Combined SCLC clinical and pathological aspects.

Combined small cell lung carcinoma (C-SCLC) is rare and accounts for 1-3% of all lung cancer cases. Although its incidence has increased recently, there are limited studies on it. The records of patients admitted to our hospital between January 2015 and December 2019 and diagnosed with histologically proven combined small cell were scanned retrospectively and reviewed. 31 patients were analyzed. The average follow-up time was 10 months. The radiotherapy (RT) rate, surgery rate, and large cell malignancy rate were significantly lower in the ex group than in the living group (p=0.024, p=0.023, p=0.015). The rates of extensive disease, metastasis, and thyroid transcription factor 1 (TTF1) were significantly higher in the old group than in the living group (p=0.000, p=0.000, p=0.029, respectively). In the univariate model, sequential RT, fatigue, lactate dehydrogenase (LDH), stage, metastasis, contralateral lung metastasis, chemotherapy were observed to be significantly effective in predicting survival time (p=0.000, p=0.050, p=0.011, p=0.004, p=0.004, p=0.045, p=0.009).  In the multivariate model, independent (p=0.015, p=0.022, p=0.049) efficacy of RT, stage, and chemotherapy in predicting survival was observed. C-SCLC is a specific mixed carcinoma and reports evaluating this type are still scarce. The stage of the disease, radiotherapy and chemotherapy are extremely important in predicting survival.

Molecular properties and survival of lung adenocarcinoma in young patients.

OBJECTIVE: This study aims to investigate the molecular properties and factors of lung cancer in young patients aged 18-45 years, affecting survival in patients with pulmonary adenocarcinoma. METHODS: Patients aged between 18 and 45 years who were diagnosed with lung adenocarcinoma in our hospital between January 2015 and December 2019 and their tumoural mutations were studied and included in this study and then reviewed retrospectively from the hospital records. RESULTS: At the time of diagnosis, 71 (3.57%) of 1985 primary lung cancer patients were 45 years old, and 42 (59.2%) male and 29 (40.8%) female patients with a mean age of 39.9 were evaluated. Most of the patients were diagnosed with advanced-stage lung cancer, 55 (77.5%) of them were in stage IV. PET CT showed that the standard intake value (SUV) of 11.1 tended to be high. Multiple organ metastases were detected in 57 patients (80.3%). EGFR (epidermal growth factor receptor) mutation was positive in 13 patients (18.3%), ALK (anaplastic lymphoma kinase) mutation was positive in 13 patients (18.3%) and ROS (c-ros) mutation oncogene was positive in 2 (2.8%) patients. Surgical operation was performed in 21 (29.6%), radiotherapy was given to 29 (40.8%), chemotherapy to 48 (67.6%) and targeted therapy to 22 (31.0%) patients. The mean overall survival of the patients was 16 months. Within 1 year, 41 (57.7%) patients died. CONCLUSION: In our study, significant efficacy of age, gender distribution, smoking, metastasis, ALK positivity, presence of chemotherapy, targeted therapy and surgical treatment was observed in young adenocarcinoma patients. The molecular properties of lung adenocarcinoma in young patients differ from those in the general population, and major driver genes are major factors influencing tumour differentiation and prognosis. In our study, we aimed to explain the molecular properties and results of pulmonary adenocarcinoma. In the future, we will provide constructive recommendations for the prevention and treatment of young patients.

Factors affecting the life expectancy in malignant pleural mesothelioma: Our 10 years of studies and experience.

Malignant pleural mesothelioma (MPM) is an aggressive tumor with a poor prognosis. In our study, we aimed to investigate the specific clinical, laboratory, and radiological features of the tumor and the prognostic effect of SUVmax (maximum standardized uptake values) according to PET/CT (positron emission tomography). Demographic, therapeutic, clinical, and survival information of patients diagnosed with histologically-validated pleural mesothelioma in our hospital between January 2010 to December 2019 will be retrospectively scanned from the hospital records. A total of 116 patients, 61 men (52.6%), and 55 women (47.4%), were analyzed. Thirty five patients (30.2%) were over the age of 65. Percentage of patients over 65 years of age, neutrophil count, and PET SUV Max values, asbestos exposure and pleural thickening rate were significantly higher in the deceased patients' group than in the living patients' group (P = .042, P = .039, P = .002, P = .004, P = .037). T stage (tumor stage), N stage (lymph nodes stage), metastasis stage, and Grade distribution were significantly higher in the deceased patients' group than in the living patients' group (P < .000, P < .000, P = .003, P < .000). The rates of chemotherapy and surgical treatment, right lung location, and epithelioid pathology were significantly lower in the deceased patients' group compared to the living patients' group (P = .016, P = .030, P = .018, P = .008). The mean follow-up time was 13 months. Key determinants of survival in MPM include age, male gender, neutrophil increase, pleural thickening, high PET SUV max values, stage, histological type, asbestos exposure, and treatment regimen.

What is the effect of tumor diameter, lymph node metastases, and SUVmax value on prognosis in limited-stage small cell lung cancer?

OBJECTIVE: This study was designed to investigate the link between survival and prognostic factors such as tumor size, lymph node metastasis, and metabolic activity detected on positron emission tomography/computed tomography in patients with limited-stage small cell lung carcinoma. METHODS: Patients who were admitted to our hospital with pathological diagnosis of limited-stage small cell lung cancer between January 2015 and December 2019 and were older than 18 years were retrospectively screened. RESULTS: A total of 77 patients, including 10 females and 67 males, were included in the study. While there were 39 patients over 60 years of age, 38 patients were under 60.The ratios of male patients, N stage, multiple lymph nodes, distant metastasis, brain metastasis, and prophylactic cranial irradiation in the deceased patients' group were significantly (p=0.008, p=0.000, p=0.000, p=0.000, p=0.013, p=0.000, respectively) higher than those in the living patients' group.In the univariate model, we observed that gender, smoking, T stage, N stage, multiple lymph nodes, distant metastasis, brain metastasis, liver metastasis, sequential chemotherapy, sequential radiotherapy, concurrent chemoradiotherapy, and prophylactic cranial irradiation had significant effect (p=0.049, p=0.021, p=0.022, p=0.000, p=0.000, p=0.000 p=0.003, p=0.037, p=0.029, p=0.049, p=0.000, respectively) on survival time. In the multivariate model, smoking, N stage, liver metastasis, and prophylactic cranial irradiation demonstrated significant independent effect (p=0.010, p=0.003, p=0.004, p=0.000, respectively) on survival time. CONCLUSION: Our findings provide useful information for better patient management, especially in terms of negative factors on the continuation of survival during and after the treatment of limited-stage small cell lung carcinoma patients.

[The treatment results of retreatment pulmonary tuberculosis patients in our clinic]. / Klinigimizde yeniden tedavi rejimi uygulanan akciger tüberkülozlu olgularin sonuçlari

164 human immunodeficiency virus (HIV) seronegative pulmonary tuberculosis cases treated in our clinic between January 1997 to December 2005 and included in category two treatment group were evaluated retrospectively. All the cases were male. The mean age was 43.72 ± 12.73 years. The mean duration of disease was 3.96 ± 4.80 years. The patients had used mean 4.62 ± 0.86 types of drugs. The patients were hospitalized for mean 100.54 ± 67.43 days. 23 (14%) patients were defined as treatment failure. 42 (25.6%) patients were relapse and 99 (60.4%) were defaulter. Mean time of conversion was 2.62 ± 1.84 months. Conversion rate was higher in relapse cases (76.2%) compared with treatment failure (56.5%) and defaulter (57.6%). In 140 patients, resistance tests were performed. 73 (52.1%) patients had any drug resistance. 45 (32.1%) patients had multidrug resistance. Among all the patients, 7 (4.3%) patients had died. 48 (29.3%) patients defaulted. 33 (20.1%) had treatment failure. 76 (46.3%) had cured. The cure rate was 65.5% in patients who were in control. 36.4% of defaulters were out of control. This rate was significantly higher than relapse and treatment failure cases (p= 0.014). Cure rate in defaulters (38.4%) were significantly lower than relapses (61.9%) and treatment failures (52.2%). There was a significant relationship between any drug resistance and cure and conversion. There was also a significant relationship between positive second and third ARB and culture and treatment success. As a result, a chance to retreatment regimen can be given in relapses and treatment failures before deciding minor drug therapy because they have higher cure rates than defaulters. Defaulters are hard to cure. They have the tendency to default again and they have higher resistance rates. The multi drug resistance rate in all patients was about 32% and 46.7% of these have cured with retreatment regimen. Bacteriological follow up of treatment outcome is effective in management of therapy.

[Evaluation of Quantiferon-TB Gold and tuberculin skin test in patients with tuberculosis, close contact of patients, health care workers and tuberculosis laboratory personnel]. / Tüberkülozlu hastalar, yakin temaslilari, saglik çalisanlari ve tüberküloz laboratuvari personelinde Quantiferon-TB Gold ve tüberkülin cilt testinin degerlendirilmesi.

Tuberculin skin test (TST) has been used effectively for a long time, despite inherent sensitivity and specificity limitations. Patients with a positive TST without active tuberculosis are identified as having latent tuberculosis infection. Identifying patients with latent tuberculosis infection with this test is an important part of control of the disease. A whole-blood inferferon gamma (IFN-γ) assay, the Quantiferon TB Gold test (QTG; Cellestis, Australia) which is a promising in vitro diagnostic test for the identification of latent tuberculosis infection (LTBI), has potential advantages over the TST. This test includes Myobacterium tuberculosis specific ESAT- 6 and CFP-10 antigens. The aim of this study was to compare the results obtained by QTG and TST in active tuberculosis (TB) patients, close contacts of patients, health care workers and tuberculosis laboratory personel. Twenty-six patients with active pulmonary TB, 6 close contacts of those patients, 11 health care workers with contact to TB patients and 8 TB reference laboratory personnel were included in the study. Prior to administration of the TST, blood samples were drawn from each participant for QTG test. All subjects were asked for BCG vaccination history and examined for a BCG scar. All individuals had a BCG scar. The QTG assay was performed in whole blood samples according to manufacturer's instructions. The agreement between TST and QTG was measured with kappa statistical analysis. In active TB patients (true-infected cases) TST (PPD) positivity was found 34.6% (9/26) while QTG positivity was 65.3% (17/26). Although the positivity rate was higher in QTG test, this difference was not found statistically significant (p > 0.001). TST and QTG positivity rates for health care workers, close house contact of TB patients and TB laboratory staff were as follows, respectively; 36% (4/11) and 27% (3/11); 16.6% (1/6) and 83% (5/6); 37.5% (3/8) and 75% (6/8). The mean PPD diameter was 11 mm in QTG negative group and 14 mm in QTG positive group with a statistically significant difference (p < 0.001). However, there was no statistical significance between QTG positive and negative groups by means of age (p ≥ 0.05) and gender (p < 0.001). In conclusion, QTG assay was superior to TST in its ability to detect LTBI and active TB infection, not to be affected with BCG vaccination, to discriminate responses due to non-tuberculous mycobacteria, and to avoid variability and subjectivity associated with application and reading the TST. Besides, QTG assay needs only one visit to the test unit. However, its being expensive than TST and requirement for special equipments and skilled laboratory personnel, are among the disadvantages of QTG assay.

[A rare form of urinary bladder cancer metastasis to lung]. / Mesane kanserinin akciger metastazinin nadir bir formu.

Sixty-seven year old male patient has attended with cough and sputum complaint. He had been operated because of transitional cell urinary bladder carcinoma four years ago. He had previous medical history of pulmonary tuberculosis 27 years ago. In chest X-ray, multiple cavitary appearances were present. In computerized tomography (CT) of the thorax, bilateral multiple cavities were seen. Sputum smear examinations for acido resistant bacilli (ARB) were negative for nine times. CT guided fine needle aspiration biopsy was performed and he was diagnosed as "pulmonary metastasis of transitional cell urinary bladder cancer". This patient is presented because of the interesting radiological appearance and rare presentation of the case.

What is the effect of tumor diameter, lymph node metastases, and SUVmax value on prognosis in limited-stage small cell lung cancer?

SUMMARY OBJECTIVE: This study was designed to investigate the link between survival and prognostic factors such as tumor size, lymph node metastasis, and metabolic activity detected on positron emission tomography/computed tomography in patients with limited-stage small cell lung carcinoma. METHODS: Patients who were admitted to our hospital with pathological diagnosis of limited-stage small cell lung cancer between January 2015 and December 2019 and were older than 18 years were retrospectively screened. RESULTS: A total of 77 patients, including 10 females and 67 males, were included in the study. While there were 39 patients over 60 years of age, 38 patients were under 60. The ratios of male patients, N stage, multiple lymph nodes, distant metastasis, brain metastasis, and prophylactic cranial irradiation in the deceased patients' group were significantly (p=0.008, p=0.000, p=0.000, p=0.000, p=0.013, p=0.000, respectively) higher than those in the living patients' group. In the univariate model, we observed that gender, smoking, T stage, N stage, multiple lymph nodes, distant metastasis, brain metastasis, liver metastasis, sequential chemotherapy, sequential radiotherapy, concurrent chemoradiotherapy, and prophylactic cranial irradiation had significant effect (p=0.049, p=0.021, p=0.022, p=0.000, p=0.000, p=0.000 p=0.003, p=0.037, p=0.029, p=0.049, p=0.000, respectively) on survival time. In the multivariate model, smoking, N stage, liver metastasis, and prophylactic cranial irradiation demonstrated significant independent effect (p=0.010, p=0.003, p=0.004, p=0.000, respectively) on survival time. CONCLUSION: Our findings provide useful information for better patient management, especially in terms of negative factors on the continuation of survival during and after the treatment of limited-stage small cell lung carcinoma patients.

Analysis of patients with hemoptysis in a reference hospital for chest diseases.

Chest physicians frequently come across with the symptom hemoptysis, an alerting symptom which may result from a wide variety of disorders. In this study, we aimed to determine the main causes of hemoptysis in a reference hospital for chest diseases. All the patients who admitted to our emergency clinic with hemoptysis during three months of study period were included in the study. The mean age of 143 patients (106 males, 37 females) who were included in this study was 48 +/- 17 years. Medical history, physical examination and chest radiography were performed for each patient. Sputum examination for acid fast bacilli, computed tomography of thorax, fiberoptic bronchoscopy, ventilation-perfusion scintigraphy, echocardiography, ear-nose-throat examination and upper gastrointestinal system endoscopy were the further diagnostic investigations for selected patients. Bronchiectasis was the most common cause of hemoptysis (22.4%), followed by lung cancer (18.9%), active tuberculosis (11.2%), and inactive tuberculosis (10.5%). Sputum smear for acid fast bacilli was performed in 102 patients and were positive in 15.6% of them. Computed tomography of thorax was performed in 102 patients and was pathologic in 81.3% of them. Fiberoptic bronchoscopy was performed in 46 patients and localized the bleeding site in 67.4% of them. In conclusion, the most common causes of hemoptysis were bronchiectasis, lung cancer and tuberculosis in our hospital. Based on this finding, we suggest that, the diagnostic approach to the patients presenting with hemoptysis should include first a detailed medical history, physical examination, and chest radiography; second sputum smear for acid fast bacilli; third computed tomography of thorax and lastly fiberoptic bronchoscopy.

[Airway inflammation and lymphocyte subset analysis in patients with chronic obstructive pulmonary disease and healthy smokers]. / Stabil kronik obstrüktif akciger hastaligi olan hastalar ile sigara içenlerde hava yolu inflamasyonu ve lenfosit alt tiplerinin analizi.

Chronic airway inflammation is reported to have an important role for the development of chronic obstructive pulmonary disease (COPD), in addition to smoking, genetic and environmental factors. The present study was aimed to investigate whether the airway inflammation differed in subjects with stable COPD and healthy smokers. A total of 35 subjects (18 patients with COPD and 17 healthy smokers) were enrolled in this study. Bronchoalveolar lavage (BAL) was performed via fiberoptic bronchoscope in all subjects and cell counts and profiles and lymphocyte subset were analyzed in BAL fluids. The number of neutrophils in BAL of subjects with stable COPD was significantly higher than that of the healthy smokers (p< 0.001), and the number of macrophages was significantly lower than that of the healthy smokers (p< 0.001). Although CD4+ T:CD8+ T lymphocyte ratio was higher in healty smokers, the difference was not significant (p> 0.05). As a result, the most marked cellular change in BAL of subjects with stable COPD is the increase in neutrophils and decrease in macrophages, suggesting a very important role in the chronic airflow limitation.