Pulmonary extranodal natural killer/T-cell lymphoma: clinical analysis of three cases

Objective To improve the understanding of pulmonary involvement of extranodal natural killer/T-cell lymphoma(ENKTL)by analyzing the clinical manifestations,imaging and pathological features of this disease.Methods Three cases of ENKTL,proven by pathological diagnosis in Fuzhou General Clinical Medical College of Fujian Medical University,were retrospectively analyzed.Results All of the 3 cases were males,aged 74,61 and 49 years,respectively.The main clinical symptoms included cold and fever.One patient had nasal congestion and runny nose.Chest CT showed multiple lung nodules(n=3),masses(n=2)and patchy shadows(n=2),with irregular lesions and clear boundaries.The 3 cases had been misdiagnosed as community acquired pneumonia,and treated with intravenous injection of moxifloxacin.ENKTL was confirmed by CT-guided percutaneous biopsy with immunohistochemical staining,which showed that 3 cases were positive for CD56,CD2,in situ hybridization for EBV encoded RNA(EBER),while negative for CD20,and 2 cases were positive for CD3,Granzyme B;and 1 case was positive for T-cell intracytoplasmic antigen-1.All 3 patients received chemotherapy,but 2 patients died,one of rejection 1 month later after bone marrow transplantation.One patient had improved after chemotherapy with follow-up.Conclusion ENKTL should be considered when patients presented with fever,multiple lung nodules or consolidations which were non-responsive to antibiotics.Lung biopsy was the key to diagnosis.

Value of circulating tumor cells detected by chromosome centromere probe identification in diagnosis of non-small cell lung cancer

Objective This study explored the value of circulating tumor cells(CTC)detected by chromosome 8 centromere probe in diagnosis of non-small cell lung cancer(NSCLC)as well as correlation between CTC counts and clinical pathological characteristics.Methods We collected 136 patients with newly diagnosed NSCLC(101 males and 35 females,aged from 34 to 79 years),149 patients with non-malignant pulmonary diseases(103 males and 46 females,age ranged from 24 to 80 years)and 32 healthy volunteers(5 males and 27 females,aged from 24 to 42 years).Detection was performed using an epithelial cell adhesion molecule-independent strategy that combined immunocytochemistry staining(ICC)of CD4 5 and fluorescence in situ hybridization detection(FISH)with chromosome 8 centromere probe(CEP8).CTC was defined as 4',6-diamidino-2-phenylindole(DAPI)positive,CD4 5 negative and CEP8 more than 2 positive points.Quantitative data were reported as x±s,and Mann Whitney test was used to compare them.Measurement data were analyzed as contingency tables and Pearson chi-squared test was used.P values of less than 0.05 were considered statistically significant.Results CTCs were detected in 114 patients(83.8%)with NSCLC,35 patients(23.5%)with non-malignant pulmonary diseases(P<0.000 1)and 5 volunteers(15.6%).CTC counts in NSCLC patients were(5.98±0.64)per 3.2 ml and(0.60±0.13)per 3.2 ml(P<0.000 1).A receiver operating characteristic curve(ROC)analysis showed similar capability of CTC count,with CEA,in discriminating NSCLC and non-malignant diseases with an area under ROC curve of 0.854(95% confidence interval:0.808-0.900,P<0.000 1).Cut-off of 2 circulating tumor cells per 3.2 ml peripheral blood gave the highest Youden Index of 0.614 in diagnosis of NSCLC with a sensitivity of 72.1%(98/136)and a specificity of 89.3%(133/149).When patients with CTC≥2/3.2 ml peripheral blood or serum CEA≥5 ng/ml were considered as having NSCLC,sensitivity and specificity of this combined test were 87.5%(119/136)and 85.9%(128/149),with a higher Youden Index of 0.734.No correlation was observed between positive rate of CTC(rate of patients with CTC≥2/3.2 ml peripheral blood)and age,gender,smoking status,pathologic types,and clinical stages.Conclusion CTC count detected by CD4 5-FISH is higher in NSCLC patients than in non-malignant disease patients.CTC≥2/3.2 ml peripheral blood is valuable in discriminating NSCLC from nonmalignant diseases,which can be more accurate when combined with CEA.