Prognostic Significance of PD-L1 Expression and Standardized Uptake Values in the Primary Lesions of Stage IV Adenocarcinoma Lung Cancer.

Background: This study evaluated the prognostic ability of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with stage IV adenocarcinoma lung cancer to detect protein death-ligand 1 (PD-L1) expression levels. Methods: In total, 86 patients with stage IV adenocarcinoma lung cancer underwent 18F-FDG PET/CT imaging and PD-L1 expression evaluation before treatment from February 2019 to November 2020 at Bach Mai Hospital, Hanoi, Vietnam. The assessed patient characteristics in this study included sex, age, smoking status, epidermal growth factor receptor (EGFR) mutation, PD-L1 expression level, survival status, tumor, node, and metastasis (TNM) stage, and metastasis locations. Results: The average age was 62.23 ± 9.51 years, and men and women represented 67.4% and 32.6% of the population, respectively. The EGFR mutation rate was 36%. PD-L1 expression was negative (detected in <1% of the tumor) in 40.7% of cases and positive in 59.3% of cases (detected in 1-49% of the tumor in 32.6%; detected in ≥50% of the tumor in 26.7%). The mean maximum standardized uptake value (SUVmax) was 11.09 ± 3.94. SUVmax was significantly higher in PD-L1-positive tumors than in PD-L1-negative tumors (12.24 ± 4.01 and 9.43 ± 3.22, respectively; p = 0.001). Receiver operating characteristic curve analysis revealed an area under the curve of SUVmax was 0.681 (95% confidence interval 0.570-0.793, p = 0.004). Compared with PD-L1-negative cases, SUVmax was significantly different in all PD-L1-positive cases (p = 0.001), weakly PD-L1-positive cases (1-49%, p = 0.005), and strongly PD-L1-positive cases (≥50%, p = 0.003). PD-L1 expression levels were significantly associated with SUVmax (p = 0.001), tumor size (p = 0.022), and EGFR mutation status (p = 0.045). Conclusions: SUVmax in the primary lesions was able to predict PD-L1 expression and may play a role in predicting PD-L1 immunotherapy efficacy in patients with stage IV lung adenocarcinoma.

Laryngotracheobronchial amyloidosis: A case report.

Primary laryngotracheobronchial amyloidosis is a rare pulmonary disease that can cause endobronchial stenosis. This disease has never previously been reported in Vietnam. We aimed to report a laryngotracheobronchial amyloidosis case in a 43-year-old female, which may be the first reported case in Vietnam. The patient had a 4-year history of progressive hoarseness, dyspnea, and hemoptysis. Multiple bronchial biopsies combined with detailed clinical information suggested an amyloidosis disease. Red congo staining was positive in bronchial samples, and a further workup found positive red congo staining in subcutaneous fatty tissue biopsy samples. Tracheostomy was performed due to severe dyspnea related to laryngeal stenosis. A multidisciplinary consultation was held, and chemotherapy with melphalan and dexamethasone were prescribed due to the systemic effects of the disease. After 2 cycles of chemotherapy, the patient showed improvement in dyspnea and cough. Due to the inexperience of both the clinicians and pathologists, this case was diagnosed quite late. In the future, if this diagnosis is considered in the differential diagnosis, an earlier diagnosis and better treatment outcome can be reached.

Congenital bronchobiliary fistula: a case report and literature review.

Congenital bronchobiliary fistula (CBBF) is a very rare malformation associated with clinical symptoms of dyspnoea, vomiting, cyanosis, persistent pneumonia, and poor response to antibiotics. Typical imaging techniques used to diagnose this malformation include bronchography, computed tomography (CT), cholangiography, hepatobiliary nuclear imaging, and magnetic resonance imaging (MRI). We diagnosed a case of CBBF that was initially diagnosed as non-resolving pneumonia. CT and fistulography were used to obtain the correct diagnosis. The fistula was confirmed by fistulography under the guidance of bronchoscopy. Surgical excision of the fistulous tract was performed, with complete recovery. The aim of this report was to emphasize the epidemiology and clinical features of CBBF patients.

Two rare cases of horseshoe lung with scimitar syndrome in Vietnam.

Horseshoe lung is a rare, congenital, pulmonary anomaly in which the caudal and basal segments of the left and right lungs are joined together. Most cases of horseshoe lung are associated with scimitar syndrome. Horseshoe lung can be diagnosed using pulmonary angiography, showing that the isthmus of the pulmonary parenchyma crosses the midline into the contralateral side. The isthmus parenchyma is typically supplied by the hypoplastic pulmonary artery. Clinical symptoms, therapeutic methods, and prognosis depend on the incidence of pulmonary hypertension, heart failure, recurrent pneumonia, and other combinations of congenital malformations. In this article, we describe two cases of horseshoe lung associated with scimitar syndrome and pulmonary malformation.