Multiple bronchioloalveolar carcinomas in acromegaly: a potential role of insulin-like growth factor I in carcinogenesis.

The molecular pathogenesis of lung cancer, especially multiple and synchronous bronchioloalveolar carcinomas (BACs), is still unknown. Here, we report two cases of multiple BACs associated with acromegaly, and discuss about the possible relationship between these two pathological condition. The first patient was a 52-year-old female with a history of Hardy's surgery for pituitary growth hormone cell adenoma 2 years earlier. The second patient was a 57-year-old female with acromegaly and obstructive sleep apnea syndrome. Both patients were non-smokers and showed a high serum level of insulin-like growth factor I (IGF-I) at the time of admission, even though the level of growth hormone had decreased. High-resolution computed tomography (HRCT) revealed multiple small nodules with pure ground-glass opacity (GGO) in both lungs of the first patient and a small nodule with pure GGO in the right lung of the second one. Partial resection for these tumors were performed under video-assisted thoracoscopic surgery. Resected lung specimens of the first case revealed one papillary adenocarcinoma, seven BACs, and 11 atypical adenomatous hyperplasias (AAHs). The second case showed two foci of BACs. Immunohistochemically, all BACs were strongly positive for IGF-IR which is a specific receptor for IGF-I, and all AAHs were also weakly positive for IGF-IR. Since IGF-I is known as a potent growth factor for normal as well as cancerous cells, it might play an important role for tumorigenesis and/or tumor progression of BACs through its interaction with and/or upregulation of IGF-IR. In addition, much attention should be paid to detect lung lesions in acromegaly with high serum level of IGF-I.

Manejo anestésico de una malformación adenoidea quística / Anesthetic management of a cyst adenoid malformation

No disponible

[Atypical adenomatous hyperplasia and dysplasia in squamous epithelium of the honeycomb lung in outcome of idiopathic fibrosing alveolitis]. / Atipicheskaia adenomatoznaia giperplaziia i displaziia v ploskom épitelii v sotovom legkom v iskhode idiopaticheskogo fibroziruiushchego al'veolita.

Relationships between sclerosis and carcinogenesis in the honeycomb lung were studied in the outcome of two variants of idiopathic fibrosing alveolitis (IFA)-common interstitial pneumonia (CIP) and desquamative interstitial pneumonia (DIP) which may be a background for lung carcinoma development. The material was obtained from 43 patients with the diagnosis of IFA. Immunohistochemically were studied: TNF-alpha (DAKO, Denmark, 1:100), pancytokeratines (Immunotech, Germany, concentration 1:100), Ki67 (DAKO, Denmark, 1:40), TGF-beta (Biosource international, USA, 1:100), CD34 (Novocastra, Great Britain, 1:100), EMA (DAKO, Denmark, 1:100). Differences in morphogenesis of CIP and DIP were found. CIP is characterised by primary pronounced lung interstitium damage with stroma vascularisation already at early stages with secondary involvement of the epithelium with development of adenomatous hyperplasia with or without atypia which is usually observed at the stage of lung honeycomb. Pronounced primary damage of alveolar epithelium as a result of action of activated alveolar macrophages with subsequent proliferation, desquamation and squamous epithelium metaplasia were more typical for DIP. The presence of squamous meta- and dysplasia of the epithelium is characteristic for DIP outcome in the honeycomb lung.

Lung adenocarcinoma associated with atypical adenomatous hyperplasia. A clinicopathological study with special reference to smoking and cancer multiplicity.

Atypical adenomatous hyperplasia (AAH) of the lung has been proposed as a possible precursor lesion of adenocarcinoma of the lung. In the present study, we sought to clarify the clinicopathological characteristics of lung adenocarcinoma cases associated with AAH, with special reference to tobacco smoking and the presence of multiple primary carcinomas of pulmonary and extrapulmonary organs. We examined 123 surgically resected lung adenocarcinomas and conducted histopathological diagnoses for AAH and multiple primary pulmonary carcinomas. Clinicopathological characteristics such as age, sex, smoking index, survival, and the presence of extrapulmonary primary carcinomas were obtained from clinical records, and the associations among these factors were examined statistically. Sixteen lung adenocarcinoma patients had accompanying AAH (the AAH group) and 107 cases did not (the NAAH group). The incidence of primary carcinomas in extrapulmonary organs was higher in the AAH group (37.5%; 6/16) than in the NAAH group (12.5%; 13/107) (P = 0.01). Multiple primary lung cancers tended to be more frequent in the AAH group, but the difference was not statistically significant (P = 0.07). Although there was no difference in tobacco smoking between the two groups, all eight cases with multiple primary lung carcinomas were smokers. Furthermore, multiple primary lung carcinomas were found more frequently in smokers of the AAH group (37.5%; 3/8) than in the smokers of the NAAH group (7.2%; 5/69) (P = 0.04). The results suggested that constitutional or genetic factors might predispose patients to the development of AAH together with extrapulmonary primary carcinomas, and that smoking might contribute to the development of multiple primary lung adenocarcinomas, especially in patients with pre-existing AAH.