Expression of two basic mRNA biomarkers in peripheral blood of patients with non-small cell lung cancer detected by real-time RT-PCR,individually and simultaneously

Although extensive research has been conducted on lung cancer markers, a singular clinically applicable marker has not been found yet. The objective of this study was to evaluate the sensitivity and the specificity of carcinoembryonic antigen [CEA] mRNA and lung-specific X protein [LUNX] mRNA biomarkers in peripheral blood to detect lung cancer individually and simultaneously.Thirty patients affected by lung cancer and 30 healthy individuals were studied in this research. Three vials of cDNA were made from each sample after taking peripheral blood samples and extracting total RNA. Each sample was examined by the real-time RTPCR technique. The result from each vial was then compared with the sensitivity of overall marker. The CEA mRNA was positive in 24 out of 30 lung cancer patients. Hence, its sensitivity was determined at 80%,differing significantly from that observed in healthy individuals, where 11 positive cases were seen. The overall sensitivity of this marker was significantly associated with positivity in vials 2 and 3 but not in vial 1 The LUNX mRNA was positive in 21 out of 30 patients, indicating 70% sensitivity. This finding significantly differed from that in healthy individuals. The overall sensitivity of this marker was significantly associated with positivity in vials 1 and 3, but not in vial 2. In 93.3% of the patients, at least one positive marker was observed.The mentioned mRNA could be suggested as sensitive and specific markers in peripheral blood for primary diagnosis of lung cancer.

Comparing docetaxel plus cisplatin with paclitaxel plus carboplatin in chemotherapy-naive patients with advanced non-small-cell lung cancer: a single institute study

The backbone of treatment in advanced non-small cell lung cancer is platinum-based doublet chemotherapy. We intended to compare the effectiveness of two commonly used regimens in real world practice. This single institute, parallel comparative post marketing study included 100 patients with chemo-naTve advanced [stage IIIB, IV] non-small cell lung cancer and Eastern Cooperative Oncology Group performance status of 0 to 2. They were randomly assigned by stratified blocks to receive Docetaxel/ Cisplatin [DC, n=50] on day 1 or Paclitaxel/Carboplatin AUC 5 [PC, n=50] on day 1, every 3 weeks for up to six cycles. Primary end point was progression free survival [PFS]; secondary end points were objective response rate, overall survival [OS] and toxicity. The administered dosage could be modified according to clinician's discretion for each individual patient. PFS was similar between DC and PC arms [4.5 +/- 0.3 v 4.6 +/- 1.8 months, respectively; HR= 1.337; 95% CI: 0.874 to 2.046, P = 0.181]. Although median overall survival for DC arm was longer [17.2 +/- 4.4 m] than PC arm [10.6 +/- 0.7 m] but was not statistically significant [P = 0.300]. The 1-year survival rates were in favor of DC arm [53.1% v 37.9%]. Objective response rates were similar in both groups. In our study, hematologic toxicity and neuropathy were more frequent in DC and PC arms, respectively. In our study two commonly used regimens of DC and PC showed statistically similar outcomes in terms of PFS and OS, albeit numerically results of OS and 1-year survival were in favor of DC arm

Primary anaplastic large cell lymphoma of trachea with subcutaneous emphysema and progressive dyspnea

Primary anaplastic large cell lymphoma of the trachea is a rare tumor. Common complaints are dyspnea and cough that could mimic a partially refractory asthma in some cases. We report a 16-year-old female with an anaplastic large cell lymphoma [null cell type] in which tracheal involvement was presented with life-threatening airway obstruction and subcutaneous emphysema. After debulking the tumor by endobronchial curettage, the patient was treated with chemotherapy followed by local radiotherapy. She had no evidence of local or distant recurrence after 25 months. Primary anaplastic large cell lymphoma of the trachea is a rare life-threatening disease. Nevertheless, this condition has a good prognosis if diagnosed immediately and treated with chemotherapy and radiotherapy

Inflammatory myofibroblastic tumor of the lung: case series

Inflammatory myofibroblastic tumor is a rare occurrence in general practice. Its biologic nature, natural history and response to different treatment modalities are obscure. We retrospectively reviewed clinical and pathological features of 5 patients with inflammatory myofibroblastic tumor of the lung observed between 1999 and 2006. Under-study patients were 3 women and 2 men with a median age of 32.6 years. All patients were symptomatic. Computed tomography [CT] scan demonstrated a mass in all cases. Four patients underwent surgery [tumor resection in 1, lobectomy in 1, bilobectomy in 1 and lobectomy with mediastinal mass debulking also in 1]. Complete resection was achieved in 2 patients who are currently alive with no evidence of disease. One died due to progressive disease. Another is alive with disease after incomplete resection, and one refused any kind of surgery. There was no operative mortality. All patients were under follow-up [range, 5 to 60 months; median 39 months]. This study illustrates that some inflammatory myofibroblastic tumors behave aggressively and have a poor prognosis. It also confirms that radical resection is the treatment of choice for this malignancy

Idiopathic bronchiolitis obliterans organizing pneumonia: case review

Bronchiolitis obliteans organizing pneumonia [BOOP] is characterized clinically by a subacute or chronic respiratory illness. The purpose of this study was to describe clinical and radiologic features of Idiopathic [cryptogenic] bronchiolitis obliterans organizing pneumonia. We retrospectively reviewed 11 patients with biopsy proven BOOP at Masih Daneshvari Hospital, for whom well documented clinical and radiographic data were available. The final diagnosis of BOOP was validated if the followings were present. 1] Negative sputum or bronchoalveolar lavage [BAL] analysis for Mycobacterium tuberculosis 2] Open lung biopsy [OLB] or trans-bronchial lung biopsy [TBLB] findings characteristic of BOOP. 3] Negative findings for systemic disorders or associated primary pulmonary lesions such as cancer. 4] Prompt response to steroid therapy. The mean age of patients with BOOP in this case series was 46.3 +/- 24.6 yrs. [range 32-70]; the male/female ratio was 7/4. The clinical pattern in BOOP presentation was more similar to classic sub-acute infectious process: dyspnea in 9 patients [81.8%], fever in 5 [45.4%], and cough in 6 [54.5%]. The symptoms were usually mild. Physical examination showed sparse crackles in 5 patients [45.4%] and wheezing in 7 [63.6%]. The most frequent radiologic patterns were ground glass appearances [63.6%] and diffuse infiltration associated with reticular pattern [27.2%]. In 6 patients chest images showed bilateral distribution. The clinical and radiological manifestation of BOOP in our patients did not differ from other reports. BOOP cases may present a distinct entity like pneumonia. Physicians in charge of these patients were all surprised of BOOP diagnosis by tissue examination. Trans- bronchial lung biopsy specimens along with strongly suggestive clinical and radiologic findings in many cases were adequate for making the diagnosis. We suggest that the diagnosis of BOOP must be considered in any immunocompetent patient with pneumonia with poor or no response to antibiotic therapy

49-year-old woman with refractory chronic sinusitis. Sarcoidosis with granulomatous sinusitis Photo Quiz

A 49-year-old married, non- smoker housewife had purulent rhinorrhea, nasal congestion, post nasal drip [PND], and feeling of sinus pressure following an episode of common cold. She had no complaints of fever, cough, dyspnea, or arthralgia. Physical examination revealed PND and a posterior auricular lymphadenopathy [1cm X 1cm]. The patient received amoxicillin for 2 weeks with mild improvement. But again, she experienced the exacerbation of signs and symptoms a week later. CT-scan of the paranasal sinuses was performed [Figure 1]. She also had erythematous patches on her face around the right eye and her back, along with splenomegaly. The patient was treated with amoxicillin/clavulanate [for two weeks], loratadine, and beclomethasone nasal spray as well as normal saline nasal wash. There was a slight improvement in patient's signs but, repeatedly after two weeks signs and symptoms exacerbated. Due to the lack of response to antibiotics, a biopsy of the skin lesion was taken which revealed the following histopathological findings

clinicopathologic study of lung cancer cases in Iran

Lung cancer remains the leading cause of cancer-related deaths in the world. In Iran, lung cancer is the fifth leading cancer and its prevalence rate has been increasing steadily. In this study, the clinicopathological aspects of lung cancer are discussed. Between October 2002 and November 2005, 242 [178 men, 64 women] patients with histologically confirmed lung cancer were interviewed according to a questionnaire. Women developed the disease at an earlier age than men [55.9 +/- 14.2 versus 61.3 +/- 12.3 years; p=0.004]; 66.5% of lung cancer patients [85.4% of men and 14.1% of women] were smokers [p<0.0001]; 76.3% of participants, who had exposure to secondhand smoke, were females. Among the environmental carcinogens, the most exposures were to inorganic dusts [49.8%] and chemical compounds [34.9%].Most male and female patients suffered from adenocarcinoma [28.9%] and non small cell carcinoma [28.5%]. The prevalence of adenocarcinoma was higher in the non-smoker group, whereas incidence of squamous cell carcinoma and small cell carcinoma was higher among smokers [p<0.0001]. In this study, most patients [74.0%] presented with an advanced-stage tumor [IIIB or IV]. Our results suggest that in addition to cigarette smoking, other environmental, occupational and socioeconomic factors may play a role in the development of lung cancer

Fungal peritonitis in Iranian children on continuous ambulatory peritoneal dialysis

Fungal peritonitis [FP], causing catheter obstruction, dialysis failure, and peritoneal dysfunction, is a rare but serious complication of peritoneal dialysis. In this study, the frequency and risk factors of FP are evaluated in children who underwent peritoneal dialysis. A retrospective multicenter study was performed at the 5 pediatric peritoneal dialysis centers in Iran from 1971 to 2006, and FP episodes among 93 children were reviewed. Risk ratios were calculated for the clinical and demographic variables to determine the risk factors of FP. Ninety-three children aged 39 months on average were included in study. Sixteen out of 155 episodes of peritonitis were fungi infections, all by Candida albicans. The risk of FP was higher in those with relapsing bacterial peritonitis [P = .009]. Also, all of the patients had received antibiotics within the 1 month prior to the development of FP. Catheters were removed in all patients after 1 to 7 days of developing FP. Six out of 12 patients had catheter obstruction and peritoneal loss after the treatment and 5 died due to infection. Fungal peritonitis, accompanied by high morbidity and mortality in children should be reduced by prevention of bacterial peritonitis. Early removal of catheter after recognition of FP should be considered

Phase II trial of celecoxib in combination with paclitaxel and carboplatin in advanced non-small cell lung cancer

Prostaglandins [PGs] can enhance tumor growth and metastasis by stimulating angiogenesis and invasiveness, in addition to apoptosis and immune surveillance. Microtubule-interfering agents induce cyclooxygenase-2 [COX-2] and PG biosynthesis and this might reduce the efficacy of paclitaxel. Preclinical studies suggest that treatment with a selective COX-2 inhibitor may augment the antitumoral effects of chemotherapy. Thus, we designed a phase II trial to evaluate the efficacy of the combination of paclitaxel, carboplatin and celecoxib in advanced non-small cell lung cancer. Thirty-seven patients were enrolled in this trial. The inclusion criteria were: chemotherapy-na‹ve advanced NSCLC [non-resectable locally advanced stage IIIA, stage IIIB and IV], age > 18 yrs. and performance status [PS] of 0-2 [ECOG]. All patients were given paclitaxel [200 mg/m[2]] and carboplatin [AUC 6] on day 1, every 21 days and celecoxib [400 mg] daily. Most of the patients were male and the mean age was 58 yrs. Old. Performance status 0, 1, and 2 were 8.2%, 40.5% and 51.3%, respectively. Four patients were in stage IIIA [10.8%], 12 patients in stage IIIB [32.4%] and 21 [56.8%] in stage IV. The overall response rate was 54%. Time to progression and median overall survival were 5.7 and 9 months, respectively. Only one patient had grade 3 anemia. There was no grade 4 cytotoxicity. Three patients had cytotoxic drug allergy. Based on this study, adding 400 mg celecoxib to the standard regimen [paclitaxel plus carboplatin] does not enhance time to progression and overall survival compared to historical data. Thus, we recommend combining higher dosage of celecoxib with other targeted agents in phase I/II trials

unusual presentation of hodgkin's lymphoma as a chest wall abscess in association with old tuberculosis

Chest wall abscess is a very rare presentation of extranodal Hodgkin's lymphoma. Only a few case reports have been found in this regard. Here, we describe a chest wall mass developed in association with tuberculosis in an 82-year-old woman. Radiologic examination revealed two masses outside of chest wall that lead to destructive changes in the manubrium of sternum. The diagnosis of Hodgkin lymphoma was made by open surgical excisional biopsy of the chest wall mass. This is a very unusual extranodal presentation of Hodgkin's lymphoma

Fiberoptic bronchoscopy: correlation of cytology and biopsy results

Fiberoptic bronchoscopy is a diagnostic method for respiratory diseases. At present, its diagnostic yield has been increased by different cytologic and histologic procedures by convention. This study was conducted to evaluate the concordance and agreement between cytologic and histologic findings in conventional diagnostic bronchoscopic methods [washing and biopsy] for lung malignancies. This was a cross-sectional study performed on 2076 cases of bronchial biopsy and bronchial washing between 1996 and 2003. Of 2163 patients who underwent fiberoptic bronchoscopy after omitting 87[4%] cases due to unsatisfactory specimens, 2076 cases were studied including 832 [36.9%] females and 1244 [63.1%] males in the age range of 2 to 100 years, [mean age 57.7 +/- 16.3 yrs]. Male to female ratio was 1.5. Malignancy was diagnosed in 657[31.6%] biopsy and 283[13.6%] cytology specimens. Two hundred and sixty-five cases had malignant lesions according to both bronchial biopsy and bronchial washing; therefore, Kappa coefficient in both methods was 46.7% [P value = 0.000]. Concordance rate was 77.4%. Ninety-seven point three percent of malignant cases were diagnosed by biopsy and 41.9% by cytology. Cytology contributed to an additional diagnostic rate of 2.6%. Kappa agreement is classified as fair and although there is a very good concordance between the two sampling techniques, the diagnostic yield of cytology for malignancy must be improved by combination of multiple assays

Pneumocystis pneumonia in patients with human immunodeficiency virus

Pneumocystis Pneumonia [PCP] caused by Pneumocystis Jjirovecii [formerly called P.Carinii] is one of the most common opportunistic infections in patients with human immunodeficiency virus [HIV]. The aim of this study was to assess PCP in HIV-infected patients at the "National Research Institute of Tuberculosis and Lung Disease" [NRITLD]. A retrospective study was performed on 12 HIV-infected patients who were hospitalized at the Masih Daneshvari Hospital [NRITLD] and diagnosed as having PCP during 2003- 2007. In patients suspected of PCP with symptoms such as exertional dyspnea, fever, cough and related radiological findings, bronchoscopy including bronchoalveolar lavage [BAL] and transbronchial lung biopsy [TBLB] were performed and high resolution computed tomography [HRCT] was obtained from all patients. Mean age of the understudy patients was 32.8 +/- 5.02 yrs. The most common symptom was exertional dyspnea [91.7% of cases]. Mean duration from the onset of symptoms until diagnosis was 27.4 +/- 18.7 days. All patients were treated with Co-Trimoxazole and no adverse effects were detected. Mortality rate was 25%. In Iran PCP is one of the common opportunistic infections in HIV-positive patients which is accompanied by a high mortality rate

Generalized lymphadenopathy: a case report of rosai-dorfman disease

Sinus histiocytosis with massive lymphadenopathy [SHML], Rosai-Dorfman Disease, is a rare histiocytic syndrome first described by Rosai and Dorfman, seen predominantly in childhood and early adulthood. Even though it is considered a benign disease, fatalities may occur due to cellular infiltrates of SHML. We report a 16-year-old boy with signs of polydypsia, polyuria, weight loss and generalized lymphadenopathy. He had been receiving corticosteroid following the diagnosis of histiocytosis X. Due to hyperglycemia, the patient was admitted with the primary diagnosis of diabetic ketoacidosis and medications were initiated. All paraclinical and immunologic examinations were negative. Axillary lymph node biopsy revealed the diagnosis of Rosai-Dorfman disease

Lymphocytic bronchiolitis as presenting disorder in an undiagnosed adult patient with chronic granulomatous disease

Chronic Granulomatous Disease [CGD] is a rare primary immunodeficiency disease. Although the most affected patients are diagnosed in childhood, there are several reports of the disease presenting in adult patients. Here we present a 40 years old man who was admitted in hospital due to respiratory symptoms and ground glass pattern in high resolution computed tomography of lung. Open lung biopsy revealed lymphocytic bronchiolitis. Because of past medical history of granulomatous lesion in lung and recurrent abscesses of skin and soft tissue, NBT test was conducted which its result revealed that the disorder was compatible with CGD and then it was confirmed by fluorescent cytometry

TNF alpha gene polymorphism in idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis [IPF] is characterized by a chronic inflammatory process and abnormal wound healing. Tumor Necrosis Factor alpha [TNF alpha] is considered to play a key role in fibroblast proliferation and increased collagen synthesis. It appears that there is a genetic predisposition to IPF. The genetic associations of TNF-alpha with IPF have been reported in different cohorts and revealing conflicting results. This study was conducted to evaluate the association of TNF- alpha-308 G/A polymorphism with IPF in Iranian patient by PCR-RFLP method. Materials and Methods: TNF alpha gene polymorphism at position 308 G/A was examined on DNA extract of 41 cases with IPF defined clinically, radiologically and histologically and compared with 82 unrelated healthy controls who were kidney donors. Results: The understudy population included 20 males and 21 females with the mean age of 50.4 yrs. Data showed that the frequencies of G allele [NO:72] and A allele [NO:10] were 87% and 12% respectively. The frequency of G/G genotype [NO:31] was 76%, followed by G/A [No:10] being 24%.we had no A/A genotype. Conclusion: There was no association between TNF alpha-308 G/A polymorphism and IPF in Iranian patients

Detection of epstein barr virus DNA in thymic epithelial tumor using nested PCR

Thymus is a lymphoepithelial organ composed of epithelial cells and lymphocytes. Primary tumors of the thymus are uncommon and a definite risk factor has not been found. There are some reports regarding the association of the [EBV] Epstein Barr Virus with thymic epithelial tumors. This study was conducted to evaluate the presence of EBV genome in thymic epithelial tumor. EBV genome, EBNA2 was examined from DNA extracts of 41 paraffin embedded specimens including 16 thymic epithelial tumors as subject cases and 25 mediastinal lymph nodes as controls. Nested PCR assay revealed that 31.25% of cases were positive for EBV genome. The presence of EBV genome EBNA2 in thymic epithelial tumor suggesting that this association may be due to the endemic nature of EBV infection

Malignant mesothelioma: a study of sixty-six cases

This study was conducted to review the epidemiology, and biochemical data of pleural fluid to assess the potential contribution to occupational risk of patients with malignant mesothelioma [MM] in Iran. Hospital files of patients with MM of the pleura in Masih Daneshvari Hospital were reviewed between 1997 and 2004 and were evaluated in a cross-sectional study. 66 patients [49 men and 17 women] with a mean age of 53.8 +/- 4.2 yrs were selected. Probable or known occupational contacts were detected in 8 [12.1%] patients. The diagnosis was confirmed by closed pleural biopsy in 26[39.4%] cases. Statistical analysis showed significant cut-off for LDH and glucose level in pleural fluid analysis. Detailed occupational history must not overemphasize blind biopsy as the first diagnostic approach for MM of pleura and pleural fluid glucose as well as LDH had characteristic levels respectively