Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11033

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    P1.24-032 - Is tuberculosis a challenge for the management of lung cancer? (ID 2391)

    09:30 - 09:30  |  Author(s): D. Koksal
    • Abstract

    Background
    It is well known that old pulmonary tuberculosis (TB) is associated with an increased risk of lung cancer and lung cancer mortality. Malignancy per se and cytotoxic chemotherapy for its treatment both are recognized risk factors for the development of active tuberculosis. Coincidence of tuberculosis and lung cancer at initial diagnosis or development of tuberculosis during the course of lung cancer is a challenge for management of both diseases.

    Methods
    Herein we analyzed 10 male lung cancer cases (9 NSCLC/ 1 SCLC) coincidentally had tuberculosis.

    Results
    The ages were ranging between 43-71 years. Only one of these patients had a pulmonary TB history. The sites of TB were lung in 7 patients, mediastinal lymphadenopathy (LAP), cervical LAP, and subcutanous nodules in 1 patient each. Four patients were diagnosed as tuberculosis and lung cancer simultaneously. The diagnosis was confirmed by mediastinoscopic lymph node biopsy in 1, transthoracic biopsy in 1 and sputum smear positivity in 2 patients. In 4 patients the diagnosis of pulmonary TB were confirmed by sputum culture 2-3 months after the diagnosis of lung cancer. All these 4 patients were suspicious for pulmonary TB at the time of lung cancer diagnosis, but sputum smears were negative for acid-fast bacilli. In 2 patients TB were diagnosed later in the follow-up period of the patient. One was diagnosed as TB lymphadenitis by cervical lymph node biopsy, the other was diagnosed as TB by biopsy of subcutaneous nodules on the right leg. One patient who was surgically resected for lung cancer tolerated antituberculosis therapy well. Another patient who was initially staged as T3N2MO lung cancer clinically and radiologically (including PET/CT evaluation) also tolerated the therapy fairly well. After 6 months of antituberculosis therapy, he was restaged as T2aN0M0 and treated with definitive radiotherapy. He died due to venous thromboembolism 1 week after the completion of radiotherapy. Another patient had progressive lung cancer during antituberculosis therapy. Hepatotoxicity was the leading adverse reaction (in 3 patients, 30%) due to antituberculosis therapy.

    Conclusion
    In conclusion; these cases highlighted the importance of thinking TB in the course of lung cancer especially in countries with high TB prevalence. TB may cause advanced staging of lung cancer at initial diagnosis; chemotherapy may worsen TB course or cause reactivation TB. Reactivation TB may be considered as progression of lung cancer without a tissue diagnosis. The tolerability of antituberculosis therapy is poor in these patients. Guidelines should refer how to manage these patients especially in certain areas with high TB prevalence.

• 12853

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  P3.24 - Poster Session 3 - Supportive Care (ID 160)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12868

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    P3.24-015 - Pulmonary adenocarcinoma in a patient with Hermansky-Pudlak Syndrome (ID 1071)

    09:30 - 09:30  |  Author(s): D. Koksal
    • Abstract

    Background
    Hermansky-Pudlak Syndrome (HPS) is a rarely seen autosomal recessive disease characterized by oculocutaneous albinism, bleeding tendency from platelet storage pool deficiency, and lysosomal occumulation of ceroid in the reticuloendothelial system. Ceroid occumulation in alveolary macrophages causes pulmonary inflammation and interstitial pneumonia. Pulmonary fibrosis is the most serious complication and main reason of mortality. Pulmonary fibrosis is also a well known etiology for the onset of lung carcinoma.

    Methods
    N/A

    Results
    A 64-year-old albino patient admitted with dyspnea, back pain, and weakness. He had a smoking history of 40 pack-years. In his past medical history, he has recurrent nasal bleeding, and he was given inhaler bronchodilators for dyspnea on exertion last year. Rutin laboratory analysis was normal. There was a mild hypoxemia (PaO2: 63 mmHg). There was a restirictive pulmonary functional deficit with a reduced diffusion capacity (%56). A thorax CT demonstrated pulmonary fibrosis, left pleural effusion, and irregularly marginated collapse and consolidation areas adjacent to pleural effusion. On PET/CT a mass lesion 6 cm in largest diameter (SUVmax: 15.6) is distiguised in left lower lobe superior segment. There was also a nodular pleural thickening (SUVmax: 13.5) on the left hemitorax and multiple mediastinal lymph nodes with high SUVmax levels. The presence of albinism, the history of bleeding diathesis, and the presence of pulmonary fibrosis suggested the diagnosis of HPS. The patient referred to ophthalmology consultation. There were hypopigmentation on coroid layer and iris. Hematology clinic comfirmed the presence of platelet dysfunction. After all the patient was diagnosed as HPS. After transfusion of platelets, a transtoracic needle biopsy was performed and the pathology was compatible with adenocarcinoma (Stage 4, pleural involvement). The patient refused any therapy and discharged from hospital with home oxygen therapy.

    Conclusion
    Herein we present a rare case with pulmonary fibrosis diagnosed simultaneously as HPS and pulmonary adenocarcinoma.