PULMONARY LEIOMYOSARCOMA

Three cases of pulmonary leiomyosarcoma were presented. The characteristic clinical features were described with review of literature. In comparison with bronchogenic carcinuma, the leiomyosarcoma has some characteristics: 1) On chest X-ray, it usually appears as a sharply demarcated, even density round mass, growing rapidly within the lung, it unusually accompanies with hilar or mediastlnal lymph node metastasis; 2) The preoperative cytological or pathological diagnosis is difficuh either by sputum smear or by bronehoscoplc biopsy or by fine needle percutaneous aspiration biopsy; 3) Pathological differential diagnosis of leiomyosarcoma of lung from anaplastie lung cancer is difficult. In conclusion, the primary pulmonary leiomyosarcoma is a rare malignant tumor, detect ing the present illness seriously, paying attention to the chest X-ray films characterize, early surglcal resection is the only way to get diagnosis and effective treatment method.     

Chest X-ray imaging of patients with SARS

Objective To investigate the chest X-ray manifestations of SARS cases.Methods A retrospective study was conducted among 52 clinically confirmed SARS patients from February 9 to May 10, 2003. Chest X-ray scanning was performed at a interval of 1 -3 days according to the requirements. The manifestations and special features of SARS in X-ray were analyzed.Results Small or large patchy shadows with intensive density in both lungs were observed in 31 cases, ground-glass like opacification in 16, small patchy shadows in one lung lobe or one lung segment in 18, nodular shadows in one lung segment in 1, and increased lung marking in lung interstitial tissues in 2. Rapidly changing consolidations revealed in chest X-ray images were found to be associated with SARS infections, and they were not affected by treatment with antibiotics.Conclusion Chest X-ray provides a sensitive and specific method for the diagnosis and treatment of SARS, and those present with symptoms and signs should undergo chest X-ray scanning every 1 -3 days.     

CT MANIFESTATIONS IN PULMONARY ALVEOLAR PROTEINOSIS AND COMPARED WITH CHEST RADIOGRAPHY（REPORT OF SIX CASES）

The CT including HRCT appearances of six patients with hisropathologically confirmed pulmonary alveolar proteinosis(PAP) were evaluated and compared with those of chest radiographs, In all patients the CT manifestations were quite similar; bilateral and diffuse airspace consolidation was usually patchy or confluent with sharply defined margins, intermingled with normal lung tissue. The configuration of lung lesions was “geographical“ in outline with angulate, strait and curved margins. There were white branching linear opacities within the ground-glass background. Although various pulmonary diseases may mimic PAP in some way, a full awareness of the characteristic CT appearances of PAP is helpful in achieving a correct diagnosis. CT may provide more accurate evidence than chest radiograph for the evaluation of the extent and delineation of PAP.     

Percutaneous Transluminal Embolization with CoilsTreatment of Pulmonary Arteniovenous Malformations

The clinical values of coils emboliztion in the treatment of pulmonary arteriovenous malformations (PAVM) and related complications were investigated.eleven patients with PAVMs verified by pulmonary arterial angiography were treated by transcatheter coils embolization.Chest X-ray (11 cases),computer tomogaphy(7 cases) and/or magnetic resonance imaging (2 cases) were performed before embolization.Blood-gas analysis was done in 5 cases before and after embolization.the follow-up materials of 8 patients were collected to evaluate the effect of embolization with coils.The clinical manifestations included cerebral embolus,hemoptysis and decreased oxygenation in 9 patients and the remaining 2 has no symptoms.9/11 cases were found by chest X-ray and 8 were diagnosed definitely.7/7,2/2 cases were diagnosed by CT or MR and diagnosis was made in all cases.Embolization was performed in 29 vessels.Partial pressure of oxygen in arterial blood of 5 cases changed significantly before and after embolization.Slight complications occurred in 6 patients,such as low fever,chest pain,pleurisy.The follow-up results showed that 7 cases were cured effectively.No primary and secondary device migration,and no medical paradoxical embolization occurred.It was concluded that coils emboliztion is a well-established method for treating PAVMs.It is minimally invasive lung preserving treatment with hight efficiency and less complication.     

Minimally invasive approaches for histological diagnosis of anterior mediastinal masses

Background Anterior mediastinal masses include a wide variety of diseases from benign lesions to extremely malignant tumors. Management strategies are highly diverse and depend strongly on the histological diagnosis as well as the extent of the disease. We reported a prospective study comparing the usefulness of core needle biopsy and mini-mediastinotomy under local anesthesia for histological diagnosis in anterior mediastinal masses. Methods Atotal of 40 patients with masses of unknown histology and located either at or near the anterior mediastinum received biopsy prior to treatment. The diagnostic methods were core needle biopsy in 28 patients and biopsy through mini-mediastinotomy under local anesthesia in 15 patients （including 3 patients for whom core needle biopsy failed to yield a definite diagnosis）. Results Histological diagnosis was achieved in 18 of the 28 patients receiving core needle biopsy. Of them, all 4 patients with pleural fibromas and 9 of the 12 patients （75%） with pulmonary mass were diagnosed definitively. In the remaining 12 patients with mediastinal mass, histological diagnosis was achieved in only 5 patients （41.7%）. In contrast, biopsy through a mini-mediastinotomy failed in only 3 patients. In the remaining 12 patients with huge mediastinal masses, who underwent mini-mediastinotomy, a definitive histological diagnosis was reached by pathological and/or immunohistochemical study （diagnostic yield 85.7% in 12 of 14 cases of mediastinal mass, P=0.038 vs core needle biopsy）. For the 9 patients with thymic epithelial tumors, the diagnostic yield was 40% （2 in 5 cases） for core needle biopsy and 83.3% （5 in 6 cases） for mini-mediastinotomy. There was no morbidity in patients receiving mini-mediastinotomy. In the 30 patients with biopsy-proven histological diagnosis, the results contributed to therapeutic decision making in 25 cases （83.3%）. Conclusions Core needle biopsy is effective in the diagnosis of pulmonary and pleural diseases. Yet its diagnostic yield in mediastinal mass is rather low. Superior to core needle biopsy, biopsy through a mini-mediastinotomy under local anesthesia is highly effective in the histological diagnosis of anterior mediastinal mass, and has a satisfactory diagnostic yield. The method is safe, minimally invasive, cost-effective, and useful in therapeutic decision making for anterior mediastinal masses.     

Diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration in intrapulmonary lesions

Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） is considered to have high value in the staging of mediastinal lymph nodes in lung cancer. The current study was conducted to investigate the diagnostic value of EBUS-TBNA in intrapulmonary lesions located near the central airway. Methods From September 2009 to March 2013, 66 patients with pulmonary masses located close to the central airways suspected to be lung cancer were accessed by EBUS-TBNA. Conventional bronchoscopic biopsy before EBUS-TBNA was nondiagnostic in all cases. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were subsequently referred for a surgical procedure. ResuLts Among the 66 cases, 59 were confirmed as pulmonary malignancies by EBUS-TBNA, of which 48 cases were non-small cell lung cancer, nine were small cell lung cancer, and two were metastatic lung tumors. No evidence of malignancy was found by biopsy and histopathological examination in the other seven cases. Thoracoscopy or thoracotomy was subsequently undergone for them. Postoperative pathological examinations confirmed three cases of squamous cell carcinoma of the lung, one case of lymphoma, two cases of sclerosing hemangioma, and one case of pulmonary tuberculoma. The definitive diagnosis rate of EBUS-TBNA for intrapulmonary lesions near the central airway was 89.4%. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing benign from malignant intrapulmonary lesions were 93.7%, 100.0%, and 93.9%, respectively. The positive and negative predictive values were 100.0% and 42.9%, respectively. The EBUS-TBNA procedures were well-tolerated by all patients. No associated complications were observed. Conclusions For intrapulmonary lesions near the central airway highly suspected of cancer, EBUS-TBNA has satisfactory diagnostic value. However, the negative predictive value of this technique is low, so negative results obtained by EBUSTBNA should be confirmed by other methods.     

Rapid Identification of Bacterial Species Associated with Bronchiectasis via Metagenomic Approach

Bronchiectasis is a chronic lung disorder and a number of bacterial pathogens are involved.However,30%-40% of sputum and purulent samples in good quality failed to grow any pathogenic bacteria,making it difficult to confirm the pathogen.In this study,we collected bronchoalveolar lavage fluid from a bronchiectasis patient undergoing acute exacerbation,and sent for 16 S rDNA pyrosequencing by a 454 GS Junior machine.Metagenomic analysis showed the composition of bacterial community in sample was complex.More than a half of reads（51.3%） were from Pseudomonas aeruginosa.This result was corresponding with the culture result but came out 2 d earlier,which is meaningful for early diagnosis and treatment.The detection with 16 S rDNA pyrosequencing technology is more sensitive and rapid than routine culture,and can detect the co-infection or symbiosis in airway,giving us a novel and convenient approach to perform rapid diagnosis.     

Analysis of 23 cases of pulmonary cryptococcosis

Pulmonary cryptococcosis (PC) is a subacute or chronic pulmonary fungitis caused by Cryptococcus neoformans. Because of no specific clinical symptoms or manifestations in chest radiographs, misdiagnosis is common.1 Between January 1980 and January 2004, 23 cases of PC were diagnosed by pathological examinations in our hospital and the clinical data were retrospectively analyzed to improve the diagnosis of PC.     

Diffuse panbronchiolitis with histopathological confirmation among Chinese

Background Diffuse panbronchiolitis (DPB) was originally and is still primarily reported in Japan, rarely in other countries. As macrolide therapy is effective for this disease with once dismal prognosis, familiarity with its clinical features is urgently needed, especially for clinicians outside Japan. The objectives of this study were to investigate the clinical features of DPB in a Chinese population and propose diagnostic procedures that will lead to increased awareness of this treatable disease among clinicians, ultimately allowing for more rapid diagnosis.Methods After a literature review, the clinical features of DPB were histopathologically confirmed in a series of 9 cases either by open lung biopsy or video-assisted thoracic surgical biopsy, resulting in the largest series of confirmed DPB cases in a non-Japanese population. Here, the cases are retrospectively described and diagnostic procedures are discussed.Results Persistent cough, sputum, and exertion dyspnea occurred in 89% of patients, a history of or current chronic sinusitis in 78%, centrilobular micronodules appearing on chest CT scans in 100%, coarse crackles in 78%, FEV1/FVC＜70% in 44%, PaO2＜80 mmHg in 56%, and titer of cold hemagglutinin≥1∶64 in 11%. According to its clinical diagnostic criteria, diagnosis was definitive in 44%, suggested in 33%, and excluded in 23% at the time of diagnosis. However, DPB was clinically considered before confirmation in only 22% of patients, with the remaining 78% of cases missed or mistaken for other diseases. Of the 9 cases, 8 received transbronchial biopsies before confirmation of the diagnosis, but all showed non-specific inflammation.Conclusions Although its clinical features may vary with disease course and ethnic populations, most cases of DPB can be diagnosed or suggested according to clinical diagnostic criteria. However, underdiagnosis as a result of unfamiliarity with its clinical features and diagnostic criteria prevails. If difficulty in diagnosis arises, the diagnosis should be based on clinicopathological features and the exclusion of other diseases. Few cases can be confirmed by transbronchial biopsies; in these cases, either an open-lung biopsy or a video-assisted thoracic surgical lung biopsy should be recommended.     

Pulmonary artery intimal sarcoma diagnosed by percutaneous transcatheter aspiration

Pulmonary artery intimal sarcoma (PAIS) is a very rare but lethal disease,firstly described by Mandelstamm in 1923.1 Since then,less than 300 cases have been reported worldwide.Due to similar clinical presentations,it is very difficult to distinguish with pulmonary thromboembolism (PTE),leading to inappropriate treatments such as anticoagulation and thrombolysis.2-5Although with improvement of imaging modalities,the diagnosis of PAIS is still based on pathological examination,and the majority of specimens are taken by surgery or autopsy.