Pulmonary tuberculosis masking lung cancer – A case report

AbstractPulmonary Tuberculosis can co-exist with lung malignancy masking the underlying disorder leading to delay in diagnosis and management. Here we present an interesting case of a 60 year old man who on initial presentation was diagnosed with tuberculosis but on nonresponse to therapy and investigation was found to have an underlying lung malignancy

Differentiating Pleural Effusions: Criteria Based on Pleural Fluid Cholesterol

Objective: To assess the efficacy of pleural fluid cholesterol in differentiating transudates and exudates as compared with Light’s criteria. Methods: Patients with pleural effusion during a 6-month period were enrolled in the study and underwent thoracentesis. Pleural fluid was analyzed for the levels of protein, lactate dehydrogenase (LDH), and cholesterol. Etiological diagnosis, which was established after considering clinical and biochemical factors, was the gold standard for comparison. Cut-off values for pleural fluid cholesterol were taken as 60 mg/dL and 45 mg/dL. Results: A total of 53 patients were included for final analysis. Of them, 19 were with transudates and 34 with exudates in their pleural fluids. The sensitivity, specificity, positive predictive value, and negative predictive value of the pleural fluid cholesterol (cut-off >45 mg/dL) were 97.06%, 94.74%, 97.06%, and 94.74%, respectively, for identifying exudates. These values were differentiating better than those obtained by Light’s criteria for pleural fluid cholesterol (cut-off >60 mg/dL) (p<0.0001). Combining pleural fluid protein with pleural fluid cholesterol (>45 mg/dL) gave a higher specificity (100%) and positive predictive value (100%) but a lower sensitivity (82.93%) and negative predictive value (63.16%). Conclusion: Pleural fluid cholesterol is better than Light’s criteria for the differentiation of transudates and exudates and is less cumbersome as it does not require a simultaneous blood sampling. Cut-off value of pleural fluid cholesterol for differentiating transudates and exudates should be 45 mg/dL. Further studies are warranted to assess the efficacy of the combination of pleural fluid protein and cholesterol as criteria for classifying effusions

Clinicopathological Profile of Lung Cancer Patients in a Teaching Hospital in South India

Introduction: Lung cancer is one of the leading causes of cancer related deaths in the world. The incidence of lung cancer is increasing in India and there is a need to understand the natural history of this disease. Aim of the study: To study the clinico- pathological- radiological profile of patients diagnosed with lung cancer from January 2013 to May 2015 at a tertiary care teaching hospital. Materials and Methods: Inpatient records of all patients admitted during the study period were examined and  all patients with a histologically proven diagnosis of bronchogenic carcinoma were recruited. Demographic characteristics, clinical, radiological and pathological details of each patient were recorded. Results: Fifty four patients with lung cancer were identified. Forty three (79.6%) were male and 11 (20.4%) were female. Thirty two (59.7%) were smokers and 22 (40.7%) were non smokers. Cough and expectoration (61.1%) was the most common presenting symptom followed by breathlessness (59.3%). Mass lesion (81.5%) was the most common radiological presentation and adenocarcinoma (42.6%) was the most common histological subtype. When compared to fiber optic bronchoscopy, image guided percutaneous biopsy had a better  yield for diagnosing lung cancer (51.9% vs 48.1%). But this difference was not statistically significant (p=0.892) Conclusion: Adenocarcinoma is replacing squamous cell carcinoma as the most common type of lung cancer in India