ABSTRACT
We described here a patient who had two lung masses. Although the two masses had the same histology and a similar good response to initial chemotherapy with gemcitabine and carboplatin, the response to pemetrexed as a second-line treatment was different after re-growth of the tumors. These two lung masses could have originated from different clones or they could have progressed through different paths of molecular pathogenesis after metastasis, which would lead to different tumor characteristics, including their chemosensitivity. Regardless of their pathogenetic mechanisms, it seems important to recognize that tumors with the same histology that develop in one patient can have different responses to drugs.
Subject(s)
Aged , Female , Humans , Antimetabolites, Antineoplastic/therapeutic use , Antineoplastic Agents/therapeutic use , Carboplatin/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Deoxycytidine/analogs & derivatives , Drug Resistance, Neoplasm , Glutamates/therapeutic use , Guanine/analogs & derivatives , Lung Neoplasms/drug therapy , Neoplasms, Second Primary/drug therapyABSTRACT
Although a paradoxical response of tuberculosis to antituberculous therapy is not a rare phenomenon, it can be a clinical challenge to differentiate a paradoxical response from treatment failure. A 25-year-old woman was admitted for miliary lung nodules and multiple intracranial nodules. Antituberculous treatment was started with a preliminary diagnosis of tuberculosis based on the history and clinical findings. After one month, the miliary lung nodules improved while the intracranial nodules increased in size and number. Based on a stereotactic biopsy, it was confirmed that the intracranial lesions were tuberculomas. Although the therapeutic regimen was not changed, the symptoms eventually were ameliorated and the intracranial nodules improved two months later.
Subject(s)
Adult , Female , Humans , Biopsy , Lung , Treatment Failure , Tuberculoma , Tuberculoma, Intracranial , TuberculosisABSTRACT
Angioimmunoblastic T-cell lymphoma (AITL) is a systemic lymphoproliferative disorder that presents with profound immune dysfunction and immunodeficiency. As in many other immunodeficiencies, Epstein-Barr virus (EBV) associated B-cell lymphoid proliferation can occur in AITL but few cases of EBV-positive B-cell lymphoma have been reported in patients with preexisting AITL. We report a case of AITL in which EBV-positive diffuse large B-cell lymphoma (DLBCL) developed 13 months after the initial diagnosis of AITL. Although the exact mechanisms remain unclear, Epstein-Barr virus may have played a role in the pathogenesis of the secondary DLBCL
Subject(s)
Humans , B-Lymphocytes , Herpesvirus 4, Human , Lymphoma, B-Cell , Lymphoma, T-Cell , Lymphoproliferative Disorders , T-LymphocytesABSTRACT
Pulmonary alveolar proteinosis is a rare disorder that is characterized by the abundant accumulation of surfactant-derived material within the alveolar spaces and distal bronchioles. Although the findings of homogenous ground-glass opacities overlaid by thickened septa, which form a "crazy paving" pattern on high-resolution computed tomography, can assist in making a diagnosis, a lung biopsy is usually required. This disorder has a variable clinical course, from spontaneous resolution to respiratory failure and death. While a whole lung lavage has been the standard treatment since the early 1960s, GM-CSF therapy has been attempted based on the recently suggested pathogenetic mechanism. We report a case of pulmonary alveolar proteinosis that resolved spontaneously after an open lung biopsy.
Subject(s)
Biopsy , Bronchioles , Bronchoalveolar Lavage , Diagnosis , Granulocyte-Macrophage Colony-Stimulating Factor , Lung , Pulmonary Alveolar Proteinosis , Respiratory InsufficiencyABSTRACT
Gefitinib is a novel drug used to treat advanced non-small cell lung cancer. However, drug-related interstitial pneumonia is a major life-threatening side effect, which has a worldwide prevalence of 0.3-0.4%. In Japan, the prevalence is high as 3-4% but the actual frequency in Korea has not been officially assessed. We report two cases of gefitinib-induced interstitial lung disease during the treatment of non-small cell lung cancer. High-resolution computerized tomography (HRCT) of one case showed nonspecific ground glass opacity and the chest x-ray of another case showed diffuse bilateral ground glass opacity. The former patient showed a rapid good response to corticosteroid treatment whereas the latter died despite receiving aggressive treatment with high dose corticosteroid and empirical antibiotics.