Use of a FluoroType® System for the Rapid Detection of Patients with Multidrug-Resistant Tuberculosis-State of the Art Case Presentations.

According to the World Health Organization (WHO), there were 465,000 cases of tuberculosis caused by strains resistant to at least two first-line anti-tuberculosis drugs: rifampicin and isoniazid (MDR-TB). In light of the growing problem of drug resistance in Mycobacterium tuberculosis across laboratories worldwide, the rapid identification of drug-resistant strains of the Mycobacterium tuberculosis complex poses the greatest challenge. Progress in molecular biology and the development of nucleic acid amplification assays have paved the way for improvements to methods for the direct detection of Mycobacterium tuberculosis in specimens from patients. This paper presents two cases that illustrate the implementation of molecular tools in the recognition of drug-resistant tuberculosis.

Treatment of pulmonary artery stump thrombosis after lobectomy: a case report and literature review.

INTRODUCTION: Lung cancer surgery is a well-known risk factor for venous thromboembolism. Thus, standard care involves the use of pharmacological and mechanical prophylaxis until discharge from the hospital. Pulmonary artery stump thrombosis (PAST) is a rare condition which can develop months to years after lung cancer surgery. This report describes a patient diagnosed with PAST and the decisions that were made regarding his treatment. CASE REPORT: A 67-year-old male was diagnosed with lung cancer due to shortness of breath, dry cough, hemoptysis, and typical chest computed tomography (CT) findings. He underwent right lower lobectomy and mediastinal lymphadenectomy by video-assisted thoracoscopic surgery. The procedure was complicated by the development of a right pleural empyema. After pleural drainage and an antibiotic regimen, he was discharged from the hospital with further improvement. A follow-up CT pulmonary angiography performed three months after lobectomy revealed thrombosis in the right lower lobar pulmonary artery stump. The patient had no symptoms. The attending physician decided to use anticoagulants. Consequently, the patient received low molecular-weight heparin subcutaneously for one month and a non-vitamin-K antagonist oral anticoagulant (NOAC) for the following 5 months. A CT scan performed after 3 months of anticoagulation showed complete resolution of stump thrombosis. Subsequent examinations showed no recurrence of either lung cancer or artery stump thrombosis and no anticoagulant-related bleeding. DISCUSSION: Pulmonary artery stump thrombosis can develop after lung cancer surgery. This complication is uncommon and the prognosis is favorable in most treated cases. However, thrombosis may progress, and pulmonary embolism or chronic thromboembolic pulmonary hypertension may develop. Decisions about instituting anticoagulation therapy and its duration are made on an individual basis after considering both the benefits and the potential risks.

The expression of circulating miR-504 in plasma is associated with EGFR mutation status in non-small-cell lung carcinoma patients.

MicroRNAs (miRNAs), key regulators of gene expression at the post-transcriptional level, are grossly misregulated in some human cancers, including non-small-cell lung carcinoma (NSCLC). The aberrant expression of specific miRNAs results in the abnormal regulation of key components of signalling pathways in tumour cells. MiRNA levels and the activity of the gene targets, including oncogenes and tumour suppressors, produce feedback that changes miRNA expression levels and indicates the cell's genetic activity. In this study, we measured the expression of five circulating miRNAs (miR-195, miR-504, miR-122, miR-10b and miR-21) and evaluated their association with EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) mutation status in 66 NSCLC patients. Moreover, we examined the discriminative power of circulating miRNAs for EGFR mutant-positive and -negative NSCLC patients using two different data normalisation approaches. We extracted total RNA from the plasma of 66 non-squamous NSCLC patients (31 of whom had tumours with EGFR mutations) and measured circulating miRNA levels using quantitative reverse transcription polymerase chain reaction (RT-qPCR). The miRNA expression levels were normalised using two endogenous controls: miR-191 and miR-16. We found significant associations between the expression of circulating miR-504 and EGFR-activating mutations in NSCLC patients regardless of the normalisation approach used (p = 0.0072 and 0.0236 for miR-16 and miR-191 normalisation, respectively). The greatest discriminative power of circulating miR-504 was observed in patients with EGFR exon 19 deletions versus wild-type EGFR normalised to miR-191 (area under the curve (AUC) = 0.81, p < 0.0001). Interestingly, circulating miR-504 levels were significantly reduced in the v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS)-mutated subgroup compared to EGFR-mutated patients (p < 0.0030) and those with EGFR/KRAS wild-type tumours (p < 0.0359). Our study demonstrated the feasibility and potential diagnostic value of plasma miR-504 expression analysis to distinguish between EGFR-mutated and wild-type NSCLC patients. However, quality control and normalisation strategies are very important and have a major impact on the outcomes of circulating miRNA analyses.

Plasma cell-free DNA levels and integrity in patients with chest radiological findings: NSCLC versus benign lung nodules.

Effective discrimination between lung cancer and benign tumours is a common clinical problem in the differential diagnosis of solitary pulmonary nodules. The analysis of cell-free DNA (cfDNA) in blood may greatly aid the early detection of lung cancer by evaluating cancer-related alterations. The plasma cfDNA levels and integrity were analysed in 65 non-small cell lung cancer (NSCLC) patients, 28 subjects with benign lung tumours, and 16 healthy controls using real-time PCR. The NSCLC patients demonstrated significantly higher mean plasma cfDNA levels compared with those with benign tumours (P = 0.0009) and healthy controls (P < 0.0001). The plasma cfDNA integrity in healthy individuals was significantly different than that found in patients with NSCLC or benign lung tumours (P < 0.0003). In ROC curve analysis, plasma cfDNA levels >2.8 ng/ml provided 86.4% sensitivity and 61.4% specificity in discriminating NSCLC from benign lung pathologies and healthy controls. cfDNA integrity showed better discriminatory power (91% sensitivity, 68.2% specificity). These data demonstrate that plasma cfDNA concentration and integrity analyses can significantly differentiate between NSCLC and benign lung tumours. The diagnostic capacity of the quantitative cfDNA assay is comparable to the values presented by conventional imaging modalities used in clinical practice.

[Synchronous multiple primary lung cancers in a 65-year old heavy smoker. Case report]. / Synchroniczne mnogie pierwotne raki pluca u 65-letniego mezczyzny z wieloletnim wywiadem nikotynowym. Opis przypadku.

Here we present a 65-year old ex-smoker with history of recent surgery for vocal cord tumor (histology: moderate grade intraepithelial neoplasia), who reported to the pulmonary outpatient clinic for the nodular lesions in the left lung seen on chest X-ray. Subsequent chest CT scan revealed focal lesion of 18 mm in diameter with spicular margins located in the right upper lobe, another irregular cyst with septa, 62 × 58 mm in the right lower lobe, and calcified nodule in the left lung, no enlarged lymph nodes or pleural effusion was seen. He underwent upper right lobe resection and wedge resection of the lower right lobe. Histological examination revealed adenocarcinoma in the right upper lobe with lymph node metastasis (pT2aN2M0). Examination of the right lower lobe showed squamous cell carcinoma (pT2bN0M0). He was subsequently treated with adjuvant chemotherapy and radiotherapy. During 20 months of the follow-up, he remained in good health with no signs of the disease progression. Patients with synchronous multiple primary lung cancers have significantly less favorable outcome than those with single primary lung malignancies, although it can be considerably improved with radical surgical treatment. Basing on the above case report, we discussed diagnostic and therapeutical scheme in patients with the primary multiple lung cancers, and have analyzed epidemiological data and some aspects of MPM etiology.

[A surprising diagnosis in a male with a tumour of the chest wall--not always lung cancer]. / Zaskakujace rozpoznanie u mezczyzny z guzem sciany klatki piersiowej--nie wszyscy choruja na raka pluca.

Lung cancer is the most frequent malignant tumour in men. Advanced disease may produce metastatic tumours in subcutaneous tissue and also infiltrate the chest wall. We present a history of a man referred to our department suspected of lung tumour infiltrating the chest wall. Additionally, bone metastatic disease was diagnosed (ribs, vertebral bodies and skull). Thanks to a wide diagnostic approach, ductal cancer of the breast was finally diagnosed, a neoplasm that is extremely rare in male patients, usually presenting as a definite nodule in the nipple area of the breast. This case shows the importance of careful histological evaluation of the chest wall tumour.

Quantitative analysis of free-circulating DNA in plasma of patients with resectable NSCLC.

OBJECTIVE: Minute amounts of free-circulating DNA are present in plasma of healthy individuals, whereas its increased concentration was observed in patients with malignant tumors including non-small cell lung cancer (NSCLC). This study aimed at demonstrating the potential usefulness of plasma DNA concentration monitoring in NSCLC patients for therapy effectiveness assessment throughout the treatment and follow-up period. METHODS: Plasma DNA concentration was assessed in 50 NSCLC patients (stage I - IIIA) prior and following the radical treatment using real-time quantitative PCR method. 10 orthopedic patient undergoing hip joint surgery and 40 healthy volunteers comprised control groups. RESULTS: NSCLC patients (8.02 ng/ml) demonstrated significantly higher mean plasma DNA concentration with respect to healthy controls (2.27 ng/ml; p < 0.0000). Drastic increase in plasma DNA levels up to mean 68.74 ng/ml was detected a week after primary tumor resection. Still, similar phenomenon was observed in patients subjected to orthopedic surgical treatment (from 3.00 to 28.38 ng/ml, p < 0.0015). Most resected NSCLC patients with no disease recurrence during 3- to 6-month follow-up demonstrated reduced plasma DNA levels (mean 2.77 ng/ml) with respect to their presurgical values, whereas in relapsed subjects plasma DNA levels were significant higher. CONCLUSION: Free-circulating DNA concentration in plasma was significantly higher in NSCLC patients versus healthy controls. Its drastic increase following radical NSCLC treatment was most likely due to the surgical trauma. Importantly, the kinetics of plasma free-circulating DNA seems to be a promising marker of long-term effects of radical surgery in NSCLC.

[Sarcoidal reaction in lung adenocarcinoma in 50-years old man]. / Reakcja sarkoidalna wokól gruczolakoraka pluca lewego u 50-letniego chorego.

A 50-year old patient was admitted to the hospital with hoarseness persisting for two weeks. Chest computed tomography revealed enlargement of lymph nodes in the aortopulmonary window. The bronchoscopy did not show any abnormalities, in transbronchial fine needle aspiration biopsy no diagnostic material was obtained. In the biopsies collected during mediastinoscopy the sarcoid granulomas were recognized. In the follow-up the computed tomography revealed a tumor mass and diagnostic thoracotomy was performed in which pulmonary adenocarcinoma was recognized. After radiotherapy the total regression was achieved. In this case sarcoid-like reaction in the course of lung cancer and the diagnostic difficulties were described.

[Pneumatocele during long-lasting observation of hyper IgE patient]. / Pneumatocele w trakcie dlugotrwalej obserwacji chorego na zespól hiper IgE (zespól Hioba)

Hyper IgE syndrome (Job's syndrome) is a rare multiorgan disease characterized by the triad: elevated serum IgE level, recurrent sinopulmonary infections, most often staphylococcal, and cutaneous cold abscesses starting in infancy. We report 21 years old patient with hyper IgE syndrome, diagnosed at age of 6 years on the basis of hyperimmunoglobulinaemia E and recurrent pulmonary and cutaneous infections. Now he was admitted because of pneumonia complicating with pneumatocele, which could not be resolved despite intravenous antibiotics. Surgical intervention was necessary. The postoperative period was complicated by Staphyloccocus aureus sepsis.

[Mediastinal and subcutaneous emphysema as a complication of labor]. / Odma sródpiersia i odma podskórna jako powiklanie porodu naturalnego.

Mediastinal emphysema and subcutaneous emphysema are rare complications of labor. We have described a case of mediastinal and subcutaneous emphysema, observed in the II stage of labor in otherwise healthy primigravida. The diagnosis was confirmed clinically and by X-ray, and endoscopies examination in District Hospital and in Clinical Department of Surgery. The etiology of this condition was not established. The mediastinal and subcutaneous emphysema, disappeared spontaneously which was confirmed by check-up after 3 months.

[Neoplastic pericarditis--the role of different diagnostic procedures]. / Ocena przydatnosci róinych metod diagnostycznych dla rozpoznawania zajecia osierdzia przez proces nowotworowy.

The aim of the study was to assess the role of different diagnostic procedures in the recognition of malignant pericarditis. Consecutive medical records of the patients with pericardial effusion treated with pericardiocentesis or pericardioscopy in the period of 1982-2002 were analyzed retrospectively. Criteria of neoplastic pericarditis were: positive result of pericardial fluid cytology and/or neoplastic infiltration found in pericardial biopsy specimen. Criteria of non-neoplastic pericarditis were: negative result of pericardial fluid cytology and pericardial biopsy specimen, no neoplastic disease diagnosed at presentation and during 3-years of follow up. Malignant pericarditis was diagnosed in 47 patients (pts), nonmalignant in 51. Echocardiographic signs of cardiac tamponade were found in 80% of pts with neoplastic pericarditis and 40% of pts with non-malignant disease (p = 0.0001). Chest CT scan revealed the presence of enlarged mediastinal lymph nodes in 94% of pts with malignant pericarditis and only 11% of pts with non-malignant disease (p = 0.00001). Pericardial thickness on CT scan exceeded 8 mm in 75% of the pts with malignant pericarditis and 8% of pts with nonmalignant disease (p = 0.0003). Pericardial fluid (pf) CEA concentration was significantly higher in the patients with neoplastic pericarditis than in the pts with non-malignant process. CEA > 5 ng/ml and Cyfra 21-1>50 ng/ml were found in 43% of the pts with malignant pericarditis and none of the pts with benign pericarditis. Thus we recommend chest CT scan and pericardial fluid tumor markers (CEA and Cyfra 21-1) assessment as the procedures helpful in the recognition of malignant pericarditis.

[Chylothorax in patients with diffuse pulmonary lymphangiomatosis]. / Chlonkotok oplucnowy w przebiegu naczyniakowatosci limfatycznej pluc.

The occurence of chylothorax is uncommon and usually is caused by trauma or neoplastic process of the mediastinum. Primary lymphatic lesions of the lungs are extremly rare. One of them is lymphangiomatosis --diffuse lesions characterized primarily by an increased number of complex anastomosing lymphatic channels in which dilatation is secondary phenomenon. These lesions can involve lungs, mediastinum and pleura. The prognosis for the patients with this disease limited to the thorax is guarded and progressive although some patients have realtively indolent course. We present 2 patients : 18-years old boy and 17-years old girl. admitted to hospital because of chylothorax. The diagnostic did could not allow to discover disruption of thoracic duct, even during thoracoscopy. In material taken from the pleura and mediastinum during exploratory thoracotomy - diffuse pulmonary lymphangiomatosis was found. CT examination of the chest revealed osteolysis of the spine. The girl died after 6 weeks from the first symptoms and boy is observed for 18 months with symptoms of progressive restrictive lung disease.

[Granular cell tumor--a rare, benign respiratory tract neoplasm in the material of the Institute of Tuberculosis and Lung Diseases]. / Granular cell tumor--rzadki, lagodny nowotwór ukladu oddechowego w materiale Instytutu Gruzlicy i Chorób Pluc.

The granular cell tumor (GCT) is a nodule that arises most commonly in the skin, the breast or the tongue. The vast majority are benign. Approximately 6-10% of granular cell tumors have been reported in the lower respiratory tract. The clinical, pathological and immunohistochemical findings of eleven cases are described in our material consisted of 6 males and 5 females aged from 35 to 58 years (median, 46 years). The GCT were solitary lesions in all our patients. The tumors were located in trachea (6 cases) and in bronchus (5 cases). They were found during bronchoscopy performed because of symptoms of pneumonia, lung cancer and hemoptysis or dyspnea alone. Diameter of the tumors ranged from 0.2-2.5 cm (median 1.2 cm). Six tumors were surgically excised and 5 were endoscopically removed. Pulmonary GCT behave in a benign fashion. It was observed that tumors of less than 8 mm were more amenable to endoscopic removal and larger tumors were more likely to infiltrate through the bronchial wall. Histologically, the GCT showed submucosal infiltrates of round or oval cells with abundant granular cytoplasm. The tumors cells were positive for S-100 protein, neuron specific enolase, CD68 and vimentin. Our immunohistochemical results are consistent with this concept.

[Diagnostic difficulties in primary mesothelioma]. / Trudnosci diagnostyczne w rozpoznawaniu pierwotnego zlosliwego miedzybloniaka osierdzia.

A 54-year-old woman with a history of fatigue and shortness of breath was found to have a pericardial effusion and mild mediastinal lymphadenopathy. Video-assisted pericardioscopy revealed thickened pericardium studded with multiple nodules. Histologically the tumor was diagnosed as papillary adenocarcinoma. The site of the primary tumor could not be identified. As lung cancer is one of the most frequent causes of pericardial metastases the patient was treated with cisplatin and vinblastin. Following 5 courses of chemotherapy--given over a 4 month period--the amount of pericardial effusion and pericardial thickness did not change. The material from pericardial biopsy was reexamined and positive immunostaining for calretinine was found. The final diagnosis was primary pericardial mesothelioma of epithelioid type. Palliative radiotherapy of mediastinum was planned but the patient deteriorated and died due to disease progression with venous thrombosis and superior vena cava syndrome. The case illustrates the difficulties in establishing diagnosis of primary pericardial mesothelioma which is a rare tumor with poor prognosis.