Possible pathological basis for false diagnoses of lymph nodes by USPIO‐enhanced MRI in rabbits

Purpose:

To determine the cause of misdiagnosis of lymph nodes in ultrasmall superparamagnetic iron oxide (USPIO) enhanced magnetic resonance imaging (MRI) using histological findings in rabbit tumor and inflammatory models.

Materials and Methods:

Thirty‐six rabbits were randomly divided into inflammatory and tumor groups. MRI of the popliteal fossa was performed before and 24 hours after USPIO administration. Diagnoses of popliteal lymph nodes were evaluated based on dedicated criteria and were compared with histological and electronic microscopic findings.

Results:

There were 46 inflammatory and 26 metastatic lymph nodes. Sensitivity, specificity, and positive and negative predictive values of the diagnosis of nodal metastasis were 84.6%, 87.0%, 78.6%, and 90.9%, respectively. There were four false‐negatives with subcapsular metastatic foci and six false‐positives with predominant cortex and paracortex hyperplasia. Electron microscopy showed that in inflammatory nodes, cytophagic bubbles contain many USPIO particles, while in metastatic nodes they contained predominantly cellular residues.

Conclusion:

Diagnosis of lymph node malignancy is largely determined by the location and number of metastatic tumor cells. A profound understanding of the physiological role of macrophages in nodes with tumor burden will contribute to better diagnoses for clinical application. J. Magn. Reson. Imaging 2010;31:1428–1434. © 2010 Wiley‐Liss, Inc.     

Inflammatory myofibroblastic tumor of the lung (inflammatory pseudotumor): uncommon cause of solitary pulmonary nodule

Lung inflammatory myofibroblastic tumor is an uncommon cause of solitary lung nodule (0.7 % of lung tumors). The principal site of inflammatory pseudotumor is the lung, but it can also occur elsewhere in various organs. Although benign, they may be locally very aggressive. Recurrent and multifocal forms have been described. Since they are likely to mimic malignant neoplasms, accurate histopathologic diagnosis is necessary in order to guide appropriate surgical excision and avoid aggressive treatments. We report a case of lung involvement in a young adult with radiologic and pathologic correlations. Received: 26 February 1998; Revision received: 31 July 1998; Accepted: 14 September 1998     

Endobronchial histiocytoma

Histiocytoma is an inflammatory pseudotumor usually found in the lung parenchyma or pleura. Endobronchial localisation is rare and can cause atelectasis or air-trapping. Conventional chest X-ray can show the tumor and secondary pulmonary changes. Conventional tomograms and CT can give additional information about tumor extension. However, to make the final diagnosis, biopsy is necessary.     

46例肺炎性假瘤CT误诊分析

目的：探讨肺炎性假瘤的影像特点及其误诊原因,方法：回顾分析46例经病理证实的肺炎性假瘤的CT表现,结果：40例误诊为肺癌（875）,6例误诊为结核球或良性肿瘤（13％）。结论：CT诊肺炎性假瘤的诊断有一定的局限性;多发病灶或合并肺门纵隔淋巴结肿大者的诊断更为困难;没有活检,诊断时过分强调某个CT征象或临床症状,缺少综合分析是导致误诊的重要原因。     

Epithelioid hemangioendothelioma with solitary bone location associated to multiple lung and liver lesions. A case report

Progressive development of a lobulated osteolytic lesion of the left calcaneus was observed in a 28-year-old woman. The bone tumor was associated with multiple lung nodules and later with a few small nodular liver lesions. A histological and immunochemical diagnosis of epithelioid hemangioendothelioma was obtained by bone tumor resection and thoracoscopic lung biopsy. Imaging aspects are reported with emphasis on its multifocality.     

Inflammatory pseudotumor of the lung: a case report

A case of inflammatory pseudotumor of the lung is reported. A 24-year-old male was referred for further examination of an abnormal shadow on chest radiography performed during a mass survey. Medical imaging data, including CT study, led to a diagnosis of benign tumor of the right lung. After right middle lobectomy, the lesion was diagnosed as inflammatory pseudotumor on the basis of histopathological study.     

Myofibroblastic inflammatory tumor of the lung: CT findings with pathologic correlation

The objective of this study was to describe the computed tomographic (CT) features of myofibroblastic inflammatory tumor of the lung with histopathologic correlation. The medical records and imaging studies of eight patients with pathologically proven myofibroblastic inflammatory tumor of the lung were reviewed. On radiographs and CT images, a poorly circumscribed mass or nodule was evident in five patients (six lesions), and a well-circumscribed lesion was evident in three patients (three lesions). Seven lesions were peripheral and two were centrally located. At CT, five lesions were of heterogeneous attenuation and four homogeneous. Increased perilesional parenchymal abnormalities, which were caused by peribronchial inflammatory infiltrates, were observed in three cases. The predominant histopathologic feature was organizing pneumonia type in three cases, lymphoplasmacytic type in three cases, and both organizing pneumonia and lymphoplasmacytic type in two cases. Variable degree of fibrous histiocytoma type was observed in all cases. The imaging characteristics of myofibroblastic inflammatory tumor of the lung are variable and nonspecific. The authors conclude that most cases appear as solitary, peripheral lesions with a predilection for the lower lobes. Associated findings may include perilesional inflammatory changes. Because myofibroblastic inflammatory tumor cannot be reliably differentiated from other pulmonary lesions based solely on the imaging appearance diagnostic biopsy is mandatory. Interpretation of the imaging findings combined with the histopathologic features of disease may help make correct diagnosis.     

Inflammatory myofibroblastic tumor of the spleen: a case report

Inflammatory myofibroblastic tumors (IMTs), otherwise known as the inflammatory pseudotumor, is a rare solid mesenchymal tumor, simulating malignant neoplasms, histologically characterized by the proliferation of spindle cells in a fibrous myxoid stroma containing inflammatory cells. CT and MR imaging are the most used tools in their assessment. Clinical features are nonspecific and depend on the localization of the tumor, radiologic findings are polymorphic and no-conclusive and present a diagnostic challenge to the radiologist. Although histology remains obligatory for the final diagnosis. Heren, we report a case of splenic IMT with histological correlation.     

Immunohistochemical expression of tumor necrosis factor-α in sepsis-induced lung injury

Sepsis is asevere, systemic inflammatory disease caused by various kinds of microbes. In the present study, we immunohistochemically examined tumor necrosis factor (TNF)-α expression in sepsis-induced lung injury, and discuss its availability for the postmortem diagnosis of sepsis. Lung samples were obtained from different lung lobes of nine sepsis and eight control cases with postmortem intervals between 12 and 48 hours. Immunohistochemical analysis using anti-human TNF-α rabbit polyclonal antibodies was carried out. In sepsis and control groups, immunoreactivity for TNF-α was strongly detected in round-shaped mononuclear cells. The intensity of the immunohistochemical staining reaction was homogeneous in all lobes of the lungs examined. Furthermore, a double-color immunofluorescence analysis revealed that macrophages were a main cellular source of TNF-α in the lungs. To semiquantitatively evaluate the expression of TNF-α in the lungs, the ratios of the number of TNF-α-positive macrophages to total number of macrophages were calculated. Morphometrically, in lungs of the sepsis group, the ratio of TNF-α-positive macrophages was significantly higher, compared with the control group. TNF-α expression in the lungs can become a clue for the postmortem diagnosis of pulmonary inflammation, especially, TNF-α-positive ratios of 20% of more might suggest sepsis as the cause of death. This study was presented at the Sixth International Symposium in Advanced Legal Medicine (ISLAM), Hamburg, Germany, September 2006     

脏器炎性肌纤维母细胞肿瘤的诊断与鉴别诊断

目的 探讨脏器炎性肌纤维母细胞瘤(Inflammatory miofibroblastic tumor,IMT)的诊断和鉴别诊断.方法 分析21例IMT的临床病理特征,病理组织学特点和免疫组化表型.所有病例行HE染色和免疫组化染色.结果 脏器IMT主要有三种细胞:肌纤维母细胞,纤维母细胞和炎细胞,这些细胞构成了IMT的三种组织学亚型:(1)黏液一血管型;(2)梭形细胞密集型;(3)少细胞纤维瘢痕型.所有病例表达vim、SMA和MSA,部分病例表达PCK和ALK.结论 脏器IMT的病理组织学和免疫表型是诊断的重要依据,鉴别诊断包括腹腔黏液囊肿和肿瘤,钙化性纤维性肿瘤.孤立性纤维性肿瘤,伴淋巴组织浸润的平滑肌瘤、和胃肠间质瘤.     

Presence of local pleural adhesion in CT screening-detected small nodule in the lung periphery suggests noncancerous, inflammatory nature of the lesion

PURPOSE: Differential diagnosis of small nodules in the lung periphery detected by low-dose chest CT screening is important before surgery. The aim of the study was to discriminate between benign and malignant lesions, identified in our preoperative imaging work-up examinations and confirmed during surgery, for nodules detected on CT screening. MATERIALS AND METHODS: This study is based on 106 patients (46 men and 60 women, median age: 61.5 years) with 123 CT screening-detected and histologically confirmed nodules smaller than 30 mm in the lung periphery identified between 2002 and 2005 at Azumi General Hospital, Japan. Lesions were classified into three groups according to histological findings: adenocarcinoma, atypical adenomatous hyperplasia (AAH) and inflammatory focal lesions. We examined the visceral pleura during surgery at a location close to lung nodules. RESULTS: The median diameter of resected lung nodules on high-resolution CT (HRCT) was 9.0 mm. Nodules were nonsolid in 42, partly solid in 51 and solid in 30. Histopathological diagnosis was lung cancer in 69, AAH in 21, other noninflammatory tumours in 6 and inflammatory lesions in 27. Fifty-four lesions were located in the subpleural zone. Eight of 123 nodules showed local pleural adhesions (LPA), while 2 were buried in extensive pleural adhesion. LPA was noted more frequently in inflammatory nodules than in cancer nodules (P<.01). CONCLUSION: The presence of LPA in close proximity to a small nodule is indicative of noncancerous lesion. This feature allows the discrimination of pulmonary peripheral inflammatory lesion from peripheral small cancer on chest low-dose CT screening.     

周围型肺癌阻塞性病变的CT表现(附18例分析)

目的:确定深呼吸时相CT扫描对周围型肺癌诊断敏感性。材料与方法:18例周围型肺癌(13例经病理证实,5例由其它方法证实)和12例良性肺肿块对照者(炎性假瘤和结核球等)均经常规CT扫描,除2例炎性假瘤患者外,其余所有病人并经肿块部位及其上下一层的深呼吸时相CT扫描。结果:周围型肺癌深呼吸时相CT扫描所见的阻塞性病变计有4例肺不张,12例阻塞性肺炎(按其帮位进而可分为远离肿块的和邻近肿块的阻塞性肺炎),1例阻塞性肺气肿,以及1例肺静脉癌栓。周围型肺癌的这些CT表现,在良性肺肿块对照者中不复被看到。结论:深呼吸时相CT扫描所见的远离肿块的阻塞性肺炎及肿块外侧的阻塞性肺气肿,可被看作是周围型肺癌的特有表现而且是其早期诊断的依据。     

Delayed lung scintigraphy with N-isopropyl-I-123-p-iodoamphetamine in lung cancer and inflammatory disease

Lung studies with N-Isopropyl-I-123-p-Iodoamphetamine (IMP) were performed on patients with lung cancer or inflammatory disease. In the present study, we evaluated the usefulness of the delayed scintigraphy. The subjects consisted of 27 patients with lung cancer (34 lesions), 3 with radiation pneumonitis, 2 with interstitial pneumonitis, 2 with old tuberculous lesion (tuberculomas), 1 with diffuse panbronchiolitis, 1 with pneumonia and 1 with lung abscess. The delayed scintigraphy was performed 24 hr after intravenous injection of 3 mCi IMP, in sitting position. In 10 patients, SPECT images were obtained following the delayed scintigraphy. Delayed scintigraphic appearances of lung cancer were classified into 5 types, high IMP uptake in the area congruent with the lesion of atelectasis and/or obstructive pneumonia (Type I), high IMP uptake in the area surrounded the tumor (Type II), a defect in the area consistent with the tumor and no high IMP uptake in the area surrounded the tumor (Type III), high IMP uptake in the area almost congruent with the tumor (Type IV) and no significant change (Type V). Excluding 10 lesions with Type IV or V, no IMP uptake was seen in the areas congruent with the tumors. Type II was the most frequently observed pattern. Normal scintigrams (Type V) were observed in 8 lesions, whose sizes were fairly small. There was no definite trend caused by difference in histological types of cancers. In 8 patients with viable inflammatory disease of the lung, the delayed scintigrams showed high IMP uptake in the areas congruent with the abnormalities on chest roentgenograms.(ABSTRACT TRUNCATED AT 250 WORDS)     

Two cases of pulmonary paragonimiasis on FDG-PET CT imaging

Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) is useful in cancer diagnosis owing to its sensitivity to the differences in glucose metabolic rate between benign and malignant diseases, especially in the lung. One pitfall in PET imaging of lung disease, however, is the overlap in metabolic rate of inflammatory and neoplastic entities. Paragonimiasis is a food-borne parasitic disease that causes the pulmonary and pleural inflammation. We present two cases of pulmonary paragonimiasis that showed high uptake suggestive of tumor on FDG-PET CT images, both confirmed on histopathology by visualization of Paragonimus westermani eggs in the involved tissues.     

CT引导经皮肺穿刺活检的临床应用(附102例报告)

目的　探讨CT引导经皮肺穿刺活检对肺占位性疾病的诊断价值。方法　应用DLTRA CUT型 18G软组织切割式活检针 ,在CT引导下对 10 2例肺占位性疾病患者进行经皮肺穿刺。结果　 10 2例经皮肺穿刺活检患者中 ,病理检查证实为原发性肺癌者 94例 ,结核 4例 ,炎性假瘤 1例 ,未能作出明确诊断者 3例 ;诊断准确率为 97 1% ,术后并发少量气胸 8例 ( 7 8% ) ,痰中带血 6例 ( 5 9% ) ,均未需作特殊处理。结论　CT引导经皮肺穿刺活检是一种比较安全、可靠的辅助诊断技术。     

Changes in CT density of solitary capillary hemangioma of the lung upon varying patient position

Solitary capillary hemangioma of the lung (SCHL) is a rare benign tumor that is difficult to differentiate from other nodular lesions, including lung cancer, on CT. We report a case of 58-year-old man with an SCHL of the left lower lung. A nodular lesion 7?mm in size varied in CT appearance when the position of the patient was changed: it was part solid and part ground-glass opacity (mixed GGO) in the supine position, but pure GGO (nonsolid) in the prone position. However, the possibility of a malignancy could not be completely excluded because the density of the lesion had increased slightly over the past five?years, so the patient underwent surgical resection. The histological diagnosis was SCHL. Therefore, changes in the CT density of a nodule upon changing patient position may indicate an SCHL.     

Smoking-related lung abnormalities on computed tomography images: comparison with pathological findings

Smoking-related lung abnormalities are now an increasing public health concern. According to the findings of large-cohort studies, approximately 8% of smokers have interstitial lung abnormalities, which are associated with a relatively high risk of all-cause mortality. We reviewed the radiological and pathological findings of smoking-related interstitial lung diseases, such as respiratory bronchiolitis-interstitial lung disease, desquamative interstitial pneumonia, and airspace enlargement with fibrosis. We have also discussed the histological basis of unclassifiable interstitial pneumonia in smokers, which exhibits airway-centered cystic lesions with fibrosis. A variety of radiological findings coexist in the lungs of a smoker. This overlapping of multiple pathological conditions might cause the radiological patterns of diseases to become unclassifiable. Therefore, diagnosis should be performed not on the basis of a single radiological finding, but in a comprehensive manner, by including clinical symptoms and disease behavior. Among interstitial abnormalities in smokers, the usual interstitial pneumonia (UIP) pattern is correlated with a worse prognosis than others. Basal-predominant subpleural reticulation is a clue for accurate diagnosis of UIP, which can be achieved by computer-aided quantitative analysis.     

KRAS突变对人肺腺癌转录组影响的生物信息学分析

目的 鼠肉瘤病毒致癌基因(Kirsten rat sarcoma viral oncogene,KRAS)突变型肺腺癌是临床常见肺癌亚型,发病机制不清,预后不良。推测可能与KRAS突变对整个基因组的影响有关。本研究通过对KRAS突变型肺腺癌的转录组分析,探讨其预后不良和耐药的组学机制。为研究KRAS突变型肺腺癌的发病机制和临床治疗提供指导。方法 从公共基因表达数据库（gene expression omnibus,GEO）中下载KRAS突变型肺腺癌的转录组数据库,首先利用R语言Impute程序包进行数据标准化,然后利用Limma程序包筛选差异基因,最后利用Robust rank aggregation算法筛选显著性基因。为进一步研究其表观调控机制,我们利用R语言Clusterprofile程序包和STRING数据库分别进行了KEGG pathway分析和蛋白质互作网络分析。结果 KRAS突变对全转录组影响复杂,包括改变细胞周期促进肿瘤细胞异常增殖;影响白细胞介素-17信号通路促炎反应导致免疫耐受,促进肿瘤生长;影响细胞色素P450信号通路导致耐药。结论 KRAS突变能够引起整个基因组发生异常变化,并与促进肿瘤生长、抑制抗肿瘤免疫以及耐药相关基因的表达密切相关。     

胸部结节或肿块的 CT 导向穿刺活检的临床应用

目的：探讨CT导向下经皮穿刺活检对胸部结节或肿块病变诊断的临床意义。方法 CT导向下采用18~20 G切吸两用穿刺针对25例胸部占位性病变进行穿刺并活检。结果25例患者穿刺活检病理诊断为恶性肿瘤12例,良性肿瘤4例,结核3例,淋巴结肿大6例;恶性肿瘤中鳞癌6例,腺癌2例,小细胞癌1例,转移瘤3例。总阳性诊断率达100%,其中细胞学诊断阳性率76%,组织学诊断阳性率92%。无一例发生严重并发症及针道转移。结论 CT导向穿刺对胸部结节或肿块的诊断安全有效,值得临床广泛应用。     

Renal duplication with a diminutive lower pole: the Nubbin sign.

Eight patients with a duplex kidney demonstrated severe attenuation of parenchyma in the lower pole. The radiographic appearance of a diminutive lower collecting system indicated the proper diagnosis when there was sufficient parenchyma for visualization. Parenchymal attenuation may represent either hypoplasia or inflammatory atrophy. Whichever the cause, it is important that the diminutive lower pole not be mistaken for a renal mass, extrinsic tumor, renal infarction, or a postoperative change.