Cases reported "Lung Neoplasms"

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1/23. Case report of lymphoepithelioma-like carcinoma of the lung--lymphoid population consisting of cytotoxic T cells in resting state.

    The present report describes a case of lymphoepithelioma-like carcinoma (LELC) of the lung and presents immunohistochemical and in situ hybridization (ISH) studies of the tumor. A 39-year-old Chinese woman, who was born in china and emigrated to japan at the age of 29, suffered from a cough for 2 years and received a middle and lower lobectomy with mediastinal lymph node dissection after induction chemotherapy. The tumor consisted of undifferentiated carcinoma and areas of more differentiated squamous cell carcinoma with an intense lymphoid infiltrate. Serological studies and ISH studies showed EBV infection of the tumor. The immunophenotype of tumor-infiltrating t-lymphocytes (TITL) of the present case was examined immunohistochemically and was compared with that of an LELC case reported previously. Most CD3-positive T cells of TITL in both cases were labeled with both CD8 and TIA-1 but not with granzyme-B, indicating the TITL to be cytotoxic T lymphocytes (CTL) in the resting state. The lack of CTL activation at the tumor site might have been due to local inhibition of EBV-specific CTL responses such as T-cell anergy. Because the EBV-specific CTL derived from peripheral blood lymphocytes, in contrast to the TITL, may not be influenced by either tumor-produced suppressor factors or negative regulatory T cells, they may inhibit the hematogenous metastasis of EBV-positive LELC, possibly resulting in a better prognosis. Because LELC of the lung responded to preoperative chemotherapy in the present study, it may be useful for reducing the local tumor burden and facilitate subsequent local therapy, although the mechanism of chemosensitivity of LELC remains unknown.
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2/23. asbestosis and small cell lung cancer in a clutch refabricator.

    OBJECTIVES: To present a case of asbestosis and small cell lung cancer caused by asbestos in a clutch refabricator. methods: Exposed surfaces of used clutches similar to those refabricated in the worker's workplace were rinsed, and the filtrate analysed by analytical transmission electron microscopy. Tissue samples were also analysed by this technique. RESULTS: Numerous chrysotile fibres of respirable dimensions and sufficient length to form ferruginous bodies (FBs) were detected from rinsed filtrates of the clutch. bronchoalveolar lavage fluid contained many FBs, characteristic of asbestos bodies. Necropsy lung tissue showed grade 4 asbestosis and a small cell carcinoma in the right pulmonary hilum. Tissue analysis by light and analytical electron microscopy showed tissue burdens of coated and uncoated asbestos fibres greatly exceeding reported environmental concentrations (3810 FBs/g dry weight and 2,080,000 structures > or = 0.5 micron/g dry weight respectively). 72% Of the cores were identified as chrysotile. CONCLUSIONS: Clutch refabrication may lead to exposure to asbestos of sufficient magnitude to cause asbestosis and lung cancer.
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3/23. A phase Ib/II trial of granulocyte-macrophage-colony stimulating factor and interleukin-2 for renal cell carcinoma patients with pulmonary metastases: a case of fatal central nervous system thrombosis.

    BACKGROUND: interleukin-2 (IL-2) and granulocyte-macrophage-colony stimulating factor (GM-CSF) are cytokines with nonoverlapping pleiotropic effects. In a prior Phase Ib study, this combination of agents exhibited antitumor effects in the lungs of four of eight patients with renal cell carcinoma and pulmonary metastases. We conducted this Phase Ib/II trial to determine the response rate of renal cell carcinoma patients with pulmonary metastases treated with continuous infusion IL-2 plus GM-CSF. methods: patients with renal cell carcinoma and pulmonary metastases were treated with 1.5, 2.25, or 4.5 x 10(6) IU/m(2)/day 96-hour continuous infusion IL-2 on Days 1-4, 8-11, and 15-18, and 1.25, 2.25, or 2.5 microg/kg/day GM-CSF on Days 8-19. RESULTS: Sixteen patients were treated per protocol, 14 of whom could be evaluated for disease progression. None of these 14 patients had >50% shrinkage of either total tumor burden or pulmonary metastasis. One patient developed Grade 5 neurotoxicity. autopsy revealed acute multifocal cerebral venous thrombosis as well as acute subdural and subarachnoid hemorrhage. CONCLUSIONS: The combination of IL-2 and GM-CSF may be associated with marked morbidity and, as in one case in this study, mortality. No significant antitumor activity was appreciated. Thus, the combination of IL-2 and GM-CSF, when administered at this dose and according to this schedule, does not appear to be active in renal cell carcinoma and is associated with significant toxicities. Further studies using this combination of agents should only be undertaken with extreme caution and particular attention to neurotoxicity.
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4/23. Acute spontaneous tumor lysis syndrome in adenocarcinoma of the lung: a case report.

    Acute tumor lysis syndrome (ATLS) is a constellation of metabolic complications that typically occurs in the setting of treatment of hematologic malignancies. On occasion, it has been reported to occur after therapy for solid tumors associated with large tumor burdens and aggressive therapy. We herein report the occurrence of spontaneous acute tumor lysis syndrome in a man with untreated metastatic adenocarcinoma of the lung, and briefly discuss the literature.
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5/23. tumor lysis syndrome in extensive-stage small-cell lung cancer.

    tumor lysis syndrome is a constellation of metabolic complications that occurs in the setting of treatment of hematologic malignancies. On occasion, it has been reported to occur after therapy for solid tumors associated with large tumor burdens and aggressive therapy. We herein report the rare occurrence of acute tumor lysis syndrome in a woman with extensive-stage small-cell lung cancer after cytotoxic therapy.
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6/23. Malignant mesothelioma in the jewelry industry.

    We conducted a clinical, environmental, pathologic, and mineral lung burden investigation of a 61-year-old man with malignant mesothelioma. For 35 years, up until three weeks prior to pneumonectomy, the patient made asbestos soldering forms at a costume jewelry production facility. Only chrysotile asbestos was used at the plant during the last decade of the patient's employment, and recent environmental sampling of the work-place identified no other asbestos fiber type. Anticipating that the patient would add to the very small number of cases of mesothelioma attributable solely to chrysotile, we found instead that the patient's lung tissue contained large numbers of both coated and uncoated amosite asbestos fibers but, surprisingly, no chrysotile. We subsequently learned that a distributor of both chrysotile and amosite supplied the company during the first 25 years the patient was fabricating soldering forms. The findings underscore the futility of estimating environmental exposure to chrysotile on the basis of fiber counts in lung tissue. Although we previously described non-neoplastic asbestos-related disease among patients engaged in similar work, this case, to the best of our knowledge, represents the first report of mesothelioma in the commercial jewelry industry. As such, it prompted us to initiate a public health campaign to replace asbestos soldering forms in this industry with readily available, safer alternatives.
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7/23. Analysis of 13 postmortem examinations with regard to the effect of chemotherapy on neuroblastoma patients.

    Thirteen postmortem examinations on neuroblastoma patients were reviewed clinicopathologically. Commonly found metastatic sites were bone, liver and lung. The introduction of massive doses of cyclophosphamide and cisplatinum into chemotherapy protocol markedly reduced the tumor burden: no tumor focus in liver or lung, small tumor burden in bone. Lymph node metastasis remained, however, and was refractory to the chemotherapy. The intensive chemotherapy caused severe side effects: interstitial or bacterial pneumonia and intrathecal bleeding, which sometimes proved fatal. Such side effects must, therefore, be carefully controlled in order to maximize the survival rate.
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8/23. role of zoledronic acid in the setting of bone metastases from non-small-cell lung cancer.

    Bone metastases are major sequelae of non-small-cell lung cancer and are associated with poor survival, skeletal-related events (SREs), and economic burden. In recent phase III trials, zoledronic acid has demonstrated a potential to prevent or delay SREs, although this has not yet translated into a survival benefit. Zoledronic acid is the first and only bisphosphonate with proven efficacy in the treatment of bone metastases associated with a broad range of tumors, including lung cancer. We report herein a case study that highlights the clinical benefit of zoledronic acid in a patient with squamous cell carcinoma of the lung.
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9/23. Large cell carcinoma of the lung secreting human chorionic gonadotropin which responded to combination chemotherapy: case report.

    A 68-year-old man was admitted to the National Cancer Center Hospital on November 10, 1988 to undergo chemotherapy for recurrent lung cancer, which had been resected on June 22, 1988. The tumor was diagnosed histologically as large cell carcinoma with trophoblastic differentiation, and human chorionic gonadotropin (HCG) was immunohistochemically found in tumor cells. Chemotherapy was initiated on November 14, 1988. The patient received three courses of methotrexate, actinomycin D and cyclophosphamide (MAC); and two courses of cisplatin and etoposide (PVP). Following this therapy, partial response was achieved, however, the tumor soon progressed and the serum HCG level increased to 7,571 mIU/ml. The patient was consequently given four courses of cisplatin, adriamycin, cyclophosphamide and etoposide (PACE) up to September 13, 1989, and received 52 Gy irradiation to the chest from July 20 to August 24. The tumor regressed markedly and the serum HCG decreased to within normal limits. The changes in serum HCG levels in serial samples correlated well with the clinical tumor burden. The patient is now in partial remission having survived for more than 15 months after the initiation of chemotherapy.
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10/23. Treatment of metastatic transitional cell carcinoma following renal transplantation.

    Renal transplantation was performed in a patient with a history of surgical excision for localized transitional cell carcinoma. The graft functioned well; however, metastatic transitional cell carcinoma developed following transplantation. The patient was treated sequentially with CISCA (cisplatin, Cytoxan [cyclophosphamide], and Adriamycin [doxorubicin hydrochloride]) and M-VAC (methotrexate, vinblastine, Adriamycin, and cisplatin) with no alteration in maintenance immunosuppression. Full-dose chemotherapy was well tolerated, with no impairment of renal function, and a demonstrable reduction in tumor burden was achieved. The patient ultimately died of metastatic disease but enjoyed an excellent quality of life throughout the post-transplant period.
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