Incidence of metastatic disease to the hypothalamic-pituitary area is low (1 to 6% in most studies), the lung and the prostate being the most common primary sites in men. Clinical presentation as panhypopituitarism is rare (0.2 to 0.8%) in patients with bronchogenic carcinoma. The authors describe a case of a man with diagnosis of squamous cell carcinoma of the lung that, during the clinical course of the disease, presented clinical and laboratorial evidence of panhypopituitarism, with an expansive sellar and supra-sellar lesion image in the CT scan of the brain.

Keywords: Panhypopituitarism. Bronchogenic carcinoma. Hypothalamic-pituitary metastases.

Mucoepidermoid carcinoma is an uncommon neoplasm of the tracheobronchial tree, of unknown etiology. Its preferred endobronchial location often results in respiratory symptoms such as obstruction of the airways and lung diseases of slow recovery. They usually are slow growing tumors although they may present an aggressive behavior with local invasion and lymph node metastases depending on their histopathologic characteristics. The mainstay therapy is complete surgical resection either by means of lobectomy or by lung sparing procedures such as bronchotomy and bronchoplasty. Prognosis depends upon the degree of cellular differentiation of the tumors. The authors report a case of this rare neoplasia and describe the clinical and radiographic characteristics, and the surgical treatment.

Meningiomas account for approximately one-sixth of all primary neoplasms of the central nervous system and rarely present extracranial metastases. A finding of multiple metastases is rare, as is the presence of respiratory symptoms. Herein, we report the case of a 67-year-old female patient presenting subacute onset of respiratory symptoms. The patient had undergone resection of a benign intracranial meningioma six months prior, but had no history of lung disease. Upon examination, multiple pulmonary metastases, originating from the primary tumor, were observed.

Keywords: Key words: Meningioma. Neoplasm Metastasis. Lung Neoplasms..

We report a case of breast cancer identified in a 72-year-old male as an accidental finding during the course of the investigation of a primary tumor and the search for pulmonary metastases. We address aspects related to the epidemiology, diagnosis, treatment and prognosis of this condition in males.

Keywords: Neoplasm metastasis/lung; Breast neoplasms; Male.

Objective: To describe the main clinical and radiological characteristics of patients with histoplasmosis mimicking lung cancer. Methods: This was a retrospective descriptive study based on the analysis of the medical records of the 294 patients diagnosed with histoplasmosis between 1977 and 2011 at the Mycology Laboratory of the Santa Casa Sisters of Mercy Hospital of Porto Alegre in the city of Porto Alegre, Brazil. The diagnosis of histoplasmosis was established by culture, histopathological examination, or immunodiffusion testing (identification of M or H precipitation bands). After identifying the patients with macroscopic lesions, as well as radiological and CT findings consistent with malignancy, we divided the patients into two groups: those with a history of cancer and presenting with lesions mimicking metastases (HC group); and those with no such history but also presenting with lesions mimicking metastases (NHC group). Results: Of the 294 patients diagnosed with histoplasmosis, 15 had presented with lesions mimicking primary neoplasia or metastases (9 and 6 in the HC and NHC groups, respectively). The age of the patients ranged from 13 to 67 years (median, 44 years). Of the 15 patients, 14 (93%) presented with pulmonary lesions at the time of hospitalization. Conclusions: The clinical and radiological syndrome of neoplastic disease is not confined to malignancy, and granulomatous infectious diseases must therefore be considered in the differential diagnosis.

Keywords: Histoplasmosis; Multiple pulmonary nodules; Solitary pulmonary nodule.

In cases of recent asthma in which clinical control with the usual treatment (corticosteroids and bronchodilator) is unsatisfactory, it is important to consider other diagnoses, such as congestive heart failure, gastroesophageal reflux or other forms of airway obstruction. We report the case of a female patient with mucoepidermoid carcinoma of the trachea mimicking asthma. The patient presented cough and wheezing, as well as abnormal spirometry results with an obstructive pattern that was responsive to bronchodilators. One year later, the patient presented clinical and spirometric worsening. The chest X-ray revealed no abnormalities. A CT scan showed a vegetative lesion obstructing the tracheal lumen and located 1 cm from the carina. Fiberoptic bronchoscopy showed a finding similar to a bronchial carcinoid tumor. The anatomopathological diagnosis made after surgical resection was low-grade mucoepidermoid carcinoma, without lymph node involvement. Although the flow-volume curve was not suggestive of upper airway obstruction, the spirometry performed after the surgery showed a significant reduction in the degree of obstruction and greater reversibility after bronchodilator use. There was no evidence of recurrence of the disease or of the symptoms after a two-year follow-up period.

Keywords: Bronchial hyperreactivity; Carcinoma, mucoepidermoid; Trachea; Asthma; Lung diseases, obstructive.

Pancoast syndrome consists of signs and symptoms resulting from a tumor affecting the pulmonary apex and adjacent structures. The process is typically caused by a neoplasm. The majority of cases of Pancoast syndrome are caused by bronchogenic carcinoma. The most commonly found histologic subtypes are adenocarcinoma and epidermoid carcinoma. There have been very few reports of small cell lung carcinoma in the genesis of Pancoast syndrome. We describe the case of a patient with Pancoast syndrome caused by small cell lung carcinoma and discuss the aspects related to the diagnosis and treatment.

Keywords: Pancoast syndrome; Small cell lung carcinoma; Lung neoplasms.

Objective: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. Methods: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. Results: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). Conclusions: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.

Keywords: Neoplasm metastasis; Survival analysis; Thoracic surgery; Metastasectomy.

Recurrent pneumonia is characterized by frequent infection and infiltrates in one or more lung lobes. The localized form of the disease is caused by intraluminal obstruction, extrinsic compression or structural abnormalities. The pattern, frequency and severity of the infections, together with a thorough review of all chest X-rays, inform the diagnosis. Herein, we report a case of recurrent pneumonia due to endobronchial obstruction by mucoepidermoid carcinoma.

Keywords: Pneumonia; Recurrent; Carcinoma, mucoepidermoid/diagnosis; Tomography, X-ray computed; Case reports

The authors describe a case of a woman submitted to radiation therapy for breast carcinoma who presented, 40 days after the end of the treatment, fever, dry cough, dyspnea on exertion, and weight loss. Chest imaging revealed migratory opacities. The histopathological examination of transbronchial biopsy specimens showed characteristic findings of BOOP. Corticosteroid therapy resulted in dramatic clinical improvement, together with complete clearing of the pulmonary opacities on chest imaging. The authors present a brief review of the literature concerning radiation-induced lung injury, emphasizing the importance of including BOOP in the differential diagnosis in these complications. The present case, as well as the two other reports from the literature, provide further evidence for the role of irradiation injury as a cause of clinicopathological syndrome identical to idiopathic BOOP, i.e., radiation-induced BOOP.

Keywords: Bronchiolitis obliterans organizing pneumonia. BOOP. Radiation pneumonitis. Radiotherapy. Breast carcinoma.

The usefulness of serum tumor markers in lung cancer is not well defined. Objective: The aim of this study is to examine the correlation between serum tumor markers and tumor extension and its prognostic value. Patients and method: From February 1995 to September 1997, 103 patients with non-small cell lung carcinoma were evaluated at the Department of Thoracic Surgery. Serum levels of CEA, CYFRA21.1, CA15.3, CA19.9, CA72.4, and NSE were determined before treatment. Results: The serum level of CYFRA21.1 was the most frequent elevated tumor marker (55%). Patients with advanced tumor had higher mean serum level of CEA (90.8 ng/ml), CYFRA21.1 (20.3 ng/ml) and CA15.3 (56.5%) than those with localized carcinoma, respectively 10.2 ng/ml, 12.6 ng/ml and 22.2 ng/ml. Considering all serum tumor markers evaluated in this study, only patients with elevated CEA had greater chance (5.6) of presenting with advanced non-small lung carcinoma than patients with normal CEA. Overall survival was influenced by performance status (p = 0.001), tumor extension (p = 0.006), elevated serum level of CEA (p = 0.043), more than two elevated serum tumor markers (p < 0.001), and type of treatment (p < 0.001). The prognostic value of anatomical tumor extension reached the limit of significance (p = 0.052); however, two or more elevated serum tumor markers and type of treatment had independent prognostic value (respectively, p = 0.035 and p = 0.005). Conclusion: None of these serum tumor markers had clinical value in the management of NSCLC patients.

Keywords: biological tumor markers, neoplasm staging, non-small cell lung carcinoma, prognosis

A case of a patient with Pancoast's syndrome associated with acquired immunodeficiency syndrome is reported. This association is rare and Kaposi's sarcoma and non-Hodgkin lymphoma are the most recurrent tumors in AIDS. The patient was an IV drug user and was admitted to the hospital for diagnosis of apex lung mass with signs of Pancoast's syndrome. HIV serology was positive and pathology of lung mass showed non-small cell lung cancer.

Keywords: Pancoast's syndrome. HIV. Bronchogenic carcinoma. Lung neoplasms. Acquired immunodeficiency syndrome.

Despite the improvements seen in the treatment of lung cancer, little has improved in the survival of these patients, and a great importance is attributed to the factors that have a role to play in such survival. Purpose: To check for possible prognostic factor differences in two populations of lung cancer patients, one of them with short survival (less than six months), and the other with longer survival (more than 24 months). Methods: From 1997 to 1999, 52 patients with histopathologic diagnosis of homogenous carcinoma were studied, and demographics, clinical parameters, smoking pattern, Karnofsky's index, disease staging, and laboratory dosing of lactic dehydrogenase, alkaline phosphatase, carcinoembryonic antigen, and calcium data were surveyed. Results: 29 patients had less than six month survival, and 23 had more than 24 month survival. The three most important factors for short survival were the low initial Karnofsky's index, loss of appetite, and high serum LDH levels. Conclusion: The three prognosis components are: current physical status, prior physical status, and current status of the disease.