[A case of bronchocentric granulomatosis resembling lung cancer on diagnostic imaging].

A 51-year-old man visited a local physician because of a chest radiographic abnormality which had been pointed out in October 2009 and March 2010. His chest CT images revealed a nodular lesion in the right middle lobe. Since the nodular lesion showed abnormal FDG accumulation on FDG-PET, the physician suspected lung cancer, but was unable to make a definitive diagnosis by CT-guided lung biopsy. The patient was thus referred to our hospital for detailed investigations. A nodular lesion with spiculation and pleural indentation was recognized in the S4 region on chest CT scans which was strongly suspected to be lung cancer. Since various examinations did not provide a definitive diagnosis, we performed surgery. The histological findings of the extirpated tumor were considered to be bronchocentric granulomatosis (BCG), because necrotic granulomatous lesions with epithelioid cells centered on the bronchioles and there was no evidence of fungus or acid-fast bacterium infection.

[Case of idiopathic pulmonary upper lobe fibrosis].

A 49-year-old man was referred to our hospital because of progressive volume reduction in bilateral upper lobes over 10 years. He was slim, with a straight back. Chest high-resolution computed tomography (HRCT) showed consolidation with small radiolucent areas in both upper lobes. Surgical biopsy by video-assisted thoracoscopy was performed in the right upper and lower lobes. The pathological findings of the upper lobe showed intraluminal fibrosis with alveolar collapse and proliferation of elastic fibers on the subpleural surface, but the lower lobe was normal. We diagnosed his illness as typical idiopathic pulmonary upper lobe fibrosis (IPUF), previously described by Amitani in 1992.

[Microscopic polyangiitis accompanied by interstitial pneumonia and abducens palsy].

A 69-year-old man was referred to our hospital with fever. Interstitial pneumonia and right pleural effusion were noted with elevated MPO-ANCA. Video-assisted thoracoscopic lung biopsy was performed and UIP -like histology was obtained. His symptoms and chest X-ray finding improved with administration of prednisolone and cyclosporine, but ten months later diplopia appeared. He had right abducens palsy and impaired perception in the first right trigeminal branch area, and we diagnosed mononeuritis multiplex due to microscopic polyangiitis.

[A case of Sjögren syndrome with pulmonary nodular amyloidosis and pulmonary multiple cysts].

A 57-year-old woman who had been given a diagnosis of Sjögren syndrome at age 53 consulted a nearby doctor because of bloody sputum. He noted her chest abnormal shadows and referred her to our hospital. Her chest radiograph and high-resolution computed tomograph showed multiple nodules and cysts in both lung fields. Video-assisted thoracoscopic lung biopsy revealed patchy fibrosis, cystic change, AL type amyloid deposition and mild lymphoid hyperplasia and a diagnosis of Sjögren syndrome-associated-pulmonary-disease was established.

[Two cases of summer-type hypersensitivity peumonitis with remarkable changes in the bronchioles].

A 56-year-old man and a 53-year-old woman with cough, sputum and dyspnea were admitted in the summer. High-resolution computed tomographic findings of the chest showed centrilobular branching opacities like diffuse panbronchiolitis with ground glass opacities. Both cases showed hypoxia, a high titer of serum anti-Tricosporon antibody and exacerbation in their own homes. Video-assisted thoracoscopic lung biopsy revealed granuloma in the bronchioles area. We diagnosed summer type hypersensitivity pneumonitis and this condition improved in response to antigen isolation and steroids. Remarkable changes in the bronchioles were characteristic in the two cases.

[A case of chronic aspiration pneumonia caused by juvenile brain stem tumor].

A 23-year-old man had been treated for repeated pneumonia from the age of 16. After a diagnosis of eosinophilic pneumonia at the age of 17, he had been given antibiotics and steroids. At the age of 23, he was referred to our hospital. Although he improved rapidly in response to antibiotic medication, his chest X-ray shadows did not improve. Video-assisted thoracoscopic lung biopsy was performed. Fibrosis and invasion of inflammatory cells were seen on the air duct walls and foreign bodies that were thought to be food residue were detected. A diagnosis of chronic aspiration pneumonia was made pathologically. A brain stem tumor was detected on his brain magnetic resonance imaging, which was thought to be the cause of his mis-swallowing.

[Macroscopic subtypes of asbestosis in relation to the amount of asbestos in 63 Japanese autopsy cases].

Atelectatic induration (AI) and honeycombing (HNCB) are two distinct macroscopic features of asbestosis. The current study was undertaken to clarify whether or not there might be a relation between the macroscopic type of asbestosis and burden of asbestos fibers in the lung. The material (N = 63) derived from 58 autopsies and 5 surgically removed lungs with lung cancers, which comprised 22 cases of AI (mean age: 67 years: 20 males and 2 females) and 41 cases of HNCB (mean age: 66 years: 38 men and 3 women) types of asbestosis, respectively. The quantification of asbestos bodies (AB) and fibers (AF) was carried out using Kohyama's method. The AI type showed 260,000 +/- 460,000 AB per 1g of wet lung and 920,000 +/- 1,360,000 AF per 1g of dry lung, whereas HNCB showed 44,000 +/- 93,000 AB and 200,000 +/- 490,000 AF, respectively. These differences were statistically significant between the types of asbestosis (p < 0.01). Diffuse pleural thickening and upper lobe involvement were more advanced in the AI type and the differences were statistically significant between subtypes (p < 0.05). In conclusion, asbestos load is considered to be a factor related to the macroscopic subtype of asbestosis.

[A case of primary pulmonary MALT lymphoma as a nodular shadow on CT scan, and relapsed with diffuse micronodular shadows after surgical resection at 7 years ago].

A 76-year-old man without symptoms was admitted to our hospital for investigation of an abnormal chest shadow in 1994. His chest radiograph showed a nodular shadow in the lingual lobe. Segmentectomy was performed and the histological diagnosis was MALT (mucosa-associated lymphoid tissue) lymphoma. In June 2001, there were no abnormal shadows on the chest radiograph or in 10 mm slice CT. However, high-resolution CT with 2-mm slice thickness revealed diffuse micronodular shadows in both lungs. A relapse of MALT lymphoma was diagnosed by immunohistochemical analysis of tissue specimens obtained by transbronchial lung biopsy. It was observed that the patterns of radiological findings in primary pulmonary MALT lymphoma cases may differ between the initial state and a relapse.