Sami Bayram

Invasive pulmonary aspergillosis: role of early diagnosis and surgical treatment in patients with acute leukemia

BackgroundAspergillus is a ubiquitous soil-dwelling fungus known to cause significant pulmonary infection in immunocompromised patients. The incidence of aspergillosis has increased during the past two decades and is a frequently lethal complication of acute leukemia patients that occurs following both chemotherapy and bone marrow transplantation. The diagnosis of invasive pulmonary aspergillosis (IPA) according to the criteria that are established by European Organization for the Research and Treatment of Cancer and Mycoses Study Group raise difficulties in severely ill patients. Despite established improvements in field of diagnosis (galactomannan antigen, quantitative PCR, real-time PCR for Aspergillus spp., and findings of computed tomography) and treatment with new antifungals, it is still a major problem in patients with acute leukemia. However, prompt and effective treatment of IPA is crucial because most patients will need subsequent chemotherapy for underlying hematologic disease as soon as possible.Case presentationWe report a 33-year-old male patient with acute promyelocytic leukemia diagnosed in 1993 that developed invasive pulmonary aspergillosis due to A. flavus at relapse in 2003. The patient was successfully treated with liposomal amphotericin B and underwent surgical pulmonary resection. The operative course was uneventful.ConclusionThis report emphasizes the clinical picture, applicability of recent advances in diagnostic and therapeutic approaches for IPA. For early identification of a patient infected with IPA, a high index of suspicion and careful clinical and radiological examinations with serial screening for galactomannan should be established. If aspergillosis is suspected, anti-aspergillosis drug should be administered immediately, and if a unique pulmonary lesion remains, surgical resection should be considered to prevent reactivation during consecutive chemotherapy courses and to improve the outcome.

Desmoid tumor of the chest wall

Abstract Desmoid tumors are low-grade fibrosarcomas that do not metastasize but are frequently associated with one or more recurrences and subsequent associated morbidity. Desmoid tumors of the chest wall are rare and have been described mainly in single case reports or as isolate cases in large series of extra-abdominal desmoid tumors. We report a case of desmoid tumor in the chest wall mimicking superior sulcus tumor.

Cisplatin Plus Etoposide in the Adjuvant Treatment of Patients with Non-Small Cell Lung Cancer

Aim: In this study, the efficacy and safety of cisplatin and etoposide (PE) combination in the adjuvant treatment of patients with resected non-small cell lung cancer (NSCLC) was investigated. Material and Method: We retrospectively evaluated the medical charts of patients receiving adjuvant treatment for NSCLC at our center. Results: Forty-five patients were evaluated. The disease-free survival was 10 (1-114) months and the median overall survival was 18 (3-114) months. Discussion: Based on our limited experience, we concluded that PE regimen is safe and effective as adjuvant therapy for patients with NSCLC.

Surgical approach in T4N0M0 (vertebral involvement) lung cancer

Approximately 5% of the cancers involve the chest wall and spine by direct extension and remain localized at the time of diagnosis. T4 lesions invading the vertebra are considered inoperable. We reviewed a new evolution in the surgical treatment of lung cancer involving the vertebra (T4N0M0) and report preliminary results of our approach. Four patients with T4N0M0 (vertebral involvement) lung cancer underwent en bloc surgical resection of tumor between 1998 and 2002. Posterior stabilization, hemilaminectomy, and osteotomy of the involved vertebral bodies below the corresponding pedicle were performed in the prone position and then, in the lateral position, en bloc resection was completed along with the lung resection (large wedge resection or lobectomy) and involved vertebral bodies. There was no immediate postoperative mortality. Three patients died during the follow-up period at the 6th, 8th, and 14th postoperative months with a postoperative recognized metastasis. The fourth patient was in follow-up at 20 months. Although T4N0M0 (vertebral involvement) lung cancers are considered inoperable, lung resection with hemivertebrectomy of the involved vertebra after neoadjuvant chemotherapy and radiotherapy is an alternative treatment in this type of lung cancer. Staging should be made meticulously for the expected surveillance.RésuméEnviron 5% des cancers pulmonaires touchent la paroi thoracique et la colonne vertébrale du fait de leur progression locale et ne sont pas métastatiques au diagnostic. Souvent considérées comme inopérables, les lésions T4N0M0 avec atteinte vertébrale peuvent faire l’objet de nouvelles approches chirurgicales dont nous rapportons ici notre expérience préliminaire. Quatre patients présentant un cancer broncho-pulmonaire T4N0M0 ont été traités par résection en bloc entre 1998 et 2002. Une hémi-laminectomie et une ostéotomie corporéale des vertèbres envahies associées à une stabilisation postérieure ont été réalisées en décubitus ventral; dans un deuxième temps, en décubitus latéral une résection en bloc pulmonaire (résection cunéiforme ou lobectomie) et vertébrale a été effectuée. Nous n’avons pas noté de décès post-opératoires immédiats. Trois patients sont décédés au 6è, 8è et 14è mois post-opératoires. Le quatrième patient est en vie au recul de 20 mois. Bien que les cancers pulmonaires aient longtemps été considérés inopérables, la résection pulmonaire associée à une hémi-vertébrectomie après chimiothérapie néoadjuvante et radiothérapie représente une nouvelle approche thérapeutique dans les lésions T4N0M0.