Association between metabolically healthy obesity and metastasis in lung cancer patients - a systematic review and meta-analysis.

Background: Many clinical trials have looked at the relationship between obesity and lung cancer (LC), however, there is scarcity of literature specifically addressing the association between metabolically healthy obesity and metastasis in LC patients. To address this gap in the body of evidence, the study was conducted to observe the association between metabolically healthy obesity and metastasis in LC patients. Methods: We conducted a pre-registered systematic review by searching six major online databases to identify studies relevant related to our investigation, in adherence with the PRISMA guidelines. A proper data extraction protocol was further established to synthesize the findings from the selected papers through a meta-analysis. Results: Eleven (11) studies met the requisite selection criterion and were included in the study. A random-effect model was used. Obesity was found to have a significant impact on readmission in LC patients. The combined analysis showed a significant effect size of 0.08 (95% CI 0.07 to 0.08), indicating a noticeable impact of obesity. It was also assessed that obese individuals had a 34% reduced risk of LC compared to normal weight individuals. Obesity was associated with a lower risk of surgical complications with a pooled risk ratio of 0.13 (95% CI 0.12 to 0.14). A statistically significant decreased risk of LC (pooled RR = 0.72, 95% CI: 0.68 to 0.77) was also observed in the obese individuals. Conclusion: The analysis reveals that obesity is associated with a noticeable increase in readmissions, although the impact on LC risk itself is negligible. Moreover, obesity appears to have a beneficial effect by reducing the risk of surgical complications. These results highlight the complex relationship between the two aforementioned factors, emphasizing the importance of considering obesity as a significant factor in patient management and healthcare decision-making. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023427612.

Diagnostic and Prognostic Significance of Serum Biomarkers - Serum Amyloid A and CYFRA 21-1 in Lung Cancer.

Introduction: Bronchogenic carcinoma is a leading cause of cancer-related death in men and women. Early diagnosis and treatment in these cases are essential for a better prognosis. Serum biomarkers such as serum amyloid A (SAA) and CYFRA 21-1 have generated encouraging results regarding their use in the diagnosis of these cases but data on their role in the Indian scenario are still lacking. Aim: The study aims to measure the levels of SAA and CYFRA 21-1 in various types of lung cancer and compare them with patients without lung cancer. It also aims to compare the values of these biomarkers before and after chemotherapy and correlate them with response to treatment. Materials and Methods: It was a prospective, case-control study conducted in the Department of Pulmonary Medicine, Government Medical College, Chandigarh. All histologically and/or cytologically proven lung cancer cases were included in the study group while patients with diseases other than lung cancer formed the control group. All patients were evaluated through a complete history and thorough clinical examination. Measurement of SAA and CYFRA 21-1 in blood was done by sandwich ELISA method. The patients in the study group were followed up regularly and the biomarkers were measured again after four cycles of chemotherapy. The response of tumors to chemotherapy was evaluated as per modified Response Evaluation Criteria in Solid Tumors criteria. The statistical analysis was carried out using SPSS version 19.0. Results: The study group and control group included 20 patients each. Hoarseness of voice and hemoptysis were significantly associated with lung cancer patients (P = 0.001 and P = 0.025, respectively). Serum levels above 8745 ng/ml for SAA and 2.55 ng/ml for serum CYFRA 21-1 were used as diagnostic biomarker in lung cancer. The serum levels of CYFRA 21-1 were found to be significantly raised in nonsmall cell carcinoma (NSCLC) in comparison to SCLC of lung. There was a statistically significant decrease in the serum levels of CYFRA 21-1 in lung cancer patients on C4 cycle of chemotherapy in comparison to C1 cycle (P = 0.014). Conclusion: SAA and CYFRA 21-1 could be valuable diagnostic biomarkers in lung cancer. CYFRA 21-1, in addition, could also be used as prognostic biomarker in lung cancer patients undergoing chemotherapy as it showed significant decrease after C4-cycle of chemotherapy. It can also be a potential biomarker to differentiate small cell and NSCLC.

[Evolution of the incidence and survival of bronchogenic carcinoma in the province of Castellón (Spain) from 2004 to 2017.] / Evolución de la incidencia y supervivencia del carcinoma broncogénico en la provincia de Castellón en el periodo de tiempo 2004-2017.

OBJECTIVE: Bronchogenic carcinoma (BC) is the second most frequent worldwide and the most lethal tumour in both sexes. Its incidence varies not only among countries but also among different areas of the same country. So, the aim of this work was to analyse the evolution of its incidence and survival in the province of Castellón from 2004 to 2017 and to compare them with those of de rest of the country. METHODS: A retrospective observational study was carried out from patients diagnosed with BC and registered in the Castellón Tumour Register from 2004 to 2017. Survival was estimated using the Kaplan-Meier method whereas to estimate the relationship among different variables both the chi-square and ANOVA test were used. RESULTS: 4,346 cases were diagnosed, whose mean age was 67.5±11.3 years, 85.2% men, the most frequent histological types were adenocarcinoma (28.3%) and epidermoid carcinoma (25.1%). The gross global incidence was 53.4 cases/105 inhabitants, 90.9 cases/105 men and 15.7 cases/105 women. Median global survival at five years was 12.7%, 12% in men and 18.4% in women. CONCLUSIONS: The global incidence of BC in Castellón is lower than the national one, having remained stable in men while it is double in women. Global survival at five years is less than 15%, being higher in women than in men, nevertheless it increases compared to that of previous studies.

OBJETIVO: El carcinoma broncogénico (CB) es el segundo tumor más frecuente a nivel mundial y el más letal en ambos sexos. Su incidencia varía, no sólo entre países, sino también entre diferentes zonas de un mismo país. Por tanto, el objetivo de este trabajo fue analizar la evolución de su incidencia y la supervivencia en la provincia de Castellón desde 2004 hasta 2017, y compararlas con las del resto del país. METODOS: Se realizó un estudio observacional retrospectivo en pacientes diagnosticados de CB e inscritos en el Registro de Tumores de Castellón desde 2004 hasta 2017. La supervivencia se estimó mediante el método de Kaplan-Meier, mientras que para estimar la relación entre distintas variables se utilizaron los test Chi-cuadrado y ANOVA. RESULTADOS: Se diagnosticaron 4.346 casos, con una edad media de 67,5±11,3 años, el 85,2% eran hombres, los tipos histológicos más frecuentes fueron adenocarcinoma (28,3%) y carcinoma epidermoide (25,1%). La incidencia global bruta fue de 53,4 casos/105 habitantes, con 90,9 casos/105 de hombres y 15,7 casos/105 de mujeres. La mediana de supervivencia global a los cinco años fue del 12,7%, siendo del 12% en hombres y del 18,4% en mujeres. CONCLUSIONES: La incidencia global de CB en Castellón es inferior a la nacional, habiéndose mantenido estable en hombres mientras que se duplica en mujeres. La supervivencia global a los cinco años es inferior al 15%, siendo mayor en mujeres que en hombres; no obstante, aumenta respecto a la reportada en estudios previos.

Evolución de la incidencia y supervivencia del carcinoma broncogénico en la provincia de Castellón en el periodo de tiempo 2004-2017 / Evolution of the incidence and survival of bronchogenic carcinoma in the province of Castellón (Spain) from 2004 to 2017

FUNDAMENTOS: El carcinoma broncogénico (CB) es el segundo tumor más frecuente a nivel mundial y el más letal en ambossexos. Su incidencia varía, no sólo entre países, sino también entre diferentes zonas de un mismo país. Por tanto, el objetivo de estetrabajo fue analizar la evolución de su incidencia y la supervivencia en la provincia de Castellón desde 2004 hasta 2017, y compararlascon las del resto del país. MÉTODOS: Se realizó un estudio observacional retrospectivo en pacientes diagnosticados de CB e inscritos en el Registro deTumores de Castellón desde 2004 hasta 2017. La supervivencia se estimó mediante el método de Kaplan-Meier, mientras que paraestimar la relación entre distintas variables se utilizaron los test Chi-cuadrado y ANOVA.RESULTADOS: Se diagnosticaron 4.346 casos, con una edad media de 67,5±11,3 años, el 85,2% eran hombres, los tipos histológicosmás frecuentes fueron adenocarcinoma (28,3%) y carcinoma epidermoide (25,1%). La incidencia global bruta fue de 53,4 casos/10 5habitantes, con 90,9 casos/10 5 de hombres y 15,7 casos/10 5 de mujeres. La mediana de supervivencia global a los cinco años fue del12,7%, siendo del 12% en hombres y del 18,4% en mujeres. CONCLUSIONES: La incidencia global de CB en Castellón es inferior a la nacional, habiéndose mantenido estable en hombresmientras que se duplica en mujeres. La supervivencia global a los cinco años es inferior al 15%, siendo mayor en mujeres que enhombres; no obstante, aumenta respecto a la reportada en estudios previos.(AU)

BACKGROUND: Bronchogenic carcinoma (BC) is the second most frequent worldwide and the most lethal tumour in both sexes. Its incidence varies not only among countries but also among different areas of the same country. So, the aim of this work was toanalyse the evolution of its incidence and survival in the province of Castellón from 2004 to 2017 and to compare them with thoseof de rest of the country. METHODS: A retrospective observational study was carried out from patients diagnosed with BC and registered in the CastellónTumour Register from 2004 to 2017. Survival was estimated using the Kaplan-Meier method whereas to estimate the relationship amongdifferent variables both the chi-square and ANOVA test were used. RESULTS // 4,346 cases were diagnosed, whose mean age was 67.5±11.3 years, 85.2% men, the most frequent histological types wereadenocarcinoma (28.3%) and epidermoid carcinoma (25.1%). The gross global incidence was 53.4 cases/105 inhabitants, 90.9 cases/105men and 15.7 cases/105 women. Median global survival at five years was 12.7%, 12% in men and 18.4% in women. CONCLUSIONS: The global incidence of BC in Castellón is lower than the national one, having remained stable in men while itis double in women. Global survival at five years is less than 15%, being higher in women than in men, nevertheless it increasescompared to that of previous studies.(AU)

Human Cytomegalovirus (CMV) Infection Associated With Decreased Risk of Bronchogenic Carcinoma: Understanding How a Previous CMV Infection Leads to an Enhanced Immune Response Against Malignancy.

INTRODUCTION:  ​Cytomegalovirus (CMV) causes a long-lasting, asymptomatic infection that reportedly has both advantageous and deleterious effects on tumor progression. The purpose of this study was to evaluate the correlation between CMV infection and the incidence of bronchogenic carcinoma. METHODS: The study was conducted using a Health Insurance Portability and Accountability Act (HIPAA) compliant national database to identify patients both with and without histories of CMV infection using International Classification of Diseases (ICD-10 and ICD-9) codes. Access to the database was granted by Holy Cross Health, Fort Lauderdale for the purpose of academic research with standard statistical methods used to analyze the data. 14,319 patients were included in both the control and CMV-exposed groups and matched by age range and Charlson Comorbidity Index (CCI) scores. RESULTS: The incidence of bronchogenic carcinoma was 1.69% (243/14,319 patients) in the CMV group and 6.08% (871/14,319 patients) in the control group. The difference was statistically significant by a p-value of less than 2.6x10-16 with an odds ratio of 0.26 (95% CI: 0.24-0.30). The two groups were also matched for treatment. Further evaluation of the CMV-specific treatment effects on outcomes was limited due to the insufficient number of treated patients in the control group. CONCLUSION: This study found a statistically significant correlation between a prior CMV infection and a reduced incidence of bronchogenic carcinoma. This study demonstrates the need for further investigation into how the tumor microenvironment and host immune system are altered by the presence of a latent CMV infection.

Trends in Imaging Patterns of Bronchogenic Carcinoma: Reality or a Statistical Variation? A Single-Center Cross-Sectional Analysis of Outcomes.

INTRODUCTION: Bronchogenic carcinoma accounts for more cancer-related deaths than any other malignancy and is the most frequently diagnosed cancer in the world. Bronchogenic carcinoma is by far the leading cause of cancer death among both men and women, making up almost 25% of all cancer deaths. The objective of this study was to identify the changing trends, if any, in radiological patterns of bronchogenic carcinoma to document the various computed tomography (CT) appearances of bronchogenic carcinoma with histopathologic correlation. METHODS: This was a single-center cross-sectional study on 162 patients with clinical or radiological suspicion of bronchogenic carcinoma with histopathological confirmation of diagnosis. RESULTS: There was a male preponderance with bronchogenic carcinoma and smoking being the most common risk factor. Squamous cell carcinoma followed by adenocarcinoma and small cell carcinoma is the most common histologic subtype. Squamous cell carcinoma was noted to be present predominantly in the peripheral location (55.5%), and adenocarcinoma was noted to be present predominantly in the central location (68.4%). CONCLUSION: CT is the imaging modality of choice for evaluating bronchogenic carcinoma and provides for precise characterization of the size, extent, and staging of the carcinoma. Among 162 bronchogenic carcinoma cases evaluated in the current study, a definite changing trend in the radiological pattern of squamous cell carcinoma and adenocarcinoma was observed. Squamous cell carcinoma was predominantly noted to be a peripheral tumor, and adenocarcinoma is predominantly noted to be a central tumor. Surveillance or restaging scans are recommended, considering the high mortality rate in patients with bronchogenic carcinoma.

Bone Metastasis As the Initial Presentation of a Hidden Bronchogenic Carcinoma.

Primary malignant bone tumours are on the whole rare, while secondary bone tumours are much more common. Up to 40% of bone metastases are associated with lung cancer. This case report highlights a rare presentation of metastatic bone disease as the initial presentation of a primary lung malignancy and only very few cases were mentioned in literature with the same presentation of no clinical signs of the primary lung pathology, except for an unexpected radiological finding of a suspicious lung lesion. An 85-year-old gentleman presented with a progressive lower backache radiating to both lower limbs over a period of 4 weeks associated with difficulty in walking, significant weight loss, and decreased appetite. A skeletal survey showed only spondylolisthesis. However, no clinical improvement was noticed with conventional therapy. Examination of the respiratory, gastrointestinal, and genitourinary systems was normal. Ultrasonography of the abdomen and pelvis, and the findings of the colonoscopy did not add anything. During the third week of follow-up, the patient reported unbearable severe pain in the left arm. A plain radiograph revealed a pathological fracture of the humerus. Secondary bone metastasis was suspected. Although the patient was a non-smoker and there were no clinical signs of underlying lung disease, a simple plain chest radiograph, unexpectedly, showed a suspicious right lower lobe lesion. Therefore, a contrast-enhanced computerized tomography (CT) scan for the chest, abdomen, and pelvis was done which revealed a right lower lobe lesion of bronchogenic carcinoma with distant metastasis. Unfortunately, the patient died after 3 weeks of palliative therapy when he was admitted to the hospital with acute renal failure and septic shock. Bone metastases in lung cancer predict a poor prognosis and short-term survival. The diagnosis of such a challenging presentation requires a high index of suspicion. If the patient had been sent for a plain chest radiograph at first, lots of time and effort could be saved in reaching the diagnosis without the need for further sophisticated or invasive diagnostic procedures.

Perfil epidemiológico de pacientes com diagnóstico de carcinoma broncogênico atendidos em uma unidade de alta complexidade em oncologia / Epidemiological profile of patients diagnosed with bronchogenic carcinoma seen in a high complexity oncology unit

Introdução: No Brasil, o carcinoma broncogênico é o segundo tipo de câncer de maior incidência em homens e o quarto tipo de câncer de maior incidência em mulheres. É a principal causa de mortalidade por câncer no país. O objetivo do presente estudo é avaliar o perfil epidemiológico dos pacientes com diagnóstico de carcinoma broncogênico atendidos em uma unidade de alta complexidade em oncologia. Métodos: Estudo observacional descritivo, retrospectivo, com coleta de dados secundários e de abordagem quantitativa. A pesquisa foi aplicada em uma unidade de alta complexidade em oncologia de um hospital de uma cidade do extremo-sul catarinense, através de prontuários eletrônicos. A coleta foi composta por 90 atendimentos no período de janeiro de 2015 a dezembro de 2017. Foram inclusos na amostra todos os pacientes com tumores broncogênicos malignos com idade igual ou superior a 18 anos, e foram exclusos 14 pacientes com prontuários incompletos. Resultados: A média de idade ao diagnóstico foi 62,39 ± 10,53 anos. Houve discreto predomínio no sexo masculino (58,9%). O tabagismo foi verificado em 78,9% dos pacientes, com uma mediana de 40,0 maços/ano. Como método diagnóstico, observou-se a maior realização de biópsia percutânea orientada por TC em 58,9% dos casos. Em relação aos tipos histológicos, 54,4% apresentaram adenocarcinoma. O estágio mais prevalente foi o IVA (42,2%). Conclusão: São de extrema importância métodos de rastreamento e diagnóstico precoce da neoplasia, bem como encorajar os pacientes ao abandono do tabagismo, a fim de reduzir sua incidência e mortalidade.

Introduction: In Brazil, bronchogenic carcinoma is the second more incident type of cancer in men, and the fourth in women. It is the leading cause of cancer mortality in the country. The aim of the present study is to assess the epidemiological profile of patients diagnosed with bronchogenic carcinoma seen in a high complexity oncology unit. Methods: This is a descriptive, observational, retrospective study with collection of secondary data and quantitative approach. The research was conducted in a high complexity oncology unit of a hospital in a municipality of the southernmost region of the state of Santa Catarina, Brazil, using electronic medical records. The sample consisted of 90 patients from January 2015 to December 2017. All patients with malignant bronchogenic tumors aged 18 years or older were included in the sample, and 14 patients with incomplete medical charts were excluded. Results: Mean age at diagnosis was 62.39 ± 10.53 years. There was a slight predominance of men (58.9%). Smoking was present in 78,9% of patients, with a median of 40.0 packets/year. CT-guided percutaneous biopsy was the most used diagnostic method, being performed in 58.9% of the cases. With regard to histological type, 54.4% of patients presented adenocarcinoma. The most prevalent stage was IVA (42.2%). Conclusion: Screening methods and early diagnosis of neoplasm are extremely important, as well as encouraging patients to quit smoking, in order to reduce disease incidence and mortality.

Endobronchial localization - arena of two tumors: a case report.

The lung is a common arena for metastases of tumors with different localization, but endobronchial localization of metastases is very rare. The most common tumors with endobronchial localization of metastasis are renal, breast, and colorectal cancer. We report a man presenting with cough and hemoptysis. Endobronchial biopsy showed renal cell carcinoma and micro-invasive bronchogenic squamous cell carcinoma. Endobronchial metastases from renal cell carcinoma are rare. The squamous cell lung cancer is one of the most common cancers in men, but the combination of renal cell carcinoma and micro-invasive squamous cell carcinoma with endobronchial localization is a casuistic case.

Imaging diagnosis of bronchogenic carcinoma (the forgotten disease) during times of COVID-19 pandemic: Current and future perspectives.

Patients with bronchogenic carcinoma comprise a high-risk group for coronavirus disease 2019 (COVID-19), pneumonia and related complications. Symptoms of COVID-19 related pulmonary syndrome may be similar to deteriorating symptoms encountered during bronchogenic carcinoma progression. These resemblances add further complexity for imaging assessment of bronchogenic carcinoma. Similarities between clinical and imaging findings can pose a major challenge to clinicians in distinguishing COVID-19 super-infection from evolving bronchogenic carcinoma, as the above-mentioned entities require very different therapeutic approaches. However, the goal of bronchogenic carcinoma management during the pandemic is to minimize the risk of exposing patients to COVID-19, whilst still managing all life-threatening events related to bronchogenic carcinoma. The current pandemic has forced all healthcare stakeholders to prioritize per value resources and reorganize therapeutic strategies for timely management of patients with COVID-19 related pulmonary syndrome. Processing of radiographic and computed tomography images by means of artificial intelligence techniques can facilitate triage of patients. Modified and newer therapeutic strategies for patients with bronchogenic carcinoma have been adopted by oncologists around the world for providing uncompromised care within the accepted standards and new guidelines.

Anti-Neutrophil Cytoplasmic Antibody-Associated Glomerulonephritis and Malignancy: A Case of a Patient Diagnosed with Renal Failure and Pulmonary Carcinoma Concurrently.

A 70-year-old man presented with proteinuria, microscopic hematuria, and an increased level of serum creatinine. A systemic workup revealed that the patient had bronchogenic carcinoma and anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis concurrently. Despite the increase in the cumulative number of publications on paraneoplastic glomerulopathies, an awareness of the link between cancer and ANCA-associated glomerulonephritis is lacking. We strongly recommend the accumulation of more cases similar to our own, thereby allowing us to clarify the management strategies as well as the nature of this disease condition more precisely.

Metástasis infrecuentes en el carcinoma broncogénico / Uncommon metastases in bronchogenic carcinoma

Introducción: El pulmón es el órgano con mayor localización de enfermedad y mortalidad tumoral. En el momento del diagnóstico 55 por ciento de los casos presentan metástasis a distancia lo que implica un estadio avanzado de la enfermedad. Las metástasis cutáneas y en huesos distales de neoplasias internas son infrecuentes comparadas con las producidas en otras vísceras. La invasión cutánea puede presentarse por extensión directa de estructuras subyacentes y suelen asentar en la pared torácica anterior, por implantación accidental en maniobras diagnósticas, embolización vía linfática y por vía hematógena con posibles lesiones en zonas muy distantes y cuya aparición suele ser más precoz. Histológicamente, es el cáncer de pulmón indiferenciado el que con mayor frecuencia metastiza en la piel. Objetivo: Presentar dos casos con diagnóstico de carcinoma de pulmón células no pequeñas que desarrollaron metástasis en localizaciones infrecuentes. Presentación de los casos: Se presentan dos casos con metástasis infrecuentes de un carcinoma broncogénico. El primero a nivel nasal y el segundo en los metacarpianos y zonas blandas de la mano izquierda, ambas lesiones tumorales aparecieron en el curso del tratamiento oncológico para el cáncer del pulmón. El segundo caso fue tratado como una tendinitis y flebitis. Ambos casos evolucionaron hacia las metástasis múltiples y la muerte. Conclusiones: Se presentaron dos casos con metástasis infrecuente de un carcinoma de pulmón células no pequeñas, y aunque una vez diagnosticadas el pronóstico es malo a corto plazo, se deben de tener en cuenta para evitar diagnósticos y conductas erróneas(AU)

Introduction: The lung is the organ with the greatest location of disease and tumor mortality. At the time of diagnosis, 55 percent of the cases present distant metastases, which implies an advanced stage of the disease. Cutaneous and distal bone metastases from internal neoplasms are rare compared to those produced in other viscera. Cutaneous invasion can occur by direct extension of underlying structures and usually settle in the anterior chest wall, by accidental implantation in diagnostic maneuvers, lymphatic and hematogenous embolization with possible lesions in very distant areas and whose appearance is usually earlier. Histologically, it is undifferentiated lung cancer that most frequently metastasizes to the skin. Objective: To report two cases with a diagnosis of non-small cell lung carcinoma that developed metastases in infrequent locations. Case report: Two cases are reported with rare metastases from bronchogenic carcinoma. The first at the nasal level and the second in the metacarpals and soft areas of the left hand, both tumor lesions appeared in the course of oncological treatment for lung cancer. The second case was treated as tendinitis and phlebitis. Both cases progressed to multiple metastases and death. Conclusions: There were two cases with infrequent metastases of non-small cell lung carcinoma, and although once diagnosed the prognosis is poor in the short term, they should be taken into account to avoid misdiagnosis and misconduct(AU)

Hydrolysates from bee pollen could induced apoptosis in human bronchogenic carcinoma cells (ChaGo-K-1).

In order to examine bee pollen hydrolysates to assess their anticancer and antioxidant properties, hydrolysis of bee pollen was first performed using three different commercially available enzymes: Alcalase®, Neutrase®, and Flavourzyme®. The study used DPPH and ABTS assay to evaluate the antioxidant properties of the hydrolysates obtained from bee pollen. All of the tested hydrolysates demonstrated antioxidant activity, while hydrolysate based on Alcalase® offered a high value for IC50 and was therefore chosen for further separation into five sub-fractions via ultrafiltration. The greatest antioxidant activity was presented by the MW < 0.65 kDa fraction, which achieved an IC50 value of 0.39 ± 0.01 µg/mL in the DPPH assay and 1.52 ± 0.01 µg/mL for ABTS. Purification of the MW < 0.65 kDa fraction was completed using RP-HPLC, whereupon the three fractions from the original six which had the highest antioxidant activity underwent further examination through ESI-Q-TOF-MS/MS. These particular peptides had between 7 and 11 amino acid residues. In the case of the MW < 0.65 kDa fraction, testing was also carried out to determine the viability of lung cancer cell lines, represented by ChaGo-K1 cells. Analysis of the antiproliferative properties allowed in vitro assessment of the ChaGo-K1 cells' viability following treatment using the MW < 0.65 kDa fraction. Flow-cytometry generated date which revealed that it was possible for the MW < 0.65 kDa fraction to induce apoptosis in the ChaGo-K1 cells in comparison to the results with cells which had not been treated.

Thoracic positron emission tomography: 18F-fluorodeoxyglucose and beyond.

Ongoing technologic and therapeutic advancements in medicine are now testing the limits of conventional anatomic imaging techniques. The ability to image physiology, rather than simply anatomy, is critical in the management of multiple disease processes, especially in oncology. Nuclear medicine has assumed a leading role in detecting, diagnosing, staging and assessing treatment response of various pathologic entities, and appears well positioned to do so into the future. When combined with computed tomography (CT) or magnetic resonance imaging (MRI), positron emission tomography (PET) has become the sine quo non technique of evaluating most solid tumors especially in the thorax. PET/CT serves as a key imaging modality in the initial evaluation of pulmonary nodules, often obviating the need for more invasive testing. PET/CT is essential to staging and restaging in bronchogenic carcinoma and offers key physiologic information with regard to treatment response. A more recent development, PET/MRI, shows promise in several specific lung cancer applications as well. Additional recent advancements in the field have allowed PET to expand beyond imaging with 18F-flurodeoxyglucose (FDG) alone, now with the ability to specifically image certain types of cell surface receptors. In the thorax this predominantly includes 68Ga-DOTATATE which targets the somatostatin receptors abundantly expressed in neuroendocrine tumors, including bronchial carcinoid. This receptor targeted imaging technique permits targeting these tumors with therapeutic analogues such as 177Lu labeled DOTATATE. Overall, the proper utilization of PET in the thorax has the ability to directly impact and improve patient care.

Pleural empyema due to Salmonella in a patient with bronchogenic carcinoma: the first case report from a cancer hospital in Egypt.

BACKGROUND: Salmonella species are motile, Gram-negative facultative anaerobic bacilli, which belong to the family Enterobacteriaceae . The most common clinical presentations of Salmonella infection are gastroenteritis and enteric fever. Detection of Salmonella organisms in empyema is very rare. CASE PRESENTATION: We report the case of a 66-year-old female patient with bronchogenic carcinoma who developed empyema, and Salmonella was identified from the culture of pleural fluid. After antimicrobial therapy and other therapeutic measures, including the insertion of an intercostal tube, oxygen supplementation, frequent suction of respiratory secretions, and chest physiotherapy, the patient's condition improved. To the best of our knowledge, this is the first case to be reported in Egypt. CONCLUSIONS: Our case sheds light on the role of Salmonella in immunocompromised patients in general and cancer patients in specific. We recommend further study of this role, since it may lead to a better understanding of the pathogenicity of this organism in these patients.

Pleural effusion in a patient with COVID-19 pneumonia and lung cancer: A case report.

Coronavirus disease is a global infection presenting with a variety of clinical features, both pulmonary and extrapulmonary symptoms. Its diagnosis depend on clinical symptoms, laboratory tests, and the typical CT chest scan findings. In this report, a 72-year-old patient (known to have lung cancer) present with pleural effusion as possible sequel of COVID-19 pneumonia. Pleural effusion may present as a complication in a patient with coronavirus disease, but there is poor evidence to this claim in the medical literature.

A clinico-epidemiological, pathological, and molecular study of lung cancer in Northwestern India.

INTRODUCTION: Lung cancer is the most common malignant disease and is the topmost cause of cancer deaths in the world across all age groups and in both sexes. It is the most common cause of cancer deaths in developed countries and is also rising at an alarming rate in the developing countries. OBJECTIVE: The present study was undertaken to explore the clinicopathological and molecular profile of bronchogenic carcinoma in northwestern population of India. MATERIALS AND METHODS: A total of 136 consecutive patients with histologically proven bronchogenic carcinoma, registered between May 2014 and April 2016 at a tertiary care hospital in New Delhi, India, were analyzed. RESULTS: Out of a total of 136 diagnosed cases, 6% were in the third to fourth decade of life, 49% in the fifth to sixth decade, and 45% in the seventh decade and above. Seventy-one percent of patients were male. Smoking was the major risk factor in 65.40% of patients. About 33% of female patients were smokers with a significant overlap in the use of smoking objects. Twenty-one percent of patients had been initially empirically treated with antitubercular therapy. Most common symptoms at presentation were cough, dyspnea, weight loss, and chest pain. Pleural effusion, paraneoplastic phenomenon, clubbing, peripheral lymphadenopathy, and Pancoast syndrome were the major signs at presentation. Twenty-one percent of nonsmokers and 40% of smoker patients presented with ECOG Performance Status 3 or 4. Ninety-three percent of patients presented in stage III or IV. Metastases to skeleton, brain, liver, pleura, adrenals, lung, and distant lymph nodes were present in 30.8%, 16.9%, 15.4%, 15.4%, 14.7%, 13.2%, and 11.8%, respectively. Fiberoptic bronchoscopy was found to be the most efficient diagnostic procedure as compared to transthoracic and thoracoscopic methods. Histologically, squamous cell carcinoma, adenocarcinoma, and small cell carcinoma and its variants were seen in 35.30%, 44.9%, and 15.40% cases, respectively. Nearly 4.4% of patients were diagnosed as poorly differentiated carcinoma. Driver mutations (epidermal growth factor receptor or anaplastic lymphoma kinase) were detected in 48% (25 of 52 tested) of adenocarcinomas and 55.55% (5 of 9 tested) of young, nonsmoker, female squamous cell carcinoma patients. CONCLUSION: This study highlights that the adenocarcinoma incidence is surpassing squamous cell carcinoma in Indian lung cancer patients also, as observed in Western population. Mean age at diagnosis is about one decade earlier than in the Western population. Driver mutations are more common in India than in the West as also reported in other Asian studies.

Sudden onset polyarthritis as a paraneoplastic syndrome from non-small cell lung cancer.

A 48-year-old male presented to the emergency room for 2 weeks of joint pain and swelling of his four extremities. His symptoms started suddenly and were quite debilitating. His hands, fingers, knees, and ankles were so swollen and painful that he was unable to get out of bed and had to use crutches to ambulate. He also complained of anorexia, nausea, and lack of energy over the past few months, but denied any other complaints. His only medical history was a traumatic left tibia fracture 1 year ago. The patient had a 30-pack year history of smoking tobacco and used marijuana daily. The patient recently had an arthrocentesis at an outside hospital which was non-diagnostic and showed no infection. Given his symptoms, a thorough rheumatic workup was ordered. The ESR and CRP were elevated. ANA, rheumatoid factor, HLA B27, HIV, hepatitis panel, TSH, T4, Coombs antibodies, gonorrhea, chlamydia, CCP, alpha 1 antitrypsin, parvovirus, fungal antibodies, and myeloperoxidase antibodies were all within the normal range. X-rays of the hands, knees, and ankles were ordered. The images showed diffuse joint swelling with no fractures, dislocations, or hardware mispositioning. It also showed tissue swelling in the fingers that could not exclude hypertrophic pulmonary osteoarthropathy. A chest x-ray revealed a large 8.5 cm oval mass in the right upper lobe. A follow-up CT revealed a massive right upper lobe lung mass concerning for malignancy versus fungal etiology. A CT guided biopsy of the mass was performed and revealed a poorly differentiated non-small-cell lung cancer, favoring adenocarcinoma. Further CT imaging revealed limited stage disease. During the hospitalization, the patient was provided with NSAIDs for his joint pain, which provided minimal benefit. There was little to no improvement in his joint swelling. Oncology was consulted and further evaluation in the outpatient setting was recommended to determine if he would be a surgical candidate and/or to decide the best chemotherapeutic regimen. This case demonstrates an unusual presentation of non-small-cell lung cancer and highlights the importance of maintaining malignancy on the differential diagnosis for sudden arthritis.

Microwave Ablation (MWA) of Pulmonary Neoplasms: Clinical Performance of High-Frequency MWA With Spatial Energy Control Versus Conventional Low-Frequency MWA.

OBJECTIVE. The objective of our study was to evaluate the clinical performance of a new high-frequency (HF) microwave ablation (MWA) technology with spatial energy control for treatment of lung malignancies in comparison with a conventional low-frequency (LF) MWA technology. MATERIALS AND METHODS. In this retrospective study, 59 consecutive patients (mean age, 58.9 ± 12.6 [SD] years) were treated in 71 sessions using HF spatial-energy-control MWA. Parameters collected were technical success and efficacy, tumor diameter, tumor and ablation volumes, ablation time, output energy, complication rate, 90-day mortality, local tumor progression (LTP), ablative margin size, and ablation zone sphericity. Results were compared with the same parameters retrospectively collected from the last 71 conventional LF-MWA sessions. This group consisted of 56 patients (mean age, 60.3 ± 10.8 years). Statistical comparisons were performed using the Wilcoxon-Mann-Whitney test. RESULTS. Technical success was 98.6% for both technologies; technical efficacy was 97.2% for HF spatial-energy-control MWA and 95.8% for LF-MWA. The 90-day mortality rate was 5.1% (3/59) in the HF spatial-energy-control MWA group and 5.4% (3/56) in the LF-MWA group; for both groups, there were zero intraprocedural deaths. The median ablation time was 8.0 minutes for HF spatial-energy-control MWA and 10.0 minutes for LF-MWA (p < 0.0001). Complications were recorded in 21.1% (15/71) of HF spatial-energy-control MWA sessions and in 31.0% (22/71) of LF-MWA sessions (p = 0.182); of these complications, 4.2% (3/71) were major complications in the HF spatial-energy-control MWA group, and 9.9% (7/71) were major complications in the LF-MWA group. The median deviation from ideal sphericity (1.0) was 0.195 in the HF spatial-energy-control MWA group versus 0.376 in the LF-MWA group (p < 0.0001). Absolute minimal ablative margins per ablation were 7.5 ± 3.6 mm (mean ± SD) in the HF spatial-energy-control MWA group versus 4.2 ± 3.0 mm in the LF-MWA group (p < 0.0001). In the HF spatial-energy-control MWA group, LTP at 12 months was 6.5% (4/62). LTP at 12 months in the LF-MWA group was 12.5% (7/56). Differences in LTP rate (p = 0.137) and time point (p = 0.833) were not significant. CONCLUSION. HF spatial-energy-control MWA technology and conventional LFMWA technology are safe and effective for the treatment of lung malignancies independent of the MWA system used. However, HF spatial-energy-control MWA as an HF and high-energy MWA technique achieves ablation zones that are closer to an ideal sphere and achieves larger ablative margins than LF-MWA (p < 0.0001).

Endobronchial metastasis from extrathoracic malignancies: A clinicopathological study of 11 cases.

INTRODUCTION: Endobronchial metastases are uncommon. It accounts for 2-28%. Most common tumors that metastasis to the endobronchial site are breast, renal, endometrial and colon carcinomas. They have to be identified properly because they present poor prognosis and different treatment modalities when compared to that of primary lung carcinomas. MATERIALS AND METHODS: We studied a total of 11 retrospective cases of Endobronchial metastasis. Detailed clinic pathological and radiological findings were analyzed along with a detailed Immunohistochemical workup and Endobronchial findings. RESULTS: Mean age of presentation was 55 years with female predominance (Male to female ratio was 1:1.2). Most common tumors encountered were carcinoma breast (3), colorectal carcinomas (2), renal cell carcinoma (2) followed by one each from carcinoma endometrium, cervix and thyroid. Common symptom was cough followed by dyspnea. Exophytic endobronchial growth was common with right main bronchus being the common site. CONCLUSION: Endobronchial metastasis occurs in various types of malignancies. It should always be differentiated from primary lung carcinomas as they carries poor prognosis and different treatment protocol when compared to that of primary lung tumors.