Ana Barroso

Primary lymphoepithelioma-like carcinoma of the lung

Lymphoepithelioma is an undifferentiated carcinoma with prominent lymphoid stroma in the nasopharynx. Tumors with similar histology have been reported with other localizations, including the lungs, and are designated as lymphoepithelioma-like carcinomas (LELC). Primary LELC of the lung is very rare, and scant information is available in the scientific literature. This paper details the case of a 25-year-old Caucasian male patient with the diagnosis (determined by thoracotomy) of primary LELC of the lung. Immunohistochemical analysis was negative for Epstein-Barr virus, as was the in situ hybridization of the tumor cells. Observation of the nasopharynx and a magnetic resonance image of the cavum were normal. Because the tumor (T4N2M0) could not be resected, the patient was treated with chemotherapy, carboplatin/5-fluorouracil, completing two cycles. The patients condition worsened when he developed contralateral pneumonia, which was then followed by pericardial effusion. The patient died 36 h later from cardiac tamponade. Presented here is a revision of this rare pathology, not often reported in the literature.

A Prospective Study of Gemcitabine and Carboplatin as First-Line Therapy in Advanced Non-Small Cell Lung Cancer: Toxicity of a Three- Versus a Four-Week Schedule

We evaluated the toxicity and activity of gemcitabine (Gemzar; Eli Lilly and Company, Indianapolis, IN) and carboplatin on a 3-week (trial A) versus a 4-week (trial B) schedule in patients with advanced/metastatic non-small cell lung cancer. Chemotherapy-naive patients in trial A received gemcitabine 1,000 mg/m(2) on days 1 and 8 plus carboplatin area under the curve of 5 on day 1, every 3 weeks. In trial B, patients received gemcitabine 1,000 mg/m(2) on days 1, 8, and 15 and carboplatin area under the curve of 6 on day 1, every 4 weeks. Thirty patients were enrolled in trial A and 28 in trial B. Patients received a total of 142 cycles in trial A and 134 in trial B. Despite more frequent treatment delays (82 cycles in trial B and 20 cycles in trial A), and dose reductions/omissions (mainly on day 15), gemcitabine mean dose intensities of both schedules were similar. The principal dose-limiting toxicity was grade 3/4 thrombocytopenia. Objective response rates were 40% in trial A and 68% in trial B (no complete response). Gemcitabine and carboplatin administered on days 1 and 8 every 3 weeks is associated with lower myelotoxicity than that of a 4-week schedule, although both schedules were active against non-small cell lung cancer. Semin Oncol 28 (suppl 10):10-14.

Tracheobronchial foreign bodies in adults – Experience of the Bronchology Unit of Centro Hospitalar de Vila Nova de Gaia

INTRODUCTION Foreign body aspiration (FBA) is frequent in children but uncommon in adults its and often remains hidden for long periods of time. A high index of suspicion is essential for the correct diagnosis of this condition. Early extraction of FB avoids sequelae and complications. METHODS Retrospective study of FBA cases in adults that occurred in a 20 year period (1985-2005). The authors reviewed of the clinical records of all patients admitted with the diagnosis of foreign body in the airway in that time period. RESULTS In that period of time 77 FB were extracted. Male:female ratio was 68:32%, mean age was 51.4 years and mean delay between FB aspiration and removal 401 days (min: 3 h, max: 21 years). Most common clinical presentations: acute asphyxia in 28%, persistent cough 22%. Nature of FB: bone fragments 33%, vegetable matter 31%. The majority of FBs (61%) was lodged in the right bronchial tree; 26% were radiopaque. Rigid bronchoscopy was performed in 75 cases and fiberoptic bronchoscopy in only two. Two patients needed two bronchoscopies for FB removal. There were no complications, need for surgery or relevant sequelae. CONCLUSIONS FBA may happen at any age. In adults the clinical presentation is variable and the FBA episode is often missed, delaying the diagnosis. Rigid bronchoscopy proved to be an efficient and safe procedure. FBA must be a diagnostic hypothesis when studying an adult with long standing respiratory complaints.

Description and management of cutaneous side effects during erlotinib and cetuximab treatment in lung and colorectal cancer patients: A prospective and descriptive study of 19 patients

Erlotinib and cetuximab are human epidermal growth factor receptor inhibitors (EGFRI) that are approved in monotherapy for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of at least one prior chemotherapy regimen. Papulopustular eruptions are the most frequent adverse effect, their occurrence being associated with increased survival in some studies. We describe 19 patients who presented with a rash located mainly to the face and trunk, without presence of comedones, shortly after initiation of EGFRI therapy. We present our algorithm to manage these patients and their respective responses. We also report other therapeutic options and cutaneous alterations that may be seen.

Lung cancer in never-smokers – what are the differences?

Abstract Introduction: Characteristics of never-smokers with lung cancer are still not fully clarified. The aim of this study was to compare never-smokers and ever-smokers with non-small cell lung cancer (NSCLC) regarding patient and tumor characteristics. Methods: All consecutive newly NSCLC patients with known smoking status diagnosed between 2011 and 2015 were included in this retrospective cohort study. Clinical, histological, and molecular characteristics were compared between ever-smokers and never-smokers. Results: Of the 558 included patients, 125 (22.4%) were never-smokers. These patients were more likely to be female (74% vs. 7%, p < .001), older (67 vs. 66 years-old, p = .019), and have adenocarcinoma (93% vs. 65%, p < .001). Never-smokers took longer to seek medical care after the symptoms onset (3 vs. 2 months, p < .001), regardless of the symptoms, histological type, or gender (OR: 1.2 [1.4–2.0]). The metastatic pattern was different in never-smokers: pleural metastases were more frequent (OR: 2.1 [1.1–4.0]), regardless of the histological type and gender. Never-smokers had a higher prevalence of ALK translocations (26% vs. 4%, p < .001) and EGFR mutations (36% vs. 8%, p < .001). The type of EGFR mutation was also significantly different between groups. Conclusions: Never-smokers with NSCLC present distinct demographic and clinical characteristics. The characteristics of tumor also differ between never-smokers and ever-smokers, which may suggest different carcinogenic pathways.

Dermatomiosite como primeira manifestação de uma neoplasia pulmonar

Dermatomyositis (DM) is a rare disease characterised by proximal muscle weakness and a typical cutaneous rash. The muscle biopsy shows inflammatory lesions consistent with myositis, being related to an increased risk of cancer, often considered as a paraneoplastic syndrome. The authors present a case of a 63-year-old man, with progressive proximal muscle weakness and cutaneous rash, appearing in two months. The muscle and skin biopsies were consistent with DM. Chest tomography showed a nodular image in the lingular region and bronchy biopsy confirmed the diagnosis of small cell lung carcinoma (SCLC). This clinical case intends to enhance the importance of a thorough diagnostic study in patients with DM, as it is often a paraneoplastic syndrome.

Tomografia emissora de positrões: Indicações no cancro do pulmão - Experiência prospectiva de um serviço

Positron emission tomography (PET) is a new technique in nuclear medicine. It uses biological radiotracers such as 18 F-fluoro-2-deoxyglucose (FDG) which permit the detection of suspected lesions with metabolic alterations that take up the glucose isotope too avidly, as is the case with neoplastic cells. PET has become an innovatory and important imaging tool for evaluating patients with lung cancer. The present recommended uses of PET include lung cancer diagnosis and the intrathoracic and extrathoracic staging in N-SCLC.

Carcinoma pleomórfico do pulmão em doente com síndroma de Mounier-Kuhn

Resumo O carcinoma pleomorfico do pulmao (CPP) e um tumor maligno raro e de prognostico reservado. Esta inserido no grupo dos carcinomas pulmonares pouco diferenciados nao pequenas celulas, exibe componente sarcomatoso ou sarcoma like (celulas fusiformes/ /celulas gigantes). Atendendo a raridade do tumor e as dificuldades no diagnostico, e apresentado pelos autores o caso de um carcinoma pleomorfico do pulmao diagnosticado por biopsia aspirativa num paciente de 44 anos, fumador, e cuja apresentacao inicial consistiu numa tumefaccao dorsal. A data de diagnostico apresentava estadio IV (TNM), nao tendo sido possivel efectuar tratamento dirigido ao tumor pelo mau performance status apresentado pelo doente, mas apenas terapeutica de suporte. A sobrevida do doente foi de 5 meses. Na sequencia do estudo clinico, foi confirmada a sindroma de Mounier-Kuhn. Reportam-se os aspectos clinico-imagiologicos mais importantes, assim como os aspectos citologicos e imunocitoquimicos que caracterizam esta entidade e permitiram efectuar o diagnostico.

Tumor solitário fibroso – a propósito de dois casos clínicos

Solitary fibrous tumor is a rare neoplasm derived from mesenchymal cell. To achieve a diagnosis and to differentiate from others neoplasm immunohistochemical analysis is needed. The majority of these tumours are benign, and complete surgical resection remains the mainstay of therapy for both the benign and malignant variants. However, there are cases of local and distant recurrences, so patients should have a close follow-up and it is far incorrect to look at this lesion as definitely benign. The authors review clinical presentation, radiological features, histological findings, and treatment options for this tumor and report two clinical cases discussing the differences between them. REV PORT PNEUMOL 2004; X (5): 421-428

Elderly patients with advanced NSCLC: The value of geriatric evaluation and the feasibility of CGA alternatives in predicting chemotherapy toxicity

Cancer is primarily a disease of the elderly, with the incidence of older patients with cancer expected to increase in the coming years. Despite remarkable advances during the last decade, lung cancer remains a leading cause of mortality worldwide, non-small cell lung cancer (NSCLC) being the dominant (85-90%) subtype. At diagnosis, 50% of NSCLC patients are ≥70 years and 15%, over 80 years of age. Due to their under-representation in clinical trials, current treatment decisions for older patients with cancer are based on a low level of scientific evidence. The little evidence that exists suggests that chemotherapy is effective in elderly NSCLC patients, but also indicates that they are at more risk of chemotherapy toxicity than younger adults. However, if carefully selected and monitored, elderly patients can benefit from standard chemotherapy regimens. The Comprehensive Geriatric Assessment (CGA) has historically been adopted to identify elderly patients who are unfit for chemotherapy, yet in clinical practice this is often not feasible as it is too time-consuming. Two promising new tools have emerged - the CRASH and CARG scores - to assign patients to varying intensities of chemotherapy based on a pre-therapy risk assessment. The strengths and shortcomings of each tool were discussed by a group of six advisors with expertise in the treatment of NSCLC. Based on a literature review and on their personal experience, CRASH and CARG were considered feasible toxicity prediction tools, appropriate for implementation in routine clinical practice, with a potentially high impact in optimizing therapy selection for elderly patients with cancer.