Paulo de Biasi Cordeiro

Risk factors for lung cancer in Rio de Janeiro, Brazil: a case-control study

The association between the risk of lung cancer and tobacco smoking, dietary factors and occupational exposures was examined in a hospital-based case-control study. The study involved 123 consecutive cases and 123 controls, matched by age (+/- 3), sex, and race. In this first study of lung cancer risk in Brazil, we found that tobacco smoking is the strongest risk factor with an odds ratio (OR) for current and former smokers of 22 (CI, 6.5-76) and 7.7 (CI, 2.2-27), respectively. An OR of 2.8 (CI, 1.0-7.7) was found for users of black tobacco in the form of hand-rolled cigarettes) in combination with conventional cigarettes, after adjustment for life-time consumption of any kind of tobacco; users of conventional cigarettes only were considered as a reference group. Cessation of smoking had an important influence in reducing the lung cancer risk, whereas early initiation of smoking increased the risk. Among dietary factors, frequent consumption of meat (P < 0.01) and pasta (P = 0.02) were positively associated with lung cancer risk after adjusting for smoking and income. No association was found with green/yellow vegetables or fruits. We were unable to detect any significant association related to occupational exposures. This study confirmed the association of lung cancer with smoking as the most important predictor of risk. It also indicates the increase in risk associated with the use of black tobacco in combination with conventional cigarettes.

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.

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.

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

Factores preditivos de risco para surgimento de segundo tumor maligno primário no pulmão em 104 casos

Objectives: The objective of our study was to identify the risks factors for the de development of a second pulmonary primary cancer. Methods: It was a primary, observational, multicentric and retrospective study with 104 patients from the Cancer National Institute and the Antonio Pedro Universitary Hospital, in Rio de Janeiro, Brazil. Results: The sites of primary tumors were: head and neck(56.7%); with laryngeal carcinoma (42.4%); lungs (15.5%); bladder (8.6%); uterine cervix (7.6%); stomach (4.8%); others (6.8%). Male patients represented 84.6%. Average age 56.7 ± 10.7 years, with a coefficient of variation 18.8%.Among the patients 91.4% were smokers and 92.0% were alcohol consumers. Multiple logistic regression model: site of primary tumor (OR:8.22; CI 95% - 2.21 to 30.56; p = 0,0017); specific histologic of primary cancer (OR:0.21; IC 95%: 0.04 to 0.99; p = 0.0498); sex (OR: 0.25; CI 95%: 0.03 to 1.81; p = 0.1711); age (OR: 0.98; CI 95%: 0.92 to 1.04; p = 0.6318); smoking (OR: 2.80; CI 95%: 0.44 to 17.55; p = 0.2711) and alcohol consumption (OR:0.76; CIIC 95%: 0.19 to 2.95; p = 0.6964). Asjusted model: odds ratio of the site of the primary tumor was 4.14,; CI 95%; from 1.36 and 12.78 and p = 0.0123 (p < 0.05). Accuracy or the model: 82. 69%. Conclusion: In this study teh site of the primary tumor was the only predictor of risk for the second pulmonary primary cancer. REV PORT PNEUMOL 2004; X (4): 297-303

Tumor carcinóide de pele envolvendo o esterno: ressecção e reconstrução

Carcinoid tumor of the skin, which is a malignant neoplasm originating in the neuroendocrine system and having its pathological substrate in the Merkel cells, is a rare occurrence. It is most frequently seen on the skin around the neck and head and is more common in the elderly. This study relates the case of a 35-year-old woman presenting with a visible and palpable tumor covering the upper third of the sternum. Resection of the tumor was indicated because the patient had experienced two significant episodes of bleeding and osseous invasion had occurred. Penetration of the full thickness of the chest wall at the sternum notch necessitated the implantation of a rigid prosthesis. The definitive histopathological diagnosis was made only through postoperative analysis of the excised section. Reconstruction using a surgical cement plate and interposition of a myocutaneous flap proved its usefulness as an alternative when resection is performed in an area important to the postoperative respiratory dynamic, a situation that typically requires a ventilatory prosthesis for up to 6 days. The stability of the chest wall, together with viability of the flap and the recuperation of pulmonary function, allowed the patient to be discharged after 18 days.

Sarcoma pleomórfico primário do pulmão

Resumo A classificacao recente da Organizacao Mundial da Saude (OMS) para os tumores pulmonares unificou o heterogeneo grupo do carcinoma de nao pequenas celulas (CPNPC), que engloba os sarcomas e os tumores com componentes sarcomatosos, sob a denominacao “carcinoma com elementos pleomorficos, sarcomatoides ou sarcomatosos”. Este grupo inclui diferentes entidades, como o carcinoma pleomorfico (CP), o carcinoma de celulas fusiformes (CCF), carcinoma de celulas gigantes (CCG), os carcinossarcomas (CS) e o blastoma pulmonar (BP). De uma forma geral, estes tumores sao raros e representam 0,1% a 0,4% de todas as neoplasias pulmonares. Ocorrem mais comummente em homens fumadores, com alta carga tabagica, e acomete-os em torno dos 60 anos e comummente tem evolucao clinica muito agressiva. Os autores relatam o caso de um doente portador de sarcoma pleomorfico primario pulmonar e reveem a literatura sobre o assunto.

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.