The incidence of thyroid cartilage invasion through the anterior commissure in clinically early-staged laryngeal cancer.

In this study, the incidence of thyroid cartilage invasion in early-stage laryngeal tumors involving anterior commissure was assessed. Medical charts and pathology reports of 62 patients who underwent supracricoid partial laryngectomy as the primary treatment of early-staged laryngeal squamous cell carcinoma were retrospectively reviewed. Patients were divided into two groups according to the macroscopic examination of the surgical specimen: tumors limited to the glottis with the involvement of anterior commissure (TLG); tumors invading both supraglottis and glottis with the involvement of anterior commissure (TISG). Thirty-seven of the cases were classified as TLG group (59.7 %) and the remaining 25 of them were classified as TISG group (40.3 %). Thyroid cartilage invasion was observed totally in ten patients (16.1 %), as macroscopic invasion in two cases and microinvasion in eight patients. Only two were in the TLG group (cartilage invasion rate of 5.4 %), the remaining eight were in the TISG group (cartilage invasion rate of 32 %). Thyroid cartilage invasion rate of TISG group was significantly higher than that of TLG group (p = 0.011, p < 0.05). Tumors limited to the glottis with AC involvement may be more suitable for endoscopic resection; on the contrary, tumors with vertical extension invading both AC and supraglottis should be evaluated more suspiciously due to high rate of thyroid cartilage invasion, which may still necessitate external laryngectomy techniques.

High-risk HPV Does not Appear to be an Important Risk Factor for Sinonasal Carcinomas in Turkish Population: A Tertiary Center Experience.

Background. The sinonasal tract is the second most common site of human papillomavirus (HPV)-related carcinomas in the head and neck. Published data on the association between sinonasal tumors and HPV are quite inconsistent among different regions. Material and methods. We performed high-risk HPV DNA in situ hybridization (ISH) and p16 immunohistochemistry on sinonasal carcinomas diagnosed between 2006 and 2016. Results. Of 105 sinonasal carcinomas, we found only two (2%) HPV-positive cases; both had non-keratinizing morphology and were diffusely positive for p16. By histologic type, HPV DNA positivity rate was 14% in non-keratinizing squamous cell carcinomas, and we did not detect HPV DNA in any other type of sinonasal carcinomas. Thirteen HPV-negative tumors (7 salivary gland carcinomas, 3 sinonasal undifferentiated carcinomas, 2 keratinizing squamous cell carcinomas, and 1 non-keratinizing squamous cell carcinoma) were positive for p16. In nine carcinomas arising from an underlying sinonasal papilloma, p16 and HPV DNA ISH were evaluated in both carcinoma and papilloma areas and all were negative. Follow-up information was available for 104 patients; 46 (44%) were alive and 58 (55%) died of disease. One of the two HPV-positive patients died of the disease; the other was alive at 100 months of follow-up. Conclusions. We detected a much lower percentage of HPV positivity in sinonasal carcinomas when compared to the literature. We believe that our results support various rates of HPV-related carcinomas depending on the geographic and ethnic characteristics.

Evaluation of MUC1, MUC2, MUC5AC, and MUC6 Expression Differences in Lung Adenocarcinoma Subtypes by Using a Final Immunoreactivity Score (FIRS).

OBJECTIVE: Lung adenocarcinomas are divided into acinar, lepidic, papillary, micropapillary, and solid predominant subtypes according to the current World Health Organization (WHO) classification. We designed this retrospective study to demonstrate profiles of MUC expression (MUC1, MUC2, MUC5AC, and MUC6) of different histologic patterns within the same tumor among pulmonary adenocarcinomas and investigate correlations of MUC expression with clinicopathologic features. MATERIAL AND METHOD: We analyzed the expression of mucins (MUC1, MUC2, MUC5AC, and MUC6) in a series of 99 resected lung adenocarcinomas, which included a total of 193 patterns (71 acinar, 30 lepidic, 25 papillary, 20 micropapillary, 34 solid and 13 mucinous) and calculated a final immune reactivity score (FIRS) per tumor. RESULTS: MUC1 IRS scores were significantly higher in lepidic and solid patterns compared with mucinous patterns (p=0.013). MUC2 expression was seen only in three cases (1 acinar, 2 mucinous). MUC5AC and MUC2 expression was more common in mucinous patterns (p < 0.001 and p=0.028, respectively). MUC6 expression was only detected in seven patterns and the expression was weak. No significant difference was seen among histologic patterns for the staining scores of MUC6. Mucinous adenocarcinoma differed from other histologic subtypes regarding MUC1 and MUC5AC expression. Mucinous adenocarcinoma showed less MUC1 expression with lower IRS scores and higher MUC5AC expression. Tumor size (p=0.006), lymphatic invasion (p=0.018), vascular invasion (p=0.025), perineural invasion (p=0.019), MUC1 IRS scores (p=0.018), and MUC1 IRS scores > 8.5 (p=0.018) were significant predictors for lymph node metastasis. CONCLUSION: An alternative scoring for MUC1 can be used as a predictor for lymph node metastasis regardless of the histologic subtype.

Videothoracoscopic excision of a diaphragmatic bronchogenic cyst appearing as a pulmonary lesion.

Diaphragmatic bronchogenic cysts are rare, and very few cases have been reported in the literature to date. Herein, we present a 42-year-old male patient who had a diaphragmatic bronchogenic cyst with the radiologic appearance of an intrapulmonary lesion as the 32nd case in the English literature. We performed a videothoracoscopic excision of the cyst, which was later found to be originated from the diaphragm. Pathologic examination confirmed the diagnosis of the bronchogenic cyst. Diaphragmatic bronchogenic cysts may present as intrapulmonary lesions radiologically. Videothoracoscopic excision is a feasible treatment method for these lesions.

Intracardiac masses: Single center experience within 12 years: I-MASS Study.

Objective: The aim of this cross-sectional, retrospective, descriptive study was to review and classify cardiac masses systematically and to determine their frequencies. Methods: The medical records of 64,862 consecutive patients were investigated within 12 years. Every patient with a cardiac mass imaged by transthoracic echocardiography (TTE) and confirmed with an advanced imaging modality such as transesophageal echocardiography (TEE), computed tomography (CT) and/or cardiac magnetic resonance imaging (CMR) was included. Acute coronary syndromes triggering thrombus formation, vegetations, intracardiac device and catheter related thrombi were excluded. Results: Data demonstrated 127 (0.195%) intracardiac masses consisting of 33 (0.050%) primary benign, 3 (0.004%) primary malignant, 20 (0.030%) secondary tumors, 3 (0.004%) hydatid cysts and 68 (0.104%) thrombi respectively. The majority of primary cardiac tumors were benign (91.67%), predominantly myxomas (78.79%), and the less malignant (8.33%). Secondary cardiac tumors were common than the primary malignant tumors (20:3), with male dominancy (55%), lymphoma and lung cancers were the most frequent. Intracardiac thrombi was the majority of the cardiac masses, thrombi accompanying malignancies were in the first range (n = 17, 25%), followed by autoimmune diseases (n = 13, 19.12%) and ischemic heart disease with low ejection fraction (n = 12, 17.65%). Conclusions: This retrospective analysis identified 127 patients with cardiac masses. The majority of benign tumors were myxoma, the most common tumors that metastasized to the heart were lymphoma and lung cancers, and the thrombi associated with malignancies and autoimmune diseases were the most frequent.

Diagnostic value of thyroglobulin measurement in fine-needle aspiration biopsy for detecting metastatic lymph nodes in patients with papillary thyroid carcinoma.

PURPOSE: We aimed to compare the diagnostic value of fine-needle aspiration cytology (FNAC) and fine-needle aspiration thyroglobulin measurements (FNA-Tg) for detecting cervical lymph node metastases from differentiated thyroid carcinomas. METHODS: This prospective study included 225 patients with neck node metastases or recurrences of papillary thyroid carcinoma. From the 225 patients, 255 lymph nodes were evaluated by FNAC and FNA-Tg. Final diagnoses confirmed by histological examination were compared to preoperative FNAC and FNA-Tg results. RESULTS: FNAC correctly diagnosed 212 metastatic lymph nodes but failed to diagnose 43 of them. FNA-Tg correctly diagnosed 253 metastatic lymph nodes but failed to diagnose two of them. FNA-Tg levels showed 100% sensitivity, 96% specificity, 99% diagnostic accuracy, a 99% positive predictive value (PPV) and a 100% negative predictive value (NPV) with a threshold level of FNA-Tg with a diagnostic accuracy 28.5 ng/ml. The specificity, diagnostic accuracy, PPV and NPV of FNA-Tg were significantly higher than those of FNAC. CONCLUSION: FNA-Tg measurement can be performed safely for the detection of lymph node metastasis in patients with differentiated thyroid carcinomas.

Evaluation of Human Papillomavirus Genotype Distribution in Cervical Samples.

BACKGROUND: The most common sexually transmitted infection in the world is human papillomavirus (HPV). HPV types 16 and 18 are responsible for 60-80% of cervical cancers and precancerous cervical lesions worldwide. AIM: In this study, it was aimed to evaluate the correlation of HPV genotype distribution with cervical cytology results in cervical smear samples and to contribute to HPV epidemiology. MATERIALS AND METHODS: This study included 72 female patients. For detection of the HPV genotypes, a multiplex real-time polymerase chain reaction (PCR) method that could detect more than 25 different HPV types was used. The cervical cytology and histopathology results of the patients were also evaluated simultaneously. RESULTS: The frequency of high-risk HPV was 35% (25/72). The most common types were HPV51 (10%), HPV16 (8%), and HPV66 (8%), respectively. The most common type HPV51 and multiple HPV types were seen in 21-34 age groups. HPV DNA was detected in 21 of 43 samples that had cervical smear diagnosis grouping. Twelve samples (26%) had normal cytology. Low grade squamous intraepithelial lesions were the most common cytological diagnosis in HPV DNA positive samples. The most common HPV types in the patients diagnosed low grade squamous intraepithelial lesions and high grade squamous intraepithelial lesions were HPV16 and HPV52. CONCLUSIONS: In this study, the frequency of high-risk HPV genotypes was 35% as similar to reports of the other studies conducted in our country. The most common types were HPV51, HPV16, and HPV66, respectively. The follow-up of patients with HPV51 infection in our area could help to improve the natural course of the disease and effective prevention programs.

Clinicopathological and Prognostic Features of 67 Cases with Pulmonary Sarcomatoid Carcinoma: An 18-Year Single-Centre Experience.

INTRODUCTION: Pulmonary sarcomatoid carcinoma (PSC) is a very rare subtype of non-small-cell lung cancer (NSCLC). It is frequently diagnosed in the advanced stage and is resistant to conventional chemotherapeutics. Due to the unique nature and rarity, we evaluated the epidemiological, clinicopathological, and survival data of PSC patients treated at our centre. PATIENTS AND METHODS: We retrospectively collected demographic and clinical data of 67 PSC patients from a single tertiary referral hospital, between the 2000 and 2018. Univariate and multivariate analyses were performed to determine the risk factors affecting survival. RESULTS: The median age was 61 years, and the percentage of male was 74.6%. Most of the patients had a smoking history (76.9%). The most common PSC subtype was pleomorphic carcinoma (46.3%). The median overall survival (OS) was 55.4 months, and the 5-year OS rate was 47.5%. Advanced stage, T4 tumour, and positive lymph node involvement were associated with poor OS (p < 0.05). The patients with negative epithelial markers had poorer prognosis (p = 0.027) and had more frequently stage IV disease (p = 0.016). Surgical treatment and stage IV disease were determined to be independent prognostic factors. CONCLUSION: PSC is an extremely rare and aggressive variant of NSCLC. Positive epithelial markers may have favourable prognostic significance in PSC. Resection of the tumour with a negative surgical margin is crucial for better survival. The prognosis of the disease is very poor in the metastatic stage.

Prognostic factors in patients undergoing pulmonary resection for sarcomatoid carcinomas of the lung.

BACKGROUND: Pulmonary sarcomatoid carcinomas are very rare lung neoplasms, and no consensus exists regarding their optimal treatment. The prognosis of sarcomatoid carcinomas has been reported to be unfavorable compared with non-small-cell lung cancers; however, prognostic factors in patients undergoing surgery for sarcomatoid carcinomas remain unclear. AIMS: To analyze clinicopathologic prognostic factors and survival outcomes in patients who underwent surgery for pulmonary sarcomatoid carcinoma. STUDY DESIGN: Retrospective cross-sectional study. METHODS: We designed a retrospective cross-sectional study in patients who underwent surgery for pulmonary sarcomatoid carcinomas and statistically analyzed the prognostic factors regarding clinicopathologic features with respect to survival outcomes. RESULTS: We had a total of 44 patients with sarcomatoid carcinoma who had pulmonary resection. Sex distribution was 34 (77%) males and 10 (22.7%) females, which was determined by declaration. The mean age of patients was 57.3 ± 16 years with a median of 60 years. The 5-year progression-free survival and overall survival rates were 59% and 58%, respectively. The 5-year survival rates were significantly different for tumors > 5 cm (P = 0.044), tumorstatus (T) (P=0.016), lymph node status (N) (P=0.005), and pathologic tumor-node-metastasis (TNM) stage (P = 0.0001 ). However, histologic subtype (P = 0.628) and adjuvant treatment (P = 0.804) did not have any significant effect on survival. Similarly, the significant prognostic factors in univariate analysis were tumor size (P = 0.085), T status (P = 0.005), N status (P = 0.028), and pathologic TNM stage (P = 0.0001). Multivariate analysis showed only T status (P = 0.058), N status (P = 0.018), and pathologic TNM stage (P = 0.019) as independent prognostic factors, with statistical power of 87%, 43.1% and 21.2%. CONCLUSION: Surgery appears to be an optimal treatment with favorable outcomes for patients with pulmonary sarcomatoid carcinoma. Patients with small tumors at earlier stages are very likely to benefit from surgery, regardless of histologic subtype.

The role of adjuvant chemotherapy in resected stage I non - small cell lung cancer: A Turkish Oncology Group Study.

PURPOSE: The benefit of adjuvant chemotherapy for tumors smaller than 4 cm is not clear. We aimed to evaluate the prognostic impact of adjuvant platin-based chemotherapy in high-risk stage I patients with non-small cell lung cancer (NSCLC). METHODS: This cooperative group study included 232 NSCLC patients who underwent curative surgery for stage I disease with tumor size 2-4 cm. Re ults: Median age at presentation was 63 years (range 18-90). The mean tumor size was 29.6 ± 7.3 mm. The frequency of patients with specified risk factors were: visceral pleural effusion (VPI): n: 82 (36.6%); lymphovascular invasion (LVI): n: 86 (39.1%); Grade 3: n: 48 (32.7%); Solid micropapillary pattern (SMP): n: 70 (48.3%). Adjuvant platin-based chemotherapy was administered to 51 patients. During a median follow-up period of 50.5 months 68 patients (29.3%) developed recurrence, 54 (23.3%) died from any cause and 38 (16.4%) of them died of lung cancer. Patients who received chemotherapy compared with the non-chemotherapy group had a longer 5-years relapse-free survival (RFS) (84.5 vs 61.1%). Also on multivariate analysis, adjuvant chemotherapy was a significant independent prognostic factor for RFS. CONCLUSION: Adjuvant platin-based chemotherapy should be considered for patients with small tumors with adverse risk factors. Key words: adjuvant chemotherapy, lung cancer, oncology, lymphovascular invasion, solid-micropapillary pattern, platinum-based therapy.

Isolated laryngo-tracheal amyloidosis presenting as a refractory asthma and longstanding hoarseness.

Respiratory tract amyloidosis is characterized by deposition of amyloid fibril protein at any site along the respiratory tract ranging from the larynx to the pulmonary parenchyma. Usually, it is not associated with primary systemic amyloidosis. We report a case with isolated laryngotracheal amyloidosis, which is relatively a rare condition, together with a history of refractory asthma accompanied with longstanding hoarseness.

Cervical mediastinoscopy for paratracheal masses in pediatric patients.

A cytological diagnosis is essential for a definitive diagnosis in children who have paratracheal lesions. Thirteen pediatric patients were biopsied using cervical mediastinoscopy. Age, gender, preoperative diagnosis, and postoperative biopsy results and complications were reviewed. Five patients had mediastinal lesions residuing or recurring after chemotherapy for either Hodgkin disease or non-Hodgkin lymphoma. In 2 of these patients, the diagnosis was recurrent disease. Among the 8 patients presenting with a paratracheal mass or enlarged lymph nodes, histopathologic diagnosis showed tuberculosis in 3 children, Hodgkin disease in 2 children, and histiocytosis X and non-Hodgkin lymphoma 1 patient in each. This study shows that cervical mediastinoscopy gave 100% correct diagnosis for mediastinal residual malignancies or uncommon forms of mycobacterium tuberculosis with paratracheal masses.

Endonasal endoscopic nasopharyngectomy for the treatment of nasopharyngeal papillary adenocarcinoma: Report of a rare case.

We report a case of low-grade nasopharyngeal papillary adenocarcinoma in a 9 year-old male that was diagnosed incidentally after an adenoidectomy procedure and treated with endonasal endoscopic nasopharyngectomy without any adjuvant therapy. The patient has been followed up for 3 years with no evidence of recurrence. We point out the importance of preoperative fiberoptic nasopharyngoscopy in the absence of longstanding symptoms in school-aged children and histopathologic examination of adenoidectomy specimens in the presence of atypical findings. We also suggest endonasal endoscopic resection in case of papillary adenocarcinoma.

An adolescent with idiopathic pleuroparenchymal fibroelastosis. Case report. / Adolescente con fibroelastosis pleuroparenquimatosa idiopatica. A propòsito de un caso.

Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare disorder recently included in rare idiopathic interstitial pneumonias according to the updated American Thoracic Society/European Respiratory Society classification. IPPFE is characterized by pleural and subpleural parenchymal fibrosis causing volume loss predominantly in the upper lung lobes. Age of onset is variable, IPPFE mainly occurs in third and fourth decades. We present a 16 year old patient with a 2-year history of exertional dyspnea, nonproductive cough and weight loss. On physical examination, auscultation revealed diminished breath sounds on the upper lobes. Chest radiograph showed apical pleural thickening and volume loss. Computerized tomographic scan (CT) of chest revealed ground glass densities and tubular bronchiectasis predominantly in upper lobes bilaterally, with interlobular septal thickening of the pleura and enlarged mediastinal lymph nodes. Thoracoscopic lung biopsy was performed and histological evaluation showed subpleural fibrosis and elastic staining demonstrated fragmented elastic fiber deposition in the subpleural area and adjacent pulmonary parenchyma suggesting IPPFE. To our knowledge this is the first case in childhood. Therefore, pediatricians should be aware of this disease for the diagnosis and appropriate management.

La fibroelastosis pleuroparenquimatosa idiopàtica (FEPPI) es un trastorno raro incluido recientemente en las neumonías intersticiales idiopáticas según la actualización de la clasificación de la Sociedad Torácica Estadounidense (American Thoracic Society) y la Sociedad Respiratoria Europea (European Respiratory Society). La FEPPI se caracteriza por fibrosis parenquimatosa pleural y subpleural que produce reducción del volumen, sobre todo en los lóbulos pulmonares superiores. La edad al momento de la aparición varía, aunque la FEPPI ocurre principalmente entre los 30 y los 50 años de edad. En este artículo, presentamos el caso de un paciente de 16 años con antecedentes de disnea de esfuerzo, tos seca y pérdida de peso en los últimos dos años. Durante el examen físico, con la auscultación se detectó disminución de los ruidos respiratorios en los lóbulos superiores. En la radiografía de tórax se observó engrosamiento pleural apical y volumen reducido. En la tomografia computarizada (TC) del tórax se observaron densidades en vidrio esmerilado y bronquiectasia tubular predominantemente en ambos lóbulos superiores, con engrosamiento septal interlobulillar de la pleura y adenopatía mediastínica. Se realizó una biopsia pulmonar por toracoscopia y en el examen histológico se observaron fibrosis subpleural y tinción de las fibras elásticas que demostraba depósito de fibras elásticas en el área subpleural y el parénquima pulmonar adyacente, lo que sugería FEPPI. Hasta donde sabemos, este es el primer caso durante la niñez. Por lo tanto, los pediatras deben estar atentos a esta enfermedad para realizar un diagnóstico y tratamiento adecuados.

Prognostic significance of carbonic anhydrase IX overexpression in stage III non-small cell lung cancer patients after neoadjuvant treatment.

BACKGROUND: To assess the prognostic importance of carbonic anhydrase IX (CA IX), a hypoxic biomarker, after neoadjuvant treatment in Stage III non-small cell lung cancer (NSCLC) patients. METHODS: Tissue CA IX expression was examined after surgical resection in 77 patients who had undergone neoadjuvant treatment. The effects of CA IX overexpression and other clinical factors on disease-free survival and overall survival were investigated. RESULTS: In multivariate analysis, number of neoadjuvant chemotherapy (CT) courses and gender emerged as significant independent predictors for disease-free survival, where administration of 2-3 courses of neoadjuvant chemotherapy (CT) (HR, 3.2 [95% CI 1.3-7.6], p = 0.009) and female gender were associated with poor survival (HR, 3.2 [95% CI 1.3-7.7], p = 0.009). The only significant independent predictor for overall survival was recurrence (HR, 5.6 [95% CI 2.4-12.8], p < 0.001). On the other hand, CA IX overexpression was not associated with disease free survival (p = 0.560) or overall survival (p = 0.799). DISCUSSION: Our results do not suggest a prognostic role for CA IX overexpression in stage III NSCLC patients who received neoadjuvant treatment.

The effects of airway pressure and inspiratory time on bacterial translocation.

BACKGROUND: Mechanical ventilation with high peak inspiratory pressure (PIP) induces lung injury and bacterial translocation from the lung into the systemic circulation. We investigated the effects of increased inspiratory time on translocation of intratracheally inoculated bacteria during mechanical ventilation with and without extrinsic positive end-expiratory pressure (PEEP). METHODS: Rats were ventilated in pressure-controlled mode with 14 cm H2O PIP, 0 cm H2O PEEP, I:E ratio 1/2, and Fio2 1.0. Subsequently, 0.5 mL of 10(5) cfu/mL Pseudomonas aeruginosa was inoculated through tracheostomy and rats were randomly assigned to six groups; two low-pressure groups (LP)1/2, 14 cm H2O PIP, 0 cm H2O PEEP, I:E = 1/2, and LP2/1 14 cm H2O PIP, 0 cm H2O PEEP, I:E = 2/1; two high-pressure groups (HP)1/2, 30 cm H2O PIP, 0 cm H2O PEEP, I:E = 1/2, and HP2/1, 30 cm H2O PIP, 0 cm H2O PEEP, I:E = 2/1; two HP PEEP groups (HPP)1/2, 30 cm H2O PIP, 10 cm H2O PEEP, I:E = 1/2, and HPP2/1, 30 cm H2O PIP, 10 cm H2O PEEP, I:E = 2/1. Blood cultures were obtained every 30 min. The rats were killed and their lungs were processed. RESULTS: When compared with baseline values, Pao2 decreased in the LP1/2, LP2/1, HP1/2, and HP2/1 groups at the last time point, but the decline in Pao2 reached statistical significance in only the HP1/2 group. The bacterial translocation rate was greater in group HPP2/1 than group HPP1/2 (P = 0.01). CONCLUSIONS: We found that high PIP, with or without prolonged inspiratory time, increased the rate of bacterial dissemination. PEEP prevented bacterial translocation in the high PIP group. However, the protective effect of PEEP was lost when inspiratory time was prolonged.

The additional value of FDG PET imaging for distinguishing N0 or N1 from N2 stage in preoperative staging of non-small cell lung cancer in region where the prevalence of inflammatory lung disease is high.

PURPOSE: The aim of this study was to evaluate the efficacy of PET imaging and compare it with the performance of CT in mediastinal and hilar lymph node staging in potentially operable non-small cell lung cancer (NSCLC). METHODS: Fifty-nine patients with potentially resectable NSCLC who underwent preoperative PET and CT imaging were enrolled into this prospective study. All patients underwent surgical evaluation by means of mediastinoscopy with mediastinal lymph node sampling (14 patients) or thoracotomy (45 patients). RESULTS: The prevalence of lymph node metastases was 53%. Overall, the sensitivity, specificity, accuracy, PPV, and NPV of PET were 79%, 76%, 78%, 86%, and 76% for N0 and N1 lymph nodes and 76%, 79%, 80%, 67%, and 83% for N2 lymph nodes, while those values for CT were 66%, 43%, 58%, 68%, and 43% for N0 and N1 stations and 43%, 66%, 54%, 41%, and 66% for N2 lymph nodes, respectively. PET correctly differentiated cases with mediastinal lymph node involvement (N2) from those without such involvement (N0 or N1) in 76% of cases. Statistical analysis of the diagnostic accuracy of nodal involvement showed that PET improves diagnostic accuracy significantly in the detection of both N0 or N1 and N2 status in the individual patient based on analysis, compared with CT (P < 0.01 and P < 0.01, respectively). When preoperative nodal staging was compared with postoperative histopathological staging, 38 (65%) patients were correctly staged, 9 (15%) were overstaged, and 12 (20%) were understaged by PET, while 29 patients (49%) were correctly staged, 13 (22%) were overstaged, and 17 (29%) were understaged by CT. CONCLUSION: It has been clearly shown that PET is more accurate than CT for the differentiation of N0 or N1 from N2 disease in patients with NSCLC. However, PET imaging alone does not appear to be sufficient to replace mediastinoscopy for mediastinal staging in patients with lung cancer, especially in geographic regions with high granulomatous or inflammatory mediastinal disease prevalence.

Primary manifestation of hepatocellular carcinoma as a cervical mass.

Metastasis of hepatocellular carcinoma to the head and neck region is unusual and its exact frequency is unknown. A 72-year-old male patient presented with a mass on the left side of the neck. Clinical examination showed multiple, painless, immobile lymphadenopathies in the cervical region. Computed tomography revealed both an irregular mass in the cervical region and hepatomegaly accompanied by a lobulated liver contour. The patient was diagnosed as having hepatocellular carcinoma following an excisional biopsy from the cervical mass and fine needle aspiration biopsy from the liver.

BRAF, NRAS, KIT, TERT, GNAQ/GNA11 mutation profile analysis of head and neck mucosal melanomas: a study of 42 cases.

Head and neck mucosal melanoma (HNMuM), which occurs mostly in the sinonasal and oral cavity, constitutes less than 1% of all malignant melanomas. Treatment options fail to improve the prognosis of this aggressive tumour that has low overall survival rates. Thus, development of new targeted therapies is essential. Unfortunately, limited data exist regarding their molecular profile. BRAF, NRAS, KIT, TERT and GNAQ/GNA11 oncogene mutations were investigated in 42 HNMuMs (28 sinonasal, 13 oral, 1 nasopharyngeal). Mutation rates were as follows: BRAF (4.8%), NRAS (4.8%), KIT (9.5%), TERT (7.5%), GNAQ/GNA11 (0%). Among 11 cases that harboured mutations (26%), 10 (91%) were located in sinonasal and one (9%) in the oral cavity. The literature was reviewed with comparison of frequencies based on the gathered data. NRAS and TERT promoter mutation rates were significantly higher in sinonasal than in oral location (p<0.05). Our results indicated that BRAF, NRAS, KIT, TERT and GNAQ/GNA11 gene mutations occur at low frequencies in HNMuMs, and subgroups (oral versus sinonasal) differ in their molecular profile. Low rates of aforementioned mutations and activation of oncogenes by pathways other than sun exposure support the distinctive nature of HNMuMs with regard to their cutaneous counterparts.

Serum amyloid A (SAA) in induced sputum of asthmatics: a new look to an old marker.

BACKGROUND: Some cellular and soluble markers of inflammation in induced sputum have been used for studying airway inflammation in asthma. The aim of this study was to assess the usefulness of systemic inflammation marker serum amyloid A (SAA) in blood and induced sputum to monitor the airway inflammation in asthmatic patients. METHOD: Seventeen non-smokers newly diagnosed mild to moderate asthmatic patients and 10 healthy volunteers were included in this prospective parallel designed study. Inflammatory cell counts, SAA and eosinophil cationic protein (ECP) levels were measured in sera and induced sputum of both groups. All tests were repeated in the asthma group after 6 months of inhaled steroid therapy. The diagnostic accuracy and reproducibility of sputum and blood SAA were estimated. RESULTS: Serum and induced sputum SAA and ECP levels, sputum eosinophils and neutrophils of untreated asthmatic patients were significantly greater compared to the control group. Sputum and sera SAA levels and sputum neutrophils remained unchanged after the 6 months of anti-inflammatory therapy, although ECP levels, sputum eosinophils and macrophages were significantly reduced. The area under the curve (AUC) for sputum SAA was found equal to AUC for sputum ECP (0.87). The reproducibility of sputum SAA was satisfactory (ICC=0.84) as well. CONCLUSION: Our findings suggest that systemic inflammatory marker SAA may be used as a reliable inflammatory marker in asthma. The facts that whether it remarks an ongoing inflammation unresponsive to treatment in the airways or reflects a systemic inflammation needs to be clarified with further studies.