Primary Lung Malignancy Research Articles

Typical Pulmonary Carcinoid Tumours and the Relevance of Ki-67 Index: A Tertiary Centre Experience in South Australia

Pulmonary carcinoid tumours are a rare type of neuroendocrine primary lung malignancy. The WHO classifies carcinoids as typical (TC) and Atypical Carcinoid (AC) based on mitotic rate and necrosis on histology [1,2]. It is widely accepted that TC has a better overall prognosis than AC. A higher stage (the presence of nodal or metastatic disease) at presentation is correlated with poorer outcomes [3].

Effect of Short-Chain Fatty Acids and Polyunsaturated Fatty Acids on Metabolites in H460 Lung Cancer Cells

Lung cancer is the most common primary malignant lung tumor. However, the etiology of lung cancer is still unclear. Fatty acids include short-chain fatty acids (SCFAs) and polyunsaturated fatty acids (PUFAs) as essential components of lipids. SCFAs can enter the nucleus of cancer cells, inhibit histone deacetylase activity, and upregulate histone acetylation and crotonylation. Meanwhile, PUFAs can inhibit lung cancer cells. Moreover, they also play an essential role in inhibiting migration and invasion. However, the mechanisms and different effects of SCFAs and PUFAs on lung cancer remain unclear. Sodium acetate, butyrate, linoleic acid, and linolenic acid were selected to treat H460 lung cancer cells. Through untargeted metabonomics, it was observed that the differential metabolites were concentrated in energy metabolites, phospholipids, and bile acids. Then, targeted metabonomics was conducted for these three target types. Three LC-MS/MS methods were established for 71 compounds, including energy metabolites, phospholipids, and bile acids. The subsequent methodology validation results were used to verify the validity of the method. The targeted metabonomics results show that, in H460 lung cancer cells incubated with linolenic acid and linoleic acid, while the content of PCs increased significantly, the content of Lyso PCs decreased significantly. This demonstrates that there are significant changes in LCAT content before and after administration. Through subsequent WB and RT-PCR experiments, the result was verified. We demonstrated a substantial metabolic disparity between the dosing and control groups, further verifying the reliability of the method.

A 5 Year Tertiary Centre Experience of Frequency & Risk Factors Association with Primary and Secondary Lung Cancers

Introduction: Lung cancer is one of the commonest cancers worldwide having either small cell or non-small cell types and smoking is its major risk factor. We intend to study distribution of various lung malignancies and their association with various risk factors in a Pakistani population sample.
 Aims & Objectives: To evaluate the frequency of types of primary and secondary lung cancers in a sample of the Pakistani population and see their association with age, gender, and smoking.
 Place and duration of study: The department of Pulmonology, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute, Lahore, Pakistan, from August 2017 to August 2022 (5 years).
 Material & Methods: Analysis of retrospective data of 156 consecutive patients age 40-70 years diagnosed with primary or secondary lung cancers. Data were stored and analyzed using IBM-SPSS version 23.0. Diagnosis was established through fibreoptic (FOB), or rigid bronchoscopies or CT and U/S guided percutaneous lung biopsies, P- value<0.05 was taken as significant
 Results: There were 156 samples, among them 37.8% were found with age group 41 – 60 years old, 31.4% with age group 61 – 70 years old, mean age of subjects was 58.3 (SD=±14.9) years. 82.1% were of male gender, 42.9% were non- smokers, 25% were found with less than or equal to 25 smoking pack years, median smoking pack years were 30 with range 5 – 100 smoking pack years. Distribution of primary lung malignancy revealed; 28.8% having Squamous cell carcinoma, 35.3% with Adenocarcinoma, 13.5% with small cell carcinoma, 2.6% with large cell carcinoma and 5.8% with primary lung carcinoid tumors. Secondary deposits of cancer in lungs were found in 22 (14.1%) subjects. Pearson Chi Square test showed significant association of primary type of cancer with age group, gender, and smoking pack years (p <0.01).
 Conclusion: Adenocarcinoma was most frequent lung malignancy followed by Squamous cell carcinoma and small cell carcinoma was less frequent. Advancing age, male gender and cigarette smoking are strongly associated with the diagnosis of lung cancer.

Lung to Lung Cannon Ball Metastases: A Case Series on Primary Lung Malignancy

Cannon ball metastases refer to large, well circumscribed, round pulmonary nodules like cannon balls that are scattered over both lungs, being a classical presentation of haematogenous tumour spread.Cannon ball pulmonary metastases are typically seen in the patients with choriocarcinoma or renal cell carcinoma. Rarely, pulmonary metastases with the same appearance may be secondary from prostate cancer, synovial sarcoma, endometrial carcinoma or haepatocellular carcinoma.The present case series is about six patients diagnosed with cannon ball metastases which occurred from primary lung carcinoma. Out of these six cases, three were of small cell carcinoma, two of squamous cell carcinoma and one of adenocarcinoma.The histopathology of all the cases was established by biopsy from the tumour site and appropriate treatment was started in the form of chemotherapy and radiotherapy as needed. Clinicians must investigate thoroughly for primary origin of cannon ball metastasis, though rare but lung cancer can present as this kind of metastasis.

99mTc-3PRGD2 SPECT/CT Imaging for Diagnosing Lymph Node Metastasis of Primary Malignant Lung Tumors.

To evaluate 99mtechnetium-three polyethylene glycol spacers-arginine-glycine-aspartic acid (99mTc-3PRGD2) single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging for diagnosing lymph node metastasis of primary malignant lung neoplasms. We prospectively enrolled 26 patients with primary malignant lung tumors who underwent 99mTc-3PRGD2 SPECT/CT and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT imaging. Both imaging methods were analyzed in qualitative (visual dichotomous and 5-point grades for lymph nodes and lung tumors, respectively) and semi-quantitative (maximum tissue-to-background radioactive count) manners for the lymph nodes and lung tumors. The performance of the differentiation of lymph nodes with and without metastasis was determined at the per-lymph node station and per-patient levels using histopathological results as the reference standard. Total 42 stations had metastatic lymph nodes and 136 stations had benign lymph nodes. The differences between metastatic and benign lymph nodes in the visual qualitative and semiquantitative analyses of 99mTc-3PRGD2 SPECT/CT and 18F-FDG PET/CT were statistically significant (all P < 0.001). The area under the receiver operating characteristic curve (AUC) in the semi-quantitative analysis of 99mTc-3PRGD2 SPECT/CT was 0.908 (95% confidence interval [CI], 0.851-0.966), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.86 (36/42), 0.88 (120/136), 0.69 (36/52), and 0.95 (120/126), respectively. Among the 26 patients (including two patients each with two lung tumors), 15 had pathologically confirmed lymph node metastasis. The difference between primary lung lesions in patients with and without lymph node metastasis was statistically significant only in the semi-quantitative analysis of 99mTc-3PRGD2 SPECT/CT (P = 0.007), with an AUC of 0.807 (95% CI, 0.641-0.974). 99mTc-3PRGD2 SPECT/CT imaging may notably perform in the direct diagnosis of lymph node metastasis of primary malignant lung tumors and indirectly predict the presence of lymph node metastasis through uptake in the primary lesions.

Safety and Efficacy Outcomes From a Single-Center Study of Image-Guided Percutaneous Microwave Ablation for Primary and Metastatic Lung Malignancy

IntroductionImage-guided percutaneous microwave ablation (MWA) is becoming a more common treatment option for patients with primary and metastatic lung malignancies. Nevertheless, there is limited literature on the safety and efficacy of MWA compared with standard-of-care therapy, including surgical resection and radiation. This study will report the long-term outcomes after MWA for pulmonary malignancies and investigate the factors related to efficacy, including lesion size, location, and ablation power. MethodsRetrospective single-center study analyzing 93 patients who underwent percutaneous MWA for primary or metastatic lung malignancies. Outcomes included immediate technical success, local tumor recurrence, overall survival, disease-specific survival, and complications. ResultsAt a single institution, 190 lesions (81 primary and 109 metastatic) were treated in 93 patients. Immediate technical success was achieved in all cases. Freedom from local recurrence was 87.6%, 75.3%, and 69.2% and overall survival was 87.7%, 76.2%, and 74.3% at 1 year, 2 years, and 3 years, respectively. Disease-specific survival was 92.6%, 81.8%, and 81.8%. The most common complication was pneumothorax, which occurred in 54.7% (104 of 190) of procedures, with 35.2% (67 of 190) requiring a chest tube. No life-threatening complications occurred. ConclusionsPercutaneous MWA seems safe and effective for treatment of primary and metastatic lung malignancies and should be considered for patients with limited metastatic burden and lesions less than 3 cm in size.

Multilayer Perceptron Analysis of Radiomics to Predict Local Recurrence of Lung Cancer After Radiotherapy

Purpose: to assess the likelihood of local recurrence of lung malignancies following stereotactic ablative radiotherapy (SABR) by evaluating clinical and radiomic features with machine learning and novel use of deep learning methods.&#x0D; Methods: pre-treatment CT images were attained from seventy patients with primary lung malignancies. The malignancy was segmented by the treating radiation oncologist and 107 radiomic features were extracted from the image. The data underwent feature reduction via Spearman’s correlation and selection with adapted LASSO regression analysis. A random forest model and a multilayer perceptron (MLP) with cost-sensitive classifier were independently used to assess for local recurrence of malignancy. The recurrence likelihood predictions from each of these were used to stratify patients into groups with high and low risk of recurrence. These were assessed for time-to-event predictions using Kaplan-Meier analyses and Gray’s test to evaluate the separation between the high and low-risk groups. The prognostic capacity of the models was evaluated with a concordance index, 95% confidence intervals and bootstrapping (10,000 iterations).&#x0D; Results: the MLP was able to predict the recurrence of malignancy with 100% sensitivity and 91% specificity (AUC 0.95). The MLP predictions showed statistically significant separation of high and low-risk patients, and robust model fit (p=0.04, c=0.79), which out-performed random forest model predictions (p=0.15, c=0.41) that did not reach statistical significance.&#x0D; Conclusions: radiomic data analysis with an MLP showed improved prediction potential within this dataset compared to random forest models for predicting local recurrence of lung cancer.

Pulmonary synovial sarcoma: A case series and review of literature

Synovial sarcoma is a rare malignant mesenchymal tumor that can develop at any anatomic site. Pulmonary sarcomas constitute 0.1–0.5% of all primary lung malignancies. Primary pulmonary synovial sarcoma is highly uncommon. Most of the patients present with large intrathoracic masses with complaints of cough, chest pain, shortness of breath, or hemoptysis. Multimodality treatment in the form of wide excision, chemotherapy, and radiotherapy is the mainstay of therapy. Synovial sarcoma is considered a high-grade tumor with a poor prognosis. We hereby present three cases of histologically proven synovial sarcoma with predominantly pulmonary involvement, along with their management and in hospital outcome.

Black Race Remains Associated with Lower Eligibility for Screening Using 2021 US Preventive Services Task Force Recommendations Among Lung Cancer Patients at an Urban Safety Net Hospital

To evaluate whether the revised US Preventive Services Task Force (USPSTF) criteria reduced inequities in lung cancer screening (LCS) eligibility among a racially diverse sample of patients with lung cancer. This is a retrospective analysis of adults diagnosed with primary lung malignancies at an urban safety net hospital. For all patients and exclusively ever-smokers, χ2 tests were used to evaluate differences in LCS eligibility among socio-demographic variables using the 2013 and 2021 USPSTF criteria. Patients who were ineligible for LCS were categorized by reason for exclusion. Among 678 lung cancer patients (46% female, mean age 66 ± 10years), 51% were White, and 39% were Black. Using the 2013 guidelines, White patients (57%) would have been more likely to be eligible than Black (37%) and other-race patients (35%) (P < 0.0001) at time of cancer diagnosis. Under the 2021 guidelines, White patients (68%) remained more likely to be eligible for LCS than Black (54%) and other-race patients (48%) (P = 0.0002). Among exclusively ever-smoking patients, we did not observe a significant difference in eligibility by race under the 2021 USPSTF guidelines (White [73%], Black [65%], and other-race [65%]; [P = 0.48]). Sex, ethnicity, education level, and insurance type were not associated with differential screening eligibility under either the 2013 or 2021 guidelines. The revised 2021 USPSTF LCS guidelines may not be sufficient to eliminate racial inequities in LCS eligibility among patients who go on to be diagnosed with primary lung cancer. Differential rates of lung cancer among never-smokers may contribute to this inequity.

Accuracy of CT-Guided Core-Needle Biopsy in Diagnosis of Thoracic Lesions Suspicious for Primitive Malignancy of the Lung: A Five-Year Retrospective Analysis.

Lung cancer represents a heterogeneous group of neoplasms, with the highest frequency and mortality in both sexes combined. In a clinical scenario characterized by the widespread of multidetector-row spiral CT, core-needle biopsy under tomographic guidance is one of the main and safest methods to obtain tissue specimens, even though there are relatively high rates of pneumothorax (0-60% incidence) and pulmonary hemorrhage (4-27% occurrence rates). The aim of this retrospective study is to assess the diagnostic accuracy of CT-guided core-needle biopsy in the diagnosis of primary lung malignancies and to compare our results with evidence from the literature. Our analysis included 350 thoracic biopsies, performed from 2017 to 2022 with a 64-row CT guidance and 16/18 G needles mounted on a biopsy gun. We included in the final cohort all samples with evidence of primary lung malignancies, precursor lesions, and atypia, as well as inconclusive and negative diagnoses. There was sensitivity of 90.07% (95% CI 86.05-93.25%), accuracy of 98.87% (95% CI 98.12-99.69%), positive predictive value of 100%, and negative value of 98.74% (95% CI 98.23-99.10%). Specificity settled at 100% (93.84-100%). The AUC was 0.952 (95% CI 0.924-0.972). Only three patients experienced major complications after the procedure. Among minor complications, longer distances from the pleura, the presence of emphysema, and the lower dimensions of the lesions were correlated with the development of pneumothorax after the procedure, while longer distances from the pleura and the lower dimensions of the lesions were correlated with intra-alveolar hemorrhage. Immunohistochemistry analysis was performed in 51% of true positive cases, showing TTF-1, CK7, and p40 expression, respectively, in 26%, 24%, and 10% of analyzed samples. The CT-guided thoracic core-needle biopsy is an extremely accurate and safe diagnostic procedure for the histological diagnosis of lung cancer, a first-level interventional radiology exam for peripheral and subpleural lesions of the lung, which is also able to provide adequate samples for advanced pathologic assays (e.g., FISH, PCR) to assess molecular activity and genetic sequencing.

ODP503 Non-Small Cell Lung Cancer Metastatic to the Thyroid Gland

Abstract Introduction Metastatic disease affecting the thyroid gland is an uncommon phenomenon, with the most common primary sites being kidney, breast, lung and gastrointestinal tract. Thyroid metastases frequently occur simultaneously with spread to other sites and are rarely symptomatic. Clinical case: 73-year-old female with remote history of stage IA (T1c, N0, M0) invasive lobular carcinoma of the right breast treated with lumpectomy, radiation and tamoxifen, previous tobacco use, remote exposure to radiation during Chernobyl nuclear accident, developed progressive dyspnea on exertion. She was found to have a large left-sided pleural effusion. Thoracentesis was performed, and the cytology revealed adenocarcinoma with features favoring lung primary. Further imaging showed a left lower lobe mass with central necrosis and left hilar adenopathy, multiple pleural masses, and a small solitary brain lesion. PET-CT also demonstrated, amongst other findings, an FDG avid left lower pole thyroid nodule. Thyroid ultrasound was obtained to further characterize the lesion, which demonstrated a 0.8×1.3×1.3 cm solid hypoechoic nodule in the left mid lobe, which was thought to be corresponding to the PET avid nodule. Two additional nodules, a mixed cystic and solid measuring 1.7×2.1×2.9 cm on the right lobe, and another left-sided solid isoechoic measuring 0.8×0.7×0.9 cm, were noted. Thyroid FNA of the 1.3 cm PET avid nodule revealed rare cells in clusters, with large pale nuclei and prominent nucleoli, some with intracytoplasmic vacuoles, morphologically similar to those seen in the prior pleural fluid. Thin prep was stained with antibody to thyroglobulin, and the malignant cells showed lack of staining, supporting the diagnosis of metastatic lung cancer. Thyroid function tests were normal. Given lack of compressive symptoms, patient was maintained on her primary oncologic treatment with carboplatin and pemetrexed, and stereotactic radiation for the brain metastasis. Repeat PET-CT, performed approximately 8 months after the initial scan, showed mildly decreased focal FDG activity in the thyroid lesion. Discussion In this scenario, a patient with primary lung malignancy was found to have an FDG avid thyroid nodule which on FNA proved to be a metastatic lesion. Per some studies, such lesions can be seen in 1.4%–3% of patients who undergo surgery for suspected malignancy in the thyroid gland. Management of metastatic thyroid cancers depends on multiple factors including the primary malignancy location and staging, patient comorbidities, compressive symptoms, etc. Surgical management may be of benefit in isolated lesions in the thyroid. Conclusion When evaluating thyroid nodules in patients with known history of malignancy, it is important to consider the differential of metastatic lesions and to perform a thorough evaluation including fine-needle aspiration for clinical elucidation and management. Presentation: No date and time listed

New lung cancer diagnosis after emergency department presentation in a tertiary hospital: patient characteristics and outcomes

ABSTRACT Objectives Currently, there are limited data available about patients who are diagnosed with lung cancer following an emergency department (ED) visit. This study sought to define the demographics, symptoms profile, staging, and prognosis of this cohort of patients. Methods We conducted a retrospective study of patients diagnosed with a primary lung malignancy at a lung cancer multidisciplinary meeting between January 2018 and January 2020. Medical records were reviewed to collect data around demographics, presenting symptoms, investigations, admission, cancer stage, and mortality. Results During the study period, 890 patients were diagnosed with a primary lung malignancy of which 209 (23.5%) presented to ED prompting diagnostic work-up. Of these 209 patients, 89% were hospitalized for a median duration of 6 days. Also, 104 (50%) were female and the average age of the cohort was 70 years. Dyspnea (38%) was the most common presenting symptom. Radiological staging and tissue biopsy were performed as an outpatient procedure in 46% and 41% of patients, respectively. A total of 188 patients had non-small cell lung cancer of whom 68% had ztage IV disease. A total of 53 (25%) patients died within 3 months of ED presentation. These patients were older with more advanced disease compared to patients who were alive at 3 months. Conclusion Emergent diagnosed patients are a significant proportion of the lung cancer population, presenting with advanced stage disease and increased short-term mortality. Future research should be directed at interventions, such as lung cancer screening program and/or community education, to reduce the need for patients to present to the ED with disabling lung cancer symptoms.

Can Ultrasound and Contrast-Enhanced Ultrasound Help Differentiate between Subpleural Focal Organizing Pneumonia and Primary Lung Malignancy?

Background: Subpleural focal organizing pneumonia (FOP) and primary lung malignancy (PLM) are usually confused. The aim of this study was to explore the value of ultrasound (US) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of FOP and PLM. Methods: A total of 23 patients (mean age: 64.57 ± 11.86 years) with FOP and 100 (mean age: 66.29 ± 11.05 years) with subpleural lesions diagnosed as PLM, confirmed by pathological diagnosis and clinical follow-up, were retrospectively enrolled. The largest lesion diameter, angle between the lesion border and thoracic wall, air bronchial sign, internal blood supply, blood supply form, and pleural effusion examined using conventional US were retrospectively analyzed. The indicators of CEUS included the arrival time of contrast agent in the lesion, lesion–lung arrival time difference, degree of enhancement, distribution uniformity of contrast medium, presence of non-enhancing region, and arterial filling mode in the lesion. A p < 0.05 was considered statistically significant. Results: Presence of air bronchial sign (odds ratio [OR] = 6.18, p = 0.025), acute angle between the lesion border and thoracic wall (OR = 7.124, p = 0.033), and homogeneous enhancement (OR = 35.26, p = 0.01) showed predictive value for the diagnosis of FOP. According to the results of the logistic regression analysis, the area under the receiver operating curve of the above features combined was 0.960, and the sensitivity and specificity were 95.0% and 82.6%, respectively. Conclusions: US combined with CEUS has the potential to differentiate between FOP and PLM.

Analysis of Clinicopathologic Features of 9 Cases of SMARCA4-deficient Non-small Cell Lung Cancer

背景与目的SMARCA4缺失的非小细胞肺癌（SMARCA4-deficient non-small cell lung cancer, SMARCA4-dNSCLC）是一种罕见的原发于肺的恶性肿瘤。虽然2021版世界卫生组织（World Health Organization, WHO）肺肿瘤分类中并未将其单独列出，但这类肿瘤具有独特的形态学、免疫表型及分子遗传学特征。本研究通过探讨SMARCA4-dNSCLC的临床病理特征、免疫组化、诊断及鉴别诊断，以加深对该类肿瘤的认识。方法收集2020年1月-2022年3月上海长海医院诊断的9例SMARCA4-dNSCLC的临床与影像学资料，通过组织学、免疫组化染色分析其临床病理特征并进行文献复习。结果9例患者中位发病年龄65岁。6例男性均有吸烟史。肿瘤平均直径3.3 cm。6例转移。影像学提示为边界不清的浸润性肿块，3例伴胸膜侵犯。9例诊断为SMARCA4-dNSCLC，主要表现为3种病理形态，包括经典的肺腺癌、肺黏液腺癌及低分化癌。低分化肿瘤细胞上皮样、合体样或横纹肌样，胞质丰富，胞质可完全透明至嗜酸性，可见嗜酸性小球或小脓肿，呈实性片状，间质较多炎细胞及片状坏死。免疫组化显示SMARCA4均为阴性，8例细胞角蛋白（cytokeratin 5.2, CAM5.2）、细胞角蛋白7（cytokeratin 7, CK7）弥漫强阳性，P40均阴性，6例甲状腺转录因子1（thyroid transcription factor-1, TTF-1）阴性，2例部分阳性，1例阳性。结论SMARCA4-dNSCLC是一类罕见的肺癌亚型，病理形态复杂多样，特征性的免疫组化表型可协助诊断。

Diagnostic workup following a multicancer early detection test with a cancer signal origin prediction.

e15037 Background: A blood-based multi-cancer early detection (MCED) test is available for use as a complement to single cancer screening modalities, though clinical experience is limited. PATHFINDER (NCT04241796; enrollment complete, n = 6662) is a prospective study in asymptomatic adults ≥50 y that returns MCED test results (‘signal not detected’ or ‘signal detected’) with ≥1 cancer signal origin (CSO) prediction to direct diagnostic workup. MCED testing is a novel approach to cancer screening, so clinical guidance on how to best utilize MCED test findings is critical. To review follow-up testing required to achieve a definitive diagnosis after a signal detected result and corresponding CSO prediction, the diagnostic workups of PATHFINDER trial participants are summarized. Methods: Participants from the interim PATHFINDER data set (data cutoff Mar-19-2021) with a confirmed new cancer identified by the MCED test and post-diagnosis clinical notes were included. Participants with a predicted or confirmed heme-related cancer were excluded as were those for whom a determinate CSO or staging information was unavailable. Key diagnostic steps from signal detected (Day 1) to resolution were summarized. A multidisciplinary review board guided initial diagnostic follow-up. Results: Five individuals met the eligibility criteria for consideration; three with gastrointestinal cancers have been described elsewhere and are therefore not summarized here. Of the remaining two participants identified, the first was a male smoker &gt; 60y (CSO prediction = Head and Neck). Based on the CSO, laryngoscopy and head and neck CT were performed. Laryngoscopy was negative, but CT revealed necrotic lymph nodes suggestive of metastases. A subsequent PET-CT found an incidental T1N0M0 stage I renal cell carcinoma and an FDG-avid base of tongue lesion, which was biopsied (moderately differentiated squamous cell carcinoma). A stage II (T2N2M0) head and neck cancer was diagnosed at Day 81. The patient underwent radiation therapy, chemotherapy, and nephrectomy and is alive with no evidence of cancer ≥502 days post-diagnosis. The second was a female smoker &gt; 60y (CSO prediction = Lung). Based on the CSO, she received a non-contrast chest CT, revealing a 2.1 cm spiculated mass highly suspicious for primary lung malignancy. PET-CT confirmed the mass was FDG-avid, and core biopsy revealed well to moderately differentiated adenocarcinoma. The participant was diagnosed with Stage IIIB (T1N3M0) lung cancer (Day 22). She underwent subsequent radiation, chemo, and immunotherapy. She is alive ≥683 days post-diagnosis, but metastatic disease has subsequently developed. Conclusions: The MCED test detected cancer signals and accurately predicted CSO for these participants, both of whom achieved diagnostic resolution &lt; 3 months. Clinical insight from the CSO prediction was used to direct the workup required to achieve a definitive diagnosis.

Acute haemothorax and pleuropulmonary blastoma: Two extremely rare complications of extralobar pulmonary sequestration

Extralobar bronchopulmonary sequestration (eBPS) is a congenital lung malformation characterized by non-functional lung tissue with no connection with the bronchial tree, receiving systemic blood supply and covered by its own visceral pleura. It is mostly asymptomatic, however it can rarely get complicated with infections and neoplastic degeneration. Its management is still debated: many authors suggest observation for asymptomatic cases and intervention only in case of symptoms, others advocate surgery even in asymptomatic patients. Pleuropulmonary blastoma (PPB) is a rare malignant sarcomatous neoplasm, representing the most common primary lung malignancy in children. Typically, PPB is associated with congenital pulmonary airway malformation (CPAM). eBPS is rarely associated with PPB. We report a case of a previously healthy three-year-old boy presented to our emergency room with massive hemothorax after a low-energy chest trauma. Imaging revealed active thoracic bleeding by an anomalous artery arising from the celiac tripod, and an irregular mass in the lower right hemithorax. After performing biopsy, pathologic examination revealed a PPB. The patient underwent four cycles of chemotherapy before surgery. The operative findings revealed a right supradiaphragmatic extralobar mass, with no communication with the bronchial tree, strictly adherent to the right middle lobe. After mass excision, histological analysis confirmed the diagnosis of PPB type 2. The patient underwent postoperative chemotherapy. No recurrence nor metastasis were noted during the current follow-up. DICER-1 research revealed biallelic mutation on the tumor and on the surrounding normal tissue. We reviewed the literature concerning PPB and BPS. Based on these data, we would recommend intervention even in case of asymptomatic eBPS.

Incidences and characteristics of primary lung malignancies in childhood in Germany: An analysis of population-based data from German cancer registries.

Primary lung malignancies are a heterogeneous group of cancers that occur very rarely in childhood. Due to limited knowledge of their epidemiologic and clinical features, these tumors present a challenge to the treating physicians. This study aimed to increase the knowledge about the occurrence of primary lung malignancies in childhood in Germany. Pseudonymized data of cases recorded at the German Center for Cancer Registry Data (ZfKD) between 1990 and 2017 were retrieved. Primary lung malignancies were identified using the ICD- and ICD-O classification. Numbers were compared to those reported to the German Childhood Cancer Registry (GCCR). Crude incidence rates were calculated using the ZfKD database. A total of 168 patients diagnosed with primary lung malignancies in the age below 19 years were identified from the ZfKD. The median age at diagnosis was 13 years. The most common tumor entities were lung carcinoids (n=49), lung carcinoma (n=36), and pleuropulmonary blastoma (n=14). An unexpected accumulation of lung cancer cases was noted in the first year of life without a clearly specified histopathological diagnosis. A substantial discrepancy in the numbers of primary lung malignancies between ZfKD and GCCR was found. We present population-based data on the occurrence of primary childhood lung malignancies in Germany, which were more frequent than previously anticipated but likely remained underreported. For better understanding and optimal treatment of these entities, cancer registration needs to be improved through mandatory reporting to the GCCR and regular data sharing between GCCR, population-based and clinical cancer registries.

Lung and Mediastinal Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Young Adults

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used to investigate pulmonary nodules, mediastinal lymphadenopathy, and mediastinal masses in both malignant and nonmalignant etiologies. EBUS-TBNA is most commonly used in the diagnosis and staging of patients with non-small-cell lung cancer in the middle-age and elderly populations. As lung cancer is uncommon in young adults, it is assumed that there are a distinct disease population and clinical background in young adults who undergo EBUS-TBNA. However, this population has not been well investigated. Methods: We identified all EBUS-TBNA cases in young adults (aged 18–39 years) between January 1, 2008, and December 31, 2018, at our institution. Cytology diagnoses were correlated with the concurrent/subsequent histologic diagnosis and clinical decisions. A final patient classification was created based on the worst cytologic or histologic diagnosis (benign, low-grade, or malignant), with the exception of atypical cytology with subsequent long clinical follow-up with no evidence of malignancy, who were considered benign. All discordant cases and positive/suspicious cases with available slides were rereviewed together by the authors to confirm the diagnosis. Results: In total, 257 EBUS-TBNA procedures were performed in 249 young adults (mean age of 31.2 years). The majority of indications were lymphadenopathy and lung nodule/mass. Final cytologic interpretations included 214 (83%) benign, 14 (5%) atypical, 5 (2%) low-grade neoplasm (carcinoid tumor), and 15 (6%) malignant cases. The final patient classification was 213 (86%) benign, 6 (2%) low-grade, and 30 (12%) malignant. Discordant results were found in 24 cases, most frequently due to sampling error (50%). Of 213 benign cases, 58% had granulomatous disease, with sarcoidosis being the most common, followed by histoplasmosis. Of 30 cases with a final malignant classification, metastatic tumor was the most common (n = 12, 4.8%), followed by primary lung tumor (n = 11, 4.4%) and lymphoma (n = 7, 2.8%). There was a variety of malignancies among primary lung cancer, including adenocarcinoma (n = 5), squamous-cell carcinoma (n = 3), inflammatory myofibroblastic tumor (n = 2), and epithelioid hemangioendothelioma (n = 1). Conclusion: In young adults, EBUS-TBNA was most frequently performed to evaluate lymphadenopathy and lung nodules, and granulomatous disease was the most common benign finding. Although rare, primary lung malignancies do occur in young adults along with metastasis from a variety of other sites, with sarcoma being the most common pathology.

The impacts of isolated N1 lymph nodes metastasis on prognosis in non-small cell lung cancer: A single-center experience.

Background This study aims to investigate long-term results related to N1 group metastases with respect to anatomical localization and many external parameters and to examine the effect of these parameters on prognosis in patients with in nonsmall cell lung cancer. Methods Between January 2006 and May 2019, a total of 52 patients (44 males, 8 females; mean age: 59.9±9.5 years; range, 42 to 80 years) who underwent lobectomy due to primary lung malignancy were retrospectively analyzed. The N1 lymph nodes were divided into three anatomical groups as hilar, peribronchial, and intraparenchymal. Demographic features, tumor features, follow-up characteristics, and survival and diseasefree survival parameters were analyzed for each group. The results were also examined in terms of number of metastasis, number of metastatic levels, rate of metastasis, and histopathological type. Results The five-year survival rate was 66.4% in the peribronchial group and 50% in the hilar group. The five-year disease-free survival rate was 45.7% in the peribronchial group and 37.5% in the hilar group. There was no statistically significant difference between the groups in terms of survival and disease-free survival for anatomical localization, number of metastasis, number of metastatic levels, rate of metastasis, and histopathological type (p>0.05 for all). Conclusion The structure that would be formed by examining N1 in terms of parameters such as subtitle levels, number of metastasis, number of metastatic stations, rate of metastasis or combinations of these would have a more impact on the decisions in the follow-up and treatment process in this patient population.

Sex Differences in Lung Cancer Treatment and Outcomes at a Large Hybrid Academic-Community Practice

IntroductionLung cancer is the leading cause of cancer-related death and the second most often diagnosed malignancy worldwide. Males have higher incidence of lung cancer and higher mortality. It is hypothesized that the sex differences in survival are primarily driven by a better response of females to treatment. The primary objective of this work is to analyze and describe outcome differences between males and females diagnosed with having lung cancer. MethodsData were obtained from a large hybrid academic-community practice institution and validated with Surveillance, Epidemiology, and End Results (SEER). The initial cohort included patients aged more than or equal to 18 years diagnosed with having primary malignant lung cancer. Patients were excluded from the analysis if they had an unknown diagnosis date, were missing sex, or had prior history of cancer. Chi-square, t test, and Kruskal-Wallis tests were used to compare characteristics of males and females. Risks were estimated by logistic and Cox regressions. ResultsA total of 8909 patients from our institution and 725,018 in SEER were analyzed. Male-to-female ratio was 1.0. Females were more likely to undergo surgery and less likely to be treated with immunotherapy. Females had higher rates of documented psychological affections, depression, anxiety, urinary tract infection, hypothyroidism, and hyperthyroidism, while displaying lower rates of acute kidney injury, myocardial infarction, and myocarditis. Paired multivariable models revealed a lower risk of death for females in SEER (hazard ratio for females = 0.84, confidence interval: 0.69–1.02, p = 0.08) and equal risks in our institution (hazard ratio for females = 0.84, confidence interval: 0.69–1.02, p = 0.08). ConclusionsFemale sex was associated with higher surgical rates, lower immunotherapy use rates, higher rates of endocrinologic complications after immunotherapy use, and higher rates of psychological disorders.