Bilateral pulmonary nodular amyloidosis: A case report and review of the literature

Pulmonary amyloidosis is uncommon and is usually associated with systemic amyloidosis. Localized pulmonary involvement in amyloidosis without systemic amyloidosis is even rarer; it is generally tracheobronchial or parenchymal in location. Parenchymal pulmonary amyloidosis is generally asymptomatic and an incidental finding, presenting as nodules varying in size and number, unilateral or bilateral. We present an unusual case of primary bilateral pulmonary nodular amyloidosis in an elderly female.     

Pulmonary hyalinizing granuloma mimicking pulmonary carcinoma

Pulmonary hyalinizing granuloma is a rare fibrosing nodular disease of the lung characterized by solitary or multiple pulmonary nodules. They can occur after inflammatory or post-inflammatory changes. A 60 years old asymptomatic patient admitted to our clinic because of a solid mass of 6 cm in his routine chest radiography. A lobectomy was performed and the histological diagnosis was reported as pulmonary hyalinizing granuloma. This case, mimicking pulmonary carcinoma, is rarely found in the literature.     

Primary Sjögren's syndrome in dizygotic adolescent twins: one case with lymphocytic interstitial pneumonia

Primary Sj?gren's syndrome (pSS) is uncommonly recognized in childhood, and familial cases are rare. Pulmonary involvement in pediatric pSS is infrequently reported. In adults, asymptomatic pulmonary involvement is increasingly recognized, manifest by pulmonary function test abnormalities and changes on high resolution computerized tomographic scan. We describe a case of pSS in a 14-year-old Vietnamese-Canadian girl who presented with pulmonary symptoms, radiologic changes, and biopsy confirmation of lymphocytic interstitial pneumonia. Her dizygotic twin sister has primary SS without extraglandular manifestations. To our knowledge this is the first report of pediatric pSS with lymphocytic interstitial pneumonia and multiple pulmonary nodules on chest radiograph. We review the literature on pulmonary involvement and familial cases of pSS in childhood.     

Pulmonary hyalinizing granuloma: a rare cause of a solitary pulmonary nodule.

Pulmonary hyalinizing granulomata are unusual, noninfectious lesions of the lung of uncertain etiology that probably represent an exaggerated immune response. They present radiographically as noncalcified solitary or multiple pulmonary nodules, thereby mimicking primary or metastatic malignancy. The article discusses a case of this rare entity that presented as a solitary pulmonary nodule.     

High resolution CT findings of pulmonary epithelioid hemangioendothelioma: unusual manifestations in 2 cases

Pulmonary epithelioid hemangioendotheliomas (PEH), also known as intravascular sclerosing bronchoalveolar tumor, is a rare vascular tumor of the lung common among young women. Primitive lumena lined by single cells is the characteristic pathologic feature. The endothelial nature of these cells is confirmed by positive staining with factor VIII and CD34. PEH usually presents as single or multiple pulmonary nodules. The present report describes high resolution CT (HRCT) findings of 2 cases with unusual manifestations of PEH. One case was a 54-year-old woman with multiple pulmonary nodules with irregular thickening of both the bronchovascular bundles and perilobular structures, representing intensive lymphangitic spread on HRCT. The other was an 18-year-old woman who had multiple minute peripheral nodules in the lungs bilaterally. These HRCT findings demonstrated the presence of tumor nodules in the lymphatic spaces, which is quite an unusual histologic presentation for this tumor. Both cases also showed hepatic lesions on abdominal CT; the former showing hypoattenuating masses with coarse calcifications and the latter showing multiple tiny calcifications in the hepatic parenchyma. Recognition of these features in the appropriate clinical setting may allow the clinician and the pathologist to consider this rare tumor.     

Diffuse pulmonary infiltration by anaplastic lymphoma kinase negative anaplastic large cell lymphoma: A case report and literature review

Anaplastic lymphoma kinase (ALK) negative anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin's lymphoma (NHL). Pulmonary infiltration with multiple nodules is an unusual manifestation. We present an adult patient who had diffuse lung and bone marrow involvement and review the pulmonary manifestation of ALCL. The present reports suggest that diffuse lung infiltration is associated with a bad clinical outcome.     

A case of Dirofilaria pulmonary infection coexisting with lung cancer

Dirofilaria immitis, the dog heartworm, may accidentally infect humans and manifest as a subpleural solitary or multiple pulmonary nodules that are often difficult to differentiate from primary or metastatic lung tumors. Our patient had biopsy proven lung cancer and a second lesion found to be pulmonary dirofilariasis after excision. The coexistence of pulmonary infection and cancer must be considered whenever 2 or more lesions have different clinical and radiologic behavior. Pulmonary dirofilariasis is a rare cause of lung nodules and may be present with lung cancer even more infrequently.     

A case of multiple pleural cryptococcosis without pleural effusion

Pulmonary cryptococcosis is most likely to occur in immunocompromised patients. The radiological manifestations generally include pulmonary parenchymal lesions, namely, pulmonary nodules, cavitary lesions, and consolidation; thus, multiple pleural nodules are unusual presentation. Here, we report a woman who presented with multiple pleural cryptococcosis without pleural effusion. The patient had previously undergone surgery for stage II rectal cancer. In addition, she received 6 cycles of chemotherapy for follicular lymphoma. Computed tomography (CT) revealed multiple small nodules involving the pleura without pleural effusion, which suggested possible recurrence of rectal cancer or malignant lymphoma as pleural dissemination. Thoracoscopic examination was performed, and pleural cryptococcosis was diagnosed. Although pleural cryptococcosis without pleural effusion is extremely rare presentation, clinicians should consider it when an immunocompromised patient presents with multiple pleural nodules. Thoracoscopic exploration should be the best procedure for the definitive diagnosis of multiple pleural nodules.     

Metastasis from transitional cell carcinoma of urinary bladder as cystic pulmonary lesion

Pulmonary metastases from transitional cell carcinoma usually present as multiple nodules, solitary mass, or interstitial micronodules but rarely manifested as cystic pulmonary lesions. We report an atypical case of multiple cavitating pulmonary metastases from transitional cell carcinoma of urinary bladder. Infectious disease is ruled out by sputum examination, laboratory exams and failure of response to antibiotic therapy. In closure, the need to exclude a second primary tumor led us to perform a fine-needle aspiration biopsy by which metastatic transitional cell carcinoma was diagnosed. Inadequacy of blood supply with necrosis may be advocated as possible mechanism of cavitations of the lesion.     

Pulmonary non-Hodgkin's lymphoma in AIDS

Whereas extralymphatic involvement is common in lymphomas associated with HIV infection, there have been few reports of pulmonary lymphoma. In 648 cases of AIDS reported in Colorado, 40 have had non-Hodgkin's lymphoma. Of these, four have had documented pulmonary involvement and are reported in detail. Clinical manifestations were nonspecific and included fever, weight loss, generalized lymphadenopathy, dyspnea, chest pain and cough. Chest roentgenograms revealed multiple nodules or interstitial infiltrates. Transbronchial biopsy failed to establish the diagnosis in all cases. Three of four patients died four to five months after appearance of pulmonary nodules; one patient with stage IE disease showed slow radiographic progression over 16 months following radiation and chemotherapy and died 18 months after appearance of pulmonary nodules. Pulmonary involvement with lymphoma should be considered in patients with HIV infection, especially if multiple nodules are seen on chest roentgenograms.     

Atypical manifestations of pulmonary adenoid cystic carcinoma

Pulmonary adenoid cystic carcinoma (PACC) typically arises in large airways. A patient who presented with a peripheral lung mass due to PACC is reported. She was found to have multiple pulmonary nodules due to PACC 11 years after resection of the original tumour. We emphasize that 10-15% of patients with PACC present with peripheral tumours.     

An unexpected pulmonary arterial aneurysm in a COPD patient

We present a case of an idiopathic pulmonary artery aneurysm in an asymptomatic patient who was treated for an irrelevant medical condition. Pulmonary artery aneurysms (PAA) are quite rare and can either be congenital or acquired. Congenital aneurysms are usually associated with cardiac malformations leading to pulmonary hypertension. Acquired aneurysms can be idiopathic or associated with infections (tuberculosis, syphilis), trauma, pulmonary valvular stenosis, or collagen diseases. Pulmonary artery aneurysms are not common and an idiopathic pulmonary artery aneurysm is a rare finding that could be diagnosed incidentally.     

Pulmonary hyalinizing granuloma mimicking lung carcinoma

Pulmonary hyalinizing granuloma has rarely been reported and is a benign entity of unknown origin. The chest radiograph reveals multiple and frequently bilateral pulmonary nodules. We describe a patient with pulmonary hyalinizing granuloma who presented with a central mass in the left lung mimicking lung carcinoma.     

肺上皮样血管内皮瘤(附1例报告及文献复习)

目的提高对肺上皮样血管内皮瘤的诊断和治疗。方法通过对1例肺上皮样血管内皮瘤患者的诊治,就本病的临床特点、诊断方法以及治疗和预后等情况进行全面的分析和讨论。结果肺上皮样血管内皮瘤是一种罕见的肺部肿瘤,病因不明,以干咳为主,影像学表现主要为双肺弥漫性小结节影,病理学检查特征是单细胞原始管腔结构、免疫组织化学提示内皮细胞源性,恶性程度并不低,疗效差。结论肺上皮样血管内皮瘤是一种罕见的肺部恶性肿瘤,临床无特异性,极易误诊,目前尚无确切的治疗方法,预后差,临床医生应该提高对其的认识程度。     

Pulmonary epithelioid hemangioendothelioma with PlGF expression: report of a case

Pulmonary epithelioid hemangioendothelioma (PEH) is a relatively uncommon neoplasm of vascular origin with a low or intermediate grade of malignancy. We present a case of a 28-year-old female with multiple pulmonary nodules which were diagnosed as PEH by video-assisted thoracoscopic surgery (VATS) biopsy. In addition, we performed an immunohistochemical analysis for placenta growth factor (PlGF) and a strong positivity for PlGF observed, suggesting that the PlGF may play some role in the tumorigenesis of PEH.     

肺隐球菌病九例分析

目的探讨肺隐球菌病临床特点、CT表现、病理所见及治疗方法。方法收集浙江大学附属邵逸夫医院自2002年1月至2004年8月经CT引导下经皮肺穿刺活检或手术病理证实的肺隐球菌病相关资料，进行回顾分析。结果本组病例共9例，男7例、女2例，年龄28～69岁，平均年龄44岁。人类免疫缺陷病毒抗体(HIV—Ab)均阴性。胸部CT扫描：8例表现为多发或单发的肺部结节和(或)肿块，1例表现为片状实变影。4例手术切除治疗，经手术病理证实；5例经CT引导下经皮肺穿刺活检病理证实。病理镜检均呈肉芽肿性改变，苏木精-伊红(HE)染色多核巨细胞内外可见大量隐球菌。5例单予抗真菌药物(氟康唑)治疗2．5～3．5个月，经半年至1年随访，肺部病灶基本吸收。结论肺隐球菌病CT表现主要为多发或单发的肺部结节和(或)肿块。经皮肺穿刺活检是很有价值的确诊手段。隐球菌肉芽肿为其病理特征。氟康唑具有良好抗新型隐球菌的活性，是合适的治疗选择。     

Association of pulmonary artery agenesis and hypoplasia of the lung

Pulmonary artery agenesis and hypoplasia of the homolateral lung occasionally occurs as an isolated lesion, but more often has associated congenital cardiac anomalies. We present a case where pulmonary artery agenesis was the sole lesion in an asymptomatic child. Pulmonary artery agenesis should be suspected in asymptomatic patients if a plain chest X-ray shows asymmetric lung fields, lung hypoplasia, or hyperinflation of the contralateral lung. Echocardiography is the best tool to establish the diagnosis. In our opinion, invasive procedures, such as cardiac catheterization, may be postponed if there is no echocardiographic evidence of pulmonary hypertension.     

Multiple aseptic pulmonary nodules with central necrosis in association with pyoderma gangrenosum

Pulmonary manifestations of pyoderma gangrenosum are relatively rare. We report the case of a 45-year-old patient with multiple pulmonary nodules with central necrosis as assessed by CT scan. The patient had a 4-year history of pyoderma gangrenosum with only minor skin manifestations. A CT-guided, fine-needle biopsy of the lung revealed a nonspecific, inflammatory, aseptic necrotic process, which was comparable to the skin biopsy of one pyoderma lesion. Following the initiation of oral prednisolone therapy, a rapid resolution of the pulmonary nodules occurred. We conclude that pulmonary nodules represent a rare pulmonary manifestation of pyoderma gangrenosum.     

Benign metastasizing leiomyoma. A case report and review of the literature.

This is a case report of an asymptomatic, 65-year-old white female who was evaluated for multiple pulmonary nodules. This patient's presentation, clinical course and pathologic specimens are consistent with benign metastasizing leiomyoma. A review of this rare disorder is included in this report with emphasis on past cases, clinical overview and treatment.     

Multiple pulmonary nodules: an unusual presentation of fludarabine pulmonary toxicity: case report and review of literature

Fludarabine monophosphate, a purine analogue is used in the treatment of lymphoid malignancies. A 73-year-old woman presented with fever and cough 2 weeks after completing the third cycle of fludarabine for chronic lymphocytic leukemia (CLL). Chest roentgenogram showed multiple pulmonary nodules. Pulmonary histopathology demonstrated a mononuclear interstitial infiltrate without evidence of malignant, infectious, granulomatous, or vascular causes. Her symptoms and pulmonary nodules resolved following treatment with corticosteroids. To our knowledge, four cases of interstitial pneumonitis associated with fludarabine have been reported in medical literature. Fludarabine induced lung toxicity must be considered in all patients who develop unexplained lung disease while receiving fludarabine. It is reversible with discontinuation of drug and administration of corticosteroids. This case extends the spectrum of fludarabine pulmonary toxicity to include pulmonary nodules.