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Pulmonary malakoplakia is a rare lung lesion more frequently found in immunocompromised patients than in immunocompetent individuals. In this study, we report the challenging case of a young immunocompetent patient with an irregular pulmonary nodule with peripheral cysts who, after undergoing surgery, was diagnosed with malakoplakia. Due to the rarity of the disease and the similarity of this condition to malignant neoplasms, cytopathological or histopathological examinations are necessary for the correct diagnosis. A description of pulmonary malakoplakia with peripheral cysts has not been previously published in the literature.

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RESUMEN Introducción: el cáncer de pulmón es un problema de Salud Pública en el mundo y en nuestro país por su alta mortalidad e incidencia. Los carcinógenos medioambientales y el tabaquismo están directamente relacionados como factores de riesgo. Objetivo: Caracterizar los factores etiológicos de fumador activo y carcinógenos medioambientales de los pacientes con cáncer de pulmón detectados durante 9 años en el Instituto Nacional del Cáncer, Paraguay. Metodología: estudio observacional retrospectivo descriptivo analítico de una base de datos del período 2004-2013. Las variables medidas fueron datos demográficos, carga tabáquica, tabaquismo, la exposición a carcinógenos medioambientales categoría I. Resultados: se incluyeron 478 pacientes con cáncer pulmonar, 88,1% de sexo masculino y 11,9% femenino. La edad promedio del sexo masculino fue 60±10 años y del sexo femenino 58±12 años. La prevalencia de exposición carcinógenos medioambientales categoría I fue 36,90%. La media del índice tabáquico fue 4,48±20. El modelo de regresión lineal múltiple entre exposición ambiental, tabaquismo y tipo histológico para predecir la severidad clínica fue 3,6%. En el análisis de regresión logística de la relación de tipos histológicos con tabaquismo, género y exposición ambiental no mejoran el modelo de predicción. Conclusiones: Los factores etiológicos relacionados con carcinógenos medioambientales estuvieron presentes en más de un tercio de la población, el hábito tabáquico es mayor en hombres que en mujeres. El tipo histológico más frecuente para ambos sexos, con y sin el hábito tabáquico, es el carcinoma de células no pequeñas.

ABSTRACT Introduction: Lung cancer is a public health problem in the world and in our country due to its high mortality and incidence. Environmental carcinogens and smoking are directly related as risk factors. Objective: To characterize the etiological factors of active smokers and environmental carcinogens of patients with lung cancer detected during 9 years at the National Cancer Institute, Paraguay. Methodology: Retrospective observational descriptive analytical study of a database for the period 2004-2013. The variables measured were demographic data, smoking load, smoking, exposure to category I environmental carcinogens. Results: Four hundred seventy-eight patients with lung cancer, 88.1% male and 11.9% female were included. The mean age of the male sex was 60±10 years and 58±12 years of the female age. The prevalence of exposure to category I environmental carcinogens was 36.90%. The mean smoking index was 4.48±20. The multiple linear regression model between environmental exposure, smoking and histological type to predict clinical severity was 3.6%. In the logistic regression analysis of the relationship of histological types with smoking, gender and environmental exposure, the prediction model was not improved. Conclusions: The etiological factors related to environmental carcinogens were present in more than one third of the population, and smoking was greater in men than in women. The most frequent histological type for both sexes, with and without the smoking habit, was non-small cell carcinoma.

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Os avanços científicos das últimas décadas permitiram que a compreensão do câncer evoluísse de uma visão simplista, na qual o principal motor seria uma atividade celular hiperploriferativa, para uma visão mais complexa onde o estado fisiológico geral permite a gênese e progressão tumoral. Essa evolução permite o desenvolvimento de novas abordagens terapêuticas e traz novas esperanças para o tratamento de muitos tipos de cânceres ainda extremamente deletérios. Dentro desse novo panorama, terapias que estimulem a imunidade antitumoral têm se mostrado extremamente promissoras. Nesse trabalho, procuramos investigar os efeitos antitumorais desencadeados pela combinação da indução de morte celular e imunoestimulação. Para tanto, visamos à recuperação da via de p53 (pela transferência gênica do próprio p53 ou p19) associada à transferência gênica de IFNbeta. A transferência gênica foi mediada por vetores adenovirais do sorotipo 5. Nossas observações, em um modelo murino de carcinoma pulmonar, permitem concluir que esta linhagem é sensível a morte induzida pela transferência gênica de p19 e não p53. Porém, a transferência gênica intratumoral de IFNbeta se mostrou chave no controle do crescimento do tumor primário. Destacamos, entretanto, que a associação de IFNbeta com p19 produziu efeitos imunoprotetores superiores à transferência de IFNbeta ou p19 sozinhos. Tal efeito parece ser dependente da indução de fatores quimiotáxicos e conseqüente recrutamento de neutrófilos para o sítio tumoral. O efeito da transferência gênica combinada de ambos os genes IFNbeta e p19 se mostrou ainda mais promissor quando associado à cisplatina, induzindo uma notável redução no crescimento tumoral...

Scientific advances from the last decades enabled the evolution of our knowledge of cancer from a simplistic vision, in which the main motor was an excessive cell proliferation, to a more complex one, where the general physiologic state enables tumorigenesis and tumor progression. This evolution enabled the development of new therapies and brings new hopes for the treatment of several types of cancers. In this context, therapies that induce an antitumor immunity are very promising. In this work, we are investigating the antitumor effects triggered by the combination of cell death induction and immunostimulation. To this end, we aimed to restore p53 pathway (by p53 or p19 gene transfer) associated with immunostimulation by IFNbeta gene transfer. The gene transfer was mediated by Adenovectors Serotype 5. Our observations in a murine model of lung cancer showed that this cell line is sensitive to cell death induced by p19 gene transfer, but not p53. Nevertheless, intratumoral gene transfer of IFNbeta, was crucial in controlling tumor growth. Moreover, p19 and IFNbeta association induced higher immunoprotecting effects than p19 or IFNbeta alone. This effect seems to be depending on the induction of chemotactic factors, and the recruitment of neutrophils to the tumor site. The effect of combined gene transfer of p19 and IFNbeta was even more promising when associated with Cisplatine, inducing a remarkable reduction in tumor growth...

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RESUMO

In patients under 15 years of age primary lung tumors are infrequent, most thoracic tumors being originated in the mediastinum or the thoracic wall. The great majority of pulmonary masses are non-neoplastic corresponding to inflammatory processes or malformations. Amongst neoplasms metastasis from solid extracraneal tumors are the predominant lesions. Other malignant neoplasms are: bronchial carcinoid, mucoepidermoid carcinoma, pulmonary lymphoma, pleuropulmonary blastoma and metastasis. In the spectrum of benign lesions the following are found: miofibroblastic inflammatory tumor, nodular lymphoid hyperplasia and hamartomas. The diagnosis of primary pulmonary neoplasms is frequently late because of its low incidence, lack of clinical suspicion and the variability of its manifestations. Radiological and tomographical signs are very proteiform and unspecific, representing a great diagnostic challenge.

En pacientes menores de 15 años los tumores pulmonares primarios son infrecuentes, generalmente los tumores torácicos son de origen mediastínico o de la pared torácica. La gran mayoría de las masas pulmonares son de origen no neoplásico, correspondiendo a procesos inflamatorios o malformaciones. Dentro de las neoplasias pulmonares, las metástasis de tumores sólidos extracraneanos son las lesiones predominantes. En el espectro de lesiones benignas se encuentran el tumor miofibroblástico inflamatorio, la hiperplasia nodular linfoidea, los síndromes linfoproliferativos y los hamartomas. Entre las neoplasias malignas se incluyen el tumor carcinoide bronquial, carcinoma mucoepidermoide, linfoma pulmonar, blastoma pleuropulmonar y las metástasis. El diagnóstico de las neoplasias primarias pulmonares frecuentemente es tardío, por su baja incidencia y la falta de sospecha clínica o por su presentación atípica. Los hallazgos radiológicos y tomográficos de los tumores pulmonares son muyproteiformes, según su estirpe y lugar de origen, y no son específicos en la mayoría de los casos, constituyendo habitualmente un gran desafo diagnóstico.

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