256 esophageal carcinoma patients subject to various surgical procedures were examined with a view to identifying as early as possible the complications and possible tumoral recurrences, early or late, at anastomosis level. The most caracteristic and frequent radiological features, especially of neoplastic recurrences are presented; the various morphological types are described and discussed and for the first time a radiographic classification is proposed, followed by a discussion of the criteria of differential diagnosis of these lesions, especially from postoperative perivisceritis. Correct identification and precise radiographic description of the early signs of neoplastic recurrence in the esophagogastric anastomoses make it possible to reoperate, at least in some patients.

Cardia↗

PubMedDate not supplied

[Evaluation of 178 mediastinoscopies (author's transl)].

Of the 178 consecutive mediastinoscopies performed at the Istituto Nazionale per lo Studio e la Cura dei Tumori of Milan from 1967 to 1974 145 were performed for diagnostic purposes and 33 for the pre-operative evaluation of resectability in cases of proven lung carcinoma. Mediastinoscopy is a very useful procedure for obtaining a definite pathological diagnsis in indeterminate mediastinal and pulmonary lesions. In succases, mediastinoscopy should precede any attempt at therapy, as 1/3 primary mediastinal lymph node lesions are benign and about 30% of suspected mediastinal tumors or lymphomas are actually misdiagnosed lung cancers (mainly oat-cell carcinomas). As to the role of mediastinoscopy in the assessment of lung cancer resectability, the current view is that it plays a part together with tomography and bronchoscopy in the clinical staging of this neoplasm, but it is no longer relied upon alone. It is mandatory in every case of suspected or probable mediastinal invasion and the criteria for inoperability are the following: spread to high paratracheal or contralateral nodes, direct invasion of the mediastinal fat, fixity of the neoplasm to the trachea or vertebral bodies. In such cases mediastinoscopy will prevent a useless exploratory thoracotomy.

Humans↗

PubMedDate not supplied

Post-thoracotomy diagnostic and staging conversion rates of clinically staged I lung cancer.

The accuracy of stage I lung cancer assessment achieved by traditional clinico-diagnostic staging was retrospectively evaluated in 164 consecutive patients who underwent thoracotomy. The diagnostic conversion rate was 6.7% (1 carcinoid and 10 innocent pulmonary lesions) and occurred only in the subset of patients lacking preoperative pathologic confirmation (15%). The conversion rate to unresectable tumor extent was 8% (11/153), and local spread was the main cause of unresectability (5.5%). The staging conversion rate was 29% (43/153): the conversion rate for nodal evaluation was double that of primary tumor evaluation (24% versus 12%), but conversion to anatomically unresectable nodal diffusion occurred in only one patient (0.6%). The ability of the surgeon to convert the wrong diagnosis was scanty without extemporary biopsy, and 7 patients with innocent lesions underwent standard resection for primary cancer. Surgical staging was a precise as pathological staging in primary tumor evaluation, but was faulty in nodal evaluation (15% error in sN- and sN1-2 assessment). It is concluded that following stage I lung cancer assessment by traditional means, supplementary examinations are requested for a better sensitivity of pathological confirmation and a better refinement of local spread. Better nodal evaluation has less value until a biologic limit to surgery for anatomically resectable nodal diffusion is universally accepted.

Adult↗

PubMedDate not supplied

Long-term infusion in cancer chemotherapy with the Groshong catheter via the inferior vena cava.

AIMS AND BACKGROUND: Vascular access through a vein draining into the superior vena cava is commonly used for long-term infusion of drugs inr cancer chemotherapy; prolonged cannulation of the inferior vena cava is generally considered as having an excessively high complication rate. METHODS: Prolonged cisplatin infusion via the inferior vena cava by means of a Groshong catheter was evaluated in 20 consecutive patients with thoracic malignancies showing evidence of superior vena cava infiltration or obstruction. RESULTS: We achieved 1,291 catheter days for our survey with a mean duration of vascular access of 64.5 days per patient and a mean duration of infusion time of 40 days. There were 2 complications, a catheter obstruction after a 7-day rest period and an ileo-femoral thrombosis 6 days after catheter placement. CONCLUSIONS: Our experience compared favourably with the results obtained by long-term central venous access via the supraumbilical route, and demonstrated the reliability and safety of this approach in cases where the superior vena cava cannulation is technically difficult or impossible.

Antineoplastic Agents↗

PubMedDate not supplied

The evolution of surgery in non-small cell lung cancer.

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Carcinoma, Non-Small-Cell Lung↗

PubMedDate not supplied

Esophageal carcinoma. Radiologic appearance of minimal lesions.

Twelve minimal lesions were found over a period of 18 months at the Istituto Nazionale Tumori of Milan at the end of the radiologic, endoscopic and histologic procedures. Eleven lesions were radiologically detected, and a radiologic diagnosis of malignancy was perspectively made in 10 of the identified lesions. The radiologic aspects of minimal lesions are described. Double contrast study of the esophagus allows excellent mucosal detail and good reproduction of lesions. Simplicity and minimal discomfort for the patient justify it as a first diagnostic step for detection of neoplastic pathology.

Adult↗

PubMedDate not supplied

Transthoracic fine needle aspiration biopsy in pulmonary lesions. Updated results.

An investigation was carried out on 271 patients who underwent transthoracic fine needle aspiration biopsy ( FNAB ) for suspected pulmonary lesions in a four-year period; 80% of them had a malignant tumor. The histologic control of the cytologic diagnoses made on the transthoracic FNAB was possible in over 50% of the cases. The sensitivity and predictive value for positive results were, respectively, 0.890 and 0.995, whereas the typing accuracy verified in 58 cases on the surgical specimen was 0.76. The comparison of the data obtained from the most recent case material with that of early observations confirmed the high sensitivity of transthoracic FNAB in the detection and characterization of malignant lesions in the lungs. The sensitivity was almost identical for primary tumors, 0.90, and metastatic disease, 0.88. Furthermore, over the years the data showed an improvement in the results due to the experience gained, the combined use of cytology and histology and the application of histochemical methods. More sophisticated methods, such as immunocytochemistry and electron microscopy, were essential to the final diagnosis in only a few cases.

Biopsy, Needle↗

PubMedDate not supplied

Pulmonary carcinoid tumors: report on 19 cases.

Nineteen cases of pulmonary carcinoid tumors, three of which showed clinically malignant behavior, are reported. The diagnostic and therapeutic possibilities are discussed. Diagnosis is sometimes possible on radiologic examination, when the clinical behavior is not yet malignant. However, these tumors are frequently mistaken for malignant heteroplasias, during the diagnostic work-up so that the postoperative histologic examination results are sometimes surprising. The clinical postoperative course is favorable in the majority of cases, and in the eight cases, we were able to follow up for more than five years, there was only one recurrence. Although pulmonary carcinoids are histologically similar to intestinal carcinoids, and like the latter are abundantly vascularized, they are only rarely accompanied by the carcinoid syndrome, which is often observed in the intestinal form.

Carcinoid Tumor↗

PubMedDate not supplied

[The palliative surgery of esophageal cancer].

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Esophageal Neoplasms↗