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Rupture of the left main-stem bronchus with a polyvinylchloride double-lumen tube.

Double-lumen tubes have proved to be a useful adjunct in thoracic surgery. Their use has become quite commonplace, particularly since the introduction of the softer polyvinylchloride (PVC) tubes, which are technically easier to use and may carry less risk for serious complications. Any such tube, however, can cause life-threatening complications. We present a case with such a complication related to the use of a PVC double-lumen tube and make recommendations regarding the use of these tubes to minimize the risk of serious intraoperative complications.

Aged↗

Mucoepidermoid tumors of the bronchus. Ultrastructural and immunohistochemical study. Histiogenic correlations.

UNLABELLED: Bronchial mucoepidermoid tumors are uncommon neoplasms, morphologically similar to their salivary gland counterpart. The histogenesis is controversial. The aim of this study is to identify myoepithelial cells and speculate on their role in the origin of these tumors. METHODS AND RESULTS: Sixteen bronchial mucoepidermoid tumor surgical specimens were formalin-fixed, paraffin-embedded and studied using a panel of nine antibodies in order to identify a myoepithelial differentiation. Additional antigens against several cytokeratins were performed in four cases and five of the biopies were studied using the electron microscopy. The different types of cells of the primary bronchial mucoepidermoid tumor (mucous luminal, intermediate and squamous) reacted strongly against AE1, CK7, 34bE12 and weakly with AE3, CK18 and CK8/18/19. S-100, alpha-smooth muscle actin, muscle actin HHF35 and alpha-actinin were consistently negative in all cell types. CD10 was positive in very few cells in just one case. CONCLUSION: The immunohistochemical and the ultrastructural study of bronchial mucoepidermiod tumors support a ductal unit origin, without a myoepithelial participation.

Adult↗

Roentgenographically occult bronchogenic carcinoma of non-polypoid type: histological patterns of longitudinal growth within the bronchus.

Microscopy of the serial block-sections of the entire bronchial tree of all the resected specimens of roentgenographically occult bronchogenic carcinoma revealed new findings with respect to the histological patterns of longitudinal growth within the bronchial wall. Twenty-seven lesions which were non-polypoid on gross appearance with longitudinal extension of 16 mm and above were classified into the following four categories. (A) In standard superficial extension, transmural invasion by carcinoma became shallower and the area involved on section became smaller gradually from the site of the origin of carcinoma to the proximal and distal ends. (B) In intraepithelial extension, carcinoma was confined within the epithelium throughout the bronchi involved except at and near the site of the origin at which it penetrated the basement membrane. (C) In lymphatic extension, carcinoma extended from the site of the origin to the proximal and distal ends in a dual pattern so that it extended longitudinally within the epithelium in parallel with an invasion into the lymphatic vessels in the lamina propria and submucosa. At the site of the origin carcinoma invaded down to the level of the submucosa or adventitia. (D) In massive extension, a massive invasion by carcinoma from the site of the origin to the proximal and distal ends, and a simultaneous invasion and destruction by carcinoma of the epithelium, basement membrane, lamina propria, submucosa, and of adventitia in places were demonstrated. There was no marked difference in bronchoscopic finding among (A), (B) and (C). The length of the lesion as estimated by histology was different from that observed at bronchoscopy. Bronchoscopic examination was not always successful in determining the line of resection precisely. Therefore it is indispensable to examine frozen sections and/or imprint specimens of the margin of resection.

Bronchi↗

Lesions preceding squamous cell carcinoma of the bronchus and multicentricity of canceration--serial slicing of minute lung cancers smaller than 1 mm.

A total of ten minute squamous cell carcinomas smaller than 1 mm were found in surgical lung specimens from 108 patients who had roentgenographically occult lung cancer. These minute lesions were detected by submitting, in all the 108 specimens, the whole bronchial tree to 2-mm-thick sequential transverse slicing which was then followed by microscopic examination of each slice on an H-E stained section. When a focus of minute carcinoma was found, the slice was further serially sectioned to study whether there were such carcinoma-related lesions as dysplasia or other atypical changes of epithelia, and when there were, the spatial relation of these with the carcinoma. It was demonstrated that all the minute carcinomas were closely associated with either dysplasia or what we call "basal cells with marked atypia", cells with markedly enlarged nuclei arranged in linear fashion on the basement membrane. The contiguity of these changes with minute carcinoma strongly suggested that they are lesions preceding overt carcinoma. Also, there were some minute foci of carcinoma, which, though not involving the entire epithelial thickness, proved to have already begun microinvasion.

Aged↗