Endoscopic ultrasound-guided biopsies for mediastinal lesions and lymph node diagnosis and staging

OBJECTIVES: To disseminate transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) as an alternative to investigate mediastinal tumoral lesions because it is an underused modality that has been available in Brazil for more than 15 years. METHODS: Descriptive analysis of a single endoscopy service's experience since 1997 in the accomplishment of EUSFNA for mediastinal staging of previously known malignancies (Group 1) or diagnostic definition of suspect lymph nodes and masses (Group 2). RESULTS: EUS-FNA was performed in 51 patients between 26 and 87 years of age. The diameter of the lesions ranged between 1.1 and 9.8 cm (mean 3.9 cm). Their location corresponded to the following stations: higher paratracheal (4 cases), lower paratracheal (7), aortic window (12), para-aortic (6), subcarinal (9), paraesophageal (8), and hilar (5). In Group 1, 17 patients had previously diagnosed primary lung (9), breast (4), kidney (2), colon (1), and bladder (1) cancer. Fifteen of these punctures were positive for malignity. Two others were later submitted to mediastinoscopy, which identified metastases not detected by EUS-FNA. Group 2 comprised 34 patients. Among these patients, EUS-FNA diagnosed 22 neoplasms, five cases of tuberculosis and two duplication cysts. Cytology was inconclusive or without a specific diagnosis in five other cases. Mediastinoscopy identified two undiagnosed cases of oat-cell carcinoma, one lymphoma and one cryptococcosis, and confirmed one reactive lymphadenitis. There were no complications related to the method. CONCLUSIONS: EUS-FNA obviated the need for surgical procedures in 86.3 percent of cases. Therefore, oncologists, pulmonologists, and thoracic surgeons should always remember the technique's potential and availability.

Lack of effect of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib.

The aim of this retrospective study was to analyze the effects of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib. A total of 295 patients who had undergone surgery from 1987-2002 were included. Forty seven patients underwent conization before definite surgery, and 2 patients were subsequently lost to follow up. Among the remaining 246 patients, 97 received allogenic blood transfusion, 38 received autologous blood transfusion, and 111 received no transfusion. The clinicopathologic finding of these three groups were reviewed and analyzed. There was no significant difference among three groups in age, chief complaints, duration of symptoms, size of lesion, histopathology, grade, margin or parametrium involvement, node status or postoperative adjuvant treatment. The most prominent presenting symptoms were abnormal vaginal discharge, abnormal vaginal bleeding, and postcoital bleeding. Although the 5-year disease-free survival (DFS) (and 95% CI) for autologous blood transfused group was 90.9% (74.4-97.0%), falling to 88.1% (77.8-93.8%) in untransfused blood group and 81.7% (71.3-88.6%) in allogenic transfused blood group, there were no significant differences among three groups (P = 0.699). In multivariate analyses, only age (P = 0.046), size of lesion (P = 0.024) and histology (P = 0.046) were statistically significantly associated with DFS, whereas transfusion status was not. In conclusion, there is no evidence that perioperative blood transfusion affects DFS of patients undergoing radical hysterectomy and pelvic lymphadenectomy. Only age, size of lesion and histology were statistically significantly associated with DFS.

A Case of Metastasis-induced Acute Pancreatitis Improved by Chemotherap / 대한소화기학회지

Pancreatic metastases are found in up to 40% of patients with small cell lung cancer, but metastasis-induced acute pancreatitis is rare. Treatment of metastasis-induced acute pancreatitis is initially supportive, but failure of conservative management are common. There are few reports on aggressive treatment with chemotherapy which lead to rapid clinical improvement and prolongation of survival in patients with metastasis-induced acute pancreatitis. We experienced a case of metastasis-induced acute pancreatitis in a patient with small cell lung cancer. Despite conservative treatment with dietary restriction and intravenous fluid supply, serum amylase levels increased persistently with severe abdominal pain. After chemotherapy with irinotecan and carboplatin, abdominal pain and serum amylase levels resolved dramatically.

Small cell carcinoma of the gall bladder: case report and review of literature.

Small cell carcinoma of the gall bladder is a very rare tumor. The neoplasm is highly lethal, metastasizes early, and may cause death shortly after diagnosis. Here we report a 56 year old male with small cell carcinoma of the gall bladder metastatic to the liver. He attained partial remission with 5 fluouracil, cisplatin based chemotherapy. However, the disease progressed after 3 months and salvage chemotherapy with docetaxel and caboplatin failed to produce any tumour response. He succumbed to the illness 13 months after cholecystectomy.

Metastasis-induced acute pancreatitis in a patient with small cell carcinoma of the lung

Acute pancreatitis in cancer patients can be secondary to the malignant process itself or a complication of antineoplastic agent administration. However, acute pancreatitis caused by metastatic carcinoma of the pancreas is an uncommon condition with a poor prognosis. We report a case of a 63-year-old man with small cell carcinoma of the lung, who developed acute pancreatitis lately. Thirteen months earlier, he developed small cell carcinoma of the lung and received 6 cycles of chemotherapy. Abdominal CT scan showed swelling of the pancreas with multiple masses. The patient was managed conservatively and pancreatitis subsided. This case indicates that metastasis induced acute pancreatitis can be a manifestation of lung cancer, especially in small cell carcinoma.

Prevalência de hipercalcemia em pacientes portadores de câncer de pulmäo / Prevalence of hypercalcemia in patients carriers of lung neoplasm

A hipercalcemia é uma das maiores freqüentes manifestaçöes paraneoplásicas, principalmente dentre as neoplasias malignas de pulmäo, mas ainda pouco valorizada em nosso meio. Neste trabalho estudamos a prevalência de hipercalcemia em uma populaçäo de pacientes portadores de tumor de pulmäo que freqüentaram o ambulatório específico da Escola Paulista de Medicina no Hospital Säo Paulo. Foram investigadso 90 pacientes assim distribuídos: 35 carcinomas espinocelulares (CEC), 30 adenocarcinomas (AdenoCa), 11 carcinomas indiferenciados de pequenas células (CIPC), 2 tumores de grandes células (RGC), 1 carcinóide, 1 mesotelioma, 2 indiferenciados, 1 adenoescamoso, 1 carcinoma in situ e 3 tumores metastáticos de origens diversas. Em todos estes pacientes foi dosado Ca ionizado (Ca-i) em amostras de sangue total. Nos pacientes em que se constataram níveis de Ca-i acima do limite de normalidade )>1,29 mmol/L), foram realizadas dosagens de paratormônio (PTH) sérico e AMP cíclico urinário para se afastar um possível hiperparatiroidismo como causa da hipercalcemia. Encontramos níveis de Ca-i elevados (variando de 1,3 a 2,0 mmol/L em 18 destes pacientes (20//), sendo: 12 CEC (66,7//), 3 AdenoCa (16,7//), 2 CIPC (11,1//) e 1 TGC (5,6//). O PTH estava baixo ou suprimido em todos os pacientes hipercalcêmicos, afastando, desta forma, um hiperparatiroidismo. A dosagem de AMP cíclico urinário näo se mostrou útil no diagnóstico diferencial, estando elevada em 6 dos 12 pacientes avaliados. Concluímos ser hipercalcemia um achado bastante comum em pacientes portadores de tumores de pulmäo, principalmente dentre os carcinomas espinocelulares, sendo seu diagnóstico sindrômico e etiológico de grande interesse para melhor tratamento desses pacientes

Metastatic involvement of the stomach secondary to lung carcinoma

Blood-borne metastatic involvement of the stomach by cancer is a rare entity. According to the number of reports in the literature, the most common tumors that spread to the stomach through the blood stream are malignant melanoma, breast carcinoma and lung carcinoma. Recently, two cases of metastatic involvement of the stomach secondary to lung carcinoma were diagnosed by gastroscopy. The first patient was a 66-year-old man who had primary lung carcinoma with multiple bone and subcutaneous metastases. Gastroscopy showed multiple submucosal tumors with central umbilications in the fundus and in the upper body of the stomach. Pathologic examination revealed massive submucosal infiltration and conical shaped and scanty deep mucosal infiltration of undifferentiated small cell carcinoma suggestive of metastatic involvement. The second patient was a 68-year-old man who had primary lung carcinoma with brain metastasis. Gastroscopy showed a large fungating mass in the greater curvature side of the stomach. Pathologic examination revealed poorly differentiated squamous cell carcinoma. We report the two cases of metastatic gastric cancer from lung carcinoma with the literature review.