According to current Polish and international recommendations, detection of EGFR gene somatic mutations is the essential part of routine diagnostic algorithm in advanced NSCLC patients considered for tyrosine kinase inhi...According to current Polish and international recommendations, detection of EGFR gene somatic mutations is the essential part of routine diagnostic algorithm in advanced NSCLC patients considered for tyrosine kinase inhibitor therapy. Molecular heterogeneity of tumor tissue and cytology materials used for molecular diagnostics is challenging for classic methods of genetic analysis, such as Sanger sequencing, driving the development and implementation of specialized, highly sensitive techniques for mutations detection. Constant, dynamic progress in molecular biology techniques, particularly development of next-generation sequencing, should enable clinical implementation of simultaneous multiple therapeutic biomarkers analysis as well as non-invasive EGFR mutations diagnostic based on free-circulating DNA isolated from blood of non-small cell lung cancer patients.
Orally inhaled products delivered via inhalation exert their effect directly to the target organ. This allows to administer a very low dose of a drug compared with an oral route with similar clinical effect and significa...Orally inhaled products delivered via inhalation exert their effect directly to the target organ. This allows to administer a very low dose of a drug compared with an oral route with similar clinical effect and significantly reduced toxicity. However inhalation therapy is also limited by several factors. Delivery of the desired dose of the drug to the airways depends on a type of the inhaler - pressurised metered-dose inhaler (pMDI) or dry powder inhaler (DPI), inhaler characteristics (low or high internal resistance, diameter of particles and distribution of the generated aerosol fine particles), thermal conditions of air, and ability of patient to generate sufficient inspiratory flow (for DPI) or to coordinate actuation with inhalation (for pMDI). Unlike pMDIs, DPIs are breath- -actuated, hence avoiding the need for the patient to coordinate actuation with inspiration. Furthermore, DPIs are propellant-free and do not produce the cold sensation on inhalation. Currently available DPIs vary widely in design, operating characteristics and performance. And poor inhalation technique may compromise treatment efficacy. Hence, there is a clear need for a careful selection of DPIs for different patient groups, including children, elderly patients and those with severe airway obstruction.
Lung cancer is the main cause of cancer death worldwide. An advanced stage of the disease at the time of diagnosis, observed in the majority of cases, does not allow for introduction of radical treatment or makes the tre...Lung cancer is the main cause of cancer death worldwide. An advanced stage of the disease at the time of diagnosis, observed in the majority of cases, does not allow for introduction of radical treatment or makes the treatment ineffective. Lung cancer as a solid tumour with a very low antigenicity escapes immune surveillance, and cytotoxic cells attack. Cytotoxic lymphocytes play a key role in anticancer defence, but the population of these cells individually differs. Many suppressor and regulatory mechanisms inhibit the recognition of tumour antigens by dendritic and cytotoxic cell activation. The population of regulatory T cells (T regs) plays a crucial role in this inhibition of immune response. Their function depends on the expression of transcription factor Foxp3 and the presence of CTLA-4 molecules. The increased proportion of T regs and high expression of Foxp3 and CTLA-4 on lung cancer cells and tumour infiltrating lymphocytes were observed. Other components of immune response inhibition and tumour promotion are: Th17 cell population, M2 macrophage polarisation, the presence of myeloid derived suppressor cells (MDSCs) and a significantly elevated concentration of cytokines: TGF-b and IL-10 in the tumour microenvironment. The recognition of these mechanisms may have important therapeutic implications. Several types of agents which are capable of modulating the immune response have recently been used in many clinical trials conducted in lung cancer patients, some of them showing efficacy. Lung cancer immunotherapy has two main directions: the first goal is to improve the cytotoxic effect (for example by inhibition of CTLA-4, stimulation of dendritic cell function, inhibition of lymphocyte apoptosis), and the second way is the production of anti-cancer vaccines using known cancer antigens: MAGE A3, MUC1, EGF and TGF-b. Immunotherapy in lung cancer treatment has a character of personalised therapy - there is a need to specify the patient's immune status prior to treatment. The analysis of immune cells and mediators in the peripheral blood allows this, but the more valuable method seems to be bronchoalveolar lavage (BAL) examination with careful assessment of the tumour microenvironment.
Anaerobes used to be the most common cause of community-acquired lung abscess, and Streptococcus species used to be the second most common cause. In recent years, this has been changing. Klebsiella pneumoniae is now an i...Anaerobes used to be the most common cause of community-acquired lung abscess, and Streptococcus species used to be the second most common cause. In recent years, this has been changing. Klebsiella pneumoniae is now an increasing cause of community- acquired lung abscess, but Streptococcus species continue to be major pathogens. Necrotizing pneumonia has generally been regarded as a rare complication of pneumococcal infection in adults. Type 3 Streptococcus pneumoniae was the single most common type implicated in necrosis; however, many other serotypes were implicated. This entity predominately infects children, but is present also in adults. Lung abscess in adults due to Streptococcus pneumoniae is not common. In this regard we present a case series of pulmonary cavitation due to Streptococcus pneumoniae and discuss the possible pathogenic mechanism of the disease.
Pulmonary veno-occlusive disease (PVOD) is a rare cause of severe pulmonary hypertension characterised by poor prognosis. We report the case of a 24-year-old male patient with increasing dyspnea and exercise intolerance...Pulmonary veno-occlusive disease (PVOD) is a rare cause of severe pulmonary hypertension characterised by poor prognosis. We report the case of a 24-year-old male patient with increasing dyspnea and exercise intolerance treated with calcium channel blockers and glucocorticosteroids, due to suspicion of pulmonary hypertension and interstitial lung disease, until lung biopsy was performed and a diagnosis of PVOD was established on the basis of the histological analysis of the lung biopsy sample. This case highlights that pulmonary veno-occlusive disease is a disorder that is difficult to diagnose and resistant to medical treatment, which is particularly poor prognostic factor. Due to poor response to medical therapy and high mortality in patients with PVOD, understanding the pathogenesis, differentiation with pulmonary arterial hypertension and the search for a new methods of treatment should be the key challenges for modern medicine.
There is no doubt that venous thromboembolism (VTE) is a complex and multicausal disease. Tuberculosis (TB) itself is found to have thrombogenic potential. There is an association between tuberculosis and VTE. We present...There is no doubt that venous thromboembolism (VTE) is a complex and multicausal disease. Tuberculosis (TB) itself is found to have thrombogenic potential. There is an association between tuberculosis and VTE. We present a case of a 31-year-old male diagnosed with TB after a 2-month delay. He was treated with an anticoagulant for pulmonary embolism (PE) complicated by pulmonary infarction, and with antibiotics for presumed bacterial pneumonia. The patient did not improve despite in-hospital treatment. Finally, TB was diagnosed with positive sputum smear for acid fast bacilli and subsequent culture of Mycobacterium tuberculosis. Antituberculous therapy was uneventful and the patient was discharged home. Thrombophilia screening revealed a heterozygous factor V Leiden mutation. This case report emphasises that although there is a steady decline in active cases of TB, it should be still placed high on the list as a differential diagnosis in non-resolving lung infection or pulmonary infarction. This is especially relevant in cases with typical radiological findings located in the upper lobes. On the other hand, definitive diagnosis may be challenging in a case of concurrent TB, bacterial pneumonia and pulmonary infarction. Thromboembolic events may develop in TB patients without any clinical VTE risk factors. Therefore, thromboprophylaxis should be cautiously considered in this group of patients.
INTRODUCTION: The available data on the epidemiology of interstitial lung disease (ILD) from India is sparse. Hence, the present study was undertaken with the aim to analyse the demographic profile and clinical, radiolog...INTRODUCTION: The available data on the epidemiology of interstitial lung disease (ILD) from India is sparse. Hence, the present study was undertaken with the aim to analyse the demographic profile and clinical, radiological and pathological characteristics along with physiological parameters of various subgroups of ILD patients. MATERIAL AND METHODS: We retrospectively studied 289 patients diagnosed with ILD during the years 2001-2013 at one of the respiratory units of Vallabhbhai Patel Chest Institute. RESULTS: Mean age at presentation was 44.24 years; females comprised 54.68% of the patients. Prior to presentation at our centre, 14.84% patients had been treated with antituberculous therapy due to misdiagnosis of tuberculosis. In the pool of ILDs analysed, sarcoidosis (37.3%) was found to be the most common subgroup, followed by IPF (27.6%) and NSIP (25.6%). Cough (92.97%) was the most common presenting symptom; exertional dyspnoea was found in 79.2% of patients. Digital clubbing was commonest in IPF, found in 30% of patients. Significant desaturation on six-minute walk test was most frequenty seen (50%) in NSIP patients. The most common pattern on chest roentgenogram was reticular/reticulo-nodular pattern (80.2%) and on HRCT - interstitial fibrosis (49.9%). Mean of predicted total lung capacity (TLC) was 64.3%, the lowest being in the IPF group (58.88%). Mean of predicted DLCO was 50.56%, the lowest being in the IPF group (42.75%). The overall diagnostic yield of bronchoscopic biopsy was 83.04%, the highest yield being among sarcoidosis patients (96.29%). CONCLUSIONS: We found sarcoidosis, IPF and NSIP to be the most common ILDs in northern India. ILDs are still frequently misdiagnosed as TB, and increased awareness, education and diagnostic facilities are required to diagnose ILDs at an early stage.
INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is a rare disease characterised by the abnormal accumulation of surfactant-like material in macrophages within the alveolar spaces and distal bronchioles. The course of...INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is a rare disease characterised by the abnormal accumulation of surfactant-like material in macrophages within the alveolar spaces and distal bronchioles. The course of the disease is variable and the prognosis is often good. However, progressive disease in some patients can cause respiratory dysfunction and can be life threatening. In this situation, the only effective treatment is whole lung lavage. The objective of the study was to present the characteristics and the course of pulmonary alveolar proteinosis in our own material, the diagnostic methods used, the indications for treatment and the treatment efficacy. MATERIAL AND METHODS: Retrospective analysis included 17 patients: 6 women and 11 men, aged from 32 to 56 years, who were observed in the Third Lung Department of Pneumonology at the National Institute of Tuberculosis and Lung Diseases between 1984 and 2013. In all patients chest X-ray, pulmonary function test and blood gases were performed. In 15 patients, high-resolution computed tomography (HRCT) was obtained. Bronchoscopy was performed in all of the patients, and in 7/17, bronchoalveolar lavage (BAL) was carried out. Fourteen patients underwent open lung biopsy. The indications for whole lung lavage (WLL) were progression of dyspnoea with restriction of daily activity and/or hypoxaemia. RESULTS: In most of the patients (13/17) the diagnosis was established outside our institute. Patients were referred to our department to establish further procedures. The criteria of diagnosis of PAP in most patients (16/17) was the histological examination of lung tissue, obtained by open lung biopsy (14 cases) and transbronchial lung biopsy (TBLB) (2 cases). Only in one patient the diagnosis was established on the basis of BAL. HRCT imaging was characteristic of proteinosis in 11/15 patients, and BAL examination in 6/7 patients, in whom BAL was performed. In four patients, who had been exposed to injurious factors for many years, secondary proteinosis was recognised; in other patients, no exposure or no other disease was found, and primary alveolar proteinosis was diagnosed. In one patient granulocyte macrophage colony stimulating factor autoantibody was detected. The majority of patients (10/17) had clinical symptoms at the diagnosis. The most commonly reported was dyspnoea, followed by respiratory tract infections. The most common abnormality (12/17) in pulmonary lung test was a decrease of diffusing capacity of the lung for carbon monoxide (DLCO). Respiratory distress at rest was found in two patients. Patients were observed for the period of 6 months to 19 years. Spontaneous partial remission was observed in 10 out of 13 untreated patients, including one complete remission; in 3 cases stabilisation was found in radiological examinations; and in other 4 patients, whole lung lavagewas used, resulting in clinical improvement with partial resolution of lesions in radiological examinations in 3 patients. In one patient, despite WLL being repeated three times, improvement was not achieved. CONCLUSIONS: Pulmonary alveolar proteinosis is a rare interstitial disease with a mild course in most cases. In 13/17 patients diagnosis was based on histological examination of samples from open lung biopsy. The presented patients were observed in the years 1984-2004, and at that time histologic examination was the main diagnostic method. The most common abnormality in pulmonary function tests was decrease of DLCO. In most cases, spontaneous remission of the disease was observed. In four patients with severe course of PAP, WLL was performed with subjective, functional and radiological improvement in 3 of them.
INTRODUCTION: In recent years, positron emission tomography (PET) has been increasingly applied in the diagnosis of neoplastic lung diseases. In contrast to conventional imaging studies, PET-CT enables the visualisation...INTRODUCTION: In recent years, positron emission tomography (PET) has been increasingly applied in the diagnosis of neoplastic lung diseases. In contrast to conventional imaging studies, PET-CT enables the visualisation of not only the morphology of the suspicious lesion, but also its metabolism. The aim of the present study was to investigate the role of PET-CT in the initial assessment of patients with indeterminate solitary pulmonary lesions. MATERIAL AND METHODS: The study was conducted on a group of 82 patients with indeterminate lung nodule diagnosed at the National Institute of Tuberculosis and Lung Diseases in the period from January 2008 to May 2011. CT and PET-CT were performed in all of the patients. Histological or cytological examination of the biopsy specimens obtained from bronchoscopy, mediastinoscopy and intraoperatively were the reference tests. RESULTS: Malignancy was documented in 40 patients (48.8%). Histopathological analysis of all tumours revealed 12 cases of squamous cell carcinoma, 18 cases of adenocarcinoma and 1 case of carcinoid, whereas in 9 patients the diagnosis of "non-small cell cancer not otherwise specified" was made. All lesions except one were of solid character on chest CT. SUV(max) values exceeding 2.5 were found in 38 cancer patients (true positives, TP). The mean value of SUV(max) was 9.1 (1-26.8). Forty-two lesions were documented as benign (51.2%). SUV(max) values equal to or less than 2.5 were found in 37 patients (true negatives, TN). The mean value of SUV(max) in this group was 1.9 (0.5-8.6). The diagnostic value of PET-CT SUV(max) exceeding 2.5 in the prediction of neoplastic origin of solitary pulmonary lesions was: sensitivity - 95% (95% CI 84-99%), specificity - 88% (95% CI 75-95%) and accuracy - 91.5% (95% CI 83-96%). Positive predictive value (PPV) was 88.4% (95% CI 76-95%), and negative predictive value (NPV) was 94.8% (95% CI 83-99%). False negative results concerned two patients, with final diagnosis of carcinoid and adenocarcinoma; false positive results were obtained in 5 patients with various inflammatory lesions. CONCLUSIONS: In the present study, PET-CT appeared to have high sensitivity (95%), but lower specificity (88%) for predicting the malignant character of solitary pulmonary lesions. Overall diagnostic value of PET-CT SUV(max) > 2.5 was high - PPV was 88.4%, NPV was 94.8%. In the authors' opinion, the PET-CT value may increase when clinical data as well as other radiological documentation (with retrospective assessment) are taken into consideration.
MicroRNAs (miRNAs) represent a group of small, non-coding RNA molecules that have been shown to regulate gene expression at the translational level by interfering with the 3' untranslated region of messenger RNAs. Gene s...MicroRNAs (miRNAs) represent a group of small, non-coding RNA molecules that have been shown to regulate gene expression at the translational level by interfering with the 3' untranslated region of messenger RNAs. Gene silencing through miRNA interference is one epigenetic mechanism impacting the development and homeostasis of the organism. MiRNAs are critical for regulation of several biological processes, cellular function, the cell cycle, differentiation and apoptosis. Deregulation of miRNAs was confirmed in several pathologies including cancer (in lung cancer among others), asthma, COPD, diabetes and cardiovascular diseases. In mice models of asthma it has been found that increased levels of miR-21 and miR-126, and decreased levels of miR-672 and miR-143 are associated with regulation of cytokines involved in inflammation and remodeling, namely Il-13, Il-12, Il-10 and matrix metalloproteinase-12 (MMP-12). In lung cancer, overexpression of several miRNAs (miR-155, miR21, miR-17-92, miR221/222) and downregulation of let-7, miR-1, miR-29 and miR-126 has been found. It has been shown that serum miRNA profile may be regarded as a potential tool for early, non-invasive lung cancer diagnosis, and it can be used for chemotherapy sensitivity prediction and prognosis. MiRNAs seem to represent a promising goal in the search for new biomarkers and may be considered as an interesting target for therapeutical intervention.
Apoptosis is a form of programmed cell death essential for maintaining homeostasis, including onset, progress and resolution of immune reactions. Two major apoptosis pathways: extrinsic (mediated by death receptors) and...Apoptosis is a form of programmed cell death essential for maintaining homeostasis, including onset, progress and resolution of immune reactions. Two major apoptosis pathways: extrinsic (mediated by death receptors) and intrinsic (mitochondrial), were distinguished. Lymphocytes with cytotoxic activity may also initiate apoptosis of target cells by granzyme/perforin (pseudoreceptor) pathway. The specific apoptotic processes, i.e. activation induced cell death (AICD) and neglect induced death (NID), are types of extrinsic and intrinsic pathways, respectively. They both seem to be crucial in apoptosis of antigen-primed T cells during the contraction phase of inflammation. Alveolar lymphocytes (AL) are almost exclusively T effector cells, engaged in interstitial lung disease (ILD) pathophysiologies. The AL numbers in lower airways depends on recruitment to the lung, proliferation and local apoptosis. According to the references, it should be noted that AL usually do not proliferate in alveoli; their apoptosis rate accounts, on average, for 1% of cells in healthy subjects, and this is significantly decreased in disorders with lymphocytic alveolitis such as sarcoidosis and extrinsic allergic alveolitis (EAA). The mechanisms of AL apoptosis have not been completely explained. However, it is the NID process that is probably critical for the culling of T-cell response, as in EAA or sarcoidosis remission, with AICD as an auxiliary and/or modulating mechanism only. It should be emphasised that many ILDs are chronic disorders with no remission or improvement, and it is difficult to describe the AL response in terms of immune expansion/contraction.
BCG (Bacillus Calmette-Guerin) comprises an attenuated strain of Mycobacterium bovis and is used for vaccination against tuberculosis. An additional use of BCG is for immunotherapy of cancer in which the vaccine is admin...BCG (Bacillus Calmette-Guerin) comprises an attenuated strain of Mycobacterium bovis and is used for vaccination against tuberculosis. An additional use of BCG is for immunotherapy of cancer in which the vaccine is administered intravesically for the treatment of superficial bladder cancer. The efficacy of immunotherapy with BCG in the prevention of recurrence is estimated at 70-99%, which is higher than for local chemotherapy. The most frequent complications of such treatment include fever and urinary bladder inflammation, while serious complications of haematogenous organ inflammation, especially inflammation of the lungs with the formation of pulmonary caseosus granulomas, are rarely seen. The authors reported a case of a 68-year-old man who was treated with intravesical BCG instillations due to a superficial bladder cancer. The patient underwent transurethral resection of bladder cancer and then periodically received intravesical BCG instillations. A few days after one instillation, systemic symptoms with a high fever appeared. Further examinations showed features of hepatitis and spread pulmonary changes. The patient underwent videothoracoscopy, and a fragment of lung parenchyma was collected. The histopathological examination revealed the presence of granulomas with central caseosus necrosis. Suspecting BCG infection, diagnostics were enhanced to include bacteriological and genetic tests for the presence of acid-resistant bacilli, which finally gave negative results. The authors diagnosed granulomatous pneumonia as a complication of intravesical BCG immunotherapy. Treatment with antituberculous drugs was initiated. After completing pharmacological treatment, radiological control was performed, which showed significant but not complete remission of pulmonary changes.
The paper examines the case of a pregnant woman in a twin pregnancy complicated by pre-eclampsia and sleep disordered breathing. The patient was admitted to hospital with high blood pressure, proteinuria and increasing o...The paper examines the case of a pregnant woman in a twin pregnancy complicated by pre-eclampsia and sleep disordered breathing. The patient was admitted to hospital with high blood pressure, proteinuria and increasing oedema. Laboratory tests revealed proteinuria and reduced total protein concentration in serum. The patient was diagnosed with mild pre-eclampsia. Due to the observed severe daytime sleepiness of the patient, loud snoring and pauses in breathing during sleep, polysomnography was performed. The test revealed a number of episodes of obstructive apnea and hypopnea. The AHI (apnea-hypopnea index) value was 82.1. A number of episodes of desaturation were observed. The lowest saturation had a value of 82%. When the patient was diagnosed with severe obstructive sleep apnea, treatment with CPAP (continuous positive airway pressure) was introduced. The use of CPAP allowed a reduction of the AHI to 1.2, and the blood pressure value normalised. The patient used CPAP between the 33rd and 35th weeks of gestation. At the 35th week of gestation, caesarean section was performed due to life-threatening symptoms of the first foetus in the CTG-recording. Two male infants were delivered in good condition. During the postpartum period, the patient discontinued the use of CPAP. Following this, an increase in AHI to 45.3 and an increase in blood pressure to a maximum of 180/100mmHg were observed. The patient was discharged from hospital in good general condition on the 7th day postpartum with recommendation for further diagnostic and therapy. The conclusion that may be drawn from the case is that sleep disorders adversely affect the health of the mother and the foetus. Also, the mood and quality of life of the pregnant woman deteriorate. It has been proven that there are many relationships between sleep and health. Sleep disorders and disorders of breathing during sleep contribute to the development of various diseases or they degrade the overall phenomena. A disease, on the other hand, additionally negatively affects the quality of sleep. Therefore, it is essential to treat not only the primary disease, but also the accompanying sleep disorders.
UNLABELLED: Lymphomas are neoplasms of lymphocytes and their precursor cells. This disease develops from lymph nodes or extranodal lymphoid tissue. A common site for such a tumour is the chest. The authors describe the c...UNLABELLED: Lymphomas are neoplasms of lymphocytes and their precursor cells. This disease develops from lymph nodes or extranodal lymphoid tissue. A common site for such a tumour is the chest. The authors describe the case of a young man, who was admitted do the thoracic surgery department with a mediastinal tumour and an induration of the base of the neck. Initial diagnostic tests gave the wrong diagnosis of actinomycosis. A lack of progress in the therapy and the occurrence of a life-threatening condition led to the implementation of more aggressive diagnostic methods. In biopsies taken during thoracotomy, the patient was finally diagnosed with Hodgkin's lymphoma of nodular sclerosis type. CONCLUSIONS: Mediastinal tumours may cause diagnostic difficulties and, to avoid mistakes, typical histological studies should be complemented by targeted immunohistochemical tests.
Lung cancer is the leading cause of cancer related death in Poland. About 85% of all lung cancer constitutes non-small cancer (NSCLC), in which the role of cytotoxic and molecularly targeted drugs is increasing. This art...Lung cancer is the leading cause of cancer related death in Poland. About 85% of all lung cancer constitutes non-small cancer (NSCLC), in which the role of cytotoxic and molecularly targeted drugs is increasing. This article presents the current evidence- based recommendations for the use of these methods in clinical practice in NSCLC and malignant pleural mesothelioma.
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. The significance of health promotion is usually emphasised among the activities which nurses should undert...INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. The significance of health promotion is usually emphasised among the activities which nurses should undertake in relation to patients suffering from COPD. The aim of the study was to analyse the frequency and types of health promotion activities undertaken by nurses in relation to patients suffering from COPD. MATERIAL AND METHODS: The diagnostic survey with the use of a questionnaire constructed by the authors was applied in the study. Data collected in 2008 among 132 nurses (100%) working in outpatient and hospital healthcare sectors in Poland were quantitatively analysed. RESULTS: Nurses working in hospitals more frequently took part in diagnosing COPD (62.30%) than those working in outpatient establishments did (33.40%). Anti-smoking counselling was performed by 69% of respondents. Nurses very rarely used professional tools for the measurement of the level of nicotine addiction (6%) or the level of motivation to fight the addiction (4%). Activities in terms of health education carried out on a patient with COPD were declared by 66.67% of primary care nurses, and by 76.81% from hospitals. The nurses surveyed did not perform any monitoring of their recommendations and did not assess their effectiveness. Participation in interdisciplinary pulmonary rehabilitation programmes was declared by 9.53% of outpatient sector nurses and by 40.58% of nurses from hospitals. CONCLUSIONS: Nurses' activities in relation to patients suffering from COPD have a mainly educational nature, but unfortunately they are casual, occasional and unplanned. Planned and formal inclusion of nurses in the process of realisation of health promotion programs for patients with COPD is recommended, i.e. by planning funds for the tasks which can be performed by them. More attention should be payed to professional training of nurses for realisation of the process of health education, especially anti-smoking intervention.
INTRODUCTION: Primary germ cell tumours with mediastinal location comprise 1-6% of mediastinal tumours and 2-5% of all germ cell tumours occurring in adults. They are identified mostly in the 3rd decade of life, in 90% o...INTRODUCTION: Primary germ cell tumours with mediastinal location comprise 1-6% of mediastinal tumours and 2-5% of all germ cell tumours occurring in adults. They are identified mostly in the 3rd decade of life, in 90% of cases in men. The most common symptoms are dyspnea, chest pain, cough, fever and weight loss. The aim of the present study was the analysis of our own results of treatment of primary germ cell tumours with mediastinal location, and a review of the literature concerning this subject. MATERIAL AND METHODS: Five patients (4 males, 1 female) median age 27.8 years (range 23-30 years) treated in the period from 1999 to 2009 in Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Lung Cancer and Chest Tumours in Warsaw, due to germinal tumours with primary mediastinal location, entered the study. RESULTS: All patients received chemotherapy according to the BEP regimen. All patients achieved an objective response to treatment. Two patients died due to disease progression in spite of II- and III-line treatment. Three patients are still in follow-up. The median survival time was 55.8 months (range 8.0-120.0 months). CONCLUSIONS: Primary mediastinal germ cell tumours have worse prognosis than do those with gonadal location. Based on our observations and review of the literature, it can be concluded that the results of treatment of non-seminoma type germ cell tumours with primary mediastinal location remain poor. Patients who develop early recurrence or progression during first-line chemotherapy are particularly at risk of unfavourable outcome. Identification of new standards of treatment in tumours resistant to cisplatin require further studies evaluating the effectiveness of new generation cytostatic drugs.