Posted by James
In our study, all patients were African Americans, therefore we had the opportunity to review the clinical and pathophysiological features of ВАС exclusively in this ethnic group. ВАС was the least common lung tumor in our series and accounted for only 3% of cases. This is in accordance with the literature reporting the incidence of ВАС at 1-9%. Women accounted for one-third of our patient population similar to the 40% of previously reported ВАС. ВАС is a unique pathological entity that is distinct from pulmonary adenocarcinoma. Although histological feaures may overlap, ВАС demonstrates a growth pattern along preexisting lung architecture without invasive or destructive growth. The association of ВАС with scarring has been recognized for years.
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Posted by James
Eight-hundred-thirty-five cases of lung cancers were diagnosed between 1984 and 1999 at this hospital. ВАС constituted 3% (27) of lung cancers and 10.5% of adenocarcinomas. The most common neoplasm was adenocarcinoma, accounting for 256 cases (30.7%) followed by squamous-cell carcinoma in 228 cases (27.3%), small-cell carcinoma in 88 cases (10.5%), large-cell carcinoma in 57 cases (6.8%) and other (including metastatic) carcinomas in 179 cases (21.4%). In other series in which ВАС was described separately, its incidence ranged from 1.1% to 6.5%. When described as subtype of adenocarcinoma, it accounted for 15-20% of cases.
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Posted by James
This is a retrospective review of 19 cases of ВАС at Howard University Hospital between 1984 and 1999. Twenty-seven cases were identified during this period. Medical records of 19 patients were available for review. All the diagnoses had been determined by biopsy of specimens obtained by resection of lesion or transbronchial biopsy or CT-guided needle biopsy. The pathological reports were reviewed. Patient ages ranged from 49-89 years (average 63 years). All 15 men and four women were African Americans (Table 1). The cases were reviewed and the following information extracted: age at diagnosis, smoking history, occupation, previous pulmonary disease, symptoms, chest X-ray and CT scan, method of diagnosis, treatment, response to treatment, and survival time from the time of diagnosis. Institutional review board approval was obtained. The results of this study were statistically compared with the study by Feldman et al., which consisted of a mainly Caucasian population. Fisher exact test was used for statistical analysis. A p-value of <0.05 was considered statistically significant.
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Posted by James
INTRODUCTION
Lung cancer is the leading cause of cancer related deaths in the United States among both men and women. There were 164,100 new cases and 156,900 deaths estimated for 2000. Nonsmall-cell lung cancer accounts for 80% of all cases, with the remaining 20% presenting as small-cell cancer. Adenocarcinomas are subdivided histologically into four subtypes; acinar, papillary, mucinous, and bronchio-alveolar carcinoma (ВАС).
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Posted by James
CASE 2
A 60-year-old postmenopausal woman presented with 10 months history of painless left breast mass that increased rapidly in size three months prior to presentation. There was an associated productive cough, which subsided with cough mixture. Patient was a known hypertensive on generic adalat, moduretic and canadian atenolol. There was no history of previous surgery. Family and social history was not contributory. Physical examination revealed a middle-aged woman who weighed 63 kg. Her pulse was 96 beats/min, full, regular and blood pressure was 140/90. Respiratory rate was 22 cycles/min. The chest was clinically clear with good air entry bilaterally. She had an enlarged firm left breast with inverted nipple and peau d’orange skin change. There was associated ipsilateral non-tender, matted axillary lymph nodes and a few discrete, firm, nontender contralateral axillary lymph node enlargements. Hematological and serum biochemistry results were essentially normal. However, radiological examination of the chest showed widespread cannon-ball metastasis in both lung fields (Figure 3). Abdominal ultrasound showed stones in the gall bladder but no evidence of metastasis in the liver. Electrocardiogram (ECG) showed left atrial enlargement. FNAC of the left breast mass and ipsilateral axillary lymph node was positive for malignant cells.
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Posted by James
The patient was sedated overnight with oral diazepam 10 mg and premedicated with another 10 mg diazepam orally just before being transferred to the theater on the morning of operation.
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Posted by James
Mastectomy is a common surgical procedure for breast malignancies. General anesthesia is traditionally favored for the operation. However, there are situations when general anesthesia may be considered unsuitable. Regional anesthesia was chosen for mastectomy in our patients due to compromised pulmonary status, resulting from widespread malignant infiltrations of the lungs.
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