ABSTRACT
We observed a rare case of invasive mucinous adenocarcinoma (IMA) with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital. T-SPOT test result was 212 pg/ml (reference value of negative is < 14 pg/ml), Mycobacterium tuberculosis culture was positive, and tuberculin skin test (PPD) was negative (skin induration < 5 mm). The patient was treated with several courses of antibiotics and anti-tuberculosis treatments. Repeated chest CT scans showed disease progression. Bronchoscopy yielded negative results. PET-CT scans showed negative results. A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls. IMA with a lepidic-predominant pattern was diagnosed after invasiveness was found after experimental treatments. Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common; however, the present case of IMA having a lepidic-predominant pattern and coexisting with active tuberculosis has not been reported yet.
Subject(s)
Aged, 80 and over , Humans , Male , Adenocarcinoma, Mucinous , Diagnosis , Pathology , Antibiotics, Antitubercular , Therapeutic Uses , Disease Progression , Lung Neoplasms , Diagnosis , Pathology , Mycobacterium tuberculosis , Positron Emission Tomography Computed Tomography , Pulmonary Alveoli , Pathology , Tuberculosis, Pulmonary , Diagnosis , Drug TherapyABSTRACT
Objective:To identify the contributions of allergen to Th1 and Th2 by determined the levels of IFN-?,IL-4 and the transcription factors T-bet and GATA-3 in peripheral blood mononuclear cells(PBMC)of allergic asthmatics.Methods:①Plasma IFN-? and IL-4 were measured in 35 asthmatics and 32 healthy by ELISA,as well as the production of IFN-? and IL-4 by Dermatophagoides farinae(Df)-activated PBMC in asthmatics and 15 healthy controls.②Twenty-five asthmatics and 15 healthy persons were enrolled.The T-bet mRNA and GATA-3 mRNA expressing levels in PBMC were assayed by one step reverse transcription polymerase chain reaction(RT-PCR).Results:①The plasma IL-4 in the patients was significantly higher than that in healthy(t=3.265 9,P=0.001 7).The plasma IFN-? levels in asthmatics were no significantly different from that of the healthy(t=0.306 8,P=0.760 0).② In the condition of PBMCs activated by Df,the IL-4 and IFN-? levels in asthmatics were increased compared with healthy(t=3.564 4,P=0.001 0;t=3.350 0,P=0.002 0).③ There were some expression of the transcription factors T-bet and GATA-3 of PBMC in asthmatics and healthy.The expression of GATA-3 in the patients was significantly higher than that in healthy(t=2.274 3,P=0.028 0).The expression of T-bet and the ratio of T-bet/GATA-3 in the patients was no significant difference with the healthy(t=0.222 0,P=0.825 8;t=1.115 2,P=0.283 4).④ In the Df-activated PBMC,the expression of T-bet and GATA-3 in asthmatics were significantly higher than that of healthy(t=2.298 2,P=0.027 6;t=3.788 7,P=0.000 6),but the ratio of T-bet/GATA-3 was no significant difference with healthy(t=1.195 9,P=0.249 1).Conclusion:The production of Th2,Th1 cytokines and the expression of GATA-3 and T-bet in allergic asthmatics are both increased.It is suggested that the imbanlance of Th1/Th2 unsatisfactorily explain the pathogenesis of allergic asthma.