ABSTRACT
The development of non-caseating granulomas in patients with neoplastic diseases is referred to as a sarcoid-like reaction. This reaction may be found in the primary tumour or near it; however, it is commonly seen in the regional lymph nodes, and usually subsides after treatment of the underlying disease. The pathogenesis of this process has not been fully explained. Sarcoid-like reactions occur in 4.4% of solid tumours, 7.3% of patients with non-Hodgkin's lymphoma, and 13.8% of patients with Hodgkin's lymphoma. The radiological image of increased lymph nodes due to the sarcoid-like reaction is similar to that of lymphadenopathy with neoplastic aetiology, and may create diagnostic difficulties. The paper presents the case of a patient with a sarcoid-like reaction in regional lymph nodes caused by lung cancer, and describes difficulties in the interpretation of results from positron emission tomography (18F-FDG PET), which may have led to inappropriate treatment. False-positive accumulation of radiotracer (fluorodeoxyglucose, FDG) in mediastinal and hilar lymph nodes in the patient, who had chemotherapy and right-side pneumonectomy, was unambiguously interpreted by the radiologists as the relapse of lung cancer. Considering the fact that the patient was in a very good condition and presented with no clinical symptoms that indicated the progression of cancer, we extended the medical diagnostics. The performed procedures ruled out neoplastic process and confirmed our assumptions regarding sarcoid-like reaction. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was the diagnostic procedure that provided conclusive results. Sarcoid granulomas were identified by the pathomorphologist in the specimen. The patient avoided toxic treatment.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Sarcoidosis/diagnostic imaging , Aged , Carcinoma, Non-Small-Cell Lung/pathology , False Positive Reactions , Fluorodeoxyglucose F18 , Humans , Lung Neoplasms/pathology , Lymph Nodes/diagnostic imaging , Male , Positron-Emission Tomography , Sarcoidosis/pathologyABSTRACT
INTRODUCTION: Chemical pleurodesis is an accepted palliative therapy for patients with recurrent and symptomatic pleural effusion. The aim of the study is to present our own experiences with a less invasive variant of this procedure performed with talc slurry administered via a chest tube under local anaesthesia. Available medical literature in Polish does not contain information about this type of pleurodesis. MATERIAL AND METHODS: During 2005-2011 in the Pulmonology and Respiratory Rehabilitation Department we hospitalized and diagnosed 162 patients with pleural fluid. Pleurodesis was performed in 24 patients (14.8%) with persistent pleural fluid. In this article we present retrospective analysis of safety, efficacy of treatment and patients' survival time. We also provide detailed information about this type of pleurodesis: clinical theory, indications, contraindications, patient's preparation, description of procedure with our modifications and use of chest X-ray and transthoracic ultrasound. RESULTS: The procedure was effective in 20 cases, partially effective in 3 cases and ineffective in one case. In-hospital mortality was 4.2% (one case). We frequently observed mild fever and local pain. Median hospitalization was 9 days. Median survival time was 32 days, whereas in the group of still living patients it was 96 days. CONCLUSIONS: Talc slurry pleurodesis with adequate patient preselection is a relatively effective and safe procedure. The procedure can be performed in a non-surgical pulmonology unit.
Subject(s)
Insufflation/methods , Pleural Effusion, Malignant/therapy , Pleurodesis/methods , Talc/administration & dosage , Adult , Aged , Case-Control Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Palliative Care/methods , Retrospective Studies , Thoracoscopy/methods , Treatment OutcomeABSTRACT
In 2001 a modified MRC questionnaire and spirometry were performed in the inhabitants of Zabrze (Poland). Two hundred and thirty-nine men and 320 women aged 19-69 years were studied. Forty percent of men and 23% of women were smokers. In men but not in women a decline in smoking habit was observed as compared with previous studies in Zabrze carried out in the eighties. More men (32%) than women (19%) gave up smoking. The prevalence of chronic productive cough was closely related to smoking habit. Dyspnea and wheezing were also related to smoking but less strongly than productive cough. The prevalence of COPD (diagnosed according to GOLD criteria) was 10.2%. COPD was more common in smokers than in non-smokers, especially among men (19% and 2% respectively). Persistent productive cough, wheezing and advanced dyspnoea as well as intensive smoking (more than 40 pack years) were strongly connected with the prevalence of COPD. COPD was previously diagnosed in more than 50% of subjects identified as having COPD in this study. Almost 80% of subjects with COPD were not given any treatment in the past year.
