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Risk analysis models, which are used in the diagnostic algorithm of incidental pulmonary nodules, are based on patient data from developed countries. Mayo Clinic, Brock University and Herder are among the most known models. We aim to compare the reliability of these models in patients with indeterminate solid nodules and to investigate the contribution of the predictors used to the model.We analysed 305 patients who performed transthoracic needle biopsy and positron emission tomography/computed tomography for solid nodules, retrospectively. For all three models, the malignancy risk probabilities of patients were calculated, and patients were classified as low (5%), moderate (60%) and high (60%) risk groups. Later, the malignancy rates of each model in three different risk groups were compared within each other and among the models.The malignancy rate is 73% in 305 patients. In the Mayo Clinic and Herder models, the difference in the low-, medium- and high-risk groups is significant (p 0.001). In the medium-risk group, the rate of malignancy is 96.8% in the Brock model. In the high-risk group, the rate of malignancy in Herder is 88.3% and the rate of malignancy in Mayo Clinic is 28.8%. The optimal cutoff values for the Mayo Clinic, Brock University, and Herder were 29.6, 13.4 and 70 (AUC, respectively; 0.71, 0.67 and 0.73). Age, smoking, gender, size, emphysema and spiculation increase the likelihood of malignancy.Close results were obtained in all three models. In the high-risk group, the Herder model has the highest reliability rate (odds ratio 3.3, confidence interval [1.1, 10.2]). Upper lobe predilection is not a reliable predictor.

INTRODUCTION Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C-ROS oncogene 1 (ROS-1) fusion change in lung adenocarcinoma. OBJECTIVES The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes. METHODS The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS-1) and distant metastasis was analysed. RESULTS A total of 845 patients were included in the study. The median age was 62 (28-88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02). CONCLUSION In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma.

OBJECTIVES The effect of non-steroidal anti-inflammatory drugs (NSAID), mostly used for postoperative analgesic purposes for wound healing, is still a matter of debate. Our goal was to evaluate the effects of the most widely used NSAID and corticosteroids after surgical operations on tracheal wound healing in an experimental rat model. METHODS Thirty-nine male Wistar albino rats were included in this study. Tracheotomy was performed in 32 rats; then they were divided into 3 groups. After the first day, the animals in group 1 were treated with an NSAID (diclofenac 10 mg/kg/day) (NSAID, n = 12) for 7 days; the animals in group 2 were treated with a corticosteroid (dexamethasone, 2 × 0.1 mg/kg/day) (steroid, n = 10) for 7 days; the animals in group 3 (control, n = 10) were not given any medications. For a fourth group (histological control, n = 7), in order to evaluate normal morphological and histological characteristics, neither surgery nor medication was used. Five rats were eliminated from the study (2 rats in the NSAID group died and 3 rats in the steroid group developed local wound infections). The drop-out rate was 12.8%. Histological characteristics, inflammation, fibrosis, necrosis, neochondrogenesis, neovascularization and epithelization were evaluated in 34 rats. Non-parametric tests were used for statistical analysis. RESULTS Inflammation, vascularization and number of fibroblasts and chondrocytes were significantly higher in the control group than in the histological control group. There was some reduction in all parameters except vascularization in the NSAID group (P > 0.05). When the steroid group was compared to the NSAID group, inflammation (P 0.05) were more suppressed in the steroid group. The number of fibroblasts increased in the steroid group (P > 0.05). CONCLUSIONS Steroids and NSAID may have negative effects on tracheal wound healing, probably by suppressing inflammation and fibroblast proliferation. NSAID was mostly used postoperatively for analgesic purposes and should be avoided.

OBJECTIVES Among the nodule types, the most controversial group are indeterminate solid nodules from 1 to 2 cm in size with the first choice being transthoracic needle biopsy (TTNB) or positron emission tomography (PET-CT) or both methods together. However, no single diagnostic algorithm could be applied to all cases. This research discusses the diagnostic success of PET-CT and TTNB. MATERIALS AND METHODS 407 Patients who referred to our hospital for any reason, with solid nodules with the size from 1 to 2 cmincidentally identified on the thoracic CT tests were investigated. Among the patients who underwent biopsy, 312 cases had PET-CT, and maximum SUV (SUVmax) values of the nodules were examined. Values of ≥2.5 were accepted as hypermetabolic. RESULTS The mean age of the patients was 61 ± 10.8 years. 84 patients were female (20.6%) and 323 were male (79.4%). For TTNB; sensitivity, specificity and accuracy rates of all cases, who were correctly diagnosed, were 76.9%, 83.3% and 78.9%, respectively (P

Background and Aims: Pulmonary hamartomas appear as parenchymal or endobronchial lesions, the latter representing ‘1.4 to 11%’ of the total number of pulmonary hamartomas. Endobronchial hamartomas usually emerge as a single mass. As they are accepted as benign tumors, endobronchial treatments are recommended today. 45 year-old male patient admitted with cough, phlegm and fever. A lesion totally obstructing the right main bronchus was found in CT. Methods: In his brochoscopy, a mobile, smooth-surfaced lesion obstructing right main bronchus was seen. Its histopathology was reported as ‘hamartoma.’ Results: The lesion was removed by using argon plasma coagulation and electrocotery. After the removal of the lesion in right main bronchus, another lesion with similar characteristics was seen in the intermedius bronchus and this lesion which histopathology was reported as ‘hamartoma’ was excised by using electrocauter snare. There was no recurrence in the 24 month follow-up. Conclusion: Reports of multiple endobronchial hamartomas are rare in the literature, and the awareness of this form of benign disease is important in the differential diagnosis of pulmonary diseases.

Introduction: Several markers have been investigated to predict the prognosis of lung cancer. In the present study, the prognostic values of epithelial growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), E-cadherin, and p120 catenin expression were investigated by immunohistochemistry in patients with a surgically resected non-small cell lung carcinoma (NSCLC). Patients and method: EGFR, VEGF, E-cadherin, and p120 catenin expression were prospectively determined in resected specimens from patients with NSCLC who had undergone surgery between 2003 and 2007. Patients’ and disease-related general characteristics and survival rate were recorded.

A 21-year-old woman presented with nausea, vomiting, decrease in appetite, and weight loss of 6 months and right chest pain of 5 days' duration. Earlier diagnostic work-ups had been inconclusive, and she was referred for the evaluation of the bilateral lung lesions as seen on her chest x-ray. Thoracic computed tomography scan showed a 6-cm mass in the right lower lobe, a minimal right pleural effusion, and a peripheral 2-cm cavitary nodule in the inferior lingular segment. Ultrasonography-guided transthoracic cutting needle biopsy of the right-sided mass and following right lower lobectomy both yielded benign specimens pathologically assessed as "inflammatory myofibroblastic tumor." The chest x-ray and thoracic computed tomography scans obtained 1 month following the thoracotomy showed spontaneous and almost complete resolution of the left-sided nodule. In follow-up 1 year after the surgery, no clinical, laboratory, or radiologic recurrence was detected. She is being closely followed as an outpatient.

Adiaspiromycosis is a world wide airborne infection and is a pulmonary disease in humans caused by the fungus Chrysosporium parvum var crescens (Emmonsia parva). It is caused by inhalation of spores of the saprophytic soil fungus. The spherules induce a granulomatous reaction, in which a single spherule is surrounded by a fibronecrotic and suppurative or fibrous granuloma. The disease can be localized and asymptomatic, or disseminated, occasionally severe, or even fatal. Reticulonodular infiltrates are the most common radiographic manifestations, with localized infiltrates occurring occasionally. We present a case with bilateral diffuse interstitial micronodular infiltration and granulomatous inflammation in the lung. The larvae of adiaspiromycosis visualized in the center of granulomatous inflammation by histopathologic examination of the lung biospy specimens. We aimed to discuss the very rare cause of diffuse interstitial and granulomatous inflammation of lung.