Tumorile neuroendocrine – de la concept la abordarea multidisciplinară (1) - Viața Medicală
Green Gate, Bd. Tudor Vladimirescu nr. We present a case of a solitary pulmonary nodule discovered in a patient with resected rectal carcinoma, irradiated and chemotreated controlled disease. The initial management was CT follow-up; because the neuroendocrine cancer run dimensions increased, the surgical resection was performed: wedge pulmonary resection and lymphadenectomy. The pathological diagnosis was stage IA lung adenocarcinoma.
A newly appeared solitary pulmonary nodule in a patient with a history of malignancy could be a metastasis, however could also be a second primary cancer - lung cancer.
Wedge pulmonary resection and lymphadenectomy is an appropriate surgical management for stage IA lung cancer in selected patients; this approach impose close follow-up for early detection of a local relapse. Diagnosticul anatomopatologic a fost de adenocarcinom pulmonar stadiul IA.
Solitary pulmonary nodules are usually asymptomatic and most frequently conceal lung cancer neuroendocrine cancer run.
Cancer risk increases with age, male gender and a smoking history. The nonneoplastic benign nodules are most commonly due to granulomas from prior infections and in our country, in a significant number of patients, they are caused by Mycobacterium tuberculosis 4.
Solitary pulmonary nodules in patients with a history of malignancy other than lung cancer have neuroendocrine cancer run higher chance of being metastatic. Still, due diligence of a solitary pulmonary nodule is to treat it as an indeterminate nodule, with the possibility of being lung cancer, metastasis or a benign lesion 2,5.
CT scan follow-up of the pulmonary nodule at 6 months revealed growth from 1. Figure 1.
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Native CT scan image of a left solitary pulmonary nodule presented case Figure 2. Contrast-enhanced CT scan image neuroendocrine cancer run the same solitary pulmonary nodule as in figure 1; the well-deligneated contour and the geographic area of endemic tuberculosis are benign criteria Results Following neuroendocrine cancer run of clinical and paraclinical investigations and maintenance of her arterial hypertension we proceeded to surgery, performing neuroendocrine cancer run nonanatomic resection of the left superior lobe.
The intraoperative frozen section histopathology showed carcinomatous infiltration without being able to distinguish a histological origin. The final paraffin embedded histological sections and immunohistochemical tests confirmed lung cancer: a poorly differentiated G3 adenocarcinoma, without lymph node metastasis, pathological stage IA, neuroendocrine cancer run.
The postoperative recovery was uneventfull, facilitated following a nonanatomical resection. The patient was forwarded towards the oncology ward.
The therapeutical decision was follow-up. Discussion Figure 3. Spiculated aspect of the nodule; this aspect and the upper neuroendocrine cancer run localization, the history of malignancy, age over 35 years, dimension over 2 cm and growth in time summarize the malignant characteristics of the solitary pulmonary nodule 6 The prevalence of solitary pulmonary nodules in the general population is unknown.
Higher rates are found in the elderly neuroendocrine cancer run, neuroendocrine cancer run smokers, in patients with nonthoracic neoplasms and in patients who are at risk for mycobacterial or fungal infections 2,6.
In Romania, there is no protocol for screening solitary pulmonary nodules or lung cancer. Owing to its superior resolution, high-resolution CT is a sensitive technique for identifying pulmonary neuroendocrine cancer run 4.
The American College of Chest Physicians developed an evidence-based clinical guideline to help establish the probability of malignancy of a pulmonary nodule 1. Predictors of malignancy include: older age, current or past smoking, history of extrathoracic cancer in the last 5 years, nodule diameter, spiculation and upper lobe location 2,5. PET-CT is a noninvasive functional imaging modality used virus del papiloma humano en alto riesgo diagnosis, staging and neuroendocrine cancer run of treatment response of lung cancer.
PET-CT is not indicated for nodules that are under 0.
For lesions that are located in the center of the lung, we can use bronchoscopy with fluoroscopic guidance 9. For nodules situated in the neuroendocrine cancer run third of the lung, transthoracic needle biopsy can help obtain a diagnosis. With a higher number of biopsy samples taken and a good on-site cytopathologyst, one may obtain a higher rate neuroendocrine cancer run positive results However, the imaging characteristics figures 1, 2, 3 classified it as an indeterminate nodule, and neuroendocrine cancer run compelled us to also consider lung cancer as a possibility.
Our thoracic neuroendocrine cancer run clinic in National Institute of Oncology proposed in a protocol for solitary neuroendocrine cancer run based on the existence of a CT scan available, 1.
American College of Chest Physicians. Evaluation of patients with pulmonary nodules: when is it lung cancer? Solitary Pulmonary Nodule. Shileds TW.
Pathology of Carcinoma of the Lung. Nodulul pulmonar solitar - cazuri operate. Chirurgia, 2 : Cancerul bronhopulmonar. In: Popescu I, ed. Tratat de Chirurgie, Horvat T ed, Vol.
Horvat T, Nicodin A. Tratamentul chirurgical in cancerul bronhopulmonar.
The patient agreed to undergo our local protocol for a solitary pulmonary nodule: surveillance and CT scan follow-up after 6 months revealed a growth of 1cm in diameter. Considering she had multiple predictors of malignancy: growth neuroendocrine cancer run time, extra thoracic cancer in the last 5 years, the nodule was in an upper lobe of the left lungwe decided that the best conduct is surgery. Conclusions A newly appeared solitary pulmonary nodule in a patient with a history of malignancy could be a metastasis, however could also be a second primary cancer - lung cancer.
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Wedge pulmonary resection and lymphadenectomy is an appropriate surgical management for stage IA lung cancer in selected patients; this approach imposes close follow-up for early detection of a local relapse. Editura Universul, Bucuresti, ; Investigation and management of the indeterminate pulmonary nodule.
Churchill-Livingstone, London, Radiologic Evaluation of Lung Cancer. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis.
Solitary pulmonary nodule. Updated: Apr 30,accessed at Neuroendocrine cancer run 17, Until trastuzumab erathe HER-2 overexpression was a negative prognostic factor and lead to a poor treatment outcome. Modern treatment is represented by combination of chemotherapy and therapies addressed to HER-2 - among classic trastuzumab, lapatinib, TDM -1 trastuzumab etamsine and pertuzumab, new neuroendocrine cancer run arise - neoadjuvant pertuzumab, and a new potential treatment with a another TKI tyrosine kinase inhibitor - Neratinib.
In our country there is only trastuzumab available after submission of documents and approval from National Health Insurance Housewith 2 routes of administration IV-intravenous and SC- subcutanein adjuvant, metastatic and recently in neoadjuvant setting.
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For Romania, breast cancer is still a major problem, taking in account the lack of a consistent national health screening program, late stage diagnosis and high mortality rates. Data regarding safety neuroendocrine cancer run are also shown especially concerning cardiac toxicity. Considering that efficient screening programs and multidisciplinary teams are available, by using neoadjuvant treatment, neuroendocrine cancer run survival and esthetic results are obtained; this option will be more detailed.
A mention will be made neuroendocrine cancer run the surgical interventions needed.