Large Cell Carcinoma Research Articles

Role of Adjuvant Radiation in pN1 Non-Small Cell Lung Cancer (NSCLC) Patients

Previous studies have shown a detrimental effect of postoperative radiation (PORT) in pN1 NSCLC patients after R0 surgery. High lymph node ratio (LNR = number of positive lymph nodes in the resected specimen/number of total lymph nodes resected) has been shown to correlate with worse outcomes. We hypothesize that PORT can improve survival outcomes in pN1 NSCLC patients with high LNR after R0 surgery.The National Cancer Database was queried for cases of lung cancer from 2004-2016. Patients without neoadjuvant treatment, with at least a lobectomy with resection of at least 10 lymph nodes, with pN1 disease, with histology of squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma and large cell carcinoma were included. Exclusion criteria were neoadjuvant therapy, lack of pathological confirmation or lack of information about chemotherapy and metastatic disease. For patients with PORT, RT was directed to thorax with dose≥30Gy. Log-rank test and Cox proportional hazards models were used to compare survival adjusted for age, sex, CCI, pT, grade, chemotherapy, LNR, and PORT. Predictors for overall survival (OS) were identified.Among 13742 patients, 12542 (91.3%) did not have PORT, and 1200 (8.7%) had PORT. Median follow up was over 5 years. For years of 2004-2010 and 2011-2016, PORT was given to 8% (413 out of 5132) and 5.5% (423 out of 7622) of patients after R0 resection, respectively. PORT was given to 36.8% and 6.55% patients with non-R0 and R0 resection, respectively (P < 0.001). PORT was given to 11.6% and 3.37% of patients with and without adjuvant chemotherapy, respectively (P < 0.001). The average LNR for patients with and without PORT were 0.2 and 0.14 (P < 0.001), respectively. In multivariate analysis (MVA) of patients with R0 resection, predictors of OS were listed in Table 1. In patients with intermediate LNR (15-29%), PORT was marginally correlated with better OS (HR, 0.80, P = 0.07). In patients with high LNR (≥30%), PORT was correlated with better OS (HR, 0.80, P = 0.047). In MVA of patients with non-R0 resection, high LNR was associated with worse OS (HR, 1.35 and 1.66 for LNR of 15-29% and ≥30%, respectively). In patients with intermediate (15-29%) and high (≥30%) LNR, PORT was numerically correlated with better OS (HR, 0.89 and 0.77 respectively, P non-significant).For pN1 NSCLC patients after R0 resection, use of PORT is decreasing. High LNR after R0 surgery in pN1 NSCLC patients portends worse survival. PORT does not benefit pN1 NSCLC patients with low LNR after R0 surgery, but it is associated with better survival for patients with high LNR after accounting for multiple confounders including adjuvant chemotherapy.

Prognostic Significance of Wnt1, Wnt2, E-Cadherin, and β-catenin Expression in Operable Non-small Cell Lung Cancer.

The role of Wnt family proteins, E-cadherin, and β-catenin in non-small cell lung cancer (NSCLC) is unclear. In this study, we assessed the expression of these proteins as well as their reciprocal interaction and clinical relevance in NSCLC. Immunohistochemical expression of Wnt1, Wnt2, E-cadherin, and β-catenin was assessed in 208 patients with NSCLC who underwent curative pulmonary resection. Expression of Wnt1, Wnt2, and E-cadherin was found in 49.5%, 22.3%, and 37.4% of the patients, respectively, whereas expression of membranous and cytoplasmic β-catenin was found in 23.7% and 34.8% of the patients, respectively. The expression of Wnt1 and E-cadherin was lower in squamous cell carcinoma than in adenocarcinoma and large cell carcinoma, and the expression of both Wnt proteins, E-cadherin, and membranous β-catenin was lower in poorly differentiated compared with well-differentiated tumors. None of the analyzed proteins was associated with relapse-free or overall survival. Expression of Wnt1, Wnt2, E-cadherin, and β-catenin is a common occurrence in NSCLC and is related to tumor histology and grade. However, these proteins have no prognostic role in operable NSCLC.

Right pneumonectomy for primary large acinic cell carcinoma (AciCC) with severe mediastinal deviation: a case report and literature review

BackgroundPrimary lung acinic cell carcinoma is very rare. Here we report a young female patient who suffered the largest primary lung acinic cell carcinoma with severe mediastinal deviation which has never been reported before. We also reviewed data and features of 20 previously reported cases of primary lung acinic cell carcinoma who underwent lobectomy.Case presentationA 27-year-old female patient presented with recurrent coughing and hemoptysis for more than 10 years came to our hospital. A chest computed tomography (CT) showed a giant space-occupying lesion in the hilum of right lung. After a thorough and detailed preoperative examination, the patient then was performed a radical right pneumonectomy with mediastinal lymph node dissection. The size of the tumor was about 8.6 × 4.5 × 4.4 cm. The pathological results demonstrated a primary acinic cell carcinoma of right lung. The immunohistochemistry of the tumor showed AE1/AE3 (+), Ki-67 (2% +), CK7 (+), Vimentin (+), CK19 (+), α1-ACT (+), AB-PAS (+), S-100 (−), TTF-1 (−). The patient was discharged less than 2 weeks after the operation. So far, the patient has been followed-up for 2 years, and no evidence of tumor recurrence or metastasis was observed.ConclusionsThe primary acinic cell carcinoma of lung in this case is the biggest one ever reported and also the first case treated with radical right pneumonectomy. In addition, the patient had a very rare condition of severe mediastinal deviation at the same time. After surgical treatment, the patient recovered uneventfully and had stable disease without recurrence and metastasis after 2 years of follow-up. This case together with the reported case indicate that primary acinic cell carcinoma of lung is of low malignancy, the prognosis and therapy effect of surgical treatment are relatively satisfactory.

Spirostane saponins with a rearranged A/B ring system isolated from the rhizomes of Ophiopogon japonicus

In this study, the popular food and medicinal herb Ophiopogon japonicus was investigated alongside a 70% ethanol extract of its rhizomes, revealing twenty-three steroidal glycosides with four undescribed steroidal saponins, named ophiopogonols A–D. Among them, ophiopogonols A–B are two unusual spirostanols with a rearranged A/B ring system (5/7/6/5/5/6 ring system) that have not previously been identified in plants. The chemical structures of all isolated steroidal glycosides were elucidated by comprehensive analysis through chemical methods, HRESIMS, and NMR spectroscopy. Further, putative biosynthetic pathways for ophiopogonols A–B were proposed. In addition, based on traditional applications of O. japonicus, cytotoxic effects of the isolates were evaluated using human large cell lung carcinoma cells (NCI–H460 cells). Sprengerinin C displayed a remarkable cytotoxic effect with IC50 values of 2.1 ± 0.8 μM by inducing apoptosis and G2/M phase cycle arrest in the NCI–H460 cell line.

Efficacy of immune checkpoint inhibitors in non-small cell lung cancer with uncommon histology: a propensity-score-matched analysis

BackgroundClinical efficacy of immune checkpoint inhibitors (ICIs) for non-small cell lung cancer (NSCLC) with uncommon histology (uNSCLC) is unknown.MethodsPatients with NSCLC treated with ICI monotherapy between January 2014 and December 2018 in 10 Japanese hospitals were retrospectively evaluated. The patients were divided into: (1) NSCLC with common histology (cNSCLC), defined as adenocarcinoma and squamous cell carcinoma; and (2) uNSCLC, defined as incompatibility with morphological and immunohistochemical criteria for adenocarcinoma or squamous cell carcinoma. Propensity score matching was performed to balance the two groups.ResultsAmong a total of 175 patients included, 44 with uNSCLC (10 pleomorphic carcinomas, 9 large cell neuroendocrine carcinomas, 2 large cell carcinomas, and 23 not otherwise specified) and 44 with matched cNSCLC (32 adenocarcinomas and 12 squamous cell carcinomas) were selected for analyses. Median progression-free survival (PFS) (4.4 months, 95% confidence interval [CI] 1.8–7.7 months) and overall survival (OS) (11.4 months, 95% CI 7.4–27.4 months) in the uNSCLC patients were not significantly different from those in matched cNSCLC patients (5.4 months, 95% CI 3.1–7.6 months, p = 0.761; and 14.1 months, 95% CI 10.6–29.6 months, p = 0.381). In multivariate analysis, Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0–1 and programmed death ligand-1 (PD-L1) expression were predictive for PFS and OS in uNSCLC.ConclusionsICIs had similar clinical efficacy for treatment of uNSCLC and cNSCLC. Good ECOG-PS and PD-L1 expression were predictive for efficacy of ICIs in uNSCLC.

P59.07 Mutation Profile of BRAF in Chinese Non-Small Cell Lung Cancer Patients

BRAF mutation is one of the most common driver gene mutations in non-small cell lung cancer (NSCLC) patients, especially in adenocarcinoma. BRAF alterations have been identified with the clinical application of next generation sequencing (NGS),however, mutation profile and co-occurring genomic alterations of BRAF have not been fully understood in Chinese non-small cell lung cancer patients. We enrolled 14703 Chinese NSCLC patients with confirmed histology subtype of adenocarcinoma, squamous carcinoma and large cell carcinoma. FFPE samples and matched peripheral blood or plasma were sequenced for NGS based 1021 cancer genes panel assay. Comprehensive genomic profiling including single nucleotide variants (SNV), short and long insertion and deletion (Indel), copy number variations (CNV) and gene arrangement/fusion were analyzed. 1.78% (261/14703) of Chinese NSCLC patients harbored at least one BRAF genomic alteration, which was mainly composed of patient with SNVs and Indels (97.3%, 254 patients), copy number variations (16.1%, 42 patients), and gene rearrangements (5.0%, 13 patients). None BRAF CNV was detected. Of the 42 patients carried CNV, 38 of them carried both CNV and BRAF SNV/Indel, whereas two of them carried both CNV and gene arrangement/fusion and two of patients carried aforementioned three types of alteration. BRAF V600E were the most common BRAF mutations, which accounted for 36% of all BRAF mutation, respectively. The most common resistant alteration G469A accounted for 11%. A total of nine types of BRAF rearrangement were detected from eight patients. AGK-BRAF were the most common BRAF rearrangement, which accounted for 36% of all BRAF rearrangement. Further analysis of co-occurring BRAF mutations revealed that of BRAF mutated Chinese NSCLC patients harbored both BRAF mutations and other driver gene mutation, such as EGFR, KRAS, PI3KCA. This study revealed BRAF variation in approximately 1.78% of Chinese NSCLC patients. BRAF V600E were the most common BRAF mutations, which accounted for 36% of all BRAF mutation. BRAF mutated Chinese NSCLC patients harbored both BRAF mutations and other driver gene mutation, such as EGFR, KRAS, PI3KCA.

Usefulness of Carcinoembryonic Antigen (CEA) in Evaluating Response to Chemotherapy in Patients with Advanced Non-Small Cell Lung Cancer

Abstract Background Lung cancer represents the top cause of death and the most common cancer worldwide. In the United States, lung cancer is the second most common cancer accounts for 12.9% of new cancer diagnoses and 27.4 of all cancer deaths. Non small cell lung cancer (NSCLC) represents up to 80% of all lung cancers which divided into two major types: squamous cell carcinoma (SCC) and nonsquamous cell carcinoma (NSCC, including adenocarcinoma, large-cell carcinoma, and other subtypes). Aim of the Work To assess the correlation between CEA (carcinoembryonic antigen) levels and response to platinum-based chemotherapy assessed by RECIST criteria of advanced non-small cell lung cancer patients. Patients and Methods This is a prospective study conducted between November 2018 and July 2019, 30 consecutive patients with advanced NSCLC previously treated with at least one line of chemotherapy were prospectively enrolled in thoracic malignancies department in Ain-Shams university hospital and Ismailia Teaching Oncology Hospital. The study was approved by the ethics committee at the faculty of medicine, Ain Shams University. Results In our study we evaluated response by CTs according to RECIST criteria and considered patients with clinical response (PR and SD) as responders and patients with PD as non-responders. Conclusion Our study found correlation between CEA and radiological response and patients with CEA reduction equal or more than 18.5% have objective response to treatment with Sensitivity and specificity 66.67% and 85.71% respectively.

Renal Transplant Recipient with Large Periorbital Basal Cell Carcinoma (BCC) Cured Nonsurgically with Vismodegib

Renal Transplant Recipient with Large Periorbital Basal Cell Carcinoma (BCC) Cured Nonsurgically with Vismodegib

Prospective Analysis of Serum HE4 as an Independent Prognostic Factor in Non Small Cell Lung Cancer

Abstract Background HE4 is expressed in most lung adenocarcinomas and in a significant number of squamous, small cell and large cell carcinomas of the lung, suggesting that it could be used as a diagnostic and/or prognostic factor to refine the standard pathologic analysis. Methodology Data was collected prospectively in the form of blood sample withdrawn from patients with NSCLC confirmed with pathology presented to bronchogenic clinic in Oncology department of Ain Shams University in pretreatment state &amp; from healthy controls with matched age &amp; sex. The Human HE4 (Epididymal Protein 4) was measured in serum samples using Enzyme linked immunosorbent assay [ELISA], the assay was performed using Human HE4 9Epididymal protein 4) ELISA kit, cat no: EH0365 (Fine Test, Wuhan Fine Biotech Co., China). Results 77 patients with NSCLC cases &amp; 30 healthy controls were enrolled in the study. Serum HE4 showed to have to a diagnostic tendency were its value in NSCLC cases was from 42 to 130 pmol/l (median= 72pmol/l). but in controls its value was from 10 to 67 pmol/l (median = 35 pmol/l), which was highly statistically significant (P = 0.001). The cut off value of serum HE4 was 60 pmol/l with sensitivity 77% &amp; specificity 96% (95% CI 0.9-1). Serum HE4 showed to be a poor prognostic marker to OS with statistically significant difference were those with pretreatment serum HE4&amp;lt; 72 pmol/l mean survival time 17.6 months in comparison to the group with pretreatment serum HE4 &amp;gt; 72pmol/l mean survival time 13.2 months (p = 0.02). Conclusion There is a negative correlation between Serum HE4 in NSCLC &amp; overall survival, the highest the serum level the shortest the survival. This result can present serum HE4 as a novel prognostic &amp; probably diagnostic marker for NSCLC.

Lung Cancer Detection using Image Processing Techniques and its Classification

Abstract: Lung cancer has been a major contribution to mortality rates world-wide for many years now. There is a need for early diagnosis of lung cancer which if implemented, will help in reducing mortality rates. Recently, image processing techniques have been widely applied in various medical facilities for accurate detection and diagnosis of abnormality in the body images like in various cancers such as brain tumour, breast tumour and lung tumour. This paper is a development of an algorithm based on medical image processing to segment the lung tumour in CT images due to the lack of such algorithms and approaches used to detect tumours. The work involves the application of different image processing tools in order to arrive at the desired result when combined and successively applied. The segmentation system comprises different steps along the process. First, Image preprocessing is done where some enhancement is done to enhance and reduce noise in images. In the next step, the different parts in the images are separated to be able to segment the tumour. In this phase threshold value was selected automatically. Then morphological operation (Area opening) is implemented on the thresholded image. Finally, the lung tumour is accurately segmented by subtracting the opened image from the thresholded image. Support Vector Machine (SVM) classifier is used to classify the lung tumour into 4 different types: Adenocarcinoma(AC), Large Cell Carcinoma(LCC) Squamous Cell Carcinoma(SCC), and No tumour (NT). Keywords: Lung tumour; image processing techniques; segmentation; thresholding; image enhancement; Support Vector Machine; Machine learning;

Correlation of PD-L1 Expression with TILs CD8+ in Non-small Cell Carcinoma Lung Cancer

BackgroundNon-small cell lung cancer (NSCLC) is an epithelial carcinoma of the lung which consists of adenocarcinoma, squamous cellcarcinoma (SCC), and large-cell carcinoma (LCC). In a microtumor environment, PD-L1 and PD-1 bonds are immune checkpointsthat act in suppressing the activity of CD8+ TILs, thus affecting the prognosis of NSCLC. Aims of this study is to determine thecorrelation between PD-L1 expression with CD8+TILs in NSCLC.MethodsThis was a cross-sectional study of NSCLC registered in Department of Anatomical Pathology Faculty of Medicine University ofSriwijaya/Dr. Moh. Hoesin Palembang Hospital since 1 January 2017 to 31 January 2020 with a total of 24 samples. All sampleswere immunostained using PD-L1 and CD8 antibodies. PD-L1 expression was assessed in tumor mass and CD8 expression inintratumoral and peritumoral TILs.ResultsOnly two subtypes, adenocarcinoma and SCC, were found in this study. Adenocarcinoma was the most frequent subtype (54.1%),sample group is dominated by &lt;60 years old and was the subtype that expressed the PD-L1 most strongly (TPS ≥50%). There wasnot significant correlation between PD-L1 expression with CD8+ TILs in NSCLC (p=0.679 and p=0.826) but based onclinicopathological characteristics, there was a significant relationship between PD-L1 with disease stage and between intratumoralCD8+ TILs density with disease stage (p=0.048 and p=0.017).ConclusionAdenocarcinoma subtype had stronger expression of PD-L1 compared to SCC. There was no correlation between PD-L1 and CD8+TILs density in NSCLC.

Immunohistochemical expression of P16 and Ki-67 in uterine cervical neoplasms

To study the expression of Ki-67 and p16 in neoplastic lesions of uterine cervix and to evaluate the prognostic significance of tumour differentiation, histological type, stage and grade, depth of tumour invasion and lymphovascular invasion in women with neoplasia of uterine cervix. This study was performed on 50 biopsies and surgically resected specimens of uterine cervix, which were fixed in 10% formalin, processed, paraffin embedded and cut into 3-5 microns thickness, stained with hematoxylin and eosin stains and immunohistochemical staining by p16 and Ki-67 antibodies was performed and studied. Majority of cases of invasive carcinoma cervix were large cell non-keratinizing squamous cell carcinoma, 58 cases (48.2%). Majority of cases of invasive carcinoma cervix were seen in stage 2B, 40 (40.8%) cases followed by stage 3B, 24 (24.4%) cases. Out of 18 cases of large cell non-keratinizing squamous cell carcinoma, 12 (66.7%) showed 3+ positivity for Ki-67. 7 (53.8%) cases of stage 2A showed 3+ positivity, 3 (23.1%) cases each showed 2+ positivity for p16. 7 (36.8%) cases of moderately differentiated SCC showed 3+ positivity, 4 (21.1%) showed 2+ positivity and 5 (26.3%) showed 1+ positivity of Ki-67. Out of 10 stable patients, 4 (40.0%) showed negative p16 immunoexpression and all the 3 cases (100%) with recurrence showed 2+ positivity and 2 (100%) patients with metastasis showed 3+ positivity. Out of 10 stable patients, 6 (60%) showed negative Ki-67 immunoexpression and all the 3 (100%) cases with recurrence showed 3+ positivity and one each (50.0%) patient with metastasis showed 2+ positivity and 3+ positivity. p16 and Ki-67 immunomarkers are useful as a diagnostic and prognostic tool in cases with recurrence and metastasis, helping in early detection of disease progression.

HISTOPATHOLOGICAL EVALUATION OF CERVICAL LESIONS IN TERTIARY BASED HOSPITAL - KUTCH REGION

Aim:To find out various cervical lesions with histopathological correlation and age. Method: This was a prospective study conducted in pathology department of a tertiary care teaching hospital over a period of two years. A total of 255 women were included in this study. All cases of gynecological lesions at Histopathology department of Gujarat adani institute of medical science,Bhuj for 2 years starting from May 2019 to May 2021 were retrieved.The demographic information such as nature of specimen which include Punch biopsy(21 cases) and total abdominal hysterectomy(234 cases) were extracted. Results: The most common finding was Nonspecific chronic cervicitis in 159 patients(62.35%) followed by normal stratified squamous epithelium was found in 42 patients(16.47%) and Papillary endocervicitis were 14 patients(5.49%).In benign tumor or tumor-like lesion,Cervical metaplasia were 12 cases(4.70%),Nabothian cyst were 6 cases(2.35%) and Endocervical polyp were 2 cases(0.78%). The premalignant cervical lesions were only 4 cases(1.56%). The malignant cervical lesions were Large cell non-keratinizing squamous cell carcinoma were 7 cases(2.74%), Large cell keratinizing squamous cell carcinoma were 4 cases(1.56%),Squamous cell carcinoma NOS were 3 cases(1.17%) ,Poorly differentiated carcinoma was only one case(0.39%),Basaloid squamous cell carcinoma was only one case(0.39%). Conclusion: Cancer cervix is an ideal malignancy for screening,can be detected early and the premalignant lesion can be treated to prevent the progress to invasive disease. Hence all women with unhealthy cervix should be subjected to punch biopsy to detect early cases of cancer &amp; carcinoma in situ. Most common cervical lesion is Squamous Cell carcinoma and most common age group is 40-49 years.

Кальцитонин, остеокальцин и остеопонтин при раке легкого

Актуальность. Маркерами рака легкого являются низкие уровни в крови гормона кальцитонина, а высокие показатели белков остеокальцина и остеопонтина, связанные между собой, отражают процессы костного метастазирования и обладают прогностической значимостью. Цель исследования: оценить уровни в крови кальцитонина, остеокальцина и остеопонтина, факторы, их определяющие, характер взаимосвязей и прогностическую роль в костном метастазировании при разных вариантах течения рака легкого. Материалы и методы. Обследованы 86 больных раком легкого в возрасте от 24 до 80 лет (в среднем 58 лет), среди которых было 84 % мужчин и 16 % женщин. Центральная форма рака имела место в 81 % наблюдений, периферическая — в 19 %. Мелкоклеточный гистологический вариант заболевания установлен у 21 % от числа больных, немелкоклеточный — у 79 %, в том числе аденокарцинома — у 38 %, плоскоклеточная карцинома — у 35 %, крупноклеточная карцинома — у 6 %. IIIA стадия опухолевого процесса отмечена в 12 % случаев, IIIB — в 21 %, IV — в 67 %. Результаты. Рак легкого сопровождается уменьшением в крови у 20 % больных остеоассоциированного гормона кальцитонина на фоне повышения концентраций опухолевых маркеров остеокальцина и остеопонтина (соответственно в 76 и 79 % наблюдений), что тесно связано с морфологическим вариантом (мелко- и немелкоклеточный), стадийностью и тяжестью течения патологического процесса, определяет развитие компрессионного синдрома, прорастание опухоли в грудную стенку, метастазирование в лимфатические узлы и кости, возникновение осложнений химиорадиотерапии в виде лучевого пневмофиброза, легочной гипертензии и миелодепрессии, а показатели остеокальцин- и остеопонтинемии обратно коррелируют с продолжительностью жизни больных. Выводы: кальцитонин, остеокальцин и остеопонтин при раке легкого являются маркерами тяжести течения заболевания, отражают метастазирование опухолевого процесса в скелет и обладают прогностической значимостью.

Non-small cell lung carcinoma histopathological subtype phenotyping using high-dimensional multinomial multiclass CT radiomics signature.

The aim of this study was to identify the most important features and assess their discriminative power in the classification of the subtypes of NSCLC. This study involved 354 pathologically proven NSCLC patients including 134 squamous cell carcinoma (SCC), 110 large cell carcinoma (LCC), 62 not other specified (NOS), and 48 adenocarcinoma (ADC). In total, 1433 radiomics features were extracted from 3D volumes of interest drawn on the malignant lesion identified on CT images. Wrapper algorithm and multivariate adaptive regression splines were implemented to identify the most relevant/discriminative features. A multivariable multinomial logistic regression was employed with 1000 bootstrapping samples based on the selected features to classify four main subtypes of NSCLC. The results revealed that the texture features, specifically gray level size zone matrix features (GLSZM), were the significant indicators of NSCLC subtypes. The optimized classifier achieved an average precision, recall, F1-score, and accuracy of 0.710, 0.703, 0.706, and 0.865, respectively, based on the selected features by the wrapper algorithm. Our CT radiomics approach demonstrated impressive potential for the classification of the four main histological subtypes of NSCLC, It is anticipated that CT radiomics could be useful in treatment planning and precision medicine.

Overexpression of Human Aspartyl (Asparaginyl) β-hydroxylase in NSCLC: Its Diagnostic Value by Means of Exosomes of Bronchoalveolar Lavage.

The human aspartyl β-hydroxylase (ASPH) is overexpressed in tumor tissues. Bronchoalveolar lavage (BAL) is a diagnostic procedure for infections and malignancies. The aim of this study was to investigate whether tumor exosomes carrying ASPH gene marker were present in bronchoalveolar fluid of patients with non-small cell lung cancer (NSCLC). A tissue microarray analysis was applied to explore the expression of ASPH in different histologic NSCLC. The human NSCLC cell lines and normal bronchial cell lines were used to study exosomal ASPH exprerssion. A total of 27 NSCLC, 21 benign tumor, and 15 healthy controls underwent BAL. Immunohistochemistry was performed to study the ASPH expression in malignant and normal lung tissues. The expression characteristics of ASPH in different NSCLC and normal bronchial cells and pneumocytes were confirmed by cell blocks. A reverse transcription-quantitative polymerase chain reaction was carried out to study the levels of exosomal ASPH expression. Immunohistochemical staining of tissue microarray demonstrated that overexpression of ASPH was found in NSCLC tissues including adenocarcinoma, large cell carcinoma, and squamous cell carcinoma, but absent in adjacent normal tissues. All NSCLC specimens exhibited high levels of ASPH immunoreactivity, while nonmalignant and normal lung tissues exhibited a very low level of expression. Overexpression of ASPH was found in exosomes from NSCLC cell lines but absent from the normal bronchial cell line NL-20. ASPH level from BAL exosomes was significantly increased in NSCLC patients compared with that from nonmalignant or health group. Our method of isolation of BAL exosomes was easily performed in the clinical laboratory. BAL exosomal ASPH can be a potential biomarker for NSCLC diagnosis.

Yield of Computed Tomography Guided Fine Needle Aspiration in Diagnosis of Suspected Cases of Lung Cancer: Experience of a Tertiary Care Hospital of North India

Background: Lung cancer is the most commonly diagnosed malignancy across the globe. CT guided FNAC of suspicious lung masses is a widely accepted and simple diagnostic method of relatively low cost with minimal complications. Methods: It was a prospective study conducted from February 2018 to February 2019 in PGIMS, Rohtak on thirty two patients of either sex having lung cancer suspected clinically or on Chest X-ray/CT Thorax who were subjected to computed tomography guided fine needle aspiration. Results: Most of the patients (79.98%) were in 41-70 years age group with 81.25% male 18.75% females and M:F 4:1. Mass was located on right side in 59% and on left side in 41% cases. Malignancy was diagnosed in 29(90.62%) cases whereas 3(9.37%) cases were inflammatory. Two patients (6.25%) had small cell carcinoma whereas 26 patients (65.62%) had non-small cell carcinoma. Out of these 26 patients, 14 had squamous cell carcinoma, 9 had adenocarcinoma and 3 had large cell carcinoma. One patient was found to have small round cell tumor. 3 patients (9.37%) had pneumothorax as a complication out of which two required chest tube drainage. Conclusions: CT guided FNAC is a simple, safe, and reliable procedure with high diagnostic accuracy for the diagnosis and sub typing of lung cancer. Though complications are rare, pneumothorax and hemoptysis are occasionally encountered but resolve with active management. Keywords: Lung Cancer; FNAC; CT Guided; Pneumothorax.

Steroidal saponins with cytotoxic effects from the rhizomes of Asparagus cochinchinensis

In the ongoing research on potent antitumor agents from the rhizomes of Asparagus cochinchinensis, seven undescribed steroidal saponins asparagusoside A–G (1–7), along with twenty known ones (8–27), were isolated and elucidated via analyzing their 1D, 2D NMR, mass spectroscopic data and chemical methods. All isolated compounds were evaluated for their cytotoxic effects against human large cell lung carcinoma cells (NCI-H460) in vitro. Among them, compounds 7, 9 and 27 showed more significant antitumor activities than the positive control cisplatin (11.56 μM) with IC50 values of 1.39, 3.04, and 2.25 μM, respectively. Further research about asparagusoside G (7) showed G0/G1 arrest in NCI-H460 cell line cycle and induced cell death by apoptosis in a dose‑dependent way.

Mandatory Nodal Evaluation During Resection of Clinical T1a Non-Small Cell Lung Cancers

BackgroundRecommendations for intraoperative lymph node evaluation are uniform regardless of whether a primary tumor is clinical T1a or T2a according to TNM 8th edition for stage I non-small cell lung cancer (NSCLC). We quantified nodal disease risk in patients with T1a disease (≤1 cm). MethodsThe National Cancer Database was queried for clinical T1a N0 M0 primary NSCLCs ≤1 cm undergoing lobectomy with mediastinal nodal evaluation from 2004-2014. Nodal disease risk was analyzed as a function of demographics and tumor characteristics. ResultsAmong 2157 cases, 6.7% had occult nodal disease: 5.1% occult N1 and 1.6% N2. Adenocarcinoma (7.5%), large cell carcinoma (25%), and poor differentiation (11.8%) or undifferentiated/anaplastic (25.0%) had high rates of combined pN1 and N2 disease (P < .001). In univariable analysis, odds of pathologic N1, N2, or N1/N2 nodal disease with respect to N0 was greatest for large cell carcinoma (ref. adenocarcinoma odds ratio [OR] 4.31, 3.62, 4.12 respectively; all P < .05), and anaplastic grade (OR 10.71, 13.09, 11.55). Bronchoalveolar adenocarcinomas had the lowest odds (OR 0.41, 0.11, 0.32) and squamous cell carcinoma had lower odds for N2 (OR 0.29, all P < .05). In multivariable analysis only bronchoalveolar adenocarcinomas had lower odds of pathologic N2 and N1/N2 disease with respect to N0. Worsening grade remained significant for pathologic N1 and N1/N2 disease (both P < .05). ConclusionsA significant rate (6.7%) of occult nodal disease is present in primary NSCLCs ≤1 cm. Risk increases with certain histology and worsening grade. We recommend mandatory systematic hilar and mediastinal nodal evaluation for T1a NSCLC tumors for accurate staging and adjuvant therapy.

CIRUGÍA DE CÁNCER DE PULMÓN EN ESTADIO TEMPRANO EN LESIÓN CAVITARIA QUE SIMULABA ABSCESO PULMONAR, REPORTE DE CASO.

Introduction Pulmonary cavitations are defined as a space filled with air, within a pulmonary area of consolidation, a mass or a nodule, they are produced by the expulsion or drainage of the necrotic part of the lesion through the bronchial tree. The most frequent causes are infectious by mycobacteria as in tuberculosis, or bacteria as in necrotizing pneumonia, pulmonary abscesses, although on rare occasions, it can also present in pulmonary embolism with infarction. Neoplasms should always be suspected, being squamous cell carcinoma the one that has been related to a greater extent to pulmonary cavitary lesion, and to a lesser extent to adenocarcinoma. Other less frequent causes are granulomatosis with polyangiitis, lymphomas, pneumoconiosis, silicosis. Case description Patient with respiratory symptoms of one year of evolution, characterized by cough with sporadic yellowish expectoration plus chest pain, in 03/2020 is accompanied by hemoptysis and progressive dyspnea, without weight loss or fever, private physician indicates antibiotic with partial improvement; On 08/2020 she presented hemoptysis, she went to the doctor again and requested a tomographic study in which she showed evidence of pulmonary cavitation associated with consolidation, a new antibiotic scheme was administered, without improvement, and she went to this clinic on 11/2020. New tomographic study showed cavitation with thick walls, preserved renal and hepatic function, infectious profile and negative immunological tests. Bronchoscopy with BAL cytology positive for malignancy, simple and contrasted body tomography and PET SCAN were indicated, showing hypermetabolic mass in the right lower lobe, with no evidence of distant metastasis or affected lymph nodes. Pulmonary function is assessed for surgical resolution, being adequate, right lower lobectomy is performed, showing free surgical edges, with negative regional nodes for malignancy, with pathology reporting lung adenocarcinoma, pathological staging T3N0, and according to the imaging study M0, determining stage IIB. He required chemotherapy and adjuvant radiotherapy. Conclusion Lung cancer symptomatology can be silent and mainly non-specific, in the study by Bradley et al. addressing lung cancer risk by symptomatology and by chest radiography, they conclude that chest radiography has limited sensitivity and that only hemoptysis has a statistically significant predictive value for malignancy. In relation to cavitated lesions as a presentation in lung cancer, they are evidenced in 5 to 15% of all patients. Within primary neoplasms the frequency with which we can observe cavitation of the lesion is related to the histological subtype, it is more frequent in squamous carcinomas (9-38%), rarer in adenocarcinomas (6-15%) and large cell carcinoma, and practically rules out small cell carcinoma. As conclusions, multidisciplinary management allows adequate orientation in both the diagnostic and therapeutic algorithm of patients, which will improve patient survival.