance of the following independent variables was tested using univariate (log-rank) and multivariate (Cox proportional-hazards) analysis: type of resection (sublobar vs lobectomy vs pneumonectomy), histology (squamous cell vs adenocarcinoma), tumour size (≤3 cm vs >3 cm), histologic vascular invasion, visceral pleura involvement, positive bronchial resection margin, general T status. Results: Overall 5-year survival was 63%. In both univariate and multivariate survival analysis, significant prognostic factors were histology (adenocarcinoma 65% vs squamous cell carcinoma 51%), tumour size (≤3 cm 67% vs >3 cm 46%), and the presence of negative resection margin. Five-year survival by general T status was 66% in T1N0 vs 55% in T2N0 disease (P = 0.19). Conclusions: Despite advances in early diagnosis and surgical technique, 5-year survival of stage I non-small cell lung carcinoma remains low as compared to survival of other solid organ neoplasm. Tumour size ≤3 cm, adenocarcinoma histologic type and negative bronchial resection margins were associated with a more favourable outcome in our patient population. More effective multimodality treatments are needed to increase survival rates.

Objective Our experience with posttraumatic and iatrogenic foreign bodies in the heart is presented and discussed along with a review of the literature on this subject. Summary background data Posttraumatic or iatrogenic foreign bodies in the heart can be treated either conservatively or surgically. Controversy exists about optimal management. Methods Fourteen cases of posttraumatic or iatrogenic foreign bodies in the heart observed between 1955 and 2000 were studied. Our series includes the following: bullets into the right or left ventricle (4 cases); needles in the left ventricle, atrium, and pulmonary artery (3 cases); retained catheter fragments in the right ventricle, right atrium, or in the pulmonary artery (4 cases); a grenade fragment into the right atrium (1 case); a circular saw fragment into the right ventricle (1 case); and a commissurotomy ring into the left atrium (1 case). Results Foreign bodies were removed when in the cardiac cavities (1 case); when in the presence of associated risk factors like embolism, arrhythmia, or infection (3 cases); and when in the presence of associated signs or symptoms including cardiac tamponade (2 cases), arrhythmia (1 case), fever (2 cases), or anxiety (1 case). Removal was accomplished by a thoracotomy (7 cases) or sternotomy (2 cases), with (3 cases) or without cardiopulmonary bypass, or percutaneously (1 case). Four asymptomatic patients were conservatively treated and have no evidence of complications at a median follow-up of 20 years. Conclusions The management of foreign bodies in the heart should be individualized: (1) symptomatic foreign bodies should be removed irrespective of their location; (2) asymptomatic foreign bodies diagnosed immediately after the injury with associated risk factors should be removed; (3) asymptomatic foreign bodies without associated risks factors or diagnosed late after the injury may be treated conservatively, particularly if they are completely embedded in the myocardium or in the pericardium.

system is generally poor, irrespective of whether the location is in the pulmonary parenchyma or the main airway. Angiosarcoma of the pulmonary parenchyma is invariably fatal within months because metastases are usually present at the time of detection, and chemotherapy thus far has not proved effective. The clinical course of solitary angiosarcoma of the main airway is also dismal in previous reports.2,4 However, mortality of these patients was mainly caused by massive and intractable hemoptysis of the small resectable tumor rather than by the invasiveness of the disease. From the experience of successful treatment of this patient, angiosarcoma should be considered in the differential diagnosis of a primary tracheal tumor. Furthermore, prompt surgical intervention with adequate resection margins is recommended in the management of these patients when the disease is localized at detection. References 1. Spragg RG, Wolf PL, Haghighi P, Abraham JL, Astarita RW. Angiosarcoma of the lung with fatal pulmonary hemorrhage. Am J Med. 1983;74:1072-6. 2. Tuppy H, Kolb R, Eckmayr J. Primary epitheloid angiosarcoma of the proximal trachea. Pathologe. 2000;21:460-3. 3. Sheppard MN, Hansell DM, Du Bois RM, Nicholson AG. Primary epithelioid angiosarcoma of the lung presenting as pulmonary hemorrhage. Hum Pathol. 1997;28:383-5. 4. Palvio DH, Paulsen SM, Henneberg EW. Primary angiosarcoma of the lung presenting as intractable hemoptysis. Thorac Cardiovasc Surg. 1987;35:105-7. 5. Egermayer P. Epidemics of vascular toxicity and pulmonary hypertension: what can be learned? J Intern Med. 2000;247:11-7. 6. Stout AP. Hemangio-endothelioma: a tumor of blood vessels featuring vascular endothelial cells. Ann Surg. 1943;118:445-64. 7. Tsang WY, Chan JK, Fletcher DC. Recently characterized vascular tumors of skin and soft tissues. Histopathology. 1991;19:489-501.

Objective: Solitary fibrous tumours (SFT) of the pleura are rare tumours originated from the mesenchimal tissue underlying the mesothelial layer of the pleura. This tumours present unpredictable clinical course probably related to their histological and morphological characteristics. Methods: Twenty-one patients affected by SFT of the pleura were referred to us for surgical resection from September 1984 to April 2000. They were 15 males and six females with median age of 51 (range 15‐73) years. Nine patients (43%) were symptomatic and predominant clinical symptoms or signs were dyspnoea (19%), coughing (14.3%), chest pain (28.5%), finger clubbing (14.3%) and hypoglycaemia (14.3%). Hypoglycaemia was related to a pathological incretion of insulin-like growth factor 2 by the tumour. Chest radiograph and computed tomography of the chest revealed intra-thoracic homogeneous sharply delineated round or lobulated mass sometimes associated with ipsilateral pleural effusion (19%) or causing pulmonary atelectasis with opacification of the complete hemithorax (19%). Surgical excision required 14 posterolateral thoracotomies, six anterior thoracotomies and one video-assisted thoracoscopy. Thirteen tumours arose from visceral pleura and wedge resection was performed, seven tumours arose from parietal pleura and extrapleural resection was carried out without any chest-wall resection, one tumour growth within the upper left lobe and required lobectomy. Tumours weighted from 22 to 1942 g and measured from 22 £ 12 £ 8 to 330 £ 280 £ 190 mm. At cut section seven cases (34%) revealed focal necrosis and hemorrhagic zones and on light microscopy six cases (28.5%) were characterized by high mitotic count: characteristics related with uncertain clinical behaviour. Immuno-histochemical reactions were in all cases positive for CD34. Results: In all our patients resections were complete. Paraneoplastic syndromes like hypoglycaemia and clubbing receded after surgery. No intraoperative or perioperative medical or surgical complications occurred. Median chest-drain duration timed 3 (range 2‐5) days and median hospital stay was 5 (range 4‐7) days. Perioperative mortality rate was 0%. Median follow-up was 68 (range 2‐189) months: during this period patients were submitted to chest Xray with 6-months interval to evaluate possible local recurrence. Only one patient experienced tumour recurrence after 124 months followup: the tumour was suspected after observation of finger clubbing. The tumour was detected and excised by redo-thoracotomy. Conclusions: Surgical resection of benign solitary fibrous tumours is usually curative, but local recurrences can occur years after seemingly adequate surgical treatment. Malignant solitary fibrous tumours generally have a poor prognosis. Clinical follow-up and radiological follow-up are indicated for both benign and malignant solitary fibrous tumours. q 2001 Elsevier Science B.V. All rights reserved.