1
|
Kuo WK, Chen PJ, Wu MH, Lee HC(H, Fan JK, Hsu PH, Weng CF. Tumor Location Is an Independent Prognostic Factor in Completely Resected Pathological Stage I Non-Small Cell Lung Cancer: A Multicenter Retrospective Study. Cancers (Basel) 2024; 16:1710. [PMID: 38730661 PMCID: PMC11083109 DOI: 10.3390/cancers16091710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Previous studies suggested that the location of the primary tumor in non-small cell lung cancer (NSCLC) is associated with clinical features and prognosis, but results are conflicting. The purpose of this study was to explore tumor location as an independent risk factor of survival for patients with completely resected pathological stage I NSCLC. This was a multicenter retrospective study conducted in Taiwan. Included patients were diagnosed with stage I NSCLC and had undergone primary tumor resection. Variables including tumor location, pathological stage, histological differentiation, and International Association for the Study of Lung Cancer (IASLC) grade were evaluated for predictive ability for disease-free survival (DFS) and overall survival (OS). A total of 208 patients were included, with 123 (59.1%) patients having a primary tumor in the upper and middle lobes. The median duration of follow-up for survivors was 60.5 months. Compared to patients with IASLC Grade 3 disease, patients with Grade 1 disease had significantly longer DFS. Tumor location and IASLC grade were independent predictors for OS in multivariate analysis. Specifically, patients with NSCLC in the lower lobe and patients who are histologically classified as IASLC Grade 3 may have poorer prognosis and require greater attention to improve outcomes.
Collapse
Affiliation(s)
- Wei-Ke Kuo
- Division of Respiratory Therapy and Chest Medicine, Department of Internal Medicine, Sijhih Cathay General Hospital, New Taipei 221, Taiwan;
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 202, Taiwan;
| | - Po-Ju Chen
- Department of Thoracic Surgery, Sijhih Cathay General Hospital, New Taipei 221, Taiwan;
| | - Mei-Hsuan Wu
- Center of Teaching and Research, Hsinchu Cathay General Hospital, Hsinchu 300, Taiwan;
- Precision Medicine Ph.D. Program, National Tsing-Hua University, Hsinchu 300, Taiwan
| | | | - Jiun-Kai Fan
- Department of Diagnostic Radiology, Hsinchu Cathay General Hospital, Hsinchu 300, Taiwan;
| | - Pang-Hung Hsu
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung 202, Taiwan;
- Center of Excellence for the Oceans, National Taiwan Ocean University, Keelung 202, Taiwan
| | - Ching-Fu Weng
- Division of Pulmonary Medicine, Department of Internal Medicine, Hsinchu Cathay General Hospital, Hsinchu 300, Taiwan
- School of Medicine, National Tsing-Hua University, Hsinchu 300, Taiwan
| |
Collapse
|
2
|
Şen N, Acer Kasman S, Baysal T, Dizman R, Yılmaz-Öner S, Tezcan ME. Apical fibrosis was the most common incidental pulmonary finding in a familial Mediterranean fever cohort. Clin Rheumatol 2023; 42:1363-1370. [PMID: 36725780 PMCID: PMC9891658 DOI: 10.1007/s10067-023-06526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Familial Mediterranean fever (FMF) is one of the common autoinflammatory diseases with multisystemic manifestation. Pleuritis is the only known pulmonary involvement of FMF; however, as far as we know, thoracic involvements in pleural, parenchymal, bronchial, and vascular structures have not been evaluated yet. METHOD We included 243 consecutive FMF patients who applied to our clinic within the last 5 years and were requested to have a thorax CT for any reason and 122 trauma patients without any comorbidity. An experienced radiologist evaluated the thorax CT images blindly according to the relevant guidelines. We then presented the common incidental pulmonary and mediastinal findings on the thorax CT. Additionally, we compared patients with and without lung involvement according to demographic and disease-related parameters. RESULTS In our study, 167 of 243 patients (68.7%) had at least one of the pulmonary findings on their thorax CT. The most common pulmonary findings were apical fibrosis in 96 (39.5%) patients, parenchymal fibrotic changes in 48 (19.8%) patients, and a solitary parenchymal nodule smaller than 4 mm in 33 (13.6%) patients. All demographic, genetic, and disease-related characteristics, including the frequency of spondyloarthropathy, were similar in patients with and without pulmonary findings. CONCLUSIONS We showed that the most common incidental pulmonary finding in our FMF cohort was apical fibrosis on thoracic CT. Our data did not show causality between FMF and apical fibrosis; therefore, more studies are needed to evaluate the frequency and clinical significance of apical fibrosis in FMF. Key Points • More than two-thirds of familial Mediterranean fever (FMF) patients in our study group who underwent a thoracic scan for any reason had pulmonary and mediastinal findings on thorax computed tomography (CT). • In our FMF cohort, the most common incidental pulmonary finding on their thorax CT was apical fibrosis. • All demographic and disease-related characteristics, including the frequency of spondyloarthritis, were similar between patients with and without pulmonary and mediastinal findings.
Collapse
Affiliation(s)
- Nesrin Şen
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey
| | - Sevtap Acer Kasman
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey.
| | - Tamer Baysal
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Rıdvan Dizman
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Sibel Yılmaz-Öner
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey
| | - Mehmet Engin Tezcan
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey
| |
Collapse
|
3
|
La Regina DP, Pepino D, Nenna R, Iovine E, Mancino E, Andreoli G, Zicari AM, Spalice A, Midulla F. Pediatric COVID-19 Follow-Up with Lung Ultrasound: A Prospective Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12092202. [PMID: 36140603 PMCID: PMC9497540 DOI: 10.3390/diagnostics12092202] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
During the COVID-19 pandemic, lung ultrasound (LUS) was widely used to assess SARS-CoV-2 infection. To date, there are patients with persistence of symptoms after acute infection. Therefore, it may be useful to have an objective tool to follow these patients. The aim of our study was to evaluate the presence of LUS artifacts after SARS-CoV-2 infection in children and to analyze the associations between time elapsed since infection and symptomatology during acute infection. We conducted an observational study, enrolling 607 children infected with SARS-CoV-2 in the previous twelve months. All patients performed a LUS and medical history of demographic and clinical data. We observed irregular pleural lines in 27.5%, B-lines in 16.9%, and subpleural consolidations in 8.6% of the cases. These artifacts were more frequently observed in the lower lobe projections. We have observed that the frequency of artifacts decreases with increasing time since infection. In symptomatic patients during COVID infection, B-lines (p = 0.02) were more frequently found. In our sample, some children, even after months of acute infection, have ultrasound artifacts and showed an improvement with the passage of time from the acute episode. Our study provides additional evidence about LUS in children with previous COVID-19 as a support to follow these patients in the months following the infection.
Collapse
Affiliation(s)
- Domenico Paolo La Regina
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Daniela Pepino
- Department of Diagnostic Medicine and Radiology, Sapienza University of Rome, 00161 Rome, Italy
| | - Raffaella Nenna
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Elio Iovine
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Enrica Mancino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Gianmarco Andreoli
- Department of Diagnostic Medicine and Radiology, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Alberto Spalice
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Fabio Midulla
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
| | | |
Collapse
|
4
|
Tung NT, Ho SC, Lu YH, Chen TT, Lee KY, Chen KY, Wu CD, Chung KF, Kuo HP, Thao HNX, Dung HB, Thuy TPC, Wu SM, Kou HY, Lee YL, Chuang HC. Association Between Air Pollution and Lung Lobar Emphysema in COPD. Front Med (Lausanne) 2021; 8:705792. [PMID: 34621758 PMCID: PMC8490678 DOI: 10.3389/fmed.2021.705792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
The development of emphysema has been linked to air pollution; however, the association of air pollution with the extent of lobar emphysema remains unclear. This study examined the association of particulate matter <2.5 μm in aerodynamic diameters (PM2.5) (≤2.5 μm), nitrogen dioxide (NO2), and ozone (O3) level of exposure with the presence of emphysema in 86 patients with chronic obstructive pulmonary disease (COPD). Exposure to the air pollution estimated using the land-use regression model was associated with lung function, BODE (a body mass index, degree of obstruction, dyspnea severity, and exercise capacity index) quartiles, and emphysema measured as low-attenuation areas on high-resolution CT (HR-CT) lung scans. Using paraseptal emphysema as the reference group, we observed that a 1 ppb increase in O3 was associated with a 1.798-fold increased crude odds ratio of panlobular emphysema (p < 0.05). We observed that PM2.5 was associated with BODE quartiles, modified Medical Research Council (mMRC) dyspnea score, and exercise capacity (all p < 0.05). We found that PM2.5, NO2, and O3 were associated with an increased degree of upper lobe emphysema and lower lobe emphysema (all p < 0.05). Furthermore, we observed that an increase in PM2.5, NO2, and O3 was associated with greater increases in upper lobe emphysema than in lower lobe emphysema. In conclusion, exposure to O3 can be associated with a higher risk of panlobular emphysema than paraseptal emphysema in patients with COPD. Emphysema severity in lung lobes, especially the upper lobes, may be linked to air pollution exposure in COPD.
Collapse
Affiliation(s)
- Nguyen Thanh Tung
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Otorhinolaryngology Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Shu-Chuan Ho
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Hsun Lu
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Tao Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chih-Da Wu
- Department of Geomatics, National Cheng Kung University, Tainan City, Taiwan.,National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Han-Pin Kuo
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Huynh Nguyen Xuan Thao
- Otorhinolaryngology Department, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hoang Ba Dung
- Otorhinolaryngology Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tran Phan Chung Thuy
- Otorhinolaryngology Department, Faculty of Medicine, Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sheng-Ming Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Yun Kou
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Lun Lee
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
5
|
Yuyun X, Lexi Y, Haochu W, Zhenyu S, Xiangyang G. Early Warning Information for Severe and Critical Patients With COVID-19 Based on Quantitative CT Analysis of Lung Segments. Front Public Health 2021; 9:596938. [PMID: 34055706 PMCID: PMC8155286 DOI: 10.3389/fpubh.2021.596938] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/12/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) outbreak is spreading rapidly around the world. Purpose: We aimed to explore early warning information for patients with severe/critical COVID-19 based on quantitative analysis of chest CT images at the lung segment level. Materials and Methods: A dataset of 81 patients with coronavirus disease 2019 (COVID-19) treated at Wuhan Wuchang hospital in Wuhan city from 21 January 2020 to 14 February 2020 was retrospectively analyzed, including ordinary and severe/critical cases. The time course of all subjects was divided into four stages. The differences in each lobe and lung segment between the two groups at each stage were quantitatively analyzed using the percentage of lung involvement (PLI) in order to investigate the most important segment of lung involvement in the severe/critical group and its corresponding time point. Results: Lung involvement in the ordinary and severe/critical groups reached a peak on the 18th and 14th day, respectively. In the first stage, PLIs in the right middle lobe and the left superior lobe between the two groups were significantly different. In the second stage and the fourth stage, there were statistically significant differences between the two groups in the whole lung, right superior lobe, right inferior lobe and left superior lobe. The rapid progress of the lateral segment of the right middle lobe on the second day and the anterior segment of the right upper lobe on the 13th day may be a warning sign for severe/critical patients. Age was the most important demographic characteristic of the severe/critical group. Conclusion: Quantitative assessment based on the lung segments of chest CT images provides early warning information for potentially severe/critical patients.
Collapse
Affiliation(s)
- Xu Yuyun
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yu Lexi
- Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Wang Haochu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Shu Zhenyu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Gong Xiangyang
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| |
Collapse
|
6
|
Takamori S, Takada K, Shimokawa M, Matsubara T, Haratake N, Miura N, Toyozawa R, Yamaguchi M, Takenoyama M, Yoneshima Y, Tanaka K, Okamoto I, Tagawa T, Mori M. Predictive and prognostic impact of primary tumor-bearing lobe in nonsmall cell lung cancer patients treated with anti-PD-1 therapy. Int J Cancer 2020; 147:2327-2334. [PMID: 32356560 DOI: 10.1002/ijc.33030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/17/2020] [Indexed: 11/05/2022]
Abstract
Immunotherapy targeting programmed cell death-1 (PD-1) has become a standard pharmacological therapy. Although tumor mutation burden level was reported to depend on the tumor location in nonsmall cell lung cancer (NSCLC), predictive impact of the tumor location on the response to anti-PD-1 therapy is unknown. Two hundred and seventeen advanced or recurrent NSCLC patients treated with anti-PD-1 therapy at Kyushu University Hospital and National Hospital Organization Kyushu Cancer Center were analyzed. To minimize the bias arising from the patients' background, adjusted Kaplan-Meier survival curves and Cox proportional hazards regression analyses using inverse probability of treatment weights (IPTW) were performed. Of the 217 patients, 132, 27, and 58 had primary NSCLC in upper, middle, and lower lobes, respectively. Patients with NSCLC in upper lobe were significantly associated with younger age (P = .0070) and smoker (P = .0003). The epidermal growth factor receptor-wild type and tumor location in upper lobe were independent predictors of disease control (P = .0175 and P = .0425, respectively). The IPTW-adjusted Kaplan-Meier curves showed that patients with NSCLC in the upper lobes had significantly longer progression-free survival (PFS) and overall survival (OS) than those in middle/lower lobes (P = .0026 and P = .0015, respectively). On IPTW adjusted Cox analysis, NSCLC in the upper lobe was an independent predictor of PFS and OS (P = .0078 and P = .0034, respectively). Patients with primary NSCLC in the upper lobes may be good candidates for anti-PD-1 therapy. These findings should be validated prospectively.
Collapse
Affiliation(s)
- Shinkichi Takamori
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kazuki Takada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Taichi Matsubara
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Naoki Haratake
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Naoko Miura
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Masafumi Yamaguchi
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Mitsuhiro Takenoyama
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yasuto Yoneshima
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kentaro Tanaka
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuzo Tagawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
7
|
Choi S, Richards JC, Chan ED. Can physics principles help explain why non-tuberculous mycobacterial lung disease is more severe in the right middle lobe and lingula? J Thorac Dis 2019; 11:4847-4854. [PMID: 31903275 DOI: 10.21037/jtd.2019.10.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Sangbong Choi
- Department of Medicine and Academic Affairs, National Jewish Health, Denver, CO, USA.,Division of Pulmonology and Critical Care Medicine, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - John C Richards
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Edward D Chan
- Department of Medicine and Academic Affairs, National Jewish Health, Denver, CO, USA.,Pulmonary Section, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
8
|
Halldin CN, Blackley DJ, Markle T, Cohen RA, Laney AS. Patterns of progressive massive fibrosis on modern coal miner chest radiographs. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2019; 75:152-158. [PMID: 31107177 PMCID: PMC6864224 DOI: 10.1080/19338244.2019.1593099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Clinical teaching generally asserts that large opacities of progressive massive fibrosis (PMF) on chest radiographs present primarily bilaterally in the upper lung zones, and with an elevated background profusion of small opacities. However, the contemporary basis for these descriptions is limited.Radiographs taken for the Coal Workers' Health Surveillance Program during 2000-2015 and previously determined to have large opacities ("PMF radiographs", n = 204), and a random sample previously deemed free of large opacities (n =22), were independently reevaluated by three National Institute for Occupational Safety and Health (NIOSH) B Readers. Large opacities were noted primarily in the upper right (41%) or upper left (28%) lung zone, but 31% were in middle or lower zones. Unilateral involvement was observed in 34% of readings, with right lung predominance (82%). The median small opacity profusion category for the radiographs with PMF was 2/1. The number of large opacities was not correlated with small opacity profusion category. The "classic" descriptions of PMF as bilateral, associated with elevated background profusions of small pneumoconiotic opacities, were each absent in a third of miners.
Collapse
Affiliation(s)
- Cara N Halldin
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - David J Blackley
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Travis Markle
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Robert A Cohen
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
- The Division of Environmental and Occupational Health Sciences School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - A Scott Laney
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| |
Collapse
|
9
|
Okamoto T, Takada K, Sato S, Toyokawa G, Tagawa T, Shoji F, Nakanishi R, Oki E, Koike T, Nagahashi M, Ichikawa H, Shimada Y, Watanabe S, Kikuchi T, Akazawa K, Lyle S, Takabe K, Okuda S, Sugio K, Wakai T, Tsuchida M, Maehara Y. Clinical and Genetic Implications of Mutation Burden in Squamous Cell Carcinoma of the Lung. Ann Surg Oncol 2018; 25:1564-1571. [PMID: 29500766 DOI: 10.1245/s10434-018-6401-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lung squamous cell carcinoma (LSCC) is a major histological subtype of lung cancer. In this study, we investigated genomic alterations in LSCC and evaluated the clinical implications of mutation burden (MB) in LSCC. METHODS Genomic alterations were determined in Japanese patients with LSCC (N = 67) using next-generation sequencing of 415 known cancer genes. MB was defined as the number of non-synonymous mutations per 1 Mbp. Programmed death-ligand 1 (PD-L1) protein expression in cancer cells was evaluated by immunohistochemical analysis. RESULTS TP53 gene mutations were the most common alteration (n = 51/67, 76.1%), followed by gene alterations in cyclin-dependent kinase inhibitor 2B (CDKN2B; 35.8%), CDKN2A (31.3%), phosphatase and tensin homolog (30.0%), and sex-determining region Y-box 2 (SOX2, 28.3%). Histological differentiation was significantly poorer in tumors with high MB (greater than or equal to the median MB) compared with that in tumors with low MB (less than the median MB; p = 0.0446). The high MB group had more tumors located in the upper or middle lobe than tumors located in the lower lobe (p = 0.0019). Moreover, cancers in the upper or middle lobes had significantly higher MB than cancers in the lower lobes (p = 0.0005), and tended to show higher PD-L1 protein expression (p = 0.0573). SOX2 and tyrosine kinase non-receptor 2 amplifications were associated with high MB (p = 0.0065 and p = 0.0010, respectively). CONCLUSIONS The MB level differed according to the tumor location in LSCC, suggesting that the location of cancer development may influence the genomic background of the tumor.
Collapse
Affiliation(s)
- Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Respiratory Medicine and Infectious Disease, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Kazuki Takada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Seijiro Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Gouji Toyokawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuzo Tagawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumihiro Shoji
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryota Nakanishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masayuki Nagahashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Ichikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Disease, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Disease, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kouhei Akazawa
- Department of Medical Informatics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Stephen Lyle
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Kazuaki Takabe
- Breast Surgery, Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biosciences, The State University of New York, Buffalo, NY, USA
| | - Shujiro Okuda
- Division of Bioinformatics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
10
|
Chinta KC, Saini V, Glasgow JN, Mazorodze JH, Rahman MA, Reddy D, Lancaster JR, Steyn AJC. The emerging role of gasotransmitters in the pathogenesis of tuberculosis. Nitric Oxide 2016; 59:28-41. [PMID: 27387335 DOI: 10.1016/j.niox.2016.06.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/30/2016] [Indexed: 12/17/2022]
Abstract
Mycobacterium tuberculosis (Mtb) is a facultative intracellular pathogen and the second largest contributor to global mortality caused by an infectious agent after HIV. In infected host cells, Mtb is faced with a harsh intracellular environment including hypoxia and the release of nitric oxide (NO) and carbon monoxide (CO) by immune cells. Hypoxia, NO and CO induce a state of in vitro dormancy where Mtb senses these gases via the DosS and DosT heme sensor kinase proteins, which in turn induce a set of ∼47 genes, known as the Mtb Dos dormancy regulon. On the contrary, both iNOS and HO-1, which produce NO and CO, respectively, have been shown to be important against mycobacterial disease progression. In this review, we discuss the impact of O2, NO and CO on Mtb physiology and in host responses to Mtb infection as well as the potential role of another major endogenous gas, hydrogen sulfide (H2S), in Mtb pathogenesis.
Collapse
Affiliation(s)
- Krishna C Chinta
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vikram Saini
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joel N Glasgow
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James H Mazorodze
- KwaZulu-Natal Research Institute for TB and HIV (KRITH), Durban, South Africa
| | - Md Aejazur Rahman
- KwaZulu-Natal Research Institute for TB and HIV (KRITH), Durban, South Africa
| | - Darshan Reddy
- Department of Cardiothoracic Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Jack R Lancaster
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adrie J C Steyn
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA; KwaZulu-Natal Research Institute for TB and HIV (KRITH), Durban, South Africa; UAB Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
11
|
A biomechanical hypothesis for the pathophysiology of apical lung disease. Med Hypotheses 2016; 92:88-93. [PMID: 27241265 DOI: 10.1016/j.mehy.2016.04.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/18/2016] [Accepted: 04/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A hypothesis is presented suggesting that the pathogenesis of apical lung disease is due to progression of subclinical congenital apical bullae in people with low Body Mass Index (BMI), a combination present in 15% of the population, due to high pleural stress levels present in the antero-posteriorly flattened chests of these individuals. DESIGN The hypothesis was tested for validity in two apical lung pathologies with widespread epidemiological literature, namely tuberculosis (TB) and primary spontaneous pneumothorax (PSP), assessing whether the hypothesis could identify high-risk populations, explain exceptional cases like apical lower lobe disease and confirm predictions. RESULTS The biomechanical hypothesis can explain the high-risk factors of apical location, age, gender and low-BMI build, as well as the occurrence of disease in the apex of the lower lobe, in both TB and PSP patients. A predicted common pathogenesis for apical lung disease was confirmed by the higher-than-expected incidence of concomitant TB and PSP. CONCLUSION Pleural stress levels depend on chest wall shape, but are highest in the apex of young males with low BMI, leading to growth of congenital bullae that can eventually limit clearance inhaled material, superinfect or burst. This hypothesis suggests that low-dose computerized tomography may be used to screen for TB eradication. This paper is the first to propose a biomechanical mechanism for all apical lung disease pathophysiology.
Collapse
|
12
|
Huang YH, Hsu KH, Tseng JS, Chen KC, Su KY, Chen HY, Chang CS, Chen JJW, Yu SL, Chen HW, Yang TY, Chang GC. Predilection of contralateral upper lung metastasis in upper lobe lung adenocarcinoma patients. J Thorac Dis 2016; 8:86-92. [PMID: 26904216 DOI: 10.3978/j.issn.2072-1439.2016.01.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lung cancer with lung to lung metastasis is common. The objective of this study was to investigate the association among the distribution of contralateral lung metastases versus primary lung tumor location, clinical characteristics, and epidermal growth factor receptor (EGFR) mutations status. METHODS The study included treatment-naïve stage IV lung adenocarcinoma with contralateral lung metastases from 2012 through 2013. RESULTS In total, 103 patients were enrolled after excluding lung cancer with histology other than adenocarcinoma, synchronous multiple primary lung cancers, or other active malignancy. The median age was 65 years (range, 28-93 years); 47 male patients (45.6%); 69 non-smoker (NS) patients (67.0%); 68 Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 patients (66.0%); 38 M1a patients (38.9%); and 60 EGFR mutation patients (58.3%). There were 51 cases (49.5%) with primary lung cancer located over upper lobes. Among them, 36 (70.6%) had contralateral upper lung predominance metastasis, 9 (17.6%) had lower lung predominance, and 6 (11.8%) had equal distribution. Among the 52 lower lobe tumors, 17 (32.7%), 19 (36.5%), and 16 (30.8%) had upper, lower lung predominance, and equal distribution metastasis, respectively. Univariate analysis showed only male gender and primary tumor location over upper lobes were significantly associated with contralateral upper lung predominance metastases. After multivariate analysis, only primary tumor location over upper lobes was significantly associated with contralateral upper lung predominance metastases (adjusted OR 5.49, 95% CI, 2.15-14.03, P<0.001). CONCLUSIONS Upper lobe lung adenocarcinoma was significantly associated with contralateral upper lung predominance metastases. Further research is needed to elucidate the mechanisms underlying this phenomenon.
Collapse
Affiliation(s)
- Yen-Hsiang Huang
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Hsuan Hsu
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jeng-Sen Tseng
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Chieh Chen
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kang-Yi Su
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsuan-Yu Chen
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chi-Sheng Chang
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jeremy J W Chen
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sung-Liang Yu
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Huei-Wen Chen
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsung-Ying Yang
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Gee-Chen Chang
- 1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan
| |
Collapse
|
13
|
Cardona PJ. The key role of exudative lesions and their encapsulation: lessons learned from the pathology of human pulmonary tuberculosis. Front Microbiol 2015; 6:612. [PMID: 26136741 PMCID: PMC4468931 DOI: 10.3389/fmicb.2015.00612] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/02/2015] [Indexed: 12/31/2022] Open
Abstract
A review of the pathology of human pulmonary TB cases at different stages of evolution in the pre-antibiotic era suggests that neutrophils play an instrumental role in the progression toward active TB. This progression is determined by the type of lesion generated. Thus, exudative lesions, in which neutrophils are the major cell type, are both triggered by and induce local high bacillary load, and tend to enlarge and progress toward liquefaction and cavitation. In contrast, proliferative lesions are triggered by low bacillary loads, mainly comprise epithelioid cells and fibroblasts and tend to fibrose, encapsulate and calcify, thus controlling the infection. Infection of the upper lobes is key to the progression toward active TB for two main reasons, namely poor breathing amplitude, which allows local bacillary accumulation, and the high mechanical stress to which the interlobular septae (which enclose secondary lobes) are submitted, which hampers their ability to encapsulate lesions. Overall, progressing factors can be defined as internal (exudative lesion, local bronchogenous dissemination, coalescence of lesions), with lympho-hematological dissemination playing a very limited role, or external (exogenous reinfection). Abrogating factors include control of the bacillary load and the local encapsulation process, as directed by interlobular septae. The age and extent of disease depend on the quality and speed with which lesions liquefy and disseminate bronchially, the volume of the slough, and the amount and distribution of the sloughing debris dispersed.
Collapse
Affiliation(s)
- Pere-Joan Cardona
- Unitat de Tuberculosi Experimental, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias Badalona, Spain
| |
Collapse
|
14
|
Owsijewitsch M, Ley-Zaporozhan J, Kuhnigk JM, Kopp-Schneider A, Eberhardt R, Eichinger M, Heussel CP, Kauczor HU, Ley S. Quantitative Emphysema Distribution in Anatomic and Non-anatomic Lung Regions. COPD 2014; 12:257-66. [PMID: 25230093 DOI: 10.3109/15412555.2014.933950] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The change of emphysema distribution with increasing COPD severity is not yet assessed. Especially, involvement of the upper aspect of the lower lobe is unknown. The primary aim was to quantitatively determine regional distribution of emphysema in anatomically (lung lobes) and non-anatomically defined lung regions (upper/lower lung halves as well as core and rind regions) in a cohort covering equally all COPD severity stages using CT. MATERIAL AND METHODS Basically 100 CT data sets were quantitatively evaluated for regional distribution of emphysema. Emphysema characteristics (emphysema index, mean lung density and 15th percentile of the attenuation values of lung voxels) were compared (t-test) in: upper lobes vs. upper halves, lower lobes vs. lower halves, core vs. rind region. RESULTS In patients with ≤ GOLD II, a significantly higher emphysema burden was found in the upper lobes as compared to upper halves. In subjects with GOLD III/IV the differences were not significant for all emphysema characteristics. A high difference between lobes and halves in subjects with ≤ GOLD II was found, in contrast to low difference in higher GOLD stages. CONCLUSIONS Lobar segmentation provides improved characterization of cranio-caudal emphysema distribution compared to a non-anatomic approach in subjects up to GOLD stage II.
Collapse
Affiliation(s)
- Michael Owsijewitsch
- 1Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg , Heidelberg , Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Lee J, Lim JK, Seo H, Lee SY, Choi KJ, Yoo SS, Lee SY, Cha SI, Park JY, Kim CH. Clinical relevance of ground glass opacity in 105 patients with miliary tuberculosis. Respir Med 2014; 108:924-30. [PMID: 24787005 DOI: 10.1016/j.rmed.2014.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 02/20/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND After the application of chest computed tomography (CT), ground glass opacity (GGO) was introduced as one of major accompanying findings of miliary tuberculosis (MT) in addition to miliary nodules. However, little is known about whether GGO is associated with the clinical manifestations and outcomes of MT. Therefore, the present study examined the clinical relevance of GGO in patients with MT. METHODS Chest radiographs and CT scans of MT patients were retrospectively reviewed. Clinical manifestations and outcomes were compared in terms of the extent of GGO revealed by chest CT. RESULTS Confirmed 105 MT patients were included. GGO was observed in 70 (67%) patients. MT patients with an extent of GGO >50% (n = 21) had symptoms of shorter duration, more frequent dyspnea, and more pronounced changes in the levels of acute phase reactants. Miliary nodules were less discernible on CT in those with an extent of GGO >50%. MT patients with an extent of GGO >50% were significantly associated with a longer hospital stay (p = 0.02) and with acute respiratory failure (p < 0.001) than those with an extent of GGO ≤ 50%. However, mortality among MT patients was not associated with the extent of GGO. CONCLUSION MT patients with an extent of GGO >50% had more rapidly progressive manifestations and a greater potential for delayed diagnosis and poorer prognosis. Nevertheless, mortality was not higher in confirmed MT patients with an extent of GGO >50% than in those with an extent of GGO ≤ 50%.
Collapse
Affiliation(s)
- Jaehee Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Jae Kwang Lim
- Department of Radiology, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Hyewon Seo
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - So Yeon Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Keum Ju Choi
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Seung Soo Yoo
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Shin Yup Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Seung Ick Cha
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Jae Yong Park
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, South Korea
| | - Chang Ho Kim
- Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, South Korea.
| |
Collapse
|
16
|
Kinsey CM, Estepar RSJ, Zhao Y, Yu X, Diao N, Heist RS, Wain JC, Mark EJ, Washko G, Christiani DC. Invasive adenocarcinoma of the lung is associated with the upper lung regions. Lung Cancer 2014; 84:145-50. [PMID: 24598367 DOI: 10.1016/j.lungcan.2014.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/03/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVES We postulated that ventilation-perfusion (V/Q) relationships within the lung might influence where lung cancer occurs. To address this hypothesis we evaluated the location of lung adenocarcinoma, by both tumor lobe and superior-inferior regional distribution, and associated variables such as emphysema. MATERIALS AND METHODS One hundred fifty-nine cases of invasive adenocarcinoma and adenocarcinoma with lepidic features were visually evaluated to identify lobar or regional tumor location. Regions were determined by automated division of the lungs into three equal volumes: (upper region, middle region, or lower region). Automated densitometry was used to measure radiographic emphysema. RESULTS The majority of invasive adenocarcinomas occurred in the upper lobes (69%), with 94% of upper lobe adenocarcinomas occurring in the upper region of the lung. The distribution of adenocarcinoma, when classified as upper or lower lobe, was not different between invasive adenocarcinoma and adenocarcinoma with lepidic features (formerly bronchioloalveolar cell carcinoma, P = 0.08). Regional distribution of tumor was significantly different between invasive adenocarcinoma and adenocarcinoma with lepidic features (P = 0.001). Logistic regression analysis with the outcome of invasive adenocarcinoma histology was used to adjust for confounders. Tumor region continued to be a significant predictor (OR 8.5, P = 0.008, compared to lower region), whereas lobar location of tumor was not (P = 0.09). In stratified analysis, smoking was not associated with region of invasive adenocarcinoma occurrence (P = 0.089). There was no difference in total emphysema scores between invasive adenocarcinoma cases occurring in each of the three regions (P = 0.155). There was also no difference in the distribution of region of adenocarcinoma occurrence between quartiles of emphysema (P = 0.217). CONCLUSION Invasive adenocarcinoma of the lung is highly associated with the upper lung regions. This association is not related to smoking, history of COPD, or total emphysema. The regional distribution of invasive adenocarcinoma may be due to V/Q relationships or other local factors.
Collapse
Affiliation(s)
- C Matthew Kinsey
- Division of Pulmonary and Critical Care, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington VT 05405, United States
| | - Raul San Jose Estepar
- Department of Environmental Health and Epidemiology, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, United States; Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States
| | - Yang Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaojin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Nancy Diao
- Department of Environmental Health and Epidemiology, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, United States
| | - Rebecca Suk Heist
- Division of Hematology and Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - John C Wain
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Eugene J Mark
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - George Washko
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States
| | - David C Christiani
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States; Departments of Environmental Health and Epidemiology, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, United States.
| |
Collapse
|
17
|
Differential Diagnosis of Upper Lobe–Predominant Diseases of the Lung. AJR Am J Roentgenol 2013; 201:W518. [DOI: 10.2214/ajr.13.10843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
18
|
|
19
|
EGASHIRA RYOKO, TANAKA TOMONORI, IMAIZUMI TAKESHI, SENDA KAZUTAKA, DOKI YOSHINORI, KUDO SHO, FUKUOKA JUNYA. Differential distribution of lymphatic clearance between upper and lower regions of the lung. Respirology 2013; 18:348-53. [DOI: 10.1111/resp.12006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 06/13/2012] [Accepted: 08/13/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - TOMONORI TANAKA
- Department of Surgical Pathology; Toyama University Hospital
| | - TAKESHI IMAIZUMI
- Department of Radiology; Faculty of Medicine; Saga University; Saga; Japan
| | - KAZUTAKA SENDA
- 1st Department of Surgery; Toyama Thoracic Society; University of Toyama; Toyama
| | - YOSHINORI DOKI
- 1st Department of Surgery; Toyama Thoracic Society; University of Toyama; Toyama
| | - SHO KUDO
- Department of Radiology; Faculty of Medicine; Saga University; Saga; Japan
| | | |
Collapse
|
20
|
Takahashi M, Tsukamoto H, Kawamura T, Mochizuki Y, Ouchi M, Inoue S, Nitta N, Murata K. Mycobacterium kansasii pulmonary infection: CT findings in 29 cases. Jpn J Radiol 2012; 30:398-406. [PMID: 22396065 DOI: 10.1007/s11604-012-0061-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 02/05/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Our aim was to assess computed tomography (CT) features of Mycobacterium kansasii pulmonary infection (M. kansasii infection). MATERIALS AND METHODS A total of 29 cases confirmed to have M. kansasii infections were analyzed. The main locations of pulmonary changes, incidence, and various imaging features of the cavity (location, maximum diameter, wall thickness, satellite nodules, intracavitary fluid), and other imaging findings such as nodules, consolidation, and bronchiectasis, were visually assessed on CT images. RESULTS Locations of the main abnormalities were as follows: right S2 41%; right S1 31%; left S1+S2 2: 21%. A total of 49 cavities were observed in 24 (83%) cases. The mean maximum diameter, wall thickness, and ratio of wall thickness to the maximum diameter were 33.0 mm, 4.7 mm, and 0.19, respectively. Shapes of the cavities were round in nine (18.4%), oval in 17 (34.7%), and tubular/meandering in 23 (47%). Satellite nodules were found in only 30.6% of patients (n = 15). Small nodules were found in 26 (89.7%) patients, and most of them showed a centrilobular distribution. CONCLUSION The characteristic CT findings suggestive of M. kansasii infection include cavities located in the right posterior or apical segment with a tubular/meandering shape and a thin wall.
Collapse
Affiliation(s)
- Masashi Takahashi
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa cho, Otsu, Shiga 520-2192, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Ketai L. Invited Commentary. Radiographics 2008. [DOI: 10.1148/radiographics.28.5.0281396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
22
|
Sperandeo M, Sperandeo G, Varriale A, Filabozzi P, Decuzzi M, Dimitri L, Vendemiale G. Contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions: a preliminary study. ULTRASOUND IN MEDICINE & BIOLOGY 2006; 32:1467-72. [PMID: 17045865 DOI: 10.1016/j.ultrasmedbio.2006.06.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 06/13/2006] [Accepted: 06/22/2006] [Indexed: 05/12/2023]
Abstract
The use of contrast-enhanced ultrasound (CEUS) for the study of peripheral lung lesions has never been systematically investigated. We evaluated the CEUS patterns of 98 peripheral lung lesions before performing US-guided fine-needle biopsies (FNB). The examinations were done with an Esaote Technos MPX scanner in the harmonic mode with a mechanical index of 0.04 or less. Contrast enhancement was achieved with a 4.8 mL bolus of SonoVue (Bracco) administered via an antecubital vein. All FNBs performed under CEUS guidance were adequate for pathologic diagnosis. Seventy-eight lesions were malignant: 33 (41.9%) were adenocarcinomas, 29 (36.5%) were squamous-cell carcinomas, 13 (17.6%) were undifferentiated large-cell carcinomas and the remaining three (4.1%) were small-cell carcinomas. All presented intralesional enhancement consistent with tumor neovascularization. In some cases, there were unenhanced areas consistent with zones of necrosis and these areas were avoided during FNB. The other 20 lesions were benign (four lipomas, two fibrous lung tumor, two noncaseous granulomas, six abscesses, one rheumatoid nodule, one histiocytosis X, one chondroid hamartoma, one sclerosing hemangioma, two sarcoid nodules) and none presented intralesional enhancement. This initial and admittedly limited experience suggests that CEUS may provide diagnostically useful information on peripheral lung lesions and increase the diagnostic yield of transthoracic FNB by reducing the risk of inadequate tissue sampling.
Collapse
Affiliation(s)
- Marco Sperandeo
- Department of Internal Medicine; IRCCS, Casa Sollievo Della Sofferenza, Viale Cappuccini, San Giovanni Rotondo (FG), Italy.
| | | | | | | | | | | | | |
Collapse
|
23
|
Yun AJ, Lee PY, Gerber AN. Integrating systems biology and medical imaging: understanding disease distribution in the lung model. AJR Am J Roentgenol 2006; 186:925-30. [PMID: 16554557 DOI: 10.2214/ajr.05.0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Many chronic diseases exhibit characteristic pulmonary distribution patterns, but the underlying biologic explanations remain elusive. On the basis of emerging evidence from systems biology, we propose that gradients of T helper immune function exist as an epiphenomenon of the hypoxic pulmonary vasoconstriction response. Regional variation of immune function may contribute to preferential distribution patterning of lung diseases. CONCLUSION The lungs represent but one example in which the distribution of immune function throughout the body may explain disease location. This hypothetic framework can apply to diseases outside the realm of pulmonary biology and illustrates the potential benefit of integrating advances in systems biology and medical imaging.
Collapse
Affiliation(s)
- Anthony J Yun
- Department of Radiology, Stanford University, 470 University Ave., Palo Alto, CA 94301, USA.
| | | | | |
Collapse
|
24
|
Chang YL, Wu CT, Huang PM, Shu HS, Lee YC. A precious experience of lobar transplantation in a teenager with end-stage chronic hypersensitivity pneumonia: Case report. Transplant Proc 2004; 36:2399-402. [PMID: 15561262 DOI: 10.1016/j.transproceed.2004.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pulmonary fibrosis inevitably develops in patients with chronic hypersensitivity pneumonia (CHP). Lobar transplantation may be a viable option for pediatric and small adult patients with end-stage CHP and life-threatening respiratory decompensation. We describe a 16-year-old girl experiencing end-stage pigeon breeder's hypersensitivity pneumonia with right heart failure, who received left allograft lobar transplantation and had an uneventful convalescent course for 1 year after transplantation. Histopathologically the excised native lung revealed diffuse infiltration of lung parenchyma by CD3+ and CD8+ cells with an absence of CD4+ cells, whereas T-lymphocyte subsets analysis revealed no abnormalities in the blood. This finding is consistent with the contribution of a local type IV immune reaction to the pathogenesis. In addition, the observation of specific cellular distribution of bronchus-associated lymphoid tissue suggests that chronic antigenic stimulation and /or inflammation in CHP may cause bronchus-associated lymphoid tissue development, which is likely to play an important role in the mucosal immune response of this disease.
Collapse
Affiliation(s)
- Y-L Chang
- Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
25
|
|
26
|
Abstract
Radiologists rely on imaging patterns to arrive at a diagnosis. The different morphological patterns in the lungs are well known, but less emphasis has traditionally been placed on the pattern of distribution. This important feature greatly assists in the differential diagnosis regarding many pulmonary diseases and is the focus of this article. Chest radiographs often result in a narrow differential if one understands the regional differences and microenvironments within the lung and takes into consideration the ancillary imaging findings. High-resolution computed tomography offers additional information at the level of the secondary pulmonary lobule to fine-tune the distribution pattern and, consequently, the differential diagnosis. Disease distribution is often as important as the morphologic appearance of the disorder. This article will approach pulmonary diseases from the perspective of distribution patterns, highlighting the more common patterns. The goal of this review article is to give radiologists a conceptual framework that may be applied in their daily work environment.
Collapse
Affiliation(s)
- Kathy Murray
- Shriners Hospital for Children, In- termountain Unit, Salt Lake City, UT, USA.
| | | | | | | | | |
Collapse
|
27
|
Onuma K, Ebina M, Takahashi T, Nukiwa T. Irregularity of airway branching in a mouse bronchial tree: a 3-D morphometric study. TOHOKU J EXP MED 2001; 194:157-64. [PMID: 11693664 DOI: 10.1620/tjem.194.157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Limited information on the degree of irregularity of branching patterns of a bronchial tree may obscure the cause of heterogeneous distribution of the lesions in a variety of lung diseases. We reconstructed three dimensional (3-D) images from hilum to terminal bronchioles of a mouse lung, and defined the irregularity of airway branching by diameter-based morphometric analysis. The relative diameter ratios of a daughter to the parent branch (D1/D0) and those of a minor to major daughter branches (D1/D2) were calculated, and irregular dichotomies were found to be distributed in 48% of bifurcations. D1/D0 is well correlated with D1/D2, and is proved to indicate regular and irregular branching, as well as D1/D2. Irregular branches with D1/D0 smaller than 0.4 correspond to typical lateral branches, taking off from major bronchi. Our novel 3-D morphometric analysis showed the first portrayal of the 3-D structures of mouse bronchial airways, which provides a quantitative description of branching patterns leading to the correlation with distribution of lesions in the diseased lung.
Collapse
Affiliation(s)
- K Onuma
- Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | | | | | | |
Collapse
|
28
|
Nakano Y, Sakai H, Muro S, Hirai T, Oku Y, Nishimura K, Mishima M. Comparison of low attenuation areas on computed tomographic scans between inner and outer segments of the lung in patients with chronic obstructive pulmonary disease: incidence and contribution to lung function. Thorax 1999; 54:384-9. [PMID: 10212100 PMCID: PMC1763774 DOI: 10.1136/thx.54.5.384] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The low attenuation areas on computed tomographic (CT) scans have been reported to represent emphysematous changes of the lung. However, the regional distribution of emphysema between the inner and outer segments of the lung has not been adequately studied. In this study the regional distribution of low attenuation areas has been compared by quantitative CT analysis and the contribution of the regional distribution to pulmonary function tests evaluated in patients with chronic obstructive pulmonary disease (COPD). METHODS Chest CT images and the results of pulmonary function tests were obtained from 73 patients with COPD. The lung images were divided into inner and outer segments in the upper (cranial), middle, and lower (caudal) sections. The percentage ratio of low attenuation area to corresponding lung area (LAA%) was then calculated. The LAA% of each segment was also compared with the results of pulmonary function tests. RESULTS The mean (SD) LAA% of the inner segment was 39.1 (18.5) compared with 28.1 (13.2) for the outer segment (p<0.0001). Linear and multiple regression analyses revealed that airflow limitation is closely correlated with the inner segment LAA% of the lower lung. In contrast, the carbon monoxide transfer factor is closely correlated with the inner segment LAA% of the upper lung. CONCLUSION Low attenuation areas on CT scans are more often found in the inner segment of the lung than in the outer segment, and the contribution of the inner segment to pulmonary function tests may be greater than the outer segment.
Collapse
Affiliation(s)
- Y Nakano
- Department of Experimental Pathology, Kyoto University, Kyoto, Japan Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | | |
Collapse
|
29
|
Gurney JW, Habbe TG, Hicklin J. Distribution of disease in cystic fibrosis: correlation with pulmonary function. Chest 1997; 112:357-62. [PMID: 9266869 DOI: 10.1378/chest.112.2.357] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVE We hypothesized that the radiographic distribution of disease is important in determining pulmonary function, with the lower lung zones of more importance than the upper lung zones. To test this hypothesis, we retrospectively studied patients with cystic fibrosis, a disease with a known proclivity for the upper lung zones. SUBJECTS AND METHODS Two hundred seventy-six chest radiographs obtained at 2- to 3-year intervals from 51 patients were scored by two radiologists using a 100-point visual severity scale. The distribution of disease was assessed by dividing the lungs into four equal horizontal zones and scoring each zone for the severity of disease. There were 146 concurrent chest radiographs and pulmonary function tests from which multiple linear regression was used to correlate these zonal scores with FEV1/FVC percent predicted. RESULTS There was excellent interobserver agreement, intraclass correlation coefficients >0.7. The distribution of disease became predominant in the upper lung zones as the patients aged. Although the median score in the upper lung zones was nearly twice that of the lower lung zones, the lower lung zones were nearly three times (partial F ratio; 6.9 lower zone score vs 2.4 upper lung zone score) as important in determining pulmonary function. CONCLUSION The regional distribution of disease is important in determining pulmonary function. Sparing of the lower lung zones is important in preserving pulmonary function.
Collapse
Affiliation(s)
- J W Gurney
- Department of Radiology, University Hospital, Omaha, NE 68198-1045, USA.
| | | | | |
Collapse
|
30
|
Satoh K, Kobayashi T, Mitani M, Kawase Y, Takahashi K, Nishiyama Y, Ohkawa M, Tanabe M, Koba H, Suzuki A. Regular and irregular dichotomies of bronchial branching in the human lung. Acad Radiol 1996; 3:469-74. [PMID: 8796703 DOI: 10.1016/s1076-6332(96)80004-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
RATIONALE AND OBJECTIVES Typical models of the human bronchial tree depict regular branching. However, some anatomic studies also have revealed irregular dichotomies in the human lung. We therefore studied the patterns of bronchial branching in the human lung. METHODS We examined a normal right lung. Bronchial branchings were traced up to terminal bronchioles (TBs) in both regular and irregular dichotomies. RESULTS In 256 TBs in peripheral regions, the number of branchings varied from 11 to 23; the largest number was found in the S10c of the basal segment, and the average was 15. In 354 TBs in hilar regions supplied by irregular dichotomies, the number of branchings ranged from 9 to 15, with the average being 10. In secondary pulmonary lobules, bronchioles supplying the secondary pulmonary lobules reached TBs in two or three divisions. CONCLUSION Irregular dichotomies are too frequent to be neglected in the interpretation of radiologic and physiologic findings.
Collapse
Affiliation(s)
- K Satoh
- Department of Radiology, Kagawa Medical School, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
One of the lesser known atypical forms of radiographic presentation of pulmonary edema is the isolated or predominant affection of the upper right lobe in patients with mitral valve insufficiency. As a possible cause of this distribution, it has been established that the regurgitation jet during the ventricular systole may be directed selectively toward the orifice of the right upper lobe vein, locally accentuating the forces responsible for edema formation. There are few cases with these characteristics in the literature reviewed. We present an additional three cases, concluding that localized pulmonary edema secondary to mitral insufficiency should be suspected in the presence of any type of airspace consolidation in the right upper lobe, with or without associated affection of the middle lobe, in patients with a history of mitral valve insufficiency, especially when there are radiologic signs of left heart failure.
Collapse
Affiliation(s)
- J J Alarcón
- Radiology Department, Hospital General Gregorio Marañón, Madrid, Spain
| | | | | | | | | |
Collapse
|
32
|
Schilero GJ, Oropello J, Benjamin E. Impairment in gas exchange after granulocyte colony stimulating factor (G-CSF) in a patient with the adult respiratory distress syndrome. Chest 1995; 107:276-8. [PMID: 7529154 DOI: 10.1378/chest.107.1.276] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We describe the previously unreported finding of reproducible arterial d desaturation after successive injections of granulocyte colony stimulating factor in a orthotopic liver transplant recipient with the adult respiratory distress syndrome and antibiotic-induced neutropenia.
Collapse
Affiliation(s)
- G J Schilero
- Department of Surgery and Medicine, Mount Sinai Medical Center, New York, NY 10029
| | | | | |
Collapse
|
33
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 5-1994. A 34-year-old woman with mild exertional dyspnea and interstitial pulmonary lesions. N Engl J Med 1994; 330:347-53. [PMID: 8277957 DOI: 10.1056/nejm199402033300510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
34
|
HYPERSENSITIVITY PNEUMONITIS. Radiol Clin North Am 1992. [DOI: 10.1016/s0033-8389(22)00863-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
35
|
Remy-Jardin M, Remy J, Farre I, Marquette CH. COMPUTED TOMOGRAPHIC EVALUATION OF SILICOSIS AND COAL WORKER'S PNEUMOCONIOSIS. Radiol Clin North Am 1992. [DOI: 10.1016/s0033-8389(22)00859-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
36
|
Galvin JR, Mori M, Stanford W. High-resolution computed tomography and diffuse lung disease. Curr Probl Diagn Radiol 1992; 21:31-74. [PMID: 1544314 DOI: 10.1016/0363-0188(92)90022-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diffuse lung diseases are often difficult to characterize on chest radiographs. It has been a challenge for the radiologist to obtain useful diagnostic information from these studies and then communicate that information to the clinician. Robert Heitzman recognized the utility of understanding lung diseases in terms of their effect on the structures of the secondary lobule. Unfortunately, he needed inflated lung specimens to reliably visualize the small structures within the secondary lobule. Such specimens are no longer needed. High-resolution computed tomography (HRCT) scans of the lung provide an excellent representation of the secondary lobule. In this monograph, we have attempted to explain the normal anatomy of the secondary lobule, the patterns of abnormality, the technique for performing HRCT, and an approach to diffuse lung disease. In the second half of the article we have classified the more common diffuse lung diseases according to the dominant pathologic change: high versus low attenuation.
Collapse
Affiliation(s)
- J R Galvin
- Department of Radiology, University of Iowa College of Medicine, Iowa City
| | | | | |
Collapse
|
37
|
Abstract
High-resolution computed tomography (HRCT) and thin-section CT are techniques that are particularly suited for evaluation of the pulmonary parenchyma. These techniques have been found useful in the assessment of bronchiectasis and solitary pulmonary nodules. HRCT offers promise in evaluation of diffuse and focal pulmonary parenchymal disease. The principles and applications of HRCT of the lung are reviewed.
Collapse
Affiliation(s)
- S J Swensen
- Department of Diagnostic Radiology, Mayo Clinic, MN
| | | | | |
Collapse
|
38
|
|