An unusual case of eosinophilic lung disease with multiple cyst formation.

We report here an unusual case of eosinophilic necrotizing inflammation of the lung that mimicked chronic eosinophilic pneumonia. A 71-year-old man who lived in an unsanitary environment and was referred to our hospital with suspected pneumonia. Peripheral blood eosinophilia was observed, and computed tomography indicated extensive consolidation with multiple cystic lesions, mainly in the left lung. A histological analysis using video-assisted thoracic surgery revealed diffuse infiltration of inflammatory cells into the alveolar wall and massive accumulation of macrophages and eosinophils in the airspace. Many tiny eosinophilic abscesses were scattered through the tissue. These findings were more severe than those associated with chronic eosinophilic pneumonia. Immunostaining revealed the deposition of eosinophil granular protein and the presence of extracellular traps and Charcot-Leyden crystals, which suggested excessive eosinophil activation. Interestingly, the patient's symptoms and clinical findings gradually improved without treatment after admission. He was discharged to a clean residence and did not have a recurrence for 19 months. The observations suggest a hypersensitivity reaction to an environmental allergen and consequent multiple cyst formation in association with eosinophilic necrotizing inflammation, although further studies are warranted.

[A Case of Primary Thymic Carcinoid Treated with Everolimus and Octreotide].

A 54-year-old woman had a history of precordial pain since February 20XX and had undergone a clinical examination at a nearby medical clinic in April 20XX. Because a plain chest radiograph revealed a mass shadow, the patient was referred to us for medical evaluation. Chest computerized tomography(CT)revealed a mass measuring 12 cm in size along its major axis diameter in the anterior mediastinal region, along with the enlargement of the anterior mediastinal, parasternal, hilar, and supradiaphragmatic lymph nodes, suggesting a thymic tumor. Histopathological examination of a needle biopsy specimen revealed a carcinoid. Thus, the patient was diagnosed with a primary thymic carcinoid. The patient was treated by partial excision of the mediastinal tumor owing to the presence of pericardial dissemination. Because of the histopathologic diagnosis of atypical carcinoid, the patient was additionally administered everolimus therapy in May. A repeat CT in July revealed shrinkage of the mass, but a subsequent CT in November revealed slight enlargement of the tumor. Because the somatostatin receptor(SSTR-2)tested positive, concomitant octreotide acetate injection was initiated in December. Follow-up CT examinations revealed stabilization of the disease at first. However, the gradual enlargement of the tumor was noted thereafter. This case constitutes one of the few reports of the treatment of primary thymic carcinoid with everolimus and octreotide.