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1.
Medicine (Baltimore) ; 98(50): e18393, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852157

RESUMO

RATIONALE: Pyothorax-associated lymphoma (PAL) is a rare type of malignant pleural lymphoma. Most lymphomas are normally discovered around 20 to 50 years after tuberculosis infection. In China, there have been few reports about PAL cases so far. We report a case of a patient, whose tuberculosis and lymphoma were diagnosed concurrently. PATIENT CONCERNS: The patient, a 76-year-old male, was reported to our hospital on March 13, 2015. He had recurrent shortness of breath during the previous 2 years of routine activities solely. His symptoms became more serious which was manifested by edema of lower limbs 1 day before his admission to our hospital. DIAGNOSES: Doctors reached the diagnosis of PAL based on the patient's pathologic cell morphology and immunohistochemistry. The chest computed tomography examination revealed that there were pleural effusions on both sides, and some extent of compressive atelectasis in the lower parts of the inflamed lungs yet without space-occupying lesions. There were multiple small nodules which may be benign in the right upper lung. INTERVENTIONS: The current first-line treatment for diffuse large B-cell lymphoma is the cyclophosphamide, adriamycin, vincristine, prednisone (CHOP) protocol. Given that the patient had cardiac diseases and cardiotoxicity of anthracyclines, doctors decided to adopt rituximab with cyclophosphamide, vincristine, and prednisone chemotherapy without anthracyclines. OUTCOMES: The treatment effect was obvious after one cycle of chemotherapy. The patient's pleural and pericardial effusions were significantly reduced. With the chemotherapy protocol above continuously adopted, pleural and pericardial effusions did not increase in multiple reexaminations on October 25, 2015, February 15, 2016, and August 10, 2016. LESSONS: Analytical research revealed that chemotherapy with rituximab can increase the complete remission rate of non-Hodgkin lymphoma, reduce the possibility of failure and relapse, and prolong disease-free and overall survival. Moreover, there is no significant increase in adverse drug reactions compared with the effect of chemotherapy with CHOP alone. In the case of this patient, chemotherapy with rituximab was safe and efficacious.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Neoplasias Pleurais/tratamento farmacológico , Rituximab/uso terapêutico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Empiema Pleural/etiologia , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Masculino , Neoplasias Pleurais/diagnóstico
2.
Pan Afr Med J ; 33: 327, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692820

RESUMO

Primary angiosarcoma of the pleura is an extremely rare tumour arising from arterial or venous pulmonary vessels of various size. It is characterized by an aggressive course and a poor prognosis. The early diagnosis is challenging due to diverse clinical and radiological manifestations. We report a case of a 70 year old male with primary right pleural epitheloid angiosarcoma. The patient had a history of a two week's progressive dyspnea. CT-scan showed a prominent thikening of the right pleura associated with pleural effusion and atelectasis. CT-scan guided by biopsy was performed and histological examination showed a tumor proliferation consisting of sheets of polygonal and epitheloid cells showing rudimentary vascular differentiation. Immunohistochemically, tumor cells were strongly positive for CD31 and Factor VIII-related antigen, negative for CD34, weakly and focally positive for EMA and Cytokeratine. The overall pathological and immunohistochemical features of the pleural specimens supported the diagnosis of epitheloid angiosarcma. The patient died after a week of discharge by pulsless ventricular tachycardia arrest. In addition, we also present a brief litterature review on pleural angiosarcoma. Our experience with this case suggests that comprehensive and sufficient sample collection and meticulous histological examination aided with immunohistochemical stains, particulary the endothelial markers, are required for accurate diagnosis of this rare malignancy.


Assuntos
Hemangiossarcoma/diagnóstico , Neoplasias Pleurais/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Idoso , Biópsia , Hemangiossarcoma/patologia , Humanos , Masculino , Neoplasias Pleurais/patologia
3.
Indian J Pathol Microbiol ; 62(4): 566-571, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31611441

RESUMO

Context: Malignant pericardial effusions (MPCEs) is a common complication observed in advanced pulmonary adenocarcinoma. In such cases, investigating molecular alterations can have significant therapeutic implication in determining anticancer drugs. Aim: The objective was to evaluate the significance of cell block technique in the diagnosis of MPCE and further investigate the morphological and molecular profiles of MPCE in patients with pulmonary adenocarcinoma. Setting and Design: Cytopathological and molecular profiles of 19 MPCE cases in patients with pulmonary adenocarcinoma were retrospectively analyzed. The control group consisted of 14 malignant pleural effusion (MPE) cases in patients with pulmonary adenocarcinoma. Materials and Methods: Anaplastic lymphoma kinase (ALK) and tyrosine-protein kinase Met (C-MET) expression was evaluated by fluorescence in situ hybridization (FISH). Epithelial growth factor receptor (EGFR) and K-Ras (KRAS) mutations were detected by ARMS real-time polymerase chain reaction (RT-PCR). Statistical Analysis Used: Associations between MPCE and MPE were analyzed using Fisher's exact test. Results: MPCE was found to have micropapillary and solid pattern predominant with mucin secretion compared to acinar patterns, as seen in MPE. Seventeen MPCE cases (89.5%) and all MPE cases (100%) underwent molecular analysis. Mutations in EGFR and KRAS, ALK rearrangement, and C-MET amplification were observed in MPCE and MPE with statistical differences. Additionally, two MPCE cases demonstrated EGFR T790M mutation and multiple insertions at L858. Conclusions: MPCE shows micropapillary and solid cytological patterns predominant with mucin secretion. MPCE are suitable to analyze oncogenic mutations and to develop targeted therapy for patients with pulmonary adenocarcinoma. Further molecular investigations may reveal novel molecular alterations.


Assuntos
Adenocarcinoma de Pulmão/genética , Perfilação da Expressão Gênica , Derrame Pericárdico/citologia , Derrame Pericárdico/genética , Neoplasias Pleurais/genética , Adenocarcinoma de Pulmão/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Receptores ErbB/genética , Feminino , Humanos , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , Mutação , Neoplasias Pleurais/diagnóstico , Proteínas Proto-Oncogênicas p21(ras)/genética , Estudos Retrospectivos
4.
Indian J Pathol Microbiol ; 62(4): 595-598, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31611448

RESUMO

Pleuropulmonary blastoma (PPB) is a rare aggressive intrathoracic tumor which is believed to originate from embryonic uncommitted lung mesenchymal cells, which are important for developing the lung. Type I PPB is cystic, type II is cystic and solid, while type III is predominantly solid. Diagnosing type 1 PPB is a challenge for both radiologists as well as pathologists. Owing to its purely cystic nature, type I PPB it is often mistaken for unrelated entities such as congenital pulmonary airway malformation and congenital lobar emphysema which delays surgical intervention. Here, we report two such cases presenting clinically and radiologically as congenital pulmonary airway malformation. On histology, a final diagnosis of type I pleuropulmonay blastoma was made. Thereafter, chemotherapy was administered following complete surgical excision.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão/diagnóstico , Neoplasias Pulmonares/diagnóstico , Blastoma Pulmonar/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Tratamento Farmacológico , Feminino , Técnicas Histológicas , Humanos , Lactente , Pulmão/patologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Neoplasias Pleurais/diagnóstico , Blastoma Pulmonar/tratamento farmacológico
5.
Pan Afr Med J ; 33: 164, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31565126

RESUMO

Schwannoma is a neurogenic tumor originating from Schwann cells. When considering the thoracic region, it is most commonly found in the mediastinum. It commonly appears as a solitary lesion and pleural involvement is extremely rare. We here report the case of a 44-year old woman with benign primitive schwannoma of the pleura whose lesion was detected after radiological assessment for chest pain and dyspnea. The patient underwent complete surgical resection using video-assisted thoracoscopic surgery (VATS) technique. The anatomopathological study showed benign primitive schwannoma of the pleura.


Assuntos
Neurilemoma/diagnóstico , Neoplasias Pleurais/diagnóstico , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Dor no Peito/etiologia , Dispneia/etiologia , Feminino , Humanos , Neurilemoma/patologia , Neurilemoma/cirurgia , Neoplasias Pleurais/patologia , Neoplasias Pleurais/cirurgia
6.
Anticancer Res ; 39(9): 5219-5223, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519636

RESUMO

AIM: This study evaluated the prognostic value of soluble mesothelin-related protein (SMRP) levels in pleural effusions (PE) from patients with pleural mesothelioma (MPM). PATIENTS AND METHODS: SMRP level in PE was tested using an enzyme-linked immunosorbent assay (ELISA) in 109 patients with MPM at diagnosis before any treatment. The Kaplan-Meier method and the Cox regression were applied to compare overall survival probabilities across tertile categories of SMRP level. RESULTS: No significant differences in Kaplan-Meier overall survival probabilities among the SMRP categories were found. A statistically non-significant trend for increased death rate ratio (RR) was computed (p=0.327) when the higher (>46.5 nM, RR=1.38) and intermediate (8.5-46.5 nM, RR=1.18) SMRP categories were compared to the lower category (<8.5 nM, RR=1.00). Cox regression modelling including a restricted cubic spline showed a moderately rising non-linear trend in death rate. CONCLUSION: The SMRP level in PE does not appear to have prognostic significance and its detection is not recommended in routine clinical management of patients with MPM.


Assuntos
Proteínas Ligadas por GPI/metabolismo , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Mesotelioma/complicações , Mesotelioma/mortalidade , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/metabolismo , Neoplasias Pleurais/complicações , Neoplasias Pleurais/mortalidade , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Masculino , Mesotelioma/diagnóstico , Mesotelioma/terapia , Pessoa de Meia-Idade , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/terapia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/terapia , Prognóstico , Curva ROC , Resultado do Tratamento
8.
J Pak Med Assoc ; 69(8): 1103-1107, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431761

RESUMO

OBJECTIVE: To assess the diagnostic value of video-assisted thoracoscopic surgery in exudative pleural effusions, and to evaluated the frequency of malignancy development with long term follow-up of patients defined as nonspecific pleuritis after surgery. . METHODS: The retrospective study was conducted at Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, and comprised data of patients with undiagnosed exudative pleural effusions seen between January 2008 and December 2013. Data related to clinical, radiological, thoracoscopical, histopathological and follow-up periods were obtained from the hospital records. SPSS 15 was used for data analysis. RESULTS: Of the 229 patients, 145(63.3%) were males and 84(36.7%) were females. The overall mean age was 54.5 }15.1 years. Malignancy was found in 84 (36.6%) patients, and tuberculosis in 26(11.4%). The remaining 119(52%) patients had nonspecific pleuritis and their mean follow-up period was 29.2}27.1 months (range: 1-103 months). Video-assisted thoracoscopic surgery was repeated in 3(2.52%) patients in the 1st, 4th and 16th months of followup period due to the recurrence of pleural effusion. Tuberculosis and mesothelioma were diagnosed in 1(0.8%) and 2(1.7%) cases, respectively. CONCLUSIONS: Video-assisted thoracoscopic surgery was found to be a valuable diagnostic procedure in patients with undiagnosed exudative pleural effusion.


Assuntos
Neoplasias Pulmonares/diagnóstico , Linfoma/diagnóstico , Mesotelioma/diagnóstico , Derrame Pleural/etiologia , Neoplasias Pleurais/diagnóstico , Pleurisia/diagnóstico , Tuberculose Pleural/diagnóstico , Adulto , Idoso , Biópsia , Exsudatos e Transudatos , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Linfoma/complicações , Linfoma/patologia , Masculino , Mesotelioma/complicações , Mesotelioma/patologia , Pessoa de Meia-Idade , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Neoplasias Pleurais/secundário , Pleurisia/complicações , Pleurisia/patologia , Estudos Retrospectivos , Toracentese , Cirurgia Torácica Vídeoassistida , Tuberculose Pleural/complicações , Tuberculose Pleural/patologia , Turquia
9.
Lung Cancer ; 131: 14-22, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31027692

RESUMO

OBJECTIVES: Tumor spread through air spaces (STAS) was recently reported as a novel risk factor for the prognosis of patients with resected lung adenocarcinoma that indicates invasive tumor behavior. The purpose of this study was to build a prognostic model consisting of STAS and other pathologic features including visceral pleural invasion (VPI), vascular invasion (VI) and histological subtype (HS) in lung invasive adenocarcinoma. MATERIALS AND METHODS: A total of 289 patients with resected lung invasive adenocarcinomas ≤4 cm were analyzed retrospectively to evaluate the potential prognostic value of STAS, VPI, VI and HS for recurrence-free survival (RFS) and overall survival (OS). RESULTS: STAS was observed in 143 patients (49.5%). Univariate and multivariate analysis showed that STAS, VPI, VI and HS were significant prognostic factors for poorer RFS and OS. Thus, a prognostic model including STAS, VPI, VI and HS was built using the results of the multivariate analysis. Nomograms were developed to predict the 5-year RFS and OS. The concordance index (C-index) of the prognostic model was 0.8122 for predicting 5-year RFS and 0.8539 for predicting 5-year OS in the internal validation. Moreover, the calibration curves for the 5-year RFS and OS showed that the nomograms were calibrated well. In addition, a similar predicted capability of the prognostic model was observed in the validation cohort. CONCLUSION: STAS, VPI, VI and HS were significant prognostic factors for poorer RFS and OS. The prognostic model including STAS, VPI, VI and HS could effectively predict prognosis.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neovascularização Patológica/diagnóstico , Neoplasias Pleurais/diagnóstico , Modelos de Riscos Proporcionais , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Estudos de Coortes , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neovascularização Patológica/patologia , Nomogramas , Neoplasias Pleurais/patologia , Valor Preditivo dos Testes , Prognóstico , Análise de Sobrevida
10.
Ann Thorac Surg ; 108(3): 889-896, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31004585

RESUMO

BACKGROUND: Current guidelines support cancer-directed surgery, chemotherapy, or active surveillance for clinical stages 1 to 3 of epithelial malignant pleural mesothelioma (MPM). Definitive chemotherapy is recommended for sarcomatoid/biphasic histologies. Our objective is to assess compliance with recommendations, measuring their impact on overall survival. METHODS: The National Cancer Database participant user file (2004 to 2014) was queried for patients diagnosed with MPM clinical stages 1 to 3. Multivariable logistic regression model identified factors independently associated with guideline compliance. Kaplan-Meier analysis and Cox proportional hazards were used for overall survival comparison with histologic subgroup analysis. RESULTS: A total of 3419 patients with clinical stages 1 to 3 met criteria for analysis and comprised epithelial (68.5%), sarcomatoid (17.2%), and biphasic subtypes (14.3%). Cancer-directed surgery was significantly underutilized in epithelial MPM, with 29.3% having no treatment. On multivariable analysis, insurance status and facility type were the strongest predictors of guideline compliance. High-volume hospitals were the most compliant with guidelines (odds ratio 3.58, 95% confidence interval (CI), 2.34 to 5.49, P < .001). Median survival estimates for no treatment, chemotherapy alone, surgery plus chemotherapy, and trimodal therapy were 10.2, 15.4, 21.1, and 21.7 months, respectively (log rank P < .001). In epithelial MPM, a significant increase in overall survival was observed in surgery plus chemotherapy (hazard ratio 0.62, 95% CI, 0.53 to 0.73, P < .001) and trimodality (hazard ratio 0.61, 95% CI, 0.49 to 0.76, P < .001; reference: no treatment). CONCLUSIONS: There is a suboptimal compliance with national guidelines for the treatment of MPM, particularly in low-volume nonacademic settings. Adherence to recommended surgery-based multimodal therapy is associated with an overall survival improvement.


Assuntos
Causas de Morte , Disparidades em Assistência à Saúde , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/terapia , Mesotelioma/mortalidade , Mesotelioma/terapia , Neoplasias Pleurais/mortalidade , Neoplasias Pleurais/terapia , Adulto , Idoso , California , Estudos de Coortes , Terapia Combinada , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Fidelidade a Diretrizes , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/diagnóstico , Masculino , Mesotelioma/diagnóstico , Pessoa de Meia-Idade , Neoplasias Pleurais/diagnóstico , Pneumonectomia/métodos , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
11.
Int J Oncol ; 54(6): 2139-2148, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30942424

RESUMO

Malignant pleural mesothelioma (MPM) is a rare malignancy arising from the pleura that is difficult to diagnose, contributing to its dismal prognosis. Previously, we reported that the degree of microRNA (miR)­34b/c methylation in circulating DNA is associated with the development of MPM. Herein, we present a newly developed droplet digital PCR (ddPCR)­based assay for the detection of miR­34b/c methylation in circulating DNA in patients with MPM. We originally prepared two probes within a short amplicon of 60 bp, designing one from the positive strand and the other from the complementary strand. The two probes functioned cooperatively, and our established assay detected DNA methylation accurately in the preliminary validation. We subsequently verified this assay using clinical samples. Serum samples from 35 cases of MPM, 29 cases of pleural plaque and 10 healthy volunteers were collected from 3 different institutions and used in this study. We divided the samples into 2 groups (group A, n=33; group B, n=41). A receiver­operating characteristic curve analysis using the samples in group A determined the optimal cut­off value for the diagnosis of MPM, with a sensitivity of 76.9% and a specificity of 90%. On the other hand, the use of the same criterion yielded a sensitivity of 59.1% and a specificity of 100% in group B, and corresponding values of 65.7 and 94.9% for the entire cohort, indicating a moderate sensitivity and a high specificity. In addition, when the analysis was focused on stage II or more advanced MPM, the sensitivity improved to 81.8%, suggesting the possibility that the methylated allele frequency in MPM may be associated with the stage of disease progression. On the whole, the findings of this study indicate that miR­34b/c methylation in circulating DNA is a promising biomarker for the prediction of disease progression in patients with MPM.


Assuntos
Biomarcadores Tumorais/genética , Ácidos Nucleicos Livres/metabolismo , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , MicroRNAs/genética , Neoplasias Pleurais/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Ácidos Nucleicos Livres/isolamento & purificação , Metilação de DNA/genética , Progressão da Doença , Estudos de Viabilidade , Feminino , Humanos , Biópsia Líquida/métodos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/sangue , Mesotelioma/genética , Mesotelioma/patologia , MicroRNAs/metabolismo , Pessoa de Meia-Idade , Neoplasias Pleurais/sangue , Neoplasias Pleurais/genética , Neoplasias Pleurais/patologia , Reação em Cadeia da Polimerase/métodos , Prognóstico , Sensibilidade e Especificidade
12.
Medicine (Baltimore) ; 98(14): e14979, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946324

RESUMO

BACKGROUND: Soluble mesothelin-related peptide (SMRP) is a widely studied tumor marker for diagnosing malignant pleural mesothelioma (MPM). This study discussed the diagnostic value of SMRPs in pleural effusion (PE) for MPM. METHODS: Medline, Embase, Web of Science, and Cochrane library system were systematically searched on the data of SMRPs in PE for MPM diagnosis. Pooled diagnostic sensitivity, specificity, and symmetric receiver operating characteristic curve were calculated. RESULTS: Thirteen studies fulfilled the inclusion criteria and a total of 3359 cases including 759 MPM cases, 1061 non-MM (malignant mesothelioma) malignant PE, and 1539 benign PE were brought into this meta-analysis. The pooled results of SMRPs in PE for diagnosing MPM were as follows: sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.68 (95% confidence interval [CI]: 0.64-0.72), 0.91 (95% CI: 0.86-0.94), 7.8 (95% CI: 5.0-12.0), 0.35 (95% CI: 0.31-0.40), and 22 (95% CI: 14-35), respectively. The area under the summary receiver operating characteristic curves (AUC) was 0.75 (95% CI: 0.72-0.80). Subgroup analyzes revealed that the AUC of cohort group using histological diagnosis could be improved to 0.86 (95% CI: 0.83, 0.89). The Deek's funnel plot asymmetry test showed no publication bias. CONCLUSION: Although the sensitivity of SMRPs was low, PE-SMRPs can be a good indicator of the existence of MPM.


Assuntos
Proteínas Ligadas por GPI/metabolismo , Neoplasias Pulmonares/metabolismo , Mesotelioma/metabolismo , Proteínas Associadas à Resistência a Múltiplos Medicamentos/metabolismo , Derrame Pleural/metabolismo , Biomarcadores Tumorais/metabolismo , Exsudatos e Transudatos/metabolismo , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Mesotelioma/diagnóstico , Mesotelioma/patologia , Derrame Pleural/diagnóstico , Derrame Pleural/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/metabolismo , Derrame Pleural Maligno/patologia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/metabolismo , Neoplasias Pleurais/patologia , Sensibilidade e Especificidade
13.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936339

RESUMO

India is the largest consumer of asbestos in the world. There is no report from India of mesothelioma related to asbestos. The case is a 42-year-old man who died of pleural mesothelioma. He was exposed to asbestos domestically and from the environment since birth. Two of his close family members worked in a factory that used asbestos. The living quarter of the family was within the premises of the factory. Asbestos waste was strewn on the grounds surrounding the quarters. After decades of legal battles by workers and families exposed to asbestos, Indian courts have ordered remedial measures and compensation to people, who are exposed to asbestos at work and the environment. Mesothelioma, currently in epidemic proportions in the west where asbestos production was banned in the 1990s, could rise to alarming levels in the next decades in India if the legal remedial measures are not implemented soon.


Assuntos
Poluentes Ocupacionais do Ar/efeitos adversos , Asbestos/efeitos adversos , Exposição Ambiental/efeitos adversos , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Exposição Ocupacional/efeitos adversos , Neoplasias Pleurais/diagnóstico , Adulto , Compensação e Reparação/legislação & jurisprudência , Exposição Ambiental/legislação & jurisprudência , Evolução Fatal , Humanos , Índia , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/mortalidade , Masculino , Mesotelioma/induzido quimicamente , Mesotelioma/mortalidade , Exposição Ocupacional/legislação & jurisprudência , Neoplasias Pleurais/induzido quimicamente , Neoplasias Pleurais/mortalidade , Indenização aos Trabalhadores/legislação & jurisprudência
14.
Jpn J Clin Oncol ; 49(6): 559-566, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30882147

RESUMO

BACKGROUND: Malignant pleural mesothelioma (MPM) is rarely an asbestos-related cancer with a poor prognosis that is difficult to distinguish from some benign conditions by using conventional biopsy techniques. The purpose of this study was to evaluate the utility of a novel biopsy technique using a cryoprobe during flex-rigid pleuroscopy for diagnosing MPM. METHODS: Consecutive patients who underwent pleural cryobiopsy during flex-rigid pleuroscopy from June through November 2017 to diagnose the cause of pleural effusion were collected. From these, cases ultimately diagnosed as MPM were selected. Pleural biopsies were performed by using conventional instruments followed by a cryoprobe. The obtained samples were histologically examined and compared with regard to the quality (sample size, tissue depth, and crush rate), immunohistochemical (IHC) staining, and p16 by fluorescence in situ hybridization (FISH). RESULTS: In total, five patients ultimately diagnosed as MPM were enrolled. The sample collected was significantly larger for cryobiopsy than conventional biopsy (18.9 mm2 vs. 6.7 mm2, P < 0.001). Full-thickness biopsies were achieved in four cases by using cryobiopsy compared with one case by conventional biopsy. Moreover, the crush rate was significantly less for cryobiopsy than conventional biopsy (9% vs. 35%, P < 0.001). The results of IHC staining and p16 by FISH were similar between biopsy techniques. Cryobiopsy successfully led to accurate diagnosis of MPM in all cases, whereas conventional biopsy was diagnostic in one case. No severe complications developed after either biopsy technique. CONCLUSION: Cryobiopsy during flex-rigid pleuroscopy is a feasible and convenient biopsy technique that supports precise diagnosis of MPM.


Assuntos
Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Toracoscopia/instrumentação , Toracoscopia/métodos , Idoso , Biópsia/instrumentação , Biópsia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Ann Biol Clin (Paris) ; 77(2): 187-190, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30907376

RESUMO

Primary plasma cell leukemia (PPCL) is an aggressive and rare variant of multiple myeloma (MM), with frequent extramedullary involvement, mainly liver and splenic lesions. Pleuropulmonary involvement has rarely been described in the literature. We report a case of primary plasma cell leukemia in a 46-year-old patient, whose first symptom was pleural effusion with mediastinal adenopathies simulating a pleural localization of a lymphomatous process. However, blood smear examination, electrophoresis as well as immunofixation of plasma proteins and immuno-histochemistry have helped to guide the diagnosis. Pleurisy is a rare mode of revelation of plasma cell leukemia and is a factor of poor prognosis.


Assuntos
Leucemia Plasmocitária/diagnóstico , Neoplasias Pleurais/diagnóstico , Pleurisia/diagnóstico , Evolução Fatal , Feminino , Humanos , Leucemia Plasmocitária/complicações , Leucemia Plasmocitária/patologia , Pessoa de Meia-Idade , Marrocos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/patologia , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologia , Pleurisia/etiologia , Pleurisia/patologia , Radiografia Torácica
16.
Pathol Res Pract ; 215(6): 152377, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30885529

RESUMO

Malignant mesothelioma (MM) is an aggressive cancer with a poor prognosis. The most common genetic alteration in MM is the deletion of the INK4a/ARF locus, which encodes the p16 protein and is located on the short arm of chromosome 9 (9p21). Recently, it has been shown that homozygous deletion of 9p21 has both diagnostic and prognostic significance in MM. It is a known fact that, to interpret fluorescence in situ hybridization (FISH) signals, a cut-off value for each probe should be determined for a correct diagnosis. To our knowledge, there is no consensus or confirmed protocol for cut-off values to evaluate FISH signals in MMs. Therefore, the aim of our research was to address 9p21 deletion status and p16 expression profiles of MM by determining our own cut-off values and the effectiveness of using p16 negativity and 9p21 deletion as markers for differentiating MMs from benign mesothelial proliferations in 114 cases. We established a cut-off value for the detection of 9p21 deletion by using 13 benign reactive cases (6 reactive mesothelial hyperplasias and 7 chronic fibrinous pleuritis cases) and found between 0-7%. According to our calculations, homozygous deletion was defined by loss of both p16 gene signals in at least 13.3% of the nuclei that showed at least 1 signal for the CEP 9 probe. Our FISH results showed homozygous 9p21 deletion in 82 of the 114 cases of MM (71.9%), and p16 expression was negative in 75 of the 114 cases (65.8%). The correlation between loss of p16 protein expression and 9p21 deletion was statistically significant. Among the p16-negative cases, 86.7% also had the 9p21 deletion. The combined examination of the 9p21 deletion and loss of p16 expression is helpful for diagnostic purposes, but because the FISH method is an expensive technique and loss of p16 expression is not specific for mesotheliomas, p16 negativity can guide practitioners to eliminate cases that require further investigation by FISH. The variability in the significance of 9p21 homozygous deletion results from inconsistencies among different institutes, suggesting that each institute should establish its own cut-off value using reactive mesothelial proliferations. Alternatively, global studies are needed to assess cut-off values.


Assuntos
Biomarcadores Tumorais/genética , Hibridização in Situ Fluorescente/métodos , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Adulto , Idoso , Cromossomos Humanos Par 9/genética , Inibidor p16 de Quinase Dependente de Ciclina/genética , Feminino , Humanos , Neoplasias Pulmonares/genética , Masculino , Mesotelioma/genética , Pessoa de Meia-Idade , Neoplasias Pleurais/genética , Valores de Referência , Deleção de Sequência
17.
J Immunoassay Immunochem ; 40(3): 269-282, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810450

RESUMO

BACKGROUND: The positive diagnosis of MPM is based on morphologic features coupled with immunohistochemical findings. Many antibodies have been published especially in order to differentiate between malignant tumors and atypical mesothelial hyperplasia. BAP-1 is a BRCA1-binding protein whose loss of expression was frequently reported in MPM. Our aim was to assess the diagnostic value of this antibody in comparison to the most sensitive diagnostic antibody represented by the calretinin antibody. METHODS: We performed a meta-analysis using the Meta-Disc software 5.1.32. RESULTS: According to our inclusion criteria, 19 studies with 11 studies dealing with BAP1 antibody and 8 studies dealing with calretinin antibody were included. The SEN of BAP 1 and calretinin antibodies was respectively estimated to 54.6% and 86.5%. The SPE reached respectively 95.7% and 76.6%. The dOR was estimated respectively to 23.664 and 38.8. The I-square revealed a heterogeneity of the parameters studied. The metaregression analysis revealed as covariates the amplification system and the histologic subtype as causing effects of heterogeneity for BAP1 antibodies and histologic subtype and chromogene as causing effects of heterogeneity for calretinin antibody. CONCLUSION: This meta-analysis revealed that BAP1 antibody should be associated with more sensitive antibodies in order to assess the diagnosis.


Assuntos
Anticorpos/análise , Anticorpos/imunologia , Biomarcadores Tumorais/análise , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Proteínas Supressoras de Tumor/análise , Ubiquitina Tiolesterase/análise , Biomarcadores Tumorais/imunologia , Humanos , Neoplasias Pulmonares/imunologia , Mesotelioma/imunologia , Neoplasias Pleurais/imunologia , Software , Proteínas Supressoras de Tumor/imunologia , Ubiquitina Tiolesterase/imunologia
18.
Lung Cancer ; 127: 164-166, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30642545

RESUMO

Introduction BRCA1 associated protein-1 (BAP1) is a key tumor driver in mesothelioma and a potential biomarker predicting response to several targeted therapies in clinical testing. Whether it also modulates response to cytotoxic chemotherapy is undetermined. This study used retrospective response analysis of BAP1 expression in archival tumor biopsies taken from patients in the MS01 trial (NCT00075699). We aimed to determine if BAP1 expression correlated with overall survival within the three treatment arms in this trial, namely active symptom control (ASC); ASC plus mitomycin, vinblastine and cisplatin (MVP); and ASC plus vinorelbine. Materials and methods We used immunohistochemical analysis of tumor samples from the MS01 trial to identify subgroups with and without nuclear BAP1 expression. We performed correlative analysis of clinical characteristics (age at diagnosis, sex and histological subtype) and overall survival within treatment arms with nuclear BAP1 expression. Results 89 tumor samples from the 409 patients originally in the trial were available for analysis. Of these, 60 samples harbored a positive internal control, in the form of positive staining of inflammatory cells for BAP1, and were carried forward for analysis. Correlative analysis suggested no significant association between loss of nuclear BAP1 expression and age at diagnosis, sex and histological subtype. Kaplan Meier survival analysis revealed a small, though non-significant, overall survival disadvantage associated with BAP1 expression in tumors from patients treated with vinorelbine. Discussion This exploratory analysis suggests BAP1 expression may modify response to vinorelbine in MPM, possibly due to prevention of mitotic microtubule formation. We suggest ongoing and planned clinical studies of vinorelbine in MPM assess BAP1 expression as a predictive biomarker of response.


Assuntos
Biomarcadores Tumorais/metabolismo , Cisplatino/uso terapêutico , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Proteínas Supressoras de Tumor/metabolismo , Ubiquitina Tiolesterase/metabolismo , Vimblastina/uso terapêutico , Idoso , Feminino , Humanos , Masculino , Mesotelioma/tratamento farmacológico , Mesotelioma/mortalidade , Microtúbulos/metabolismo , Neoplasias Pleurais/tratamento farmacológico , Neoplasias Pleurais/mortalidade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
19.
Lung Cancer ; 127: 69-75, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30642555

RESUMO

The pathologist plays a central role in the diagnosis and management of malignant mesothelioma, including definitive tissue-based diagnosis in conjunction with clinical and radiographic data; diverse ancillary studies of diagnostic, prognostic, and predictive importance; and research efforts to better define the pathobiology of mesothelioma and develop novel clinical applications. The pivotal role of pathology in care of mesothelioma patients was on display at the recent meeting of the International Mesothelioma Interest Group (iMig) in Ottawa, Canada. This review summarizes the key findings of the "Molecular Pathways and Diagnosis in Malignant Mesothelioma" plenary session, including a large multi-institutional validation of a composite nuclear grading system for pleural mesothelioma, including incorporation of tumor necrosis as an additional independent prognostic factor; the correlation between nuclear grading in small biopsies and paired resection specimens in pleural mesothelioma; a multi-institutional study of important clinical and pathologic prognostic factors in peritoneal mesothelioma; the diagnostic role of HEG1 immunohistochemistry as a highly sensitive and specific marker of mesothelial lineage; the prevalence and diagnostic significance of MET protein overexpression in mesothelioma, as well as the correlation between MET protein overexpression and MET gene amplification; and the prognostic role of EZH2 protein overexpression in mesothelioma, together with data indicating an important pathogenic role for EZH2 in mesothelioma tumorigenesis. Special consideration is given to the convergence of diagnostic, prognostic, and predictive tools and their role in guiding highly personalized patient-centered management, and to the translation of novel research findings to practical techniques for routine pathologic practice.


Assuntos
Biomarcadores Tumorais/metabolismo , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias Peritoneais/diagnóstico , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/metabolismo , Canadá , Congressos como Assunto , Regulação Neoplásica da Expressão Gênica , Humanos , Cooperação Internacional , Neoplasias Pulmonares/metabolismo , Mesotelioma/metabolismo , Neoplasias Peritoneais/metabolismo , Prognóstico , Opinião Pública , Transdução de Sinais
20.
Eur Radiol ; 29(6): 2981-2988, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30617480

RESUMO

OBJECTIVES: To evaluate differences in the tumor response classifications that result from clinical measurements and to compare these response classifications with overall survival for patients with malignant pleural mesothelioma (MPM). METHODS: One hundred thirty-one computed tomography (CT) scans were collected from 41 MPM patients enrolled in a clinical trial. Primary measurements had been acquired by clinical radiologists at a single center during routine clinical workflow, and the variability of these measurements was investigated. Retrospective measurements were acquired by a single radiologist in compliance with the study protocol based on the modified response evaluation criteria in solid tumors (RECIST). Differences in response classification categories by the two measurement approaches were evaluated and compared with patient survival. RESULTS: Eleven (27%) of the 41 MPM patients had primary measurements at baseline or at follow-up that deviated from the guidelines of the clinical trial protocol. Among the 41 baseline scans, no statistical difference was observed in summed tumor measurements between primary and retrospective measurements. Response classification based on primary and retrospective measurements was different in 23 (26%) of the 90 follow-up scans, and best response was the different in seven (17%) of the 41 patients. Using Harrell's C statistic as a measure of correlation, response based on retrospective measurements correlated better with survival (C = 0.62) than did response based on primary measurements (C = 0.57). CONCLUSIONS: Strict compliance with the measurement protocol yields tumor response classifications that may differ from those obtained in clinical practice. Response based on retrospective measurements correlated better with survival than did response based on primary measurements. KEY POINTS: • Response classifications could be different between clinical primary and retrospective measurements for malignant pleural mesothelioma. • Response classifications obtained by strict compliance with the trial-specific protocol correlated better with survival than the classifications based on primary measurements. • Quality assurance and radiologist training measures should be used to ensure the integrity of image-based tumor measurements in mesothelioma clinical trials.


Assuntos
Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Estadiamento de Neoplasias/métodos , Neoplasias Pleurais/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Vorinostat/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Feminino , Humanos , Illinois/epidemiologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/mortalidade , Masculino , Mesotelioma/tratamento farmacológico , Mesotelioma/mortalidade , Pessoa de Meia-Idade , Neoplasias Pleurais/tratamento farmacológico , Neoplasias Pleurais/mortalidade , Critérios de Avaliação de Resposta em Tumores Sólidos , Estudos Retrospectivos , Taxa de Sobrevida/tendências
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