Annual General Meeting of the Irish Thoracic Society - IJMS | Irish ...

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SESSION THREE ONE
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
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SESSION
SESSION THREE ONE
Malignancy / Techniques
3.39
Hypoxic induction of proliferation in primary human
lung fibroblasts: potential implications in pulmonary
fibrosis
Introduction
Idiopathic pulmonary fibrosis (IPF) is a disease
of unknown aetiology that is associated with
alveolar epithelial injury and the development of
fibroblast proliferation and differentiation. This
leads to increased matrix deposition and ultimately
severe derangement of gas exchange units. Loss of
alveolar function leads to impaired ventilation and
potentially the development of local tissue hypoxia.
Our hypothesis is that local tissue hypoxia in the
lung contributes to aberrant remodelling.
Results
Control and patient-derived primary human lung
fibroblasts and airway epithelial cells were used to
study the effect of hypoxia on proliferation. Cells
were cultured in controlled oxygen environments
of 1%, 3%, 5%, and 21% for various times and
proliferation was measured using tritiated thymidine
incorporation. Significantly increased fibroblast
proliferation was seen after culture in 3% and 5%
oxygen. Conditioned media from hypoxic fibroblast
cultures induced proliferation in naïve cells
indicating that a soluble pro-proliferative mediator
may be secreted into media by fibroblasts exposed
to hypoxia. Furthermore, conditioned media from
hypoxic epithelial cultures was also able to induce
exaggerated proliferation in lung fibroblasts.
Conclusions
We believe that physiologically relevant hypoxic
conditions induce significant increases in fibroblast
proliferation and that this may have important
implications in the pathogenesis of fibrotic lung
disease. Ongoing studies are aimed at identifying the
molecular mechanisms involved in hypoxia induced
fibroproliferation.
AB Byrne, L Li,
SC Donnelly, JA Baugh
Dept of Medicine and
Therapeutics, The
Conway Institute for
Biomolecular and
Biomedical Research,
University College
Dublin
3.41
Angiosarcoma arising from the right atrium: an usual
case of recurrent pulmonary embolism
Introduction
Angiosarcoma is an uncommon primary cardiac
malignancy that usually arises from the right atrium.
Clinical features are non-specific, and the tumour is
frequently undiagnosed until autopsy.
Method
We report the case of a 37-year-old male who
presented with right-sided chest pain, haemoptysis
and dyspnoea.
Results
Pulmonary embolism was diagnosed by spiral
computed tomogram (CT) scanning, however
the patient failed to improve with standard
anticoagulant therapy. Repeat CT scan confirmed
non-resolution of embolism and demonstrated a
concomitant right atrial filling defect. Transthoracic
3.42
St James’ Lung Cancer Audit 2004
echocardiography and magnetic resonance imaging
were performed, and identified a mass lesion which
extended from the free wall of the right atrium into
the right main pulmonary artery. Surgical exploration
confirmed extensive tumour, and radical resection
was performed with right atrial reconstruction
and evacuation of tumour from the pulmonary
artery. Histological evaluation revealed a high-grade
angiosarcoma, with positive immunohistochemial
staining for CD31 and CD34. The patient was treated
with adjuvant combination chemotherapy and
remains in remission at 18 months follow up.
Conclusions
Although the diagnosis of angiosarcoma usually
portends a poor prognosis, aggressive multimodality
therapy can result in a favourable outcome.
DS O’Callaghan, 1
DP Breen, 1 , B Kent, 1
CJ D’Adhemar, 2
M Higgins, 3
F O’Connell, 1 V Young 1
1. CResT Directorate,
2. LabMed Directorate,
and
3. HOPE Directorate,
St James’s Hospital,
Dublin
3.40
Congenital tracheo-oesophageal fistula: an unusual
cause of recurrent RTIs in an adult
Case Report
A 56 year old woman presented with recurrent RTIs.
She had had 5 episodes of cough with purulent
sputum, fever and dull R pleuritic chest discomfort in
the previous 18 months with less frequent episodes
for many years prior to that. CXR showed dense R
basal consolidation which was slow to improve with
antibiotics. Bronchoscopy revealed a smooth, benignlooking
tracheo-oesophageal fistula (TOF) posteriorly
at the junction of the upper 2/3 and lower 1/3 of the
trachea. Niopam contrast swallow demonstrated
pooling of contrast in the lower oesophagus, which
was dilated, and extensive spillover of contrast
through the fistula leading to a bronchogram of the
entire tracheo-bronchial tree. Bronchiectasis was
noted in the R middle and lower lobes. PFTs showed
mild combined restriction/airflow obstruction with
mild impairment of gas transfer efficiency. After
recovery from her current episode, the patient was
advised to undergo surgical closure of the fistula,
with consideration of R middle and lower lobectomy,
but declined this advice. Three years later, she
suffered a severe RTI with septicaemia, and after a
prolonged ICU admission, passed away.
Conclusion
Congenital TOF is a rare, though easily diagnosed
cause of recurrent RTIs and bronchiectasis in adults.
B Kent, D O’Callaghan,
D Breen, F O’Connell
CResT Directorate,
St James’s Hospital,
Dublin
Introduction
Lung cancer remains the foremost cancer killer in
Ireland, responsible for 20% of all cancer deaths.
Although prevalence has fallen in men, recent years
have seen a dramatic increase in lung cancer in
women. Patients tend to present with late stage
disease and stage for stage, lung cancer survival is
worse than for other common cancers. Overall 5 year
survival is less than 10%.
Aim
To audit lung cancer at St James’s for 2004.
Method
Interrogation of the St James’s lung cancer database.
Results
297 patients attended St James’s with lung cancer
in 2004, representing a 6% increase on the previous
year and almost 20% of the national lung cancer
population. Gender analysis showed 60.9% male, 39.1%
female (male:female ratio 1.56:1) with women tending
to present younger than men. Almost 50% were
tertiary referrals from outside the HSE SW area. 6.7%
were never-smokers while 36.4% reported a family
history of cancer. Analysis of morphology showed
NSCLC 75%, SCLC 17.3%, Carcinoid 2%, Mesothelioma
5.1% and unknown 0.7%. Of note, females represented
37.6% of NSCLC (male:female ratio 1.7:1) but 45.1% of
SCLC (ratio 1.2:1). Stage analysis in NSCLC showed 30.4%
had Stage I or II disease, 75% of whom had treatment
with curative intent. 18.6% had stage III disease, 22%
of whom had treatment with curative intent. 25%
of those treated with curative intent for NSCLC had
chemotherapy as part of their treatment. Almost 50%
of patients with SCLC had limited stage disease.
Conclusions
Lung cancer attendances at St James’s continue to
rise with increasing proportion of females, who tend
to present younger and have a greater propensity to
develop SCLC. Chemotherapy is playing an increasing
role in treatment of NSCLC with curative intent.
M Devlin, R Luddy,
F O’Connell
St James’s
Multidisciplinary
Thoracic Oncology
Group
42 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3
IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3 43