The clinicopathological challenges of symptomatic and incidental pulmonary hamartomas diagnosis.

Pulmonary hamartomas (PHs) are the most common benign lung tumors. Usually, they are asymptomatic and incidentally discovered during assessment for other diseases or during the autopsy exam. In this context, we have performed a retrospective analysis of surgical resections in a 5-year series of patients diagnosed with PHs in the Clinic of Pulmonary Diseases, Iasi, Romania, aiming to evaluate their clinicopathological features. A total of 27 patients with PH (40.74% males and 59.26% females) were evaluated. 33.33% of patients were asymptomatic, while the others exhibited variable symptoms, such as chronic cough, dyspnea, chest pain or weight loss. In most cases, PHs presented as solitary nodules, predominantly disposed in the right upper lobe (40.74% of cases), followed by the right lower lobe (33.34%), and left lower lobe (18.51%). The microscopic examination revealed a mixture of mature mesenchymal tissue, such as hyaline cartilage, adipose tissue, fibromyxoid tissue, and smooth muscle bundles, in variable proportions, associated with clefts of entrapped benign epithelium. A dominant adipose tissue component was observed in one case. PH was associated with a history of extrapulmonary cancer diagnosis, in one patient. Although considered benign lung tumors, PHs diagnosis and therapy may be challenging. Having in mind the possibility of recurrence or their occurrence as a part of specific syndromes, PHs should be thoroughly investigated for an appropriate patients' management. Their complex significance and the correlation with other types of lesions, including malignancies, may be further studied, by more extensive studies of surgical and necroptic cases.

Surgical and Anatomical Particularities and Difficulties in Histopathological Sampling for Superior Vena Cava Syndrome.

The superior vena cava syndrome is due to the increased venous pressure in the upper torso, neck and head, caused by the obstruction of the superior vena cava. Both external and internal factors cause obstruction (95% are malign causes), and the most severe manifestation is represented by cerebral edema that can even lead to coma. The diagnostic algorithm for the superior vena cava syndrome is widely known. There are many controversies and discussions about the safety of histopathological sampling. The purpose of this paper is to assess such risks, the complication rate and the diagnostic yield of surgical sampling, by analyzing the 26 interventions performed in our clinic. Although the complication rate was higher than that observed in the absence of the superior vena cava syndrome, surgery remains mandatory for a rapid histopathological diagnosis, therefore demanding a protocol that must include a mandatory extemporaneous exam of the biopsy.

[Videomediastinoscopic transcervical approach of postpneumonectomy left main bronchial fistula]. / Abordarea cervicala video-mediastinoscopica a fistulei de bont bronsic post-pneumonectomie stânga.

Bronchopleural fistulas and empyema are the most devastating complications after lung resection. The optimal management remains a major subject of controversy for thoracic surgeons over the wide variety of therapeutic approaches, none suitable for all patients. In 1996 Azorin et al. reported the first successful mediastinoscopic reclosure by stapling of an insufficient bronchial stump after left pneumonectomy using video-assisted mediastinoscopy. The authors report the first national case of left-sided bronchopleural fistula closure using video-assisted mediastinoscopy, describing their experience with this technique. A 40 years old woman presented to our unit with left thorax empyema after having undergone left pneumonectomy for TB destructed lung with aspergillosis in another hospital. Bronchoscopy revealed a 15 mm long bronchial stump with insufficiency. Despite all advances made over the last decades in perioperative management, bronchopleural fistula after pneumonectomy remains a significant problem in thoracic surgery. Video-mediastinoscopy is an alternative to the open methods as it allows approaching the bronchial stump via the mediastinum. The dissection of the trachea through its natural route enables bronchial mobilization. Positive factors influencing our decision were the virgin mediastinum with no surgical dissection and no radiation therapy applied. The mediastinoscopic approach for bronchial stump closure after pneumonectomy is a novel option in highly selected patients. This is our choice for a long (at least 10 mm) bronchial stump because its morbidity is minimal compared with transpericardial sternotomy or a transthoracic approach. It warrants minimal surgical trauma; however, skilled surgeons with experience in mediastinoscopy have to be prepared to convert to an open technique immediately.