Analysis of tissue lipidomics and computed tomography pulmonary fat attenuation volume (CTPFAV ) in idiopathic pulmonary fibrosis.

BACKGROUND AND OBJECTIVE: There is increasing interest in the role of lipids in processes that modulate lung fibrosis with evidence of lipid deposition in idiopathic pulmonary fibrosis (IPF) histological specimens. The aim of this study was to identify measurable markers of pulmonary lipid that may have utility as IPF biomarkers. STUDY DESIGN AND METHODS: IPF and control lung biopsy specimens were analysed using a unbiased lipidomic approach. Pulmonary fat attenuation volume (PFAV) was assessed on chest CT images (CTPFAV ) with 3D semi-automated lung density software. Aerated lung was semi-automatically segmented and CTPFAV calculated using a Hounsfield-unit (-40 to -200HU) threshold range expressed as a percentage of total lung volume. CTPFAV was compared to pulmonary function, serum lipids and qualitative CT fibrosis scores. RESULTS: There was a significant increase in total lipid content on histological analysis of IPF lung tissue (23.16 nmol/mg) compared to controls (18.66 mol/mg, p = 0.0317). The median CTPFAV in IPF was higher than controls (1.34% vs. 0.72%, p < 0.001) and CTPFAV correlated significantly with DLCO% predicted (R2 = 0.356, p < 0.0001) and FVC% predicted (R2 = 0.407, p < 0.0001) in patients with IPF. CTPFAV correlated with CT features of fibrosis; higher CTPFAV was associated with >10% reticulation (1.6% vs. 0.94%, p = 0.0017) and >10% honeycombing (1.87% vs. 1.12%, p = 0.0003). CTPFAV showed no correlation with serum lipids. CONCLUSION: CTPFAV is an easily quantifiable non-invasive measure of pulmonary lipids. In this pilot study, CTPFAV correlates with pulmonary function and radiological features of IPF and could function as a potential biomarker for IPF disease severity assessment.

High-grade chondrosarcoma of the larynx: a case report and literature review.

A 64-year-old male presented with a 2-month history of sudden onset dysphonia. Endoscopic evaluation of the larynx revealed a complete right vocal cord palsy. Computed tomography of the neck revealed a mass medial to the right thyroid associated with the cricoid cartilage. Histologic examination confirmed high-grade chondrosarcoma. The patient underwent right-sided hemicricoidectomy with tracheal flap reconstruction, right thyroid lobectomy and partial oesophagectomy with primary anastomosis followed by adjuvant radiation therapy. He is currently being followed as an outpatient with no evidence of disease. High-grade chondrosarcoma of the larynx is an exceedingly rare tumour, associated with a poor prognosis. Current best evidence suggests primary surgical resection with negative margins. There is a lack of evidence to guide post-operative management of high-grade chondrosarcoma. They have a poor prognosis following surgical resection and a 10-year survival rate of 29%.