Tracheal Mucoepidermoid Carcinoma Mimicking Deteriorated Bronchial Asthma during Pregnancy

Primary bronchial tumors are extremely rare. However, symptoms, such as coughing and wheezing, are not specific to this disease, and primary bronchial tumors are often misdiagnosed as bronchial asthma. This report describes the case of a pregnant patient with a bronchial tumor that mimicked deteriorating bronchial asthma. A 37-year-old female patient suffered from repeated episodes of pneumonia since 26 weeks of gestation. Despite treatment, she suffered from another episode of pneumonia at 28 weeks of gestation. This was considered as deteriorating asthma. Bronchoscopy performed at 34 weeks of gestation showed a tumor in the left main lung bronchus, obstructing nearly 100% of the trachea. After cesarean delivery at 34 weeks, she underwent endoscopic bronchial tumor resection. Because of recurrent bronchial obstruction and the possibility of malignant disease, subsequent left main lung bronchial resection and bronchoplasty were performed. The pathological diagnosis was low-grade mucoepidermoid carcinoma. In conclusion, if pneumonia develops repeatedly during pregnancy, the possibility of bronchial tumor should be considered.

The Diameter of Bronchial Resection Margin is Associated With Postoperative Lung Metastasis and Long-term Survival

BackgroundTo investigate the significance of the diameter of bronchial resection margin (DBRM) on the postoperative lung metastasis and long -term survival of patients with primary lung cancer.MethodsWe retrospectively analyzed the data of 1844 patients with primary lung cancer between January 2006 and December 2010 after surgery. Patients were divided into DBRM≤1 cm group (826 patients) and DBRM>1 cm group (1018 patients). Propensity score matching was used to reduce grouping selection bias. Furthermore, we divide the 974 patients who had definite first metastasis site into lung metastasis group (283 patients) and other metastasis group (691 patients), and analyzed related risk factors and prognosis of metastasis. Disease-free survival and overall survival were the study end points.ResultsThe DBRM≤1 cm group had a significantly better prognosis than DBTM>1 cm group (5-year DFS, 36.5% vs 25.7%; P < 0.001; 5-year OS, 45.4% vs 34.1%; P < 0.001). After multivariate survival analysis, DBRM remained the independent favorable effect on DFS (HR, 1.198; 95% CI, 1,071 to 1.340; P = 0.002) and OS (HR, 1.186; 95% CI, 1.060 to1.327; P = 0.003). PSM further confirmed that DBRM≤1 cm group had a better DFS (P = 0.032) and OS (P = 0.026) than the DBRM>1 cm group. It revealed that the DBRM was an independent risk factor for postoperative lung metastasis, and postoperative adjuvant therapy could improve the OS of lung metastases.ConclusionsThe DBRM was an independent risk factor for postoperative lung metastasis and adjuvant therapy could improve long-term survival.

Photodynamic therapy for R1 lung cancer resections

Theobjectivewas to evaluate the effectiveness of endobronchial photodynamic therapy (PDT) for preventing a non-small cell lung cancer (NSCLC) relapse after R1 resection with positive bronchial resection margins.Material and methods.This study included 17 patients. The planned morphological diagnostics revealed the presence of tumor cell complexes at the bronchial resection margins in 5 (29 %) patients (cancer in situ – 2, invasive cancer – 3), in peribronchial tissues – in 5 (29 %) patients, in lymphatic vessels at the resection margins – in 7 (41 %) patients.Results.All patients underwent one session of endobronchial PDT as an adjuvant treatment. No complications of PDT were noted. The five-year observation revealed a relapse at the bronchial stump area in 1 patient only (6 %). 16 (94 %) patients lived for 1 year, 12 (71 %) patients – for 5 years. Long-term results were significantly worse in patients with tumor complexes in lymphatic vessels at the bronchial resection margins (5-year survival rate – 29 %, p=0.04), with pN2 (0 %, p=0.01), lung adenocarcinoma (20 %, p=0.03).Conclusion.The use of endobronchial PDT as an adjuvant treatment for patients with NSCLC after R1 resection with positive bronchial resection margins is simple, safe and characterized by good immediate and long-term results.

Reduction of resection volume in patients with non-small cell lung cancer after neoadjuvant chemoand photodynamic therapy

OBJECTIVE. The research evaluated efficacy of combined treatment of initially nonresectable and inoperable cases of non-small cell lung cancer. The treatment consisted of preoperative endobronchial and intraoperave photodynamic therapies. MATERIAL AND METHODS. The prospective investigation included patients with central non-small cell lung cancer. These cases were initially considered as nonresectable (the trachea was involved in tumor) or inoperable (functional intolerance of pneumoectomy/ bilobectomy). Neoadjuvant chemotherapy (2-6 courses) and endobronchial photodynamic therapy (PDT) were conducted for these patients in preoperative period. PDT of resection edge was carried out during the operation and it was straight away after specimen removal and ipsilateral lymphodissection. RESULTS. The research was made on 38 patients. Lung resections underwent 30 (79 %) patients. Surgeries included 20 pneumoectomies and 10 lobectomies. Bronchial resection was performed by crossing an initially affected zone. It was noted that 5-year survival consisted of 68 %. CONCLUSIONS. Photodynamic therapy was important in combination with chemotherapy and surgical treatment of central non-small cell lung cancer. These measures allowed doctors to decrease the resection volume in part of inoperable patients or patients with initially nonresectable tumors.

Bronchial Stump Recurrence after Complete Resection of Lung Cancer: Effect of the Distance between the Tumor and Bronchial Resection Margin

Purpose The purpose of this study was to evaluate the following parameters after complete resection in established lung cancer patients: the frequency of bronchial stump recurrence (BSR), the effect of the distance between the tumor and bronchial resection margin (DBTM) on BSR, the survival of patients with BSR, and the effect of the DBTM on survival. Patients and Methods We retrospectively evaluated 553 consecutive lung cancer patients who underwent complete lung resection. The patients were classified as DBTM: ≤ 10 mm (group 1), 11 to 20 mm (group 2), and > 20 mm (group 3). Results We found BSR in eight (1.5%) patients. Six patients were in group 1, and two were in group 2. The difference was found to be statistically significant (p = 0004; groups 1 vs. 3). In multivariable analysis, we observed a trend toward significance for the effect of a DBTM on BSR development (p = 0.1). The DBTM did not significantly affect survival (p = 0.61). The survival of patients who developed BSR was significantly poor compared with those who did not develop BSR (p = 0.001). Conclusion BSR can develop even after complete resection of lung cancer. The DBTM is associated with BSR risk, and the survival of patients who develop BSR is poor.