Pulmonary In Situ Adenocarcinoma with Mosaic Paving Pattern

CONTEXT: Adenocarcinoma already comprises half the cases of lung cancer. Its insidious clinical evolution contributes to the fact that, in absolute numbers, lung tumor is the cancer with the highest mortality in the world. When still in situ, the adenocarcinoma is even quieter, making its typical presentation on the computerized tomography of an irregular semisolid nodule smaller than 3.0 cm. It is often diagnosed in a finding of examination in an asymptomatic patient. The prevalence of in situ adenocarcinoma (ISA) is less than 5% of pulmonary malignancies and its radiological presentation with a diffuse mosaic paving pattern is even more unusual, mimicking other conditions more frequent to this finding. CASE REPORT: We describe the case of a 44-year-old male patient with a history of chronic smoking admitted to the emergency room at a referral hospital in S?o Paulo on 12/16/2016 with a complaint of progressive dyspnea associated with dry cough for 3 months, intermittent fever and weight loss of 8 kg in 2 months. A chest X-ray and computed tomography showed discrete focal points of peribroncovascular consolidation, predominantly central, areas with frosted glass attenuation associated with smooth thickening of the interlobular septa, sometimes interspersed with areas of preserved parenchyma, giving an aspect of “crazing paving” with diffuse distribution by the pulmonary parenchyma. The patient underwent a biopsy with the anatomicopathological diagnosis of primary Adenocarcinoma in situ of the lung. CONCLUSION: We emphasize that the “crazing paving” of adenocarcinoma in situ pulmonary should be considered and known by the radiologist, because although isolated it is a rare condition, its early distrust in cases of atypical evolution of the most common injuries can avoid a diagnosis in phases more advanced and higher mortality.

Serum von Willebrand factor for early diagnosis of lung adenocarcinoma in patients with type 2 diabetes mellitus

BACKGROUND The elevation of plasma von Willebrand factor(vWF)has been proposed to be a predictor of lung cancer.Type 2 diabetes mellitus(T2DM)causes endothelial activation,resulting in the secretion of vWF.However,the role of vWF in patients with T2DM complicated with lung cancer remains unclear.AIM To investigate the clinical value of serum vWF as a tumor marker in patients with T2DM combined with lung adenocarcinoma in situ(AIS).METHODS This study enrolled 43 patients with T2DM combined with lung AIS(T2DM+AIS group),43 patients with T2DM alone(T2DM group),43 patients with lung AIS alone(AIS group),and 43 healthy volunteers(control group).The serum levels of vWF,insulin-like growth factor 1,and insulin-like growth factor binding protein 3 were determined.Multiple linear stepwise regression was performed to determine the correlations among variables.RESULTS Serum concentration of vWF in the T2DM+AIS group was significantly higher than those in the T2DM,AIS,and control groups(P<0.05).Serum vWF levels in the T2DM and AIS groups were significantly higher than that in the control group(P<0.05).There was no significant difference in serum vWF level between the T2DM and AIS groups.In the T2DM+AIS group,serum vWF was independently associated and positively correlated with serum levels of insulinlike growth factor 1 and insulin-like growth factor binding protein 3(P<0.05).CONCLUSION Serum vWF level may represent a novel biomarker for the early diagnosis of lung AIS.

Selective applications of excisional surgical treatments of cervical precancers

Cervical precancers encompass high-grade squamous intraepithelial lesion and adenocarcinoma in situ.Treatment of precancerous lesions can reduce cervical cancer mortality and prevent the development of invasive cervical cancer.The choice of treatment regimen needs to follow the principle of individualization and should be based on a combination of factors,including the patient's age,fertility requirements,pregnancy status,pathological type,type of colposcopic transformation zone,patient's follow-up conditions,and the experience of the treating provider.This article presents an opinion regarding the appropriate indications for excisional surgery and total hysterectomy in the management of precancerous lesions of the cervix,with the aim of establishing standardized therapeutic approaches for the treatment of precancerous lesions of the cervix.