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Alveolar adenoma — Two cases of a rare lung tumour
Preuention
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Alveolar adenoma - Two cases of a rare lung tumour
M. Almodovar, J. Dionisio, D. Matias, N Abecassis, O. Almeida.
chest X-ray screening reduce lung cancer death? A •7-9-] Can population-based case-control study in Gunma prefecture, Japan
Lisboa, Portugal Alveolar adenoma are very rare benign tumours, more frequent in middle aged woman. We present two cases of alveolar adenoma. Case one: a 55-year-old woman, non-smoker presented with cough for two years. Chest x-ray revealed a 4-cm round opacity in the upper right lobe that was confirmed by a CT scan, and no other abnormalities. Bronchofibroscopy was inconclusive and a CT guided biopsy of the mass revealed lung parenchyma. She underwent diagnostic and therapeutic surgery. Pathologic diagnosis was alveolar adenoma. She is alive and well seven years latter. Case two: A 77- year-old woman, non-smoker assymptomatic performed a Chest x-ray which revealed a 6-cm round opacity in the upper left lobe that was confirmed by a CT scan, that showed contact with pleura and mediastinum. Bronchofibroscopy was normal and two CT guided biopsies of the mass revealed lung parenchyma. She underwent diagnostic and therapeutic surgery. Pathologic diagnosis was alveolar adenoma. She is alive and well two years latter. Alveolar adenoma is a rare lung tumour with a difficult diagnosis and a good prognosis. Our first case has a typical presentation. In the second case the patient is older and the tumour larger than usual.
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Variant E1038G of the BRCA1 gene is associated with lung cancer in families with multiple breast/ovarian cancer relatives P. Yang, J, Jett, E. Bass, F. Couch. Mayo Clinic and Foundation,
Rochester, MN, USA It has been reported that lung cancer and breast/ovarian cancer aggregate within families. In addition, an elevated risk for lung cancer has been detected in individuals that carry BRCA1 mutations. The BRCA1 gene has been linked to the susceptibility of breast and ovarian cancer. Thus, we hypothesize that lung cancer in patients with a strong family history of breast and/or ovarian cancer may be associated with inherited BRCA1 alterations. To test this hypothesis, we have analyzed leukocyte DNA from 16 primary lung cancer patients for sequence changes in the BRCA1 gene. These patients were sequentially identified from an ongoing comprehensive lung cancer epidemiology research program in our institution, based on family history of three or more lung/breast/ovarian cancer relatives. Conformation Sensitive Gel Electrophoresis (CSGE), a PCR-based heteroduplex detection method, was used to screen the BRCA1 and BRCA2 genes for mutations. A total of 77 primer pairs were used to PCR amplify the entire coding region and all the exon-intron boundaries of these genes in lung cancer samples. The PCR products were then heteroduplexed and electrophoresced on polyacrylamide gels. Variants were detected due to altered mobility within the gel, and were sequenced to identify the specific base pair changes. Although no known gene mutations associated with development of breast and ovarian cancer were detected, we found that 13 of the 16 (81.3%) patients carried an E1038G sequence variant of BRCAI. This observed frequency is significantly greater (p < 0.001) than the reported frequency (23.8%) in a general female population from Quebec, Canada (Durocher, et al., 1996). The role of this variant in lung tumor development depends on the effect of its alteration on BRCA1 function, and on careful exclusion of potential confounding factors from the association analysis. Further investigation with a larger sample and proper controls is warranted.
227
T. Nakayama 1, T. Baba 2, T. Suzuki 1, M. Sagawa 3, M Kaneko4.
1Division of Epidemiology, Department of Field Research, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; 2Gunma Health Foundation, Maebashi; 3Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendal; 4Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan There is little evidence to confirm the usefulness of annual chest X-ray examinations (CXE) to prevent lung cancer death. In order to evaluate the efficacy of annual CXE lung cancer screening, a case-control study was conducted in Gunma Prefecture, Japan. Methods: In the study area, a population-based lung cancer screening program based on annual CXE has been conducted. In this study, 121 case subjects of high-risk males or non-high-risk females, aged 40-79, who died from lung cancer between 1992 and 1997, were collected. For each case, 3-5 controls (536 controls in total) matched by gender, year of birth, address and smoking habits were selected. Results: The smoking adjusted odds ratio (OR) of lung cancer death for those screened within 12 months before diagnosis vs. those not screened was 0.68 (95% confidence interval (CI): 0.44-1.05; p = 0.084). The ORs for adenocarcinoma and squamous cell carcinoma were 0.62 (95% Ch 0.31-1.24) and 1.01 (95% CI: 0.44-2.31), respectively. With an attempt to eliminate self-selection bias, the OR was 0.35 (95% Ch 0.15-0.81; p = 0.015). Conclusions: The results of the study suggested that up to 32% of the deaths attributable to lung cancer, especially adenocarcinoma, could be prevented by annual CXE. Since CXE proved ineffective for squamous cell carcinoma, further study concerning the evaluation of sputum cytology is necessary.
[7-•
True progress in survival of patients (pts) with small cell lung cancer (SCLC) over a period of 14 years
E. Quoix 1, M R Lebitasy 2, G. Hedelin 2, F. Klinzig 1 , A. Purohit 1, L. Moreau 1, B. Mennecier 1. 1Dept. of Pneumology, University
Hospital; 2Dept. of Epidemioly Louis Pasteur University, Strasbourg, France Recent analyses of series of SCLC pts included in clinical trials have shown that survival was improved overtime. Whether this was due to a selection bias or to the Will Rogers phenomenon or to a true therapeutic improvement could not be determined. We reviewed the medical records of all consecutive pts diagnosed as SCLC between 1981 and 1994 in a french department, the Bas-Rhin. 787 pts (83.4% of all eligible pts) were included in our study. There were 696 males, median age was 63 years. There was no significant period effect for sex, age, occupation, living place. On the other hand there was a significant period effect for the work-up performed to evaluate extent of disease. There was a significant correlation between the mean number of investigations and the mean number of sites involved by tumor. 76.4% of pts were treated with chemotherapy between 1981 and 1983, 84.7% between 1987 and 1989 and 91.7% in 1993 and 1994. Mediastinal radiotherapy was administered to 52.9% of pts between 1981 and 1983, 29% of pts between 1984 and 1986 and then to around 24-25% of pts. The use of cisplatin and VP16 increased overtime whereas the use of adriamycin, methotrexate, belustine decreased. The proportion of pts included in clinical trials increased overtime from 4.4% to 13.7%. The median survival time of all pts increased overtime from 6.57 months in 1981-1983 to 11.27 months in 1993-1994. This improvement was observed as well for limited disease stage (11.2 months to 14.39 months) and extensive disease stage (3.9 months to 9.49 months). Multivariate analysis of survival showed that extent of disease, period, age, number of metastatic sites were independent prognostic factors. In LD disease survival was improved in patients receiving mediastinal irradiation.
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Alveolar adenoma - Two cases of a rare lung tumour
M. Almodovar, J. Dionisio, D. Matias, N Abecassis, O. Almeida.
chest X-ray screening reduce lung cancer death? A •7-9-] Can population-based case-control study in Gunma prefecture, Japan
Lisboa, Portugal Alveolar adenoma are very rare benign tumours, more frequent in middle aged woman. We present two cases of alveolar adenoma. Case one: a 55-year-old woman, non-smoker presented with cough for two years. Chest x-ray revealed a 4-cm round opacity in the upper right lobe that was confirmed by a CT scan, and no other abnormalities. Bronchofibroscopy was inconclusive and a CT guided biopsy of the mass revealed lung parenchyma. She underwent diagnostic and therapeutic surgery. Pathologic diagnosis was alveolar adenoma. She is alive and well seven years latter. Case two: A 77- year-old woman, non-smoker assymptomatic performed a Chest x-ray which revealed a 6-cm round opacity in the upper left lobe that was confirmed by a CT scan, that showed contact with pleura and mediastinum. Bronchofibroscopy was normal and two CT guided biopsies of the mass revealed lung parenchyma. She underwent diagnostic and therapeutic surgery. Pathologic diagnosis was alveolar adenoma. She is alive and well two years latter. Alveolar adenoma is a rare lung tumour with a difficult diagnosis and a good prognosis. Our first case has a typical presentation. In the second case the patient is older and the tumour larger than usual.
•
Variant E1038G of the BRCA1 gene is associated with lung cancer in families with multiple breast/ovarian cancer relatives P. Yang, J, Jett, E. Bass, F. Couch. Mayo Clinic and Foundation,
Rochester, MN, USA It has been reported that lung cancer and breast/ovarian cancer aggregate within families. In addition, an elevated risk for lung cancer has been detected in individuals that carry BRCA1 mutations. The BRCA1 gene has been linked to the susceptibility of breast and ovarian cancer. Thus, we hypothesize that lung cancer in patients with a strong family history of breast and/or ovarian cancer may be associated with inherited BRCA1 alterations. To test this hypothesis, we have analyzed leukocyte DNA from 16 primary lung cancer patients for sequence changes in the BRCA1 gene. These patients were sequentially identified from an ongoing comprehensive lung cancer epidemiology research program in our institution, based on family history of three or more lung/breast/ovarian cancer relatives. Conformation Sensitive Gel Electrophoresis (CSGE), a PCR-based heteroduplex detection method, was used to screen the BRCA1 and BRCA2 genes for mutations. A total of 77 primer pairs were used to PCR amplify the entire coding region and all the exon-intron boundaries of these genes in lung cancer samples. The PCR products were then heteroduplexed and electrophoresced on polyacrylamide gels. Variants were detected due to altered mobility within the gel, and were sequenced to identify the specific base pair changes. Although no known gene mutations associated with development of breast and ovarian cancer were detected, we found that 13 of the 16 (81.3%) patients carried an E1038G sequence variant of BRCAI. This observed frequency is significantly greater (p < 0.001) than the reported frequency (23.8%) in a general female population from Quebec, Canada (Durocher, et al., 1996). The role of this variant in lung tumor development depends on the effect of its alteration on BRCA1 function, and on careful exclusion of potential confounding factors from the association analysis. Further investigation with a larger sample and proper controls is warranted.
227
T. Nakayama 1, T. Baba 2, T. Suzuki 1, M. Sagawa 3, M Kaneko4.
1Division of Epidemiology, Department of Field Research, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; 2Gunma Health Foundation, Maebashi; 3Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendal; 4Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan There is little evidence to confirm the usefulness of annual chest X-ray examinations (CXE) to prevent lung cancer death. In order to evaluate the efficacy of annual CXE lung cancer screening, a case-control study was conducted in Gunma Prefecture, Japan. Methods: In the study area, a population-based lung cancer screening program based on annual CXE has been conducted. In this study, 121 case subjects of high-risk males or non-high-risk females, aged 40-79, who died from lung cancer between 1992 and 1997, were collected. For each case, 3-5 controls (536 controls in total) matched by gender, year of birth, address and smoking habits were selected. Results: The smoking adjusted odds ratio (OR) of lung cancer death for those screened within 12 months before diagnosis vs. those not screened was 0.68 (95% confidence interval (CI): 0.44-1.05; p = 0.084). The ORs for adenocarcinoma and squamous cell carcinoma were 0.62 (95% Ch 0.31-1.24) and 1.01 (95% CI: 0.44-2.31), respectively. With an attempt to eliminate self-selection bias, the OR was 0.35 (95% Ch 0.15-0.81; p = 0.015). Conclusions: The results of the study suggested that up to 32% of the deaths attributable to lung cancer, especially adenocarcinoma, could be prevented by annual CXE. Since CXE proved ineffective for squamous cell carcinoma, further study concerning the evaluation of sputum cytology is necessary.
[7-•
True progress in survival of patients (pts) with small cell lung cancer (SCLC) over a period of 14 years
E. Quoix 1, M R Lebitasy 2, G. Hedelin 2, F. Klinzig 1 , A. Purohit 1, L. Moreau 1, B. Mennecier 1. 1Dept. of Pneumology, University
Hospital; 2Dept. of Epidemioly Louis Pasteur University, Strasbourg, France Recent analyses of series of SCLC pts included in clinical trials have shown that survival was improved overtime. Whether this was due to a selection bias or to the Will Rogers phenomenon or to a true therapeutic improvement could not be determined. We reviewed the medical records of all consecutive pts diagnosed as SCLC between 1981 and 1994 in a french department, the Bas-Rhin. 787 pts (83.4% of all eligible pts) were included in our study. There were 696 males, median age was 63 years. There was no significant period effect for sex, age, occupation, living place. On the other hand there was a significant period effect for the work-up performed to evaluate extent of disease. There was a significant correlation between the mean number of investigations and the mean number of sites involved by tumor. 76.4% of pts were treated with chemotherapy between 1981 and 1983, 84.7% between 1987 and 1989 and 91.7% in 1993 and 1994. Mediastinal radiotherapy was administered to 52.9% of pts between 1981 and 1983, 29% of pts between 1984 and 1986 and then to around 24-25% of pts. The use of cisplatin and VP16 increased overtime whereas the use of adriamycin, methotrexate, belustine decreased. The proportion of pts included in clinical trials increased overtime from 4.4% to 13.7%. The median survival time of all pts increased overtime from 6.57 months in 1981-1983 to 11.27 months in 1993-1994. This improvement was observed as well for limited disease stage (11.2 months to 14.39 months) and extensive disease stage (3.9 months to 9.49 months). Multivariate analysis of survival showed that extent of disease, period, age, number of metastatic sites were independent prognostic factors. In LD disease survival was improved in patients receiving mediastinal irradiation.