Successful management of a lung cancer patient harbouring both EGFR mutation and EML4-ALK fusion gene with disseminated intravascular coagulation.

Lung cancer patients harbouring driver oncogene alterations are markedly responsive to molecular target agents, such as epidermal growth factor receptor (EGFR), tyrosine kinase inhibitor (TKI), and echinoderm microtubule-associated protein like 4 - anaplastic lymphoma kinase (EML4-ALK)-TKI. We encountered an exceptionally rare case, harbouring both EGFR mutation and EML4-ALK fusion gene, and suffering from severe disseminated intravascular coagulation. In this case report, we present two notable points. First, our patient was successfully treated with a third-generation EGFR-TKI, osimertinib. Second, osimertinib could manage severe conditions, such as disseminated intravascular coagulation. Third-generation EGFR-TKIs may be a viable option for patients harbouring both EGFR mutations and EML4-ALK fusion genes, even in severe conditions.

Three cases of intra-abdominal free air onset associated with COPD treated conservatively.

Pneumoperitoneum is caused by respiratory disease in rare cases and can be treated conservatively. It is important to confirm physical abdominal examinations, laboratory data, and radiological findings to avoid unnecessary surgical procedures. The diagnosis of pneumoperitoneum associated with respiratory disease requires the exclusion of other fatal illnesses, especially gastrointestinal perforation.

High prevalence of airway obstruction and pulmonary emphysema in urothelial (renal pelvis, ureter, and bladder) cancer patients.

BACKGROUND: Cigarette smoking is a major cause of COPD, with patients also presenting complications that stem from other smoking-related diseases, including urothelial cancer. However, the prevalence of COPD or airflow obstruction in urothelial cancer patients has not been well studied. METHODS: We investigated the prevalence of airflow obstruction (FEV1/FVC < 70%) in newly diagnosed urothelial cancer patients and identified the risk factors for airflow obstruction in existing urothelial cancer patients. Additionally, we compared the characteristics of subjects who had been diagnosed with both airflow obstruction and urothelial cancer, and subjects whose airflow obstruction was discovered during health screenings. RESULTS: A total of 217 patients were newly diagnosed with urothelial cancer during the study period at our institution. Among all patients, 210 (96.8%) underwent an evaluable lung function test, in which 38.6% (81 patients) displayed airflow obstruction defined as FEV1/FVC < 70%. In urothelial cancer patients, age, smoking index (pack-years), and BMI proved to be significant risk factors for airflow obstruction in multivariate logistic regression (p = 0.007, p < 0.0001, and p = 0.035, respectively). Gender, cancer stage, and cancer location were not significant risk factors. Patients with both airflow obstruction and urothelial cancer showed a more advanced emphysematous change than subjects presenting with airflow obstruction alone (unpaired t-test, p = 0.0003). CONCLUSIONS: Airflow obstruction was identified in 38.6% of urothelial cancer patients. Age, smoking index (pack-years), and BMI were significant risk factors. A significantly higher emphysematous score was observed in subjects with urothelial cancer than in subjects with airway obstruction alone.

The characteristics of patients with pulmonary Mycobacterium avium-intracellulare complex disease diagnosed by bronchial lavage culture compared to those diagnosed by sputum culture.

BACKGROUND AND OBJECTIVE: The utility of bronchoscopy for the diagnosis of pulmonary Mycobacterium avium-intracellulare complex (MAC) disease has been reported; however, which patients require bronchoscopy remains unclear. Our objective was to identify the characteristics of the patients in whom bronchoscopy is needed for the diagnosis of MAC disease. METHODS: Fifty-four patients with pulmonary MAC disease were divided into two groups according to established diagnostic criteria: 39 patients were diagnosed by sputum culture and 15 patients were diagnosed by bronchial lavage culture. We analysed the differences in demographic and clinical characteristics as well as microbiological and radiological data between the two groups. RESULTS: There were no significant differences in age, sex, smoking status, MAC species, underlying diseases, or steroid use. Significantly more patients diagnosed by sputum culture than bronchial lavage culture had a positive sputum smear for acid-fast bacilli (79.5% vs. 0.0%, respectively; p < 0.001) and any symptoms (75.3% vs. 46.2%, respectively; p = 0.0059). No significant differences were found in the prevalence of each computed tomography finding, including nodules, air-space disease, bronchiectasis, and cavities. However, more patients diagnosed by sputum culture than bronchial lavage culture had abnormalities in the left upper division (48.7% vs. 13.3%, respectively; p = 0.017) and higher numbers of affected lobes (4.3 ± 1.4 vs. 3.3 ± 1.6, respectively; p = 0.034). CONCLUSION: If patients suspected of having pulmonary MAC disease have a negative sputum smear, no symptoms, no abnormal findings in the left upper division, or fewer affected lobes on computed tomography, bronchoscopy might be needed for the diagnosis.