Karcinom jezika s endobronhijalnom metastazom: rijedak slučaj

Endobronchial metastases of extrapulmonary malignant tumors are quite rare. We present a patient with endobronchial metastasis previously operated for tongue carcinoma. A 71-year-old female patient presented with the complaint of cough. She had a history of tongue carcinoma operation 2 years before. Chest x-ray revealed an air-fluid level in the lower zone of the right hemithorax. There was a big cavitary lesion in the right lower lobe and bilateral multiple nodular lesions, some of which had cavity formation on computed tomography. Bronchoscopy revealed a polypoid lesion with necrotic appearance and pathologic examination showed squamous cell carcinoma. The lesion was accepted as a metastasis of tongue carcinoma after evaluation of the materials taken from the tongue on previous operation. There was no finding suggestive of local recurrence; however, the patient died from hemoptysis and respiratory insufficiency. In conclusion, endobronchial metastasis should be considered in patients with extrapulmonary malignancies and bronchoscopic examination should be performed in such cases, even in the presence of atypical radiological findings.Endobronhijalne metastaze ekstrapulmonalnih zloćudnih tumora vrlo su rijetke. Prikazuje se bolesnica s endobronhijalnom metastazom, koja je prethodno operirana zbog karcinoma jezika. Bolesnica u dobi od 71 godine žalila se na kašalj. Anamneza je pokazala da je bolesnica bila operirana zbog karcinoma jezika dvije godine ranije. Rentgenografijom prsišta otkrivena je razina zraka i tekućine u donjem dijelu desnog hemitoraksa. Nađena je velika kavitarna lezija u desnom donjem režnju te obostrano višestruke nodularne lezije od kojih su neke pokazale stvaranje kaviteta na kompjutoriziranoj tomografiji. Bronhoskopski je otkrivena polipoidna lezija nekrotičnog izgleda, a patološki je opisana kao karcinom pločastih stanica. Nakon procjene materijala prethodno uzetog tijekom operacije jezika zaključeno je da lezija predstavlja metastazu podrijetlom iz karcinoma jezika. Nijedan nalaz nije upućivao na lokalni recidiv karcinoma, a bolesnica je umrla od hemoptize i respiracijske insuficijencije. U zaključku, na endobronhijalne metastaze treba misliti kod bolesnika s ekstrapulmonalnim zloćudnim bolestima i provesti bronhoskopski pregled, čak i kod atipičnih radioloških nalaza

Prevalence of smoking and chronic obstructive pulmonary disease amongst teachers working in Kocaeli, Turkey

Abstract Aim To evaluate smoking and COPD prevalence amongst teachers working in the schools of Kocaeli City, Turkey. Method In this cross-sectional study, a questionnaire focusing on respiratory symptoms and smoking habits was administered to all participants who accepted to join the study.All subjects also underwent a physical examination and a pulmonary function test performed with portable spirometer. According to GOLD criteria, subjects who had post-bronchodilator FEV1/FVC Results A total of 685 teachers were included [female n = 307 (45%), male n = 378 (55%)] with mean age 38.9 ± 8.9 years. Smoking habit was evaluated in 660 subjects: 291 (44.1%) were smokers, 252 (38.2%) were non-smokers and 117 (17.7%) were ex-smokers. Pulmonary function test was available in 651 subjects and 510 (78.3%) were defined as normal on spirometric analysis. Small airway obstruction was found in 115 of the cases (17.7%) in whom FEF25-75 level was found to be lower than 70% predicted. FEV1/FVC level was lower than 70% in 16 subjects (2.5%). Five subjects who had positive reversibility test were excluded from the study. The remaining 11 subjects who were considered as COPD consisted of 2 (18%) females and 9 (82%) males. Six of these subjects were aged over 40 years. Conclusion Spirometry has an important role in early diagnosis of COPD. Spirometric evaluation of cases with risk factors for COPD could be helpful in diagnosing patients before the progressive decline in lung function begins. Further studies are needed to evaluate whether the interventional strategies at this stage such as smoking cessation could prevent the progression of disease.</p