RESUMO
Fluid overload-associated large B-cell lymphoma (FO-LBCL) is a new entity described in the fifth edition of the World Health Organization (WHO) Classification of Hematolymphoid Tumors (WHO-HAEM5). It refers to malignant lymphoma present with symptoms of serous effusions in body cavities (pleural, peritoneal, and/or pericardial) in the absence of an identifiable tumor mass. We present a case of an 82-year-old man with a history of atrial fibrillation and atrial flutter, status post-ablation, essential hypertension (HTN), hyperlipidemia (HLD), and diabetes mellitus (DM) type 2 who was referred to our hospital for shortness of breath due to recurrent pleural effusion. Right video-assisted thoracoscopy with right pleural biopsy was performed. Histopathological examination of the pleural biopsy revealed dense fibrous tissue, chronic inflammation, lymphoid aggregates, and granulation tissue, with no evidence of lymphoma. Cytology of the right pleural fluid revealed large lymphoid cells, which were positive for CD45, CD20, PAX-5, MUM-1, BCL2, BCL6, and MYC protein. They were negative for CD3, CD10, CD138, and HHV-8 by immunohistochemistry (IHC). Epstein-Barr virus (EBV) was negative by in situ hybridization (ISH). Due to the absence of any evidence of lymphoma elsewhere, a diagnosis of fluid overload-associated large B-cell lymphoma (FO-LBCL) was made. We provide a synopsis of the main clinicopathological features of FO-LBCL and the two main differential diagnoses, primary effusion lymphoma (PEL) and diffuse large B-cell lymphoma (DLBCL).
RESUMO
Objectives: For patients with lung cancer, surgical resection remains the best curative option and is associated with the longest disease-free survival. We present our institutional outcomes treating pulmonary malignancy with robotic lobectomy over the course of 1 year. Methods: A retrospective review was conducted on patients who underwent robotic pulmonary lobectomy for malignancy at a single institution in 2018. Results: Over the course of 1 year, 166 patients underwent robotic lobectomy for pulmonary neoplasm. The mean age of the patients was 75 years; 73% were current or prior smokers and 52% of the patients were male. The mean body mass index was 28 kg/m2. Conversion to open thoracotomy occurred in 7% of patients. The mean total hospital length of stay (LOS) was 3 days. Histopathological examination revealed a mean tumour size of 2.7 cm with 11 lymph nodes harvested. Left-sided tumours had a significantly higher number of lymph nodes harvested when compared to right-sided tumours (11.6 vs. 9.8, P = 0.01), despite sampling the recommended minimum of three N2 stations. The most common pathology was adenocarcinoma (65%), followed by squamous cell carcinoma (17%) The 30-day operative mortality was 0.6%. Conclusions: Robotic video-assisted thoracoscopic surgery is a safe, feasible and oncologically adequate procedure for lung malignancies. Comparison of our outcomes to previously reported national averages suggests a similar hospital LOS, lymph node harvest, conversion rate to open thoracotomy and 30-day mortality rate. We acknowledge the limitations of this non-randomised, retrospective study. Future research on robotic lobectomies is encouraged.
