Pulmonary blastoma: a report of five cases and review of the literature / 中国肺癌杂志

<p><b>BACKGROUND</b>Pulmonary blastoma is a rare primary malignancy of the lung. It is now recognized in two forms: adult type pulmonary blastoma and childhood pleuropulmonary blastoma. The clinical characteristics, diagnosis and treatments of adult type pulmonary blastoma are discussed in this article.</p><p><b>METHODS</b>The clinical records of 5 patients with adult type pulmonary blastoma admitted in Cancer Center, Sun Yet-sen University from 1964 to 2004 were analyzed and the literature on pulmonary blastoma was reviewed.</p><p><b>RESULTS</b>Three patients were male and two were female with the ages ranged from 22 years old to 70. Their symptoms consisted mainly of cough, hemoptysis and chest pain. The pulmonary blastomas were mainly manifested as a solitary parenchymal mass of the lung on chest radiograph and CT. None of these patients was diognosed by fibrobronchoscopy nor sputum cytology. Three patients underwent lobectomy, one underwent pneumonectomy, and these four patients underwent mediastinal lymph node resection also. The fifth one received wedge resection and postoperative chemotherapy. At the end of follow-up, three patients died and two was alive, and the survival time was from 6 months to 11 years.</p><p><b>CONCLUSIONS</b>Pulmonary blastoma is difficult to be diagnosed before operation. Surgery is the best therapeutic choice up to now. It has poor response to radiotherapy and chemotherapy. The prognosis of patient with pulmonary blastoma is variable.</p>

The diagnostic value of mediastinoscopy and its application in staging for lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of mediastinoscopy in diagnosing unknown mediastinal disease and staging of lung cancers.</p><p><b>METHODS</b>From October 2000 to August 2001, 41 patients were examined by cervical mediastinoscopy with or without anterior mediastinotomy for diagnostic and staging purposes. Of these 41 patients, 12 were for diagnosis of unknown mediastinal disease, 3 for diagnosis and staging of pulmonary nodule or mass clinically suspected to be malignancy and 26 for the staging of lung cancer.</p><p><b>RESULTS</b>Ten of 12 patients with unknown mediastinal disease were diagnosed pathologically as thymoma in 1, metastatic lesion from lung cancer in 1, metastatic thyroid carcinoma in 1, lymph node hyperplasia in 1, teratoma in 1, sarcoidosis in 1, inflammatory pseudotumor in 1 and tuberculosis in 3, giving a diagnostic rate of 83.3%. Of three patients with suspected malignancy, one was diagnosed as tuberculosis by cervical mediastinoscopy and the other two as lymphoma and pulmonary inflammatory pseudotumor by thoracoscopy and thoracotomy. The sensitivity and specificity of mediastinoscopy for the staging of mediastinal nodes in 26 lung cancers were 87.5% and 100%. Only one wound infection but no other major complication was found.</p><p><b>CONCLUSION</b>Mediastinoscopy is a safe procedure which can accurately provide information on diagnosis and staging.</p>

Prognostic factor analysis of pneumonectomy for non-small cell lung cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To identify predictors of survival following pneumonectomy for non-small cell lung cancer (NSCLC) and provide evidence for the revision of patient selection criteria.</p><p><b>METHODS</b>81 cases of pneumonectomy for NSCLC from January 1990 to May 1996 at our hospital were reviewed retrospectively. There were 65 men (80.2%) and 16 women (19.8%), with a mean age 53.4 +/- 9.4 years (range 20 - 68 years). Predominant histological types included squamous cell carcinoma (54.3%), adenocarcinoma (24.7%), and squamoadenocarcinoma (17.3%). After follow-up for more than 5 years, data were examined using the chi-square test, Kaplan-Meier method, and Cox-mantel test. The possible factors affecting survival were tested with univariate and multivariate analysis.</p><p><b>RESULTS</b>The 5-year survival of N(0), N(1) and N(2) disease of NSCLC following pneumonectomy was (20.8 +/- 9.9)%, (15.4 +/- 10.0)% and (4.0 +/- 2.8)%, respectively. There was no perioperative death. The operative complications morbidity was 22.2%. Factors adversely affecting survival with univariate analysis included age over 60 years for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, peripheral location, tumor greatest dimension more than 10 cm, chest wall involvement and N(2) disease. Factors adversely affecting survival with multivariate analysis included cardiopulmonary complications, greatest tumor dimension more than 10 cm, chest wall involvement and N(2) disease.</p><p><b>CONCLUSIONS</b>Pneumonectomy provides survival benefit with a high operative complications morbidity. Old age (>/= 60 years) for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, and N(2) disease may be negative prognostic factors of long-term survival. Patient selection should be based on cardiopulmonary evaluation and the stage of disease.</p>

Clinical analysis of 10 patients with pleural mesothelioma in surgical treatment / 中国癌症杂志

Purpose:To investigate the clinical features,diagnosis, surgical treament and prognosis of pleural mesothelioma. Methods:A retrospective study was conducted in a total of 10 cases of pleural mesothelioma hospitalized from January 1980 to June 2000. Results: None of the 10 patients had history of exposure to asbestos,and the clinical manifestation were chest pain and feeling of compression,cough,shortness of breath. Pleural thickening or nodules were found in radiography examaination with or without pleural effusion.Of 10 cases,4 cases were localized type and 6 cases were diffused type, 8 cases received surgery(5 cases received radical operation and 3 cases received palliative operation) Conclusions:Exposure to asbestos or not has no definite relations to pleural mesothelioma,cytology examination of pleural effusion is not very helpful in pathologic diagnosis due to low positive rate.CT scan and pleural needle biopsy are helpful preoperatively. Surgical operation is the optional treatment in localized type and the prognosis is good,but prognosis is poor in diffused type and multimodality therapy is emphasized.