Ülkü Yazıcı

Localized fibrous tumors of the pleura: clinical and surgical evaluation

BACKGROUND Localized fibrous tumors of the pleura, which are considered to originate from submesothelial connective tissue, are rare. The purpose of this study was to investigate the clinical features of these tumors and to determine the optimal treatment and follow-up. METHODS The records of 10 consecutive patients with localized fibrous tumors of the pleura operated on at the Ataturk Center for Chest Diseases and Thoracic Surgery between 1995 and 2001 were retrospectively reviewed. Diagnostic procedures, clinical courses, and outcomes of these patients were studied. Total excision through a thoracotomy was performed in all of the patients. Pneumonectomy was required in 1 patient because of a giant intraparenchymal localized fibrous tumor of the pleura. Additional partial chest wall resections were done in 2 patients. RESULTS The size of excised tumors ranged from 10 x 8 x 4 cm to 30 x 25 x 20 cm. Malignant transformation was seen in 1 patient 22 months after resection of a benign tumor. Four cases were pathologically considered to be malignant. All patients except 1 are alive (follow-up 16 to 57 months after resection). CONCLUSIONS Although localized fibrous tumors of the pleura are considered histologically benign tumors, because of the risk of recurrence and malignant transformation, complete surgical resection is indicated and long-term follow-up is recommended in all patients.

Clinical impact of visceral pleural, lymphovascular and perineural invasion in completely resected non-small cell lung cancer

OBJECTIVES This study is conducted to show the relationship between visceral pleural, lymphovascular, and perineural invasion, and other clinicopathologic characteristics and their significance as prognostic factors. METHODS The clinicopathologic characteristics of 289 patients who underwent a potentially curative surgical resection between 2000 and 2009 in our clinic were reviewed retrospectively. The prognostic factors were then evaluated by univariate and multivariate analysis. The patients who were given neoadjuvant-adjuvant chemotherapy and/or radiotherapy and who died due to postoperative mortality were excluded. Data from 188 patients were analyzed. RESULTS Out of the 188 patients (108 diagnosed as adenocarcinoma and 80 squamous cell carcinoma), 66 patients had lymphovascular invasion, 53 patients had perineural invasion, and 92 patients had visceral pleural invasion. Visceral pleural invasion was related with T factor, tumor histology, dimension, stage, and differentiation. Lymphovascular invasion was related with N status and stage. Perineural invasion was observed more frequently in tumors with moderate/poor differentiation. Visceral pleural and lymphovascular invasion were found to be poor prognostic factors but we could not show statistically meaningful effect of perineural invasion on survival. CONCLUSION The presence of visceral pleural or lymphovascular invasion can show higher risk of mortality whereas perineural invasion has no effect on prognosis.

Prognostic significance of micropapillary pattern in lung adenocarcinoma and expression of apoptosis-related markers: caspase-3, bcl-2, and p53

Cakir E, Yilmaz A, Demirag F, Oguztuzun S, Sahin S, Yazici UE, Aydin M. Prognostic significance of micropapillary pattern in lung adenocarcinoma and expression of apoptosis related markers: caspase‐3, bcl‐2, and p53. APMIS 2011;

Giant hydatid cysts of lung and liver

A 13-year-old girl was admitted to our clinic with the complaints of dyspnea, abdominal distention, cough, and right-sided chest pain.The diagnosis of disease was made with physical examination and radiologic evaluation. She underwent right thoracotomy and phrenotomy for the management of the hydatid cysts of the lung and the liver. The postoperative course was uneventful and she was discharged on the 10th postoperative day. We believe that the simultaneous management of concomitant pulmonary and hepatic hydatid cysts through a thoracicroute is a convenient option.

Synchronous Bilateral Multiple Typical Pulmonary Carcinoid Tumors

Synchronous bilateral multiple carcinoid tumors of the lung are uncommon. We report an unusual case of synchronous, bilateral, and multiple typical pulmonary carcinoids. A 58-year-old woman with cough and chest pain was admitted to our clinic. A thoracic computed tomographic scan showed multiple bilateral nodular lesions. Bronchoscopic evaluation was normal. We performed sequential bilateral thoracotomies, frozen section examination, wedge resection, and lymphadenectomy. Histopathologic examinations revealed typical carcinoid tumor in both lungs. No pathologic lesions were observed in 18-month postoperative follow-up. We discuss treatment of synchronous bilateral multiple carcinoid tumors.

Pulmonary tumor thrombotic microangiopathy from metastatic epithelioid angiosarcoma

The lung is most common site for metastatic disease via hematogenous route. Tumor emboli of the vessels of the lung induces fibrocellular and fibromuscular intimal proliferation. These histopathological changes may cause pulmonary tumor trombotic microangiopaty. Few cases are diagnosed antemortem. We report a 60 year old woman with by metastatic epithelioid angiosarcoma involving the lung. Tumor cells were positive for VEGF and topoisomerase II. VEGF may be involved in the pathogenesis pulmonary tumor trombotic microangioapy and topoisomerase II positivity showed sensitivity against catalytic topoisomerase II inhibitors.

Treatment of persistent postpneumonectomy empyema by vacuum-assisted management: an analysis of nine patients.

BACKGROUND Conventional treatment methods in postpneumonectomy empyemas (PPE) are associated with long stay in hospital, poor patient comfort, and high rate of postoperative mortality. Vacuum-assisted management (VAM) may be helpful in solving these problems. METHODS VAM was performed on nine patients with PPE in our clinic between July 2010 and September 2011 to provide continuous drainage of empyema in the pouch and to improve empyema with obliteration of the pouch by accelerating tissue granulation. RESULTS All nine patients were men (mean age: 54.5 years; range: 18-68 years). Empyema resolution and obliteration of the pouch were achieved with VAM in the cases with empyema without fistula (n = 7) after the pneumonectomy. In the patients with fistula (n = 2), VAM was performed after closure of the fistula. Mean duration of hospital stay was 36.5 (12-57) days. The treatment was successful in eight of nine patients (88.9%). Mean duration of follow-up in the successfully treated patients was 10.9 (3-17) months. CONCLUSION Intrathoracic VAM was effective and safe in the treatment of PPE.

A Rare Case of Hemoptysis: Intrapulmonary Cavitary Lesion Appearing as a Thoracic Endometriosis

Pulmonary endometriosis is a rarely seen disease of the lung. On computed tomography, a cavitary lesion of 15 × 26 in size was detected in the lung parenchyma of a 38-year-old female patient who was examined due to hemoptysis. The pathologic result of the surgically excised cavitary lesion was reported as pulmonary endometriosis.

Simultaneous Pulmonary and Transdiaphragmatic Surrenal Resection in Non-small Celled Lung Cancer

1 A. Irfan Tastepe1, Ulku Yazici2, Pinar Bicakcioglu2, S.S. Erkmen Gulhan2, Yetkin Ağackiran3 1Department of Thoracic Surgery, Gazi University Medical Faculty, Besevler, 2Department of Thoracic Surgery, 3Department of Pathology, Ataturk Education and Research Hospital for Chest Diseases and Thoracic Surgery, Kecioren, Ankara, Turkey Eş Zamanlı Akciğer ve Sürrenal Rezeksiyonu / Simultaneous Lung and Surrenal Resection Simultaneous Pulmonary and Transdiaphragmatic Surrenal Resection in Non-small Celled Lung Cancer

Intrathoracic fibrodysplasia ossificans progressiva.

Fibrodysplasia ossificans progressiva is an extremely rare disease that is usually seen in the form of sporadic cases and seems to be localized outside of the thoracic cavity. Inflammation and trauma are accused in the etiology, and too many diagnostic mistakes are done. The disease, which may present genetic transmission and has not a definitive treatment, was seen as an intrathoracic mass for the first time. Intrathoracic mass was excised, and the cure was achieved in our patient, who was defined to be sporadic as a result of familial screening.