ABSTRACT
A 44-year-old man presented at our hospital to be evaluated for persistent fever and dyspnea. A chest computed tomography (CT) scan showed diffuse ground glass shadows and a left hilar tumor shadow. Upon further examination, he was found to have leukopenia, thrombocytopenia, and elevated lactate dehydrogenase and ferritin levels. He was diagnosed with both squamous cell lung carcinoma by a transbronchial lung biopsy and hemophagocytic syndrome by a bone marrow biopsy. After receiving treatment with dexamethasone and etoposide, the blood test abnormalities and performance status improved. Chemotherapy for lung cancer was initiated. He had a partial response after first-line chemotherapy and thereafter underwent left upper sleeve lobectomy.
Subject(s)
Carcinoma, Squamous Cell , Lung Neoplasms , Lymphohistiocytosis, Hemophagocytic , Adult , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnosis , Epithelial Cells , Humans , Lung , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Lymphohistiocytosis, Hemophagocytic/diagnosis , MaleABSTRACT
OBJECTIVES: To investigate the potential of computed tomography (CT)-based texture analysis and elastographic data provided by endobronchial ultrasonography (EBUS) for differentiating the mediastinal lymphadenopathy by sarcoidosis and small cell lung cancer (SCLC) metastasis. METHODS: Sixteen patients with sarcoidosis and 14 with SCLC were enrolled. On CT images showing the largest mediastinal lymph node, a fixed region of interest was drawn on the node, and texture features were automatically measured. Among the 30 patients, 19 (12 sarcoidosis and 7 SCLC) underwent endobronchial ultrasound transbronchial needle aspiration, and the fat-to-lesion strain ratio (FLR) was recorded. Texture features and FLRs were compared between the 2 patient groups. Logistic regression analysis was performed to evaluate the diagnostic accuracy of these measurements. RESULTS: Of the 31 texture features, the differences between 11 texture features of CT ROIs in the patients with sarcoidosis versus patients with SCLC were significant. Among them, the grey-level run length matrix with high gray-level run emphasis (GLRLM-HGRE) showed the greatest difference (P<0.01). Differences between FLRs were significant (P<0.05). Logistic regression analysis together with receiver operating characteristic curve analysis demonstrated that the FLR combined with the GLRLM-HGRE showed a high diagnostic accuracy (100% sensitivity, 92% specificity, 0.988 area under the curve) for discriminating between sarcoidosis and SCLC. CONCLUSION: Texture analysis, particularly combined with the FLR, is useful for discriminating between mediastinal lymphadenopathy caused by sarcoidosis from that caused by metastasis from SCLC.
Subject(s)
Lung Neoplasms/diagnostic imaging , Mediastinal Diseases/diagnostic imaging , Radiographic Image Interpretation, Computer-Assisted/methods , Sarcoidosis/diagnostic imaging , Small Cell Lung Carcinoma/diagnostic imaging , Aged , Aged, 80 and over , Diagnosis, Differential , Elasticity Imaging Techniques , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Female , Humans , Logistic Models , Lymphatic Metastasis , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Immune checkpoint inhibitors (ICIs) are the key drugs used in patients with non-small cell lung cancer (NSCLC). However, anti-PD-1 therapy might worsen chronic infection by reactivating the immune response to infectious diseases. Here, we describe a case of successful treatment with nivolumab in a patient with NSCLC complicated by pulmonary aspergilloma, which was safely treated by surgical resection before administration of nivolumab. In conclusion, to safely treat patients with locally limited chronic pulmonary aspergillosis (CPA), surgical resection should be considered before ICI therapy.
