Aspectos clínicos y epidemiológicos en pacientes con cáncer de pulmón en un servicio de neumología / Clinical and epidemiological aspects in patients with lung cancer in a pneumology service

Se realizó un estudio descriptivo y transversal de 125 pacientes con cáncer de pulmón, ingresados y diagnosticados en el Servicio de Neumología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero de 2015 a octubre de 2016, con vistas a caracterizarles según variables clínicas y epidemiológicas de interés, además de factores de riesgo genéticos y no genéticos, independientemente de las características histológicas y el estadio clínico del proceso neoplásico. Entre los resultados preponderantes figuraron el sexo masculino y el grupo etario de 51-69 años -- aunque fue evidente el incremento del número de féminas y de pacientes en las edades más jóvenes de la vida --, igualmente la broncoscopia como método diagnóstico, la localización en el pulmón derecho, el adenocarcinoma como variedad histológica, el tabaquismo entre los factor de riesgo no genético y el parentesco de primer grado en los factores genéticos. La mayoría de los afectados presentaban menos de un año de evolución y un elevado porcentaje correspondía al estadio IV de la enfermedad.

A descriptive and cross-sectional study of 125 patients with lung cancer, admitted and diagnosed in the Pneumology Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from January, 2015 to October, 2016, aimed at characterizing them according to clinical and epidemiological variables of interest, besides genetic and non genetic risk factors, independently from the histological characteristics and the clinical stage of the neoplastic process. Among the predominant results there were the male sex and the age group 51-69, although the increment of the females and of patients in the youngest ages in the life was evident --, equally the bronchoscopy as diagnostic method, the localization in the right lung, the adenocarcinoma as histological variety, smoking habit among non genetic risk factors and the first degree relation in the genetic factors. Most of the affected patients presented a clinical course shorter than a year and a high percentage were in the stage IV of the disease.

Research on Relationship between Bronchioloalveolar Carcinoma Syndromes and Metastasis by Thoracoscopic Techniques / 世界科学技术-中医药现代化

This study was aimed to reveal the relationship of bronchioloalveolar carcinoma (BAC) syndromes and metastasis, in order to provide new scientific basis for syndrome differentiation, treatment and prognostic assessment, which proved the scientificity and feasibility of internal and external inspection. A total of 60 BAC cases were divid-ed into two groups according to the syndrome of deficiency and excess. Another 30 cases of benign pulmonary nod-ules were simultaneous collected in the physical examination as control group. The quality of life (FACT-L) was scored one day before operation for patients in each group. The thoracoscopic technique was used in the biopsy of targeted tissues, in order to reveal indicators related with metastasis. The results showed that the comparison of FACT-L score of patients from two syndromes of BAC and that of the control group indicated that the score of physi-ological state, social/family condition, emotional condition, functional situation, additional situation and total score of the previous one were obviously higher than the latter one (P < 0.01). And the score of patients in the deficiency syndrome group was higher than that of the excess group with statistical significance (P< 0.01). The comparison be-tween the tumor tissues of patients from two syndromes of BAC and the benign pulmonary nodules showed that the VEGF, MMP-2, MMP-9 of the previous one were higher than the latter one (P< 0.01). The comparison between two syndromes showed that all indexes of the deficiency syndrome were higher than the excess syndrome (P < 0.01). It was concluded that syndromes of BAC was related with metastasis.

Characteristics and prognostic analysis of 193 patients with special type of lung adenocarcinoma / 中国肿瘤临床

Objective: This work aimed to investigate the negative prognostic factors of bronchioloalveolar carcinoma (BAC) and adenocarcinoma with BAC characteristics, based on the 2004 pathological classification by the World Health Organization (WHO), which were further verified with the new pathological classification of lung adenocarcinoma (WHO 2011), to identify crucial factors that determine the prognosis of BAC and adenocarcinoma with BAC features, and to prove the coherence of the two pathological classi-fications in assessing clinical prognosis. Methods: Upon pathological diagnosis, some of the 193 cases of BAC or adenocarcinoma with BAC features were categorized into adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA), based on the 2011 WHO classification. Gender, age, tumor size, familial cancer history, smoking history, TNM stage, symptoms, duration of symp-toms, and the choice of treatment were recorded and analyzed for prognosis. The survival rate was calculated by Kaplan-Meier method. Log-rank test was introduced to compare the survival rate. Univariate and multivariate factors for the survival rate were analyzed by Cox proportional hazards regression model. Results:The overall 1-, 3-and 5-year survival rates were 84.3%, 60.6%, and 45.6%, respec-tively. Cox univariate analysis revealed that the tumor size, symptoms, TNM stage, pathological outcomes, and the choice of treatment were all prognostic factors. Cox multivariate analysis revealed that TNM stage was an independent prognostic factor for patients with BAC. Data from patients with AIS and MIA revealed better survival. Conclusion:The overall survival rate of BAC and adenocarcino-ma with BAC features are superior to that of other non-small cell lung cancer (NSCLC). The clinical symptoms are non-specific com-pared with other types of NSCLC. Clinical stage at diagnosis is a key prognostic factor, such that early correct diagnosis significantly improves survival. The new classification criteria of WHO, released in 2011, is more elaborate and more conducive to clinical practice.

CT diagnosis of pure bronchioloalveolar carcinoma / 肿瘤研究与临床

Objective To explore the HRCT characteristics of solitary pure bronchioloalveolar carcinoma.Methods Compared with postop pathological appearance,21 patients with 22 affections tumors which were pathologically confirmed pure bronchioloalveolar carcinoma were retrospectively reviewed.Results the histopathological results prior to surgery showed that 20 patients with 21 affections tumors were non-mucilaginous BAC and 1 patient was mucilaginous BAC.Noguchi's classification:Type A 3 cases,Type B 12 cases,Type C 5 cases.(Mucilaginous BAC was not classified)Stage classification:There were 21 cases with stage ⅠA,the maximum tumor diameter was from 0.3 to 3.0 mm (average diameter 1.3 mm).No case showed pleura metastasis,vessel invasion and lymphaticmetastasis.Appearance of HRCT:according to the amount of GGO,all affections were divided into 4 groups.A group(5/22),B group(7/22),C group(7/22),D group(3/22).There were 11 cases with pleura traction,5 cases with clear boundary and trimmed edges and other 17 cases were contradistinction.There were 21 cases with blood vessel or bronchus shadow.Conclusion HRCT can show scan can provide details of structure characteristics of BAC's pathological histology,so it plays an important role in prediction of pathological infiltration of tumor cells and prognosis assessment.

The Value of 18F -fluoodeoxyglucose PET-CT and CT in Diagnosing Bronchioloalveolar Carcinoma / 中国医科大学学报

Objective To explore the value of 18F-fluorodeoxyglucose（18F-FDG）PET-CT and CT in diagnosing bronchioloalveolar carcinoma （BAC）.Methods The PET-CT and CT findings of 15 patients with BAC pathologically confirmed were retrospectively analyzed.Results According to 18F-FDG PET-CT,there was definite diagnosis of malignant in 8 cases（53.3 %）,no exclusion of malignancies in 2 cases （13.3%）,definite diagnosis of benign tumors in 5 cases（33.3%）.The misdiagnosis rate of 18F-FDG PET-CT is higher.According to CT,there was definite diagnosis of malignant tumors in 11 cases（73.3 %）,no exclusion of malignancies in 2 cases（13.3%）,definite diagnosis of benign tumors in 2 cases（13.3%）.Conclusion The false negative rate and the misdiagnosis rate are high when SUVmax as 2.5 was employed as criteria in the diagnosis of BAC.To improve diagnosis accuracy and decrease misdiagnosis of BAC,we should be familiar with the CT images of different BACs and adjust the SUVmax as a diagnosis value.

Analysis of 94 patients with bronchioloalveolar carcinoma by surgical treatment / 肿瘤研究与临床

Objective To explore the effect of surgical treatment of bronchioloalveolar carcinoma (BAC). Methods Data were collected from 94 patients with BAC (including 67 cases with pure bronchioloalveolar carcinoma, 16 cases with BAC by local infiltration and 11 cases with adenocarcinoma having BAC character). All patients were proved pathologically bronchioloalveolar carcinoma from January 1989 to December 2003. Clinical features, characteristics of radiology, methods of treatment and survival status were studied retrospectively. Surgical treatment and efficacy approaches according to different TNM stages and clinical patterns were also analyzed. Results Ninety-eight patients underwent complete resection and 4 underwent palliative operation and 2 underwent exploratory thoractomy. The 1-, 3-, 5-year survival rates were 75.5 %, 53.2 %, 41.5 %. According to international staging system of lung cancer, there were marked difference in stage Ⅰ group, stage Ⅱ group and stage Ⅲ group (P <0.01). According to pathological classification, there were marked difference in pure bronchioloalveolar carcinoma, BAC with local infiltration and adenocarcinoma having BAC character (P <0.01). Conclusion Bronchioalveoar carcinoma is a special form of lung cancer. It has its own characteristics on biology,radiology,clinic or pathology. Lobectomy is performed commonly in patients with bronchioloalveolar carcinoma. It may be concluded that the early diagnosis, early therapy are the key points for improving the survival rate of BAC.

Consolidative Bronchioloalveolar Carcinoma Presenting as Pneumonia, and This Led to a Late Diagnosis due to the Improvement after Antibiotic Therapy / 결핵및호흡기질환

Non-resolving or slowly resolving pulmonary infiltrates in spite of administering adequate antimicrobial therapy are a clinical diagnostic challenge for physicians. The rate of radiographic resolution varies with the patients' age, the underlying comorbidities, the extent of radiographic involvement, the functional status and the causal pathogens. It is important to differentiate non-resolving or slowly resolving bacterial pneumonia from other uncommon infectious pneumonias or malignancies that require invasive diagnostic techniques to confirm the diagnosis. Bronchioloalveolar carcinoma can present with various clinical and radiographic features. Unfortunately, the radiographic similarity of consolidative BAC to pneumonia often leads to an incorrect diagnosis of pneumonia and possibly significant delays in obtaining appropriate diagnostic studies. We describe here a case of a mixed adenocarcinoma and bronchioloalveolar carcinoma that was initially diagnosed as pneumonia due to the consolidation pattern on the radiography and the patient's initial improvement with antibiotic treatment.

A Case of Bronchioloalveolar Carcinoma Presenting Adult-onset Still's Disease-like Manifestations due to Paraneoplastic Syndrome / 대한류마티스학회지

Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder with the characteristics of high spiking fever, evanescent salmon-colored skin rash, arthralgia or arthritis, lymphadenopathy, hepato-splenomegaly, sore throat, leukocytosis, negative autoantibody and hyperferritinemia. There are reports that rheumatic diseases such as dermatomyositis, polymyositis, hypertrophic osteoarthropathy, and polymyalgia rheumatica are associated with neoplasms. And small cell lung cancer, thymoma, lymphoma, leukemia, and breast cancer are known to be more associated with paraneoplastic syndromes mimicking rheumatic diseases. We experienced a case with bronchioloalveolar carcinoma who developed clinical manifestations of AOSD. Although there are several reports that AOSD is associated with paraneoplastic syndrome, to our knowledge, this is the first case of bronchioloalveolar carcinoma mimicking AOSD reported in the world.

A Case of Bronchioloalveolar Carcinoma Presenting with Initial Symptom of Visual Disturbance due to Intraocular Metastasis / 결핵및호흡기질환

Intraocular tumors are uncommon and an intraocular metastatic carcinoma is extremely rare. An intraocular metastasis in adults most often originates from the breast or the lung. An intraocular lesion may be the first presentation of cancer and a search should be made to locate the primary tumor. To our knowledge, an intraocular metastasis of a bronchioloaveolar carcinoma has not reported in Korea. We report a case of a bronchioloalveolar carcinoma presenting with the initial symptom of a unilateral visual disturbance due to an intraocular metastasis.

Diffe rentiation of Pneumonic-Type Bronchioloalveolar Carcinoma and Infectious Pneumonia in Clinical, Radiologic Findings

Bronchioloalveolar carcinoma may present with a variety of clinical and radiographic findings. It is originated from the periphery of the lung and can be mistaken for lobar pneumonia or atypical pneumonia. The most frequent symptoms and signs are cough, sputum, shortness of breath, weight loss, hemoptysis, and fever. Brochorrhea is unusual and a late manifestation. We conclude that early diagnosis of disease will increase operability and improve chances of survival and that aggressive diagnostic workup for suspicious pulmonary infiltrate is essential as early operation offers the best chances of cure.We report two cases of brochioloalveolar carcinoma presenting as proper clinical and radiological findings.

Well Differentiated Adenosquamous Carcinoma of Lung Mimicking Benign Lesions in Fine Needle Aspiration Cytology: Report of a Case / 대한세포병리학회지

Fine needle aspiration (FNA) cytological examination is an appropriate method for the evaluation of pulmonary nodules. In major types of lung cancer, its diagnostic accuracy is quite high. However, it is sometimes difficult, using this technique, to differentiate between some unusual phenotypes including adenosquamous carcinoma, bronchioloalveolar carcinoma (BAC), neuroendocrine tumor, mucoepidermoid carcinoma, and sclerosing hemangioma. Here, we present a case involving extremely well differentiated adenosquamous carcinoma, mimicking benign lesions, such as pulmonary scar and adenomatoid malformation with squamous metaplasia. The patient was a 68-year-old man presenting with a solitary pulmonary nodule (1.6x1.6 cm), which was incidentally found at the periphery of the right lower lobe. FNA revealed some clusters of glandular cells with minimal atypia, in addition to squamous cells at a nearly full maturational state. Histological examination verified the cytological diagnosis on a lobectomy specimen. The tumor exhibited a well differentiated adenocarcinoma component, mimicking the bronchioles in scarred lung tissue, and a well differentiated squamous cell carcinoma component, mimicking the squamous cell nests of adenoacanthoma, in the other organs. In the present case, the possibility of adenosquamous carcinoma should have been considered if squamous cells were seen in the FNA from the peripheral pulmonary nodule, even though they appeared to be benign.

HRCT Findings and Pathological Analysis of Bronchioloalveolar Carcinoma / 实用放射学杂志

Objective To analyse the HRCT manifestations of bronchioloalveolar carcinoma.Methods HRCT manifestations ofbronchioloalveolar carcinoma confirmed by pathology in 20 cases were retrospectively analysed.Results The most focus of disease located under the pleural membrane with irregular from,the lesions might appeared as patch,nodus and star-like.The ground glass,vacuolus and honeycomb sign had higher incidence in this tumor.Conclusion The ground glass and honeycomb sign usually point out the diagnosis of bronchioloalveolar carcinoma.

Bronchioloalveolar Carcinoma:Imaging Classification and Dynamic Changing / 实用放射学杂志

Objective To research the imaging classification and dynamic changing of bronchioloalveolar carcinoma (BAC). Methods The imaging types of BAC proved by operation and pathology in 32 cases were divided into single nodules, single segment or lobe consolidation, multiple segments or lobar consolidation and multiple diffuse nodules according to the features of plain chest films and CT at first examination. The spreading lesions in lung were recorded.The developing course and changes in size of lesions on the followed-up plain films and CT were observed, then the developing rules of different types of BAC were analyzed. Results The single noduli were enlarged and became poor defined opague shadows gradually. The single segment or lobar consolidation enlarged until the whole lobe. All single lesions progressed and coexisted with diffused nodular or opaque pulmonary involvement eventually. Multiple segments or lobar consolidation developed from peripheral to center of the segment or lobar, diffused pneumonia-like shadows appeared simultaneous. Multiple extensive nodules showed a trend of getting larger and then fused.Conclusion Different types of BAC have theirown developing rule,but they finally form a consequence that the primary lesion coexisted with the spread ones from different way.

CT Diagnosis of Solitary Bronchioalveolar Carcinoma / 实用放射学杂志

Objective To analyse the CT features of solitary bronchioalveolar carcinoma(SBAC) so that to improve the CT diagnostic accuracy.Methods CT findings of 39 cases with SBAC proved by operation and pathology were studied,and an analysis as compared with 48 cases other type of peripheral pulmonary carcinoma.Results CT findings included lobulations in 32,spiculation in 33,pleural tags in 25,bronchovascular bundles in 14,vacuole or/and bronchiologram in 18 and ground glass changs in 8 cases.Conclusion The characteristic CT manifestations of SBAC are:(1)Vacuole or/and bronchiologram;(2)Long spiculation;(3)Ground-glass.It is important to recognize the CT appearances of SBAC in order to improve diagnostic ability.

Bronchioloalveolar carcinoma presenting with obstructive jaundice: A case report.

An unusual case of bronchioloalveolar carcinoma of the lung presented with chronic cough and obstructive jaundice in an adult Thai male, who subsequently died after having undergone palliative treatment with percutaneous transhepatic biliary drainage (PTBD). Autopsy finding included typical bronchioloalveolar carcinoma diffusely distributed in both lungs and its metastatic tumors at paratracheal nodes, both adrenal glands, spleen, liver and soft tissue around common bile duct that caused obstruction of biliary tract mimicking hepato-biliary cancer, clinically. In addition to histopathologic evaluation, the ultrastructural finding of dense bodies reminiscent of lamella bodies, and the identical DNA index of near diploid aneuploid cell cycle of the tumors in the lung and liver, confirmed the bronchioloalveolar carcinoma of the lung as the primary tumor that had a widespread metastasis.

Management of high-flow priapism: A case report and review.

A case of high-flow priapism was presented. Diagnosis was based on the history of painless and persistent erection for 20 days. Cavernous blood gas showed arterial type. The arteriocavernous fistula was detected by either a perineal duplex Doppler ultrasonography or an internal pudendal arteriography. The treatment of choice was selective embolization with a good result and no immediate complication. Detumescence was noticed within 10 days. Follow up of perineal and penile duplex Doppler ultrasonographies showed no turbulent flow and low inflow of cavernous blood. Erectile function partially recovered at 2 months after the treatment.

The Characteristics of Bronchioloalveolar Carcinoma Presenting with Solitary Pulmonary Nodule / 결핵

BACKGROUND: Bronchioloalveolar carcinoma (BAC) has been reported to diveres spectrum of chinical presentations and radiologic patterns. The three representative radiologic patterns are followings; 1) a solitary nodule or mass, 2) a localized consolidation, and 3) multicentric or diffuse disease. While, the localized consolidation and solitary nodular patterns has favorable prognosis, the multicentric of diffuse pattern has worse prognosis regardless of treatment BAC presenting as a solitary pulmonary nodule is often misdiagnosed as other benign disease such as tuberculoma. Therefore it is very important to make proper diagnosis of BAC with solitary nodular pattern, since this pattern of BAC is usually curable with a surgical resection. METHODS: We reviewed the clinical and radiologic features of patients with pathologically-proven BAC with solitary nodular pattern from January 1995 to September 1996 at Samsung Medical Center. RESULTS: Total 11 patients were identified. 6 were men and 5 were women. Age ranged from 37 to 69. Median age was 60. Most patients with BAC with solitary nodular pattern were asymptomatic and were detected by incidental radiologic abnormality. The chest radiograph showed poorly defined opacity or nodule and computed tomography showed consolidation, ground glass appearance, internal bubble-like lucencies, air bronchogram, open bronchus sign, spiculated margin or pleural tag in most patients. The initial diagnosis on chest X-ray were pulmonary tuberculosis in 4 patients, benign nodule in 2 patients and malignant nodule in 5 patients. The FDG-positron emission tomogram was performed in eight patients. The FDG-PET revealed suggestive findings of malignancy in only 3 patients. The pathologic diagnosis was obtained by transbronchial lung biopsy in 1 patient, by CT guided percutaneous needle aspiration in 2 patients, and by lung biopsy via video-assited thoracocopy in 8 patients. Lobectomy was performed in all patients and postoperative pathologic staging were T1N0M0 in 8 patients and T2N0M0 in 3 patients. CONCLUSION: Patients of BAC presenting with solitary nodular pattern were most often asymptomatic and incidentally detected by radiologic abnormality. The chest X-ray showed poorly defined nodule or opacity and these findings were often regarded as benign lesion. If poorly nodule or opacity does not disappear on follow up chest X-ray, computed tomography should be performed. If consolidation, ground glass appearance, open bronchus sign, air bronchogram, internal bubble like lucency, pleural tag or spiculated margin are found on computed tomography, further diagnostic procedures, including open thoracotomy, should be performed to exclude the possiblity of BAC with solitary nodular pattern.

A case of very slowly progressed pneumonic consolidation / 결핵

Bronchioloalveolar carcinoma is originated from the periphery of the lung and can be mistaken for lobar pneumonia or atypical pneumonia clinically and at gross examination. Recently the authors experienced a 67-year-old woman who had slowly progressed pulmonary lesions for four years. At first, she visited this hospital for intermittent chest pain four years before. And she visited other hospitals for the same problem and had a series of evaluation including two times of biopsy but did not have any conclusive diagnosis. With aggravation of chest pain, she was referred to this hospital again and the lesion was reexamined and confirmed as bronchioloalveolar carcinoma by ultrasonography-guided needle biopsy. Being performed left lower lobectomy, she kept good condition without any complication.