Tumor fibroso solitario de mediastino anterior adherido a pericardio. Reporte de un caso / Solitary fibrous tumor of anterior mediastinum adhered to pericardium. A case report

Se presenta el caso de un paciente de 82 años, con tumor intratorácico de crecimiento rápido, con aumento progresivo de la disnea, antecedentes de enfermedad coronaria y baja función cardíaca, obesidad y síndrome de apnea de sueño, quien fue sometido a toracotomía y a quien se le diagnosticó un tumor solitario fibroso de la pleura, tumor de muy baja frecuencia, adherido en forma sésil al pericardio, lo cual lo hace aún menos frecuente. Se hace una revisión general de las posibilidades terapéuticas, el diagnóstico histológico y por inmunohistoquímica, así como los criterios de benignidad y malignidad para este tipo de tumor, que son en su mayoría de buen pronóstico.

We present the case of an 82-year-old patient with a rapidly growing intrathoracic tumor, progressive increase in dyspnea, and a history of coronary heart disease and low cardiac function, obesity, and sleep apnea syndrome, who underwent thoracotomy and who was diagnosed with a Solitary Fibrous Tumor of the Pleura, a very low frequency tumor, adhered in sessile form to the pericardium, which makes it even less frequent. A general review is made of the therapeutic possibilities, the histological and immunohistochemical diagnosis, as well as the criteria of benignity and malignancy for this type of tumor, most of which have a good prognosis.

Clinical Characteristics and Risk Factors Analysis for Visceral Pleural Invasion in Mixed Ground-glass Nodular Lung Adenocarcinoma / 中国肺癌杂志

BACKGROUND@#Lung cancer is still the malignant tumor with the highest morbidity and mortality in China. Lung adenocarcinoma is the most common subtype, and the number of lung cancer presenting as mixed ground glass nodule (mGGN) in imaging is gradually increasing. Visceral pleural invasion (VPI) is an important factor affecting the prognosis of mGGN type lung adenocarcinoma. The aim of the study is to explore and analyze the risk factors for VPI in mGGN type lung adenocarcinoma.@*METHODS@#From November 2016 to November 2019, 128 patients with mGGN lung adenocarcinoma underwent radical surgical resection in the First Affiliated Hospital of Nanjing Medical University. Their clinical data, including imaging, pathological and biological features, were collected and analyzed retrospectively. There were 40 males and 88 females, aged 60.3±9.3 years ranging from 30 to 81 years. Single factor Chi-square test and multivariate Logistic regression were used to analyze the risk factors of VPI in mGGN type lung adenocarcinoma.@*RESULTS@#Among 128 mGGN patients who met the inclusion criteria, 57 cases were pathologically confirmed with pleural invasion. Between the VPI (+) and VPI (-) group (P<0.05), there were significant differences in gender, maximum diameter of solid component, consolidation tumor ratio (CTR), spicule sign, history of lung disease, family history of hypertension, relation of lesion to pleura (RLP), coursing relationship between bronchi and nodules. In multivariate Logistic regression analysis, RLP (OR=3.529, 95%CI: 1.430-8.713, P=0.006) and coursing relationship between bronchi and nodules (OR=3.993, 95%CI: 1.517-10.51, P=0.005) were found to be independent risk factors for VPI (P<0.05).@*CONCLUSIONS@#The possibility of VPI in m GGN lung adenocarcinoma should be evaluated by combining these parameters in clinical diagnosis and treatment. As independent risk factors, RLP and coursing relationship between bronchi and nodules are instructive to identify VPI in mGGN type lung adenocarcinoma.

Mesotelioma pleural relacionado à exposição ao asbesto: revisão de literatura / Pleural mesothelioma related to asbestos exposure: literature review

RESUMO Mesotelioma pleural é uma doença que acomete a pleura e é definida pela exposição ocupacional ao amianto que constitui seu único fator de risco. Realizar o diagnóstico é um grande desafio para médicos, pelo fato de ser uma doença silenciosa e que se manifesta mesmo anos após a exposição ao mineral. Atualmente, não há definição do melhor tratamento para a doença, há grandes divergências na literatura; deve, portanto, individualizar cada caso. Sabe-se que a terapia multimodal é superior estatisticamente a terapia monomodal de tratamento da doença. Dessa forma, o objetivo do trabalho é revisar artigos que descrevam a doença, a qual relaciona a exposição ocupacional ao asbesto e alternativas globais para diminuir sua incidência; e, por conseguinte, aprimorar o seu tratamento. PALAVRA-CHAVE: Asbestos, mesotelioma, pleura

ABSTRACT Pleural mesothelioma is a disease that affects the pleura and is defined by occupational exposure to asbestos, which is its only risk factor. Diagnosis is a major challenge for physicians, as it is a silent disease that manifests itself years after exposure to the mineral. Currently, there is no definition of the best treatment for the disease, there are great divergences in the literature; it must, therefore, be individualized for each case. It is known that multimodal therapy is statistically superior to monomodal therapy for treating the disease. Thus, the objective of the work is to review articles that describe the disease, which relates occupational exposure to asbestos and global alternatives to reduce its incidence; and, therefore, improve its treatment. KEYWORDS: Asbestos, mesothelioma, pleura

Manejo quirúrgico de una fístula gastropleural posterior a manga gástrica / Surgical management of a gastropleural fistula after gastric sleeve

Se presenta el caso de una paciente de 30 años de edad, sometida a un procedimiento de manga gástrica por laparoscopia en marzo de 2014, quien presenta, al tercer y cuarto años del procedimiento inicial, dos episodios de hemoptisis masiva, con falla en la segunda terapia de embolización, por lo que requirió una lobectomía pulmonar inferior izquierda. Al segundo día de este postoperatorio presenta salida de material de nutrición por las sondas de tórax, estableciéndose el diagnóstico de fistula gastropleural. Debido a falla con el manejo conservador, fue sometida a una resección quirúrgica de la fístula por vía laparoscópica, con gastrectomía proximal y reconstrucción en Y de Roux. A propósito de nuestra experiencia con esta paciente, se discuten en este artículo las estrategias de manejo para una fístula gastropleural, propuestas en la literatura a la fecha

This is a clinical case of a 30-year-old patient, who underwent a laparoscopic gastric sleeve procedure in March 2014, who presented, at the third and fourth years of the initial procedure, two episodes of massive hemoptysis, with failure in the second embolization therapy, requiring a lower left pulmonary lobectomy. On the second day of this postoperative period, the nutrition material came out through the chest tubes, establishing the diagnosis of gastropleural fistula. Due to failure of conservative management, she underwent laparoscopic surgical resection of the fistula, with proximal gastrectomy and Roux-en-Y reconstruction. Regarding our experience with this patient, this article discusses the management strategies for a gastropleural fistula, proposed in the literature to date

An experimental pleural drainage device in hypertensive pneumothorax

ABSTRACT Purpose To develop a specific device for pleural drainage in hypertensive pneumothorax. Methods The prototype was modeled from the free version of a 3D modeling application, printed on a 3D printer using ABS® plastic material, and tested in a pleural drainage simulator. Results Pleural drainage in the simulator using the prototype was feasible and reproducible. Conclusions While the prototype is functional in the simulator, it requires improvement and refinement for use in humans.

Sensibilidade e especificidade dos registros de câncer nas notificações do mesotelioma maligno / Sensibilidad y especificidad de los registros de cáncer en las notificaciones del mesotelioma maligno / Sensitivity and specificity of the reporting of malignant mesothelioma

RESUMO Objetivo: Mensurar a sensibilidade e especificidade das notificações de mesotelioma maligno do Registro de Câncer Base Populacional de Curitiba/Paraná. Método: Estudo retrospectivo, transversal, realizado no registro de câncer de base populacional de Curitiba e em 11 fontes notificadoras, de janeiro a dezembro de 2017. A amostra final foi composta por 92 prontuários de pacientes adultos, com diagnóstico e notificação de registrados com câncer de topografia C38 (pleura, coração e mediastino) e C48 (peritônio e retroperitônio). Para análise da sensibilidade e especificidade utilizou-se o software Stata 14, com análise da consistência interna; para cada caso notificado pelo registro foi examinado o prontuário da fonte notificadora correspondente, considerando-o como padrão ouro. Resultados: A sensibilidade do registro em notificar mesotelioma (CID-10: C45) e câncer de pleura (CID-10: C38.4) foi de 100% (8/8) e 50% (1/2), respectivamente. A especificidade foi 90,2% (74/82), tendo oito casos de outros cânceres classificados como câncer de pleura. Conclusões: O registro apresentou alta sensibilidade para notificar mesotelioma maligno, não havendo subnotificação para esses casos, e uma sobre-estimativa para as notificações de câncer de pleura (nove ao invés de um) devido à notificação errônea e equívoca.

resumen Objetivo: determinar la sensibilidad y especificidad de las notificaciones de mesotelioma maligno del Registro de Cáncer Base Poblacional de Curitiba/Paraná/Brasil. Método: estudio retrospectivo, transversal, realizado en el registro de cáncer de base poblacional de Curitiba y en 11 fuentes notificantes, de enero a diciembre de 2017. La muestra final fue compuesta por 92 registros médicos de pacientes adultos, con el diagnóstico y la notificación de registrados con cáncer de topografía C38 (pleura, corazón y mediastino) y C48 (peritoneo y retroperitoneo). Para el análisis de la sensibilidad y especificidad se utilizó el software Stata 14, con análisis de la consistencia interna. Para cada caso notificado por el registro, fue examinado el registro médico de la fuente que ha notificado, considerándolo como estándar de oro. Resultados: la sensibilidad del registro para notificar mesotelioma (CID-10: C45) y cáncer de pleura (CID-10: C38.4) fue de 100% (8/8) y 50% (1/2), respectivamente. La especificidad fueel90,2% (74/82), con ocho casos de otros cánceres clasificados como cáncer de pleura. Conclusiones: el registro presentó alta sensibilidad para notificar mesotelioma maligno, no existiendo subnotificación para estos casos, y un incremento para las notificaciones de cáncer de pleura (nueve al revés de uno) debido a la notificación incorrecta y equivocada.

ABSTRACT Objective: To measure the sensitivity and specificity of the reporting of malignant mesothelioma in the Population-Based Cancer Registry in Curitiba, PA, Brazil. Method: Retrospective, cross-sectional study conducted in the Population-Based Cancer Registry in Curitiba and 11 reporting institutions, from January to December 2017. The final sample was composed of 92 medical records of adult patients, with diagnoses and reporting of cancer, with topographical codes C38 (pleura, heart, and mediastinum) and C48 (peritoneum and retroperitoneum). Stata 14 was used to analyze sensitivity and specificity, and internal consistency. Each medical record (considered the gold standard) provided by the reporting institutions was compared to those in the registry. Results: The registry sensitivity in reporting mesothelioma (ICD-10: C45) and pleural cancer (ICD-10: C38.4) was 100% (8/8) and 50% (1/2), respectively. Specificity was 90.2% (74/82), as eight cases were wrongly classified as pleural cancer. Conclusions: the registry presented high sensitivity in the reporting of malignant mesothelioma, with no underreporting, and overestimated pleural cancer reporting (nine instead of one) due to erroneous and misleading reporting.

Extrapleural closure of patent Ductus Arteriosus: how we do it

Abstract Patent ductus arteriosus (PDA) is a clinical condition mostly found in premature newborns. Among several medical, surgical and interventional treatment options, extrapleural ligation through a left minithoracotomy is recognized as a safe, efficient and less expensive technique. In fact, it requires short surgical times, grants good exposure of the duct and nearby structures (e.g., thoracic duct, left recurrent laryngeal nerve), and avoids pleural space opening and subsequent pulmonary complications in preterm patients. This approach seems ideal due to its lower costs, especially in developing countries with a high birth rate and limited resources.

Placas pleurales por inhalación de fibras de asbesto: reporte de dos casos y revisión de literatura / Pleural plaques by inhalation of asbestos fibers: report of two cases and literature review

INTRODUCCIÓN: Las placas pleurales por fibras de asbesto se caracterizan por lesiones compuestas por tejido fibroso que se ubican en la pleura parietal. Suelen aparecer hasta en un 3% a 58% de los trabajadores que estuvieron expuestos a fibras de asbesto, y en un 0,5% a 8% en población general. El OBJETIVO de este artículo es presentar dos casos clínicos de pacientes a los que se les detectó en la radiografía de tórax alteraciones pleurales posiblemente asociadas a la exposición a fibras de asbesto. CASOS CLÍNICOS: Caso 1. Paciente de sexo masculino de 49 años, trabajador de la construcción con antecedentes de exposición a fibras de asbesto. Se le realizó una radiografía de tórax con técnica OIT (Organización Internacional del Trabajo), la que evidenció alteraciones pleurales focales. Una tomografía axial computarizada de tórax, confirmó la presencia de placas pleurales. Caso 2. Paciente de sexo femenino de 79 años, jefa de hogar, sin exposición laboral conocida a fibras de asbesto. En una radiografía de tórax anteroposterior, se observó la presencia de una placa pleural focal. Se solicitó una tomografía axial computarizada de tórax, la que confirmó la presencia de placas pleurales. CONCLUSIÓN: La radiografía de tórax con técnica OIT es el instrumento básico para la identificación de enfermedades relacionadas con la exposición a fibra de asbesto. El estudio debe ser completado con una tomografía axial computarizada de tórax cuya sensibilidad es mayor permitiendo detectar tempranamente las anomalías pleurales. Es fundamental la historia ocupacional detallada ya que constituye el método más fiable y práctico para medir la exposición a fibra de asbesto.

INTRODUCTION: Asbestos fiber pleural plaque is characterized by lesions composed of fibrous tissue that are located in the parietal pleura. They usually appear in up to 3 to 58% of workers who were exposed to asbestos fiber, and 0.5 to 8% in the general population. The OBJECTIVE of this article is to present two clinical cases of patients who were detected in the chest radiograph pleural alterations associated with exposure to asbestos fibers. CLINICAL CASES: First case: 49-year-old male patient, building worker with a history of exposure to asbestos fibers. Focal pleural alterations were detected by a chest x-ray performed according ILO (International Labour Organization) technique. The presence of pleural plaques was confirmed in a computed tomography of the chest. Second case: Holder, without occupational exposure to asbestos fibers. An anteroposterior chest radiography showed the presence of focal pleural plaque in a CT scan of the chest. CONCLUSION: Chest x-ray with ILO technique is the basic instrument for the identification of diseases related to asbestos fiber exposure. The study should be completed with a CT scan of the chest whose sensitivity is greater, allowing early detection of pleural abnormalities. Detailed occupational history is essential, as it is the most reliable and practical method to measure asbestos fiber exposure.

A Case of Solitary Fibrous Tumor of Subungual Region

Solitary fibrous tumor (SFT) is a relatively uncommon mesenchymal neoplasm that usually arises in the pleura, but also has been reported in numerous extrapleural locations, including cutaneous site. The skin lesion presents as a circumscribed nodule or tumor, mainly on the head and neck. A 41-year-old male presented with 6 months history of nail lesion without symptom on the left third finger. The lesion is slightly yellowish discoloration with subungual erythematous nodule and distal onycholysis. Biopsy specimen from the nail lesion showed the spindle cells form patternless pattern with hypercellular and hypocellular area. And small blood vessels and dilated vascular spaces were present. The result of special stain for specimen showed that positive for CD34, Bcl-2, and CD99 but negative for S-100, FactorXIIIa, and smooth muscle action. Recognition of this uncommon location of SFT is important because of possible confusion with other subungual tumors, including glomus tumor, fibroma and other fibrohistiocytic tumors like dermatofibrosarcoma protuberans, superficial acral fibromyxoma and cellular digital fibroma. Here in, we report a case of SFT of subungual region. We think this case is interesting because of uncommon location and may be helpful to more understand the character of this disease.

Primary Cutaneous Solitary Fibrous Tumor on the Back

Solitary fibrous tumors (SFT) are uncommon mesenchymal tumors. SFT have several synonyms including localized fibrous tumor, benign mesothelioma, localized fibrous mesothelioma, and submesothelial fibroma. SFT usually occur in the pleura or other serosal surfaces, but SFT can also develop in extrapleural areas including the nasal cavity, orbit, retroperitoneum, and pelvis. Cutaneous SFT is extremely rare, and more likely to occur in the head and neck region. Histologically, this tumor can mimic a variety of benign and malignant tumors such as dermatofibroma, dermatofibrosarcoma protuberans, spindle cell lipoma or other mesenchymal tumors. Most cases of SFT show non-aggressive clinical courses, with low recurrence rates. Herein, we describe a case of primary cutaneous SFT which presented with huge mass on the back.

Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea

OBJECTIVE: This study presents a preliminary report on the chest radiographic and computed tomography (CT) findings of the 2019 novel coronavirus disease (COVID-19) pneumonia in Korea.MATERIALS AND METHODS: As part of a multi-institutional collaboration coordinated by the Korean Society of Thoracic Radiology, we collected nine patients with COVID-19 infections who had undergone chest radiography and CT scans. We analyzed the radiographic and CT findings of COVID-19 pneumonia at baseline. Fisher's exact test was used to compare CT findings depending on the shape of pulmonary lesions.RESULTS: Three of the nine patients (33.3%) had parenchymal abnormalities detected by chest radiography, and most of the abnormalities were peripheral consolidations. Chest CT images showed bilateral involvement in eight of the nine patients, and a unilobar reversed halo sign in the other patient. In total, 77 pulmonary lesions were found, including patchy lesions (39%), large confluent lesions (13%), and small nodular lesions (48%). The peripheral and posterior lung fields were involved in 78% and 67% of the lesions, respectively. The lesions were typically ill-defined and were composed of mixed ground-glass opacities and consolidation or pure ground-glass opacities. Patchy to confluent lesions were primarily distributed in the lower lobes (p = 0.040) and along the pleura (p < 0.001), whereas nodular lesions were primarily distributed along the bronchovascular bundles (p = 0.006).CONCLUSION: COVID-19 pneumonia in Korea primarily manifested as pure to mixed ground-glass opacities with a patchy to confluent or nodular shape in the bilateral peripheral posterior lungs. A considerable proportion of patients with COVID-19 pneumonia had normal chest radiographs.

Pathological interpretation of connective tissue disease-associated lung diseases / 영남의대학술지

Connective tissue diseases (CTDs) can affect all compartments of the lungs, including airways, alveoli, interstitium, vessels, and pleura. CTD-associated lung diseases (CTD-LDs) may present as diffuse lung disease or as focal lesions, and there is significant heterogeneity between the individual CTDs in their clinical and pathological manifestations. CTD-LDs may presage the clinical diagnosis a primary CTD, or it may develop in the context of an established CTD diagnosis. CTD-LDs reveal acute, chronic or mixed pattern of lung and pleural manifestations. Histopathological findings of diverse morphological changes can be present in CTD-LDs airway lesions (chronic bronchitis/bronchiolitis, follicular bronchiolitis, etc.), interstitial lung diseases (nonspecific interstitial pneumonia/fibrosis, usual interstitial pneumonia, lymphocytic interstitial pneumonia, diffuse alveolar damage, and organizing pneumonia), pleural changes (acute fibrinous or chronic fibrous pleuritis), and vascular changes (vasculitis, capillaritis, pulmonary hemorrhage, etc.). CTD patients can be exposed to various infectious diseases when taking immunosuppressive drugs. Histopathological patterns of CTD-LDs are generally nonspecific, and other diseases that can cause similar lesions in the lungs must be considered before the diagnosis of CTD-LDs. A multidisciplinary team involving pathologists, clinicians, and radiologists can adequately make a proper diagnosis of CTD-LDs.

Clinical Significance of Pleural Attachment and Indentation of Subsolid Nodule Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Lung cancers presenting as subsolid nodule commonly have peripheral location, making the cancer-pleura relationship noteworthy. We aimed to evaluate the effect of pleural attachment and/or indentation on visceral pleural invasion (VPI) and recurrence-free survival. MATERIALS AND METHODS: Patients who underwent curative resection of lung cancer as subsolid nodules from April 2007 to January 2016 were retrospectively evaluated. They were divided into four groups according to their relationship with the pleura. Clinical, radiographical, and pathological findings were analyzed. RESULTS: Among 404 patients with malignant subsolid nodule, 120 (29.7%) had neither pleural attachment nor indentation, 26 (6.4%) had attachment only, 117 (29.0%) had indentation only, and 141 (34.9%) had both. VPI was observed in nodules of 36 patients (8.9%), but absent in nonsolid nodules and in those without pleural attachment and/or indentation. Compared to subsolid nodules with concurrent pleural attachment and indentation, those with attachment only (odds ratio, 0.12; 95% confidence interval [CI], 0.02 to 0.98) and indentation only (odds ratio, 0.10; 95% CI, 0.03 to 0.31) revealed lower odds of VPI. On subgroup analysis, the size of the solid portion was associated with VPI among those with pleural attachment and indentation (p=0.021). Such high-risk features for VPI were associated with earlier lung cancer recurrence (adjusted hazard ratio, 3.31; 95% CI, 1.58 to 6.91). CONCLUSION: Concurrent pleural attachment and indentation are risk factors for VPI, and the odds increase with larger solid portion in subsolid nodules. Considering the risk of recurrence, early surgical resection could be encouraged in these patients.

Distinguishing between Thymic Epithelial Tumors and Benign Cysts via Computed Tomography

OBJECTIVE: To investigate whether computed tomography (CT) and fluorine-18-labeled fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) may be applied to distinguish thymic epithelial tumors (TETs) from benign cysts in the anterior mediastinum. MATERIALS AND METHODS: We included 262 consecutive patients with pathologically proven TETs and benign cysts 5 cm or smaller who underwent preoperative CT scans. In addition to conventional morphological and ancillary CT findings, the relationship between the lesion and the adjacent mediastinal pleura was evaluated qualitatively and quantitatively. Mean lesion attenuation was measured on CT images. The maximum standardized uptake value (SUVmax) was obtained with FDG-PET scans in 40 patients. CT predictors for TETs were identified with multivariate logistic regression analysis. For validation, we assessed the diagnostic accuracy and inter-observer agreement between four radiologists in a size-matched set of 24 cysts and 24 TETs using a receiver operating characteristic curve before and after being informed of the study findings. RESULTS: The multivariate analysis showed that post-contrast attenuation of 60 Hounsfield unit or higher (odds ratio [OR], 12.734; 95% confidence interval [CI], 2.506–64.705; p = 0.002) and the presence of protrusion from the mediastinal pleura (OR, 9.855; 95% CI, 1.749–55.535; p = 0.009) were the strongest CT predictors for TETs. SUVmax was significantly higher in TETs than in cysts (5.3 ± 2.4 vs. 1.1 ± 0.3; p < 0.001). After being informed of the study findings, the readers' area under the curve improved from 0.872–0.955 to 0.949–0.999 (p = 0.066–0.149). Inter-observer kappa values for protrusion were 0.630–0.941. CONCLUSION: Post-contrast CT attenuation, protrusion from the mediastinal pleura, and SUVmax were useful imaging features for distinguishing TETs from cysts in the anterior mediastinum.

Remnant parietal serosa detection in a cat with true diaphragmatic hernia using computed tomography / 대한수의학회지

A 4-year-old cat was referred for a suspected pulmonary mass. True diaphragmatic hernia presence was diagnosed via computed tomography (CT). There was a thin membrane covering the diaphragmatic defect. The membrane was thinner than the diaphragm. After contrast injection, the membrane was less enhanced than that of the normal diaphragm. The membrane was identified as a remnant of the parietal pleura. In addition, contrast-enhanced CT images provided clarity in viewing the herniated liver and falciform fat. A thinner membrane, covering the diaphragmatic defect, and attached to the thicker normal diaphragm, is considered a unique CT feature of true diaphragmatic hernia.

A Case of Solitary Fibrous Tumor of Hard Palate / 대한이비인후과학회지

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm first described and often encountered in the pleura. It has also been documented in a variety of extrapleural sites including the abdominal cavity, respiratory tract, lung, breast, and rarely in the head and neck region. SFT in the hard palate is an extremely unusual location. We present a rare case of SFT that presented as a palate mass, which was suggested as a mesenchymal cell neoplasm by preoperative punch biopsy, and finally diagnosed as STF after successful surgical excision. SFTs should be considered as a differential diagnosis of palate benign tumor when preoperative pathologic findings show mesenchymal neoplasms of fibroblastic or myofibroblastic origin. Possible malignant variants should be distinguished by evaluating the histological parameters, including high cellularity, frequent mitotic activity, nuclear pleomorphism, and presence of necrosis.

The role of salvage radiotherapy in recurrent thymoma

PURPOSE: To explore the role of salvage radiotherapy (RT) for recurrent thymoma as an alternative to surgery. MATERIALS AND METHODS: Between 2007 and 2015, 47 patients who received salvage RT for recurrent thymoma at Yonsei Cancer Center were included in this study. Recurrent sites included initial tumor bed (n = 4), pleura (n = 19), lung parenchyma (n = 10), distant (n = 9), and multiple regions (n = 5). Three-dimensional conformal and intensity-modulated RT were used in 29 and 18 patients, respectively. Median prescribed dose to gross tumor was 52 Gy (range, 30 to 70 Gy), with equivalent doses in 2-Gy fractions (EQD₂). We investigated overall survival (OS), progression-free survival (PFS), and patterns of failure. Local failure after salvage RT was defined as recurrence at the target volume receiving >50% of the prescription dose. RESULTS: Median follow-up time was 83 months (range, 8 to 299 months). Five-year OS and PFS were 70% and 22%, respectively. The overall response rate was 97.9%; complete response, 34%; partial response, 44.7%; and stable disease, 19.1%. In multivariate analysis, histologic type and salvage RT dose (≥52 Gy, EQD₂) were significantly associated with OS. The high dose group (≥52 Gy, EQD₂) had significantly better outcomes than the low dose group (5-year OS: 80% vs. 59%, p = 0.046; 5-year PFS: 30% vs. 14%, p=0.002). Treatment failure occurred in 34 patients; out-of-field failure was dominant (intra-thoracic recurrence 35.3%; extrathoracic recurrence 11.8%), while local failure rate was 5.8%. CONCLUSION: Salvage RT for recurrent thymoma using high doses and advanced precision techniques produced favorable outcomes, providing evidence that recurrent thymoma is radiosensitive.

Tumor fibroso maligno de pleura / Malignant fibrous tumor of the pleura

Varón de 50 años con disnea, tos, pérdida de peso, mialgias y poliartralgias de nueve meses de evolución. La tomografía computarizada (TC) evidenció masa pleural, sólida, de densidad heterogénea, vascularizada, con diámetros mayores de 18x16 cm, asociada a líquido pleural libre, atelectasia del pulmón adyacente y dilatación del esófago en toda su extensión, como hallazgo incidental (Figura 1). El estudio de la masa resecada (Figura 2) demostró pleomorfis-mo celular, Ki-67 60%, áreas necróticas, numerosas mitosis, posi-tividad para BCL2 y CD34, y negatividad para S100 y vimentina. Se diagnosticó tumor fibroso solitario de pleura maligno. El tumor fibroso solitario de pleura es una neoplasia rara, gene-ralmente benigna. El 10% de TFSP son potencialmente malignos y pueden cursar con recurrencia local y metástasis (1-3).El comportamiento maligno se asocia a factores pronósticos que incluyen: elevada actividad mitótica, necrosis, bordes quirúrgicos positivos y un diámetro tumoral mayor de 10 cm (1, 4, 5).

Two-stage Surgical Treatment of a Giant Solitary Fibrous Tumor Occupying the Thoracic Cavity

A solitary fibrous tumor (SFT) is a mesenchymal fibroblastic tumor inside the pleura, for which complete surgical resection is the standard treatment. For large SFTs, preoperative identification of tumor-feeding vessels using angiography is important for achieving complete resection without unexpected operative bleeding. Extensive adhesions can make resection difficult in a limited operative window, and pulmonary resection may be required to achieve complete SFT resection. Herein, we report successful resection of a large pleural SFT in a 39-year-old man without any complications using a 2-stage approach, in which ligation of the feeding vessels through small another operative window was the first step.

Mesothelioma in Sweden: Dose–Response Analysis for Exposure to 29 Potential Occupational Carcinogenic Agents

BACKGROUND: There is little information on the dose–response relationship between exposure to occupational carcinogenic agents and mesothelioma. This study aimed to investigate this association as well as the existence of agents other than asbestos that might cause mesothelioma. METHODS: The Swedish component of the Nordic Occupational Cancer (NOCCA) study consists of 6.78 million individuals with detailed information on occupation. Mesothelioma diagnoses recorded in 1961–2009 were identified through linkage to the Swedish Cancer Registry. We determined cumulative exposure, time of first exposure, and maximum exposure intensity by linking data on occupation to the Swedish NOCCA job-exposure matrix, which includes 29 carcinogenic agents and corresponding exposure for 283 occupations. To assess the risk of mesothelioma, we used conditional logistic regression models to estimate hazard ratiosand 95% confidence intervals. RESULTS: 2,757 mesothelioma cases were identified in males, including 1,416 who were exposed to asbestos. Univariate analyses showed not only a significant excess risk for maximum exposure intensity, with a hazard ratio of 4.81 at exposure levels 1.25–2.0fb/ml but also a clear dose–response effect for cumulative exposure with a 30-, 40-, and 50-year latency time. No convincing excess risk was revealed for any of the other carcinogenic agents included in the Swedish NOCCA job-exposure matrix. CONCLUSION: When considering asbestos exposure, past exposure, even for short periods, might be enough to cause mesothelioma of the pleura later in life.