Post-transplant lymphoproliferative disease (PTLD) comprises a spectrum of clinically relevant lymphatic diseases that occur in patients after transplantation. The PTLD-related mortality is high and ...the clinical picture and location of the lesions are very variable. For these reasons, the diagnosis of PTLD is difficult and new diagnostic tools are sought.
A 31-year-old woman, 17 years after kidney transplantation, presented with recurrent upper respiratory tract infections, fever, and weakness and was diagnosed with pulmonary PTLD. Computed tomography appearance was not typical for lymphoma and demonstrated multiple bilateral pulmonary nodules and masses with a halo sign. Initial differential diagnosis included invasive pulmonary aspergillosis and acute Wegener granulomatosis. Since cultures from bronchoalveolar lavage and anti-neutrophil cytoplasmic antibodies were negative, videothoracoscopy with lung biopsy was performed. Pathology analysis revealed diffuse large T-cell lymphoma with histopathologic features of infiltrative growth along the lung interstitium, vessel invasion, and hemorrhagic necrosis possibly explaining the presence of a halo sign.
We suggest PTLD should always be suspected in a transplant recipient presenting with the CT halo sign. Moreover, the correlation of this radiological phenomenon with the patient's clinical presentation and severe pathologic findings allows us to conclude that the thoracic halo sign in PTLD may reflect a worse prognosis.
Background: Surgical treatment is an accepted method to manage esophageal perforation, but in many cases it may result in failure. This paper compares the efficacy of surgical treatment and stenting ...in patients after previous surgical intervention for esophageal perforation.
Methods: A single-institution retrospective study was performed in a group of patients treated for esophageal perforation admitted to our centre from 2010 to 2015. Seventy eight patients (76.5%) with esophageal perforation received surgical treatment. In this group of patients, the mean time between perforation and treatment was 80.6 h (24-240 h). Spontaneous and iatrogenic perforation was observed in 33 (42.3%) and 45 (57.7%) patients, respectively. Partial esophageal resection was performed in 11 cases (14.1%). The perforation site was sutured in the remaining 67 patients (85.9%). Surgical treatment failed in 29 cases (37.2%).
Results: In patients with failed previous surgical treatment, revision surgery was performed in 14 patients (48.3%) (group A), and a large-diameter self-expandable stent was implanted in 15 cases (51.7%) (group B). Perforation in the thoracic and distal esophagus was observed in 5 (35.7%) and 9 (64.3%) patients from group A, and in 7 (46.7%) and 8 (53.3%) patients from group B, respectively. The mean intubation time in both groups was 30.3 and 12.5 days (p < 0.001), respectively. The mean daily drainage within five days after the intervention was 350 mL in group A, and 500 mL in group B (p < 0.02). In both groups hospitalisation time was 41.5 and 19.4 days, respectively (p < 0.001). Six patients died (42.8%) following revision surgery, and 2 (13.3%) patients died after stent implantation (p < 0.001).
Conclusions: Intubation time, hospitalization, and the rate of fatal complications in patients who underwent stent implantations were significantly lower compared to reoperated patients; however, the rate of prolonged drainage was lower in patients who underwent revision surgery. In conclusion, stent implantation is a significantly superior method to treat persistent leakage following failure of previous surgical treatment.
OBJECTIVES
To assess the results of surgical treatment of T-ALI (adjacent lobe invasion) tumours in patients with non-small-cell lung carcinoma.
METHODS
Multicentric retrospective analysis of a ...prospectively maintained database of 13 065 patients, aged 32–89 years (mean 52.9, median 63 years), who underwent resection between January 2009 and September 2014.
RESULTS
In the whole study group, T-ALI was observed in 324 patients (2.5%): 201 patients (62.0%) with a tumour invading the pleura in the inter-lobar fissure (T-ALI-A), and 123 patients (38.0%) with a tumour in the adjacent lobe but without pleural invasion in the fissure (T-ALI-D). With regard to N0 patients, the 3- and 5-year survival rates in the T2 group were significantly higher than that of the T-ALI group (76.1 and 68.4%, P = 0.002 vs 58.3 and 51.0%, P = 0.008, respectively). On the other hand, when the N1 group was analysed, the 5-year survival rates were 54.3 and 48%, respectively (P = 0.041). In the N2 group, the 5-year survival rates in the T2 and T-ALI groups were 40.2 and 35.0%, respectively (P = 0.241). The comparison of the T-ALI and T3 groups for stages N0, N1 and N2 revealed differences in 5-year survival rates as follows: 68.4 vs 62.9% (P = 0.048), 48.0 vs 37.6% (P = 0.08) and 35.0 vs 27.6% (P = 0.121), respectively. In the whole group, the difference in survival rate between T-ALI N0 and T2N0 was statistically significant (P = 0.008) and statistically significant for the T3N0 group (P = 0.048). The 3-year survival rate in the T-ALI N0 group was statistically lower following pneumonectomy than following lobectomy (56.4 vs 61.3%, P = 0.03). The best survival rate was observed following bilobectomy (75.6%).
CONCLUSIONS
In our study, a tumour with ALI (T-ALI) represented a separate stage of cancer between T2 and T3. The survival rate in the T-ALI-A group was significantly poorer than that in the T-ALI-D group. Overall treatment results were similar for stage T3, suggesting that it may be necessary to divide this group into T3a and T3b. We would suggest that all tumours between 5 and 7 cm be classified as T3b, and any tumour smaller than 5 cm but with ALI be classified as T3a. Treatment of choice should include lobectomy or bilobectomy. Pneumonectomy should be performed only in a selected group of patients.
Highlights • NSCLC patients present significantly higher plasma cfDNA levels than those with benign lung tumours. • Plasma cfDNA integrity is significantly altered in patients with NSCLC or benign ...lung tumours. • Diagnostic capacity of our cfDNA assay is comparable to values presented by conventional imaging modalities. • Plasma cfDNA quantification can be used to differentiate between NSCLC and benign lung tumours significantly.
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e22540
Background: Primary pulmonary sarcomas (PPS) are the very rare cancer type (0.01% - 0.4% of all malignant tumours of the lung). PPS can derive from stromal elements of the ...bronchial wall, blood vessels and connective tissue steep of lung parenchyma. The aim of the study was evaluation of PPS patients’ outcome. Methods: The analysis included 23 patients (11 males, 12 females) age 28-70 years (median 49.6 years) with PPS treated surgically in the Department of Surgery, Institute of Lung Diseases and Tuberculosis in Warsaw from 1994 to 2009. Results: There were 3 leiomyosarcomas (13%), 3 hemangiopericitomas (13%), 3 MFH (13%), 3 malignant peripheral nerve sheath tumours (13%), 3 PNET (13%), 2 fibrosarcomas (8.8%), 2 liposarcomas (8.8%), 2 sarcomas synoviale (8.8%), 1 angiosarcomas (4.3%), 1 chondrosarcomas (4.3%) (according to the 3rd edition of the WHO Classification of Tumours of Soft Tissue and Bones). There were performed 5 pneumonectomies (21.7%), 5 lobectomys (21.7%), 5 wedge resection (21.7%), 6 exploratory thoracotomys (26.1%), 2 stent inserts (8.8%). In the case of 15 patients (65%) were performed operation R0. Adjuvant therapy was used in 7 patients (30%), 3 patients (13%) received chemotherapy, 2 patients (13%) radiotherapy and 1 patient (4%) chemo-radiotherapy. Palliative chemotherapy and or radiotherapy were given to 6 patients (26%). Median overall survival (OS) was 22 months (5- and 10-years OS was 26% and 17%, respectively) and depended on sex (p = 0.006), tumor size (p = 0.02), operation R0 (p = 0.07). Conclusions: Surgery, especially operation R0, is the most effective treatment method of PPS. Subsequent studies on larger groups are necessary.
Liposarcoma is one of the most common soft tissue sarcomas in adults, but it is exceedingly rare in the gastrointestinal tract. To the authors' knowledge, only 17 cases of esophageal liposarcomas ...have been described in the literature.
The case of a 56-year-old woman is reported who complained of dyspnea and airway obstruction and was referred for multi-slice computed tomography (MSCT) with the suspicion of mediastinal tumor. MSCT revealed a heterogeneous mass within the esophagus. The density measurements from pre- and post-contrast scanning suggested a fatty tissue component of the lesion and a possible malignant nature. The patient underwent esophagotomy. The diagnosis of liposarcoma was established. Five months after the surgery, follow-up chest MSCT was performed which revealed an inhomogeneous mass behind the left atrium. Additional CT was performed with a perfusion protocol which suggested a malignant nature of the lesion. After thoracotomy with removal of the tumor, the patient underwent adjuvant radiotherapy. The patient is still being followed up and two years after the esophagotomy has been well, with no metastases in subsequent endoscopic and CT examinations.
To the authors' knowledge this is the first case of liposarcoma of the esophagus detected and postoperatively monitored using MSCT. MSCT, even as the first examination, may enable a proper diagnosis of liposarcoma in patients with atypical clinical features.
MicroRNAs (miRNAs), key regulators of gene expression at the post-transcriptional level, are grossly misregulated in some human cancers, including non-small-cell lung carcinoma (NSCLC). The aberrant ...expression of specific miRNAs results in the abnormal regulation of key components of signalling pathways in tumour cells. MiRNA levels and the activity of the gene targets, including oncogenes and tumour suppressors, produce feedback that changes miRNA expression levels and indicates the cell’s genetic activity. In this study, we measured the expression of five circulating miRNAs (miR-195, miR-504, miR-122, miR-10b and miR-21) and evaluated their association with
EPIDERMAL GROWTH FACTOR RECEPTOR
(
EGFR
) mutation status in 66 NSCLC patients. Moreover, we examined the discriminative power of circulating miRNAs for
EGFR
mutant‐positive and -negative NSCLC patients using two different data normalisation approaches. We extracted total RNA from the plasma of 66 non-squamous NSCLC patients (31 of whom had tumours with
EGFR
mutations) and measured circulating miRNA levels using quantitative reverse transcription polymerase chain reaction (RT-qPCR). The miRNA expression levels were normalised using two endogenous controls: miR-191 and miR-16. We found significant associations between the expression of circulating miR-504 and
EGFR
-activating mutations in NSCLC patients regardless of the normalisation approach used (
p
= 0.0072 and 0.0236 for miR-16 and miR-191 normalisation, respectively). The greatest discriminative power of circulating miR-504 was observed in patients with
EGFR
exon 19 deletions versus wild-type
EGFR
normalised to miR-191 (area under the curve (AUC) = 0.81,
p
< 0.0001). Interestingly, circulating miR-504 levels were significantly reduced in the v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (
KRAS
)-mutated subgroup compared to
EGFR
-mutated patients (
p
< 0.0030) and those with
EGFR/KRAS
wild-type tumours (
p
< 0.0359). Our study demonstrated the feasibility and potential diagnostic value of plasma miR-504 expression analysis to distinguish between
EGFR
-mutated and wild-type NSCLC patients. However, quality control and normalisation strategies are very important and have a major impact on the outcomes of circulating miRNA analyses.
Abstract Objectives The paper aimed to compare the efficacy of log odds (LODDS) compared to a classification based on the distribution of involved lymph nodes (pN) and lymph node ratio (LNR). Methods ...Material was collected retrospectively from an online survey-based database of the Polish Lung Cancer Group and included a group of 17,369 patients who received radical surgical treatment (R0) due to lung cancer. Results In the whole group the median survival for N0, N1 and N2 was 76.1, 41.7 and 24.2 months, respectively. The median survival for individual LODDS categories (-6,-4, (-4,-3, (-3,-2, (-2,-1, (-1,0, (0,1 and (1,2 was 76.5, 76.3, 71.7, 45.4, 25.0, 19.1 and 17.7 months, respectively. The median survival for LNR in individual categories (0), (0,0.25, (0.25,05, (0.5075 and (0.75,1.0 was 75.6, 40.3, 24.1, 18.8 and 16.4 months, respectively. A multi-variant analysis demonstrated that each LODDS category is an independent prognostic factor: (-4,-3 (HR = 0.982; 95% CI 0.867–1.112; P = 0.775), (-3,-2 (HR = 1.114; 95% CI 0.984–1.262; P = 0.089), (-2,-1 (HR = 1.241; 95% CI 1.080–1.425; P = 0.002), (-1,0 (HR = 1.617; 95% CI 1.385–1.887; P < 0.0001), (0,1 (HR = 1.918; 95% CI 1.579–2.329; P < 0.0001) and (1,2 (HR = 2.016; 95% CI 1.579–2.573; P < 0.0001). Conclusions Based on LODDS it is possible to discriminate patients with regard to lung cancer stage more effectively compared to pN and LNR classification, and it is also a better classification system.
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