RESUMEN
Tuberculosis affects pulmonary and extra-pulmonary sites with a multitude of differing presentations. The involvement of thoracic wall is a rare entity. We report the case of a patient who had a tumefaction on the right chest wall 6 months after a right breast mastectomy. After an initial radiological suspicion of malignancy, we detected intraoperatively an abscess in which histologic examination revealed granulomas with multinucleated giant cells.
RESUMEN
Most developed countries accepted the chronological age of 70 years as the definition of "elderly" and there is a general consensus in clinical practice to consider this age as the threshold in risk assessment. This has a strong impact in the choice of treatment of these lung cancer patients. Indeed, more than 50% of these patients are over 70 and nearly 30% are over 75 years old. Because of the increasing number of elderly patients that are generally fitter than in the past, the treatment options should rather be based on individual fitness, taking into account risks and benefits of the diagnostic and therapeutic procedures. This means considering biological rather than chronological age to make decisions. For these reasons, we developed a simplified short comprehensive geriatric assessment (sCGA), including a standardised evaluation of activity of daily living, depression, cognitive status, comorbidities and geriatric syndromes. This allowed us the classification of these patients into 3 categories: frail, vulnerable and fit. Through the emblematic case of a fit elderly man affected by NSLCC, we present the multidisciplinary assessment and discussions to identify the best treatment options for this patient.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/terapia , Carcinoma de Células Escamosas/terapia , Evaluación Geriátrica , Neoplasias Pulmonares/terapia , Anciano , Anciano de 80 o más Años , Manejo de la Enfermedad , Anciano Frágil , Humanos , MasculinoAsunto(s)
Biomarcadores de Tumor/genética , Neoplasias de los Bronquios/genética , Reordenamiento Génico , Hemotórax/etiología , Proteínas Proto-Oncogénicas/genética , Proteínas Represoras/genética , Sarcoma Sinovial/genética , Anciano de 80 o más Años , Neoplasias de los Bronquios/complicaciones , Neoplasias de los Bronquios/patología , Neoplasias de los Bronquios/cirugía , Hemotórax/diagnóstico , Hemotórax/cirugía , Humanos , Hibridación Fluorescente in Situ , Masculino , Neumonectomía , Sarcoma Sinovial/complicaciones , Sarcoma Sinovial/patología , Sarcoma Sinovial/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The two essential requirements for pathologic specimens in the era of personalized therapies for non-small cell lung carcinoma (NSCLC) are accurate subtyping as adenocarcinoma (ADC) versus squamous cell carcinoma (SqCC) and suitability for EGFR molecular testing, as well as for testing of other oncogenes such as EML4-ALK and KRAS. Actually, the value of EGFR expressed in patients with NSCLC in predicting a benefit in terms of survival from treatment with an epidermal growth factor receptor targeted therapy is still in debate, while there is a convincing evidence on the predictive role of the EGFR mutational status with regard to the response to tyrosine kinase inhibitors (TKIs).This is a literature overview on the state-of-the-art of EGFR oncogenic mutation in NSCLC. It is designed to highlight the preclinical rationale driving the molecular footprint assessment, the progressive development of a specific pharmacological treatment and the best method to identify those NSCLC who would most likely benefit from treatment with EGFR-targeted therapy. This is supported by the belief that a rationale for the prioritization of specific regimens based on patient-tailored therapy could be closer than commonly expected.