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INTRODUCTION: Pulmonary neuroendocrine cells (PNEC) are present in the normal lungs with the incidence of 1 in 2500 epithelial cells. They usually proliferate in the presence of reactive processes related to inflammation and fibrosis of the lung parenchyma. The division of pulmonary neuroendocrine cell hyperplasia proposed by Travis et al. additionally distinguished diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) or proliferation that occurs in people without reactive hyperplasia risk factors. The confirmation of the DIPNECH diagnosis requires staining of biopsy specimens using the immunohistochemical technique for neuroendocrine markers. AIM: The aim of this study is to overview the cases of 5 patients in whom the histopathological DIPNECH diagnosis was made in the process of invasive diagnostics performed at the Department of Thoracic Surgery. The aim of the study is to evaluate typical clinical, functional, radiological and histopathological features of this rare disease syndrome. MATERIAL AND METHODS: In the period from April 2010 to June 2014, five patients with lesions in the lungs were subjected to invasive diagnostics. Histopathological and immunohistochemical examinations of the collected specimens were used to make the DIPNECH diagnosis in these patients. The natural history of the disease was traced based on a 5-year follow-up in one of the patients. In addition, we analyzed the literature with regard to the described cases. CONCLUSIONS: Thanks to the early diagnosis of non-specific lesions in the lungs, typical carcinoid which develops on the basis of discussed DIPNECH, was found in the resected material in two out of five operated patients. The accurate diagnosis of DIPNECH allows for the implementation of appropriate treatment and channels further management of the patient into the right direction.
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Hiperplasia/diagnóstico por imagem , Hiperplasia/patologia , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Células Neuroendócrinas/patologia , Idoso , Proliferação de Células , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Tomografia Computadorizada por Raios XRESUMO
A mature teratoma is a tumour of primary germ cells. It is often found in the mediastinum. The authors describe a case of a young man who demonstrated haemoptysis as the only symptom of a mediastinal tumour. The tumour was removed operatively, sent for histopathological examination and immunohistochemistry. The removed tumour was a mature teratoma including elements of the pancreas. The authors revealed the presence of trypsin in the pancreatic acinar cells. The proteolytic activity of the tumour was taken as the cause of haemoptysis because of enzymatic erosion of lung tissue intimately attached to the tumour. In such cases surgical removal saves life of patients.
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Hemoptise/etiologia , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/enzimologia , Pâncreas/enzimologia , Teratoma/enzimologia , Teratoma/patologia , Tripsina/metabolismo , Células Acinares/enzimologia , Células Acinares/ultraestrutura , Adulto , Humanos , Imuno-Histoquímica , Masculino , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Pâncreas/patologia , Proteólise , Teratoma/complicações , Teratoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The aim of this study was to investigate whether the concentrations of metals differ among patients with and without lung cancer with different smoking status and living in industrialized environments. We also evaluated the relationships between metals and blood parameters including hematocrit level (Hct), hemoglobin concentration (Hb), red (RBC) and white (WBC) blood cells numbers. Concentrations of metals were measured with AAS (copper - Cu, iron - Fe, magnesium - Mg, zinc - Zn) and CV-AAS (mercury - Hg). Neither smoking status nor industrialization could be considered as a significant factor for metals accumulation in blood, lungs and tumor tissues, with the exception of mercury which differed in the aspect of industrialization. According to the type of the disease, Fe, Hg and Mg concentrations differed significantly in lungs. Correlations between metals and blood parameters were observed. Additionally, concentrations of Mg, Cu and Zn were correlated between lungs and tumor tissue of patients with cancer as well as they all were related to each other in lungs, tumor and blood tissues.
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Poluentes Ambientais/farmacocinética , Neoplasias Pulmonares/metabolismo , Pulmão/metabolismo , Metais Pesados/farmacocinética , Adulto , Estudos de Casos e Controles , Cobre/análise , Cobre/farmacocinética , Poluentes Ambientais/análise , Feminino , Humanos , Indústrias , Ferro/análise , Ferro/farmacocinética , Limite de Detecção , Pulmão/patologia , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/patologia , Magnésio/análise , Magnésio/farmacocinética , Masculino , Mercúrio/análise , Mercúrio/farmacocinética , Metais Pesados/análise , Pessoa de Meia-Idade , Polônia , Fumar/efeitos adversos , Fumar/metabolismo , Espectrofotometria Atômica , Distribuição Tecidual , Zinco/análise , Zinco/farmacocinéticaRESUMO
UNLABELLED: Lymphomas are neoplasms of lymphocytes and their precursor cells. This disease develops from lymph nodes or extranodal lymphoid tissue. A common site for such a tumour is the chest. The authors describe the case of a young man, who was admitted do the thoracic surgery department with a mediastinal tumour and an induration of the base of the neck. Initial diagnostic tests gave the wrong diagnosis of actinomycosis. A lack of progress in the therapy and the occurrence of a life-threatening condition led to the implementation of more aggressive diagnostic methods. In biopsies taken during thoracotomy, the patient was finally diagnosed with Hodgkin's lymphoma of nodular sclerosis type. CONCLUSIONS: Mediastinal tumours may cause diagnostic difficulties and, to avoid mistakes, typical histological studies should be complemented by targeted immunohistochemical tests.
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Doença de Hodgkin/diagnóstico , Doença de Hodgkin/patologia , Actinomicose/diagnóstico , Actinomicose/patologia , Adulto , Biópsia , Diagnóstico Diferencial , Doença de Hodgkin/cirurgia , Humanos , Imuno-Histoquímica , Linfonodos/patologia , Masculino , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , ToracotomiaRESUMO
BCG (Bacillus Calmette-Guerin) comprises an attenuated strain of Mycobacterium bovis and is used for vaccination against tuberculosis. An additional use of BCG is for immunotherapy of cancer in which the vaccine is administered intravesically for the treatment of superficial bladder cancer. The efficacy of immunotherapy with BCG in the prevention of recurrence is estimated at 70-99%, which is higher than for local chemotherapy. The most frequent complications of such treatment include fever and urinary bladder inflammation, while serious complications of haematogenous organ inflammation, especially inflammation of the lungs with the formation of pulmonary caseosus granulomas, are rarely seen. The authors reported a case of a 68-year-old man who was treated with intravesical BCG instillations due to a superficial bladder cancer. The patient underwent transurethral resection of bladder cancer and then periodically received intravesical BCG instillations. A few days after one instillation, systemic symptoms with a high fever appeared. Further examinations showed features of hepatitis and spread pulmonary changes. The patient underwent videothoracoscopy, and a fragment of lung parenchyma was collected. The histopathological examination revealed the presence of granulomas with central caseosus necrosis. Suspecting BCG infection, diagnostics were enhanced to include bacteriological and genetic tests for the presence of acid-resistant bacilli, which finally gave negative results. The authors diagnosed granulomatous pneumonia as a complication of intravesical BCG immunotherapy. Treatment with antituberculous drugs was initiated. After completing pharmacological treatment, radiological control was performed, which showed significant but not complete remission of pulmonary changes.
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Vacina BCG/efeitos adversos , Granuloma/etiologia , Imunoterapia/efeitos adversos , Pneumopatias/etiologia , Pneumonia/etiologia , Neoplasias da Bexiga Urinária/terapia , Idoso , Febre/etiologia , Granuloma/patologia , Hepatite/etiologia , Humanos , Pulmão/patologia , Pneumopatias/patologia , Masculino , Necrose , Recidiva Local de Neoplasia/prevenção & controle , Pneumonia/patologia , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
Nodular lymphoid hyperplasia (NLH) belongs to a very rare, mild, lymphoproliferative disease of unestablished aetiology historically included in the group of pseudolymphomas. Its existence was controversial for many years, until modern techniques of pathomorphological diagnosis approved it as a separate entity of lung disease. It manifests in the form of well limited nodules localized in the lungs, which are mostly identified accidentally. Clinical symptoms are rare and nonspecific; the disease usually occupies only one lung. Pathomorphological diagnosis requires immunohistochemical designation of expressions of numerous antigens in order to exclude malignant lymphoma of the lungs. Surgical resection is used in cases of larger nodules; the smaller ones require periodic observation, and the prognosis is good. The authors describe the case of 65-year-old woman with pulmonary nodules which were detected accidentally in the right lung. The patient was qualified for right-sided videothoracoscopy and removal of the lung nodule. In classic HE staining of the histological material, the presence of lymphoid infiltration of the lungs was revealed, which formed lymph follicles with reactive germinal centres. In order to differentiate from the malignant lymphatic expansion, immunohistochemical designations were made, which showed positive expression of CD20 antigen in the B cell zone, positive expression of the CD3 antigen in the T cells zone, positive expression of CD23 antigen in the lymph follicles, negative expression of bcl-2 in the lymph follicles, and positive expression of MIB-1 in the germinal centres of lymph follicles. Such a histopathological and immunohistochemical picture provided the basis for diagnosis of nodular lymphoid hyperplasia of the lung.
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Transtornos Linfoproliferativos/patologia , Transtornos Linfoproliferativos/cirurgia , Nódulos Pulmonares Múltiplos/patologia , Nódulos Pulmonares Múltiplos/cirurgia , Idoso , Antígenos/análise , Feminino , Humanos , Hiperplasia/diagnóstico , Hiperplasia/imunologia , Hiperplasia/cirurgia , Transtornos Linfoproliferativos/imunologia , Nódulos Pulmonares Múltiplos/imunologia , Doenças RarasRESUMO
Lung cancer is the most common malignancy in the world. Its large ability to regional extension of the tumor and formation of local and distant metastases causes that the number of deaths and cases of disease are almost identical. The reason of this ability lies in the creation process of blood vessels that is angiogenesis, which main stimulus is the vascular-endothelial growth factor (VEGF). VEGF is synthesized by cancer cells in response to ischemia and a key transcription factor regulating the synthesis of VEGF in hypoxic cell is HIF-1 (hypoxia inducible factor-1). By connecting to its receptors on endothelial cells, the vascular-endothelial growth factor causes an increase in vascular permeability and leakage of plasma protein outside the blood vessel. Forming extracellular matrix becomes the target of migrating and proliferating endothelial cells which finally build a blood vessel. The research confirms that the existence of vasculature in the tumor is a necessary condition to the creation of metastases. The study also revealed that increased levels of VEGF in the plasma of patients with lung cancer correlates with disease progression, in this case the existence of distant metastases. In this work, the authors present the role of vascular-endothelial growth factor in the process of angiogenesis and the biology of the lung cancer and antiangiogenic therapy directions.
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Neoplasias Pulmonares/irrigação sanguínea , Neoplasias Pulmonares/metabolismo , Neovascularização Patológica/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Progressão da Doença , Matriz Extracelular/metabolismo , Humanos , Metástase Neoplásica/fisiopatologiaRESUMO
Lung tissue is directly exposed to high oxygen pressure, as well as increased endogenous and exogenous oxidative stress. Reactive oxygen species (ROS) generated in these conditions play an important role in the initiation and promotion of neoplastic growth. In response to oxidative stress, the antioxidant activity increases and minimizes ROS-induced injury in experimental systems. The aim of the present study was to evaluate the activity of antioxidant enzymes, such as superoxide dismutase (SOD; isoforms: Cu/ZnSOD and MnSOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), and glutathione S-transferase (GST), along with the concentration of malondialdehyde (MDA) in tumor and adjacent noncancerous tissues of two histological types of NSCLC, i.e., adenocarcinoma and squamous cell carcinoma, collected from 53 individuals with surgically resectable NSCLC. MDA concentration was similar in tumors compared with adjacent noncancerous tissues. Tumor cells had low MnSOD activity, usually low Cu/ZnSOD activity, and almost always low catalase activity compared with those of the corresponding tumor-free lung tissues. Activities of GSH-related enzymes were significantly higher in tumor tissues, irrespective of the histological type of cancer. This pattern of antioxidant enzymes activity could possibly be the way by which tumor cells protect themselves against increased oxidative stress.
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Antioxidantes/metabolismo , Carcinoma Pulmonar de Células não Pequenas/enzimologia , Neoplasias Pulmonares/enzimologia , Proteínas de Neoplasias/metabolismo , Oxirredutases/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Telomerase, undetectable in normal somatic cells, plays a critical role in carcinogenesis of the majority of human tumors including lung carcinoma. The aim of our study was to determine human telomerase reverse transcriptase (hTERT) mRNA expression in patients with non-small cell lung cancer (NSCLC) in order to estimate its usefulness as diagnostic and/or prognostic factor. hTERT expression was analyzed in a group of 12 females and 28 males with NSCLC using Quantitative Real-Time Polymerase Chain Reaction (QRT-PCR method) in cancerous and non-cancerous lung tissues. Results were analyzed according to clinical data and one-, two-, and five-year survival rates. hTERT expression in the cancerous tissue was significantly higher than in the lung parenchyma free from neoplasm infiltration (p<0.05). There was no significant association between hTERT expression in the tumor tissue and age, gender, grading or clinical stage. A significant difference in hTERT expression between two types of histopathological patterns (adenocarcinoma and squamous cell carcinoma) was detected (p=0.01). No association between hTERT expression in NSCLC specimens and survival rates was found. hTERT mRNA detection by QRT-PCR in tumor and corresponding cancer-free tissues can be used as a diagnostic marker in patients with NSCLC, but seems not to be a prognostic factor.
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Carcinoma Pulmonar de Células não Pequenas/genética , Regulação Neoplásica da Expressão Gênica , Neoplasias Pulmonares/genética , Telomerase/genética , Adenocarcinoma/genética , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Biomarcadores Tumorais/genética , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de SobrevidaRESUMO
BACKGROUND: Surgical site infection (SSI) is considered to be a priority in infection control. The objective of this study is the analysis of results of active targeted surveillance conducted over a two-year period in the Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra, in southern Poland. PATIENTS AND METHODS: The retrospective analysis was carried out on the basis of results of active monitoring of SSI in the 45-bed Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra between April 1, 2014 and April 30, 2016. Surgical site infections were identified based on the definitions of the European Centre for Disease Prevention and Control (ECDC) taking into account the time of symptom onset, specifically, whether the symptoms occurred within 30 d after the surgical procedure. Detection of SSI relied on daily inspection of incisions by a trained nurse, analysis of medical and nursing entries in the computer system, and analysis of all results of microbiologic tests taken in the unit and in the operating room. RESULTS: In the study period, data were collected regarding 1,387 treatment procedures meeting the registration criteria. Forty cases of SSI were detected yielding an incidence rate of 3%. Most cases (55%) were found in the course of hospitalization and 45% were detected after the patient's discharge. The SSIs were classified as follows: superficial, 37.5%; deep infections, 7.5%; and organ/space infection, 55%. Among patients who were diagnosed with SSI, most were male (77.5%). For patients with an American Society of Anesthesiologists (ASA) score I-II the incidence rate was 2%; ASA score III or more, 3.7%. The incidence rate varied from 0.3% in clean surgical site to 6.5% in clean-contaminated site. CONCLUSIONS: The study validated the usefulness of targeted surveillance in monitoring SSIs in patients hospitalized in thoracic surgery departments. Surgical site infection surveillance identified areas of care requiring modifications, namely, organization of post-discharge and microbiologic diagnostics of infection cases.
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Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Idoso , Bactérias/classificação , Bactérias/isolamento & purificação , Feminino , Unidades Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Estudos RetrospectivosRESUMO
Benign metastasizing leiomyoma (BML) is a rare disease that occurs in middle-aged women with a history of uterine myomas. The most common location of BML is the lungs. We report the case of a 44-year-old obese woman (BMI 45.5) who underwent surgery to remove uterine leiomyomata and then continued to take a drug containing the hormone estradiol for a period of 15 years. Computed tomography chest examinations revealed multiple size nodules of varying size in both lungs. Videothoracoscopy and right thoracotomy was performed, and a few nodules were enucleated from each lobe of the right lung. Postoperative histopathological examination revealed benign metastasizing leiomyoma staining positive for estrogen and progesterone receptors (ER+, PR+). Because of the hormonally dependent cell proliferation, the previously used hormonal drug was discontinued. Treatment with a gonadotropin-releasing hormone analog was included, yielding radiological stabilization of the lung lesions.
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INTRODUCTION: High telomerase activity has been detected in the majority of malignant neoplasms including lung cancer. The purpose of the study was to attempt to use telomerase activity as a prognostic factor in patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Telomerase activity was analyzed in 47 tissue specimens taken from patients with NSCLC. The control group consisted of 30 specimens of non-cancerous lung parenchyma. Telomerase activity was measured by means of the telomeric repeat amplification protocol (TRAP). RESULTS: Telomerase activity in the neoplastic tissue was significantly higher than in the lung parenchyma that was free from neoplastic infiltration. There was no significant association between telomerase activity and age, gender, tobacco smoking, histological type of the tumor, or staging (pTNM). No association was found between the level of telomerase activity in NSCLC specimens and the two-year survival rate of patients (p = 0.326). A higher level of telomerase activity in poorly differentiated tumors (G3) as compared to moderately differentiated tumors (G2) was detected (p = 0.008). A positive association was identified between telomerase activity in pulmonary parenchyma free from tumor infiltration and the presence of leukocyte infiltration (p = 0.0001). CONCLUSIONS: No association was found between the level of telomerase activity in NSCLC specimens and the two-year survival rate of patients. The study has revealed a positive association between telomerase activity and the grade of differentiation (G) in NSCLC.
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OBJECTIVE: In order to evaluate the follow-up study of surgical treatment for primary adenosquamous lung carcinoma (ASC) we specified prognostic criteria, also in comparison with primary adenocarcinoma (AC). METHODS: The study group consisted of 96 patients discharged between 1990 and 1999 after radical surgical treatment for ASC-80 (83%) men and 16 (17%) women aged 34-73, mean 56 years. Consequently, we evaluated 252 patients operated during the same time period for primary AC. RESULTS: Apart from grading, we did not find any significant differences between both ASC and AC groups of patients. Among the 96 patients operated radically for ASC median overall survival (OS) was 20 months. The cumulative postoperative survival rates at 5 and 10 years were 25.4 and 19.2%, respectively. By comparison, median OS for 252 patients with AC, discharged after surgical treatment in the same period, was 28.5 months and the cumulative postoperative survival rates at 5 and 10 years were 42.5 and 39.1%, respectively (P=0.006). At pathologic stages IA, the cumulative survival rate at 5 years was 63.3% for patients with ASC as compared with 72.1% for patients with AC (P=0.330). However, out of IB stage patients treated surgically for ASC 31.8% survived 5 years in comparison with 56.3% operated for AC (P=0.017). Study of survival rates did not differ significantly between ASC and AC patients at stage IIA (P=0.824) and stage IIB (P=0.217), respectively. Univariate analysis revealed that six factors of tumor size, T status, N status, as well visceral pleura involvement, tumor localization (central vs. peripheral) and tumor structure were significantly associated with the survival rate according to these variables. Multivariate analysis using Cox's proportional hazards model indicated that T factor, nodal involvement and one of the tumor components predominating were significant factors associated with the postoperative survival of patients with ASC. CONCLUSIONS: Our findings indicate that in patients after radical operation for ASC, predominance for one of the histopathological components (adenous or squamous) within primary tumor is attended by worst prognosis. Our study confirmed also that the prognosis of ASC of the lung was poorer than that of primary AC. Lack of generally accepted diagnostic criteria and unclear prognosis, even in the pathologic stage I suggest that there is a need for prospective studies in this respect.