Interstitial lung disease associated with docetaxel in a patient treated for breast cancer - a case report.

Docetaxel is a semisynthetic cytostatic drug that belongs to the family of taxoids. Docetaxel inhibits normal interphase and mitotic cellular function, causing cell death. Docetaxel is indicated for the treatment of breast, lung and prostate cancers, head and neck cancer and gastric adenocarcinoma. Interstitial pneumonitis is an uncommon side effect of docetaxel. We report a case of docetaxel induced interstitial lung disease (ILD) in a patient with breast cancer.

[Liposarcoma--a rare primary neoplasm of the thorax]. / Tluszczakomiesak--rzadki pierwotny nowotwór w klatce piersiowej.

Liposarcoma is a rare tumour localised within the thorax. It can originate from a different thoracic structures (for example: lung parenchyma, mediastinum, pleura) or thoracic wall. We present a case of a 35-year-old woman with a giant tumour of the left hemithorax, who had two weeks history of non-productive cough and progressive dyspnoea from eight months. Chest radiography showed a large, round opacity in the left hemithorax, which displaced the cardiac silhouette to the right. Contrast-enhanced computed tomography showed a huge, heterogeneous, well-circumscribed mass in the left pleural cavity. The tumour expanded locally towards the thoracic wall and left lung, and displaced mediastinal structures to the right. There was no lymphadenopathy on the physical examination and CT scan. Abdominal ultrasonography was normal. There was no proof of tumour in the extremities and trunk. The patient underwent surgical excision of the tumour via thoracotomy, but because of tumour infiltration, part of the third rib and surrounding wall were resected. There was no evidence of lung and mediastinum involvement. The mass measured 17.5 × 18 × 10 cm and weighed 1690 g. A final diagnosis of a well-differentiated liposarcoma - sclerosing subtype - was established after histological and immunohistochemical staining. In our opinion, the liposarcoma in this case originated from the chest wall. Surgical resection was the only treatment. During six months after surgery the patient had no evidence of disease progression.

[Fibrosing mediastinitis with pulmonary hypertension as a rare complication of sarcoidosis]. / Wlóknienie sródpiersia z nadcisnieniem plucnym jako rzadkie powiklanie sarkoidozy.

Fibrosing mediastinitis is a rare disease, mostly associated with previous granulomatous diseases, such as histoplasmosis, tuberculosis, or sarcoidosis. We present a case of 42-year-old woman with sarcoidosis, who had developed fibrosing mediastinitis and pulmonary hypertension. Contrast-enhanced computer tomography showed abnormal, bilateral, solid tissues surrounding the hila and mediastinum. Magnetic resonance imaging showed: abnormal, intermediate signal tissue in the mediastinum, surrounding hila, narrowing both lower lobe arteries and both lobe bronchi, left upper lobe atelectasis, and contrast enhancement of mediastinal infiltration. The patient was treated with steroids for 14 months (initial dose of prednisone was 1 mg/kg/day, then tapered) with clinical and radiological improvement. We reviewed the literature concerning fibrosing mediastinitis. The various causes of that disorder, the radiological manifestation, and possible treatment modalities are discussed. The causes of pulmonary hypertension in our patient are another aspect of the article. It could be associated with both the fibrosing mediastinitis and the sarcoidosis.

[Polymorphism in the N-acetyltransferase 2 gene in patients with lung cancer. Short communication]. / Polimorfizm w genie N-acetylotransferazy 2 u chorych na raka pluca. Doniesienie wstepne.

INTRODUCTION: Individual's risk of developing lung cancer depends not only on exposure to tobacco smoke, but also on the activity of enzymes involved in the activation or deactivation of carcinogens. Arylamine N-acetyltransferase (EC 2.3.1.5) is an enzyme involved in biotransformation of xenobiotics, mainly aromatic and heterocyclic amines and hydrazines. The different acetylation phenotypes within a population are derived from mutations in the NAT 2 gene. These mutations influence the activity (specifically resulting in high or low activity) of the NAT enzyme. Some authors have demonstrated lung cancer predisposing role of slow acetylator phenotype, whereas other reported increased lung cancer risk for fast acetylators or neutral effect of the NAT2 polymorphism. The aim of this preliminary report was to determine the NAT2 gene polymorphism in patients with lung cancer. MATERIAL AND METHODS: 39 patients with inoperable lung cancer (29 - NSCLC and 10 - SCLC), median age 59 years (42- -72) entered the study. Acetylation genotype was determined in the genomic DNA using an allele-specific polymerase chain reaction. We investigated four genetic mutations, C481T, G590A, A803G i G857A, of the gene NAT2. RESULTS: There were 10 different NAT2 genotypes among the 39 patients. Fourteen patients with a NAT2*2 4/4, *4/5, *4/6 and *4/7 were classified as fast acetylators; and 25 patients with a NAT2*5/5, *5/6, *5/7, *6/6, *6/7 or *7/7 genotype were classified as slow acetylators. Among the 10 patients with SCLC - 4 were fast acetylators, and among 29 patients with NSCLC dominated slow acetylation type found in 19 patients (genotypes NAT2 *5/5 and NAT2 *5/6). CONCLUSIONS: Among patients with small cell lung cancer, there was no predominance of genotype of acetylation, whereas among patients with non-small cell lung cancer predominated NAT2*5/5 and NAT2*5/6 genotypes (slow acetylators).

[Normal D-dimer concentration in hospitalized patients with lung diseases]. / Czestosc prawidlowego stezenia D-dimerów u pacjentówhospitalizowanych z chorobami pluc.

INTRODUCTION: The use of D-dimer testing is an established part of the diagnosis of suspected pulmonary embolism (PE). However, in hospitalized patients many various factors might be responsible for increased D-dimer concentration and they could lower utility of D-dimer in exclusion of PE in such population. According to some published data, calculating the index D-dimer/fibrinogen could increase the specificity of D-dimer in the recognition of venous thromboembolism (VTE). The aim of the present study was to determine the frequency of normal D-dimer concentration in hospitalized patients with lung diseases in whom the differential diagnosis of PE is particularly difficult and to evaluate the utility of the index D-dimer/fibrinogen in subgroups of patients: with acute VTE and with lung cancer. MATERIAL AND METHODS: 619 consecutive patients aged 54.9 (± 15.4) hospitalized in reference pulmonary center were enrolled into observation. Among them, there were 96 (15%) patients with acute VTE, 65 (10%) with exacerbation of COPD and 172 (27%) with lung cancer. RESULTS: Mean D-dimer concentration (Vidas D-dimer New) was 1956 ± 3691 ng/ml and median value 842 (45-35 678) ng/ml. Normal D-dimer concentration (〈 500 ng/ml) was found in 225/523 (43%) without acute VTE. In 49% (32/65) patients with COPD and in 25% (43/172) patients with lung cancer D-dimer concentration was below 500 ng/ml as well. The index D-dimer/fibrinogen was significantly higher in acute VTE patients compared to lung cancer patients - 808 ± 688 and 289 ± 260 respectively, p 〈 0.001. CONCLUSIONS: Normal D-dimer concentration was found in more than 40% of patients with lung diseases hospitalized in reference pulmonary center. This observation could suggest higher than described in the literature utility of D-dimer measurement in exclusion of PE in such a population. The value of the index D-dimer/fibrinogen, which is significantly higher in acute VTE than in lung cancer requires further evaluation to establish its clinical utility.

[Elevated serum NSE level in locally advanced and metastatic NSCLC predispose to better response to chemotherapy but worse survival]. / Podwyzszone surowicze stezenie NSE w nieoperacyjnym niedrobnokomówym raku ptuca jest zwiazane z lepsza odpowiedzia na leczenie, ale z gorszym rokowaniem.

The aim of the study was to evaluate the predictive and prognostic values of elevated serum levels of selected cancer markers (NSE, Cyfra 21-1, CEA, ferritin, free beta-hCG, LDH) in patients with inoperable non-small-cell lung cancer (NSCLC). We investigated a group of 79 patients (49 men and 30 women) with NSCLC. Multivariate regression analysis showed response in patients with NSE > 12.5 ng/ml (p = 0.002), good performance status (p = 0.007) and elderly patients (p = 0.005). However, elevated NSE adversely affected the prognosis. Median survival in patients with NSE < 12.5 ng/ml, 12.5-20.0 ng/ml and > 20.0 ng/ml was 13.3, 11.3 and 6.7 months, respectively (p = 0.004). The negative effect of elevated NSE was independent of the response category. Univariate regression analysis showed that the following factors had a significantly negative effect on the prognosis: performance status, stage IIIB or IV, weight loss of > 10%, NSE > 20 ng/ml, Cyfra 21-1 > 10 ng/ml, CEA > 3 ng/ml, ferritin ratio > 1 and LDH > 480 IU/l. Multivariate analysis showed an independent adverse prognostic effect of stage IIIB or IV and elevated ferritin.

Disseminated Mycobacterium avium infection in a 20-year-old female with partial recessive IFNgammaR1 deficiency.

We report the case of a 20-year-old female with disseminated Mycobacterium avium disease involving bones, lungs and brain. She was completely healthy up until the present illness and had been vaccinated with BCG in infancy without complications. Mycobacteriosis progressed in spite of treatment with antituberculous drugs and was controlled only after addition of interferon-gamma subcutaneously. A homozygous hypomorphic I87T mutation was found in the gene encoding the ligand-binding chain of the IFN-gamma receptor (IFNgammaR1). This mutation is the only known recessive hypomorphic lesion in IFNGR1 and had been reported before in only 1 child with curable BCG infection and his sibling with primary tuberculosis. Our report illustrates the clinical heterogeneity of patients sharing exactly the same form of partial recessive IFNgammaR1 deficiency. A diagnosis of partial recessive IFNgammaR1 deficiency should be contemplated in adults with unexplained environmental mycobacterial diseases.

[The significance of the serum tumour markers as a prognostic and predictor factors in nonsmall cell lung cancer patients]. / Znaczenie wybranych biochemicznych markerów nowotworowych dla prognozowania wczesnej odpowiedzi na leczenie i rokowanie u chorych na niedrobnokomórkowego raka pluca.

The aim of the study was to assess the role of serum tumour markers (NSE, Cyfra 21-1, CEA, LDH, ferritin) as a prognostic and predictive factors in 79 patients with advanced NSCLC treated with chemotherapy. Objective response to treatment was significantly more frequent in the patient with serum NSE > 12.5 ng/ml. Progression of disease was observed more often in patients with serum Cyfra 21-1 >10 ng/ml or LDH >480 U/L. CEA >3 ng/ml, LDH >480 U/L, for coefficient >1, NSE >20 ng/ml and Cyfra 21-1 >10 ng/ml had a negative impact on survival in univariate analysis. Independent negative prognostic significance of fer coefficient >1 was confirmed by multivariate analysis.

[Prognosis in limited disease (LD) small cell lung cancer (SCLC) patients according to status performance, local extension of lesions, type of treatment and the completeness of staging]. / Rokowanie chorych na ograniczona postac drobnokomórkowego raka pluca w zaleznosci od stanu sprawnosci, lokalnej rozleglosci zmian, sposobu leczenia oraz stopnia precyzji w ustaleniu zaawansowania.

The aim of this study was to assess the prognosis in LD SCLC pts according to their performance status, local extension of lesions, type of treatment and the completeness of staging. In the period 01.01.1986-31.12.1996 in the Institute of Tuberculosis and Chest Diseases 579 consecutive SCLC pts were treated. LD was diagnosed in 345 pts. In 193 out of them the staging was complete that is in addition to chest x-ray, abdomen USG/CT, brain CT/MRI and bilateral bone marrow trepanobiopsy was done. 152 pts were also regarded as limited but the staging was not complete. LD pts proved by complete staging survived significantly longer (median survival 15.7 months) than others (median survival 10.2 months). The pts in whom complete staging was done were however in better performance status and had smaller local extension of lesions and had more often radiotherapy than others. Status performance, local extension of lesions and radiotherapy but also completeness of staging were independent prognostic factors in multivariate analysis.

[Churg-Strauss syndrome--cardiac problem in lung disease department]. / Zespól Churga-Strauss. Problem kardiologiczny w klinice chorób pluc.

Eosinophilia and pleural effusion may suggest pulmonary eosinophilia. We present a case of 42 years old woman with hypereosinophilia history since 5 months and no evidence of parasitic infections. She had no history of heart disease. Laboratory tests revealed eosinophilia (13.0 x 10(9)/l) and elevated serum IgE (2050 IU/ml), ANCA was not detected. ECP was not elevated. Pleural effusion contained 37% of eosinophils. An ECG revealed low voltage of QRS in all leads and Q waves in leads Vi-V-3. An echocardiography showed enlargement of left auricle and left ventricle with ejection fraction = 35%. The only pulmonary manifestation in this case was eosinophilic pleural effusions associated with congestive heart failure. A women was treated with prednisone 1 mg/kg/d and cyclophosphamide 2 mg/kg/d with clinical improvement and normalisation of eosinophil number in peripheral blood. But echocardiographic picture of the heart was nor better during 2 months of observation.

[Pulmonary mycobacterioses--frequency of occurrence, clinical spectrum and predisposing factors]. / Postaci plucne mykobakterioz--czestosc wystepowania, obrazy kliniczne i czynniki predysponujace.

Various types of non-tuberculous mycobacteria can be the aetiologic factors of chronic lung infections especially in patients with underlying chronic lung diseases. The aim of this study is to present the cases of pulmonary mycobacterioses observed in Institute of Tuberculosis and Lung Diseases in the years 1995-2001. There were 23 patients, 12 men and 11 women in the age between 35-77 years, mean 56 years. 16 out of 23 patients had underlying respiratory problems, mainly healed tuberculosis (7) and COPD (6). Two additional patients suffered from other diseases with potential immunosuppression (leukopenia). In 5 patients no disease other than mycobacteriosis was found, but they were chronic smokers. In 19 cases cough and expectoration of purulent sputum lasting from several months to several years was observed. In 5 patients onset of disease was acute or subacute with high fever. Eight patients had haemoptysis. In chest X-ray pathological lesions including (18 cases) lung cirrhosis (10) and cavities (15) were found. In 4 cases disseminated bronchiectases with small nodules were the main radiologic feature. Mycobacteriosis was caused by M. kansasii in 11 cases, by M. intracellularae in 6, by M. xenopi in 5 and by M. scrofulaceum in 1 case.