(1976). Thorax, 31,[475][476][477][478][479]. Fibrous histiocytoma of the lung. A case of asymptomatic fibrous histiocytoma of the lung is described in a 14-year-old girl. A left thoracotomy was performed followed by partial resection of the lingula. Postoperative progress was uneventful.When a 'coin' lesion is found on radiological examination of the chest one of the differential diagnoses to be considered is fibrous histiocytoma of the lung. This lesion is difficult to classify as. its origin is not firmly established. Many authors consider it to be a variant of sclerosing haemangioma although there are no morphological criteria for such a view. The purpose of this report is to describe a case of asymptomatic fibrous histiocytoma of the lung occurring in a 14-yearold girl. CASE REPORTA 14-year-old white girl was referred to 'La Paz' Hospital for surgical evaluation of a pulmonary opacity found on routine x-ray examination of the chest. One year before admission she had complained of a mild pain in the posterior part of the left hemithorax. One month before admission she had an episode of high fever. Physical examination revealed no abnormality. Her erythrocyte sedimentation rate was 95 mm in the first hour but apart from this there was no haematological or biochemical abnormality. The sputum did not contain acid-fast bacilli and no tumour cells were seen. A tuberculin test was negative. Respiratory function tests were normal. The chest radiograph showed a well-circumscribed nodule 5 cm in diameter present in the left upper lobe (Fig. 1). A left thoracotomy was performed and a nodule was found to be present in the lingula. Partial resection of the lingula was performed. Postoperative recovery was uneventful and one year after the operation no clinical or radiological abnormality of the chest was present.PATHOLOGY The gross appearance of the tumour showed a clearly demarcated, encapsulated nodule measuring 6X5X5 cm. It was soft and the cut surface had a white fasciculated appearance punctuated by isolated yellowish areas. Histology Sections showed the tumour to be composed of numerous spindle-shaped cells with elongated vesicular nuclei and prominent nucleoli. The cells were arranged in compact bundles with a little surrounding collagen (Figs 2 and 3). Interspersed throughout the lesion were small isolated groups of polygonal-shaped cells with plentiful cytoplasm and indented nuclei that were considered to be histiocytes. These cells were often surrounded by fairly numerous plasma cells and lymphocytes (Fig. 4).The Prussian blue reaction revealed isolated granules of haemosiderin in some of the histiocytic zones. In other areas the histiocytes contained a considerable quantity of lipid in their cytoplasm (Fig. 5) and this was confirmed by fat stains on frozen sections.Blood vessels were not a prominent feature of the tumour. Mitoses were very scanty and there was no significant cellular atypia. Reticulin was scanty and revealed no distinct pattern; in particular there was no evidence of its exhibiting a periva...

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We report a case of carcinoma following 42 years of chronic empyema in a patient who underwent surgery for a hydatid cyst at the age of 3. At the time of diagnosis, an esophageal fistula was observed and treated with cyanoacrylate. We hypothesize that chronic inflammation of the pleura, caused by decades of empyema, associated with the presence of heterotopic squamous epithelium due to a long-standing esophago-pleural fistula, led to neoplastic transformation.

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En junio de 2003, en el contexto del IX Congreso Nacional de la S.E.O.M., la Sociedad Española de Oncología Quirúrgica organizó una mesa redonda para la revisión actualizada del papel de la cirugía en el tratamiento de la enfermedad diseminada. Se introdujo con un breve análisis global de la situación, resultando evidente que, aunque es posible el tratamiento quirúrgico de las metástasis en cualquier localización en el organismo, la cirugía desempeña un papel esencial fundamentalmente en el tratamiento de la enfermedad metastásica localizada en hígado, pulmón y peritoneo. En consecuencia se desarrollaron ponencias para analizar la problemática inherente a cada una de dichas localizaciones. Dado el interés actual por los tratamientos adyuvantes, se incluyó una ponencia para evaluar la contribución del tratamiento adyuvante al tratamiento quirúrgico de las metástasis. En la excelente monografía titulada "Cirugía Oncoló-gica", el doctor Díe Goyanes define este concepto y delimita su campo de acción, analizando los diversos tipos de cirugía oncológica en función de las distintas aplicaciones e indicaciones que plantea el tratamiento quirúrgico de la enfermedad cancerosa (tabla 1) 1 . Sin embargo, la cirugía constituye un método de control locorregional del cáncer, por lo que cabría considerar que no tiene lugar en el tratamiento con pretensión curativa de la enfermedad diseminada, quedando -teóricamente-reservada su contribución para otras finalidades, como podría ser la de diagnosticar o confirmar el estadio diseminado de la enfermedad, su empleo como procedimiento de ayuda o de soporte en el tratamiento de la enfermedad diseminada (reservorios vasculares, ostomías, etc.), o la paliación, cuando las características del caso lo requieran. No obstante, disponemos hace ya tiempo de evidencia histórica del buen resultado con el tratamiento quirúrgico de las metástasis, habiéndose comunicado su tratamiento en múltiples localizaciones, incluyendo la afectación de partes blandas, hueso, hígado, pulmón, sistema nervioso central, mediastino, páncreas, estómago, o cavidad peritoneal. Por otra parte, hemos asistido a un desarrollo significativo del conocimiento de la biología tumoral en general, y en particular del Surgical alternatives to metastatic disease ARTÍCULO ESPECIAL Alternativas quirúrgicas de la enfermedad metastásica

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