Perfil epidemiológico de pacientes com diagnóstico de carcinoma broncogênico atendidos em uma unidade de alta complexidade em oncologia / Epidemiological profile of patients diagnosed with bronchogenic carcinoma seen in a high complexity oncology unit

Introdução: No Brasil, o carcinoma broncogênico é o segundo tipo de câncer de maior incidência em homens e o quarto tipo de câncer de maior incidência em mulheres. É a principal causa de mortalidade por câncer no país. O objetivo do presente estudo é avaliar o perfil epidemiológico dos pacientes com diagnóstico de carcinoma broncogênico atendidos em uma unidade de alta complexidade em oncologia. Métodos: Estudo observacional descritivo, retrospectivo, com coleta de dados secundários e de abordagem quantitativa. A pesquisa foi aplicada em uma unidade de alta complexidade em oncologia de um hospital de uma cidade do extremo-sul catarinense, através de prontuários eletrônicos. A coleta foi composta por 90 atendimentos no período de janeiro de 2015 a dezembro de 2017. Foram inclusos na amostra todos os pacientes com tumores broncogênicos malignos com idade igual ou superior a 18 anos, e foram exclusos 14 pacientes com prontuários incompletos. Resultados: A média de idade ao diagnóstico foi 62,39 ± 10,53 anos. Houve discreto predomínio no sexo masculino (58,9%). O tabagismo foi verificado em 78,9% dos pacientes, com uma mediana de 40,0 maços/ano. Como método diagnóstico, observou-se a maior realização de biópsia percutânea orientada por TC em 58,9% dos casos. Em relação aos tipos histológicos, 54,4% apresentaram adenocarcinoma. O estágio mais prevalente foi o IVA (42,2%). Conclusão: São de extrema importância métodos de rastreamento e diagnóstico precoce da neoplasia, bem como encorajar os pacientes ao abandono do tabagismo, a fim de reduzir sua incidência e mortalidade.

Introduction: In Brazil, bronchogenic carcinoma is the second more incident type of cancer in men, and the fourth in women. It is the leading cause of cancer mortality in the country. The aim of the present study is to assess the epidemiological profile of patients diagnosed with bronchogenic carcinoma seen in a high complexity oncology unit. Methods: This is a descriptive, observational, retrospective study with collection of secondary data and quantitative approach. The research was conducted in a high complexity oncology unit of a hospital in a municipality of the southernmost region of the state of Santa Catarina, Brazil, using electronic medical records. The sample consisted of 90 patients from January 2015 to December 2017. All patients with malignant bronchogenic tumors aged 18 years or older were included in the sample, and 14 patients with incomplete medical charts were excluded. Results: Mean age at diagnosis was 62.39 ± 10.53 years. There was a slight predominance of men (58.9%). Smoking was present in 78,9% of patients, with a median of 40.0 packets/year. CT-guided percutaneous biopsy was the most used diagnostic method, being performed in 58.9% of the cases. With regard to histological type, 54.4% of patients presented adenocarcinoma. The most prevalent stage was IVA (42.2%). Conclusion: Screening methods and early diagnosis of neoplasm are extremely important, as well as encouraging patients to quit smoking, in order to reduce disease incidence and mortality.

Papel de la interleuquina-17 en procesos inflamatorios y patologías pulmonares / Role of interleukin-17 in inflammatory processes and pulmonary pathologies

Resumen Introducción: Cuatro de las diez principales causas de muerte en el mundo corresponden a patologías pulmonares donde las infecciones respiratorias se ubican en tercer lugar y a su vez son uno de los principales motivos de consulta médica. Por otro lado, la interleuquina IL-17 parece tener un papel importante en la inmunopatogénesis de un gran número de enfermedades, pues se ha descrito que niveles elevados en sangre periférica u otros fluidos corporales se relacionan con metástasis e infecciones. Diferente a patologías cutáneas e intestinales, donde el papel de la IL-17 se conoce con mayor detalle, en procesos pulmonares su rol es aún controversial. Objetivo: Describir conocimientos actuales sobre la función de la IL-17 en procesos inflamatorios y patologías locales pulmonares. Metodología de búsqueda: Se realizó una búsqueda bibliográfica de artículos originales y revisiones de tema en los motores de búsqueda MEDLINE y Science Direct, de los cuales 50 cumplieron con los criterios de inclusión. Conclusiones: Se encontró que la respuesta de IL-17 parece estar relacionada con buen pronóstico en el caso de algunas neumonías bacterianas. Igualmente, el bloqueo de la vía de señalización de la IL-17 en neoplasias pulmonares podría ser beneficioso y se considera como un potencial blanco terapéutico en estas condiciones, por lo que los estudios en este tema continúan siendo fundamentales para conocer mejor el verdadero rol de esta proteína en diversas condiciones patológicas del pulmón. MÉD.UIS.2021;34(1): 55-62.

Abstract Introduction: Four out of ten major causes of death in the world are due to pulmonary pathologies where respiratory infections are in third place and in turn, are one of the main reasons for medical consultation. Interleukin (IL)-17 seems to have an important role in the immunopathogenesis of many diseases. Elevated levels of IL-17 in peripheral blood or other body fluids have been reported to be associated with metastases and infections. Likewise, the role that IL-17 has in the skin and intestinal pathology is clearly known, however; its role within pulmonary pathologies is controversial yet. Objective: To describe the current knowledge on the role of IL-17 in inflammatory processes and pulmonary pathologies. Search Methodology: A bibliographic search of original and review papers was carried out in the MEDLINE and Science Direct database, in which 50 articles matched the inclusion criteria. Conclusions: The response involving IL-17 in the lung seems to be related to a good prognosis in the case of some bacterial pneumonia. Blocking the IL-17 signaling pathway in lung cancer could be beneficial and is considered as a potential therapeutic target under these conditions, so studies on this subject must be continued to better understand the true role of this protein in every pathologic lung condition. MÉD.UIS.2021;34(1): 55-62.

Metástasis infrecuentes en el carcinoma broncogénico / Uncommon metastases in bronchogenic carcinoma

Introducción: El pulmón es el órgano con mayor localización de enfermedad y mortalidad tumoral. En el momento del diagnóstico 55 por ciento de los casos presentan metástasis a distancia lo que implica un estadio avanzado de la enfermedad. Las metástasis cutáneas y en huesos distales de neoplasias internas son infrecuentes comparadas con las producidas en otras vísceras. La invasión cutánea puede presentarse por extensión directa de estructuras subyacentes y suelen asentar en la pared torácica anterior, por implantación accidental en maniobras diagnósticas, embolización vía linfática y por vía hematógena con posibles lesiones en zonas muy distantes y cuya aparición suele ser más precoz. Histológicamente, es el cáncer de pulmón indiferenciado el que con mayor frecuencia metastiza en la piel. Objetivo: Presentar dos casos con diagnóstico de carcinoma de pulmón células no pequeñas que desarrollaron metástasis en localizaciones infrecuentes. Presentación de los casos: Se presentan dos casos con metástasis infrecuentes de un carcinoma broncogénico. El primero a nivel nasal y el segundo en los metacarpianos y zonas blandas de la mano izquierda, ambas lesiones tumorales aparecieron en el curso del tratamiento oncológico para el cáncer del pulmón. El segundo caso fue tratado como una tendinitis y flebitis. Ambos casos evolucionaron hacia las metástasis múltiples y la muerte. Conclusiones: Se presentaron dos casos con metástasis infrecuente de un carcinoma de pulmón células no pequeñas, y aunque una vez diagnosticadas el pronóstico es malo a corto plazo, se deben de tener en cuenta para evitar diagnósticos y conductas erróneas(AU)

Introduction: The lung is the organ with the greatest location of disease and tumor mortality. At the time of diagnosis, 55 percent of the cases present distant metastases, which implies an advanced stage of the disease. Cutaneous and distal bone metastases from internal neoplasms are rare compared to those produced in other viscera. Cutaneous invasion can occur by direct extension of underlying structures and usually settle in the anterior chest wall, by accidental implantation in diagnostic maneuvers, lymphatic and hematogenous embolization with possible lesions in very distant areas and whose appearance is usually earlier. Histologically, it is undifferentiated lung cancer that most frequently metastasizes to the skin. Objective: To report two cases with a diagnosis of non-small cell lung carcinoma that developed metastases in infrequent locations. Case report: Two cases are reported with rare metastases from bronchogenic carcinoma. The first at the nasal level and the second in the metacarpals and soft areas of the left hand, both tumor lesions appeared in the course of oncological treatment for lung cancer. The second case was treated as tendinitis and phlebitis. Both cases progressed to multiple metastases and death. Conclusions: There were two cases with infrequent metastases of non-small cell lung carcinoma, and although once diagnosed the prognosis is poor in the short term, they should be taken into account to avoid misdiagnosis and misconduct(AU)

Ion mobility spectrometry: the diagnostic tool of third millennium medicine

SUMMARY Ion mobility spectrometry (IMS) is a fast, low cost, portable, and sensitive technique that separates ions in a drift tube under the influence of an electric field according to their size and shape. IMS represents a non-invasive and reliable instrumental alternative for the diagnosis of different diseases through the analysis of volatile metabolites in biological samples. IMS has applications in medicine in the study of volatile compounds for the non-invasive diagnose of bronchial carcinoma, chronic obstructive pulmonary disease, and other diseases analysing breath, urine, blood, faeces, and other biological samples. This technique has been used to study complex mixtures such as proteomes, metabolomes, complete organisms like bacteria and viruses, monitor anaesthetic agents, determine drugs, pharmaceuticals, and volatile compounds in human body fluids, and others. Pharmaceutical applications include analysis of over-the-counter-drugs, quality assessment, and cleaning verification. Medical practice needs non-invasive, robust, secure, fast, real-time, and low-cost methods with high sensitivity and compact size instruments to diagnose different diseases and IMS is the diagnostic tool that meets all these requirements of the Medicine of the future.

RESUMO A espectrometria de mobilidade iônica (IMS) é uma técnica rápida, de baixo custo, portátil e sensível que separa íons em um tubo de deriva sob a influência de um campo elétrico de acordo com seu tamanho e forma. A IMS representa uma alternativa instrumental não invasiva e confiável para o diagnóstico de diferentes doenças por meio da análise de metabólitos voláteis em amostras biológicas. A IMS possui aplicações em medicina no estudo de compostos voláteis para o diagnóstico não invasivo de carcinoma brônquico, doença pulmonar obstrutiva crônica e outras doenças que analisam respiração, urina, sangue, fezes e outras amostras biológicas. A IMS tem sido usada para estudar misturas complexas, como proteomas, metabólitos, organismos completos como bactérias e vírus, monitorar agentes anestésicos, determinar drogas, produtos farmacêuticos e compostos voláteis em fluidos corporais e outros fluidos. As aplicações farmacêuticas incluem análises de medicamentos sem receita, avaliação de qualidade e verificação de limpeza. A prática médica precisa de métodos não invasivos, robustos, seguros, rápidos, em tempo real e de baixo custo com instrumentos de alta sensibilidade e tamanho compacto para diagnosticar diferentes doenças e a IMS é a ferramenta de diagnóstico que atende a todos esses requisitos da medicina do futuro.

Panhipopituitarismo secundario a metástasis del sistema nervioso central por un adenocarcinoma broncogénico / Panhypopituitarism secondary to metastasis of the central nervous system due to a bronchogenic adenocarcinoma

Resumen Mujer de 45 años de edad con antecedente de extabaquismo pesado, cursó con cuadro crónico de cefalea en región occipital irradiado a región temporal asociado a disminución de la agudeza visual de ojo izquierdo. El cuadro empeoró en los últimos seis meses y se asoció a polidipsia y poliuria. Presentó cuadro sincopal con amnesia retrógrada, para lo cual se realizó una tomografía axial computarizada (TAC) contrastada de cráneo que mostró múltiples lesiones parenquimatosas cerebrales y del cerebelo compatibles con metástasis. Se hizo estudio hormonal para evaluar la función hipofisiaria evidenciando un panhipopituitarismo secundario. Se detectó foco primario neoplásico mediante TAC contrastada de tórax, evidenciando una lesión espiculada en el lóbulo superior derecho sugestiva de carcinoma broncogénico, posteriormente se tomó biopsia por fibrobroncoscopia el cual confirmó por histopatología e inmunohistoquímica el diagnóstico de un adenocarcinoma broncogénico. (Acta Med Colomb 2018; 43: 115-118).

Abstract A 45-year-old woman with a history of heavy extabaquism presented with chronic headache in the occipital region irradiated to the temporal region associated with decreased visual acuity of the left eye. The picture worsened in the last six months and was associated with polydipsia and polyuria. She presented a syncopal picture with retrograde amnesia, for which a contrast computed tomography (CT) of the skull was performed, which showed multiple parenchymal brain and cerebellar lesions compatible with metastasis. Hormonal study was done to evaluate the hypophyseal function evidencing a secondary panhypopituitarism. A primary neoplastic focus was detected by a contrast chest CT scan, showing a spiculated lesion in the right upper lobe suggestive of bronchogenic carcinoma. A biopsy was subsequently taken by fibrobronchoscopy, which confirmed the diagnosis of a bronchogenic adenocarcinoma by histopathology and immunohistochemistry. (Acta Med Colomb 2018; 43: 115-118).

Quiste broncógeno mediastinal puro: reporte de tres casos / Pure mediastinal bronchogenic cyst: three case reports

Fundamento: el quiste broncógeno mediastinal puro suele localizarse en el mediastino medio, aparece en ambos sexos y a cualquier edad, aunque por ser congénito es mayor en niños y jóvenes, por lo general son asintomáticos y su diagnóstico muchas veces es casual. Se realiza una introducción temática sobre esta tumoración en cuanto a su origen, cuadro clínico, diagnóstico y tratamiento. Se señala que pueden aparecer en otras partes del tórax y cuello. Objetivo: exponer las diferentes formas de presentación del quiste broncógeno mediastinal. Casos clínicos: tres pacientes mujeres, mayores de 45 años atendidas en los servicios de cirugía de los hospitales Amalia Simoni y Manuel Ascunce Domenech a las cuales se le extirpó una tumoración quistíca mediastinal y que fueron estudiadas con anteriodad mediante el análisis en su conjunto del cuadro clínico, la radiografía, ultrasonografía y tomografía axial computarizada del tórax y confirmado el diagnóstico de quiste broncógeno por estudio histopatológico. El tratamiento incluyó resección del tumor mediante toracotomía con buena evolución postoperatoria en todas las enfermas. Conclusiones: se presentan tres enfermas mayores de 45 años tratadas con resección de un quiste broncógeno mediastinal por toracotomía abierta, con buenos resultados terapéuticos.

Background: pure mediastinal bronchogenic cyst is usually located in the middle mediastinum. It is more frequent in both sexes and at any age, although as it is congenital its incidence is higher in children and teenagers. Generally these cysts are asymptomatic and their diagnoses are casual in a lot of cases. A thematic introduction about a mediastinal cystic tumor was performed taking into account its origin, clinical manifestations, diagnosis and treatment. It has been pointed that it might appear in other parts of thorax and neck. Objective: to show the different forms of appearance of mediastinal bronchogenic cyst. Clinical cases: three women over 45 years old were treated in the surgical services areas of Amalia Simoni and Manuel Ascunce Domenech hospitals, to whom a resection of the mediastinal cystic tumor was performed. They were studied in advance through the analysis of the symptoms, thorax radiography, ultrasonography, computerized axial tomography and then the diagnosis was confirmed with the histopathological study. The treatment included tumor excision through thoracotomy with good post-operatory evolution in all the patients. Conclusions: three patients older over 45 years old were treated with mediastinal cystic tumor excision through open thoracotomy with good therapeutic results.

Comparison of the quality of life among persons with lung cancer, before and after the chemotherapy treatment / Comparação da qualidade de vida de portadores de câncer de pulmão antes e após o tratamento quimioterápico / Comparación de la calidad de vida de portadores de cáncer de pulmón antes y después del tratamiento de quimioterapia

OBJECTIVE: this prospective study aimed to assess the quality of life related to health (QLRH) of patients with lung cancer after chemotherapy treatment. METHOD: The QLRH was assessed using the questionnaires Quality-of-Life Questionnaire-Core 30 (QLQ-C30) and Lung Cancer Module (LC13), version 3.0. RESULTS: the sample was made up of 11 women and 19 men, with an average age of 68 years (51-87 years). After the chemotherapy treatment, the authors observed a clinically-relevant improvement in general quality of life, as well as in the symptoms of dyspnea, insomnia, hemoptysis, cough, thoracic pain, pain in the arm/shoulder, and financial difficulty. There was a worsening on the functional scale which assesses role performance and symptoms of fatigue, nausea and vomiting, sensory neuropathy, pain in other parts, constipation, loss of appetite and alopecia. CONCLUSION: although the patients have an improvement of their QLRH and symptoms related to the lung cancer after the chemotherapy treatment, there was a worsening of the symptoms which resulted from the toxicity of the chemotherapy medications. .

OBJETIVO: estudo prospectivo, com o objetivo de avaliar a Qualidade de Vida Relacionada à Saúde de pacientes com câncer de pulmão, após tratamento quimioterápico. MÉTODO: a Qualidade de Vida Relacionada à Saúde foi avaliada pelos questionários Quality-of-Life Questionnaire-Core 30 e Lung Cancer Module, versão 3.0. RESULTADOS: a amostra foi composta por 11 mulheres e 19 homens, com média de idade de 68 anos (51-87 anos). Após o tratamento quimioterápico, observou-se melhora clinicamente relevante da qualidade de vida geral, assim como dos sintomas de dispneia, insônia, hemoptise, tosse, dor torácica, dor no braço/ombro e dificuldade financeira. Houve piora na escala funcional que avalia o desempenho de papel e dos sintomas de fadiga, náusea e vômito, neuropatia sensorial, dor extratorácica, constipação, perda de apetite e alopecia. CONCLUSÃO: os pacientes apresentaram melhora da Qualidade de Vida Relacionada à Saúde e sintomas relacionados ao câncer de pulmão, após o tratamento quimioterápico; entretanto, houve piora dos sintomas decorrentes da toxicidade dos medicamentos quimioterápicos. .

OBJETIVO: estudio prospectivo con objetivo de evaluar la calidad de vida relacionada a la salud (CVRS) de pacientes con cáncer de pulmón después de tratamiento de quimioterapia. MÉTODO: la CVRS fue evaluada por los cuestionarios Quality-of-Life Questionnaire-Core 30 (QLQ-C30) y Lung Cancer Module (LC13), versión 3.0. RESULTADOS: la muestra estuvo compuesta por 11 mujeres y 19 hombres, con promedio de edad de 68 años (51-87 años). Después del tratamiento de quimioterapia, observamos una mejoría clínicamente relevante de la calidad de vida general, así como en los síntomas de disnea, insomnio, hemoptisis, tos, dolor torácico, dolor en el brazo/hombro y dificultad financiera. Hubo empeoramiento en la escala funcional que evalúa el desempeño de papel y de los síntomas de fatiga, náusea y vómito, neuropatía sensorial, dolor extra-torácico, constipación, pérdida de apetito y alopecia. CONCLUSÍON: los pacientes presentaron mejoría de la CVRS y de los síntomas relacionados al cáncer de pulmón después del tratamiento de quimioterapia, entretanto hubo un empeoramiento de los síntomas provenientes de la toxicidad de los medicamentos de la quimioterapia. .

Plásticas bronquiales como alternativa terapéutica en lesiones centrales / Bronchoplastic as a therapeutic alternative in central lesions

Introducción: Los procedimientos broncoplásticos son útiles en lesiones de localización central. El objetivo es describir la serie de plásticas bronquiales realizadas por el mismoequipo quirúrgico en dos centros de Argentina. Pacientes y métodos: 54 plásticas bronquiales realizadas desde enero de 1978 hasta diciembre del 2009 fueron analizadas. Las lesiones fueron categorizadas como benignas,de bajo y alto grado de malignidad para el análisis. Resultados: Se practicaron 29 lobectomías asociadas a plástica bronquial (54%), 21 resecciones en manguito (39%) y 4 lobectomías asociadas a plástica bronquial y arterial(7%). El promedio de edad de los pacientes con lesiones de bajo grado de malignidad es significativamente menor (34 años vs 53 p=0.0025), mientras que la prevalencia del sexo masculino (37.5% vs 75%, p=0.051), el antecedente de tabaquismo (31% vs 75%, p=0.002) y el número de plásticas vasculares (2.5% vs 37.5%, p=0.002) fue mayor entre los carcinomas. El riesgo de muerte fue 9 veces mayor entre los carcinomas (HR8.64, IC 95% 1.6-47.7, p=0.013), sin diferencias significativas en la supervivencia a 5 años y 10 años entre los dos grupos. Conclusiones: los procedimientos broncoplásticos permiten una resección oncológicaviable con preservación de parénquima pulmonar sin afectar la supervivencia alejada.

Introduction: bronchoplastic procedures are useful in tumours of central location.The aim of this study is to describe the range of bronchoplastic procedures performed by the same surgical team at two centers in Argentina. Patients and methods: The study included 54 bronchoplastic therapies made fromJanuary 1978 through December 2009. The lesions were classified as benign, low grade of malignancy and high grade of malignancy. Results: 29 sleeve lobectomies (54%), 21 sleeve resections (39%) and 4 lobectomieswith bronchovascular plastic procedures (7%) were performed. The mean age ofpatients with low grade of malignancy was significantly lower (34 years vs. 53 years; p = 0.0025), whereas male prevalence (37.5% vs 75%, p = 0.051), smoking habit history (31% vs 75%, p = 0.002) and number of bronchovascular plastic procedures(2.5% vs 37.5%, p = 0.002) was higher in cases of high grade of malignancy. The risk of death was 9 times higher in these patients (HR 8.64, 95% CI 1.6-47.7, p = 0.013) but no significant differences in survival at 5 and 10 years between the twogroups were observed. Conclusions: bronchoplastic procedures allow oncologic resection with preservationof lung parenchyma without affecting survival.

Nódulo sincrônico pulmonar e hepático em paciente com antecedente de carcinoma broncogênico: a importância da confirmação histopatológica / Synchronous pulmonary and hepatic nodules in a patient with previous bronchogenic carcinoma: the relevance of histopathological confirmation

A apresentação de lesão sincrônica pulmonar e hepática em um paciente com antecedente de carcinoma broncogênico operado gera a suspeita de recidiva tumoral e indica a necessidade de re-estadiamento. Apresentamos o caso de um paciente de 71 anos submetido à lobectomia pulmonar com ressecção de pericárdio e linfadenectomia mediastinal (T3N0M0). Cinco anos após a cirurgia, detectou-se a presença de uma nova lesão pulmonar. No re-estadiamento, foi diagnosticada uma lesão sincrônica no fígado. Apesar da forte suspeita de recidiva tumoral, prosseguiu-se a investigação e uma punção hepática revelou carcinoma hepatocelular. Para esclarecer a etiologia da lesão pulmonar (hipóteses de recidiva de carcinoma brônquico ou de metástase de carcinoma hepatocelular), foi realizada uma biópsia a céu aberto, compatível com reação inflamatória crônica com focos de antracose e de calcificação distrófica. O paciente foi então submetido à ressecção hepática não-regrada com intuito curativo. Teve boa evolução, com alta no 10º dia de pós-operatório. O presente relato destaca a importância do diagnóstico histopatológico em pacientes com antecedente de carcinoma broncogênico e suspeita de recidiva. Hipóteses diagnósticas e condutas terapêuticas são discutidas.

The synchronous presentation of pulmonary and hepatic nodules in a patient with previously resected bronchogenic carcinoma raises suspicion of recurrence and mandates restaging. We present the case of a 71-year-old male with a history of lobectomy with pericardial resection and mediastinal lymphadenectomy (T3N0M0). At five years after the operation, he presented with a new pulmonary lesion. Restaging detected a synchronous nodule in the liver. Despite the strong suspicion of tumor recurrence, further investigation with a percutaneous liver biopsy revealed hepatocellular carcinoma. In order to investigate the etiology of the pulmonary lesion (hypotheses of recurrent bronchial cancer and of metastatic hepatocellular carcinoma), an open lung biopsy was performed, which revealed chronic inflammatory tissue with foci of anthracosis and dystrophic calcification. The patient was submitted to a non-anatomic resection of the liver lesion. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. This report highlights the relevance of the histopathological diagnosis in patients with a history of bronchogenic carcinoma and suspicion of tumor recurrence. Differential diagnoses and the treatment administered are discussed.

Câncer de pulmão: histologia, estádio, tratamento e sobrevida / Lung cancer: histology, staging, treatment and survival

OBJETIVO: Analisar os principais tipos histológicos, estádio, tratamento e sobrevida dos portadores de câncer de pulmão. MÉTODOS: Estudo retrospectivo a partir da análise dos prontuários de pacientes acompanhados no Hospital das Clínicas da Faculdade de Medicina de Botucatu, num período de seis anos. RESULTADOS: De janeiro de 2000 a janeiro de 2006, foram acompanhados 240 doentes com câncer de pulmão, com predominância do sexo masculino (64 por cento). O tipo histológico mais freqüente foi o carcinoma escamoso (37,5 por cento), seguido pelo adenocarcinoma (30 por cento), carcinoma neuroendócrino (19,6 por cento) e carcinoma de grandes células (6,6 por cento). Apenas 131 pacientes (54,6 por cento) foram tratados. Destes, 52 pacientes (39,7 por cento) foram submetidos à quimioterapia exclusiva, 32 (24,4 por cento) realizaram quimioterapia associada à radioterapia e 47 (35,9 por cento) foram submetidos à cirurgia associada ou não à quimioterapia exclusiva e/ou radioterapia. Somente 27 pacientes (20,6 por cento) foram submetidos à cirurgia exclusiva.Em relação ao estadiamento, 34,4 por cento apresentavam, no momento do diagnóstico, estádio IV, 20,6 por cento estádio IIIB, 16,8 por cento estádio IIIA e os outros 28,2 por cento pertenciam aos estádios I e II. A sobrevida em cinco anos foi de 65 por cento para o estádio I e 25 por cento para os estádios remanescentes. CONCLUSÕES: O tipo histológico predominante foi o carcinoma escamoso e o de menor freqüência foi o carcinoma de grandes células. A maioria se encontrava em estádio avançado ao diagnóstico, estando nos estádios iniciais menos de 30 por cento dos casos. Isto justifica a baixa sobrevida e a pequena quantidade de pacientes submetidos ao tratamento cirúrgico exclusivo, em comparação à maioria que foi submetida à quimioterapia exclusiva.

OBJECTIVE: To analyze principal histological types of lung cancer, as well as the staging, treatment and survival of lung cancer patients. METHODS: This was a retrospective study based on the analysis of medical charts of patients treated at the Botucatu School of Medicine Hospital das Clínicas over a six-year period. RESULTS: From January of 2000 to January of 2006, 240 patients with lung cancer, most (64 percent) of whom were male, were treated. The most common histological type was squamous cell carcinoma (37.5 percent), followed by adenocarcinoma (30 percent), neuroendocrine carcinoma (19.6 percent) and large cell carcinoma (6.6 percent). Only 131 patients (54.6 percent) were treated. Of those, 52 patients (39.7 percent) received only chemotherapy, 32 (24.4 percent) were treated with chemotherapy combined with radiotherapy, and 47 (35.9 percent) were submitted to surgery alone or surgery accompanied by chemotherapy, with or without radiotherapy. Only 27 patients (20.6 percent) were submitted to surgery alone. Concerning staging, 34.4 percent presented stage IV at the time of diagnosis, 20.6 percent presented stage IIIB, 16.8 percent presented stage IIIA, and the remaining 28.2 percent were classified as stage I or II. Five-year survival was 65 percent for those in stage I and 25 percent for those in the remaining stages. CONCLUSIONS: Of the various histological types, the most common was squamous cell carcinoma and the least common was large cell carcinoma. Most cases presented advanced stages at the moment of diagnosis, and less than 30 percent of the cases presented early stages. This accounts for the low survival rate and the small number of patients submitted to surgical treatment alone, the majority being submitted to chemotherapy alone.

Osteoartropatia hipertrófica secundária ao carcinoma broncogênico (síndrome de Pierre-Marie-Bamberger) / Hyperthrophic osteoarthropathy associated with bronchogenic carcinoma (Pierre-Marie-Bamberger syndrome)

Descreveremos um raro e memorável caso de osteoartropatia hipertrófica (OAH), cujos sinais e sintomas osteoarticulares da síndrome conduzem ao diagnóstico de adenocarcinoma de pulmão em uma paciente assintomática respiratória. Discutiremos também as diversas particularidades da síndrome, fazendo uma revisão da literatura. Nesta revisão, destacaremos alguns dos novos aspectos de sua obscura etiopatogenia, seu diagnóstico diferencial com doenças reumáticas clássicas e os achados singulares da ressonância magnética, que podem, inclusive, preceder os do RX convencional.

Epidemiología del carcinoma broncogénico en España en los comienzos del siglo XXI / Epidemiology of bronchogenic carcinoma in the early XXI century in Spain

In the early 1990s the Spanish lung cancer incidence and mortality rates where clearly lower than European rates. But recently, in 2002, the incidence and mortality rates where 55.8 and 49.2 cases/100 000 respectively in men (similar to the mean of Southern European countries) and 5.4 y 4.7 cases/100 000 in women (very low rates although growing). This tumor is the most frequent in men and responsible of the highest mortality (15 995 deaths in 2002, 26.2% of all tumor deaths). 2 119 women also died (5.8% of tumor derived deaths). The men from Extremadura, Asturias and Cantabria, and the women from País Vasco, Castilla-León and Navarra showed the highest mortality rates among Spanish communities. Absolute survival in five years time is around 8% based on clinical and epidemiological Spanish studies and the age-adjusted relative survival is 12.4% in men and 12.8% in women based in the Eurocare-3 study

A pesar de que a principios de los '90 las tasas ajustadas de incidencia y mortalidad del carcinoma broncogénico se encontraban en España claramente por debajo de las correspondientes a los países de su entorno europeo, en el año 2002 llegaron a 55.8 y 49.2 casos por 100 000, respectivamente, en hombres, similares ya a la media de los países del sur de Europa. En las mujeres alcanzaron 5.4 y 4.7 por 100 000, valores muy bajos en el contexto continental pero que se encuentran en continuo crecimiento actualmente. El carcinoma broncogénico es el tumor diagnosticado con mayor frecuencia en los hombres españoles y el que ocasiona mayor mortalidad (15 995 fallecimientos en 2002; 26.2% de todas las muertes por tumores). Fue también causa de muerte en 2 119 mujeres (5.8% de las causadas por tumores). Por comunidades autónomas, las tasas brutas de mortalidad más altas las presentan los hombres extremeños, asturianos y cántabros, junto con las mujeres del País Vasco, Castilla-León y Navarra. Según estudios clínico-epidemiológicos españoles, la supervivencia absoluta a los 5 años se halla próxima al 8%, pero la supervivencia relativa (ajustada por edad según otras causas de muerte en una población similar) alcanza el 12.4% en hombres y el 12.8% en mujeres, de acuerdo con los resultados del estudio Eurocare-3

Lavado y cepillado bronquiales en tumores pulmonares centrales y periféricos sospechosos de malignidad / Bronchial washing and brushing in central and peripheral lung masses suspicious of malignancy

El diagnóstico citológico e histopatológico en casos de tumores pulmonares se realiza con alta confiabilidad a través de muestras obtenidas por fibrobroncoscopía (FBC). Puede haber diferencias que dependen de la localización del tumor. Objetivo: Determinar la sensibilidad del lavado, cepillado bronquial y biopsia por (FBC) en una muestra de tumores pulmonares centrales, donde hay alteraciones endoscópicas evidentes y en otra de tumores pulmonares periféricos con sospecha de malignidad donde las alteraciones son menos frecuentes. Casos: Se estudiaron 86 enfermos con tumores pulmonares, 44 centrales (Grupo A) y 42 periféricos (Grupo B). Todos fueron objeto de estudio por FBC con lavado y cepillado; en 15 casos se practicó biopsia. Resultados: Hubo una diferencia significativa (p < 0.005) con respecto a la apariencia normal y anormal entre tumores centrales (A) y periféricos (B). El diagnóstico de malignidad basado en la presencia de células malignas por cepillado y lavado bronquiales fue positivo en 21 del Grupo A y en 14 del Grupo B con sensibilidad de 60 y 40%, respectivamente. En 15 casos de tumor endobronquial se practicó biopsia. En los casos negativos, 23 del A y 28 del B, se emplearon otros métodos diagnósticos (p < 0.05). Se detectaron 76 casos de neoplasias, predominando el carcinoma bronquiogénico (43%). Diez casos fueron procesos infecciosos. Conclusión: El estudio por FBC permanece como un importante método diagnóstico en casos de tumores pulmonares. El lavado y el cepillado tuvieron resultados positivos en 35/86, cifra relativamente baja que sugiere la necesidad de mejorar la calidad de las muestras obtenidas. La negatividad por FBC obliga el empleo de otros métodos diagnósticos. El costo estimado de los procedimientos, erogado por el paciente en dólares americanos, es notablemente menor que en países como Holanda, que se tomó como comparativo.

Cytologic and histologic diagnosis of lung tumors can usually be done by means of fiberoptic bronchoscopy (FOB), but there are some differences in cases of central or peripheral tumors. Objective: To determine the sensititivity of bronchial brushing, lavage and biopsy performed by FBO in a sample of central tumors, with evident bronchial alterations, and another sample of peripheral lesions in which these alterations are less frequent. A preliminary comparison of the costs of FOB in Mexico and Holland was also done. Cases: There were 86 patients with tumoral lesions suspicious of malignancy, 44 central (Group A) and 42 peripheral (Group B); all were subjected to FOB, lavage and bronchial brush ings; biopsy was done in 15 cases of endobronchial lesions. Results: There was a significat difference (p < 0.005) as to the normal or abnormal appearance of the bronchial mucosa between central tumors (A) and peripheral (B) lesions. Diagnosis of malignancy by lavage and brushing based in the finding of malignant cells was positive in 21 of the Group A and in 14 of Group B, sensitivity of 60% and 40% respectively. Biopsy was performed in 15 cases with endobronchial tumor. In the negative cases, 23 in Group A and 28 in Group B, other diagnostic methods were employed (p < 0.05). A total of 76 cases of malignancy were detected; bronchogenic carcinoma was predominant (43%). Ten cases of infectious diseases were identified. Conclusion: FOB remains as an important diagnostic tool in cases of lung tumors. Bronchial lavage and brushing had positive results for malignant cells in 35/86; this relative low figure suggests the need to improve the quality of the samples obtained by FOB. Other diagnostic methods must be used in cases with negative FOB results. Estimated costs, in US dollars, of diagnostic methods are much lower in Mexico than in an European country, The Netherlands.

Rendimento diagnóstico da broncofibroscopia no diagnóstico do câncer de pulmão: análise de 84 exames / Diagnostic yield of fiberoptic bronchoscopy in the diagnosis of lung cancer: analysis of 84 procedures

Introdução: a broncofibroscopia (BFC) é o principal método diagóstico do câncer de pulmão (CP). O objetivo deste estudo foi avaliar o rendimento da BFC no diagnóstico do CP. Métodos: foram restrospectivamente estudados os prontuários de pacientes com suspeita clínica de CP, submetidos a BFC, no período de 1° de Janeiro de 2001 a 31 de Março de 2002, em um hospital universitário terciário. O rendimento da BFC foi avaliado em 3 grupos, de acordo com o resultado obtido ao exame endoscópico: presença de lesão visível, ausência de lesão visível e sinais indiretos de lesão brônquica. Resultados: foram estudados os prontuários de 84 pacientes (62 homens), com média de idade de 55,4 anos (variando de 32-83 anos). O diagnóstico definitivo foi estabelecido através da BFC em 80%dos casos (67/84). O maior rendimento da BFC ocorreu na presença de lesão visível (91%, 58/64), com a biópsia obtendo o diagnóstico em 75% (48/65) dos casos, o lavado brônquico e/ou broncoalveolar em 39% (33/84) e escovando brônquico em 31%; 26/84). O carcinoma escamoso foi o tipo histológico mais frequente (38%; 32/84), seguido do adenocarcinoma (31%; 26/84). Ocorreram complicações em 8% (7/84) dos casos e em somente 2% (2/84) dos pacientes foi necessário interromper o exame por sangramento. Conclusões: a BFC apresenta bom rendimento diagnóstico no CP, sendo os tipos histológicos mais frequente o carcinoma escamoso e o adenocarcinoma.

Introduction: Fiberoptic bronchoscopy (FB) is an excellent method to investigated patients with suspicion of lung cancer (LC). The aim of this manuscript was to evaluate the yield of bronchoscopy for LC in a Universitary Hospital In Rio de Janeiro. Methods: charts of patients underwent to a bronchoscopy from January 1, 2001 to March, 31, 2002 in a University Hospital were retrospectively evaluated. The authors decribe the yield of FB in 3 groups: presence of visible lesion on endoscopy, absence of visible lesion and indirect findings. Results: 84 patients (62 men) were studied with a mean age of 55.4 years (range 32-83 years). A diagnosis was established by FB in 67 (80%, 67/84). Higher yields (90.6%) were found among patients with visible lesion on endoscopy (58/64). Biopsy specimens provided a positived result in 75% (49/65), bronchial washing in 39% (33/84), and bronchial brushing in 31% (10/32). Highest yields were seen in squamous cell lung center cancer (38%, 32/84). Complications were low (8%, 7/84) and severe bleeding leading to interruption of the procedure was associated only with bronchial brushing in 2% (2/84). Conclusions: FB reached a reasonable yield in the diagnosis of LC and most prevalent histological type were squamous cell lung center and adenocarcinoma.