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Potentas-Policewicz M, Szolkowska M, Blasinska K, Gawryluk D, Sobiecka M, Fijolek J. Lung cancer in older patients with granulomatosis with polyangiitis: a report of three cases. BMC Pulm Med 2024; 24:193. [PMID: 38649886 PMCID: PMC11034167 DOI: 10.1186/s12890-024-03024-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA) is characterized by necrotizing granulomatous inflammation with necrotizing vasculitis predominantly affecting small to medium vessels. The survival rates have drastically improved; however, GPA can be lethal, with older patients having a worse prognosis and higher mortality than younger patients. Moreover, the incidence of various cancers has been reported to increase in patients with GPA. We aimed to discuss possible associations between GPA and lung cancer and emphasize the associated diagnostic challenges. CASE PRESENTATION We encountered three older patients with chronic GPA who developed lung cancer during long-term follow-up. Two of the patients had a smoking history, with one having silicosis and the other having chronic obstructive pulmonary disease. Furthermore, all of them had radiation exposure from repeated radiography/computed tomography. All the patients had confirmed GPA, and vasculitis relapse was first suspected when new lung lesions were noted during follow-up. However, they had no new clinical symptoms, and serum ANCA titer increased only in one patient. All the patients received standard immunosuppressive treatment but eventually died. CONCLUSIONS Lung cancer is uncommon in patients with GPA; however, the similarity between the imaging findings of lung cancer and GPA may pose a diagnostic challenge. Clinicians should be particularly vigilant when treating older patients with an increased risk of cancer, as they are often asymptomatic or have poorly apparent clinical features.
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Affiliation(s)
| | - Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Katarzyna Blasinska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Dariusz Gawryluk
- The Third Department of Pneumonology and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Malgorzata Sobiecka
- The First Department of Pneumonology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Justyna Fijolek
- The Third Department of Pneumonology and Oncology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
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Molina TJ, Roden AC, Szolkowska M, Shimizu S, Moreira AL, Chalabreysse L, Besse B, de Montpréville V, Marom EM, Detterbeck F, Girard N, Nicholson AG, Marx A. International reproducibility study of thymic epithelial tumors staging: pT stage is an issue. proposals for improvement. A RYTHMIC/ITMIG study. Lung Cancer 2024; 189:107479. [PMID: 38306885 DOI: 10.1016/j.lungcan.2024.107479] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Pathologists are staging thymic epithelial tumors (TET) according to the 8th UICC/AJCC TNM system. Within the French RYTHMIC network, dedicated to TET, agreement on pathologic tumor stage (pT) among the pathology panelists was difficult. The aim of our study was to determine the interobserver reproducibility of pT at an international level, to explore the source of discrepancies and potential interventions to address these. METHODS An international panel of pathologists was recruited through the International Thymic Malignancy Interest Group (ITMIG). The study focused on invasion of mediastinal pleura, pericardium, and lung. From a cohort of cases identified as challenging within the RYTHMIC network, we chose a series of test and validation cases (n = 5 and 10, respectively). RESULTS Reproducibility of the pT stage was also challenging at an international level as none of the 15 cases was classified as the same pT stage by all ITMIG pathologists. The agreement rose from slight (κ = 0.13) to moderate (κ = 0.48) between test and validation series. Discussion among the expert pathologists pinpointed two major reasons underlying discrepancies: 1) Thymomas growing with their "capsule" and adhering to the pleurae, pericardium, or lung were often misinterpreted as invading these structures. 2) Recognition of the mediastinal pleura was identified as challenging. CONCLUSION Our study underlines that the evaluation of the pT stage of TET is problematic and needs to be addressed in more detail in an upcoming TNM classification. The publication of histopathologic images of landmarks, including ancillary tests could improve reproducibility for future TNM classifications.
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Affiliation(s)
- Thierry J Molina
- Department of Pathology, Université Paris Cité, Hôpitaux Necker-Enfants Malades et Robert Debré, APHP, INSERM, U1163, Institut IMAGINE, Paris, France.
| | - Anja C Roden
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Malgorzata Szolkowska
- Department of Pathology, The Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Shigeki Shimizu
- Department of Laboratory Medicine and Pathology, NHO Kinki-chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Andre L Moreira
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lara Chalabreysse
- Department of Pathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France, Paris-Saclay University, Orsay, France
| | | | - Edith M Marom
- Department of Diagnostic Radiology, Tel Aviv University, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Frank Detterbeck
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Nicolas Girard
- Thorax Institute Curie Montsouris, Paris, France, Universite de Versailles Saint Quentin (UVSQ), Paris Saclay University, Versailles, France
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, and National Heart and Lung Institute, Imperial College, London, England
| | - Alexander Marx
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
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Roden AC, Judge M, den Bakker MA, Fang W, Jain D, Marx A, Moreira AL, Rajan A, Stroebel P, Szolkowska M, Cooper WA. Dataset for reporting of thymic epithelial tumours: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2023; 83:967-980. [PMID: 37722860 DOI: 10.1111/his.15047] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/11/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
AIMS Thymic epithelial tumours (TET), including thymomas and thymic carcinomas and thymic neuroendocrine neoplasms, are malignant neoplasms that can be associated with morbidity and mortality. Recently, an updated version of the World Health Organization (WHO) Classification of Thoracic Tumours 5th Edition, 2021 has been released, which included various changes to the classification of these neoplasms. In addition, in 2017 the Union for International Cancer Control (UICC) / American Joint Committee on Cancer (AJCC) published the 8th Edition Staging Manual which, for the first time, includes a TNM staging that is applicable to thymomas, thymic carcinomas, and thymic neuroendocrine neoplasms. METHODS AND RESULTS To standardize reporting of resected TET and thymic neuroendocrine neoplasms the accrediting bodies updated their reporting protocols. The International Collaboration on Cancer Reporting (ICCR), which represents a collaboration between various National Associations of Pathology, updated its 2017 histopathology reporting guide on TET and thymic neuroendocrine neoplasms accordingly. This report will highlight important changes in the reporting of TET and thymic neuroendocrine neoplasms based on the 2021 WHO, emphasize the 2017 TNM staging, and also comment on the rigour and various uncertainties for the pathologist when trying to follow that staging. CONCLUSION The ICCR dataset provides a comprehensive, standardized template for reporting of resected TET and thymic neuroendocrine neoplasms.
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Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Meagan Judge
- International Collaboration on Cancer Reporting, Sydney, NSW, Australia
| | - Michael A den Bakker
- Maasstad Hospital, Rotterdam, The Netherlands
- Academic Hospital Erasmus MC, Rotterdam, The Netherlands
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Andre L Moreira
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philipp Stroebel
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Malgorzata Szolkowska
- Department of Pathology, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, NSW, Sydney, Australia
- Institute of Medicine and Health Pathology, University of Sydney, NSW, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Sigurdson S, Marom EM, Rimner A, Shepherd A, Szolkowska M, Roden AC, Marino M, Tomiyama N, Ball D, Falkson C, Rajan A. The therapeutic relevance of a BRCA2 mutation in a patient with recurrent thymoma: a case report. Mediastinum 2022; 6:40. [PMID: 36582974 PMCID: PMC9792822 DOI: 10.21037/med-22-9] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/21/2022] [Indexed: 01/01/2023]
Abstract
Background Thymomas are characterized by a low tumor mutation burden and a paucity of actionable mutations. Clinical behavior can vary from relatively indolent to very aggressive and impact survival. Platinum-based chemotherapy is the primary treatment modality for inoperable disease and is palliative in intent. Patients with advanced thymoma frequently experience disease recurrence after frontline therapy. Treatment options for relapsed thymoma are relatively limited. A case of recurrent thymoma harboring a breast cancer gene 2 (BRCA2) mutation was presented for multidisciplinary discussion at the International Thymic Malignancy Interest Group (ITMIG) Tumor Board meeting. Case Description A 63-year-old female presented with Tumor Node Metastasis (TNM) stage I, World Health Organization (WHO) subtype B1 thymoma at diagnosis and underwent surgical resection. First recurrence occurred in the left costophrenic recess and was treated with preoperative external beam radiotherapy (EBRT), surgical excision, and post-operative chemotherapy. Histology was consistent with WHO subtype B2 thymoma and genomic analysis of the resected tumor detected a BRCA2 mutation. Second recurrence occurred in the mediastinum and bilateral pleurae. Mediastinal disease was treated with EBRT, and the pleural deposits were observed initially. However, upon further progression, the case was discussed at the ITMIG tumor board meeting to determine optimal second line therapy for this patient. Conclusions A potential role of poly (ADP-ribose) polymerase (PARP) inhibitors versus cytotoxic chemotherapy for treatment of BRCA2-mutated recurrent thymoma merits discussion. However, due to the absence of data to support the functional and therapeutic significance of BRCA2 mutations in patients with thymoma, the potential for severe toxicity associated with PARP inhibitors, and availability of other safe and effective alternatives, other treatment options should be considered. PARP inhibitors can be considered for treatment of BRCA2-mutated thymomas as part of a clinical trial or when other treatment options have been exhausted.
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Affiliation(s)
- Samantha Sigurdson
- Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - Edith M. Marom
- The Chaim Sheba Medical Center, Affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annemarie Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Anja C. Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Yamadaoka, Osaka, Japan
| | - David Ball
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Conrad Falkson
- Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Zielinski M, Roden AC, Truong MT, Van Raemdonck D, Komaki R, Wakelee H, Szolkowska M. ITMIG 2021 Tumor Board: a case of a 37-year-old man with TNM stage IVA thymoma. Mediastinum 2022; 6:26. [PMID: 36164363 PMCID: PMC9385874 DOI: 10.21037/med-22-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Marcin Zielinski
- Thoracic Surgery Department, Pulmonary Hospital, Zakopane, Poland
| | - Anja C. Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Mylene T. Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dirk Van Raemdonck
- University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | | | - Malgorzata Szolkowska
- Department of Pathology, The Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
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Murase T, Nakano S, Sakane T, Domen H, Chiyo M, Nagasaka S, Tanaka M, Kawahara Y, Toishi M, Tanaka T, Nakamura S, Sawabata N, Okami J, Mukaida H, Tzankov A, Szolkowska M, Porubsky S, Marx A, Roden AC, Inagaki H. Thymic Mucoepidermoid Carcinoma: A Clinicopathologic and Molecular Study. Am J Surg Pathol 2022; 46:1160-1169. [PMID: 35319525 DOI: 10.1097/pas.0000000000001886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thymic mucoepidermoid carcinoma (MEC) is a rare tumor, and its characteristics remain to be clarified. Here we investigated 20 cases of thymic MEC to systematically characterize its clinical, histopathologic, and molecular features. The median age of the patients was 56 years (range, 19 to 80 y), there was a slight male predilection (3:2), and 44% of the patients were asymptomatic at diagnosis. The median tumor size was 6.8 cm in diameter, 55% were pT1 tumors, and 50% were TNM stage I tumors. When 4 tumor grading systems for salivary MEC (Armed Forces Institutes of Pathology, Brandwein, modified Healey, and the Memorial Sloan-Kettering) were employed, low-grade, intermediate-grade, and high-grade tumors accounted for 35% to 70%, 5% to 25%, and 25% to 50%, respectively. Many histologic variants were noted, and 70% of the cases were classified as nonclassic variants. MAML2 rearrangement was detected in 56% of cases, and the fusion partner was CRTC1 in all cases. CRTC1-MAML2 fusion was associated with lower pT classification and lower TNM stage. The overall survival rate of all patients was 69% and 43% at 5 and 10 years, respectively. Worse overall survival was associated with higher pT stage, higher TNM stage, residual tumors, greater tumor size, high-grade tumor histology (Armed Forces Institutes of Pathology and Memorial Sloan-Kettering, but not the other 2), and with the absence of CRTC1-MAML2 fusion. Of note, none of the patients with CRTC1-MAML2 fusion-positive tumors died during the follow-up. In conclusion, the clinicopathologic and molecular findings of thymic MEC presented here are expected to contribute to the management of this rare tumor.
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Affiliation(s)
- Takayuki Murase
- Department of Pathology and Molecular Diagnostics, Graduate School of Medical Sciences, Nagoya City University
| | - Satsuki Nakano
- Department of Pathology and Molecular Diagnostics, Graduate School of Medical Sciences, Nagoya City University
| | - Tadashi Sakane
- Department of Pathology and Molecular Diagnostics, Graduate School of Medical Sciences, Nagoya City University
| | - Hiromitsu Domen
- Depatment of Thoracic Surgery, NTT-East Sapporo Hospital, Sapporo
| | - Masako Chiyo
- Department of Thoracic Surgery, National Hospital Organization Chiba Medical Center, Chiba
| | - Satoshi Nagasaka
- Department of General Thoracic Surgery, National Center for Global Health and Medicine
| | - Michio Tanaka
- Department of Pathology, Tokyo Metropolitan Hiroo General Hospital
| | | | - Masayuki Toishi
- Department of Chest Surgery, Nagano Municipal Hospital, Nagano
| | - Takuji Tanaka
- Department of Diagnostic Pathology, Gifu Municipal Hospital, Gifu
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka
| | - Hidenori Mukaida
- Department of General Thoracic Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Alexandar Tzankov
- Department of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University Hospital Basel, Basel, Switzerland
| | - Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Stefan Porubsky
- Department of Pathology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - Alexander Marx
- Department of Pathology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN
| | - Hiroshi Inagaki
- Department of Pathology and Molecular Diagnostics, Graduate School of Medical Sciences, Nagoya City University
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7
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Szpechcinski A, Szolkowska M, Winiarski S, Lechowicz U, Wisniewski P, Knetki-Wroblewska M. Targeted Next-Generation Sequencing of Thymic Epithelial Tumours Revealed Pathogenic Variants in KIT, ERBB2, KRAS, and TP53 in 30% of Thymic Carcinomas. Cancers (Basel) 2022; 14:cancers14143388. [PMID: 35884448 PMCID: PMC9324890 DOI: 10.3390/cancers14143388] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary The biology of thymic epithelial tumours (TETs), including thymomas and thymic carcinomas, and particularly the extent of molecular dysregulation, is poorly understood. Through next-generation sequencing of 15 genes implicated in common solid tumours in 53 TETs, we found a larger number of single nucleotide variants (SNVs) in thymic carcinomas than thymomas. About 30% of thymic carcinomas had at least one somatic pathogenic gene variant in TP53, ERBB2, KIT, or KRAS, whereas variants of uncertain clinical significance in KIT, ERBB2, and FOXL2 were found exclusively in thymomas. The presence of somatic pathogenic variants was non-significantly associated with shorter disease-free survival in thymic carcinoma patients. No somatic pathogenic or likely pathogenic SNV was found in thymomas. Importantly, we also evaluated germline SNVs, adding to the number of known genetic alterations in TETs and thereby enhancing our molecular understanding of these neoplasms. Abstract A better understanding of the molecular pathogenesis of thymic epithelial tumours (TETs) could revolutionise their treatment. We evaluated thymomas and thymic carcinomas by next-generation sequencing (NGS) of somatic or germline single nucleotide variants (SNVs) in genes commonly mutated in solid tumours. In total, 19 thymomas and 34 thymic carcinomas were analysed for nonsynonymous SNVs in 15 genes by targeted NGS (reference genome: hg19/GRCh37). Ten SNVs in TP53 (G154V, R158P, L194H, R267fs, R273C, R306 *, Q317 *), ERBB2 (V773M), KIT (L576P), and KRAS (Q61L) considered somatic and pathogenic/likely pathogenic were detected in 10 of 34 (29.4%) thymic carcinomas. No somatic SNVs confirmed as pathogenic/likely pathogenic were found in thymomas. Rare SNVs of uncertain or unknown functional and clinical significance, to our knowledge not reported previously in TETs, were found in ERBB2 (S703R), KIT (I690V), and FOXL2 (P157S) in 3 of 19 (16%) thymomas. The most frequent germline SNVs were TP53 P72R (94% TETs), ERBB2 I655V (40% TETs), and KIT M541L (9% TETs). No significant difference in median disease-free survival (DFS) was found between thymic carcinoma patients with and without pathogenic SNVs (p = 0.190); however, a trend toward a longer DFS was observed in the latter (16.0 vs. 30.0 months, respectively). In summary, NGS analysis of TETs revealed several SNVs in genes related to the p53, AKT, MAPK, and K-Ras signalling pathways. Thymic carcinomas showed greater genetic dysregulation than thymomas. The germline and rare SNVs of uncertain clinical significance reported in this study add to the number of known genetic alterations in TETs, thus extending our molecular understanding of these neoplasms. Druggable KIT alterations in thymic carcinomas have potential as therapeutic targets.
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Affiliation(s)
- Adam Szpechcinski
- Department of Genetics and Clinical Immunology, The Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland;
- Correspondence: (A.S.); (M.S.); Tel.: +48-22-43-12-105 (A.S.); +48-22-43-12-257 (M.S.)
| | - Malgorzata Szolkowska
- Department of Pathology, The Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland
- Correspondence: (A.S.); (M.S.); Tel.: +48-22-43-12-105 (A.S.); +48-22-43-12-257 (M.S.)
| | - Sebastian Winiarski
- Clinics of Thoracic Surgery, The Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland;
| | - Urszula Lechowicz
- Department of Genetics and Clinical Immunology, The Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland;
| | - Piotr Wisniewski
- Department of Pathology and Laboratory Medicine, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Magdalena Knetki-Wroblewska
- Department of Lung Cancer and Chest Tumours, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
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Roden AC, Ahmad U, Cardillo G, Girard N, Jain D, Marom EM, Marx A, Moreira AL, Nicholson AG, Rajan A, Shepherd AF, Simone CB, Strange CD, Szolkowska M, Truong MT, Rimner A. Thymic Carcinomas – A Concise Multidisciplinary Update on Recent Developments from the Thymic Carcinoma Working Group of the International Thymic Malignancy Interest Group. J Thorac Oncol 2022; 17:637-650. [DOI: 10.1016/j.jtho.2022.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
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9
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Szolkowska M, Blasinska K, Czajkowski W, Zielinski M, Bartczak A, Knetki-Wroblewska M, Kowalski D, Wiśniewski P, Marx A. A thymoma or not a thymoma-that is the question: a case report. Mediastinum 2021; 5:38. [PMID: 35118343 PMCID: PMC8794394 DOI: 10.21037/med-2021-01] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
Thymomas are malignant, epithelial tumors of the thymus of diverse morphology that may metastasize or relapse after resection. The WHO histological classification includes five main subtypes A, AB, B1, B2 and B3. Types A and AB usually harbour a specific GTF2I gene mutation. Thymolipomas are very rare, benign tumors composed of thymic parenchyma and adipose tissue. We present the case of a 37-year-old male with an incidentally found mediastinal tumor that shared morphological features of a thymoma of unknown histological type and a thymolipoma-like tumor. Microscopically the tumor contained three components: (I) a highly organoid component that reproduced the thymic parenchyma with numerous Hassall corpuscles; (II) a lymphocyte-poor, epithelial component; (III) mature adipose tissue. A wide panel of immunohistochemical tests was used, but the results were not decisive for differential diagnosis. Genetic analysis of GTF2I, BRAF and NRAS genes revealed no mutations. The tumor was completely resected. The patient did not receive adjuvant radiotherapy. A 1.5 years after resection there was no evidence of tumor recurrence. Based on our case we carefully analyse and compare the microscopic features of thymoma vs. thymolipoma. The differentiation between these tumors is crucial due to their distinct clinical course and required therapeutic approach.
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Affiliation(s)
- Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Katarzyna Blasinska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Marcin Zielinski
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | - Artur Bartczak
- Department of Pathology, Pulmonary Hospital, Zakopane, Poland
| | - Magdalena Knetki-Wroblewska
- Department of Lung Cancer and Chest Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Dariusz Kowalski
- Department of Lung Cancer and Chest Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Wiśniewski
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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10
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Matyjek A, Stanowska O, Talarek L, Wagrodzki M, Olszewska K, Castaneda-Wysocka P, Owczarek J, Szolkowska M, Prochorec-Sobieszek M, Rymarz A, Niemczyk S. Giant Intrathoracic Mass in a Young Woman With Acute Kidney Injury. Chest 2021; 160:e217-e223. [PMID: 34366048 DOI: 10.1016/j.chest.2021.03.050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/13/2021] [Accepted: 03/06/2021] [Indexed: 11/25/2022] Open
Abstract
CASE PRESENTATION A 35-year-old woman without past medical history sought treatment for fatigue and dry cough of 3 weeks' duration. Basic laboratory tests revealed severe anemia. She had no history of bleeding, hemoptysis, dyspnea, or fever. The patient was admitted for RBC transfusion and more extensive diagnostics.
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Affiliation(s)
- Anna Matyjek
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
| | - Olga Stanowska
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Lukasz Talarek
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michal Wagrodzki
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarzyna Olszewska
- Department of Translational and Molecular Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Joanna Owczarek
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Monika Prochorec-Sobieszek
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Pathology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Aleksandra Rymarz
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Stanislaw Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
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Abstract
Thymic carcinoma encompasses a diverse group of rare tumors that occur almost exclusively in the prevascular (anterior) mediastinum. Thymic carcinomas have a worse outcome than thymomas with a median time to death of under 3 years. These tumors lack the typical lobulation of thymomas, exhibit commonly more cytologic atypia, are associated with a desmoplastic stromal reaction, and lack thymocytes, features that distinguish them from thymomas. The most common thymic carcinoma is squamous cell carcinoma; other subtypes include mucoepidermoid carcinoma, NUT carcinoma, and adenocarcinoma, among others. Largely due to multi-institutional and global efforts and meta-analysis of case reports and series, some of the thymic carcinoma subtypes have been studied in more detail and molecular studies have also been performed. Morphology and immunophenotype for the vast majority of thymic carcinoma subtypes are similar to their counterparts in other organs. Therefore, the distinction between thymic carcinoma and metastatic disease, which is relatively common in the prevascular mediastinum, can be challenging and in general requires clinical and radiologic correlation. Although surgical resection is the treatment of choice, only 46 to 68% of patients with thymic carcinoma can undergo resection as many other tumors present at high stage with infiltration into vital neighboring organs. These patients are usually treated with chemotherapy and/or radiation. The search for better biomarkers for prognosis and treatment of thymic carcinomas is important for improved management of these patients and possible targeted therapy.
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Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, Hilton 11, 200 First St SW, Rochester, MN, 55905, USA.
| | - Malgorzata Szolkowska
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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12
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Thunnissen E, Weynand B, Udovicic-Gagula D, Brcic L, Szolkowska M, Hofman P, Smojver-Ježek S, Anttila S, Calabrese F, Kern I, Skov B, Perner S, Dale VG, Eri Z, Haragan A, Leonte D, Carvallo L, Prince SS, Nicholson S, Sansano I, Ryska A. Lung cancer biomarker testing: perspective from Europe. Transl Lung Cancer Res 2020; 9:887-897. [PMID: 32676354 PMCID: PMC7354119 DOI: 10.21037/tlcr.2020.04.07] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A questionnaire on biomarker testing previously used in central European countries was extended and distributed in Western and Central European countries to the pathologists participating at the Pulmonary Pathology Society meeting 26-28 June 2019 in Dubrovnik, Croatia. Each country was represented by one responder. For recent biomarkers the availability and reimbursement of diagnoses of molecular alterations in non-small cell lung carcinoma varies widely between different, also western European, countries. Reimbursement of such assessments varies widely between unavailability and payments by the health care system or even pharmaceutical companies. The support for testing from alternative sources, such as the pharmaceutical industry, is no doubt partly compensating for the lack of public health system support, but it is not a viable or long-term solution. Ideally, a structured access to testing and reimbursement should be the aim in order to provide patients with appropriate therapeutic options. As biomarker enabled therapies deliver a 50% better probability of outcome success, improved and unbiased reimbursement remains a major challenge for the future.
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Affiliation(s)
- Erik Thunnissen
- Department of Pathology, AmsterdamUMC, Location VU Medical Center, Amsterdam, The Netherlands
| | | | - Dalma Udovicic-Gagula
- Clinical Center University of Sarajevo, Department of Pathology and Cytology, Sarajevo, Bosnia and Herzegovina
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Malgorzata Szolkowska
- National Tuberculosis and Lung Diseases Research Institute, Department of Pathology, Warsaw, Poland
| | - Paul Hofman
- Nice University Hospital, FHU OncoAge, Laboratory of Clinical and Experimental Pathology, Nice, France
| | - Silvana Smojver-Ježek
- Clinical Unit for Pulmonary Cytology, Department of Pathology and Cytology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sisko Anttila
- Department of Pathology, HUSLAB, Helsinki and Uusimaa Health Care District, Helsinki, Finland
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Izidor Kern
- Laboratory for cytology and pathology, University Clinic Golnik, Golnik, Slovenia
| | - Birgit Skov
- Department of Pathology, University Hospital, Copenhagen Ø, Denmark
| | - Sven Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany;,Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Vibeke G. Dale
- Department of Pathology, St. Olavs Hospital, Trondheim, Norway
| | - Zivka Eri
- Institute for pulmonary diseases of Vojvodina, Department for Pathology, put dr Goldmana 4, Sremska Kamenica, Serbia
| | - Alex Haragan
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, England
| | - Diana Leonte
- National Institute of Pneumology, Pathology Department, Bucharest, Romania
| | - Lina Carvallo
- Institute of Anatomical and Molecular Pathology, Faculty of Medicine – University of Coimbra, Coimbra, Portugal
| | - Spasenja Savic Prince
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Siobhan Nicholson
- Department of Histopathology, St. James’s Hospital, Dublin 8, Ireland
| | - Irene Sansano
- Pathology Department, Passeig de la Vall d’Hebron 119-129, Barcelona, Spain
| | - Ales Ryska
- The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, Hradec Kralove, Czech Republic
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13
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Sigurdson S, Moideen N, Marom EM, Szolkowska M, Roden AC, Rajan A, Girard N, Marino M, Noh JM, Kirk A, Detterbeck FC, Falkson CB. Case presentations and recommendations from the 2018 ITMIG Annual Meeting. Mediastinum 2020; 4:7. [PMID: 35118275 PMCID: PMC8794334 DOI: 10.21037/med.2020.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Samantha Sigurdson
- Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - Nikitha Moideen
- Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - Edith M. Marom
- The Chaim Sheba Medical Center, Affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Anja C. Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicolas Girard
- Université de Lyon, Université Claude Bernard Lyon, Lyon, France
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea
| | - Alan Kirk
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Conrad B. Falkson
- Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
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Sigurdson S, Roden AC, Marom EM, Szolkowska M, Girard N, Rajan A, Marino M, Rimnera A, Moideen N, Russell WE, Weksler B, Detterbeck FC, Falkson CB. Case presentation and recommendations from the April 2019 ITMIG tumor board: an international multidisciplinary team. ACTA ACUST UNITED AC 2019; 3:41. [PMID: 35118267 PMCID: PMC8794379 DOI: 10.21037/med.2019.11.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Samantha Sigurdson
- Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - Anja C. Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA
| | - Edith M. Marom
- The Chaim Sheba Medical Center, affiliated with the Tel Aviv University, Tel Aviv, Israel
| | - Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Nicolas Girard
- Université de Lyon, Université Claude Bernard Lyon, Lyon, France
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mirella Marino
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Nikitha Moideen
- Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | | | - Benny Weksler
- Division of Thoracic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Conrad B. Falkson
- Department of Oncology, Queen’s University, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
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Szolkowska M, Szczepulska-Wojcik E, Maksymiuk B, Burakowska B, Winiarski S, Gatarek J, Rudzinski P, Orlowski T, Langfort R. Primary mediastinal neoplasms: a report of 1,005 cases from a single institution. J Thorac Dis 2019; 11:2498-2511. [PMID: 31372287 DOI: 10.21037/jtd.2019.05.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background This study was an epidemiological analysis of all primary mediastinal neoplasms (PMNs) diagnosed between 2000 and 2016 at the National Tuberculosis and Lung Diseases Research Institute, Poland. Methods All patients with any mediastinal abnormality were included in the analysis. The patients' age and gender were obtained from the institutional database. Results From a cohort of 5,108 patients, 3,691 primary mediastinal lesions were found, including 1,005 (19%) PMNs: lymphomas (533, 53% of PMNs), thymomas (215, 21%), neurogenic tumors (NTs) (100, 10%), germ cell tumors (GCTs) (62, 6%), soft tissue tumors (STTs) (47, 5%) and thymic carcinomas/thymic neuroendocrine tumors (TCs/TNETs) (37 in total, 4%). The most frequent lymphomas were classical Hodgkin lymphomas [256] and primary mediastinal large B-cell lymphomas [163]. Type AB [73] predominated in thymomas and squamous cell carcinomas [9] and carcinoids [10] in TCs/TNETs. NTs encompassed mainly schwannomas [49], ganglioneuromas [21] and neurofibromas [10]. The most frequent STTs were hemangiomas [13] and lymphangiomas [11]. Lymphomas, thymomas and NT were more often in women, TCs/TNETs in men (P<0.001). Lymphomas predominated between the 2nd and 4th decade of life, NTs under the 3rd decade and thymic epithelial tumors between the 6th and 8th decade (P<0.001). There was no correlation between the subtypes of thymomas and the patients' gender (P=0.389) but it was found between histology and patients' age: in patients <30 years of age type B2 and B3 thymomas and >70 years of age AB type and micronodular thymomas with lymphoid stroma (P<0.001) predominated. In the group of GCTs half of them were malignant and these were noted exclusively in men. No correlation between subtypes of NTs or TCs/TNETs and patients' age and gender was found (P>0.05). Conclusions PMNs are rare conditions thus awareness of basic epidemiology may be very helpful for final diagnosis.
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Affiliation(s)
- Malgorzata Szolkowska
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Ewa Szczepulska-Wojcik
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Beata Maksymiuk
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Barbara Burakowska
- Department of Radiology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Sebastian Winiarski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Juliusz Gatarek
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Piotr Rudzinski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Tadeusz Orlowski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Renata Langfort
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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16
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Szolkowska M. Thymomas in children. Mediastinum 2019; 3:14. [PMID: 35118242 PMCID: PMC8794414 DOI: 10.21037/med.2019.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 11/22/2022]
Affiliation(s)
- Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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17
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Fijołek J, Wiatr E, Polubiec-Kownacka M, Błasińska-Przerwa K, Szolkowska M, Szczepulska-Wojcik E, Roszkowski-Śliż K. Gruźlica płuc imitująca rozwój raka płuca po 10 latach od remisji raka. Adv Respir Med 2018. [DOI: 10.5603/arm.59694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Różnicowanie pomiędzy gruźlicą płuc a rakiem płuca stanowi często prawdziwe wyzwanie dla klinicystów, szczególnie że oba schorzenia mogą występować równocześnie. Jest to spowodowane tym, że zarówno objawy kliniczne, jak i radiologiczne obu chorób są podobne. Prezentowany opis przypadku przedstawia pacjentkę leczoną 10 lat wcześniej na zaawansowanego raka płuca, która z powodu pojawienia się nowych objawów klinicznych i zmian radiologicznych trafiła ponownie do szpitala z powodu podejrzenia progresji raka, a u której ostatecznie rozpoznano gruźlicę.
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18
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Szolkowska M, Blasinska-Przerwa K, Knetki-Wroblewska M, Rudzinski P, Langfort R. Malignant pleural mesothelioma: main topics of American Society of Clinical Oncology clinical practice guidelines for diagnosis and treatment. J Thorac Dis 2018; 10:S1966-S1970. [PMID: 30023092 DOI: 10.21037/jtd.2018.04.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Malgorzata Szolkowska
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Magdalena Knetki-Wroblewska
- Department of Lung Cancer and Chest Tumors, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute, Warsaw, Poland
| | - Piotr Rudzinski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Renata Langfort
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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19
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Zieliński M, Rybak M, Solarczyk-Bombik K, Wilkojc M, Czajkowski W, Kosinski S, Fryzlewicz E, Nabialek T, Szolkowska M, Pankowski J. Subxiphoid uniportal VATS thymectomy. J Vis Surg 2017; 3:171. [PMID: 29302447 DOI: 10.21037/jovs.2017.09.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/25/2017] [Indexed: 11/06/2022]
Abstract
Background To present the technique of minimally invasive extended thymectomy performed through the uniportal subxiphoid approach, with double elevation of the sternum for nonthymomatous myasthenia gravis (MG). Methods Operative technique: the whole dissection was performed through the 4-7 cm transverse or longitudinal subxiphoid incision with use of videothoracoscope. The sternum was elevated with two hooks connected to the sternal frame (Rochard bar, Aesculap-Chifa, Nowy Tomysl, Poland). The lower hook was inserted through the subxiphoid incision and the superior hook was inserted percutaneously, after the mediastinal tissue including the major mediastinal vessels were dissected from the inner surface of the sternum. The fatty tissue of the anterior mediastinum and the aorta-pulmonary window was completely removed. Results There were four patients in the period 1.1.2017-30.4.2017. There was no mortality and morbidity. Conclusions The uniportal subxiphoid approach combined with double elevation of the sternum enabled very extensive thymectomy in case of thymoma.
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Affiliation(s)
- Marcin Zieliński
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | - Mariusz Rybak
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | | | - Michal Wilkojc
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | | | - Sylweriusz Kosinski
- Department of Anaesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland
| | - Edward Fryzlewicz
- Department of Anaesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland
| | - Tomasz Nabialek
- Department of Anaesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland
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20
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Langfort R, Rudzinski P, Szczepulska E, Maksymiuk B, Orlowski T, Szolkowska M. P1.02-037 Pulmonary Carcinoid Tumors: A Prognostic Implications of Ki-67 Proliferative Index. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.770] [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: 10/18/2022]
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21
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Zieliński M, Rybak M, Solarczyk-Bombik K, Wilkojc M, Czajkowski W, Kosinski S, Fryzlewicz E, Nabialek T, Szolkowska M, Pankowski J. The Zakopane Pulmonary Hospital experience on subxiphoid thymectomy. J Vis Surg 2017; 3:2. [PMID: 29078565 DOI: 10.21037/jovs.2016.12.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/16/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND To present the technique of minimally invasive extended thymectomy performed through the subxiphoid-bilateral subcostal video-assisted thoracoscopic surgery (VATS) approach, with double elevation of the sternum for nonthymomatous myasthenia gravis (MG). METHODS The whole dissection was performed through the 4-7 cm transverse subxiphoid incision with single 10 mm extra-long bariatric laparoscopy ports inserted subcostally to the right and left chest cavities for videothoracoscope and subsequently for chest tubes. The sternum was elevated with two hooks connected to the sternal frame (Rochard bar, Aesculap-Chifa, Nowy Tomysl, Poland). The lower hook was inserted through the subxiphoid incision and the superior hook was inserted percutaneously, after the mediastinal tissue including the major mediastinal vessels were dissected from the inner surface of the sternum. The fatty tissue of the anterior mediastinum and the aorta-pulmonary window was completely removed. RESULTS There were 147 patients (62 patients operated on for thymomas, 75 patients for nonthymomatous MG and 10 for rethymectomies) in the period 1.1.2009-30.3.2016. There was no mortality and morbidity. The mean operative time was 109.1 min (range, 75-150 min). CONCLUSIONS The subxiphoid approach combined with bilateral single port subcostal VATS and double elevation of the sternum enables very extensive thymectomy in case of nonthymomayous MG.
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Affiliation(s)
- Marcin Zieliński
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | - Mariusz Rybak
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | | | - Michal Wilkojc
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | | | - Sylweriusz Kosinski
- Department of Anaesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland
| | - Edward Fryzlewicz
- Department of Anaesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland
| | - Tomasz Nabialek
- Department of Anaesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland
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Grajkowska W, Matyja E, Kunicki J, Szymanska S, Marx A, Weis CA, Langfort R, Szolkowska M. AB thymoma with atypical type A component with delayed multiple lung and brain metastases. J Thorac Dis 2017; 9:E808-E814. [PMID: 29221349 PMCID: PMC5708497 DOI: 10.21037/jtd.2017.07.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/11/2017] [Indexed: 11/06/2022]
Abstract
An atypical type A thymoma is a newly added entity to the last World Health Organization (WHO) histological classification [2015] of uncertain prognosis. The conventional type A and AB thymomas are usually locally aggressive neoplasms that rarely metastasize with distant metastases to the central nervous system (CNS) occurring extremely exceptionally. We present a history of a woman with a mediastinal tumor originally considered to be a Masaoka-Koga stage II "mixed thymoma with well-differentiated thymic carcinoma component" according to the historic Müller-Hermelink nomenclature. By applying the criteria of the new WHO classification the tumor should be reclassified as an AB thymoma with an atypical A component. The patient developed metastases to the lung and brain 10 and 15 years after the original diagnosis, respectively. All metastases morphologically corresponded to an atypical A component of primary thymoma. Molecular study revealed GTF2I mutations in the primary and one of the metastatic tumors. To our knowledge, this is the first description of a GTF2I mutation in AB thymoma with atypical A component and its metastases. The presented case highlights the necessity of an accurate microscopic search for atypical areas in A or AB thymomas because of their potentially negative impact on prognosis.
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Affiliation(s)
- Wieslawa Grajkowska
- Department of Pathology, The Children’s Memorial Health Institute, Warsaw, Poland
- Department of Experimental and Clinical Neuropathology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Ewa Matyja
- Department of Experimental and Clinical Neuropathology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Jacek Kunicki
- Department of Neurosurgery, M. Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Sylwia Szymanska
- Department of Pathology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Renata Langfort
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Malgorzata Szolkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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Polaczek M, Baranska I, Szolkowska M, Zych J, Rudzinski P, Szopinski J, Orlowski T, Roszkowski-Sliz K. Clinical presentation and characteristics of 25 adult cases of pulmonary sequestration. J Thorac Dis 2017; 9:762-767. [PMID: 28449484 DOI: 10.21037/jtd.2017.03.107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pulmonary sequestration (PS) is a rare congenital abnormality of lung tissue. Only few series of adult cases are reported. The aim was to describe clinical characteristics in adult cases of PS and to compare outcomes in different clinical situations. METHODS Using MSD engine we searched for cases of PS that have been diagnosed between Jan 1st, 2005 and Dec 31st, 2015. Clinical data was retrospectively gathered. Statistica v.12 (StatSoft, Inc.) was used for statistical analyses. RESULTS We found 25 cases (18 females, 7 males), which underwent surgery and were histologically proven. There were 22 cases of intralobar PS. 7 cases were asymptomatic, 12 had infectious history (including 3 cases of lung abscess and pleural empyema), 4 presented with hemoptysis, 2 with chest pain. The average age to undergo surgery was 38.24, in the asymptomatic group 34, in symptomatic 39.89. In the latter the symptoms preceded the surgery for 2.45-year. Great majority of sequestrations was located in lower lobes (96%), 52% on the left. Symptomatic cases were at higher than expected risk of surgical complications, comparing to asymptomatic (chi2, P=0.04). In most cases there were surgical and histological signs of infection, only in 9 cases etiological factor was determined: in 5 cases it was A. fumigatus. A 0.53-day longer post-surgical hospital stay was observed in the symptomatic group, no statistical significance was found (U-test, P=0.45). CONCLUSIONS Surgical treatment of symptomatic cases of PS is characterized by slightly longer post-surgical hospital stay and higher risk of surgical complications. Fungal infections are the most likely to occur in PS.
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Affiliation(s)
- Mateusz Polaczek
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - Inga Baranska
- Radiology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Malgorzata Szolkowska
- Pathology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Jacek Zych
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Piotr Rudzinski
- Surgery Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Janusz Szopinski
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Tadeusz Orlowski
- Surgery Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Kazimierz Roszkowski-Sliz
- Third Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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Dziedzic D, Peryt A, Szolkowska M, Langfort R, Orlowski T. Evaluation of the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration for metastatic mediastinal tumors. Endosc Ultrasound 2016; 5:173-7. [PMID: 27386474 PMCID: PMC4918300 DOI: 10.4103/2303-9027.183973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives: The mediastinum is a relatively uncommon site of distant metastases, which typically appear as peripheral lung nodules. We chose to assess the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of distant metastases to the mediastinum. Materials and Methods: Over the period 2008–2013, a total of 446 patients with concurrent or previously diagnosed and treated extrathoracic malignancies were evaluated. Results: Surgical treatment was carried out in 414 patients (156 women and 237 men aged 26–68 years, mean age of 56.5 years) presenting with distant metastases to the lungs: Thoracoscopic wedge resection was completed in 393 patients and lobectomy and segmentectomy were performed in 7 and 14 patients, respectively. The median time from primary tumor resection was 6.5 years (range: 4.5 months to 17 years). Thirty-two of these patients underwent EBUS-TBNA for mediastinal manifestation of the underlying disease. EBUS-TBNA specimens were aspirated from the subcarinal or right paratracheal lymph node stations in 26 (81%) patients and from the hilar lymph nodes in 6 (18.8%) patients only. Metastases to lymph nodes were confirmed in 14 of these patients (43.8%). Primary lung cancer was diagnosed in seven patients. Mediastinoscopy was performed in two patients to reveal either lymph node metastasis or sarcoidosis. Thoracotomy for pulmonary metastases resection and mediastinal lymph node biopsy was performed in nine patients. Lymph node metastasis was confirmed in five patients (15.6%). The diagnostic efficacy, sensitivity, specificity, and negative predictive value (NPV) of EBUS-TBNA were 78.8%, 93.3%, 100%, and 87.5%, respectively. Conclusion: EBUS-TBNA is a valuable diagnostic tool in a selected group of patients with secondary tumors in the mediastinum and lungs.
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Affiliation(s)
- Dariusz Dziedzic
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Adam Peryt
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Malgorzata Szolkowska
- Department of Patomorphology, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Renata Langfort
- Department of Patomorphology, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Tadeusz Orlowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
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Dziedzic D, Peryt A, Szolkowska M, Langfort R, Orlowski T. Endobronchial ultrasound-guided transbronchial needle aspiration in the staging of lung cancer patients. SAGE Open Med 2015; 3:2050312115610128. [PMID: 26770805 PMCID: PMC4679334 DOI: 10.1177/2050312115610128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/31/2015] [Indexed: 11/19/2022] Open
Abstract
Objective: Mediastinoscopy as diagnostic procedure for evaluation of mediastinum in patients with non-small-cell lung cancer has long been considered the reference standard. However, less invasive method has occurred. Endobronchial ultrasound–guided transbronchial needle aspiration came into widespread use and has resulted in controversy as to whether it is a good replacement for mediastinoscopy. We chose to demonstrate the usefulness of endobronchial ultrasound–guided transbronchial needle aspiration in evaluating the mediastinum in patients with non-small-cell lung cancer. Material and methods: Over a 48-month period, 1841 patients underwent endobronchial ultrasound–guided transbronchial needle aspiration at our healthcare centre. In all patients, 2964 biopsies from the lymph node group N2 and 783 from group N1 were taken. The mean short axis of the lymph nodes biopsied was 2.0 (range: 0.6–2.6). The mean number of lymph node stations biopsied per patient was 2.6. Patients with a negative result of endobronchial ultrasound–guided transbronchial needle aspiration underwent mediastinoscopy. All patients with a negative result in endobronchial ultrasound–guided transbronchial needle aspiration and mediastinoscopy underwent surgical resection with lymph node sampling. Results: The metastases to lymph nodes N2/N3 and N1 were found in 1111 (60.3%) and 199 (9.3%), respectively. Mediastinoscopy was performed in 730 patients with a positive result in 83 (11.4%) patients. In the group of operated patients, metastatic N1 disease was found in 264 (14.1%). In the group of the operated patients, mediastinal involvement of disease (N2) was found in 30 patients (4.5%). The sensitivity, negative predictive value and diagnostic accuracy for hilar lymph node staging for endobronchial ultrasound–guided transbronchial needle aspiration were 57%, 96% and 96%, respectively. The sensitivity, negative predictive value and diagnostic accuracy per patient for mediastinal lymph node staging for endobronchial ultrasound–guided transbronchial needle aspiration and mediastinoscopy were 91%, 85%, 93% and 73%, 95.5%, 97%, respectively. The specificity and positive predictive value of both tests were 100%. Conclusion: The clinical usefulness of endobronchial ultrasound–guided transbronchial needle aspiration is undeniable according to diagnostic performance data. Endobronchial ultrasound–guided transbronchial needle aspiration should be considered complementary to mediastinoscopy in the evaluation of patients with radiographically abnormal mediastinum.
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Affiliation(s)
- Dariusz Dziedzic
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Adam Peryt
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Malgorzata Szolkowska
- Department of Patomorphology, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Renata Langfort
- Department of Patomorphology, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Tadeusz Orlowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
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Chabowski M, Szymanska-Chabowska A, Szolkowska M, Janczak D. A unilateral hemothorax as a presenting manifestation of mediastinal spindle cell sarcoma. Adv Exp Med Biol 2015; 852:17-9. [PMID: 25416071 DOI: 10.1007/5584_2014_96] [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: 02/04/2023]
Abstract
The article presents the case of a 73-year-old female injured in a bicycle accident, who was diagnosed with a left hemothorax. Initially, a chest drain was inserted and the pleural hematoma was evacuated. Then a thoracotomy was performed. A hematoma debridement and decortication with a subsequent tissue biopsy was carried out and a final diagnosis of spindle cell sarcoma was made. There is a brief discussion on the differential diagnosis of spontaneous hemothorax and its management.
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Affiliation(s)
- M Chabowski
- Department of Surgery, Fourth Military Teaching Hospital, 5 Weigla St., 50-981, Wroclaw, Poland,
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Szpechcinski A, Kopinski P, Giedronowicz D, Rozy A, Jagus P, Szolkowska M, Chorostowska-Wynimko J. Simple flow cytometric protocol of CD4+/CD8+ lymphocyte ratio assessment in bronchoalveolar lavage fluids from patients with interstitial lung diseases. Anal Quant Cytol Histol 2011; 33:289-296. [PMID: 22611757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To validate the fast and accurate flow cytometric (FCM) protocol using blood-standardized antibodies for alveolar lymphocyte subtyping with respect to standard immunocytochemistry (IC). STUDY DESIGN FCM and IC were applied to immunophenotype T cell subsets in bronchoalveolar lavage (BAL) fluids from patients with interstitial lung diseases. Diagnostic BAL specimens from 50 patients with suspected sarcoidosis, idiopathic pulmonary fibrosis, and hypersensitivity pneumonitis were evaluated by both IC and FCM. In FCM, CD4+ and CD8+ T cells were identified by light scatter gating with CD3 selection using basic tricolor cytometer. RESULTS Relative amounts of CD4+, CD8+ T cells, and CD4+/CD8+ ratios demonstrated by the FCM showed excellent, significant correlations with IC results. FCM values did not differ significantly from IC results. However, the sensitivity and specificity of conventional IC staining were not sufficient to assess CD4+/ CD8+ ratio in most idiopathic pulmonary fibrosis cases. Additionally, performing IC immunophenotyping in BAL samples with low lymphocyte content introduced a remarkable error into CD4+/CD8+ ratio assessment. CONCLUSION FCM allowed reliable, precise, and fast T-cell subset measurement in all BAL samples, overcoming the IC disadvantages. Our validated FCM protocol provides diagnostically relevant CD4+/CD8+ ratio determination by simple light scatter gating strategy with CD3 selection.
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Affiliation(s)
- Adam Szpechcinski
- Laboratory of Molecular Diagnostics and Immunology and Department of Pathomorphology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
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Krenke R, Klimiuk J, Korczynski P, Kupis W, Szolkowska M, Chazan R. Hemoptysis and Spontaneous Hemothorax in a Patient With Multifocal Nodular Lung Lesions. Chest 2011; 140:245-251. [PMID: 21729897 DOI: 10.1378/chest.10-1865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Rafal Krenke
- Department of Internal Medicine, Pneumonology, and Allergology, Medical University of Warsaw, Poland.
| | - Joanna Klimiuk
- Department of Internal Medicine, Pneumonology, and Allergology, Medical University of Warsaw, Poland
| | - Piotr Korczynski
- Department of Internal Medicine, Pneumonology, and Allergology, Medical University of Warsaw, Poland
| | - Wlodzimierz Kupis
- Department of Surgery, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Malgorzata Szolkowska
- Department of Pathology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Ryszarda Chazan
- Department of Internal Medicine, Pneumonology, and Allergology, Medical University of Warsaw, Poland
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Winek J, Rowinska-Zakrzewska E, Demkow U, Szopinski J, Szolkowska M, Filewska M, Jagodzinski J, Roszkowski-Sliz K. Interferon gamma production in the course of Mycobacterium tuberculosis infection. J Physiol Pharmacol 2008; 59 Suppl 6:751-759. [PMID: 19218702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 08/08/2008] [Indexed: 05/27/2023]
Abstract
It is not clear why some individuals with unknown predisposition develop tuberculosis, while others remain healthy in spite of heavy exposure. Interferon gamma (IFNgamma) is considered to be the key cytokine responsible for resistance to M. tuberculosis infection, as confirmed by increased susceptibility to mycobacterial infections in rare inherited defects in IL-12-IFNgamma axis. The aim of this study was to assess the IFNgamma production by peripheral blood lymphocytes from immunocompetent tuberculosis (TB) patients. The study group included 51 TB patients. In all cases, TB was confirmed by culture. Twenty healthy TB contacts were considered as control group. Commercially available ELISA-based assays were used to measure IFNgamma in the supernatant of whole blood cell cultures after stimulation with PWM (Phytolacca Americana), PHA (phytohemagglutynin), and PPD (purified protein derivative). No difference in IFNgamma secretion between the patients and control group was found when blood cells were stimulated by PWM or PHA. PPD-induced IFNgamma formation was higher in TB patients than in controls. The secretion of IFNgamma after non-specific stimulation varied in different clinical and radiological presentation of tuberculosis and it was lower in most advanced and extensive forms of the disease. It is unclear whether the difference in formation and release of IFNgamma is a primary or secondary phenomenon in the course of the disease.
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Affiliation(s)
- J Winek
- National Tuberculosis and Chest Diseases Research Institute, Warsaw, Poland.
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