Ahmet Önen

Bax, bcl-2 and c-kit expression in non-small-cell lung cancer and their effects on prognosis

In non‐small‐cell lung cancer (NSCLC), stage of the disease is still the most important prognostic factor. Other than stage, many biological markers and many other prognostic factors are studied to define their effects on prognosis of lung cancer. In this study, we aimed to evaluate the expressions of Bax and bcl‐2 genes which are important in apoptosis and c‐kit, which is a tyrosine kinase transmembrane receptor, as well as searched their response to treatment modalities and effects on survival.

A case of a bronchogenic cyst in a rare location

Bronchogenic cysts occur as a result of a developmental fault during the division and budding of the tracheobronchial tree in the embryonic period. They are usually located in the mediastinum and intrapulmonary regions. They may cause serious respiratory distress in childhood; they present less commonly in adults and often present with a variety of symptoms, including recurrent infections. We report the case of an adult female patient who presented with recurrent pulmonary infections and swelling of the neck because of a bronchogenic cyst that was unusually located in the cervical region.

Chylothorax due to tuberculosis lymphadenopathy: Report of a case

While pulmonary tuberculosis is a very frequent infection, chylothorax is an unusual manifestation of tuberculous disease. A 71-year-old woman with chylothorax is herein presented. The ductus thoracicus was ligated and lymphadenomegaly, which was adjacent to diaphragm, was resected. Based on the findings of various tests, a diagnosis of tuberculosis lymphadenitis was made. The patient was administered antituberculosis chemotherapy and has since remained asymptomatic for 1 year after the operation. In conclusion, tuberculosis lymphadenomegaly may lead to the development of chylothorax. The combination of appropriate surgical and medical treatment is an effective therapeutic strategy for this pathology.

CD10 Expression in Epithelial and Stromal Cells of Non-small Cell Lung Carcinoma (NSCLC): A Clinic and Pathologic Correlation

CD10 is a zinc dependent metallopeptidase, and its expression in stromal and/or epithelial cells of many carcinomas has been suggested to have prognostic value. This study investigates CD10 expression in epithelial and stromal cells of non small cell lung carcinoma (NSCLC), and evaluates its prognostic value for this tumor and its histologic subtypes. Sixty-six cases of NSCLC [35 cases of nonsquamous cell carcinoma (NSCC) and 31 cases of squamous cell carcinoma (SCC)] were analyzed immuno-histochemically for CD10 antibody. Fisher’s exact test and univariate survival analyses were performed. Comparison of clinicopathologic characteristics for NSCLC showed that only stromal CD10 expression had worse prognostic impact, associated with the presence of recurrence (p = 0.001), death (p = 0.006) and disease positivity (p = 0.001). For SCC, CD10 was found to be expressed mainly in the stromal cells, and was associated with a decreased survival (p = 0.000) and disease free survival (p = 0.000). CD10 expression was restricted to the epithelial cells in NSCC and associated with an increased disease free survival (p = 0.036). Stromal CD10 expression apppears to be a worse prognostic factor in NSCLCs. CD10 which is expressed in different cell components of SCC and NSCC appears to have opposing effects on the behaviour of these histologic types.

Intrathoracic migration of ventriculoperitoneal shunt: a case report

IntroductionIntrathoracic migration of ventriculoperitoneal shunt can be transdiaphragmatic or supradiaphragmatic. This complication causes important respiratory symptoms.Case presentationA 7 year-old Caucasian female, hospitalized with the prediagnosis of pneumonia, was determined to have ventriculoperitoneal shunt migration at left hemithorax. A left thoracotomy was performed and the shunt was successfully removed transdiaphragmatically.ConclusionThe patients with intrathoracic migration of ventriculoperitoneal shunt must be treated surgically as soon as possible. Transdiaphragmatic surgical approach would be more suitable from the point of surgical easiness.

Giant Solitary Fibrous Tumor of the Pleura

A 74-year-old male presented with dyspnea, cough, and chest pain. On physical examination, breath sounds were diminished over the posterior inferior part of the right hemithorax. A chest roentgenogram revealed elevation of the right hemidiaphragm (Fig. 1). Computed tomography (CT) of the chest revealed a homogeneous mass with welldefined borders filling a large part of the right hemithorax. The mass had scattered necrotic areas causing compression of adjacent vascular structures and bronchi (Fig. 2). Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) revealed a supradiaphragmatic mass with a standardized uptake value of 2.0 (Fig. 3). A transthoracic fineneedle aspiration biopsy was nondiagnostic. A right thoracotomy revealed a brown, lobulated, encapsulated mass that was pedunculated with increased vascularity. The mass occupied most of the right hemithorax and originated from diaphragmatic parietal pleura. The resected mass was 2,700 g and measured 25 9 15 9 11 cm. Histopathologic examination of the mass was consistent with a solitary fibrous tumor of the pleura. There were large necrotic areas within the tumor separated from each other by collagenous bands. In other locations there was a myxoid appearance. Spindle-shaped neoplastic cells that contained nuclear atypical and pleomorphism were noted. These cells were positive with CD34, vimentin, and BCL-2. The number of mytoses was 3 per 10 9 high-powered field (Fig. 4). The patient was discharged from the hospital 6 days after surgery. The patient received radiotherapy (10 9 300 cGy) 1 month following surgery. No recurrence was observed 1 year following discharge. Solitary fibrous tumor of the pleura is a relatively rare tumor originating from the mesenchymal cells of the submesothelial tissue of the pleura. It has unusual histologic and clinical features. The majority of these tumors are benign, but about 20% fulfill criteria for malignancy [1]. Individuals may present with symptoms of dyspnea, cough, chest pain, or hemoptysis. Postobstructive pneumonia may occur. The tumors can become locally aggressive and lifethreatening. The larger the tumor, the more likely that symptoms will be present. In giant solitary fibrous pleural tumors, pulmonary atelectasis or complete lung collapse and contralateral mediastinal shift may occur [2]. Radiologic imagining plays an important role in the diagnosis. However, in our individual, PET scanning was not very helpful other than to show no extrathoracic metastasis. Fine-needle aspiration biopsies rarely provide S. Karapolat (&) A. Onen A. Sanli M. Eyuboglu Department of Chest Surgery, Dokuz Eylul Medical School, Izmir, Turkey e-mail: samikarapolat@yahoo.com Fig. 1 Chest roentgenogram showing elevation of the right hemidiaphragm

Morgagni hernia: late diagnosis in a case with Down syndrome.

Accessible online at: www.karger.com/res A 37-year-old woman was admitted for right-sided chest pain for the previous 1–1.5 months. She had been taken to an emergency service for abdominal ache, nausea and vomiting 1.5 months previously. No chest X-ray was taken in the emergency service as pulmonary symptoms were absent. She was of short stature, and developmental retardation was evident besides her mongoloid face. In the pulmonary system, auscultation respiratory sounds were decreased in the right lower zone. The right cardiac contour was not easily detected on chest X-ray. A nonhomogenous increase in density, which had its convexity facing the lateral chest wall, was detected in the right middle and lower zones (fig. 1). A defect in the diaphragm localized at the cardiophrenic sinus in the anterior mediastinum, as well as herniated intestinal segments, were seen on the thorax CT (fig. 2). A hernia sac with a diameter of 20 cm showing adhesions to the anterior chest wall, pericardium and lung was seen during the surgery. Congenital diaphragmatic hernias usually develop posterolaterally, but Morgagni hernias (MHs) are retrosternal and account for 3% of congenital diaphragmatic hernias; they are 90% right-sided. In Down syndrome, accompanying abnormalities may be present. MH is an uncommon defect accounting for only 3% of such abnormalities. Hernias of Morgagni’s foramen are found on the medial or anterior side of the diaphragm and are localized parasternally or retrosternally [1]. Diagnosis is confirmed by showing an empty hernia sac with barium enema, CT or ultrasonography. Fusion of the pleuroperitoneal membrane with the septum transversum in the 8th fetal week makes up the diaphragm. MHs occur as a result of an embryological defect in the septum transversum between the lateral aspect of the diaphragm and the anterior chest wall [1]. A literature review showed variations in age distribution between neonatal and 12 years in patients with concurrence of Down syndrome and MH [2]. Although a transabdominal approach has been advocated, we performed transthoracic surgery because of adhesions to surrounding tissue in the present case. Treatment of MH is surgery even if cases are asymptomatic because of the risk of intestinal obstruction and perforation [1]. We wish to emphasize the association of Down syndrome with MH, which can stay asymptomatic until an advanced age. In such cases with late presentation, as there is the possibility of adhesion of the hernia sac to intrathoracic organs, a transthoracic surgical approach is preferred, which is an easy and safe procedure. References 1 Kı̇lı̇ç D, Nadir A, Döner E, Kavukcu Ş, Akal M, Özdemir N, Akay H, Ökten I: Transthoracic approach in surgical management of Morgagni hernia. Eur J Cardiothorac Surg 2001;20:1016–1019. 2 Becmeur F, Chevalier-Kauffmann I, Frey G, Sauvage P: Laparoscopic treatment of a diaphragmatic hernia through the foramen of Morgagni in children. A case report and review of eleven cases reported in the adult literature (in French). Ann Chir 1998;52:1060–1063. Fig. 1. Appearance of the lung before surgery in our case. Fig. 2. CT of the thorax showed significant omental fatty tissue and herniated intestinal segments in the right chest cavity. 1

Growth of a solitary pulmonary nodule after 6years diagnosed as oncocytic carcinoid tumour with a high 18-fluorodeoxyglucose (18F-FDG) uptake in positron emission tomography-computed tomography (PET-CT).

Introduction:  Pulmonary carcinoid tumour is low‐grade neuroendocrine malignancy that is seen 1%–2% of all lung neoplasms. Oncocytic carcinoid type is a rarely seen variant of pulmonary carcinoids. As carcinoid tumours have hypometabolic activity, they usually have lower 18‐fluorodeoxyglucose (18F‐FDG) uptake than expected for lung carcinoma on positron emission tomography (PET).

Chaperonin (HSP60) and annexin-2 are candidate biomarkers for non-small cell lung carcinoma

Background: Lung cancer is responsible of 12.4% and 17.6% of all newly diagnosed cancer cases and mortality due to cancer, respectively, and 5-year survival rate despite all improved treatment options is 15%. This survival rate reaches 66% in the Stage 1 and surgically treated patients. Early diagnosis which could not be definitely and commonly achieved yet is extremely critical in obtaining high survival rate in this disease. For this reason; proteomic differences were evaluated using matrix assisted laser desorption ionization (MALDI) mass spectrometry in the subgroups of lung adenocarcinoma and squamous cell carcinoma. Methods: Fresh tissue samples of 36 malignant cases involving 83.3% (n = 30) men and 16.7% (n = 6) women patients were distributed into 2 groups as early and end stage lung cancer and each group were composed of subgroups including 18 squamous cell carcinoma (9 early stage cases, 9 end stage cases) and 18 adenocarcinoma cases (9 early stage cases, 9 end stage cases). The fresh tissues obtained from the tumoral and matched normal sites after surgical intervention. The differences in protein expression levels were determined by comparing proteomic changes in each patient. Results: In the subgroups of advanced stage adenocarcinoma; tumoral tissue revealed differences in expression of 2 proteins compared with normal parenchymal tissue. Of those; difference in protein expression in heat shock protein 60 (HSP60) was found statistically significant (P = 0.0001). Subgroups of early and advanced stage squamos cell carcinoma have differed in certain 20 protein expression of normal tissue and diseased squamos cell carcinoma. Of those, increased protein expression level of only annexin-2 protein was found statistically significant (P = 0.002). No significant difference was detected in early and advanced stage protein expressions of the tumoral tissues in the subgroups of adenocarcinoma and squamous cell carcinoma. Conclusions: We conclude that with respect to early diagnosis of lung cancer that HSP60 and annexin-2 proteins are the important biomarkers in the subgroups of adenocarcinoma and squamous cell carcinoma. We also consider that these 2 proteins are molecules which may provide critical contribution in evaluation of prognosis, metastatic potential, response to treatment, and in establishment of differential diagnosis between adenocarcinoma and squamous cell carcinoma.

Primer hydatid cyst of thymus: report of a case.

Cystic lesions in the mediastinum constitute one-fourth of all mediastinal masses and are usually identified incidentally. However, hydatid cysts very rarely present in the mediastinum. A 13-year-old male patient was admitted to our hospital because of chest pain and cough. A chest roentgenogram and computed tomography examination found a homogeneous cystic lesion with a size of 7.5 x 7 cm in the anterior mediastinum. Thymectomy was performed following a left thoracotomy in order to complete the pericystectomy. The histological diagnosis was hydatid cyst. No recurrence was observed during 1 year of follow-up.