Small cell carcinoma of the bladder / Carcinoma de células pequenas de bexiga

Small cell carcinoma of the urinary bladder is an extremely aggressive and rare tumor. Even though small cell carcinoma most commonly arises from the lungs there are several reports of small cell carcinoma in extrapulmonary sites. Due to its low frequency there is no well-established management for this disease. We report the case of a 61 year-old man with small cell carcinoma of the bladder who underwent radical cystectomy following neoadjuvant chemotherapy. We also reviewed the literature for the optimal treatment strategy.

O carcinoma de células pequenas da bexiga urinária é um tumor extremamente agressivo e raro. Apesar desses tumores terem como sítio principal o pulmão, existem diversos relatos de carcinoma de pequenas células extrapulmonares. Pela baixa frequência, ainda não existe um tratamento bem estabelecido para essa neoplasia. Relatamos o caso de um homem de 61 anos de idade com carcinoma de células pequenas da bexiga urinária que foi submetido à quimioterapia neoadjuvante seguida de cistectomia radical. Fazemos ainda revisão na literatura em busca dos métodos de maior sucesso para o tratamento.

A retrospective study of diaphragmatic motion, pulmonary function, and quality-of-life following video-assisted thoracoscopic lobectomy in patients with nonsmall cell lung cancer.

BACKGROUND: Diaphragmatic dysfunction and its negative physiologic disadvantages are less commonly reported in patients with lung cancer video‑assisted thoracoscopic lobectomy. The aim of this study was to investigate the outcomes of this complication on pulmonary function and quality‑of‑life in patients following video‑assisted thoracoscopic lobectomy. OBJECTIVES: The aim of this study was to investigate potential benefits on pulmonary function and quality‑of‑life with normal diaphragmatic motion. MATERIALS AND METHODS: A retrospective study was conducted in 64 patients with nonsmall cell lung cancer after video‑assisted thoracoscopic lobectomy. The population were divided into groups 1 (with diaphragmatic paralysis, n = 32) and group 2 (without diaphragmatic paralysis, n = 32) according diaphragmatic motion after postoperatively 6 months. And then, we investigated the difference between the two groups on pulmonary function and quality‑of‑life. RESULTS: (1) At 6 months after resection, the patients in group 1 had lost 25% of their preoperative forced expiratory volume in the 1 s (FEV1) (P < 0.001), and the patients in group 2 had lost 15% of their preoperative FEV1 (P < 0.001). And the other spirometric variables in group 1 were significantly worse than that of group 2 (P < 0.001). (2) The most frequently reported postoperative symptoms were fatigue, coughing, dyspnea, and thoracotomy pain in two groups. Of all the symptom scales, only the dyspnea scale showed a significant difference which subject has a higher proportion and scale compared to control. CONCLUSIONS: The present study indicates that unilateral diaphragmatic paralysis following video‑assisted thoracoscopic lobectomy caused adverse effects on postoperative pulmonary function and quality‑of‑life.

Different limited resection of pulmonary lobe methods under the thoracoscopy in the treatment of early nonsmall cell lung cancer occurred in the old age.

OBJECTIVES: The objective was to explore clinical effect of limited resection of lung lobe under the thoracoscopy in the treatment of early nonsmall cell lung cancer occurred in the old age. METHODS: A total of 150 patients with nonsmall cell lung cancer in the old age is treated by limited resection of lung lobe under thoracoscope. It can be divided into segmental resection group and wedge resection group by surgical methods, to make a comparative analysis of operation time, intraoperative blood loss, hospital stays, and complications during the perioperative period. And there will be postoperation follow‑up on survival, relapse and death situation etc., RESULTS: 10 cases are changed to make other operation because of maladaptation to limited resection, and a total of 140 patients have undergone limited resection. Operation time and hospital stays of wedge resection group are shorter than those of segmental resection group (P < 0.05); compared with the bleeding and indwelling drainage tube time in two groups, differences have no statistical significance (P > 0.05). Compared with cases of complications, recurrence and death for groups of segmental resection and wedge resection group, the differences have no statistical significance (P > 0.05). CONCLUSION: Limited resection of lung lobe in the early treatment of nonsmall cell lung cancer occurred in the old age under the thoracoscopy is safe and feasible.

A rare case of concurrent multiple primary lung cancer of different histological types.

Occurrence of concurrent multiple primary malignancies with different histopathological presentations of the same organ at the same time is often not diagnosed and rarely reported in the literature. We present a case of multiple primary lung cancers with hepatic metastasis where the patient had a moderately differentiated adenocarcinoma of the right lower lobe and a moderately differentiated squamous cell carcinoma of the right upper lobe.

Carcinoma de pequenas células do esôfago / Small cell carcinoma of the esophagus

Small cell carcinoma of the esophagus is a rare tumor, described to the first time by Mckeown in 1952. Clinically it is very similar to small cell carcinoma of the lung, with quick evolution and early dissemination. It is more frequent in men between 60 and 70 years of age. The patients usually have dysphagia and weight loss. Most of the tumours arise in the middle and distal third of the esophagus. Chronic alcohol and tobacco use are usually present. The manegement of primary small cell cancer of the esophagus remains controversial with groups reporting treatment based on operation alone, local radiotherapy, chemotherapy alone, or operation with adjuvant therapy. Overall survivel remains poor at a mean of 5.1 months, with the best rate of survivel in patients undergoing operation with adjuvant chemotherapy. The authors relate two cases of a small cell carcinoma of the esophagus. Both of these patients was female and white, with 51 and 64 years old. The first mainestation was dysphagia and weight loss. Histologic study from endoscopic biopsies reveled the diagnosis. The treatment was, in the both cases surgery, however in one case, chemotherapy and mediastinal irradiation was associated to the ressection. The authors comment the more important aspects about this pathology, and the treatment and survival of the patients

Perspectivas no carcinoma avenocelular do pulmäo / Perspectives in oat cell carcinoma of the lung

O carcinoma avenocelular de pulmäo tem certas particularidades que o difere das demais neoplasias pulmonares. Os autores, tendo acompanhado e operado câncer de pulmäo por mais de 10 anos, após revisäo bibliográfica, fazem algumas reflexöes sobre as exclusividades desse tumor e as impressöes gerais da sua remoçäo cirúrgica como mais uma forma, dentro da multiplicidade terapêutica. Embora reconheçam a crirugia como repleta de controvérsias e que o tumor tenha sido, até pouquíssimos tempos atrás, um dos critérios de inoperabilidade, vislumbram a conduta como uma luz no final do túnel na resoluçäo definitiva de täo agressivo carcinoma

Tumores neuroendocrinos del tórax: variedad carcincoides / Neuroendocrine thoracic tumors: carcinoid type

Los carcinomas neuroendocrinos son tumortes epiteliais que contienen gránulos neurosecretorios en el citoplasma. Comparten esta característica los carcinoides y los carcinomas indiferenciados de pequeñas células. Los primeros se presentan en 2 variedades: el típico o central y el atípico. Entre ambos hay diferencias histológicas francas. El segundo es más agresivo por su mayor propagación local y su capacidad de colonización en ganglios regionales y sitios distantes. Los carcinoides broncopulmonares se originan en células de las mucosa bronaquial, y los mediastinales parecen hacerlo en restos tímicos. En muchos casos se requiere complementar la histología convencional con microscopia electrónica e inmunohistoquímica para obtener el diagnóstico de certeza. Se trataron 12 pacietes con carcinoides, la mitad de los cuales eran atípicos. Con excepción de 2 irresecables, los demás fueron extirpados mediante exéresis oncológicas típicas, tales como lobectomías. Debido al carácter maligno de los carcinoides, los autores no consideran indicadas las resecciones económicas tipo enucleación

Mediastino e indicación de intervención quirúrgica en el cáncer de pulmón / Mediastinum and surgical indication in lung cancer

Entre 1962 y 1986, se intervinieron 1.654 pacientes con carcinoma de pulmón de células no pequeñas, según el sistema de clasificación de la UICC (Unión Internacional Contra el Cáncer). En 532 casos de los 648 correspondientes al estadio III, se practicó una resección pulmonar combinada con la disección d elos ganglios linfáticos del mediastino y el porcentaje de supervivencia fue del 23,8%. En los 116 casos restantes no se realizó la disección y el porcentaje de supervivencia fue del 5,1%. Del total de casos en el estadio III, el porcentaje de supervivencia a 5 años para aquellos con disección linfática fue del 15,9%, mientras que el porcentaje de supervivencia para 81 casos sin disección fue del 6,7%. Dentro del total de 426 casos N2, se seleccionaron 242 en los cuales se pudo practicar una operación curativa que dio como resultado un porcentaje de supervivencia a 5 años del 19,2%. Los resultados finales en pacientes N2M0 a quienes se les realizó una resección pulmonar combinada con la disección completa de los ganglios linfáticos mediastínicos fueron mejores que los resultados finales en el grupo en que no se disecaron dichos ganglios y alienta a intentar realizar todas las operaciones curativas posibles teniendo en cuenta el tipo histológico y el factor T