Bronchioloalveolar Carcinoma in a Juvenile Rhadomyosarcoma Patient

Primary tumors of the lung are uncommon in pediatric patients, particularly bronchioloalveolar carcinoma (BAC). An 11-year-old female suffering from back pain for 1 month was referred to Seoul St. Mary's Hospital for treatment of a pathologic fracture of the lumbar spine. Comprehensive evaluation disclosed numerous pulmonary metastases of rhabdomyosarcoma (stage IV). During chemotherapy, most of the lung lesions regressed, with the exception of two nodules. Wedge resections, intended for diagnosis and cure, yielded a histologic diagnosis of BAC.

Choroidal metastasis as the first sign of bronchioloalveolar lung cancer: case report / Metástase coroidal como primeira manifestação de carcinoma bronquioloalveolar: relato de caso

Metastatic tumors are the most common intraocular malignances and choroid is by far the most common site. Breast and lung cancer are the first cause in women and men respectively. We report the case of a 71-year old woman who had choroidal tumor in her left eye. Further image body scans demonstrated several lesions in both sides of the lungs with dissemination to other organs. Diagnosis of a brochioloalveolar carcinoma established after a biopsy carried out. The patient died before initiating a proper treatment.

Tumor metastático é a neoplasia ocular mais frequente, e a coroide é o local mais comum desta. Tumor de mama seguido de tumor pulmonar são as causas mais comuns de metástases oculares em mulheres e homens, respectivamente. Relatamos o caso de uma paciente de 71 anos com tumor coroidal no olho esquerdo. Posteriormente, estudos de imagem mostraram lesões pulmonares em ambos os pulmões e disseminação a outros órgãos. O diagnóstico de carcinoma bronquioloalveolar foi feito por biópsia. A paciente foi a óbito antes de se iniciar tratamento adequado.

Research on the relationship between chinese medical syndrome types and Th1/Th2 in bronchioloalveolar carcinoma by thoracoscopic technique / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the relationship between Chinese medical syndrome types of bronchioloalveolar carcinoma (BAC) and Th1/Th2.</p><p><b>METHODS</b>Totally 60 BAC patients were syndrome typed as qi and yin deficiency syndrome (QYDS) and qi stagnation and phlegm-blood stasis syndrome (QSPSS), 30 cases in each group. Meanwhile, 30 subjects with benign pulmonary nodules were recruited as the control group. The contents of interferon-gamma (INF-gamma), interleukin 4 (IL-4), IL-2, and IL-5 were detected using thoracoscopic technique.</p><p><b>RESULTS</b>As for Th1 (INF-gamma and IL-2), it was ranked from high to low as the control group > the QSPSS group > the QYDS group (P < 0.05). As for Th2 (IL-4 and IL-5), it was ranked from high to low as the QYDS group > the QSPSS group >the control group (P < 0.05). As for Th1/Th2 (INF-gamma/lL-4, IL-2/IL-5), it was ranked from high to low as the control group > the QSPSS group >the QYDS group (P < 0.05).</p><p><b>CONCLUSIONS</b>Compared with the tissue of benign nodules, Th1 function in tumor tissue of BAC patients was weaker and Th2 function stronger. Chinese medical syndrome types of BAC had correlation with Th1/Th2. Patients of excess syndrome had stronger immunity with Th1/Th2 shifting left,while those of deficiency syndrome were predispose to humoral immunity with Thl/Th2 shifting right.</p>

Diagnostic value of (18)F-FDG PET/CT for solitary nodular-type bronchoalveolar carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the value of (18)F-FDG PET/CT in the diagnosis of solitary nodular-type bronchoalveolar carcinoma (BAC).</p><p><b>METHODS</b>The clinical and radiographic data were analyzed retrospectively in 30 patients with pathologically confirmed solitary nodular-type BAC who underwent (18)F-FDG PET/CT examinations between August, 2005 and December, 2006. The morphological and radioactive findings of the lesions were reviewed, and the maximum standard uptake values (SUVmax) were measured. The diagnostic accuracy of PET, PET/CT, and HRCT were analyzed.</p><p><b>RESULTS</b>The (18)F-FDG SUV was markedly lower in BAC than in other well differentiated adenocarcinoma. In 19 of the BAC cases, PET showed a SUVmax of no less than 2.5, demonstrating positive changes. Of the total of 30 cases, 5 had ground glass opacity (GGO) changes, 3 exhibited mixed nodules with GGO changes around the lesions, and 22 cases presented with solid nodules. HRCT showed that BAC located often in the superior lobes of the bilateral lungs, mostly below the pleura in the surrounding lung field; the lesions were patchy or nodular with irregular shapes, showing lobulation in 22 cases, spiculation in 15 cases, pleural indentation in 21 cases, and vacuolar changes in 4 cases. The diagnostic accuracy of PET, PET/CT and HRCT for solitary nodular-type BAC was 36.67%, 93.33%, and 93.33%, respectively.</p><p><b>CONCLUSION</b>The SUVmax of BAC provides only limited value for defining the nature of the lesions, but can serve as a general reference for assessing the disease activity. PET/CT, which allows both functional and imaging assessment, can be a valuable modality to reduce the misdiagnosis rate of BAC.</p>

Primary tumor SUVmax measured on (18)F-FDG PET-CT correlates with histologic grade and pathologic stage in non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To assess the relationship between preoperative maximum standardized uptake value (SUVmax) measured on (18)F-FDG PET-CT and clinicopathologic parameters in patients with surgically resected non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>A total of 540 patients (348 men and 192 women, mean age 60 ± 10 years) with histologically proven non-small cell lung cancer, who had undergone both preoperative (18)F-FDG PET-CT imaging and curative surgery in our institution from October 2006 to January 2013, were analyzed retrospectively in this study. Primary tumor (18)F-FDG uptake, measured as SUVmax corrected for lean body mass, was compared among different variables and correlated with tumor size, histologic grade and postoperative pathologic TNM stage. Histologic grade was categorized into three degrees, where grade I represents highly, grade II moderately and grade III poorly differentiated. Large cell carcinomas were all assessed as poorly differentiated (grade III). Pathologic stage was assigned according to the seventh AJCC TNM staging system.</p><p><b>RESULTS</b>There were 344 adenocarcinomas (AC, non- BAC type), 146 squamous cell carcinomas (SCC), 28 bronchioloalveolar carcinomas (BAC), 10 adenosquamous carcinomas (ASC) and 12 other type carcinomas (OTC, including 6 large cell carcinomas, 5 sarcomatoid carcinomas and 1 lymphoepitheloid carcinoma); the SUVmax in ascending order was BAC (1.3 ± 1.1), AC (5.1 ± 3.4), ASC (8.5 ± 2.8), SCC (9.9 ± 4.6) and OTC (10.9 ± 5.1), respectively. There were 76 grade I, 251 grade II and 213 grade III; the SUVmax in ascending order was grade I (2.4 ± 2.2), grade II(5.9 ± 3.9), grade III (8.4 ± 4.4), respectively, and significant difference was identified among grade I, grade II and grade III (all P < 0.01). The SUV max was positively correlated with tumor size (r = 0.564, P < 0.01), histologic grade (r = 0.492, P < 0.01), T stage (r = 0.306, P < 0.01), N stage (r = 0.368, P < 0.01), and TNM stage (r = 0.437, P < 0.01).</p><p><b>CONCLUSIONS</b>The preoperative SUV max of the primary tumor differed significantly among histologic types in NSCLC. There were positive correlations between SUV max and tumor size, histologic grade and pathologic stage. Our findings may suggest that a high SUVmax could be used to identify a high-risk population who would benefit most from adjuvant therapies.</p>

Expression of Transforming Growth Factor beta1 and E-Cadherin Proteins in Pulmonary Adenocarcinoma: Its Significance in Tumor Progression / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted in order to investigate the significance of transforming growth factor beta1 (TGFbeta1) and E-cadherin proteins in tumor progression of lung adenocarcinoma and to evaluate their differential expression in association with morphologic characteristics. MATERIALS AND METHODS: A total of 65 pulmonary adenocarcinomas were reclassified according to the new classification system proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. Tumor samples from 20 adenocarcinomas in situ (AIS, formerly bronchioloalveolar carcinoma [BAC]), 9 minimally invasive adenocarcinomas (MIA, formerly BAC with 5 mm invasion), and 19 invasive adenocarcinomas with no BAC features were analyzed by immunohistochemistry for expression of TGFbeta1 and E-cadherin proteins. RESULTS: TGFbeta1 expression was detected in 46% (21/46) of noninvasive elements and 87% (39/45) of invasive elements (p=0.001). E-Cadherin expression was less frequent in invasive components than in noninvasive components (38% vs. 65%, p=0.009). Negative correlation was identified between TGFbeta1 expression and E-cadherin expression in noninvasive elements (p=0.022). More importantly, significantly higher frequency of TGFbeta1 expression was observed in noninvasive components of LPA (14/17, 82%), compared with those of either AIS (5/20, 25%) or MIA (2/9, 22%) (p=0.008). CONCLUSION: Our data indicate involvement of both TGFbeta1 and E-cadherin proteins in tumor progression of pulmonary adenocarcinoma. It is noteworthy that TGFbeta1 up-regulation precedes alveolar destruction by invasion of tumor cells. TGFbeta1 may thus have the potential to improve lung adenocarcinoma diagnostics and therapeutics.

A Case of Atypical Adenomatous Hyperplasia of Larger Than 2 cm / 결핵및호흡기질환

Atypical adenomatous hyperplasia (AAH) has been considered to be a precursor lesion of bronchioloalveolar carcinoma (BAC) and pulmonary adenocarcinoma. It usually coexists with BAC and/or an adenocarcinoma. Chest computed tomography reveals multiple well-defined nodules with ground-glass opacity. Usually, AAH does not exceed 10 mm in size. AAH with extensive involvement on one side of the lung field or one that is larger than 2 cm has not been previously reported. We herein report a case of a 71-year-old nonsmoking female with lung AAH of larger than 2 cm.

Aspectos tomográficos do carcinoma bronquíolo-alveolar e dos adenocarcinomas mistos com componente bronquíolo-alveolar / Aspects of bronchioloalveolar carcinoma and of adenocarcinoma with a bronchioloalveolar component: CT findings

O carcinoma bronquíolo-alveolar e os adenocarcinomas mistos com componente bronquíolo-alveolar têm apresentações variadas e múltiplos padrões por imagem. O objetivo deste ensaio foi descrever e ilustrar os achados mais característicos desses tumores em TC. São descritas três apresentações: nódulo pulmonar solitário, consolidação e apresentação difusa, sendo que as duas últimas são importantes no diagnóstico diferencial com acometimento infeccioso. O conhecimento das diversas apresentações e a utilização de propedêutica diagnóstica adequada são definitivos para o diagnóstico precoce e o aumento na sobrevida.

Bronchioloalveolar carcinoma has various presentations and a wide spectrum of imaging patterns, as does adenocarcinoma with a bronchioloalveolar component. The objective of this essay was to describe and illustrate the CT findings that are most characteristic of these tumors. Three presentations are described: solitary pulmonary nodule, consolidation, and diffuse pattern. The last two should be included in the differential diagnosis, together with infectious diseases. Knowledge of the various presentations and the use of proper diagnostic procedures are crucial to early diagnosis and to improving survival.

Relationship between EGFR and KRAS mutations and prognosis in Chinese patients with non-small cell lung cancer: a mutation analysis with real-time polymerase chain reaction using scorpion amplification refractory mutation system / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the gene mutation of EGFR and KRAS in Chinese patients with non-small cell lung cancer (NSCLC), and to analyze the relationship between the gene mutations and the clinicopathological features and EGFR-TKI efficiency.</p><p><b>METHODS</b>EGFR mutation was detected in 120 patients and KRAS mutation in 104 patients with NSCLC in Peking Union Medical College Hospital from March 2009 to December 2010, and the correlation of the gene mutations with the clinicopathological features and EGFR-TKI efficiency was analyzed in the study.</p><p><b>RESULTS</b>EGFR mutation was detected in 44 of 120 (36.7%) patients with NSCLC, in which three types of EGFR gene mutations were found: deletion in exon 19, exon 21 L858R (2573T > G) and Exon 21 L861Q (2582T > A) mutations. There were 29(24.2%) patients with EGFR exon 19 deletion, 14 (11.7%) patients with EGFR exon 21 L858R mutation and one (0.8%) with EGFR exon 21 L861Q mutation in the patients. All the mutations were single point mutations, and no multiple points mutations detected. EGFR mutation rate of bronchioloalveolar carcinoma and adenocarcinoma were higher than that of non-adenocarcinoma (P = 0.009). EGFR mutation rate was higher in female patients or patients without smoking history than male patients or patients with smoking history (P = 0.014, P = 0.001, respectively) in NSCLC patients. EGFR mutation rate was higher in patients without smoking history or patients with well-differentiated carcinoma than patients with smoking history or patients with moderately-and poorly-differentiated carcinoma (P = 0.008, P = 0.018, respectively). There was no difference in prognosis and EGFR-TKI treatment response rate between EGFR mutation patients and EGFR wild-type patients. Nine (8.7%) patients with KRAS mutation were detected in 104 NSCLC patients. There were four types of KRAS gene mutations detected: KRAS Gly12Ala (GGT > GCT), KRAS Gly12Arg (GGT > CGT), KRAS Gly12Val (GGT > GTT) and KRAS Gly12Cys (GGT > TGT). There were 4 patients with Cys mutation, 2 with Arg mutation, 2 with Val mutation and 1 with multiple points mutation of both Cys and Arg in exon 12. No relationship was found between KRAS mutation and clinicopathological feature either in NSCLC or in adenocarcinoma. Prognosis was worse in patients with KRAS mutation than in wild-type patients (P = 0.008). No patient with both EGFR and KRAS mutation was detected.</p><p><b>CONCLUSIONS</b>EGFR mutation rate is related with gender, smoking history and pathological type in NSCLC patients, and is also related with differentiation and smoking history in adenocarcinoma patients. And prognosis is worse in patients with KRAS mutation than that with wild type.</p>

Urticaria as the initial presentation of early stage bronchioloalveolar carcinoma: a case report / 中华医学杂志(英文版)

Bronchioloalveolar carcinoma is a subtype of the lung adenocarcinoma. Early stage bronchioloalveolar carcinoma is usually asymptomatic, especially in the peripheral lung. Rarely, urticaria has been described occurring with lung cancer, usually small-cell lung cancer, but no case has been reported of the bronchioloalveolar carcinoma yet. We report here a unique and initial urticaria on a patient, lasting for 6 months, who finally was diagnosed as early stage bronchioloalveolar carcinoma (T1aN0M0). After treatment of surgery, the symptom of urticaria disappeared and did not recur. Therefore, we consider that utricaria is a possibly clinical manifestation in early stage bronchioloalveolar carcinoma.

Comparing 18F-Fluorodeoxyglucose Positron Emission Tomography and Video-assisted Thoracoscopic Surgery in the Evaluation of Small Pulmonary Nodules in Patients with a History of Malignancy

BACKGROUND: The aims of the study were to determine the accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting pulmonary metastasis through video-assisted thoracoscopic surgery (VATS), a technique that allows the excisional biopsy of small pulmonary nodules in patients with known malignancies. MATERIALS AND METHODS: Between October 2007 and April 2010, 28 patients with known malignancies and small pulmonary nodules underwent VATS excisional biopsies. All patients were in follow-up for a previously treated malignancy. The malignancies included the following: colorectum (9), breast (6), head and neck (5), stomach (3), lymph (1), ovary (1), uterus (1), bladder (1), and liver (1). RESULTS: There were 16 men and 12 women whose mean age was 56.7 years old (range, 38 to 77 years). The sizes of the mean nodules removed were 11.3 mm (range, 7 to 21 mm). Diagnoses included metastatic (11), bronchioloalveolar carcinoma (1), primary adenocarcinoma (1), pulmonary tuberculosis (6), fibrosis (5), organizing pneumonia (3), lymphoid hyperplasia (1). Among these lesions, 46.4% were malignant. CONCLUSION: True positive FDG-PET was 39.2%. FDG-PET is not a sensitive test in the evaluation of patients with a history of an extrathoracic malignancy and newly diagnosed small pulmonary nodules. VATS excision allows the early diagnosis of small pulmonary nodules, with low morbidity, in patients with known malignancies.

Expression of Transforming Growth Factor beta1 and Cadherins in Lung Adenocarcinoma

PURPOSE: There is evidence supporting the concept of tumor progression from pulmonary adenocarcinoma in situ (formerly bronchioloalveolar carcinoma, BAC) to adenocarcinoma with varying degrees of invasion. The aim of this study was to investigate the role of transforming growth factor beta1 (TGFbeta1) in tumor invasiveness in lung adenocarcinoma, and to determine the potential relationships between its expression and immunophenotypes of cell adhesion molecules. MATERIALS AND METHODS: Tumor samples from adenocarcinoma in situ (n=13), minimally invasive adenocarcinoma (formerly BAC with 5 mm invasion, n=25) were examined for the expression of TGFbeta1, E-cadherin, N-cadherin, and H-cadherin proteins using immunohistochemistry. RESULTS: Of a total of 40 cases, 25 (63%) were positive for TGFbeta1. The frequency of immunoreactivity in patients with adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidic predominant invasive adenocarcinoma was 23% (3/13), 50% (1/2), and 84% (21/25), respectively (p=0.001). TGFbeta1 correlated with T classification (p=0.006) and stage (p=0.001). Loss of E-cadherin expression was more frequently observed in invasive adenocarcinomas than in adenocarcinomas in situ (p=0.034). E-cadherin expression inversely correlated with T classification (p=0.009). TGFbeta1 expression showed a statistically significant correlation with H-cadherin expression (p=0.040), but not with E-cadherin expression (p=0.752). CONCLUSION: These results suggest that TGFbeta1 and E-cadherin may play an important role in invasive progression of lung adenocarcinoma through regulating epithelial-to-mesenchymal transition.

Variación histológica y pronóstico del carcinoma mucoepidermoide pulmonar / Histology variation and prognosis of pulmonary mucoepidermoid carcinoma

Introducción: El carcinoma mucoepidermoide pulmonares un tumor relativamente raro bien definido, que seorigina en las glándulas serosas del epitelio traqueo bronquialy se caracteriza por la coexistencia de tres tipos de células:células epidermoides, mucosecretantes e intermedias,con lo cual se establecen distintos grados histológicos, queguardan relación estrecha con el pronóstico. Objetivos: Sepresentan dos casos de carcinoma mucoepidermoide, haciendoespecial énfasis en la forma de presentación, tipohistológico y tratamiento instaurado. Resultados: Dos mujeresde 46 y 21 años sin patologías previas, la primera pacientepresento neumonía a repetición acompañado de tos yhemoptisis intermitente a diferencia de la segunda que consultapor dolor torácico acompañado de disfonía y disfagia.La fibrobroncoscopia en ambos casos demostró presenciade obstrucción (tumor) endobronquial. En la TAC de Tóraxse evidencia atelectasia en el primer caso e infiltrado micronodulillarcon adenopatías en el segundo caso. Las dospacientes fueron sometidas a cirugías, logrando reseccióntumoral por toracotomía en el primer caso, en el segundocaso se realizó la toracoscopia diagnóstica encontrándosepatología avanzada por lo que va a tratamiento paliativo.Conclusión: El carcinoma mucoepidermoide pulmonar espoco frecuente. La sintomatología en la mayoría de los casosasemeja a una neumonía a repetición, donde la radiologíay la endoscopía bronquial pueden hacer el diagnóstico.El tratamiento y sobretodo el pronóstico dependerá del gradode diferenciación histológica, pudiendo asociarse luegode la exéresis quirúrgica a tratamientos complementarioscomo la quimio y/o radioterapia.

Relationship between mutations of epidermal growth factor receptor gene and clinicopathologic features of non-small cell lung cancers / 中华病理学杂志

<p><b>OBJECTIVE</b>To explore the relationship between the mutations of epidermal growth factor receptor (EGFR) gene and clinicopathological characteristics in patients with non-small cell lung cancers (NSCLC).</p><p><b>METHODS</b>Paraffin-embedded tissue specimens were obtained from 1444 patients with NSCLC. The genomic DNA was extracted. Mutations of EGFR gene (exons 19 and 21) were detected by real-time PCR.</p><p><b>RESULTS</b>DNA was available in 1410 cases. Somatic mutations of the EGFR gene were identified in 401 cases (27.8%). Among patients with EGFR mutations, 41.4% (n=166) had del E746-A750 of exon19, 6.7% (n=27) had del L747-P753insS of exon 19, 50.3% (n=201) had L858R of exon 21, and 1.5% (n=6) had L861Q of exon 21. Woman, non-smoker and adenocarcinoma showed a higher percentage of EGFR mutation (43.2%, 37.6%, and 33.5%, respectively). However, there was no association among age, grades, lymph node metastasis, and TNM stages (P>0.05). The mutation rate of BAC subtype (61.3%, 19/31) and adenocarcinoma with BAC features (48.0%, 12/25) was significantly higher than that of conventional adenocarcinoma (32.4%, 336/1038). A further assess of the smoking status found a trend that the more increased smoking exposure, the lower the incidence of EGFR mutations. A multivariable analysis revealed that adenocarcinoma, never smoking, and female were independently associated with EGFR mutations (odds rations=3.381, 2.393, and 1.727, respectively).</p><p><b>CONCLUSIONS</b>The detection rate of EGFR mutation is higher in Chinese patients, especially in non-smoking female patients with adenocarcinoma. Real-time PCR is a sensitive and accurate method to detect the mutations of EGFR gene and can therefore provide useful information for clinical treatment.</p>

Detection of epidermal growth factor receptor gene mutations and its clinical significance in non-small cell lung cancers / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the detection technology and its clinical significance of the EGFR gene mutation in non-small cell lung cancer.</p><p><b>METHODS</b>DNA direct sequencing methods by PCR amplification were used to detect EGFR gene exons 18-21 mutation and to analyze its clinical pathological significance in 192 patients with non-small cell lung cancer.</p><p><b>RESULTS</b>64 of the 192 cases presented with EGFR gene tyrosine kinase binding domain mutation (64/192, 33.3%), of which exon 19 deletion mutation rate was 60.9% (39/64), exon 21 alternative mutation rate was 39.1% (25/64), but exons 18 and 20 mutation was not found in this group of patients. EGFR gene mutation rate was 58.5%(24/41) in lung adenocarcinoma associated with bronchioloalveolar carcinoma differentiation, which was significantly higher than that of ordinary adenocarcinoma (37.9%, 33/87), squamous cell carcinoma (7.5%, 4/53), large cell carcinoma (1/5) and adenosquamous carcinoma (2/6, P<0.05). EGFR gene mutation rates in male patients (20.9%, 24/115), were significantly higher than in the females (51.9%, 40/77; P<0.01); non-smokers (50.0%, 57/114), significantly higher than that of smokers (9.0%, 7/78; P<0.01).</p><p><b>CONCLUSIONS</b>DNA direct sequencing method by PCR amplification is stable and reliable in detection of EGFR gene mutation in non-small cell lung cancer. It might provide a scientific basis for targeted therapy.</p>

Relationship of epidermal growth factor receptor gene mutations, clinicopathologic features and prognosis in patients with non-small cell lung cancer / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate epidermal growth factor receptor (EGFR) gene mutations in exons 19 and 21 of patients with non-small cell lung cancer (NSCLC) and to analyze the relationship of EGFR mutations with clinicopathological features and prognosis.</p><p><b>METHODS</b>The EGFR gene exons 19 and 21 of paraffin-embedded tumor tissue were amplified by PCR, followed by direct sequencing in 282 surgically-removed specimens of NSCLC. The relationship of EGFR gene mutations in NSCLC with clinicopathological features and prognosis were analyzed.</p><p><b>RESULTS</b>EGFR mutations were detected in 120 of 282 (42.6%) patients with NSCLC. There were 61 cases of the mutations in exon 19 and 66 cases of the mutations in exon 21, including 7 cases of the mutations both in exons 19 and 21. Mutations were more frequently observed in women (55.2%, 53/96) than in men (36.0%, 67/186), in 51 to 60-years-old (51.3%, 39/76) than ≤50-years-old (30.4%, 21/69) and >60-years-old (43.8%, 60/137), in non-smokers (54.3%, 69/127) than smokers (32.9%, 51/155), there was negative correlation of EGFR mutations with smoking status (P=0.000, rs=-0.216). EGFR mutations were more frequently observed in adenocarcinomas (47.8%, 64/134), bronchiolo-alveolar carcinomas (73.0%, 27/37), adenosquamous carcinomas (7/9) than squamous cell carcinomas (23.6%, 17/72) and other types (16.7%, 5/30). The EGFR mutation rate in the well differentiated, the middle differentiated, the poorly differentiated and the undifferentiated was 55.7% (68/122), 50.8% (30/59), 22.7% (17/75), 19.2% (5/26) respectively, the incidences of EGFR mutations decreased with the degrading of differentiation, there was positive correlation of EGFR mutations with differentiation of lung cancer (P=0.000, rs=0.296). The patients with EGFR mutations had better prognosis than those with wild-type EGFR (P=0.027). There was no association of EGFR mutations with clinical TNM stage.</p><p><b>CONCLUSIONS</b>EGFR mutations occur frequently in females, non-smokers and adenocarcinomas, bronchioloalveolar carcinomas, and adenosquamous carcinomas. The patients with EGFR mutations have better prognosis. The results may offer a practical approach to select the patients who may benefit from anti-EGFR target therapy.</p>

Neumotórax y bulla enfisematosa gigante rota como manifestación inicial de un carcinoma / Pneumothorax and ruptured giant emphysematous bulla as a manifestation of carcinoma

Se presenta el caso de un paciente de 64 años de edad que acudió al cuerpo de guardia con dolor torácico agudo localizado en hemitórax derecho y disnea intensa. La persistencia del neumotórax sin que se lograra la reexpansión pulmonar con la pleurotomía y el drenaje torácico obligó a una toracotomía. Se encontró una bulla enfisematosa gigante rota, y se realizó una bilobectomía superior y media. El diagnóstico histológico fue carcinoma bronquioalveolar. La coincidencia de un cáncer de pulmón en una bulla enfisematosa no es excepcional, pero la aparición y persistencia de un neumotórax como manifestación inicial de un cáncer de pulmón es poco frecuente(AU)

This is the case of a patient aged 64 seen in the emergency room due to a acute thorax pain located in right hemithorax and intense dyspnea. The persistence of pneumothorax without to achieve a pulmonary re-expansion with a pleurotomy and thoracic drainage be necessary a thoracotomy. A ruptured giant emphysematous bulla was found thus the superior and middle bilobectomy. The histological diagnosis was a bronchoalveolar carcinoma. Coincidence of a lung cancer in a emphysematous bulla isn't exceptional and the persistence of pneumothorax as initial manifestation of lung cancer is not frequent(AU)

Prevalence and pattern of nodal metastasis in pT4 gingivobuccal cancers and its implications for treatment.

Context: The pattern of nodal spread in oral cancers is largely predictable and treatment of neck can be tailored with this knowledge. Most studies available on the pattern are from the western world and for early cancers of the tongue and floor of the mouth. Aims: The present study was aimed to evaluate the prevalence and pattern of nodal metastasis in patients with pathologic T4 (pT4) buccal/alveolar cancers. Settings and Design: Medical records of the patients with pT4 primary buccal and alveolar squamous cell carcinomas treated by single-stage resection of primary tumor and neck dissection at Gujarat Cancer and Research Institute (GCRI), Ahmedabad, a regional cancer center in India, during September 2004 to August 2006, were analyzed for nodal involvement. Materials and Methods: The study included 127 patients with pT4 buccal/alveolar cancer. Data pertaining to clinical nodal status, histologic grade, pT and pN status (TNM classification of malignant tumors, UICC, 6th edition, 2002), total number of nodes removed, and those involved by tumor, and levels of nodal involvement were recorded. Statistical analysis was performed using the Chi-square test. Results: Fifty percent of the patients did not have nodal metastasis on final histopathology. Occult metastasis rate was 23%. All of these occurred in levels I to III. Among those with clinically palpable nodes, level V involvement was seen only in 4% of the patients with pT4 buccal cancer and 3% of the patients with alveolar cancer. Conclusions: Elective treatment of the neck in the form of selective neck dissection of levels I to III is needed for T4 cancers of gingivobuccal complex due to a high rate of occult metastasis. Selected patients with clinically involved nodes could be well served by a selective neck dissection incorporating levels I to III or IV.

Carcinoma bronquíolo-alveolar em leão-africano (Panthera leo) / Bronchioloalveolar carcinoma in an African lion (Panthera leo)

Um caso de carcinoma bronquíolo-alveolar difuso do tipo misto foi diagnosticado em um leão-africano (Panthera leo), hospitalizado com sinais de dispnéia e emagrecimento progressivo. Em todos os lobos pulmonares havia múltiplos nódulos esbranquiçados, macios e homogêneos, de 0,2-0,5cm em diâmetro. Histologicamente, os nódulos eram constituídos por células neoplásicas arranjadas em alvéolos e papilas sustentados por moderado estroma fibrovascular, um padrão que lembrava a estrutura pulmonar pré-existente. Na reação pelo ácido periódico de Schiff (PAS) foi observada marcação positiva no citoplasma de numerosas células neoplásicas. Todas as células neoplásicas demonstraram forte e uniforme imunorreatividade citoplasmática para pancitoceratina. A marcação para o fator 1 de transcrição da tireóide (TTF-1) foi observada em focos nos núcleos das células neoplásicas das margens dos nódulos. Nas secções avaliadas para surfactante A, a marcação foi observada em múltiplas áreas focais, tanto no citoplasma como na membrana citoplasmática das células neoplásicas. O diagnóstico de carcinoma bronquíolo-alveolar difuso do tipo misto foi feito com base nos achados histológicos, histoquímicos e imuno-histoquímicos. Essa parece ser a primeira descrição de um neoplasma pulmonar primário maligno em leão-africano.

A case of diffuse bronchioloalveolar carcinoma of the mixed type was diagnosed in the lung of an adult female African lion (Panthera leo) with presenting signs of progressive dyspnea and weight loss. In all pulmonary lobes there were multiple 0.2-0.5cm in diameter soft and homogenous white nodules. Histologically, these nodules consisted of neoplastic cells with an alveolar and papillary disposition, a pattern reminiscent of the preexistent pulmonary structure. The cytoplasms of numerous neoplastic cells were positive in the periodic acid-Schiff (PAS) stain. At immunohistochemistry examination, all neoplastic cells reacted strongly and uniformly to pancytokeratin; focal reactivity for thyroid transcription factor 1 (TTF-1) was observed in the nucleus of neoplastic cells mainly in those at the margins of the nodules. Positive reaction for surfactant A was observed in multifocal areas, both in the cytoplasm and plasma membranes of neoplastic cells. The diagnosis of diffuse bronchioloalveolar carcinoma of the mixed type was made based on histological, histochemistry and immunohistochemistry findings. This seems to be the first report of a primary malignant neoplasm in the lung of the African lion.