Tracheal pleomorphic adenoma with coexisting pulmonary tuberculoma / 영남의대학술지

Tracheal tumors are rare and difficult to diagnose. Moreover, delays in diagnosis are very common because the symptoms are nonspecific. As a result, tracheal tumors are commonly mistreated as chronic obstructive pulmonary disease or bronchial asthma. We report a case of a 49-year-old male who presented with a 3-month history of dyspnea and cough. Chest computed tomography scan showed a 1.5×1.3 cm homogenous tumor originating from the right lateral wall of the tracheobronchial angle into the tracheal lumen as well as a 0.5×0.4 cm round nodular lesion at the right upper lobe with multiple mediastinal lymph nodes enlargement. Bronchoscopic findings revealed a broad-based, polypoid lesion nearly obstructing the airway of the right main bronchus. The patient was diagnosed with pleomorphic adenoma which is the most common benign tumor of the salivary glands, but rarely appears in the trachea. Upon surgery, tracheal pleomorphic adenoma and co-existing active pulmonary tuberculoma that had been mistreated as bronchial asthma over 3 months was revealed. Following surgery, the patient underwent anti-tuberculosis treatment. No recurrence has been detected in the 3 years since treatment and the patient is now asymptomatic.

Tracheal pleomorphic adenoma with coexisting pulmonary tuberculoma / 영남의대학술지

Tracheal tumors are rare and difficult to diagnose. Moreover, delays in diagnosis are very common because the symptoms are nonspecific. As a result, tracheal tumors are commonly mistreated as chronic obstructive pulmonary disease or bronchial asthma. We report a case of a 49-year-old male who presented with a 3-month history of dyspnea and cough. Chest computed tomography scan showed a 1.5×1.3 cm homogenous tumor originating from the right lateral wall of the tracheobronchial angle into the tracheal lumen as well as a 0.5×0.4 cm round nodular lesion at the right upper lobe with multiple mediastinal lymph nodes enlargement. Bronchoscopic findings revealed a broad-based, polypoid lesion nearly obstructing the airway of the right main bronchus. The patient was diagnosed with pleomorphic adenoma which is the most common benign tumor of the salivary glands, but rarely appears in the trachea. Upon surgery, tracheal pleomorphic adenoma and co-existing active pulmonary tuberculoma that had been mistreated as bronchial asthma over 3 months was revealed. Following surgery, the patient underwent anti-tuberculosis treatment. No recurrence has been detected in the 3 years since treatment and the patient is now asymptomatic.

Changes in skin reactivity and associated factors in patients sensitized to house dust mites after 1 year of allergen-specific immunotherapy

BACKGROUND: Allergen-specific immunotherapy (SIT) can significantly improve symptoms and reduce the need for symptomatic medication. OBJECTIVE: The aim of this study was to investigate changes in skin reactivity to house dust mites (HDMs) as an immunologic response and associated factors after 1 year of immunotherapy. METHODS: A total of 80 patients with allergic airway diseases who received subcutaneous SIT with HDMs from 2009 to 2014 were evaluated. The investigated parameters were basic demographic characteristics, skin reactivity and specific IgE for HDM, serum total IgE level, blood eosinophil counts, and medication score. RESULTS: The mean levels of skin reactivity to HDMs, blood eosinophil counts, and medication scores after 1 year were significantly reduced from baseline. In univariate comparison of the changes in skin reactivity to HDMs, age ≤30 years, HDMs only as target of immunotherapy, and high initial skin reactivity (≥2) to HDMs were significantly associated with the reduction in skin test reactivity. In multivariate analysis, high initial skin reactivity and HDMs only as target allergens were significantly associated with changes in skin reactivity to HDMs. In the receiver operating characteristic curve of the initial mean skin reactivity to HDMs for more than 50% reduction, the optimal cutoff value was 2.14. CONCLUSION: This study showed significant reductions in allergen skin reactivity to HDMs after 1 year of immunotherapy in patients sensitized to HDMs. The extent of initial allergen skin reactivity and only HDMs as target allergen were important predictive factors for changes in skin reactivity.

A Case of Pulmonary Cryptococcosis Mimicking Bronchogenic Lung Cancer in an Immunocompetent Patient: A Review of the Literature / 대한의진균학회지

We experienced a 59-year-old immunocompetent female patient who complained progressive cough. A bronchoscopic examination revealed an endobronchial mass protruding from the left lower lobe and occluding anterior-basal segment bronchus. Bronchial biopsy and endobronchial ultrasound guided transbronchial needle aspiration were consistent with cryptococcal infection. However, the response of medical therapy was an unsuccessful. Finally, the patient underwent left lower lobectomy with lymph node dissection. We report a case of pulmonary cryptococcosis mimicking bronchogenic lung cancer, and surgical therapy with antifungal treatment resulted in successful resolution of the pneumonia.

Neuron-specific enolase as a novel biomarker reflecting tuberculosis activity and treatment response

BACKGROUND/AIMS: It is not clear which tests are indicative of the activity and severity of tuberculosis (TB). This study aimed to investigate the predictive value of neuron-specific enolase (NSE) and to determine the origin of NSE in TB patients. METHODS: A single-center retrospective analysis was conducted on newly diagnosed TB patients between January and December 2010. Patients were categorized into one of two disease groups (focal segmental or extensive) based on chest X-ray. Pre- and post-treatment NSE concentrations were evaluated. To determine the origin of serum NSE concentration, NSE staining was compared with macrophage-specific CD68 staining in lung tissues and with a tissue microarray using immunohistochemistry and immunofluorescence. RESULTS: A total of 60 newly diagnosed TB patients were analyzed. In TB patients, NSE serum concentration was significantly increased and NSE level decreased after treatment (p < 0.001). In proportion to serum high-sensitivity C-reactive protein concentration, the mean serum concentration of NSE in the extensive group (25.12 ng/mL) was significantly higher than that in the focal segmental group (20.23 ng/mL, p = 0.04). Immunohistochemical staining revealed a large number of macrophages that stained positively for both NSE and CD68 in TB tissues. In addition, NSE signals mostly co-localized with CD68 signals in the tissue microarray of TB patients. CONCLUSIONS: Our results suggest that NSE may be a practical parameter that can be used to monitor TB activity and treatment response. Elevated serum NSE level originates, at least in part, from macrophages in granulomatous lesions.

Efficacy of Foreign Body Removal using a Cryoprobe in Flexible Bronchoscopy / 고신대학교의과대학학술지

OBJECTIVES: Endobronchial foreign body impaction is a medical emergency because of the air way obstruction. Therefore, immediate foreign body removal is crucial in such situations. Recently, there have been several reports about cryoprobe use as a tool for removal of foreign bodies. In this study, we determined the efficacy and complications of foreign body removal using a cryoprobe during flexible bronchoscopy. METHODS: This is a retrospective review of 27 patients who visited Kosin University Gospel Hospital from August 2007 to August 2010 with respiratory symptoms due to a foreign body in the airway. There were 17 males and 10 females, aged from 7 to 78 years. The foreign bodies were more frequently located (55%) in the right bronchus. The cryoprobe was inserted through the forceps channel of the flexible bronchoscope under local anesthesia. The lesion was quickly frozen for 5 seconds at -80degrees C, and the bronchoscope was removed with the probe after crystal formation on the contacted area. RESULTS: The success rate of removal of foreign bodies was 85% (23/27) using the cryoprobe. One case of broncholith did not undergo attempted removal because of the possibility of excessive hemorrhage by the tight bronchus impaction, and three cases (plastic,silicon,and implant) failed due to limited crystal formation. There were no severe hemorrhages, arrhythmias, or casualties during the procedure. CONCLUSIONS: The removal of foreign body using a cryoprobe during flexible bronchoscopy was shown to be safe and effective. The nature of the material should be attempted before removing a foreign body.

Association between genetic variations of the transforming growth factor beta receptor type III and asthma in a Korean population

Transforming growth factor-beta (TGF-beta) and its receptors have been suggested to play key roles in the pathogenesis of asthma. The aim of this study was to evaluate the effects of genetic variations in the TGF-beta receptor type III (TGFBR3) on asthma and on its related phenotypes in the general population. A cohort of 2,118 subjects aged from 10 to 18 years responded to a questionnaire concerning asthma symptoms and risk factors. Methacholine airway hyperresponsiveness (AHR), skin test responses to common aeroallergens, and serum total IgE levels were evaluated in the cohort. A total of 19 SNPs for TGFBR3 were found using direct re-sequencing in 24 healthy adults. Of these, informative SNPs [+44T>C (S15F) and +2753G>A at 3'UTR] were selected and scored using the high throughput single base extension method. Atopy was identified in subjects with 44T>C allele [P = 0.04, OR (95% CI) = 0.79 (0.62-0.99)] and in subjects with Ht1 (CG) more frequently than in subjects with other haplotypes [P = 0.04, OR (95% CI) = 1.27 (1.01-1.59)]. The A allele in 2753G>A was more common in subjects with non-atopic asthma [OR (95% CI) = 1.76 (1.01-3.05)]. A significant association was found between non-atopic asthma and 44T_2753A [OR (95% CI) = 2.16 (1.22-3.82)]. Genetic variations in TGFBR3 appear to be associated with a genetic predisposition to development of asthma and to phenotypes of asthma. Also, the minor allele 2753G and the haplotype TA in the TGFBR3 gene were associated with a pathogenesis of non-atopic asthma.

Efficacy and Safety of Pemetrexed in Advanced Non-Small Cell Lung Carcinoma / 결핵및호흡기질환

BACKGROUND: Pemetrexed has been prescribed newly as a second line chemotherapy in advanced non-small cell lung carcinoma (NSCLC). The aim of study was to determine the efficacy and toxicity of pemetrexed in advanced NSCLC. METHODS: Patients with histologically or cytologically confirmed NSCLC were evaluated from June 2006 to December 2008. The patients had relapsed or progressed after prior chemotherapy treatment. They were treated with intravenous pemetrexed 500 mg/m2 for 10 min on Day 1 of each 21-day cycle. RESULTS: A total of 89 patients were eligible for analysis. The response rate and disease control rate were 11% and 66%. Non-squamous cell carcinoma histology was significantly associated with a superior response rate (p=0.035) and disease control rate (p=0.009) than squamous cell carcinoma histology. The median survival time was 13 months and the median progression free survival time was 2.3 months. The median survival time of patients with ECOG PS 0~1 was 13.2 months, whereas median survival time was 11.6 months for patients with PS 2 (p=0.002). The median progression free survival time of patients with PS 0~1 were 3.8 months, but 2.1 months for patients with PS 2 (p=0.016). The median progression free survival time of smokers with non-squamous cell carcinoma was 3.4 months, which was significant (p=0.014). Grade 3~4 neutropenia were seen in 7.9% patients. CONCLUSION: Pemetrexed has efficacy in patients who had prior chemotherapy with advanced NSCLC and less hematologic toxicity.

EGFR and KRAS Mutations in Patients With Adenocarcinoma of the Lung

BACKGROUND/AIMS: Mutations of the epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene (KRAS) are important in the pathogenesis of lung cancer, and recent reports have revealed racial and geographical differences in mutation expression. METHODS: This study was conducted to investigate the prevalence of EGFR and KRAS mutations and their correlation with clinical variables in Korean patients with adenocarcinoma of the lung. Formalin-fixed adenocarcinoma specimens from 104 randomly selected patients diagnosed at Kosin University Gospel Hospital from October 1996 to January 2005 were used for the study. RESULTS: We found a high prevalence of EGFR mutations and a low prevalence of KRAS mutations. EGFR mutations were present in 24% (25 of 104) of the samples: one mutation in exon 18, 13 in exon 19, one in exon 20, and 10 in exon 21. The presence of an EGFR mutation was not associated with gender, smoking history, histological grade, age, bronchioalveolar components, or cancer stage in patients with adenocarcinoma of the lung. CONCLUSIONS: Mutations of KRAS were present in 9.6% (9 of 94) of the samples: eight in codon 12 and one in codon 13. EGFR mutations were never found in tumors with KRAS mutations, suggesting a mutually exclusive relationship.

Clinical Features of the Lung Cancer Patients Who Were Seen in Kosin University Gospel Hospital from 1994 to 1998

PURPOSE : Lung cancer is the leading cause of cancer death in the world, including Korea. The aim of this study was to investigate the clinical features of the lung cancer patients who were seen in a University hospital between 1994 to 1998. MATERIALS AND METHODS : We performed a retrospective review of lung cancer clinical information at Kosin University Gospel Hospital from 1994 to 1998. We analyzed the age, gender, pathologic types, treatment methods and survival. RESULTS : Among 1,547 patients, 1,232 patients (79.6%) were male. The age distribution ranged from 20 to 84 years, and the mean age was 60.2 years old. Squamous cell carcinoma was the most common type of lung cancer (39.7%), followed by adenocarcinoma (23.1%), and small cell carcinoma (16.4%). However, there was an increasing incidence of adenocarcinoma every year. The stages at the diagnosis were I : 6.6%, II : 6%, III : 45.6% and IV : 41.8%. For the small cell carcinoma, 44.6% of the patients were in a limited stage and 55.4% were in an extensive stage. The initial treatments included chemotherapy (46.5%), surgery (15.1%) and radiotherapy (5.1%), but 32.2% of the patients received supportive care only. For the cases receiving surgery, the 5 year survival rate for the stage I patients was 66%, that for the stage II patients was 43.2% and that for the stage III patients was 11.8%. The median survival time (MST) for patients who underwent surgery plus adjuvant chemotherapy was 3.22 year, but the MST of the surgery-treated only patients was 1.51 years. So, adjuvant chemotherapy prolonged survival (p=0.000). On the subgroup analysis, young age and female lung cancer patients who did not receive adjuvant chemotherapy showed poor survival. CONCLUSION : Squamous cell carcinoma was the most common type of lung cancer. The active treatments were important for the patients' prognosis. For the patients receiving surgery, adjuvant chemotherapy had a role in improving survival and especially for young age and female lung cancer patients

Sex-related Clinicopathologic Differences in Patients with Adenocarcinoma of the Lung / 결핵및호흡기질환

BACKGROUND: The incidence of adenocarcinoma of the lung has been increasing worldwide, and it has been generally been accepted to be relatively unrelated to smoking with a female preponderance. The aim of this study was to examine the gender-related pathological and survival differences in patients with an adenocarcinoma of the lung. MATERIAL AND METHOD: A retrospective review of the clinical information of patients diagnosed with an adenocarcinoma of the lung at Kosin Medical Center from January 1999 to September 2005 was performed. The patient's demographics (age, gender), smoking history, stage, serum tumor marker, pathology classification, EGFR mutation, K-ras mutation, treatment methods, and survival time were analyzed. RESULT: Of the 438 patients, 179 (40.9%) were female. The median age at the diagnosis was 58 years for females and 59 years for males. However, 25.8% of women and only 17.7% of men were under 50 years of age (p=0.02). The distribution of the disease stage was similar in both men and women. The bronchioloalveolar carcinoma component was diagnosed more often in women (11.2%) than in men (5.0%). The overall survival rate was higher in women than in men (p=0.01), and women had a superior therapeutic response to a combined treatment of surgery and chemotherapy. CONCLUSION: This study showed significant genders differences in terms of the smoking history, bronchioloalveolar carcinoma component, overall survival, and survival after combined treatment of surgery and chemotherapy. Therefore, gender differences should be considered when diagnosing and treating adenocarcinomas of the lung.

Detection of Pre-invasive Endobronchial Tumors with D-light/Autofluorescence System

Autofluorescence bronchoscopy (AFB) is one of the newly developed diagnostic tools to detect the pre-cancerous lesions in the bronchial tissue. The utility of DLight/AFB in the detection of pre-cancerous lesions was compared to the standard white light bronchoscopy (WLB). In 113 patients (male 106, female 7), who visited hospital for evaluation of lung cancer, WLB and AFB were done and 364 biopsy specimens were obtained from November 2001 to August 2002. The bronchoscopic findings on WLB and AFB were compared to the pathological findings. The pathologic diagnoses of the specimens were as follows: normal in 96; hyperplasia in 69; metaplasia in 32; mild dysplasia in 13, moderate dysplasia in 6, severe dysplasia in 4; carcinoma in situ in 6; invasive carcinoma in 57. The relative sensitivity of adjunctive AFB to WLB vs. WLB alone was 1.5 in moderate dysplasia or worse lesions, and 3.2 in intraepithelial neoplasia. The specificity of adjunctive AFB and WLB alone were 0.91 and 0.5, respectively. The adjunctive AFB to the standard WLB increased the detection rate of the localized pre-invasive lesions. However, there was high rate of false positive in AFB.

Photodynamic Therapy in Early Lung Cancer: A Report of Two Cases

Photodynamic therapy (PDT) that is based on the science of photochemistry has been recognized as a lung sparing local therapeutic modality that can achieve remarkable responses. It is an alternative treatment for early stage lung cancer patients who have poor lung function or multiple sites of cancer. Recently we treated a 70-year-old man who presented with squamous carcinoma in situ at a previous pneumonectomy site, and a 64-year-old man with a newly developed secondary superficial lung cancer, with PDT. There were no complications related to the procedure. Both patients had poor lung function due to prior lung cancer surgery. Clinical and histological complete remissions were achieved without any evidence of recurrence during 30 months of follow-up in both patients.

Smoking Status and Serum NSE Level, as Prognostic Factors in Adenocarcinoma of Lung / 결핵및호흡기질환

BACKGROUND: The incidence of lung adenocarcinoma, which is more prevalent in women and nonsmokers, is increasing. The aim of this study was to determine the prognostic factors of an adenocarcinoma of the lung. MATERIAL AND METHOD: The clinical information of patients diagnosed with an adenocarcinoma of the lung at the Kosin University Gospel Hospital from January 1994 to July 2004 was reviewed retrospectively. The survival time of these patients was analyzed by the patient's age, gender, performance status, weight loss, smoking history, location of the primary tumor, clinical stage, serologic tumor markers, and treatment modality. RESULTS: For all 422 patients with an adenocarcinoma of the lung, 247 (58.5%) were male, and their mean age was 59.8 years the. The majority of patients were smokers (58.3%), and the tumors were located in the periphery (59.7%). In the smokers, the tumor was located more in the central airway compared to the non-smokers (42.8% vs. 31.9%, p=0.12). The overall median survival time was 390 days (95% CI;304-436 days). Univariate survival analysis revealed that an older age (>or=65 years old), male, weight loss, smoker, central type, advanced clinical stage, elevated serum carcinoembryonic antigen (CEA, >5 ng/ml) and neuron specific enolase (NSE, >15 ng/ml), and the supportive care only were significantly poor prognostic factors. The median survival time was shorter in the smokers than nonsmokers (289 days vs. 533 days, p<0.001). In addition, it was also shorter in the elevated NSE group than in the normal range group (207 days vs. 469 days, p<0.001). Multivariate analysis showed that age, clinical stage, serum NSE, smoking status, and treatment modality were independent predictors of survival (hazard ratios: 1.68, 1.94, 1.92, 2.39 and 1.57, respectively). CONCLUSIONS: Smoking is an important prognostic factor in an adenocarcinoma of the lung, but not gender. This suggests that the better prognosis of women is more related with the lower rate of smoking. In addition, the elevated serum NSE is also an important prognostic in an adenocarcinoma of the lung.