Anterior cervical spinal surgery can lead to various complications. We hereby present a case of two rare complications combined-pharyngo-oesophageal diverticulum and its perforation after cervical plate dislodgement. A 53-year old male patient presented with progressive dysphagia 18 years after anterior cervical spinal fusion with tricortical bone graft and custom-made plate at the C6/7 level. Oesophagography revealed a pharyngo-oesophageal diverticulum in front of the cervical plate. It was confirmed by subsequent oesophagoscopy, which also demonstrated a 3-cm longitudinal defect at the posterior wall of the diverticulum. During surgical exploration of the patient's neck, the plate was removed, the diverticulum was completely mobilized and excised, the oesophageal wall manually sutured and a cricopharyngeal myotomy performed. An oesophageal suture line failure was suspected postoperatively, but was not confirmed during reoperation. A year later, the patient has no dysphagia or any other symptoms.

Background: Thymic epithelial tumors are rare thoracic tumors for which pathological diagnosis is challenging due to the definition of multiple subtypes, tumor heterogeneity, and variations in interobserver reproducibility. In this study, we aimed at analyzing the quality of pathological reporting in line with the consistency between initial diagnosis and final diagnosis after expert review through a collaboration between the largest thoracic oncology center in Estonia, and one expert center in France. Methods: Hospital electronic database and pathology databases from the Tallinn North Estonia Medical Centre were searched for thymic and mediastinal tumors from 2010 to 2017. Pathology specimens were referred to the Pathology Department of the Lyon University hospital. Overall, 55 tissue specimens from 49 patients were included. Results: From pathology reports, tumor size, diagnosis, and invasion had been mentioned in ≥80% of cases, while resection status and staging were assessed in only 48% and 17% of cases, respectively. The initial diagnosis was consistent with that of the review in 60% of cases. Diagnostic concordance for thymoma subtypes was low (Cohen's kappa 0.34, 95% CI: 0.16-0.52). Overall, a major change in the management of 8 (16%) patients had to be made after pathological review: 3 patients had a normal thymus according to the reference centre, while thymoma B1 or B2 had been diagnosed locally; 5 additional patients had a final diagnosis of non-thymic tumor. Conclusions: Implementing structured pathology reports may help to decrease discrepancies in the diagnosis of thymic epithelial tumors. The development of expert networks is an opportunity to improve diagnosis and patient care, particularly in regard to rare cancers.

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Left tracheal sleeve pneumonectomy is rare and challenging surgical procedure with high postoperative complication and mortality rates. We describe the least invasive single-stage surgical approach using uniportal video-assisted thoracoscopic surgery (VATS) currently successfully applied for a left centrally located bronchogenic carcinoma with tracheal involvement. This case shows how uniportal VATS can be effectively used in challenging cases for reducing invasiveness without compromising patient safety nor oncological principles of complete surgical resection.

We separated CSCs from cell lines and lung cancer tissues by CSC marker CD133 and ALDH. Then we knock down the expression of TLR9 and then investigate biological changes of CSCs, including sphere formation, self-renewing ability, invasion, resistance to drugs, and in vivo tumor formation. Result: We found toll-like receptor (TLR9) are constitutively overexpressed on cancer stem cells (CSCs) derived from lung cancer cell lines and patients' tissue when compared with non-stem cells. Knocking down of TLR9 in lung CSCs resulted in inhibited capacity for proliferation, invasion, tumorigenesis and resistance to chemotherapeutic drugs. Furthermore, cell cycle was arrested at G2/M stages and more apoptosis existed after TLR9 expression decreased. Further analysis indicated that TLR9 maintain the stemness of cancer cells by changing expression of other stem cell markers Gli1, Notch1 and beta-catenin, drug transporters ABCB1, ABCC1 and ABCG2 and anti-apoptotic factors BCL2 and Survivin. Of which, beta-catenin, was found to be most obviously related with TLR9 expression. Moreover, TLR9 expression was positively associated with tumor differentiation and inversely associated with lung cancer patient survival in clinic. Conclusion: Based on above data, TLR9 is crucial for marker and phenotype of lung CSC. It might work as a lung cancer stem cell maintainer.

Background: Previous recurrence risk models offered individualized prediction using a more diverse set of factors than traditional staging measures American Joint Committee on Cancer Tumor Node Metastasis (AJCC TNM) Staging System. Several studies have demonstrated gene mutation as a new prognostic factor, such as EGFR, KRAS and so on. This study aimed to analyze a comprehensive and reliable Nomogram prognostic model to predict recurrence in stage IA lung adenocarcinoma (ADC) with radical resection. Method: This was a retrospective, single-center and case-control study. Clinicopathologic, genetic, therapeutic features and survival status were collected. Univariate and multivariate Cox proportional hazards model was conducted. The nomogram for recurrence prediction was developed using Cox proportional hazards regression. Three nomograms were established based on a) AJCC 8 th TNM Staging, b) multivariate analysis results and c) risk factors recorded in published references. The higher concordance index (C-index) of model identified better performance of nomogram. Result: 1499 patients with pathological stage IA ADC from Cancer Hospital, Chinese Academy of Medical Sciences from October 2012 to December 2015 were enrolled in this study. The recurrence rate was 3.5% (53/1499). No recurrence of 180 patients randomly selected and analyzed in this study. Median DFS was not reached. The C-index of AJCC 8th TNM staging and the nomogram based on multivariate analysis was 0.598 (95% CI 0.538-0.659) and 0.696 (95% CI 0.629-0.764), respectively. The nomogram established on prognostic factors in previous studies, which included gene mutation such as EGFR, KRAS and ALK, showed higher discrimination with C-index 0.833 (95% CI 0.786-0.880). Conclusion: This was the first individualized nomogram combining clinicopathologic features with genetic information to predict recurrence in ADC. The nomogram added with gene mutation status demonstrated superior predictive capability comparing to other nomograms based on traditional AJCC T staging and multivariate analysis. Our nomogram was more reliable to guide prognostic factors and recurrence rate in stage IA ADC patients.

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