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array:23 [ "pii" => "S0300289624002308" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.06.010" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "3605" "copyright" => "SEPAR" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:662-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289624001728" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.05.011" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "3569" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2024;60:664-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Sometimes it's What it Doesn’t Look Like: Atypical Dissemination of Lung Adenocarcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "664" "paginaFinal" => "665" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3573 "Ancho" => 2510 "Tamanyo" => 888191 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical case images: chest X-ray, computed tomography scan and positron emission tomography/computed tomography. Posteroanterior (A) and lateral (B) chest X-ray with bilateral nodular pattern. Chest computed tomography showing the lung mass (asterisk) in left lower lobe (coronal (C) and axial (E) views) with multiple bilateral ground-glass nodules, with a tendency to cavitation better defined in lower lobes (lateral view (D)). Fluorine-18 fluorodeoxyglucose positron emission tomography (E) with pathologic increased uptake in the mass, with unspecific low generalized metabolic activity.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Jiménez-Gómez, Ignacio Alba-de-Cáceres, José Ignacio de-Granda-Orive" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Jiménez-Gómez" ] 1 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Alba-de-Cáceres" ] 2 => array:2 [ "nombre" => "José Ignacio" "apellidos" => "de-Granda-Orive" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624001728?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000010/v1_202410020659/S0300289624001728/v1_202410020659/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0300289624002291" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.06.009" "estado" => "S300" "fechaPublicacion" => "2024-10-01" "aid" => "3604" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:660-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Letter</span>" "titulo" => "Use of Extracorporeal Carbon Dioxide Removal Therapy in an Intermediate Respiratory Care Unit" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "660" "paginaFinal" => "661" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 649 "Ancho" => 900 "Tamanyo" => 88325 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT scan of the patient before admission.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Esther Barbero, Antonio Gomis, David Pestaña" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Esther" "apellidos" => "Barbero" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Gomis" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Pestaña" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624002291?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000010/v1_202410020659/S0300289624002291/v1_202410020659/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Letter</span>" "titulo" => "Right Adrenal Metastasis of Lung Cancer Diagnosed via Endoscopic Ultrasound (EUS-B) by a Pulmonologist" "tieneTextoCompleto" => true "saludo" => "To the Director," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "662" "paginaFinal" => "663" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Cascón-Hernández, Javier López-García, Imane Saidi" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Juan" "apellidos" => "Cascón-Hernández" "email" => array:1 [ 0 => "jcasconh@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Javier" "apellidos" => "López-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Imane" "apellidos" => "Saidi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Interventional Pulmonology Unit, Department of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Respiratory Medicine, Hospital Universitario Virgen de la Victoria, Malaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Respiratory Medicine, UM6P Hospital, Faculty of Medical Sciences, Mohammed VI Polytechnic University, Ben Guerir, Morocco" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1647 "Ancho" => 2467 "Tamanyo" => 397561 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Coronal PET scan: mediastinal mass, right (thick arrow) and left adrenal (thin arrow). (B) and (C) Right adrenal gland (thick arrow) in axial PET scan (B) and EUS-B (C). (D) and (E) Left adrenal gland (thin arrow) in axial PET scan (D) and EUS-B (E).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">There is mounting evidence that pulmonologists can safely and reliably sample lesions located near the esophagus and stomach using an echobronchoscope (EUS-B). These lesions include both supra-diaphragmatic (lung, pleura, pericardium, and mediastinal lymph nodes—LN—) and infra-diaphragmatic locations (left adrenal gland—LAG—, liver, pancreas, and retroperitoneal LN).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Nevertheless, there is no documented evidence of EUS-B-guided fine-needle aspiration (EUS-B-FNA) of a right adrenal gland (RAG).</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of an 82-year-old non-smoker woman who was referred to the pulmonary department for asthenia and hemoptysis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">CT and PET scans showed a 48<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mm right mediastinal-hilar mass, with a maximum standard uptake volume (SUV) of 25.8 and a few subcentimetric LN at 4R (SUV of 5.1) and 11R (SUV of 4.9). Additionally, they revealed bilateral adrenal lesions (right: 23<span class="elsevierStyleHsp" style=""></span>mm, SUV of 22.7, and left: 28<span class="elsevierStyleHsp" style=""></span>mm, SUV of 19.9), as well as a left femur lesion (SUV of 16.1) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">An endobronchial ultrasound (EBUS) was initially performed, sampling the 4L LN and the mediastinal mass. In the same sitting, the procedure was completed via the esophagus with the same EBUS scope (EB19-J10U, Pentax). At the level of the lesser curvature of the stomach a 19.7<span class="elsevierStyleHsp" style=""></span>mm heterogeneous lesion in the RAG was visualized. Three punctures were made with a 22-gauge needle (SonoTip EBUS ProFlex, MediGlobe). Similarly, an EUS-B-FNA of the LAG (14.1<span class="elsevierStyleHsp" style=""></span>mm) was performed. The entire procedure was completed in 33<span class="elsevierStyleHsp" style=""></span>min without any complications.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The anatomic pathology findings of the RAG showed numerous medium-to-large atypical cells, which were positive for TTF-1. The molecular study was positive for the p.L858R mutation in EGFR, thereby rendering the patient eligible for treatment with tyrosine-kinase inhibitors. The PD-L1 expression was weakly positive (<50%).</p><p id="par0030" class="elsevierStylePara elsevierViewall">These findings were consistent with metastasis of pulmonary adenocarcinoma. The results of both the LAG and the mediastinal mass biopsies were comparable. 4L was negative for malignancy.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical stage was determined to be IVB, based on the 9th edition of the TNM classification for lung cancer (9th TNM). The tumor committees proposed the initiation of treatment with Osimertinib.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Adrenal metastases are present in 8% of metastatic lung cancers. It is possible to perform EUS-B to complete extra-thoracic staging during a single procedure and this is a feasible and safe (0.2% minor complications, no major complications)<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> procedure recommended by international guidelines. Moreover, it may have a significant impact on the treatment plan<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and may obviate the need for multiple supplementary procedures.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Due to its anatomical location (typically in close proximity to the second part of the duodenum), RAG is not usually accessible to EBUS, and thus is not included in lung cancer staging recommendations or guidelines. The puncture of the RAG with an echoendoscope has been previously described,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> however, even by gastroenterologists the access to the RAG is more challenging than that of the LAG.</p><p id="par0050" class="elsevierStylePara elsevierViewall">An alternative approach to the adrenals is CT-guided percutaneous puncture, which has been associated with a higher reported complication rate (2.5%).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Nevertheless, if accessible, it is crucial to confirm the location and number of extrathoracic metastases, particularly considering the proposed changes in the 9th TNM,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> as these may influence prognosis.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, this is the first report to confirm a right adrenal metastasis using an echobronchoscope and performed by a pulmonologist.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0065" class="elsevierStylePara elsevierViewall">Study concept and design, JCH. Acquisition of data, JCH, JLG, IS. Drafting of the manuscript, JCH. Critical revision of the manuscript for important intellectual content, JCH, JLG, IS.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Informed consent form</span><p id="par0070" class="elsevierStylePara elsevierViewall">The patient has signed the informed consent form.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Informed consent form" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interests" ] 3 => array:2 [ "identificador" => "xack778792" "titulo" => "Acknowledgments" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1647 "Ancho" => 2467 "Tamanyo" => 397561 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Coronal PET scan: mediastinal mass, right (thick arrow) and left adrenal (thin arrow). (B) and (C) Right adrenal gland (thick arrow) in axial PET scan (B) and EUS-B (C). (D) and (E) Left adrenal gland (thin arrow) in axial PET scan (D) and EUS-B (E).</p>" ] ] 1 => array:6 [ "identificador" => "202410020700387051" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 196 "Ancho" => 192 "Tamanyo" => 6243 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "sat0005" "detalle" => "Twitter Ico" "rol" => "short" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic ultrasound-guided pancreas biopsy in the hands of a chest physician" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. Issa" 1 => "J.S. Sidhu" 2 => "S.G. Tehrani" 3 => "P.F. Clementsen" 4 => "U. Bodtger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmcr.2023.101833" "Revista" => array:5 [ "tituloSerie" => "Respir Med Case Rep" "fecha" => "2023" "volumen" => "43" "paginaInicial" => "101833" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36942163" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of EUS-FNA and EUS-B-FNA for the diagnosis of left adrenal glands metastases in patients with lung cancer: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Moretti" 1 => "B. Kovacevic" 2 => "P. Vilmann" 3 => "J.T. Annema" 4 => "D.A. Korevaar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lungcan.2023.107391" "Revista" => array:4 [ "tituloSerie" => "Lung Cancer" "fecha" => "2023" "volumen" => "186" "paginaInicial" => "107391" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Change in therapeutic management after left adrenal biopsy with a single broncho-echoendoscopy (EUS-B): pushing the envelope" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Cascón-Hernández" 1 => "L. Fernández-Fernández" 2 => "F. López-González" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2024.04.024" "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2024" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of adrenal lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Patil" 1 => "M.A. Ona" 2 => "C. Papafragkakis" 3 => "S. Duddempudi" 4 => "S. Anand" 5 => "L.H. Jamil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.20524/aog.2016.0047" "Revista" => array:5 [ "tituloSerie" => "Ann Gastroenterol" "fecha" => "2016" "volumen" => "29" "paginaInicial" => "307" "paginaFinal" => "311" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The international association for the study of lung cancer lung cancer staging project: proposals for revision of the TNM stage groups in the forthcoming (ninth) edition of the TNM classification for lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Rami-Porta" 1 => "K.K. Nishimura" 2 => "D.J. Giroux" 3 => "V.W. Rusch" 4 => "H. Asamura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtho.2024.02.011" "Revista" => array:2 [ "tituloSerie" => "J Thorac Oncol" "fecha" => "2024" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack778792" "titulo" => "Acknowledgments" "texto" => "<p id="par0080" class="elsevierStylePara elsevierViewall">Dr. Rosa Cordovilla (Interventional Pulmonology Unit) and Dr. Antonio Velasco and Dr. Alberto Álvarez (Endoscopy Unit) of the University Hospital of Salamanca, for all the tips on the EUS-B technique.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Dr. Francisco López, Dr. Lucía García-Alfonso, Dr. Miguel Ariza (IP Unit, HUCA) for all their advice.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Dr. Luis Fernández, Dr. Héctor Torres (Pathology Department, HUCA) for the analysis of the samples.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Inmaculada Sánchez and María Gil (Nurses, IP Unit, HUCA) for taking care of the patient.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000010/v1_202410020659/S0300289624002308/v1_202410020659/en/main.assets" "Apartado" => array:4 [ "identificador" => "98299" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cllinical Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000010/v1_202410020659/S0300289624002308/v1_202410020659/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624002308?idApp=UINPBA00003Z" ]
