[Surgical resection of recurrent pulmonary metastases]

[Primary pulmonary synovial sarcoma: a report and diagnosis of 2 cases]

Synovial sarcoma is an extremely rare primary pulmonary tumor whose description is based on a limited number of cases. We report two cases diagnosed by thoracotomy. One patient was initially treated surgically, and a later recurrence was controlled by combined chemotherapy and a second operation after three years of monitoring. In the second case, surgery was imperative to treat massive hemoptysis and was followed by combined chemotherapy after diagnosis of lesions consistent with extrapulmonary metastasis.

Intraoperative techniques to prevent air leaks

Persistent air leaks prolong chest tube duration and hospital stay after lung surgery. Air leaks also may lead to life-threatening empyemas. Preventing postoperative air leaks and BPFs is the best treatment for air-leak complications. Meticulous closure of parenchymal, pleural, and bronchial defects is the mainstay of air-leak control. The reinforcement of parenchymal suture and staple lines, pleural apposition, and well-vascularized tissue-flap coverage of bronchial suture and staple lines further reduce the incidence of prolonged air leaks and BPFs.

Characterization of the frequency distribution for human hematogenous metastases: evidence for clustering and a power variance function

When groups of mice are injected with cells from a metastasizing tumor, a minority of individuals within a given group tends to sustain disproportionately larger numbers of metastases relative to the remaining group members. This clustering of metastases obeys a power function relationship, sigma2 = amub, between the variance sigma2 and the mean number of lung metastases per animal mu (a and b constant). To see whether such clustering occurs with human lung, brain, and liver metastases, a meta-analysis of clinical and pathological series was performed. Thirty-three published series were identified that provided data regarding the numbers of organ metastases sustained by 5582 people. The data were grouped according to the primary tumor, site of metastasis and method of detection of metastases. Clustering of metastases within individuals of each subgroup (similar to the murine systems) was demonstrated by variance to mean ratios greater than 1, and by a strong correlation to the variance to mean power function (a approximately 0.49, b approximately 2.24, r2 = 96%, p < 10(-6)). The cause of this clustering remains unclear, but it may in part relate to heterogeneities in regional blood flow. As a consequence of this clustering, limited metastases would be expected to occur more frequently than predicted from random chance-providing for some optimism in the management of limited metastasis. As well, the frequency distribution for metastases revealed certain scaling symmetries, likely reflective of the underlying mechanisms of metastasis, that could be of interest to both clinicians and experimentalists working with metastasis.