Aim of the studyIn the paper clinical cases of individuals diagnosed with lung cancer below the age of 40 years have been analyzed.Material and methodsThe analysis included: sex, age, clinical symptoms found before and at the moment of diagnosis, character of changes visible in radiological imaging, time that passed from the first symptoms to reporting to a doctor and to establishing a diagnosis, type of diagnostic method used in establishing the final diagnosis, histopathologic type of cancer, degree of cancer progression.ResultsThe results have been compared with a peer group who had been diagnosed 20 years earlier. Currently 7% of patients were diagnosed at the age of 25 or younger, whereas in the previous cohort patients in this age constituted 2%. The predominant pathological type was adenocarcinoma (currently 33%, previously 4%) in contrast to the earlier group in which 57% of patients had small cell lung cancer (57%). The incidence is equally distributed between both sexes, although there is an evident increase in female lung cancer cases. In the majority of patients the clinical presentation is a peripheral mass on chest X-ray. 20% of patients present pleural effusion on diagnosis. Patients reported the following complaints: breathlessness, chest pain, weight loss and fatigue. The majority of cases were diagnosed in advanced stages on the basis of a bronchoscopy acquired specimen. Time course from symptoms to diagnosis tends to be shorter than 20 years ago.

Pulmonary localisation represents only 15% of all cases of actinomycosis. The clinical symptoms and radiological changes of this disease are non-specific and sometimes it can be misdiagnosed, usually as tuberculosis, lung cancer or lung abscess. In the reported case, what might look like the lung cancer, finally turned out to be actinomycosis. The interesting case is presented of lung actinomycosis in a 77-year-old farmer, admitted to the Department of Pneumonology, Oncology and Allegology in Lublin due to a massive haemoptysis. CT scan of the chest showed, apart from other changes, the spicular consolidation in the right lung which aroused oncology vigilance. The diagnostic path, which was a real medical challenge, led to the diagnosis of actinomycosis. The process of diagnosis and consequent treatment, which led to the complete regression of clinical and radiological changes, is presented.

The diagnosis of cutaneous tuberculosis poses a serious challenge due to many skin diseases of different etiology resembling the lesions caused by the TB (tuberculosis) bacillus, and difficulties in confirming the disease. The presented case concerns skin lesions in a hobby aquarist stung in the finger of the left hand by a fish. The resulting inflammatory infiltration was to be cutaneous tuberculosis or mycobacteriosis caused by MOTT (Mycobacterium other than tuberculosis). Laboratory, pathomorphologic, genetic and microbiologic tests of samples obtained from the patient, fish and water in the aquarium gave ambiguous results. A multidisciplinary discussion is presented on the difficulties in the differential diagnosis, problems with a clear interpretation of the results of various conducted tests, and possible ways of transmission of the infection, relevant to the described example.

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Pathological processes involving internal organs can manifest themselves through a variety of skin lesions. In the case of neoplasms, these include typical paraneoplastic syndromes, which themselves do not constitute neoplastic lesions [1,2]. More rarely, in the case of 1-12% of neoplasms, metastatic lesions from primary foci located in internal organs appear on the skin [2-6]. The involvement of the skin in the course of neoplastic diseases means that the neoplasm has gained access to the systemic circulation, which confirms its late stage and significantly worsens the prognosis. The survival time of patients with metastases to the skin is usually less than 1 year [3,7]. An interesting phenomenon is the occurrence of a metastasis in the skin already involved in a neoplastic process, usually benign, which is referred to as a "tumour-to-tumour metastasis" [4].Cutaneous paraneoplastic syndromes can manifest under different forms, and usually include a variety of hyperkeratotic and sclerotic lesions. In the case of lung cancer, these are predominantly hyperkeratoses, including Bazex syndrome (cornification, nail eczema), ichthyosis acquisita, dermatomyositis and acanthosis nigricans [1]. Metastatic cutaneous lesions originating from lung cancer can take the form of hard, indolent, mobile, erythroid nodules covered with normal or inflamed skin. Typically, there is one or several nodules, but some cases include several hundred.We report a case of primary skin presentation of lung cancer in a 66-year-old male patient, an ex-smoker, who was admitted to the hospital in medium-severe condition due to general weakness, exercise-induced dyspnoea and dry cough. On admission to the department, in the subcutaneous tissue and on the skin of the patient, palpable and macroscopically visible nodules were observed, 2-3 cm in diameter, tender on palpation, of a rosy-bluish colour (Figure 1). These lesions were located on the front of the chest near a post-sternotomy scar, and in the dorsal area of the neck, as well as in the left supraclavicular, left-groin and left-thigh areas. The exanthems were of a polymorphic nature, and varied in terms of their size, colour and tenderness. As indicated by the patient, they appeared a month before admission to the department. During the patient's hospitalisation, new cutaneous lesions appeared and the old ones evolved. The lesion in the left groin area became spontaneously painful and showed signs of "fluctuation". The semi-liquid content was collected and sent for histopathological and bacteriological examination. A nodular lesion, 3 cm in diameter, appeared on the left side of the neck. The skin on the surface of the lesion was normal. Neck ultrasound revealed a mixed echogenic focal lesion and single neighbouring lymph nodes with preserved fatty hila. The submandibular and parotid glands were normal. Single nodules were also revealed in the thyroid area. Computed tomography of the chest performed 2 weeks before the hospitalisation revealed a tumour 8 cm in diameter in the right lung hilum....