ABSTRACT
INTRODUCTION: Isolated splenic metastases from a bronchial carcinoma, without other visceral metastatic involvement, are exceptionally uncommon. CASE REPORT: The authors report the finding of an isolated splenic metastasis 21 months after a left pneumonectomy for an undifferentiated large cell carcinoma, initially staged pT3N1M0. The splenic metastasis presented as a major deterioration in general health and sharp pains in the left hypochondrium. Splenectomy confirmed the metastatic nature of the splenic tumour and relieved the severe abdominal pains. Two years after the splenectomy and with out adjuvant treatment the patient remains in complete remission. CONCLUSION: Splenectomy for a metastasis from a bronchial carcinoma should avoid the later complications of this type of metastasis: severe abdominal pain, splenic rupture and compression of neighbouring vessels. If the bronchial carcinoma is controlled locally and the splenic metastasis is isolated, splenectomy offers, perhaps, a further chance of prolonged survival.
Subject(s)
Carcinoma, Large Cell/pathology , Lung Neoplasms/pathology , Splenic Neoplasms/secondary , Aged , Humans , Male , Splenectomy , Splenic Neoplasms/diagnosis , Splenic Neoplasms/surgeryABSTRACT
BACKGROUND: Chronic lung rejection (CLR) induces a fibroproliferative disorder leading to the occlusion of small airways. It has emerged as the major factor limiting the survival of lung transplant recipients. Predictive markers of CLR are lacking, and its diagnosis is generally ascertained when the fibrosis process is irreversible. METHODS: We have quantified the expression of transforming growth factor-beta (TGF-beta), a critical mediator of fibrogenesis, in alveolar cells from lung transplant recipients using a competitive reverse transcriptase polymerase chain reaction method. RESULTS: We have shown that patients with CLR presented marked peaks of TGF-beta mRNA expression, in contrast with patients without CLR. These peaks preceded the diagnosis of CLR by several months in two of three patients who died within 2 years of diagnosis. CONCLUSIONS: Our data suggest that TGF-beta expression in alveolar cells could serve as an early predictive and prognostic marker of chronic lung rejection.
