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Malignant pleural mesothelioma (MPM) is an aggressive tumor with a poor prognosis. In our study, we aimed to investigate the specific clinical, laboratory, and radiological features of the tumor and the prognostic effect of SUVmax (maximum standardized uptake values) according to PET/CT (positron emission tomography). Demographic, therapeutic, clinical, and survival information of patients diagnosed with histologically-validated pleural mesothelioma in our hospital between January 2010 to December 2019 will be retrospectively scanned from the hospital records. A total of 116 patients, 61 men (52.6%), and 55 women (47.4%), were analyzed. Thirty five patients (30.2%) were over the age of 65. Percentage of patients over 65 years of age, neutrophil count, and PET SUV Max values, asbestos exposure and pleural thickening rate were significantly higher in the deceased patients' group than in the living patients' group (P = .042, P = .039, P = .002, P = .004, P = .037). T stage (tumor stage), N stage (lymph nodes stage), metastasis stage, and Grade distribution were significantly higher in the deceased patients' group than in the living patients' group (P .000, P .000, P = .003, P .000). The rates of chemotherapy and surgical treatment, right lung location, and epithelioid pathology were significantly lower in the deceased patients' group compared to the living patients' group (P = .016, P = .030, P = .018, P = .008). The mean follow-up time was 13 months. Key determinants of survival in MPM include age, male gender, neutrophil increase, pleural thickening, high PET SUV max values, stage, histological type, asbestos exposure, and treatment regimen.

Aim: To determine the programmed death ligand-1 (PD-L1) expression rates in sarcomatoid lung carcinomas and to compare clinicopathologic features and survival rates of PD-L1-positive and negative patients. Methods: PD-L1 expression was evaluated in 65 surgically resected sarcomatoid carcinomas. The clinicopathologic features of cases with PD-L1-positive and negative tumors were compared. Kaplan-Meier survival analysis was performed. Multiple Cox proportional hazard regression analysis was performed to determine independent predictors of overall survival. Results: PD-L1 antibody positivity was found in 72.3% of surgically resected sarcomatoid lung carcinomas. Regarding histopathologic subtypes, PD-L1 expression was positive in 80.4% of pleomorphic carcinomas, 62.5% of spindle- and/or giant-cell carcinomas, and 16.7% of carcinosarcomas. Pleural invasion was observed in 68.1% of PD-L1-positive cases and 27.8% of PD-L1-negative cases (p = 0.008). No difference in survival was found between PD-L1-positive and negative tumors. The only factor significantly associated with poor survival was the pathological stage of the tumor. Conclusions: This study reveals a high rate of PD-L1 positivity in a large number of sarcomatoid lung carcinoma cases with pleomorphic carcinoma, spindle- and/or giantcell carcinoma, and carcinosarcoma subtypes. The only significantly different clinicopathologic feature in PD-L1-positive cases is pleural invasion. PD-L1 positivity is not a significant predictor of survival in sarcomatoid lung carcinomas.

Background: Ewing sarcoma (ES) is an uncommon aggressive malignant tumor of the bone and/or soft tissue and belongs to peripheral primitive neuroectodermal tumor (PNET) family of tumors. Bone PNETs primarily arise from the diaphysis of long bones, where as soft tissue PNETs are most commonly found in the chest wall. Multidisciplinary treatments, including chemotherapy, surgery, radiotherapy, or all three combined, improve the survival of patients with localized ES. However, the best approach to achieve local control remains controversial.Materials and Methods: We retrospectively analysed the medical records and pathology data of 14 patients (8 male, 6 female; mean age, 23.2 [range, 4-54] years) with primary thoracic ES who underwent surgery in our clinic between January 2002 and December 2019. In addition, the treatment modalities and tumor-related factors of chest wall ES and lung parenchyma were evaluated.Results: The most frequent complaint was chest pain (n = 7). In 10 patients, the tumor originated from the ribs, whereas the remaining 4 patients had lung parenchymal tumors. Ten patients underwent complete tumor excision with chest wall resection, one patient underwent lower lobectomy with chest wall resection, and three patients underwent complete tumor excision via wedge resection. All patients were treated with chemotherapy, except two who underwent bone marrow transplantation. The median follow-up was 31.6 (range, 2-84) months. Relapses were seen in 5 cases in the median 19.8th (range, 4-60) month.Conclusions: Complete tumor resection is the most effective treatment for thoracic ES and multimodal therapy (surgical resection, chemotherapy, and local radiation therapy), which is recommended when indicated, constitutes the optimal treatment for ES. Although relapses occur within the early postoperative period, late relapses are not uncommon. The follow-up periods must be short and should be maintained long term for late relapses.Keywords : Ewing’s sarcoma, chest wall, chemotherapy, surgery, recurrence

Background: Prostatic leiomyoma is a benign and rare condition of the prostate. Robotic surgery is increasingly being applied in the surgical management of prostate cancer. Case Presentation: Herein, a mass lesion that was located in the posterior part of the prostate between seminal vesicles that was identified during robotic surgery is presented. This lesion further challenged the console surgeon during performing a robotic radical prostatectomy procedure for a 200 g large prostate with prostate cancer. Conclusion: Prostatic leiomyomas that are benign mesenchymal smooth muscle tumors might present as a posteriorly located mass lesion between seminal vesicles that could challenge the surgeon during surgery, which should be kept in mind.

Aim: Malignant pleural mesothelioma (MPM) increases the risk of thromboembolic events (TEEs). In this retrospective study, we aimed to determine the rate of TEEs in MPM and investigate its relationship with the presence of thrombocytosis, the disease stage, and the tumor histopathology. Methods: The study included 178 patients who were histopathologically diagnosed as MPM between the years January 2008 and June 2014. Results: The mean age was 58.7 ± 11.8 years, and the median follow-up time was 8 months. Seventy-one patients (39.9%) had thrombocytosis (>350 × 103/mL). In total, 14 (7.9%) TEEs were identified: 6 (3.4%) pulmonary thromboembolism, 6 (3.4%) deep venous thrombosis, and 2 (1.1%) myocardial infarctions. Although 5 (2.8%) of the TEEs preceded the diagnosis of MPM, 1 (0.6%) occurred simultaneously with the diagnosis of MPM and 8 (4.5%) followed the diagnosis of MPM. Thromboembolic event rates were not statistically different based on the presence of thrombocytosis ( P = .51), disease stage ( P = .14), and histopathology ( P = .38). Conclusion: The rate of TEEs was 7.9%. Presence of thrombocytosis, disease stage, and histopathology did not affect the incidence of TEEs.

Coexistence of two or more primary cancers is a relatively rare case. Not with standing that the coexistence of multiple primary cancers is often discussed in the literature, there is a small number of publications concerning the coexistence of squamous cell lung carcinoma and renal cancer. In this case report, detection of both squamous cell lung carcinoma and primary renal cancer in one male patient is going to be discussed.

Introduction Pulmonary Langerhans cell histiocytosis (PLCH) is a rarely seen disease of younger population. Almost all of the patients were smoker. In this study we aimed to evaluate the characteristics, diagnosis, treatment modalities and prognosis of 11 cases with PLCH. Materials and methods We retrospectively reviewed our case series of eleven patients who were pathologically diagnosed as PLCH. The median age was 35 years (19-51) and male to female ratio (M/F) was 5/6. All of the patients were symptomatic. The most common symptoms were dyspnea (81.8%) and dry cough (72.7%). Mean duration of the symptoms was 10.8 months. All patients except two of them were smoker (81.8%). All patients were also passive smokers. Results Bilateral cystic appearance (n= 9, 81.8%), interstitial findings [septal and peribronchovascular thickening (72.7%) and nodular pattern (54.5%)] were common radiological findings. Spontaneous pneumothorax was present in two cases. All patients were diagnosed with surgical biopsies (90.9%) or transbronchial parenchymal biopsy (9.1%). Smoking cessation (81.8%) and immunosupression therapy (methylprednisolone) were the treatment modalities. Mean follow-up period was 5.40 ± 1.78 years. Generally, symptoms were improved with smoking cessation or methylprednisolone therapy. One patient was readmitted to our clinic with recurrent pneumothorax. In conclusion, it should be kept in mind that passive smoking is also responsible in the pathogenesis of PLCH. Conclusion Exact consensus for PLCH treatment was not present except a few recommendations. In the future, with the understanding of the pathogenesis of the disease, new therapeutic agents will be discovered for this rare condition.

Parathyroid cysts are unilocular, thin-walled cysts, and they are seen very rarely. Their formation mechanisms are not clear. They are usually localized in the cervical region, and mediastinal settlements are rare. They are usually asymptomatic, but cysts that have settled in the neck may be symptomatic, such as tracheal pressure symptoms. There are two types-namely, functional cysts and non-functional cysts-depending on their hormonal characteristics. There are still difficulties in the diagnosis, and they can be mistaken by thyroid pathology. Treatment is surgery. We discussed two cases of parathyroid cysts that we surgically excised.

Hydatid cyst is one of the five most diagnosed zoonotic diseases in the Mediterranean region. However, intramuscular localisation is very rare. It is reported that muscular involvement constitutes 1–5.4% of all Echinococcus infections. Here we would like to report an unusual case of hydatid cyst in the gluteus muscle, which had been treated with both surgical and medical treatment.

Diffuse pulmonary ossification is a rare entity of characterized by diffuse small bone fragments in lung tissue. Two types are described: ‘nodular’ and ‘dendriform’. Living cases are rarely encountered; most are diagnosed at autopsy. A 29-year-old man had a moderate chest pain ongoing for two weeks was referred to our hospital with bilateral, multifocal, diffuse calcified nodular densities on chest radiography and computed tomography (CT). Use of risperidone and valproic acid due to bipolar personality disorder for three years, working as a car repairer for one year were present in his history. On positron emission tomography (PET-CT) was taken for suspected metastatic disease, increased metabolic activity was detected in multiple nodules with low density. Video-assisted thoracic surgery (VATS) lung biopsy was performed for diagnose. Even though macroscopic appearance of specimens suggestive of malignancy, histopathology was consistent with DPO. Drugs used by the patient were found not to be the direct cause of pathology in lung however previous studies have reported valproic acid effects osteogenesis in vitro and in vivo through by mesenchymal pluripotent cell proliferation and differentiation in extracellular matrices. Although the exact pathogenesis of diffuse pulmonary ossification is unknown, underlying fibrosis is the precursor of DPO has been shown. Also pulmonary fibrosis can be triggered with deposition of heavy metals (eg., serium oxid/ phosphate). Based on this, sodium valproate and heavy metals may play a role in inflammation-mediated heterotopic ossification was considered in our case. In conclusion, we herein presented a case of living DPO accompanied by an inflammation-mediated heterotopic ossification related to sodium valproate and/or heavy metals with high probability.

The treatment strategy of differentiating lung carcinomas into small-cell lung carcinoma and non-small-cell lung carcinoma has been satisfactory until recently. The introduction of novel cytotoxic agents that affect a patient's response to therapy has made further differentiation important. Non-small-cell carcinoma represents a heterogeneous group of cancers with varying histologic subtypes, hence the necessity to subgroup them. In the case of adenocarcinoma and squamous cell cancer, their different responses to novel therapeutic agents and their higher occurrence make differentiation between them even more important. New markers such as desmoglein-3 (positive for squamous carcinoma) and Napsin A (positive for adenocarcinoma), which show improved specificity and sensitivity, may be particularly useful for this type of differentiation. In our study, 124 surgically resected specimens were used: 57 adenocarcinoma, 42 squamous cell carcinoma, 16 large-cell carcinoma, 1 small-cell carcinoma, and 8 typical carcinoid tumor samples. The sensitivity to desmoglein-3 and Napsin A was 92.8% and 85.9%, whereas specificity was 100% and 97%, respectively. The use of a desmoglein-3 and Napsin A double-staining strategy in our study confirmed that these markers are useful in differentiating pulmonary squamous cell carcinoma and pulmonary adenocarcinoma from other subtypes.

SUMMARY Pulmonary involvement in sea-blue histiocytosis Ersin GUNAY 1 , Selma FIRAT GUVEN 1 , Zafer AKTAS 1 , Tugrul SIPIT 1 , Yetkin AĞACKIRAN 2 , Hakan ERTURK 3 1 Clinic of Chest Diseases, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey, 2 Clinic of Pathology, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey, 3 Clinic of Radiology, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey. Sea-blue histiocytosis is one of the six types of Niemann-Pick disease. It is characterized by childhood onset of hepatosple-nomegaly, lack of neurological involvement and diminished sphingomyelinase activity. Pulmonary system is rarely invol-ved sea-blue histiocytosis. In this paper, we present a 39-years-old male who had previously diagnosed as sea-blue histi-ocytosis at the age of 15. He was admitted to our clinic due to productive cough, hemoptysis, fever and weight loss. Hissymptoms did not resolve with the antibiotic treatment and further investigations revealed pulmonary involvement of sea-blue histiocytosis. After diagnostic bronchoalveolar lavage, his symptomes were improved, interestingly. This rare entitywas discussed with literature survey.

Small cell osteosarcomas are very rare tumors which are classified as the component of Ewing's sarcoma family. Although the tumor generally is seen on long bones, short bone involvement is rare. Moreover, rib localization is quite uncommon and to the best of our knowledge, only one case has been reported so far. Herein, we described a case of rib-localized small cell osteosarcomas which was only presented with localized left sided pain. Resection surgery followed by adjuvant chemotherapy was performed. Clinico-pathological features and therapeutic approach are discussed in the light of the relevant literature.

Objective:Pulmonarycarcinoidtumors arerare low-grade malignant neoplasms andconstitute2—5% of all lung tumors. In this study, we aimed to determine the clinical presentations, types of surgery, long-term treatment outcomes and survival rates of patients diagnosed with carcinoid tumor treated surgically in our clinic. Methods: Patients operated in our clinic between 1992 and 2008 with confirmed or suspected diagnoses of carcinoid tumorswere includedin our study. Patients’ hospital records were retrospectively analyzed.Results:A total of 104 patients (age 19—71 years, mean 44 13 years, 2 SD) with pathologically confirmed carcinoid tumor were analyzed. A total of 84 patients (81%) were diagnosed as typical and the remaining 20 (19%) being atypical carcinoid tumor. As many as 24 patients (23%) were asymptomatic. The most frequent symptom was recurrent respiratory infection (35%). The most used surgical procedures were lobectomy (47%) and bilobectomy (16%). Mean postoperative follow-upperiodwas72months(6—190months).No surgeryrelatedmortalitywasnoticed.Asmanyas 15(14%)patientsdied duringthefollow-up period. Overall 5- and 10-year survival rates were 89% and 72%, respectively. For typical carcinoid tumors, the 5- and 10-year survival rates were 92% and 83%, and for atypical carcinoids 73% and 46%, respectively (p < 0.001). Conclusions: In our study, we noticed histological subtype, stage of the disease and the type of surgery performed to be prognostic factors of carcinoid tumors. Atypical carcinoid tumors tend to be more metastatic and had worse prognosis when compared with typical carcinoid tumors. We conclude that surgery is the best treatment of choice for carcinoid tumors, especially parenchyma-sparing procedures, because of their good mid- and long-term survival rates. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

A retrospective study of primary tumors of the ribs (PTR) was conducted to review their clinical, radiological, and pathological features, as well as the early and long-term results of surgical management. Seventy-eight patients (48 male, 30 female, age range: 7-80 years) with PTR were treated in our clinic between January 1998 and July 2008. Forty-nine (63%) of the patients had benign lesions and 29 (37%) had malignant lesions. In the group with malignant tumors, the main symptom was pain, but in the group with benign tumors, the main symptom was swelling. Eight cases in the benign group and four cases in the malignant group were asymptomatic (accidental radiological findings in recruitment centers). Most of the patients with PTR had benign lesions. All PTR should be considered as malignant until proven otherwise. Surgery must consist of wide resection with tumor-free margins in order to provide the best chance for cure in both benign and malignant lesions.

It has been suggested that reactive oxygen species (ROS) plays an important role in radio contrast media (RCM)-induced ischemia reperfusion tissue injury although antioxidants may have protective effects on the injury. We investigated the effects of erdosteine as an antioxidant agent on RCM-induced liver toxicity in rats by evaluation of lipid peroxidation (as TBARS), catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH) and glutathione peroxidase (GSH-Px) values and histological evaluation. Twenty-one rats were equally divided into three groups as follows: control, RCM, and RCM plus erdosteine. RCM was intraperitoneally administered for 1 day. Erdosteine was administered orally for 2 days after RCM administration. Liver samples were taken from the rats and they homogenized in a motor-driven tissue homogenizer. TBARS levels were significantly (p < 0.005) higher in RCM group than in control although SOD activities significantly (p < 0.05) decreased in RCM group. TBARS levels were lower in RCM plus erdosteine group than in control although SOD activity and GSH level increased (p < 0.05) in liver as compared to RCM alone. Erdosteine showed also histopathological protection (p < 0.0001) against RCM induced hepatotoxicity. GSH-Px and CAT activities were not statistically changed by the erdosteine. According to our results, it can be concluded that radiocontrast media can induce oxidative stress in liver as suggested by previous studies. Erdosteine seems to be protective agent on the radiocontrast media-induced liver toxicity by inhibiting the production of ROS via the enzymatic antioxidant system.

To evaluate the effects of oxidant/antioxidant mechanisms and levels of trace elements on trauma-stimulated moderate pulmonary contusions after vitamin E administration. Materials and methods: Sixty-three male Sprague Dawley rats were used. Animals were studied in 4 groups. Vitamin E (150 mg/kg) was injected intraperitoneally 30 min after trauma and on the first and second days. Blood samples were obtained for nitric oxide (NO) levels and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities. Zinc (Zn^{+2}), copper (Cu^{+2}), and iron (Fe^{+3}) were measured in serum. Results: Lung contusion increased serum and tissue NO levels and SOD activities and decreased GSH-Px activities (P < 0.05). Vitamin E significantly (P < 0.05) decreased NO levels and SOD activities and increased GSH-Px. Serum Zn^{+2}, Cu^{+2}, and Fe^{+3}) levels were statistically significantly influenced by the administration of vitamin E (P < 0.05). Group 4 had lower scores compared to Group 3 (P < 0.05) and no difference compared to Group 1 (P > 0.05). Conclusion: These results suggest that treatment with vitamin E reduces lung oxidative stress and related mechanisms in isolated lung contusion as demonstrated by an experimental rat model.

Isolation and identification of Avibacterium paragallinarum, the causative agent of infectious coryza, is considered a challenging task in laboratories with limited specialties. In the present study, 14 commercial layer fowls showing the typical symptoms of infectious coryza were subjected to primary isolation followed by polymerase chain reaction confirmation of suspect colonies (culture-PCR). Direct PCR assays on infraorbital sinus swab samples were also carried out. Thirty-five suspected cases of infectious coryza in commercial broiler chickens were also screened using direct PCR on infraorbital sinus swabs. In culture-PCR, only 1 of the 4 suspected isolates was confirmed as Av. paragallinarum. In comparison, in direct PCR, 5 layer samples were shown to be positive for Av. paragallinarum. All of the broiler samples were negative in the direct PCR assay. Our findings indicate that primary isolation in combination with PCR can be a simple method for diagnosis of infectious coryza, although with a lower sensitivity than direct PCR. While direct PCR is comparably the more rapid and sensitive test, there will be instances in which the bacterial isolate is needed for further use. Hence, the culture-PCR method can be a practical and simple approach, especially in laboratories with limited specialty in identification of this fastidious organism.

Esophageal gastrointestinal stromal tumors (GISTs) are less common than other tumors of the esophagus. Gastrointestinal autonomic nerve tumors (GANTs) comprise a subgroup of GISTs. These tumors are mostly located in the small intestine and stomach, whereas they rarely arise in the esophagus. In immunohistochemical examinations, staining for CD117 and CD34 is positive in these tumors, whereas smooth muscle actin staining is negative. The most important risk factors for progressive disease are the mitotic count and tumor size, and surgery is recommended for the treatment of suitable cases. In this article, we discussed the clinicopathologic features of GISTs and the treatment options in light of the literature of a patients diagnosed with esophageal GANTs. Gastrointestinal stromal tumors (GISTs) have been reported to be anatomically located in the stomach; small intestine; colon, rectum, and appendix; and esophagus in 51-70%, 25-36%, 5-7%, and 1-3% of cases, respectively (1). Gastrointestinal autonomic nerve tumors (GANTs) comprise a subgroup of GISTs. These tumors are mostly located in the small intestine and stomach, whereas they rarely arise in the esophagus. On computed tomography of the thorax of a 61-yearold female patient who presented to our clinic with shortness of breath and swallowing difficulty, a lesion of approximately 62 × 33 × 68 in size was observed. The lesion filled the prevertebral distance and subcarinal area from the level of the arcus aorta in the mediastinum and compressed the right and left main bronchi, and it had borders with the esophagus that could not be distinguished. A diagnosis could not be made, and as a result, transbronchial biopsy was performed. The maximum standardized uptake value on positron emission tomography-computed tomography (PET/CT) of the mass was 23.8 (Figure 1a). There was no pathologic involvement for the mass on PET/CT, and the patient underwent right thoracotomy. The lesion, which appeared to originate from between the muscle fibers of the esophagus, was excised without complete removal of the esophageal mucosa (Figure 1b). On immunohistochemical examination of the tumor, in which microscopically spindle cells were generally organized as cellular areas, CD117 and CD34 staining was positive, and in addition to the existence of neuronal cells and S-100 positivity, staining for smooth muscle actin, desmin, and synaptophysin was negative (Figure 2). The mass was 7 cm in size with 1 mitotic count per 50 high-power fields (HPFs). The tumor was histopathologically diagnosed as a GANT, and the risk for progressive disease as intermediate.

Pericardial cysts are rare benign congenital mediastinal lesions. It accounts 30% of all mediastinal cysts. They are usually asemptomatic. They can produce the compression of the mediastinal structures typically caused the symptoms of dyspnea, thoracic pain, tachicardia and cough due to the unusual large size of the cyst. It can performed symptoms of lung atelectasia. The case was a sixty-five years old woman followed with a diagnosis of COPD for seven years. The patient was admitted to our center with the diagnosis of elevation of the right hemidiaphragm on chest radiography. The computed tomography revealed a cystic lesion adjacent to the right hemidiaphragm and cyst excision was performed via right thoracotomy. Patient%u2019s postoperative clinical findings indicated that the symptoms of COPD regressed completely and the patient did not require any further bronchodilator therapy. The aim of this case report is to demonstrate that the pericardial cysts can be missed in chest radiographs and impression of cysts may cause COPD like symptoms in these patients.

Benign metastasizing leiomyoma is typically seen in young premenopausal women after a mean period of 15 years following uterine leiomyoma or hysterectomy surgery. They are usually incidentally seen on chest x-rays and are nodular lesions that appear as bilateral nodules with a benign appearance and consist of smooth muscle proliferation. A 44-year-old female presented at her healthcare institution for backache for the last 9 months. Multiple nodules (largest 15 mm) scattered in both lungs and consistent with metastases were detected on computed tomography. The PET-CT results revealed multiple nodular densities with increased metabolic activity (SUVmax: 1.92) in both lungs, with the largest one measuring approximately 15 mm and located in the lower lobe superior segment of the right lung. A benign metastasizing leiomyoma was diagnosed with open wedge biopsy of the lung. We present this case due to its interesting clinical presentation and rarity and emphasize the pathogenesis.

Synchronous bilateral multiple carcinoid tumors of the lung are uncommon. We report an unusual case of synchronous, bilateral, and multiple typical pulmonary carcinoids. A 58-year-old woman with cough and chest pain was admitted to our clinic. A thoracic computed tomographic scan showed multiple bilateral nodular lesions. Bronchoscopic evaluation was normal. We performed sequential bilateral thoracotomies, frozen section examination, wedge resection, and lymphadenectomy. Histopathologic examinations revealed typical carcinoid tumor in both lungs. No pathologic lesions were observed in 18-month postoperative follow-up. We discuss treatment of synchronous bilateral multiple carcinoid tumors.

A 28-year-old female patient presented with back pain, dyspnea and coughing. Chest radiograph showed a mass in the middle zone of the right hemithorax. CT confirmed the mass was confined to the 5th rib. During the exploratory thoracotomy, a smooth, firm mass measuring 7 x 9 x 5 cm was found to have destroyed the middle and posterior parts of the 5th rib. Together with the adjacent intercostal muscles, the 5th rib was excised en-block. Postoperative pathology was cavernous haemangioma. Cavernous haemangioma of the rib is very rare, and very few cases have been reported in the literature.

Primary pulmonary lymphomas (PPL) only constitute 4% of extra-nodal, non-Hodgkin lymphomas (NHL), less than 1% of NHL in general, and between 0.5% and 1% of malignant pulmonary neoplasms. Fifty-eight to 87% of cases of this extremely uncommon disease are low-grade B-cell lymphomas and 11%-19% are high-grade or large B-cell lymphomas. The prognosis for.high-grade or large B-cell lymphomas is worse than for low-grade lymphomas; respiratory and general symptoms are usually present. However asthmatic symptoms are not often found in their clinic. We report the case of a 49-year old woman with resistant asthma clinic in the form of wheezing, dyspnea and non-productive painless cough; associated with an irregular lobulated mass with air bronchograms in the lower lobe of the right lung. Histological diagnosis showed a pattern of high-grade B-cell lymphoma and all asthmatic symptoms disappeared following gross total resection of this lesion.

Calcifying fibrous tumors are uncommon lesions. These lesions are made up of hyalinized collagenous fibrotic tissues interspersed with lymphoplasmacytic infiltrates and extensive dystrophic calcifications mimicking psammomatous features. Calcifying tumor of pleura is rarely presented. Multiple calcifying tumor of pleuras have been reported extremely seldom. Forty-year-old male patient was admitted to our clinic with complaints of dyspnea. Because of the multiple soft tissue formations at the pleural region with the largest diameter of 2 cm on thorax computed tomography, surgical intervention was planed. Frozen sections of pleural biopsies that were taken during video-assisted thoracoscopic surgery were reported as calcifying fibrous tumor. Because of the presence of multiple lesions and pleural adhesions, curative pleural decortication was performed. This case is presented with extremely rare entity of multiple calcifying tumor of plevras.

Lymphangioleiomyomatosis is an uncommon lung disease primarily affecting women of childbearing age. It is characterized by the progressive proliferation and infiltration of smooth muscle-like cells, which lead to cystic destruction of the lung parenchyma; obstruction of airways, blood vessels, and lymphatics; and loss of pulmonary function. We present the case of a 46-year-old female patient with chest pain, cough, sputum, and dyspnea on exertion for three weeks. Minimal pneumothorax was noted, and the patient was referred to our center for further investigation and treatment. High-resolution computed tomography revealed numerous bilateral thin-walled air cysts and interstitial thickening affecting the central and peripheral part of the upper zone of the lung. We performed an open-lung biopsy to confirm lymphangioleiomyomatosis. Our aim is to discuss the pathogenesis and other lesions noted in the differential diagnosis of this rare disease.

Pulmonary fibrosis (PF) is a progressive fatal disorder. Bleomycin (BLM) is a widely used chemotherapeutic agent causing PF. Numerous agents have been investigated to prevent the progression of PF so far, but there is still a need to find more efficacious agents. Proanthocyanidin (PA) is a strong antioxidant, the main ingredient of grape seed extract. Since PA is ready for use in practice, we aimed to compare the preventive effect of PA in comparison with taurine (Tau) in BLM-induced PF. Forty Wistar male albino rats were used in the study and were divided into four groups: group 1, control; group 2, BLM-induced PF group; group 3, BLM-induced PF and treated with PA group; and group 4, BLM-induced PF and treated with Tau group. Treatments were begun 10 days before and continued 21 days after BLM injection. PA and Tau effectively inhibited inflammation, edema, severity of fibrosis, fibrosis extension, inflammatory cell accumulation, iNOS staining, and hydroxyproline level as well (p < 0.05). Total histological scores of the PA group were similar to the control group; Tau was significantly higher than the control group but lower than the BLM group (p < 0.05). We believe that PA could be a new treatment choice for PF, but further studies need to be conducted to verify the findings of the current study.

The aim of this study was to investigate the effects of caffeic acid phenethyl ester (CAPE) in the lungs by biochemical and histopathological analyses in an experimental isolated lung contusion model. Eighty-one male Sprague-Dawley rats were used. The animals were divided randomly into four groups: group 1 (n = 9) was defined as without contusion and without CAPE injection. Group 2 (n = 9) was defined as CAPE 10 mu mol/kg injection without lung contusion. Group 3 (n = 36) was defined as contusion without CAPE-administrated group which consisted of four subgroups that were created according to analysis between days 0, 1, 2, and 3. Group 4 (n = 27) was defined as CAPE 10 mu mol/kg administrated after contusion group divided into three subgroups according to analysis on days 1, 2, and 3. CAPE 10 mu mol/kg was injected intraperitoneally 30 min after trauma and on days 1 and 2. Blood samples were obtained to measure catalase (CAT) and superoxide dismutase (SOD) activities and level of malondialdehyde (MDA) and for blood gas analysis. Trace elements such as zinc and copper were measured in serum. The lung tissue was also removed for histopathological examination. Isolated lung contusion increased serum and tissue SOD and CAT activities and MDA levels (p < 0.05). Both serum and tissue SOD, MDA, and CAT levels on day 3 were lower in group 4 compared to group 3 (p < 0.05). Further, the levels of SOD, MDA, and CAT in group 4 were similar compared to group 1 (p > 0.05). CAPE also had a significant beneficial effect on blood gases (p < 0.05). Both serum zinc and copper levels were (p < 0.05) influenced by the administration of CAPE. Histopathological examination revealed lower scores in group 4 compared to group 3 (p < 0.05) and no significant differences compared to group 1 (p > 0.05). CAPE appears to be effective in protecting against severe oxidative stress and tissue damage caused by pulmonary contusion in an experimental setting. Therefore, we conclude that administration of CAPE may be used for a variety of conditions associated with pulmonary contusion. Clinical use of CAPE may have the advantage of prevention of pulmonary contusion.

Pulmonary endometriosis is a rarely seen disease of the lung. On computed tomography, a cavitary lesion of 15 × 26 in size was detected in the lung parenchyma of a 38-year-old female patient who was examined due to hemoptysis. The pathologic result of the surgically excised cavitary lesion was reported as pulmonary endometriosis.

We describe a case of chronical bronchial foreign body presenting with cough, dyspnea and recurrent hemoptysis mimicking asthma, chronic bronchitis and lung cancer and undergoing surgical resection for diagnosis. Occult tracheobronchial foreign body aspirations are infrequently seen in adults. It may be undetected for months to years as in our case. Sometimes it can mimic a lung cancer with an endobronchial lesion placed in the bronchus.

Hemangioma is exceedingly rare in the ribs. A case of rib hemangioma in a 54-year-old woman is presented. Chest roentgenogram and computed tomography revealed a mass in the left lateral costaphrenic sinus with bone destruction. She underwent resection of the 7th and 8th rib. The pathologic diagnosis was cavernous hemangioma. Hemangiomas of the rib are rare tumours but should be kept in mind in the differential diagnosis of rib tumours.

[corrected] The goal of this experimental study was to investigate whether erdosteine has a protective effect against lung injury as a remote organ after hind-limb ischemia-reperfusion (I/R).The rats were divided into three groups: control, I/R, and I/R + erdosteine. After the experimental procedure, nitric oxide (NO) levels, myeloperoxidase (MPO), adenosine deaminase (ADA), and the activities of xanthine oxidase (XO) were determined on the lung tissue. The levels of NO and activities of MPO were also measured on the bronchial alveolar lavage (BAL). In addition, the lung tissue was examined by histopathology.The lung tissue ADA and XO activities were increased in the I/R group compared with the control group (P0.05). In the I/R group, the levels of NO were higher than the control group (P0.05), whereas the erdosteine treatment did not alter the NO levels (P0.05). The MPO activities increased after I/R in the I/R group compared to both control and I/R + erdosteine group (P0.05). The activity of MPO increased in the IR group in comparison with the control group in BAL (P0.05). The activity of MPO in the I/R + erdosteine group was significantly lower than the I/R group in BAL (P0.05). NO levels increased in all I/R groups compared to control group in BAL (P0.05). However, treatment of erdosteine significantly decreased NO levels compared to I/R group (P0.05). The animals of the I/R group had total destruction of normal alveolar structure with the intense presence of infiltrating neutrophils and mononuclear phagocytes in histopathological examination. The rat lung exhibited mild degrees of destruction in the erdosteine group.As a result, erdosteine may be a protective effect for lung injury, decreasing oxidative stress and neutrophil accumulation after hind-limb I/R in rats.

Objective: To present a case of hydatid disease of the first rib as a rare cause of thoracic outlet syndrome. Clinical Presentation: A 57-year-old female patient who had suffered from pain on the left shoulder radiating to the arm and numbness and weakness on the left arm for 3 months was admitted to our hospital. She had undergone an operation due to a mass lesion of the first rib compressing the thoracic outlet which was detected in the preoperative examinations. During the intraoperative examination it was decided that the lesion was a hydatid cyst and the first rib was totally resected. Conclusion: This report shows that hydatid disease should be taken into consideration amongst the tumoral diseases of the first rib as a very rare cause of thoracic outlet syndrome.

Kaposi sarcoma commonly occurs in HIV-positive and immunocompromised patients. We describe a case of Kaposi sarcoma that developed in an HIV-negative patient with tuberculosis. The Kaposi sarcoma completely regressed with antituberculous therapy without the institution of chemotherapy. The patient remained disease-free after a follow-up period of 20 months. Patients with Kaposi sarcoma should be monitored for coexisting diseases such as tuberculosis.

Lipoblastoma is a rare benign tumor of adipose tissue seen almost always in infanthood and early childhood. It is typically located in the extremities and the trunk and less frequently in the head-neck region, mediastinum, and retroperitoneum. However, cases of pleural, thoracic wall, and pulmonary lipoblastoma have also been reported in the literature. Lipoblastoma is a tumor with good prognosis despite its potential for local invasion and rapid growth. Our patient is a 7-month-old girl who was brought to our clinic for a rapidly growing mass in the right hemithorax. With the aim of both diagnosis and treatment, the mass was removed by thoracic wall resection and the resultant defect covered with an absorbable polyglactine mesh. The excised mass was diagnosed pathologically as a benign lipoblastoma. In the postoperative period, the thorax wall was stable, and after 24 months of follow-up no recurrence was observed. In the literature, 4 types of thoracic wall lipoblastomas have been reported, but thoracic wall resection has not been applied in any benign lipoblastoma case. To the best of our knowledge, the only benign lipoblastoma case in which a thoracic wall resection was carried out, with its clinical and histopathologic specifications alongside that in the literature, is presented here for the first time.

Fig. 1. (A) The posteroanterior chest X-ray demonstrating a homogenous mass residing in the middle and inferior zones of the right hemithorax. (B) Thoracoabdominal magnetic resonance scan (T2 weighted coronal view) depicting a hyperintense lobulated paravertebral mass lesion in the right hemithorax, infiltrating both the thoracal and the abdominal cavities, and extending laterally along the diaphragm.

* Corresponding author. Address: Kardelen mahallesi Mobilyacilar sitesi, 482/19 Batikent, Ankara, Turkey. Tel.: C90-312-3801031; fax: C90-3122568136. E-mail address: mehmetsirmali@yahoo.com (M. Sirmali). the thorax depicted the mass lesion 5!6!7.5 cm in dimensions, including multiple septal formations in the location of left first rib (Fig. 1B). The left first rib was resected en bloc with the adjacent soft tissues via left posterior thoracotomy. Postoperative pathological evaluation was consistent with aneurysmal bone cyst (Fig. 2). European Journal of Cardio-thoracic Surgery 26 (2004) 826–827 www.elsevier.com/locate/ejcts

Osteoklast benzeri multinükleer dev hücreler içeren stromal reaksiyonlar karsinomlarda nadir olarak görülür, akciğer karsinomlarında ise daha da nadirdir. Radyolojik olarak sağ akciğerinde volüm kaybına sebep olan 61 yaşındaki erkek hasta kliniğe kabul edildi. Hastaya yapılan bronkoskopide sağ üst lob bronşundan kaynaklanan ve sağ ana bronşu tama yakın tıkayan endobronşiyal lezyon tespit edildi. Lezyondan multipl biyopsiler alındı. Biyopsi sonucu osteoklast benzeri multinükleer dev hücreler içeren non-small cell karsinom olarak raporladık. Hastaya sağ torakotomi ile sleeve üst lobektomi yapıldı. Postoperatif tanıyı osteoklast benzeri multinükleer dev hücreler içeren az diferansiye skuamöz hücreli karsinoma olarak raporladık. Hasta 42. ayında ve sorunsuz olarak takip edilmektedir. Osteoklast benzeri multinükleer dev hücreler içeren karsinomlar meme, tiroid, karaciğer, safra kesesi, mide, pankreas, prostat ve endometriumda çok sayıda raporlanmıştır, ancak akciğer karsinomlarında oldukça az sayıdadır. Osteoklast benzeri multinükleer dev hücreler içeren akciğer karsinomlarının ayırıcı tanısı önemlidir çünkü bu karsinomlar yabancı cisim tipi stromal reaksiyonlar ve dev hücreli karsinomlarla karışabilir. Stromal reactions including benign osteoclast-like giant cells are rarely seen within carcinomas. They are even extremely rare in lung carcinomas. A 61-year-old male patient who had marked volume loss in the right lung radiologically was admitted. Fiberoptic bronchoscopy was performed, an endobronchial lesion arising from the right upper lobe bronchus and nearly completely obstructing the right main bronchus was detected and multiple biopsies were taken. Histopathological examination of these biopsies confirmed a non-small cell carcinoma with osteoclast-like multinuclear giant cells. A sleeve upper lobectomy was performed through a right thoracotomy. Histopathological examination of the specimen showed “poorly differentiated squamous cell carcinoma and osteoclast-like multinuclear giant cells within”. The patient is well and disease-free 42 months after the operation. There are numerous cases of osteoclast-like giant cells reported within the breast, thyroid, liver, gall bladder, stomach, pancreas, urinary bladder and endometrium but they are very rare within lung carcinomas. A diagnosis of lung carcinoma with osteoclast-like giant cells is very important as it may cause diagnostic confusion with giant cell carcinomas and foreign body type stromal reactions.