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Pulmonary epithelioid hemangioendothelioma (PEH) is a rare vascular tumor of low-grade malignancy, the prognosis of which remains unpredictable. Surgical and/or chemotherapeutic options have to be evaluated depending on intrathoracic tumor spread and systemic metastases. Three cases of PEH with both clinical and pathological findings are herein summarized and the relevant current literature discussed.

Primary involvement of skeletal muscle is a very rare event in ALK-1 positive anaplastic large cell lymphoma (ALCL). We describe a case of a 10-year old boy presenting with a three week history of pain and a palpable firm swelling at the dorsal aspect of the left thigh. Histological examination of the lesion revealed a tumoral and diffuse polymorphic infiltration of the muscle by large lymphoid cells. Tumor cells displayed eccentric, lobulated \"horse shoe\" or \"kidney-shape\" nuclei. The cells showed immunohistochemical positivity for CD30, ALK-1, CD2, CD3, CD7, CD8, and Perforin. Fluorescence in situ hybridization analysis revealed a characteristic rearrangement of the ALK-1 gene in 2p23 leading to the diagnosis of ALK-1 positive ALCL. Chemotherapy according to the ALCL-99-NHL-BFM protocol was initiated and resulted in a complete remission after two cycles. This case illustrates the unusual presentation of a pediatric ALCL in soft tissue with a good response to chemotherapy.

PurposeThis study evaluates medical and economic effects of a clinical pathway (CP) for open lobectomy and bilobectomy with respect to process quality, outcome quality, and hospital cost.MethodsWe compared 38 consecutive patients who underwent open lobectomy or bilobectomy between April 2007 and June 2008 and were treated with a CP (CP group) with 43 consecutive patients treated without CP between 2005 and 2007 (pre-pathway group). Indicators for process quality were duration of catheter placement, pain intensity, respiratory exercising, and mobilization. Outcome quality was measured through morbidity, mortality, re-operations, and re-admissions. Cost of hospital stay was calculated using an imputed daily rate.ResultsCentral venous catheters were used in 90% of patients in the CP group (pre-pathway group 40%; p < 0.0001). Epidural catheters were placed in 84% of patients in the CP group (pre-pathway group 56%; p = 0.01). Variation in duration of catheter placement was reduced in the CP group. The reduction of hospital stay was 3 days (−19%, p = 0.003). Perioperative outcome quality remained unchanged. There was a significant cost reduction of €1,614 per stay after CP introduction (−19%; p = 0.003).ConclusionsAfter CP implementation for open lobectomy the quality and standardization of care improved. Although length of hospital stay was significantly reduced, there was no significant increase of re-admissions or morbidity. Patients benefited from a shortened hospital stay while the hospital achieved cost reduction. This early analysis shows that the implementation of CP for open lobectomy has positive effects in terms of quality and cost of care.