Matrix metalloproteinases (MPs) constitute a family of proteolytic enzymes (proteases) that degrade extracellular matrix (ECM) and promote the local or metastatic potential of carcinoma cells, and whose action is restrained by special inhibitors (metalloproteinase inhibitors; MIs). We assessed the role of the MPs stromelysin-3 (STR-3), putative metalloproteinase-1 (PUMP-I), and the gelatinases of molecular weights 72 kDa and 92 kDa, as well as the role of their inhibitors tissue inhibitor of metalloproteinase-1 (TIMP-1) and TIMP-2, as markers of metastatic potential in 25 fresh biopsies of squamous-cell lung carcinomas (SCLCs). We examined levels of messenger ribonucleic acid (mRNA) expression for these MPs and inhibitors through Northern blot analysis in 10 carcinomas of high-to-moderate differentiation without lymph-node involvement, and in 15 infiltrative carcinomas of moderate-to-low differentiation with lymph-node involvement. Five cases with significant epithelial atypia and five samples with normal mucosa were used as controls. Expression of STR-3 and TIMP-2 was also assessed immunohistochemically with the avidin-biotin-complex (ABC) technique. We noticed a progressive increase in the expression levels of MPs, especially of STR-3, and of TIMP-2, from the stage of epithelial atypia to the detection of carcinoma, finding the highest values of these substances among carcinomas of low differentiation with nodal metastases. These findings were also confirmed with immunohistochemical analysis. Our results suggest that there is a significant association of the expression of MPs and MIs with both the local and metastatic potential and the degree of cellular differentiation of SCLC, and that this association is clinically important because of its prognostic and therapeutic implications.
A rare case of systemic lupus erythematosus (SLE), with massive bilateral pleural effusions as the first manifestation, is described. The patient was a previously healthy 20-year-old soldier. Initial investigations were unrevealing, but after 3 months the patient developed the full-blown syndrome. He responded well to corticosteroids and cyclophosphamide with resolution of the pleural effusions and improvement of the clinical picture. SLE should always be considered in cases of massive pleural effusions, even in the absence of other overt stigmata of the disease.
Background: Sarcoidosis is rarely associated with a distinct disease. One disease infrequently associated with sarcoidosis is psoriasis.
We report a rare case of pleural multicystic mesothelial proliferation in a 33-year-old man with pleurisy of unknown etiology. The diagnosis was made by medical thoracoscopy. Histologic examination of the cystic lesions, immunohistochemical staining, and DNA study confirmed the mesothelial origin of the disease and suggested a reactive process. A brief review of the available data from the literature is presented to further support our results.Key Words: multicystic mesothelial proliferation, pleura, medical thoracoscopy (J Bronchol 2005;12:168-170) T he clinicopathologic entity of multicystic mesothelial proliferation has been well described into the peritoneal cavity. Similar lesions have been rarely reported into the pleural cavity. To our knowledge, this is the third case that has been described in the pleura and the first that was diagnosed by medical thoracoscopy. CASE REPORTA 33-year-old man, heavy smoker (45 pack-years), was admitted to the pneumonology department of our hospital with a 1-month history of pleuritic chest pain and a small right-sided pleural effusion. His past history was negative. The laboratory blood tests were normal. His electrocardiogram was normal. The chest x-ray and the computed tomography (CT) scan of the chest revealed a small right-sided pleural effusion without other abnormalities. Thoracocentesis revealed a yellowish exudative pleural fluid with a lymphocyte predominance (60%) and ADA 49 IU/L. Cytologic and bacteriologic examinations of the pleural fluid were negative.A perfusion lung scan and triplex ultrasonography of the lower extremities were both negative for venous thromboembolism. PPD skin test was positive (16 mm). A 3-drug antituberculosis treatment scheme (isoniazid, rifampicin, and ethambutol) was initiated based on the patient's clinical features (young age, excellent performance status, no clinical or radiologic evidence of malignancy), the positive PPD skin test, and the characteristics of the pleural fluid (lymphocytosis and high levels of ADA). The symptoms of the patient were gradually improved and on follow up, a few months later, his chest radiograph was normal. The patient completed 9 months of antituberculosis therapy without any complications.One year after his first hospitalization, the patient was admitted again to our hospital with recurrence of his symptoms. The physical examination and the radiologic evaluation with a chest x-ray and CT revealed a small right-sided pleural effusion. Thoracocentesis revealed a yellowish exudative pleural effusion with 40% lymphocytes, 45% neutrophils, and 15% mononuclear cells. ADA was 30 IU/L. Cytologic and bacteriologic examinations of the pleural fluid were negative.Medical thoracoscopy was performed under local anesthesia for pleural inspection and biopsy. Two 7-mm telescopes were used with direct (0°) and lateral vision (50°) (Wolf, Germany). Biopsies were taken through a second point of entry using a 5-mm rigid forceps. Thoracoscopy revealed a chronic inflammation of the parietal pleura with thickened areas m...
A 45-year-old officer, working for a period of 18 years at a military radar base, presented with progressive exertional dyspnea, dry cough, and hemoptysis. Subsequent evaluation demonstrated a left pulmonary artery occlusion as well as a left upper lobe bronchus stenosis, due to a dense fibrotic mediastinal mass. Histologically, this proved to be idiopathic mediastinal fibrosis (IMF). The development of IMF in a man exposed for a long period to radio-frequency radiation (RFR) is unique in the literature in English. The possible association of radiation exposure with IMF is discussed.
The probability of an AIDS patient being infected with tuberculosis (TB) has been studied in different populations and found to be increased by as much as 500 times, but the reverse, i.e. the probability of a patient with TB being infected with HIV, has not been studied. The aim of this study was to investigate the hypothesis of greater HIV seropositivity and altered immune status, as indicated by CD4+ T-lymphocyte counts, in TB patients. We prospectively studied 162 males, aged 18-30 years, hospitalized for active, proven TB. Serum for HIV antibodies was tested twice by ELISA and confirmed by the Western blot technique. The control group consisted of 145,000 blood donor volunteers serving in the army, aged 18-30 years. The number of CD4+ T lymphocytes was also measured in the patients and the control group. We found that the rate of HIV seropositivity in TB patients was 2.4% (4 of 162), while it was 0.214% in the control group (p < 0.0001). Using the Bayes’ theorem we found that the probability of a TB patient being infected with HIV was 9.1%, approximately 150 times higher than the expected rate in the matched control group (p < 0.0001). The number of CD4+ T lymphocytes was significantly lower in pulmonary and extrapulmonary TB patients than in the control group, taking into account the HIV status (p < 0.001). Our results suggest that there is a 150 times greater probability of a TB patient being infected with HIV. CD4+ T lymphocytes are significantly lower in all groups of TB patients.
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