[Show abstract][Hide abstract] ABSTRACT: Ductal adenocarcinoma of the pancreas is a lethal disease. Surgical extirpation only offers the slim chance for long-term survival in localized disease. We report on a 73 year old female patient who initially underwent successful resection of pancreatic adenocarcinoma in May 2005. She was treated with adjuvant chemotherapy with gemcitabine. In October 2010 the patient noticed increasing dyspnea with haemoptysis. She was soon referred to our center. After the diagnosis of pulmonary adenocarcinoma with widespread metastasis, she was treated with systemic chemotherapy. For a period of next three years, she was treated with different chemotherapy regimens due to repeated episodes of tumor progression. To the best of our knowledge after reviewing the literature, this case represents an unusually clinical course with metachronous pulmonary adenocarcinoma arising after treatment of a primary pancreatic cancer after a long latency period.
Case reports in oncological medicine. 01/2014; 2014:841907.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: To identify dose-volume parameters predictive for severity of acute esophagitis (CTC > grade 2) in locally-advanced non small-cell lung cancer (LA-NSCLC) patients treated with neoadjuvant concurrent hyperfractionated-accelerated chemoradiotherapy (HA-CRT) a retrospective analysis was performed. 88 patients were treated with HA-CRT followed by radical surgery. Predictive power of absolute oesophageal length, absolute and relative oesophageal volume included in the 95%-isodose, patient- and tumor-related factors for severity of acute esophagitis was assessed. FINDINGS: A total of 82 patients (93%) developed radiation-induced acute esophagitis. Grade 1 was documented in 1 (1%), grade 2 in 55 (67%), grade 3 in 23 (28%) and grade 4 in 3 (4%) patients, respectively. Absolute oesophageal volume included in the 95%-isodose (42.8 Gy) achieved 13.5 cm3 (range: 3 -- 29 cm3). Of the tested variables in univariate analysis, absolute oesophageal volume included in the 95%-Isodose was found to be the only significant variable (p = 0.03) predicting severe acute esophagitis (CTC > grade 2). For this volume a gradation scale of the likelihood of severity was built. CONCLUSION: Increase of absolute oesophageal volume included in the 95%-isodose correlates with severity of acute esophagitis in LA-NSCLC patients treated with neo-adjuvant concurrent HA-CRT.
[Show abstract][Hide abstract] ABSTRACT: Soft tissue tumors originating within the endobronchial tree are extremely rare and most of them correspond to lipomas or leiomyomas. We here report a rare clinical presentation of leiomyosarcoma mimicking glomus tumor at initial biopsy arising from the left main bronchial trunk leading to left lower lobe atelectasis. Primary leiomyosarcoma of the lung is an unusual malignancy. Among this entity, the endobronchial form is very rare and the preoperative diagnosis is extremely difficult. We documented two different presentations and outcomes of primary endobronchial leiomyosarcoma of the lung. In this clinical presentation, histological study and immunohistochemical stain of the surgical resection provided the final diagnosis. Through the following we present the diagnostic and therapeutic difficulties encountered with endobronchial leiomyosarcoma.
Irish Journal of Medical Science 05/2013; · 0.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 30-year old woman was referred to our center because of suspicion of a primary lung tumor of the right upper lobe. Histological examination of the lung lesion revealed lung metastasis of a previously treated alveolar soft part sarcoma of the musculus vastus medialis of the right femur, which was resected 20 years ago. Alveolar soft-part sarcoma is a rare malignant tumor that occurs most often in the soft tissue of lower limbs. It is a slow-growing malignant soft tissue tumor arising in muscle tissue, usually in young adults. Due to pleural and extensive mediastinal infiltration with bilateral lung metastases, a systemic treatment with chemotherapy doxorubicin and ifosfamide was initiated. Late metastases from previously treated alveolar part sarcoma should be considered in patients with suspicious lung lesions even if surgical treatment was performed a long time ago.
Case reports in oncological medicine. 01/2013; 2013:690520.
[Show abstract][Hide abstract] ABSTRACT: Introduction. Pleural mesothelioma with metastasis to the subcutaneous tissue of the abdominal wall at first diagnosis and without penetration into the peritoneum is an extremely rare clinical presentation. Methods. Patients with pleural mesothelioma have low survival rate. Usually, the disease at presentation is confined to its site of origin (most often the pleural cavity). A 55-year-old man was referred to our center due to increasing dyspnea and a painful periumbilical mass in the anterior abdominal wall. CT scan revealed both advanced mesothelioma of the pleura and a tumor mass confined to the subcutaneous fatty tissue without penetration through the peritoneum. Results. Video-assisted thoracoscopy confirmed the diagnosis of epithelioid pleural mesothelioma, which was also confirmed by a biopsy of the periumbilical mass. Systemic chemotherapy with cisplatin and pemetrexed was initiated. Under the ongoing systemic chemotherapy, the evaluation revealed partial remission of pleura mesothelioma and its subcutaneous manifestation of the abdominal wall. Conclusion. Mesothelioma of the pleura with a simultaneous metastasis to the subcutaneous fatty tissue of the abdominal wall at presentation without penetration of peritoneum is a rare clinical presentation of mesothelioma disease. The knowledge of its natural history is very limited. This is the first ever clinical documentation of a patient with pleura mesothelioma and simultaneous subcutaneous manifestation of abdominal wall.
Case reports in oncological medicine. 01/2013; 2013:198729.
[Show abstract][Hide abstract] ABSTRACT: Patient prognosis in lung cancer largely depends on early diagnosis. The exhaled breath of patients may represent the ideal specimen for future lung cancer screening. However, the clinical applicability of current diagnostic sensor technologies based on signal pattern analysis remains incalculable due to their inability to identify a clear target. To test the robustness of the presence of a so far unknown volatile organic compound in the breath of patients with lung cancer, sniffer dogs were applied. Exhalation samples of 220 volunteers (healthy individuals, confirmed lung cancer or chronic obstructive pulmonary disease (COPD)) were presented to sniffer dogs following a rigid scientific protocol. Patient history, drug administration and clinicopathological data were analysed to identify potential bias or confounders. Lung cancer was identified with an overall sensitivity of 71% and a specificity of 93%. Lung cancer detection was independent from COPD and the presence of tobacco smoke and food odours. Logistic regression identified two drugs as potential confounders. It must be assumed that a robust and specific volatile organic compound (or pattern) is present in the breath of patients with lung cancer. Additional research efforts are required to overcome the current technical limitations of electronic sensor technologies to engineer a clinically applicable screening tool.
European Respiratory Journal 08/2011; 39(3):669-76. · 6.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare clinical pathological syndrome. There have been only 49 cases of DIPNECH reported in the literature so far. We report a case of a 69-year-old nonsmoking man with a 7-year follow-up.
The initial CT scan from December 2003 showed persistent nonspecific bilateral reticulonodular infiltrates. In January 2004, the patient underwent a video-assisted thoracoscopic wedge resection of his right lower lobe for further diagnostic workup. Pathology of the resected wedge of the right lower lobe revealed a diffuse idiopathic pulmonary cell hyperplasia (DIPNECH) highlighted by staining for the neuroendocrine typical carcinoid markers, such as marker CD 56.
All the performed CT scans over a 7-year period showed no progression of the bilateral pulmonary lesion. The bilateral pulmonary nodules were stable in terms of size, number and form. The yearly control with chest CT scans will be continued.
The neuroendocrine cell hyperplasia is confined to the airway mucosa without penetration through the basement membrane and appears in a diffuse pattern, generally in close association with obliterative bronchiolar fibrosis. DIPNECH is characterized by a mixed obstructive and/or restrictive ventilation pattern with bilateral reticulonodular infiltrates and a predilection for middle-aged women. Little is known about the clinical course and treatment for DIPNECH.
Journal of Cancer Research and Clinical Oncology 08/2011; 137(10):1495-8. · 2.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bronchopulmonary aspergillosis is becoming more frequent, is often hard to diagnose and with today's antimycotics better to treat than before. It is therefore of current interest. This also concerns bronchial aspergillosis which is less common than pulmonary aspergillosis and the topic of this paper. A total of 39 patients with bronchial aspergillosis are presented: 1) 4 cases with endobronchial aspergilla, two which are visual bronchoscopically, 2) one case with chronic necrotising pulmonary aspergillosis (CNPA), where a bronchus has necrotised, 3) an invasive aspergillosis in the region of a bronchial anastomosis, 4) 7 cases with an Aspergillus invasion from endobronchial tumour tissue and 5) 26 cases with allergic bronchopulmonary aspergillosis (ABPA). 37 of the 39 cases are part of a single centre study with a total of 116 bronchopulmonary aspergilloses, which were collected over seven years. The focus of attention in this paper is on the bronchoscopic and radiological results.
[Show abstract][Hide abstract] ABSTRACT: Purpose: This case is only the third case of the Sialadenoma papilliferum of the bronchial system. This is a extremely rare tumor of the bronchial system. This report highlights once again the histo-pathological difficulties of diagnosing such a rare tumor.Patients and methods: A 53 year old woman with a 3 weeks history of a productive cough associated with hemoptysis presented to the Community hospital Stuttgart (Teaching Hospital of the University of Tübingen). A thoracic CT revealed a solid mass in the right lower lobe with 10 mm diameter. In the community hospital a bronchoscopic biopsy was suspicious for an adenocarcinoma of the lung.Result: The patient was transferred to our institution for thoracic surgery and a right lower bilobectomy with semicircular intrapericardial vessel resection and total nodal resection was performed. By immune-histochemical analysis, the removed tumor (size 10 mm) revealed to be a benign adenoma from the seromucosal bronchial glands, which is a very rare benign tumor of the Sialadenoma papilliferum type. All of the removed lymph nodes were analyzed and showed no signs of malignancy.Conclusion: At present there have been reported only two cases of the pulmonary Sialadenoma papilliferum in the literature. This case report represents the first case of pulmonary Sialadenoma papilliferum in Germany and western Europe. The biologic behavior of this tumor still remains unknown.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Pulmonary aspergillosis is a devastating complication in immunocompromised patients. Timing of surgery is controversial and depends on the patients' general condition.Methods: From 2000 to 2007, 16 patients (mean age 47 years, range 20-64) underwent surgery for pulmonary aspergillosis. All patients were receiving immunosuppressive drugs due to chemotherapy of hematological malignancies, ten with additional bone marrow or stem cell transplantation. Perioperatively, aspergillosis was treated with antifungal agents. If granulocyte numbers in the peripheral blood was below 1.0x10(9)/l, granulocyte stimulating factor and granulocyte transfusions were administered perioperatively.Results: Four patients underwent lobectomy and wedge resections of the same lung, one patient bilobectomy, two patients lobectomy, eight patients wedge resections of one lung, and one patient wedge resections of both lungs. All patients survived surgery without major complications. Five patients were bone marrow or stem cell transplanted 1, 2, 3, 7 and 10 months after surgery. Three of them died due to recurrence of the underlying malignancy. All other patients are alive and free of fungal disease.Conclusions: Timing of surgery in the context of antifungal therapy and adequate numbers of granulocytes and platelets in the peripheral blood appear essential for successful surgical therapy and avoidance of major complications.
[Show abstract][Hide abstract] ABSTRACT: Summary The lung has not been suitable for ultrasonic investigation, because of the presence of air. Since we achieved good in vitro results on atelectatic pulmonary tissue, we have applied ultrasonography for the localization of intra-pulmonary tumours in video-assisted thoracoscopic resections. Four different probes were tested. In nine out of 10 cases peripherally and centrally located tumours could be identified and thoracoscopically resected. In one case it was not possible to deflate the lung sufficiently. The sonic intensity of the probes was between 5 and 7.5 MHz. Both frequencies are ideal for locating the tumours. Intrathoracic manipulation of the probes still poses a problem. We have now constructed a casing for the ultrasonic probe which can be controlled extrathoracically. Resection of peripheral tumours, about 50% of which are benign, is already a domain of thoracoscopic surgery. However, approximately 40% of these tumours cannot be localized and thoracoscopically removed using the usual instruments. We demonstrate that thoracoscopic resection is possible for the majority of these tumours with the use of intrathoracic ultrasound.
[Show abstract][Hide abstract] ABSTRACT: Summary A total of 41 cases (11 female, 30 male) for non-malignant spontaneous pneumothorax received thoracoscopic surgery between March 1991 and April 1994. All patients entered a prospective trial. Five conversions to an open procedure were necessary. Of the remaining 36 cases, 30 received thoracoscopic bulla resection and 35 pleurodesis. No patients were lost during the median follow-up period of 24.2 months (minimum 9.7 months). Two partial relapses (5.6%) were noticed. A striking high incidence of sensory loss of the chest wall or pain was observed after coagulation of the parietal pleura or pleur-ectomy (15 out of 33, 45.5%). Severe pain was experienced by only one patient after coagulation (5.5%) compared to four after pleurectomy (26.6%). All three patients without these procedures were free of these complications. An increased recurrence rate may be assumed for cases without any visible changes or with disseminated bullae. After an entire resection of circumscribed bullous changes, additional pleurodesis, with its specific complications, may be an overtreatment. Complications that exceed those of tube drainage treatment limit a more liberal indication for video-thoracoscopic treatment of spontaneous pneumothorax.