Safety and efficacy of nivolumab therapy in patients with metastatic renal cell carcinoma and impaired kidney function.

INTRODUCTION: Patients with renal insufficiency, usually defined as those with creatinine clearance < 40 mL/min, were excluded from pivotal clinical trials, especially in studies involving nivolumab therapy in patients with renal cell carcinoma (RCC). The aim of the study is to evaluate the efficacy and safety of nivolumab in patients with metastatic RCC (mRCC) stratified according to creatinine clearance. MATERIAL AND METHODS: Data from mRCC patients treated with nivolumab were retrospectively analyzed. Patients were classified into two categories according to their estimated glomerular filtration rate (eGFR); the first category (C1) included patients with eGFR < 40 mL/min/1.73 m2 and the second category (C2) included those with eGFR ≥ 40 mL/min/1.73 m2. RESULTS: Of the 95 patients enrolled, 1. group included 26 patients (27.4%) and 2. group included 69 patients (72.6%). None of the pts in category 1 were on hemodialysis. Overall incidence of adverse events was not statistically different between the two groups (P = .469). The overall response rate ORR was 50% in the first group and 42.0% in the second group (P = .486). Median overall survival (OS) was longer with 23.3 months in the 2. group versus 11 months in the 1. group (P = .415). CONCLUSION: Renal insufficiency is a common problem in patients with advanced renal cancer since they often undergo nephrectomy and their renal function may also worsen while receiving tyrosine kinase inhibitor therapy. We found that there is no significant difference in the safety and efficacy of nivolumab treatment between two groups. Nivolumab appears to be a safe and effective agent in patients with renal impairment.

Imprint cytology in the endoscopic diagnosis of gastrointestinal malignancies.

BACKGROUND/AIMS: To compare imprint cytology with histopathology regarding diagnostic accuracies and quickness in the diagnosis of gastrointestinal malignancies. METHODOLOGY: Multiple endoscopic biopsies were taken from 146 patients having various lesions without a prior histopathological diagnosis. Imprint smears were prepared, using all biopsied tissues, on 3-5 slides. Tissues were fixed in 10% formalin. Time from the materials were received at the pathology laboratory to when the results were available was recorded. Cytopathologists and histopathologists, blinded to each other's diagnosis, examined the imprint smears and tissues. RESULTS: Average time to get imprint cytology results was shorter than that of histopathology (55 minutes vs. 8 days). Fifty-eight patients had a final diagnosis of malignancy. Histopathology and imprint were positive in 56 and 54, respectively. Eighty-eight patients had benign histopathology, all of these had negative imprint results. False-negative and false-positive rates for imprint were 6.8%, 0% and for histopathology were 3.4%, 0%, respectively. CONCLUSIONS: Imprint cytology is an easy, reliable method that can be used as an adjunctive measure with histopathology. It gives the earliest information about the nature of the lesion with a minimum misdiagnosis risk. Imprint cytology lets the surgeon plan a therapeutic strategy approximately 1 week earlier.

Comparison of five detection methods for Helicobacter pylori.

OBJECTIVE: To evaluate which diagnostic test is preferable for the diagnosis of Helicobacter pylori in patients with gastroduodenal disease. STUDY DESIGN: H pylori infection was diagnosed prospectively in 101 patients. Diagnosis of H pylori was made by tests based on five different principles: (1) culture, (2) direct histologic demonstration, (3) imprint cytology, (4) brushing cytology, and (5) gram staining of H pylori. Efficacy of each test was compared. RESULTS: All the tests were reliable for diagnosing H pylori infection; 73.3% of patients showed concordance in at least two tests. All the tests were positive in > 50% of patients. Significant concordance between brushing and imprint cytology was also determined. These two tests have almost similar specificity when compared to other tests. CONCLUSION: When patients undergo upper endoscopy, we recommend taking biopsy specimens for culture and histology. H pylori can be assessed equally well with all the tests, but imprint and brushing cytology have the advantage of rapid response, specificity, much lower cost and reproducibility.

Adenoid cystic carcinoma of the tongue.

Malignant tumours of the salivary glands in children are extremely rare. We present here a 12-year-old girl initially diagnosed as pleomorphic adenoma on fine needle aspiration biopsy, and adenoid cystic carcinoma (ACC) after the lesion was excised and examined by histopathology. A wide resection of the lesion and bilateral supraomyohyoid neck dissection was performed. To our knowledge this is one of the youngest patients with ACC of the minor salivary glands. Due to its benign histological appearance, the biological agressiveness of ACC is usually underestimated. Although fine needle aspiration cytology (FNAC) is very valuable in diagnosis, cytological variations of pleomorphic adenoma must be considered. ACC of the tongue in a young age group should be treated with wide resection and selective neck dissection if the tumour is localized in places where the risk of metastasis is increased and if there is a clinically palpable lymph node. In such cases the clinician should not avoid radical operations even in a young patient.

Imprint cytology in the diagnosis of Helicobacter pylori. Does imprinting damage the biopsy specimen?

OBJECTIVE: To investigate the efficacy of imprint cytology in the diagnosis of Helicobacter pylori infection and whether it damages the biopsy specimen for subsequent histologic examination. STUDY DESIGN: Two antral biopsies were taken from 76 patients with dyspeptic symptoms undergoing upper gastrointestinal endoscopy. Imprint cytology was made from the first specimen. This specimen was fixed in 10% formalin and sent for histopathologic examination. The second specimen was directly fixed in 10% formalin for routine histopathologic examination without being used for an imprint. The imprint smears were examined by cytopathologists. The biopsy specimens were examined by pathologists who did not know which specimens were used for the imprints. RESULTS: H pylori was seen in smears from 55 (72%) patients and in both biopsy specimens from the same patients. The pathologists could not recognize the biopsy specimens from which the imprints were made. Concordance between imprint cytology and histopathology was 100%. CONCLUSION: Imprint cytology is a suitable test for H pylori diagnosis, and imprints do not adversely affect the quality of the biopsy specimen.

Inhaled corticosteroids may reduce neutrophilic inflammation in patients with stable chronic obstructive pulmonary disease.

BACKGROUND: Although both inhaled and oral corticosteroids have anti-inflammatory effects causing improvement in clinical symptoms and spirometry in the treatment of asthma, the role of corticosteroids in the management of chronic obstructive pulmonary disease (COPD) is controversial. OBJECTIVE: To evaluate the effects of inhaled corticosteroids on sputum neutrophilia in clinically stable COPD patients. METHODS: In total, 18 patients were enrolled in the study. During 2 months, 9 patients in group A inhaled fluticasone propionate (FP) 500 microg 3 times daily. In group B 9 patients received placebo. All of the patients continued to inhale both salbutamol and ipratropium bromide. In 9 patients, sustained-released theophylline was also administered. Blood samples, spirometric tests, blood gas analyses, and either spontaneous or induced sputum cultures were evaluated on entry into the study, after a 2 months of treatment and following the 6-week washout period. RESULTS: After the 2-month FP treatment, no significant changes in the number of peripheral blood neutrophils, blood gas and spirometry data were observed in both groups. In group A, the total cell number and the number of neutrophils decreased from a mean of 3. 4 +/- 1.3 x 10(6) cells/g and 0.6 +/- 0.3 x 10(6) neutrophils/g on entry into study to 1.9 +/- 0.6 x 10(6) cells/g and 0.02 +/- 0.01 x 10(6) neutrophils/g after 8-week treatment with FP, returning to 3.3 +/- 1.1 x 10(6) cells/g and 0.5 +/- 0.3 x 10(6) neutrophils/g following the washout period. The percentages of neutrophils were 55. 6 and 77.9% in groups A and B after 2 months of FP treatment. There was no significant change in group B values during the study. CONCLUSION: These data suggest that neutrophilic inflammation in sputum may be decreased by inhaled corticosteroids in clinically stable COPD patients.

Idiopathic granulomatous mastitis. Report of a case diagnosed with fine needle aspiration cytology.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a benign, inflammatory breast disease of unknown etiology. Although it is rare, it frequently presents in a manner similar to that of breast carcinoma. CASE: A 41-year-old female developed unilateral idiopathic granulomatous mastitis, diagnosed by fine needle aspiration cytology. The clinical presentation and mammographic findings were suspicious for carcinoma. Fine needle aspiration cytology showed granulomatous inflammation. Histopathologic examination revealed a noncaseating, granulomatous lesion. Further clinical, radiologic and laboratory investigations disclosed no etiology. Therefore, we considered the case to be idiopathic granulomatous mastitis. CONCLUSION: Cytologically it may be difficult to distinguish IGM from carcinoma of the breast. Typical cytologic findings of the lesion are helpful to rule out cancer. In the differential diagnosis, all known causes of granulomatous changes have to be excluded before a diagnosis of idiopathic granulomatous mastitis is made.

Congenital cystic adenomatoid malformation. Report of two cases and review of the literature.

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare pulmonary lesion, characterized by an excessive overgrowth of the terminal respiratory bronchioles. The lesion is almost always unilateral and may occur in any lobe. We present two children with CCAM. The first case was a one-day-old female infant admitted with respiratory distress and cyanosis. The second case was a 19-month-old girl with a nine-month history of recurrent respiratory infections. Preoperative diagnosis of both cases was intrapulmonary mass. The histopathological examinations revealed CCAM.

Stasis dermatitis of the hand associated with an iatrogenic arteriovenous fistula.

Stasis dermatitis is a cutaneous finding associated with chronic venous failure resulting in venous stasis. Arteriovenous fistula in the hand may cause a chronic venous stasis. We report a case of stasis dermatitis of the hand associated with an iatrogenic arteriovenous fistula. Stasis dermatitis should be considered as a potential complication of iatrogenic arteriovenous fistula.

Sustained ventricular tachycardia in cardiac hemochromatosis treated with amiodarone.

Cardiac hemochromatosis can cause heart failure and cardiac arrhythmias. Among these arrhythmias, ventricular tachycardia may be resistant to treatment. A case of cardiac hemochromatosis complicated with ventricular tachycardia that did not respond to intravenous lidocaine, procainamide or propafenone, nor to DC cardioversion, was successfully treated with amiodarone. Amiodarone, a class III antiarrhythmic drug, may be highly effective in similar cases.

Cystic chondroma arising from the falx cerebri: a case study with review of literature.

A 28-year-old woman was presented with an 1-year history of headache, double vision and left hand and foot paresthesia. Clinical and CT findings were evaluated malignant. During the operation a solid mass attached to the falx cerebri was found. Pathological examination showed a chondroma with large central cystic degeneration. Our review of the literature revealed only 9 cases of falcine chondroma up to now, excluding ours.

A case of intrapulmonary teratoma presenting with hair expectoration.

Benign cystic teratomas of the lung are extremely rare. Up to the present time, around 30 cases have been reported in the literature. We report an additional case, a 28-year-old woman, admitted with the complaint of expectoration of hair. Histopathological, clinical, and Ct features are presented.

Large cell carcinoma of the lung with unilateral hamartoma.

A 54-year-old Turkish male was admitted with a history of nonproductive cough and left chest pain. Chest roentgenogram demonstrated two masses located on different lobes of the left lung. One was a chondromatous hamartoma, the other was a large cell carcinoma.