Coexistent Non-Small Cell Carcinoma and Small Cell Carcinoma in a Patient Presenting with Hyponatremia.

Despite recent advances in screening methods, lung cancer remains the leading cause of cancer-related deaths worldwide. By the time lung cancer becomes symptomatic and patients seek treatment, it is often too advanced for curative measures. Low-dose computed tomography (CT) screening has been shown to reduce mortality in patients at high risk of lung cancer. We present a 66-year-old man with a 50-pack-year smoking history who had a right upper lobe (RUL) pulmonary nodule and left lower lobe (LLL) consolidation on a screening CT. He reported a weight loss of 45 pounds over 3 months, had recently been hospitalized for hyponatremia, and was notably cachectic. A CT of the chest showed a stable LLL mass-like consolidation and a 9 × 21 mm subsolid lesion in the RUL. Navigational bronchoscopy biopsy of the RUL lesion revealed squamous non-small cell lung cancer (NSCLC). Endobronchial ultrasound-guided transbronchial needle aspiration of the LLL lesion revealed small cell lung cancer (SCLC). The final diagnosis was a right-sided Stage I NSCLC (squamous) and a left-sided limited SCLC. The RUL NSCLC was treated with stereotactic radiation; the LLL SCLC was treated with concurrent chemotherapy and radiation. In patients with multiple lung nodules, a diagnosis of synchronous multiple primary lung cancers (MPLCs) is crucial, as inadvertent upstaging of patients with MPLC (to T3 and/or T4 tumors) can lead to erroneous staging, inaccurate prognosis, and improper treatment. Recent advances in the diagnosis of small pulmonary nodules via navigational bronchoscopy and management of these lesions dramatically affect a patient's overall prognosis.

Medullary thyroid microcarcinoma recommendations for treatment - a single-center experience.

BACKGROUND: Conflicting recommendations exist regarding lymph node (LN) surgery in microMTC (or=10pg/ml) and pentagastrin-stimulated calcitonin levels (sCT:>100pg/ml) were selected for initial surgery. None of the patient was a member of any known MTC family. Biochemical and morphological data of microMTC were compared with 146 patients with C-cell hyperplasia (CCH). RESULTS: MicroMTC (tumor diameter: 4.2+/-2.6mm; unifocal:68; multifocal:29) was documented in 97 of 159 (61%) MTC patients. In 11 (11%) patients, 1-19 LNs were involved. Correlating bCT and sCT levels neither predicted N-stage, nor differentiated between microMTC and CCH. CONCLUSIONS: The biochemical discrimination cannot be made between patients with CCH and MTC, and patients with MTC with/without LN metastasis. Thus, thyroidectomy and central neck dissection is indicated in patients with "mildly" elevated sCT levels (<560pg/ml) (LN positive: 1 of 37 patients [2.7%]). A lateral neck dissection may be added "on demand" (in the setting of measurable postoperative bCT and/or sCT levels indicating LN metastasis). Patients with "highly" elevated sCT (>or=560pg/ml) must be treated as "palpable" MTC (LN positive: 10 of 54 patients [18.5%]).

Diagnostic accuracy of chest X-rays acquired using a digital camera for low-cost teleradiology.

Store-and-forward telemedicine, using e-mail to send clinical data and digital images, offers a low-cost alternative for physicians in developing countries to obtain second opinions from specialists. To explore the potential usefulness of this technique, 91 chest X-ray images were photographed using a digital camera and a view box. Four independent readers (three radiologists and one pulmonologist) read two types of digital (JPEG and JPEG2000) and original film images and indicated their confidence in the presence of eight features known to be radiological indicators of tuberculosis (TB). The results were compared to a "gold standard" established by two different radiologists, and assessed using receiver operating characteristic (ROC) curve analysis. There was no statistical difference in the overall performance between the readings from the original films and both types of digital images. The size of JPEG2000 images was approximately 120KB, making this technique feasible for slow internet connections. Our preliminary results show the potential usefulness of this technique particularly for tuberculosis and lung disease, but further studies are required to refine its potential.