Primary Pulmonary Cancer Research Articles

Clinical characteristics of human pulmonary dirofilariasis in Japan: An uncommon differential diagnosis of a solitary pulmonary nodule.

Human pulmonary dirofilariasis (HPD) is a zoonosis caused by Dirofilaria immitis. Most HPD cases are asymptomatic and are either found on annual health checkups or incidentally identified during investigation of another disease, particularly primary or metastatic pulmonary lung cancer. However, the frequency of Japanese HPD and clinical features remain not well-known. We analyzed data from the Japanese Medical Abstract Society database and identified 69 cases from 1978 to 2022. The incidence of HPD had increased until the 2000s but declined markedly in the 2010s. The incidence was higher in the southwestern and lower in the northeastern region of Japan. Health checkups were the primary diagnostic opportunity. High incidence rates per population were observed in the Chugoku and Shikoku regions. The diagnosis of HPD using a noninvasive procedure is typically difficult due to absence of specific clinical symptoms, and approximately 70% of the cases were detected using video-assisted thoracoscopic surgery. Global warming may increase the incidence of HPD in the northeastern region of Japan, and travel to countries with poor vector control may be a risk factor for HPD transmission. Physicians should consider this parasitic infectious disease when examining patients who present with a solitary nodule in the lungs.

Reduced risk of secondary primary extra pulmonary cancer in advanced/metastatic lung cancer patients treated with immune checkpoint inhibitors

BackgroundLung cancer survivors are at high risk of developing a second primary cancer (SPC). We explored the Unicancer Epidemiology Strategy Medical-Economics for advanced or metastatic lung cancer (AMLC) database to assess the impact of immune checkpoint inhibitors (ICI) on the risk of SPC in patients with advanced/metastatic lung cancer. Patients and methodsThis retrospective study used data from patients with AMLC, with treatment initiated between January 1st 2015 and December 31st 2018. Patients with lung cancer as the second primary cancer were excluded and a 6-months landmark threshold was applied to exclude patients with synchronous SPC, patients dead without SPC or with a follow-up inferior to 6 months. A propensity score (PS) was calculated on the following baseline covariates: Age at locally advanced or metastatic diagnosis, sex, smoking status, metastatic status, performance status and histological type. The inverse probability of treatment weighting approach was used on the analyses aiming to assess the impact of ICI administered for AMLC, on the risk of occurrence of SPC. ResultsAmong the 10 796 patients, 148 (1.4%) patients had a diagnosis of SPC in a median interval of 22 (min–max: 7–173) months. All the patients (100%) with locally advanced or metastatic LC received at least one systemic treatment including (chemotherapy regimen (n = 9 851, 91.2%); ICI (n = 4 648, 43.0%); targeted treatment (n = 3 500; 32.4%). 40 (0.9%) SPC were reported in the 4 648 patients with metastatic LC treated with ICI vs 108 (1.7%) out of the 6 148 who did not receive immunotherapy (p < 0.0001). The multivariate analysis identified that treatment with ICI in patients with AMLC is associated with a reduced risk of SPC (HR = 0.40, 95% CI 0.27–0.58). ConclusionTreatment with ICI in AMLC patients was associated with a significantly reduced risk of SPC. Prospective studies are required to confirm these results.

Analysis of Clinical Characteristics, Treatment, and Prognostic Factors of 106 Breast Cancer Patients With Solitary Pulmonary Nodules.

ObjectiveThe clinical features of solitary pulmonary nodules (SPN) in breast cancer patients were retrospectively analyzed, and the clinical features of primary lung cancer (PLC) and metastatic pulmonary breast cancer (MBC) in breast cancer patients were compared, and the treatment plan, curative effect and influencing factors were analyzed.MethodsThe clinical data of 106 patients of SPN combined with breast cancer surgery in our hospital from January 2015 to June 2020 were analyzed. There were 65 patients of PLC and 41 patients of MBC. Record the characteristics of the primary breast cancer lesion in our patient, the interval between the initial diagnosis of breast cancer and the appearance of SPN, the previous treatment history of our patient, and the characteristics and surgical method of SPN. The survival status of all patients during the follow-up period was recorded.ResultsThe onset age, interval, maximum nodule diameter, ER expression positive rate and radiotherapy history ratio of PLC patients were higher than those of MBC patients, and the lymph node positive rate and triple negative rate were lower than those of MBC patients (P < 0.05). Median survival was 51 months in patients with PLC and 37 months in patients with MBC. The 1, 3, and 5 year overall survival rates in patients with PLC were higher than those in patients with MBC (P < 0.05). Vascular tumor thrombus, SPN type and chemotherapy were all independent factors affecting the prognosis of patients with breast cancer combined with SPN (P < 0.05).ConclusionPLC patients and MBC patients have significant differences in pathological characteristics, like the onset age, interval, maximum nodule diameter, ER expression positive rate, radiotherapy history ratio, the lymph node positive rate, and triple negative rate. Septum, vascular tumor thrombus, SPN type, and chemotherapy are all independent factors that affect the curative effect of breast cancer patients with SPN. Based on the nature of SPN, it can provide reference for clinicians to decide the treatment plan, improve patients' quality of life and prolong their survival time.

Differential diagnosis of multiple primary lung cancers and intra-lung metastasis of lung cancer by multiple gene detection.

Differential diagnosis of multiple primary lung cancers and intra-lung metastasis of lung cancer by multiple gene detection.

Mapping distribution of brain metastases: does the primary tumor matter?

PurposePrior reports on the location and sizes of brain metastases almost entirely focus on patients with primary breast and pulmonary cancer. This is the first study comparing multiple other types of cancer that metastasize to the brain.MethodsThis monocentric retrospective study includes 369 untreated patients with 3313 intraaxial brain metastases. Following semi-manual segmentation of metastases on post-contrast T1WI, cumulative spatial probability distribution maps of brain metastases were created for the whole group and for all primary tumors. Furthermore, mixed effects logistic regression model analysis was performed to determine if the primary tumor, patient age, and patient sex influence lesion location.ResultsThe cerebellum as location of brain metastases was proportionally overrepresented. Breast and pulmonary cancer caused higher number of brain metastases to what would normally be expected. Multivariate analyses revealed a significant accumulation of brain metastases from skin cancer in a frontal and from breast and gastrointestinal cancer in a cerebellar location.ConclusionDistribution of brain metastases is very heterogeneous for the distinct primaries, possibly reflecting the diversity of mechanisms involved in brain metastases formation. In daily clinical practice distribution patters may be beneficial to predict the primary cancer site, if unknown.

Etiología de nódulos pulmonares en pacientes con cáncer mamario

Objetivo: Describir los diagnósticos histopatológicos a partir de los casos las pacientes con cáncer de mama que fueron llevadas a resección de nódulos pulmonares en el Instituto Nacional de Cancerología (INC).&#x0D; Materiales y métodos: Se desarrolló un estudio tipo serie de casos donde se describen las características clínicas, histológicas y anatomopatólogicas de un grupo de pacientes con diagnóstico confirmado de cáncer de mama de novo o que durante su enfermedad presentaron nódulos pulmonares que requirieron resección quirúrgica mediante cuña pulmonar o lobectomía en el INC, entre 1 de enero de 2015 y el 30 de abril de 2018.&#x0D; Resultados: En el periodo de estudio se realizaron 225 resecciones en cuña pulmonar y lobectomías de las cuales y se seleccionaron 55 casos de los cuales el 69.1% fueron de origen neoplásico 26 (47.3%) fueron metástasis de cáncer mama, 9 (16.4%) segundo primario pulmonar y 1 (1.8%) paciente tenía concomitantemente cáncer primario pulmonar y una metástasis de mama. Otras 2 (3.6%) pacientes tenían metástasis de otros órganos, uno de recto y uno de tiroides, mientras que las 17 (30.9%) pacientes restantes presentaron reporte de lesiones pulmonares benignas en la anatomía patológica&#x0D; Conclusión: La presencia de nódulos pulmonares en pacientes con cáncer de mama no siempre son secundarias a enfermedad metastásica en pulmón; pueden existir otras etiologías como cancer primario pulmonar, metástasis de otros órganos, tumores benignos o infecciones. Conocer la etiología de los nódulos pulmonares en pacientes con cáncer de mama es determinante para evaluar las opciones terapéuticas.

JCSE01.22 Tumor Microenvironment Is Associated with Efficacy of PD-1/PD-L1 Inhibitors in Patients with Primary Pulmonary Lymphoepithelioma-Like Cancer

Primary pulmonary lymphoepithelioma-like carcinoma (LELC) is Epstein-Barr (EB) virus related subtype of non-small-cell lung cancer. Evidence of immunotherapy in LELC is scarce. The role of immune markers in tumor microenvironment and their relation with the efficacy of PD-1/PD-L1 inhibitors in LELC remain poorly explored. Primary pulmonary lymphoepithelioma-like carcinoma (LELC) is Epstein-Barr (EB) virus related subtype of non-small-cell lung cancer. Evidence of immunotherapy in LELC is scarce. The role of immune markers in tumor microenvironment and their relation with the efficacy of PD-1/PD-L1 inhibitors in LELC remain poorly explored. A total of seventeen patients treated with PD-1/PD-L1 inhibitors in Guangdong Lung Cancer Institute were enrolled. We detected multiple immune markers including PD-L1, IDO1, TIM3, LAG3, CD4 and CD8 by immunohistochemistry in eleven of these patients. Dynamic changes of the checkpoint biomarkers in two patients (#10 and #11) treated with PD-1 inhibitors were analyzed. Tumors with 1% TPS (tumor proportion staining) were defined as PD-L1 positive. H-score of PD-L1, IDO1, TIM3 and LAG3 was calculated by multiplying percentage of positively stained cells and intensity score (0, absent; 1, weak; 2, moderate; 3, strong). For CD4 and CD8, the H-score equals the percentage of staining positive lymphocytes among all nucleated cells. In the 17 patients, most of them suffered from lines of chemotherapy (only two patients (2/17, 11.8%) received PD-1/PD-L1 inhibitors as the first line therapy). There are eight males and nine females. The median age was 47 years (range from 13 to 63). All of them were stage IIIB and IV. Thirteen of seventeen patients received single agent PD-1/PD-L1 inhibitor. PD-1/PD-L1 inhibitor showed an 82.4% disease control rate and 17.6% objective response rate. The median progression free survival was 7.4 months. The overall survival was not reached. Biomarkers of IDO1, LAG3, and TIM3 were not mutually exclusive with PD-L1, and could be highly expressed in responder patients to PD1/PD-L1 inhibitors. Notably, TIM3 expression was up-regulated at disease progression in two patients treated with PD-1 inhibitor. PD-1/PD-L1 inhibitors had preliminary good activity, and TIM3 up-regulation might be a mechanism of resistance to PD-1 inhibitors in advanced pulmonary LELC.

P1.04-42 Tumor Microenvironment Is Associated with Efficacy of PD-1/PD-L1 Inhibitors in Patients with Primary Pulmonary Lymphoepithelioma-Like Cancer

P1.04-42 Tumor Microenvironment Is Associated with Efficacy of PD-1/PD-L1 Inhibitors in Patients with Primary Pulmonary Lymphoepithelioma-Like Cancer

P1.01-28 Mutational Heterogeneity Between Primary Pulmonary Cancer Lesions and Matched Brain Metastases

P1.01-28 Mutational Heterogeneity Between Primary Pulmonary Cancer Lesions and Matched Brain Metastases

PRIMARY PULMONARY COLLISION TUMOR WITH ADENOCARCINOMA AND SCLC

SESSION TITLE: Lung Cancer 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: A collision tumor is defined as two histologically independent malignant neoplasms within the same organ. Our case presents a 78 year-old man with heavy smoking history that presented with 1 week long history of productive cough and shortness of breath. Imaging revealed a large pleural effusion; a spiculated left lung mass, fluid analysis positive for mixed adenocarcinoma and small lung cell carcinoma and pleural histology showed small lung cell carcinoma. CASE PRESENTATION: A 78-year-old man was brought to the emergency department with 1 week history of productive cough and shortness of breath. He reported unintentional 60 lbs weight loss over the 2 months, and reported heavy smoking history since he was 7 years-old. Physical exam and imaging were consistent with large left pleural effusion and consolidation of the left upper and left lower lobes. Pleural fluid chemistry suggested exudative effusion, and cytology revealed metastatic mixed adenocarcinoma and small cell carcinoma consistent with lung primary tumor. He underwent pleural biopsy, talc pleurodesis and partial decortication. Pleural histology was positive for small lung cell carcinoma. DISCUSSION: Collision tumors are rare entities, defined as two or more histologically distinct malignant neoplasms developing in the same organ [1]. There are 3 main tumorigenesis theories that explain the pathophysiology. The first one considers the accidental meeting of coexisting malignancies developing in the same organ, the second one considers a single carcinogen that precipitates two distinct neoplasms that collide, and the third theory is the tumor-to-tumor carcinogenesis, in which one neoplasm induces the second primary [2]. Clinical data has suggested that some of these collision tumors are developing from a single cell that eventually differentiates into distinct types and on the other hand our patient does have a strong smoking history and would likely be the carcinogenic stimulus [2, 3]. The relative risk of lung cancer in smokers of 20 or more cigarettes a day is 20 to 30 times higher than in nonsmokers [3]. Small Cell Lung Carcinoma is the histopathological subtype most commonly associated with smoking and adenocarcinoma most commonly seen in nonsmokers [3].Prognosis is dependent on the cytological grading of each neoplasm, and staging, which is highly undifferentiated and advanced in our patient [3]. When brain metastases are present, without treatment, the median survival is about 1-2 months. Whole brain radiotherapy (WBRT) is the mainstay of treatment with median survival between 3-6 months. CONCLUSIONS: Collision tumor of the lung with multiple primary lung neoplasms is a rare occurrence. It is mostly diagnosed port operatively after histological diagnosis and classification. Due to its very low incidence, this case is meant to bring awareness of cancer behavior, tumorigenesis, differentiation, and adhesion. Reference #1: Suzuki, Shigeki, T. Ohtsuka, T. Hato, et al., “Primary pulmonary collision tumor with three components in the underlying interstitial lung disease,” Thoracic Cancer, vol. 5, no. 5, pp 460-462, 2015. Reference #2: Michalinos, Adamantios, A. Constantinidou, M. Kontos, “Gastric collision tumors: An insight into their origin and clinical significance,” Gastroenterology Research and Practice, vol. 2015, Article ID 314158, 8 pages, 2015. https://doi.org/10.1155/2015/314158 Reference #3: Nakata, Shoji, Y. Nagata, M. Sugaya, et al., “Primary pulmonary collision cancer consisting of large cell carcinoma and adenocarcinoma,” Annals of Thoracic Surgery, vo. 2008, no. 80, pp 340-2. DISCLOSURES: No relevant relationships by Sandra Donahue, source=Web Response No relevant relationships by Anoopa Gollapudi, source=Web Response

Abstract P2-18-04: Differential prognosis of pulmonary lumpectomy in patients with a history of curative breast cancer

Abstract Objective: Treatment of patients with a history of breast cancer who are diagnosed as newly found solid pulmonary nodule is still controversial. Our study is to find out whether the pulmonary nodule represents a primary cancer, metastasis, or benign lesion secondary to breast cancer can be differentially prognostic. Methods: A total of 165 consecutive patients who underwent surgery or biopsy for pulmonary nodules between 2007 and 2013 after curative operation for breast cancer were reviewed. The postoperative survival rate was analyzed and the difference in survival rate was assessed between groups of pulmonary nodules representing a primary cancer, metastasis, and benign lesion. Results: Among these 165 patients, median age was 59 and mean follow-up was 51 months (range from 5 to 398). The pathologic diagnoses of pulmonary nodules were pulmonary metastases of breast cancer in 71 patients (43%), primary lung cancer in 59 (35.8%), and other diagnoses in 35 (21.2%) (hyperplasia in 11; pneumonia in 9; granuloma in 6; sclerosing hemangioma and pulmonary fibrosis in 4 each). In those who were diagnosed as malignant pulmonary tumor, about one half (56.4%) were secondary malignant and the rest were metastatic. There was no statistically difference in median age or disease free interval between operation date of breast surgery and pulmonary surgery or biopsy among these groups. However, those who were diagnosed as primary malignant or benign lesion had significantly higher incidence of isolated pulmonary nodule shown on their CT scan results (P=0.036). The incidence of positive lymph node involvement and negative ER/PR status was significantly higher in metastatic breast cancer patients (63.8% and 70.6%, respectively). Among patients with metastatic pulmonary nodules, rates of discordance between primary breast tumor and metastasis foci were 20.3%, 23.7% and 14.7% for ER, PR and HER2, respectively, which changed a lot the regimen used for treatment of metastatic breast cancer. Both the 5-year and 10-year disease-free survival from the initial mastectomy were significantly shorter in metastatic breast cancer patients (72.9%, 35.3%) when compared with patients with primary pulmonary cancer (82.9%, 53.8%) or pulmonary benign lesions (91.6%, 67.8%). Prognostic factors in metastatic breast cancer patients were a disease-free interval of &amp;gt;60 months with 10-year survival of 48.3% (P&amp;lt;0.05), solitary lung metastasis is associated with a survival rate of 78.9% after 5 years and of 48.7% after 5 and 10 years, and this is statistically significant compared to multiple metastases. Conclusions: We think that pulmonary lumpectomy is the best option in selected cases of solitary or multiple pulmonary nodules from breast cancer, which can be useful for differential diagnosis, predicting prognosis and deciding the drug treatment strategy in some cases. Citation Format: Zhebin Liu, Yihua Sun, Fangjing Ma, Hong Ling, Keda Yu, Guangyu Liu, Genhong Di, Zhen Hu, Canmin Chen, Yifeng Hou, Jiong Wu, Zhenzhou Shen, Zhimin Shao. Differential prognosis of pulmonary lumpectomy in patients with a history of curative breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-18-04.

Primary pulmonary cancer colliding with metastatic choriocarcinoma.

Collision tumors are rare in nature. Although lung is one of the main organs where metastatic tumors may occur, collision neoplasms consisting of a primary lung cancer and metastatic choriocarcinoma have never been reported so far. Here we describe a case of primary squamous-cell lung carcinoma (SCC) colliding with metastatic choriocarcinoma in a 55-year-old woman.

肺扁平上皮癌術後にみられた衝突癌の1例

今回，肺扁平上皮癌術後に同時多発肺癌の特殊型と考えられる肺の衝突癌の手術例を経験したので報告する．症例は70歳の男性．右肺扁平上皮癌にて右下葉切除，リンパ節郭清を施行．術後5年目に右S2に結節影を認めた．2ヵ月後のCTにて増大を認め，生検にて扁平上皮癌の診断となった．精査にて右肺扁平上皮癌T2aN0M0 Stage IBの診断となった．手術は右S2区域切除，壁側胸膜合併切除を施行．術後，扁平上皮癌と腺癌の衝突癌と診断された．また今回異時性癌と衝突癌の補助診断に，p53の免疫染色を用い有用であった．

Primary pulmonary cancer colliding with metastatic breast carcinoma: Hitherto unreported cases of cancer-to-cancer metastasis focusing on clinical implications

Lung is one of the main sites of metastatic tumors, but collision neoplasms consisting of a primary lung cancer and metastatic breast carcinoma have never been so far reported. We describe here 2 cases of primary non-small cell lung cancers (squamous cell and adenocarcinoma, respectively) colliding with metastatic breast carcinomas (ductal and lobular carcinomas, respectively). Clinico-pathologic features characterizing this challenging diagnosis and the important therapeutic implications are discussed.

Application value of radionuclide bone imaging in patients with primary pulmonary cancer before and after treatment

Objective To probe the application value of radionuclide bone imaging in pre-treatment selection of therapeutic plan and regular post-treatment follow-up of patients with primary pulmonary cancer.Methods 810 patients with primary pulmonary cancer had radionuclide bone imaging respectively before the treatment. The follow-up radionuclide bone imaging was performed in 492 cases that were treated by surgery in 2 years after the operation. For 318 cases that were treated by non-surgery way,only 142 cases that had no skeletal metastases had follow-up radionuclide bone imaging in 2 years after the treatment. Results 179 cases (22.1%) had skeletal metastases in 810 cases. Multiple skeletal lesions were found in 157 cases and single skeletal lesion found in 22 cases. The majority sites of skeletal metastases were ribs, vertebrae column and pelvis. 57 cases that were treated by surgery had new skeletal lesions in 2 years after the operation. For non-surgery patients,79 cases had new skeletal lesions in 2 years after the treatment. Conclusion Radionuclide bone imaging is useful in the selection of therapeutic plan and staging of primary pulmonary cancer before the treatment.Regular bone imaging after the operation is helpful to detect early bone metastasis and choose the therapeutic plan, and should be regarded as a foremost method to detect the skeletal lesion. Radionuclide bone imaging after the non-surgery treatment maybe help us to conclude the prognosis of the patients. Key words: Lung neoplasms; Neoplasms metastasis; Bone; Radionuclide imaging

Sinnhaftigkeit und Dauer von palliativer Chemotherapie in Bezug auf die Lebensqualität betroffener Patienten

I am reporting on a 74-year-old female patient with primary pulmonary and hepatic metastatic colon cancer. In the course of three-and-a-half years the patient decided to receive multiple cycles of palliative chemotherapy, irradiation of the liver and of the upper body. As a result of the extended anti-tumour therapy, remissions of the advanced cancer disease could be achieved repeatedly, which lead to a substantial increase of the patient's quality of life. This case shows that even in an advanced palliative situation the goal of a multimodal treatment is to curb disease progression and to extend the life and increase quality of life of the patient.

Early detection of recurrence by 18FDG-PET in the follow-up of patients with colorectal cancer

We assessed the potential benefits of including systematic 18fluorodeoxyglucose positron emission tomography (FDG-PET) for detecting tumour recurrence in a prospective randomised trial. Patients (N=130) who had undergone curative therapy were randomised to undergo either conventional (Con) or FDG-PET procedures during follow-up. The two groups were matched at baseline. Recurrence was confirmed histologically. ‘Intention-to-treat’ analysis revealed a recurrence in 46 patients (25 in the FDG-PET group, and 21 in the Con group; P=0.50), whereas per protocol analysis revealed a recurrence in 44 out of 125 patients (23 and 21, respectively; P=0.60). In another three cases, PET revealed unexpected tumours (one gastric GIST, two primary pulmonary cancers). Three false-positive cases of FDG-PET led to no beneficial procedures (two laparoscopies and one liver MRI that were normal). We failed to identify peritoneal carcinomatosis in two of the patients undergoing FDG-PET. The overall time in detecting a recurrence from the baseline was not significantly different in the two groups. However, recurrences were detected after a shorter time (12.1 vs 15.4 months; P=0.01) in the PET group, in which recurrences were also more frequently (10 vs two patients) cured by surgery (R0). Regular FDG-PET monitoring in the follow up of colorectal cancer patients may permit the earlier detection of recurrence, and influence therapy strategies.

Primary Pulmonary Collision Cancer Consisting of Large Cell Carcinoma and Adenocarcinoma

A case of pulmonary collision tumor is herein reported. An abnormal shadow was discovered in the right lung of a 53-year-old man. A right upper lobectomy with a mediastinal lymph node dissection was performed. Based on the findings of a postoperative pathologic examination, this tumor was considered to be a collision tumor of large cell carcinoma and adenocarcinoma, as the distribution of each tumor was clearly separated. This case is the first report of a primary pulmonary collision tumor consisting of large cell carcinoma and adenocarcinoma.

Prevalence of tuberculosis in small pulmonary nodules obtained by video-assisted thoracoscopic surgery

The prevalence of tuberculosis in small solitary lesions of the lung obtained by video-assisted thoracoscopic surgery (VATS) is still unclear. Of 103 lung lesions resected by VATS in 98 patients (47 men, 51 women), 19 were identified macroscopically as inflammatory changes, 78 were neoplastic, and 6 were undefined. Presumptive diagnosis based on microscopic analysis of fresh specimen smears treated with Papanicolaou stain was performed in 19 lesions. Of these, 11 lesions had epithelioid cells, granulomas with caseous necrosis and Langerhans-type giant cells. The 6 undefined lesions were non-inflammatory benign changes. Isolation and identification of tuberculosis were based on microscopic findings of fresh material smears and sections of fixed specimens stained with Ziehl-Neelsen's dye, cultivation using egg-based Ogawa medium, and in situ hybridization between polymerase chain reaction (PCR) products of each of the 11 lesions and specific DNA sequences for Mycobacterium tuberculosis, M. avium, and M. intracellulare. Of these 11 lesions, M. tuberculosis was confirmed in one (0.96%) by PCR and M. avium was confirmed in four by culture and PCR. Of the 78 malignant lesions, final pathologies were primary lung cancer (n=59, 70.2%) and pulmonary metastatic cancer (n=19, 22.6%). The most frequent primary malignant cancer was adenocarcinoma, which was found in 19 men and 28 women in the present study. Eight lesions in 8 men were squamous cell carcinomas. The results of the present study suggested that even though the prevalence of lung tuberculosis is low, attention should be paid to the presence of M. tuberculosis in specimens obtained by VATS.

Factores preditivos de risco para surgimento de segundo tumor maligno primário no pulmão em 104 casos

The objective of our study was to identify the risks factors for the de development of a second pulmonary primary cancer. It was a primary, observational, multicentric and retrospective study with 104 patients from the Cancer National Institute and the Antonio Pedro Universitary Hospital, in Rio de Janeiro, Brazil. The sites of primary tumors were: head and neck (56.7%); with laryngeal carcinoma (42.4%); lungs (15.5%); bladder (8.6%); uterine cervix (7.6%); stomach (4.8%); others (6.8%). Male patients represented 84.6%. Average age 56.7 +/- 10.7 years, with a coefficient of variation 18.8%. Among the patients 91.4% were smokers and 92.0% were alcohol consumers. Multiple logistic regression model: site of primary tumor (OR:8.22; CI 95% - 2.21 to 30.56; p = 0,0017); specific histologic of primary cancer (OR:0.21; IC 95% : 0.04 to 0.99; p = 0.0498); sex (OR: 0.25; CI 95% : 0.03 to 1.81; p = 0.1711); age (OR: 0.98; CI 95%: 0.92 to 1.04; p = 0.6318); smoking (OR: 2.80; CI 95%: 0.44 to 17.55; p = 0.2711) and alcohol consumption (OR:0.76; CIIC 95%: 0.19 to 2.95; p = 0.6964). Adjusted model: odds ratio of the site of the primary tumor was 4.14, ; CI 95%; from 1.36 and 12.78 and p = 0.0123 (p < 0.05). Accuracy or the model: 82. 69%. In this study teh site of the primary tumor was the only predictor of risk for the second pulmonary primary cancer.