Percutaneous computed tomography-guided localization of pulmonary nodules with hook wire prior to video-assisted thoracoscopic surgery.

PURPOSE: To evaluate the use of percutaneous computed tomography (CT)-guided localization of suspicious intrapulmonary nodules with hook wire prior to video-assisted thoracoscopic surgery (VATS). METHODS: From April 2010 to February 2011, 15 patients with suspicious subpleural pulmonary nodules underwent preoperative CT-guided hook wire localization of the lesions, prior to VATS. RESULTS: Histological analysis of the resected suspicious pulmonary nodules revealed malignancy in 12 cases, 2 cases with granulomas and 1 case with bronchiolitis obliterans organizing pneumonia (BOOP). Better results were achieved with the double-thorn hook wire. Conversion to thoracotomy was necessary in the patient with BOOP, due to limited hemorrhage at the site of the lesion. CONCLUSION: Preoperative CT-guided nodule localization using hook wire fixation is a useful and safe technique that helps in the precise localization of suspicious lesions, reduces the operation time, the postoperative complications, and the hospitalization.

Simultaneous bilateral carotid endarterectomy under local anesthesia.

A 75-year-old man with bilateral carotid stenosis and severe coronary artery disease underwent successful simultaneous bilateral carotid endarterectomy under local anesthesia. A few days later, coronary artery bypass grafting was performed with no complications.

Desmoid tumors of the chest wall.

Chest wall desmoid tumors (DT) are rare pathologic entities with microscopic features similar to, or undistinguishable from, fibromas or fibrosarcomas. From 1996 to 2001, four patients with DT were surgically managed in our department. Their ages ranged from 27 years to 43 years (mean 32.25 years, median 29.5 years). A resection of the lesion was performed with negative margins of 4 cm around the tumor (wide resection). A reconstruction of the chest wall was also performed with polytetrafluoroethylene (PTFE) in 2 patients and methylmethacrolate with Marlex mesh in 1 patient. One patient had a recurrence 15 months later, and was admitted for complementary resection, and remains disease-free for 5 years. The rest 3 patients are disease-free for 6 months to 5 years. Resection must include all adjacent, overlying and underlying musculature as well as soft tissues and any spare skin from the procedure should be used. Prognosis after a wide resection is good.

Primary Malignant Melanoma of the Lung: A Case Report.

BACKGROUND: Primary melanoma of the lung is an extremely rare pathological entity and sparsely reported in the literature. CASE PRESENTATION: A case of primary malignant melanoma of the lung in a 41-year-old female is reported. The clinical, radiological and histopathological features are discussed. The initial symptom was cough, whereas the chest radiography showed a round opacity of the right lung. The computed tomography of the chest revealed a well-demarcated mass lesion in the right upper lobe. Endobronchial mass causing obstruction of the upper lobar bronchus was the bronchoscopic finding. Patient underwent pneumonectomy. A diagnosis of melanoma was confirmed postoperatively after the immunohistochemistry. Primary nature of the tumour in the lung results from the demonstration of characteristic junctional pattern of melanoma cells beneath the bronchial epithelium on histopathology, and from exclusion of other potential primary sites in the clinical, paraclinical and laboratory examination. CONCLUSIONS: Primary melanoma of the lung represents a rare pathological entity. Careful interpretation of histopathological information in correlation with all other findings from clinical and paraclinical studies can establish a diagnosis. Follow-up is necessary in order to diagnose potential dissemination or secondary sites of the disease. Due to the small number of cases reported in the literature, there is no experience on the management and the prognosis of the disease, but surgical resection remains the cornerstone of the treatment.