Bazzocchi R

Giant leiomyoma of the esophagus

Leiomyoma is the most common benign tumour found in the esophagus but it is, however, a rare neoplasm; in fact of all esophageal tumours, benign tumours account for fewer than 10%, of which 4% are leiomyomas. Leiomyomas should be removed when diagnosed, even if asymptomatic, because malignancy cannot otherwise be excluded and symptoms are likely to develop if treatment is delayed or omitted. Enucleation of esophageal leiomyoma is a safe and effective procedure. We report a case of symptomatic giant anular leiomyoma of the distal esophagus, compressing the trachea and the descending aorta, resected after right thoracotomy.

Bilateral recurrent pneumothorax complicating chemotherapy for pulmonary metastatic breast ductal carcinoma: report of a case.

Secondary spontaneous pneumothorax (SSP) is a rare complication of chemotherapy for pulmonary metastases and to the best of our knowledge, only 28 cases have been described, most of which occurred in patients with osteosarcoma or germ cell tumors. We present herein the case of a 56-year-old woman in whom bilateral and recurrent SSP was caused by the rupture of pulmonary lacunae induced by chemotherapy, given for bilateral lung metastases secondary to breast carcinoma. Our experience of this case led us to conclude that: patients with pulmonary metastases may develop bilateral and/or recurrent pneumothoraces following chemotherapy; computed tomography scan is essential for defining the cause of SSP; and closed chest tube drainage remains the therapy of choice, while chemical pleurodesis may also be used to prevent recidivant SSP.

Spontaneous biliopneumothorax (thoracobilia) following gastropleural fistula due to stomach perforation by nasogastric tube

Gastropleural fistula may occur after pulmonary resection, perforated paraesophageal hernia, perforated malignant gastric ulcer at the fundus, or gastric bypass surgery for morbid obesity. We describe a case of gastropleural fistula after stomach perforation by a nasogastric tube in a patient who underwent Billroth II gastric resection for adenocarcinoma. Left biliopneumothorax occurred and was treated by thoracic drainage with -20 cm H2O aspiration. As gastropleural fistula persisted, laparotomy was repeated and gastric and diaphragmatic perforations were sutured. Gastropleural fistula is rare and, to our knowledge, this is the first reported case of gastropleural fistula and biliopneumothorax caused by gastric and diaphragmatic perforation by a nasogastric tube.

Radioimmunoguided surgery and intraoperative lung cancer staging.

Radioimmunoguided surgery (RIGS) has proven its worth, especially when used in primary, recurrent, and metastatic colon-rectum adenocarcinomas, and in liver metastases from other intestinal adenocarcinomas. Until now, RIGS has not been investigated for lung cancer surgery, chiefly because of problems related to the blood pool radioactivity background which is at its highest in the thoracic area. The positive RIGS experience with other tumors encouraged us to investigate its effectiveness in lung adenocarcinomas. In six cases, RIGS gave excellent results in the detection of primary pulmonary lesions; no false negatives or false positives were shown. Data on lymph nodes revealed one false negative. Immunohistochemical staining was always performed in association with traditional pathology of the resected specimens. In one case, a noncancerous lesion, as defined by traditional hematoxylin-eosin (H&E) staining, confirmed RIGS intraoperative finding of nonmalignant tissue.

Pulmonary infiltration from retroperitoneal carcinoma requiring diaphragm, chest wall and lung resection after thoracoabdominal access

Primary retroperitoneal carcinoma is a rare but highly aggressive tumour often resulting in infiltration of abdominal organs and diaphragm. We describe a case of retroperitoneal carcinoma infiltrating the diaphragm, the lower lobe of the left lung and ribs IX and X, but sparing the abdominal organs. After thoracoabdominal access, our patient underwent resection of the retroperitoneal carcinoma, left hemidiaphragm and ribs IX and X with wedge resection of the left lower lobe. Haematogenous lung metastasis from retroperitoneal carcinoma is well known; on the contrary, direct transdiaphragmatic lung invasion is very rare and requires thoracoabdominal access for a one step operation, representing one of the most stimulating challenges for thoracic surgeons.