Twelve cases of oesophageal intramural pseudodiverticulosis are described and the findings in 85 previously reported cases are reviewed. The condition occurs in all age groups, predominantly in the sixth and seventh decades, with a slight predilection for males. The characteristic radiographic appearance is of multiple flask shaped outpouchings of 1-4 mm with narrow necks communicating with the oesophageal lumen. The source of the pseudodiverticula has been shown to be pathologically dilated excretory ducts of the submucous glands due to chronic submucosal inflammation. The distribution was segmental in 57 cases (59%) and diffuse in 40 (41%). Dysphagia is the main symptom and was found in 85 cases (88%); 88 cases out of 97 had radiological narrowing of the oesophagus; of these, 39 (44%) were in the upper oesophagus, 20 (23%) in the middle oesophagus, and 29 (33%) in the lower oesophagus. Treatment is directed towards management of the associated disorder, as the diverticula themselves rarely cause problems.

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The factors affecting long-term survival following oesophagectomy for oesophageal cancer are poorly understood. We examined the significance of microscopic tumour involvement at the circumferential resection margin (CRM) on postoperative survival following oesophagectomy. The case notes of 329 patients who underwent a potentially curative oesophagectomy for squamous or adenocarcinoma were reviewed retrospectively. As part of the procedure, all patients underwent an en-bloc resection of their perioesophageal tissue. The presence of tumour either at, or within, 1 mm of the CRM was recorded and correlated with their TNM and survival data. A total of 67 patients (20%) were noted to have a positive CRM, of which 40 cases (12%) had tumour at the resection margin and the remainder had tumour within 1 mm of the margin. Univariate analysis showed no statistically significant association between survival and either category of CRM involvement. Multivariate analysis showed that only T-stage, nodal status and tumour grade were prognostic markers. In conclusion, the presence of microscopic tumour at the CRM following an en-bloc oesophagectomy is not a significant prognostic marker. Despite advances in the management of oesophageal cancer, survival following oesophagectomy remains poor with a 5-year survival of approximately 25% (Alexiou et al, 1998; Ellis, 1999). A number of studies (Edwards et al, 1989;Robey-Cafferty et al, 1991;Patti and Owen, 1997) have attempted to identify histological characteristics that correlate with long-term postoperative survival. The presence of microscopic tumour at the circumferential margin of excision is one such histological factor that has recently been investigated as a possible prognostic marker. A retrospective study carried out in 1991 showed that tumour involvement at the circumferential resection margin (CRM) was associated with a higher incidence of local recurrence (Sagar et al, 1993). Further work by the same group (Dexter et al, 2001) showed that the presence of microscopic tumour at the CRM reduces median postoperative survival; and that the prognostic effect of this factor was most pronounced in those patients with a few metastatic lymph nodes. However, neither of these series examined the longterm prognostic effect of CRM involvement. In addition, both studies were limited by their relatively small sizes. The purpose of our study was to analyse our experience of the significance of microscopic tumour involvement at the CRM on long-term postoperative survival following oesophagectomy in a large cohort of patients. METHODSThe case notes of 431 patients who underwent an oesophagectomy for squamous or adenocarcinoma between January 1987 and July 1996 at Nottingham City Hospital were reviewed retrospectively. We then excluded all cases of surgical mortality (defined as death occurring within 30 days of operation), incomplete excision (defined as cases with the presence of microscopic tumour within 1 mm of the proximal or distal margins of excision), primary gastric carcinomas, sync...

Primary angiosarcomas of the chest wall and pleura are extremely rare and carry a dismal prognosis. Two cases are reported. One patient (case 1), presented with massive recurrent haemothorax, was found to have multifocal angiosarcoma of the pleura, treated with surgical de-bulking, chemical pleurodesis and chemotherapy, achieving control of the bleeding. She died 10 months later from complications related to chemotherapy. A full post-mortem examination confirmed this was a primary pleural angiosarcoma with no evidence of disease elsewhere. Another patient (case 2) with a large solitary angiosarcoma of the chest wall, discovered incidentally on a routine physical examination, was successfully treated with surgical excision and subsequent radical radiotherapy, remaining well 15 years post-operatively.

This study suggests that female gender exerts a significant positive effect on survival following lung resection for NSCLC. This effect is pronounced at early disease stage and persists after adjusting for important differences in the clinical, histo-pathological features and extent of pulmonary resection between male and female patients.