A primary tracheal carcinoid tumor masquerading as chronic obstructive pulmonary disease.

Primary tumors of the trachea are rare and can be missed because of the paucity of symptoms and findings and the difficulty in detecting them with chest radiographs. A 31-year-old male patient was admitted with complaints of shortness of breath, coughing, phlegm, and blood in the sputum. He stated that he was being treated for chronic obstructive pulmonary disease. Fiberoptic bronchoscopy revealed a vegetative mass with a wide base on the posterolateral wall of the distal one-third of the trachea. Postoperative histopathological examination revealed a typical carcinoid tumor. In patients with an unexplained cough, dyspnea, infrequent hemoptysis, and normal pulmonary imaging findings, tracheal carcinoma should be suspected. In such cases, early thoracic computed tomography and bronchoscopic examination can provide a rapid diagnosis and treatment options and prevent a false diagnosis.

Pleural effusion as the first sign of multiple myeloma.

Multiple myeloma (MM) is a rare disorder that affects all tissues, except reticuloendothelial tissues, and seldom causes a myelomatous pleural effusion. A 56-year-old male patient attended our clinic complaining of shortness of breath and fatigue for the past month. A posteroanterior chest radiograph revealed a left pleural effusion, which was subsequently assessed as being exudative in nature. Protein electrophoresis demonstrated hypergammaglobulinemia. Serum and pleural fluid immunofixation electrophoresis showed an increase in the IgG and kappa fractions. The Bence-Jones protein level in the 24-hours urine was high. Pleural biopsy showed plasmocyte infiltration. Bone marrow biopsy revealed atypical plasma cell infiltration, some with immature morphology, carrying IgG/Kappa clonality in a diffuse pattern. The patient was diagnosed with IgG/k type MM and underwent chemotherapy with vincristine, doxorubicin, and prednisolone. Complete regression of the pleural effusion was achieved after one round of chemotherapy, and the patient has been followed for 18 months.

[Value of transbronchial needle aspiration in the diagnosis of endobronchial malignant lesions]. / Endobronsiyal malign lezyonlarin tanisinda transbronsiyal igne aspirasyonunun degeri.

Aim of our study was to investigate the sensitivity of transbronchial needle aspiration (TBNA) and its contributions to conventional diagnostic methods (CDM) in the endobronchial lesions of the patients who underwent TBNA during fiberoptic bronchoscopy (FOB) and had final diagnosis of lung cancer. Bronchoscopy records of 1194 patients, who underwent FOB for uncertain lung cancer in our clinic, were reviewed retrospectively. Eighty-one patients with final histopathological diagnosis of primary lung cancer who underwent TBNA, were included to study. Endobronchial lesions were divided into three groups as endobronchial mass, submucosal lesions and peribronchial diseases. Other CDMs performed during bronchoscopy such as forceps biopsy, bronchial brushing and bronchial lavage were also recorded. Sixty-six (82%) of 81 patients were diagnosed by means of FOB. Remaining 15 (18%) patients were diagnosed by means of other methods than FOB. The diagnostic successes of TBNA and CDMs alone and together, were compared according to the types, locations and histopathological types of the lesions. By the addition of TBNA to CDMs, histopathological diagnosis was made in 17 (21%) additional patients and diagnostic sensitivity of bronchoscopy was increased from 60% to 82% (p= 0.001). By the addition of TBNA to CDMs, a statistically significant increase in the sensitivity in the submucosal lesion group was observed (p= 0.008). By the addition of TBNA to CDMs, diagnostic success was increased from 52% to 76% in the non-small cell lung cancer group and from 81% to 95% in the small cell lung cancer group (p= 0.001 and p= 0.250, respectively). Although the diagnostic success was increased in all localizations by the addition of TBNA to CDMs, statistically significant increase was observed only for the lesions located at trachea and the main bronchi (p= 0.008). Joining TBNA to CDMs, especially for the submucosal lesions, may improve the diagnostic success of bronchoscopy.