Aysen Taslak Sengul

Pure Yolk-Sac Tumor of the Lung

Primary germ cell tumors of the chest often localize in the anterior mediastinal compartment. Such tumors originating from lungs and pleura are rare. Chest tomography revealed a mass in the middle lobe of the right lung in a 25-year-old man. A middle lobe medial segmentectomy was performed, and chemotherapy was applied postoperatively.

Postoperative Lung Volume Change Depending on the Resected Lobe

OBJECTIVES The aim of this study was to evaluate the lung volume changes depending on the resected lobes. The changes were quantitatively evaluated using stereological methods on computed tomography images and by pulmonary function tests (PFTs). METHODS The study subjects included 30 patients who underwent lung resection. Of these, 26 patients underwent lung resection due to non-small cell lung cancer and 4 patients for benign reasons. Patients were classified into the following six groups according to the resected lobes and lungs: right lower lobectomy, right upper lobectomy, left lower lobectomy, left upper lobectomy, right pneumonectomy, and left pneumonectomy cases. All patients were evaluated with the PFT and computed thorax tomography (CTT), preoperatively and in the postoperative 3rd month. Volume changes due to resection were estimated on CTT scans using the Cavalieri principle of the stereological methods, and their relationships to the PFTs were evaluated. RESULTS Stereologically estimated data showed that the volume loss was 19.01% in upper lobectomy and 5.57% in lower lobectomy (p < 0.05). The highest volumetric increase of the contralateral lung and minor volume loss of the ipsilateral lung was observed in lower lobectomy. After right lower lobectomy, the highest postoperative volume increase was observed at the contralateral lung and the least volume loss in the remaining ipsilateral lung. In PFT, forced vital capacity (FVC) decreased to 3.07% after lower lobectomy whereas it decreased to 11.94% after upper lobectomy. FVC revealed that no significant change occurred after right lower lobectomy (p < 0.05). CONCLUSIONS Although the parenchyma resected in lower lobectomy is larger, the postoperative total lung volume reduction is less than that of upper lobectomy. After lower lobectomy, postoperative compensation is achieved specifically by the expansion of contralateral lung, together with the remaining ipsilateral lung.

Giant parenchymal bronchogenic cyst mimicking hydropneumothorax

Bronchogenic cysts are believed to result from abnormal budding of the tracheal diverticulum between the third and sixth weeks of gestation and consequently may be mediastinal or intrapulmonary in location. In the adult, bronchogenic cysts are frequently asymptomatic and present as an incidental finding in the chest roentgenogram. We present a patient with a giant parenchymal bronchogenic cyst that appeared as hydropneumothorax on chest radiograph and CT. The unusual cause and the interesting clinical course of asymptomatic bronchogenic cyst are described.

Effects of platelet-rich plasma on cartilage regeneration after costal cartilage resection: a stereological and histopathological study

Abstract Background: In cases of congenital chest wall deformities, it is important to maintain the flexibility of the chest wall after rib cartilage resection. In this study, we aimed to determine the regeneration capability of cartilage and the effects of platelet-rich plasma (PRP) on the regeneration process. Methods: A total of 16 four-week-old New Zealand rabbits were used in this study. In the 4th–5th right costal cartilages, the perichondrial sheaths were dissected and costal cartilages were excised. Then, the perichondrial sheaths were closed with absorbable material in the sham group (n = 8), and this was done after replacing PRP in the PRP group (n = 8). The left costal cartilages of the animals were used as controls. The volumes of the costal cartilages and their perichondrial sheaths were estimated using Cavalieri’s principle. In addition, the mean numerical densities of the chondroblasts and chondrocytes per square millimetre were estimated using unbiased counting frames. Results: In the PRP and sham groups, the volumes of the cartilages and perichondrial sheaths were higher than those of the control group (p < 0.05). The numerical densities of the chondroblasts and chondrocytes increased more in the PRP group than in the sham group (p < 0.05). Conclusions: Applying PRP after resection may provide better healing and faster regeneration of cartilage.

Endobronchial Hypertrophic Seromucous Salivary Gland: A Rare Bronchial Occlusion

A 41-year-old woman came to our clinics describing increased cough and shortness of breath. A chest roentgenogram revealed a loss of volume in her right lung. Computed tomography revealed a lesion at the level of the main carina, clogging the right main bronchus almost totally. The lesion underwent biopsy by use of flexible bronchoscopy. Histopathologic evaluation showed that the specimen was a hypertrophic seromucous salivary-type gland. Total excision of the mass was performed by bronchotomy through a right thoracotomy. We describe this case of a hypertrophic seromucous salivary gland in the tracheabronchial system.

EMMPRIN and fascin expression in non-small cell lung carcinoma

Fascin and EMMPRIN (CD 147) have a demonstrated relationship with the invasion and progression of many tumors. The aim of this study was to analyze fascin and EMMPRIN expression in non-small cell lung carcinoma and their relationship with clinicopathologic features. Fascin and EMMPRIN expression levels were investigated via the immunohistochemistry of paraffin-embedded tissues of 64 patients with non-small cell lung carcinoma, including 46 squamous cell carcinoma and 18 adenocarcinoma patients. The patients were scored on the basis of staining extent and intensity, and were then assigned a combined score. Fascin expression was present in 44 of 46 (95.6%) patients with SCC and 16 of 18 (88.8%) patients with adenocarcinoma. There was a significant correlation between fascin expression and tumor stage in the SCC and adenocarcinoma groups. EMMPRIN expression was observed in all patients with SCC (46 of 46, 100%) and 16 of 18 (88.8%) patients with adenocarcinoma. There was significant correlation between EMMPRIN expression and both tumor stage and diameter in the SCC group, but not in the adenocarcinoma group. This study revealed that high levels of fascin and EMMPRIN expression may indicate the importance of their roles in the progression of non-small cell lung carcinoma and they could be used as prognostic marker for these tumors.

The effect of minimally invasive surgical repair on the lung volumes of patients with pectus excavatum.

OBJECTIVES To assess the increase in lung volume after Nuss surgery in patients with pectus excavatum (PE) by using stereological methods and to evaluate the correlation between the lung volume and spirometry findings. METHODS Twenty patients, treated for PE between 2008 and 2010, were evaluated prospectively. They underwent preoperative chest radiography, computed thorax tomography (CTT), and spirometry. Thereafter, the Haller index was calculated for each patient. In the third postoperative month, CTT and spirometry were repeated.Lung volumes and volume fractions were evaluated using CTT images, applying the Cavalieri principle for stereological methods. Then the correlation between the pre- and postoperative values of the lung volumes with spirometry findings was determined. RESULTS Volumes of the right and left lungs were calculated stereologically, using CTT images. Postoperative volume increase of ∼417.6 ± 747.6 mL was detected. The maximum volume increase was observed in the left lung. In the postoperative period, the total volume increase and the volume increase detected in the left lung were found to be statistically significant (p < 0.05).The preoperative correlation coefficients (r) for forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow 25 to 75% were 0.67, 0.68, and 0.61, respectively; the postoperative r figures were 0.43, 0.42, and 0.35, respectively. Although there was a strong correlation between the preoperative lung volume and spirometry findings (p < 0.05), no correlation was observed between the postoperative lung volume and spirometry findings (p > 0.05). CONCLUSIONS Postoperative pulmonary volume increase occurs in patients with PE after Nuss surgery. However, postoperative spirometry findings may not reflect morphological improvement because pain restricts thoracic movements. Therefore, in patients with PE, quantitative evaluation of the results of surgical repair is possible using the CTT images through a combination of stereological methods.

Castleman's Disease: Due to a rare interlobar location

It is more commonly observed in the thorax, but it can be found anywhere in the body. It is usually localized in the middle or anterior mediastinum. Castleman’s disease should be differentiated from other mediastinal autoimmune or neoplastic diseases. With the review of the literature, we hereby introduce a case of Castleman’s disease excised from the interlobar area, which is a rare location for this disease.