Computed tomography findings in 66 patients with malignant pleural mesothelioma due to environmental exposure to asbestos.

We aimed to investigate the computed tomography (CT) findings of malignant pleural mesothelioma (MPM) caused by environmental asbestos exposure. We retrospectively reviewed CT scans of 66 patients, which were performed before any invasive procedure was done. Pleural effusion (80.3%), pleural thickening (77.2%), volume contraction (37.9%), involvement of mediastinal pleura (31.8%) and interlobar fissure (28.8%) were the most common CT findings of MPM. Although none of these findings are pathognomonic for MPM, they may provide valuable clues for the differential diagnosis, at least in patients with a history of asbestos exposure.

Thromboembolic Events in Malignant Pleural Mesothelioma.

AIM: Malignant pleural mesothelioma (MPM) increases the risk of thromboembolic events (TEEs). In this retrospective study, we aimed to determine the rate of TEEs in MPM and investigate its relationship with the presence of thrombocytosis, the disease stage, and the tumor histopathology. METHODS: The study included 178 patients who were histopathologically diagnosed as MPM between the years January 2008 and June 2014. RESULTS: The mean age was 58.7 ± 11.8 years, and the median follow-up time was 8 months. Seventy-one patients (39.9%) had thrombocytosis (>350 × 10(3)/mL). In total, 14 (7.9%) TEEs were identified: 6 (3.4%) pulmonary thromboembolism, 6 (3.4%) deep venous thrombosis, and 2 (1.1%) myocardial infarctions. Although 5 (2.8%) of the TEEs preceded the diagnosis of MPM, 1 (0.6%) occurred simultaneously with the diagnosis of MPM and 8 (4.5%) followed the diagnosis of MPM. Thromboembolic event rates were not statistically different based on the presence of thrombocytosis (P = .51), disease stage (P = .14), and histopathology (P = .38). CONCLUSION: The rate of TEEs was 7.9%. Presence of thrombocytosis, disease stage, and histopathology did not affect the incidence of TEEs.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM: The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS: The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION: The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

The effect of mannose-binding protein gene polymorphisms in recurrent respiratory system infections in children and lung tuberculosis.

Mannose-binding lectin (MBL) is able to bind pathogens as an opsonin and plays an important role in the innate immunity. The aim of the present study was to determine the frequencies of the MBL gene variants in the Turkish population and to examine the presence of any association between MBL variants and development of tuberculosis (TB) in adults and recurrent respiratory tract infections in children. Two structural gene mutations in exon 1 of MBL gene (codon 54 and codon 57) were studied. The overall distribution of genotypes did not significantly differ between controls and TB patients/children with recurrent respiratory system infections. The frequency of allele B was calculated as 0.14, 0.09 and 0.06 for control, TB patients and children with recurrent respiratory system infections, respectively. It was found to be significantly lower in children with recurrent respiratory system infections than in controls (chi2: 4.68, d.f: 1, p: 0.030).

Decreased metabolic uptake in tuberculous pericarditis indicating response to antituberculosis therapy on FDG PET/CT.

Early diagnosis and adequate treatment of tuberculosis are important for disease control and prevention of complication. However, diagnosing disease is frequently delayed because of difficulties of bacilli isolation or reproduction in cultures, and also, the decision of the efficiency of treatment sometimes can be impossible. FDG PET has become a promising imaging modality in the field of infection and inflammation, especially for the extension and severity of disease. Here, we describe an unusual case of tuberculous pericarditis that shows marked increased FDG uptake on initial scan, with decreasing metabolic activity on follow-up scan indicating response to antituberculosis therapy.

Desmoglein-3 and Napsin A double stain, a useful immunohistochemical marker for differentiation of lung squamous cell carcinoma and adenocarcinoma from other subtypes.

The treatment strategy of differentiating lung carcinomas into small-cell lung carcinoma and non-small-cell lung carcinoma has been satisfactory until recently. The introduction of novel cytotoxic agents that affect a patient's response to therapy has made further differentiation important. Non-small-cell carcinoma represents a heterogeneous group of cancers with varying histologic subtypes, hence the necessity to subgroup them. In the case of adenocarcinoma and squamous cell cancer, their different responses to novel therapeutic agents and their higher occurrence make differentiation between them even more important. New markers such as desmoglein-3 (positive for squamous carcinoma) and Napsin A (positive for adenocarcinoma), which show improved specificity and sensitivity, may be particularly useful for this type of differentiation. In our study, 124 surgically resected specimens were used: 57 adenocarcinoma, 42 squamous cell carcinoma, 16 large-cell carcinoma, 1 small-cell carcinoma, and 8 typical carcinoid tumor samples. The sensitivity to desmoglein-3 and Napsin A was 92.8% and 85.9%, whereas specificity was 100% and 97%, respectively. The use of a desmoglein-3 and Napsin A double-staining strategy in our study confirmed that these markers are useful in differentiating pulmonary squamous cell carcinoma and pulmonary adenocarcinoma from other subtypes.

Pulmonary alveolar microlithiasis with low fluorodeoxyglucose accumulation in PET/computed tomography.

Pulmonary alveolar microlithiasis (PAM) is an uncommon lung disease characterized by accumulation of intraalveolar calcifications. The disease can be diagnosed based on the radiological findings. We present a 27-year-old women with five-year history of shortness of breath. She was diagnosed with PAM due to the presence of the characteristic chest X-ray and thorax computed tomography (CT) findings. We performed (18)F-fluorodeoxyglucose (FDG)-PET/CT imaging in order to detect any evidence of inflamation in the lung before deciding an anti-inflammatory treatment. The lung regions with dense calcifications revealed low FDG uptakes (SUVmax: 2.7) and the lung regions without calcifications showed lower FDG uptakes. No further treatment modality was planned besides inhaler salbutamol. Herein, we discuss this rare entity with literature search.