Lung adenocarcinoma is the most common cell type in females (smokers or non-smokers) and in non-smoking males. Its incidence has been increasing in younger cohorts of males and females until very recent years. Changes in classification and in pathological techniques account for some of this increase. In females and non-smoker males, the increase could be partly due to a detection bias in former studies. Nevertheless, successive cohorts over time seem more likely to develop adenocarcinoma and less likely to develop squamous cell carcinoma. These differences between birth cohorts suggest that the increasing incidence of adenocarcinoma is not only due to changes in pathological diagnosis. Geographical differences are also observed: in Europe, the squamous cell type still predominates and an increase in incidence of adenocarcinoma has only been reported in the Netherlands. In Asia, in the 1960s and 1970s, the proportion of adenocarcinoma was higher than in North America or Europe and seems to be increasing. To what extent these differences are due to differences. In establishing diagnosis remains unknown. Despite these biases in temporal and geographical trends detailed in this review, there has probably been a true increase in incidence of adenocarcinoma. An explanation for this should be sought in studies on detailed smoking history and passive smoking exposure, occupational exposure, diet and cooking, pollution and other environmental factors.

Benign metastasizing leiomyomas (BMLs) occur predominantly in women during reproductive years. The condition is characterized by uterine leiomyomas associated with the development, typically years later, of slow-growing metastatic lesions. The most commonly affected organs are the lungs, but BMLs have been reported in lymph nodes, deep soft tissues, mesentery, bones, the central nervous system, and the heart. In many cases, these lesions have an indolent course and are discovered rather incidentally. However, occasionally they can present with debilitating symptoms or even life-threatening complications. The presence of estrogen and progester- U TERINE LEIOMYOMAS HAVE been reported in as-sociation with extrauterine benign-appearing smooth muscle tumors. This condition has been described mainly in women of reproductive age but can occur at any age. It has been referred to in the literature as benign metastasizing leiomyoma (BML). This term was introduced in 1939 by Steiner (1) in his report of a case of a 36-yr-old woman who died after massive pulmonary and hilar lymphatic metastases of a uterine leiomyoma. The interest of this condition to endocrinologists is its susceptibility to the hormonal milieu. Knowledge of this susceptibility may lead to effective clinical control of this metastasizing tumor by hormonal manipulation. We report two cases of BML in which hormonal manipulation with LHRH agonists, antiestrogens, and aromatase inhibitors (AIs) caused alleviation of symptoms and regression of the metastatic lesions. Case 1A 47-yr-old Caucasian woman consulted because of recurrent left subscapular pain that presented every few weeks with spontaneous resolution within a few days. Her complaint was initially attributed to cervical arthrosis and treated with analgesics. Three years later she developed numbness over her left hand, and a firm mass of about 5 cm was noticed in the left supraclavicular area (Fig. 1). A magnetic resonance image (MRI) revealed a large paraspinal tumor involving the brachial plexus and extending into the vertebral canal (Fig. 2). C5-T1 laminectomies, debulking of the extraspinal, and near complete removal of the intraspinal component was carried out. Pathological evaluation revealed a well-differentiated leiomyosarcoma [1-3 mitoses per 10 high-power fields (HPFs) and no necrosis] with bony involvement (Fig. 3).Radiotherapy was planned but the patient refused it. Shortly afterward she began experiencing cervical pain unrelieved by opioid analgesia, with a similar cyclical pattern to her previous pain; this prompted consultation to endocrinology. Her past medical history was remarkable for a total hysterectomy at age 36 yr for a 6-cm uterine leiomyoma. The histological blocks were retrieved and reexamined; the new report described a tumor with ill-defined infiltrative borders, areas of coagulative necrosis, mitotic rate of 4/10 HPFs, and few pathological mitotic figures but no significant cytological atypia. The conclusion was smooth muscle tumor of low malignant potential (2). The histol...

Our results show that when the TPS ≥50% is used as the end point, PD-L1 IHC performs well with cytology cell blocks. Cell blocks should be considered as a valuable resource for PD-L1 testing in advanced NSCLC. The clinical significance of higher PD-L1 IHC scores in cytology specimens needs to be evaluated prospectively.

This telecommunication service was efficacious in reducing the mean arterial pressure of patients with established essential hypertension.

BackgroundBiological and some clinical evidence suggest that high-dose intravenous vitamin C (IVC) could increase the effectiveness of cancer chemotherapy. IVC is widely used by integrative and complementary cancer therapists, but rigorous data are lacking as to its safety and which cancers and chemotherapy regimens would be the most promising to investigate in detail.Methods and FindingsWe carried out a phase I-II safety, tolerability, pharmacokinetic and efficacy trial of IVC combined with chemotherapy in patients whose treating oncologist judged that standard-of-care or off-label chemotherapy offered less than a 33% likelihood of a meaningful response. We documented adverse events and toxicity associated with IVC infusions, determined pre- and post-chemotherapy vitamin C and oxalic acid pharmacokinetic profiles, and monitored objective clinical responses, mood and quality of life. Fourteen patients were enrolled. IVC was safe and generally well tolerated, although some patients experienced transient adverse events during or after IVC infusions. The pre- and post-chemotherapy pharmacokinetic profiles suggested that tissue uptake of vitamin C increases after chemotherapy, with no increase in urinary oxalic acid excretion. Three patients with different types of cancer experienced unexpected transient stable disease, increased energy and functional improvement.ConclusionsDespite IVC’s biological and clinical plausibility, career cancer investigators currently ignore it while integrative cancer therapists use it widely but without reporting the kind of clinical data that is normally gathered in cancer drug development. The present study neither proves nor disproves IVC’s value in cancer therapy, but it provides practical information, and indicates a feasible way to evaluate this plausible but unproven therapy in an academic environment that is currently uninterested in it. If carried out in sufficient numbers, simple studies like this one could identify specific clusters of cancer type, chemotherapy regimen and IVC in which exceptional responses occur frequently enough to justify appropriately focused clinical trials.Trial RegistrationClinicalTrials.gov NCT01050621

The 6MW declines significantly after two cycles of chemotherapy. This decline may have been even greater as patients with lower 6MW were more likely to drop out of the study. An initial 6MW > or =400 m might be a useful prognostic factor for survival in patients with advanced non-small cell lung cancer.

BackgroundAccurate prediction of outcome in advanced nonsmall-cell lung cancer (nsclc) remains challenging. Even within the same stage and treatment group, survival and response to treatment vary. We set out to determine the predictive value of inflammatory markers C-reactive protein (crp) and white blood cells (wbcs) in patients with advanced nsclc. Patients and MethodsPatients were assigned a prognostic index (pi):• 0 for crp 10 mg/L or less and wbcs 11×10 9 /L or less,• 1 if one of the two markers was elevated, and • 2 if both markers were elevated.We then used chest computed tomography (ct) imaging to evaluate response after 2 cycles of chemotherapy treatment. ResultsOf 134 patients, 46 had a pi of 0; 60, a pi of 1; and 28, a pi of 2. Disease progressed in 41 patients. Progression was significantly more frequent among patients with a pi of 2 (p = 0.008). Median survival was 20.0 months for the pi 0 group, 10.4 months for the pi 1 group, and 7.9 months for the pi 2 group (p < 0.001). The pi was the only significant prognostic factor for survival even after adjustment for performance status, smoking, and weight loss (hazard ratio: 1.57; 95% confidence interval: 1.2 to 2.14; p = 0.004). ConclusionsInflammatory state correlates significantly with both chemotherapy response and survival in stage iv nsclc. The pi may provide additional guidance for therapeutic decision-making.

Our results show a high incidence of DVT in NSCLC patients. Advanced stage and, to a lesser extent, male sex, are important predictors of DVT. Trials to evaluate the use of prophylactic anticoagulant treatments in patients with NSCLC should be conducted.