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Open access

P. Fildan, E. Dantes and O.C Arghir


Lung cancer is the most frequent neoplasm worldwide and the incidence in Constanta County is in continuous increasing. Occupation as a cause of lung cancer is common. The authors examined the relation between occupation and lung cancer in two patient cohorts from different areas of Romania: Constanta and Valcea. In 2005-2010, in Constanta and Valcea counties, 488 and 344 incident lung cancer cases were enrolled. Lifetime occupational histories (industry and job title) were coded by using standard international classifications and were translated into occupations known (list A) or suspected (list B) to be associated with lung cancer. An exposure excess of 14.6% for patients from Constanta ever employed in occupations known to be associated with lung cancer (list A) was found, with the largest contributions from the oil refinery and shipbuilding industries No overall excess was found for list B with the exception of bus and truck drivers (men) and launderers and dry cleaners (women), in both groups of patients. These results indicate that past exposure to occupational carcinogens remains an important determinant of lung cancer occurrence.

Open access

B.A. Suciu, T. Mezei, Zsuzsanna Pap, L. Denes, Ioana Hălmaciu, Z. Pavai, Klara Brînzaniuc and L. Azamfirei


The aim of this study is to evaluate tumor angiogenesis in patients with non-small cell lung carcinoma. A total of 20 patients with pulmonary adenocarinoma have been included in the study. In order to evaluate tumor angiogenesis we studied the importance of CD34 expression. Evaluation of vascular density was performed with a semiautomated method using the dedicated software called ImageJ. We introduced in our study 20 patients with lung adenocarcinoma. We were able to identify tumor angiogenesis in 19 cases (95%). Immunolabeling of CD34 positive endothelial cells provided a good overview of tumor vascularization. Immunohistochemical staining of CD34 positive endothelium cells provided a good basis for tumor vascularity assessment, and also an excellent contrast for computer assisted morphometric measurements. Also we studied the intensity of the immunohistochemical staining of CD34 in the tumoral cells. We obtained the following results: a minor expression in 4 cases (20%), a moderate expression in 9 cases (45%) and an intense expression in 6 cases (30%). The histological type of adenocarcinomas influences the architecture and branching of the vessels. The density of newly developed vessels is higher in patients with papillary pulmonary adenocarcinomas, which may indicate a possible relationship between the histological type and development of vascular supply.

Open access

Mirela Jozicic, Alen Imsirovic, Lea Katalinic, Branimir Krtalic and Nikolina Basic Jukic


Introduction. Although the incidence of malignancy has increased after solid organ transplantation, data on lung cancer in this group of patients is scarce. The aim of this study was to determine clinical characteristics and outcome of patients who developed lung cancer after renal transplantation. Methods. Among a cohort of 1658 patients who received a transplant at our institution and were followedup between 1973 and 2014, five patients developed lung cancer. We analyzed risk factors, transplantation characteristics, treatment options and survival. Results. Lung cancer was diagnosed in 5 patients (0.3%). Time to diagnosis after the transplant procedure ranged from 26 to 156 months (mean 115 months). All of them had a smoking history. Tumors were classified as IIB (20%), IIIA (40%), and IV (40%). Histological types included adenocarcinoma (80%) and there was one case of sarcomatoid carcinoma (20%). One patient had concomitant thyroid papillary carcinoma. Radiotherapy was applied in 2 patients, 2 underwent chemotherapy (erlotinib and combination of carboplatinum and etopozide in one patient each), and 2 died within one month after the diagnosis from disseminated malignant disease. Patients with stage IIIA survived 14 and 24 months after the diagnosis. The patient with sarcomatoid cancer underwent thoracotomy with a complete resection, lost his graft function and died 7 months after the diagnosis. Conclusion. Lung cancer is relatively rare malignancy in renal transplant recipients, but associated with high mortality. Smoking is a significant risk factor, thus smoking cessation should be promoted among renal transplant recipients, as well as regular screening for lung cancer.

Open access

Lučka Debevec, Tina Jerič, Viljem Kovač, Marko Bitenc and Miha Sok

Is there any progress in routine management of lung cancer patients? A comparative analysis of an institution in 1996 and 2006

Background. The aim of the study was to establish eventual progress in routine management of lung cancer patients over a ten-year period at University Clinic for Respiratory and Allergic Diseases Golnik, Slovenia, comparing the results of analysis of 345 patients, diagnosed in 1996 (with analysis performed in 2002), and 405 patients, diagnosed in 2006 (with analysis performed in 2008).

Patients and methods. The patients of both analysed groups were of comparable age and number of patients in stage I and II, but there were relatively more females, patients with better performance status, more precise clinical staging and tumour histology in the 2006 group. The parameters used for assessing the progress of management were as follows: time period from admittance to diagnosis and to surgery; precision of staging; accordance of clinical and pathological staging in resected patients; percentage of exploratory thoracotomy; and use of new treatment modalities. The proportion of patients in selected/actual primary treatment modality and survival rate could also be used for assessing the progress.

Results. Although unessential longer time from admittance to microscopic confirmed diagnosis increased from a mean 7.4 to 8.6 days in 2006 progress was established by the following: more precise clinical staging (stage I and II also A and B stage, TNM staging also in small-cell lung cancer patients); improved accordance with clinical and pathological staging in resected patients (46% against 58%); decreased percentage of exploratory thoracotomy (13% against 4%); increased use of multimodality therapy as primary treatment modality (radiotherapy/chemotherapy, neoadjuvant chemotherapy); newly performed radio frequency tumour ablation. The proportion in selected/actual surgery increased from 76% to 93% and median survival rate of all patients from 6.2 to 10.6 months. One-year survival increased from 33.6% to 45.8% and two-year survival from 17.4% to 23%.

Conclusions. Progress in routine lung cancer management was proved by better staging, lower percentage of exploratory thoracotomy, use of new treatment modalities, minor discordance between selected and actual therapy, and improved short-term survival rate.

Open access

Simona Claudia Cambrea, Ghiulendan Resul, Elena Danteș, Stela Halichidis and S. Chirilă


Even though there are many similarities in symptoms and radiological aspect between pulmonary tuberculosis (TB) and lung neoplasia, there are many differences between them like different etiologies, different consequences, and altogether different management. We present a case of a 59 years old male, heterosexual, who was HIV diagnosed in the last 16 years. He had a good immunological and virusological evolution over the time. In the last 5 months of his life he was diagnosed with pulmonary TB and he received specific treatment. After 4 months of antituberculous treatment patient became asthenic, febrile, with productive cough, and weight loss. Imagistic evolution was unfavorable. The suspicion of pulmonary neoplasm raises in the last 3 weeks of his life. Macroscopic lung examination during autopsy was suggestive rather to a pulmonary TB than a lung neoplasm, with a nodular pattern very similar with nodular TB. Histopathological examination evidenced a lung adenocarcinoma.

In HIV patients a delayed or missed diagnosis of lung cancer, can lead to late treatment or wrong treatments, and finally death of patient.

Open access

Biljana Poposka, Snezana Smickova, Simonida Crvenkovska, Beti Ivanovska, Tome Stefanovski and Gordana Petrusevska

Prognostic value of immunohistochemical expression of HER-2/neu in patients with lung carcinoma

Background. The amplification and the overexpression of the Her-2/neu gene have been shown in certain human tumours and are postulated to be important in human carcinogenesis. In this study we evaluated the expression of HER-2/neu gene in patients with lung carcinoma (LC) and assessed its prognostic significance.

Patients and methods. HER-2/neu expression was determined in 127 LC patients using immunohistochemistry (IHC) performed on paraffin-embedded section - Hercep Test™ (DAKO).

Results. The overall HER-2/neu expression was seen in 36 (28.35%) of 127 LC patients. According to the histological type, HER-2/neu overexpression was detected in 12 patients with adenocarcinomas (60%), in 19 patients with squamous cell carcinomas (31.14%), in 4 patients with small cell-lung carcinomas (10%) and in 1 patient with other carcinomas (16.66%). Only in patients with small cell-lung carcinomas HER-2/neu overexpression was in correlation with the stage of the disease (p<0.001). The patients with HER-2/neu positive expression were associated with a significantly shorter survival compared with those who were HER-2/neu negative (log rank, p<0.002).

Conclusions. These observations suggest that HER-2/neu positivity may serve as a prognostic indicator in patients with LC. HER-2/neu plays a role in identifying patients at risk for the shortened survival, who may benefit from a more aggressive therapy.

Open access

Arghir Oana-Cristina, Trenchea Mihaela, Iliescu Mădălina, Galie N. and Ciobotaru Camelia


A 74 year old Caucasian man, presents with a 6 week history of right sided chest pain including traumatic related painful right shoulder. Shoulder minor contusion was diagnosed and partial managed by symptomatic treatment associated to rehabilitation. The pain was initially eased with nonsteroidal anti-inflammatory drug (NSAID) use and finally changed worsening. He has evidence of moderate COPD on spirometry and has been commenced on inhalers. An invasive primitive adenocarcinoma lung cancer was confirmed by chest CT scan and lymphnode biopsy through mediastinoscopy

Open access

Takashi Ono, Tomonori Yabuuchi, Tatsuya Nakamura, Kanako Kimura, Yusuke Azami, Katsumi Hirose, Motohisa Suzuki, Hitoshi Wada, Yasuhiro Kikuchi and Kenji Nemoto



There have been few reports about high total dose hypofractionated proton beam therapy for central lung cancer. The aim of this study was to examine retrospectively the safety and efficacy of high total dose hypofractionated proton beam therapy for central lung cancer.

Patients and methods

Patients treated by proton beam therapy for central lung cancer located less than 2 cm from the trachea, mainstem bronchus, or lobe bronchus were included in this study. All patients received 80 Gy of relative biological dose effectiveness (RBE) in 25 fractions with proton beam therapy over 5 weeks between January 2009 and February 2015. The toxicities were evaluated using the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer criteria.


Twenty patients, including 14 clinically inoperable patients (70%), received proton beam therapy for central lung cancer. The median patient age was 75 years (range: 63–90 years), the median follow up time was 27.5 months (range: 12–72 months), and the median tumor diameter was 39.5 mm (range: 24–81 mm). All patients were followed for at least 20 months or until death. The 2-year overall survival rate was 73.8% (100% in operable patients, and 62.5% in inoperable patients), and the 2-year local control rate was 78.5%. There was no Grade 3 or higher toxicities, including bronchial stricture, obstruction, and fistula.


The present study suggests that a high total dose hypofractionated proton beam therapy for central lung cancer was safe and feasible.

Open access

Elena Dantes, Doina Ecaterina Tofolean, Ariadna Petronela Fildan, Laura Mazilu, Ioana Gogonea, S. Dumitrache-Rujinski and Oana Cristina Arghir


Lung cancer remains one of the most frequent pathologies in Pulmonology Departments. Tumor extension, histopathological types, and treatment influence the prognosis and survival in lung cancer. Five years survival dramatically decreases for the 4th-stage of the disease. Non-small cell lung cancer (NSCLC) represents the vast majority of lung cancers. In the last decades, important findings have been made on identifying standardized molecular biomarkers that control tumor growth in lung adenocarcinoma. The discovery of new drugs led to the increased survival, even in extensive forms of the disease. The greatest advances could be obtained by targeting EGFR genetic mutations or EML4-ALK translocate in patients diagnosed with adenocarcinoma lung cancer

Open access

Mariusz Kaczmarek, Joanna Maciejewska, Łukasz Spychalski, Magdalena Socha-Kozłowska, Agata Nowicka and Jan Sikora


The lung cancer is often associated with the development of pleural effusion. Neutrophils are the most numerous population of immune system cells which are an essential component of tumor leukocyte infiltration. These cells are engaged in the development and maintenance of the inflammation. It is indicated that neutrophils support the development of cancer. The aim of the study was the evaluation of neutrophils, regarding their presence and activity in pleural effusions. This was achieved by assessing of molecular structures, which are used by neutrophils in chemotaxis and phagocytosis. 60 pleural effusions and 34 peripheral blood samples received from patients and 15 peripheral blood samples from the control group were analyzed. Expression of CD11a, CD11b, CD11c, CD18 and CD62L molecules with use flow cytometry was evaluated. The concentration of the neutrophil elastase in pleural effusions were measured with use ELISA test. The number of neutrophils in the peripheral blood of patients with pleural effusion was lower than that observed in the control group. Neutrophils present in pleural effusions were characterized by an increased ability to chemotaxis and secrete significant amounts of neutrophil elastase. Neutrophils recruited into the pleura during the formation of the effusion are an essential element of the developing inflammatory reaction in this environment. The presence of neutrophils in pleural effusion may promote its further formation and support the development of cancer.