Human pulmonary dirofilariasis: parasitological aspects of the 2d case reported in Italy]

The parasitological aspects of a case of pulmonary human dirofilariasis, recently reported by Fabbretti and collaborators (1990) in a 58 year-old man from Ferrara province, are described. This is the second case of pulmonary human dirofilariasis recorded in Italy. The nematode was rolled up inside a small pulmonary artery and was associated with a nodular infarcted lesion, discovered during an X-ray check as a "coin lesion". A pulmonary lobectomy was performed on the patient with a presumptive diagnosis of a malignant neoplastic nodule. The exact diagnosis was only made with the histological examination. In spite of the bad preservation of the nematode, it was possible to diagnose it as an immature female of Dirofilaria probably belonging to the species repens.     

Pulmonary adenocarcinoma, Lambert--Eaton myasthenic syndrome, and voltage-gated calcium channels: a case report

ABSTRACT: INTRODUCTION: Lambert--Eaton myasthenic syndrome is a rare disorder and it is known as a paraneoplastic neurological syndrome. Small cell lung cancer often accompanies this syndrome. Lambert--Eaton myasthenic syndrome associated with lung adenocarcinoma is extremely rare; there are only a few reported cases worldwide. CASE PRESENTATION: A 75-year-old Japanese man with a past history of chronic rheumatoid arthritis and Sjogren syndrome was diagnosed with Lambert--Eaton myasthenic syndrome by electromyography and serum anti-P/Q-type voltage-gated calcium channel antibody level preceding the diagnosis of lung cancer. A chest computed tomography to screen for malignant lesions revealed an abnormal shadow in the lung. Although a histopathological examination by bronchoscopic study could not reveal the malignancy, lung cancer was mostly suspected after the results of a chest computed tomography and [18F]-fluorodeoxyglucose positron emission tomography. An intraoperative diagnosis based on the frozen section obtained by tumor biopsy was adenocarcinoma so the patient underwent a lobectomy of the right lower lobe and lymph node dissection with video-assisted thoracoscopic surgery. The permanent pathological examination was the same as the frozen diagnosis (pT2aN1M0: Stage IIa: TNM staging 7th edition). Immunohistochemistry revealed that most of the cancer cells were positive for P/Q-type voltage-gated calcium channel. CONCLUSIONS: Our case is a rare combination of Lambert--Eaton myasthenic syndrome associated with lung adenocarcinoma, rheumatoid arthritis and Sjogren syndrome, and to the best of our knowledge it is the first report that indicates the presence of voltage-gated calcium channel in lung adenocarcinoma by immunostaining.     

Bronchial granular-cell tumor. Report of a case with preoperative cytologic diagnosis on bronchial brushings and immunohistochemical studies

A 42-year-old man presented with a polypoid endobronchial mass of the right apical segmental bronchus. Bronchial brushing smears contained clusters of cells exhibiting abundant diffusely granular cytoplasm with indistinct borders. A cytologic diagnosis of granular-cell tumor was rendered. Histologic examination of the upper right lobectomy specimen provided confirmation. Immunohistochemically, the granular cells strongly reacted with the S-100 protein antibody. This case demonstrates that the cytologic diagnosis of bronchial granular-cell tumor is possible if this lesion is considered in the differential diagnosis of lung tumors.     

Cystic echinococcosis in humans: our clinic experience

Echinococcosis in humans is a zoonotic infection caused by larval stages of cestode species of the Echinococcus genus. In cystic echinococcosis (CE), caused by Echinococcus granulosus, the liver is the first and the more frequent involved organ, followed by the lung. Heart, spleen, kidney and brain are usually less involved. The finding of a cyst in course of echinococcosis is usually fortuitous, during ultrasound examination, X-ray or CT. The Authors report 4 cases of human CE admitted to the Department of Infectious Diseases University of Naples "Federico II". Each case is peculiar both for the organ involved by the cysts and for the symptomatolgy. The abdominal pain, in case 1 caused by gallstones, allowed, by the ultrasound examination, to find several hydatid cysts in the liver, never symptomatic until then. The woman, in case 2, was operated for cysts in the lung, without receiving pharmacological prophylaxis. The same occurred in case 4, in which the lack of prophylaxis caused very serious relapses. In case 3, the young woman underwent an ultrasound examination because of an abdominal pain. A unique large cyst extended only in the spleen. The specific serology for immunoglobulin anti-E. granulosus resulted positive 1:61 (n.v. < 50). The Albendazole therapy caused the disappareance of pain, quickly. Later, the patient was splenectomized. It's not clear why only the spleen was involved and why the anti-E. granulosus serum levels of were increased only a little. The man, in case 4, was admitted with chest pain and electrocardiographic findings of myocardial anterior ischemia. He underwent surgical treatment of three hepatic cysts by E. granulosus, during the previous year. Two-dimensional echocardiography, transesophageal echocardiography, and cardiac magnetic resonance revealed a round cystic mass, 6 x 6 mm, located in the middle interventricular septum. The cardiac isoenzymes were in the normal ranges, but the anti-E. granulosus immunoglobulins were positive 1:5120 (n.v. < 64). The patient was treated with Albendazole. This caused the almost simultaneous disappearance of the circular cystic and clinical and electrocardiographic findings of myocardial ischemia. A cardiac hydatid cyst is an uncommon lesion, occurring in about 0.4-2% of patients with echinococcosis. In conclusion, Cystic echinococcosis is a problem in Mediterranean regions because of the high population of stray dogs, favourable conditions created by man and, above all, the illegal slaughtering.     

Treatment of stage IIIB squamous-cell lung cancer with pembrolizumab combined with chemotherapy to achieve pCR: a case report

Lung cancer is currently the leading cause of global cancer-related deaths and its incidence increases every year. Most squamous-cell lung cancers are in the advanced stage at diagnosis. This study reported a case of a 66-year-old man diagnosed with unresectable stage IIIB squamous-cell lung cancer (cT2aN3M0), who was treated with pembrolizumab combined with paclitaxel (albumin-bound) + nedaplatin. After four cycles, a follow-up chest computed tomography (CT) scan showed the disappearance of the original right lower lobe lung mass with cavitation-like changes, and a follow-up chest CT scan 6w later revealed a solid nodule measuring approximately 1.5 cm in diameter within the cavity. Subsequent surgical excision of the residual primary lesion was performed to achieve complete pathological remission. The patient was treated with pembrolizumab combined with paclitaxel (albumin-bound) + nedaplatin and achieved complete pathological remission with surgical excision.     

Muscular metastasis, a rare presentation of non-small-cell lung cancer

A 71-year-old man presented with a 2-week history of pain and swelling of his left arm. Subsequent investigations revealed an intramuscular lesion, suggestive of soft tissue sarcoma. Histologic analysis was surprisingly consistent with metastasis from a primary squamous cell lung cancer. Skeletal muscle metastasis as a mode of presentation of primary lung cancer is an unusual phenomenon. A brief literature review accompanies this report.     

Intraoperative cytologic diagnosis of symptomatic carcinoma (pulmonary small cell carcinoma) metastatic to the pituitary gland: a case report

BACKGROUND: Carcinoma metastatic to the pituitary gland is infrequent and has been reportedly detected in approximately 1% of pituitary surgical cases. It may masquerade as a pituitary adenoma both clinically and radiologically. CASE: A 49-year-old man presented with a 1-month history of severe headache, diplopia and blurred vision. Neurologic examination revealed bitemporal hemianopsia and left sixth nerve palsy. The initial radiologic diagnosis based on magnetic resonance imaging was pituitary adenoma. A biopsy of the lesion was performed. While intraoperative frozen section examination could not completely exclude an "atypical" pituitary adenoma, cytologic touch imprint findings were diagnostic of metastatic small cell carcinoma. Subsequently, additional workup revealed that the patient had a mass lesion in the right lung and right-sided mediastinal lymphadenopathy on chest computed tomography. This was a rare case of pituitary metastasis as the first manifestation of an occult malignancy. CONCLUSION: For intraoperative diagnosis at the time ofpituitary surgery, cytologic imprints can be used reliably to make a diagnosis not only of pituitary adenoma but also of metastatic lesions. It is appropriate in current neuropathology practice that the imprint method be used as the sole modality for intraoperative consultation for pituitary lesions.     

Cytopathologic and genetic diagnosis of pulmonary amebiasis: a case report

BACKGROUND: Amebiasis is a parasitic infection with Entamoeba histolytica. Pulmonary amebiasis is rare since the infection is commonly manifested as amebic colitis or liver abscess. Most pleuropulmonary amebiasis is seen in patients with amebic liver abscesses. A pulmonary amebic lesion without either a liver abscess or amebic colitis is extremely rare. Thus, reported cases of sputum cytologic diagnosis of a pulmonary amebic lesion from a patient without a liver abscess are also very rare. CASE: A 53-year-old man presented with a dry cough and mild fever. Chest radiography revealed an abnormal solitary mass lesion in the right upper lung field. The clinical diagnosis was a bacterial lung abscess. Sputum cytologic examination demonstrated many trophozoites of E. histolytica. Following sputum cytodiagnosis, serologic tests revealed a slightly high but almost normal titer of IgG antibodies to E. histolytica, indicating the possible presence of the pathogen. Polymerase chain reaction (PCR) using E. histolytica-specific primers for DNA extracted from the sputum sample revealed specific DNA product. CONCLUSION: Pulmonary amebiasis without either a liver abscess or amebic colitis must be distinguished from bacterial abscesses and neoplastic disease. A sputum cytologic examination combined with PCR for DNA extracted from a sputum sample is a good approach to the diagnosis of a pulmonary amebic abscess.     

Antibiotic anaphylaxis

Pulmonary cancer when localized to the lung, is curable by operation. Tumors found by routine x-ray examination before they cause symptoms are much more often confined to the lung and as such are curable. Unlike other internal growths which are more hidden, lung tumors can often be seen early on x-ray films of the chest.X-ray films of the chest were made routinely on all patients entering a hospital, regardless of the nature of their illness. In all, some 40,000 films were made. Sixty patients were found to have unsuspected solitary lesions in the lung. Twenty-four of the lesions were diagnosed and treated by operation and removal. Twelve were diagnosed by other methods. Of the 36, eight were cancer of the lung, an incidence of 22 per cent. There were also 14 localized tuberculous nodules which are best treated by removal. Since early cancer is surgically curable, it is felt that everyone over the age of 40 should have a routine x-ray examination of the chest every six months. Solitary lesions of the lung found should be excised for diagnosis.     

Constrictive pericarditis in a post–renal transplant patient: a case report

Introduction

Glomangiomas are rare soft tissue tumors originating from the perivascular tissue. The most common localization is in the dermis of the extremities, with a few reports of respiratory tract involvement.

Case presentation

We present the case of a 48-year-old Caucasian female patient with a glomangioma in her left lung. It was diagnosed incidentally as a coin lesion in a chest X-ray performed during preoperative work-up for a gastric Roux-en-Y bypass for alimentary obesity. A computed tomography scan of her chest revealed a lesion in her upper left lung lobe 31mm in diameter. After resection, a histopathological examination presented typical signs of a glomangioma, originating from the pulmonary parenchyma.

Conclusion

Glomangiomas of the lung are extremely rare. However, whenever incidental lesions in the lung parenchyma are found, glomangioma should be taken into diagnostic consideration. To the best of our knowledge, signs of malignancy have not previously been reported in the literature. In fact, this tumor entity shows benign behavior, with a low potential for recurrence after complete resection.     

A rare tumor of the lung: inflammatory myofibroblastic tumor

ABSTRACT: Inflammatory myofibroblastic tumor is a rare benign lesion whose tumor origin is now proven. It represents 0.7% of all lung tumors. We report the case of a three-year-old child who suffered from a chronic cough with recurrent respiratory infections. Chest X-ray and computed tomography revealed the presence of a left lower lobe lung mass. After pneumonectomy, histological examination combined with immunohistochemical study discovered an inflammatory myofibroblastic tumor. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8722069326962972.     

Finding of pentastomes of genus Reighardia (Pentastomida) in the Belcher's gull (Larus belcheri)

This report describes the finding of Reighardia sp. (Pentastomida) infecting the air sac of two Belcher's gulls (Larus belcheri) found dead on the beaches of Pucusana, a district in southern Lima, Peru. Three pentastomes were collected from two Belcher's gulls. Then, they were morphologically and molecular analyzed. Molecular characterization of the parasite was achieved by amplifying a fragment of the small subunit ribosomal RNA gene (SSU rRNA). Based on both morphological and molecular data the pentastomes were identified as pentastomes of the genus Reighardia. This is the first report showing that the Belcher's gull is a new natural definitive host for this pentastome.     

X-ray diagnosis of lung cancer and its morphological variants

The purpose of the study was to substantiate the capacities of X-ray recognition of the histological types of lung cancer and different tumor differentiation grades. The data available on 238 patients were studied; of them 169 patients were diagnosed as having primary lung cancer that was morphologically verified. In 154 patients, the tumor was not greater than 3.0 cm in diameter and belonged to the main histological types. X-ray study, analogue, digital tomography, X-ray surgery with percutaneous needle biopsy and rapid cytology were used. The diagnosis made by WHO ICD-10 C34.1-3 BDU (probable) and C34.1-3 M (valid) was a criterion for the quality of a accomplished diagnostic case. Of 13 traditional X-ray sings of lung cancer, 6 characteristics of a tumor image were taken for a following analysis. A number of signs correlate with the histological type of lung cancer in the symptom complexes that characterize the image of its histological types. Thus, "specula" are detectable in adenocarcinoma; a lobate pattern and minor focal clarification are also almost without exception characteristic. The differences between the images of squamous-cell carcinoma and adenocarcinoma were statistically significant (p < 0.05). The statistical models of lung cancer and its types were tested on 60 patients. Implementation of the optimized symptom complex positively changed the parameters of X-ray diagnosis: there were increases in the sensitivity from 68.6% to 80.0%, in the specificity from 24.3% to 65.0%; in the prognostic value of a positive result from 55.6% to 82.1%; in that of a negative result from 34.0% to 64.9%, and in the accuracy from 50.0% to 75.0%.     

PULMONARY SEGMENTAL RESECTION OF SOLITARY LESIONS OF DOUBTFUL CHARACTER

Pulmonary cancer can be diagnosed earlier if patients with pulmonary symptoms of chronic type are given x-ray examination early, if patients over 40 years of age have a yearly roentgen examination of the chest regardless of their state of health, and if those with acute pulmonary illness are examined by x-ray within one month of the onset of illness.Observation of a known intrapulmonary lesion of unknown character should never last for more than one month. If it persists after that period, complete investigation, including thoracotomy, should be carried out if necessary to establish an exact diagnosis. A localized intrapulmonary lesion can be removed by segmental resection so that all healthy functioning lung is conserved if the disease is benign. If, after pathological examination, the lesion is shown to be cancerous, more radical resection can be carried out.     

Pulmonary segmental resection for solitary lesions of doubtful character

Pulmonary cancer can be diagnosed earlier if patients with pulmonary symptoms of chronic type are given x-ray examination early, if patients over 40 years of age have a yearly roentgen examination of the chest regardless of their state of health, and if those with acute pulmonary illness are examined by x-ray within one month of the onset of illness. Observation of a known intrapulmonary lesion of unknown character should never last for more than one month. If it persists after that period, complete investigation, including thoracotomy, should be carried out if necessary to establish an exact diagnosis. A localized intrapulmonary lesion can be removed by segmental resection so that all healthy functioning lung is conserved if the disease is benign. If, after pathological examination, the lesion is shown to be cancerous, more radical resection can be carried out.     

Humoral Hypercalcemia of Malignancy in a Patient with Large Cell Carcinoma of the Lung: Report of Case and Review of Literature

ObjectiveTo report a case of hypercalcemia associated with parathyroid hormone-related protein (PTHrP) in large cell carcinoma of the lung.MethodsWe present a case of PTHrP-mediated hypercalcemia in a patient with a large cell carcinoma of the lung and review the related literature.ResultsA 43-year-old African American man required medical attention because of lethargy, confusion, and poor oral intake. He had bullous emphysema attributable to a 50-pack-year smoking history. On physical examination, vital signs were normal, he was oriented to place and person but not time, and he had cachexia. Breath sounds were decreased in the left lower lung field. Findings on cardiac and abdominal examination were normal. Results of laboratory studies (and corresponding reference ranges) were as follows: calcium 12.1 mg/dL (8.5 to 10.5), albumin 2.0 g/dL (3.5 to 5.0), phosphorus 2 mg/dL (2.5 to 4.5), alkaline phosphatase 68 U/L (40 to 150), intact parathyroid hormone 5 pg/mL (10 to 60), PTHrP 7.0 pmol/L (0.0 to 1.5), 1,25-dihydroxyvitamin D 20.8 pg/mL (25.1 to 66.1), and 25-hydroxyvitamin D 3.7 ng/mL (10 to 60). Computed tomographic scans of the chest showed a large complex lesion in the left lower hemithorax, a small right pleural effusion, and extensive pulmonary emphysema bilaterally. Open lung biopsy revealed a large cell undifferentiated carcinoma. Abdominal and pelvic computed tomographic scans showed no evidence of metastatic involvement. A bone scan was negative for osseous metastatic lesions.ConclusionAlthough the finding is rare, patients with large cell carcinoma of the lung and hypercalcemia may have humoral hypercalcemia mediated by PTHrP. (Endocr Pract. 2007;13:389-395)     

A case of tongueworms (Pentastomida): a specific problem in context of the modern phylogenetics

A short essay on anatomy, ultrastructure and larval development, life cycles, classification, palaeontology and phylogenetic relationships of Pentastomida is given. Currently, the Pentastomida are usually placed within Crustacea, as sister group of Branchiura (Crustacea, Maxillopoda). The grounds are striking similarities in ultrastructures of spermatozoa and congruence in the 18S rRNA nucleotide sequence. Both taxa are however sharply disparate in all other characters concerning morphology, embryology, life cycles and geological history. A direct introduction of Pentastomida in the system of Crustacea implies an unjustified inflation of the taxonomic diagnosis of the latter group; hence it is unacceptable. Two alternative hypotheses are suggested as tentative phylogenetic relationships to be tested. Each hypothesis infers however a very complex and unlikely evolutionary scenario. 1) Pentastomida and Branchiura are true sister groups as justified by coincidence in spermatozoan ultrastructure and sequence of ribosomal RNA. Since their divergence, the evolutions of pentastomids and branchiurans ran in different milieus, in different shapes and with different rates. To present time, the pentastomids lost nearly all characters of maxillopods and crustaceans as well as majority of anthropod features. 2) Pentastomida and Branchiura are not close related. The similarity in ultrastructural details of spermatozoa may be occasional or resulted from convergent evolution with unknown factors. Coincidence in nucleotide sequences or ribosomal RNA should be reexamined and tested with other pentastomid species. The second hypothesis seems to be more likely.     

To the role of computed tomography in the algorithm of diagnosis of lung cancer

The paper summarizes the results of examination of 100 patients with malignant tumors of the lung. The results of X-ray study, linear tomography, and computed tomography (CT) used in the examination of patients with lung cancer were compared by using as an indicator the following parameters: to make diagnosis of lung cancer, to reveal mediastinal intergrowths, to detect enlarged lymph nodes, pulmonary metastases, and pleural lesions, to obtain information on tumor spread into the chest, to reveal growths into the vascular walls. To evaluate the efficiency of the techniques in solving the above diagnostic tasks, a statistical analysis including the estimation of their accuracy, specificity, and sensitivity was made. Recommendations for examination of patients with lung cancer were drawn up for therapeutic institutions of different types.     

Benign paratesticular fibrous pseudotumor with malignant clinical features

Paratesticular tumors are rare intrascrotal masses that grow mainly in structures containing connective tissue around the testis, epididymis, or spermatic cord. We report here on a case of a 55-year-old man with a mass in the hemiscrotum that was found to be a paratesticular fibrous pseudotumor in the orchiectomy specimen pathologic examination. From this case report and literature review, a diagnostic and therapeutic strategy is demonstrated for the management of this uncommon lesion.