[A case of radiographic stage 0 sarcoidosis with severe cough].

A 63-year-old woman complained of continuous dry cough and high fever for two months. Chest radiography showed no abnormality, but inspiratory fine crackles were audible. Interstitial lung disease was suspected and bronchoalveolar lavage was performed via a bronchoscope. Disseminated minute granular lesions with redness and hypervascularity from the upper trachea to bilateral lober bronchi were detected. Lesions were also present in the membranous portion of the left main bronchus. Histological results for bronchial biopsy and transbronchial lung biopsy showed non-caseous epithelioid cell granuloma. This, together with a high CD4/8 lymphocyte ratio (4.11) in bronchoalveolar lavage fluid and the gallium scintigraphic findings, confirmed the diagnosis of sarcoidosis. To the best of our knowledge there are no other reports of cases with a similar bronchoscopic appearance in which the chest roentgenologic classification was stage 0, despite severe respiratory symptoms. Nodular lesions are seen in some cases of endobronchial sarcoidosis, but in this case, these widespread granular lesions were a unique feature that prompted us to make this report.

[A case of follicular lymphoma with onset of chylothorax].

We report a case of follicular lymphoma with chylothorax. A 45-year-old man visited our hospital complaining of shortness of breath and abdominal distension. Chest X-rays showed bilateral pleural effusion, and an abdominal CT scan revealed a large intraperitoneal tumor around the abdominal aorta and pancreas. Bilateral cervical and inguinal lymph nodes were swollen. Biochemical study of the pleural fluid revealed the presence of chylomicrons, and an inguinal lymph node biopsy led to a follicular lymphoma diagnosis. The patient achieved complete remission, with disappearance of pleural effusion, following 8 cycles of chemothreapy (R-CHOP). Cases of malignant lymphoma with chylothorax are rarely reported in Japan, but should be taken into account when examining cases of non-traumatic chylothorax.

Squamous Cell Carcinoma of the Lung Spreading Along the Alveolar Walls With a Bubblelike Appearance on HRCT.

On health examination, a nodular opacity of size of 25 mm was detected in a 54-year-old man. High-resolution computed tomography scans showed irregular-shaped ground glass opacity with bubble-like appearance in the right lung. The low-magnified histological findings after right upper lobectomy demonstrated squamous cell carcinoma that progressed along the alveolar septum and resembled the growing pattern of bronchioloalveolar carcinoma. As the mechanism of the formation of air density on computed tomography, the presence of check valve phenomenon was estimated. Squamous cell carcinoma of the lung that multiplies along alveolar walls shows localized ground glass opacity including air density areas similar to those in bronchioloalveolar carcinoma on high-resolution computed tomography.