Solitary Lung Research Articles

EXCEPTIONAL LONG-TERM SURVIVAL OF AN ELDERLY PATIENT WITH METASTATIC SMALL CELL NEUROENDOCRINE CARCINOMA OF THE CERVIX – A CASE REPORT

Small cell neuroendocrine cervical carcinoma (SCCC) is known for its aggressive nature and poor prognosis. There are no standard treatments so small cell lung cancer treatments are often referenced due to their similar morphology. Typical treatment options include a combination of external beam radiotherapy and brachytherapy for localised disease and palliative chemotherapy for advanced disease. The 5-year survival rate for patients presenting with advanced disease is dismal, around 0–14%. Here, we report a case of a 75-year-old woman who was diagnosed with small cell neuroendocrine cervical carcinoma (SCCC) in 2015. She presented with locally advanced SCCC with vaginal involvement, as well as solitary lung and peripancreatic metastases. She was treated with a combination of chemotherapy, chemoradiation and stereotactic radiotherapy, followed by maintenance etoposide, and achieved a very long-term survival. The patient continues to survive today.

Solitary multicystic lesion lung cancer: two case reports and review of the literature

BackgroundLung cancer associated with cystic airspaces, especially solitary multicystic lesion lung cancer, is a rare disease (a rare imaging performance of non-small cell lung cancer). It is difficult to diagnose owing to the lack of a clear definition; therefore, diagnosis of these neoplastic lesions remains challenging.Case presentationWe outlined two cases of elderly Chinese men who were admitted to the hospital with a solitary multicystic lesion of the lung and subsequent surgical resection, confirming a diagnosis of adenocarcinoma.ConclusionsFor solitary pulmonary cystic airspaces (especially solitary multicystic lung lesions), it is important to properly recognise their imaging features. Due to the possibility of malignancies, timely surgery is an effective treatment strategy for early diagnosis.

Outcome of untreated lung nodules with histological but no microbiological evidence of tuberculosis

BackgroundThe outcome of lung nodule(s) with histopathological findings suggestive of tuberculosis (TB) but lack of microbiologic confirmation remains unclear. Whether these patients require anti-TB treatment remains unknown. The aim of the study was to compare the risk of active TB within 4 years in untreated patients with histological findings but no microbiological evidences suggestive of TB.MethodsFrom January 2008 to June 2013, patients with either solitary or multiple lung nodules having histological findings but no microbiological evidences suggestive of TB were identified from a medical center in Taiwan and were followed for 4 years unless they died or developed active TB.ResultsA total of 107 patients were identified. Among them, 54 (51%) were clinical asymptomatic. Biopsy histology showed granulomatous inflammation in 106 (99%), and caseous necrosis was present in 55 (51%) cases. Forty (37%) patients received anti-TB treatment, and 21 (53%) of them had adverse events, including 13 initially asymptomatic patients. Anti-TB treatment was favored in patients with caseous necrosis, whereas observation was preferred in subjects whose nodules were surgically removed. Only 1 case in the untreated group developed culture-confirmed active pulmonary TB during 4-year follow-up (1 case per 251.2 patient-years). None of the 16 cases having co-existing histologic finding of malignancy became incident TB case within a follow-up of 56.7 patient-years.ConclusionsIn patients having lung nodules with only histologic features suggestive of TB, the incidence rate of developing active TB was low. Risk of adverse events and benefit from immediate treatment should be carefully considered.

Repeat stereotactic body radiotherapy (SBRT) for local recurrence of non-small cell lung cancer and lung metastasis after first SBRT

BackgroundThis study evaluated the safety and efficacy of repeat SBRT for local recurrence of stage I non-small-cell lung cancer (NSCLC) and solitary lung metastasis.MethodsThirty-one patients with in-field local relapse of NSCLC (n = 23) or lung metastasis (n = 8) underwent repeat SBRT. All patients had grade 2 or lower radiation pneumonitis after the first SBRT. Local recurrence was diagnosed with CT and FDG-PET in 17 patients and by biopsy in 14. The median interval between the first and second SBRT was 18 months (range, 4–80). The first SBRT dose was mainly 48–52 Gy in 4 fractions (n = 25) according to the institutional protocols. Second SBRT doses were determined based on the tumor size and distance to organs at risk, and were mostly 48–52 Gy in 4 fractions (n = 13) or 60 Gy in 8 fractions (n = 13).ResultsAt 3 years, overall survival and local control rates were 36 and 53%, respectively, for all 31 patients. Four patients showed no further recurrence for > 5 years (63–111 months) after the second SBRT. Radiation pneumonitis after the second SBRT was grade 2 in 4 patients, and no grade 3 pneumonitis was observed.ConclusionRepeat SBRT was safe. Local control and survival rates were higher than expected. SBRT should be an important treatment option for local recurrence of NSCLC or lung metastasis after previous local SBRT.Trial registrationThis retrospective study was approved by the ethics committee of our institution (September, 2017; approval number: 27–10).

Relationship between solitary pulmonary nodule lung cancer and CT image features based on gradual clustering

Abstract Background The relationship between the medical characteristics of lung cancers and computer tomography (CT) images are explored so as to improve the early diagnosis rate of lung cancers. Methods This research collected CT images of patients with solitary pulmonary nodule lung cancer, and used gradual clustering methodology to classify them. Preliminary classifications were made, followed by continuous modification and iteration to determine the optimal condensation point, until iteration stability was achieved. Reasonable classification results were obtained. Results the clustering results fell into 3 categories. The first type of patients was mostly female, with ages between 50 and 65 years. CT images of solitary pulmonary nodule lung cancer for this group contain complete lobulation and burr, with pleural indentation; The second type of patients was mostly male with ages between 50 and 80 years. CT images of solitary pulmonary nodule lung cancer for this group contain complete lobulation and burr, but with no pleural indentation; The third type of patients was also mostly male with ages between 50 and 80 years. CT images for this group showed no abnormalities. Conclusions the application of gradual clustering methodology can scientifically classify CT image features of patients with lung cancer in the initial lesion stage. These findings provide the basis for early detection and treatment of malignant lesions in patients with lung cancer.

Akciğerde İzole Kitle Şeklinde Bulgu Veren Prostat Kanseri Metastazı

To demonstrate a case with solitary lung and brain metastasis originating from prostate cancer without bone spread. A 72-year-old male who had previous surgery (radical prostatectomy) for prostate cancer was referred to us with cough, sputum production and chest pain. Radiological examinations showed a mass at the right lower lobe. On PET-CT the lesion confirmed and in addition to this lesion a left parietal lesion suggesting brain metastasis was seen. No lymph node or bone metastasis was detected. Transthoracic biopsy confirmed metastasis of prostate cancer. Without the usual pathway of metastasis, prostate cancer may spread to lung or brain without bone metastases.

Pulmonary Hyalinizing Granuloma: A Case Report

Pulmonary hyalinizing granuloma (PHG) is a rare nodular disease of unknown etiology. PHG can present with solitary or bilateral lung nodules and be asymptomatic or present with fever, cough, dyspnea, chest pain and hemoptysis.

BMET-38METASTASIS TO BRAIN AND LUNG IN CARCINOSARCOMA OF THE PAROTID GLAND - A CASE REPORT

Carcinosarcoma of the parotid gland is a rare and aggressive malignant mixed tumor in which carcinomatous and sarcomatous elements coexist and they may metastasize together or independently. The tumor may occur in patients with previous or coexisting pleomorphic adenoma or may arise de novo of the parotid gland. We report a case of 56-year old male with history of carcinosarcoma of the parotid gland that subsequently developed solitary brain and lung metastases. The patient underwent craniotomy of the metastatic and symptomatic brain lesion and had adjuvant radiosurgery postoperatively. After that, his headache disappeared and the left hemiparesis improved. The next-generation sequencing gene study identified the amplification of IRS2, CDK4, IGF1R, MDM2 and MYC genes in metastatic brain lesion. In primary parotid lesion, genomic alteration identified amplification of RAF1, CDK4, IGF1R, MDM2 and MYC genes. The patient then entered a clinical trial and did not show any improvement. Due to the brain mets re-growth, a 2nd craniotomy was performed. He again improved significantly postoperatively. He currently received salvage chemotherapy for his progressive lung metastasis. The prognosis of carcinoma with distant metastasis is poor and the standard treatment has not been established yet. Herein we will present detailed pathological and molecular abnormality profiles of this case and will review similar cases reported in literatures. To our knowledge, this is the first case with carcinosarcoma of the parotid gland that developed brain and lung metastasis.

Surgery for Isolated Metachronous Thyroid Metastasis in a Non-small Cell Lung Carcinoma Patient with Hashimoto?s Thyroiditis: A Case Report

Non-small cell lung cancer (NSCLC) is the one of the leading causes of cancer deaths in Western population. Chemotherapy with platinum-based regimens is the first line management for majority of advanced NSCLC. Distant metastasis in lung cancer commonly involves the adrenal glands, liver, bones and brain. Metastatic involvement of the thyroid gland is infrequent despite its rich vascular supply. Here, we report a case of thyroid metastasis of NSCLC as a primary which was treated by thyroidectomy which is not the conventional approach. A 71 year-old female with a solitary left lower lobe lung mass was diagnosed with invasive poorly-differentiated adenocarcinoma. She was treated with cisplatin and pemetrexed followed by video-assisted thoracoscopic left lower lobectomy. The resected mass showed poorly-differentiated adenocarcinoma and was staged as pT2bN0 (Stage IIA). On a surveillance Computed Tomography (CT) chest, a left thyroid nodule was noted with findings consistent with Hashimoto's thyroiditis in a multinodular goiter. Fine-needle aspiration biopsy was consistent with metastasis from lung primary. This represented a solitary site of metastasis based on positron emission tomography (PET) Scan. Metastatic involvement of thyroid gland is infrequent despite its rich vascular supply. Given the long disease-free interval (DFI) of 1.5 years from initial diagnosis to documentation of isolated thyroid metastasis, she underwent total thyroidectomy followed by platinum-based adjuvant chemotherapy. Patient continues to be disease-free for more than 3 years as of her last follow up. A greater than 3-year disease-free survival to date in this case demonstrates that thyroidectomy can be a successful approach in the management of isolated metachronous thyroid metastasis from NSCLC in the well-selected patient.

原発巣治療16年後外科的治療を施行した皮膚悪性黒色腫孤立性脳肺転移の1例

症例は74歳女性．16年前に右拇指悪性黒色腫の切除術を受けていた．当科紹介1年前頭痛，ふらつきが出現．前医で右前頭葉と右肺中葉の腫瘤影を指摘された．症状改善と診断目的に当院脳神経外科で開頭腫瘍摘出術を施行．黒色腫脳転移と診断された．症状改善後気管支鏡検査でも同診断となり，当科受診した．肺転移切除で閉塞性肺炎が改善し転移巣全摘除と判断．外科的治療を選択した．胸腔鏡補助下右肺中下葉切除術およびND2a-2を施行．経過良好であったが，術後2ヵ月目急激な脳と気管気管支内腔の局所再発を来し，術後4ヵ月目に死亡した．脳と肺の転移に対する外科的治療は予後を改善し得なかったが，組織学的診断と症状改善の点で有効であった．同疾患既往がある場合，経過期間に関わらず転移再発を考慮すべきである．また転移再発に対する外科的治療の有効性と適応について，さらなる検討が必要である．

Postablation Insufficiency Fracture of the Iliac Crest: Management by Percutaneous Screw Fixation

The bony skeleton is the third most common metastatic site from cancer after the lungs and liver. Prostate, breast, and lung cancer represent the three most common tumours that tend to metastasize to bones. Recently different percutaneous techniques have been used to offer pain palliation resulting from bone metastases [1–3]. Although cementoplasty is used strictly for osteolytic lesions in weightbearing bones and only with palliative intent, thermal ablation techniques can be used both for lytic and sclerotic lesions. Furthermore, in cases of solitary or oligometastases or metastases from neuroendocrine tumours, complete ablation with sufficient safety margins can improve life expectancy or even offer a chance for cure [4]. We herein present the case of a solitary painful lung metastasis in the right iliac wing treated with curative cryoablation and complicated with an iliac crest insufficiency fracture that was subsequently treated percutaneously with screw fixation. Institutional Review Board approval for retrospective studying of the patient’s file was not required. A 55-year-old woman with history of right lobectomy for lung adenocarcinoma (pT4N2M0) presented on 2-year follow-up with a painful right iliac wing metastasis confirmed on positron-emission tomography (PET)-computed tomography (CT) and percutaneous biopsy (Fig. 1A). The metastasis was single, and a multidisciplinary decision to treat the patient with percutaneous cryoablation with a curative intend was made. Informed patient consent was obtained.

Pulmonary Giant Cell Carcinoma Associated With Pseudomyxoma Peritonei

Pulmonary giant cell carcinoma is a rare subtype of sarcomatoid carcinoma. Pseudomyxoma peritonei (PMP) is a rare condition in which gelatinous material accumulates within the peritoneal cavity. It is believed PMP arises from a primary appendiceal mucinous neoplasm that perforates the gut, causing mucinous ascites. There are sporadic reports of PMP associated with neoplasms of other organs, rarely the lung. Here, we report on a 60-year-old woman with pulmonary giant cell carcinoma associated with PMP. She presented with progressive dyspnea and abdominal distention. Abdominal computed tomography revealed moderately dense ascites without an obvious mass. Chest computed tomography revealed a large, solitary right lower-lobe lung mass. She underwent transbronchial fine-needle aspiration of the mass, and was diagnosed with pulmonary giant cell carcinoma. The ascites showed scattered malignant cells in a background of mucin, confirming PMP. To our knowledge, this is the first report of pulmonary giant cell carcinoma associated with PMP.

FDG-PET is a Prognostic Factor of Relapse-free Survival in Stage I Non-small Cell Lung Cancer Treated with 3-dimensional Non-coplanar Conformal Radiotherapy

Purpose/Objective(s): For solitary non-small cell lung cancers (NSCLC), we have been using 3-dimensional non-coplanar conformal radiotherapy (3DNCCRT) with middle-sized fractions with a fairly good treatment results. Maximum uptake value of FDG has been reported to correlate with the activity of the tumor, and thus with the prognosis of the tumor. We investigated whether the prognosis of our cases were correlated with the SUV-max of FDG-PET scan prior to the conformal radiotherapy.

Fever of unknown origin (FUO) due to a solitary cavitary lung lesion: The deadly ferritin-laced doughnut

Fever of unknown origin (FUO) is the clinical designation for patients who have fevers >101F that have persisted for >3 weeks that remain undiagnosed, after an intensive ambulatory/in-hospital workup. Fevers of unknown origin may be due to wide variety of infectious, neoplastic, or rheumatic/inflammatory disorders. The most common causes of FUOs in elderly patients are infectious and neoplastic diseases. With FUOs, the clinical presentation and routine laboratory tests are usually sufficient to narrow differential diagnostic possibilities. We present a case of an elderly Italian woman who presented with an FUO and a solitary, thick-walled cavitary lesion on chest x-ray (CXR). The infectious disease differential diagnosis of her FUO included lung abscess, M. tuberculosis (TB), systemic mycoses, and echinococcal-cyst (or hydatid-cyst) disease. The malignancy and neoplastic differential diagnosis included bronchogenic carcinoma, lymphoma, and metastatic carcinoma. Her nonspecific laboratory tests indicated a highly elevated erythrocyte sedimentation rate (ESR) >100 mm/hour, chronic thrombocytosis, relative lymphopenia, and highly elevated serum ferritin levels. Excluding highly elevated serum ferritin levels, the differential diagnosis of her FUO with a solitary, thick-walled cavitary lesion was lung abscess vs tuberculosis. However, her highly elevated serum ferritin levels proved to be the critical diagnostic clue in predicting the diagnosis of squamous-cell carcinoma. We conclude that serum ferritin levels are an important part of the laboratory workup. As with other nonspecific laboratory tests, the diagnostic significance of highly elevated ferritin levels depends associated clinical features in the clinical presentation.

Pulmonary Microcystic Fibromyxoma: Report of 3 Cases

Three cases of pulmonary myxoid tumors showing a variable degree of microcystic change are described. They are presented as incidental solitary peripheral lung nodules on routine radiologic studies. The patients included 2 women, 45 and 65 years old, and 1 man, 33 years old. Clinical work-up showed no evidence of neoplasia in other sites. Following surgical resection, no evidence of disease was observed after a mean follow-up of 48 months. The tumors ranged in size from 1 to 2.3 cm (mean 1.4 cm). Microscopically, the lesions were well circumscribed with conspicuous cystic change and myxoid stroma. Innocuous, widely-spaced, spindled to stellate tumor cells showed minimal nuclear pleomorphism and absence of mitotic activity. The myxoid stroma contained acid mucopolysaccharides, sensitive to hyaluronidase digestion. No epithelial, chondroid, neural, myofibroblastic, lipomatous or vascular differentiation was evident on immunohistochemical studies. Although these cases display cytologic features, myxoid stroma and benign clinical course characteristic of pulmonary myxomas; the presence of microcystic architecture is unique to the current series, and thus a descriptive designation "microcystic fibromyxoma" is suggested.

P-876 Retrospective study of coexisting lung cancer and active pulmonary tuberculosis patients presenting as a solitary or multiple lung mass

P-876 Retrospective study of coexisting lung cancer and active pulmonary tuberculosis patients presenting as a solitary or multiple lung mass

39. Retrospective analysis of a CT scan, FDG PET and anatomopathology of the solitary pulmonary nodule and lung cancer in the AZ Middelheim Hospital, Antwerp, Belgium

39. Retrospective analysis of a CT scan, FDG PET and anatomopathology of the solitary pulmonary nodule and lung cancer in the AZ Middelheim Hospital, Antwerp, Belgium

Transthoracic Needle Aspiration Biopsy

The purpose of this study was to assess the value of transthoracic fine-needle aspiration in the diagnosis of mycobacterial infection as the cause of focal lung opacities. Six hundred twelve fine-needle aspiration biopsies were performed from 1985 to 1997 in 587 patients with solitary or multiple lung opacities. Initial procedures, including sputum analysis and bronchoscopy, had been nondiagnostic. Fluoroscopic or computed tomography guidance was used, and a pathologist was present. A diagnosis of mycobacterial infection was established when acid-fast bacilli were demonstrated in the aspirate. In 487 patients, a malignant cause was confirmed, and six other patients had carcinoid tumor. Of 94 nonmalignant opacities, 24 (26%) were determined to have a mycobacterial cause. Fine-needle aspiration biopsy detected acid-fast bacilli in 15 of 24 cases (sensitivity, 62.5%; specificity, 100%). Radiologic findings included upper lobe involvement (17 of 24 cases), single opacities (12 of 24 cases), satellite nodules (4 of 12 cases with single opacities), irregular borders (19 of 24), eccentric calcification (2 of 24), and cavitation (8 of 24). The authors conclude that fine-needle aspiration biopsy must be processed for acid-fast bacilli when nonmalignant cytologic findings result, even if the results of sputum smears, cultures, and bronchoscopy are negative.

Are growth rates of tumors of any clinical importance?

The tumor doubling times were determined in 142 rounded pulmonary lesions of 78 patients (13 bronchial carcinomas, 7 benign pulmonary tumors, and 122 pulmonary metastases). They varied between +12 and +8863 days of tumor growth and of -1810 days of decrease in tumor mass. Forty-four percent of all pulmonary metastases doubled their volume within 60 to 250 days. The growth rates during the period of observation varied greatly in several pulmonary metastases of the same patient, even for the same solitary circular lung focus of the same person. There is no relationship between tumor doubling time and histological type of the tumor, nor between the interval between operative removal of the primary tumor and the occurrence of pulmonary metastases. In patients between the ages of 10 and 30 years only rapidly growing pulmonary metastases with a tumor doubling time of less than 60 days could be found; even though there is no proved relationship between growth rate and age. The tumor doubling time gives no useful information on the nature of a circular lung focus, and there are no clinical consequences for diagnosis.

Surgical treatment of tendosynovial sarcoma

Tendosynovial sarcoma is notorious for its high rates of local recurrence and metastases after surgical treatment. A retrospective study was made of 109 cases of monobloc wide soft part resection and amputation for primary tumors, and 29 patients who underwent resection of pulmonary metastases. Actuarial five-year survival rates after soft part resection was 70% for untreated, and 61% for previously treated, locally recurrent neoplasms. Corresponding rates after amputation were 47% and 64%. Local tumor recurrence developed in 18% of the primary soft part resections and 4% of the amputations, usually when some basic surgical principle had been violated. 35% five-year survival was achieved with judicious resection of solitary and multiple lung metastases in most cases without chemotherapy. Local control of a tendosynovial sarcoma can be achieved with properly executed surgical procedures which adhere to established tenets of cancer surgery. Resection of pulmonary metastases merits an important position in the management of these patients.