Fine-needle cytology of inflammatory myofibroblastic tumor of the lung. Report of a case.

BACKGROUND: Inflammatory myofibroblastic tumor (IMT) of the lung is a rare condition that may mimic cancer. CASE: We describe a case of inflammatory myofibroblastic tumor discovered by a routine chest X-ray in a 26-year-old male patient, primarily diagnosed by fine needle aspiration biopsy. The clinical, cytopathological and differential diagnostic findings of this rare entity are briefly discussed. CONCLUSION: IMT may be diagnosed accurately on needle cytology samples, provided that other pseudoneoplastic and neoplastic entities can be excluded from its differential diagnosis.

Endoscopic and surgical palliation of esophageal cancer.

BACKGROUND: Esophageal carcinoma is frequently diagnosed at an advanced stage. Therefore for most patients either surgical or endoscopic palliation with or without radiochemotherapy may be taken into consideration. This retrospective study analyzes immediate and long term results of perendoscopic treatment in patients with unresectable esophageal cancer. Moreover a comparative analysis has been made with a group of patients who underwent palliation surgery. METHODS: From 1982 to 1998 458 patients with esophageal cancer underwent palliation perendoscopic disobstructive treatment (427 patients), palliation surgery (29 patients) and dis-obstruction followed by perendoscopic gastrostomy (2 patients). Among patients treated by perendoscopic procedures, 18 underwent dilation, 53 dilation and radiotherapy, 236 stent implantation, respectively of the plastic (102) and self-expandable metallic (134) type. 120 patients underwent NdYAG laser treatment. RESULTS: The results for patients who underwent perendoscopic procedures are referred to as regards the first 30 days after treatment and on the long run in terms of grade of dysphagia according to Visick's scale. For the group of patients undergoing simple dilation we had an improvement (from Visick III-IV to I-II) in 33% of cases and in 54.7% when radiotherapy was added. Far better results were achieved in all groups undergoing stent implantation, with or without brachytherapy, and NdYAG laser treatment with or without previous chemical necrolysis (range 90.3-100%). Most frequent complications were obstruction and stent displacement. Mean survival was better for patients undergoing laser recanalisation (7.2 months) while among stents the metallic type has given better results than plastic ones both for survival (6.2 vs 5.9 months) and mortality (2.4 vs 4.9%). Comparison with the group undergoing palliation surgery has shown that mean survival is the same for patients undergoing jejunostomy or gastrostomy while it is significantly better for patients undergoing palliation resection or by-pass surgery compared with those treated by stent implantation or laser recanalisation. CONCLUSIONS: The palliation treatment of patients with esophageal and cardial carcinoma is still a complex problem as far as therapeutic strategy is concerned. The best palliation is surgery even though characterized by a greater morbidity and mortality compared with perendoscopic techniques that may represent, in selected cases, a suitable alternative.

[Palliative surgical treatment of thoracic esophageal cancer]. / Trattamento chirurgico palliativo del cancro dell'esofago toracico.

BACKGROUND: Esophageal carcinoma is frequently diagnosed at an advanced stage, therefore most patients may only benefit from surgical or endoscopic palliation. METHODS: From 1982 to 1998, out of 247 patients who underwent palliation for thoracic esophageal carcinoma, 29 (11.7%) underwent surgical palliation. Eight received a palliative resection, 10 a bypass, 5 a jejunostomy and 6 a gastrostomy. A retrosternal transposition of the stomach (17 patients) and colon (1 patient) was performed. In 15 out of 29 patients palliation was decided during surgical exploration. All resected patients underwent postoperative radiotherapy (400 Gy) while 3 received also preoperative chemotherapy (PDD and % FU). RESULTS: Seven temporary neck fistulas and 9 cardiorespiratory complications were recorded. Two patients (11%) died of severe cardiac and respiratory insufficiency. Mean survival for resected patients was 12.5 months (range 3-21), higher than for bypass (11.5 months; range 3-18) and for jejunostomy or gastrostomy (5 months; range 2-12). CONCLUSIONS: Palliative resection, when technically feasible, is the treatment of choice in advanced thoracic esophageal carcinoma in selected patients. The type of procedure to be performed depends on site, extent of the disease and surgeon's experience together with the quality of life expected by the patient.

Serum and tissue levels of CEA, TPA, CA 125 and CA 15.3 in patients with lung cancer.

Forty-nine healthy subjects (Group I), 24 patients with benign lung diseases (Group II) and 48 patients surgically treated for lung cancer (Group III): 28 with squamous cell carcinoma (SCC) and 20 with adenocarcinoma (adenoca), were tested for the presence of carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), cancer antigen CA 125 and antigen CA 15.3. The four markers were measured in the serum of the patients of the three groups and in the cytosol extract of tumoral and peritumoral tissues of Group III subjects. The mean levels of serum CEA and TPA were significantly higher in squamous cell carcinoma and in adenocarcinoma patients than in normal subjects. In benign lung disease serum CEA was equal and TPA slightly higher than in normal subjects. CA 125 was higher in the serum of patients with malignant diseases compared to normal or benign lung diseases but this difference was not statistically significant. Serum CA 15.3 levels were similar in all subjects studied. CA 125 in squamous cell carcinoma cytosol was much higher than in peritumoral cytosol whereas the other three markers were not significantly different in tumor cytosol or peritumoral cytosol. A direct correlation between serum and cytosol values was observed for CEA, but not for the other markers. The levels of the four markers in serum and cytosol did not correlate with the stage or grade of the tumors.

Epidermal growth factor receptor and lipid membrane components in human lung cancers.

The binding of 125I-epidermal growth factor (EGF) to the plasma membranes of 54 samples of human lung tumors was determined. These included 34 squamous cell carcinomas and 20 adenocarcinomas. Twenty samples of histologically normal lung excised surgically along with the tumors were used as controls. Most of the plasma membranes showed an EGF receptor level higher than that of normal tissue. A moderate increase in the amount of 125I-EGF bound (2-5 fold) was observed in the majority of the tumors. Only a few cases (5-10% of the total) showed a large increase (> than 10 fold). The binding of 125I-EGF was compared with clinical stages and grades of differentiation. No correlation between the stage of the tumor and 125I-EGF binding was observed. However, the highest levels of EGF receptor (EGF-R) were found in poorly differentiated squamous cell carcinomas. The total amount and the distribution pattern of gangliosides and phospholipids were analyzed in individual tumors. A decrease in GD1b, GD1a and sphingomyelin and an increase in GM1 and GM3 was observed. No correlation was detected when tumors with the highest or lowest levels of gangliosides or phospholipids were compared with tumors exhibiting the highest binding of 125I-EGF.

Mediastinoscopy vs. anterior mediastinotomy in the diagnosis of mediastinal lymphoma: a randomized trial.

We selected 95 patients with mediastinal adenopathy and no signs of goiter, myasthenia gravis or mediastinal involvement by other disease. All patients underwent, for screening purposes, transthoracic fine needle aspiration biopsy based on chest x-ray and CT findings. Patients were then subdivided into 4 groups. One group of 22 patients with prevalent anterior mass localization underwent anterior mediastinotomy. One group of 19 patients with prevalent middle mediastinal mass localization underwent cervical mediastinoscopy. Two other groups of 27 patients each with both anterior and middle mediastinum localization randomly underwent anterior mediastinotomy or mediastinoscopy. Fifty-one Hodgkin's and 44 non-Hodgkin's lymphomas were diagnosed in total. In 11 cases (11.57%), median sternotomy (2) or thoracotomy (9) were necessary for establishing the final diagnosis. The overall diagnostic accuracy was 80.43% for cervical mediastinoscopy and 95.91% for anterior mediastinotomy. The statistical analysis performed on all patients showed a significant difference (chi 2 = 5.56, P less than 0.025, df = 1) between the two procedures.

Tumor markers and lung cancer: correlation between serum and bronchial secretion levels of CEA, TPA, CanAg CA-50, NSE and ferritin.

The levels of carcinoembryonic antigeny (CEA), tissue polypeptide antigeny (TPA), CanAg 50, neuron specific enolase (NSE) and ferritin were determined in bronchial secretion and serum of patients with neoplastic and non-neoplastic lung diseases. Simultaneous determination of two or three markers in the serum and in bronchoalveolar lavage (BAL) may be clinically useful for the diagnosis of lung cancer and even for the type of tumor. The positivity of CEA determined simultaneously in serum and in BAL of patients with lung cancer is higher than 80% whereas in patients with benign lung disease it is lower than 40%. The simultaneous assay of TPA in serum and in BAL showed 100% positivity in patients with oat-cell carcinoma, the frequencies of positivity were similar in patients with non-oat-cell carcinoma. For NSE and CanAg CA-50 patients with oat-cell carcinoma showed 100% positivity. Simultaneous assay of ferritin in serum and in BAL gave 85% positivity in patients with oat-cell carcinoma and only 23% in patients with non-oat-cell carcinoma. We conclude that the simultaneous determination of CEA and CanAg CA-50 or NSE in serum and in BAL is a useful aid in the diagnosis of lung malignancy.

[Suture of the diaphragm with collagen: histological study in the rat]. / Sutura del diaframma con collageno: studio isotologico nel ratto.

The Authors evaluated the histological aspects on 2nd, 7th, 21st day of diaphragma of rat sutured by collagen. In result they proved that collagen produced a small inflammatory acute and chronic reaction and the absorbment was complete on 7th day.