Ali Özdil

Myasthenia Gravis with Thymoma: Histopathologic Examination and Rate of Complication After Surgery

Aim It is known that thymus and thymoma have a role in the etiopathogenesis of myasthenia gravis (MG). These associations and their effects on the survival have investigated in several studies since 17th century. The incidence of MG in patients with thymoma was reported to be 20-50% in different studies. The aim of this study is to investigate the relationship between thymoma and MG and to evaluate the rates of postoperative complications. Material and Methods The study included 25 patients (13 female and 12 male) and the mean age of patients was 42.3 years (range 24 to 70 years). 11 (44%) of patients had been treated with the diagnosis of MG. Eight (57%) of 14 (56%) patients without the diagnosis of MG had no symptoms and thymoma was detected accidentaly. The common symptom of the other 6 (43%) patients was cough. 9 (36%) patients were staged according to WHO classification. The other patients could not be staged according to WHO classification; because they were operated before the year of 2001. Four of patients were stage B1, 2 were stage B2, 2 were stage B3 and 1 was stage AB. Postoperative complication occured in 4 (16%) patients. Results MG was seen with a higher rate in cortical thymoma when compared with medullary thymoma, in immunohistochemical investigations. MG had been thought as a negative prognostic factor for thymoma but in the last years it had been reported as a positive prognostic factor due to the development of postoperative intensive care conditions, medical therapy and follow up.

Pulmonary Metastasectomy of Sarcoma: Is the Ratio of Surgical Margin to Nodule Size a Prognostic Factor?

BACKGROUND  Main prognostic factors of improved survival after pulmonary metastasectomy (PM) for osteogenic and soft tissue sarcomas are suggested as histological type, number and size of pulmonary nodules, and disease-free interval (DFI). METHODS  Sixty-nine patients who underwent PM between January 1999 and December 2017 were evaluated retrospectively. Relations between parameters and prognostic risk factors for overall survival (OS) and disease-free survival (DFS) were evaluated. RESULTS  Osteosarcoma was the most common histologic type (36.2%) and 21 of 25 cases were seen under the age 20 years (p < 0.001). Comparison of patient groups including osteosarcoma and nonosteosarcoma patients showed significant difference according to age (p < 0.001), nodule size (p = 0.033), ratio of surgical margin to nodule size (p = 0.007), and DFI (p = 0.039). Univariate analysis showed that the number of nodules (p = 0.008), ratio of surgical margin to nodule size (p = 0.001), and localization of nodule (p = 0.039) were significant factors associated with DFS. Also, nodule size (p = 0.042), number of nodules (p = 0.003), ratio of surgical margin to nodule size (p < 0.001), and laterality (p = 0.027) were significant prognostic factors associated with OS. Cut-off values of ratio of surgical margin to nodule size for DFS and OS were calculated as 0.94. Logistic regression analysis determined the ratio of surgical margin to nodule size as the common significant risk factor for DFS and OS. CONCLUSIONS  Our study showed that the ratio of surgical margin to nodule size ≥ 1 should be taken as a common risk factor for DFS and OS. Therefore, resection of nodules with the possible widest surgical margin is an important point of PM.

Diagnostic value of 18 F-FDG-PET/CT in benign lung diseases

Introduction There are many diseases which, despite not being malignant, show high metabolic activity and cause false-positive results. Aim To evaluate the results of positron emission tomography (PET) in patients who underwent resection after preliminary diagnosis of malignancy based on fluorodeoxyglucose (FDG) uptake value, in whom the lesions were later classified as pathologically benign. Material and methods The analysis included the records of 106 (12.3%) patients out of 862 patients who underwent surgery between January 2012 and December 2015 after being initially diagnosed with malignant lung lesions based on PETCT results, in whom the lesions were later classified as pathologically benign. Diagnoses, PET findings, types of surgery, and demographic data of the patients were recorded. Results The mean age of the patients was 55.5 (26–79) years. The mean diameter and SUVmax of the lesions were 2 ±2.14 (0.5–13) and 3.55 ±4.35 (0–22.2) cm, respectively. The pathology results were analyzed in five different groups. The SUVmax in the hamartoma group was significantly lower than in the other groups (p < 0.001), while the SUVmax in the granulomatous disease group was significantly higher than in the other groups (p < 0.001). Conclusions The possibility of false positive PET results must be kept in mind when diagnosing and treating lung cancer. In particular, in the case of suspected granulomatous disease, all available pre- and intraoperative diagnostic procedures must be used.

Assessment of Cardiac Complications in Patients Undergoing Pulmonary Resection

BACKGROUND Patients who underwent lung resection in our clinic were retrospectively investigated in terms of development of postoperative cardiac complications. METHODS The file records of 207 patients who underwent lung resection between the years 2010 and 2014 were reviewed. One hundred and eighteeen (118) (57%) of the patients were evaluated by the preoperative cardiologist and the risk level of the patients was determined according to the Lee index. Postoperative cardiac complication relation was compared with each parameter. RESULTS The difference between the mean age of the patients with and without complication was statistically significant (p=0.024). When the patients were grouped as over and under 65 years old, the risk of developing postoperative complications was higher and statistically significant (p=0.015) in patients over 65 years of age. When the patients were evaluated in line with the presence of additional disease, smoking and electrocardiogram (ECG) findings, patients with hypertension developed more complications than those without hypertension (p=0.002). When the logistic regression was adjusted according to age and sex, the development of cardiac complications in patients with hypertension was 3.25 times greater. CONCLUSIONS It should be kept in mind that the presence of hypertension in patients who will undergo lung resection and advanced age increases the risk of cardiac complications and that preoperative cardiology care may be appropriate for these patients.

Spontaneous Splenic Rupture in the Early Postoperative Period to After Lobectomy

Spontaneous splenic rupture is a quite rare entity that may develop secondary to some special situations (lymphoma, post-abdominal surgey etc). In the literature, the case of a patient has been reported following thoracic surgery. In a patient who had undergone right upper lobectomy for pulmonary carcinoma, signs of acute abdomen and low levels in the hemogram were detected on the fifth postoperative day; therefore, the patient underwent further investigations. A radiological evaluation revealed splenic rupture, and the patient was operated on. A case is presented that may be fatal and requires emergency response and that has to be kept in mind, although it is extremely rare. A case of spontaneous splenic rupture has been presented that may be fatal and requires emergency response; this should be kept in mind, although it is extremely rare.

The prognostic value of carcinoembryonic antigen levels in blood and intraoperative pleural lavage fluid in non-small-cell lung cancer

Introduction There is no specific marker for lung cancer, but, in some lung cancer types, carcinoembryonic antigen (CEA) can reach high levels in the blood and pleural fluid. Aim This study investigated the relationship of CEA levels in blood (CEAB) and intraoperative pleural lavage fluid (CEAP) in non-small-cell lung cancer (NSCLC) with the type, stage, and extent of lung cancer. Material and methods A total of 50 patients, who underwent surgery at our clinic due to NSCLC (group I) or benign lung pathology (group II), were assessed. For this prospectively designed study, 25 consecutive patients were included in each group, and their CEAB and CEAP levels were investigated. Results When the levels of CEAP were compared, the average value of group I (1.35 ng/ml) was significantly higher than the average value of group II (0.04 ng/ml) (p = 0.027). When CEA levels were examined separately, and average values were taken according to surgical pathology results, both CEAB and CEAP levels of adenocarcinoma patients were found to be higher than those of the other groups. This difference was only significant for the level of CEAP (p = 0.026). Conclusions Although the average CEAB levels of patients with adenocarcinoma were higher than those of patients with other histopathological types, this difference was not statistically significant. However, we found that CEAP levels were significantly higher in patients with adenocarcinoma. These results have led us to consider that CEAP elevation is a more sensitive marker than the elevation of CEAB.

Psychiatric assessments in patients operated on due to lung cancer

Background This study was undertaken to determine the relationship between preoperative and postoperative psychiatric status and postoperative complications in patients operated on due to lung cancer. Methods We prospectively enrolled 25 patients undergoing surgery with a diagnosis of lung cancer. There were 17 (68%) males, 8 (32%) females, and the mean age was 61 ± 8.9 years (range 38–81 years). Their psychiatric status was assessed using the Experiences in Close Relationships Scale II, European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, Perceived Family Support Scale, the combined Stress Thermometer and Hospital Anxiety Depression Scale, in the preoperative period, and the Perceived Family Support, Stress Thermometer, and European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 at 1 month postoperatively. Results We found that 44% of patients had depression and 28% had anxiety. There was no difference between sexes in terms of anxiety (p = 0.088), but more women had depression (p = 0.03). Postoperative complications occurred in 5 of 18 patients with negligible anxiety scores (27.8%) and 3 (42.9%) of 7 patients with high scores, as well as 3 (21.4%) patients with negligible depression scores and 5 (45.5%) of 11 patients with high scores. Conclusions Patients selected for lung cancer surgery should be assessed preoperatively using the Hospital Anxiety-Depression Scale and Stress Thermometer. Psychosocial support is recommended to improve their quality of life and reduce postoperative complications.

An unusual pathology with an undefined etiology:solitary fibrous tumors of the pleura.

BACKGROUND/AIM The aim of the present study was to evaluate the etiology and clinical and pathological behavior of solitary fibrous tumors of the pleura (SFTPs), as well as the most appropriate surgical approach and the results of long-term follow-up of this condition. MATERIALS AND METHODS Clinical and long-term follow-up records of 14 patients who had surgery for SFTP between 2001 and 2014 were reviewed retrospectively. Etiological factors, diagnostic procedures, and clinical courses and outcomes for these patients were studied. RESULTS Of the 14 patients, 8 were male (57%) and 6 were female (43%) patients. The mean age was 54.14 ± 10.35 (41-75) years. There was no remarkable common etiological factor. Preoperative diagnosis was achieved only in 2 patients. Predominant symptoms were cough and chest pain. Complete resection was achieved in all patients. Video-assisted thoracic surgery (VATS) was performed in 8 patients. All but one patient were classified as having benign SFTP. The mean follow-up was 58.5 ± 41.4 (10-132) months and no recurrence was noted in the follow-up. CONCLUSION These rarely seen tumors of the pleura are usually benign and asymptomatic and their preoperative diagnosis is difficult. Clinical and pathological behavior is still unpredictable and the treatment consists of complete resection. Minimally invasive techniques such as VATS are recommended for surgery if the tumor size is appropriate.

A Rare Congenital Pulmonary Anomaly of a Young Adult: Pseudosequestration.

Pgenic lung tissue that has no bronchial communication with the normal tracheobronchial tree and has an arterial blood supply from systemic artery instead of pulmonary artery. It is classified as intraor extralobar sequestration according to its location [1]. Besides this, pseudosequestrations that are detected incidentally and located frequently in the lower lobes are very rare congenital anomalies of the lung. Pseudosequestrations are usually asymptomatic but such complaints such as cough, dyspnea, and hemoptysis can be seen in adult patients [2]. Contrasted computed tomographic investigation is diagnostic in these patients in terms of showing the vessel supplying pseudosequestration and