Churg-Strauss syndrome related to montelukast.

A young male with complaints of cough, dyspnea and hemoptysis was admitted. He was using fluticasone propionate and salmeterol for two years for his asthma. Leukotriene receptor antagonist was prescribed two weeks prior to his admission and no reduction of his inhaled steroid therapy was performed. Eosinophil count was detected as 1460/mm³ (15%) and immunoglobulin E level was 547 IU/mL. Thorax computerized tomography revealed patchy infiltration. Increased eosinophilic inflammation were detected in bronchoalveolar lavage fluid and transbronchial biopsy. He received prednisolone treatment for Churg-Strauss syndrome. Improvement was observed on three months follow up period. He has no complaint in his follow up.

Comparison of osteopontin, beta-catenin and hnRNP B1 expression in lung carcinomas.

This study was performed to compare osteopontin (OPN), beta-catenin and heterogeneous nuclear ribonucleoprotein B1 (hnRNP B1) immunreactivities in small cell lung carcinomas (SCLC) and non-small cell lung carcinomas (NSCLC). Correlation of these three antibodies with grade and clinicopathologic stage of the tumor in NSCLC was also investigated. Twenty-nine SCLC, 6 large cell carcinoma, 36 adenocarcinoma and 30 squamous cell carcinoma (SCC), totally 101 cases, were included in this study. OPN, beta-catenin and hnRNP B1 expressions were immunohistochemically evaluated. OPN positivity was 6.9% in SCLC and 67% in NSCLC. When NSCLC types were individually considered, OPN positivity was 66.7% in large cell carcinoma, 80% in SCC and 55.6% in adenocarcinomas. beta-catenin positivity was observed in 48.6% of NSCLC and none of SCLC cases. These results were statistically significant (p < 0.05). Neither grade nor stage of NSCLC was correlated with osteopontin, beta-catenin or hnRNP B1 immunreactivity. We observed that OPN and beta-catenin are useful in differentiating SCLC from NSCLC. This may be helpful in small lung biopsies where morphology is obscured by crush artifacts.

Is D2-40 a useful marker for distinguishing malignant mesothelioma from pulmonary adenocarcinoma and benign mesothelial proliferations?

Since pulmonary adenocarcinomas, malignant mesotheliomas (MM), and sometimes benign mesothelial proliferations show a great histomorphological resemblance to each other, an immunohistochemical panel is usually necessary for differential diagnosis. D2-40 is an available monoclonal antibody, which is already in use as a lymphatic endothelial marker. It has also been suggested to be useful in identifying the mesothelial differentiation. The aim of this study is to compare D2-40 immunostaining in MM, pulmonary adenocarcinoma, and benign mesothelial proliferations. In this retrospective study, D2-40 immunostaining was investigated in 37 cases of MM, 36 cases of pulmonary adenocarcinoma, and 31 cases of benign mesothelial proliferation. The diagnosis of MM had previously been confirmed by a panel including calretinin, CK5/6, and CEA. Predominantly membranous immunoreactivity was observed in 51% of MMs and in 55% of benign mesothelial proliferations. All the 36 pulmonary adenocarcinomas were negative. These results were statistically significant (p<0.001). We believe that D2-40 may be helpful in the differential diagnosis of MM from pleural involvement of pulmonary adenocarcinoma.

Catamenial hemoptysis.

Catamenial hemoptysis is a rare condition that is associated with the presence of intrapulmonary or endobronchial endometrial tissue. We describe a case of endobronchial endometriosis with catamenial hemoptysis. The patient was a 22 years-old girl presented with recurrent hemoptysis episodes for the last two years. Bronchoscopic examination was performed within first days of menses, and indicated multiple purplish-red submucosal patches in distal one third of trachea and bilateral bronchial trees that bled easily when touched. The cytological evaluation of the bronchial brushing specimens demonstrated clusters of small cuboidal cells consistent with an endometrial origin. Follow-up bronchoscopic examination at the end of the menstrual cycle revealed that the previous tracheobronchial lesions disappeared. The patient was treated with Gonadotropin-Releasing Hormone (GnRH) analogues and hormones including estrogen and progesterone therapy. Recurrent hemoptysis stopped following the medical treatment.

A retrospective study on the coexistence of hydatid cyst and aspergillosis.

OBJECTIVES: Hydatid cyst is a zoonotic disease with an endemic regional distribution, and Aspergillus is a saprophytic fungus that may cause allergic pulmonary aspergillosis, aspergilloma, and semi-invasive and invasive aspergillosis. The coexistence of a saprophytic fungus and hydatid cyst is extremely rare. The aim of this retrospective study was to evaluate the coexistence of aspergillosis and echinococcosis in archival materials and to discuss its probable clinical significance. METHODS: Hematoxylin-eosin (HE)-stained sections of 100 archival cases with the diagnosis of hydatid cyst were reevaluated by four pathologists independently. Grocott's methenamine-silver (GMS) and periodic acid-Schiff (PAS) were applied to the slides that were suspected of having co-infection with Aspergillus to confirm the diagnosis. RESULTS: Two cases of aspergillosis and hydatid cyst coexistence were found out of the 100 reevaluated archival cases with a diagnosis of hydatid cyst. Both of the cases were located in the lung, in immunocompetent patients. CONCLUSIONS: Aspergillosis and hydatid cyst coexistence may be important in patients with immune deficiency and in cases with pre- or perioperatively ruptured cysts. There are no reliable data on the specificity and sensitivity of radiological imaging techniques in detecting the existence of Aspergillus in hydatid cysts. Histopathological evaluation is essential for diagnosis and for the planning of management.

Local defense systems in the prepuce.

OBJECTIVE: Urinary tract infection (UTI) is a common bacterial infection in children. Circumcision reduces the incidence of UTI, and prevents preputial colonization with uropathic bacteria in childhood. However, there is insufficient information about the reason(s) why such colonization tends to occur in prepucium skin. MATERIAL AND METHODS: We evaluated some of the humoral and cellular defense systems in the prepucium skins of 30 boys (age range 6 months to 5 years). We measured the expressions of Langerhans cells, mast cells, T lymphocytes, IgA, IgG and IgM in the prepuce and compared them with those in normal skin. Tissues obtained during circumcision were divided into two groups. In the first group, sections were stained with hematoxylin-eosin and toluidine blue. Immunohistochemical reactions were performed on paraffin-embedded tissue by means of the avidin-biotin-peroxidase complex method. The antibodies used were S-100 for Langerhans cells and CD8 and CD4 for T lymphocytes. In the second group, frozen sections were stained for IgA, IgG and IgM using an immunofluorescence method. RESULTS: The distribution of mast cells and IgG positivity was similar to that of normal skin. Langerhans cells were increased in prepucium skin (p<0.05), whilst only a few CD4 T lymphocytes were observed around the perivascular area and no expression of CD8 was observed in the prepucium and normal skin. CONCLUSIONS: The increase in Langerhans cells in prepucium skin may be the result of continuous stimulation of bacteria found in the periurethral area, and the absence of CD8 may help the colonization of uropathic bacteria.

Urotensin-II immunoreactivity in children with chronic glomerulonephritis.

BACKGROUND: Human urotensin-II (hU-II) is one of the most potent vasoconstrictors in mammals. To our knowledge, there is no study about the role of U-II in childhood glomerulonephritis. We first determined the expression of h U-II in kidneys of children with chronic glomerular diseases. METHODS: Normal human kidneys were obtained from postmortem biopsies and compared with the kidney biopsy specimens of 24 children with membranoproliferative glomerulonephritis (MPGN) and 6 children with membranous GN. Kidney needle biopsies in 10% neutral buffered-formalin prior to routine processing through to embedded blocking sections were cut, and immunohistochemical reactions were performed on paraffin-embedded tissue by an avidin-biotin peroxidase complex method. The antibodies used in the present study were hU-II. The positivities were revealed as weak (+), moderate (++), and severe (+++), according to the color intensity. RESULTS: In kidneys of children with MPGN, differently fom the normal kidneys, more dense U-II immunoreactivity was seen in the glomerular basement membrane (GBM), glomerular mesangium, Bowman capsule, and tubules. Interestingly, we also observed U-II immunoreactivity in crescents. In children with MGN, U-II was mostly seen in GBM and Bowman capsule. CONCLUSION: Our findings suggest that U-II may have a possible autocrine/paracrine function in the kidneys, and may be an important target molecule in studying renal pathophysiology.