The Usefulness of a Simple Classification for Bronchoscopic Findings for Diagnosis of Peripheral Pulmonary Tumour.

BACKGROUND: Normal bronchial epithelium has been described in terms of transparency and smoothness. No studies have compared bronchoscopic and pathological findings in the identification of bronchial epithelium. OBJECTIVES: This study aimed to classify bronchoscopic findings for peripheral pulmonary tumour (PPT) for accurate bronchoscopic diagnosis accounting for the presences of bronchial epithelium and bronchial stenosis using an ultrathin bronchoscope. METHODS: We performed endocytoscopy using narrow-band imaging (NBI) of specimens immediately after lobectomy to investigate the normal bronchial epithelium under the physiological saline injection technique (PSIT) prior to classification of PPT. A retrospective study to classify bronchoscopic findings included 46 patients diagnosed with malignancy by bronchoscopy for PPT. RESULTS: We recognized a "light blue line" (LBL) with NBI under PSIT, corresponding to strong reflection of short-wavelength light by cilia on the epithelial surface in an ex vivo endocytoscopic study. Bronchoscopic findings of PPT were classified morphologically into stenotic type (ST) and non-stenotic type (NonST). Tumours were also classified as exposed type (ET) and non-exposed type (NonET) based on the presence of epithelium. Most ST and NonET lesions (74%) were adenocarcinoma. Among squamous cell carcinoma, 55% were categorized as ST and ET. All NonST and NonET cases were adenocarcinoma. A significant difference in the presence of LBL was seen between ET and NonET. CONCLUSIONS: Our simple classification based on the appearance of stenosis and LBL in PPT may facilitate pathological diagnosis.

[Pulmonary alveolar proteinosis detected by a nodular lesion on chest computed tomography].

A 74-year-old woman was admitted to our hospital for further examination of chest X-ray abnormality. The chest computed tomography (CT) revealed a nodular lesion (1.0 cm in diameter) in right lung. Bronchoscopic biopsy showed no malignant cells and bronchoalveolar lavage fluid was not milky white. We performed video-assisted thoracic surgery and a tumor was resected. Histologically, dilated alveolar areas was filled with eosinophilic materials. This finding was compatible with pulmonary alveolar proteinosis (PAP). The characteristic CT finding of PAP is ground glass opacities in both lungs with thickened alveolar septa (so-called crazy-paving appearance). The CT findings of this case (unilateral, single nodular lesion) are very rare, so we report this case with references to the literatures.

[Pleomorphic carcinoma of the lung; report of a case].

A 66-year-old female complained of cough, and was referred to our hospital. Chest radiography and computed tomography (CT) showed a tumor mass near the right hilum and atelectasis of the middle lobe. Bronchoscopy revealed a whitish polypoid tumor obstructing the middle lobe bronchus. Histology by punch biopsy suggested adenocarcinoma Right upper and middle lobectomy was performed, due to the direct invasion of the tumor from the middle lobe to the upper lobe. Histological findings showed adenocarcinoma comprised of spindle cell component, finally diagnosing as pleomorphic carcinoma of the lung. After the operation, systemic chemotherapy, including paclitaxel and carboplatin was performed. About 42 months after operation, the patient died of multiple brain metastases.