Extranodal marginal zone B-cell lymphoma of MALT-type of the lung: single-center experience with 12 patients

The lung is a relatively rare site for mucosa-associated lymphoid tissue (MALT) lymphomas: we report the largest available single-center series of patients with this presentation. From August 1992 to October 2000, 12 patients with untreated primary low-grade MALT lymphoma of the lung were submitted either to chemotherapy alone (n = 8), surgery alone (n = 2) or surgery plus chemotherapy (n = 2). At diagnosis, 6 (50%) were asymptomatic and 6 (50%) had nonspecific pulmonary symptoms. The most common radiologic findings were a pulmonary infiltrate (7 cases) and a mass lesion (5 cases). Histological diagnosis was obtained with transbronchial lung biopsy/bronchoalveolar lavage (BAL) (6 cases), with transthoracic needle biopsy (1 case), or an open thoracotomy (5 cases). All patients had stage IE. All 12 (100%) achieved complete remission; 3 (25%) local recurrences were observed. The global 6-year survival rate was 100% with a relapse-free survival rate of 50%. In conclusion, these data underline the diagnostic utility of BAL and the therapeutic efficacy of a chemotherapeutic strategy based on regimens such as N-CVP in the context of localized MALT lymphoma of the lung.     

Pulmonary Involvement as the Major Manifestation of Chronic Lymphocytic Leukemia

Respiratory symptoms and abnormal findings on chest X-ray are frequently noted in patients with chronic lympllocytic leukemia (CLL). However, most of these represent pulmonary infections or mediastinal lymphadenopathy, and leukemic involvement of the lung is seldom diagnosed during life. In this report we describe three patients with non-progressive, responsive CLL who developed biopsy proven pulmonary infiltration with CLL. In one case, pulmonary involvement was the sole manifestation of recurrent disease and a second case had little disease elsewhere with minimal CLL in the blood at the time pulmonary involvement appeared. In all three cases, transbronchial biopsy and bronchoalveolar lavage performed during fibreoptic bronchoscopy provided adequate tissue for diagnosis. We conclude that CLL may involve the lung even in the presence of a low peripheral white blood cell count with responsive disease elsewhere, and can readily be diagnosed by transbronchial biopsy and bronchoalveolar lavage.     

超选择性支气管镜肺刷检对肺第5~9级支气管间占位性病变的诊断价值

[目的]探讨在高分辨率CT片定位下,气管镜下刷检对位于肺第5～9级支气管间的肺占位性病变的诊断价值.[方法]对85例肺部肿块位于肺第5～9级支气管间的患者,术前在高分辨率CT片定位下行支气管镜下刷检细胞学检查,以细胞病理学结果为诊断依据.[结果]经支气管镜肺刷检总阳性率为44.71％,其中非小细胞癌20例,小细胞癌18例.所有患者术后均未发生气胸、肺内大出血等严重并发症.[结论]高分辨率CT片定位下对位于第5～9级支气管的病灶进行超选择性的刷检具有一定的诊断价值.     

Diagnostic Aspects of Fine Needle Aspiration for Lung Lesions: Series of 245 Cases

Background: Transthoracic fine needle aspiration (FNA) is one of several methods for establishing tissuediagnosis of lung lesions. Other tissue or cell sources for diagnosis include sputum, endobronchial biopsy, washingand brushing, endobronchial FNA, transthoracic core needle biopsy, biopsy from thoracoscopy or thoracotomy.The purpose of this study was to compare the sensitivity and specificity of FNA and other diagnostic tests indiagnosing lung lesions. Materials and Methods: The population included all patients undergoing FNA for lunglesions at Meir Medical Center from 2006 through 2010. Information regarding additional tissue tests was derivedfrom the electronic archives of the Department of Pathology, patient records and files from the Department ofOncology. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculatedfor each test. Results: FNA was carried out in 245 patients. Malignant tumors were diagnosed in 190 cases(78%). They included adenocarcinoma (43%), squamous cell carcinoma (15%), non-small cell carcinoma, nototherwise specified (19%), neurondocrine tumors (7%), metastases (9%) and lymphoma (3%). The specificityof FNA for lung neoplasms was 100%; sensitivity and diagnostic accuracy were 87%. Conclusions: FNA is themost sensitive procedure for establishing tissue diagnoses of lung cancer. Combination with core needle biopsyincreases the sensitivity. Factors related to the lesion (nature, degenerative changes, location) and to performanceof all stages of test affect the ability to establish a diagnosis.     

Lung cancer in systemic lupus erythematosus

BACKGROUND: Evidence points to a link between systemic lupus erythematosus (SLE) and an increased risk of lung cancer. Our objective was to provide a brief report of the lung cancer cases from an SLE cohort, with respect to demographics, histology, and exposures to smoking and immunosuppressive medications. METHODS: Data were obtained from a multi-site international cohort study of over 9500 SLE patients from 23 centres. Cancer cases were ascertained through linkage with regional tumor registries. RESULTS: We analyzed information on histology subtype for 30 lung cancer cases that had occurred across five countries. Most (75%) of these 30 cases were female, with a median age of 61 (range 27-91) years. In eight cases, the histological type was not specified. In the remainder, the most common histological type reported was adenocarcinoma (N=8; two of the adenocarcinomas were bronchoalveolar carcinoma) followed by small cell carcinoma (N=6), and squamous cell carcinoma (N=6) with one case each of large cell carcinoma and carcinoid tumor. Most (71%) of the lung cancer cases were smokers; only the minority (20%) had been previously exposed to immunosuppressive agents. CONCLUSIONS: The histological distribution of the lung cancers from the SLE sample appeared similar to that of lung cancer patients in the general population, though the possibility of a higher proportion of more uncommon tumors (such as bronchoalveolar and carcinoid) cannot be excluded. A large proportion of the cancer cases were smokers, which is also not surprising. However, only a minority appeared to have been exposed to immunosuppressive agents. A large case-cohort study currently in progress should help shed light on the relative importance of these exposures in lung cancer risk for SLE patients.     

Lung cancer histologic type in the surveillance, epidemiology, and end results registry versus independent review

Because few studies have assessed the accuracy of lung cancer histologic diagnoses reported by state cancer registries, we examined whether the Iowa Surveillance, Epidemiology, and End Results Cancer Registry (i.e., the Iowa Cancer Registry)-reported lung cancer histologic diagnoses were reliable. We investigated agreement between lung cancer histologic types reported for 413 patients with lung cancer by the Iowa Cancer Registry and those obtained through an independent review of diagnostic slides. Among lung cancer histologic types, small-cell carcinoma had the highest sensitivity (94.1%, 95% confidence interval [CI] = 85.6% to 98.4%), positive predictive value (94.1%, 95% CI = 85.6% to 98.4%), negative predictive value (98.8%, 95% CI = 96.9% to 99.7%), and highest percent exact agreement (98.0%, 95% CI = 96.6% to 99.4%). The lowest sensitivity (21.9%, 95% CI = 9.3% to 40.0%) and positive predictive value (23.3%, 95% CI = 9.9% to 42.3%) were noted for large-cell carcinoma, probably because other more specific features of adenocarcinoma or squamous carcinoma were absent. Adenocarcinoma had the lowest specificity (84.4%, 95% CI = 79.0% to 88.9%), negative predictive value (85.2%, 95% CI = 79.9% to 89.6%), and percent exact agreement (82.9%, 95% CI = 79.2% to 86.6%). Samples collected by cytologic examination (odds ratio [OR] = 2.4, 95% CI = 1.1 to 5.2) or biopsy examination (OR = 2.2, 95% CI = 1.1 to 4.2) were more likely to be misclassified than samples obtained via resection. Thus, the histologic type obtained by the Iowa Cancer Registry is reasonably reliable, but independent slide review is needed for precise histologic typing of lung cancer.     

Bronchoscopic invasive diagnostic techniques in the cancer patient.

The cancer patient often presents with fever and pulmonary infiltrates, in particular during the course of chemotherapy or after bone marrow transplantation. In these conditions, specific diagnoses are mainly related to an infective cause, but noninfectious processes, malignant or not, are also found alone or in combination with infection. Identification of the pulmonary process can be achieved by bronchoscopic techniques, including bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB). BAL may help identify opportunistic organisms but also bacterial pneumonia, provided quantitative cultures are performed, and TBB has been shown to increase the diagnostic yield of BAL. These two procedures should then be combined, provided there is no contraindication.     

实时超声支气管镜引导下经支气管针吸活检术对肺癌的诊断作用

评价实时超声支气管镜引导下的经支气管针吸活检术（EBUS-TBNA）对肺癌的诊断价值。方法:回顾分析中山大学肿瘤防治中心2010年8月至2011年2月期间,46例经胸部CT或PET-CT检查显示为纵隔和/或肺门淋巴结肿大和/或胸内气管旁肿块（≥1 cm）的患者行EBUS-TBNA的资料（其中临床拟诊为肺癌并肺门和/或纵隔淋巴结转移25例,纵隔和/或肺门不明原因淋巴结肿大21例）,统计实时EBUS-TBNA在肺癌诊断中的敏感性、特异性、阳性预测值、阴性预测值及诊断率。结果:46例患者中,其中经病理学检查确诊为肺癌患者38例,淋巴结结核3例,淋巴结炎3例,结节病1例,淋巴瘤1例。46例患者中,经EBUS-TBNA诊断为肺癌34例,淋巴结核2例,淋巴结炎3例,结节病1例。38例肺癌患者共穿刺48组淋巴结,1例气管旁肿物,其中经EBUS-TBNA诊断为肺癌34例,假阴性4例,敏感性为89.5%,特异性为100%,阳性预测值为100%,阴性预测值为66.7%,诊断率为87.0%。EBUS-TBNA过程安全,全部病例无严重并发症发生,仅1例一过性发热。结论:实时EBUS-TBNA,并发症少,可在门诊进行,且诊断率、敏感性及阴性预测值高,是诊断肺癌安全、有效的方法。当常规支气管镜未能取到阳性病理结果时,亦可尝试通过对肺门或纵隔淋巴结或肺内肿块行EBUS-TBNA来诊断。      

Report on the incidence of interstitial lung diseases in Spain

BACKGROUND AND AIM OF THE WORK: Almost no epidemiological data are available on a worldwide basis on the prevalence, incidence or relative frequency of interstitial lung diseases (ILD). We report the results of a registration of ILD by 23 centers of pulmonary medicine in Spain over one year (from October 2000 to September 2001). METHODS: A standardized questionnaire was sent to the centers, together with guidelines for classification and diagnostic evaluation. This questionnaire included questions about the explorations performed to establish the diagnosis. RESULTS: A total of 511 cases were registered. The mean age of the patients was 61 +/- 0.7 (x +/- SEM) yrs. The male to female ratio was 1.2:1. The estimated incidence of ILD was 7.6 per 100,000/year. The most frequent disease was idiopathic pulmonary fibrosis (38.6%), followed in decreasing order by sarcoidosis (14.9%), cryptogenic organizing pneumonia (10.4%), ILD associated with collagen vascular diseases (9.9%) and hypersensitivity pneumonitis (6.6%). In 5.1% of cases ILD was unclassified. HRCT scan was performed in 91.9% of cases, bronchoalveolar lavage in 67.9%, transbronchial lung biopsy in 59.9%, and surgical lung biopsy in 22.7%. CONCLUSIONS: This registration provides interesting information on the occurrence of ILD in Spain and on the procedures used to establish the diagnosis.     

内皮抑素在肺癌患者外周血清及支气管肺泡灌洗液中的表达研究

 目的 探讨内皮抑素（Endostatin）在肺癌患者外周血清及支气管肺泡灌洗液（Bronchoalveolar lavage fluid，BALF）中的表达以及与肺癌临床病理生理特征的关系。方法 采用酶联免疫吸附法（Enzyme-linked immunosorbent assay，ELISA）检测初诊肺癌47例及肺良性病变18例患者外周血清及BALF中Endostatin的表达水平。结果 肺癌患者外周血清及BALF中Endostatin分别为（131．71±50．32）ng／ml和（502．56±302．00）ng／ml，显著高于肺良性病变者（P〈0．01）；肺癌晚期、有淋巴结及远处转移、肺腺癌患者外周血清及BALF中Endostatin高表达；肺癌患者Endostatin在外周血清及灌洗液中的表达呈线性正相关（P=0．000）。结论 检测外周血清及支气管肺泡灌洗液中Endostatin均有助于肺癌的诊断及较好提示其生物学行为。     

经支气管镜肺活检对周围型肺癌的诊断价值

背景与目的 肺癌是现今全世界发病率和死亡率最高的恶性肿瘤.由于部位特殊和检查方法的局限,周围型肺癌诊断较困难,应用经支气管镜肺活检(TBLB)技术,旨在评价TBLB对周围型肺癌的诊断价值.方法 78例周围型肺癌,经支气管镜常规检查无法观察到病变,采用TBLB证实42例.对于未获得诊断的36例周围型肺癌患者,其中22例通过CT引导下经皮肺活检(PNLB)证实,另外14例患者依次经外科手术、淋巴结活检、胸膜活检、胸水细胞学检查等获取标本,经病理学或细胞学检查证实.结果 已经病理学或细胞学确诊为肺癌78例,经支气管镜肺活检、刷检的阳性率分别为53.8%、8.9%,联合后总阳性率为57.7%;两种取材方法中,以TBLB的阳性率最高,与刷检相比,差异有统计学意义(P<0.01);随着病灶逐渐增大,活检阳性率逐渐增高;右肺活检阳性率高于左肺,两下叶活检阳性率高于上叶;病例越靠近肺内带和肺门,TBLB的活检阳性率越高;PNLB并发症发生率高于TBLB.结论 经支气管镜肺活检检查是确诊周围型肺癌的重要手段之一,联合应用多种取材方法和技术可提高周围型肺癌的诊断准确率.     

Centrally Located Squamous Cell Carcinoma of the Lung Mimicking Endobronchial Tuberculosis

Here we report a case of centrally located squamous cell carcinoma of the lung mimicking endobronchial tuberculosis. On the basis of the white light bronchoscopic (WLB) findings, bronchial tuberculosis was initially suspected. But transbronchial biopsy of the lesion revealed squamous cell carcinoma. Autofluorescence imaging bronchovideoscopy (AFI) showed the lesion area as magenta. After four cycles of chemotherapy, the magenta area was markedly shrunk on AFI. Performance of AFI might be useful for differentiating centrally located lung cancer from endobronchial tuberculosis.     

Bronchogenic carcinoma and secondary aspergillosis--common yet unexplored: evaluation of the role of bronchoalveolar lavage-polymerase chain reaction and some nonvalidated serologic methods to establish early diagnosis

BACKGROUND: More cases of bronchogenic carcinoma have been reported in recent years, and these patients are more prone to secondary aspergillosis. However, the frequency of secondary aspergillosis in bronchogenic carcinoma still has not been defined clearly in the literature. METHODS: The current study population was comprised of 69 patients with bronchogenic carcinoma and 16 healthy controls. Histopathologic examination was done to identify carcinoma cell types and to categorize aspergillosis types. Bronchoalveolar lavage (BAL) fluids were collected for direct fungal examination, culture, Aspergillus polymerase chain reaction (PCR), and galactomannan (GM) detection using a 1-stage immunoenzymatic sandwich microplate assay; and blood samples were collected for fungal serology by double immunodiffusion (DID), enzyme-linked immunosorbent assay (ELISA), and dot blot assay (DBA). The sensitivity, specificity, positive predictive value, and negative predictive value were analyzed for various nonvalidated tests. Twenty-five patients had follow-up data available for an analysis of clinical and diagnostic outcomes. RESULTS: The cohort included patients with squamous cell carcinoma (n = 47), adenocarcinoma (n = 16), small cell carcinoma (n = 3), large cell carcinoma (n = 2), and undiagnosed type (n = 1), and patients were categorized with definite invasive pulmonary aspergillosis (IPA) (n = 6), probable IPA (n = 17), possible IPA (n = 13), and non-IPA (n = 33). Most patients were in the group ages 45 years to <60 years, and there was a preponderance of men (10.5:1). Cultures from 20 of 69 patients (29%) revealed the growth of Aspergillus species. Anti-Aspergillus antibodies were detected in 26 of 69 patients (37.7%) each by DID and DBA, whereas antibodies were detected in 28 of 69 patients (40.6%) by ELISA. GM was detected in BAL fluids from 25 of 69 patients (36.2%), whereas Aspergillus DNA was detected in 32 of 69 patients (46.4%) by PCR. The sensitivity of PCR and serologic tests (ELISA, DID, and DBA) was 100% for definite IPA, whereas the sensitivity of PCR was comparatively higher than that of serologic tests for probable IPA, possible IPA, and non-IPA. CONCLUSIONS: The current study indicated that there frequently is an association between bronchogenic carcinoma and secondary aspergillosis, and definite IPA and probable IPA are common clinical problems in patients with nonsmall cell lung cancer.     

Carcinoembryonic antigen in the diagnosis of lung-cancer using bronchoalveolar lavage - a comparative-study with healthy-subjects, chronic-bronchitis, respiratory-infections and interstitial pulmonary-diseases

The use of serum CEA values in the prognosis and in monitoring the course of lung cancer is well accepted. However, the main problem presented by using serum CEA determinations for diagnosis is the lack of sensitivity. In this study, sensitivity was increased by determining CEA using bronchoalveolar lavage (BAL) of the affected lung. We studied CEA in the BAL of healthy subjects and patients with chronic bronchitis, respiratory infections and interstitial pulmonary diseases to observe if CEA could differentiate malignancies from benign pulmonary pathologies. Five groups of patients (previously described) were studied using BAL in the affected area of the patients with lung pathologies or in the middle lobe and lingula of healthy people. CEA was analyzed in the BAL using radioimmunoanalysis according to the Behring Institute recommendations. CEA levels in BAL of lung cancer patients were higher than in the other groups. No correlation was found between CEA concentrations in BAL and tumor histology. CEA studies in BAL may be useful in the diagnosis of lung cancer and in the screening of the high risk people to develop bronchial carcinoma.     

The trend of small cell lung cancer among young men

In this report, we investigated the distribution of histologic types of lung cancer by age in Turkey. Among 1354 lung cancer cases diagnosed in Social Security Agency Okmeydani Hospital, Istanbul, Turkey, we included 912 male cases with data on age, smoking status, and histopathologic type. We calculated the smoking-adjusted risk for histopathologic types by age. A majority of the cases were between 45 and 64 years of age (70.5%). The smoking-adjusted risk of squamous cell carcinoma increased with advancing age, while the risk of small cell carcinoma decreased with age. The risk of small cell carcinoma was 1.6 times higher among men younger than 45 years of age compared to older men (odds ratios (OR): 1.6, 95% confidence intervals (CI): 1.1-2.3). In conclusion, we found a significant decreasing trend for small cell carcinoma by increasing age, which resulted with an excess risk among men younger than age 45.     

CEA levels in serum and BAL in patients suffering from lung cancer

Background Carcinoembryonic antigen (CEA) is a tumor marker belonging to the immunoglobulin gene superfamily of adhesion molecules. CEA is synthesized by epithelial and tumor cells. In this study, CEA levels in sera and bronchoalveolar lavage fluid (BAL) were measured in patients with malignant lung cancer and benign lung diseases. Methods In the present study CEA was measured in serum using IRMA methods and in bronchoalveolar lavage of individuals undergoing fiberoptic bronchoscopy. Fifty patients with lung cancer (G1), 20 patients with benign lung lesions (G2), and a control group consisted of 20 individuals (G3) were enrolled in the study. Results We found that serum CEA levels were significantly higher in G1 compared to G2 and G3 (p < 0.01). No significant difference in serum CEA levels was found between smokers and nonsmokers in any of the three groups studied. CEA was significantly higher in G1 BAL (p < 0.05) compared to G2 and G3 BAL. Furthermore, a statistically significant difference was found in CEA levels in BAL between smokers and nonsmokers of G2. Conclusions CEA levels in BAL of normal individuals may be influenced by smoking and other factors that affect lung epithelial cell function. Thus, CEA measurement in BAL alone has little value in the diagnosis of malignancy. BAL CEA levels in smokers of G2 are found significantly higher compared with nonsmokers of the same group and healthy individuals. Smokers of G2 have to be followed up carefully for the possibility of lung cancer growth.     

模拟定位器引导经皮穿刺肺活检(附19例报告)

1978年4月至1984年2月我们使用模拟定位器引导,对19例周围型肺癌进行经皮肺针吸活检(PALB),获阳性病理诊断12例,阳性率63.2％。其中腺癌5例、鳞癌4例、小细胞癌1例,癌(未分类)2例。PALB阳性组12例中,经药物治疗7例均在3～11月内死亡;采取手术治疗5例,术后病理学诊断与PALB诊断相同。PALB阴性组7例均行手术治疗,术后病理诊断为腺癌3例、鳞癌3例、支气管肺泡癌1例。本方法对肺癌早期诊断为一有用途径。     

NOB1 expression predicts early response to cisplatin-based chemotherapy in patients with advanced non-small cell lung cancer

Background: The aim of this study was to investigate the predictive value of Nin one binding (NOB1) expression for response to cisplatin-based chemotherapy in patients with advanced non-small-cell lung cancer (NSCLC).

Methods: A total of 105 consecutive patients with advanced NSCLC were retrospectively investigated between January 2012 and June 2014. We used transbronchial biopsy to collect cancer tissue samples. Immunohistochemistry were used in the detection of NOB1 protein expression. We assessed the chemotherapy early response by response evaluation criteria in solid tumours (RECIST) Version 1.1 at the end of the second cycle of chemotherapy.

Results: In the 105 transbronchial biopsy NSCLC specimens, 22 (21.0%) stained NOB1 ??, 35 (33.3%) stained +, 31 (29.5%) stained ++ and 17 (16.2%) stained +++. The early response rate to chemotherapy was 59.0% in overall NSCLC. Early response to chemotherapy has no relationship with patients' age, gender, smoke status, performance status and chemotherapy regimens (P>0.05), but related with TMN stage, histopathological grade, as well as NOB1 expression (P?P?=?0.008) for early response to chemotherapy.

Conclusion: Our results suggest that enhanced expression of NOB1 related with poor early response to cisplatin-based chemotherapy in patients with advanced non-small cell lung cancer.     

Association between chronic lymphocytic leukemia and sarcoidosis: clinical value of bronchoalveolar lavage

We report a case of sarcoidosis, occurred in a patient with chronic lymphocytic leukemia (CLL) shortly following the completion of initial chemotherapy, who relapsed shortly after a second course. Since bronchoalveolar lavage (BAL) demonstrated a predominance of CD4+ lymphocytes, it largely excluded spread of the malignant disorder to the lung, and strongly suggested that sarcoidosis was the cause of the pulmonary infiltrates. This diagnosis was confirmed by the finding of non-caseating granuloma on transbronchial lung biopsy.     

肺泡灌洗液中多聚免疫球蛋白受体分泌片段测定的临床意义

背景与目的:检测肺癌患者支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)中多聚免疫球蛋白受体分泌片段(polymeric immunoglobulin receptor secretory component,pIgR SC)的蛋白水平,并探讨其临床意义.材料与方法:采用酶联免疫吸附分析法(ELISA)测定52例肺癌患者患侧肺及其中18例患者配对健侧肺BALF中pIgR SC的蛋白水平.结果:肺癌患者患侧BALF中pIgR SC蛋白水平显著高于健侧对照组(P=0.009);肺腺癌患者BALF中pIgR SC蛋白水平显著高于肺鳞癌患者(P=0.014);而在肺鳞癌患者组,手术时发现淋巴结转移的患者BALF中pIgR SC蛋白水平显著高于手术时未发现淋巴结转移患者(P=0.012).结论:BALF中pIgR SC蛋白水平在肺癌患者患侧较健侧显著升高,肺腺癌患者BALF中plgR SC蛋白水平显著高于肺鳞癌患者,BALF中pIgR SC蛋白水平与肺鳞癌淋巴结转移密切相关.