Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a diagnostic technique for assessing intrathoracic lymph nodes and masses. EBUS-TBNA skill is most commonly acquired through training in interventional pulmonology (IP) or thoracic surgery, but there is no consensus on what constitutes appropriate training. Kingston Health Sciences Centre (KHSC) is a Canadian tertiary care academic institution without a formal IP training program that introduced EBUS in 2014. We seek to describe the attainment of EBUS skill by assessing diagnostic performance and to describe acquisition of skill at this non-IP center. Retrospective analysis of EBUS-TBNA procedures at KHSC since 2014 was conducted. We reviewed the first 70 EBUS procedures performed by each of 4 pulmonologists without prior EBUS training between 2014 and 2019 (n=280). Collected data included patient characteristics, indication for EBUS, number, size, and sites of sampled lymph nodes, and diagnostic yield based on pathology reports. Descriptive statistics were used to assess performance and skill acquisition. The number of EBUS-TBNA procedures increased from 5.3/month in 2014 to 18.3/month in 2019 and 25.5/month in 2023. In the 1st quartile of skill acquisition (n=17 EBUS per pulmonologist), mean diagnostic yield was 76.5% (range, 70.6-82.4%) compared with 93.4% in the 4th quartile (n=19 EBUS per pulmonologist; range, 89.5-94.7%). Complications such as persistent hypoxemia and bleeding were rare, occurring in 1 (0.4%) and 2 (0.7%) cases, respectively. Non-IP trained pulmonologists were able to safely acquire EBUS-TBNA skill at a Canadian academic tertiary care center with a diagnostic accuracy comparable with those reported in literature, within their first 70 cases.

Granulomatous inflammation in tuberculosis is a risk factor for hypercalcemia. In hypercalcemia caused by tuberculosis, calcium levels return to normal after anti-tuberculosis therapy; however, high calcium levels are a risk factor for renal damage. A clinical case of renal damage caused by hypercalciemia in a patient with generalized tuberculosis is presented. The examination revealed a diagnosis of tuberculous meningoencephalitis, miliary pulmonary tuberculosis, tuberculosis of the intrathoracic lymph nodes in the abscessing phase, tuberculosis of the peripheral (supraclavicular, subclavian, anterior cervical) lymph nodes in the infiltration and abscessing phase, and tuberculosis of the bone marrow. The blood calcium level upon admission was 3.86 mmol/l, serum creatinine was 255 μmol/l. During the course of anti-tuberculosis, infusion and symptomatic therapy, normalization of the calcium level and restoration of renal function, positive dynamics of the tuberculosis process were achieved. Conclusion. Timely administration of infusion, symptomatic, anti-tuberculosis therapy allows normalizing calcium levels and restoring renal function in a patient with renal damage caused by capercalcemia in a patient with tuberculosis.

Background: Sarcoidosis is a multisystem inflammatory disorder characterized by non-caseating granulomas, most commonly affecting the lungs and intrathoracic lymph nodes. Angiotensin-converting enzyme (ACE) levels and calcium abnormalities are recognized biomarkers, while ^18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is increasingly used to assess disease activity. However, neither provides sufficient diagnostic accuracy alone. Therefore, this study aimed to investigate the relationship between FDG-PET/CT metabolic findings and serum ACE and calcium (Ca2+) levels as surrogate indicators of inflammatory metabolic intensity in sarcoidosis. Methods: In this retrospective single-center study, 127 patients with pulmonary sarcoidosis who underwent PET/CT at diagnosis were evaluated. Demographic and clinical data, ACE, and Ca2+ levels were recorded. FDG uptake in mediastinal, pulmonary, and extrapulmonary sites was analyzed, and correlations with biomarkers were assessed. Results: The cohort included 89 females (70.1%) and 38 males (29.9%), mean age 51.3 ± 11.9 years. FDG uptake was most frequent in mediastinal lymph nodes (84.3%) and lung parenchyma (40.9%). ACE levels correlated weakly with total SUVmax (r = 0.214, p = 0.019). Calcium levels correlated with extrapulmonary SUVmax (r = 0.327, p = 0.001) and were higher in patients with extrapulmonary involvement (p = 0.045). No associations were found between symptom presence and biomarkers or SUVmax values. Conclusions: FDG-PET/CT metabolic parameters, particularly total and extrapulmonary SUVmax, demonstrated modest yet statistically significant associations with ACE and calcium levels. These findings suggest that a combined biomarker-imaging approach may provide complementary information regarding inflammatory metabolic intensity and systemic involvement; however, the results should be interpreted as exploratory and require validation in prospective studies.

The intrathoracic lymph nodes (LN) of clinical interest in dogs are the sternal (STLN), cranial mediastinal (CrMLN), and tracheobronchial (TBLN) groups. Although computed tomography (CT) depicts and measures these nodes well, thoracic screening commonly relies on three-view radiographs. We hypothesized that enlargement of these nodes would not be consistently identified radiographically, even by experienced observers. In this retrospective, multicenter study (2012-2023), three board-certified radiologists independently graded three-view thoracic radiographs from 74 dogs. Each LN group was scored on a 5-point scale (1, cannot assess; 2, normal; 3, mild; 4, moderate; 5, marked). Corresponding per-group CT volumes (STLN, CrMLN, and combined TBLN) were calculated using the ellipsoid formula, and analyses were performed at the LN-group level. Inter-rater agreement was estimated with Gwet's AC1, and associations between radiographic grades and CT volumes were evaluated with Spearman's rank correlation. Observer agreement on radiographs was almost perfect (AC1: STLN 0.88, CrMLN 0.93, and TBLN 0.95). Correlations between radiographic grades and CT volumes were weak or nonsignificant; only one observer for TBLN showed a weak positive correlation (ρ=0.27, p=0.02). No CT-derived volume threshold yielded a unanimous radiographic classification of enlargement (grade≥3) across observers. Radiographs frequently failed to detect enlarged nodes and occasionally overcalled normal-sized nodes. These findings indicate poor alignment between radiographic grading and CT-measured volume for intrathoracic lymphadenomegaly, despite high interobserver agreement. When accurate intrathoracic LN assessment is expected to influence clinical decision-making, CT should be considered.

Introduction: Sarcoidosis is a multisystemic and often chronic disease that can involve nearly any organ. The lungs and intrathoracic lymph nodes are the most commonly affected structures. The aim: of the study is to classify the stages of sarcoidosis and analyze their correlation with clinical symptoms. Material and Methods: A total of 50 patients with sarcoidosis came to our University Clinic for Pulmonology and Allergology-Skopje during 2022-2023 period – a retrospective observational study. A high-resolution computed tomography (HRCT) using a 128-slice PHILIPS INCISIVE CT scanner was performed to all patients, using a 1 mm thin-slice protocol optimized for thoracic imaging. Disease staging was conducted according to the Scadding Score System. Clinical symptoms such as smoking, dyspnea and cough were identified from the MOJ TERMIN medical records and compared with the stage of the disease. Results: The disease stage did not significantly correlate with the patients’ sex and age, but it did significantly correlate with their place of residence. There was a statistically significant difference in the distribution of former smokers across disease stages, driven by the significantly higher proportion of former smokers in stage III compared to stage II. The disease stage had a significant impact on patient hospitalization. The disease stage had a significant impact on the presence of reticular opacities in the upper and middle zones.

BackgroundEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard diagnostic procedure for evaluating intrathoracic lymphadenopathy. Both conventional mode and elastography aid in differentiating malignant from benign nodes. This study aimed to evaluate the diagnostic accuracy of an integrative approach combining conventional mode and elastography.MethodsA retrospective cross-sectional study was conducted in patients with intrathoracic lymphadenopathy who underwent EBUS-TBNA at Rajavithi Hospital between July 2015 and December 2018. Data were obtained from video recordings, including both conventional mode and elastography. The diagnosis of each lymph node was based on cytological or histopathological findings. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the area under the receiver operating characteristic curve (AUC). Logistic regression analysis was performed to evaluate the diagnostic odds ratio (DOR).ResultsEBUS-TBNA was performed on 210 lymph nodes from 104 patients (mean size 17.4±9.5 mm), with 124 malignant nodes (59%) and 86 benign nodes (41%). Malignant nodes on conventional mode were associated with size >20 mm, round shape, absence of a central hilar structure (CHS), and presence of coagulation necrosis. Elastographic predictors of malignant nodes included type III (predominantly blue) and a strain ratio (SR) >12.48. In the multivariable analysis of the combined model, a SR >12.48 yielded the highest DOR (11.0), followed by absence of a CHS (4.8), round shape (3.5), coagulation necrosis (3.4), and lymph node short-axis >20 mm (3.3). The integrative use of elastography with conventional mode significantly improved diagnostic performance for distinguishing malignant lymph nodes, achieving an AUC of 0.90 [95% confidence interval (CI): 0.85–0.94], compared with 0.83 (95% CI: 0.78–0.89; P=0.002) for conventional mode alone and 0.79 (95% CI: 0.73–0.85; P<0.001) for elastography alone. Combining SR >12.48 with any single conventional feature (lymph node size >20 mm, coagulation necrosis, round shape, or absence of CHS) yielded comparably high diagnostic accuracy (AUC 0.81–0.84), with no significant differences among the combinations.ConclusionsThe integrative application of conventional mode and elastography enhances the diagnostic accuracy for differentiating malignant intrathoracic lymph nodes compared with either modality alone. This combined approach provides preliminary diagnostic information that may facilitate lymph node targeting and optimize sampling strategies.

Background. Lung cancer and tuberculosis are among the leading causes of morbidity and mortality, both within the categories of oncological and infectious diseases and among all pathological conditions of the human. Aim. To show the features of the clinical course, preoperative diagnosis, and surgical treatment in patients with concurrent lung cancer and tuberculosis across different age groups. Materials and methods. A retrospective analysis of data from 69 patients with concurrent lung cancer and tuberculosis observed between 2002 and 2024, divided into 7 age groups (44 years, 45–49 years, 50–54 years, 55–59 years, 60–64 years, 65–69 years, and ≥70 years). Results. The time from symptom onset to hospitalization, clinical presentation, comorbidity (Charlson index), pulmonary function test results, characteristics of the tuberculosis process and M. tuberculosis susceptibility, extent of surgical intervention, duration of postoperative recovery, and frequency of postoperative complications showed no statistically significant difference. Younger and middle-aged patients more frequently exhibited mediastinal lymphadenopathy on CT scans, central squamous cell carcinoma with mediastinal lymph node involvement in combination with active tuberculosis, and a higher rate of postoperative complications. In contrast, older patients more often had intact or calcified intrathoracic lymph nodes on CT scans, peripheral adenocarcinomas at an early stage of malignancy, frequently against a background of post-tuberculosis changes. Conclusion. Concurrent lung cancer and tuberculosis manifest, are diagnosed, and have different life expectancy prognoses depending on the age at diagnosis.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology that predominantly affects the lungs and intrathoracic lymph nodes [1,2]. We present a rare case of pulmonary sarcoidosis with pseudo-tumoral features mimicking malignancy. Histopathological confirmation remains crucial to differentiate sarcoidosis from other granulomatous or neoplastic conditions.

Tuberculosis of the musculoskeletal system in children is currently a rare pathology. Low incidence contributes to insufficient alertness on the part of both pediatricians and surgeons and orthopedic traumatologists. In this regard, ostitis and spondylitis of tuberculous etiology, even in the presence of a phthisiatric anamnesis (active tuberculosis of the respiratory organs, a history of tuberculosis, changes in tuberculin tests, social and medical risk factors, etc.) are diagnosed already at the stage of bone tissue destruction. With late diagnosis and without timely assistance for spinal tuberculosis in children and adolescents, in 100 % of cases, disability occurs, the degree of which increases with age. The purpose of this demonstration is to attract the attention of specialists in various fields to the problem of the development of severe complications of tuberculosis in children with untimely diagnosis of the disease and the absence of etiotropic therapy. Clinical observation: child B., 5 years old, from an asocial family. During the examination, a diagnosis of tuberculosis of the intrathoracic lymph nodes in the consolidation phase was established. The child's mother refused inpatient treatment. A year later, tuberculous spondylitis C5-Th1, complicated by abscess, was diagnosed. The development of the disease was facilitated by low alertness of general practitioners in terms of the development of extrapulmonary tuberculosis in a child with several risk factors for the disease, the passive position of the child's parents, their refusal of etiotropic therapy in inpatient settings, and the absence of stable, regulated relationships between employees of medical organizations and social services.

Sarcoidosis is a multisystem granulomatous disorder that classically involves the lungs and intrathoracic lymph nodes in a bilateral distribution. Unilateral disease is rare and may closely mimic malignancy, leading to diagnostic uncertainty. We report the case of a 71-year-old man with a history of coronary artery disease, prior tuberculosis exposure, and a 20–pack-year smoking history, who was found to have pleural-based, calcified pulmonary nodules on screening computed tomography (CT) scan. Initial positron emission tomography (PET) imaging demonstrated no avidity; however, follow-up revealed interval growth and new fluorodeoxyglucose (FDG) uptake, prompting CT-guided biopsy. Histopathology showed chronic inflammation with multinucleated giant cell reaction and focal calcification, consistent with sarcoidosis and without evidence of malignancy. The patient later developed cough and wheezing, with symptoms and imaging findings improving on corticosteroid therapy. This case highlights the diagnostic challenges of unilateral sarcoidosis, the limitations of PET in differentiating granulomatous inflammation from malignancy, and the value of surveillance with targeted biopsy.LEARNING POINTSUnilateral sarcoidosis can mimic malignancy. Even in the absence of bilateral lymphadenopathy, sarcoidosis should remain in the differential for unilateral, positron emission tomography (PET) fluorodeoxyglucose (FDG)-avid pulmonary nodules to avoid unnecessary surgical interventions.Calcified pleural-based nodules represent an uncommon sarcoid phenotype. The presence of coarse calcification does not exclude active disease, and interval progression with evolving FDG avidity highlights the need for longitudinal imaging surveillance.Targeted biopsy and measured therapy are key. In atypical presentations without accessible lymphadenopathy or extrapulmonary disease, percutaneous parenchymal biopsy is essential for diagnosis. Steroid therapy can be highly effective, and a surveillance-first approach can spare patients from invasive procedures.

Patient: Male, 58-year-oldFinal Diagnosis: High grade angiosarcoma transformation in schwannomaSymptoms: Associated with mild pain • skin and softClinical Procedure: —Specialty: OncologyObjective: Rare diseaseBackgroundEpithelioid angiosarcoma arising in a schwannoma is an exceedingly rare and aggressive malignancy, with less than 25 cases reported in the English-language literature. Histopathologically, it combines the spindle cell characteristics of schwannomas with the epithelioid, vascular nature of angiosarcomas. The presence of SMARCB1 frameshift loss-of-function (LOF) mutations impairs gene function, contributing to various aggressive cancers.Case ReportA 58-year-old man presented with slow-growing masses on the back and arm. Ultrasound and MRI findings were suspicious for nerve sheath tumor. He underwent surgical resection and biopsy, with results revealing SOX10-positive, S100-positive, CD31-positive, excisional margins-positive characteristics of high-grade epithelioid angiosarcoma arising in a schwannoma. A PET scan suggested metastasis to intrathoracic lymph nodes. Tempus molecular profiling showed SMARCB1 frameshift LOF. He was treated with weekly paclitaxel and tazemetostat, with slight improvement in pain; however, he developed symptomatic disease progression. Due to extensive metastatic disease precluding surgical resection, palliative radiation was added to the systemic treatment regimen. After several cycles of treatments with worsening symptoms, he decided to enter hospice care.ConclusionsPresentation of high-grade angiosarcoma arising in schwannoma can be non-specific, posing a diagnostic challenge. Histopathology and immunohistochemistry are essential in the diagnosis and may be characterized by the presence of SMARCB1 frameshift LOF as a prognostic biomarker. Surgical resection with negative margins is the cornerstone of treatment supplemented by chemotherapy and radiotherapy. Patients should be monitored closely for recurrence or metastasis.

Patients with single metastases from colorectal cancer constitute a subgroup with an excellent 5-year OS of 55-70% and with a real chance for cure. In this situation, local margin recurrence in the lung may impair the prognosis and thus is the main outcome target of surgery. A retrospective multicenter analysis of patients with single metastases from colorectal cancers was performed. Four German Thoracic Surgery units contributed data from their prospective metastasectomy databases. Statistical analysis was focused on tumor recurrence and risk factors for local margin recurrence. 166 patients from four centers could be further analyzed. For later comparison, 93 (56%) anatomic resections and 73 (44%) non-anatomic resections were pooled. Tumor recurrence was detected: at any site 87/161 (54%), within the lung 62/161 (38.5%) at intrapulmonary margins 25/145 (17.2%) and in intrathoracic lymph nodes 14/138 (10.1%). Intrapulmonary local margin recurrence was more often found in non-anatomic (25.4%) versus anatomic (11.6%) resections (p = 0.052). After propensity score matching (PSM), local margin recurrence was significantly more frequent after non-anatomic resection of intermediate and peripherally located metastases (p = 0.042). Furthermore, local margin recurrence was associated with small safety margins (p < 0.001), small number of lymph nodes removed (p < 0.001) and with intrathoracic lymph node recurrence (p = 0.001). The 5- and 10-year OS of the whole group was 70% and 47% with a median survival of 9.0 years. The 5- and 10-year RFS of the whole group was 59% and 43% with a median of 7.3 years. This study demonstrates that anatomical resection of single CRC lung metastases is superior to non-anatomic resection with respect to local radicality and local intrapulmonary margin recurrence, but there was no difference in OS and RFS.

The recommended methods for obtaining biopsy material for the differential diagnosis of mediastinal lymphadenopathy (ML), such as transbronchial or transesophageal needle biopsy under the control of intraluminal ultrasound (ultrasound transbronchial fine-needle biopsy – US-FNB), require expensive equipment and consumables, while the availability of US-FNB for routine use is currently limited. The aim of the study is to evaluate the safety and efficacy of forceps transbronchial lymph node biopsy (FTLB) as one of the main methods for verifying the etiology of ML. Methods. A study was conducted in 2024 – 2025, which included patients (n = 91) with radiologically confirmed ML. The experience of using an alternative endoscopic approach to diagnosing the causes of ML using widely available equipment is presented. Results. The following diagnoses were confirmed based on the obtained histological material – sarcoidosis of intrathoracic lymph nodes (77 (85%)), cryptococcosis (2 (2%)), squamous cell lung cancer (G2) (1 (1%)), and poorly differentiated lung adenocarcinoma (3 (3%)). The biopsy material was uninformative in 7 (8%) cases. Conclusion. The presented method of PTBL can be used in centers where equipment for ultrasound-FBI is not available or in cases where ultrasound-FBI was ineffective.

Objective. To evaluate the risk, diagnostic capabilities and surgical tactics for silicone lymphadenopathy following implant rupture. Material and methods. Silicone breast implant ruptures were diagnosed in 72 patients after primary surgery. The period until rupture ranged from 6 months to 25 years. To assess the incidence of silicone changes, we analyzed ultrasound, CT and MRI data in 50 patients. Silicone lymphadenopathy was detected in two cases 5 and 6 years after implantation. A review of the literature for recent years is presented. Results. MRI-verified lymph node enlargement following implant rupture was found in 40% of patients (20/50). There were non-specific changes in 16 cases (32%). Two patients had lymph node enlargement corresponding to silicone lymphadenopathy without morphological confirmation. Lymphadenopathy involved axillary, supraclavicular and intrathoracic lymph nodes with their enlargement up to 1.5—2.5 cm in two patients with implant ruptures 5 and 6 years after augmentation mammoplasty. Lymph node biopsy excluded cancer. In this patient, implants were removed simultaneously with lymph nodes. Histological examination revealed asteroid-like bodies and foreign body particles (silicone) in lymph nodes typical for silicone lymphadenopathy. Among 72 patients with implant ruptures, the incidence of silicone lymphadenopathy was 2% (2/72). Conclusion. Silicone lymphadenopathy can complicate breast implant ruptures ≥ 5 years after mammoplasty. This complication requires differential diagnosis with malignancies. Lymph node biopsy is usually required for definitive diagnosis. Lymph node removal is necessary if clinical symptoms are present.

The draining lymph node (LN) is the most frequent and often first site of cancer metastasis. Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is frequently performed as a standard practice in lung cancer diagnosis and staging, its diagnostic accuracy remains modest, primarily due to the minuscule sample size of needle aspirates. With the advent of single-cell technologies, we comprehensively analyzed the immune cell repertoire in a series of EBUS-TBNA samples. Intrathoracic LN samples from 18 subjects with pathologically confirmed metastasis and four controls without evidence of metastasis were compared using single-cell RNA sequencing and mass cytometry analyses. We found that immune cell composition and gene expression patterns differed markedly between metastatic and control LNs. In particular, metastatic LNs contained relatively more APOE-high myeloid cells, with the latter exhibiting significant transcriptional derangement and a powerful intercellular interaction signature. Additionally, CD8 T cells in metastatic LNs demonstrated a unique exhausted phenotype. In conclusion, immune cell phenotypes and gene expression patterns from EBUS-TBNA samples can be leveraged to advance our understanding of cancer immunology and may have independent diagnostic value when malignant cells fail to be identified on histopathology.

Background Patients with pulmonary sarcoidosis or intrathoracic lymph node tuberculosis (TB) may present with comparable clinical manifestations that pose challenges in differentiation. This study aims to improve the diagnostic accuracy of pulmonary sarcoidosis. Methods A retrospective analysis of patients diagnosed with pulmonary sarcoidosis or intrathoracic lymph node TB within the past decade at four tertiary hospitals in China was conducted. According to the inclusion and exclusion criteria, a total of 968 patients were ultimately enrolled in the study, comprising 477 individuals diagnosed with pulmonary sarcoidosis and 491 individuals diagnosed with intrathoracic lymph node TB. The analysis focused on general information, clinical manifestations, and auxiliary examination results, with a comparative analysis between the two groups. Results The median age of onset for pulmonary sarcoidosis was 50 years, with females accounting for 68.94% of the patients. Common symptoms of pulmonary sarcoidosis included cough, sputum production, dyspnea, and chest pain, while approximately 34.12% of patients were asymptomatic. Fever, fatigue, and night sweats occurred less frequently in pulmonary sarcoidosis patients than in those with intrathoracic lymph node TB. Uveitis and myocardial sarcoidosis were observed exclusively in pulmonary sarcoidosis patients. The median time from symptom onset to the diagnosis of pulmonary sarcoidosis was up to three months. Approximately 47.29% of pulmonary sarcoidosis patients had reduced peripheral blood lymphocyte counts, and 94.12% exhibited symmetric enlargement of hilar lymph nodes on chest CT. Both pulmonary sarcoidosis and intrathoracic lymph node TB showed granulomatous inflammation, with 64.36% of intrathoracic lymph node TB cases presenting necrotic foci. Bronchoscopy was the primary method for biopsy, and only 11.06% of pulmonary sarcoidosis patients had multiple nodules in the tracheal or bronchial mucosa, with a low positivity rate for pathogen tests. Conclusion Pulmonary sarcoidosis predominantly affects middle-aged and young women and can be differentiated from intrathoracic lymph node TB by the presence of uveitis and myocardial sarcoidosis, although these manifestations are rare. A significant proportion of pulmonary sarcoidosis patients experience a reduction in their peripheral blood lymphocyte count. Chest CT scans often reveal symmetric bilateral enlargement of hilar lymph nodes, and in some cases, multiple nodules in the tracheal or bronchial mucosa. Both pulmonary sarcoidosis and intrathoracic lymph node TB show granulomatous inflammation, but tuberculosis lesions are more likely to necrose.

The article presents a clinical case of a patient suffering from a chronic generalized sarcoidosis with lungs, intrathoracic lymph nodes, heart and kidneys involvement, the results of examination and treatment.

Introduction. Cutaneous melanoma is a highly aggressive malignancy with a significant risk of metastasis. Current treatment strategies include surgical resection, immunotherapy, and targeted therapy directed at mutations in the MAPK/ ERK pathway, particularly BRAF V600E. Despite the efficacy of dual BRAF/MEK inhibition, the rapid development of drug resistance remains a challenge, prompting interest in combination immunotherapy plus targeted therapy. Aim. This study aimed to evaluate the efficacy and tolerability of triple therapy, involving atezolizumab, vemurafenib, and cobimetinib in patients with BRAF V600 mutation-driven metastatic melanoma following failure of prior lines of therapy. Materials and methods. We present a detailed case report of a patient with metastatic cutaneous melanoma who achieved disease stabilization for 27 months following surgery and first-line therapy with dabrafenib and trametinib. After subsequent progression, second- and third-line therapies with pembrolizumab followed by pembrolizumab and lenvatinib were administered; however, both therapies proved ineffective. Fourth-line therapy with atezolizumab, vemurafenib, and cobimetinib demonstrated a significant clinical response. Results and discussion. Following six months of triple therapy, positron emission tomography/computed tomography (PET/CT) confirmed complete metabolic regression of the previously identified lesions, including those in the intrathoracic lymph nodes and pulmonary metastases. The treatment was well tolerated, with no grade 3–4 adverse events. Conclusion. This clinical case highlights the potential of the atezolizumab, vemurafenib, and cobimetinib therapy in patients with pretreated BRAF V600E-mutated metastatic melanoma. This regimen may benefit patients with acquired resistance to BRAF/MEK inhibitors and immune checkpoint inhibitors. The findings underscore the importance of personalized treatment strategies and the need for further research in this area.

Intrathoracic lymph node tuberculosis (ITLNTB), or tuberculous bronchoadenitis, is increasingly diagnosed in middle aged patients in the era of spreading human immunodeficiency virus (HIV) infection. The difficulty of early diagnosis lies in the absence of specific symptoms at the initial stages of the disease. Often, the diagnosis can be verified only after complications develop.The aim of the study was to analyze a clinical case of diagnosing ITLNTB in the practice of a pulmonologist.Methods. The article presents the results of general clinical, laboratory, and instrumental research methods, and other materials of a patient with a long previous history of respiratory symptoms.Results. According to the results of the diagnostic minimum at the initial examination, no data for tuberculosis were found, and the antibacterial therapy for 7 days had no effect. Intoxication syndrome persisted. Computed tomography (CT) of the chest organs detected fistulas from the paratracheal lymph nodes to the esophagus and bronchi. Mycobacterium tuberculosis was detected in the bronchoalveolar lavage fluid using the Ziehl – Neelson staining method.Conclusion. Despite the modern extensive diagnostic capabilities, such as CT, fibrobronchoscopy (FBS), and fibrogastroduodenoscopy, the diagnosis of tuberculosis is still highly challenging due to the numerous “masks”, long-term latent development of symptoms, and clinical manifestations only with the development of a fistula. FBS is recognized as the primary method for diagnosing tuberculosis of the trachea and bronchi. It not only visualizes the mucosal lesion, but also allows obtaining material for microbiological and histological examination.

Background. Tuberculosis in tender-age infants remains a serious and urgent problem due to the immaturity of the immune system, the lack of a specific clinical picture in the early stages of infection, difficulties in the differential diagnosis of X-ray signs of the disease and anatomical and physiological characteristics of the body. It is important that children from the group of close bacillary contact have a higher risk of developing the disease during the first years of life, especially in the absence of preventive treatment and dynamic monitoring.Case report. A case report of combined tuberculosis of the larynx and lungs in a child born to a mother with tuberculosis and who did not receive preventive therapy is presented. During the first year of life, the patient was repeatedly treated in the infectious diseases department of the city hospital with the diagnosis: “Sublingular laryngitis, laryngeal stenosis” — without improvement. Based on the ineffectiveness of the treatment and the deterioration of the patient’s condition, a chest examination was performed. Laryngeal microlaryngoscopy was performed, Mycobacterium tuberculosis complex DNA was detected in the biopsy materials by polymerase chain reaction. According to the conducted studies, at the age of 1 year and 3 months, a diagnosis was made: “Tuberculosis of multiple localizations: miliary tuberculosis of the lungs. Tuberculosis of the intrathoracic lymph nodes of all groups on the left, paratracheal group on the right, bifurcation group, infiltration phase with calcification elements. Tuberculosis of the larynx. Without isolation of Mycobacterium tuberculosis”. A full course of anti-tuberculosis therapy was performed.Conclusion. The presented case report clearly showed the lack of preventive antituberculosis measures, which led to infection and subsequent late diagnosis of widespread tuberculosis in a tender-age infant.