Bronchial Cytokine Changes Following Bronchial Resection and Reconstruction for Carcinoid Tumor.

As bronchial carcinoids are known to be notably rare, adequate histochemical investigations couldn’t have been carried out on these types of tumors hitherto. In this study, we investigated bronchial cytokines in a carcinoid tumor localized in the left main bronchus. Bronchial resection and reconstruction was performed without the lung resection. Bronchial lavage samples were obtained from both sides of main bronchial system preoperatively and postoperatively. TNF-α, IL-8 and IL6 levels were measured by ELİSA. Preoperative TNF-α and IL-8 levels were found to be 2- folds and 5-folds higher on the tumor side respectively (TNF-α; 14.184 pg/ml and IL-8; 3359.86 pg/ml) compared to tumor-free bronchial system (TNF-α; 6.886 pg/ml, IL-8; 615.072 pg/ml). Interestingly, both cytokine levels were found to be equal and within normal ranges on both sides subsequent to bronchial resection and reconstruction. There were no significant difference in IL-6 levels between two bronchial systems preoperatively (IL-6 levels of right bronchus, 16.44 pg/ml; levels of left bronchus, 19.11 pg/ml). However, there was more than four-fold increase in postoperative levels (IL-6 level; 89.41 pg/ml). In our study, we found that preoperative TNF-α and IL-8 levels were higher compared to the postoperative ones; whereas IL-6 levels showed a significant increase, postoperatively. These findings led us through the idea that carcinoid tumors might be activating the inflammatory process among TNF-α and IL-8 and the surgical bronchoplastic procedure could be the cause of enhanced IL-6 response.

Bronchial Sleeve Resection for Lung Cancer Preoperative Empyema.

Surgical management of the cancer with empyema has rarely been reported in the literature because few of such cases are operable. Many patients might be misevaluated because of the incorrect staging associated with an acute or sub-acute infection. Even in the presence of an operable tumor mass; surgeons behave timid to these patients because of the possibility of infective postoperative complications. The balance between expected benefits and possible risk of surgical intervention is also important. If it is indicated, by the time pleural empyema is restored, procedures such as resection and even bronchoplasty should be performed. 59-years old patient with squamous cell carcinoma that completely obstructed left basal segments and caused to empyema. A thoracic catheter was inserted. Multiple pleural irrigations were done and proper antibiotherapy. Pathologic diagnosis of pleural fluid and pleural biopsy were benign. Pleural cultures were negative and amount of empyema fluid volume has decreased within two months. Positron emission tomography (PET) revealed a 2.5 cm sized left infrahilar tumor, right paratracheal, prevascular and subcarinal lymph nodes and non-homogeneous increased pleural activity. Mediastinal lymph nodes were evaluated as reactive with mediastinoscopy. Left lower lobectomy and lingulectomy were performed with bronchial resection and pathologic stage was 2A (T1bN1MO).