Effect of Thyrocervical Artery Embolization for Mediastinal Hemangioma with Pleural Effusion.

A 72-year-old man was admitted to our hospital with a complaint of breathlessness. Computed tomography (CT) revealed a tumor with intense early enhancement and pleural effusion. Although the pleural effusion was not bloody, the tumor showed a hypervascular area on angiography. Left thyrocervical artery embolization was performed to prevent bleeding during the operation. After embolization, chest radiography revealed decreased pleural effusion. The tumor was resected and pathologically diagnosed as a mediastinal cavernous hemangioma. To our knowledge, mediastinal hemangiomas with pleural effusion are extremely rare; thus, this is the first report of reduced pleural effusion in mediastinal hemangiomas after artery embolization.

Life-threatening pneumothorax after release from isolation with COVID-19 pneumonia.

Pneumothorax was previously considered as a complication of severe coronavirus disease 2019 (COVID-19) pneumonia. However, it is now known that pneumothorax can develop in other cases. Here, we describe the case of a patient who developed tension pneumothorax after release from isolation from COVID-19 pneumonia. The patient was admitted to our hospital with severe COVID-19 pneumonia on the 10th day after onset. Ventilatory management was carried out on the first day of admission; however, the patient was weaned off the next day. The treatment course was uneventful. On the morning of discharge from the hospital, the patient experienced sudden dyspnea. Chest radiography revealed a large left-tension pneumothorax with a mediastinal shift to the right. As this finding required immediate attention, a chest tube was inserted. Chest computed tomography (CT) showed an airspace in the left thoracic cavity and subpleural thin-walled cystic lesions, such as bullae in the left lobe. One month later, chest CT showed resolution of the cystic lesions. The development of pneumothorax in COVID-19 pneumonia should be considered not only in cases of severe illness, but also after release from isolation. Recently, revisions to measures against COVID-19 have been considered worldwide, including shortening of the isolation period and reviewing the identification of all cases. This is an educational report demonstrating that life-threatening pneumothorax may develop after release from isolation due to COVID-19 pneumonia.

A case of allergic bronchopulmonary mycosis due to Schizophyllum commune with elevated serum carcinoembryonic antigen levels.

A 78-year-old Japanese woman without any history of asthma or smoking presented prolonged cough. Laboratory data showed elevated serum CEA levels and a chest CT revealed a mass with abnormal uptake in the left lower lobe. One month later, the mass spontaneously regressed, and CEA levels improved. However, the symptoms progressed during the observation period without treatment. Chest radiograph findings revealed collapse of the right middle lobe, and Schizophyllum commune was isolated from the mucous plugs; the patient was diagnosed with allergic bronchopulmonary mycosis (ABPM). Herein, we report the first case of ABPM caused by S. commune with elevated CEA levels and mimicking lung cancer.

Interstitial lung disease associated with adjuvant and neoadjuvant chemotherapy in early breast cancer.

BACKGROUND: Interstitial lung disease (ILD) is a rare adverse event in patients receiving adjuvant or neoadjuvant chemotherapy (NAC) for breast cancer. Few studies have reported the frequency of ILD in detail, and only small numbers of cases have been described in the literature. Given these previous findings concerning ILD, we retrospectively examined the clinicopathological characteristics of five cases of ILD who had received epirubicin and cyclophosphamide (EC) and compared their findings with non-ILD cases. METHODS: The present single-center retrospective study included breast cancer patients who underwent adjuvant chemotherapy or NAC at our hospital between January 2014 and January 2021. RESULTS: Thirty-nine patients who had received EC for operable breast cancer were enrolled in this study. ILD developed 5 out of 39 patients (12.8%). The incidence of ILD in patients with non-dose-dense (dd) or dd chemotherapy was statistically significantly different (p = 0.0149). ILD occurred in three patients during dd EC treatment and two during weekly paclitaxel (wPTX) after dd EC. ILD was detected in one patient with high Krebs von den Lungen-6 (KL-6) levels, in two patients with continuous pyrexia, and in two patients from computed tomography imaging, which was taken to estimate the efficacy of chemotherapy, in two patients. Three of the 5 ILD patients underwent bronchoalveolar lavage, and 2 of these patients were diagnosed with Pneumocystis jirovecii pneumonia (PCP). There were no cases of serious ILD that required steroid pulse therapy. CONCLUSIONS: Dd chemotherapy may be associated with an increased ILD frequency, which may reflect developing PCP. Careful monitoring and a timely diagnosis are useful for detecting early-stage ILD.

Malignant lymphoma mimics miliary tuberculosis by diffuse micronodular radiographic findings.

This case reports rare findings on computed tomography of a manifestation of malignant lymphoma, in which diffuse lung shadows appeared as miliary nodules distributed throughout the lungs bilaterally. The patient had a history of surgical treatment of rectal cancer and had received chemotherapy for suspicious liver metastasis. At her current presentation for evaluation suspected miliary tuberculosis on chest radiography, subsequent liver biopsy revealed a mass infiltration of atypical lymphocytes, which was diagnosed as follicular lymphoma. The miliary tuberculosis was suspected more than neoplastic lesions, such as metastatic rectal cancer or malignant lymphoma. Despite repeated bacteriologic tests of various samples, including sputum, urine, bronchial secretion, peripheral blood, bone marrow aspiration, and gastric lavage, all results were negative for mycobacterium tuberculosis. Finally, multiple, small, mass lesions of lymphocytes were demonstrated in the lung obtained from video-assisted thoracic surgery, and a diagnosis of follicular lymphoma was given. The final interpretations of liver mass and military lung lesions were tumor involvement by the follicular lymphoma. This radiologic findings of multiple miliary opacities throughout the whole lungs confused definite diagnosis because these images were remarkably similar with miliary tuberculous. This case reminds us to consider a wide variety of differential diagnoses even we assumed to be familiar with radiographic imaging at first glance.

Elevated serum ß-d-glucan levels in cavitary pulmonary nocardiosis.

An 86-year-old woman with Borrmann type III colorectal cancer (Union for International Cancer Control pT4aN2bM1c, pStage IVc) had received dexamethasone for the last 6 months as palliative care. She presented with a low-grade fever, chest pain and cough. Chest radiography on admission showed cavities and consolidations bilaterally in the upper lobes. A blood examination on admission revealed highly elevated serum ß-d-glucan levels. The diagnosis by bronchoscopy was pulmonary nocardiosis. With trimethoprim/sulfamethoxazole and imipenem/cilastatin, the ß-d-glucan levels were decreased, and chest X-ray showed improvement after 1 month. ß-d-glucan is known to be a biomarker of fungal infection. It is possible that ß-d-glucan levels also indicate a pulmonary infection by Nocardia.

Cancer-associated Retinopathy with Neuroendocrine Combined Large-cell Lung Carcinoma and Adenocarcinoma.

We herein report the case of a 74-year-old woman with a lung tumor. She presented with complaints of blurred and rapid, progressively impaired vision. A visual field examination revealed bilateral concentric contraction of the visual field and a ring scotoma in the right eye. She was diagnosed with cancer-associated retinopathy (CAR) combined with large-cell neuroendocrine carcinoma (LCNEC) of the lung via a visual field examination and underwent thoracoscopic surgery. CAR has been mostly associated with small-cell lung cancer (SCLC). Combined LCNEC is relatively rare and accounts for 10.6% of all LCNECs. This is the first case report of CAR-combined LCNEC.

A case of lung tumorlets secondary to pulmonary hypoplasia with recurrent haemoptysis.

Most patients with lung tumorlets are usually asymptomatic, and most diagnoses are incidental findings during microscopic lung examinations at autopsy or after excision of a tissue lesion. A 73-year-old woman was admitted to our hospital due to recurrent haemoptysis. Chest computed tomography demonstrated right inferior lobe collapse with bronchiectasis. Bronchoscopic examination revealed the right inferior lobar bronchus to be filled with blood clots. Haemoptysis persisted even after two arterial embolization trials and occlusion with endobronchial Watanabe spigot. Therefore, right lower lobectomy was performed, and multiple tumorlets on lobar hypoplasia were observed on histopathological examination of the excised specimen. We believe that the haemoptysis in our patient was possibly caused by the lung tumorlets secondary to lobar hypoplasia.

[A case of Wegener's granulomatosis with pachymeningitis].

A 49-year-old man was admitted to our hospital because of headache, rhinorrhea, and general fatigue. Chest CT revealed some lung nodules bilaterally, and laboratory data were positive for C-ANCA. Brain MRI revealed the findings of pachymeningitis. Wegener's granulomatosis (WG) was diagnosed by the pathological findings of his paranasal sinuses and kidneys. Most of his symptoms remarkably improved with oral corticosteroids and cyclophosphamide. A MEDLINE search about WG with pachymeningitis obtained only 15 cases previously reported in Japan. Considering those reports about WG with pachymeningitis in both Japan and overseas, in some cases pachymeningitis preceded WG, and relatively more cases than normal WG were negative for C-ANCA, furthermore the pathological findings of pachymeningitis were mainly necrotizing granuloma. Therefore pachymeningitis with WG might be mainly composed of granuloma rather than angitis and which might be a expansion of granulomatous inflammation of upper respiratory tract.

[A case of pulmonary amebiasis].

A 57-year-old man was admitted to our hospital because of dyspnea and right abdominal pain. Chest X-ray radiogram showed right massive pleural effusion. Ultrasonic echogram of abdomen showed a unilocular liver cyst. He was treated with intravenous infusion of meropenem, and percutaneous pleural and liver drainage were performed. At the time of drainage, we injected contrast medium into the liver cyst and confirmed a fistula connecting to the right pleural space. Initially we made a diagnosis of bacterial empyema and liver abscess, yet there was no response to the initial treatment. Cultures of pleural effusion and liver abscess were confirmed to be negative. A few days after admission, the patient stated that he was a homosexual. Liver amebiasis and its perforation became the most likely diagnosis, and metronidazole was administered. On admission day 21, tests for anti-amebic antibody were positive. Finally he fully recovered. We must be aware of the rare pulmonary manifestation of amebiasis. We report this case and review the literature.

Phosphatidylinositol and PI-4-monophosphate recover amyloid beta protein-induced inhibition of Cl- -ATPase activity.

The neuronal Cl- -ATPase/pump is a candidate for an outwardly directed active Cl- transport system, which requires phosphatidylinositol-4-monophosphate (PI4P) for its optimal activity. We previously reported that low concentrations (1-10 nM) of amyloid beta proteins (Abetas, Abeta1-42, Abeta25-35), the neurotoxic peptides in Alzheimer's disease, reduced Cl- -ATPase activity in cultured rat hippocampal neurons without any changes in the activities of Na+/K+-ATPase or anion-insensitive Mg(2+)-ATPase, and decreased PI, PIP, and PIP2 levels in neuronal plasma membranes (Journal of Neurochemistry 2001, 78, 569-579). In this study, we examined the effects of exogenously applied PI and PI4P on the Abeta25-35-induced changes in Cl- -ATPase activity, the intracellular concentration of Cl- ([Cl- ]i), and glutamate neurotoxicity using primary cultured rat hippocampal neurons. The Abeta decreased Cl- -ATPase activity to 47% of control and increased [Cl- ]i in hippocampal pyramidal cell-like neurons to a level 3 times higher than the control. The addition of PI (50-750 nM) or PI4P (50-150 nM) dose-dependently blocked the inhibitory effects of Abeta on Cl- -ATPase activity. High doses of PI (750 nM) and PI4P (100-150 nM) reduced Na+/K+-ATPase activity to 41% and 35% of control, respectively, but this inhibition was attenuated by the co-application of phosphatidylserine (PS, 1 micro M). PI or PI4P (75 nM each) reversed the Abeta-induced increase in [Cl-]i. In the Abeta-exposed culture, stimulation by glutamate (10 micro M, 10 min) resulted in an increase in DNA fragmentation and decreases in cell viability. Addition of PI or PI4P prevented the Abeta-induced aggravation of glutamate neurotoxicity. Thus, PI and PI4P were demonstrated to prevent Abeta-induced decreases in Cl- -ATPase activity and increases in neuronal [Cl- ]i in parallel with the attenuation of Abeta-induced aggravation of glutamate neurotoxicity.