The lung is a common site for metastasis of malignant tumors from other organs. The metastatic cascade is a complex process that involves a series of events. Tumors can spread to the lung through hematogenous or lymphangitic routes. In the absence of extrathoracic metastasis, complete resection is associated with increased survival, regardless of histology. With appropriate patient selection, life expectancy is often improved with pulmonary metastasectomy. Stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) are 2 approaches that have been increasingly reported for pulmonary tumors. Although these new therapies have yet to match the long-term success rates of surgical therapy, the techniques demonstrate good results in treating high-risk surgical candidates with metastatic lesions to the lungs that would otherwise be considered with resection. This review will focus on the role of local therapy in oligometastasis that arise in the lung.
Life Expectancy ; Lung ; Metastasectomy ; Neoplasm Metastasis ; Patient Selection

Protein-losing enteropathy (PLE) is a syndrome characterized by excessive gastrointestinal protein loss, resulting in hypoproteinemia and edema. A variety of benign and malignant conditions can be associated with PLE and acute leukemia is a very rare cause of PLE. We report a case of PLE associated with acute lymphoblastic leukemia. A 27-year-old man was admitted due to watery diarrhea, epigastric pain and bilateral leg edema. Laboratory findings showed hypoproteinemia and polycythemia. The diagnosis of PLE and acute lymphoblastic leukemia were confirmed on the measurement of fecal alpha1-antitrypsin clearance and bone marrow examination. After systemic chemotherapy and autologous stem cell transplantation, his clinical symptoms and abnormal laboratory findings were gradually improved.
Adult ; Bone Marrow Cells/pathology ; Endoscopy, Gastrointestinal ; Humans ; Magnetic Resonance Imaging ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*diagnosis/genetics ; Protein-Losing Enteropathies/complications/*diagnosis ; Thoracic Vertebrae/radiography ; Tomography, X-Ray Computed ; Translocation, Genetic ; alpha 1-Antitrypsin/analysis

A central nervous system (CNS) relapse is a rare but mostly fatal complication in patients with diffuse large B cell lymphoma (DLBCL). CNS involvement can occur as an isolated event or can be combined with progression of systemic disease. There are limited data on treatment outcomes of patients with DLBCL and secondary CNS involvement. We report the clinical data, treatments, and outcomes of two DLBCL patients with isolated CNS relapses involving the brain parenchyma. Isolated CNS disease involving the brain parenchyma may be potentially treatable as the initial relapse site after complete remission from systemic treatment.
Brain* ; Central Nervous System ; Central Nervous System Diseases ; Humans ; Lymphoma, B-Cell* ; Lymphoma, Large B-Cell, Diffuse ; Recurrence*

PURPOSE: We have examined the expression of c-erbB-2 oncogene in sera and tissues of non-small cell lung cancer patients. MATERIALS AND METHODS: Serum levels of c-erbB-2 protein were measured by an enzyme im munoassay in 55 patients with non-small cell lung cancer. Sera from patients with surgical therapy were evaluated again after surgery. Immunohistochemical staining was performed in 47 of these tumors. RESULTS: Elevated levels (> or =45 U/mL, control mean 2SD) were observed in 15% of 55 non-small cell lung cancer patients, as compared with none of control subjects (p<0.05). The incidence of elevated level was higher in the adenocarcinoma than squamous cell carcinoma (22% vs 4%, p<0.01). The serum levels of c-erbB-2 protein decreased significantly after surgical tumor ablation (p<0.01). Tissue overexpression was obtained in 23/47 cases (49%). The incidence of c-erbB-2 overexpression was higher in the adenocarcinoma (73% vs 29%, p<0.005). No relationship was found between c-erbB-2 protein expression in serum and tumor tissue and clinicopathologic feature. Elevated serum c-erbB-2 levels predicted tissue overexpression with sensitivity 30% and specificity 96%. There was relationship between serum level and expression in tumor tissue of c-erbB-2 protein. CONCLUSION: Serum and tissue levels of c-erbB-2 correlate in patients with non-small cell carcinoma. Serum c-erbB-2 protein may be a useful indicator of tumor burden in patients with non-small cell lung cancer.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Humans ; Incidence ; Oncogenes ; Receptor, erbB-2* ; Sensitivity and Specificity ; Tumor Burden

The idiopathic hypereosinophilic syndrome consists of peripheral blood eosinophilia of 1500/mm3 or more without a known cause, plus signs and symptoms of organ eosinophilia. The prognosis of HES without treatment is poor. However, about one third of the patients with this syndrome may respond to corticosteroid thrapy. Morever, the majority of the remainder may have a favorable response to hydroxyurea. We present here a case of hypereosinophilic syndrome without any identifiable causes, involving bone marrow, liver, lungs and cervical lymph node. We tried corticosteroid as a treatment but it showed no response. However the hydroxyurea showed good response.
Bone Marrow ; Eosinophilia ; Humans ; Hydroxyurea ; Hypereosinophilic Syndrome ; Liver ; Lung ; Lymph Nodes ; Prognosis

Renal cell carcinoma is well known for its tendency to metastasize early to the lung, bone, and liver, but skeletal muscle is an extremely unusual site of metastasis. We report here on an unusual case with numerous skeletal muscle metastases in the posterior abdominal wall and buttock 2 years after radical nephrectomy for renal cell carcinoma.
Abdominal Wall ; Buttocks ; Carcinoma, Renal Cell* ; Liver ; Lung ; Muscle, Skeletal* ; Neoplasm Metastasis* ; Nephrectomy*

BACKGROUND: The possibility of cord blood transplantation in adults was limited by the amount of cord blood that could be collected. Cord blood transplantation after ex vivo expansion with cytokines have already been tried in adults. Amifostine is a phosphorylated aminothiol that affords broad cytoprotection from the myelosuppressive effects of antineoplastic agents. The purposes of this study were to investigate expansion of progenitor and myeloid cells after ex vivo culture of mononuclear cells (MNCs) in umbilical cord blood with growth factor and characterize hematopoietic activities of amifostine. METHODS: MNCs were cultured and ex vivo expanded into myeloid progenitors by using hematopoietic growth factors (IL-1beta, IL-3, IL-6, G-CSF, GM-CSF, SCF, EPO) which are known to stimulate differentiation and proliferation of myeloid progenitors. MNCs exposed to the appropriate amount of amifostine for 15 min were cultured in semisolid media and harvested at 24h intervals, and then apoptosis was assessed by propidium iodide staining. RESULTS: Myeloid colonies were successfully produced from MNCs. Maximal expansion was obtained with the combination of IL-3+SCF+G-CSF+GM-CSF. SCF was thought to be the most important growth factor for expansion of myeloid progenitor. Pretreatment with amifostine for 15 min stimulated formation of hematopoietic colonies at clinically relevant concentrations ranging from 1 to 100 micrometer. Increase in colony number compare to control were comparable after pretreatment with amifostine (10micrometer), and CFU-GEMM and BFU-E were highly responsive. Further enhancement of colony was not observed after prolonging the duration of pre- incubation exposure to 1, 8 and 24 hours. Amifostine enhanced IL-1 and IL-3 induced formation of CFU-GEMM and BFU-E. Incubation of MNCs with amifostine in suspension culture increased recovery of secondary colonies. Treatment with amifostine retarded cell loss and apoptosis, and promoted cell survival at 24, 48 and 72 hours in cytokine-deficient medium. CONCLUSION: Cord blood MNCs can be successfully expanded into myeloid progenitors by using hematopoietic growth factors. This investigation extend the previously recognized hematologic effects of amifostine, and indicate that in addition to its cytoprotective properties, amifostine is a stimulant of hematopoietic progenitor growth.
Adult ; Amifostine* ; Antineoplastic Agents ; Apoptosis ; Cell Survival ; Cytokines ; Cytoprotection ; Erythroid Precursor Cells ; Fetal Blood ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Intercellular Signaling Peptides and Proteins ; Interleukin-1 ; Interleukin-3 ; Interleukin-6 ; Myeloid Cells ; Myeloid Progenitor Cells ; Propidium

Essential thrombocythemia (ET), a subcategory of chronic myeloproliferative disorder, is characterized by absolute thrombocytosis due to excessive clonal proliferation of platelets, hyperaggregability of platelets, and increased incidence of thrombosis and hemorrhage. We consider a diagnosis of ET when an unexplained and persistent thrombocytosis is observed. It is difficult to consider ET first when we meet a patient with esophageal varix bleeding or unusual multiple thromboses like mesenteric vein, splenic vein, and portal vein. This article reports a patient who presented initially with esophageal varix bleeding and unusual multiple thromboses, thereafter, she was diagnosed with ET after testing positive for the Janus Tyrosine Kinase 2 (JAK2) V617F mutation. In conclusion, in patients with varix bleeding and unusual multiple thromboses, myeloproliferative disorders like essential thrombocythemia should be considered as a potential cause and testing for the JAK2 mutation is warranted.
Blood Platelets ; Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Incidence ; Mesenteric Veins ; Myeloproliferative Disorders ; Portal Vein ; Splenic Vein ; Thrombocythemia, Essential ; Thrombocytosis ; Thrombosis ; TYK2 Kinase ; Varicose Veins

TNF-alpha mediated apoptosis of the hematopoietic cells has been thought to contribute to the ineffective hematopoiesis observed in myelodysplastic syndrome (MDS). The combination of pentoxifylline (P) and ciprofloxacin (C) has been shown to reduce the serum levels of TNF-alpha, and an earlier trial of P and C with dexamethasone (D) provided good palliation for patients with MDS. The purpose of this study is to assess the hematologic response to PCD therapy for patients suffering with MDS. 21 of 25 patients who completed at least of 12 weeks of treatment were evaluable for the treatment efficacy. At baseline, the patient's median age was 60 yr (range: 18-75 yr). The diagnoses according to WHO classification included: RA (n=5), RCMD (n=10), RARS (n=1), RCMD/RS (n=1), RAEB (3), and CMML (n=1). 11 patients (52%) had at least single lineage response. 3 patients (11%) showed improvement of triple lineage cytopenia. There were no differences in the response rates between the FAB subtypes. The median time to response was 4 weeks (range: 2-12 weeks), and it is interesting that 9 of 11 patients who had a response remained without relapse for a median of 177 days (range: 78-634 days). These preliminary results indicate that anti-cytokine therapy with PCD is an effective and well tolerated palliative treatment for patients with MDS.
Adolescent ; Adult ; Aged ; Anti-Infective Agents/adverse effects/therapeutic use ; Anti-Inflammatory Agents/adverse effects/therapeutic use ; Apoptosis/*drug effects ; Ciprofloxacin/adverse effects/therapeutic use ; Comparative Study ; Dexamethasone/adverse effects/therapeutic use ; Drug Therapy, Combination ; Erythrocyte Count ; Female ; Hematologic Agents/adverse effects/therapeutic use ; Humans ; Male ; Middle Aged ; Myelodysplastic Syndromes/*blood/drug therapy ; Nausea/chemically induced ; Pentoxifylline/adverse effects/therapeutic use ; Platelet Count ; Time Factors ; Treatment Outcome ; Tumor Necrosis Factor-alpha/*metabolism

PURPOSE: This study was conducted to evaluate the efficacy and safety of combination chemotherapy, with docetaxel and cisplatin, as a first line treatment for advanced non-small cell lung cancer. MATERIALS AND METHODS: Between March 1998 and December 2001, 35 patients with advanced non-small cell lung cancer were enrolled in this study. The patients were treated at 3-week intervals, with one course of a regimen consisting of docetaxel (75 mg/m2 IV for 1 hours) on day 1 and cisplatin (60 mg/m2 IV) on day 2. RESULTS: The median age of the patients was 60.3 years. Of the 35 patients, 20 and 15 had stage IIIb and stage IV diseases, respectively. A complete response was observed in 1 patient and partial response in 15, with an overall response rate of 46%. The overall median survival duration was 40.3+/-25.2 weeks. The median time to progression and response duration were 21.6+/-5.5 and 15.1+/-5.9 weeks, respectively. The survival duration was statistically significantly longer in the response group (50.6 weeks) than in the non-response group (31.6 weeks) (p<0.05). Of the hematological side effects, grades III and IV leukopenia were observed in 4.8% of patients. Grades III and IV nausea and vomiting were observed in 48.5%, and grades I and II neuropathy in 11.4% of the treated patients. These toxicities were well tolerable and reversible. There were no hypersensitivity reactions. CONCLUSION: Docetaxel and cisplatin combination chemotherapy is relatively effective and safe in advanced non-small cell lung cancer patients.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy, Combination* ; Humans ; Hypersensitivity ; Leukopenia ; Nausea ; Vomiting