[Adenoid cystic carcinoma of respiratory airways: course and treatment]. / Carcinoma adenoide quístico de vías aéreas respiratorias: evolución y tratamiento.

Until recently, adenoid cystic carcinoma (ACC) has been considered to be a borderline disease between benign and malignant because of its low level of malignancy, slow growth and scarce aggressivity. ACC is now a histologically well defined tumor and is currently classified as malignant; it has a prolonged natural history, is infiltrative, and tends to recur locally and give rise to local-regional metastases or, more rarely, remote metastases. Its incidence in the lower airways is low (0.1% of all broncho-pulmonary neoplasms). Eight patients (6 women and 2 men) have undergone surgery for ACC since 1969. The initial clinical picture included long-term evolution and symptoms were usually produced by large caliber obstruction of the airways, mainly affecting the trachea and large bronchi. Three cases involved the trachea resection with end-to-end anastomosis in two cases, right pneumonectomy in two others (one of which also involved tracheal carina resection), and two lobectomies. After thoracotomy, resection of the tumor was deemed impossible in two cases. Postoperative mortality was 12% (1 patient). Complementary radiotherapy was provided in the two non-resectable cases, or when there was invasion of resected edges or regional metastasis involving ganglia. Total survival was 71.4% after two years, 57.1% after five years and 38% after ten years, after excluding postoperative exitus. When the trachea was involved, survival was 33.3% after two and five years and nil after ten years, with the longest survival 108 months. When bronchi were involved, survival was 75% at five and ten years. We conclude that ACC is a rare, locally invasive tumor that tends to local recurrence, but that survival after surgery is prolonged with or without adjuvant radiotherapy.

[Results of surgical treatment of non-microcytic bronchopulmonary carcinoma in III-A stage]. / Resultados del tratamiento quirúrgico del carcinoma broncopulmonar no microcítico en estadio III-A.

To analyze results and survival after surgical treatment of various stage III-a subgroups. We reviewed 748 case histories of patients with non-small cell bronchopulmonary carcinoma between January 1970 and December 1991, selecting 121 patients who underwent resection of stage III-a tumors, according to the pathologist's report. Overall survival at 3, 5 and 10 years was 26, 16 and 12%, respectively. The subgroup with better response to treatment was that of patients with T-3 tumors (peripheral), N-0, with survival of 21% at five years. If peribronchial and/or hilar (N-1) nodes were affected, survival was slightly less (16%). If mediastinal adenopathy (N-2) was present, there were no survivors after 3 years. In this same T-3 group, but with neoplastic invasion of the pericardium, mediastinal pleura or principal bronchi, survival after 3 years was nil. The survival rates of peripheral T-3 patients undergoing block resections were 27, 20 and 17% at 3, 5 and 10 years, respectively, 16% at 2 years and 0% at 5, for those with extrapleural resection. Patients with the poorest response to treatment were those with mediastinal nodes (N-2), in whom survival was 17, 12 and 8% at 3, 5 and 10 years, respectively. In the 34 patients received postoperative irradiation of the mediastinum, survival was 16% higher. The survival rates after 5 years were similar for epidermoid carcinoma (18%) and adenocarcinoma (14%). The results of surgical treatment are variable and depend on several factors: extension and extrapulmonary location of lesions, surgical technique used for T-3 tumors and histological type.

Validity of enlarged mediastinal nodes as markers of involvement by non-small cell lung cancer.

To assess the validity of enlarged mediastinal nodes as markers of involvement for staging in non-small cell lung cancer, we studied the records of 167 consecutive patients who underwent thoracotomy for this disease in the last 4 yr in our center. Careful search for both hilar (N1) and ipsilateral mediastinal nodes (N2) was done in every case. All nodes found at thoracotomy (regardless of their size) were either removed or sampled and then sent to the pathology department for examination. We found enlarged nodes (larger than 10 mm) in 131 of the 167 patients included in the study (72%). Of these patients, 58 had enlarged nodes at the hilar level (presumably N1 disease, 38%), and 73 were considered as presumably N2 at thoracotomy, before pathologic examination (62%). Only 12 of 58 patients with presumably N1 disease had true neoplastic involvement at this level (21%), whereas there was true N2 disease in only 18 of 73 patients with enlarged mediastinal nodes (25%). The positive predictive value for N2 in epidermoid carcinoma was 23%, and it was even lower with adenocarcinoma (18%). We conclude that open surgery with careful sampling is the method of choice for evaluation of mediastinal nodes in non-small cell lung cancer if evidence of malignant involvement cannot be proven histologically before thoracotomy.

[Primary pulmonary leiomyoma. Presentation of 3 cases]. / Leiomioma pulmonar primitivo. Presentación de tres casos.

Pulmonary leiomyoma is a benign tumor of mesodermal origin, very rare of which only three cases have been described on the Spanish scientific literature. We present our experience with three new cases and discuss the clinical and therapeutic characteristics of these neoplasms according to their topographical localization. We insist on the need of a gynecological revision when females are affected, because its possible association with uterine tumors.