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Idiopathic pulmonary fibrosis in patients with early-stage non-small-cell lung cancer after surgical resection

Hribernik Nezka
Hribernik Nezka
, 
Pozek Igor
Pozek Igor
 and 
Kern Izidor
Kern Izidor
   | Sep 24, 2019
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Article Category: Research Article
Published Online: Sep 24, 2019
Page range: 357 - 361
Received: Jan 22, 2019
Accepted: Jun 26, 2019
DOI: https://doi.org/10.2478/raon-2019-0032
© 2019 Hribernik Nezka, Pozek Igor, Kern Izidor, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Radiological images and images of pathological specimens for Patient No.1. (A) CT scan before lung resection demonstrating honeycomb cystic changes in the subpleural regions of the lung characteristic for typical UIP pattern and tumor in left lower lobe. (B) CT scan after (radical treatment) lobectomy showing extensive bilateral ground glass opacities which are consistant with acute exacerbation of UIP and progressive reticular fibrotic changes. (C) Surgical specimen showing subpleural honeycombing with fibroblastic focus. (D) Autopsy specimen showing acute lung injury with hyaline membranes.
Radiological images and images of pathological specimens for Patient No.1. (A) CT scan before lung resection demonstrating honeycomb cystic changes in the subpleural regions of the lung characteristic for typical UIP pattern and tumor in left lower lobe. (B) CT scan after (radical treatment) lobectomy showing extensive bilateral ground glass opacities which are consistant with acute exacerbation of UIP and progressive reticular fibrotic changes. (C) Surgical specimen showing subpleural honeycombing with fibroblastic focus. (D) Autopsy specimen showing acute lung injury with hyaline membranes.

Figure 2

Radiological images and images of pathological specimens for Patient No.2. (A) Chest X ray before surgical resection shows some reticular changes in the periphery of the lower lobes. CT shows reticular fibrotic changes with multiple calcifications in the periphery of the lung in combination with paraseptal emphsema and small tumor in the left lower lobe. (B) Chest X ray after left sided lobectomy shows new bilateral alveolar opacities. (C) Surgical resection specimen demonstrating microcystic changes with fibroblastic focus. (D) Autopsy specimen showing acute lung injury with hyaline membranes
Radiological images and images of pathological specimens for Patient No.2. (A) Chest X ray before surgical resection shows some reticular changes in the periphery of the lower lobes. CT shows reticular fibrotic changes with multiple calcifications in the periphery of the lung in combination with paraseptal emphsema and small tumor in the left lower lobe. (B) Chest X ray after left sided lobectomy shows new bilateral alveolar opacities. (C) Surgical resection specimen demonstrating microcystic changes with fibroblastic focus. (D) Autopsy specimen showing acute lung injury with hyaline membranes

Baseline clinical, radiological and pathological characteristics of the two patients who died in two months time after radical treatment of early-stage non-small cell lung cancer due to acute exacerbation of idiopathic pulmonary fibrosis (IPF)

Characteristics Patient No. 1 Patient No. 2
Gender Male Male
Age, years 73 81
Smoking status Former-smoker Former-smoker
FEV1/FVC before operation 72% 70%
FEV1 before operation 2800 ml (93%) 3110 ml (121%)
FVC before operation 3900 ml (94%) 4570 ml (122%)
DLCO before operation 57% 47%
Histological subtype Squamous cell carcinoma Squamous cell carcinoma
Pathologic TNM stage (8th edition) IIIA IA
Lobe distribution Left lower lobe Left lower lobe
Type of operation Lobectomy Lobectomy
Adjuvant therapy Chemotherapy and radiotherapy No
Time from the end of radical treatment till death 54 days after finishing radiotherapy 14 days after surgical resection

Baseline clinical, radiological and pathological characteristics of patients with early-stage non-small cell lung cancer and idiopathic interstitial pneumonia

Characteristics N = 13 (%)
Gender Male 11 (84.6)
Female 2 (15.4)
Age, years 73.3 ± 4
Current smoker 3 (23.1)
Smoking status Former-smoker 8 (61.5)
Never-smoker 2 (15.4)
FEV1/FVC before operation 0.71 ± 0.08
FEV1 before operation ml % 2769 ± 690 101.6 ± 20
FVC before operation ml % 3910 ± 818 105 ±19
DLCO before operation % 74.2 ±21
Squamous cell carcinoma 7 (53.8)
Histological subtype Adenocarcinoma 5 (38.5)
Adenosquamous cell carcinoma 1 (7.7)
pT1a 3 (23.0)
pT2a 6 (46.2)
pT2b 4 (30.8)
Pathologic TNM stage IA 2 (15.4)
(8th edition) IB 2 (15.4)
IIA 3 (23.0)
IIB 4 (30.8)
IIIA 2 (15.4)
Left lower lobe 7 (53.8)
Lobe distribution Right lower lobe 4 (30.8)
Right middle lobe 2 (15.4)
Type of operation Lobectomy Bilobectomy 11 (84.6) 2 (15.4)
Adjuvant chemotherapy 4 (30.8)
Adjuvant therapy Adjuvant radiotherapy 1 (7.7)
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