Radiation therapy can result in injury to the lung parenchyma and central airways; the latter is less well documented in the literature. Here, we describe a 65-year-old Caucasian male, who developed ...focal endobronchial nodules and right main bronchial stenosis suggesting tumour recurrence, 32 months following curative intent concurrent chemoradiation therapy for Stage 3B squamous cell carcinoma of the lung. Computed tomography and positron emission tomography results are detailed. Flexible bronchoscopy with bronchial biopsies revealed squamous metaplasia rather than malignant tumour recurrence, with ongoing observation planned.
Radiation therapy can result in injury to the lung parenchyma and central airways; the latter is less well documented in the literature. Here, we describe a 65-year-old Caucasian male, who developed ...focal endobronchial nodules and right main bronchial stenosis suggesting tumour recurrence, 32 months following curative intent concurrent chemoradiation therapy for Stage 3B squamous cell carcinoma of the lung. Computed tomography and positron emission tomography results are detailed. Flexible bronchoscopy with bronchial biopsies revealed squamous metaplasia rather than malignant tumour recurrence, with ongoing observation planned.
Localized tracheobronchial amyloidosis (TBA) is a rare manifestation of pulmonary amyloid disease, and can result in central airway obstruction. The nature of presentation is variable and there may ...be a delayed diagnosis. TBA has a variable prognosis and the most commonly used strategy for management is airway recanalization. Here, we describe the tailored management approach for a 64‐year‐old Caucasian female presenting with localized TBA of the left main bronchus. Pulmonary function testing, computed tomography and positron emission tomography results are detailed. Rigid bronchoscopy was utilized for diagnostic and therapeutic intervention, which involved debulking and stent insertion. Amyloid deposition and localized inflammation were identified through histopathology. Focal external beam radiation therapy was administered following multidisciplinary discussion and review of the literature, with no evidence of active disease at 6 months follow‐up.
Localized tracheobronchial amyloidosis (TBA) is a rare manifestation of pulmonary amyloidosis, resulting from the pathological deposition of amyloid protein within the central airway wall. We present the initial management and subsequent outcomes of a patient with localized TBA, presenting with central airway obstruction.
Abstract
Cushing's syndrome (CS) and the pituitary tumour causing hypercortisolaemia, known as Cushing's Disease (CD), is a rare and challenging diagnosis. It is complicated by nonspecific symptoms ...and a range of diagnostic tests, with an average diagnostic delay of 3 years. Our objective was to compare the intended diagnostic workup by clinicians and medical students (students) against Endocrine Society Clinical Practice Guidelines (Guidelines). Comparisons were also drawn between the Guidelines and the workup of patients with suspected CS, aiming to identify areas to improve diagnosis and reduce diagnostic delay. This study had two parts. The first was a mixed cohort cross-sectional study involving an anonymised online survey, which examined the clinical experience of respondents, intended diagnostic pathway for CD and recommendations for improvement. The survey was distributed to clinicians and students in Australia, at four tertiary hospital facilities and students at two tertiary centres. The second part was a retrospective clinical audit of the diagnostic workup for patients with suspected CS, performed by senior endocrinologists, associated with an Australian tertiary health facility. Survey responses were received from 102 individuals (52 doctors and 50 students). Most doctors were trained in endocrinology (77%). Most doctors had seen <10 CS or CD patients throughout their careers and training (79%). The most common initial screening tests for clinicians and students were 24-hour urinary free cortisol (80% and 82%, respectively) and low dose overnight dexamethasone suppression testing (67% and 50%, respectively). Plasma adrenocorticotropic hormone (ACTH) and Magnetic Resonance Imaging (MRI) were selected by most clinicians (80% and 74%, respectively) and most students (70% and 82%, respectively), as tests for localising confirmed hypercortisolism. Recommendations suggested by respondents were broadly categorised into: greater clarity of the diagnostic process, by means such as flow charts (50%); increasing awareness (44%); and non-endocrine physician training (31%). Audit inclusion criteria was met by 15 patients (53% female; 47% male; mean age 46.9 years). The mean time from endocrinology referral to diagnosis was 13.5 months. Hypercortisolism was confirmed in 11 patients; including 4 patients with CD and 1 patient with ectopic CS. ACTH was ordered prior to confirming hypercortisolism in 14 patients and 1 patient was tested prior to excluding exogenous steroid use. Our study demonstrated that the majority of clinicians and students when surveyed, would make diagnostic decisions in line with the Guidelines. Half of respondents suggested there was a lack of clarity in diagnostic algorithms available. Minor discrepancies were seen between Guideline recommendations and patients’ assessments amongst the cohort audited. However, ACTH was consistently sent during screening and a patient was assessed with iatrogenic Cushing's, which are not recommended. Our findings suggest improved resources for the diagnostic workup of hypercortisolism, such as comprehensive flowcharts, may be helpful for clinicians and students.
Presentation: No date and time listed
Radiation therapy can result in injury to the lung parenchyma and central airways; the latter is less well documented in the literature. Here, we describe a 65-year-old Caucasian male, who developed ...focal endobronchial nodules and right main bronchial stenosis suggesting tumour recurrence, 32 months following curative intent concurrent chemoradiation therapy for Stage 3B squamous cell carcinoma of the lung. Computed tomography and positron emission tomography results are detailed. Flexible bronchoscopy with bronchial biopsies revealed squamous metaplasia rather than malignant tumour recurrence, with ongoing observation planned.
Radiation therapy can result in injury to the lung parenchyma and central airways; the latter is less well documented in the literature. Here, we describe a 65-year-old Caucasian male, who developed ...focal endobronchial nodules and right main bronchial stenosis suggesting tumour recurrence, 32 months following curative intent concurrent chemoradiation therapy for Stage 3B squamous cell carcinoma of the lung. Computed tomography and positron emission tomography results are detailed. Flexible bronchoscopy with bronchial biopsies revealed squamous metaplasia rather than malignant tumour recurrence, with ongoing observation planned.
Localized tracheobronchial amyloidosis (TBA) is a rare manifestation of pulmonary amyloid disease, and can result in central airway obstruction. The nature of presentation is variable and there may ...be a delayed diagnosis. TBA has a variable prognosis and the most commonly used strategy for management is airway recanalization. Here, we describe the tailored management approach for a 64-year-old Caucasian female presenting with localized TBA of the left main bronchus. Pulmonary function testing, computed tomography and positron emission tomography results are detailed. Rigid bronchoscopy was utilized for diagnostic and therapeutic intervention, which involved debulking and stent insertion. Amyloid deposition and localized inflammation were identified through histopathology. Focal external beam radiation therapy was administered following multidisciplinary discussion and review of the literature, with no evidence of active disease at 6 months follow-up.
The Hubble UV Legacy Library of Young Stars as Essential Standards (ULLYSES) Director's Discretionary Program of low-mass pre-main-sequence stars, coupled with forthcoming data from ALMA and JWST, ...will provide the foundation to revolutionize our understanding of the relationship between young stars and their protoplanetary disks. A comprehensive evaluation of the physics of disk evolution and planet formation requires understanding the intricate relationships between mass accretion, mass outflow, and disk structure. Here we describe the Outflows and Disks around Young Stars: Synergies for the Exploration of ULLYSES Spectra (ODYSSEUS) Survey and present initial results of the classical T Tauri Star CVSO 109 in Orion OB1b as a demonstration of the science that will result from the survey. ODYSSEUS will analyze the ULLYSES spectral database, ensuring a uniform and systematic approach in order to (1) measure how the accretion flow depends on the accretion rate and magnetic structures, (2) determine where winds and jets are launched and how mass-loss rates compare with accretion, and (3) establish the influence of FUV radiation on the chemistry of the warm inner regions of planet-forming disks. ODYSSEUS will also acquire and provide contemporaneous observations at X-ray, optical, NIR, and millimeter wavelengths to enhance the impact of the ULLYSES data. Our goal is to provide a consistent framework to accurately measure the level and evolution of mass accretion in protoplanetary disks, the properties and magnitudes of inner-disk mass loss, and the influence of UV radiation fields that determine ionization levels and drive disk chemistry.
PDF
