Lung cancer is a malignant tumor that is often fatal. Vaginal metastasis of pulmonary adenocarcinoma is very rare. To the best of our knowledge, this is the second such report worldwide and the first one from Korea. A 67-year-old woman presented with cough, excessive sputum and dyspnea that she had sufferd with for the past one year and she had a palpable lesion in the vagina. Chest CT showed diffuse bronchial wall thickening involving the left main bronchus, the left upper lobar bronchus and the lingular divisional bronchus of the left upper lobe. There were multiple, various sized nodules in both lungs, of which the largest one measured about 1.0 cm in diameter. Both lung and vaginal biopsies were performed and the masses were diagnosed as adenocarcinoma. Immunohistochemically, the tumor cells were positive for cytokeratin 7 and TTF-1, but they were negative for cytokeratin 20. We present this case of primary lung adenocarcinoma metastasis to the vagina.
Adenocarcinoma ; Aged ; Biopsy ; Bronchi ; Cough ; Dyspnea ; Female ; Humans ; Keratin-20 ; Keratin-7 ; Korea ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Sputum ; Thorax ; Vagina

PURPOSE: Primary lung tumors in children and adolescents are uncommon. We report here on the clinical presentations, the methods of treatment, the results and the outcomes of a series of children with these rare tumors. MATERIALS AND METHODS: We conducted a retrospective review on all the patients less than 19 years of age with primary lung tumors and who were treated at Samsung Medical Center between 1995 and 2009. Twenty two cases of primary lung tumors were reviewed and the clinical-pathological information concerning the tumor characteristics, the therapy and the follow-up was collected. RESULTS: The average age of the 10 male patients and 12 female patients was 11.5 years (range: 3 months to 18 years). Of the 22 primary lung tumors, 18.2% (4/22) were benign, 36.4% (8/22) were of borderline malignancy and 45.4% (10/22) were malignant. The pathologic types were inflammatory myofibroblastic tumor (6/22), mucoepidermoid carcinoma (4), pleuropulmonary blastoma (2), adenocarcinoma (1), alveolar soft part sarcoma (1), malignant lymphoma (1), leiomyoma (1), pulmonary leiomyomatous hamartoma (1), congenital pulmonary myofibroblastic tumor (1), Langerhans' cell histiocytosis (1), neurilemmoma (1), sclerosing pneumocytoma (so-called sclerosing hemangioma) (1) and atypical carcinoid tumor (1). After surgery for the benign tumors, no postoperative recurrence was been observed during long-term follow-up. All the patients with the benign tumors were alive with no evidence of disease. For the patients with the tumors of borderline malignancy, one patient experienced recurrence, but there was no death from disease. For the group with malignant tumors, two patients died from untreatable metastatic disease and 8 patients survived their disease on the long-term follow-up. CONCLUSION: The primary lung tumors during childhood and adolescence had different characteristics compared with their adult counterparts with respect to the incidence and prognosis. These facts must be considered when making the diagnosis and deciding on proper therapy.
Adenocarcinoma ; Adolescent ; Adult ; Carcinoid Tumor ; Carcinoma, Mucoepidermoid ; Child ; Female ; Follow-Up Studies ; Hamartoma ; Histiocytosis ; Humans ; Incidence ; Leiomyoma ; Lung ; Lymphoma ; Male ; Myofibroblasts ; Neurilemmoma ; Prognosis ; Pulmonary Blastoma ; Recurrence ; Retrospective Studies ; Sarcoma, Alveolar Soft Part

PURPOSE: Incidence of peripheral squamous cell carcinoma (pSCCs) of the lung has increased over recent years, but the immunohistochemical factors involved in pSCCs have not been well established. The aim of this study was to analyze the immunohistochemical differences between pSCCs and central-type SCCs (cSCCs), and similarities between pSCCs and peripheral adenocarcinomas (pADCs). MATERIALS AND METHODS: In this retrospective study, we investigated the expression of three potential prognostic factors (p53, Ki-67, t-CEA), and two potential therapeutic targets (epidermal growth factor receptor [EGFR], and c-erbB-2) in 263 surgically resected cases of primary SCC and pADCs of the lung from January 2001 to July 2008. We divided the SCCs between peripheral and central types, and compared the expression rates of markers between pSCCs and cSCCs, and between pSCCs and pADCs. RESULTS: In this study, there were 149 pADC cases, and among the 114 SCC cases, there were 41 pSCCs (36.0%). There were significantly higher expression rates of Ki-67 and EGFR in pSCCs than in cSCCs or pADCs (p=0.003, p=0.039, respectively). CONCLUSION: We found immunohistochemical differencies in pSCCs from cSCCs and pADCs.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Incidence ; Lung ; Lung Neoplasms ; Retrospective Studies

PURPOSE: T790M is a mechanism underlying acquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). We hypothesized that a synergistic combination of cytotoxic drugs and EGFR-TKIs may overcome resistance. MATERIALS AND METHODS: The antiproliferative effects and cell cycle distributions following treatments with Erlotinib (E) and cytotoxic drugs (C) were studied using a lung cancer cell line (NCI-H1975) harboring two mutations (L858R and T790M) in the EGFR gene. The cell viability assay and cell cycle analysis were conducted via an MTT assay and flow cytometry. The results of the treatments in different sequences were assessed using the combination index. RESULTS: Antagonisms were noted when erlotinib was administered before cytotoxic drugs (EC sequence), whereas synergisms were observed when pre-treatment with cytotoxic drugs was administered before erlotinib (CE sequence). Treatment in the EC sequence arrested the cells in G0/G1 phase and reduced the apoptotic fraction. However, treatment in the CE sequence arrested the cells in the G2/M and S phase and a trend toward higher fractions of apoptotic cell death was observed. CONCLUSION: Our studies demonstrated a schedule-dependent effect of cytotoxic drugs and erlotinib in an NSCLC cell line with the T790M mutation. Sequential treatment may overcome EGFR-TKI resistance.
Carcinoma, Non-Small-Cell Lung ; Cell Cycle ; Cell Death ; Cell Line ; Cell Survival ; Flow Cytometry ; Genes, erbB-1 ; Lung ; Lung Neoplasms ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; S Phase ; Erlotinib Hydrochloride

In this article, the modern concepts of computer-aided diagnosis (CAD), the methods of pulmonary nodule detection, and facts derived from the literature on the pulmonary nodule differential CAD are compiled in one source and described in some detail. Several issues in lung cancer (LC) epidemiology and early diagnosis are discussed. Analysis of research done so far shows evidence that various CAD systems can be successfully applied to chest radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). These modalities can serve as useful potential alternative tools available to practicing medical professionals performing routine diagnostics.
Diagnosis, Differential ; Diagnostic Imaging ; Early Diagnosis ; Lung Neoplasms ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Thorax

Over the last decade, intense interest has been focused on discovery of biomarkers and their clinical uses. Lung cancer biomarker discovery has particular eminence in this field due to its anticipated critical role in risk stratification, early detection, treatment selection, prognostication, and monitoring for recurrence of cancer. Significant progress has been made in our understanding of the steps involved in lung carcinogenesis and in development of novel technologies for biomarker discovery. The most active areas of research have been in promoter hypermethylation, proteomics, and genomics. Many investigators have adopted panels of serum biomarkers in an attempt to increase sensitivity. Markers for identification of lung cancer patients who may benefit from targeted therapy have been developed more rapidly. Development of targeted lung cancer therapy has engendered interest in markers for identification of optimal candidates for these therapies. Despite extensive study to date, few have turned out to be useful in the clinic. Even those used in the clinic do not show enough sensitivity, specificity, and reproducibility for general use. All biomarkers identified so far must be validated in larger clinical cohorts.
Biomarkers ; Cohort Studies ; Genomics ; Humans ; Lung ; Lung Neoplasms ; Proteomics ; Recurrence ; Research Personnel ; Sensitivity and Specificity

More effective treatments in first, second, and third-line of metastatic non-small cell lung cancer (NSCLC) enable patients to live longer, with a better quality of life (QOL). Especially epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) contributed to this improvement. Gefitinib was compared with Docetaxel in four randomized trials, i.e., SIGN, Japanese V-1532, Korean ISTANA, and INTEREST in second or third-line treatment of metastatic NSCLC. In all the trials, and also by meta-analysis of 2,257 patients in these trials, Gefitinib was found non-inferior or superior to Docetaxel, with less toxicity, convenient oral administration, and better QOL. Detailed results are presented in the review article. Knowing that every line of treatment we may lose about 50% of patients for further treatment, it is very important to offer each patient the best option for every line of treatment. Gefitinib has a favorable benefit-risk profile compared with Docetaxel in this patient population.
Administration, Oral ; Asian Continental Ancestry Group ; Carcinoma, Non-Small-Cell Lung ; Humans ; Oligosaccharides ; Protein-Tyrosine Kinases ; Quality of Life ; Quinazolines ; Receptor, Epidermal Growth Factor ; Taxoids

For Stereotactic Radiosurgery of lung tumor, 4 dimensional CT was done during for free breathing of the patient. The movement of the treated target was measured in the CT images, and appropriate breathing cycle was selected for treatment. For patient A, the movement of the treatment target was 10.1 mm during full breathing cycle, and 5.4 mm for treated breathing cycle, 30~70%. For patient B, the movement was 13 mm, and 3.5 mm for full breathing cycle and treated breathing cycle, respectively.
Four-Dimensional Computed Tomography* ; Humans ; Lung Neoplasms* ; Lung* ; Radiosurgery* ; Respiration

We present herein an unusual case of multilocular thymic cyst, with prominent lymphoid follicular hyperplasia, in a 64-year-old man. It was incidentally founded as a mediastinal mass on chest radiography, during a routine health check-up. Computed tomography revealed a cystic lesion, which contains thick septa involving the thymus. The resected mass, 8x4 cm in diameter, involved the thymus and there is no adhesion or invasion into the adjacent tissue. The cut surface showed cystic spaces with thick white-tan firm wall, which cysts contained gelatinous material. Microscopically, the lesion was characterized by multiple cysts, lined by flattened cuboidal epithelium that was separated by thick walls, having a dense lymphoid tissue with lymphoid follicles. The patient was discharged without any complication and is well without evidence of recurrence for sixteen months.
Epithelium ; Gelatin ; Humans ; Hyperplasia ; Lymphoid Tissue ; Mediastinal Cyst ; Mediastinal Diseases ; Middle Aged ; Recurrence ; Thorax ; Thymus Gland

PURPOSE: There is evidence supporting the concept of tumor progression from pulmonary adenocarcinoma in situ (formerly bronchioloalveolar carcinoma, BAC) to adenocarcinoma with varying degrees of invasion. The aim of this study was to investigate the role of transforming growth factor beta1 (TGFbeta1) in tumor invasiveness in lung adenocarcinoma, and to determine the potential relationships between its expression and immunophenotypes of cell adhesion molecules. MATERIALS AND METHODS: Tumor samples from adenocarcinoma in situ (n=13), minimally invasive adenocarcinoma (formerly BAC with < or =5 mm invasion, n=2), and lepidic predominant invasive adenocarcinoma (formerly mixed adenocarcinoma showing non-mucinous BAC features with >5 mm invasion, n=25) were examined for the expression of TGFbeta1, E-cadherin, N-cadherin, and H-cadherin proteins using immunohistochemistry. RESULTS: Of a total of 40 cases, 25 (63%) were positive for TGFbeta1. The frequency of immunoreactivity in patients with adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidic predominant invasive adenocarcinoma was 23% (3/13), 50% (1/2), and 84% (21/25), respectively (p=0.001). TGFbeta1 correlated with T classification (p=0.006) and stage (p=0.001). Loss of E-cadherin expression was more frequently observed in invasive adenocarcinomas than in adenocarcinomas in situ (p=0.034). E-cadherin expression inversely correlated with T classification (p=0.009). TGFbeta1 expression showed a statistically significant correlation with H-cadherin expression (p=0.040), but not with E-cadherin expression (p=0.752). CONCLUSION: These results suggest that TGFbeta1 and E-cadherin may play an important role in invasive progression of lung adenocarcinoma through regulating epithelial-to-mesenchymal transition.
Adenocarcinoma ; Adenocarcinoma, Bronchiolo-Alveolar ; Cadherins ; Cell Adhesion ; Humans ; Lung ; Lung Neoplasms ; Proteins ; Transforming Growth Factor beta1 ; Transforming Growth Factors