Prognostic factors affecting survival in non-small cell lung carcinoma patients with malignant pleural effusions.

BACKGROUND AND AIMS: Lung cancer is the most common cause of malignant pleural effusions (MPEs). For patients with lung cancer and MPE, median survival is only 3-4 months. The aim of this study was to evaluate lung cancer patients with MPE by clinical and laboratory findings on admission, and determine 2-year survival rate and prognostic factors. METHODS: Between 2008 and 2011, we examined 199 cases of non-small cell lung carcinoma with MPE. Demographic factors of patients, tumor characteristics, treatment delivered and laboratory parameters affecting prognosis were evaluated. Survival rates were estimated by Kaplan-Meier method. Significance of each prognostic factors selected by univariate analysis were confirmed using Cox regression model. RESULTS: The study included 139 (69.8%) male and 60 (30.2%) female patients with a median age of 64 (30-85) years. Median overall survival was 4.4 months. Adenocarcinoma was the leading cause of MPE with 80.4%. A univariate analysis showed that factors affecting mortality included gender (P < 0.001), MPE with distant metastasis (P = 0.025), lower serum albumin (P < 0.0001), lower pleural protein (P < 0.0001), increased serum lactate dehydrogenase (P = 0.003), increased serum C-reactive protein (CRP) (P < 0.0001), increased white blood cells (P < 0.0001), histopathological type (P = 0.004) and treatment decision (P < 0.0001). A multivariate analysis revealed that patients who had high level of serum CRP (P = 0.017), lower serum albumin (P = 0.009) and lower pleural protein (P = 0.003), MPE with distant metastasis (P = 0.003) and those who were chemotherapy naive (P < 0.0001) had shorter survival. CONCLUSION: High level of serum CRP, lower serum albumin and lower pleural protein, MPE with distant metastasis were most important prognostic factors for non-small cell lung carcinoma in patients with MPEs.

Chronic eosinophilic pneumonia with mucous plugs in a child.

Chronic eosinophilic pneumonia is a rare cause of chronic lung disease in children. A 7-year-old girl who attended our clinics with cough and sputum lasting for 5 years, has been evaluated for bilateral alveolar infiltration and ground-glass opacities. Peripheral eosinophilia was detected in total cell blood count. Flexible bronchoscopy showed mucous plugs. Bronchoalveolar lavage fluid and cell block of mucous plugs determined hypereosinophilia. Chronic eosinophilic pneumonia was confirmed after the elimination of other eosinophilic lung diseases and the case was accepted to be idiopathic. She showed a dramatic response to oral corticosteroids. This is the first reported case of chronic eosinophilic pneumonia presenting with mucous plugs in children described to date in the literature.

Chlorine-induced extensive tracheobronchial necrosis concomitantly benzene-induced pancytopenia presented with severe pneumonia.

We report a case of 25-year-old woman with severe tracheobronchial necrosis caused by chlorine released from a mixture household cleaning agents. She subsequently exposed benzene while she was fixing the seats with benzene containing gum. The case was found interesting with its history, delayed diagnosis, bronchoscopic features, and fatal outcome. We presented its bronchoscopic and pathological images which has not been shown in the literature up to date.

Pleomorphic carcinoma of the lung: a report of six cases.

We presented six patients with pleomorphic carcinoma of the lung. There were 4 male and 2 female whose ages ranged from 43 to 64 years, with a mean age of 54.3 years. While two patients were nonsmoker, four patients were current smoker, with a mean smoking history of 52.5 (30-90) pack-years. Bronchoscopic examination detected endobronchial lesion in three patients. The diagnosis of pleomorphic carcinoma was established with cutting needle biopsy in one case and with thoracotomy in five cases. Epithelial component was squamous cell carcinoma in three cases and adenocarcinoma in the other three cases. There was bone metastasis in one case. She received chemotherapy and died two months after therapy. Among five patients who underwent surgery, pathologic staging was Stage IB in two patients, Stage IIB in two patients and Stage IV in one patient. Treatment modality was lobectomy in three cases and pneumonectomy in two cases. Survival time for patients after surgery was 2 to 20 months. In conclusion, pleomorphic carcinoma is a rare tumor of the lung. Diagnosis is frequently established with thoracotomy. These tumors have poor prognosis.

Does needle size affect diagnostic yield of transthoracic needle biopsy in malignant pulmonary lesions? Comparison of 18-, 22- and 25-gauge needles in surgical specimens.

OBJECTIVE: To evaluate the effect of needle size on the diagnostic yield of transthoracic needle aspiration biopsy in malignant pulmonary lesions. METHODS: The study assessed samples from 35 patients who underwent surgery for lung cancer. We used surgical specimens for needle aspiration biopsy. Aspirations were performed with 25-, 22- and 18-gauge, 9 cm in length aspirating needles. All pathology preparations were coded. At the end of the study period, all needle aspiration preparations were interpreted by the same pathologist. RESULTS: Lobectomy was performed in 19 patients, pneumonectomy in 15 and bilobectomy in one. Squamous cell carcinoma was the most frequent tumour type, followed by adenocarcinoma. The diagnostic yield of aspiration biopsy was 85.7% for 18-gauge needle and 82.9% for both 22-gauge and 25-gauge needles. There was no statistically significant difference for the three needles with respect to diagnostic yield (P > 0.05). Cell type concordance for 18-, 22- and 25-gauge needles was 70%, 65.6% and 65.6%, respectively. There was no statistically significant difference for the three needles with respect to cell type concordance (P > 0.05). CONCLUSION: Needle size did not affect diagnostic yield or accuracy for malignant lesions. Smaller needles such as 22-gauge needle would appear to be suitable for transthoracic needle aspiration biopsy in the diagnosis of malignant pulmonary lesions.

A relapsing case of Wegener's granulomatosis presenting as an endobronchial mass.

Wegener's granulomatosis (WG) relapse is frequent. Although lung involvement occurs in 85% of patients, endobronchial presentation of the disease is uncommon. We reported a relapsing case of WG presenting as an endobronchial mass. A 56- year-old man present ed with recurrence of WG following 14 months of cyclophosphamide and prednisolone therapy and 36 months of complete remission. At his first presentation, he was diagnosed as having WG with involvement of kidney, lung, upper airways, skin, joints and eyes. His chest X-ray showed bilateral patchy consolidation. Cytoplasmic-anti-neutrophil cytoplasmic antibodies (c-ANCA) was also present in high titres. c-ANCA was negative after therapy. At the time of relapse, he presented with nasal symptoms and hemoptysis. His chest X-ray showed right paracardiac opacity. Fiberoptic bronchoscopy revealed a mass lesion subtotally obstructing the proximity of right lower lobe. He has been given prednisolone in tapering doses and cyclophosphamide for 10 months.

Histopathological diagnosis of endobronchial endometriosis treated with argon laser.

The authors present a case of endobronchial endometriosis with catamenial haemoptysis. The lesion was diagnosed as endobronchial endometriosis based on histopathological examination of a bronchial biopsy from the right second carina. Fibreoptic bronchoscopic examination revealed a tiny hyperaemic submucosal area with bleeding and a brown-coloured diverticulum at bottom of this lesion encompassing a 2-cm2 area at the right second carina. Multiplanar reconstructions of a spiral CT scan revealed a 0.5-cm lesion that looked like a diverticulum at the right second carina. The patient was treated with argon laser at bronchoscopy. Following treatment, the patient has been asymptomatic with no recurrence of haemoptysis.

Does Helicobacter pylori infection play a role in lung cancer?

BACKGROUND: Helicobacter pylori infection is a world-wide common disease and leads to many gastrointestinal and respiratory illnesses. It is suggested that one of these respiratory illnesses is lung cancer. METHODS: Forty-three patients with non-small cell lung cancer and 28 control subjects have been included to this study. H. pylori status of the patients and controls was determined by immunoblot for the detection of IgG (RIDA Blot Helicobacter). All subjects were examined to evaluate the presence of VacA and CagA gene. RESULTS: Seropositivity of anti H. pylori IgG was significantly higher in cancer patients than in control groups, 40 (93%) and 12 (42%), respectively (P<0.01). Although both VacA and CagA seropositivity was high in lung cancer patients, only VacA positivity was statistically significant when compared with control subjects, 35 (81%) and 11 (42%), respectively (P<0.05). CONCLUSION: H. pylori infection may be associated with development of lung cancer.

Coexisting bronchial carcinoid tumor and pulmonary tuberculosis in the same lobe: a case report.

The synchronous occurrence of pulmonary tuberculosis and bronchial carcinoid tumor is unusual. Although pulmonary tuberculosis can coexist with all histological types of lung cancer, few coexisting cases of bronchial carcinoid tumor and pulmonary tuberculosis have been reported. We present coexistent bronchial carcinoid tumor and pulmonary tuberculosis in the same lobe. A 39-year-old woman was admitted to our clinic with chest pain for two months. Chest radiograph showed consolidation in the right lower field. Computed tomography of the thorax demonstrated multiple mediastinal lymphadenopathies, infiltration and atelectasis in the right lower lobe. Fiberoptic bronchoscopy showed a mass lesion totally obstructing the proximal right lower lobe bronchus. The pathological diagnosis was typical carcinoid tumor. Right lower lobectomy with mediastinal lymph node dissection was performed. The pathological examination of resected material revealed coexistent tuberculosis and carcinoid tumor in the same lobe and mediastinal tuberculous lymphadenitis.

Pulmonary glomus tumour: a case initially diagnosed as carcinoid tumour.

Pulmonary glomus tumours are rare lesions, with few cases reported previously. Herein, we present the clinical and pathological features of a case of pulmonary glomus tumour. A 29-year-old female patient presented to our clinic complaining of cough, dyspnoea and left-sided chest pain. Computed tomography (CT) of the thorax revealed a nodular lesion causing obstruction of the left main bronchus. Fibreoptic bronchoscopy demonstrated a polypoid mass occluding the left main bronchus 10 mm distal to the main carina. Bronchoscopic biopsy was interpreted histologically as carcinoid tumour. Bronchotomy plus mass extirpation was performed with left thoracotomy. Microscopically, a tumoral structure composed of uniform cells with a round centrally located nucleolus and narrow eosinophilic cytoplasm was seen. Thin-walled vessels lined with endothelium were interspersed between tumoral structures. The cells were stained chromogranin and cytokeratin negative and strongly vimentin positive. The pathological diagnosis for the thoracotomy specimen was pulmonary glomus tumour. Follow-up chest CT was negative for recurrent tumour and the patient remains free of disease 17 months after surgery.

Detection of SV40 DNA sequences in malignant mesothelioma specimens from the United States, but not from Turkey.

The incidence of malignant mesothelioma (MM) shows a strong epidemiological association with exposure to asbestos fibers. Recently, simian virus 40 (SV40) DNA sequences have been reported in MM tumor specimens from the United States and several European countries, and the SV40 tumor virus has been implicated as a potential co-factor in the etiology of this disease. However, several large studies from the US, Finland, and Turkey did not detect SV40 sequences in MM samples. To address this discrepancy, MM specimens from Turkey and the US were analyzed in the same laboratory under identical conditions to detect the presence of SV40 DNA. We detected SV40 sequences in 4 of 11 specimens from the United States, but in none of the 9 Turkish samples examined. These findings suggest that geographical differences exist with regard to the involvement of SV40 in human tumors.