Fine Needle Aspiration Cytologic Features of Well-Differentiated Papillary Mesothelioma in the Pleura: A Case Report

Well-differentiated papillary mesothelioma (WDPM) is a rare subtype of malignant mesothelioma, which is considered to have low malignant potential. Because of its rare occurrence in the pleura, cytopathologists are not familiar with the cytologic features of WDPM, and to date only one report regarding the cytomorphology of aspiration biopsies of WDPM in pleura has been released. The authors present the findings of fine needle aspiration cytology of WDPM in the pleura in a 53-year-old woman. Aspiration smears showed papillary clusters composed of one to three layers of surface tumor cells and a central hyalinized stromal core. Tumor cells were round, ovoid, and spindle like with minimally atypical nuclei and small conspicuous nucleoli. Mitotic activity was virtually absent. Excisional biopsy histologic and immunohistochemical findings were wholly compatible with WDPM findings. Knowledge of the specific cytologic findings of WDPM is crucial for accurate diagnosis and appropriate treatment.

Risk factors of Pneumonectomy in Non-Small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: In the resection of lung cancer, pneumonectomy occupied 20~35% of all resections, and significantly high operative mortality is reported in right pneumonectomy (10~25%). The aim of this study is to identify the characteristics of morbidity, operative mortality and factors affecting operative mortality after pneumonectomy. MATERIAL AND METHOD: This study recruited the database which performed pneumonectomy for lung cancer in Korea Cancer Center Hospital from Aug 1987 to Apr 2002. RESULT: Total of 386 pneumonectomies were performed in that period. Sidedness were left in 238, right in 148; and the procedures were standard resection in 207, and extended resection in 179. Morbidity occurred in 115 cases (29.8%, 115/386). Mortality occurred in 12 cases (3.1%, 12 in 386). This mortality rate was similar to that of lobectomy (2.1%, 13 in 613) during the same period. Morbidity consisted of 42 hoarseness, 17 (9) pneumonia and ARDS, 8 empyema, 5 (1) broncho-pleural fistula, 5 reoperation for bleeding, 5 (1) arrhythmia, 1 (1) pulmonary edema, and 25 others (The number in the parenthesis is the number of mortality case for that morbidity). Several factors affecting the operative mortality were evaluated. At first, extended procedure (3.3%, 6 in 179) affected the operative mortality similar to the standard procedure (2.9%, 6 in 207)(p=0.812). Second, the rate of operative mortality in an elderly group over 60 years (5.5%, 10 in 182) was significantly higher than the younger group under 60 years (1%, 2 in 204)(p=0.016). Third, sidedness of resection affects to operative mortality. Right pneumonectomy (6.8%, 10 in 148) showed higher operative mortality than that of left pneumonectomy (0.8%, 2 in 238)(p=0.002). The group over 60 years showed higher incidence of respiratory morbidity (11.0%, 20 in 182) than that of the group under 60 years (3.4%, 7 in 204)(p=0.005). Right pneumonectomy also showed significantly higher incidence (11.5%, 17 in 148) than that of left pneumonectomy (4.2%, 10 in 238)(p=0.008). CONCLUSION: Age and sidedness of pneumonectomy were the risk factors of operative mortality and respiratory complications. Therefore, careful selection of patients and more attention perioperatively were demanded in right pneumonectomy. However, because the operative mortality is acceptable, pneumonectomy could be done safely if the pneumonectomy is necessary for curative resection of lung cancer.

Surgical Treatment for T4 Non-small Cell Lung Cancer Invading Mediastinal Structures / 대한흉부외과학회지

BACKGROUND: Non-small cell lung cancer (NSCLC) with invasion of mediastinal structures is classified as stage IIIB, and has been considered surgically unresectable. However, in a selected group of these patients, better results after surgical resection compared to non-surgical group have been reported. The aim of this study is to evaluate the role of surgical resection in treatment of mediastinal T4 NSCLC. MATERIAL AND METHOD: Among 1067 patients who underwent surgical intervention for non-small cell lung cancer from Aug 1987 to Dec 2001 in Korea cancer center hospital, 82 patients had an invasion of T4 mediastinal structures (7.7%). Resection was possible in 63 patients (63/82 resectability 76.8%). Their medical records in Data Base were reviewed, and they were followed up completely until Jun 2002. Surgical results and prognostic factors of NSCLC invading mediastinal structures were evaluated retrospectively. RESULT: Lung cancer was resected completely in 52 patients (63.4%, 52/82). Lung resection was lobectomy (or more) in 14, pneumonectomy in 49. The mediastinal structures invaded by primary tumor were great vessel (61.9%), heart (19%), vagus nerve (9.5%), esophagus (7.9%), and vertebral body (7.9%). Nodal status was N0 in 11, N1 in 24, and N2 in 28 (44.4%). Neoadjuvant therapy was done in 6 (9.5%, 5 chemotherapy, 1 radiotherapy), and adjuvant therapy was added in 44 (69.8%, 15 chemotherapy, 29 radiotherapy) in resection group (n=63). Complication was occurred in 23 (31.7%), and operative mortality was 9.5% in resection group. Median and 5 year overall survival including operative mortality was 18.1 months and 21.7% in resection group (n=63), 6.2months and 0 % in exploration only group (n=19, p=.001), 39 months and 32.9% in N2 (-) resection group (n=35), and 8.8 months and 8.6% in N2 (+) resection group (n=28, p=.007). The difference of overall survival by mediastinal structure was not significant. CONCLUSION: The operative risk of NSCLC invading mediastinal structures was high but acceptable, and long-term result of resection was favorable in selected group. Aggressive resection is recommended in well selected pateints with good performace and especially N2 (-) NSCLC with mediastinal invasion.