Michael Magarakis, MD
1611 NW 12th Avenue, Miami, Fl 33136
Email address: mmagarakis@yahoo.com
Phone: 305-585-5271
In 1993, an otherwise healthy 37-year-old male presented to our service
with increasing shortness of breath, fatigue and lethargy. The patient
was a marathon runner, non-smoker and generally in good physical
condition. He thought he was undergoing a routine check-up when he was
given what many consider a “terminal diagnosis”, Bilateral Multifocal
Bronchoalveolar Carcinoma (BAC).
BAC is a distinct subtype of non-small cell lung cancer (NSCLC) with
lower rates of nodal and extra-thoracic metastases and better survival
compared to other subtypes of NSCLC (1,2). BAC tends to recur or
metastasize within the lung often to a point that is beyond the scope of
surgical management; and, it is associated with a dismal prognosis
having a median survival of 1 year (3).
Lung transplantation, although a major operation, may occasionally be
the only hope for permanent cure. Some motivated centers have pursued
lung transplantation for this disease and outcomes are no different
compared to non-cancer lung transplant recipients. However, only a
little over 50 cases have been reported (4).
In 1993, one month after patient’s initial diagnosis, he underwent
double-lung transplantation without the use of cardiopulmonary bypass.
Pathology at the time revealed extensive involvement of both lungs with
BAC and no nodal metastases. (Figure 1) The patient did well for several
months, until a follow up CT scan revealed multiple nodules in both
lungs, which was biopsy confirmed BAC. At the time, we hypothesized
contamination during transplantation had occurred. The patient remained
eager to cooperate and stay alive: he was started on Taxol based
chemotherapy without improvement.
In 1995, the patient underwent Heart/Lung transplantation. We used
cardiopulmonary bypass, the heart and lungs were removed. The trachea
was clamped, transected and thoroughly washed with saline solution to
prevent aerogenous contamination. (Figure 2) The patient achieved a
complete recovery, and has had no complications to date.
During regular follow up visits the patient continues to express his
gratitude for the chance he was given to live; more importantly,
acknowledgement of not giving up on him or losing vigor to save his
life. We are not aware of another report of redo Heart/Lung
transplantation for BAC; yet the purpose of this case presentation is to
emphasize to the next generation of surgeons the importance of not
giving up on your patients.