Regression of invasive thymoma following corticosteroid therapy.

A case of invasive thymoma is presented showing tumour regression after palliative treatment with prednisone. Moderate doses of prednisone resulted in a longtime palliation via remarkable anti-tumour effect. The literature of corticosteroid responses of thymomas is reviewed.

Video assisted thoracoscopic treatment of pleuropericardial cysts.

Question of the Study In this study, safety and feasibility of thoracoscopic fenestration of pleuropericardial cysts under local and general anaesthesia is evaluated. Besides, a rare case of a pleural cyst, causing a superior vena cava syndrome, is described.Materials, Patients and Methods In a retrospective study, the results of thoracoscopic treatment of pleuropericardial cysts in three patients are presented. We performed videothoracoscopic fenestration of pleuropericardial cysts. One of these was performed under local anaesthesia. The two other cases were performed under general anaesthesia. After fenestration, talc poudrage of the inner lining of the cysts was performed in one case.Results Thoracoscopic fenestration appeared to be safe and effective. No recurrence was observed. One patient was lost to follow-up.Answer to the Question Thoracoscopic fenestration of pleuropericardial cysts is safe and effective. This procedure can be performed under local anaesthesia in selected cases. The role of talc poudrage of the cysts is unclear and needs further investigation.

Gemcitabine and cisplatin as induction regimen for patients with biopsy-proven stage IIIA N2 non-small-cell lung cancer: a phase II study of the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group (EORTC 08955).

PURPOSE: Our objective was to better define the activity/feasibility of gemcitabine/cisplatin (GC) as induction chemotherapy in patients with stage IIIA N2 non-small-cell lung cancer (NSCLC) followed by surgery or radiotherapy within a large, ongoing comparative study (EORTC 08941). PATIENTS AND METHODS: Forty-seven chemotherapy-naive patients with NSCLC, median age of 58 years, stage IIIA N2 disease, World Health Organization performance status of 0 or 1, and the ability to tolerate a pneumonectomy received gemcitabine 1,000 mg/m(2) on days 1, 8, and 15 and cisplatin 100 mg/m(2) on day 2, every 4 weeks. Patients received induction chemotherapy (three cycles) before re-evaluation and randomization to surgery or radiotherapy. RESULTS: Grade 3/4 thrombocytopenia, the main hematologic toxicity, occurred in 60% of patients but was not associated with bleeding. Full-dose gemcitabine was given in 48% of the courses. Severe nonhematologic toxicity was uncommon. Two patients with preexisting, autoimmune pulmonary fibrosis had deterioration of pulmonary function after radiotherapy. Thirty-three (70.2%; 95% confidence interval, 55.1% to 82.7%) of the 47 eligible patients had objective responses (three complete responses and 30 partial responses). Mediastinal nodes were tumor-free after induction therapy in 53% of cases. Resections were considered complete in 71% of the patients who underwent thoracotomy after induction therapy. Median survival for all recruited patients (N = 53) was 18.9 months, with an estimated 1-year survival rate of 69%. CONCLUSION: In patients with N2 stage IIIA NSCLC, GC is a highly active and well-tolerated induction regimen. GC should be explored in combination with surgery or radiotherapy in stage I and II patients.

[Intracerebral tuberculomas in a pregnant Somalian woman]. / Intracerebrale tuberculomen bij een zwangere Somalische.

A pregnant Somalian woman aged 28 years, in the Netherlands for the last five years, suffered from a progressive hemiparesis, epilepsia, behavioural problems and low fever. Brain MRI showed multiple lesions with contrast enhancement. Extensive serologic and parasitologic tests on serum and cerebrospinal fluid did not disclose any cause. A brain biopsy revealed only necrosis, but bacterial culture and polymerase chain reaction (PCR) supplied the diagnosis of 'tuberculosis'. PCR on the cerebrospinal fluid remained negative. In the meantime the chest X-ray showed miliary tuberculosis and a spine MRI thoracic spondylodiscitis and a large paravertebral abscess. Subsequently the patient was treated successfully with tuberculostatic agents. Her healthy child which was born by caesarean section was treated with the tuberculostatic agents as well.

[Achlorhydria and stomach carcinoma]. / Achloorhydrie en maagcarcinoom.

Patients with achlorhydria are suspected to have an increased risk of developing gastric adenocarcinoma. However, in the literature the reported risk varies considerably. In The Netherlands no such data are available. The risk of developing gastric adenocarcinoma was investigated in 129 achlorhydric patients. During a mean observation period of 12.3 yrs gastric adenocarcinoma was diagnosed in six patients. The expected incidence was 1,275, calculated by making use of age, sex and calendar specific incidence and mortality rates of gastric cancer in the Dutch population. The relative risk to develop gastric cancer was 4.7 (95% confidence limits: 1.7-10.2; p less than 0.05). Despite a significantly increased risk, screening of achlorhydric patients for gastric cancer is not advised.

Benign clear cell tumour of the lung--intermediate filament typing as a tool in differential diagnosis.

A case of a benign clear cell ('sugar') tumour of the lung in a 61-year-old woman is presented. Characteristic routine histological features are provided and problems concerning differential diagnosis are discussed. Immunohistochemical stainings for the intracytoplasmatic intermediate filament proteins keratin and vimentin in our patient suggest a mesenchymal origin for this rare pulmonary neoplasm, and provide useful diagnostic aid in inconclusive cases.