Immunoglobulin G4-related lung disease presenting with a mediastinal mass

Immunoglobulin G4-related disease (IgG4-RD) is a recently identified systemic disease characterized by increased IgG4 level in serum and plasma cell infiltration resulting in “storiform fibrosis”. Although lung involvement is rare, clinical presentation is highly variable, including mediastinal lymphadenopathy, interstitial pneumonia, and pleural effusion. Glucocorticoid therapy is accepted as the mainstay treatment in IgG4-RD. Here, we present an IgG4-related lung disease (IgG4-RLD) case who was admitted to the hospital with chest pain; found out to have a mediastinal mass. IgG4-RLD was diagnosed based on histopathological features and a high blood IgG4 level. The patient’s steroid therapy was effective and there were no steroid-related side effects

The IL-25/ILC2 axis promotes lung cancer with a concomitant accumulation of immune-suppressive cells in tumors in humans and mice

Background: Group 2 innate lymphoid cells (ILC2) can be activated by interleukin (IL)-33 or IL-25. IL-25-activated ILC2 cells help protect the host against helminth infection while exacerbating allergic-like inflammation and tissue damage in the lung. In the context of cancer, IL-33-activated ILC2 cells were found to bear anti-tumoral functions in lung cancer while IL-25-activated ILC2 cells promoted tumorigenesis in colorectal cancer. The role of IL-25-activated ILC2 cells in lung cancer remains to be addressed. Methods: We examined the overall survival of human non-small cell lung cancer (NSCLC) patients according to IL25 expression as well as the distribution of ILC2 cells and regulatory T cells (Tregs) in various NSCLC patient tissues and peripheral blood (PB) of healthy donors (HDs). We analyzed the effect of adoptive transfer of IL-25-activated ILC2 cells on tumor growth, metastasis and survival in a heterotopic murine model of lung cancer. Results: We report that human NSCLC patients with high IL-25 expression have reduced overall survival. Moreover, NSCLC patients bear increased frequencies of ILC2s compared to HDs. Frequencies of Tregs were also increased in NSCLC patients, concomitantly with ILC2s. In mice bearing heterotopic lung cancer, adoptive transfer of IL-25-activated ILC2s led to increased tumor growth, increased metastasis and reduced survival. The frequencies of monocytic myeloid-derived suppressor cells (M-MDSCs) were found to be increased in the tumors of mice that received ILC2s as compared to controls. Conclusion: Overall, our results indicate that the IL-25/ILC2 axis promotes lung cancer potentially by recruiting immune-suppressive cells to the tumors both in humans and in mice, and that it may therefore represent a suitable novel target for NSCLC immunotherapeutic development

Predictive value of the tuberculin skin test and QuantiFERON-tuberculosis Gold In-Tube test for development of active tuberculosis in hemodialysis patients

Background: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in HD patients. AIM: In our study, we evaluated the value of the TST and QFT-G In-Tube (QFG-IT) test in the development of active tuberculosis (TB), in the HD patients, and in healthy controls. Methods: The study enrolled 95 HD patients and ninety age-matched, healthy controls. The TST and QFG-IT were performed. All the subjects were followed up 5 years for active TB disease. Results: Compared to the healthy controls, a high prevalence of LTBI was found in the HD patients by QFG-IT (41% vs. 25%). However, no significant difference was detected by TST (32% vs. 31%). Four HD patients and one healthy control progressed to active TB disease within the 5-year follow-up. For active TB discovered subjects, QFG-IT was positive in all, but TST was positive in two (one patient and one healthy control). In HD patients; sensitivity, specificity, positive and negative predictive values of QFG-IT, and TST for active TB was 100% and 25%, 62% and 67%, 10%, and 3%, and 100% and 95%, respectively. Receiver operating curve analysis revealed that the results are significantly different (P = 0.04). Conclusion: QFG-IT test is a more useful diagnostic method than TST for detecting those who will progress to active TB in HD patients

Scimitar syndrome associated with gallbladder duplication

WOS: 000335276400027PubMed ID: 24560746Scimitar syndrome is a rare congenital anomaly associated with the venous drainage of the lung to the inferior vena cava through a systemic vein. Chest radiography of an asymptomatic patient, aged 36, showed a linear opacity extending from the pulmonary hilum to the diaphragm, on the right chest (Scimitar sign). Computerized tomography of the thorax exposed that the cause of that image was Scimitar vein. Abdominal ultrasonography revealed duplication in the gallbladder. The literature holds no reports of an association between Scimitar syndrome and gallbladder duplication. Secondary gastrointestinal malformations can also be found in patients suffering from this syndrome. (C) 2014 Elsevier Inc. All rights reserved

Farklı yöntemlerle örneklenen akciğer küçük hücreli dışı karsinom dokularında programlı ölüm ligandı 1 ekspresyon analizi

Aim: This study aims at investigating the concordance of programmed death-ligand 1 (PD-L1) expression in non-small cell cancer tissues that have been sampled using different methods and its relationship with the pathologic parameters of tumors. Methods: PD-L1 expression assays were made on the cell blocks taken using fine needle aspiration, the small tissue samples representing endoscopic biopsy and the large tissue samples representing the resected tumor taken from the tumors of 100 subjects diagnosed with non-small cell lung cancer; their percentage values were evaluated and their groups were determined based on these values. Results: The average difference in expression rates found through different sampling methods was close to 0, and the values of such differences changed mostly in a narrow range. In paired comparisons, a good level of concordance was observed between all the sampling methods. The values were 0.8865 (SE: 0.0306, CI: 0.8264-0.9466) in the comparison of tumor tissue (TT) and small biopsy (SB): 0.8637, (SE: 0.033, CI: 0.7989- 0.9285) TT to cell block (CB): 0.8916, (SE: 0.0272, CI: 0.8383- 0.9449) SB tissue to the CB. Conclusion: Therefore, it can be concluded that the PD-L1 expression does not differ between the tissues sampled through various methods in non-small cell lung cancers.Amaç: Çalışmada amacımız farklı yöntemlerle örneklenmiş küçük hücreli dışı karsinomda programmed death-ligand 1 (PDL1) ekspresyon uyumunu ve tümör patolojik parametrelerle ilişkisini araştırmaktır. Yöntemler: Küçük hücreli dışı akciğer karsinom tanısı alan 100 olgunun tümöründen ince iğne aspirasyonu hücre bloğu, endoskopik biyopsiyi temsil eden küçük doku ve rezeksiyon tümör temsil eden büyük doku örneğinde PD-L1 ekspresyon tayini yapılıp yüzde değerleri ve buna göre grupları değerlendirildi. Bulgular: Örnekleme yöntemleri tarafından saptanmış ekspresyon oranlarının ortalama farkının 0’a yakın olduğu gibi, fark değerlerinin, büyük oranda, dar uyum içinde olduğu bulundu. İkişerli karşılaştırmalarda, tüm örnekleme yöntemleri arasında, PD-L1 ekspresyon oranı açısından iyi düzeyde uyum olduğu izlendi. Tümör dokusu-biyopsi dokusu karşılaştırmasında 0,8865 (SE: 0,0306, CI: 0,8264-0,9466), tümör dokusu-hücre bloğunda 0,8637 (SE: 0,033, CI: 0,7989-0,9285); biyopsi dokusuhücre bloğunda 0,8916 (SE: 0,0272, CI: 0,8383-0,9449) idi. Sonuç: Sonuçta akciğerin küçük hücreli dışı karsinomlarında PDL1 ekspresyonu farklı yöntemlerle örneklenmiş dokular arasında fark göstermemektedir.Health Sciences University BAP departmen

Ultrasonographic applications in the thorax

Rapid developments and increasing technological knowledge have changed perspectives on ultrasonography. Previously, ultrasonography was used to evaluate chest wall pathologies, to distinguish between pleural effusion and consolidation, to evacuate pleural effusion, or to evaluate diaphragm movement. Today, it is also used in a wide range of pleural and parenchymal diseases. Ultrasonography is not just used in the emergency department and the intensive care units, it is also utilized in many clinical branches dealing with the respiratory system-due to its ease of use, fast ac-cess, price advantage, non-radiation exposure, higher diagnostic sensitivity, and specificity in many clinical situations-and has become a part of the examination. In this review, we have assessed not just transthoracic ultrasonography but also more focal and targeted sonographic applica-tions, such as the endobronchial ultrasound and esophageal ultrasound

Ruptura intrabronquial de un aneurisma de arteria pulmonar en un paciente con enfermedad de behçet

A 54-year-old man diagnosed with Behc ̧ et’s Disease (BD) 5 yearspreviously at another hospital was admitted to our center withmassive hemoptysis. The chest X-ray showed bilobular, smoothedged opacity localized in the left hilar and paracardiac regionthat not conceal heart contours (Fig. 1a, arrow)

Endobronchial management of an endobronchial hamartoma

Endobronchial hamartoma (EH) is a rare benign tumor of the bronchial tree. This tumor can obstruct the bronchus or cause bleeding. The treatment method is chosen according to location and extent of the tumor. Endobronchial hamartoma can be resected via bronchoscopic approach; surgical therapy, is alternative only for cases where the tumor cannot be resected completely through endoscopy, or if irreversible pulmonary changes secondary to obstruction of the bronchus occurred. We herein describe a 52-year-old female presented with progressive dyspnea and treated with diagnosis of asthma. In this patient, EH which is located in the left main lobe bronchus was found in radiologic assement. Bronchoscopy revealed a broad-based mass obstructing the bronchus. The tumor was resected after coagulation of the tumor with argon plasma coagulation, by the rigid bronchoscope. Pathologic diagnosis was reported as EH. This report highlights the success of rigid bronchoscopic approach in the management of EH

Amplitud de distribución eritrocitaria en pacientes con enfermedad pulmonar obstructiva crónica y en sujetos sanos

Background Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease (CVD). Red blood cell distribution width (RDW) is accepted as a powerful predictor of outcomes in patients with CVD. Aims To study RDW in patients with COPD, and to compare the value of this measurement with clinical, echocardiographic, nutritional and laboratory status. Secondly, we aimed to determine the effect of smoking on RDW values in healthy subjects. Methods One hundred and seventy-five patients with stable COPD and 210 healthy controls were enrolled in the study. Demographic, clinical, nutritional status, echocardiographic, and laboratory characteristics, RDW values were recorded and compared. Results RDW values were higher in the COPD group than in controls (15±2.3% vs 13.8±2.5%, p<0.001). In COPD patients, RDW levels positively correlated with CRP levels (r=0.27, p<.001), albumin levels (r=0.23, P=.04), right ventricular dysfunction (RVD) (r=0.24, P=.001), pulmonary hypertension (PAH) (r=0.1, P=.02), and presence of CVD (r=0.24, P=.02). In multivariable logistic regression suggested that presence of CVD (4.3; 95% CI: 1.3–11; P=.01), and presence of RVD (3.1; 95% CI: 1.7–8.3; P=.02) were independently related to elevated RDW levels in COPD patients. In the healthy population, correlations analysis showed only a significant correlation between RDW and cigarette smoking years (r=0.57, p<.001). Conclusion RDW is independently associated with CVD and RVD in patients with COPD. In the healthy population, RDW is also associated with smoking status

Tiroid ince iğne aspirasyonda hangi sitolojik özellikler papiller karsinom için daha değerlidir?

WOS: 000423909700009Aim: Fine-needle aspiration plays a significant role in the evaluation of solitary thyroid nodules. Several cytological criteria are defined and these primarily aim to distinguish papillary carcinoma (PC), the most common thyroid malignancy, from other benign diseases. In our study, we aimed to determine which cytologic criteria are more valuable in diagnosing PC. Methods: Patients, who had undergone thyroidectomy operation between January 2013 and December 2014 and had preoperative fine-needle aspiration cytology, were screened. Among cases that were postoperatively diagnosed as benign, 62 cases and among those diagnosed as PC and papillary microcarcinoma, 24 cases were included in this study. The cytologic criteria were reassessed. In the linear regression analysis, the variables associated with the diagnosis of malignancy at the level of p<0.05 were considered significant for predicting the diagnosis of PC. Results: The variables that remained as predictive for the diagnosis of cancer as the result of the Backward analysis following the multivariate analysis performed with the variables with a p value of less than 0.1 were cellular pleomorphism, nuclear atypia, papillary structures with fibrovascular cores, and intranuclear pseudoinclusion. Conclusion: Although every cytological feature is characteristic for PC, none of them alone is specific; they should be evaluated together with all nuclear and structural features during the diagnostic approach.Amaç:­Tiroidin soliter nodül değerlendirmesinde ince iğne aspirasyonu önemli bir rol oynar. Bir takım sitolojik kriterler tanımlanmış olup, bunlar öncelikle tiroid malignitesi içinde en sık rastlanılan papiller karsinomu (PK) diğer benign hastalıklardan ayırmayı amaçlar. Çalışmamızda hangi sitolojik kriterlerin PK tanısı koydurmada daha değerli olduğunu saptamayı amaçladık. Yöntemler: Hastanemizde Ocak 2013 ve Aralık 2014 tarihleri arasında tiroidektomi operasyonu gerçekleşen ve preoperatif dönemde ince iğne aspirasyon sitolojisi uygulanan olgular tarandı. Postoperatif tanısı benign olanlardan 62’si, PK ve papiller mikrokarsinomlardan 24’ü çalışmaya dahil edildi. Sitolojik değerlendirme kriterleri yeniden değerlendirildi. Lineer regresyon analizinde malignite tanısıyla p<0,05 düzeyinde ilişkili bulunan değişkenler PK tanısını öngörmede anlamlı kabul edildi. Bulgular: Çalışmamızda p<0,1 olan değişkenlerle çok değişkenli analiz yapılıp Backward analiz sonucunda kanser tanısını öngörmede anlamlı kalan değişkenler; hücresel pleomorfizm, nükleer atipi, fibrovasküler korlu papiller yapılar ve intranükleer psödoinklüzyondur. Sonuç: Her bir sitolojik özellik PK için karakteristik olmakla birlikte hiç birinin tek başına varlığı spesifik değildir. Tanı yaklaşımında tüm nükleer ve yapısal özelliklerle birlikte değerlendirilmelidir