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OBJECTIVE@#To investigate the computed tomography findings, clinicopathological features, genetic characteristics and prognosis of in situ adenocarcinoma (AIS) and minimally invasive adenocarcinoma (MIA) of the lung.@*METHODS@#We retrospectively analyzed the data including computed tomography (CT) images, histopathological findings, Ki-67 immunostaining, and genetic mutations in patients with lung adenocarcinoma undergoing surgery at our hospital between 2014 and 2019.@*RESULTS@#Of the total of 480 patients with lung adenocarcinoma we reviewed, 73 (15.2%) had AIS (=28) or MIA (=45) tumors. The age of the patients with MIA was significantly younger than that of patients with AIS ( < 0.02). CT scans identified pure ground-glass nodules in 46.4% of AIS cases and in 44.4% of MIA cases. Multiple GGOs were more common in MIA than in AIS cases ( < 0.05), and bluured tumor margins was less frequent in AIS cases ( < 0.05). No significant difference was found in EGFR mutations between MIA and AIS cases. A Ki-67 labeling index (LI) value ≥2.8% did not differentiate MIA from AIS. The follow-up time in MIA group was significantly shorter than that in AIS group, but no recurrence or death occurred.@*CONCLUSIONS@#Despite similar surgical outcomes and favorable survival outcomes, the patients with AIS and MIA show differences in terms of age, CT findings, EGFR mutations and Ki-67 LI.
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Humans , Adenocarcinoma of Lung , Diagnostic Imaging , Pathology , ErbB Receptors , Genetics , Ki-67 Antigen , Genetics , Lung Neoplasms , Diagnostic Imaging , Pathology , Mutation , Prognosis , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective To study the clinical outcomes of robotic extended thymectomy and thoracoscopic extended thymectomy for thymoma patients with myasthenia gravis compared with conventional median sternotomy extended thymectomy.Methods The clinical data of thymoma patients with myasthenia gravis treated by extended thymectomy between June 2013 and June 2016 were retrospectively reviewed.The clinical outcome parameters were compared according to surgical approach.Results 41 thymoma patients with myasthenia gravis,8 cases underwent robotic extended thymecotmy,11 cases underwent thoracoscopic extended thymectomy and 20 underwent median sternotomy extended thymectomy.The resected extension included tumor,thymus tissue and adipose tissue in anterior mediastinum.There were no significant differences between robotic group and thoracoscopic group regarding operative time,blood loss,chest tube duration,hospital stay,postoperative complications and postoperative myasthenic crisis (P ＞ 0.05).The blood loss of robotic group and thoracoscopic group was significantly lower than that in median sternotomy group(P ＜ 0.05).The chest tube duration of thoracoscopic group was significantly shorter than that in median sternotomy group(P ＜0.05).The effective rates of MG after extended thymectomy in robotic group,thoracoscopic group and sternotomy group was 65.0％ 、69.2％ 、62.5％ respectively and there was no significant difference (P ＜ 0.05).Conclusion Robotic thymectomy and thoracoscopic thymecotomy are both minimal invasive surgery approach with less bleeding for thymoma patients with myasthenia gravis.The clinical outcomes of robotic thymectomy and thoracoscopic thymecotomy are similar.
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Objective To detect the mRNA expression of mesenchymal-epithelial transition factor (MET)gene in patients with non-small cell lung cancer (NSCLC),and to investigate the relationship and clinical significance between the mRNA expression of MET gene and clinical pathological characteristics. Methods From June 201 1 to November 201 3,48 patients with pathologically confirmed NSCLC in Chinese People′s Liberation Army General Hospital were selected.All patients included in the study were not treated before surgery.The branched DNA liquid chip technology was used to detect mRNA expression of MET gene in tumor tissues.The relationship between mRNA expression of MET gene and clinical pathological characteristics was analyzed.Results The constituent ratios of low,moderate and high mRNA expression level of MET gene were 22.9%,50.0% and 27.1 % respectively,mainly for the moderate expression.The mRNA expression of MET gene was related to the pathologic type (χ2 =7.1 83,P =0.020)and TNM stage (χ2 =24.566,P =0.01 7)of the patients;but it was not related to the gender (χ2 =0.566,P =0.754),age (χ2 =1 .857,P =0.395),smoking history (χ2 =4.959,P =0.084),degrees of differentiation (χ2 =5.749,P =0.067), lymph node metastasis (χ2 =1 .631 ,P =0.442)and distant metastasis (χ2 =4.261 ,P =0.1 1 9).Conclusion mRNA expression of MET gene is more likely to present moderate and higher level in NSCLC patients.MET gene can also be used as a biomarker for judging tumor pathological type.
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Objective To evaluate the clinical effect of CT guided localization with a hook-wire system united with single port video-assisted thoracoscopic resection (VATS)for small ground glass opacity (GGO) pulmonary nodules (CT lesion diameter <1 .5 cm and no pleural changes).Methods Fifteen patients with small GGO pulmonary nodules who underwent CT-guided transthoracic localization with a hook-wire system in operation room after anesthesia were performed with single port VATS from August 2009 to March 201 3.The accuracy of puncture location,complications,resection rate and pathological results were evaluated.Results All patients underwent CT-guided hook-wire localization and single port VATS resection.The success rate of localization was 1 00%,and the average procedure time was (1 3.60 ±2.06)min,only 1 patient occurred mini-mal pneumothorax.The resection rate of single port VATS was 1 00%,and lobectomy performed in 1 patient, segmentectomy in 1 ,and local resection in 1 3.Pathological diagnosis:adenocarcinoma in situ in 9,atypical adenomatous hyperplasia (AAH)in 5,AAH and adenocarcinoma in situ in 1 .Post-operation follow-up showed all patients survived,and no recurrence and metastasis.Conclusion In operation,use of CT guided localiza-tion with a hook-wire system for small GGO pulmonary nodules (CT lesion diameter <1 .5 cm and no pleural changes)united with video-assisted thoracoscopic resection is accurate,quick and safe,and it has good clinical value.
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Objective:To discuss the clinical and imaging features as well as the treatment and prognosis of primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. Methods:We retrospectively analyzed the clinical, imaging, and follow-up data of 13 patients with pulmonary MALT lymphoma in the Chinese PLA General Hospital from April 2000 to July 2012. Results:Of the 13 patients with pulmonary MALT lymphoma, 8 were male and 5 were female (1.6:1 ratio). The age of onset varies from 21 years to 67 years, and the median age is 59 years. The major clinical manifestations include chest discomfort in 6 cases, cough in 2 cases, fever in 2 cases, and chest pain in 1 case. Two cases had no observable discomfort. One patient suffered from Sj?gren's syndrome. The chest CT of the patients showed pulmonary consolidation with air bronchogram in 3 cases, patchy shadows in 3 cases, mass shadow in 4 cases, and ground-glass opacities in 4 cases. In addition, 10 cases showed bilateral pulmonary multiple changes, 4 showed mediastinal lymph node enlargement, and 1 showed pleural effusion. Operation was performed on 6 patients, 3 of which were given postoperative adjuvant chemotherapy. Four patients underwent chemotherapy involving the CHOP or R-CHOP regimen, whereas three patients received symptomatic and supportive treatment only. One case was lost to follow-up. The follow-up period ranged from 1 year to 11 years. In one patient, the disease progressed four years after the diagnosis, and the patient died after 11 years. One patient died from the side effects of chemotherapy. The remaining 10 cases were still alive and did not show any progression of the disease. Conclusion:The clinical feature of pulmonary MALT lymphoma is not typical. Thus, imaging techniques cannot detect specific changes. Surgical resection is vital in the diagnosis and treatment of this disease because it can help provide a clear diagnosis, particularly to patients with limited lesions and from which specimens could not be obtained using conventional methods. Moreover, the prognosis of this treatment is generally good.
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<p><b>BACKGROUND AND OBJECTIVE</b>Video-assisted thoracoscopic surgery (VATS) has been widely used in the diagnosis and treatment of chest diseases. The aim of this study was to explore the feasibility and clinical value of lobectomy with single utility port complete VATS.</p><p><b>METHODS</b>From September 2009 to December 2009, 21 cases underwent lobectomy with single utility port complete VATS. Of 21 patients, right upper lobectomy was 12 cases, left lower lobectomy 5 cases, right lower lobectomy 2 cases, left upper lobectomy 1 case, right middle lobectomy 1 case.</p><p><b>RESULTS</b>The operation process were smooth in all patients and without conversion to thoracotomy. The mean operative time was (132.7 +/- 16.2) min and the mean intraoperative blood loss was (110.5 +/- 24.6) mL. The average chest tube drainage time was (3.1 +/- 1.3) d, and the mean hospitalization day was (5.2 +/- 3.2) d. All patients recovered smoothly and without severe complications. There were no post-operative deaths.</p><p><b>CONCLUSION</b>Lobectomy with single utility port VATS is technically feasible and has the advantages of minimal invasive and rapid recovery.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Lung Neoplasms , General Surgery , Pneumonectomy , Methods , Thoracic Surgery, Video-Assisted , Methods , Treatment OutcomeABSTRACT
Objective To investigate the surgical treatment and prognosis of bronchial mucoepidermoid cancer. Methods During a 17-year-period, 19 consecutive patients underwent surgery for bronchial mucoepidermoid cancer, and the surgical treatment and prognosis were analyzed retrospectively. Results Among them, 13 cases were treated by lobectomy, 5 by pneumonectomy, and 1 by exploratory thoracotomy. Four cases were proved pathologically to be high malignancy and 15 low malignancy. All patients were followed up postoperatively for about 68.26 months on average. The 1, 3, and 5-year survival rates were 94.44%, 80.00%, and 70.00% respectively. In the low malignancy group, the 1, 3, 5-year survival rates were 100%; in the high malignancy group, the 1-year survival rate was 33.33%, and 3-year survival rate was 0. Conclusion Patients with low malignant grade of cancers can be cured after complete resection, and those with high malignant grade predispose to metastasis and hence result in a poor prognosis.