Introduction: Lung cancer is one of the most common malignancies worldwide and adenocarcinoma is the most commonly. Vitamin D is secosteroid hormone and there is evidence supporting the hypothesis of an anticancer effect of vitamin D. Vitamin D is converted to its active form locally in the lung, suggesting that it may play an important role in lung health. The metabolite active of vitamin D (calcitriol) and tyrosine kinase inhibitors (TKIs) are synergistic inhibit EGFR mutation and modulate extracellular signal-regulated kinase (ERK) and Akt pathways. This study aimed to analysis the associated of serum vitamin D levels and response therapy in advanced lung adenocarcinoma patient after used TKIs. Methods: This study was an observational analytic study. The subjects where patient with advanced lung adenocarcinoma who received tyrosine kinase inhibitors (TKIs) for 3 months at Dr. Soetomo general hospital Surabaya from July 2020 to March 2021 who met the inclusion and exclusion criterias. The independent variable in this study are the serum levels of vitamin D and response therapy objective (RECIST criteria) as the dependent variable. Results: The results of stastitical analysis showed that there was no significant associated of serum vitamin D levels and response therapy (p>0.05). Patient insufficiency with partial response had a greater number than patient sufficiency with partial response. The mean of vitamin D levels in patient with progressive disease was the highest. Conclusion: Although the serum levels of vitamin D in lung cancer was lower but this study showed that there was no significant associated of serum vitamin D levels and response therapy in patient advanced lung adenocarcinoma with tyrosine kinase inhibitors.

No abstract

Background: Pseudomesotheliomatous carcinoma is a rare case of lung cancer with marked pleural extension resembling malignant pleural mesothelioma on diagnostic imaging. One of tool to diagnose lung pseudomesothelioma is by performing thorocoscopy pleural biopsy. Diagnostic thoracoscopy also has a higher sensitivity than pleural fluid cytology and needle biopsy.Case: We report a rare case of pseudomesotheliomatous carcinoma of the lung in a 50-year-old man with asbestos exposure. The patient had complained of dyspnea and chest roentgenogram showed left pleural effusion. Computed tomography (CT) of the chest revealed diffuse irregular left pleural thickening and without a clear initial primary lesion found in both of lung parenchyma, which mimicked pleural mesothelioma. Pleural tissue sampling was performed to obtain definitive diagnosis by video-assisted thoracoscopic surgery. At the operation, the tumor was found to have spread along the pleural surface and primary lesion was not detected in the right lung parenchyma. Immunohistochemically, the tumor was positive for Thyroid Transcription Factor- 1 (TTF-1), but negative for calretinin, P63, and Neuron Specific Enolase (NSE). Final diagnosis was adenocarcinoma of the lung and patient had good clinical response to Gefitinib.Conclusion: Based on the results of clinical studies (images and clinical observations), although pseudomesotheliomatous in patient with asbestos exposure is difficult to distinguish from pleural mesothelioma, we have a case of pseudomesotheliomatous lung diagnosed by a thoracoscopic pleura biopsy. For such cases, thoracoscopic pleural biopsy should be performed at an early stage.