Lung consolidation in a young-age active smoker: An unexpected diagnosis.

A 29-year-old man presented to Emergency Department with nonspecific symptoms. Through a series of radiological and invasive diagnostic studies we finally reach an unexpected diagnosis of hypersentivity pneumonitis; this is a complex and heterogeneous disease which diagnosis can be challenging as its clinical, radiologic and histopathologic features overlap with those of other interstitial lung diseases (ILDs). Diagnosing an ILD is a dynamic process, and that is the reason why complex cases discussed in a multidisciplinary team may need to be reconsidered in light of evolution of the disease and the results of the performed exams with a flexible approach.

Diagnostic role of internal mammary lymph node involvement in tuberculous pleurisy: a multicenter study.

BACKGROUND AND OBJECTIVES: Diagnosis of tuberculous pleurisy (TP) may be challenging and it often requires pleural biopsy. A tool able to increase pre-test probability of TP may be helpful to guide diagnostic work-up and enlargement of internal mammary lymph node (IMLN) has been suggested to play a potential role. The aim of the present investigation was to assess role of IMLN involvement in TP in a multi-centric case-control study, by comparing its prevalence and test performance to those observed in patients with infectious, non-tuberculous pleurisy (NTIP), and in controls free from respiratory diseases (CP). METHODS: A total of 419 patients, from 14 Pulmonology Units across Italy were enrolled (127 patients affected by TP, 163 affected by NTIP and 129 CP). Prevalence, accuracy and predictive values of ipsilateral IMLN involvement between cases and control groups were assessed, as well as concordance between chest computed tomography (CT scan) and thoracic ultrasound (TUS) measurements. RESULTS: The prevalence of ipsilateral IMLN involvement in TP was significantly higher than that observed in NTIP and CP groups (respectively 77.2%, 39.3% and 14.7%). Results on test performance, stratified by age, revealed a high positive predictive value in patients aged ≤50 years, while a high negative predictive value in patients aged >50 years. The comparison between CT scan and ultrasound showed moderate agreement (Kappa=0.502). CONCLUSIONS: Evaluation of IMLN involvement plays a relevant role in assessing the pre-test probability of TP. Considering the increasing global prevalence of mycobacterial infections, a tool able to guide diagnostic work-up of suspected TP is crucial, especially where local sources are limited.

Idiopathic pulmonary fibrosis landscapes: looking glass from pathology to therapy.

Idiopathic pulmonary fibrosis (IPF) is a rare chronic and ultimately fatal disease resulting in an aberrant scarring and thickening of lung tissue. Molecular pathogenetic mechanisms of IPF are still unknown and till now no effective therapy is known to really improve disease's outcome. A deeper understanding of IPF biology is now mandatory to clarify IPF origin in order to identify actionable targets. Here we discuss and analyze the data presented by a recent paper published by De Pianto et al. on the prestigious respiratory journal Thorax. The work is focused on how gene expression analysis can be applied to stratify IPF cases based on their risk of disease progression. Moreover they tried to match genetic and phenotypic profiles in order to predict therapeutic response and patients' prognosis.

Surgical options to early-stage lung cancer: can "the less" mean "the safe"?

Lung cancer is the leading cause of death for solid tumors worldwide. Approximately 5-10% of patients present with an early stage tumor and can undergo radical surgery. There are different kinds of thoracotomies depending on the location of surgical entry and how much lung is removed. At the present, lobectomy is the standard procedure to remove early stage lung cancer. Two options can be performed: i) open lobectomy, through which a lobe of the lungs is removed through a long incision on the side of the chest (thoracotomy); ii) video-assisted thoracoscopic surgical (VATS) procedure which allows the lobe removal through a few small incisions in the chest with the assistance of instruments and a camera. Here we discuss and analyze the findings of a paper by Subroto and colleagues, recently published by the British Medical Journal which compares long term survival after minimally invasive lobectomy and thoracotomy lobectomy, by using a propensity matched approach. Although some methodological limitation, the study findings point out that between the two techniques there are no differences regarding the outcome, but the minor comorbidity associated to VATS. Further investigation in the form of a randomized controlled trial are thus needed to assure to ​VATS wider indications in thoracic oncology.

Idiopathic pulmonary fibrosis landscapes: looking glass from pathology to therapy.

Idiopathic pulmonary fibrosis (IPF) is a rare chronic and ultimately fatal disease resulting in an aberrant scarring and thickening of lung tissue. Molecular pathogenetic mechanisms of IPF are still unknown and till now no effective therapy is known to really improve disease's outcome. A deeper understanding of IPF biology is now mandatory to clarify IPF origin in order to identify actionable targets. Here we discuss and analyze the data presented by a recent paper published by De Pianto et al. on the prestigious respiratory journal Thorax. The work is focused on how gene expression analysis can be applied to stratify IPF cases based on their risk of disease progression. Moreover they tried to match genetic and phenotypic profiles in order to predict therapeutic response and patients' prognosis.

Idiopathic pulmonary fibrosis clustering based on cilium gene expression: profiling a new paradigm.

Idiopathic pulmonary fibrosis (IPF), the commonest form of the interstitial lung diseases identifies a specific form of chronic, progressive fibrosing interstitial pneumonia, occurring primarily in older adults, and limited to the lungs. IPF represents an unsolved health problem with an urgent medical need due to lack of effective therapies. Although precise IPF etiology remains elusive, during the past decade there has been a shift away from the pathogenetic theory of generalized inflammation progressing to a paradigm of disordered fibroproliferation and alveolar epithelial cell function. A better understanding of the molecular mechanisms driving IPF fibroblasts proliferation is mandatory to provide insights into the pathogenesis, and to identify highly reproducible biomarkers for disease onset and progression. In this review we aim to discuss and analyze the findings recently published by Yang et al. on Thorax, which reported a strong molecular signature as-sociated with the expression of cilium genes that divides IPF/ usual interstitial pneumonia into two subtypes, one with increased cilium gene expression and one with low expression of cilium genes. The study presents a number of methodology limitations, mainly related to samples characterization and to a general overstatement of the conclusions from class clustering analysis. Nevertheless, the study clearly demonstrates ­ for the first time ­ that the cilium apparatus is activated in microscopic honeycombing. In such setting, cilia are likely to act as signaling "machine" which cooperates in promoting proliferative and regenerative cellular processes. Although preliminary, these results sustain a rationale to develop further investigations to confirm the impact of cilium gene expression in IPF with the final perspective of therapeutic intervention.

Multi-platform lung tumors profiling identifies actionable targets and unveils series of uncommon/rare diseases.

Lung cancer is characterized by a number of genetic alterations, of which a proportion is still unknown. Nevertheless numerous pathogenetically important driver changes have been already been detected in a substantial fraction of patients and translated into a system to improve detection and outcome of the disease. In this scenario, the Lung Cancer Mutation Consortium developed an ambitious project aimed to perform on large scale the molecular profile of lung adenocarcinoma in order to identify actionable targets. The review analyses the paper - recently published showing study findings- taking into account if the car and not the driver matters in lung cancer precision management.

Lung cancer: can staging improvement ensure a better survival?

Lung cancer is among the most common cancers in the world. Despite advances in defining the molecular mechanisms involved in lung oncogenesis and the remarkable efforts made to improve screening programs for secondary cancer prevention, patients' prognosis remains poor. Moreover, wide international inequalities remain apparent, even among developed countries. Here we analyze and discuss the findings of the extensive work by Walters S et al., recently published in "Thorax", which aimed to clarify whether differences in stage at diagnosis might explain these divergences. A better understanding of why survival differences between different states still exist will facilitate policy design to increase lung cancer overall survival itself and to bring it up to the highest international standards. It is the first international population-based study of lung cancer survival by stage at diagnosis and includes nearly 60,000 patients. By using a well detailed and appropriate statistical approach, authors conclude that improvement in outcomes is primarily related to a proper initial disease staging and that socioeconomic international and interregional inequalities might play a relevant role in this scenario. Our review takes in consideration both the methodological and scientific issues of the paper, focusing on the potential consequences in lung cancer management and on the need, in the post genomic era, of a molecular-based epidemiologic approach.