Shadi Hamouri

Bilateral Facial Nerve Paralysis as First Presentation of Lung Cancer

Leptomeningeal carcinomatosis is rare, and its precise incidence is unknown. It is associated with a wide spectrum of solid and hematological malignancies. To complicate its diagnosis, the clinical presentation of leptomeningeal carcinomatosis can be variable. We report a case of a 38-year-old male with bilateral facial nerve paralysis as first presentation of lung adenocarcinoma. To our knowledge, this is the only case describing bilateral facial nerve palsy as the first and only manifestation of lung adenocarcinoma.

Indikationen für thoraxchirurgische Interventionen

ZusammenfassungPalliative Thoraxchirurgie dient der Aufrechterhaltung einer möglichst hohen Lebensqualität des Patienten. Die Evidenz für interventionelle, minimal-invasive und offen chirurgische Verfahren ist für kurative Therapieansätze beim Lungenkarzinom sehr hoch. Im palliativen Konzept ist Heilung nicht die Zielforderung, sondern die Aufrechterhaltung einer hohen Lebensqualität sowie eines guten kosmetischen Ergebnisses unter sinnvoller Nutzen-Risiko-Abwägung für den Patienten. Neben den Problemen, die durch akute tumorbedingte Hämoptysen oder Infektionen ausgelöst werden können, sind Atemwegsstenosen, Lungenkarzinome mit Brustwandbeteiligung mit nachfolgenden Ulzerationen, Schmerzen oder optischen Verstümmelungen sowie die Behandlung von bösartigen Pleura- und Perikardergüssen die Domäne der palliativen Thoraxchirurgie. In seltenen Fällen können zur Symptomlinderung, zur Verhinderung von schweren Infektionen oder lebensbedrohlichen Komplikationen durch Lungenkarzinome auch anatomische Lungenresektionen bis zur Pneumonektomie notwendig werden. Voraussetzungen für die Indikation der palliativen Thoraxchirurgie sind immer der Wille des Patienten, die Prognose seiner Grunderkrankung und das Fehlen einer besseren konservativen Therapiemöglichkeit. Grundsätzlich sollten Indikationen zur palliativen Thoraxchirurgie immer im interdisziplinären Konsens gefällt werden.AbstractPalliative thoracic surgery is intended to maintain the highest possible quality of life. The evidence for interventional, minimally invasive, and open thoracic surgical procedures in curative treatment for lung cancer is very high. In palliative concepts, the challenges are maintenance of quality of life, cosmetic outcome, and consideration of risk-benefit balance. Next to tumor-associated problems, including acute hemoptysis, infections, airway narrowing, cancer invasion of the chest wall with ulceration, pain, and visual mutilation, the treatment of malignant pleural and pericardial effusions is considered the domain of palliative thoracic surgery. In some cases anatomic lung resection up to pneumonectomy may be necessary for symptom control and prevention of life-threatening and/or infectious complications. Palliative thoracic surgery is preconditioned by patient will, prognosis, and lack of alternative treatment and should in principle be indicated by interdisciplinary consensus.

Trends of Gallbladder Cancer in Jordan Over 2 Decades: Where Are We?:

Background and Study Aims: The prevalence of gallbladder cancer (GBC) varies between different parts of the world. This study is a review of literature and an update of a previously published study conducted in our university and aims to reassess the incidence of GBC over the past 2 decades. Patients and Methods: We conducted a retrospective study between 2002 and 2016. Data regarding demographics, clinical presentation, risk factors, histopathology, investigations, and treatments were obtained. A diagnosis of GBC established during surgery or primarily detected in the surgical specimen was classified as incidental. Results: Of 11 391 cholecystectomies performed, 31 cases (0.27%) of GBC were found. The mean age of patients with GBC was 68 years (43-103 years), 74% were women. The annual incidence of GBC was 0.2/100 000 (men: 0.1/100 000; women: 0.3/100 000). Biliary colic and acute cholecystitis were the main presentations. Diagnosis of GBC was “incidental” in 67% of cases. About 75% of patients with GBC had gallstones, 13% had polyps, and 3% had porcelain gallbladder. Adenocarcinoma was the dominant (87%) histologic type. Conclusions: The GBC rate in our region, similar to others parts of the world, is still low and has not changed over the past 2 decades. This study consolidates the previously published recommendations regarding the high index of suspicion of GBC in elderly with cholelithiasis.

Concurrent pulmonary sequestration and pulmonary hydatid cyst in a child: A case report

Pulmonary sequestration (PS) happens when an area of the lung receives its arterial blood supply from systemic circulation, resulting in a non‐functional lesion (Intralobar or extralobar). Hydatid cyst results from infection of the tapeworm Echinococcus. We report a case of hydatid cyst existed concurrently with intralobar PS. A 12‐year‐old girl presented with recurrent hemoptysis of 2 years duration. Serology for Echinococcus granulosus was positive. CT chest suggested intralobar PS in the right middle lobe, which was surgically removed. In conclusion, recurrent localized pulmonary infections should raise the suspicion of intralobar PS which may rarely coexist with hydatid cyst.

Primary tracheal schwannoma a review of a rare entity: current understanding of management and followup

BackgroundNeurogenic tumors of the tracheobronchial tree are extremely rare and include neurofibroma and schwannoma. We report a case of primary recurrent tracheal schwannoma causing obstructive airway symptoms.Case presentationA 60-year-old man presented with obstructive airway symptoms due to recurrent tracheal schwannoma. Due the recurrence, size of the tumor and low surgical risk, the patient was treated with tracheal resection.ConclusionPrimary endotracheal neurogenic tumors are extremely rare, but one should consider them in the differential diagnosis of persistent upper airway symptoms. While endoscopic therapies recur nearly a quarter of the time, surgical resections do not have any recorded recurrences.

Corpuscular thymoma, case report and review of literature

Aim: Hassall corpuscles are concentric arrangement of keratinizing epithelial cells that are restricted to the medulla of the normal thymus. Hassall corpuscles in thymomas are unusual findings and are seen in thymomas WHO type B1–3 with medullary differentiation, but rare cases have been documented. Thymoma with abundant Hassall corpuscles (corpuscular thymoma) must be differentiated from thymic carcinoma, well differentiated keratinizing squamous cell carcinoma type. Case report: We report a case of a 73-year-old male patient, presenting with cough for one year. Computed tomography (CT) scan showed a well defined anterior superior mediastinal mass. Surgical excision of the mass was performed. Gross examination revealed a large, oval shaped, well circumscribed, encapsulated, firm brown mass measuring 10 × 6 × 4 cm, and weighing 219 g, with heterogeneous pale white solid, small cystic spaces, and necrotic cut surfaces. Light microscopic examination revealed two alternating components, the first forming a delicate loose network of neoplastic epithelium equally admixed with non-neoplastic lymphocytes, and the second forming vague solid sheets with paucity of lymphocytes. Both components show abundant Hassall corpuscles, extensive areas of coagulative tumor necrosis, small cystic spaces, and cholesterol clefts. Immunohistochemical studies showed that the neoplastic epithelium is strongly and diffusely immunoreactive for HMWCK, panCK, and EMA, and focally positive for CAM5.2, and negative for CD5, and C-KIT immunohistochemical stains. Conclusion: Corpuscular thymoma reported in the literature as WHO type B2 or B3. Our presented case is of type B3, Modified Masoaka stage 1. We believe that thymoma with corpuscular differentiation is a rare distinct variant of organotypical thymomas, although it is not mentioned in the 2004 WHO classification. Recognition of this rare variant of thymomas is very important to avoid confusion with thymic carcinoma and squamous cell carcinoma type. Careful microscopic examination and immunohistochemical stains are mandatory to differentiate between these entities.

Indikationen für thoraxchirurgische InterventionenIndications for thoracic surgery

ZusammenfassungPalliative Thoraxchirurgie dient der Aufrechterhaltung einer möglichst hohen Lebensqualität des Patienten. Die Evidenz für interventionelle, minimal-invasive und offen chirurgische Verfahren ist für kurative Therapieansätze beim Lungenkarzinom sehr hoch. Im palliativen Konzept ist Heilung nicht die Zielforderung, sondern die Aufrechterhaltung einer hohen Lebensqualität sowie eines guten kosmetischen Ergebnisses unter sinnvoller Nutzen-Risiko-Abwägung für den Patienten. Neben den Problemen, die durch akute tumorbedingte Hämoptysen oder Infektionen ausgelöst werden können, sind Atemwegsstenosen, Lungenkarzinome mit Brustwandbeteiligung mit nachfolgenden Ulzerationen, Schmerzen oder optischen Verstümmelungen sowie die Behandlung von bösartigen Pleura- und Perikardergüssen die Domäne der palliativen Thoraxchirurgie. In seltenen Fällen können zur Symptomlinderung, zur Verhinderung von schweren Infektionen oder lebensbedrohlichen Komplikationen durch Lungenkarzinome auch anatomische Lungenresektionen bis zur Pneumonektomie notwendig werden. Voraussetzungen für die Indikation der palliativen Thoraxchirurgie sind immer der Wille des Patienten, die Prognose seiner Grunderkrankung und das Fehlen einer besseren konservativen Therapiemöglichkeit. Grundsätzlich sollten Indikationen zur palliativen Thoraxchirurgie immer im interdisziplinären Konsens gefällt werden.AbstractPalliative thoracic surgery is intended to maintain the highest possible quality of life. The evidence for interventional, minimally invasive, and open thoracic surgical procedures in curative treatment for lung cancer is very high. In palliative concepts, the challenges are maintenance of quality of life, cosmetic outcome, and consideration of risk-benefit balance. Next to tumor-associated problems, including acute hemoptysis, infections, airway narrowing, cancer invasion of the chest wall with ulceration, pain, and visual mutilation, the treatment of malignant pleural and pericardial effusions is considered the domain of palliative thoracic surgery. In some cases anatomic lung resection up to pneumonectomy may be necessary for symptom control and prevention of life-threatening and/or infectious complications. Palliative thoracic surgery is preconditioned by patient will, prognosis, and lack of alternative treatment and should in principle be indicated by interdisciplinary consensus.

Chirurgische Optionen beim kleinzelligen Bronchialkarzinom

ZusammenfassungVor 1970 war die Standardbehandlung für Patienten mit Bronchialkarzinom die chirurgische Resektion für alle histologischen Subtypen. Seit den 70er-Jahren des letzten Jahrhunderts ist die Chemotherapie das grundlegende Behandlungselement für das SCLC. Wegen vieler Studien der späten 70er- und frühen 80er-Jahre war es lange Zeit Konsens, dass die chirurgische Resektion des SCLC weder das Langzeitüberleben von Patienten mit positiver Antwort auf eine Chemotherapie verbessert noch Einfluss auf die Quote der Lokalrezidive hat. Basierend auf den neueren Chemotherapien, gilt die chirurgische Resektion in ausgewählten Fällen für das SCLC als akzeptable Option, wird aber unverändert sehr kontrovers diskutiert.AbstractBefore 1970 the standard treatment of patients with lung cancer including all the histological types was surgical resection. Since the 1970s chemotherapy has been the essential treatment modality for SCLC. Because of multiple studies in the late 1970s and early 1980s consensus was reached that pulmonary resection neither improved the survival for SCLC chemotherapy responders nor influenced the pattern of relapse. Based on the publications of surgical resection combined with newer chemotherapeutics a number of indications for SCLC resection are accepted, but the role of surgery in the treatment of this disease is still controversial.