Serum Specific Antibodies Do Not Seem to Have an Additional Role in the Diagnosis of Hypersensitivity Pneumonitis.

BACKGROUND: We aimed to investigate the contribution of serum IgG testing to the history of exposure in the diagnosis of fibrotic hypersensitivity pneumonitis. METHODS: A single-center, retrospective, cross-sectional study including 63 patients pathologically diagnosed with fibrotic hypersensitivity pneumonitis in line with the guidelines of the American Thoracic Society. Descriptive statistics were presented and Kappa statistic was performed to evaluate the compatibility between panel and the history of exposure. RESULTS: The median age was 63 (22-81) years and 34 (54%) were male. Forty-six patients (73%) had a positive history of exposure. Thirty-nine patients (61.9%) had a positive HP/Avian panel. The most common exposure agent was mold (34.9%), followed by parakeet (31.7%). The antibody detected the most was penicillium chrysogenum lgG (36.5%), followed by aspergillus fumigatus (31.8%). There was no compatibility between HP/Avian panel and history of exposure (kappa coefficient= 0.18, p= 0.14). When the exposure was only assessed based on the history, 4 (6.35%) patients were diagnosed as fibrotic hypersensitivity pneumonitis with low confidence, 6 (9.52%) with moderate confidence, 11 (17.46%) with high confidence and 42 (66.67%) with definite confidence; whereas 4 (6.35%) patients were diagnosed as fibrotic hypersensitivity pneumonitis with low confidence, 6 (9.52%) with moderate confidence, 9 (14.29%) patients with high confidence and 44 (69.84%) patients with definite confidence if exposure was evaluated with history and/or panel. CONCLUSIONS: Serum specific precipitating antibody panel does not seem to provide additional value to the history of exposure in the diagnosis of fibrotic hypersensitivity pneumonitis.

Analysis of SMARCA4 and SMARCA2 Loss in Lung Sarcomatoid Carcinomas.

OBJECTIVE: Sarcomatoid carcinomas of the lung are a group of aggressive tumors. It has been reported that losses of SMARCA4 and SMARCA2, which play a role in the repair and remodeling of chromatin, contribute to the initiation, progression, and differentiation of neoplasms. The aim of our study was to examine SMARCA4 and SMARCA2 profiles in sarcomatoid carcinomas of the lung. MATERIAL AND METHOD: We screened pleomorphic carcinomas (PCs), carcinosarcomas (CSs), and pulmonary blastomas (PBs). The loss of SMARCA4 and SMARCA2 expression in the tumors was evaluated using immunohistochemical methods. The tumors were also examined to determine immunophenotype, histological tumor diagnosis, surgical resection, tumor histological component, largest tumor diameter, and lymph node metastasis status. RESULTS: Sixty-nine cases were screened, of which 84% were PCs, 13% were CSs, and 2.8% were PBs. In PCs components, 84.4% were biphasic and 15.5% were monophasic. The PCs showed the most frequent loss of SMARCA4 (25.8%) and SMARCA2 (44.8%). A loss of SMARCA4 and SMARCA2, respectively, was detected in 14.2% and 24.4% in both components of biphasic PCs; 12.2% and 14.2% in the sarcoma component of biphasic PCs; 0% and 8.1% in the carcinoma component of biphasic PCs; 22.2% and 33.3% in monophasic PCs; 0% and 22.2% in both components of CSs; and 0% and 22.2% in the sarcoma component of CSs. CONCLUSION: These findings demonstrate a loss of expression of SMARCA4 and SMARCA2 in pulmonary sarcomatoid carcinomas. Loss of the SMARCA complex may be caused by the heterogeneous morphological profile of sarcomatoid carcinomas, independent of tumor histopathological parameters.

Evaluation of the Interstitial Histological Lesions in Pulmonary Langerhans Cell Histiocytosis.

OBJECTIVE: Pulmonary Langerhans cell histiocytosis is a cystic lung disease characterized by the proliferation of parenchymal dendritic cells. The disease can become chronic or even cause pulmonary fibrosis. Our aim in this study was to investigate the typical histological findings and interstitial fibrosis in pulmonary Langerhans cell histiocytosis cases. MATERIAL AND METHOD: In the study, cases that had undergone diagnostic resection were screened. Smoking, histological stage (subacute, subacute-chronic), and cystic and eosinophilic granulomas were confirmed in the cases. In addition to emphysema, chronic nonspecific bronchiolitis, interstitial fibrosis (subpleural-paraseptal fibrosis, peribronchial fibrosis, fibrotic nonspecific interstitial pneumonia), honeycomb-type fibrocysts, and unexpected lesions were investigated. Descriptive and comparative (Fisher exact test) statistical analyses were used in the study (p < 0.05). RESULTS: A total of 27 cases were detected; age distribution was 17-68 (36.4). Smoking was present in 15 (55.5%) cases. Six (22.2%) cases were subacute, and 21 (7.7%) cases were subacute-chronic histological stage. A cystic lesion was present in 22 (81.4%) cases. All cases had emphysema accompanying the underlying lesions. Chronic nonspecific bronchiolitis was detected in 14 (51.8%) cases. Interstitial fibrosis was detected in 8 (29.6%) patients. Compared to interstitial fibrosis and nonfibrosis, there was no significant difference between being younger than 39 years, gender, smoking, and histological stage (p=0.41; 1; 0.69; 0.63, respectively). CONCLUSION: There is a risk of developing interstitial fibrosis patterns and honeycomb-type fibrocysts in the progression of pulmonary Langerhans cell histiocytosis. Histopathological evaluation can play an important role in the detection of risk groups.

Benign Solitary Pulmonary Necrotic Nodules: How Effectively Does Pathological Examination Explain the Cause?

Aims: We investigated the histopathological features of solitary pulmonary necrotic nodules (NNs) of undetermined cause. We combined our findings with those obtained using other methods to determine how well the etiological factors were explained. Methods: We screened patients who underwent surgery to treat solitary pulmonary granulomatous and nongranulomatous NNs of undetermined cause. The NN sizes and features of both the NNs and adjacent parenchyma were evaluated. Histochemical analyses included Ehrlich-Ziehl-Neelsen (EZN), Grocott, and Gram staining. Polymerase chain reaction (PCR) was used to detect tuberculous and nontuberculous mycobacteria, panfungal DNA, Nocardia, Francisella tularensis types A and B, and actinomycetes. Results: The NNs were granulomatous in 78.9% and nongranulomatous in 21% of the 114 patients included. EZN staining or PCR was positive for Mycobacterium in 53.5% of all NNs: 62.2% of granulomatous and 20.8% of nongranulomatous NNs. We found a weak but significant correlation between granulomatous NNs and Bacillus positivity and a significant correlation between granulomas surrounding the NNs and the presence of multiple necroses. The NN etiology was determined via histopathological, histochemical, and PCR analyses in 57% of patients but remained undetermined in 42.9%. Conclusion: The causes of both granulomatous and nongranulomatous NNs can be determined by pathological examination. Granulomatous necrosis and granulomas in the adjacent parenchyma are important for differential diagnosis. When both features are present, they strongly support a diagnosis of tuberculosis, even in the absence of bacilli.

Cavitary pulmonary nodules in rheumatoid arthritis; case reports and review of the literature.

Rheumatoid nodules are the most common pulmonary manifestations of rheumatoid arthritis (RA) and are usually asymptomatic. In rare cases, they progress cavitary formation and cause severe clinical symptoms because of disease activity, infectious diseases, and other etiologies. The determination of clinical and histopathological features may be helpful for differential diagnosis in patients with RA with cavitary pulmonary nodules. Herein, we report two female patients with RA with cavitary pulmonary nodules and aim to obtain more detail data by means of reviewing previously reported cases.

Bronchial Stump Recurrence after Complete Resection of Lung Cancer: Effect of the Distance between the Tumor and Bronchial Resection Margin.

PURPOSE: The purpose of this study was to evaluate the following parameters after complete resection in established lung cancer patients: the frequency of bronchial stump recurrence (BSR), the effect of the distance between the tumor and bronchial resection margin (DBTM) on BSR, the survival of patients with BSR, and the effect of the DBTM on survival. PATIENTS AND METHODS: We retrospectively evaluated 553 consecutive lung cancer patients who underwent complete lung resection. The patients were classified as DBTM: ≤ 10 mm (group 1), 11 to 20 mm (group 2), and > 20 mm (group 3). RESULTS: We found BSR in eight (1.5%) patients. Six patients were in group 1, and two were in group 2. The difference was found to be statistically significant (p = 0004; groups 1 vs. 3). In multivariable analysis, we observed a trend toward significance for the effect of a DBTM on BSR development (p = 0.1). The DBTM did not significantly affect survival (p = 0.61). The survival of patients who developed BSR was significantly poor compared with those who did not develop BSR (p = 0.001). CONCLUSION: BSR can develop even after complete resection of lung cancer. The DBTM is associated with BSR risk, and the survival of patients who develop BSR is poor.

Endobronchial Treatment of Carcinoid Tumors of the Lung.

BACKGROUND: Bronchial carcinoid tumors are known as low-grade malignancies. Surgery has been proposed as the best treatment of choice for lung carcinoids. However, less invasive treatment approaches may be considered due to low-grade malignancy potential of such tumors. The aim of this study was to review the results of endobronchial treatments of carcinoid tumors of the lung and to compare with the outcome after surgery. METHODS: Initial complete tumor eradication with an endobronchial treatment was attempted for 29 patients. Diode laser or argon plasma coagulation was used during these treatments. Cryotherapy or laser treatments were applied consecutively in patients for whom there was good bronchoscopic visualization of the distal and basal tumor margins and no evidence of bronchial wall involvement. Surgery was performed in cases of atypical carcinoid and in cases of nonvisualization of the basal and distal part of the tumor. RESULTS: Overall, 29 patients have been included (median age 58 years; range, 23-77 years). Median follow-up has been 49 months (range, 22-94 months). A total of 24 patients (69%) had typical carcinoid tumor, 5 patients (31%) had atypical carcinoid tumor. Initial endobronchial treatment provided complete tumor eradication in 21 of 29 patients (72%). Of the eight other patients (28%), two were atypical carcinoids, and underwent surgical treatment. There was no tumor-related death and no recurrence during the follow-up in both groups. There was no difference for survival or recurrence between the surgical and the endobronchial treatment group of patients (p > 0.05). CONCLUSION: Endobronchial treatment may be considered as safe, effective treatment for typical carcinoid tumors in the central airways. Addition of initial endobronchial treatment had no negative effect on the surgical outcome.

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases.

OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value. METHODS: We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up. RESULTS: We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases. CONCLUSIONS: The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy.

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in various lung diseases / Valor diagnóstico da punção aspirativa por agulha guiada por ultrassom endobrônquico em diferentes doenças pulmonares

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value.Methods: We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up.Results: We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases.Conclusions: The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy.

Objetivo: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, punção aspirativa por agulha guiada por ultrassom endobrônquico) é um novo método para o diagnóstico e estadiamento das doenças pulmonares e seu uso está aumentando em todo o mundo. Ela tem sido utilizada como um método diagnóstico de câncer de pulmão em estágios iniciais, e há dados que apoiam sua utilização para o diagnóstico de doenças pulmonares benignas. O objetivo deste estudo foi compartilhar a nossa experiência com EBUS-TBNA e discutir seu valor diagnóstico.Métodos: Analisamos, retrospectivamente, os resultados relacionados a 159 pacientes submetidos a EBUS-TBNA em nossa clínica de medicina pulmonar entre 2010 e 2013. Registramos a localização e o tamanho dos linfonodos visualizados durante EBUS. Os linfonodos suspeitos durante o procedimento foram puncionados ao menos duas vezes. Foram registrados os resultados diagnósticos por EBUS-TBNA e, para os casos com diagnóstico indefinido após EBUS-TBNA, os diagnósticos finais após investigação aprofundada e acompanhamento.Resultados: Avaliamos 159 pacientes, dos quais 89 (56%) eram homens e 70 (44%) eram mulheres. As médias de idade foram de 54,6 ± 14,2 anos nos homens e de 51,9 ± 11,3 anos nas mulheres. Dos 159 pacientes avaliados, 115 (84%) foram diagnosticados corretamente por EBUS. A acurácia diagnóstica de EBUS-TBNA foi de 83% para doenças granulomatosas benignas e de 77% para doenças malignas.Conclusões: O valor diagnóstico de EBUS-TBNA também é alto para patologias benignas, como sarcoidose e tuberculose. Em pacientes com alterações no mediastino, o uso de EBUS-TBNA deve ser incentivado, principalmente devido à redução significativa da necessidade de mediastinoscopia.

Lymph node characteristics of sarcoidosis with endobronchial ultrasound.

BACKGROUND: Sonographic features of lymph nodes on endobronchial ultrasound (EBUS) have been shown to be useful in prediction of malignancy in mediastinum and hilum. The aim of this study was to assess the utility of morphologic features of mediastinal and/or hilar lymph nodes obtained by EBUS in patients with sarcoidosis. MATERIALS AND METHODS: We retrospectively reviewed the records of 224 patients with mediastinal/hilar lymph node enlargements who underwent EBUS for diagnostic purpose. The lymph nodes were characterized based on the EBUS images as follows: (1) Size; based on short-axis dimension, <1 cm or ≥1 cm, (2) shape; oval or round, (3) margin; distinct or indistinct, (4) echogenicity; homogeneous or heterogeneous, (5) presence or absence of central hilar structure, and (6) presence or absence of granular (sandpaper) appearance. RESULTS: One hundred (24.4%) nodes exhibited indistinct margins while 309 (75.6%) had distinct margins. One hundred and ninety nine (48.7%) nodes were characterized as homogeneous, and 210 (51.3%) nodes as heterogeneous. Granular appearance was observed in 130 (31.8%) lymph nodes. The presence of granules in lymph nodes on EBUS had the highest specificity (99.3%) for the diagnosis of sarcoidosis. Logistic regression analysis revealed the finding of distinct margin alone as an independent predictive factor for the diagnosis of sarcoidosis. CONCLUSIONS: The presence of granular appearance in lymph nodes by EBUS had the highest specificity (99.3%) for the diagnosis of sarcoidosis. Lymph nodes having distinct margins tend to suggest sarcoidosis.

Interobserver agreement among histological patterns and diagnosis in lung adenocarcinomas.

OBJECTIVE: The aim of this study was to investigate the interobserver agreement in determination of the dominant histological pattern and the final diagnosis in lung adenocarcinomas. MATERIAL AND METHOD: A total of 12 patients with a diagnosis of primary lung adenocarcinoma were included in the study. Twelve pathologists from eight study centers were asked first to determine the dominant histological pattern in these cases and then to decide whether the final diagnosis was in situ, minimally invasive or invasive adenocarcinoma. RESULTS: The kappa value for the agreement in determining the dominant pattern among the pathologists was 0.36 (p < 0.001), with the values for the lepidic, acinar, papillary, solid, micropapillary patterns and mucinous character of adenocarcinoma being 0.34, 0.28, 0.30, 0.80, 0.16 and 0.38 respectively (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001). None of the cases was diagnosed as in situ adenocarcinoma. On the other hand, the kappa value for the agreement in differentiating minimally invasive from invasive adenocarcinoma among reviewers was 0.17 (p < 0.001). CONCLUSION: The agreement among pathologists in determining the subtype of lung adenocarcinomas that depends on the identification of the dominant pattern was at intermediate level. In addition, the agreement in deciding whether the case is minimally invasive or invasive, was at low level. The criteria defining the histological patterns should be clarified and described in more detail. Educational activities and larger multicenter studies might be helpful in improving the agreement and standardization.

Relationship between lung adenocarcinoma histological subtype and patient prognosis.

PURPOSE: Lung adenocarcinoma (AC) demonstrates various histological subtypes within the tumour tissue. A panel established jointly by the IASLC, ATS and ERS classified invasive lung ACs based on the predominant histological subtype. We examined the distribution of tumours in lung AC patients according to histological subtype and analysed the effects of this classification on survival. METHODS: The records of patients who had pulmonary resection for lung cancer between January 2000 and December 2009 were reviewed and 226 lung AC patients who fulfilled the inclusion criteria were identified. Histological subtypes of the ACs and their ratios in the tumour tissue were determined. Tumours were classified according to the predominant histological subtype and subsequently graded. The relationship between the predominant histological subtype, grade and survival were analysed. RESULTS: Tumours were predominantly acinar in 99 cases (43.8%), solid in 89 (39.3%), lepidic in 20 (8.8%), and papillary in 11 (4.8%), whereas 7 tumours (3%) were variants of AC. Stage significantly affected survival (p = 0.001); however, the predominant histological subtype had no significant effect. The 5-year survival rate for patients with histologically grade II tumours was 48.6%, whereas that in patients with grade III tumours was 56%. (p = 0.69). CONCLUSION: Invasive lung ACs may be defined by their predominant histological subtype. However, it is not yet possible to conclude that this classification is related to survival.

Squamous cell carcinomas confined to the bronchial wall: the effect of growth patterns.

BACKGROUND: Squamous cell carcinomas confined to the bronchial wall (SCC-CBW) exhibit two distinct patterns of growth: superficially spreading and endobronchial mass lesions. We examined whether differences exist in the histopathological features and prognosis of SCC-CBW exhibiting different growth patterns. MATERIALS AND METHODS: In this study, 37 cases with SCC-CBW were included. Tumors were classified into two groups: superficially spreading squamous cell carcinoma (s-SCC) and nodular squamous cell carcinoma (n-SCC). For each case, the growth pattern, T and N status, lymphovascular and perineural invasions, immunohistochemical expressions of p53 and Ki-67, and survival rates were analyzed. RESULTS: Twenty cases were classified as s-SCC, and 17 cases were classified as n-SCC. There was a significant relationship and correlation between the length of s-SCC in the longitudinal axis and the depth of invasion (p = 0.01, R = 0.557). There was a statistically significant positive relationship between the depth of invasion and the nodal status (N1 involvement) (p < 0.0001, R = 0.71). CONCLUSIONS: SCC-CBW exhibits variable growth patterns. However, despite this variability, there are no biological or histological differences between tumors of different growth patterns, and this variability has very little, if any, effect on survival.

A rare tumor of trachea: Inflammatory myofibroblastic tumor diagnosis and endoscopic treatment.

Inflammatory myofibroblastic tumors (IMTs) are rare childhood neoplasms, with benign clinical course. Although etiology of IMTs are not clear, recent studies have reported that IMT is a true neoplasm rather than a reactive or inflammatory lesion. IMTs are rarely seen in adults and tracheal involvement is also rare both in adults and also in children. We describe a 16-year old female patient who was misdiagnosed and treated as asthma in another center for a few months and presented with acute respiratory distress due to upper airway obstruction. Computerized tomography (CT) of the chest and rigid bronchoscopy revealed a mass lesion that was nearly totally obliterating tracheal lumen. Bronchoscopic resection was performed under general anesthesia and the final pathological diagnosis was tracheal IMT.

The approaches of physicians working in the field of pathology regarding forensic pathology practice and the training process.

OBJECTIVE: Forensic autopsies are performed by the forensic medicine department and the microscopic examination processes by pathology specialists within the forensic medicine practice in Turkey. This disconnection in the process raises problems in the training of both branches. The aim of this study was to determine the awareness of pathology staff on forensic medicine practices and responsibilities and their opinion on the pathology training model in the forensic medicine specialty and to discuss the matter within the framework of the present situation and global applications. MATERIAL AND METHOD: A 15-item questionnaire form distributed to the participant physicians during registration at the 21st National Pathology Congress held in 2011 was evaluated. RESULTS: 94 participants responded. A negative opinion was expressed by 72% about the interest in the general post-mortem process. The view that pathology specialists should undergo a separate training to perform autopsies was predominant and there was a general lack of interest in all kinds of autopsy processes. The percentage who said they knew the legal responsibility of a pathology specialist regarding forensic autopsies correctly was 37%. The questions "what are the necessary factors to contribute to the pathology training in forensic medicine" and "if anything is required, which of them would take priority" were respectively answered as "for me to be interested (46%)" and "a system guaranteeing that training will always be given by pathology specialists (67%)". Despite the possibility of becoming a forensic medicine specialist in two years, the mean answer score of the participants to the phrase "I do not consider becoming a forensic medicine specialist" was 4.1 (out of 5). CONCLUSION: A reluctance among the pathologists in our country was seen regarding forensic medicine specialists being able to perform post-mortem microscopic examination. However, despite their legal responsibilities, their interest in forensic pathology practice was low. There seems to be rational factor that would increase this interest in the near future. Cooperation is necessary to enable forensic medicine specialists to perform post-mortem pathology procedures. This cooperation should be based on improving the training of pathology research assistants.

Which type of surgery should become the preferred procedure for malignant pleural mesothelioma: extrapleural pneumonectomy or extended pleurectomy?

PURPOSES: Since radiation and chemotherapy have limitations as therapies for malignant pleural mesothelioma (MPM). The type of surgery [extrapleural pneumonectomy (EPP), extended pleurectomy (E/P), and pleurectomy/decortication (P/D)] remains controversial. METHODS: This study involves 76 consecutive patients. 58 of the cases were males (76%) with a median age of 53.17±10.93 years. EPP, E/P, and P/D were performed in 31, 20, and 25 cases, respectively. RESULTS: The median survival time was 20 months in all patients. Overall, five-year survival rate was 14.3%. The survival rate was significantly better in epithelioid mesothelioma (P=0.049). For EPP cases, the median survival rate was 17 months, and the three-to-five year survival rates were 21% and 17%, respectively. For E/P cases, the median survival rate was 27 months and the three-year and four-year survival rates were 34% and 30%, respectively. For P/D cases, the median survival rate was 15 months and the three-to-five year survival rate was 13% and 0%. There were no statistically significant differences between the three surgical techniques (P=0.088). A comparative analysis indicates only a statistically significant difference in the E/P and P/D comparison (P=0.032). Hospital mortality showed a higher trend in EPP group (EPP: 12.9%, E/P: 0% and P/D: 4%, P=0.145). N2 cases, there were no cases of two-year survival. The survival rate in N2 was comparatively much lower, which was statistically significant (P=0.005). In multivariate analysis, only P/D (OR 0.3, 95% CI: 0.1-0.9, P=0.049) and N2 (OR 1.6, 95% CI: 0.9-2.6, P=0.090) were found to be poor prognostic factors. CONCLUSIONS: E/P could be encouraged to EPP with lower mortality rate and better survival trend in MPM. N2 diseases were negative prognostic factors in MPM.

18F-FDG PET-CT features of primary primitive neuroectodermal tumor of the chest wall.

A case of primary primitive neuroectodermal tumor (PNET) of the chest wall in an adolescent is presented with imaging findings including 18F-fluorodeoxyglucose (18F-FDG) positron-emission computed tomography (PET-CT). To date, radiological description of the PNET of the chest wall has mainly been carried out by radiographic analysis, computed tomography (CT), and magnetic resonance imaging (MRI). We demonstrated that 18F-FDG PET-CT visualizes the active focus of glucose metabolism of PNET of the chest wall and is effective for the preoperative evaluation of patients with this tumor.