Gastrobronchial fistula is an extremely rare condition. It is usually associated with trauma, esophagogastric surgery, subphrenic abscess, gastric ulcer, and neoplasm. A case of recurrent gastrobronchial fistula secondary to a benign gastric ulcer 2 and 3 years after Ivor Lewis procedure for treatment of esophageal carcinoma is described. The literature of this subject is reviewed and discussed.
Bronchial Fistula ; Esophageal Neoplasms ; Esophagectomy* ; Fistula* ; Postoperative Complications ; Stomach Ulcer ; Subphrenic Abscess

BACKGROUND: McKeown first described two autopsy cases of esophageal small cell carcinoma (SMC) in 1952; about 230 cases have since been reported in the literature. Small cell carcinoma has been reported to account for 0.4% to 7.6% of all esophageal malignancies. SMC of the esophagus as regarded as having a poor prognosis with frequent systemic dissemination. Choice of treatment remains controversial. MATERIAL AND METHOD: From August 1987 to December 1998, a review of the records and histologic sections of 8 patients with primary small cell carcinoma of the esophagus seen in 11 years was undertaken. RESULT: Small cell carcinoma of the esophagus constituted 1.5% of all esophageal cancers. The median age was 61.5 years (range from 42 to 71 years). Seven patients were male, tumor was mainly located in the middle and lower thirds (6 cases) of the esophagus. Pure SMC is 5 cases, and mixed SMC is 3 cases. Operative procedure were as follow: transthoracic esophagectomy with thoracic or cervical reconstructon in 7 patients, transhiated esophagectomy with cervical reconstruction in one. The operative death was none. Adjuvant chemotherapy was performed in 7 patients except one who had poor general condition. Recurrence was observed in 4 patients (mediastinal LN, abdominal LN, SCN, bone). The overall median survival was 15.9 months. Only one patient survived for more than 5 years. CONCLUSION: We considered that esophageal SMC should be regarded as a systemic disease, and multimodality treatment including chemotherapy should be used. Surgery may be offered in selected patients to manage local disease as part of a chemotherapy based treatment program.
Autopsy ; Carcinoma, Small Cell* ; Chemotherapy, Adjuvant ; Drug Therapy ; Esophageal Neoplasms ; Esophagectomy ; Esophagus* ; Humans ; Male ; Prognosis ; Recurrence ; Surgical Procedures, Operative

No abstract available.
Esophagus* ; Stomach*

No abstract available.

Endobronchial lipomas are rare lesions that usually obstruct a major bronchus and cause irreversible pulmonary damage distally. They are histologically benign tumors. But they can produce pulmonary damage or irreversible bronchiectasis if dignoses or treatments are delayed. Whenever possible, the treatment of choice is resection by means of bronchoscopy. If endoscopic removal is not possible or if the nature of the tumor is unclear, surgery is necessary, with lobectomy or pneumonectomy being required in most cases due to the extensively damaged pulmonary parenchyma. We present a case of endobronchial lipoma causing bronchial obstruction and peripheral organizing pneumonia with its clinical features, diagnosis and treatment methods.
Bronchi ; Bronchiectasis ; Bronchoscopy ; Diagnosis ; Lipoma* ; Pneumonectomy ; Pneumonia

In this paper, we present an extremely rare case of a primary intrapulmonary neurogenic tumor, in which localization of S-100 protein was investigated using immunohistochemical staining. The patient, who was a 47 year old man, experienced no symptoms, however, a routine chest X-ray revealed a round tumor like shadow in the hilar area of left lung. To confirm and cure the mass, surgery was performed. Histopathological examination of the excised tumor revealed it to be a primary intrapulmonary neurilemmoma. Immunohistochemical staining demonstrated the presence of S-100 protein in the tumor cells.
Humans ; Lung ; Lung Neoplasms ; Middle Aged ; Neurilemmoma* ; S100 Proteins ; Thorax

BACKGROUND: The long-term survival after operation of patients with lung cancer invading the chest wall is known to be related to regional nodal involvement, completeness of resection and depth of chest wall involvement. In this study results of complete resection are reviewed to determine survival charateristics. MATERIAL AND METHOD: Of 680 consecutive patients who were operated on for primary non-small cell carcinoma between 1988 and 1998, we retrospectively reviewed 55 patients(8.0%) who had complete resection for lung cancer invading the chest wall or parietal pleura. RESULT: Resection of the chest wall was en bloc in 29 patients(47.3%), and extrapleural in 26(52.7%). In the patients undergoing extrapleural resection, the depth of chest wall invasion was confined to the parietal pleura in all patients(100%). In the patients underging en bloc resection, the pathologic depth of invasion was into the parietal pleura alone in 9(31.0%) and into the chest wall in 20(69.0%). The follow-up rate of these patients was 100%. Hospital mortality was 5.4%(n=3). The actuarial 5-year survival rate was 26% for all hospital survivors(n=52). The actuarial 5-year survival rate of patients with T3N0M0 disease(29%) was better than that of T3N2M0 disease(18%), however, there was no significant(p=0.30) difference. The depth of chest wall invasion had no statistically significant effect on survival in our series, neither for patients with involved lymphatic metastasis nor for those without(p=0.99). CONCLUSION: These observations indicate that the good five year survival in patients with T3 NSCLC invading the chest wall resulted from complete resection. Survival of patients with lung cancer invading the chest wall after complete resection is dependent on the extent of nodal involvement and much less so on the depth of chest wall invasion.
Carcinoma, Non-Small-Cell Lung* ; Follow-Up Studies ; Hospital Mortality ; Humans ; Lung Neoplasms ; Lymphatic Metastasis ; Pleura ; Retrospective Studies ; Survival Rate ; Thoracic Wall* ; Thorax*

PURPOSE: Multicentric occurrence of esophageal squamous neoplasm has been known to be significant in terms of its pathogenesis and production of detectable early lesions. This study was performed to establish the incidence, pattem and clinico-pathologic features of multiple squamous epithelial neoplasia of the esophagus in Korea. MATERIALS AND METHODS: Forty-two consecutive cases of esophageal squamous cell carcinoma surgically treated at Korea Cancer Center Hospital in 1991 were studied. For pathological analysis, whole esophagectomy specimens were sectioned, micrascopically examined, and reconstructed. Age, sex, alcohol and smoking history, tumor location, stage, lymph node metastasis and survival were compared among different neoplastic conditions. RESULT: Fifteen cases (35.7%) showed multiple squamous lesions, 6 (14.3%) with multiple carcinomas and dysplasias, and 9 (21.4%) with single carcinomas with separate dysplasias. Intraepithelial lesions contiguous to main tumors were commonly observed (61.9%). Lugol`s solution staining pattern was compatible with epithelial pathology. Lymph node metastasis rate was significantly higher in cases with multiple carcinomas. Smoking history was significantly more common in patients with solitary catcinomas only. CONCLUSION: The multicentric occurrence of squamous epithelial dysplasia and carcinoma in the esophagus was confirmed in Korean patients, supporting the concept of field carcinogenesis at this region. However, lack of evidence for strong environmental influence in the patients with multiple lesions suggests yet another risk factor.
Carcinogenesis ; Carcinoma, Squamous Cell ; Esophagectomy ; Esophagus* ; Humans ; Incidence ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Pathology ; Risk Factors ; Smoke ; Smoking

We report a patient who suffered from bronchiolitis obliterans organizing pneumonia(BOOP) after Ivor Lewis operation for esophageal cancer. The patient presented low grade fever, dry cough and mild dyspnea at 4 day after operation. Chest roentgenograms and chest CT revealed bilateral patchy and infiltrative shadows. The respiratory symptoms worsened and respiratory failure developed with mild elevation of WBC count despite of conservative treatment. An open lung biopsy was done and the biopsy specimen showed bronchiolitis obliterans organizing pneumonia(BOOP). After several weeks of steroid therapy, there were marked clinical, physiological and roentgenographic improvements. Our experience suggests that BOOP may be one of the underlying pathology in a number of patients presenting with ARDS after thoracotomy. Since steroid therapy may improve survival in these patients, thoracic surgeons should heighten their index of suspicion for this entity. Early histologic diagnosis should be considered in patients with treatment-resistant ARDS after thoracotomy.
Biopsy ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Cough ; Cryptogenic Organizing Pneumonia* ; Diagnosis ; Dyspnea ; Esophageal Neoplasms ; Fever ; Humans ; Lung ; Pathology ; Respiratory Insufficiency ; Thoracotomy* ; Thorax ; Tomography, X-Ray Computed

We managed surgically a case of local recurrence in esophageal cancer Twenty month after transthoracic subtotal esophagectomy and csophago-gastrostomy, he su(fared from dysphagia. Chest CT and percutaneous needle aspiration biopsy showed. Local recurrence involving residual esophagus, thyroid gland, posterior membraneous portion of trachea. We did cervical esophagectomy, laryngectomy thyroidectomy, partial resection of trachea and reconstruction with free jejunal antograft successfully.
Biopsy, Needle ; Deglutition Disorders ; Esophageal Neoplasms* ; Esophagectomy ; Esophagus ; Laryngectomy ; Needles ; Recurrence* ; Thyroid Gland ; Thyroidectomy ; Tomography, X-Ray Computed ; Trachea ; Transplants*