A case report of high-grade intraepithelial neoplasia of the bronchial mucosa.

BACKGROUND: Lung cancer is the most common cause of cancer death worldwide and poses an immediate health threat. Despite decades of basic and clinical research, the 5-year survival rate for lung cancer patients is less than 10%.The most important drawbacks in efficient treatment of lung cancer are delayed diagnosis and absence of effective screening. Detection and study of precancerous lesions of the bronchial mucosa might be one of the turning points in understanding of neoplastic transformation. Therefore, it would be the most effective prevention and early treatment modality. We report a case of high-grade intraepithelial neoplasia of the bronchial mucosa in which a neoplastic growth in the lumen of intrinsic segment in the upper lobe of the left lung was detected on electronic bronchoscopy, and biopsy confirmed squamous papillary hyperplasia with high-grade intraepithelial neoplasia. CASE PRESENTATION: A 74-year-old male was admitted to the hospital due to a mass lesion in his left lung. After admission, computed tomography scan of the chest showed an intraluminal mass in the intrinsic segment of the upper lobe of the left lung and an enlarged left hilum. CONCLUSIONS: High-grade intraepithelial neoplasia of the bronchial mucosa is rare in the respiratory system. We report a case that can provide useful information for early diagnosis and treatment of the disease.

[Evolution of the incidence and survival of bronchogenic carcinoma in the province of Castellón (Spain) from 2004 to 2017.] / Evolución de la incidencia y supervivencia del carcinoma broncogénico en la provincia de Castellón en el periodo de tiempo 2004-2017.

OBJECTIVE: Bronchogenic carcinoma (BC) is the second most frequent worldwide and the most lethal tumour in both sexes. Its incidence varies not only among countries but also among different areas of the same country. So, the aim of this work was to analyse the evolution of its incidence and survival in the province of Castellón from 2004 to 2017 and to compare them with those of de rest of the country. METHODS: A retrospective observational study was carried out from patients diagnosed with BC and registered in the Castellón Tumour Register from 2004 to 2017. Survival was estimated using the Kaplan-Meier method whereas to estimate the relationship among different variables both the chi-square and ANOVA test were used. RESULTS: 4,346 cases were diagnosed, whose mean age was 67.5±11.3 years, 85.2% men, the most frequent histological types were adenocarcinoma (28.3%) and epidermoid carcinoma (25.1%). The gross global incidence was 53.4 cases/105 inhabitants, 90.9 cases/105 men and 15.7 cases/105 women. Median global survival at five years was 12.7%, 12% in men and 18.4% in women. CONCLUSIONS: The global incidence of BC in Castellón is lower than the national one, having remained stable in men while it is double in women. Global survival at five years is less than 15%, being higher in women than in men, nevertheless it increases compared to that of previous studies.

OBJETIVO: El carcinoma broncogénico (CB) es el segundo tumor más frecuente a nivel mundial y el más letal en ambos sexos. Su incidencia varía, no sólo entre países, sino también entre diferentes zonas de un mismo país. Por tanto, el objetivo de este trabajo fue analizar la evolución de su incidencia y la supervivencia en la provincia de Castellón desde 2004 hasta 2017, y compararlas con las del resto del país. METODOS: Se realizó un estudio observacional retrospectivo en pacientes diagnosticados de CB e inscritos en el Registro de Tumores de Castellón desde 2004 hasta 2017. La supervivencia se estimó mediante el método de Kaplan-Meier, mientras que para estimar la relación entre distintas variables se utilizaron los test Chi-cuadrado y ANOVA. RESULTADOS: Se diagnosticaron 4.346 casos, con una edad media de 67,5±11,3 años, el 85,2% eran hombres, los tipos histológicos más frecuentes fueron adenocarcinoma (28,3%) y carcinoma epidermoide (25,1%). La incidencia global bruta fue de 53,4 casos/105 habitantes, con 90,9 casos/105 de hombres y 15,7 casos/105 de mujeres. La mediana de supervivencia global a los cinco años fue del 12,7%, siendo del 12% en hombres y del 18,4% en mujeres. CONCLUSIONES: La incidencia global de CB en Castellón es inferior a la nacional, habiéndose mantenido estable en hombres mientras que se duplica en mujeres. La supervivencia global a los cinco años es inferior al 15%, siendo mayor en mujeres que en hombres; no obstante, aumenta respecto a la reportada en estudios previos.

A Case Report of an Unusual Cause of Dysphagia from Enlarged Subcarinal Lymph Node.

Cough, hemoptysis, chest pain, and weight loss are classic symptoms of bronchial carcinoma. Small cell lung cancer presents late with obviously abnormal chest radiographs and with bulky, usually mediastinal lymph node involvement. Dysphagia rarely occurs in patients with bronchial carcinoma. There are many causes of dysphagia in bronchial carcinoma such as mediastinal lymphadenopathy, direct tumor invasion of the mediastinum, radiotherapy, secondary achalasia. This report presents a case of progressive dysphagia to solid foods and weight loss of a 28-year-old male, non-smoker due to subcarinal lymph node enlargement from metastatic bronchial adenocarcinoma.

Trends in Imaging Patterns of Bronchogenic Carcinoma: Reality or a Statistical Variation? A Single-Center Cross-Sectional Analysis of Outcomes.

INTRODUCTION: Bronchogenic carcinoma accounts for more cancer-related deaths than any other malignancy and is the most frequently diagnosed cancer in the world. Bronchogenic carcinoma is by far the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths. The objective of this study was to identify the changing trends, if any, in radiological patterns of bronchogenic carcinoma to document the various computed tomography (CT) appearances of bronchogenic carcinoma with histopathologic correlation. METHODS: This was a single-center cross-sectional study on 162 patients with clinical or radiological suspicion of bronchogenic carcinoma with histopathological confirmation of diagnosis. RESULTS: There was a male preponderance with bronchogenic carcinoma and smoking being the most common risk factor. Squamous cell carcinoma followed by adenocarcinoma and small cell carcinoma is the most common histologic subtype. Squamous cell carcinoma was noted to be present predominantly in the peripheral location (55.5%), and adenocarcinoma was noted to be present predominantly in the central location (68.4%). CONCLUSION: CT is the imaging modality of choice for evaluating bronchogenic carcinoma and provides for precise characterization of the size, extent, and staging of the carcinoma. Among 162 bronchogenic carcinoma cases evaluated in the current study, a definite changing trend in the radiological pattern of squamous cell carcinoma and adenocarcinoma was observed. Squamous cell carcinoma was predominantly noted to be a peripheral tumor, and adenocarcinoma is predominantly noted to be a central tumor. Surveillance or restaging scans are recommended, considering the high mortality rate in patients with bronchogenic carcinoma.

[Early onset of small cell carcinom of the lung in a young patient in Benin]. / Survenue précoce d'un carcinome bronchique à petites cellules chez un sujet jeune au Bénin.

Context Bronchial cancer in a person under 30 years of age is quite rare. It generally occurs after 40 years of age following heavy smoking intoxication. We report a clinical case illustrating the early onset of a small cell lung carcinoma in young heavy smoker. CASE REPORT: A 30-year-old patient, current smoker for about 10 years (15 packs/year), consulted for a cough with haemoptotic sputum. Clinical and paraclinical examinations diagnosed small cell carcinoma of the right lung with some controlatéral metastatic nodules. . He was classified as stage T2bN2M1a. Unfortunately, due to lack of financial accessibility to suitable chemotherapy, the patient died after one month. CONCLUSION: Early-onset of bronchial carcinoma in young smokers calls for strengthened control of teenage tobacco use, especially in Africa, where the phenomenon has been taking on alarming proportions.

Community-acquired round Pneumonia in a 63-year-old Female.

Round pneumonia is a radiological manifestation of pulmonary lesion. This is found as spherical or oval-shaped radio-opacity on chest X-ray. Round pneumonia has been reported in literature uncommonly. Round pneumonia was first time reported in the radiology literature in 1954 (Wagner et al., 1998). It was first recognized in children. In 1973, Rose and Ward reviewed 21 cases of round pneumonia in children. Radiological findings resembled pulmonary and mediastinal masses. Since then, time and again, round pneumonia has been reported in children; but, this is also found rarely in adults. There are many causes of round pneumonia in adults, for example, infectious and noninfectious. It may mimic pulmonary neoplasms due to its radiological appearance. Hence, the usual diagnostic challenge of round pneumonia is to differentiate pneumonia from bronchogenic carcinoma. Here we present an interesting case of round pneumonia in an adult female.

Perfil epidemiológico de pacientes com diagnóstico de carcinoma broncogênico atendidos em uma unidade de alta complexidade em oncologia / Epidemiological profile of patients diagnosed with bronchogenic carcinoma seen in a high complexity oncology unit

Introdução: No Brasil, o carcinoma broncogênico é o segundo tipo de câncer de maior incidência em homens e o quarto tipo de câncer de maior incidência em mulheres. É a principal causa de mortalidade por câncer no país. O objetivo do presente estudo é avaliar o perfil epidemiológico dos pacientes com diagnóstico de carcinoma broncogênico atendidos em uma unidade de alta complexidade em oncologia. Métodos: Estudo observacional descritivo, retrospectivo, com coleta de dados secundários e de abordagem quantitativa. A pesquisa foi aplicada em uma unidade de alta complexidade em oncologia de um hospital de uma cidade do extremo-sul catarinense, através de prontuários eletrônicos. A coleta foi composta por 90 atendimentos no período de janeiro de 2015 a dezembro de 2017. Foram inclusos na amostra todos os pacientes com tumores broncogênicos malignos com idade igual ou superior a 18 anos, e foram exclusos 14 pacientes com prontuários incompletos. Resultados: A média de idade ao diagnóstico foi 62,39 ± 10,53 anos. Houve discreto predomínio no sexo masculino (58,9%). O tabagismo foi verificado em 78,9% dos pacientes, com uma mediana de 40,0 maços/ano. Como método diagnóstico, observou-se a maior realização de biópsia percutânea orientada por TC em 58,9% dos casos. Em relação aos tipos histológicos, 54,4% apresentaram adenocarcinoma. O estágio mais prevalente foi o IVA (42,2%). Conclusão: São de extrema importância métodos de rastreamento e diagnóstico precoce da neoplasia, bem como encorajar os pacientes ao abandono do tabagismo, a fim de reduzir sua incidência e mortalidade.

Introduction: In Brazil, bronchogenic carcinoma is the second more incident type of cancer in men, and the fourth in women. It is the leading cause of cancer mortality in the country. The aim of the present study is to assess the epidemiological profile of patients diagnosed with bronchogenic carcinoma seen in a high complexity oncology unit. Methods: This is a descriptive, observational, retrospective study with collection of secondary data and quantitative approach. The research was conducted in a high complexity oncology unit of a hospital in a municipality of the southernmost region of the state of Santa Catarina, Brazil, using electronic medical records. The sample consisted of 90 patients from January 2015 to December 2017. All patients with malignant bronchogenic tumors aged 18 years or older were included in the sample, and 14 patients with incomplete medical charts were excluded. Results: Mean age at diagnosis was 62.39 ± 10.53 years. There was a slight predominance of men (58.9%). Smoking was present in 78,9% of patients, with a median of 40.0 packets/year. CT-guided percutaneous biopsy was the most used diagnostic method, being performed in 58.9% of the cases. With regard to histological type, 54.4% of patients presented adenocarcinoma. The most prevalent stage was IVA (42.2%). Conclusion: Screening methods and early diagnosis of neoplasm are extremely important, as well as encouraging patients to quit smoking, in order to reduce disease incidence and mortality.

Actinomyces meyeri causing disseminated actinomycosis in the presence of concurrent bronchogenic carcinoma.

We describe the presentation of a 72-year-old woman with concurrent diagnoses of lung adenocarcinoma in conjunction with disseminated Actinomyces meyeri infection; a rare pathogen which can mimic lung cancer both symptomatically and radiologically. The patient was found to have a pelvic mass initially presumed to be cervical metastases-later confirmed to be of xanthogranulomatous inflammatory origin following transvaginal ultrasound-guided biopsy. The pathogenic cause, identified following pleural aspirate, being a fully sensitive A. meyeri infection; treated with prolonged course amoxicillin.

12â€¯× 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?

PURPOSE: The aim of this study was to evaluate the safety and long-term tumor control after stereotactic radiotherapy (SRT) with 12â€¯× 6 Gy of patients with primary bronchial carcinoma (BC) or with pulmonary metastases (MET) of various solid tumors. Local progression-free survival (LPFS), progression-free survival (PFS), overall survival (OS), and prognostic factors were compared. METHODS: Between May 2012 and January 2020, 168 patients with 206 pulmonary lesions (170 MET and 36 primary BC) were treated with 12â€¯× 6 Gy (BED10 116 Gy). The irradiated pulmonary MET were from the following cancers: 47 (27.6%) head and neck, 37 (21.8%) rectum or colon, 30 (17.6%) bronchial, 13 (7.6%) malignant melanoma, 9 (5.3%) esophageal, 9 (5.3%) sarcoma, and 25 (14.8%) other. RESULTS: The median follow-up was 16.26 months (range: 0.46-89.34) for BC and 19.18 months (0.89-91.11) for MET. Survival rates at 3 years were: OS 43% for BC and 35% for MET; LPFS BC 96% and MET 85%; PFS BC 35% and MET 29%. The most frequently observed grade 3 adverse events (AEs) were pneumonitis (5.9% BC, 4.8% MET), pulmonary fibrosis (2.9% BC, 4% MET), and pulmonary embolism (2.9% BC, 0.8% MET). The favorable prognostic effects on overall survival of patients with MET were female gender (log-rank: p < 0.001), no systemic progression (log-rank; p = 0.048, multivariate COX regression p = 0.039), and malignant melanoma histology (log-rank; p = 0.015, multivariate COX regression p = 0.020). For patients with BC, it was tumor location within the lower lobe (vs. upper lobe, log-rank p = 0.027). LPFS of patients with metastatic disease was beneficially influenced by female gender (log-rank: p = 0.049). CONCLUSION: The treatment concept of 12â€¯× 6 Gy is associated with 96% local progression-free survival for BC and 85% for pulmonary metastases after 3 years. There was no difference in response after SRT of primary lung carcinoma or pulmonary metastases.

Mapping lung squamous cell carcinoma pathogenesis through in vitro and in vivo models.

Lung cancer is the main cause of cancer death worldwide, with lung squamous cell carcinoma (LUSC) being the second most frequent subtype. Preclinical LUSC models recapitulating human disease pathogenesis are key for the development of early intervention approaches and improved therapies. Here, we review advances and challenges in the generation of LUSC models, from 2D and 3D cultures, to murine models. We discuss how molecular profiling of premalignant lesions and invasive LUSC has contributed to the refinement of in vitro and in vivo models, and in turn, how these systems have increased our understanding of LUSC biology and therapeutic vulnerabilities.

Hahn-PCNN-CNN: an end-to-end multi-modal brain medical image fusion framework useful for clinical diagnosis.

BACKGROUND: In medical diagnosis of brain, the role of multi-modal medical image fusion is becoming more prominent. Among them, there is no lack of filtering layered fusion and newly emerging deep learning algorithms. The former has a fast fusion speed but the fusion image texture is blurred; the latter has a better fusion effect but requires higher machine computing capabilities. Therefore, how to find a balanced algorithm in terms of image quality, speed and computing power is still the focus of all scholars. METHODS: We built an end-to-end Hahn-PCNN-CNN. The network is composed of feature extraction module, feature fusion module and image reconstruction module. We selected 8000 multi-modal brain medical images downloaded from the Harvard Medical School website to train the feature extraction layer and image reconstruction layer to enhance the network's ability to reconstruct brain medical images. In the feature fusion module, we use the moments of the feature map combined with the pulse-coupled neural network to reduce the information loss caused by convolution in the previous fusion module and save time. RESULTS: We choose eight sets of registered multi-modal brain medical images in four diease to verify our model. The anatomical structure images are from MRI and the functional metabolism images are SPECT and 18F-FDG. At the same time, we also selected eight representative fusion models as comparative experiments. In terms of objective quality evaluation, we select six evaluation metrics in five categories to evaluate our model. CONCLUSIONS: The fusion image obtained by our model can retain the effective information in source images to the greatest extent. In terms of image fusion evaluation metrics, our model is superior to other comparison algorithms. In terms of time computational efficiency, our model also performs well. In terms of robustness, our model is very stable and can be generalized to multi-modal image fusion of other organs.

Automated detection and segmentation of thoracic lymph nodes from CT using 3D foveal fully convolutional neural networks.

BACKGROUND: In oncology, the correct determination of nodal metastatic disease is essential for patient management, as patient treatment and prognosis are closely linked to the stage of the disease. The aim of the study was to develop a tool for automatic 3D detection and segmentation of lymph nodes (LNs) in computed tomography (CT) scans of the thorax using a fully convolutional neural network based on 3D foveal patches. METHODS: The training dataset was collected from the Computed Tomography Lymph Nodes Collection of the Cancer Imaging Archive, containing 89 contrast-enhanced CT scans of the thorax. A total number of 4275 LNs was segmented semi-automatically by a radiologist, assessing the entire 3D volume of the LNs. Using this data, a fully convolutional neuronal network based on 3D foveal patches was trained with fourfold cross-validation. Testing was performed on an unseen dataset containing 15 contrast-enhanced CT scans of patients who were referred upon suspicion or for staging of bronchial carcinoma. RESULTS: The algorithm achieved a good overall performance with a total detection rate of 76.9% for enlarged LNs during fourfold cross-validation in the training dataset with 10.3 false-positives per volume and of 69.9% in the unseen testing dataset. In the training dataset a better detection rate was observed for enlarged LNs compared to smaller LNs, the detection rate for LNs with a short-axis diameter (SAD) ≥ 20 mm and SAD 5-10 mm being 91.6% and 62.2% (p < 0.001), respectively. Best detection rates were obtained for LNs located in Level 4R (83.6%) and Level 7 (80.4%). CONCLUSIONS: The proposed 3D deep learning approach achieves an overall good performance in the automatic detection and segmentation of thoracic LNs and shows reasonable generalizability, yielding the potential to facilitate detection during routine clinical work and to enable radiomics research without observer-bias.

Papel de la interleuquina-17 en procesos inflamatorios y patologías pulmonares / Role of interleukin-17 in inflammatory processes and pulmonary pathologies

Resumen Introducción: Cuatro de las diez principales causas de muerte en el mundo corresponden a patologías pulmonares donde las infecciones respiratorias se ubican en tercer lugar y a su vez son uno de los principales motivos de consulta médica. Por otro lado, la interleuquina IL-17 parece tener un papel importante en la inmunopatogénesis de un gran número de enfermedades, pues se ha descrito que niveles elevados en sangre periférica u otros fluidos corporales se relacionan con metástasis e infecciones. Diferente a patologías cutáneas e intestinales, donde el papel de la IL-17 se conoce con mayor detalle, en procesos pulmonares su rol es aún controversial. Objetivo: Describir conocimientos actuales sobre la función de la IL-17 en procesos inflamatorios y patologías locales pulmonares. Metodología de búsqueda: Se realizó una búsqueda bibliográfica de artículos originales y revisiones de tema en los motores de búsqueda MEDLINE y Science Direct, de los cuales 50 cumplieron con los criterios de inclusión. Conclusiones: Se encontró que la respuesta de IL-17 parece estar relacionada con buen pronóstico en el caso de algunas neumonías bacterianas. Igualmente, el bloqueo de la vía de señalización de la IL-17 en neoplasias pulmonares podría ser beneficioso y se considera como un potencial blanco terapéutico en estas condiciones, por lo que los estudios en este tema continúan siendo fundamentales para conocer mejor el verdadero rol de esta proteína en diversas condiciones patológicas del pulmón. MÉD.UIS.2021;34(1): 55-62.

Abstract Introduction: Four out of ten major causes of death in the world are due to pulmonary pathologies where respiratory infections are in third place and in turn, are one of the main reasons for medical consultation. Interleukin (IL)-17 seems to have an important role in the immunopathogenesis of many diseases. Elevated levels of IL-17 in peripheral blood or other body fluids have been reported to be associated with metastases and infections. Likewise, the role that IL-17 has in the skin and intestinal pathology is clearly known, however; its role within pulmonary pathologies is controversial yet. Objective: To describe the current knowledge on the role of IL-17 in inflammatory processes and pulmonary pathologies. Search Methodology: A bibliographic search of original and review papers was carried out in the MEDLINE and Science Direct database, in which 50 articles matched the inclusion criteria. Conclusions: The response involving IL-17 in the lung seems to be related to a good prognosis in the case of some bacterial pneumonia. Blocking the IL-17 signaling pathway in lung cancer could be beneficial and is considered as a potential therapeutic target under these conditions, so studies on this subject must be continued to better understand the true role of this protein in every pathologic lung condition. MÉD.UIS.2021;34(1): 55-62.

Metástasis infrecuentes en el carcinoma broncogénico / Uncommon metastases in bronchogenic carcinoma

Introducción: El pulmón es el órgano con mayor localización de enfermedad y mortalidad tumoral. En el momento del diagnóstico 55 por ciento de los casos presentan metástasis a distancia lo que implica un estadio avanzado de la enfermedad. Las metástasis cutáneas y en huesos distales de neoplasias internas son infrecuentes comparadas con las producidas en otras vísceras. La invasión cutánea puede presentarse por extensión directa de estructuras subyacentes y suelen asentar en la pared torácica anterior, por implantación accidental en maniobras diagnósticas, embolización vía linfática y por vía hematógena con posibles lesiones en zonas muy distantes y cuya aparición suele ser más precoz. Histológicamente, es el cáncer de pulmón indiferenciado el que con mayor frecuencia metastiza en la piel. Objetivo: Presentar dos casos con diagnóstico de carcinoma de pulmón células no pequeñas que desarrollaron metástasis en localizaciones infrecuentes. Presentación de los casos: Se presentan dos casos con metástasis infrecuentes de un carcinoma broncogénico. El primero a nivel nasal y el segundo en los metacarpianos y zonas blandas de la mano izquierda, ambas lesiones tumorales aparecieron en el curso del tratamiento oncológico para el cáncer del pulmón. El segundo caso fue tratado como una tendinitis y flebitis. Ambos casos evolucionaron hacia las metástasis múltiples y la muerte. Conclusiones: Se presentaron dos casos con metástasis infrecuente de un carcinoma de pulmón células no pequeñas, y aunque una vez diagnosticadas el pronóstico es malo a corto plazo, se deben de tener en cuenta para evitar diagnósticos y conductas erróneas(AU)

Introduction: The lung is the organ with the greatest location of disease and tumor mortality. At the time of diagnosis, 55 percent of the cases present distant metastases, which implies an advanced stage of the disease. Cutaneous and distal bone metastases from internal neoplasms are rare compared to those produced in other viscera. Cutaneous invasion can occur by direct extension of underlying structures and usually settle in the anterior chest wall, by accidental implantation in diagnostic maneuvers, lymphatic and hematogenous embolization with possible lesions in very distant areas and whose appearance is usually earlier. Histologically, it is undifferentiated lung cancer that most frequently metastasizes to the skin. Objective: To report two cases with a diagnosis of non-small cell lung carcinoma that developed metastases in infrequent locations. Case report: Two cases are reported with rare metastases from bronchogenic carcinoma. The first at the nasal level and the second in the metacarpals and soft areas of the left hand, both tumor lesions appeared in the course of oncological treatment for lung cancer. The second case was treated as tendinitis and phlebitis. Both cases progressed to multiple metastases and death. Conclusions: There were two cases with infrequent metastases of non-small cell lung carcinoma, and although once diagnosed the prognosis is poor in the short term, they should be taken into account to avoid misdiagnosis and misconduct(AU)