Importance of mediastinal granulomatous/sarcoid-like lymphadenopathy in extrathoracic malignancies.

BACKGROUND: In patients with extrathoracic malignancies (ETM), granulomatous lymph adenopathy called sarcoid-like reactions (SLR) can be seen in the regional or draining lymph nodes. We hypothesized that SLR may be a sign of imminent metastasis and investigated the clinical course and rate of recurrence in patients with ETM and granulomatous mediastinal lymphadenopathy (MLN). METHODS: In this retrospective observational study, we reviewed the medical files of patients with known ETM and who underwent EBUS-TBNA for initial staging or detection of recurrence from 2011 to 2023. Patients with granulomatous MLN were included. RESULTS: Forty-one patients (29 female) enrolled in the study. Breast and colorectal carcinomas were the most common malignancies. A total of 81 lymph nodes were sampled. The final diagnosis of patients was five sarcoidosis, one tuberculosis, one second primary, one drug reaction, and 33 SLR. Among patients with SLR, in one patient lymph nodes progressed during the follow-up and were accepted as false-negative without confirmatory biopsy. The negative predictive value (NPV) of granulomatous MLN for metastasis was 97.05%. CONCLUSION: Granulomatous MLN may be due to tuberculosis, drug reaction, sarcoidosis, or SLR in patients with ETM. SLR has a high NPV in patients with ETM. Follow-up imaging rather than confirmatory biopsy is reasonable in these patients.

Is endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) reliable and safe procedure in geriatric patients?

BACKGROUND: Even though studies have indicated the usefulness and safety of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA), elderly patient data are limited due to the small sample sizes. AIM: We aimed to evaluate usage and safety of EBUS-TBNA in elderly population. METHODS: This single-center retrospective study was conducted with patients who underwent an EBUS-TBNA procedure between September 2011 and December 2019. The patients were categorized into two groups: those aged 65 years or older (elderly group) and those younger than 65 years (younger group). RESULTS: 2444 patient data, 1069 of which were in the elderly group, were analyzed. The cytological examination of EBUS-TBNA identified specimen adequacy in 96.8% of patients. One hundred and thirty patients (5.3%) experienced complications, with similar complication rates recorded in both the elderly and younger groups (5.4% vs 5.2%, p: 0.836). Logistic regression analyses revealed that age, and presence of hypertension, diabetes mellitus, coronary artery disease and malignancy are associated significantly with complication-related EBUS-TBNA. For the lymph nodes with a final diagnosis of malignancy, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EBUS-TBNA revealed a diagnostic performance in excess of 90% except for metastasis and lymphoma. CONCLUSION: EBUS-TBNA can be considered a safe and effective technique in patients aged 65 years and over.

Using RV/LV ratio and cardiac biomarkers to define the risk of mortality from pulmonary embolism.

INTRODUCTION: Acute pulmonary thromboembolism (PTE) is a common cause of cardiovascular mortality. Right ventricular (RV) dysfunction is the most important cause of mortality. Computed Tomography Pulmonary Angiography (CTPA) can detect right ventricular enlargement which is an indicator of RV dysfunction at the time of diagnosis. This study aimed to determine the parameters indicating RV dysfunction in CTPA and correlation of early mortality findings. MATERIALS AND METHODS: In this retrospective study, electronic files of patients diagnosed PTE with CTPA between January 2012 and December 2017 were evaluated. Measurements of heart chambers, IVC reflux, and IVS morphology were calculated. In-hospital mortality of the patients after acute PTE diagnosis was evaluated. RESULT: There were 206 eligible patients. Among the evaluated radiological parameters, right atrium (RA) size (p= 0.002), PA size (p= 0.003), Ao size (p= 0.006), and the presence of IVC reflux (p= 0.001) were associated with mortality. No significant relationship was found between RV/LV ≥1 and mortality (p= 0.908). All patients with PTE-related mortality had RV/LV ratio ≥1 in CTPA and had IVC reflux. Patients with an RV/LV ratio of ≥1 had statistically significantly higher troponin levels (p= 0.004) and IVC reflux (p= 0.025) compared to patients with an RV/LV ratio of <1. CONCLUSIONS: In conclusion, RV/LV ratio should be evaluated together with cardiac biomarkers to define mortality risk.

Regional distribution of genetic mutation in lung cancer in Turkey (REDIGMA).

INTRODUCTION: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey. MATERIALS AND METHODS: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients' biopsy materials. RESULT: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p<0.000, p<0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient's age, area of residence, comorbidity and clinical stage and mutation frequency. CONCLUSIONS: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African-American and Caucasian patients, and was lower than in East Asia.

Frequency of vitamin K oxidoreductase complex subunit-1 (VKORC1) polymorphisms and warfarin dose management in patients with venous thromboembolism.

Warfarin works by inhibiting VKORC1, so polymorphisms of this gene modify the required drug dose. The aim of this study is to examine the relation between therapeutic weekly dose of warfarin and C1173T/G1639A polymorphism of VKORC1 in patients with VTE. Seventy-five patients with VTE were enrolled. Weekly warfarin doses and time (day) to reach therapeutic INR were evaluated retrospectively along with VKORC1-C1173T and G1639A alleles. The mean weekly warfarin dose was lower and time to reach therapeutic INR was shorter in homozygote alleles (AA and TT) (p < 0.05). The multivariate regression model was produced, R2 = 0.05% for age (p = 0.04), R2 = 6% for VKORC1 (p = 0.03), the model for estimating warfarin dose R2 = 17% (p > 0.05). In particular, patients who need overdose of warfarin or whose bleeding score is high, study of these polymorphisms can be considered.

Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment.

INTRODUCTION: The pulmonary embolism severity index (PESI) or simplified version (sPESI) are widely validated risk scores for the identification of eligible patients for outpatient treatment. Saturation is one of these criteria. For this metric, saturation of 90% or greater is assigned zero points. However, 90% saturation does not always exclude hypoxemic respiratory failure. OBJECTIVE: The aims of this study were first was to define corresponding partial arterial oxygen pressure (PaO2 ) values according to saturation in pulmonary embolism (PE) patients, and the second was to define a target saturation that can exclude hypoxemic respiratory failure and enable secure discharge of PE patients from emergency departments. METHODS: This is a retrospective study. To determine the optimal saturation value by which to detect hypoxemic respiratory failure, we generated receiver operating characteristic (ROC) curves and calculated the negative predictive value. RESULTS: Total of 65 patients were included in this study. Mean PaO2 levels from SaO2 89% to SaO2 93% were 52.8, 57.1, 57.3, 61, and 63.8 mmHg, respectively. ROC curve analysis revealed SaO2 level of 91.5% to be optimal target saturation for excluding respiratory failure with 84.6% specificity and 89.7% sensitivity; area under the curve was 0.885 (95% CI 0.796-0.975). The negative predictive value was 80% for SaO2 level of 92%. CONCLUSION: Patients with PE may be in respiratory failure despite an oxyhemoglobin saturation of ≥90%. Although saturation is likely more important than precise PaO2 in tissue oxygenation, clinicians should be aware of the physiological effects of hypoxemia and take this into account before making outpatient treatment decisions.

High serum YKL-40 level is associated with poor prognosis in patients with lung cancer.

INTRODUCTION: YKL-40 is a glycoprotein that plays role in inflammation and malignant processes. High serum YKL-40 levels are associated with short survive in cancer and chronic obstructive pulmonary disease (COPD) is another reason to increase its' level. However, limited knowledges are known in YKL-40 along with lung cancer and COPD. MATERIALS AND METHODS: One hundred patients were involved to study with lung cancer (84 men, 16 women, and median age 62). Results were compared with 30 healthy volunteers. Thirteen patients were small cell lung cancer (SCLC), 87 patients were non-small cell lung cancer (NSCLC). 62% of patients were inoperable. RESULT: Median YKL-40 level was 222.7 ± 114.1 ng/mL in patients and was 144.5 ± 105.7 ng/mL in controls (p< 0.001). Stage, tumour size, lymph node involvement and distant metastasis weren't associated with serum YKL-40 level. Above all cut-off values (133.159 and 162 ng/mL) survival was shorter (p> 0.05). Patients with COPD had worse survive above all cut-off values (p< 0.05), especially according to 133 ng/mL (p= 0.01). CONCLUSIONS: YKL-40 level is useful in lung cancer however it's not related to cell type and prognosis. It is associated with poor prognosis in lung cancer patients with COPD.

Prognostic significance of serum vascular endothelial growth factor and Angiopoietin-2 in patients with lung cancer.

INTRODUCTION: Vascular endothelial growth factor (VEGF) and Angiopoietin-2 (Ang-2) are major angiogenic mediators in neovascularization process. In current literature both biomarkers are discussed separately and only for non-small cell lung cancer (NSCLC). So in this study we aimed to examine them together for both cell types NSCLC and small cell lung cancer (SCLC). PATIENTS AND METHODS: 100 patients with lung cancer were enrolled to this single center study. 87 of patients were diagnosed with NSCLC including 28 adenocarcinomas and 59 squamous cell cancers and 13 were SCLC. Results were compared with 30 healthy volunteers. Pre-treatment serum VEGF and Ang-2 levels were measured by using ELISA method. RESULTS: While serum Ang-2 levels were higher in patients than healthy controls (23395 pg/mL vs. 4025 pg/mL, p< 0.001), VEGF levels didn't differ (2308 pg/mL vs. 2433 pg/mL, p> 0.05). There was no difference between cases with SCLC and NSCLC in terms of Ang-2. But serum VEGF values were significantly lower in SCLC than NSCLC and control groups. None of these mediators were correlated with cell type, tumor size, TNM staging, performance status and operability. VEGF levels were higher in patients with chronic obstructive pulmonary disease (COPD), but it was not significant. Three cut of values were determined according to sensitivity and specificity by using youden index. They were 8515.73 pg/mL (sensitivity 78%, specificity 76%), 7097 pg/mL (sensitivity 80%, specificity 70%) and 11063.48 pg/mL (sensitivity 76%, specificity 70%). Patients with SCLC had shorter survival time above cut-off values (p> 0.05). VEGF and Ang-2 showed a weak positive correlation (p= 0.1 and r= 0.638). CONCLUSION: In conclusion, serum VEGF wasn't useful to predict lung cancer, prognosis or cell type. Albeit Ang-2 was higher in patients with lung cancer without any effect on survival. Due to the heterogeneity of the studies done with serum measurement Ang-2 on tumor tissue should be more meaningful.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM: The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS: The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION: The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

The evaluation of arsenic and cadmium levels in biological samples of cases with lung cancer.

INTRODUCTION: Chronic exposure to the toxic metals plays an important role among the causes of lung cancer beside of smoking. We aimed to evaluate the association between the histopathologic type of lung cancer and arsenic and cadmium levels in biological samples. MATERIALS AND METHODS: This study in a single center was conducted through the years 2009-2013, including 72 patients with lung cancer, within a prospective study design. Biological samples (whole blood, scalp hair, urine) of subjects obtained before the treatment, and arsenic and cadmium levels were analyzed by atomic absorption spectrophotometer. The characteristics of lung cancer cases and metal levels were compared statistically (power: 0.74). RESULTS: Fifty six (77.8%) of patients were non-small cell lung cancer (NSCLC), 16 (22.2%) were small cell lung cancer (SCLC) in 72 study subjects (7 F/65 M, mean age= 62.2 ± 8.7 years). According to TNM staging, 27 of NSCLC were stage IV, 14 of SCLC were extensive disease. In blood, scalp hair and urine samples of cases, mean arsenic levels were 23.1 ± 9.2 µg/L, 0.6 ± 0.3 µg/g and 3.6 ± 1.9 µg/L, while cadmium levels were 1.2 ± 0.8 µg/L, 0.3 ± 0.1 µg/L and 2.8 ± 1.6 µg/L, respectively. A significant negative correlation was found between blood and urine arsenic levels (r= -0.350; p= 0.025). Blood and hair cadmium levels were also significant positive correlated (r= -0.371; p= 0.017). Both of metal levels except of urine arsenic were higher in NSCLC patients than SCLC, without any statistical significance. No significance relation was found in terms of TNM staging and mortality (p> 0.05). CONCLUSION: Any difference was observed between the arsenic and cadmium levels measured in biological samples and histopathological type, staging and mortality of patients with lung cancer in this study. We thought that further studies are needed.

Association of cadmium but not arsenic levels in lung cancer tumor tissue with smoking, histopathological type and stage.

BACKGROUND: To evaluate association of lung cancer with arsenic and cadmium levels measured in tumor tissue. MATERIALS AND METHODS: Ninety-five patients with lung cancer tumor tissue obtained surgically were included in this study. Arsenic and cadmium levels were measured and levels of metals were compared among types of lung cancer and with reference to patient data. RESULTS: The histopathologic diagnoses of the 95 cases were SCC, 49, adenocarcinoma, 28, large cell, 11 and SCLC, 1. Mean tumor arsenic and cadmium levels were 149.3±129.1µg/kg and 276.3±219.3µg/kg, respectively. Cadmium levels were significantly associated with smoking (p=0.02), histopathologic type (p=0.005), and TNM staging (r=0.325; p=0.001), although arsenic was not related to any parameter (p>0.05). There was no relation between metal levels and mortality (p>0.05). CONCLUSIONS: We found a significant association between tumor cadmium levels of patients with lung cancer and smoking, histopathologic type and staging, although there was no relation with arsenic levels.

[Lung cancer and family history of cancer]. / Akciger kanseri ve ailesel kanser hikayesi.

There are many studies supporting the family history in lung cancer. The study included 213 subjects with new and former diagnoses of lung cancer. Patients were enrolled from the Department of Chest Diseases Ankara University Faculty of Medicine and Atatürk Chest Diseases and Chest Surgery Training and Research Hospital between January-June 2005. For the control group, 200 healthy subjects were gathered. We aimed to investigate the family predisposition for lung and other cancers, additionally the relationship of this predisposition to age, gender, smoking habits and cell types. The number of first degree relatives of patients and control group were 2058 and 2045, respectively. In conclusion, positive family history for cancer estimated in 38% of 213 individuals with lung cancer. In these individuals, 41.9% had lung cancer, 19% had gastrointestinal system cancer, 7.6% had breast cancer, 5.7% had prostate cancer, 25.7% had other system cancers (larinx, skin, bone, hematologic system, central nervous system). Besides, 4.6% of 213 patients had accompanying other system cancers (urinary bladder, kidney, lung, head-neck). In control group, positive family history for the cancer was 21.5% and this was statistically significant (p< 0.001). In the family members of patients with lung cancer, the risks of lung, gastrointestinal system and breast cancer development were increased. Besides, the lung and other system cancers (except prostate and gastrointestinal system cancers) were significantly increased at the brothers of patients with lung cancer, supporting the genetical transition hypothesis. The presence of head-neck, bladder, prostate, lung and kidney cancers in the history of the patients increase the risk of lung cancer, supporting the genetic transition.

[Lung cancer in women: clinical features and factors related to survival]. / Kadinlarda akciger kanseri: Klinik özellikler ve sagkalima etkili faktörler.

Lung cancer in women is increasing in worldwide. This process beginning with the difference on the susceptibility of lung cancer in women smokers may be different from men in the prognosis. In this study, it was aimed to evaluate the clinical features, and prognostic factors of female patients with lung cancer diagnosed between January 2000-December 2005. The data of 109 patients data was evaluated. The mean age was 59.40 +/- 11.56 and 17 (15.6%) patients were smokers. In 20 patients (18.3%) having a family history of cancer, 55% of them had a relative with lung cancer. In admission, cough (81.7%), dyspnea (78.9%), chest pain (40.3%) were the most frequent presenting symptoms. The most common site of tumoral lesion in bronchoscopy were right upper lobe (16.5%). In the study group histopathological diagnosis were as follows; adenocarcinoma (44.9%), small cell lung cancer (SCLC) (19.3%), squamous cell (10.1%), non-small cell lung cancer (NSCLC) --undefined (22.0%), carsinoid tumors (2.8%), in non-smokers adenocarcinoma was significantly higher than smokers (44.9%/17.7%) (p< 0.001). 61.9% of NSCLC patients and 57.1% of SCLC patients had a stage IV disease at the initial evaluation. The most common sites of metastasis were bone (28.4%), liver (22.9%), and brain (11.9%), there were multiple metastasis in 10 patients. Median survival time was found as 288 days. In univariate analysis, comorbidity, primary tumor stage, bone metastasis, advanced disease stage, ECOG performance score >or= 2 and supportive care alone were poor prognostic factors. In multivariate analysis, poor performance status (p= 0.003), advanced disease stage (p= 0.002) and bone metastasis (p= 0.04) were negatively related to survival. In women, the definition of the clinical features, disease course and survival related factors may contribute to our future treatment approaches based on our national data.

The prognostic value of serum epidermal growth factor receptor level in patients with non-small cell lung cancer.

Epidermal growth factor receptor (EGFR) has been implicated as a factor indicating tumour progression or as a prognostic factor in non-small cell lung cancer (NSCLC), in which its overexpression is often detected. The usefulness of identifying EGFR in serum from patients with NSCLC is controversial. This study was designed to identify serum EGFR levels in patients with NSCLC and to evaluate the relationship between serum EGFR levels and clinical stage, histological subtype and survival time. Serum EGFR levels were measured using quantitative enzyme-linked immunosorbent assay. The study included 43 patients with NSCLC and 16 healthy controls. The histological classification was 29 squamous carcinomas and 14 adenocarcinomas. Serum samples were collected before treatment.There was no difference between serum EGFR levels in patients with NSCLC (17.53+/-8.09 fmol/mL) in comparison with those healthy controls (16.88+/-7.08 fmol/mL; p=0.912). There was also no difference in serum EGFR levels according to clinical stage or histological subtype. There was no relationship between serum EGFR levels and survival time in patients with NSCLC. The study's results suggest that, the utility of serum EGFR levels in patients with NSCLC as a tumour marker or as a prognostic factor is limited. However, further prospective studies on a large number of patients will be necessary to confirm this study's results.

Distribution of Bcl-2 gene expression and its prognostic value in non-small cell lung cancer.

The aim of this study was to determine the expression of Bcl-2 gene and prognostic importance of Bcl-2 expression in paraffin embedded blocks of patients diagnosed with non-small cell lung cancer (NSCLC). This study included the retrospective analysis of overall 46 patients diagnosed with NSCLC in our clinic between 1996 and 1999. In 16 (34.8%) patients, the diagnosis was made on biopsy of bronchial mucosa and in 30 (65.2%) patients, on materials obtained by surgical resection (lobectomy and pneumonectomy). We reviewed the sections 4-6 microns in size and stained with Hemotoxylin-Eosine (HE) obtained from paraffin embedded blocks and fixed by 10% formalin. These sections are transferred on to slides covered with poly-L-lysine, then de-paraffinization was made. In all cases, immunohistochemical staining with Bcl-2 antibodies was performed. Positive staining was observed in 9 (19.6%) patients, but not in 37 (80.4%) patients. Out of 32 cases with squamous cell tumor, 8 (25%) were observed to have positive staining in their sections, but 24 (75%) were not so. No staining was observed in 11 cases whose cell type was adenoma and two cases whose cell type was adenosquamos (100%). Staining was present in the section of one case with large cell (100%). Median survival time was 36.6 months in cases in which staining was observed and 6.10 months in cases in which staining was not observed, with a significant difference (p< 0.05). In conclusion, the rate of survival was higher in cases in which staining was present.

The prognostic significance of vascular endothelial growth factor levels in sera of non-small cell lung cancer patients.

BACKGROUND: Angiogenesis, the formation of new blood vessels from the existing vascular bed, is essential step for the growth and invasion of the primary tumor. Vascular endothelial growth factor (VEGF) is known to play crucial role in tumor angiogenesis. Increased serum VEGF levels may be associated with poor prognosis in patients with non-small cell lung cancer (NSCLC). METHODOLOGY: In the present study, we measured plasma VEGF levels in 20 normal subjects and 75 patients with untreated NSCLC; 23 operable (stages I, II, IIIA) and 52 inoperable (stages IIIB, IV) (Histology: squamous cell carcinoma, 40; adenocarcinoma, 27; undetermined, 8). VEGF was measured by enzyme-linked immunosorbent assay. RESULTS: The median VEGF level in patient group was 119 pg/ml (29-1235), which was significantly higher than the control group (P = 0.044). Median survival of patients was 210 days (30-220). The patients were divided into high VEGF (> 119 pg/ml) and low VEGF (< 119 pg/ml) groups using the median value as a cut-off. It was investigated if there were significant associations between serum VEGF level and clinico-pathological parameters like age, sex, histopathological diagnosis and TNM staging. Also high VEGF and low VEGF patient groups were compared according to the median survival. CONCLUSIONS: Serum VEGF level is significantly associated with the clinical staging of the patients (operable and inoperable) (P = 0.031) and it also correlates with the prognosis of the patients (P = 0.0006).

Immunoglobulins and complement components in patients with lung cancer.

Based on data providing a correlation between immunoglobulin or complement components levels and malignancies and specific disease parameters, we examined the possible correlation between the immunoglobulins, complement component levels and the stage of disease and the survival of patients. Sera from 55 patients with lung cancer and 22 healthy donor were assayed in order to evaluate the concentration of IgG, IgA, IgM, IgE, C3, C4. No considerable differences were found between the levels of immunoglobulins in patients with carcinoma of the lung versus subjects in the control group. Complement components (C3 and C4) levels were elevated in cancer patients with different cell types compared with levels in the control group. No statistically significant differences were found between the levels of the studied parameters and the stage of the disease and the survival time of patients. Our study confirm the hypothesis that malignant tumours contribute to elevation of complement components levels but additional studies are needed for demonstrating the prognostic value of immunoglobulin and complement components levels in lung cancer patients.

Elevated levels of circulating matrix metalloproteinase-9 in non-small cell lung cancer patients.

Elevated levels of matrix metalloproteinase have been implicated as playing important role in tumour progression in several types of cancers. Our aim was to determine whether these enzyme might be a useful tumour marker for lung cancer and also to evaluate the correlation of circulating levels of matrix metalloproteinase-9 (MMP-9) with tumour histology, staging, nodal status, metastasis and prognosis. Blood samples were collected from 35 nonsmall cell lung cancer patients who were diagnosed histologically, and 14 healthy controls. The MMP-9 levels were significantly higher in the cancer group (p< 0.001). However no significant correlation between several clinical features (such as histology of the tumour, staging, tumour status, or nodal status) and plasma MMP-9 levels have been observed. Though it does not show statistical significance, more patients with metastasis seemed to have higher MMP-9 levels. At the end of six month 11 patients were out of follow-up. Among the remaining 24 patients eight patients had lower MMP-9 levels, seven were survivors at the end of six months. Sixteen patients had MMP-9 levels above the threshold. Only 10 have survived to six months. In conclusion MMP-9 can serve as a marker for metastasis and can be valuable in the follow-up of lung cancer patients.

[A patient with meningeal carcinomatosis and small cell lung cancer]. / Meningeal karsinomatozisli bir küçük hücreli akciger kanseri olgusu.

Cranial metastasis because of lung cancer shows the poor prognosis. Cranial metastasis is common: In order lung, breast, skin, kidney, gastrointestinal system cancer is the 80% of the cause of metastasis. Cranial metastases are common in lung cancer especially in small cell lung cancer. Cranial metastasis can be seen in different location but leptomeningeal infiltration is rare and interesting. Because of this we will describe a case which has been death seven months after diagnose because leptomeningeal infiltration of small cell lung cancer.