[To the question of reasonability of lung biopsy in primary spontaneous pneumothorax].

A biopsy of lung tissues was a conventional diagnostic method for detection of disseminated processes in the lung, which weren't diagnosed on preoperative stage. It was used during surgical anti-relapse treatment of spontaneous pneumothorax (SP). A retrospective analysis of the results of lung parenchyma biopsy was made in 143 patients, who have been operated for SP. Basic entry criteria of the research were: the age younger than 40 years old, a presence of one episode of spontaneous pneumothorax, an absence of complaints for respiratory organs before the development of the first episode of spontaneous pneumothorax. The biopsy with following pathomorphological investigation allowed a formulation of exact variant of disseminated processes, which gave the reason for the development of spontaneous pneumothorax in 9 (6%) patients out of 143. The presence of disseminated processes in the lung was detected with multispiral CT in all these patients on preoperative stage. The study of biopsy material found out the presence of emphysema of different degree of manifestation or fibrosis sites in the rest of the patients. An analysis of presented materials allowed the conclusion, that a performance of biopsy was indicated in the case of suspicion for lung disseminated processes in patients with SP. The biopsy with the following histological study didn't explain the reason of the development of emphysematous and fibrous changes in lung parenchyma in all other cases. At the same time, it didn't give the option for pathogenetic treatment and it wasn't possible to predict the following pathogenesis.

[Thoracic endometriosis--the rare pathology in thoracic surgery].

Thoracic hematogenic endometriosis is a rare pathology. A clinical course hasn't pathognomic symptoms, because of it, the diagnosis is established due to histological study. The article presented two cases of female patients, who were suffering from thoracic endometriosis. They were hospitalized to the department of thoracic surgery of Municipal multifield hospital No 2 in Saint-Petersburg. The first patient had a posterior mediastinum tumor with asymptomatic disease course. The second patient was with recurrent catamenial pneumothorax.

[Pulmonary histiocytosis from Langerhans cells as the problem of clinical morphology].

There are discussed modern views on one of the most difficult diagnosed forms of pulmonary dissemination. They relate to the dynamics of granulomatous changes in the lung tissue at the cellular and subcellular level as well as a characteristic of the immunophenotype of Langerhans cells. At present the frequency of this disease increases, which improves the responsibility for the timely diagnosis based on performing explicit clinical and morphological studies.

[Primary bronchial melanoma].

The paper describes 4 cases of primary bronchial melanoma. The primacy of the tumor was established in all cases, by ruling out primary melanoma at another site (skin, nasal mucosae, and bowel), the presence of intraepithelial melanocytic proliferation in the areas of the metaplastic bronchial epithelium.

[Airway granular cell tumor].

The paper describes the clinical, morphological, and immunohistochemical characteristics of 13 granular cell tumors of the upper airway. These tumors are shown to have virtually the same histological and immunohistochemical features as granular cell tumors at another site. The histogenesis of these tumors is discussed. There are currently a number of more or less solid grounds for considering them as neurogenic tumors to be close to schwannomas. At the same time one cannot ignore the fact that there is morphological and immunohistochemical evidence for that the granular cell tumors have rather cytotypical than histotypical properties, which cannot implicitly assign them to nerve tissue tumors. Most likely, the granular cell tumors belong to a histogenetically heterogeneous mixed group, in this connection their place in the classification of tumors needs further investigation, by applying the criteria developed by Russian histologists and oncomorphologists.

[Spontaneous pneumothorax -an analysis of 1489 cases].

A retrospective analysis of medical history of 1489 patients with spontaneous pneumothorax was made. The patients were hospitalized to the department of thoracic surgery in municipal hospital No 2. According to the data, the incidence rate of primary spontaneous pneumothorax was noted in men during last decade in Saint-Petersburg. The number of patients with secondary spontaneous pneumothorax didn't considerably increase in spite of the growth of incidence of chronic obstructive lung disease. The secondary spontaneous pneumothorax took place in female population two times more, than in male.

[Differential diagnosis of lymphoid infiltrates in the lungs].

Clinico-morphological and immuno-histological data on 15 cases of marked lymphocytic lung tissue infiltration are presented. The nature of B- and T-lymphocyte distribution, their proliferative activity as well as patterns of distribution of cells synthesizing light chains of immunoglobulins are described. In 12 cases, lymphocytic interstitial pneumonia was diagnosed; it featured distinct boundaries between zones of B- and T-lymphocytes of proliferating and resting cells. However, non-Hodgkin's lymphoma (MALT) detected in 3 cases lacked such a pattern. That might be interpreted as a marker of the particular pathology.

[Specific medical strategy for spontaneous pneumothorax in patients with chronic obstructive pulmonary disease].

Results of examination and treatment of 62 patients with spontaneous pneumothorax which appeared against the background of chronic obstructive pulmonary disease during the period from 1998 to 2009 were analyzed retrospectively. Emergent drainage of the pleural cavity was made to all the patients at admission to hospital. Surgical intervention was fulfilled in 28 (45%) patients. Complications at the postoperative period were noted in 54% of the patients. An assessment of occurrence of complications did not reveal their regular increasing along with the degree of bronchial obstruction. Differential approach and selection of high risk patients is considered to be necessary.

[Immunomorphological characteristics of pulmonary langerhans cell histiocytosis].

Lung tissue specimens, obtained during lung biopsy or resection, were morphologically and immunohistochemically studied in 27 patients with Langerhans cell (LC) histiocytosis (LCH). The latter was diagnosed on the basis of the expression of CD1a and S-100. Without immunophenotyping, its diagnosis was difficult due to impaired tissue architectonics (sclerosis, bullous transformation) and artifacts that were inevitably present during lung biopsy. LCs in the infiltrates were shown to be capable for apoptosis. Induction of LC apoptosis may be regarded as a therapeutic strategy.

[Transbronchial biopsy of the lungs in diagnosis of respiratory sarcoidosis].

AIM: To specify diagnostic potentialities of transbronchial biopsy of the lungs (TBB) in respiratory sarcoidosis (RS). MATERIAL AND METHODS: TBB of the lungs was performed in bronchofibroscopy under local anesthesia and TV x-ray control with intake of 4-5 biopsy specimens. RESULTS: Biopsy specimens consisted primarily of alveolar tissue in 62.5% patients, of bronchial wall - in 34.8%, were insufficiently informative - in 2.4% patients. Histological examination of the biopsies detected sarcoid granulemas which served the basis for RS diagnosis in 62.5% patients (stage 1 - 51.1%, stage 2 - 70.4%, stage 3 - in 61.6%). Sarcoid granulemas were detected more frequently in alveolar tissue than in bronchial walls (75.3 and 38.5%, respectively, p < 0.05). In RS stage 1 granulemas in the bronchial walls were found less often than in stages 2 and 3 (56.3, 42.9%, respectively, p < 0.01). CONCLUSION: TBB provides morphological RS diagnosis in 2/3 patients and is a safe method. Obtaining biopsies containing alveolar tissue raises efficacy of TBB, especially in the disease stage 1.

[Endobronchial biopsy in the diagnosis of pulmonary sarcoidosis].

Bronchofiberscopy (BFS) with endobronchial biopsy (EBB) was performed in 66 patients with pulmonary sarcoidosis (PS). Transbronchial biopsy (TBB) was made in 49 patients from this group to compare the diagnostic value of EBB and TBB. The normal endoscopic picture was observed in 19.6% of patients. Bronchial mucosal hypervascularization and thickening were found in 25.7% of cases; the signs of enlarged bronchopulmonary lymph nodes were detected in 13.6%; catarrhal endobronchitis in 10.6%, and tuberosity changes in 4.5%. Epithelioid granulomas in the bronchial mucosa were identified in 37.8% of cases (30.75 and 39.6% in the intact and abnormal mucosa, respectively). The diagnostic value of TBB was 65.3%. EBB could reveal epithelioid-cell granulomas in 4 of the 17 patients with negative TBB. The findings suggest that BFS with EBB should be included as a necessary diagnostic method for the examination of patients with PS.

[Solitary fibrous tumor: a clinico-morphological and immunohistochemical study].

Solitary fibrous tumor is a rare neoplasm which may occur at any site although it is more frequent in the pleura, mediastinum and lung. The study used 4 cases of tumor localization in the pleura and orbit. Three cases presented as a "hemangiopericytic" variety of spindle cells; there were numerous giant cells in orbit tumor. Solitary fibrous tumor revealed enhanced expression of vimentin, CD34, bel-2 and CD99. Expression of S-100, desmine and non-striated muscle actin was found in few cells in some cases. Such features as large size (over 10 cm), necrosis, high cellularity, nuclear polymorphism and high mitotic index (more than 4 mitoses within 4 visual fields, at high magnification) were used as malignancy criteria:. Tumor histological pattern of "hemangiopericytic" variety could be reliably identified thanks to immunohistochemical procedure.

[Pulmonary lymphangioleiomyomatosis].

A clinicomorphological analysis of 41 pulmonary lymphangioleiomyomatosis (PLAM) cases has been performed. Focal (7 cases) and diffuse (34 cases) forms were identified. Expression of NMB-45, desmin, actin, vimentin prove myogenic nature of the disease and confirm combination of two morphogenesis directions - proliferation of smooth muscle cells at the active phase of the growth and fibrosis at late stages. The presence of estrogen and progesteron receptors in smooth muscle cells shows hormonal dependance of cell proliferation. Thus, LAM is multisystem disease linked with abdominal tumors (angiomyolipomas, angioleiomyomas). Prognosis in the focal form is favourable, that in the diffuse form- unfavourable.

[Effect of preoperative chemotherapy, mediastinal lymph node dissection and stump cover on bronchial regeneration following experimental pneumonectomy].

The dynamics of morphological changes occurring in the bronchial stump depending on the extent of mediastinal lymph dissection, preoperative chemotherapy and the stump cover method are discussed. Stump healing after right-side pneumonectomy was assessed in 32 non-inbred dogs. Typical procedure was tested in group 1 while complete systematic mediastinal lymph dissection (CSMLD)--in groups 2-4. In groups 3-4, pneumonectomy was performed after two courses of chemotherapy (cisplatin 80 mg/m2 per day + etoposide 120 mg/m2, days 1,3,5). In groups 1-3, the stump was covered with a parietal strap; in group 4, a m. latissimus dorsi strap was fixed on a vascular "pedicle". Experiment was suspended on days 3, 7, 14, 21 and 30. One animal in group 2 died of ischemic necrosis of the esophagus terminating in mediastinitis. None of the animals developed bronchial fistula. Angiography detected reduced blood flow in the right-side third of the trachea and medial surface of the left main bronchus in the CSMLD groups. Microscopically, all the groups revealed a similar pattern of stump healing. CSMLD did not influence bronchial stump regeneration significantly. Nor was it hampered in any way by preoperative chemotherapy. The latter was followed by expansion of necrotic and edematous area thus slightly affecting regeneration. Primary bronchoplasty failed to speed up regeneration, yet it might diminish the risk of bronchial fistula.

[Vascular invasion by tumor in the absence of regional lymph node metastases in patients with locally advanced non-small cell lung cancer]. / Opukholevaia invaziia sosudov pri otsutstvii metastazov v regionarnye limfaticheskie uzly u bol'nykh mestnorasprostranennym nemelkokletochnym rakom legkogo.

The study included 45 patients radically operated for locally advanced (T3, T4) non-small cell lung cancer (NSCLC), free from metastasis to the regional lymph nodes. The histological subtypes were: squamous cell cancer (40; 89%), adenocarcinoma (4; 6%) and large-cell lung cancer (1; 2%). Pathomorphological stage: IIb (p T3N0M0)--35 (78%); IIIb (p T4N0M0)--10 (22%). Blood vessel invasion: tumor T3--8 (23%); T4--2 (20%). Lymph vessel invasion: T3--9 (9%) and T4--2 (2%) (p(0.05). In total, tumor invasion was reported in 16 patients: T3--12 (34%) and T4--4 (40%) (p(0.05). There was no significant difference in survival among IIb or IIIb stage NSCLC patients. None of the cases of blood vessel invasion survived 5 years after surgery. Five-year survival in patients without vascular invasion was 55% (p(001). Tumor invasion of blood and lymph vessels is associated with high probability of tumor dissemination and poor prognosis.

[Some aspects of pathogenesis, clinical manifestations and diagnosis of occupational chronic occupational bronchitis]. / Nekotorye aspekty patogeneza, kliniki i diagnostiki khronicheskikh bronkhitov professional'noi étiologii.

The article represents data characterizing course of chronic bronchitis in 78 machinery workers subjected to toxic irritative and sensibilizing aerosols. Findings are early bronchial obstruction and pulmonary emphysema, frequent disorders of microcirculation and lesser circle perfusion, propensity to interstitial pulmonary fibrosis and lung hypertension. The results could serve as a base for pathogenetic therapy and necessitate to include COLD into Occupational Diseases Register.

[Prognostic factors influencing results of the surgical treatment of pancreatic cancer]. / Prognosticheskie faktory, vliiaiushchie na rezul'taty khirurgicheskogo lecheniia pri rake podzheludochnoi zhelezy.

In patients with carcinoma of the pancreas 128 gastropancreatoduodenal resections (GPDR), 15 distal resections of the pancreas and 3 pancreatectomies were performed. After GPDR 5-year survival was 12%, the survival median was 24.3 months. Only one patient is living 6 years after left-sided resection and pancreatectomy. Long-term results of the operative treatment for carcinoma of the pancreas depended on the amount of regional metastases, degree of differentiation of the tumor, its size and invasion into the vessels. The long-term results were considerably worse if the tumor was localized in the uncinate process, body and tail of the pancreas. The 5-year survival was noted mainly in patients with the 0 and I stages of the disease. It shows the early diagnostics to be necessary.