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The left adrenal gland (LAG) is a common metastatic site in patients with non--small-cell lung cancer. In practice, staging mainly relies on radiologic studies and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Recently, a new technique using convex probe--endobronchial ultrasound (CP-EBUS) scope through the esophagus (EUS-B) has been introduced. A complete mediastinal staging and a reach for upper-abdominal structures in a single session naturally attract attention. However, scientific data are not sufficient to clearly judge the role of this technique in the cytological diagnosis of left adrenal lesions. Therefore, we present cases in which our patients have undergone EUS-B for LAG lesions to increase the data in the literature with regard to accessibility, diagnostic performance, and rate of complications. [ABSTRACT FROM AUTHOR]

Introduction: Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C‐ROS oncogene 1 (ROS‐1) fusion change in lung adenocarcinoma. Objectives: The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes. Methods: The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS‐1) and distant metastasis was analysed. Results: A total of 845 patients were included in the study. The median age was 62 (28‐88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02). Conclusion: In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Amyloidosis is a disease that is characterized by an extracellular accumulation of fibril proteins called amyloid in tissues, and organ dysfunction. There are various types of amyloidosis, with nodular pulmonary amyloidosis usually considered a subtype of AL amyloidosis. Surgical excision is usually curative and the prognosis is excellent. This case is presented to emphasize the rare occurrence of pulmonary amyloidosis and the need to keep malignancies in mind in differential diagnosis. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Neuroendocrine tumors of the lungs are a clearly different group of tumors with definite ultrastructural, immunohistochemical, and molecular features. We reported and analyzed the incidence, clinicopathological features, surgery rates, responses to first-line therapy, and survival outcomes of this rare condition according to our lung cancer patient database. MATERIALS AND METHODS: We retrospectively collected the data of 62 patients who were histopathologically diagnosed with large cell neuroendocrine carcinoma of lung (LCNEC) between January 2010 and January 2016. RESULTS: The patients were predominantly (95%) men (male:female=59:3) with their average age being 60.3±8.6 years. Diagnosis was made by the fine-needle aspiration biopsy (NAB) in 7 patients, bronchoscopic transbronchial biopsy in 13, and surgery in 42. Nearly 43.5% of the patients presented with the tumor in the right upper lobe. Additionally, tumors of 46.8% patients could be observed in peripheral locations. Sixteen patients presented with stage 1, 17 with stage 2, 15 with stage 3, and 14 with stage 4. Median progression-free survival (PFS) was 29 months (SE: 12.2) (95% CI, 5.2-52.8 months). Progression-free survival (PFS) was significantly better in patients with low N, M0, early stage, p63 positive, and TTF-1 positive across the entire cohort. Overall survival (OS) was significantly better in patients with comparatively lower N, M0, low stage, and peripheral location. CONCLUSION: This study demonstrated a single-center experience with clinicopathologic factors and survival outcomes of LCNEC patients. [ABSTRACT FROM AUTHOR]

Background: Predominant histologic subtypes have been reported as predictors of survival of patients with pulmonary adenocarcinoma. Aims: To evaluate the predictive value of histologic classification in resected lung adenocarcinoma using the classification systems proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, European Respiratory Society, and World Health Organization (2015). Study Design: Cross-sectional study. Methods: The histologic classification of a large cohort of 491 patients with resected lung adenocarcinoma (stages I-III) was retrospectively analyzed. The tumors were classified according to their predominant component (lepidic, acinar, papillary, solid, micropapillary, and mucinous), and their predictive values were assessed for clinicopathologic characteristics and overall survival. Results: The patient cohort comprised 158 (32.2%) patients with solid predominant, 150 (30.5%) with acinar predominant, 80 (16.3%) with papillary predominant, 75 (15.3%) with lepidic predominant, 22 (4.5%) with mucinous, and 5 (1.0%) with micropapillary subtype, and 1 (0.2%) with adenocarcinoma in situ. Overall 5-year survival of 491 patients was found to be 51.8%. Patients with lepidic, acinar, and mucinous adenocarcinoma had 70.9%, 59.0%, and 66.6% 5-year survival, respectively, and there was no statistically significant difference between them. Whereas patients with solid, papillary, and micropapillary predominant adenocarcinoma had 41.0%, 40.5%, and 0.0% 5-year survival, respectively. Compared to other histologic subtypes, patients with solid and papillary predominant adenocarcinoma had significantly lower survival than those with lepidic (p<0.001, p=0.002), acinar (p<0.001, p=0.008), and mucinous (p=0.048, p=0.048) subtypes, respectively. The survival difference between patients with solid subtype and those with papillary subtype was not statistically significant (p=0.67). Conclusion: Solid and papillary histologic subtypes are poor prognostic factors in resected invasive lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study wass to compare the cytological features of pleural exudative fluids by conventional smear (CS) method and cell block (CB) method and also to assess the utility of the combined approach for cytodiagnosis of these effusions. Materials and Methods: In all, 113 pleural exudative fluid samples were subjected to evaluation by both CS and CB methods over a period of 2 years. Cellularity, architecture patterns, morphological features, and yield for malignancy were compared, using the two methods. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of malignancy were calculated for both the methods, using histology as a gold standard. Results: CB method provided higher cellularity, better architectural patterns, and additional yield for malignancy when compared with CS method. For 22 (40%) patients, histologic subtype was determined with CB especially for adenocarcinoma. The sensitivity, specificity, positive, and negative predictive values of cytology and CB were 48%, 100%, 100%, 67.8% and 59.2%, 100%, 100%, 72.8%, respectively. Conclusion: CB technique definitively increased detection of malignancy in pleural fluid effusion when used as an adjunct to CSs. Also, CB provides material suitable for molecular genetic analysis for targeted therapies especially in the treatment of adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background: Sarcoidosis and Mediastinal Tuberculous Lymphadenitis (MTLA) are two granulomatous diseases. Differentiation between these two diseases is dependent on clinical presentation, microbiological investigation, and cytopathological examination. In endemic regions, differential diagnosis of MTLA and sarcoidosis might be difficult. Endobronchial ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) is a new diagnostic procedure for the diagnosis of mediastinal lymphadenopathy. EBUS not only enables the sampling of Lymph Nodes (LN), but also visualization of sonographic features of them. We hypothesized that the sonographic features of LN may help to differentiate MTLA from sarcoidosis. Materials and Methods: This is a retrospective analysis of patients with intrathoracic lymphadenopathy who underwent EBUS-TBNA and were finally diagnosed as sarcoidosis or MTLA. Size, shape, margin, echogenicity, and coagulation necrosis were compared between the groups. Results: A total of 257 LNs (215 sarcoidosis, 42 MTLA) were examined in 101 patients. A heterogeneous echotexture of lymph nodes was significantly more common (P <0.0001) in MTLA (69%) than sarcoidosis (36.2%). Also, necrosis was statistically significantly higher in MTLA compared to sarcoidosis (P<0.0001). The vascular pattern was similar in both groups (P=0.9050). Nearly half of the patients had grade 1 vascular pattern in both groups. The odds for diagnosis of MTLA were significantly higher in the presence of heterogeneous echotexture (odds ratio [OR], 7,00) or necrosis sign (OR, 131,2). Conclusion: Vascular patterns of two diseases were similar. Heterogeneous echotexture and necrosis sign in the LNs on EBUS are specific for MTLA. Combination of these findings with a positive tuberculin skin test, favors the diagnosis of MTLA over sarcoidosis. [ABSTRACT FROM AUTHOR]

Background/aim: Mediastinal lymph nodes are the second most commonly affected lymph nodes in tuberculous lymphadenitis. It is often difficult to diagnose tuberculosis in patients with lymphadenopathy without parenchymal lesions. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isolated mediastinal tuberculous lymphadenitis (MTLA). Materials and methods: This study included 527 patients who had undergone EBUS-TBNA between December 2012 and December 2014. Patients with the final diagnosis of MTLA were evaluated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of EBUS-TBNA were calculated. Results: The prevalence of MTLA in all patients who had undergone EBUS-TBNA for mediastinal lymphadenopathy of unknown etiology was 5.2% (28/527). EBUS-TBNA was diagnostic in 21/28 (75%) patients, and the remaining 7 patients required additional procedures for confirmation of diagnosis. Sensitivity, specificity, PPV, NPV, and accuracy of combined cytopathological and microbiological examinations of EBUS-TBNA in the diagnosis of MTLA were 87.5%, 98.5%, 91.4%, 98%, and 94.4%, respectively. There were no major complications. Conclusion: EBUS-TBNA is a safe and effective procedure for the diagnosis of MTLA. When microbiological and cytopathological examinations of samples are combined, EBUS-TBNA demonstrates good diagnostic accuracy and NPV for the diagnosis of MTLA. [ABSTRACT FROM AUTHOR]

Background: Matrix metalloproteinase (MMP) inhibitors decrease inflammation in normal tissues and suppress cancer progress in normal tissues. Valproic acid (VA) and doxycycline (DX) are MMP inhibitors that have radio-protective effects. Their ability to inhibit MMPs in irradiated tissue is unknown and the role of MMPs in radio-protective effects has not been tested to date. Aims: The purpose of this study was to examine whether administration of VA and DX to rats before irradiation affects tissue inflammation and apoptosis in the early phase of radiation, and whether the effect of these drugs is mediated by MMP inhibition. Study Design: Animal experimentation. Methods: Twenty-six Wistar rats were randomized into four groups: control (CTRL), radiation (RT), VA plus radiation (VA+RT), and DX plus radiation (DX+RT). Three study groups were exposed to a single dose of abdominal 10 Gy gamma radiation; the CTRL group received no radiation. Single doses of VA 300 mg/kg and DX 100 mg/kg were administered to each rat before radiation and all rats were sacrificed 8 hours after irradiation, at which point small intestine tissue samples were taken for analyses. Levels of inflammatory cytokines (TNF-α, IL-1β, and IL-6) and matrix metal- loproteinases (MMP-2 and MMP 9) were measured by ELISA, MMP activities were measured by gelatin and casein zymography and apoptosis was assessed by terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Results: VA decreased the levels of TNF-a and IL-1β proteins insignificantly and decreased apoptosis significantly in the irradiated tissue, but did not inhibit MMPs. In contrast, VA protected the basal MMP activities, which decreased in response to irradiation. No effect of DX was observed on the levels of inflammatory cytokines or activities of MMPs in the early phases of radiation apoptosis. Conclusion: Our findings indicated that VA protects against inflammation and apoptosis, and DX exhibits anti-apoptotic effects in early radiation and these effects are independent from MMP inhibition. [ABSTRACT FROM AUTHOR]

Hypersensitivity pneumonitis is a chronic inflammatory disease that represents one possible response of the interstitial and paranchimal tissue to the intensive and repeated inhalation of antigenic substances. It was rarely seen and overlooked many times because of the different clinical symptoms. The most important point in the diagnosis is to consider HP and to profoundly question the environmental and occupational exposure. We present three women, four men (mean age 32) 7 HP cases who applied to our clinic with different pre-diagnosis and were diagnosed with HP, as a result of the examinations, and started treatment, receiving follow-up in the light of the literature. [ABSTRACT FROM AUTHOR]

A 72 year old female, who was previously investigated in another medical centre, presented with left sided pleural effusion, cough and dyspnea of three months duration. On chest roentgenogram, a left sided pleural opacity up to the level of the fourth rib was noted. On chest computerized tomography (CT), paratracheal and paraaortic lymph nodes ranging between 1-2 cm and left sided pleural effusion were determined. We performed thoracentesis. The appearance of pleural fluid was chylous. Cholesterol was 96 mg/dl, triglyceride 1750 mg/dl, LDH 253 IU/l, glucose 80 mg/dl, and albumin 3.2 gr/dl in the pleural fluid. Pleural fluid ARB was negative. There was no history of trauma, but she was complaining of severe cough at the time of initial presentation. Talc pleuredesis was performed after tube thoracostomy. Mediastinoscopy was performed 15 days after the pleuredesis to determine the diagnosis. Pathology revealed granulomatous lymphadenitis without necrosis. Tuberculin skin test was negative. We evaluated the case as sarcoidosis complicated with chylothorax. The patient was discharged for follow up. There was no progression at the end of the eighth month. The case has been presented because sarcoidosis complicated with chylothorax has been rarely reported in the literature. [ABSTRACT FROM AUTHOR]

A 61-year-old woman presented with an eosinophilic pleural effusion, secondary to transdiaphragmatic intrapleural spread of an hepatic hydatid cyst. Right posterolateral thoracotomy and frenotomy revealed a loculated pleural effusion associated with a 10 × 8 cm hydatid cyst in the posterior segment of the liver. Hydatid disease should be included in the differential diagnosis of eosinophilic pleural effusions in endemic regions. [ABSTRACT FROM AUTHOR]

Bronchioloalveolar carcinoma (BAC), a subtype of adenocarcinoma, forms 2.6-4.3% of all lung cancers. BAC shows pure lepidic growth without invasion of stroma, blood vessels or pleura. BAC mostly appears as a peripheral pulmonary nodule; however, the tumor may sometimes present as a segmental, lobar consolidation, and have a multifocal or diffuse pattern. An unusual form of BAC is presented which has well defined, scattered, and sometimes united nodules throughout the lungs. [ABSTRACT FROM AUTHOR]