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Celidonio J, Bahethi R, Malhotra R, Yan K. Acute myeloid leukemia: An unusual manifestation of the trachea. Laryngoscope Investig Otolaryngol 2024; 9:e1231. [PMID: 38525124 PMCID: PMC10960239 DOI: 10.1002/lio2.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/16/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives Hematologic malignancy involving the trachea is rare. It is even less common for tracheal involvement to be the initial manifestation of this disease. We present a case report highlighting an unusual diagnosis of acute myeloid leukemia (AML) that first presented with prominent tracheal manifestations. There have been only three other published case reports of extramedullary AML with involvement of the trachea. Methods We discuss direct laryngoscopy and bronchoscopy findings, including pinkish-white irregular lesions, which were similar to findings described in the available literature for tracheal AML. Results Laboratory findings from our case are reported, including peripheral smear demonstrating 57% blasts and bone marrow biopsy confirming the diagnosis of AML, and the relevance of these findings is discussed. Conclusion In patients with unusual airway lesions, laboratory testing and a comprehensive airway evaluation including biopsy are necessary to narrow the differential diagnosis. Level of Evidence 5.
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Affiliation(s)
- Joseph Celidonio
- Department of Otolaryngology – Head and Neck SurgeryRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Rohini Bahethi
- Department of Otolaryngology – Head and Neck SurgeryRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Raj Malhotra
- Department of Otolaryngology – Head and Neck SurgeryRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Kenneth Yan
- Department of Otolaryngology – Head and Neck SurgeryRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
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Verma S, Singh MM, Kakkar L, Thakur PB, Deswal S. Endobronchial Squamous Cell Carcinoma Presenting as Long Continuous Bronchial Thickening on 18Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. Indian J Nucl Med 2023; 38:307-309. [PMID: 38046979 PMCID: PMC10693367 DOI: 10.4103/ijnm.ijnm_19_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/29/2023] [Indexed: 12/05/2023] Open
Abstract
A 67-year-old man is presented with complaints of chest pain and productive cough for 1½ years. Chest X-ray was suggestive of right upper lobe Koch's lesion. Sputum was positive for mycobacterium tuberculosis. His symptoms got relieved partially by antitubercular treatment but the patient had an aggravation of symptoms for which he was evaluated. Computed tomography (CT) thorax revealed an endobronchial lesion in the right upper lobe bronchus. Bronchoscopy showed a mass in the right main bronchus and biopsy was suggestive of moderately differentiated squamous cell carcinoma (SCC). 18Fluoro-deoxy-glucose positron emission tomography/CT was performed for staging. There would have been chances of coexisting tuberculosis with SCC.
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Affiliation(s)
- Shashwat Verma
- Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Man Mohan Singh
- Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Lavish Kakkar
- Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyamedha Bose Thakur
- Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Satyawati Deswal
- Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Li D, Li Z, Li S, Zhang H, Yao S, Li Y, Chen J. Development and Validation of a Prediction Model for Positive Findings of Preoperative Flexible Bronchoscopy in Patients with Peripheral Lung Cancer. Curr Oncol 2022; 30:315-325. [PMID: 36661674 PMCID: PMC9858296 DOI: 10.3390/curroncol30010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: It has yet to be determined whether preoperative flexible bronchoscopy (FB) should be routinely performed in patients with peripheral lung cancer. The aim of this study was to construct a model to predict the probability of positive FB findings, which would help assess the necessity of preoperative FB. (2) Methods: A total of 380 consecutive patients with peripheral lung cancer who underwent preoperative FB were recruited for this study. A prediction model was developed through univariate and multivariate logistic regression, with predictors including gender, age, body mass index (BMI), smoking, history of chronic lung diseases, respiratory symptoms, lesion size, lesion type, lesion location in the bronchi, and lesion location in the lobe. The predictive performance of the model was evaluated by validation using 1000 iterations of bootstrap resampling. Model discrimination was assessed using the area under the receiver operating characteristics curve (AUC), and calibration was assessed using the Brier score and calibration plots. (3) Results: The model suggested that male patients with respiratory symptoms, decreased BMI, solid lesions, and lesions located in lower-order bronchi were more likely to have positive FB findings. The AUC and Brier score of the model for internal validation were 0.784 and 0.162, respectively. The calibration curve for the probability of positive FB findings showed convincing concordance between the predicted and actual results. (4) Conclusions: Our prediction model estimated the pretest probability of positive FB findings in patients with peripheral lung cancers. Males and patients with lower BMI, the presence of respiratory symptoms, larger lesions, solid lesions, and lesions located in lower-order bronchi were associated with increased positive FB findings. The use of our model can be of assistance when making clinical decisions about preoperative FB.
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Affiliation(s)
- Dongyu Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
- Yuncheng Central Hospital, Yuncheng 044000, China
| | - Zaishan Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Shaolei Li
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Hongbing Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Siqing Yao
- Yuncheng Central Hospital, Yuncheng 044000, China
| | - Yi Li
- Yuncheng Central Hospital, Yuncheng 044000, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
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The prognosis of non-small cell lung cancer patients according to endobronchial metastatic lesion. Sci Rep 2022; 12:13588. [PMID: 35948652 PMCID: PMC9365769 DOI: 10.1038/s41598-022-17918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/02/2022] [Indexed: 11/09/2022] Open
Abstract
To evaluate the prognosis of non-small cell lung cancer (NSCLC) patients according to endobronchial metastatic lesion (EML), especially those not identified on positron emission tomography or computed tomography. We evaluated progression-free survival (PFS) and overall survival (OS) according to the presence of EML in patients with NSCLC who were diagnosed at a tertiary hospital between January 2010 and December 2019. A total of 364 patients were enrolled in this study. EML was found in 69 (19.0%) patients with NSCLC. In the patients with EML versus the patients without EML, median PFS was 7.0 (3.5–13.5) and 9.5 (5.5–17.5) months (P = 0.011), and median OS was 12.0 (6.0–30.0) versus 20.0 (10.0–39.0) months (P = 0.016), respectively. Median PFS and OS rates were highest in epidermal growth factor receptor (EGFR) (+) and EML (−) patients and lowest in EGFR (−) and EML (+) patients (P < 0.001). By multivariate cox regression analysis, PFS in overall patients with NSCLC was significantly associated with EML, EGFR mutation, performance status, and pleural effusion. NSCLC patients with EML had worse prognoses of PFS and OS than patients without EML.
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5
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Inter-observer agreement on the morphology of screening-detected lung cancer: beyond pulmonary nodules and masses. Eur Radiol 2019; 29:3862-3870. [DOI: 10.1007/s00330-019-06243-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/28/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
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Yoon SH, Goo JM, Lee CH, Cho JY, Kim DW, Kim HJ, Paeng JC, Kim YT. Virtual reality-assisted localization and three-dimensional printing-enhanced multidisciplinary decision to treat radiologically occult superficial endobronchial lung cancer. Thorac Cancer 2018; 9:1525-1527. [PMID: 30253072 PMCID: PMC6209781 DOI: 10.1111/1759-7714.12879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 08/26/2018] [Indexed: 11/27/2022] Open
Abstract
Herein, we report the unique case of a 75‐year‐old male patient who had undergone a left upper lobectomy for lung cancer and developed an incidental superficial endobronchial squamous cell carcinoma in the right upper lobe that was not localizable on modern cross‐sectional imaging modalities. The superficial endobronchial squamous cell carcinoma was successfully localized by computed tomography‐driven virtual reality endoscopy and was identically matched with a small, whitish, patch lesion on bronchoscopy. The localized lesion was annotated on the corresponding computed tomography images, and illustrated in a fabricated three‐dimensional (3D)‐printed airway model. Because the exact anatomic location of the lesion and the acute angle of the adjacent bronchial trajectory were visible in the 3D model, enhanced multidisciplinary consultation resulted in the decision to treat the lesion using photodynamic therapy. Photodynamic therapy was successfully performed without complications. A follow‐up bronchoscopy two months after treatment confirmed that the superficial endobronchial squamous cell carcinoma had been cured.
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Affiliation(s)
- Soon Ho Yoon
- Department of Radiology, Seoul National College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National College of Medicine, Seoul National University Hospital, Seoul, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Chang-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jae Young Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, South Korea
| | - Jin Cheol Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Minimally Invasive but Maximally Obstructive: Carcinoma In Situ Obstructing a Mainstem Bronchus. J Bronchology Interv Pulmonol 2017; 24:67-69. [PMID: 26905438 DOI: 10.1097/lbr.0000000000000219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Here we report a case of mainstem bronchus obstruction due to a carcinoma in situ. Preinvasive lesions, such as carcinoma in situ, are usually small and limited to the bronchial wall. This exceptional presentation shows a tumor growth large enough to completely occlude the right mainstem bronchus. The endoluminal lesion was removed using rigid bronchoscopy. The patient, not eligible for a local treatment, has been treated with surgery.
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Song Y, Choi YW, Paik SS, Han DH, Lee KY. Endobronchial squamous cell carcinoma presenting as localized, long, continuous bronchial thickening on CT. Eur J Radiol 2017. [PMID: 28629578 DOI: 10.1016/j.ejrad.2017.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To report pulmonary squamous cell carcinomas presenting as localized, long, continuous, bronchial thickening on computed tomography (CT). MATERIALS AND METHODS This study comprised five men (mean age, 66 years; range, 60-79 years) with pulmonary squamous cell carcinoma, including two (0.6%) selected from 310 consecutive patients with the diagnosis. Inclusion criteria were as follows: histological diagnosis obtained from thickened bronchi; continuous bronchial thickening >5cm in longitudinal extension on CT. CT scans were retrospectively reviewed, focusing on bronchial abnormalities. They were correlated with histopathological findings in four patients who underwent lobectomy. RESULTS On initial CT, bronchial thickening was continuous without skip area (n=5), measured 56-114mm in maximum longitudinal length, involved lobar (n=3) or segmental and distal bronchi (n=5) of the right upper (n=4) or lower (n=1) lobe, and was focally bulbous (n=2). Follow-up CT before treatment, available in two, showed progression of bronchial thickening in its thickness and longitudinal length (n=2) and a new bulbous portion (n=1) and peribronchial nodules (n=1) along the thickened bronchi. Cancer recurred after lobectomy in two, one of which manifested as continuous bronchial thickening extending from the bronchial stump on CT. On CT-histopathological correlation, bronchial thickening was mostly due to tumor spreading along the bronchus. A focal or short segmental tumor outgrowth from the thickened bronchi corresponded to a nodule or bulbous portion along thickened bronchi on CT, respectively. CONCLUSION Pulmonary squamous cell carcinoma may present as localized, long, continuous, bronchial thickening on CT, simulating benign infectious or inflammatory diseases.
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Affiliation(s)
- Yoonah Song
- Department of Radiology, Hanyang University Seoul Hospital, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea.
| | - Yo Won Choi
- Department of Radiology, Hanyang University Seoul Hospital, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea.
| | - Seung Sam Paik
- Department of Pathology, Hanyang University Seoul Hospital, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea.
| | - Dae Hee Han
- Department of Radiology, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-Gu, Seoul 06591, South Korea.
| | - Kyo Young Lee
- Department of Pathology, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-Gu, Seoul 06591, South Korea.
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Kim HJ, Kim DK, Kim YW, Lee YJ, Park JS, Cho YJ, Kim SJ, Yoon HI, Lee JH, Lee CT. Outcome of incidentally detected airway nodules. Eur Respir J 2016; 47:1510-7. [PMID: 27030677 DOI: 10.1183/13993003.01992-2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/13/2016] [Indexed: 12/18/2022]
Abstract
Low-dose chest computed tomography (LDCT) screening increased detection of airway nodules. Most nodules appear to be secretions, but pathological lesions may show similar findings. The National Comprehensive Cancer Network (NCCN) recommends repeating LDCT after 1 month and proceeding to bronchoscopy if the nodules persist. However, no reports exist about incidentally detected airway nodules. We investigated the significance of airway nodules detected by LDCT screening.We screened patients with incidental airway nodules detected by LDCT in the Seoul National University Hospital group. The characteristics of computed tomography, bronchoscopy, pathology and clinical findings were analysed.Among 53 036 individuals who underwent LDCT screening, 313 (0.6%) had airway nodules. Of these, 186 (59.4%) were followed-up with chest computed tomography and/or bronchoscopy. Seven (3.8%) cases had significant lesions, including leiomyoma (n=2), endobronchial tuberculosis (n=2), chronic inflammation (n=1), hamartoma (n=1) and benign granuloma (n=1). The remaining 179 lesions were transient, suggesting that they were secretions.The use of LDCT for lung cancer screening demonstrated the low incidence of airway lesions. Most lesions were transient secretions. True pathological lesions were rare, and no malignant lesion was found. The current recommendation of the NCCN guideline is a reasonable approach that can avoid unnecessary bronchoscopy.
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Affiliation(s)
- Hyung-Jun Kim
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
| | - Deog Kyeom Kim
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Whan Kim
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeon Joo Lee
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
| | - Jong Sun Park
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
| | - Young-Jae Cho
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
| | - Se Joong Kim
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
| | - Ho Il Yoon
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
| | - Jae Ho Lee
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
| | - Choon-Taek Lee
- Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea
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