ABSTRACT
Solitary fibrous tumor (SFT) of the pleura and the lung is an uncommon spindle cell neoplasm arising from the visceral pleura in the majority of the cases. However there are some extrapleural sites including the lung. Current considerations were raised by a peculiar recent case: an 81-year-old female, no smoker, presented with undefined left thoracic pain. Radiographic findings of a large solid lung mass (10 cm × 9 cm). Computed tomography (CT) confirmed the thoracic mass showing characteristics of a well defined mass with capsule, the position of the mass in proximity of the postero-basal and lateral-basal wall. No secondary lesions were found. Through a left inferior lobectomy and ilo-mediastinal lymph node sampling, the entire mass was resected. Histopathological examination revealed a SFT. In conclusion STF is a rare lesion and this case showed a peculiar extremely large lesion never described before in literature.
ABSTRACT
OBJECTIVES: One of the fundamental steps in an anatomical pulmonary resection is the main and lobar bronchus suture. Nowadays, two different types of staplers are on the market: the linear TA stapler for open surgery (Tyco Healthcare Group LP, Norwalk, CT, USA), which is based on a 'guillotine' mechanism, sewing, but not cutting the bronchus, and the endoscopic linear stapler which both cuts and sews. This study aimed to fill the void in the use of an instrument used to staple and cut at the same time in 'open' thoracic surgery, eliminating the need for a scalpel: the curved cutter stapler (Contour Curved Cutter Stapler; Ethicon Endo-Surgery, Inc., Cincinnati, OH, USA). METHODS: Between May 2009 and March 2011, the Contour Curved Stapler (Ethicon) was used for the bronchus in 139 cases of non-small cell lung carcinoma (NSCLC)-29 females and 110 males ranging between 48 and 85 years (average 71.1)-and comprising 115 lobectomies (8 bilobectomies) and 24 pneumonectomies (8 on the right lung, 16 on the left lung). RESULTS: All patients underwent a bronchoscopic check-up 30 days after they were discharged: in all cases, the bronchial stump was clearly within normal limits. No cases of bronchopleural fistulas were observed in the 139 patients. CONCLUSIONS: On the basis of this study, the curved cutter stapler showed to be a satisfactory device for securing the bronchus during an anatomic resection (whether lobar or main), in 'open' thoracic surgery. However, even though there were no cases of fistula, we consider that our data is still too limited to be statistically significant.
Subject(s)
Bronchi/surgery , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Pneumonectomy/instrumentation , Surgical Staplers , Aged , Aged, 80 and over , Bronchial Fistula/etiology , Bronchial Fistula/prevention & control , Female , Humans , Male , Middle Aged , Pleural Diseases/etiology , Pleural Diseases/prevention & control , Pneumonectomy/adverse effects , Pneumonectomy/methods , Respiratory Tract Fistula/etiology , Respiratory Tract Fistula/prevention & control , Surgical StaplingABSTRACT
BACKGROUND: Myostatin is a negative regulator of skeletal muscle mass. We recently demonstrated that myostatin expression is upregulated in an experimental model of cancer cachexia, suggesting that modulations of this pathway might play a pathogenic role in cancer-related muscle wasting. The present study was designed to investigate whether myostatin signaling is modulated in the muscle of non-weight-losing (nWL) patients with lung and gastric cancer. METHODS: Myostatin signaling was studied in muscle biopsies obtained during surgical procedure from nWL patients affected by gastric (n=16) or lung (n=17) cancer. Western blotting was applied to test both the total expression of myostatin and the expression of phosphorylated form of GSK-3beta and Smad2/3. RESULTS: In patients with gastric cancer, the expression of both myostatin and phosphorylated GSK-3beta (p-GSK3ß) were significantly increased. By contrast, in patients with lung cancer, myostatin levels were comparable to controls, whereas the expression of p-GSK3ß significantly decreased in patients with disease stage III/IV. CONCLUSIONS: Myostatin signaling is altered in nWL cancer patients. Different tumor types may give rise to different patterns of molecular changes within the muscle, which occur even before cachexia becomes clinically apparent.
