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Background Concurrent pulmonary tuberculosis (TB) and lung cancer are rarely encountered in Western countries; however, it is more common in developing countries. We aim to share the diagnostic and treatment approaches in this study. Materials and Methods Clinical files of all patients undergoing lung resection for non-small cell carcinoma with concurrent pulmonary TB between February 2006 and December 2012 were investigated retrospectively in terms of patient characteristics, operation methods, definite pathology and stage of tumor, postoperative treatment schemes, and associated complications. Results TB was detected in 17 (1.3%) of 1,266 operated carcinoma patients. Eleven had squamous cell carcinoma and six had adenocarcinoma. Mean age was 54.9 years. Two patients received anti-TB treatment preoperatively. Fifteen patients were given anti-TB treatment postoperatively, as soon as definite microbiological confirmation was obtained, and concurrently given adjuvant therapy after 3 weeks of sole four-drug TB treatment. Pneumonectomy was performed in four (23.5%), sleeve lobectomy in three (17.6%), lobectomy in eight (47%), and bilobectomy in two (11.7%) patients. Postoperative complications occurred in four (23.5%) patients, with bronchopleural fistula being seen in only one pneumonectomy patient. No postoperative mortality or reactivation of TB was seen. Mean survival time was 32 ± 2 months. Conclusion Resection following a 3-week anti-TB treatment or concurrent anti-TB and postoperative adjuvant chemotherapy does not constitute an additional postoperative risk for patients with concomitant lung malignancy and pulmonary TB. The determination of optimum treatment for these patients presents a challenge in developing countries, where TB is still a common disease.
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Adenocarcinoma/cirugía , Antituberculosos/administración & dosificación , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía , Tuberculosis Pulmonar/tratamiento farmacológico , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma del Pulmón , Adulto , Anciano , Antituberculosos/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Esquema de Medicación , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neumonectomía/efectos adversos , Neumonectomía/métodos , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/microbiologíaRESUMEN
OBJECTIVE: Prolonged air leak remains as one of the most common complications after surgery for bullous lung disease. Reinforcement of the staple line with either prosthetic material or bovine pericardial strips has been advocated to avoid this problem. We used the patients' own parietal pleural layer to cover the staple lines to prevent air leak and subsequently assessed the comparative results. METHODS: A total of 22 patients underwent thoracotomy for bullous lung disease, mainly due to lobe-dominance bullae combined with emphysema, between November 2006 and November 2008. A case-control study was set from the surgical data of patients who were operated on using stapling devices without any buttressing material (group I=12) and were compared with the group of patients who were operated on using staplers buttressed with an autologous pleural layer (group II=10). Patient characteristics, chest-tube removal time and length of hospital stay were prospectively recorded in group II. The outcomes of the two groups were analysed based on postoperative complications, chest-tube removal time and postoperative length of hospital stay. RESULTS: There was no statistically significant difference between both the groups in preoperative characteristics including age, sex, co-morbid factors, and respiratory functions, heterogeneity of emphysema, intra-operative adhesion density and length of staple line. However, the chest tube was removed significantly earlier in patients whose bullae were resected by stapling devices buttressed with autologous-parietal pleura (p=0.04). CONCLUSIONS: Autologous pleural reinforcement of the staple line in surgery for bullous lung disease is a safe, effective and cost-free procedure that precipitates the early removal of the chest tube.
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Enfermedades Pulmonares/cirugía , Pleura/trasplante , Neumonectomía/métodos , Grapado Quirúrgico/métodos , Adulto , Aire , Vesícula/cirugía , Tubos Torácicos , Métodos Epidemiológicos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neumonectomía/efectos adversos , Cuidados Posoperatorios/métodos , Enfisema Pulmonar/cirugía , Resultado del TratamientoRESUMEN
The aim of this study was to perform a prospective evaluation of the effectiveness of computed tomography (CT)-guided transthoracic fine needle aspiration (TFNA) in the diagnosis of pulmonary lesions and to determine the complication rate of this procedure. A prospective review was conducted of 134 patients who underwent CT-guided TFNA at our center between December 2003 and August 2005. All fine needle aspirations were performed with a 22-gauge single-pass Chiba needle under CT guidance. The biopsies were performed by one pulmonologist. Two hundred twenty two (91%) malignant lesions and 12 (9%) benign lesions were reviewed in the present study. An accurate diagnosis was made in 107 (88%) of the 122 malignant lung lesions and a specific diagnosis was obtained in 42% of the benign lesions. The sensitivity of TFNAs for the detection of malignancy was 83%, and the overall accuracy of TFNA for diagnosing malignancy was 84%. Pneumothorax occurred in 22 of the 134 patients (16%). Pneumothorax was more frequently observed in centrally located lesions (p= 0.001). Our results suggest that CT-guided TFNA has a high diagnostic accuracy and an acceptable rate of complications. Moreover, we suggest that the most important factor increasing the risk of pneumothorax is an increase in the depth of aerated lung traversed for sampling.
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Biopsia con Aguja Fina , Enfermedades Pulmonares/patología , Neoplasias Pulmonares/patología , Pulmón/patología , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina/efectos adversos , Biopsia con Aguja Fina/métodos , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Cirugía Asistida por Computador , Adulto JovenRESUMEN
A 30-year-old man patient was admitted to our clinic with complaints including cough, dyspnea, and chest pain. He had been diagnosed with pulmonary Langerhans' cell histiocytosis (LCH) 9 years previously. HRCT of the thorax demonstrated the presence of diffuse emphysematous areas in both lungs with a honeycomb appearance, an increase in reticular density at the lower lobes, a mass lesion in the left hilus, and a mass lesion at the lower lobe of the left lung. Histological diagnosis of TBNA from the right lower paratracheal and subcarinal lymph nodes was adenocarcinoma. Chemotherapy was begun, but the patient died due to respiratory failure after two courses of chemotherapy. We present this case as an example of the rare development of bronchogenic carcinoma during the long-term course of LCH.
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Adenocarcinoma/etiología , Histiocitosis de Células de Langerhans/complicaciones , Neoplasias Pulmonares/etiología , Adenocarcinoma/diagnóstico , Adenocarcinoma/tratamiento farmacológico , Adulto , Progresión de la Enfermedad , Quimioterapia , Resultado Fatal , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamiento farmacológico , MasculinoRESUMEN
OBJECTIVE: To evaluate the diagnostic contribution and utility of bacteriologic surveys using bronchoscopic washing and gastric lavage in cases of radiologically suspected tuberculosis with no detectable acid-fast bacilli (AFB) in the sputum. MATERIAL AND METHODS: This prospective study performed bronchoscopic lavage following gastric washing in suspected pulmonary tuberculosis patients. The presence of AFB was determined via direct microscopy and materials were cultured in Löwenstein-Jensen medium. RESULTS: Thirty-eight consecutive patients were enrolled in the study (30 males and 8 females; mean age, 33.8 +/- 10.9 years). Three patients could not give sputum. In 23 of 35 cases (66%), sputum cultures (SC) were positive. In 17 cases (49%), gastric lavage cultures (GLC) were positive. Eighteen cases (55%) had positive bronchoscopic washing cultures (BWC). No statistically significant difference was observed when SC positivity was compared to GLC and BWC, and no difference was observed when the GLC results were compared with BWC. Tuberculosis was confirmed in 30 of 38 (79%) patients when SC and GLC were evaluated together, in 33 of 38 patients (87%) when SC and BWC were evaluated together, and in 36 of 38 (95%) when SC, GLC, and BWC were evaluated together (P = 0.016, P = 0.002, and P = 0.0001, respectively). The increase in positive cultures was statistically significant when gastric lavage was evaluated together with bronchoscopic washing (P = 0.004). CONCLUSION: Adding gastric lavage and bronchial washing to sputum culture could increase culture positivity for M tuberculosis bacilli in suspected pulmonary tuberculosis patients with AFB-negative sputum smears.
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Lavado Broncoalveolar , Broncoscopía/métodos , Lavado Gástrico , Tuberculosis Pulmonar/diagnóstico , Adulto , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Estudios Prospectivos , Esputo/microbiologíaRESUMEN
Primary tumors of the trachea are rare and can be missed because of the paucity of symptoms and findings and the difficulty in detecting them with chest radiographs. A 31-year-old male patient was admitted with complaints of shortness of breath, coughing, phlegm, and blood in the sputum. He stated that he was being treated for chronic obstructive pulmonary disease. Fiberoptic bronchoscopy revealed a vegetative mass with a wide base on the posterolateral wall of the distal one-third of the trachea. Postoperative histopathological examination revealed a typical carcinoid tumor. In patients with an unexplained cough, dyspnea, infrequent hemoptysis, and normal pulmonary imaging findings, tracheal carcinoma should be suspected. In such cases, early thoracic computed tomography and bronchoscopic examination can provide a rapid diagnosis and treatment options and prevent a false diagnosis.
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Tumor Carcinoide/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Neoplasias de la Tráquea/diagnóstico , Adulto , Broncoscopía , Tumor Carcinoide/diagnóstico por imagen , Tumor Carcinoide/fisiopatología , Tumor Carcinoide/cirugía , Diagnóstico Diferencial , Disnea/etiología , Hemoptisis/etiología , Humanos , Masculino , Pruebas de Función Respiratoria , Tomografía Computarizada por Rayos X , Tráquea/diagnóstico por imagen , Neoplasias de la Tráquea/diagnóstico por imagen , Neoplasias de la Tráquea/fisiopatología , Neoplasias de la Tráquea/cirugíaRESUMEN
Multiple myeloma (MM) is a rare disorder that affects all tissues, except reticuloendothelial tissues, and seldom causes a myelomatous pleural effusion. A 56-year-old male patient attended our clinic complaining of shortness of breath and fatigue for the past month. A posteroanterior chest radiograph revealed a left pleural effusion, which was subsequently assessed as being exudative in nature. Protein electrophoresis demonstrated hypergammaglobulinemia. Serum and pleural fluid immunofixation electrophoresis showed an increase in the IgG and kappa fractions. The Bence-Jones protein level in the 24-hours urine was high. Pleural biopsy showed plasmocyte infiltration. Bone marrow biopsy revealed atypical plasma cell infiltration, some with immature morphology, carrying IgG/Kappa clonality in a diffuse pattern. The patient was diagnosed with IgG/k type MM and underwent chemotherapy with vincristine, doxorubicin, and prednisolone. Complete regression of the pleural effusion was achieved after one round of chemotherapy, and the patient has been followed for 18 months.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Mieloma Múltiple/diagnóstico , Derrame Pleural/diagnóstico , Proteína de Bence Jones/metabolismo , Proteína de Bence Jones/orina , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Mieloma Múltiple/patología , Derrame Pleural/etiología , Derrame Pleural/patología , Inducción de Remisión , Resultado del TratamientoRESUMEN
Aim of our study was to investigate the sensitivity of transbronchial needle aspiration (TBNA) and its contributions to conventional diagnostic methods (CDM) in the endobronchial lesions of the patients who underwent TBNA during fiberoptic bronchoscopy (FOB) and had final diagnosis of lung cancer. Bronchoscopy records of 1194 patients, who underwent FOB for uncertain lung cancer in our clinic, were reviewed retrospectively. Eighty-one patients with final histopathological diagnosis of primary lung cancer who underwent TBNA, were included to study. Endobronchial lesions were divided into three groups as endobronchial mass, submucosal lesions and peribronchial diseases. Other CDMs performed during bronchoscopy such as forceps biopsy, bronchial brushing and bronchial lavage were also recorded. Sixty-six (82%) of 81 patients were diagnosed by means of FOB. Remaining 15 (18%) patients were diagnosed by means of other methods than FOB. The diagnostic successes of TBNA and CDMs alone and together, were compared according to the types, locations and histopathological types of the lesions. By the addition of TBNA to CDMs, histopathological diagnosis was made in 17 (21%) additional patients and diagnostic sensitivity of bronchoscopy was increased from 60% to 82% (p= 0.001). By the addition of TBNA to CDMs, a statistically significant increase in the sensitivity in the submucosal lesion group was observed (p= 0.008). By the addition of TBNA to CDMs, diagnostic success was increased from 52% to 76% in the non-small cell lung cancer group and from 81% to 95% in the small cell lung cancer group (p= 0.001 and p= 0.250, respectively). Although the diagnostic success was increased in all localizations by the addition of TBNA to CDMs, statistically significant increase was observed only for the lesions located at trachea and the main bronchi (p= 0.008). Joining TBNA to CDMs, especially for the submucosal lesions, may improve the diagnostic success of bronchoscopy.
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Biopsia con Aguja Fina , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Células Pequeñas/patología , Neoplasias Pulmonares/patología , Bronquios/patología , Lavado Broncoalveolar , Broncoscopía , Femenino , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Castleman disease is a reactive lymph node hyperplasia of unknown origin that often involving the thorax although it may involve all parts of the body. It is usually seen in young adults and presents an asymptomatic course. It is usually located to anterior and middle mediastinum. Pemphigus vulgaris is a bullous skin disease in which immune mechanisms take place in the pathogenesis. Mouth and oropharynx are the most commonly involved structures. IgG antibodies against the epidermal intracellular structures are essential in the diagnosis. We have wanted to discuss a 28 years old female with the literature review since the association between pemphigus vulgaris and Castleman's disease is rare.
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Enfermedad de Castleman/diagnóstico , Adulto , Enfermedad de Castleman/diagnóstico por imagen , Enfermedad de Castleman/patología , Enfermedad de Castleman/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Pénfigo/diagnóstico , Pénfigo/patología , Toracotomía , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The aim of this study was to determine the incidence and diagnostic features of pleural manifestations of pulmonary hydatid disease. METHODOLOGY: Patients with pleural pathology in association with surgery for pulmonary hydatid disease over an 8-year period were evaluated. RESULTS: Twenty-nine (6%) of 474 patients with histologically confirmed pulmonary hydatid disease had pleural abnormalities. The diagnosis was determined preoperatively in 22 patients and was based on radiographic, clinical, and/or serology findings. Bronchoscopic specimens were diagnostic in two of seven patients who had bronchoscopy. Five patients were not diagnosed until surgery. Radiographic abnormalities consisted of pleural thickening and/or free fluid without intrapleural rupture of the cysts in 21 patients. Eight patients had a hydropneumothorax. Sixteen patients had an exudative, uncomplicated effusion. The remaining patients had empyemas. All patients had resection of the pulmonary cysts, and 20 also underwent a pleurectomy. The mean length of hospital stay was 23 +/- 14 days. There was no hospital mortality. CONCLUSION: Pleural lesions associated with pulmonary hydatid disease are rare and have a variable radiographic appearance. In regions in which echinococcal disease is endemic, a high level of clinical suspicion is necessary for diagnosis and appropriate management of this condition.