Matache Radu Șerban

Background and Clinical Significance: Solitary fibrous tumor (SFT), historically termed hemangiopericytoma (HPC), is a rare fibroblastic mesenchymal neoplasm with variable biological behavior. Pulmonary involvement is uncommon and may represent either a primary thoracic tumor or metastatic disease from an extrapulmonary site. Its clinical course ranges from indolent, surgically curable disease to aggressive malignancy with local recurrence and distant dissemination. In this retrospective case, confirmatory STAT6 immunohistochemistry was unavailable; therefore, the tumor is described as a hemangiopericytoma/solitary fibrous tumor spectrum neoplasm. Case Presentation: We report the case of a 33-year-old woman who presented with sudden-onset hemoptysis and was found to have two large, well-defined bilateral pulmonary masses. Initial clinical and radiological evaluation raised suspicion of primary pulmonary tumors or other benign lesions. Because both lesions were considered resectable, staged pulmonary resections were performed. Subsequent reassessment of the patient’s medical history revealed previous surgeries for a poorly documented recurrent thigh tumor, later confirmed to represent the primary malignant hemangiopericytoma/solitary fibrous tumor spectrum neoplasm. Despite staged pulmonary resections, systemic chemotherapy, and further oncologic management, the disease progressed rapidly, with cerebral, bilateral pulmonary, mediastinal, and subcutaneous metastases. The patient died within 18 months of the initial pulmonary diagnosis. Conclusions: This case highlights the diagnostic difficulty of metastatic pulmonary hemangiopericytoma, particularly when the primary soft tissue tumor is inadequately documented. It emphasizes the importance of detailed clinical history, retrieval of previous histopathological reports, and long-term surveillance in patients with soft tissue tumors, even when initially considered benign.

Background: Endobronchial tumors represent a heterogeneous spectrum of benign and malignant histopathological types. Selecting the optimal surgical strategy remains a multidisciplinary challenge. This study evaluates how the integration of spirometry, DLCO, and CPET can objectively stratify cardiorespiratory risk and guide surgical decision-making regarding resection type, postoperative complications, and perioperative mortality. Methods: A single-center, retrospective study was conducted between 2020 and 2025, evaluating an initial screening cohort of 93 patients with endobronchial masses. Following multidisciplinary tumor board review based on functional and anatomical criteria, 36 patients were excluded from major resection due to extensive disease or prohibitive functional risk, while 57 underwent tailored surgical interventions, including sleeve resections, lobectomies, bilobectomies, and pneumonectomies. Preoperative evaluation included spirometry, DLCO, cardiological assessment, CT, and autofluorescence bronchoscopy (AFB). Results: Spearman correlation analysis demonstrated that advanced age and higher ASA scores significantly correlated with reduced preoperative DLCO (p < 0.0001). The overall postoperative morbidity rate was 36.84% (n = 21) and perioperative mortality was 5.26% (n = 3). Stratified analysis by surgical magnitude demonstrated a significant escalation in overall complication rates from parenchymal-sparing sleeve resections (17.6%, 95% CI: 3.8% to 43.4%) to standard lobectomies (40.7%, 95% CI: 22.4% to 61.2%), bilobectomies (50.0%, 95% CI: 15.7% to 84.3%), and radical pneumonectomies (60.0%, 95% CI: 14.7% to 94.7%; p = 0.042). Severe morbidity (Clavien–Dindo Grade III–IV) was significantly lower in the sleeve resection subgroup (5.8%) compared to pneumonectomies (40.0%, p = 0.015). Fatal outcomes occurred exclusively following major resections and were attributable to ARDS and acute cardiovascular events. Conclusions: A multi-parametric preoperative protocol provides an informative framework for risk stratification in endobronchial tumor surgery, helping to describe baseline reserves and explore post-resection trends. However, the anatomical and hemodynamic magnitude of radical pneumonectomy constitutes an independent risk modifier that cannot be fully captured by preoperative functional testing alone, highlighting the exploratory nature of these single-center retrospective observations rather than a definitive algorithmic validation.

Background: Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80–85%) and pulmonary (15–20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than 0.1–2% of cases. Case presentation: We present a rare case of a 26-year-old male, a farmer for 10 years, with occupational exposure to dogs and horses, with a personal history of multiple surgically treated abdominal cysts in 2016, admitted after abdominal computed tomography revealed liver cysts greater than 5 cm, as well as mediastinal and diaphragmatic cysts. Histopathological examination of the surgically resected hepatic cyst material confirmed echinococcosis. Serology was also positive for echinococcosis. Echocardiography revealed a pericardial cyst, posterior to the left atrium. Under these circumstances, antiparasitic treatment was initiated by an infectious disease specialist, followed by surgical treatment of the abdominal cysts, confirming the final diagnosis of hydatid disease, and subsequently, surgical treatment of the thoracic hydatid cysts was performed. The postoperative course was complicated by bronchial superinfection with Stenotrophomonas maltophilia, identified from bronchial aspirate culture after extended incubation and managed with trimethoprim–sulfamethoxazole. Conclusions: This case underscores the necessity of lifelong surveillance in hydatid disease, the potential role of postoperative antiparasitic therapy in preventing long-term recurrence, and the vital role of a multidisciplinary team in managing complex, disseminated relapses.

Background: Mediastinal staging plays a critical role in guiding treatment decisions for non-small cell lung cancer (NSCLC). While mediastinoscopy has been the gold standard for assessing mediastinal lymph node involvement, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive alternative with comparable diagnostic accuracy. This systematic review evaluates the diagnostic performance, safety, cost-effectiveness, and feasibility of EBUS-TBNA versus mediastinoscopy for mediastinal staging. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines, including searches in Medline, Scopus, EMBASE, and Cochrane databases for studies published from 2010 onwards. A total of 1542 studies were identified, and after removing duplicates and applying eligibility criteria, 100 studies were included for detailed analysis. The extracted data focused on sensitivity, specificity, complications, economic impact, and patient outcomes. Results: EBUS-TBNA demonstrated high sensitivity (85–94%) and specificity (~100%), making it an effective first-line modality for NSCLC staging. Mediastinoscopy remained highly specific (~100%) but exhibited slightly lower sensitivity (86–90%). EBUS-TBNA had a lower complication rate (~2%) and was more cost-effective, while mediastinoscopy provided larger biopsy samples, essential for molecular and histological analyses. The need for general anaesthesia, longer hospital stays, and increased procedural costs make mediastinoscopy less favourable as an initial approach. Combining both techniques in select cases enhanced overall staging accuracy, reducing false negatives and improving diagnostic confidence. Conclusions: EBUS-TBNA has become the preferred first-line mediastinal staging method due to its minimally invasive approach, high diagnostic accuracy, and lower cost. However, mediastinoscopy remains crucial in cases requiring posterior mediastinal node assessment or larger tissue samples. The integration of both techniques in a stepwise diagnostic strategy offers the highest accuracy while minimizing risks and costs. Given the lower hospitalization rates and economic benefits associated with EBUS-TBNA, its widespread adoption may contribute to more efficient resource utilization in healthcare systems.

A rise in fungal infections has been observed worldwide among patients with extended hospital stays because of the severe infection caused by the new coronavirus pandemic. A 62-year-old female patient was admitted with a severe form of Coronavirus disease 2019 (COVID-19) and spent four weeks in the intensive care unit (ICU) requiring mechanical ventilation support before being moved to a tertiary hospital for further testing. Aspergillus fumigatus filamentous fungus, Candida spp., and positive bacteriology for multidrug-resistant Klebsiella pneumoniae and Proteus mirabilis were identified by bronchial aspirate cultures. The patient’s progress was gradually encouraging while receiving oral antifungal and broad-spectrum antibiotic therapy along with respiratory physical therapy; but ultimately, thoracic surgery was necessary. Long-lasting tissue damage and severe, persistent inflammatory syndrome were the two main pathophysiological mechanisms that led to significant outcomes regarding lung lesions that were rapidly colonized by fungi and resistant flora, cardiac damage with sinus tachycardia at the slightest effort, and chronic inflammatory syndrome, which was characterized by marked asthenia, myalgias, and exercise intolerance.

We report the case of a 59-year-old female patient, a former smoker, who was diagnosed with bilateral pulmonary nodules. Extensive medical investigations were conducted, including a surgical lung biopsy, which led to the diagnosis of pulmonary amyloidoma. The diagnostic process was guided by the presence of a persistent, polymorphic, and nonspecific clinical picture, strengthened by imaging findings characterized by mixed nodular lesions and the addition of interstitial involvement, along with partial deterioration of the pulmonary parenchyma architecture. Although it is recognized as a benign tumor, pulmonary amyloidoma requires special care in order to rule out systemic involvement, association with lymphomas, or systemic amyloidosis. This case highlights the comprehensive investigations required in the presence of multiple pulmonary nodules and the wide range of possible diagnoses. It underscores the pivotal role of surgical lung biopsy and histopathological examination. The case is instructive, addressing a rare pathology, on the border between specialties, while also emphasizing potential evolving challenges and providing further insights into the clinical course of this disease.

Background: Endobronchial squamous cell carcinoma is one of the most common types of tumors located inside the tracheobronchial tree. Patients often present in advanced stages of the disease, which most often leads to a targeted therapeutic attitude of pneumonectomy. Practicing lung parenchyma-preserving surgery led us to undertake this review. Materials and methods: We used three search platforms—SCIENCE, MEDLINE, and PubMed—in order to identify studies presenting case reports, investigations, and reviews on endobronchial squamous cell carcinoma. We identified the clinical and paraclinical features of endobronchial squamous cell carcinoma. All the selected articles were in English and addressed the clinical criteria of endobronchial squamous cell carcinoma, autofluorescence bronchoscopy in endobronchial squamous cell carcinoma, imaging features of endobronchial squamous cell carcinoma, blood tumor markers specific to lung squamous cell carcinoma, and histopathological features of endobronchial squamous cell carcinoma. Results: In total, 73 articles were analyzed, from which 48 articles were selected as bibliographic references. We present the criteria used for the identification of endobronchial squamous cell carcinoma in order to highlight its main characteristics and the most reliable technologies that can be used for the detection of this type of cancer. Conclusions: The current literature review highlights the clinical and paraclinical characteristics of endobronchial squamous cell carcinoma. It aims to open new paths for research and early detection with respect to the frequent practice of lung parenchymal preservation surgery.

BACKGROUND – Endobronchial squamous cell carcinoma is one of the most common types of tumors with such a location. Patients often present in advanced stages of the disease, which leads to a targeted therapeutic attitude of pneumonectomy, most of the time. Practicing a lung parenchyma-preserving surgery led us to do this review. MATERIAL AND METHODS - We used three search platforms SCIENCE, MEDLINE and PubMed, in order to identify studies presenting case reports, studies and reviews on endobronchial squamous cell carcinoma. We identified clinical and paraclinical features of endobronchial squamous cell carcinoma. All selected articles were in English and contained clinical criteria of endobronchial squamous cell carcinoma, autofluorescence bronchoscopy in endobronchial squamous cell carcinoma, imaging features of endobronchial squamous cell carcinoma, blood tumor markers specific for lung squamous cell carcinoma, histopathological features of endobronchial squamous cell carcinoma. RESULTS - 73 articles were analyzed, from which 43 articles were selected as bibliographic references. We have presented the criteria found for endobronchial squamous cell carcinoma in order to highlight the main characteristics and high reliability technologies for the detection of this type of cancer. CONCLUSIONS – The current literature review highlights the clinical and paraclinical characteristics of endobronchial squamous cell carcinoma. It aims to open new horizons for research and early detection, frequent practice of lung parenchymal preservation surgery

Context: Endobronchial tumors are relatively rare. Pathological types are varied, both benign and malignant. Establishing the diagnosis and sleeve resection criteria for such tumors remains a challenge for pulmonologists, bronchoscopists, radiologists, thoracic surgeons, and pathologists. The management of the preoperative assessment of these patients and the establishment of the indication for sleeve resection, represent a big problem. Lung parenchymal sparing surgery remains a challenge, especially in neoplastic patients. Material and methods: We carried out a monocentric retrospective study, during the period 2009-2017, on a number of 57 patients. In our center they benefited from clinical examination, radiography, tomography, respiratory function evaluations, autofluorescence bronchoscopy, cardiological evaluation and detection of blood tumor markers. All the patients benefited from the analysis of the tumorboard of our institute and the establishment of the surgical indication for scleev resection. Results: Sparing of the lung parenchyma was achieved in case of the 57 patients included in the study. The complex evaluations of laboratory parameters, functional tests, CT examination, bronchoscopy, cardiology, were analyzed by the tumor board, so that the indication for surgical intervention was sleeve resection with preservation of the lung parenchyma. Conclusions: We selected patients for sleeve resection, those who presented endobronchial tumors of 2 cm in diameter, with cartilages and bronchial mucosa intact at least 1 cm or 2 cartilages from the formation, on CT and bronchoscopic examination. Cardiological examination and functional tests showed values that do not contradict surgical intervention.

We present the case of a 35-year-old patient without pathological history who developed hemopneumothorax due to altitude barotrauma during a commercial airline flight. The computed tomography (CT) of the chest identified the presence of right hydropneumothorax and emphysema “blebs” and bubbles. After the therapeutic insertion of a drain tube, the patient returned to the country by land transport. Three weeks later, he was diagnosed with right-sided pleurisy based on a CT scan with contrast material. A surgical intervention was then performed, and three biopsy samples were taken; the histopathological result highlighted suggestive elements for the diagnosis of desquamative interstitial pneumonia (DIP).