[A case of tumor-like pulmonary sarcoidosis]. / Sarcoidoza pulmonara--forma pseudotumorala.

We present the case of a female patient age 32, with no medical history, presenting with chest pain and asthenia. Chest X-ray and CT scan revealed multiple nodular shadows in both lungs, suggesting lung metastasis. Bronchoscopy and broncho-alveolar lavage didn't reveal any malignant cells. Clinical examination and lab examinations didn't find any primitive extra-pulmonary tumor. Open lung biopsy was performed, revealing sarcoidosis. Patient received oral steroids, with significant radiologic improvement after only 1 month.

[Sequential approach in a case of tracheal hemangioma: segmental tracheal resection after Nd-YAG laser application]. / Abord secvential intr-un caz de hemangiom traheal: rezectie traheala segmentara precedata de Nd-YAG laser.

Tracheal tumors of malignant or benign origin are very rare. The symptoms may mimic asthmatic crisis, dyspnea at rest or light efforts appear only when the tumor obstructs 60% of the tracheal diameter. We present the case of a 50 year old patient, ex-smoker with symptoms present 5 years before admittance with dyspnea and small hemoptysis. Diagnosis was based on bronchoscopic examination, CT scan and histological examination of the resection sample revealing a rare benign tracheal tumor: a hemangioma. The sequential treatment of the disease is presented: interventional endoscopy and surgical resection. The excellent postoperative evolution emphasized the diagnostic and therapeutic value of bronchoscopy as well as surgery in benign tracheal tumors.

[Pulmonary benign lymphocytic angiitis and granulomatosis--a benign lymphoproliferative condition]. / BLAG pulmonar--o conditie limfoproliferativa benigna.

BLAG--benign lymphocytic angiitis and granulomatosis is a granulomatosis disease which histologically presents a dense infiltrate of lympnoid cells that disturbes the normal alveolar architecture. Faint granuloma formation occur within the lympnoid infiltrate. A 32 years female patient was admitted for dry cough, exertional dispnea, low fever during last 11 month. Histological diagnosis was BLAG. The treatment was a combination of cyclophosphamide and prednisone. Follow up information after 9 month of treatment show a generally favorable evolution (clinical and radiological).

[Thyroid tuberculosis--a clinical case]. / Tuberculoza tiroidiana--caz clinic.

We present the case of a 38-year-old male patient with tuberculosis of the thyroid; the diagnosis was established on histological examination after surgery.

[Pulmonary tuberculosis and Kaposi syndrome in HIV positive patient]. / Tuberculoza pulmonara si sindrom Kaposi la o bolnava HIV pozitiv.

The authors point out the case of a young woman with AIDS who presents at the same time the test HIV (+), the secondary caseoextensive bilateral pulmonary tuberculosis confirmed by the bacterial examination (bK(+) culture), the skin's and pulmonary histological manifestations of the Kaposi disease, clinically suspected, was confirmed only at the autopsy. Clinical manifestations began with skin's modifications, followed 2-3 months later by the diagnosis of a pulmonary tuberculosis, the demise decease 4-5 month after the appearance of the first skin's lesion.

Disseminated tuberculosis with gradual evolution and unusual localization.

We present a case of disseminated tuberculosis (pulmonary, skeletal and lymph nodes) accompanied by subcutaneous abscesses and with unusual localization, osteolytic lesions of the skull caused by Mycobacterium tuberculosis var. hominis. Although the patient was immunocompetent, the disease had a gradual and unexpected progression. In the malign forms of tuberculosis, treatment must be extended for a year or more.

Cellular immune response in atypical tuberculosis diagnosed by PCR in paraffin embedded material.

The aim was to evaluate the cellular immune response in atypical tuberculosis and granulomatous inflammation consistent with tuberculosis (TBC), negative histochemically for acid-fast bacilli and analysed by PCR for Mycobacterium tuberculosis (MT) detection in paraffin-embedded tissue. Thirty six samples of differently localized atypical tuberculous lesions and granulomatous tuberculoid lesions negative for acid fast bacilli and 4 positive cases on Ziehl-Nielsen stain were analysed by PCR for MT detection and were tested immunohistochemically (IHC) for the cellular immune response in the granulomas and perigranulomatous tissue. The samples selected were: 7 pulmonary and 33 extrapulmonary specimens, especially lymph nodes. Histologically, the atypical tuberculous lesions contained supurative necrosis, defective granulomas and cellular polymorphism. The epithelioid cells showed frequent mitoses. The immunoprofile of cells was polymorphous. L26 positive small lymphocytes were found in nodular lymphoid aggregates surrounding granulomas. A significantly increased number of positive UCHL1 cells were found in 33 out of the 40 analysed cases, with a larger percentage of CD4 positive T cells (81.8% of cases). CD44 was positive in multinucleated giant cells (17.5% of cases), epithelioid cells (60% of cases) and lymphocytes (30% of cases). CD68 was localized in multinucleated giant cells and epithelioid cells, in a 4%, respectively 62.5% of cases. The PCR was performed in all 40 cases; the tissue samples were heterogeneous (lung, lymph nodes, lever, nasopharynx, etc.) and needed a good quality extraction of DNA. Performing a control PCR for Beta Globin tested the extraction; a good result was obtained in 31 cases (77.5%); from these, 19 cases had amplification for IS 6110. The cellular immune response in the atypical tuberculous lesions was similar in cases with and without acid-fast bacilli, but positive for PCR. In the most cases with negative PCR reaction, it was due to a deficient fixation of the material. The T lymphocytes were numerous in all types of tuberculous granulomas, with the prominence of CD4 positive subtype. The immunoprofile of the epithelioid cells, positive for CD44 and CD68, presenting frequently mitoses suggests an activate state in a possible relationship to the T-cell-mediated immune response in tuberculosis.

[Diagnostic difficulties--salvage diagnostic thoracotomies]. / Dificultati de diagnostic--toracotomii diagnostice salvatoare.

The authors are presenting the difficulties of diagnosis, in clearing up the etiology in two cases, where the acceptance of the exploring thoracotomy, influenced the prognostic and permitted to settle up the diagnosis. We are passing through, at this occasion, also the indications of this kind of operation.

[Bilateral multifocal pulmonary leiomyomatosis]. / Leiomiomatoza pulmonara plurifocala bilaterala.

A case of diffuse primary pulmonary leiomyomatosis with a 24-years-old asymptomatic woman having a pulmonary radiological aspect of miliary dissemination 3 years after a myomectomy for sub-serous uterine fibroma. The diagnosis was established after a surgical pulmonary biopsy. The case presented certain peculiar features: a young woman; the inter-relation between pulmonary leiomyomatosis and the operated sub-serous uterine fibroma; the aggravating factor--the pregnancy; a confirmed probably hormonal cause (hyperestrogenemia); a progressive aggravating evolution.

[Pulmonary alveolar microlithiasis--a clinical case]. / Microlitiaza alveolara pulmonara--caz clinic.

A new case of alveolar microlithiasis is reported, demanding for the diagnosis besides the radio-clinical investigations, complete respiratory function tests, also the pathologic proof. Authors recall the diagnostic approach and our present ignorance of the pathogenesis of this curious entity; no valid therapy is presently able to check the relentless course toward progressive respiratory failure.

[Goodpasture's syndrome--a case report]. / Sindromul Goodpasture--prezentare de caz.

A female subject case aged 64 years is presented. The history shows several hospital admissions for lung diffuse infiltrative processes, accompanied with hemoptoic sputa. These infiltrations had a regressive evolution either spontaneously or under treatment. The diagnosis of Goodpasture syndrome was fixed post-mortem by alterations evidenced in the kidneys.

[New aspects of collagen formation]. / Noi aspecte privind formarea colagenului.

New data are presented concerning the process of synthesis and secretion of collagen. The stages are described of its elaboration and biochemical transformations of collagen molecules occurring in the cell and the alterations leading to collagen fibres building-up in the extracellular spaces. Electronic microscopy of fibrogenesis study, carried out during an experimental research on lung fibrosis, has shown new aspects not yet described in the literature. It is demonstrated that collagen fibres could be formed by assembling the tropocollagen molecules in the fibroblast cytoplasm, before the expulsion from the cell. This phenomenon could represent a new way not yet mentioned among the mechanisms of collagen synthesis. It is likely that this process take place in the framework of pathological process of fibrosis development.

[Clinico-radiologic and morphopathologic aspects of mediastinal-pulmonary hemangiopericytoma]. / Aspecte clinico-radiologice si morfopatologice in hemangiopericitomul mediastino-pulmonar.

The paper points out the diagnosis of intrathoracic hemangiopericytoma in 13 patients in the "M.Nasta" Institute of Pneumophthisiology, a seldom seen disease considered quite serious because of its malignant form and its late finding out. This is due to its non-distinctive, small number of symptoms, which has a negative influence upon the disease prognosis and evolution.

[Atypical pulmonary hydatid cyst]. / Kyste hydatique pulmonaire atypique.

An atypical form of a pulmonary hydatid cyst is described. This was a solitary super-infected pseudo-tumoral cyst and the membrane was incarcerated which has enabled us to propose as a description for this new morphological aspect of a cyst, with a filled margin of the proliferative membrane. We propose the term "Rosebud".

[Acute rhinopharyngitis, acute interstitial pneumonia and parieto-frontal brain abscess with H. influenzae type B]. / Rinofaringita acuta, pneumonie acuta interstitiala si abces cerebral parieto-frontal cu H.influenzae tip B.

The paper deals with a parietal frontal cerebral abscess caused by HITB biotype I in a girl aged 8 months. First a meningitis is suspected, then a tuberculous meningitis unsuccessfully treated with ampicillin, biseptol, respectively INH, rifampicin, pyrazinamide, prednisone, phenobarbital and chloramphenicol. The patient died through a central respiratory standstill on the 17th day of disease. The anatomopathological examinations revealed a giant parietal frontal cerebral abscess. H.influenzae, (serum type B, biotype I) resistant to ampicillin, chloramphenicol, Kanamycin, rifampicin and tetracycline but sensitive to erythromycin and neomycin was also found. A pharyngeal infection with HITB was presumably the origin of the abscess.

[Mediastinal-pulmonary lymphangioleiomyomatosis. The anatomicoclinical aspects]. / Limfangioleiomiomatoza mediastino-pulmonara. Aspecte anatomoclinice.

The lymphangioleiomyomatosis is a rare disease which has a severe course and prognosis and occurs exclusively in females. The symptomatology is not characteristic and the radiological picture is that of a reticular and micronodular diffuse interstitial process. The morphological examination is the only which elucidates the diagnosis. Two cases are reported, the diagnosis of which was established postmortem. In the first case, the site was predominantly pulmonary; in the second case, in addition to the lung, the mediastinal lymph system was also strongly damaged. The morphological changes are characterized by an abnormal proliferation of muscular tissue at the level of the pulmonary interstitium and of the pulmonary and mediastinal lymphatics. The process develops towards destructive lesions of the bronchiolo-alveolar and vascular structures. The pathogenesis is unknown, but genetic and endocrine factors seem to be involved.