Prognostic significance of p53 and Ki-67 antigen expression in surgically treated non-small cell lung cancer: immunocytochemical detection with imprint cytology.

The purpose of this study was to determine the prognostic significance of the expression of p53 and Ki-67 in non-small cell lung cancer (NSCLC) using immunocytochemical detection. All consecutive NSCLC cases were selected for study, and, after surgery, a part of each tumor sample was frozen at -20 degrees C and stored for immunocytochemical studies. Overexpression of p53 was associated significantly with worse patient outcome in stage I disease, whereas no excess risk was evident in stage II and III cases. The same pattern was observed for Ki-67 expression. The excess risk in stage I cases with p53 and Ki-67 overexpression was observed only in adenocarcinoma. These findings are in agreement with other retrospective studies and support the hypothesis that p53 alteration may have different roles in adenocarcinoma and in squamous cell carcinoma, such as a carcinogenic factor for both cellular types but progression only for adenocarcinoma.

[T4 tracheo-bronchial carcinoma: clinical evaluation of 48 sleeve pneumonectomies]. / Carcinoma tracheobronchiale T4. Bilancio clinico di 48 sleeve pneumonectomies.

The aim of the study was to verify the indications for surgery in T4 tracheo-bronchial carcinomas. Forty-eight tracheal-sleeve pneumonectomies for T4 bronchogenic carcinoma were performed in our unit from 1986 to 2003. The patients were 42 males and 6 females. A postero-lateral thoracotomy was preferred (46 right, 2 left). Bronchial reimplantation was performed additionally (tracheal-sleeve lobectomy) in 2 patients on the right side. The morbidity was 25% and the mortality 6.2% (1 acute respiratory distress syndrome, 1 myocardial infarction, 1 anastomotic fistula). Twenty-three cases were sT4N2M0, 14 sT4N1M0, and 11 sT4N0M0. The sT4N2M0 and sT4N1M0 cases were not associated with more than 3 year survival, despite adjuvant therapies; sT4N0M0 squamous cell carcinomas, on the other hand, had > 40% 10-year survival with no adjuvant therapy. Associated prosthetic replacement of the superior vena cava neither affected the risk nor improved the prognosis. Surgery for T4 tracheo-bronchial carcinoma appears feasible for well differentiated sT4N0 squamous cell carcinomas; at more advanced stages this procedure is no more than a dangerous form of palliation.

Pulmonary resection for inflammatory complications due to benign oesophageal disease.

Benign oesophageal disease is sometimes causes an irreversible damage to the pulmonary parenchyma. The earliest symptoms often occur when the respiratory tract is involved. Primary oesophageal disease can only be detected by taking an accurate and precise medical history of the patient, so that oesophageal contrast radiography can provide the correct diagnosis. In this article we present two cases in which it was necessary to carry out a diverticulectomy with pulmonary resection, left lower lobectomy and left pneumonectomy. Reports from the literature agree that diverticular disease of the oesophagus, if misdiagnosed, can have serious consequences for the pulmonary parenchyma, even if this is rare. In both cases we present the contrast radiographic study of the oesophagus together with a double endoscopic examination of the airways and upper digestive tract which played a crucial role in the diagnosis. We can therefore conclude that respiratory symptoms in an otherwise healthy patient may constitute the basis for the diagnosis of a benign oesophageal lesion.