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Introduction : The close anatomical relationship between the oesophagus and bronchial tree results in formation of an oesophago-respiratory fistula in a subset of patients with advanced oesophageal or lung cancer. In those patients stenting of both the oesophagus and tracheobronchial tree is a valid option of palliative treatment. Aim : To determine the effectiveness, tolerance, quality of life, safety and survival after double stenting procedures. Material and methods: Retrospective analysis of a prospectively collected database was performed, concerning consecutive patients with oesophago-respiratory fistulas treated with double stenting. In all patients the degree of dysphagia, respiratory function before and after the procedure, and quality of life were evaluated. Partially covered oesophageal self-expanding metallic stents (PCESEMS) were used for oesophageal stenting, and silicone Y-type or partially covered self-expanding bronchial and tracheal stents (PCASEMS) were used to restore airway patency. Results: Between 2003 and 2015, 31 patients underwent double stenting due to oesophago-respiratory fistulas. Twenty-nine patients were diagnosed with oesophageal squamous cell carcinoma and 2 with bronchial carcinoma. In all patients, improvement in the general condition and quality of life was observed after airway patency restoration. Two patients required mechanical ventilation due to respiratory failure immediately after the procedure. Seven patients with oesophageal fistulas died because of bleeding in the long-term follow-up. Four patients required endoscopic re-intervention. Mean survival time was 67.1 days. Conclusions : Double stenting is an effective procedure improving patients’ quality of life. However, life-threatening complications can occur.

In adults, an isolated non-traumatic fracture of the lesser trochanter should arouse strong suspicion of an underlying malignant pathology. In this article, we present the case of a 55-year-old male patient who presented with a non-traumatic isolated fracture of the lesser trochanter secondary to a delayed diagnosis of metastases of bronchial carcinoma. [ABSTRACT FROM AUTHOR]

Bronchogenic cysts are congenital foregut dysplasia that occur mostly in the lungs and mediastinum. Here, we report a rare case of retroperitoneal bronchogenic cyst, the location, relationship to adjacent structures and blood supply of which were determined by computed tomography (CT) recombination technology and resected by laparoscope. The case was a 41-year-old female patient. The patient came to the hospital because of intermittent lumbar back discomfort for 1 month. CT scanning revealed a cystic mass of 3.9 cm Ã--3.2 cm Ã--3.0 cm behind the left peritoneum. The mass was close to the left adrenal gland, and a branch artery from the left renal artery was revealed to supply the mass. The cystic mass was excised by laparoscopy and confirmed as bronchogenic cyst on histopathology. [ABSTRACT FROM AUTHOR]

Endobronchial metastases of extra pulmonary tumors are rare. This report presents a case with diffuse endobronchial metastases with rectum carcinoma. A 63-year-old non-smoker female was admitted to our outpatient clinic with dyspnea and dry cough for two months. She had a history of rectum carcinoma and resection surgery eight months ago. On physical examination, wheezing was remarkable. There was patchy consolidation in both lung fields on chest x-ray. PET-CT revealed widespread nodules in pulmonary parenchyma which were consistent with rectal cancer metastasis. Bronchoscopy was performed and revealed extensive mucosal infiltration and multiple various sizes of polypoid lesions in the distal trachea and both main lobar bronchus. The histopathological evaluation reported as metastasis of rectum carcinoma. The oncological medical treatment regimen and radiotherapy was also planned. She admitted to emergency department with chest pain and progressive dyspnea 2 months after the diagnosis. Thorax CT demonstrated that increased metastatic peribronchial infiltrates, septal thickening and endobronchial polypoid lesions which was consisted with lymphangitic carsinomatosis and endobronchial metastasis. There was hypercapnic respiratory failure according to arterial blood gases analysis. She was intubated and admitted to the intensive care unit (ICU) and died in ICU on 7th day of admission. This case indicates that the possibility of endobronchial metastasis should be considered in a patient with underlying malignancy. If available bronchoscopic intervention should be planned not to let misdiagnosis. [ABSTRACT FROM AUTHOR]

Bronchogenic cysts (BC) are rare congenital malformations arising during the development of the ventral foregut. Bronchogenic cysts form as a result of abnormal budding of the bronchial tree during embryogenesis (between 4th-6th weeks). Most bronchogenic cysts originate in the mediastinum, while 15% to 20% occur in the lung parenchyma. According to the literature, most intrapulmonary cysts occur in the lower lobes. But bronchogenic cysts are commonly found in the middle and superior mediastinum. The bronchogenic cyst in our patient was subcarinal. It was striking in terms of its giant size and laying on two hemithoraxes.The bronchogenic cysts are usually asymptomatic and often diagnosed incidentally during routine chest roentgenogram for other reasons.They may not be detected until adulthood. Our patient was 56 years old. She had no obvious symptoms . The patient was referred to our clinic because of cough,and her bronchogenic cyst was determined. Basic treatment of bronchogenic cyst consists of surgical excision. However, in cases where resection cannot be performed, the epithelium should be peeled as in our case. [ABSTRACT FROM AUTHOR]

Accumulating evidence indicates that miRNAs can be promising diagnostic and/or prognostic markers for various cancers. In this study, we identified a novel miRNA, miR-3607-3p, and its targets in non-small cell lung cancer (NSCLC). The expression of miR-3607-3p was measured and its correlation with patient prognosis was determined. Ectopic expression in NSCLC cells, xenografts, and metastasis models was used to evaluate the effects of miR-3607-3p on proliferation and migration of NSCLC. Luciferase assay and western blotting were performed to validate the potential targets of miR-3607-3p after preliminary screening by microarray analysis and computer-aided algorithms. We demonstrated that miR-3607-3p was downregulated in NSCLC tissues and that miR-3607-3p might act as an independent predictor for overall survival in NSCLC. Moreover, serum miR-3607-3p may be a novel and stable marker for NSCLC. We found that overexpression of miR-3607-3p inhibited cell proliferation, colony formation, migration and invasion, and hampered the cell cycle of NSCLC cell lines in vitro. Our results suggested that miR-3607-3p directly targets TGFBR1 and CCNE2. In accordance with in vitro studies, we confirmed that miR-3607-3p functions as a potent suppressor miRNA of NSCLC. We showed that miR-3607-3p agomir could reduce tumor growth and inhibit TGFBR1 and CCNE2 protein expression. Taken together, our findings indicate that miR-3607-3p can inhibit NSCLC cell growth and metastasis by targeting TGFBR1 and CCNE2 protein expression, and provide new evidence of miR-3607-3p as a potential non-invasive biomarker and therapeutic target for NSCLC. [ABSTRACT FROM AUTHOR]

Background: The survival benefit of PCI in ES-SCLC reported by a European randomized trial (RCT) in 2007 was not replicated by a Japanese RCT published in 2017. This study aimed to evaluate the uptake of PCI before and after publication of the European RCT and its association with survival in ES-SCLC.Methods: We identified eligible patients in the only two Singapore national cancer centres from 2003 to 2010. We linked their electronic medical records to the national death registry. We described the utilization of PCI in patients diagnosed from 2003 to 2006 (pre-adoption cohort) with patients diagnosed from 2007 to 2010 (post-adoption cohort). We performed univariable and multivariable Cox regression analysis to assess the association between PCI and survival.Results: We identified 224 patients with ES-SCLC with no brain metastases. Among the 71 patients who had at least stable disease after first line chemotherapy, there was an increase in the use of PCI from the period 2007 to 2010 compared with 2003 to 2006 (32% versus 10%, P = 0.044). PCI was associated with improved OS (hazard ratio 0.22, 95% CI 0.10 to 0.47, P < 0.001) compared to no PCI in the multivariable analysis.Conclusion: There was an increase in the adoption of PCI for ES-SCLC since 2007. PCI was associated with improved survival in patients who did not have mandatory MRI brain imaging prior to PCI and had stable disease or better after first line chemotherapy, suggesting that the results of the European RCT are reproducible in the real-world practice. [ABSTRACT FROM AUTHOR]

Objective: Programmed death‐ligand 1 (PD‐L1) immunohistochemistry (IHC) is essential in patients of advanced non‐small‐cell lung cancer to determine eligibility for immunotherapy. PD‐L1 IHC assays have been clinically validated only on formalin‐fixed paraffin‐embedded tissue; however, lung cancer is frequently diagnosed on cytology. PD‐L1 immunocytochemistry (ICC) has shown high concordance of immunoexpression between cytology samples and paired small biopsies. Feasibility of liquid‐based cytology (LBC) smears for PD‐L1 ICC has not been analysed previously. Methods: PD‐L1 ICC and IHC (clone SP263) were performed on paired LBC smears and small biopsies, respectively, in patients with advanced non‐small‐cell lung cancer. Cases with fewer than 100 viable tumour cells on LBC smear/biopsy were excluded from analysis. PD‐L1 was interpreted positive when 25% or more tumour cells showed membranous and/or cytoplasmic protein expression of any intensity greater than background staining. Results: A total of 26 patients, harbouring adenocarcinomas (50%) and squamous cell carcinomas (50%), had available bronchial brushings/washings processed as LBC smears and concurrently obtained endobronchial biopsies. PD‐L1 IHC was interpreted positive in 46% (12/26) biopsies. PD‐L1 ICC was interpreted positive in 35% (9/26) LBC smears, all of which were IHC‐positive. No IHC‐negative case was positive on cytology. The overall concordance between LBC smears and small biopsies was 88.4%. Conclusion: PD‐L1 ICC can be performed on LBC processed smears, with certain challenges in interpretation inherent to LBC smears and their processing methods. Nevertheless, they represent a potential resource for ICC, especially when alternate histology material is not available. Future studies are required to validate the predictive value of PD‐L1 ICC on LBC smears. Analysis of PD‐L1 expression in liquid based cytology samples and matched biopsies in advanced stage of NSCLC. [ABSTRACT FROM AUTHOR]

Abstract Background and purpose Recent studies have postulated that patients undergoing lung stereotactic body radiotherapy (SBRT) for ultracentral tumors have higher toxicity and mortality rates than those with central tumors. Our aim was to compare the outcomes after lung SBRT for central versus ultracentral tumors in our own series. Material and methods This was a retrospective review of patients with primary and metastatic lung tumors treated with SBRT from 1 September 2009 to 30 June 2015. Patients were included if they were treated with five-fraction SBRT to central or ultracentral tumors. Central tumors were defined as tumors where the closest point was within 2 cm of (but not abutting) the proximal bronchial tree, or within 2 cm of (whether abutting or not) mediastinal structures. Ultracentral tumors were defined as tumors abutting the proximal bronchial tree. The 2-year overall survival (OS), 2-year local failure (LF), and 2-year grade ≥3 toxicity rates were compared between patients with central and ultracentral tumors. Results A total of 107 patients were included in this study. There were no significant differences in 2-year OS between the two groups, with 2-year OS 57.7% for central tumors, and 50.4% for ultracentral tumors (p = 0.10). There were no significant differences in 2-year LF between the two groups, with 2-year LF 3.4% for central tumors and 4.3% for ultracentral tumors (p = 0.92). There were no significant differences in 2-year grade ≥3 toxicity rate for the two groups, with 3.5% with central tumors and 8.7% with ultracentral tumors (p = 0.23). Conclusions There were no significant differences in OS, LF, or grade ≥3 toxicity between patients with central and ultracentral lung tumors. Although these results indicate that SBRT for ultracentral tumors may be safe, caution should be applied in selecting and treating these patients until the completion of large prospective trials. [ABSTRACT FROM AUTHOR]

Introduction: the incidence of N1 and N2 metastases in relation to the presence of peritumoral lymphovascular infiltration and tumor grade in bronchial carcinoma still remains insufficiently researched area that could provide valuable guidance. Several studies have shown a statistically significant difference in the occurrence of N 1 and N2 metastases in relation to the type and size of the bronchial carcinoma. The relationship between the occurrence of N1 and N2 metastases and the degree of the tumor immaturity in the bronchial carcinoma remains insufficiently documented. The aim of this research was to determine the frequency of N1 and N2 metastases in relation to the presence/absence of peritumoral lymphovascular invasion, as well as to investigate the relative risk of N metastases development in relation to the presence of peritumoral lymphovascular invasion. Materials and methods: this study included 331 patients of all ages, both men and women, diagnosed with bronchial carcinoma using various diagnostic procedures. In these patients, surgical treatment was indicated and the anatomical resection was performed. Results: a total of 331 patients were included in the study and N1 metastases were present in 39.88% of cases, while N2 metastases were present in 4.53% of cases with bronchial carcinoma. Peritumoral lymphovascular invasion was present in 37.55% of cases (86 out of 229 patients) with N0 disease, in 55.89% of cases (128 out of 229 patients) with N1 disease, and in 6.55% of cases (15 out of 229 patients) with confirmed N2 disease. Conclusion: the presence of the peritumoral lymphovascular invasion is more often accompanied by metastases in corresponding regional lymph nodes. By calculating the total relative risk, there is almost a 30- fold higher risk of developing metastases in N1 and N2 lymph nodes in the presence of peritumoral lymphovascular invasion. [ABSTRACT FROM AUTHOR]

Backgrounds: Self-efficacy plays an important role in pulmonary rehabilitation, but it is still unknown which factors exert their effects on postsurgical rehabilitation self-efficacy among non-small cell lung cancer (NSCLC) patients. This study aims to assess relationships among physical function, social factors, psychological factors, quality of life (QOL) and self-efficacy, and the effects of these variables on self-efficacy among NSCLC patients. Methods: A cross-sectional survey was administered to 238 postsurgical NSCLC patients (response rate 95.2%) at five tertiary hospitals in Fuzhou, China. the participants completed a pack of questionnaires. Structural equation modeling (SEM) was conducted to test the hypothetical model. Results: The SEM results supported the hypothesized structural model (χ2/df = 1.511, p>0.05). The final model showed that confrontation coping, subjective well-being (SWB), social support, psychological growth (PTG) and anxiety and depression can be directly related to self-efficacy (coefficient = 0.335, coefficient = 0.288, coefficient = 0.150, coefficient = 0.024, and coefficient = -0.004, respectively, p<0.01). Confrontation coping also had indirect effect via SWB (coefficient = 0.085, p<0.01), which had indirect connection via PTG (coefficient = 0.005, p<0.01). Social support and anxiety and depression had indirect pathways as well. As expected, self-efficacy directly affected the quality of life. Conclusions: This study suggests that higher confrontation coping style, SWB, social support, and PTG and lower anxiety and depression levels could effectively enhance their self-efficacy and consequently, improve QOL. These findings may help develop an intervention aimed at enhancing self-efficacy for this patient population. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to develop gefitinib-loaded polymeric foams that can be used as coating of drug-eluting stents for palliative treatment of bronchotracheal cancer. Release of such an anticancer drug from such stent coating can retard tumor regrowth into the bronchial lumen. Gefitinib-loaded polyurethane (PU) foams were prepared by embedding either gefitinib micronized crystals or gefitinib-loaded poly(lactic- co -glycolic acid) microspheres in water-blown films, with up to 10% w/w loading for gefitinib microcrystals and 15% w/w for gefitinib microspheres (corresponding to 1.0% w/w drug loading). Drug-release studies showed sustained release of gefitinib over a period of nine months, with higher absolute release rates at higher drug loading content. By the end of the studied nine month release periods, 60–100% of the loaded gefitinib had been released. Foams loaded with gefitinib-PLGA microspheres at 15% w/w showed accelerated drug release after 4 months, coinciding with the degradation of PLGA microparticles in the PU foam as demonstrated by scanning electron microscopy (SEM). When applied on a nitinol braided bronchotrachial stent, PU coatings with gefitinib microspheres showed similar mechanical properties as the drug-free PU coating, which indicated that the loading of microspheres did not affect the mechnical properties of the PU foams. In conclusion, we have fabricated drug-loaded PU foams that are suitable for bronchotracheal stent coating. [ABSTRACT FROM AUTHOR]

Bronchial neuroendocrine tumors (NET) are classified into well-differentiated typical carcinoids (TC), atypical carcinoids (AC), large cell neuroendocrine carcinomas (LCNEC), and small cell lung carcinomas (SCLC). We retrospectively reviewed and analyzed the diagnostic and therapeutic aspects, follow-up data, and outcomes of all patients diagnosed with a bronchial NET from 1995 to 2015 at our institution. Patients with LCNEC or SCLC were excluded due to the biological and clinical differences from the other bronchial NET. The clinical, laboratory, imaging, treatment, and follow-up data were collected and analyzed keeping in mind the recently published international recommendations. Forty-six patients were included in the study. Of these, 37 had a TC and 5 an AC. In 4 patients, the histological characterization was inadequate. Forty-four patients underwent surgery. Four patients developed metastatic disease. Interestingly, 14 patients had one or more other tumors diagnosed at some stage and 3 of them had three different tumors. A total of 7 patients died. The analysis of the laboratory and pathology assessment identified some inconsistencies when compared to the international recommendations. Although the treatment of bronchial NET at our institution was consistent with the successively published recommendations, it appears that the diagnostic process and the follow-up surveillance were not. We think that a systematic multidisciplinary approach might improve bronchial NET patient care. A relatively high rate of occurrence of a second, or also a third, non-NET tumor was observed, though the statistical value of such observation could not be exhaustively elucidated in this numerically limited patient population. In our opinion, the observed high rate of second malignancies in this patient cohort highlights the necessity of optimizing the follow-up of the bronchial NET patients, also considering the very good survival rate achieved with regard to the bronchial NET. [ABSTRACT FROM AUTHOR]

Background: Bronchogenic carcinoma is the single most important cause of cancer-related deaths with approximately 1.5 million cases worldwide every year. Computed tomography (CT) scanning can only estimate the proximal extent "with difficulty in visualization the real borders" of a tumor. The role of MRI in local staging of bronchogenic carcinoma is limited by the signal loss secondary to respiratory motion and heterogeneity of the magnetic field caused by the tissue/air interfaces. Positron Emission tomography combined with CT (PET/CT can accurately delineate the viable tumor from surrounding atelectasis and collapse/consolidation, This information cannot only demarcate the size and extent of the tumor for accurate T staging, but also provide guidance for biopsies if histological confirmation is required Purpose: It was to emphasize the role of PET/CT in differentiation the bronchogenic carcinoma from its inseparable pseudo-neoplastic lesions for better staging and increase the accuracy of follow up by ruling out the pseudo progression as well as pseudo regression. Patients and Methods: The study involved 32 patients proved histo-pathologically to have bronchogenic carcinoma and referred for PET/CT scanning. Each patient included in the study was subjected to full history taking, reviewing medical sheet and PET/CT examination. The study was done in private center (Techno-scan holding center, Heliopolis branch using PET-CT machine (GE Discovery VCT 64 PET/CT, USA); in which PETCT examination was followed by diagnostic contrast enhanced CT examination and processed at Ain Shams University, Radiology department. Results: In this study we found presence of inseparable pseudo neoplastic lesions among 20 patients out of 32 patients and the mean diameter of the bronchogenic mass lesion was 6.89 +/- 3.65 SD as measured by CT, while it was 5.77 +/-3.38 SD as measured by PET/CT in centimeters. Conclusion: The combined PET/CT using 18F-FDG is the best oncologic imaging modality with valuable role in local staging and follows up in patients of bronchogenic carcinoma. [ABSTRACT FROM AUTHOR]

Nephrotic syndrome (NS) is a pivotal manifestation of glomerular injury associated with various types of neoplasms. It may either precede or act as the presenting feature of the disease, whereas membranous nephropathy (MN) is a major phenotype of paraneoplastic glomerulopathies. However, there is a lack of information regarding the remission from paraneoplastic NS due to MN in patients who achieve favorable long-term survival after the successful removal of malignant tissue. We, herein, describe a case of biopsy-proven MN in a 65-year-old male patient with bronchogenic carcinoma, which was found during the systemic workup for concurrent NS. He was successfully treated with thoracoscopic left lower lobectomy and achieved a complete remission from NS at approximately 10 months after radical surgery. In 10 years of follow-up, there has been no recurrence of the pulmonary cancer and the patient is doing well with no relapse of NS, despite having never received treatment with any type of immunomodulating agent. Several concerns, including diagnostic management and therapeutic strategies for paraneoplastic NS, are discussed. [ABSTRACT FROM AUTHOR]

Introduction: MicroRNAs (miRNAs) are a group of small non-coding RNAs that affect multiple aspects of tumor biology including chemo resistance. miR-181b has been reported to modulate multidrug resistance in non-small cell lung cancer cells. This study was undertaken to determine the role of miR-181b in chemo resistance of small cell lung cancer cells.Material and Methods: This study was undertaken to determine the role of miR-181b in chemoresistance of small cell lung cancer cells with use of qRt-PCR, WB, bioinformatics analysis, and double luciferase reporter system.Results: Our data showed that miR-181b was significantly downregulated in cisplatin-resistant H446 small cell lung cancer cells, compared to parental cells, compared to parental cells. Ectopic expression of miR-181b inhibited cell proliferation and invasion in cisplatin-resistant H446 cells (p = 0.023). Moreover, overexpression of miR-181b increased the susceptibility of cisplatin-resistant H446 cells to cisplatin. Mechanistic investigations demonstrated that miR-181b inhibited B-cell lymphoma-2 (Bcl-2) expression by binding to the 3'-untranslated region. Overexpression of Bcl-2 reversed miR-181b-mediated chemo sensitization, which is accompanied by a reduced apoptotic response.Conclusions: Taken together, this work demonstrated that miR-181b might have the ability to overcome chemo resistance of small cell lung cancer cells, and restoration of this miRNA may represent a potential therapeutic strategy for improving chemo sensitivity in small cell lung cancer. [ABSTRACT FROM AUTHOR]

Aims: As immunomodulatory therapy is being integrated into treatment regimens for non‐small‐cell lung carcinoma, we aimed to prospectively collect data on the immunohistochemical profile of tumours assessed in our institution and to correlate this with morphological tumour features. Methods and results: Immunohistochemistry for programmed death‐ligand 1 (PD‐L1) was considered to be adequate when >100 tumour cells were seen microscopically. When adequate, PD‐L1 staining was scored as <1%, ≥1–49% or ≥50% positive membrane staining within tumour cells only. There were 197 assessable cases, of which 87% of those with pleomorphic features (n = 39) showed ≥50% positivity for PD‐L1 expression, as compared with only 33% of cases without pleomorphic features (P < 0.05) (90% versus 25% in resected cases). Further correlation of PD‐L1 expression with architectural patterns within the tumours was performed in 74 adenocarcinoma resections. All invasive mucinous adenocarcinomas scored <1%. All lepidic components in non‐mucinous adenocarcinoma resections scored <1%. Thirty‐five per cent of the acinar/papillary components and 53% of the solid/micropapillary components were positive for PD‐L1 expression. Conclusions: There are significant differences in PD‐L1 expression in relation to histological patterns, with particularly high levels in those with pleomorphic features and low/undetectable levels in invasive mucinous adenocarcinomas and the lepidic components of non‐mucinous adenocarcinomas. Assessment of PD‐L1 expression in a resected adenocarcinoma with a lepidic component may therefore not be reliable when immumodulatory therapy for recurrent disease is being considered, and either re‐biopsy or limiting assessment to the invasive component may be more appropriate. [ABSTRACT FROM AUTHOR]

Esophageal bronchogenic cysts are extremely rare. Here we report a case of massive upper digestive tract hematoma and bronchogenic cyst mimicking aortic dissection that was safely removed without esophagectomy. A 30-year-old man was referred to our hospital for the treatment of a mediastinal cystic tumor located in the submucosa of the distal esophagus. His chief complaints were dysphagia > 1 week and severe persistent upper abdominal pain mimicking aortic dissection with constant vomiting for 1 day after gastroscopy examination. The serum level of carbohydrate antigen (CA)199 was > 1,000 U/mL and CA125 was 4,816 U/mL. Hemoglobin levels decreased from 122 g/L to 85 g/L in 5 days. Imaging examinations detected a huge hematoma of the gastric wall. Preoperative diagnosis was difficult. Although the pain indicated a possible aortic dissection, the abnormal levels of tumor biomarkers suggested malignancy. The patient underwent left thoracotomy. The cyst showed an exophytic lesion connected to the esophageal wall at the level of the gastroesophageal junction. Muddy brown contents were obtained by aspiration of the mass intraoperatively. Because enucleation could not be performed, esophageal myotomy in the distal esophagus and partial resection of the cyst were selected. Histopathological examination indicated a bronchogenic cyst of the esophagus. At a follow-up visit 3 months later, the patient had no signs of disease recurrence or any complaints. Postoperative tumor biomarkers returned to normal range. The present report summarizes the clinical details of the case and reviews the literature in order to improve the accuracy of diagnosis. [ABSTRACT FROM AUTHOR]

PURPOSE: In this study, results of surgery for patients with mediastinal cystic pathology who were treated by the utilization of robotic surgery system were analyzed. MATERIALS AND METHODS: Prospectively collected data of 296 patients on whom robotic surgery system was used between October 2011 and June 2017 were retrospectively examined. Of these patients, 9 (3%) patients who were operated due to cystic pathologies of mediastinum were included in this study. Age, gender, docking, and console times of the robot, pathology results, length of hospital stay, anatomic localization of the lesions, blood transfusion requirement, conversion to open surgery, mortality, and morbidity rates were recorded. RESULTS: Five patients were male and 4 were female, and the mean age was 45.5 ± 21.2 years. The lesion was localized in anterior mediastinum in two patients, middle mediastinum in four patients, and in posterior mediastinum in three patients. Six patients underwent surgery with the diagnosis of bronchogenic cyst, one patient underwent surgery with the diagnosis of the pericardial cyst, and two patients underwent surgery with the diagnosis of the thymic cyst. The mean length of hospital stay was 3.3 ± 1.5 days. The median console time was 45 min (30-110 min) and the median docking time was 20 min (10-40 min). CONCLUSION: We consider that, with technical advantages provided to the surgeon in mediastinal surgery, robotic technology can be preferred in cystic pathologies of the mediastinum localized in areas that may pose challenges in dissection. [ABSTRACT FROM AUTHOR]

Background: Translocations of the IGH locus on 14q32.3 are present in about 8% of patients with chronic lymphocytic leukemia (CLL) and contribute to leukemogenesis by deregulating the expression of the IGH-partner genes. Identification of these genes and investigation of the downstream effects of their deregulation can reveal disease-causing mechanisms. Case presentation: We report on the molecular characterization of a novel t(12;14)(q23.2;q32.3) in CLL. As a consequence of the rearrangement ASCL1 was brought into proximity of the IGHJ-Cμ enhancer and was highly overexpressed in the aberrant B-cells of the patient, as shown by qPCR and immunohistochemistry. ASCL1 encodes for a transcription factor acting as a master regulator of neurogenesis, is overexpressed in neuroendocrine tumors and a promising therapeutic target in small cell lung cancer (SCLC). Its overexpression has also been recently reported in acute adult T-cell leukemia/lymphoma. To examine possible downstream effects of the ASCL1 upregulation in CLL, we compared the gene expression of sorted CD5+ cells of the translocation patient to that of CD19+ B-cells from seven healthy donors and detected 176 significantly deregulated genes (Fold Change ≥2, FDR p ≤ 0.01). Deregulation of 55 genes in our gene set was concordant with at least two studies comparing gene expression of normal and CLL B-lymphocytes. INSM1, a well-established ASCL1 target in the nervous system and SCLC, was the gene with the strongest upregulation (Fold Change = 209.4, FDR p = 1.37E-4). INSM1 encodes for a transcriptional repressor with extranuclear functions, implicated in neuroendocrine differentiation and overexpressed in the majority of neuroendocrine tumors. It was previously shown to be induced in CLL cells but not in normal B-cells upon treatment with IL-4 and to be overexpressed in CLL cells with unmutated versus mutated IGHV genes. Its role in CLL is still unexplored. Conclusion: We identified ASCL1 as a novel IGH-partner gene in CLL. The neural transcription factor was strongly overexpressed in the patient's CLL cells. Microarray gene expression analysis revealed the strong upregulation of INSM1, a prominent ASCL1 target, which was previously shown to be induced in CLL cells upon IL-4 treatment. We propose further investigation of the expression and potential role of INSM1 in CLL. [ABSTRACT FROM AUTHOR]

Clear cell odontogenic carcinoma (CCOC) is a rare malignant odontogenic tumour (MOT) that mainly affects the mandible, with a slight female predominance in adult patients. In this study, we described an exuberant CCOC in mandible of a 22-year-female patient. On radiographic examination, a radiolucent lesion in the region of tooth 36 to 44 with tooth displacement and alveolar cortical resorption was observed. Histopathological study revealed a malignant neoplasm of the odontogenic epithelium, composed of PAS-positive clear cells and immunoreactivity for CK5, CK7, CK19, p63. The Ki-67 index was low (<10 %). Fluorescent in situ hybridization revealed EWSR1 gene rearrangement. The diagnosis of CCOC was established and the patient was referred for surgical treatment. [ABSTRACT FROM AUTHOR]

Objective To investigate the typing characteristics of TCM excess pattern of primary bronchogenic lung cancer. Methods The diagnostic criteria for primary bronchogenic lung cancer were formulated after referring past relevant criteria and literature and combining past research achievements by Professor Zhang Peitong’s research team. The unified pattern differentiation and classification were carried out in the patients with primary bronchogenic lung cancer (n=135). Results All 135 patients had manifestations of excess pattern, and the frequency of manifestations of excess pattern were, in an descending order, qi stagnation pattern, qi counterflow pattern, phlegm congealing pattern, and blood stasis pattern. There were 2 (1.48%) patients with single pattern and 133 (98.52%) with combination of 2 or more patterns. The frequency of 4-pattern combination, 3-pattern combination and 5-pattern combination were higher. The frequency of in-pairs excess patterns, were qi stagnation pattern+qi counterflow pattern, qi counterflow pattern+phlegm congealing pattern, qi stagnation pattern+phlegm congealing pattern, qi stagnation pattern+blood stasis pattern, qi counterflow pattern+blood stasis pattern, and blood stasis pattern+phlegm congealing pattern. Conclusion Qi stagnation pattern and qi counterflow pattern dominate the occurrence and development of primary bronchogenic lung cancer. The combinations of multi-pattern are common and 4-pattern combination is the most common in the patients. The in-pairs excess patterns are qi stagnation pattern, qi counterflow pattern, phlegm congealing pattern and blood stasis pattern. [ABSTRACT FROM AUTHOR]

Purpose: To explore the impact of different width detector on the volume and geometric position of gross tumor volume (GTV) of the solitary pulmonary lesion (SPL), as well as the impact on scanning time and radiation dose during the simulation.Materials and Methods: Twenty-three patients with SPL underwent three-dimensional computed tomography (3DCT) simulation using different width detector, followed by four-dimensional computed tomography (4DCT) scans. GTV16 and GTV4 derived from different width detectors were compared with internal gross tumor volume (IGTV) generated from 4DCT on the volume and geometric position. Fourteen patients with lesions located in the upper lobe were defined as Group A and nine patients in the middle or lower lobe were defined as Group B. The scanning time and radiation dose during the simulation with the different width detector were compared as well.Results: The volumes of IGTV, GTV16, and GTV4 in Group A were 13.86 ± 14.42 cm3, 11.88 ± 11.93 cm3, and 11.64 ± 12.88 cm3, respectively, and the corresponding volumes in Group B were 12.84 ± 11.48 cm3, 6.90 ± 6.63 cm3, and 7.22 ± 7.15 cm3, respectively. No difference was found between GTV16 and GTV4 in Groups A and B (PA = 0.11, PB = 0.86). Either GTV16 or GTV4 was smaller than IGTV (P16 = 0.001, P4 = 0.000). The comparison of the centroidal positions in x, y, and z directions for GTV16, GTV4, and IGTV showed no significant difference both in Groups A and B (Group A: Px = 0.19, Py = 0.14, Pz = 0.47. Group B: Px = 0.09, Py = 0.90, Pz = 0.90). The scanning time was shorter and radiation dose patient received was lower using 16 × 1.5 mm detector combination than 4 × 1.5 mm detector (P = 0.000).Conclusions: Different width detector had no impact on the volume and geometric position of GTV of SPL during 3DCT simulation. Using wide detector would save time and decrease radiation dose compared with the narrow one. 3DCT simulation using either 16 × 1.5 mm detector or 4 × 1.5 mm detector could not cover all tumor motion information that 4DCT offered under free breathing conditions. [ABSTRACT FROM AUTHOR]

Flexible fiberoptic bronchoscopy is often the initial technique for diagnosis of lung and bronchial tumors. Many studies have shown the high accuracy rate of bronchial washing and brushing cytology in the evaluation of neoplastic and non-neoplastic bronchopulmonary lesions. The aim of this study is to emphasize the value of the bronchial cytologic findings for diagnosis of non-neoplastic bronchopulmonary lesions. In a cross-sectional study, we retrieved all cases with bronchial washing and brushing cytology from 21 Mach 2014 to 21 December 2015. The slides of 100 patients with negative cytological reports were reviewed and concomitantly correlated with history, physical examination, clinical and pathologic documents. The cases with insufficient clinical and pathological diagnostic documents were rejected. The results classified in subgroups according to final diagnosis and cytological findings were discussed. We evaluated 100 cases that were previously had negative cytological reports.60 cases were male, and 40 cases were female with male to female ratio: 6/4. The age range was between 21 to 88 with the mean age of 57 years. Regarding lung cancer, 31% of cases were false negative. Causes of these falsely negative reports were been errors in screening, low cellularity, unsatisfactory smears and poor fixation. 23% were known cases of tuberculosis with some cytological findings including inflammation, necrotic calcified deposits, multinucleated giant cell and reserve cell hyperplasia. 19% were pneumonic patients with smears demonstrating inflammation, curschmann's spiral and reserve cell hyperplasia. Other non-neoplastic cases included in this study were asthma, granulomatous inflammation, rheumatoid arthritis, sarcoidosis, Wegener, SLE, heart failure, hydatid cyst, interstitial lung disease, and end stage renal disease. Cytological specimens from patients underwent bronchoscopic washing and brushing should be carefully examined. In situations with negative cytologic results, correlation with history, imaging and biopsy specimen is mandatory. [ABSTRACT FROM AUTHOR]

Introduction: Spinal bronchogenic cysts are rare findings, with only four cases of lumbar bronchogenic cysts reported in the literature. All of these bronchogenic cysts involved the conus medullaris. We present the first case of a lumbar bronchogenic cyst and arachnoid cyst arising from the cauda equina in a 68-year-old male. Uniquely, this bronchogenic cyst also contained components of an arachnoid cyst. Methods: Magnetic resonance imaging (MRI) demonstrated a compressive cystic lesion at the level of the L3 vertebra splaying the cauda equina. An L3/L4 laminectomy was performed with marsupialisation of the cyst. Results: Histological examination revealed pseudostratified ciliated columnar epithelium confirming the diagnosis of a bronchogenic cyst, as well as a pleated fibrovascular tissue lined by sparsely spaced small monomorphic arachnoidal cells, indicating an arachnoid cyst. Conclusion: We demonstrate that bronchogenic cysts can be successfully treated with marsupialisation. [ABSTRACT FROM AUTHOR]

Objectives: Hematological malignancies of the breast share a presentation similar to primary breast carcinomas but differ substantially in therapeutic approach and clinical outcomes. In this study, we investigate the frequency of hematological malignancies, their relative primary and secondary occurrences, and further characterize the distinct histopathologies of these malignancies with a special focus on lymphomas. To our knowledge this is one of the largest and most comprehensive studies of breast hematologic malignancies.Methods: We conducted a retrospective review of our institution's pathology database for hematologic neoplasms diagnosed in breast tissue during a period of 22 years (1992-2014). Clinical characteristics, patient history, histologic subtype, and patient outcomes were analyzed.Results: We identified 52 cases; 46 lymphomas, 4 plasmacytomas, and 2 myeloid sarcomas. The lymphoma cases were 15 diffuse large B-cell lymphomas (DLBCLs), 14 follicular lymphomas (FLs), 8 marginal zone lymphomas (MZLs), 2 anaplastic large T-cell lymphomas, 2 peripheral T-cell lymphomas-not otherwise specified, 1 each of small lymphocytic lymphoma, Burkitt lymphoma, mantle cell lymphoma, B-cell lymphoblastic lymphoma, and T-cell lymphoblastic lymphoma. In total, 30 cases were primary and 22 cases were secondary to the breast. Primary lymphomas accounted for 60% of lymphomas. Most FLs and almost all MZLs were primary.Conclusions: Primary hematological malignancies of the breast are more common than secondary: 58 % versus 42%. This finding is more evident in lymphomas: 63% versus 37%. The most common hematological malignancy in our study was DLBCL, followed by FL and MZL. Most FLs and almost all MZLs were primary. At the same time, the percentage of primary DLBCLs in our study is lower than the percentage reported in previous studies. We suggest that this could be the result of transformation from low-grade lymphomas. Although rare, hematological malignancies of the breast warrant a higher level of clinical suspicion as they present similarly to breast carcinomas but require a substantially different therapeutic approach. [ABSTRACT FROM AUTHOR]

Aim: To provide an overview of the lung cancer incidence trends in the City of Zagreb (Zagreb), Split-Dalmatia County (SDC), and Croatia in the period from 2001 to 2013. Method Incidence data were obtained from the Croatian National Cancer Registry. For calculating incidence rates per 100 000 population, we used population estimates for the period 2001-2013 from the Croatian Bureau of Statistics. Age-standardized rates of lung cancer incidence were calculated by the direct standardization method using the European Standard Population. To describe incidence trends, we used joinpoint regression analysis. Results: Joinpoint analysis showed a statistically significant decrease in lung cancer incidence in men in all regions, with an annual percentage change (APC) of -2.2% for Croatia, 1.9% for Zagreb, and -2.0% for SDC. In women, joinpoint analysis showed a statistically significant increase in the incidence for Croatia, with APC of 1.4%, a statistically significant increase of 1.0% for Zagreb, and no significant change in trend for SDC. In both genders, joinpoint analysis showed a significant decrease in age-standardized incidence rates of lung cancer, with APC of -1.3% for Croatia, -1.1% for Zagreb, and -1.6% for SDC. Conclusion: There was an increase in female lung cancer incidence rate and a decrease in male lung cancer incidence rate in Croatia in 2001-20013 period, with similar patterns observed in all the investigated regions. These results highlight the importance of smoking prevention and cessation policies, especially among women and young people. [ABSTRACT FROM AUTHOR]

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a common critical emergency with high mortality in clinical practice. The key mechanism of ALI/ARDS is that the excessive inflammatory response damages the integrity of alveolar and bronchial cell membrane and thus affects their basic function. Phospholipids are the main component of cell membranes. Phospholipase A2 (PLA2), which catalyzes the cleavage of membrane phospholipids, is the most important inflammatory mediator of ALI. However, clara cell secretory protein 1 (CCSP1), an endogenous PLA2 inhibitor can increase the self-defense of membrane phospholipids. Thus, CCSP1 up-regulation and PLA2 inhibition constitutes an effective method for ensuring the stability of membrane phospholipids and for the treatment of ALI/ARDS. In the present study, we developed an in vitro model of ALI via lipopolysaccharide (LPS) stimulation of a human bronchial epithelial cell line, BEAS-2B, and assessed the mRNA and protein levels of CCSP1 and PLA2 in the model cells. The results demonstrated LPS induction inhibited the transcription and protein expression of CCSP1, but only the protein level of membrane associated PLA2 was increased, suggesting that in the in vitro ALI model, abnormally regulated CCSP1 transcription plays a crucial role in the damage of cell membrane. To find out the reason that CCSP1 expression was decreased in the ALI model, we predicted, by means of bioinformatics, putative transcription factors which would bind to CCSP1 promoter, examined their background and expression, and found that a transcription factor, CCAAT/enhancer binding protein β (C/EBP β), was correlated with the transcription of CCSP1 in the in vitro ALI model, and its phosphorylation in the model was decreased. CHIP-PCR and luciferase reporter assay revealed that C/EBP β bound to CCSP1 promoter and facilitated its transcription. Therefore, we conclude that there is a C/EBP β/CCSP1/PLA2 pathway in the in vitro ALI model. The study of underlying mechanism show that the activity of C/EBP β depends on its phosphorylation:LPS stimulation reduced C/EBP β phosphorylation and suppressed the transcription of CCSP1 in BEAS-2B cells, which resulted in enhanced PLA2 and the consequent membrane damage. And further study shows that overexpression of CDK2(Cyclindependent kinase 2), promoted the phosphorylation of C/EBP β and inhibited PLA2 through the C/EBP β/CCSP1/PLA2 pathway, so as to attenuate membrane damage. The significance of this study lies in that artificial C/EBP β phosphorylation regulation may ease the membrane damage in ALI and improve membrane repair. [ABSTRACT FROM AUTHOR]

Paraneoplastic neurological syndromes ( PNS) are often characterized by the presence of antineuronal antibodies in patient serum or cerebrospinal fluid. The detection of antineuronal antibodies has proven to be a useful tool in PNS diagnosis and the search for an underlying tumor. Here, we describe three patients with autoantibodies to several epitopes of the axon initial segment protein tripartite motif 46 ( TRIM46). We show that anti- TRIM46 antibodies are easy to detect in routine immunohistochemistry screening and can be confirmed by western blotting and cell-based assay. Anti- TRIM46 antibodies can occur in patients with diverse neurological syndromes and are associated with small-cell lung carcinoma. [ABSTRACT FROM AUTHOR]

The feasibility and effectiveness of transoral robotic surgery (TORS) in children with tongue base masses (TBMs) were evaluated. Eight pediatric patients who were treated with TORS for TBMs between January 2010 and January 2016 at a tertiary hospital included in the study. All pathologies were congenital lesions: four were lingual thyroglossal ductus cysts (LTGDCs), one was a minor salivary gland tumor, one was a vallecular cyst, one was a bronchogenic cyst, and one was an ectopic thyroid tissue. TORS was performed successfully in all cases. The mean robotic set-up and exposure time was 13.0 ± 2.1 min (range 10-16 min) and the mean robotic surgery time was 8.8 ± 6.9 min (range 4-25 min). Estimated blood loss was lower than 5 ml for one patient and lower than 50 ml for another one. The remaining patients' estimated blood loss was lower than 10 ml. No patient required tracheostomy intra- or post-operatively. Only one minor complication occurred on day 10 after surgery (minor bleeding), which was resolved without intervention. No major complications or recurrence were observed. Better visualization and small, flexible arms allow surgeons to treat TBM faster and easily using TORS. This leads to decreased morbidity compared to open and transoral endoscopic/microscopic surgical methods. In the future, we believe that TORS may become the gold standard method for the treatment of pediatric TBM with continued development of robotic technology. [ABSTRACT FROM AUTHOR]

Objective. To examine the relationship between the Sirtuin-3 (SIRT3) expression and the clinical indicators/prognosis of patients with non-small-cell lung cancer (NSCLC). Methods. The mRNA level of SIRT3 was detected by real-time PCR, while the protein level was detected by Western blot and immunohistochemical staining. SPSS 16.0 software was used for statistical analysis. Results. The expression of SIRT3 was significantly higher in NSCLC tissue than in adjacent tissue. The SIRT3 level was correlated significantly with lymph node metastasis and clinical stage of NSCLC patients. Moreover, univariate analysis showed that the expression of SIRT3, tumor size, lymph node metastasis, degree of differentiation, and clinical stage were correlated with the prognosis of NSCLC patients. Multivariate analysis demonstrated that lymph node metastasis, the tumor size, and SIRT3 expression were independent prognostic factors for NSCLC patients. Conclusions. SIRT3 is associated with the development and progression of NSCLC. The SIRT3 expression can be used as an independent prognostic factor for NSCLC patients and help identify prognosis of NSCLC. Therefore, SIRT3 has the potential to become a new factor for prognosis prediction and personalized treatment of NSCLC. [ABSTRACT FROM AUTHOR]