Single-stage resection of multiple pulmonary ground-glass opacities: A clinical analysis / 中国胸心血管外科临床杂志

@#Objective    To summarize our experience of surgical resection of multiple ground-glass opacity (GGO) in recent years. Methods    Clinical data of patients who underwent one-stage resections of multiple GGO from November 2015 to May 2019 in our hospital were collected, including 13 males and 52 females at an average age of 56.0±9.4 years. The clinical effects and pathological types of GGO were evaluated. Results    Time interval from first discovery to surgery was 8-1 447 (236.5±362.4) days. There were 48 patients with unilateral surgery and 17 patients with bilateral surgery during the same period. Except for 2 patients who underwent open thoracotomy due to total thoracic adhesions, other patients underwent video-assisted thoracoscopic surgery (VATS). The mean postoperative hospital stay was 12.2±4.3 days. No severe perioperative complication or death occurred. A total of 156 GGO lesions were resected, 80 lesions were pure GGO, including 58 (72.5%) malignant lesions and 22 (27.5%) benign lesions, with an average diameter of 7.7±3.3 mm and 5.5±2.6 mm, respectively. Another 76 lesions were mixed GGO, including 69 (90.8%) malignant lesions and 7 (9.2%) benign lesions, with an average diameter of 13.6±6.6 mm and 7.7±3.5 mm, respectively. Conclusion    Patients with multiple GGO should be treated with anti-inflammatory therapy firstly. When conservative treatment is ineffective and no benign outcomes are observed, surgical treatment should be considered. And when lung function is sufficient for patients to underwent surgeries, the simultaneous unilateral or bilateral thoracoscopic resection is suggested, and the sublobar resection or lobectomy methods can be adopted flexibly according to the clinical features of the lesion and the rapid pathological results, which will not increase the risk of postoperative complications. Otherwise, surgical resection should be given priority for pure GGO lesions with a diameter > 7.7 mm and mixed GGO lesions.

Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules / 中国胸心血管外科临床杂志

@#Objective To share the experience of single-stage bilateral pulmonary resections by video-assisted thoracic surgery (VATS) for multiple nodules. Methods Clinical records of patients undergoing one-stage bilateral resections of multiple pulmonary nodules between January 2015 and December 2016 in our institution were retrospectively reviewed and analyzed. There were 9 males and 15 females, aged from 33 to 69 (55.0±8.0) years. Two patients underwent bilateral lobectomy. Lobar-sublobar (L/SL) resection and bilateral sublobar resection (SL-SL) were conducted in 9 patients and 13 patients respectively. Results All operations completed successfully. Operation time was 135–330 (231.4±59.1) min, duration of use of chest drains was 2–17 (5.4±3.1) days. Overall duration of hospitalization after surgery was 5–37 (8.6±6.3) days. There was no perioperative death. Postoperative course was uneventful in 17 (70.8%) patients. The postoperative complications included one patient of incision infection and one patient of pulmonary infection. Persistent air leak for >3 days duration and unilateral pleural drainage for more than 200 ml/d were observed in 3 patients and 2 patients respectively. Conclusion Single-stage bilateral surgery in selected patients with synchronous bilateral multiple nodules is feasible and associated with satisfactory outcomes.

Primary hepatocellular carcinoma patients with multiple nodules increased short-term recurrence after radical resection / 中华肝胆外科杂志

Objective To investigate the relationship between primary hepatocellular carcinoma (HCC) with multiple nodules and short-term recurrence after radical resection.Methods We retrospectively analyzed the clinical data and follow-up of 692 consecutive HCC patients who underwent curative resection at the Affiliated Hospital of Qingdao University from January 2000 to December 2011.The diagnosis of multiple nodules was based on preoperative imaging data and observations in operation.Results Of 692 HCC patients, 126 patients had multiple nodules (18.2％, the MN group) and 566 patients had a single nodule (71.8％, the SN group).The 1-, 2-, 5-, and 10-year overall survival (OS) rates were 86.5％,72.2％, 38.1％, and 23.2％ for the MN group, and 93.8％, 82.7％, 58.2％, and 35.7％ for the SN group, respectively (P ＜ 0.05).The 1-, 2-, 5-, and 10-year disease-free survival (DFS) rates were 68.6％, 46.8％, 27.2％, and 19.8％ for the MN group, and 80.2％, 62.1％, 42.0％, and 34.6％ for the SN group, respectively (P ＜ 0.05).Cox regression model analysis showed a maximum nodule diameter of ＞ 5 cm was an independent risk factor of short-term recurrence in the MN group.Conclusions The prognosis of HCC patients with multiple nodules after radical resection was poorer and the short-term recurrence rate was significantly higher than those patients with a single-nodule.A maximum nodal diameter of ＞ 5 cm was an independent risk factor of short-term recurrence for patients with multiple nodules after radical resection.Therefore, patients with multiple nodules, especially ＞ 5 cm, should be followed up closely and they are good candidates for a multiple disciplinary team (MDT) treatment.

MULTIPLE PULMONARY NODULES CAUSED BY Corynebacterium striatum IN AN IMMUNOCOMPETENT PATIENT / Nódulos pulmonares múltiplos causados por Corynebacterium striatum numa paciente imunocompetente

Nondiphtherial corynebacteria are ubiquitous in nature and commonly colonize the skin and mucous membranes of humans, however they rarely account for clinical infection. We present the first reported case of multiple pulmonary nodules caused by Corynebacterium striatum. The infection occurred in a 72-year-old immunocompetent female, and the diagnosis was obtained by Gram's stain and culture of lung biopsy. C. striatum should be recognized as a potential pathogen in both immunocompromised and normal hosts in the appropriate circumstances.

Bacilos não diftéricos são ubiquitários na natureza e comumente colonizam a pele e as membranas mucosas humanas, contudo eles raramente acarretam doença clínica. Apresentamos o primeiro relato de múltiplos nódulos causados por Corynebacterium striatum. A infecção ocorreu numa mulher imunocompetente de 72 anos de idade e o diagnóstico foi obtido pela coloração de Gram e cultivo de biópsia pulmonar. C. striatum deve ser reconhecido como potencial patógeno tanto em pacientes imunodeprimidos como em hospedeiros normais, em circunstâncias apropriadas.

Value of ultrasound in detection of malignant foci among multiple thyroid nodules / 中国医学影像技术

Objective To probe the value of ultrasound in detection of malignant foci among multiple thyroid nodules. Methods Ultrasonograms of 83 patients with pathologically confirmed thyroid cancer combined with benign nodules were analyzed.Results Among 83 patients of thyroid carcinoma, 89 malignant and 87 benign nodules were detected with ultrasound. Significant differences of two-dimensional ultrasounic signs including low echoes, border fuzzy, micro-calcification and rear echo attenuation were found bteween malignant and benign nodules (P<0.01). There were significant differences in the grade Ⅱ, Ⅲ blood flow between malignant and benign ones (P<0.01). Of 89 malignant nodules, small thyroid carcinoma with diameter ≤1 cm accounted for 52.81% (47/89), and ultrasound diagnostic rate of all cancer nodules was 67.42% (60/89).Conclusion Ultrasounic characteristics including low echoes, border fuzzy, micro-calcification, rear echo attenuation and internal rich blood flow contribute to differentiate the thyroid microcarcinoma from multinodules.In particular, the microcarcinoma should not be ignored.

A case of benign metastasizing leiomyoma in the lung of woman with a history of myomectomy / 대한내과학회지

Benign metastasizing leiomyoma is usually detected years after hysterectomy or myomectomy and characterized by well-circumscribed, singular or, often, multiple nodules. The patient was a 33-year-old woman who presented with cough. She underwent a myomectomy for a large uterine leiomyoma 9 years ago. And now she has recurrent uterine myoma. Multiple nodular lesions in both whole lung fields were incidentally found on a routine chest radiograph. Video-assisted thoracoscopy (VATs) was performed. The resected small nodular lesions composed of extremely well- defferentiated smooth muscle cells with collagen. On immunohistochemical stain, they are positive for smooth muscle markers (desmin and actin). There is no definite evidence of malignancy. Therefore, these multiple nodules are considered as benign metastasizing leiomyoma from a uterine leiomyoma. We report this case with review of literatures.

A Case of Cutaneous Metastasis from Hepatocellular Carcinoma Manifested as Multiple Nodules on Whole Body / 대한간학회지

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Frequent sites of extrahepatic metastasis are the lung, adrenal gland, bone, etc. But, cutaneous metastasis from HCC is rare event. Several cases of subcutaneous seeding after percutaneous transhepatic biopsy or aspiration of liver were reported, however, most of these cases had solitary nodular lesion which was located at the biopsy site. We experienced a case of multiple cutaneous metastasis on whole body from HCC which was not related to percutaneous transhepatic biopsy of liver in a 34-ear-ld male patient. Thus, we report a case of multiple cutaneous metastasis from HCC with brief review of related literature.