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Saleh MM, Scheffler M, Merkelbach-Bruse S, Scheel AH, Ulmer B, Wolf J, Buettner R. Comprehensive Analysis of TP53 and KEAP1 Mutations and Their Impact on Survival in Localized- and Advanced-Stage NSCLC. J Thorac Oncol 2021; 17:76-88. [PMID: 34601169 DOI: 10.1016/j.jtho.2021.08.764] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/12/2021] [Accepted: 08/31/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION TP53 and KEAP1 are frequently mutated in NSCLC, but their prognostic value is ambiguous, particularly in localized stage tumors. METHODS This retrospective cohort study included a total of 6297 patients with NSCLC who were diagnosed between November 1998 and February 2020. The primary end point was overall survival. Patients were diagnosed in a central pathology laboratory as part of the Network Genomic Medicine collaboration, encompassing more than 300 lung cancer-treating oncology centers in Germany. All patients underwent molecular testing, including targeted next-generation panel sequencing and in situ hybridization. RESULTS A total of 6297 patients with NSCLC were analyzed. In 1518 surgically treated patients (Union for International Cancer Control [UICC] I-IIIA), truncating TP53 mutations and KEAP1 mutations were independent negative prognostic markers in multivariable analysis (hazard ratio [HR]TP53truncating = 1.43, 95% confidence interval [CI]: 1.07-1.91, p = 0.015; HRKEAP1mut = 1.68, 95% CI:1.24-2.26, p = 0.001). Consistently, these mutations were associated with shorter disease-free survival. In 4779 patients with advanced-stage (UICC IIIB-IV) tumors, TP53 mutations did not predict outcome in univariable analysis. In contrast, KEAP1 mutations remained a negative prognostic factor (HRKEAP1mut = 1.40, 95% CI: 1.23-1.61, p < 0.001) in patients with advanced-stage tumors. Furthermore, those with KEAP1-mutant tumors with co-occurring TP53 missense mutations had longer overall survival than those with KEAP1-mutant tumors with wild-type or truncating TP53 mutations. CONCLUSIONS This study found that TP53 and KEAP1 mutations were prognostic for localized and advanced-stage NSCLC. The increased relative hazard of harboring TP53 or KEAP1 mutations was comparable to an increase in one UICC stage. Our data suggest that molecular stratification on the basis of TP53 and KEAP1 mutation status should be implemented for localized and advanced-stage NSCLC to optimize and modify clinical decision-making.
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Affiliation(s)
- Mohamed Mahde Saleh
- Lung Cancer Group Cologne, Institute of Pathology, Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany
| | - Matthias Scheffler
- Lung Cancer Group Cologne, Department I for Internal Medicine, Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Lung Cancer Group Cologne, Institute of Pathology, Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany
| | - Andreas Hans Scheel
- Lung Cancer Group Cologne, Institute of Pathology, Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany
| | - Bastian Ulmer
- Lung Cancer Group Cologne, Institute of Pathology, Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany
| | - Jürgen Wolf
- Lung Cancer Group Cologne, Department I for Internal Medicine, Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany
| | - Reinhard Buettner
- Lung Cancer Group Cologne, Institute of Pathology, Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany.
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Quaas A, Schloesser H, Fuchs H, Zander T, Arolt C, Scheel AH, Rueschoff J, Bruns C, Buettner R, Schroeder W. Improved Tissue Processing in Esophageal Adenocarcinoma After Ivor Lewis Esophagectomy Allows Histological Analysis of All Surgically Removed Lymph Nodes with Significant Effects on Nodal UICC Stages. Ann Surg Oncol 2021; 28:3975-3982. [PMID: 33305335 PMCID: PMC8184552 DOI: 10.1245/s10434-020-09450-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/16/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND In esophageal carcinoma, the numbers of metastatic and total removed lymph nodes (LN) are well-established variables of long-term prognosis. The overall rate of retrieved LN depends on neoadjuvant treatment, the extent of surgical lymphadenectomy, and the modality of the pathological workup. The question in this study is whether technically extended histopathological preparation can increase the number of detected (metastatic) LN with an impact on nodal UICC staging. PATIENTS AND METHODS A cohort of 77 patients with esophageal adenocarcinoma was treated with Ivor Lewis esophagectomy including standardized two-field lymphadenectomy. The specimens were grossed, and all manually detectable LN were retrieved. The remaining tissue was completely embedded by the advanced "acetone compression" retrieval technique. The primary outcome parameter was the total number of detected lymph nodes before and after acetone workup. RESULTS A mean number of 23,1 LN was diagnosed after standard manual LN preparation. With complete embedding of the fatty tissue using acetone compression, the number increased to 40.5 lymph nodes (p < 0.0001). The mean number of metastatic LN increased from 3.2 to 4.2 nodal metastases following acetone compression (p < 0.0001). Additional LN metastases which caused a change in the primary (y)pN stage were found in ten patients (13.0%). CONCLUSIONS Advanced lymph node retrieval by acetone compression allows a reliable statement on the real number of removed LN. Results demonstrate an impact on the nodal UICC stage. A future multicenter study will examine the prognostic impact of improved lymph node retrieval on long-term oncologic outcome.
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Affiliation(s)
- A Quaas
- Institute of Pathology, Gastrointestinal Cancer Group Cologne (GCGC), University Hospital Cologne, Cologne, Germany.
| | - H Schloesser
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany
| | - H Fuchs
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany
| | - T Zander
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - C Arolt
- Institute of Pathology, Gastrointestinal Cancer Group Cologne (GCGC), University Hospital Cologne, Cologne, Germany
| | - A H Scheel
- Institute of Pathology, Gastrointestinal Cancer Group Cologne (GCGC), University Hospital Cologne, Cologne, Germany
| | - J Rueschoff
- Institute of Pathology, Nordhessen and Targos Molecular Pathology GmbH, Kassel, Germany
| | - C Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany
| | - R Buettner
- Institute of Pathology, Gastrointestinal Cancer Group Cologne (GCGC), University Hospital Cologne, Cologne, Germany
| | - W Schroeder
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany
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Grau S, Herling M, Mauch C, Galldiks N, Golla H, Schlamann M, Scheel AH, Celik E, Ruge M, Goldbrunner R. [Brain metastases-Interdisciplinary approach towards a personalized treatment]. Chirurg 2021; 92:200-209. [PMID: 33502584 DOI: 10.1007/s00104-020-01344-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/01/2022]
Abstract
The incidence, treatment and prognosis of patients with brain metastases have substantially changed during the last decades. While the survival time after diagnosis of cerebral metastases was on average a maximum of 3-6 months only 10 years ago, the survival time could be significantly improved due to novel surgical, radiotherapeutic and systemic treatment modalities. Only a few years ago, the occurrence of brain metastases led to a withdrawal from systemic oncological treatment and the exclusion of drug therapy studies and to a purely palliatively oriented treatment in the sense of whole brain radiation therapy (WBRT) with or without surgery. The increasing availability of targeted and immunomodulatory drugs as well as adapted radio-oncological procedures enable increasingly more personalized treatment approaches. The aim of this review article is to demonstrate the progress and complexity of the treatment of brain metastases in the context of modern comprehensive interdisciplinary concepts.
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Affiliation(s)
- S Grau
- Klinik für Allgemeine Neurochirurgie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Kerpener Str. 62, 50937, Köln, Deutschland. .,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.
| | - M Herling
- Klinik I für Innere Medizin, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - C Mauch
- Klinik für Dermatologie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - N Galldiks
- Klinik für Neurologie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - H Golla
- Zentrumfür Palliativmedizin, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - M Schlamann
- Institut für Radiologie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - A H Scheel
- Institut für Pathologie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - E Celik
- Klinik für Radioonkologie, Cyberknife und Strahlentherapie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - M Ruge
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
| | - R Goldbrunner
- Klinik für Allgemeine Neurochirurgie, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Kerpener Str. 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen Bonn Köln Düsseldorf, Universität zu Köln, Medizinische Fakultät, Klinikum der Universität, Köln, Deutschland
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Michels S, Scheel AH, Scheffler M, Schultheis AM, Gautschi O, Aebersold F, Diebold J, Pall G, Rothschild S, Bubendorf L, Hartmann W, Heukamp L, Schildhaus HU, Fassunke J, Ihle MA, Künstlinger H, Heydt C, Fischer R, Nogovà L, Mattonet C, Hein R, Adams A, Gerigk U, Schulte W, Lüders H, Grohé C, Graeven U, Müller-Naendrup C, Draube A, Kambartel KO, Krüger S, Schulze-Olden S, Serke M, Engel-Riedel W, Kaminsky B, Randerath W, Merkelbach-Bruse S, Büttner R, Wolf J. Clinicopathological Characteristics of RET Rearranged Lung Cancer in European Patients. J Thorac Oncol 2016; 11:122-7. [PMID: 26762747 DOI: 10.1016/j.jtho.2015.09.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rearrangements of RET are rare oncogenic events in patients with non-small cell lung cancer (NSCLC). While the characterization of Asian patients suggests a predominance of nonsmokers of young age in this genetically defined lung cancer subgroup, little is known about the characteristics of non-Asian patients. We present the results of an analysis of a European cohort of patients with RET rearranged NSCLC. METHODS Nine hundred ninety-seven patients with KRAS/EGFR/ALK wildtype lung adenocarcinomas were analyzed using fluorescence in situ hybridization for RET fusions. Tumor specimens were molecularly profiled and clinicopathological characteristics of the patients were collected. RESULTS Rearrangements of RET were identified in 22 patients, with a prevalence of 2.2% in the KRAS/EGFR/ALK wildtype subgroup. Co-occurring genetic aberrations were detected in 10 patients, and the majority had mutations in TP53. The median age at diagnosis was 62 years (range, 39-80 years; mean ± SD, 61 ± 11.7 years) with a higher proportion of men (59% versus 41%). There was only a slight predominance of nonsmokers (54.5%) compared to current or former smokers (45.5%). CONCLUSIONS Patients with RET rearranged adenocarcinomas represent a rare and heterogeneous NSCLC subgroup. In some contrast to published data, we see a high prevalence of current and former smokers in our white RET cohort. The significance of co-occurring aberrations, so far, is unclear.
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Affiliation(s)
- Sebastian Michels
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Andreas Hans Scheel
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Anne Maria Schultheis
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Oliver Gautschi
- Department for Medical Oncology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Joachim Diebold
- Institute of Pathology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Georg Pall
- Department for Internal Medicine, Haematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria
| | - Sacha Rothschild
- Department for Oncology, University Hospital Basel, Basel, Switzerland
| | - Lukas Bubendorf
- Department for Cytopathology, University Hospital Basel, Basel, Switzerland
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute of Pathology, University Hospital of Münster, Münster, Germany
| | - Lukas Heukamp
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | | | - Jana Fassunke
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Michaela Angelika Ihle
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Helen Künstlinger
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Carina Heydt
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Rieke Fischer
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Lucia Nogovà
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Christian Mattonet
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Rebecca Hein
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Anne Adams
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Ulrich Gerigk
- Thoracic Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Wolfgang Schulte
- Departent for Pulmonology Cardiology and Allergology, Johanniter Hospital, Bonn, Germany
| | - Heike Lüders
- Evangelic Lung Clinic Berlin, Department of Pneumology, Berlin, Germany
| | - Christian Grohé
- Evangelic Lung Clinic Berlin, Department of Pneumology, Berlin, Germany
| | - Ullrich Graeven
- Department for Hematology, Oncology and Gastroenterology, Maria Hilf Hospital Mönchengladbach, Mönchengladbach, Germany
| | | | - Andreas Draube
- Department for Internal Medicine, St. Vinzenz Hospital Cologne, Cologne, Germany
| | - Karl-Otto Kambartel
- Department for Pulmonology and Allergology, Bethanien Hospital Moers, Moers, Germany
| | - Stefan Krüger
- Department for Pulmonology/Allergology/Sleep Medicine and Respiratory Care, Florence-Nightingale-Hospital, Düsseldorf, Germany
| | - Susanne Schulze-Olden
- Department for Pulmonology/Allergology/Sleep Medicine and Respiratory Care, Florence-Nightingale-Hospital, Düsseldorf, Germany
| | - Monika Serke
- Department for Pulmonology and Thoracic Oncology, Lung Clinic Hemer, Hemer, Germany
| | | | - Britta Kaminsky
- Clinic for Pulmonology and Allergology, Bethanien Hospital, Solingen, Germany
| | - Winfried Randerath
- Clinic for Pulmonology and Allergology, Bethanien Hospital, Solingen, Germany
| | - Sabine Merkelbach-Bruse
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany.
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Thangarajah F, Mallmann P, Frommke L, Morgenstern B, Fridrich C, Puppe J, Krempel K, Markiefka B, Büttner R, Scheel AH, Schultheis AM. PD-1 und PD-L1 Expression in Plattenepithelkarzinomen der Vulva. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Höpfner M, Scheel AH, Braun M, Rüschoff J, Löser C. Unusual Nodular Regenerative Hyperplasia Mimicking Liver Metastases in CEUS. Ultraschall Med 2014; 35:199-202. [PMID: 24327467 DOI: 10.1055/s-0033-1355907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Scheel AH, Kitz J, Heimbucher J, Ströbel P, Rüschoff J. [Angioinvasion by neuroendocrine jejunal tumor. Demonstration of a malignancy sign by acetone compression]. Pathologe 2013; 34:352-5. [PMID: 23468136 DOI: 10.1007/s00292-012-1737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neuroendocrine neoplasms of the digestive system are classified by current World Health Organization (WHO) guidelines as G1 and G2 neuroendocrine tumors (NET) as well as neuroendocrine carcinoma (NEC) based on proliferation and differentiation. The G1 NET tumors are highly differentiated, low proliferating and usually exhibit a favorable course of the disease without the development of metastases. In the case presented here, angioinvasion by a pT3 NET G1 was demonstrated after complete work-up of the mesenterial fat by acetone compression. The findings indicate an unfavorable course of disease requiring intensive surveillance.
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Affiliation(s)
- A H Scheel
- Institut für Pathologie Nordhessen, Germaniastrasse 7, Kassel, Germany.
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Scheel AH, Krause D, Haars H, Schmitz I, Junker K. Talcum induced pneumoconiosis following inhalation of adulterated marijuana, a case report. Diagn Pathol 2012; 7:26. [PMID: 22420484 PMCID: PMC3348083 DOI: 10.1186/1746-1596-7-26] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 03/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background Talcosis, a granulomatous inflammation of the lungs caused by inhalation of talcum dust, is a rare form of pneumoconiosis. Besides inhalative occupational exposure, intravenous abuse of adulterated drugs is a major cause for this condition. Minerals such as talcum (magnesium silicate) and sand (predominant silicon dioxide) are used to increase both volume and weight of illicit substances. In intravenous heroin-abuse, talcosis is a well-known complication. Here we describe a case of talcosis caused by inhalative abuse of adulterated marijuana. Clinical history A 29-year old man presented with persistent fever, dyspnea and cervical emphysema. He admitted consumption of 'cut' marijuana for several years, preferentially by water pipe smoking. Morphologic findings Lung-biopsies showed chronic interstitial lung disease, anthracotic pigments and birefringent material. Energy dispersive x-ray spectroscopy revealed silicon-containing particles (1-2 μm) and fine aluminum particles (< 1 μm), magnesium and several other elements forming a spectrum compatible with the stated water pipe smoking of talcum-adulterated marijuana. Conclusions The exacerbated chronic interstitial lung disease in a 29-year old patient could be attributed to his prolonged abuse of talcum-adulterated marjuana by histopathology and x-ray spectroscopy. Since cannabis consumption is widely spread among young adults, it seems to be justified to raise attention to this form of interstitial pulmonary disease. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnomx.eu/vs/krause/html/start.html.
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