Search

Fluoroscopically guided transthoracic fine needle biopsies were performed in 890 patients (380 female, 582 male, mean age: 56 years). In 795 patients (89.4%) the first biopsy was successful. The success rate of biopsy correlated closely with the size of the lesion and increased with larger size. Sensitivity in the diagnosis of malignant lesions was 94.6%, specificity 99.5%. Due to cytological, histological, and clinical confirmation of benign lung lesions in 300 patients (33.7% of all patients), the number of unnecessary diagnostic thoracotomies for benign disease could be reduced significantly. In 9 of 113 cases (8%) histological reclassification of the cytologic results was necessary. Reclassification was not necessary in the differentiation between benign and malignant lesions and between small cell and non-small cell carcinomas. The overall complication rate was 24.7% (220 patients). Only 36 patients (4% of all patients) required chest-tube insertion. There were no fatal complications. Percutaneous fluoroscopically guided transthoracic fine needle biopsy of the lung, performed with the Rotex needle, is a time-effective, safe, and efficient method for diagnosing focal pulmonary lesions.

On the basis of 2 own patients and 18 cases reported in the literature, clinicopathological features of primary malignant fibrous histiocytoma of the lung are reviewed. Of the 20 patients (age-range: 14-75 yrs; 13 male, 7 female), 14 underwent resection. Recurrences were noted in 7 of them. 8 patients were free of disease at least 8 months postoperatively, one having undergone successful pulmonary metastasectomy. Postresection disease-free survival ranged from 8 months to 10 years. Adjuvant chemotherapy or irradiation (3/14) did not influence postoperative outcome. After chemotherapy, irradiation or conservative measures alone (6/20) survival did not exceed 12 months; remissions were not reported. The course was fatal within 12 months in 9/20 cases due to distant metastasis or local growth. 1 patient died of tumour-associated hypoglycemia. Age, sex, localization of the tumor and histologic subtype did not influence prognosis. Small tumors, asymtomatic at time of detection probably carry a better prognosis than larger ones.

Important features of diagnostic and operative management and the postoperative course of tracheobronchial injuries as well as pathological findings at the anastomosis are discussed in a review of our 11 cases from the last 12 years. Diagnosis was established clinically, localization of the rupture was carried out by rigid or fiberoptic bronchoscopy. Tracheobronchial continuity was reestablished by end-to-end anastomosis of the ruptured bronchi, by direct suture of any tracheobronchial tears, or by patching inveterated lesions. Two cases of rupture of the right main bronchus are presented separately, considering clinical, diagnostic, operative and histopathologic criteria.

The precise nature of the relationship between cirrhosis and HCC remains to be elucidated. However, it seems likely that no single explanation will cover the various forms the association takes in different parts of the world. In the high HCC incidence regions of sub- Saharan Africa and the Far East, an etiology common to the two disorders, HBV and possibly other hepatitis viruses, seems to account for the majority of cases. The role of aflatoxin in these areas is uncertain because it appears not to cause cirrhosis in man. In populations in which HCC is uncommon, alcoholic cirrhosis is the most frequent association of HCC. There is no convincing evidence to support a shared etiology in this situation because alcohol has not thus far been proved to be directly oncogenic for the liver. Possibly, cirrhosis renders the hepatocytes more susceptible to environmental carcinogenic factors. The same explanation may apply to hemochromatosis. There is at present little evidence for the postulate that HCC is an inevitable consequence of the hyperplasia of cirrhosis.

In five patients solitary pulmonary lesions were detected radiographically during routine follow up after malignant melanoma. Surgical removal was done in each case under the tentative diagnosis of metastases. Histologically, two lesions turned out as benign chondroma, one as organized pulmonary infarction and one as bronchogenic carcinoma. Only in one patient was a melanoma metastasis present. The findings underline the usefulness also in malignant melanoma of a surgical approach in suspected solitary pulmonary metastases.

In a retrospective study 157 liver specimens from hemophiliac patients (105 percutaneous needle and 12 wedge biopsies, 40 autopsy specimens) were read blindly and independently by four pathologists on the basis of a computer codable questionnaire asking for evaluation of individual histologic features, classification of the liver disease, and speculation on etiology. The majority of cases had histologic evidence of mild chronic viral hepatitis; 7.6% of all cases were classified as CAH, and an additional 7.6% as CPH by all four interpreters. A large number (40.8%) were on the borderline of CAH and CPH or CLH. These were classified as "possible CAH" because of a diagnosis of CAH by one to three of the pathologists. Although there was therefore some interobserver variability in the diagnostic labels applied to these cases, all four pathologists were strikingly similar in their identification of individual histologic features. Furthermore, on blind rereadings, each pathologist made the same diagnosis in more than 90% of readings. In this retrospective study, serologic data were not available in many cases. Thus, etiologic considerations were based purely on speculation from the histologic appearance. One case was identified as "definite" and 28 of 157 (18%) as "possible" HBV infection. Based on the assumption that some of the individual histologic criteria indeed might be in favor of NANB hepatitis, 21 cases (13%) were considered "definite" NANB, and "possible" NANB was suspected in 107 additional cases (68%). The addition of these figures makes clear that within the limitations of histologic assessment, double infections appear to be frequent in this setting.(ABSTRACT TRUNCATED AT 250 WORDS)