[Bronchial carcinoid tumor and Cushing's syndrome. Apropos of 3 cases].
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Biomedical subjects
Publications and source records attributed to A Rojas-Miranda.
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The authors report a case of pulmonary metastasis which exceptionally occurred 19 years after hysterectomy for uterine choriocarcinoma. They use this opportunity to take stock of our present knowledge concerning this subject by reviewing a vast literature. This case is of interest, as it provides a new element to the theoretical study of carcinogenesis.
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The authors analyse a series of 194 thymomas (epithelial tumours of the thymus gland) which were operated over a period of about 25 years. The long term prognosis (70% 5 year survival and 60% 10 year survival) is examined in terms of the anatomo-surgical stage of the thymoma, the histological type of the tumour and the presence of associated auto-immune diseases. The authors recommend a more rigorous classification which takes into account both the anatomo-surgical and the histopathological findings so that the indications for post-operative mediastinal irradiation can be extended in a attempt to reduce the rate of distant recurrence of these tumours.
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Tracheal resection was performed in 10 patients with non-malignant tracheal tumors. Clinical, histological, and technical features are discussed, particular emphasis being given to long-term results. These tumors, mostly cylindromas (7 out of 10 cases in this series) are amenable to very wide surgical resection of the resection-anastomosis type. Suggested treatment for cylindromas should include systematic postoperative irradiation, as this considerably improves long-term (10 and 15 years) results.
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The authors review the various treatments of the Pancoast and Tobias syndrome and propose a new surgical approach in two stages. The first, cervical stage involves resection of the internal half of the clavicle and of the first rib and dissection of the vessels and nerves lying in the supraclavicular fossa, so that the tumour can be lowered in one piece and exposed. The second stage consists of posterolateral thoracotomy with exeresis of the lung. The wide cervicotomy has several advantages: the tumour can be biopsied for extemporaneous histological examination, and its extension to the lymph nodes, thoracic wall and mediastinum can be assessed; freeing the nerves relieves pain and considerably facilitates the second stage of the operation.
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