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N. Ocal
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P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.04-041 - Synchronous Lung Cancers, Squamous Cell and Adenocarcinoma Coexistence, Case Report (ID 255)
09:30 - 09:30 | Author(s): N. Ocal
- Abstract
Background:
Synchronous lung cancers are simultaneously diagnosed, physically distinct and separate lung cancers which have no common lymphatics with the primary tumor and may have same or different histology with the primary neoplasms. Although radiological imaging techniques guide in terms of initial diagnosis, histopathological evidence is required for definitive diagnosis of synchronous multiplee primary lung cancers. Early diagnosis represents the only chance to obtain a surgical cure in these patients.
Methods:
not applicable
Results:
Here, we present a case with synchronous multiplee primary lung cancers in whom both tumors are diagnosed simultaneously. A 69 year-old male patient with cough and left-sided chest pain complaints and 90 pack / year history of active smoking admitted to our clinic. Thoracic CT of the patient revealed a pleural-based mass in the right lower lobe and another mass on the left lung which is associated with the hilum and caused atelectasis in the distal airways. Diagnostic bronchoscopy was performed to the patient and separate biopsies were taken from the both lesions. Histological sections obtained from the bronchoscopic biopsy specimens revealed that there was an infiltrative tumor in both right and left lung. In right lung, the tumor composed of abortive glandular structures and single cell infiltrations within the desmoplastic stroma. The second tumor (left lung) was consist of solid islands composed of atypical squamous cells with eosinophilic cytoplasm and darkly basophilic nuclei. Histochemically, in the first tumor, neoplastic cells had intracytoplasmic vacuoles stained by mucicarmin indicating a feature of adenocarcinoma whereas there were no cells containing mucin vacuoles in the second tumor. Immunohistochemical study has supported the histological and histochemical findings. The tumor on the right side showed a diffuse immunoreactivity by CK7 which is a highly spesific marker for adenocarcinomas whereas the tumor on the left side was stained by the basal cell markers such as CK5/6 and p63 which are highly specific markers for squamous cell carcinoma. Briefly, histopathologic examination of the biopsies from left upper lobe and right lower lobe revealed squamous cell lung carcinoma and adenocarcinoma, respectively. Thereupon oncologic PET examination was performed for screening and evaluating if there is another primary tumor site for adenocarcinoma. In PET examination, FDG uptakes of extrapulmonary tissues were considered to be normal. Thus both lesions thought to be primary lung tumors.
Conclusion:
Our case is a good example of simultaneously detected synchronous primary tumors of the lung and we reported this case in order to emphasize the possibility of another primary tumor in the cases which are initially thought to be metastatic lesions and for sure the need of biopsies separately.
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P2.06 - Poster Session/ Screening and Early Detection (ID 219)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.06-017 - Incidental Detection of Lung Cancer by Pre-Operative Evaluation, a Series of 6 Cases (ID 282)
09:30 - 09:30 | Author(s): N. Ocal
- Abstract
Background:
American Society of Anesthesiologists (ASA) classification is an useful pre-operative evaluation system which helps clinicians in prediction of possible complications and risks due to surgery. In ASA classification, surgical candidates are divided into six groups according to their risk status. Following ASA classification, grading is done according to the severity of the operation. Grades are determined due to the severity and the duration of the operation. After determining ASA classes and grades, necessary tests are performed according to age groups to complete the pre-operative assessment. However, in this evaluation, randomly determined pathologies can dramatically change the assessment results in those cases without any symptoms. For this purpose, we retrospectively analyzed the results of the patients received pre-operative pulmonary evaluation during the last one year.
Methods:
Pre-operative pulmonary evaluation results of 520 cases were analyzed retrospectively who were referred to our clinic between January 2014-January 2015.
Results:
Through them, 6 (1.2%) patients (4 men, 2 women) with mass and/or nodule images in their chest radiographs, were histopathologicaly diagnosed with lung cancer. 3 of these cases were planned for inguinal herniorrhaphy, and other 3 cases for knee replacement surgery. The common points of these cases were being asymptomatic and included into ASA 1 - grade II group. The mean age of the patients was 71.1 (65- 87). Lung cancer diagnosis was proven by transthoracic needle biopsy in 3 cases, bronchoscopy in 1 case and thoracentesis + pleural biopsy in 1 case with pleural effusion. All of the cases are non-small cell lung cancer; 3 adenocarcinoma and 3 squamous cell lung carcinoma. 4 cases were found to be in stage IIIB and over, while the other 2 patients who were underwent lobectomy were in stage IB. Chemoradiotherapy was performed to the inoperable cases.
Conclusion:
Pre-operative tests conducted according to current ASA classification are still useful in terms of determining the possible complications and risks. However, in some cases, as in ours, examinations broader than recommended may be necessary. According to ASA classification; ASA group 1describes healthy person with no systemic problem accept for current surgical pathology, and grade 2 describes short timed operations (30 minutes - 1 hour) in which vital organs are affected minimum (inguinal herniorrhaphy, tonsillectomy, arthroscopy, cystoscopy, etc.). ASA recommends preoperatively complete blood count, serum electrolytes, blood glucose, blood urea nitrogen, creatinine tests for ASA group 1- grade II patients aged 61 years and older. Chest radiography is not routinely recommended in these patients with no obvious symptoms or signs. However, in our own clinical approach for pre-operative evaluation of patients aged over 65 years, chest radiograph is a preferred test. Considering that 6 asymptomatic lung cancer patients were determined by this approach, the benefits of pre-operative chest radiograph which is a cheap, fast and easy examination are remarkable in pre-operative pulmonary evaluation. We presented this case series in order to emphasize this subject.
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P2.11 - Poster Session/ Palliative and Supportive Care (ID 230)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.11-012 - A Retrospective Assessment of Mortality of Patients Who Died in the Respiratory Intensive Care Unit with a Diagnosis of Lung Cancer (ID 1534)
09:30 - 09:30 | Author(s): N. Ocal
- Abstract
Background:
According to 2015 data of WHO, lung cancer is still the most common causes of cancer death (1.59 million deaths in 2012) which is more than the combination of next three most common cancers (colon, breast and pancreatic). The number of deaths due to lung cancer has increased approximately 3.5 percent between 1999 and 2012. The number of deaths among men has reached a plateau but the number is still rising among women perhaps related with changesinsmoking habits. The age-adjusted death rate for lung cancer is higher for men than for women.
Methods:
In this study, firstly we retrospectively reviewed the data of 123 patients who died in respiratory intensive care unit of our hospital within last two years. We determined that 63 of them died because of lung malignancies and associated pathologies. Ages, genders, smoking habits, survival times, diagnosis methods, histopathological types of lung cancer, stages, metastatic states of the patients were compiled. In addition; clinical findings just before the death, indications of intensive care unit intake, underlying and immediate death causes were detected. The underlying death cause defines the disorder which initiated the events leading to death.The immediate death cause defines the final disorder or condition resulting in death.Some definitions were used in classifying the cause of death. When the amount of tumor in the lungs was the most important factor in fatal respiratory failure, this death cause was defined as tumor burden. Malfunction of the organs due to widespread metastases was defined as metastatic organ failure.
Results:
56 cases were primary lung cancer patients. 11 cases were female and 45 cases were male. Mean age of the cases was 71.81 (46-88) in females and 68.91(50-84) in males. 5 of female cases were adenocancer, 4 were squamous cell lung cancer and 2 were small cell lung cancer. 20 of male cases were squamous cell lung cancer, 14 were adenocancer, 11 were small cell lung cancer. Diagnostic methods were bronchoscopy in 33 patients, transthoracic lung biopsy in 12 patients, thoracentesis in 7 patients, metastatic organ biopsy in 4 patients. Mean survival periods were 3.1 months for small cell lung cancer, 6.7 months for squamous cell lung cancer and 8.2 months for adenocancer. All of the small cell lung cancer cases had metastasis at diagnosis time. Pneumonia and MODS-sepsis were the most common death causes in all cases.
Conclusion:
We think that our results would be helpful clinicians about lung cancer and follow up these patients.
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P3.06 - Poster Session/ Screening and Early Detection (ID 220)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 2
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.06-018 - Quick Radiological Course of Lung Cancer Mimicking Pulmonary Tuberculosis (ID 269)
09:30 - 09:30 | Author(s): N. Ocal
- Abstract
Background:
Cavitary lung lesions are primarily due to pulmonary tuberculosis but they also can be associated with other etiologies such as lung malignancies, fungal infections. To exclude tuberculosis with ARB tests when these kind of lesions detected, is a generally accepted clinical approach. Rapid radiological progression in cavitary lesions are usually interpreted as tuberculosis while a slower progression is expected in malignancies.
Methods:
‘not applicable’
Results:
We presented this rare case because of a rapid radiological progression in a patient with lung cancer. Sixty-six year old male was admitted to our clinic with cough, weight loss, fever and fatigue. ARB test was planned and nonspecific antibiotherapy was started because of the cavitary lesions in left upper lobe on CT which was performed in another centre one week before admission to our clinic. ARB test was negative and control CT was planned. CT revealed prominent progression of the lesions. Although tuberculosis was the initial diagnosis because of this rapid progression diagnostic bronchoscopy was performed. Endobronchial lesion in the left upper lobe was detected and pathological examination revealed squamous cell lung cancer.
Conclusion:
Although cavitary lesions can be observed in lung cancer, such a rapid progression as observed in our case suggests infections, especially pulmonary tuberculosis rather than malignancies. We presented this case to be useful for the clinicians in cavitary lung lesion assessment process.
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P3.06-021 - Lung Cancer Presented with Neurological Symptoms and Diagnosed after Brain Surgery (ID 252)
09:30 - 09:30 | Author(s): N. Ocal
- Abstract
Background:
Lung cancer is still one of the the most important and common mortality cause. Although, the presentation and course of the disease differ with the cell type, usually typical symptoms are seen. The most common symptoms include fatigue, weight loss, shortness of breath, and chest pain. These symptoms especially in smoking patients suggest lung cancer first. But in some cases paraneoplastic syndromes and symptoms of other systems caused by diffusing cancer come forward. Such findings are most common in small cell lung cancers (SCLC) among lung cancers. Because early metastasis and paraneoplastic syndromes SCLC can have very different clinical presentations.
Methods:
To emphasize this issue, we present a case of SCLC having only neurological signs.
Results:
60 years old male patient with a history of 70 pack years smoking, admitted to neurology clinic with vertigo, headache, nausea, and changes in consciousness. Because of the tumoral lesion in the left cerebellum seen in brain computed tomography, he was referred to brain surgery. Although, a preoperative thorax tomography revealed a mass lesion in left lung, he was operated for palliation of neurological symptoms and pathological diagnosis. Intraoperative frozen sampling diagnosed as small cell lung cancer. Patient is still followed by our department and radiation oncology.
Conclusion:
We present this case as a reminder of lung malignancies can be met by different presentations.
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P3.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 226)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 2
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.08-030 - Bronchoscopic Diagnosis of Esophageal Carcinoma Mimicking Lung Cancer (ID 257)
09:30 - 09:30 | Author(s): N. Ocal
- Abstract
Background:
Esophageal cancers are usually determined by examining the etiology of symptoms. Diagnosis in people without symptoms is rare and usually incidental. Although the most common symptom of esophageal cancer is dysphagia, in some cases clinical presentation can be different or misleading. Nevertheless, most esophageal cancers do not cause symptoms until they have reached an advanced stage. Here, we present an esophageal cancer case which suggests pulmonary malignancy with the clinical presentation.
Methods:
‘not applicable’
Results:
68-year-old male admitted our clinic with loss of appetite, weight loss and chest pain complaints. He had a smoking history of 30 packs/year. He was using LABA + ICS because of COPD. He told that his complaints had started 6 months before and gradually progressed. Because of the bilateraly suspicious hilar enlargement in chest X-ray, thorax CT examination was performed. In thorax CT, a conglomerate lesion, extending from subcarinal area to the posterior aspect of trachea, was observed. A clear distinction of lymphadenopathy/soft tissue could not be made. Diagnostic EBUS (endobronchial ultrasound) was performed to the patient under general anesthesia. During the process, a lesion protruded into the tracheal lumen with irregular surface was observed and biopsy was taken from this area. Also, EBUS guided biopsies were taken from the soft tissue lesions observed in thorax CT. In PET-CT of the patient, which was performed after this procedure, increased focal FDG uptake (SUWmax: 27.1) in the relevant field was observed without increased uptake elsewhere. Histopathological evaluations of these biopsies have been reported as esophageal squamous cell carcinoma. Subsequently, endoscopy was performed by gastroenterologists. In the course ofˈd(y)o͝oriNG endoscopy process, an ulcerated lesion, 1.5 cm in diameter and obstructing approximately 1/3 of the lumen, was observed on esophageal Z line at 44th cm from the incisors. The results of the biopsies taken from this area were also reported as esophageal squamous cell carcinoma. Thereafter, the patient was referred to Medical Oncology Department for oncologic treatment and follow-up.
Conclusion:
We shared this case in terms of being an informative example for local metastasis of esophageal malignancies presented with pulmonary symptoms which must be considered in differential diagnosis of intrathoracic masses.
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P3.08-031 - Endobronchial Spread of Malignant Melanoma to Lungs, a Case with Original Images (ID 268)
09:30 - 09:30 | Author(s): N. Ocal
- Abstract
Background:
Malignant melanoma, result of malignant transformation of melanocytes, metastasis mainly to regional lymph nodes, skeletal, and nervous systems. However, malignant melanoma can also metastasis to lung either. These metastases usually reach the lungs by tumor emboli to pulmonary arteries. Endobronchial spread of malignant melanoma to lungs diagnosed by bronchoscopy cases have limited number in literature. Here we share a malignant melanoma case spread endobronchially.
Methods:
‘not applicable’
Results:
62 years old male patient known to have malignant melanoma, was accepted to intensive care unit with respiratory distress and was intubated. In first evalution of his HRCT, consolidation and pleural effusion, constitute with large part of left lung’s atelectasis and less pleural effusion and partial atelectasis of neighbor parenchyma in right lung were seen. For both possible endobronchial metastasis causing airway obstruction and tumoral infiltration of parenchyma, bronchoscopy was performed through the endotracheal tube. Airway visualization revealed edema of the left main bronchus, concentrically significantly narrowed upper lobe, but segments were visible. Left lower lobe input was narrowed and segments were not visible. In entrance of left upper lobe there was an endobronchial lesion in brown- black color and slightly bulging form the mucosa like nevus. Transbronchial biopsy was taken from this nevus like formed lesion and left lung upper lobe apicoposterior. Both samples were reported as malignant melanoma by pathologist.
Conclusion:
We shared this case as an example of rare appearance of malignant melanoma with original images. We believe that this case report would be helpfull in terms of clinical practice.
