IntroductionPulmonary aspergilloma is the most common human disease caused by saprophytic species of the genus Aspergillus (1,2). It involves the formation of a fungus ball or mycetoma. Antifungal agents are usually ineffective and a cure can be achieved only with surgical treatment (1,3,4). Patients with an aspergilloma require surgical treatment because there is a risk of sudden life-threatening hemoptysis, and alternative medical treatments are usually ineffective. However, the surgical indications remain controversial because of the high incidence of postoperative complications (1,5,6).This retrospective study analyzed the clinical presentation, underlying lung disease, surgical indications, techniques, treatment outcomes, and postoperative complications of pulmonary aspergilloma. Materials and methodsWe operated on 77 patients for pulmonary aspergilloma between January 2000 and December 2013. The medical records were reviewed to determine the patients' history, clinical presentation, underlying lung disease, indications for surgery, surgical procedures, and postoperative complications. The subjects included 53 males (mean age: 44.26 (range: 10-73) years) and 24 females (mean age: 48.25 (range: 26-70) years).The patients were diagnosed based on history and radiological findings on a posteroanterior lung X-ray or computed tomography. We classified the lesions as simple pulmonary aspergilloma (SPA) if the lesion was welllocalized, with a thin-walled cavity smaller than 5 cm and little or no surrounding atelectasis or consolidated areas. Lesions were classified as complex pulmonary aspergilloma (CPA) if they were well-localized, thin-walled cavities larger than 5 cm or with thick walls, and surrounded by parenchymal sequelae as disseminated consolidation and atelectasis resulting from underlying lung disease, such as bronchiectasis or tuberculosis in most cases (Figure 1) (7-11).Background/aim: This retrospective study evaluated the clinical presentation, underlying lung disease, surgical indications, technique, treatment outcomes, and postoperative complications of pulmonary aspergilloma. Materials and methods:We evaluated 77 patients who underwent pulmonary resection of an aspergilloma at Atatürk Chest Diseases and Thoracic Surgery Research and Training Hospital between January 2000 and December 2013. The initial operations were 4 pneumonectomies, 24 lobectomies, 9 lobectomy plus myoplasties, 10 segmental resections, and 30 wedge resections. Six reoperations were carried out to deal with postoperative complications: 1 myoplasty, 2 completion lobectomies plus myoplasties, 2 myoplasties with rib resections, and 1 completion lobectomy. Results:The subjects comprised 53 males (mean age: 44.26 (range: 10-73) years) and 24 females (mean age: 48.25 (range: 26-70) years). The most common indication for surgery was hemoptysis in 52 patients (67.53%). The most common underlying lung disease was tuberculosis in 37 patients (48.05%). Forty patients (51.94%) had a simple pulmonary aspergilloma and 37 (48.05%) had a complex...

Video-assisted thoracic surgery (VATS) is widely used for thoracic surgery operations, and day by day it becomes routine for the excision of undetermined pulmonary nodules. However, it is sometimes hard to reach millimetric nodules through a VATS incision. Therefore, some additional techniques were developed to reach such nodules little in size and which are settled on a challenging localization. In the literature, coils, hook wires, methylene blue, lipidol, and barium staining, and also ultrasound guidance were described for this aim. Herein we discuss our experience with CT-guided methylene blue labeling of small, deeply located pulmonary nodules just before VATS excision. From April 2013 to October 2016, 11 patients with millimetric pulmonary nodules (average 8, 7 mm) were evaluated in our clinic. For all these patients who had strong predisposing factors for malignancy, an 18F-FDG PET-CT scan was also performed. The patients whose nodules were decided to be excised were consulted the radiology clinic. The favorable patients were taken to CT room 2 hours prior to the operation, and CT-guided methylene blue staining were performed under sterile conditions. Mean nodule size of 11 patients was 8.7 mm (6, 2-12). Mean distance from the visceral pleural surface was 12.7 mm (4-29.3). Four of the nodules were located on the left (2 upper lobes, 2 lower lobes), and seven of them were on the right (four lower lobes, two upper lobes, one middle lobe). The maximum standardized uptake values (SUV max) on 18F-FDG PET/CT scan ranged between 0 and 2, 79. CT-guided methylene blue staining of millimetric deeply located pulmonary nodules is a safe and feasible technique that helps surgeon find these undetermined nodules by VATS technique without any need of digital palpation.

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Complete surgical resection is the treatment of choice for early-stage LCNEC and chemotherapy after radical surgical treatment improves survival. Follow-up periods after surgery adjuvant chemotherapy will prevent recurrence and patients may survive for many years if complete surgical resection and adjuvant chemotherapy are possible.

ÖZLeiomyomlar benign düz kas tümörü olup, akciğerde yerleşimleri nadirdir. Etyolojisi tam olarak bilinmemekte, ortalama görülme yaşı 21 ile 55 arasında değişmektedir. Total eksizyon önerilen birinci basamak tedavidir. Bu yazıda, sol akciğerde plevral aralıkta kitle olan ve sol tek port video yardımlı torakoskopik cerrahi ile endoskopik stapler kullanılarak total olarak eksize edilen 51 yaşında postmenopozal bir kadın olgu sunuldu. Ameliyat sonrası patolojik tanı, plevral leiomyoma olarak bildirildi.Anah tar söz cük ler: Eksizyon; plevral leiomyoma, video yardımlı torakoskopik cerrahi. ABSTRACTLeiomyomas are benign smooth muscle tumors, which are rarely localized in the lung. Although its etiology is not exactly known, the mean age ranges from 21 to 55 years. Total excision is recommended as the first-line therapy. Herein, we present a 51-year-old postmenopausal female case with a mass in the subpleural area of the left lung which was excised totally using endoscopic stapler via left-single port video-assisted thoracoscopic surgery. The mass was pathologically diagnosed as pleural leiomyoma postoperatively.

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Localization of deeply, small, non-visible and non-palpable subcentimetre nodules can be difficult during videoassisted thoracoscopic surgery (VATS) and even during minithoracotomy. Linear ultrasound probe helps surgeon find these undetermined nodules by VATS or thoracotomy technique without any need of digital palpation and has been demonstrated a safe and feasible technique alternative to computed tomography guided procedure (coils, hook wires, methylene blue, lipidol and barium staining). Herein, we describe a case who we preoperatively labeled peripheral lung lesion in the right lower lobe with methylene blue digitalization were not possible by palpation and peripheral two lesions were successfully demonstrated with the use of linear ultrasound probe during thoracic surgery.

Objectives: Pulmonary giant cell carcinoma (PGCC) is a histological type of nonsmall cell lung cancer and classified as one of the five subtypes of sarcomatoid carcinoma of the lung. Pure PGCC is very rare. Material and Method:We represent our experience in the management of 7 patients (6 males and 1 female, with a range of 44-63 yr) with PGCC. The most representing symptoms were cough and hemoptysis. Upper lobectomy (n=7) and additionally mediastinal lymphadenectomy were performed in all patients.Results: Definitive histological examination confirmed the diagnosis of PGCC in all cases. Even though there was no perioperative mortality, postoperative complications developed in a case were hemorrhage in the early perioperative period and bronchus fistula after two months from the operation. The mean survival of the patients was estimated as 28.8 months (38 days -116 months). Conclusion:The main treatment for PGCC is the complete surgical resection. Complete surgical resection was found to be usefull as a treatment of choice of PGCC in the early stage and contributed to survival.