Positive association between heart dosimetry parameters and a novel cardiac biomarker, solubleST-2, in thoracic cancer chest radiation.

BACKGROUND: Early screening and diagnosis of radiation-induced heart disease (RIHD) is difficult in patients with chest radiation exposure. sST-2 is involved in myocardial stress or injury. We evaluated the relationship between heart dose parameters and sST-2 changes in chest malignant tumor patients who received chest radiation. METHODS: We prospectively collected thoracic malignancy cancer patients who had received chest radiotherapy. Heart dosimetry parameters were extracted from the treatment planning system. sST-2 was measured at baseline, the middle stage, and after radiotherapy (recorded as pre-ST-2, mid-ST-2, and post-ST-2). sST-2 change rate was calculated. Scatter plots showed the relationship between cardiac dose parameters and ST-2 change rate. Multiple regression was used to analyze the relationship between cardiac dose parameters and ST-2 change rate. RESULTS: Totally, 60 patients were enrolled. The mean V5 , V10 , V20 , V30 , V40 , and MHD was 60.93 ± 27.79%, 51.43 ± 25.44%, 39.17 ± 21.75%, 28.07 ± 17.15%,18.66 ± 12.18%, and 18.60 ± 8.63 Gy, respectively. The median M-LAD was 11.31 (IQR 3.33-18.76) Gy. The mean pre-ST-2, mid-ST-2, and post-ST-2 was 5.1 ± 3.8, 6.4 ± 3.9, and 7.6 ± 4.4, respectively. sST-2 was elevated with thoracic irradiation (P < .001). Multivariate linear regression analyses showed that V5 , V10 , V20 , and MHD were independently and positively associated with ST-2 change rate (ß = .04, .04, .04, and .10, respectively, all P < .05). CONCLUSION: Serum sST-2 levels were elevated over time during radiotherapy. V5 , V10 , V20 and MHD were independently and positively associated with the elevated ST-2 change rate.

Postoperative Inflammation Is an Independent Prognostic Factor in Patients With Thoracic Esophageal Squamous Cell Carcinoma.

BACKGROUND: The aim of this study was to elucidate the impact of postoperative inflammatory response on prognosis in patients with stage I thoracic esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS: Seventy-five consecutive patients who underwent subtotal esophagectomy for clinical stage I thoracic ESCC were reviewed retrospectively. Maximum serum CRP level (CRPmax) and white blood celI count (WBCmax) were evaluated as postoperative inflammatory parameters. Prognostic factors were analyzed using Cox proportional hazards modeling. RESULTS: Optimal cut-off values were 10.7 mg/dl for CRPmax and 19,700/mm3 for WBCmax On univariate analyses, older age, worse performance status, higher WBCmax, and infectious complications were significantly associated with poorer overall survival. Multivariate analysis revealed WBCmax >19,700/mm3 to be an independent prognostic factor for poorer overall survival (hazard ratio=3.356; 95% confidence interval=1.221-9.220; p=0.019). CONCLUSION: A high WBCmax in the early postoperative phase, but not infectious complications, was an independent prognostic factor for poor overall survival in patients with clinical stage I thoracic ESCC.

Abilities of Pre- and Postoperative High-Sensitivity C-Reactive Protein Levels to Predict 90-Day Mortality After Surgery for Abdominal and Thoracic Cancers.

BACKGROUND: Elevated high-sensitivity C-reactive protein (hsCRP) levels are known to be associated with a poor prognosis for cancer patients, but inadequate data exist regarding whether pre- or postoperative hsCRP levels have better predictive value after oncologic surgery. This study evaluated the associations between pre- and postoperative hsCRP levels and 90-day postoperative mortality among patients who underwent surgery for abdominal or thoracic cancers. METHODS: This retrospective cohort study included 7933 patients who underwent elective surgery between January 2010 and December 2016. Cox regression analysis and receiver operative characteristic curve analyses were used to evaluate the prognostic values of preoperative hsCRP (< 1 month before surgery) and postoperative hsCRP (< 3 days after surgery). RESULTS: For predicting 90-day mortality, the area under the receiver operating characteristic curve was significantly larger for preoperative hsCRP than for postoperative hsCRP [0.76; 95% confidence interval (CI) 0.71-0.81 vs 0.65 95% CI 0.57-0.72; P < 0.001]. The optimal cutoff values were 0.5 mg/dL for preoperative hsCRP and 9.7 mg/dL for postoperative hsCRP. Based on these cutoff values, increased risks of 90-day mortality were significantly associated with preoperative hsCRP levels higher than 0.5 mg/dL [hazard ratio (HR) 7.60; 95% CI 4.43-13.03; P < 0.001] and postoperative hsCRP levels higher than > 9.7 mg/dL (HR 1.83; 95% CI 1.12-2.98; P = 0.016). CONCLUSION: Both elevated pre- and postoperative hsCRP levels were associated with increased risks of 90-day mortality after surgery for thoracic and abdominal cancer. However, preoperative hsCRP had better prognostic value than postoperative hsCRP.

Non-islet cell tumor hypoglycemia caused by intrathoracic solitary fibrous tumor: a case report.

BACKGROUND: Non-islet cell tumor hypoglycemia (NICTH) is defined as a form of hypoglycemia caused by an extrapancreatic tumor. Solitary fibrous tumor (SFT) associated with hypoglycemia is rare. CASE PRESENTATION: A 76-year-old woman, who had frequently experienced hypoglycemic symptoms such as presyncope for the prior 6 months, visited our hospital to undergo detailed examinations. Her fasting glucose level was low at 49 mg/dl. The blood levels of IRI and C-peptide were also low at 0.2 µU/ml and 0.21 ng/ml, respectively. Chest computed tomography revealed a mass measuring 15 cm in the left thoracic cavity. Percutaneous needle biopsy yielded a diagnosis of intrathoracic SFT associated with NICTH. The tumor was removed by video-assisted thoracoscopic surgery. Histological examination showed a tumor composed of simple spindle-shaped cells with an irregular arrangement. Immunohistochemical staining was positive for CD34, bcl-2, and vimentin and negative for alpha SMA and mesothelin. These results confirmed the diagnosis of SFT. Her hypoglycemic symptoms resolved rapidly after surgery. The clinical course has since remained favorable with no signs of recurrence. CONCLUSION: We report a case of non-islet cell tumor hypoglycemia caused by intrathoracic SFT. The high-molecular-weight IGF-II produced by the tumor has been regarded as the cause of NICTH.

Rare Occurrence of Hypergastrinemia Due to Thoracic Neuroendocrine Tumor: Detection and Characterization by 68Ga-DOTATATE PET/CT.

Hypergastrinemia is a prominent feature of a segment of gastroenteropancreatic neuroendocrine tumors, the gastrinomas, occurring mostly in the gastrinoma triangle. Hypergastrinemia due to a thoracic neuroendocrine tumor is a very rare occurrence, with a paucity of literature elucidating the same. We report a case of thoracic neuroendocrine tumor in a patient who had initially presented with symptoms of peptic ulcer disease of 3-y duration. On evaluation, the patient's fasting serum gastrin levels were found to be raised. Conventional imaging modalities and endoscopic evaluation did not identify the location of a possible gastrinoma or any other mass in the abdomen. In view of the hypergastrinemia, somatostatin receptor-targeted imaging with (68)Ga-DOTATATE PET/CT was undertaken and showed a somatostatin receptor-expressing paravertebral mass next to the thoracic aorta in the left lung. The mass was excised and was histopathologically suggestive of metastatic neuroendocrine tumor (MIB-1 labeling index, 2%). The present case underscores the importance of (68)Ga-DOTATATE PET/CT in both detecting and characterizing a causative lesion missed on contrast-enhanced CT, especially when the lesion is not easily amenable to biopsy.

Nonamyloid tumoral light-chain-deposition disease (aggregoma) of the paraspinal region.

Aggregomas are rare localized masses of monoclonal nonamyloid immunoglobulin light-chain deposits. To date, there have been only a few reports of isolated aggregomas, with the majority detailing renal, lymph node and brain deposition. We present a rare case of paraspinal aggregoma in a 67-year-old female who presented with a complaint of cough and chest pain. Imaging demonstrated a left-sided paravertebral mass extending from T7-T10. Pathological analysis showed lamellar deposition of extracellular eosinophilic material with an associated lymphoplasmacytic nonamyloid infiltrate. To our knowledge, this is the first report of a paraspinal aggregoma. While exceedingly rare, this tumor can be included in the radiologic differential diagnosis of paravertebral soft tissue tumors in adults. The observation of our case adds to the limited understanding of the etiology, pathogenesis, natural history, and treatment of nonamyloid light-chain depositions.

Thoracic tumor effects on plasmatic coagulation: role of hemeoxygenase-1.

OBJECTIVES: Lung cancer is an important health threat worldwide, and is associated with a 3.8-13.9% incidence of thrombophilia. Of interest, patients with lung tumors have been noted to have an increase in endogenous carbon monoxide production via upregulation of hemeoxygenase-1 activity. Given that it has been demonstrated that carbon monoxide enhances plasmatic coagulation in vitro and in vivo via formation of carboxyhemefibrinogen, we sought to determine if patients with thoracic tumors undergoing lung resection/pneumonectomy had an increase in endogenous carbon monoxide and concurrent plasmatic hypercoagulability. MATERIALS AND METHODS: Nonsmoking patients with thoracic tumors (n=19) had preoperative carboxyhemoglobin (a measure of carbon monoxide production) determined, and a thromboelastometric method to assess citrated plasma coagulation kinetics and the formation of carboxyhemefibrinogen was utilized. Thoracic tumor patient coagulation kinetics was compared with normal subject (n=30) plasma samples. RESULTS AND CONCLUSION: Patients with thoracic tumors were determined to have an abnormally increased carboxyhemoglobin concentration of 2.1±0.6%, indicative of hemeoxygenase-1 upregulation. It was found that 84% of thoracic tumor patients had plasma clot strength that exceeded the 95% confidence interval value observed in normal subjects, and 44% of this hypercoagulable subgroup had carboxyhemefibrinogen formation. Future investigation of the role played by plasmatic hypercoagulability and hemeoxygenase-1 derived carboxyhemefibrinogen in the pathogenesis of thoracic tumor related thrombophilia is warranted.

Extramedullary haematopoiesis presented as intrathoracic tumour in a patient with alpha-thalassaemia.

The authors report a case of extramedullary haematopoiesis (EMH) presenting as an intrathoracic tumour in a patient with alpha-thalassaemia. CT scan and MRI of the chest were obtained and followed by tumour excision. Compared to beta-thalassaemia, only two cases of EMH in patients with alpha-thalassaemia have been described in the literature. A possible reason for this disparity is discussed.

Differences in initial NSE levels in malignant and benign diseases of the thoracic wall.

BACKGROUND: Neuron-specific enolase (NSE) is widely used to follow-up patients with small cell lung cancer (SCLC). Since the NSE level can be influenced by a broad range of diseases and disorders a large study should be done to assess its level in various lung and non-lung tumors and benign diseases. METHODS: This research included 328 SCLC patients, 717 non-small cell lung cancer (NSCLC), 50 other thoracic cancers such as tumors of the mediastinum and mesothelioma, 35 non-pulmonary cancers like esophagus, breast and stomach cancer, 205 benign diseases, and 37 healthy individuals. The serum level of NSE was measured at initial diagnosis prior to therapy using electrochemiluminescence immunoassay (ECLIA, Roche Diagnostics). RESULTS: The high levels of NSE in SCLC differed significantly from all other groups. The results imply very good sensitivity of NSE in SCLC and good discriminatory power of NSE between SCLC and NSCLC. CONCLUSIONS: The NSE level in SCLC differs significantly from all other tested groups (p < 0.01). The highest values are seen in SCLC extensive disease. ROC curves revealed good discriminatory power of the initial NSE levels separating SCLC from other lung lesions. NSE can be used as a diagnostic tool for the early recognition of the neuroendocrine component of lung tumors and follow-up of SCLC patients.

Chest radiography as a method of screening for occult cancer in patients with idiopathic deep vein thrombosis.

The occurrence of neoplasms in patients with idiopathic deep vein thrombosis (DVT) may result in a significant reduction in survival rates. The aim of our study was to assess the use of chest X-rays (CXRs) as a screening method of intrathoracic neoplasms in patients who with idiopathic DVT. In observational, cross-sectional study, the medical records of 99 patients with idiopathic DVT, who were submitted to CXR (during the hospital stay or within 30 days after discharge), were investigated. Of these patients, 15.1% had images suggestive of thoracic neoplasias (single or multiple pulmonary nodules and mediastinal widening). Neoplasms were diagnosed in 4 patients in the follow-up with CXR. The CXR is an option of early screening for thoracic neoplasms and other nonmalignant diseases in patients with idiopathic DVT.

[Primary hyperparathyroidism due to an intrathoracic parathyroid adenoma. - A case report and review of the literature]. / Kalkvakaóhóf vagna kalkkirtilsaexlis í brjóstholi - sjúkratilfelli med umfjöllun.

A 72 year old gentleman presented to the emergency department with symptoms of diffuse joint and muscular pain, fatigue and diminished memory. Serum calcium and parathyroid hormone levels were raised, consistent with primary hyperparathyroidism. No abnormality was found on an ultrasound scan of the neck. However, a sestamibi scan suggested a possible adenoma in the anterior mediastinum, which on computed tomography (CT) scan was 1.5 cm in size. A partial upper sternotomy was performed in order to excise the adenoma and his symptoms disappeared within several weeks. This case highlights the variable and commonly nonspecific symptoms of primary hyperparathyroidism and the less well known fact that parathyroid adenoma may occasionally be found intrathoracically.

[A case of triple negative chest wall recurrent breast cancer treated with capecitabine and docetaxel combination therapy (XT therapy)].

A 59-year-old woman underwent modified radical mastectomy for left breast cancer 9 years earlier. This time, a chest wall recurrence was found. A chest CT showed a chest wall tumor and lymph node metastases. PET images showed increased uptake in chest wall tumor and lymph nodes. The serum tumor markers have also elevated. Open biopsy of chest wall tumor was performed, and the tumor was diagnosed as invasive ductal carcinoma[ER(-), Pg R (-), HER2 score(0)]. Combination chemotherapy with capecitabine and docetaxel was initiated. After 7 courses of treatment, a marked response has been seen. Capecitabine and docetaxel combination therapy are considered useful for treatment of triple negative recurrent breast cancer.

Clinical value of using serological cytokeratins as therapeutic markers in thoracic malignancies.

In recent years, there has been an increasing awareness among physicians of the value of therapeutic interventions in patients suffering from lung cancer and mesothelioma. A search for an optimal approach using surgery, irradiation and chemotherapy in different settings of the tumour disease, including curatively aimed adjuvant chemotherapy after locoregional surgery or radiotherapy, has resulted in gradually improved survival rates. Still, early detection is crucial if there is to be a possibility of curing patients or prolonging life in cases of relapsed disease. Several studies have been initiated in which surrogate markers are evaluated in comparison to chest X-rays and computer tomography. The present review focuses on the predictive and prognostic value of using serological cytokeratins as tumour markers for patients suffering from thoracic malignancies.

[Cutaneous metastases from adenocarcinoma of unknown primary site]. / Metástasis cutáneas de adenocarcinoma de origen primario desconocido.

Metastatic cancer of unknown primary site appears in 5-10% of oncologic patients. The primary tumor is usually discovered at autopsy and only in 27% of patients alive. Metastases from cancer of unknown primary site may be located in the skin and subcutaneous tissue and it is the dermatologist the first in evaluating these patients. We present a case of cutanoeus metastases from moderately-differentiated adenocarcinoma of unknown primary site. The immunohistochemical study revealed positive staining for CEA and negative staining for PSA. The primary tumor could not be identified in spite of the imaging and endoscopic studies performed. Based on these studies we excluded a colorectal or prostatic origin and considered a pancreatic adencarcinoma as the possible primary tumor. Even though a minority of these patients will have a curable disease, the appropriate use of pathological diagnosis and selected imaging studies for an optimal management of patients with a tumor of unknown primary site should not be ignored.

Diffuse thoracic lymphangiomatosis with disseminated intravascular coagulation in a child.

An 8.5-year-old girl who presented with chronic cough and hemoptysis underwent a CT scan of the chest showing diffuse mediastinal and parenchymal infiltration and pleural effusion, and laboratory findings showed disseminated intravascular coagulation. Disseminated lymphangiomatosis was diagnosed after an open-lung biopsy. She was treated by systemic steroids, interferon, tamoxifen, chemotherapy, and radiation but died of respiratory failure and disseminated intravascular coagulation 2 years after the diagnosis. This patient represents a rare presentation of diffuse pulmonary lymphangiomatosis together with disseminated intravascular coagulation, involving both the mediastinum and pulmonary parenchyma, in a child.

[The features of cases of intrathoracic lymphomas]. / Intratorasik lenfoma olgularimizin özellikleri.

In this study, 18 patients who had been diagnosed as intrathoracic lymphoma between January 1999 and August 2001 had been evaluated retrospectively to guide the diagnostic approaches. 12 (66.6%) of the patients were male and 6 (33.4%) were female. The mean age was 46.47 +/- 17.31. The leading symptoms were disapnea, cough, weight loss and fever. The most frequently seen laboratory findings were decreased hemoglobin and hematocrit rates (72.2%) and increased Lactate Dehydrogenase levels (44.4%). Radiologically, 18 (100%) patients had mediastinal lymph node enlargement, 8 (44.4%) patients had bilateral and 6 (33.3%) had unilateral hilar enlargement, 3 (16.6%) patients had appearance of mass lesion, 1 (5.5%) had appearance of consolidation, 2 (11.1%) patients had atelectasis, 3 (16.6%) patients had appearance of pleural effusion. Histopathological diagnosis were undertaken with lymph node biopsies in 11(61.1%) patients, with bronchial biopsies in 2 (11.1%) patients, with pleural biopsy in 1 (5.5%) patient, with lymph node and bronchial biopsies in 3 (16.6%) patients, with lymph node and pleural biopsies in 1 (5.5%) patient. 11 (61.1%) patients were diagnosed as Hodgkin Disease (nine as nodular type, two as mixed cellular type). 7 (38.9%) patients were diagnosed as non Hodgkin Lymphoma. After taking diagnosis the patients were sent to medical oncology clinics for follow up and therapy. These findings showed that different locations of intrathoracic lymphomas could be seen with nodal or extranodal presentations so it must be taken into account in differential diagnosis of other pathological conditions.

Screening for autoantibodies in children with opsoclonus-myoclonus-ataxia.

Various paraneoplastic autoantibodies have been linked to discrete neurologic syndromes and tumors in adults, but little is known about their incidence in children. We report a cross-sectional study of known paraneoplastic antibodies in 59 children with opsoclonus-myoclonus-ataxia, 86% of whom were moderately or severely symptomatic, and 68% of whom had relapsed at the time of testing. This total number of patients includes 18 children with low-stage neuroblastoma (tested after tumor resection), six of whom had never been treated with immunosuppressants. All were seronegative for anti-Hu, anti-Ri, and anti-Yo, the three paraneoplastic antibodies most associated with opsoclonus-myoclonus or ataxia in adults. These data contrast with reports of anti-Hu-positive sera in children with high-stage tumors and suggest that anti-Hu, anti-Ri, and anti-Yo do not explain relapses in pediatric opsoclonus-myoclonus-ataxia. They underscore the need to search for unique autoantibodies, as well as cellular mechanisms of pediatric paraneoplastic disease.

Circulating IL-6 as a predictor of radiation pneumonitis.

PURPOSE: We report results from a clinical research protocol investigating circulating pro-inflammatory cytokines (interleukin-6 [IL-6] and tumor necrosis factor alpha [TNFalpha]) in relation to radiation pulmonary injury. METHODS AND MATERIALS: In a protocol for cytokine measurement, 25 patients had clinical follow-up longer than 12 months, and 24 had serial cytokine data. Serial plasma specimens before, during, and after thoracic radiotherapy were analyzed for IL-6 and TNFalpha using enzyme-linked immunosorbent assay (ELISA). Radiation pulmonary injury was defined using National Cancer Institute Common Toxicity Criteria. RESULTS: Of the 24 patients, 6 had Grade 1 pneumonitis, and 13 had Grade 2 pneumonitis. There was no Grade 3/4 pneumonitis. Median time of radiation pneumonitis was between 8 and 12 weeks post-therapy. IL-6 levels before, during, and after thoracic radiation therapy were significantly higher in those who developed pneumonitis. In contrast, we did not detect a significant correlation between plasma TNFalpha and radiation pneumonitis. CONCLUSIONS: High pretreatment plasma levels of IL-6 predisposed patients to the risk of radiation pneumonitis. Pretreatment IL-6 level may serve as a predictor for radiation pneumonitis. Serial plasma IL-6 was consistently higher for the pneumonitis group. The role of IL-6 in the cytokine cascades that promote radiation pulmonary injury deserves further investigation.