The coexistence of tuberculosis infection and lung cancer in patients treated in pulmonary department of Medical Academy in Lublin during last ten years (1990-2000)

The coexistance of tuberculous infection (TB-infection) and lung cancer in patients treated in Pulmonary Department of Medical Academy in Lublin during last ten years (1990-2000) has been evaluated. Inclusion criteria involved: aging from 50 to 80 years, tobacco smoking, tuberculous infection in present or in past, lung cancer. All analyzed patients (32 males, 13 females) were heavy smokers (from 10 to 70 cigarettes per day, during at least 5 years). 27 patients were suffered from lung tuberculosis in past, the rest of them had active tuberculous infection. In 19 cases we detected carcinoma planoepitheliale, in 13 cases carcinoma macrocellulare, in 7 cases carcinoma microcellulare and in 6 cases adenocarcinoma. We concluded, that increased occurrence of lung cancer in TB reinfected patients may be connected with immunodepression caused by chronic TB infection. In patients with new active TB-infection in whom the clinical status and chest X-ray were getting worse in spite of antituberculotic treatment recommended procedures for cancer diagnosis were performed. We suggest that bad results of anti-tuberculotic treatment in TB-infected patients are not always caused by bactericidal resistance. In these cases, the proper diagnosis of lung cancer should be considered.     

Mucoepidermoid carcinoma of lung masquerading as urothelial carcinoma of bladder

Background

Mucoepidermoid carcinoma (MEC) of the lung is a rare subtype of non-small cell lung cancer. There is no consensus regarding optimal management for this disease.

Case report

We present a case of MEC of the lung in a 75 year-old female with a history of superficial urothelial carcinoma of the bladder. The patient was found to have an asymptomatic lung mass. Initial biopsy suggested metastatic recurrence of urothelial carcinoma and therefore, cisplatin and gemcitabine chemotherapy was administered prior to surgical resection. Pathological analysis of the resected specimen confirmed a diagnosis of stage IIIA MEC with focal high-grade features including transitional cell-like areas. Adjuvant radiotherapy was administered due to a positive microscopic resection margin. No chemotherapy was given due to lack of supporting data. The patient developed widespread metastatic disease 3 months following completion of radiotherapy and died 1 month later.

Conclusion

This case demonstrates the possibility of dual pathology in cases where metastatic disease is suspected. The use of small tissue samples may complicate diagnosis due to the heterogeneity of malignant tumours.     

Progressive multifocal leukoencephalopathy: two cases with electron microscopic and viral studies.

Part I of this review described the pathogenesis of lung cancer and emphasized that it was largely a preventable disease. In the present paper, attention is drawn to the prevalent but false impression that treatment of established disease is quite in-effective. In eight consecutive series of cases (over 2300 patients) the authors have seen a change in the clinical environment in which lung cancer is treated—from one of discouragement and apathy to one of outspoken encouragement and enthusiasm.Complete preoperative assessment—an evaluation of the biology of the tumour-host relationship as well as technical resectability—avoids unnecessary surgical intervention and stimulates a trend to earlier referral. This has permitted increasing use of resection with a declining mortality and a continuing improvement in overall survival. On the basis of present resectability rates (37.5%) and a 39% five-year survival rate in those who have had curative resection, it is estimated that current over-all five-year salvage should exceed 13%. This is more than a five-fold increase in survival for all patients compared to that achieved by treatment before 1952.     

CANCER OF THE LUNG IN TUBERCULOUS PATIENTS

Of all tuberculous patients over 45 years of age admitted to Olive View Sanatorium in the five-year period ended July, 1958, 1.4 per cent had cancer of the lung. This is a much higher incidence than in a comparable segment of the general population.Careful examination of serial roentgenographic studies in all cases of suspected pulmonary lesions was found to increase diagnostic acuity. Scalene node biopsy, cytologic study and bronchoscopy were of less help. Diagnostic thoracotomy was the single most useful procedure for diagnosis.As to operability, the results in patients with both cancer and tuberculosis compared very well with those in patients who had only cancer. Patients who have inactive pulmonary tuberculosis and cancer have much poorer results than patients with active tuberculosis and cancer. There are difficulties in accurately diagnosing cancer in the presence of tuberculosis; and there are special problems in patients with inactive tuberculosis and cancer.     

Ostéite tuberculeuse de l’os frontal simulant une métastase lytique d’un carcinome papillaire de la thyroïde : à propos d’un cas

The authors report a case of patient followed for papillary thyroid carcinoma with osteolytic calvarial image at left frontal bone. Bone metastasis of thyroid carcinoma is suspected in the first. Histopathological examination of the material of craniotomy revealed granulomatous lesion in favour of tuberculous osteitis. Such an association is exceptional and only histology allows a definitive diagnosis.     

Clinical Diagnosis of Thyroid Cancer

In a survey of 293 patients with carcinoma of the thyroid, a goitre or enlarged lymph nodes in the neck were the commonest symptoms and a mass confined to one lobe the commonest sign. Hardness of the mass was an important diagnostic feature, and at least two-thirds of the tumour could be recognized before operation. It is suggested that the preoperative evaluation of thyroid swellings should be classified as benign, cancer suspected, and cancer probable.     

Mycobacterium tuberculosis DNA in tissue affected by sarcoidosis.

OBJECTIVE--To investigate the prevalence of Mycobacterium tuberculosis DNA in granulomatous tissues from patients with sarcoidosis and from controls matched for age, sex, and tissue by using the polymerase chain reaction. DESIGN--Single blind control trial. SUBJECTS--16 patients with sarcoidosis who had undergone diagnostic biopsy of lung, skin, or lymph node and 16 patients with squamous cell carcinoma or Hodgkin''s disease to act as controls. In addition, four lung specimens infected with M tuberculosis were included as positive controls. RESULTS--M tuberculosis DNA was present in sarcoid tissues containing granulomas from seven of the 16 patients and one of the 16 matched controls. Two of the four specimens known to be infected with M tuberculosis were positive in the controlled experiment. CONCLUSION--These figures suggest that M tuberculosis DNA is detected as readily in patients with sarcoidosis as in patients with frankly tuberculous tissues and imply that M tuberculosis may be linked to the cause of sarcoidosis.     

肺癌性胸腔积液中生存素基因检测的诊断意义探讨

目的：生存素基因（survivin）是一种新近发现的抗凋亡基因,在肿瘤组织中呈现表达。本文旨在探讨和比较肺癌性胸腔积液和结核性胸腔积液中生存素基因的表达情况,以及其联合细胞学检查对判断肺癌性胸腔积液的敏感度。方法：应用逆转录酶-聚合酶链反应法（RT-PCR）检测2007年06月～2008年03月42例肺癌患者癌性胸腔积液标本,及同时期28例结核性胸腔积液标本的生存素mRNA表达情况,并联合细胞学检查结果进行对比分析。结果：42例肺癌患者胸腔积液标本中生存素mRNA的阳性率为52138％（22／42）;癌细胞的检出率为30．95％（13／42）;生存素mRNA检测联合细胞学检查诊断肺癌的敏感性为61．90％（26／42）,显著高于单独胸腔积液细胞学检测的敏感性（P〈0．001）。28例结核性胸腔积液标本的生存素mRNA阳性率为7．14％（2／28）,显著低于肺癌患者胸腔积液标本生存素mRNA的阳性率（P〈0．001）。结论：运用RT—PCR方法检测胸腔积液中生存素mRNA的表达在判断肺癌性胸腔积液中具有一定的敏感性和特异性,可能作为肺癌辅助诊断的一个新检测指标。     

Methodichlorophen as anti-tumor drug.

Methodichlorophen was given to 26 patients with terminal malignant disease. Eight patients received adequate doses, and five of them showed objective evidence of tumour regression while three failed to respond. Those who responded included four out of five patients with lung cancer (three with squamous-cell carcinoma and one with oat-cell carcinoma) and a patient with hypernephroma. Two patients with testicular teratomas and one with acute myeloid leukemia failed to respond. The drug may be given safely by mouth to outpatients if certain precautions are taken.     

Lifestyle and clinical factors associated with elevated C-reactive protein among newly diagnosed Type 2 diabetes mellitus patients: a cross-sectional study from the nationwide DD2 cohort

The involvement of the testis by metastatic medullary thyroid carcinoma has never been described before. We describe the first case of metastatic medullary thyroid carcinoma affecting testis and inguinal lymph nodes. A 73-year-old Caucasian man was referred to undergo urologic surgery due to a painless nodule in the right testis and an homolateral inguinal lymphoadenomegaly. The patient had a history of medullary thyroid carcinoma with relapsing disease to the spine and lung nodules. Serum calcitonin and CEA levels were 175 pg/ml and 22 ng/ml, respectively. With suspected testicular cancer, the patient underwent radical right orchiectomy with the excision biopsy of the right inguinal lymph node. Histopathology and immunohistochemistry revealed that both the lesions were due to metastases from medullary thyroid carcinoma. Metastases to the testis and inguinal lymph nodes may be due to various solid and hematological tumors. This case, despite its rarity, suggests that testis and inguinal lymph nodes should be considered as potential secondary sites of medullary thyroid carcinoma as well.     

A phase-II trial of Corynebacterium parvum as adjuvant to surgery in the treatment of operable lung cancer

A phase-II randomized trial has been undertaken in 49 patients with operable lung cancer, to determine the effect of a single IV infusion of killed C. parvum vaccine as an adjuvant to surgery. The number of patients was insufficient to provide a decisive result, but analysis 6 years after the last patient was admitted shows that the adjuvant therapy certainly did not shorten, and may well have prolonged, survival. Of the patients with squamous cell carcinoma who were alive 1 year after operation all except one in the C. parvum-treated group were alive 4 years later, whereas five in the control group died during this interval. Judgement concerning the value of IV administration of CP as adjuvant therapy in patients with operable lung cancer should be deferred until further evidence is available.     

Importance of mastalgia in operable breast cancer.

The importance of pain as a presenting symptom of breast cancer has been assessed in a series of 240 patients with operable breast cancer over four years. From an analysis of the case histories of 36 patients the diagnosis proved difficult in one-quarter of the cancers. This is explained by the high incidence of subclinical and lobular carcinoma in the group. Cancer must be seriously considered as a diagnosis in patients presenting with well-localised breast pain of recent onset. These patients should be followed for at least one year after the onset of the pain before cancer is confidently excluded.     

Inflammatory Lesions of the Breast: Diagnosis By Fine Needle Aspiration

Amongst 1061 breast lesions diagnosed by fine needle aspiration (FNA) over a period of 6 years (1985-1990), 128 were reported to be showing changes consistent with an inflammatory lesion. On review, the cytodiagnosis was found to be inaccurate in 31 cases. The cytological features of the 97 cases that were correctly reported are described in this report. The cytological diagnoses issued in these 97 cases were acute mastitis or breast abscess (57 cases) and tuberculous mastitis (30 cases). Non-specific chronic mastitis and miscellaneous conditions accounted for four and six cases respectively. Acid fast bacilli (AFB) were demonstrated in 28.0% of tuberculous mastitis cases and 10.0% of those diagnosed as acute mastitis or breast abscess. FNA cytology was found to be useful for the diagnosis of inflammatory lesions of breast and their classification, as only five out of 57 cases of acute mastitis/breast abscess and one out of 30 tuberculous mastitis cases were suspected on clinical grounds.     

Occult breast carcinoma in reduction mammaplasty specimens: 14-year experience

Reduction mammaplasty is commonly performed for bilateral macromastia, congenital asymmetry, or as a contralateral symmetry procedure in breast reconstruction following mastectomy for cancer. Occult carcinoma has been detected in 0.06 percent to 0.4 percent of breast reduction specimens. The purpose of this study was to examine the incidence of breast cancer in breast reductions performed in one institution over a 14-year period. The authors reviewed their experience with 800 reduction mammaplasties performed between 1988 and 2001. Six cancers were detected (0.8 percent). Of these cancers, three were invasive (0.4 percent) and three were ductal carcinoma in situ (0.4 percent). Stratified by indication for surgery, there was a trend toward higher detection rates in the reconstruction group (1.2 percent) compared with the macromastia (0.7 percent) or congenital asymmetry (0 percent) groups. Mammography was performed preoperatively in these patients and all results were negative for masses or suspicious microcalcification. Pathological diagnosis was guided by gross specimen evaluation in two patients and specimen radiography in one patient. Reduction mammaplasty has a small but definite risk of finding cancer in the resection specimen.     

Antibiotic anaphylaxis

Pulmonary cancer when localized to the lung, is curable by operation. Tumors found by routine x-ray examination before they cause symptoms are much more often confined to the lung and as such are curable. Unlike other internal growths which are more hidden, lung tumors can often be seen early on x-ray films of the chest.X-ray films of the chest were made routinely on all patients entering a hospital, regardless of the nature of their illness. In all, some 40,000 films were made. Sixty patients were found to have unsuspected solitary lesions in the lung. Twenty-four of the lesions were diagnosed and treated by operation and removal. Twelve were diagnosed by other methods. Of the 36, eight were cancer of the lung, an incidence of 22 per cent. There were also 14 localized tuberculous nodules which are best treated by removal. Since early cancer is surgically curable, it is felt that everyone over the age of 40 should have a routine x-ray examination of the chest every six months. Solitary lesions of the lung found should be excised for diagnosis.     

Cancer of the lung: what should be the present approach?

The best opportunities at present for improving the results in the treatment of patients with cancer of the lung are by way of (a) utilizing the information obtained on routine x-ray examination of the chest, (b) decreasing the delay between the time of the first symptoms and the time the patient consults a physician, and (c) decreasing the delay between the time the patient first consults a physician and the time the cancer is surgically removed. The medical profession must increase its index of suspicion of cancer of the lung and persist in efforts to make a diagnosis when lung cancer is suspected. Exploratory thoracotomy should be used in suspicious cases when the diagnosis cannot be established by other methods.     

CANCER OF THE LUNG—What Should Be the Present Approach?

The best opportunities at present for improving the results in the treatment of patients with cancer of the lung are by way of (a) utilizing the information obtained on routine x-ray examination of the chest, (b) decreasing the delay between the time of the first symptoms and the time the patient consults a physician, and (c) decreasing the delay between the time the patient first consults a physician and the time the cancer is surgically removed.The medical profession must increase its index of suspicion of cancer of the lung and persist in efforts to make a diagnosis when lung cancer is suspected.Exploratory thoracotomy should be used in suspicious cases when the diagnosis cannot be established by other methods.     

Phagocytic activity of alveolar macrophages in patients with bronchogenic carcinoma

Summary Human bronchoalveolar cells were obtained by lavage during diagnostic fiberoptic bronchoscopy of 21 patients suspected of having lung malignancies. Of these patients 11 were diagnosed as having primary lung cancer (Group I) and included individuals with squamous cell carcinoma, adenocarcinoma, undifferentiated large and oat cell carcinoma at varying locations and TNM stages, 4 patients demonstrated nonprimary metastatic carcinoma (Group II), and 6 patients did not reveal detectable tumors by bronchoscopy or follow-up (Group III) and were included as study controls. We examined the ability of pulmonary alveolar macrophages (PAMs) lavaged from patients in each of the three study groups to phagocytose opsonized sheep red blood cells. Phagocytic activity varied among patients in the same and different study groups; however, no significant differences were observed in the phagocytic or tumoristatic activities of PAMs recovered from tumor-bearing and nontumor-bearing lung regions of the same patient. Moreover, lavage fluids collected from tumor-bearing regions did not suppress the phagocytic activity of PAMs collected from control lungs nor lung regions contralateral to the tumor-bearing lung. The data do not support the view that bronchial neoplasms or their secreted products suppress phagocytic functions of alveolar macrophages.