Deborah Cordeiro Lannes

Tumor de células gigantes costal ocupando todo o hemitórax

The authors report the case of a 28-year-old female patient with a giant cell tumor originating from the rib. The tumor, measuring 25 × 17 cm, occupied the entire hemithorax and caused atelectasis of the left lung. This tumor was a benign mesenchymal neoplasm, which rarely affects the ribs. A thoracotomy involving en bloc resection of the chest wall and tumor was performed. Despite the large dimensions of the tumor, complete resection was possible, and lung function was restored.

Transbronchial needle aspiration of hilar and mediastinal lymph nodes

BACKGROUND Besides clarifying the etiology of unidentified lymphadenomegaly, puncturing hilar and mediastinal lymph nodes by a flexible bronchoscopic needle is an aid in diagnosing and staging broncho- genic cancer or other metastatic cancers. OBJECTIVE Our study had the principal objective to evaluate the positivity of transbronchial needle aspiration (TBNA). METHOD We evaluated retrospectively the effectiveness of all TBNA done in 74 consecutive patients. Forty-nine patients were male and the median age was 59. We used Wang-needles, 21-gauge (Bard, USA), and the same technique described for different authors. Of the 74 patients evaluated, 11(15%) showed mediastinal mass and 65 (85%) hilar mass. We observed 76 endoscopic abnormalities. RESULTS According to the classification of the specimens, we had 32/74 (43%) unsatisfactory specimens, 34/74 (46%) satisfactory and diagnostic specimens, and 8/74(11%) satisfactory and non-diagnostic specimens. Thirty four (46%) of the examinations were found to be positive out of the total amount of specimens. Of the positive results, 30/34 specimens (88%) contained malignant disease. Small-cell carcinoma was the most frequent finding, with 10/34 cases (29%); squamous cell carcinoma 7/34 (21%); adenocarcinoma 7/34 (21%), non- -small cell carcinoma 6/34 (17%); sarcoidosis 2/34 (6%) and tuberculosis 2/34 (6%). CONCLUSION Our study indicated that this method is safe, easy to per- form, with a minimum of complications and useful for the diagnosis and staging of pulmonary neoplasms.

Transthoracic biopsy with core cutting needle (Trucut) for the diagnosis of mediastinal tumors

AIM To determine the contribution of percutaneous biopsy with core cutting needle (Trucut) in the diagnosis of mediastinal tumours. METHOD Retrospective review of 56 patients with mediastinal lesions who underwent percutaneous core cutting needle biopsy, oriented but not guided by computer assisted tomography of the thorax, 1999 - 2008. RESULTS Percutaneous biopsy with core cutting needle provided adequate material in 49/56, with a total positive sample rate of 88%. In 7/56 (12%) cases the material was insufficient to define the diagnosis. Percutaneous core cutting needle biopsy established a specific histological diagnosis in 88% of the patients: 23/56 (41%) lymphomas; 12/56 (21%) thymomas; 5/56 (3%) thymic carcinomas; 3/56 (2%) small cell carcinoma and 1/56 (0.6%) metastatic adenocarcinoma, metastatic squamous cell carcinoma, neuroendocrine primitive carcinoma, plasmocytoma, teratoma and goiter. All patients underwent thoracic X-ray after the procedure. No complications were found in these patients. CONCLUSION Percutaneous core cutting needle biopsy (Trucut) oriented but not guided by computer assisted tomography of the thorax is an easy and safe procedure which can provide a precise diagnosis in the majority of mediastinal tumours and can prevent the need for exploratory thoracic surgery in cases which are medically treatable or non-resectable.

Transthoracic biopsy with core cutting needle for the diagnosis of mediastinal tumors

OBJECTIVE: To determine the contribution of percutaneous biopsy with core cutting needle in the diagnosis of mediastinal tumors. METHOD: Retrospective review of 22 patients with mediastinal lesions who were submitted to percutaneous core cutting needle biopsy, oriented, but not guided by computer assisted tomography of the thorax, between 1999 and 2002. RESULTS: Percutaneous biopsy with core cutting needle provided adequate material in 18/22 cases, with a total positive sample rate of 82%. In 4/22 cases, the material was insufficient to define the diagnosis (18%). Percutaneous core cutting needle biopsy established a specific histologic diagnosis in 82% of the patients: 8/22 (36%) lymphoma; 5/22 (28%) thymoma; 2/22 (11%) thymic carcinoma; 1/22 (6%) metastatic adenocarcinoma; 1/22 (6%) neuroectodermic primitive tumor; and 1/22 (6%) plasmocytoma. All the patients were submitted to a thoracic X-ray after the biopsy. No complications were found in these patients. CONCLUSION: Percutaneous core cutting needle biopsy oriented, but not guided by computer assisted tomography of the thorax, is an easy and safe procedure which can provide a precise diagnosis in most mediastinal tumors, and can prevent the exploratory thoracic surgery in inoperable or chemotherapy-treated cases.

Biópsia transtorácica com agulha cortante (Trucut) para o diagnóstico dos tumores mediastínicos

Resumo Objetivo: Determinar a contribuicao da biopsia percutânea com agulha cortante (Trucut) no diagnostico das massas mediastinicas. Metodo: Revisao retrospectiva de 56 doentes com massas mediastinicas submetidos a biopsias com agulha cortante orientadas, mas nao guiadas, pela tomografia computadorizada do torax, no periodo de 1999 a 2008. Resultados: A biopsia percutânea com agulha cortante forneceu material adequado para o diagnostico em 49/56 casos, com indice de positividade de 88%. Em 7/56, o material colhido foi insuficiente para definir o diagnostico (12%). Este metodo foi capaz de definir o diagnostico em 88% dos doentes: 23/56 (41%) linfomas; 12/56 (21%) timomas; 5/56 (3%) carcinomas timicos; 3/56 (2%) carcinoma indiferenciado de pequenas celulas e 1/56 (0,6%) adenocarcinoma metastatico, carcinoma epidermoide metastatico, carcinoma neuroendocrino primitivo, plasmocitoma, teratoma, bocio. Apos a biopsia, os doentes foram submetidos a radiografia do torax. Nao houve nenhum tipo de complicacao nestes doentes. Conclusao: A biopsia transtoracica com agulha cortante (Trucut) orientada, mas nao guiada pela tomografia computadorizada, tem alto rendimento, esclrrecendo o diagnostico na maioria dos portadores de massas mediastinicas e pode ser util, evitando a toracotomia exploradora, nos casos de tumores do mediastino inoperaveis ou de tratamento quimioterapico. Rev Port Pneumol 2009; XV (4): 589-595

Blastoma pulmonarPulmonary blastoma

Pulmonary blastoma is a rare primary lung tumor with poor prognosis that commonly presents at a younger age than the non-small cell lung cancer. Classicaly they are large, symptomatic tumors with lymph nodal metastasis and carry poor prognosis. Pathological examination revealed features suggesting a biphasic tumor with mesenchymal and epithelial components. Over 200 cases have been reported so far worldwide since the first description of the tumor in 1945. Authors present a case of pulmary blastoma with literature revision.

Linfoma não-Hodgkin endobrônquico

Os linfomas nao-Hodgkin fazem parte de um grupo de doencas malignas linfoproliferativas com diferentes padroes de comportamento, de tratamento e de prognostico. Eles podem comprometer as estruturas intratoracicas, particularmente o mediastino e o parenquima pulmonar, em alguma fase do curso da doenca. Entretanto, o envolvimento endobronquico e extremamente raro, mesmo na presenca de doenca avancada. Os autores relatam um caso de linfoma nao-Hodgkin endobronquico e fazem revisao da literatura.

Punção aspirativa transbrônquica por agulha no diagnóstico e estadiamento do câncer de pulmão

BACKGROUND: Transbronchial needle aspiration (TBNA) with a flexible bronchoscope has been used to diagnose bronchogenic carcinoma for many years in the United States. However, little information on the subject is available in Brazil. OBJECTIVE: To assess the effectiveness of transbronchial needle aspiration in the diagnosis and staging of lung cancer. METHOD: A retrospective review was made of 74 TBNA performed at the National Cancer Institute in Rio de Janeiro, Brazil. a thoracic computerized tomography had oreviouslbeen made of all patients.Eleven (15%) patients exhibited mediastinal masses and 63 (85%) hilar masses. Seventy six endoscopic alterations were detected: enlargement of the main carina in 44 (59%) patients; enlargement of the secondary carina in 12 (16%); paratracheal compression in 5 (7%); posterior tracheal wall compression in 3 (4%); main bronchus compression in 5 (7%) AND BRONCOSCOPY was normal in 5 (7%) patients. RESULTS: Specimens were satisfactory for diagnosis in 42 (57%) patients and in 34 (46%) diagnosis was confirmed. Malignancy was confirmed in 30 of 34 patients (88%): as follows: small cell undifferentiated carcinoma in 10 of 30 (33%); squamous cell lung cancer in 7 of 30 (23%); adenocarcinoma 7 of 30 (23%); and non-small cell lung cancer in 6 of 30 (20%). Four of 30 (12%) were diagnosed as bearers of benign disease: tuberculosis 2 of 4 (50%) and sarcoidosis 2 of 4 (50%). No complications related to the method were perceived. CONCLUSION: This preliminary study of TBNA in 74 patients indicated that this method is safe, easy to perform, with a minimum of complications and useful for the diagnosis and staging of pulmonary neoplasms.