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Reproducibility of pulmonary invasive adenocarcinoma diagnosis is poor when applying the World Health Organization (WHO) classification. In this article, we aimed first to explain by 3-dimensional morphology why simple pattern recognition induces pitfalls for the assessment of invasion as applied in the current WHO classification of pulmonary adenocarcinomas. The underlying iatrogenic-induced morphologic alterations in collapsed adenocarcinoma in situ overlap with criteria for invasive adenocarcinoma. Pitfalls in seemingly acinar and papillary carcinoma are addressed with additional cytokeratin 7 and elastin stains. In addition, we provide more stringent criteria for a better reproducible and likely generalizable classification.
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Adenocarcinoma del Pulmón , Adenocarcinoma , Neoplasias Pulmonares , Invasividad Neoplásica , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/diagnóstico , Adenocarcinoma del Pulmón/patología , Adenocarcinoma del Pulmón/diagnóstico , Adenocarcinoma/patología , Adenocarcinoma/diagnósticoRESUMEN
BACKGROUND. Concern may exist that pulmonary lesions associated with cystic airspaces are at risk of increased biopsy complications or lower biopsy accuracy given challenges in targeting tissue abutting or intermingled with the cystic airspaces. OBJECTIVE. The purpose of this study was to evaluate the safety and diagnostic performance of CT-guided core needle biopsy (CNB) of pulmonary lesions associated with cystic airspaces. METHODS. This retrospective study included 90 patients (median age, 69.5 years; 28 women, 62 men) who underwent CT-guided CNB of pulmonary lesions associated with cystic airspaces (based on review of procedural images) from February 2010 to December 2022 and a matched control group (2:1 ratio) of 180 patients (median age, 68.0 years; 56 women, 124 men) who underwent CNB of noncystic noncavitary lesions during the same period. The groups were compared in terms of complications, nondiagnostic biopsies (i.e., nonspecific benignities, atypical cells, or insufficient specimens), and CNB diagnostic performance for detecting malignancy using as reference the final diagnosis from a joint review of all available records. For lesions associated with cystic airspaces that underwent surgical resection after CNB, histologic slides were reviewed to explore the nature of the cystic airspace. RESULTS. The final diagnosis was malignant in 90% (81/90) of lesions associated with cystic airspaces and 92% (165/180) of noncystic noncavitary lesions. Patients with lesions associated with cystic airspaces and patients with noncystic noncavitary lesions showed no significant difference in frequency of complications (overall: 40% [36/90] vs 38% [68/180], p = .79; major: 4% [4/90] vs 6% [10/180], p = .78; minor: 36% [32/90] vs 32% [58/180], p = .59), frequency of nondiagnostic biopsies (12% [11/90] vs 9% [16/180], p = .40), or diagnostic performance (accuracy: 94% [85/90] vs 97% [175/180], p = .50; sensitivity: 94% [76/81] vs 97% [160/165], p = .50; specificity: 100% [9/9] vs 100% [15/15]; p > .99), respectively. All false-negative results for malignancy in both groups occurred in patients with nondiagnostic CNB results. Among lesions associated with cystic airspaces that were resected after CNB (all malignant), the cystic airspaces most commonly represented tumor degeneration (22/31 [71%]). CONCLUSION. CT-guided CNB is safe and accurate for assessing pulmonary lesions associated with cystic airspaces. CLINICAL IMPACT. CNB may help avoid a missed or delayed cancer diagnosis in pulmonary lesions with cystic airspaces.
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Biopsia Guiada por Imagen , Neoplasias Pulmonares , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Anciano , Biopsia Guiada por Imagen/métodos , Biopsia Guiada por Imagen/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Estudios Retrospectivos , Estudios de Casos y Controles , Biopsia con Aguja Gruesa/métodos , Biopsia con Aguja Gruesa/efectos adversos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/diagnóstico por imagen , Persona de Mediana Edad , Quistes/diagnóstico por imagen , Quistes/patología , Enfermedades Pulmonares/patología , Enfermedades Pulmonares/diagnóstico por imagen , Radiografía Intervencional/métodos , Anciano de 80 o más Años , Adulto , Pulmón/patología , Pulmón/diagnóstico por imagenRESUMEN
BACKGROUND: The interplay between cancer cells and the immune system is crucial in cancer progression and treatment. In this regard, the tumor immune microenvironment and macroenvironment, marked by systemic inflammation markers and TILs, could be considered key prognostic factors in tumors, including oral and lung squamous cell carcinoma. METHODS: We conducted a retrospective clinical study on patients with Oral Squamous Cell Carcinoma (OSCC) and Lung Squamous Cell Carcinoma (LUSCC), examining stages, comorbidities, treatments, and outcomes. We evaluated the prognostic significance of pre-surgical systemic inflammation markers and tumor microenvironment composition. RESULTS: Associations were found between systemic inflammation markers-NLR, MLR, and PLR-and tumor microenvironment factors, such as TILs and CD8+ cell prevalence-elevated inflammation markers correlated with advanced stages. Specifically, NLR was prognostic in OSCC, whereas PLR was prognostic in LUSCC. Using a cutoff value, we divided our tumor samples into two prognostic groups. Moreover, TILs levels >15% of tumor stroma correlated with prolonged overall survival in both OSCC and LUSCC, while increased CD8+ expression was linked to extended disease-free survival in LUSCC. DISCUSSION: Systemic inflammation markers and TILs can be valuable prognostic factors of survival, highlighting the immune response's role in OSCC and LUSCC. Despite limited clinical integration of the presented cohorts due to a lack of standardization, we concluded that analyzing tumor immune profiles may offer novel prognostic insights. CONCLUSIONS: Future integration into cancer classification could improve risk stratification and treatment guidance.
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PURPOSE: To report the clinical and multimodal imaging features of sympathetic ophthalmia in the acute and chronic phases. METHODS: Retrospective cohort study of consecutive patients with sympathetic ophthalmia seen at a tertiary referral center. Charts, imaging studies, and histopathological specimens were reviewed. The clinical features and multimodal imaging in the sympathizing eye were analyzed by sorting features into those seen in the acute and chronic phase. RESULTS: Ten patients were included in the analysis and all of them had previous ocular trauma or complicated retinal detachment. In the acute phase, 70% had anterior uveitis, 70% had vitritis, and 100% had active posterior uveitis; posterior uveitis included multifocal choroiditis (80%), optic disc swelling (40%), multiple serous retinal detachments (20%), MEWDS-like findings (10%), and retinal vasculitis with chorioretinitis (10%). In the chronic phase, posterior manifestations included widespread patches of chorioretinal atrophy in the mid- and far-periphery (80%), peripapillary subretinal fibrosis (50%), and nummular perivascular atrophy (50%). CONCLUSIONS: Sympathetic ophthalmia shows different posterior segment manifestations in the acute and chronic phase. Active sympathetic ophthalmia should be ruled out in eyes with a MEWDS-like presentation or rapidly progressing chorioretinitis, and history of trauma in the fellow eye. Peripapillary subretinal fibrosis and perivascular nummular atrophy may be useful features to suspect SO once acute inflammation has resolved.
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CONTEXT.: Loose tumor cells and tumor cell clusters can be recognized in the lumen of intratumoral pulmonary arteries of resected non-small cell lung cancer specimens. It is unclear whether these should be considered tumor-emboli, and as such could predict a worsened prognosis. OBJECTIVE.: To investigate the nature and prognostic impact of pulmonary artery intraluminal tumor cells. DESIGN.: This multicenter study involved an exploratory pilot study and a validation study from 3 institutions. For the exploratory pilot, a retrospective pulmonary resection cohort of primary adenocarcinomas, diagnosed between November 2007 and November 2010, were scored for the presence of tumor cells, as well as potentially other cells in the intravascular spaces using hematoxylin-eosin, and cytokeratin 7 (CK7) stains. In the validation part, 2 retrospective cohorts of resected pulmonary adenocarcinomas, between January 2011 and December 2016, were included. Recurrence-free survival (RFS) and overall survival (OS) data were collected. RESULTS.: In the pilot study, CK7+ intravascular cells, mainly tumor cells, were present in 23 of 33 patients (69.7%). The 5-year OS for patients with intravascular tumor cells was 61%, compared with 40% for patients without intravascular tumor cells (P = .19). In the validation study, CK7+ intravascular tumor cells were present in 41 of 70 patients (58.6%). The 5-year RFS for patients with intravascular tumor cells was 80.0%, compared with 80.6% in patients without intravascular tumor cells (P = .52). The 5-year OS rates were, respectively, 82.8% and 71.6% (P = .16). CONCLUSIONS.: Loose tumor cells in pulmonary arterial lumina were found in most non-small cell lung cancer resection specimens and were not associated with a worse RFS or OS. Therefore, most probably they represent an artifact.
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We report a case of localized malignant pleural mesothelioma (LMPM) of the interlobar fissure mimicking lung cancer. A 74-year-old woman presented with dyspnoea and a left pleural effusion. Chest computed tomography revealed a bulky mass, arising from the left lower lobe with intense uptake at the 18F-FDG PET. A left lower lobectomy was performed after thoracoscopic pleural biopsies. The final histology revealed an LMPM epithelioid like. We describe the diagnostic and curative path of the disease, speculating on the differential diagnosis and treatment of LMPM.
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Neoplasias Pulmonares , Mesotelioma Maligno , Mesotelioma , Neoplasias Pleurales , Anciano , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Mesotelioma/diagnóstico por imagen , Mesotelioma/cirugía , Pleura/patología , Neoplasias Pleurales/diagnóstico por imagen , Neoplasias Pleurales/cirugíaRESUMEN
Paraneoplastic neurologic syndromes (PNSs) are a wide spectrum of neurologic diseases characterized by different clinical features, associated with a neoplasia, and triggered by an immune-mediated process. In most cases, it is possible to detect specific neuronal antibodies and the Hu protein is one of the most frequently recognized intracellular antigens in patients with PNSs. Small-cell lung cancer is the most common cancer associated with PNSs, followed by urological, gynecological and hematological malignancies. Otherwise, extra-pulmonary small-cell carcinomas, including Merkel cell carcinoma (MCC), have been rarely described as related to PNSs. In this article we report, for the first time in the published literature, a case of anti-Hu antibody-related subacute sensory neuronopathy in association with MCC.
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Carcinoma de Células de Merkel , Carcinoma de Células Pequeñas , Neoplasias Pulmonares , Neoplasias Primarias Desconocidas , Síndromes Paraneoplásicos del Sistema Nervioso , Síndromes Paraneoplásicos , Neoplasias Cutáneas , Anticuerpos , Carcinoma de Células de Merkel/complicaciones , Carcinoma de Células Pequeñas/complicaciones , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Primarias Desconocidas/complicaciones , Neoplasias Cutáneas/complicacionesRESUMEN
Oral squamous cell carcinoma is an extremely malignant tumour: in order to reduce mortality and morbidity, early diagnosis and treatment is the clinician's best weapon.
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OBJECTIVES: The aim of the study was to evaluate the condylar and ramal asymmetry of the mandible in patients with juvenile idiopathic arthritis (JIA) using orthopantomographies (OPTs). METHODS: A total of 30 JIA patients with confirmed diagnosis of JIA and a routine OPT, seeking for orthodontic therapy, free of specific symptoms of temporomandibular joint involvement, and 30 normal matched subjects with OPT were comprised in the study. The method of Habets et al. was used to compare the condyles and rami in OPT. The significance of between-group differences were assessed using Mann-Whitney test. RESULTS: The results showed a high significant difference in the range of asymmetry of the condyle, being the patient group highly asymmetrical (P < 0.0001). No differences were found in the range of asymmetry of the ramus between groups (P = 0.47). The intra-group comparison between males and females showed a difference in the patient group (P = 0.04), being the females more asymmetric. CONCLUSIONS: Knowing that the temporomandibular joint (TMJ) is highly susceptible to inflammatory alterations during growth, even in absence of symptomatology, and being the OPT a cost-benefit favorable imaging tool widespread in the dental field, the latter could be used as a first screening examination in JIA patients to calculate the condylar asymmetry index. The use of this screening tool will help the physicians in addressing the patients that should undergo a more detailed TMJ imaging to early detect TMJ abnormalities and to early set up a targeted therapy of the related cranial growth alterations.