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We are presenting the case of a 60-year-old woman (OM ) with a bronchial-pulmonary carcinoid which the only, first and dominating symptom was paroxysmal atrial tachycardia, as well as ventricular group extrasystoles. After 1.5 years of treatment with amiodarone, the patient was admitted to hospital because of haemoptysis. In the imaging examinations of the thorax, a cavernous structure of 36 x 47 mm in the III segment of the left lung was discovered. The patient underwent urgent surgery after an episode of massive pulmonary haemorrhage--surgery included excision of the upper lobe of the left lung containing the tumour and mediastinal lymph nodes. On microscopic examination, an atypical carcinoid was diagnosed. After the surgery, arrhythmia ceased and did not return for a period of 3 following years. The current imaging examinations and determinations of 5-HIO uringexcretion acid do not indicate relapse of the tumour.

Acromegaly is usually caused by excess GH (growth hormone) secretion by pituitary adenoma. Extremely rare (< 1% of cases) acromegaly can be a result of ectopic GHRH (growth hormone releasing hormone) secretion by bronchial tubes, lung, pancreatic or intestinal tumor. The aim of this description is to present the case of successfully treated acromegaly caused by ectopic GHRH secretion by bronchial neuroendocrine tumor and the usefulness of chromogranin A assay in the disease monitoring. The diagnosis of acromegaly in 61-year old woman was based on typical clinical picture and elevated GH and IGF-1(insulin-like growth factor-1) levels. MRI (magnetic resonance imaging) images revealed no tumor in the pituitary but only the pituitary enlargement. Moreover, the right lung tumor (10 cm size) and elevated GHRH level were documented. The secretion of GH, IGF-1 and GHRH were normalized and progression of acromegaly was stopped after the carcinoid tumor surgery. Currently, 5 year after surgery, acromegaly is still in the remission, as the normal levels of GH, IGF-1, chromogranin A and normal chest and pituitary images confirm. The authors emphasize usefulness of measurement of chromogranin A concentration for the evaluation of the tumor remission in case the routine GHRH assay is not accessible.

Lack of improvement in treatment results of lung cancer leads to searching for new methods. One of the most distressing symptoms for lung cancer patients is airway obstruction due to the tumor, commonly resulting in dyspnea, postobstructive pneumonia, cough, or hemoptysis. Removal of endobronchial obstruction leads to quick improvement of clinical status and Quality of Life. Brachytherapy HDR of tracheal and lung cancer is a well-established method for the local treatment of patients with inoperable tumors of the tracheobronchial system. It seems that another promising treatment method of lung cancer is interstitial brachytherapy using permanent implants. The paper presents principles of brachytherapy, indications for this treatment and treatment results of tracheal and lung cancer. Indications for radical, palliative and interstitial treatment are discussed, respectively. Selected results of brachytherapy as an independent treatment and that combined with teletherapy, radical and, palliative are presented separately. Most commonly recognized complications are discussed which include: fatal pulmonary hemorrhage and fistula formation.

A case of 59 year old woman with a 21 year history of recurrent pneumonias of the upper left lobe is presented. When she at last agreed for the diagnosis her chest X-rays revealed atelectasis and cirrhosis with bronchiectases of the left lung. Tumor of the left main bronchus and severe inflammation of the surrounding mucosa with purulent secretion were found during bronchofiberoscopy. The patient underwent left pneumonectomy. Histological examination of the specimen revealed presence of carcinoid in the main left bronchus without involvement of the regional lymphnodes, with signs of irreversible damage of other bronchi and pulmonary tissue. The very long period of observation since the first symptoms, no metastases in the bronchopulmonary lymphonodes and no distant metastases indicate the low-grade malignancy of the carcinoid in the presented case.

A case of a 50-year male patient is presented. A cause of hemoptysis lasting for several months could not be identified in this patient. Chest X-ray and laboratory tests were normal. Temporarily atypical tubercle (Mycobacterium scrofulaceum) were seen in sputum, making proper diagnosis difficult. Further follow-up suggested cancer of the left lung. The diagnosis was ultimately confirmed intraoperatively. Histologically exceptionally malignant cancer--mucoepidermoid carcinoma--was diagnosed.