Routine practical contribution of innovations with 2015 world health organization classification in the diagnosis of large cell lung carcinoma

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 1 7 10.26663/cts.2019.0001 67 article Routine practical contribution of innovations with 2015 world health organization classification in the diagnosis of large cell lung carcinoma Funda Incekara 1 Gokturk Findik 1 Ebru Guven Sayilir 1 Koray Aydogdu 1 Mustafa Sevki Demiroz 1 Funda Demirag 2 Hakan Nomenoglu 1 Selim Sakir Erkmen Gülhan 1 Abdullah İrfan Tastepe 3 Sadi Kaya 1 Department of Thoracic Surgery, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyDepartment of Pathology, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyDepartment of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, TurkeyBackground: Large-cell lung carcinoma (LCLC) is a relatively aggressive tumor and constitutes a small proportion of non-small-cell lung carcinoma (NSCLC). The purpose of this study was to investigate the clinicopathological characteristics of LCLC and reclassify patients according to the 2015 World Health Organization (WHO) criteria to improve the diagnosis rate of LCLC. Materials and Methods: The clinicopathological data of 32 patients who were diagnosed as LCLC in our clinic between January 1999 and December 2016 and underwent surgery were retrospectively investigated. The 32 patients with LCLC accounted for 1.6% of the total 1935 patients who were diagnosed as having pulmonary cancer during the corresponding time period at our institution. Results: There were 30 males and 2 females with a mean age of 56.4 (range, 39-76) years. The ratio of smoking / non-smoking patients was 22/32 (68.7%). Based on the new definition of LCLC, a total of 32 patients with LCLC were detected. 16 patients with null immunohistochemical features, 12 with no stains available, and 4 with unclear immunohistochemical features. Our 1, 3, and 5-year survival rates were 65.6%, 53.1%, and 46.9%, respectively. Conclusions: According to the new classification, formerly diagnosed LCLCs were mostly reclassified as adenocarcinoma and non-keratinizing squamous cell carcinoma. LCLC, which became a more homogeneous group with the 2015 WHO classification, may significantly benefit from multimodal treatment with surgery. https://cts.tgcd.org.tr/pdf.php?id=67 large-cell carcinomasurgerychemotherapyradiotherapy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 8 12 10.26663/cts.2019.0002 68 article The effect of polyglycolic acid mesh application in tracheal anastomoses on pressure and tensile strength: an ex vivo experimental study Ali Kılıcgün 1 Yusuf Özgür Biçer 2 Ali Cevat Kutluk 3 Sinan Seyhan 2 Serap Köybaşı Sanal 2 Department of Thoracic Surgery, Abant İzzet Baysal University, Medical School, Bolu, TurkeyDepartment of Head and Neck Surgery, Abant Izzet Baysal University, Medical School, Bolu, TurkeyDepartment of Thoracic Surgery, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, İstanbul, TurkeyBackground: This study aims to investigate the effect of polyglycolic acid (PGA) mesh application in tracheal anastomosis on the air-leakage and tension resistance. Materials and Methods: Tracheae were collected from freshly slaughtered healthy sheep weighing 25-30 kg (2-3 years old) that were acquired from the local slaughterhouse. Twenty-eight tracheae were transported to the laboratory within an hour of slaughter and then dissected to remove the esophagus before obtaining 20-cm long tracheae. All tracheae were transected at the midpoint. In Groups 1 and 2, the transected tracheae were anastomosed by using interrupted 3-0 Vicryl sutures. In Groups 3 and 4, after anastomosing the transected tracheae with interrupted 3-0 Vicryl, the sites of anastomosis were reinforced by using Polyglycolic acid mesh. Groups 1 and 3 were tested for tensile strength, while Groups 2 and 4 were tested for pressure resistance. Results: The median pressure was 49.00 ± 7.47 mmHg in the group anastomosed with only Vicryl, whereas it was measured as 70 ± 13.49 mmHg in the group on which the anastomoses were reinforced with PGA mesh. The median force needed to break anastomoses were 166.40 ± 24.28 Newton in the Vicryl-only group and 136.80 ± 34.93 newton in the PGA- reinforced group. The difference between the pressure resistance values of the Vicryl-only group and the PGA reinforced group was significant (p = 0.006). However, the difference with regard to the tensile strength was insignificant (p = 0.201). Conclusion: We found that the reinforcement of the anastomosis site with polyglycolic acid mesh significantly increases the pressure resistance but does not significantly affect tensile strength. https://cts.tgcd.org.tr/pdf.php?id=68 tracheaanastomosespolyglycolic acid eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 13 20 10.26663/cts.2019.0003 69 article The role of fluids in postpneumonectomic pulmonary edema: an experimental study Murat Akkuş 1 Ali Cevat Kutluk 2 Department of Thoracic Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Yedikule Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyBackground: The role of fluids in the etiology of postpneumonectomy pulmonary edema (PPE) is controversial. The aim of this experimental study was to assess the effect of crystalloid or colloid fluids and normal or high volume on the etiology of PPE. Materials and Methods: 20 New Zealand rabbits were used and divided into 4 groups. Pneumonectomy had performed firstly in each subject, then for 3 hours, normal and high volume of crystalloid and colloid fluids were administered. The first group were administered 3 ml/kg/h crystalloid (0.9% NaCl), the second group received 10 ml/kg/h of the same crystalloid, the third group were administered 3 ml/ kg/h colloid (6% HES/0.7) and the fourth group received 10 ml/kg/h of the same colloid infusion. Pneumonectomy and remaining lung materials were weighed when wet and dry and pathologic investigation was performed with a light microscopy. Results: There was no significant difference between the preoperative and postoperative wet/dry ratio (W/DR) of pneumonectomy and remaining lung material in all groups administered crystalloid and colloid (1st Group Z = 0.707; p = 0.480, 2nd Group Z = 0.577; p = 0.564, 3rd Group Z = 0.577; p = 0.564, 4th Group Z = 0.677; p = 0.498). There was no significant difference identified between pneumonectomy material W/DR for all crystalloid and colloid groups (x2 = 2.787; p = 0.426) and again between the remaining lung material W/DR (x2 = 2.858; p = 0.414). The histopathologic assessments of all groups were similar. Conclusion: Administration of crystalloid or colloid fluids at normal or high volume was assessed not be responsible alone for the PPE etiology in subjects with normal cardiac function. Histopathologic findings were similar in all groups. https://cts.tgcd.org.tr/pdf.php?id=69 pulmonary edemapneumonectomy complicationspulmonary resection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 21 25 10.26663/cts.2019.0004 70 article Is delayed puberty a new etiological factor for primary spontaneous pneumothorax? Tevfik Ilker Akcam 1 Sukran Darcan 2 Ali Ozdil 1 Onder Kavurmaci 1 Ayse Gul Ergonul 1 Kutsal Turhan 1 Alpaslan Cakan 1 Ufuk Cagirici 1 Department of Thoracic Surgery, Ege University, School of Medicine, Izmir, TurkeyDepartment of Pediatric Endocrinology, Ege University, School of Medicine, Izmir, TurkeyBackground: Although the etiology of primer spontaneous pneumothorax (PSP) is not exactly understood, it has been suggested to be associated with rupture of bulla/bleb formations at the lung apices in thin, tall, young adults. In this study, we aim to evaluate whether delayed puberty is a new etiological factor for PSP. Materials and Methods: A total of 91 patients who were treated for PSP in our clinic between January 2013 and September 2016 and who were scheduled for a follow-up visit by phone call and underwent pubertal-stage assessment were retrospectively analyzed. Results: Of all patients, 10 (12.1%) were females and 81 (87.9%) were males. The mean age was 25.90 ± 6.83 (range, 17 to 38) years and the mean height was 178.90 ± 7.6 (range, 161 to 197) cm. The mean age at menarche of female patients was 14.20 ± 1.31 (range, 12 to 17) years. The women had a late age at menarche compared to the overall Turkish female population (p < 0.0001). The mean age for the development of facial hairs in the men was 16.63 ± 1.69 (range, 13 to 22) years, showing a later age, compared to the overall Turkish male population (p < 0.0001). Conclusion: Our study results showed that the patients with pneumothorax had an advanced age at puberty, compared to the normal overall population, and that the pubertal growth spurt occurred within a short period of time. This condition is also suggested to have an effect on the lung maturity and the development of pneumothorax. https://cts.tgcd.org.tr/pdf.php?id=70 primer spontaneous pneumothoraxpubertal growthlung maturity eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 26 33 10.26663/cts.2019.0005 71 article Is intercostal nerve protection necessary and safe technique for postthoracotomy pain? Celal Bugra Sezen 1 Cemal Aker 1 Anil Gokce 2 Cem Emrah Kalafat 1 Suleyman Anıl Akboga 2 Muhammet Sayan 2 Ali Celik 2 Abdullah Irfan Tastepe 2 Department of Thoracic Surgery,Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, TurkeyDepartment of Thoracic Surgery, Gazi University, School of Medicine, Ankara, TurkeyBackground: Our objective in this study was to prospectively evaluate the effects of conventional closure techniques, intracostal suture, and intercostal nerve preservation on postoperative morbidity and longterm pain management. Materials and Methods: This prospective study was conducted between 2012 and 2015. Three different closure techniques were applied to patients who underwent posterolateral thoracotomy: conventional suture technique, intracostal suture technique, and intracostal suture technique with intercostal nerve preservation. Early postoperative pain level was assessed using a visual analog scale; pain at postoperative six months was assessed with the LANNS pain scale. Results: Seventy-three male patients (82%) and 16 (18%) female patients were included in the study. Suturing time differed significantly between the groups. At postoperative day 0, 1, and 2, there were significant differences between the groups in pain scores when at rest and while coughing (p < 0.001). Complications occurred in 22 patients (24.7%). There were no significant differences in complications between the groups (p = 0.603). Chronic pain at postoperative six months was more prevalent in group A compared to groups B and C (p < 0.05). Conclusion: Compared to the conventional technique, the intracostal suture technique with intercostal muscle flap is yields better outcomes in terms of early and chronic postoperative pain. https://cts.tgcd.org.tr/pdf.php?id=71 painchronic painthoracotomyintercostal nerve eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 34 41 10.26663/cts.2019.0006 72 article Primary sarcomas of the lung: report of five cases and review of the literature Makbule Ergin 1 Hakan Keskin 1 Abdullah Erdogan 1 Department of Thoracic Surgery, School of Medicine, Akdeniz University, Antalya, Turkey Case Report CorrespondingPrimary pulmonary sarcomas of the lung are rare tumors with a low incidence. We reviewed the literature and analyzed 5 patients retrospectively. All clinical datas and therapeutic protocols were recorded. The required surgical procedure was lobectomy in 4 patients and diagnostic broncoscopy and mediastinoscopy in one patient. At histological examination; 2 carcinosarcoma, 1 undifferentiated pleomorphic sarcoma, 1 leiomyosarcoma and 1 synovial sarcoma diagnosed. Primary sarcomas of the lung cannot be differentieted from more common tumors of the lung tumors clinically. Early diagnosis and complete surgical resection is critical for prognosis. https://cts.tgcd.org.tr/pdf.php?id=72 carcinosarcomaleiomyosarcomasarcomasynovial sarcoma eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 42 45 10.26663/cts.2019.0007 73 article A rare lung tumor: pulmonary carcinosarcoma Murat Kara 1 Berker Özkan 1 Berk Çimenoğlu 1 Fahmin Amirov 1 Yasemin Özlük 2 Department of Thoracic Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, TurkeyDepartment of Pathology, Istanbul University, Istanbul Medical Faculty, Istanbul, TurkeyPulmonary sarcomatoid carcinoma is an extremely rare malignant lung tumor with an unfavorable prognosis, which shows carcinomatous and sarcomatous components. We present a case of 78-year-old patient with a middle lobe tumor who underwent a bronchial sleeve middle lobectomy. The tumor was a carcinosarcoma with squamous cell carcinoma and rhabdomyosarcoma components histologically. We tried to emphasize this extreme lung tumor and its clinicopathological features. https://cts.tgcd.org.tr/pdf.php?id=73 pulmonary carcinosarcomasurgeryresection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 46 48 10.26663/cts.2019.0008 74 article Poland’s anomaly with contralateral spontaneous pneumothorax: is this a coincidence? Güntuğ Batıhan 1 Kenan Can Ceylan 1 Şeyda Örs Kaya 1 Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, University of Health Sciences, Izmir, TurkeyPoland’s syndrome is a rare developmental anomaly characterized by absence of pectoralis major muscle and presence of ipsilateral hand abnormalities (mostly syndactyly). Numerous malformations as a component of this syndrome was defined in literature such as congenital heart diseases, upper limb anomalies and pulmonary or renal hypoplasia. The incidence of Poland’s syndrome ranges from 1 in 7,000 to 1 in 100,000 live births. Here we describe a rare case of patient with Poland’s syndrome with contralateral spontaneous pneumothorax. https://cts.tgcd.org.tr/pdf.php?id=74 Poland’s anomalypneumothoraxcongenital malformation eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 49 51 10.26663/cts.2019.0009 75 article A rare case: extramedullary plasmacytoma of the mediastinum Yiğit Yılmaz 1 Mesut Melih Özercan 1 Burcu Ancın 1 Ulaş Kumbasar 1 Erkan Dikmen 1 Department of Thoracic Surgery, Hacettepe University, School of Medicine, Ankara, TurkeyPlasmacytomas are localized proliferations of plasma cells in bone marrow. Extraosseous tissue involvement is uncommon. Herein, we report a case of mediastinal extramedullary plasmacytoma in a 54-year-old woman. A 85 mm lesion was reported in computed chest tomography of the patient who referred to ourvhospital with dyspnea. Since interventional radiologists did not think the patient was suitable for percutaneous biopsy, a surgical biopsy was performed and the pathology reported a plasmacytoma. Various investigations were done to rule out multiple myeloma. Since no result in favor of multiple myeloma was obtained, mass was diagnosed as extramedullary plasmacytoma. Radiotherapy was scheduled for the patient. https://cts.tgcd.org.tr/pdf.php?id=75 extramedullary plasmacytomamediastinummediastinal mass eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 1 52 55 10.26663/cts.2019.00010 76 article A rare cause of mediastinal mass: tuberculosis Kenan Can Ceylan 1 Guntug Batıhan 1 Seyda Ors Kaya 1 Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, University of Health Sciences, Izmir, TurkeyNeoplastic and non-neoplastic pathologies can cause lesions in the mediastinum. Bronchogenic cysts, germ cell tumors, lymphoma, lymph node hyperplasia, thymoma, thymic cysts, and thyroid masses tend to develop in mediastinal compartments. Tuberculosis would cause lymph node enlargement in many areas of the body but it is a very rare cause of mediastinal mass. We report a case of tuberculosis presenting with isolated, large middle mediastinal mass with high FDG uptake in PET/CT. We also present a short review of reported cases of mediastinal tuberculosis. https://cts.tgcd.org.tr/pdf.php?id=76 mediastinal masstuberculosisvideo-assisted thoracoscopic surgery