Primary Bronchogenic Carcinoma Research Articles

Overview of Lung Cancer

The two main types of lung cancer are small cell carcinoma and non-small cell carcinoma. Lung cancer is a primary bronchogenic carcinoma. Patients who are diagnosed with lung cancer typically exhibit symptoms like hemoptysis, dyspnea, chronic cough, chest pain, or weight loss. Since the onset of symptoms typically indicates that a patient's stage has already progressed, screening with low-dose chest CT (LDCT) exams is advised for high-risk patients. Cytology and core biopsy specimens are the main sources of the diagnosis for these patients. Staging, histology, genetic, and immunotherapy biomarker tests form the basis of the treatment. The most often used pharmacological therapies include radiotherapy, adjuvant platinum-based chemotherapy, surgery, which might involve mediastinal lymph node dissection or lymph node sampling, as well as total removal of the tumor (typically stages I and II). Currently, meanwhile, immunotherapy is the most advanced form of treatment for NSCLC that is oncogenic driver negative

Screening of latent TB infection in patients with recently diagnosed bronchogenic carcinoma.

Cancer and pulmonary tuberculosis are major global health concerns and are associated with substantial morbidity and mortality. The association between active tuberculosis and subsequent cancer development has been investigated for many years. This study was planned to determine the prevalence of latent tuberculosis infection in patients with recently diagnosed bronchogenic carcinoma. Sixty-four newly diagnosed primary lung cancer patients were enrolled. Diagnosis of latent tuberculosis infection was performed with QuantiFERON-TB Gold In-Tube tests, with exclusion of active tuberculosis. Latent tuberculosis infection was detected in 16 (25%) patients, and 8 (12.5%) had indeterminate results of the QuantiFERON-TB Gold In-Tube test. Being a current smoker was associated with a higher prevalence of latent tuberculosis (p = 0.001). Comorbidities, tumor site, and histopathology were not associated with latent tuberculosis infection. There is a considerable risk of concurrent latent tuberculosis in newly diagnosed primary bronchogenic carcinoma. The need for treatment of latent tuberculosis in these patients and its influence on the outcome and prognosis are issues for further investigations.

Radiographic manifestations of inoperable primary bronchogenic carcinoma

Bronchogenic carcinoma should be a topic of paramount importance to all who interpret chest radiographs because of its increasing incidence. For several decades the disease has been underestimated in the developing world. A prospective study was carried out on 52 patients (43 males, 9 females) with primary bronchogenic carcinoma at Oncology Teaching Hospital/Medical City-Baghdad from October 2016 to March 2017. All patients had standard plain chest radiographs (postero-anterior, and lateral views). Any abnormality detected was further studied with conventional tomography. The diagnosis was confirmed by histopathology examinations for all patients who were clinically evaluated by other methods of investigations. Most patients had more than one radiological feature which were mainly pulmonary masses, either hilar or peripheral or both at the same time. Other less common features were; mediastinal adenopathy (27%), atelactasis (25%) and pleural effusion (21%). Radiological signs that determine inoperability were evaluated together with other factors that were used as basic principles in the assessment of inoperability. From the total of fifty-two patients; 45 (86.5%) were inoperable radiologically and clinically, and also 4 patients (57%) out of the 7 who underwent thoracotomy were inoperable due to invasion and adhesion to the vessels and other vital structures. The chest radiograph is still important, cheap and available diagnostic procedure in lung cancer, and to decide further management.

A Preliminary Study of Microbiota Diversity in Saliva and Bronchoalveolar Lavage Fluid from Patients with Primary Bronchogenic Carcinoma.

BackgroundThe present study aimed to evaluate the difference in microbiota diversity in the oral cavity and fluid bronchoalveolar lavage (BALF) of patients with lung cancer.Material/MethodsBuccal (saliva) and lower respiratory tract BALF samples were collected from 51 patients with primary bronchogenic carcinoma and 15 healthy controls, and bacterial genomic DNA was extracted. High-throughput 16S rDNA amplicon sequencing was performed, and microbial diversity, composition, and functions of microbiota were analyzed by bioinformatics methods.ResultsPatients with lung cancer have lower microbial diversity than healthy controls in both saliva and BALF samples. Significant segregation was observed between the different pathological types of lung cancer groups and the control group regardless of the sampling site. Treponema and Filifactor were identified as potential bacterial biomarkers in BALF samples, while Filifactor was ideal to distinguish healthy controls from lung cancer patients. Moreover, the predictive variation analysis of the KEGG (Kyoto Encyclopedia of Genes and Genomes) metabolic pathway showed that the metabolic differences in microbiota varied by sampling site.ConclusionsLung cancer patients carry a different and less diverse microorganism community than healthy controls. Certain bacterial taxa might be associated with lung cancer, but the exact species depends on the sampling site and the pathological type. This study provides basic data on the microbiota diversity in BALF and saliva samples from lung cancer patients. Further investigation with a larger sample size should help validate the enriched species in different pathological types of lung cancers.

Partial Vertebrectomies without Instrumented Stabilization During En Bloc Resection of Primary Bronchogenic Carcinomas Invading the Spine: Feasibility Study and Results on Spine Balance

It is unknown whether spinal instrumentation is required to prevent deformity after partial vertebrectomy in the treatment of primary bronchogenic carcinomas invading the spine (PBCIS). In this study, we focus on the postoperative spine deformity in patients who underwent operation for partial vertebrectomies without instrumentation during en bloc PBCIS resection. Our objective was to determine whether deformity depends on the type of vertebral resection and if any vertebral resection threshold can be observed to justify additional spinal instrumentation. This is a retrospective study, including all patients with PBCIS operated without spinal instrumentation from 2009 to 2018. Partial vertebrectomies were classified into categories A, B, and C depending on vertebral resection. Patients had long-term radiologic follow-up to assess the spine deformity evolution. Eighteen patients were included. The median follow-up was 27 months. Four patients underwent a secondary posterior instrumentation surgical procedure due to progressive spinal deformity. A low-risk group of deformation was characterized as type A resection and type B resection on less than 3 vertebrae. There are no validated criteria to justify a systematic spinal instrumentation when performing a partial vertebrectomy during en bloc resection of PBCIS. Performed alone without spine instrumentation, both type A and type B resections on less than 3 resected vertebrae were not subject to sagittal and coronal deformity even after a long follow-up, emphasizing that a systematic stabilization is not needed in this low-risk group. These results could help to reduce the perioperative morbidity of these procedures that are usually long and complex.

Feasibility of lung cancer RNA acquisition from a single transbronchial or transthoracic needle pass (FASTT trial)

IntroductionRNA isolation from tumor tissue is used for biomarker analyses and validation. Limited diagnostic material from small volume biopsies combined with an increasing demand for standard histologic, molecular characterization, and next generation sequencing applications often leads to limited material for research. We sought to evaluate small volume sampling of lung cancer tissue collected from a single needle pass during a diagnostic procedure and determine if it can provide RNA of acceptable quantity and quality. MethodsWe enrolled 140 patients with probable primary bronchogenic carcinoma and collected RNA from a dedicated FNA aspiration. Total RNA (ηg), RNA integrity number (RIN), and %Mass in base pairs were evaluated from each patient sample. A customized nanoString nCounter® 95-gene panel was used to profile the expression patterns of feature NSCLC genes. We compared gene expression patterns that distinguish lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC) in our cohort with a corresponding Cancer Genome Atlas (TCGA) NSCLC datasets. ResultsOf the 149 patients consented. RNA-extraction was performed in 101 eligible patients. A satisfactory total RNA mass and RIN was quantified for all samples with a similar distribution among cellular subtypes. Mean %-Mass over 300 base pairs was noted for all specimens and 96% of samples met criteria to perform genetic evaluation with our commercialized gene expression assay. The FNA-derived transcriptomic results showed excellent consistency with the TCGA counterparts, and the differential expression pattern of LUAD vs LUSC subtypes were highly similar. DiscussionIn this study, RNA retrieval from a single-pass FNA regardless of procedural approach showed equivalence and suitability for gene expression assessments. RNA extraction from small volume samples has the potential to provide valuable material for genetic profiling.

Radiographic manifestations of inoperable primary bronchogenic carcinoma

Radiographic manifestations of inoperable primary bronchogenic carcinoma

Transthoracic fine-needle aspiration versus tru-cut biopsy under computed tomography-scan guide in diagnosis of peripheral lung lesions

Background: Lung cancer is the number one cause of cancer-related death in the Western world. Intrapulmonary nodules are presenting either solitary or multiples. Primary bronchogenic carcinoma is the most common malignant tumor that presents as a solitary pulmonary nodule. Fine-needle aspiration (FNA) and Tru-cut biopsy are parts from several interventional procedures that need to reach to the final diagnosis. Aim: This study aims to assess the comparison between transthoracic FNA results and Tru-cut biopsy results in the diagnosis of peripheral pulmonary lesions and the possibility of depending on one of them in the diagnosis of these lesions. Materials and Methods: FNA and true cut biopsy under computed tomography scan guided were performed to patients had peripheral pulmonary lesion and sent to the cytological and histopathological laboratory for analysis. Results: All patients (20) that had pulmonary lesion were evaluated. Results of FNA were; 15/20 of them were adequate samples for diagnosis while 5/20 were inadequate. Results of Tru-cut biopsies were – 17/20 were adequate for histopathological assessment while 3/20 were inadequate. Thirteen out of 20 patients had malignancy, five patients diagnosed by both Tru-cut biopsy and FNA, other five diagnosed by Tru-cut biopsy only and three patients diagnosed by FNA only. One patient had benign lesion and diagnosed by both procedures. Six out of 20 patients had other results that diagnosed by both procedures. Squamous cells carcinoma was 5/13 patients (38.46%) and adenocarcinoma was the same percentage. The concordance of FNA results with Tru-cut biopsy results was 60%. Conclusion: The study demonstrated that Tru-cut biopsy is moderately superior to FNA in the evaluation of peripheral malignant lung lesions. Therefore, we advise not using the FNA alone in the evaluation of peripheral chest lesions that suspected of malignancy (except if large bullae or severe emphysema present) and Tru-cut biopsy is often required together to reach the diagnosis.

Pulmonary mucosa-associated lymphoid tissue lymphoma: a case report and review of literature

Objective To help improve the diagnosis and treatment of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma by reporting a case and reviewing relevant literature. Methods Clinical data of 1 case diagnosed with MALT lymphoma by pathology was retrospectively analyzed, and literature related to this disease was reviewed. Results An 80 year old male patient was admitted to the hospital for a pulmonary shadow, which had been diagnosed as primary bronchogenic carcinoma 5 years earlier without any treatment. The patient had a history of airway foreign body aspiration. During hospitalization, chest CT showed a pulmonary shadow larger than on a previous CT scan and signs of pleural effusion. A diagnosis of pulmonary MALT lymphoma was made through a percutaneous lung biopsy. Conclusions Primary MALT lymphoma is uncommon and pulmonary MALT lymphoma is even more rare and often shows untypical clinical presentations, which can be easily confused radiologically with those of lobar pneumonia and lung cancer. Pulmonary MALT lymphoma progresses slowly, has a high 5-year survival rate in untreated cases, and is often diagnosed based on anatomic pathology and immunohistochemistry. Key words: Lymphoma; Diagnosis

Stage IV primary bronchogenic carcinoma presenting as a lesser trochanteric avulsion fracture

Uddin, Fares MB, BCh, BAOa; Tayara, Bader MBBSb; Al-Khateeb, Hesham FRCS(T&O)a Author Information

Analysis of Pathological Types and Clinical Epidemiology of 6,058 Patients with Lung Cancer

背景与目的肺癌的流行病学特征通常随时间、地域、人群分布的变化而发生改变，本研究拟通过回顾性分析郑州大学第一附属医院2012年-2014年住院的原发性支气管肺癌患者的病理类型特点及临床流行病学特征，以初步了解近年来肺癌的流行趋势。方法收集2012年-2014年郑州大学第一附属医院住院的诊断为原发性支气管肺癌并登记为河南地区常住人口的病例，对患者的性别、年龄、城乡来源、吸烟史、饮酒史、地区、手术情况和病理类型等临床资料进行比对分析。结果收集肺癌病例共6, 058例，其中2012年1, 495例，2013年2, 070例，2014年2, 493例。肺癌患者男女比例2012年-2014年分别为2.26:1、2.29:1、2.20:1（χ2=0.367, P=0.832）.发病年龄以60岁-69岁年龄段居多，占35.72%，男女患者各年龄段病理类型差异具有统计学意义（χ2=109.848, P＜0.001）。2012年-2014年不同病理类型肺癌患者的构成比差异有统计学意义（χ2=25.344, P=0.013）。男女性肺癌患者均以腺癌为主，在各类病理类型中分别占37.64%和73.63%，差异具有统计学意义（χ2=562.382, P＜0.001）。各年龄段肺癌患者中腺癌所占比例分别为60.62%、56.59%、49.84%、45.15%、47.03%和41.25%，差异具有统计学意义（χ2=48.886, P＜0.001）。豫北地区腺癌的构成比最高，占55.95%。在城市与农村患者中，各病理类型构成比差异具有统计学意义（χ2=29.732, P＜0.001）。吸烟患者中以鳞癌居多，占38.39%。饮酒患者中也以鳞癌居多，占37.37%。接受手术治疗的患者占15.40%。结论近年来腺癌在所有类型肺癌中所占比例呈上升趋势，鳞癌呈下降趋势。男性肺癌患者以腺癌最常见。腺癌在中青年患者高发，鳞癌在男性患者中高发并与吸烟饮酒关系密切。

Radiological evaluation of various types of primary bronchogenic carcinoma: a study of 65 cases

Background: Orderly approach to diagnosis and staging based on the knowledge of lung cancer requires selection of treatment for either potential cure or optional palliation of individual patient. A radiological imaging is extremely valuable and indispensable when it comes to diagnosis and staging of primary bronchogenic carcinoma. Objective: To study the imaging features on various radiological and imaging techniques in various types of primary bronchogenic carcinoma and to differentiate bronchogenic carcinoma from other lung masses. Materials and Methods: This was a prospective observational study. Ethical committee permission was taken before enrollment of the patients in the study. Data of participants regarding demographics, history of smoking habit, clinical presentation, histopathological type, radiographic findings on chest radiograph, ultrasonography, computed tomography (CT) scan, and, if required, magnetic resonance imaging were recorded in detail. The method of diagnosis and clinical stage of the disease were obtained. Statistical analysis was performed using descriptive statistics of the collected data. Result: The maximum prevalence of bronchogenic carcinoma was seen between 60–69 years of age (50.76%) with male predominance (90.76%). About 92.31% patients showed positive smoking history. Thirty-three patients (50.76%) showed primary tumor size in lung, which was > 4 cm size. All masses (100%) showed heterogeneous contrast enhancement. Other common findings by CT scan were loss of patency of bronchus (41.53%), hilar enlargement (38.46%), enlarged mediastinal lymph nodes (35.38%), mediastinal invasion (24.61%), rib, chest wall, and plural invasion (20%), pleural effusion (15.38%), calcification (13.84%), necrosis (10.76%), cavitation (12.3%), and superior vena cava compression (10.76%). Conclusion: The evaluation of a patient with known or suspected bronchogenic carcinoma requires the detection and characterization of the lesions involving the lungs, hila, mediastinum, pleura, chest wall, and upper abdomen. Various radiological imaging techniques play a dominant role in diagnosis and proper staging of the primary bronchogenic carcinoma.

Isolated endobronchial metastasis of clear cell renal cell carcinoma a decade after primary diagnosis: a case report with review of literature

Endobronchial metastasis from extrapulmonary malignant tumors is rare. The clinical and radiological features of endobronchial metastases and primary bronchogenic carcinoma are indistinguishable. Here, we report a case of isolated endobronchial metastasis of renal cell carcinoma almost a decade after initial presentation. The importance of histopathology and immunohistochemistry has been emphasized in this case. It is thereby worthwhile to consider endobronchial metastases as a differential diagnosis in patients with persistent pulmonary symptoms having a previous history of non-pulmonary malignancy.

Diagnostic utility of medical thoracoscopy in peripheral parenchymal pulmonary lesions

IntroductionVisceral pleural biopsy and peripheral lung biopsy can be undertaken at the same time as parietal pleural biopsy during medical thoracoscopy, with or without coexistence of a pleural effusion with lung disease. ObjectiveTo assess the accuracy and safety of medical thoracoscopy for the evaluation of peripheral parenchymal pulmonary lesions. PatientsWe studied 15 patients with peripheral parenchymal pulmonary disease, the cause of which had not been determined after initial investigations, including needle biopsy and thoracocentesis if pleural effusion is present. Two patients have solitary peripheral lesions while thirteen have diffuse pathology. Seven patients have pleural effusion in addition to parenchymal lesions. MethodsOnly one patient had thoracoscopy under general anaesthesia while the remaining fourteen were given local anaesthesia with mild sedation. Visually directed biopsies were taken from the lung using electrocautery in all patients. Biopsies were taken also from the parietal pleura in only seven patients. MeasurementsWe recorded clinical characteristics, laboratory data, findings and duration of thoracoscopy, and any complications associated with the procedure. ResultsA definitive diagnosis was established in 12 patients: 4 patients had primary bronchogenic carcinoma while 5 patients had metastases. Only 3 patients had benign parenchymal disease. Overall, thoracoscopy had a sensitivity of 80% for the diagnosis of peripheral parenchymal pulmonary lesions. Thoracoscopy was well tolerated under local anaesthesia and entailed hospitalization for less than 48h in most cases. No deaths occurred, although 6.7% of patients had major complications, and 20% had minor complications. ConclusionsAmong patients with peripheral parenchymal pulmonary lesions remaining undiagnosed after usual initial investigation and even transthoracic needle biopsies, thoracoscopy done under local anaesthesia is a rapid, safe, and well-tolerated procedure with an excellent diagnostic yield that is equivalent to that of thoracotomy.

Human papillomavirus type-16 positive endobronchial metastasis from uterine cervical cancer.

Although the lung is the most common site of metastasis from extrapulmonary malignancies, endobronchial metastases (EBM) are relatively rare. EBM typically originate from breast, colorectal, or kidney cancer. EBM from uterine cervical cancer is relatively rare and is difficult to confirm. In this study, we report a case of EBM in a patient with previously treated uterine cervical cancer. In this case, differentiation of the EBM from primary bronchogenic carcinoma with clinical, radiological, and pathologic findings was difficult. As identical human papillomavirus (HPV)-16 DNA was detected in both the EBM and in previously resected tissues from the prior uterine cervical cancer, the patient was diagnosed with EBM from uterine cervical cancer. HPV genotyping may aid in discriminating EBM from primary bronchogenic carcinoma in patients with uterine cervical cancer.

Incidence and Clinicopathologic Features of Primary Lung Cancer: A North-Eastern Anatolia Region Study in Turkey (2006-2012)

Lung cancer is the most frequent cancer among men and second highest among women overall, including in Turkey. Cigarette smoking is the most important etiologic factor for the development of cancer in both men and women. To determine the lung cancer incidence in Northeastern Anatolia Region of Turkey with a focus on clinical properties, cancer subtypes, the relationships of tumors with cigarette smoking and radiological properties of the lesions. In a retrospective study design, 566 lung cancer cases diagnosed at the Pathology Department of Ataturk University in Erzurum over the last seven years extending from January 2006 to June 2012 were investigated. The results were compared with statistical analyses. The most common histopathological subtype of primary bronchogenic carcinoma in our study was found to be the squamous cell carcinoma, 46.1% (261 out of 566), and the second was small cell lung carcinoma 15.7% (89 out of 566). Based on our data, an overall male predominance was noted with a male/female ratio of 6.1/1. While 296 (52.2%) of the patients were found to be smokers at the time of diagnosis, 125 (22.0%) were nonsmokers and 145 (25.6%) were ex-smokers. Smoking status was found to have a strong correlation with primary lung cancer (p <0.05), and there were significant differences between males and females (p<0.001). Although relative prominence of subtypes of lung cancers differ between Turkish and other populations, lung cancer overall remains as an important health problem in Turkey. Our findings stress the critical need for effective cancer prevention programs such as anti-smoking campaigns.

Merkel cell carcinoma versus metastatic small cell primary bronchogenic carcinoma

Introduction: Merkel cell carcinoma (MCC) of the skin is a rare, aggressive, malignant neuroendocrine neoplasm. The tumor classically demonstrates positive immunohistochemistry (IHC) staining for chromogranin A(ChrA), cytokeratin 20 (CK20), neuron specific enolase (NSE) and/or achaete-acute complex-like 1 (MASH1). The newly identified Merkel cell polyomavirus (MCPyV) has been found to be associated with most MCC cases. The primary histologic differential diagnoses of cutaneous MCC is small cell primary bronchogenic carcinoma (SCLC); moreover, both are of neuroendocrine origin. SCLC accounts for approximately 10-15% of all primary lung cancer cases; this histologic subtype is a distinct entity with biological and oncological features distinct from non-small cell lung cancer (NSCLC). In contradistinction to MCC, SCLC is classically IHC positive for cytokeratin 7 (CK7) and transcription factor (TTF-1). Similar to SCLC, MCC cell lines may be classified into two different biochemical subgroups designated as Classic and Variant. In our review and case report, we aim to emphasize the importance of a multidisciplinary approach to the approach to this difficult differential diagnosis. We also aim to comment about features of the cells of origin of MCC and SCLC; to summarize the microscopic features of both tumors; and to review their respective epidemiologic, clinical, prognostic and treatment features. We want to emphasize the initial workup study of the differential diagnosis patient, including evaluating clinical lymph nodes, a clinical history of any respiratory abnormality, and chest radiogram. If a diagnosis of primary cutaneous MCC is confirmed, classic treatment includes excision of the primary tumor with wide margins, excision of a sentinel lymph node, and computed tomography, positron emission tomography and/or Fluorine-18fluorodeoxyglucose positron emission tomography scan studies.

An Unusual Cause of Transient Ischemic Attack

1Department of Cardiology, Royal Melbourne Hospital; 2Institute for Breathing and Sleep, Heidelberg; 3Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia Correspondence: Dr Liam Hannan, Institute for Breathing and Sleep, 145 Studley Road, Heidelberg, Melbourne, Victoria 3084, Australia. Telephone 778-8361863, e-mail liam.hannan@austin.org.au In April 2011, a 57-year-old woman with a long smoking history presented with transient symptoms of left-hand incoordination and dysarthria. At the time of arrival to hospital, there had been complete resolution of neurological signs and symptoms. Computed tomography and subsequent magnetic resonance imaging of the brain demonstrated no evidence of cerebral infarction and no other intracranial pathology. A routine chest radiograph revealed right middle lobe collapse. Computed tomography of the chest demonstrated a large proximal obstructing mass within the right middle lobe in addition to multiple bilateral pulmonary nodules suggestive of an advanced primary bronchogenic carcinoma with pulmonary metastases. There appeared to be tumour extension into the lateral wall of the left atrium (Figures 1A and 1B). Standard bronchoscopy demonstrated an endobronchial tumour at the origin of the right middle lobe bronchus, and endobronchial biopsy and brush cytology confirmed an adenocarcinoma that was TTF-1 and cytokeratin positive, consistent with a primary lung malignancy. A transesophageal echocardiogram demonstrated tumour infiltration of the right lower pulmonary vein with extension into the left atrium (Figure 2). There was no evidence of vegetations on the aortic or mitral valves, effectively excluding the possibility of marantic endocarditis. No other alternative sources of emboli were identified to explain the transient ischemic attack. With the exception of atrial myxoma, embolic phenomena due to intracardiac tumours are uncommon. Previous case reports of intracardiac extension of primary lung tumours have generally described extension via the pulmonary vein, as was apparent in the present case (1). The patient was referred for palliative radiotherapy for the primary lesion in addition to systemic chemotherapy. imAges in RespiRAtoRy medicine

Endobronchial metastasis from primary anorectal melanoma

Patient: Male, 64Final Diagnosis: Metastatic anorectal melanoma with endotracheal metastasisSymptoms: Fatigue • weight loss • hematochezia • coughMedication: NoneClinical Procedure: Biopsy of anal mass • rigid bronchoscopySpecialty: Internal medicine • oncology • pulmonologyObjective:Rare diseaseBackground:Anorectal melanoma is a rare cancer with a poor prognosis. The mean survival after diagnosis is 15–25 months. At the time of diagnosis, 61% of patients have local regional lymph node metastases, and 21% have distant metastases. The lungs are a common site for metastasis for all tumors including melanoma. However endobronchial metastasis is a rare phenomenon. Endotracheal metastases are even rarer, occurring in only 5% of patients with extrapulmonary endobronchial metastases. It is most commonly seen in breast, colorectal, and kidney cancers. It is extremely rare for cutaneous melanoma. The mean survival after diagnosis is only 15 months and treatment options are limited.Case Report:We report the case of a 64 year-old gentleman with newly diagnosed metastatic anorectal melanoma. A 3 cm by 3 cm bluish-black, oval-shaped, exophytic mass protruding from his anus was found on physical exam. Endobronchial and endotracheal metastasis to the trachea were discovered on computed tomography and he was subsequently taken to the operating room for argon plasma coagulation laser recanalization of his trachea via rigid bronchoscopy, and resection of his anal mass.Conclusions:We have presented the first known case of anorectal melanoma with endobronchial metastasis. Palliative APC laser recanalization was used to prevent asphyxiation from the endotracheal mass. Endobronchial metastasis is uncommon and can be easily mistaken for primary bronchogenic carcinoma. It should always be considered when evaluating patients with new lung masses.

The level of bronchoalveolar lavage fluid prostaglandine E2; is it diagnostic of bronchogenic carcinoma?

BackgroundLung cancer is the leading cause of cancer-related mortality in the United States. Cigarette smoking is the number one risk factor for lung cancer. It causes about 90% of lung cancers (14). ObjectiveEvaluation of bronchoalveolar lavage level of PGE2 in patients with primary bronchogenic carcinoma. Subjects and methodsThe study was conducted on forty subjects; including twenty patients with bronchogenic carcinoma, ten patients with non-malignant lesions, and ten healthy control subjects. All subjects were submitted to fiberoptic bronchoscopy with bronchoalveolar lavage was done and examined for prostaglandin E2. ResultsThe PGE2 level was significantly higher in BALF of group III (malignant group) compared to group I & II, with no significant difference between group I and group II. The cut- off value of PGE2 was 45.63pg/ml with minimal overlap between malignant and benign lesions. ConclusionsBronchoalveolar lavage level of PGE2 was significantly increased in patients with bronchogenic carcinoma.