Cavitary lung lesion in a patient with systemic lupus erythematosus: an unusual manifestation of cytomegalovirus pneumonitis

We report a 35-year-old female patient with systemic lupus erythematosus (SLE). She was admitted due to deterioration of lupus nephritis and received treatment with a high dose of steroid and cyclosporine. Approximately 1 month after admission, the patient was also treated for cytomegalovirus (CMV) infection because she was found to have CMV antigenemia. Although a cavitary lesion was shown by chest computed tomography (CT), its cause could not be clarified by blood examination, smears or cultures, or by bronchoscopy. We considered that this lesion may have been caused by CMV pneumonitis because it was resolved during the treatment for CMV infection. It is known that CMV causes opportunistic infections in patients with collagen vascular diseases (CVD) who are receiving immunosuppressive therapy. However, it is extremely rare for a cavitary lesion to be formed as a result of CMV pneumonitis. Here we describe the details of this interesting case.     

High-grade fetal adenocarcinoma of the lung with abnormal expression of alpha-fetoprotein in a female patient: Case report

Introduction:Fetal adenocarcinoma of the lung (FLAC) is an extremely rare tumor. Due to its rarity, most of the knowledge about FLAC comes from case reports. FLAC is an invasive adenocarcinoma that is similar to the fetal lung in the pseudo-glandular stage (8–16 weeks of gestation). Owing to the differences in histopathology and clinical process, FLAC has been further divided into low-level (L-FLAC) and high-level (H-FLAC). H-FLAC is usually associated with other conventional types of lung adenocarcinoma. Lung adenocarcinoma that produces alpha-fetoprotein (AFP) is a rare type of lung cancer. Its characteristics have not been fully elucidated.Patient''s concerns:We recently encountered this type of FLAC in a 51-year-old female patient. A computed tomography (CT) scan of the chest revealed a 74 × 51-mm sized tumor in the lingual segment of the superior lobe of the left lung. Among the tumor markers, serum AFP was elevated (816.2 ng/mL).Primary diagnosis, interventions, and outcomes:The diagnosis of FLAC in this patient was confirmed by bronchoscopy with lung biopsy. Through a thoracoscope, left lung pneumonectomy, and mediastinal lymph node dissection were performed. The postoperative pathological results were consistent with the preoperative diagnosis of H-FLAC. Western blotting showed the difference in the AFP expression between the normal lung tissue and the cancerous lung tissue. Eventually, the diagnosis was AFP-producing H-FLAC. Using an immunohistochemical marker for AFP, cancer cells were shown to express AFP, specifically in their nuclei. After the operation, the patient underwent conventional chemotherapy. Her serum AFP gradually decreased over the course of 2 weeks.Conclusion:Presently, specific tumor markers for the diagnosis of lung cancer have not been established. To the best of our knowledge, this is the first case of abnormal AFP expression in a patient with H-FLAC. It may provide a basis for the clinical diagnosis of H-FLAC, a rare tumor, and AFP may be considered as a specific tumor marker.     

Predilection of contralateral upper lung metastasis in upper lobe lung adenocarcinoma patients

Background

Lung cancer with lung to lung metastasis is common. The objective of this study was to investigate the association among the distribution of contralateral lung metastases versus primary lung tumor location, clinical characteristics, and epidermal growth factor receptor (EGFR) mutations status.

Methods

The study included treatment-naïve stage IV lung adenocarcinoma with contralateral lung metastases from 2012 through 2013.

Results

In total, 103 patients were enrolled after excluding lung cancer with histology other than adenocarcinoma, synchronous multiple primary lung cancers, or other active malignancy. The median age was 65 years (range, 28–93 years); 47 male patients (45.6%); 69 non-smoker (NS) patients (67.0%); 68 Eastern Cooperative Oncology Group performance status (ECOG PS) 0–1 patients (66.0%); 38 M1a patients (38.9%); and 60 EGFR mutation patients (58.3%). There were 51 cases (49.5%) with primary lung cancer located over upper lobes. Among them, 36 (70.6%) had contralateral upper lung predominance metastasis, 9 (17.6%) had lower lung predominance, and 6 (11.8%) had equal distribution. Among the 52 lower lobe tumors, 17 (32.7%), 19 (36.5%), and 16 (30.8%) had upper, lower lung predominance, and equal distribution metastasis, respectively. Univariate analysis showed only male gender and primary tumor location over upper lobes were significantly associated with contralateral upper lung predominance metastases. After multivariate analysis, only primary tumor location over upper lobes was significantly associated with contralateral upper lung predominance metastases (adjusted OR 5.49, 95% CI, 2.15–14.03, P<0.001).

Conclusions

Upper lobe lung adenocarcinoma was significantly associated with contralateral upper lung predominance metastases. Further research is needed to elucidate the mechanisms underlying this phenomenon.     

Horseshoe lung and scimitar syndrome in an asymptomatic child

The authors describe a case of scimitar syndrome in a 7-year-oldasymptomatic boy in whom CT scan showed a horseshoe lung. Thus,although this association is traditionally considered severeand a cause of early death, it can be compatible with a normallife.     

Case report: Filamin A mutation lung disease recognized in an 11-year-old child

The loss of function (LOF) due to mutations in the Filamin A (FLNA) gene may result in abnormality of the FLNA protein. Of the many clinical syndromes, this condition may produce chronic lung disease, which usually presents and is diagnosed in the infant/toddler age group. Its clinical pattern may mimic broncho-pulmonary dysplasia. It is part of the entities included in childhood interstitial lung disease group of disorders. We are herein reporting a patient that was diagnosed with FLNA-associated lung disease at 11 years of age. This case provides a unique insight into the long-term course of lung disease in this illness and broadens our understanding of the spectrum of its presentation. Although the patient had symptoms early in life, the diagnosis was not entertained because of the rarity of the disorder, its atypical and clinically mild presentation, and discontinuous care due to parents moving to different cities for employment reasons. Her presentation to our institution was for pneumonia. Due to highly unusual chest X-ray images, asthenia, and early clubbing, an extensive workup included further imaging and a lung biopsy. The final diagnosis was confirmed by the detection of FLNA LOF gene mutation.     

老年人无症状高尿酸血症诊治策略及进展

我国大于60岁老年人高尿酸血症的患病率大约为5.5%~19.3%。随着我国人口老龄化的进展,高尿酸血症的发病人口会不断上升。针对无症状性高尿酸血症的老年人是否需要积极降尿酸治疗,目前临床上尚无指南依据。本文从尿酸的代谢过程及病理、生理、老年人高尿酸血症合并共病的治疗策略、具体的治疗流程及药物治疗进展等方面进行综述。     

Primary pulmonary botryomycosis: an important differential diagnosis for lung cancer

This is the sixteenth reported case of pulmonary botryomycosis, an uncommon suppurative bacterial infection of the lung. We describe the case of a 69-year-old man who presented with a chronic cough and intermittent haemoptysis and on subsequent chest computed tomographic scan imaging was found to have a right lower lobe mass. He underwent a right lower lobectomy for presumed lung cancer. Histological analysis however revealed a bacterial aetiology. The past literature is reviewed outlining the pathogenesis and difficulties of clinical and radiological diagnosis. Primary pulmonary botryomycosis forms an important curative differential diagnosis for lung cancer.     

开胸肺活检对肺间质疾病的诊断价值

目的探讨开胸肺活检对肺间质疾病的诊断作用。方法对１９９３～１９９８年６月２４例开胸肺活检的肺间质疾病患者进行回顾性分析。结果２４例患者均获病理确诊,其中普通型间质性肺炎（ＵＩＰ）７例,闭塞性细支气管炎伴机化性肺炎（ＢＯＯＰ）３例,结节病３例,弥漫性泛细支气管炎（ＤＰＢ）２例,肺结核２例。其他急性间质性肺炎（ＡＩＰ）、呼吸性细支气管炎伴肺间质病（ＲＢＩＬＤ）、肺组织细胞增生症Ｘ、炎性结节、多发性肺脓肿、肺组织炎症和肺泡细胞癌各１例。结论开胸肺活检作为一种诊断方法,能获得足够的肺组织,具有很高的敏感性和特异性,能明确病变的部位和程度。对常规和纤维支气管镜未能确诊的病例,尤其是一些罕见病和不典型的病例,具有较大的价值。     

Primary salivary gland-type polymorphous adenocarcinoma in the lung: A case report and literature review

Rationale:Polymorphous low-grade adenocarcinoma is a low-risk infiltrative malignant tumor of the salivary glands. However, some of these tumors are more malignant than the low-grade tumors and therefore, according to the most recent recommendation of the World Health Organization, they are renamed as polymorphous adenocarcinomas (PACs). Primary polymorphous low-grade adenocarcinomas/PACs of the lungs are rare. Herein, we report a case of primary PAC of the lung with bronchial cartilage and perineural invasion, and lymph node metastasis.Patient concerns:A 58-year-old man had developed fever half a month prior, without chills or other accompanying symptoms, and the underlying reasons were unknown. His self-measured temperature was up to 39°C, accompanied by cough and expectoration, yellow and thin sputum, and shortness of breath. The patient''s general state was normal, and respiratory sounds originating from the right lung were weak. Enhancement computed tomography revealed that the bronchial lumen of the basal segment of the lower lobe of the right lung was narrow; soft tissue density nodules were seen, with a range of approximately 2.4 cm × 1.3 cm.Diagnosis:Based on clinical information, morphological features, and immunohistochemistry results, the pathological diagnosis was primary PAC of the lungs.Intervention:Thoracoscopic resection of the middle and lower lobes of the right lung was performed, further extended dissection of the mediastinal lymph nodes was performed.Outcomes:The postoperative course was uneventful.Lessons:Primary PAC of the lung is rare and may cause misdiagnosis. When encountering a lung tumor with diverse tissue structures, uniform cell type and nerve invasion, we should consider the possibility of PAC. Morphological and immunohistochemical features can be useful for diagnosing primary PAC of the lungs.     

Noninfectious interstitial lung disease during infliximab therapy: Case report and literature review

Pulmonary abnormalities are not frequently encountered in patients with inflammatory bowel diseases.However,lung toxicity can be induced by conventional medications used to maintain remission,and similar evidence is also emerging for biologics.We present the case of a young woman affected by colonic Crohn’s disease who was treated with oral mesalamine and became steroid-dependent and refractory to azathioprine and adalimumab.She was referred to our clinic with a severe relapse and was treated with infliximab,an antitumor necrosis factor α(TNF-α)antibody,to induce remission.After an initial benefit,with decreases in bowel movements,rectal bleeding and C-reactive protein levels,she experienced shortness of breath after the 5thinfusion.Noninfectious interstitial lung disease was diagnosed.Both mesalamine and infliximab were discontinued,and steroids were introduced with slow but progressive improvement of symptoms,radiology and functional tests.This represents a rare case of interstitial lung disease associated with infliximab therapy and the effect of drug withdrawal on these lung alterations.Given the increasing use of anti-TNF-α therapies and the increasing reports of pulmonary abnormalities in patients with inflammatory bowel diseases,this case underlines the importance of a careful evaluation of respiratory symptoms in patients undergoing infliximab therapy.     

原发性支气管肺癌合并COPD患者临床特征分析

目的 分析原发性支气管肺癌(简称肺癌)合并COPD临床特征及诊治情况,指导临床医师正确诊断和治疗.方法 将2009年1月至2010年10月在首都医科大学附属北京世纪坛医院住院的198例肺癌患者分为合并COPD组(n=59)及无COPD组(n=139).回顾性分析其临床特征及诊断、治疗情况.结果 两组间在性别(P =0.074)、平均年龄(t=0.06,P=0.946)、吸烟指数(P=1.000)、肿瘤分化程度(x2=1.942,P=0.378)、治疗方式(P=0.211)及手术后30 d内死亡率(P =0.138)等方面差异无统计学意义.合并COPD肺癌组在肺活量(t=2.492,P=0.015)、FVC(t=2.522,P=0.013)、FEV1 (t=5.450,P＜0.001)、FEV1/FVC(t=6.040,P＜0.001)、FEV1％ pred(t=10.2,P＜0.001)、肺腺癌患者比例(P=0.041)均低于无COPD肺癌组.合并COPD肺癌组在肺鳞癌(P=0.001)、临床分期Ⅲ期(P=0.001)、既往存在呼吸系统症状患者比例(P＜0.001)及手术患者住院时间(t=18.95,P＜0.001)、术后并发症发生率(P=0.016)均高于无COPD肺癌组.依据GOLD肺功能分级标准,将合并COPD肺癌组患者分为肺功能轻度减低组(GOLD Ⅰ+GOLDⅡ,n=40)及肺功能中重度减低组(GOLDⅢ+GOLDⅣ,n=10).两组间在性别(P =0.704)、平均年龄(t=1.057,P=0.296)、吸烟史(P=0.671)、病理类型(x2=4.828,P =0.089)、临床分期(P=0.659)及治疗方式(P=0.494)等方面差异无统计学意义.肺功能中重度减低组术后并发症发生率(P＜0.003)及术后30 d死亡率(P=0.041)高于肺功能轻度减低组.59例合并COPD肺癌患者入院时临床诊断COPD仅16例(27.1％),住院期间15例(25.4％)短期给内予吸入支气管扩张剂、布地奈德吸入剂;出院时诊断COPD 24例(40.7％),其中内科诊断16例,外科诊断8例,仅15例(25.4％)规律应用长效支气管扩张剂/吸入激素药物(长效β2受体激动剂/吸入糖皮质激素或长效抗胆碱能药物).结论 肺癌合并COPD并不少见,但临床漏诊率高,治疗不规范.与无COPD肺癌组比较,合并COPD肺癌组患者既往存在更明显呼吸系统症状,鳞癌患者更多,腺癌患者更少,临床分期Ⅲ期患者更多,肺功能更差,手术后住院时间更长,术后并发症更多.肺功能中重度减低组术后并发症发生率及术后30 d死亡率更高.应在诊治肺癌过程中早期发现和规范治疗COPD,以改善预后.     

Gallbladder function and dynamics of bile flow in asymptomatic gallstone disease

AIM： To investigate the effects of gallbladder stones on motor functions of the gallbladder and the dynamics of bile flow in asymptomatic gallstone disease. METHODS： Quantitative hepatobiliary scintigraphy was performed to detect the parameters of gallbladder motor function [gallbladder ejection fraction （GBEF）, gallbladder visualization time （GBVT）, gallbladder time to peak activity （GBTmax）, gallbladder half emptying time （GBT1/2）, and transit time of bile to duodenum （TTBD）] in 24 patients with asymptomatic cholelithiasis who were diagnosed incidentally during routine abdominal ultrasonographic examination and 20 healthy subjects with normal gallbladder. RESULTS： Even though there was no significant difference in the clinical and laboratory parameters between the patient and control groups, all parameters of gallbladder function except TTBD were found to differ significantly between the two groups. GBEF in the patient group was decreased （P = 0.000） and GBVT, GBT GBT1/2 in the patient group were longer （P = 0.000, P = 0.015, P = 0.001, respectively）.there were not any clinical and laboratory findings, gallbladder filling and emptying could be impaired in patients with gallstone disease.     

CT引导下经皮肺活检的临床应用

目的:评价CT引导下经皮肺活检诊断肺周围性病变的价值。方法:回顾性分析北京安贞医院87例患者的临床资料。所有患者均采取CT引导下经皮肺活检检查,其中13例实施手术,进一步做病理组织检查。结果:CT引导下经皮肺穿刺活检诊断肺周围性病变的确诊率高达97.7%。在确诊的85例中肺癌41例,结核18例,非特异性炎症9例,坏死性炎症7例,淋巴瘤2例,非精原细胞性生殖细胞肿瘤1例,前列腺癌肺转移1例,血管内皮瘤1例,间皮瘤1例,结节病1例,肺吸虫病1例,皮肌炎1例,特发性肺纤维化1例。实施手术的13例患者术后病理确诊均为阳性,其中包括经皮肺活检未确诊的1例,其术后病理检查为腺癌。CT引导下经皮肺穿刺活检的患者中有16例出现并发症。结论:CT引导下经皮肺活检操作简便、准确率高、安全性好及并发症少,能为肺周围性病变的诊断和鉴别诊断提供可靠依据。     

外科肺活检诊断弥漫性实质性肺疾病的临床分析

目的评价外科肺活检诊断弥漫性实质性肺疾病的有效性和安全性。 方法回顾性分析南京鼓楼医院呼吸与危重症医学科2006年1月至2018年9月54例行外科肺活检的弥漫性实质性肺疾病患者的临床资料。 结果54例患者中,37例接受了电视辅助胸腔镜手术,17例接受了开胸肺活检,术后最常见的病理诊断是机化性肺炎,48例(88.9%)患者术后获得明确的诊断,术后38例(70.4%)患者根据诊断结果调整了治疗方案。术前接受小创伤肺活检未明确诊断的患者,接受外科肺活检后96%确诊。按术后有无并发症分为并发症组和无并发症二组。15例(27.8%)患者术后出现并发症,其中9例(16.7%)气胸,5例(9.3%)肺部感染,3例(5.6%)脱机困难,3例(5.6%)呼吸衰竭,1例(1.9%)术后再次插管,1例(1.9%)术后出血,1例(1.9%)进行气管切开。术后30 d病死率为1.9%,死亡原因主要是呼吸衰竭。术后并发症组和无并发症组在性别、年龄、FVC% pre、FEV₁%pre、DLCO% pre、术前PaO₂、术前激素使用情况和手术方式之间的差异没有统计学意义(P>0.05)。 结论对于结合临床病史、胸部高分辨率CT、实验室检查及小创伤肺活检资料仍诊断不明的弥漫性实质性肺疾病的患者,外科肺活检可作为最后一项有意义的检查方法,其诊断率为88.9%。外科肺活检是一项相对安全且可靠的诊断弥漫性实质性肺疾病的手段,但基础情况较差的患者,术后出现并发症的可能性较高,此类患者应尽量避免外科肺活检。     

Gastric subepithelial lesion complicated with abscess: Case report and literature review

Gastric abscess is a localized pyogenic inflammation of the gastric wall, which is a rare form of suppurative gastritis. The rarity of gastric abscess may be associated with the difficulty of early diagnosis and high mortality as a result. In general, subepithelial lesions (SELs) of the stomach are incidentally detected during the course of upper endoscopy without specific clinical symptoms and signs. However, some gastric SELs present rarely as a form of hemorrhage, obstruction, perforation, and abscess. Here we report a 45-year-old man with gastric SEL presenting as a gastric abscess, which was diagnosed as an ectopic pancreas of the stomach, along with a review of the literature. Although gastric SEL presenting as an abscess is known as a serious and life-threatening lesion, the patient made a complete recovery through surgical resection as well as medical treatment.