Mediastinal fibrosis and Hodgkin lymphoma mimicking bronchiolitis obliterans organizing pneumonia.

Bronchiolitis obliterans organizing pneumonia (BOOP) represents a kaleidoscope of concepts and morphologies, often being confused with a series of conditions, among which the most feared are Hodgkin's lymphoma and bronchioloalveolar carcinoma. We shall present the case of a 56-year-old patient, diagnosed in August 2013 with a pulmonary tumour of the right upper lobe, which was CTstaged - T4N0M0 (IIIA), who underwent a video-assisted thoracotomy for histopathological confirmation. A mediastino-pulmonary formation had been detected intraoperatively and multiple biopsies had been collected. The information brought by the histopathological examination suggested the presence of 2 synchronous pathologies, namely: the mediastinal biopsy showed an advanced degree of dense, compact fibrosis and the pulmonary biopsy highlighted the presence of granulation tissue and Masson bodies in the distal airspace with destruction of vascular and alveolar structures, an aspect which was compatible with organizing pneumonia (BOOP). Once a diagnosis was established, an oral corticosteroid therapy was initiated (Prednisone 30 mg/day) over a period of one month, but the symptomatology of the patient worsened. A new thoracic CT carried out in November 2013 highlighted the progression and extension of the paramediastinal tumoral formation, exhibiting central necrosis and invading the mediastinal vessels, causing their compression (superior vena cava syndrome) associated with multiple mediastinal and hilar adenopathies. The non-favorable evolution and the extensive array of conditions that may mimic the BOOP histopathological pattern have been the key elements, which were the basis of our persistence in getting a real diagnosis. Therefore, in this respect, the biopsy parts performed by thoracotomy were sent for immunohistochemical testing. The CD30 and CD15 positive markers distinctive for Reed-Sternberg cells allowed the diagnosis of Hodgkin's lymphoma.

Giant left-sided pleuropericardial cyst, mimicking a heart disease.

Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered thanks to tomodensitometry, sometimes by magnetic resonance imaging. Rarely symptomatic, excepted in cases of very large cysts, they are mainly pleuropericardic cysts (PPC) that represent 30% of MC Surgery is commonly performed by videothoracoscopy or by video-assisted mini-thoracotomy, mainly for PPC We report the case of a 62-year-old woman, smoker (30 packs years), who is hospitalized in Constanta Pneumology Hospital in June 2011 for slight shortness of breath, sweating, pain in the left hemi thorax, minor hemoptysis, recurrent. In her medical history, there are to be noticed a blood transfusion after hysterectomy for uterine fibroma (1995), arterial hypertension (2006). After admission, X-ray exam of the chest shows cardiomegaly and a few lung nodular lesions in the right upper lobe. An initial differential diagnosis includes congestive heart failure, dilated cardiomyopathy, valvular heart disease, left pleurisy, pericarditis, paracardiac tumor mass, tuberculosis +/- HIV. Following laboratory tests imaging (chest CT and ultrasound performed in June 26th 2011 and 27h) a possible pleuropericardic cyst was suspected. Exploratory thoracentesis was not performed and, a month later, in the Institute of Pulmonology "Marius Nasta" Bucharest, a left open thoracotomy revealed a cystic formation about 10 cm in diameter. Histopathologic exam confirmed the diagnosis of cyst pleuropericardic. The prognosis after surgery was favorable. As a feature of the case are worth mentioning: the large size of pericardial cyst at the upper limit of the data reported in the literature, which mimics cardiomegaly, the hemoptoic onset in a hypertensive patient, heavy smoker; the late suspicion of pleuropericardic cyst through pleural echographic exam; the atypical localization; the facilitated certain diagnosis by surgery and hystological exam; the favorable postoperative prognosis; and all morbidities cofound (Pulmonary Tuberculosis, bronchiectasis, COPD).

[Unilateral salpingian and ovarian TB, a rare form of extrapulmonary TB]. / Salpingo--ovarita bacilara unilaterala, forma, rara de tuberculoza extrapulmonara.

TB salpingitis and ovarian TB is a rare association of extrapulmonary tuberculosis, especially when the lesions are not associated with lung involvement. The correct therapy leads to the sterilization of the tuberculosis foci, although the risk of scars and adhesions is high, causing local functional disorders.

[Sternal chondrosarcoma and the complications poststernectomy]. / Condrosarcomul sternal si complicatiile poststernectomie.

Primary tumors of the sternum are unusual, and, of these chondrosarcoma is extremely rare. Prior cases were more frequent in men. It is the consensus that central (axial) skeletal lesions are always suspected of malignancy. It is difficult to deduce from the roengenographic and pathologic findings the presence of a sternal tumor. This case report of primary sternal chondrosarcoma illustrated an extremely rare cartilaginous lesion in a male 64 years old. Extensive sternal excision was indicated despite the apparent benignity of the tumor. This aggressive surgical method facilitated the diagnosis of a malignant tumor with moderate cellular differentiation G2 chondrosarcoma. After surgery done, bilateral pleural empiema occurred.

[Practical issues of transbronchial lung biopsy (TLB) in pneumology]. / Biopsia pulmonara transbronsica--repere practice.

METHOD: We present a survey of 78 TLB which have been performed in Bronchology Service (during 2003-2005) for diffuse interstitial lung diseases--70 cases or located diseases--8 cases; TLB was not performed for solitary peripherally opacities because we have no radiological device with mobile arm (for good position of forceps). RESULTS: In 78% of cases we obtained illustrative lung tissue and in 22% of cases we prelevated just bronchial wall. Histological confirmation was obtained for 53% of cases; 47% of cases have as result lung tissue without significant modifications. Histological diagnosis was obtain in 41% of cases. The diagnosis of lung pathology was: diffuse lung fibrosis, tuberculosis, sarcoidosis stage II-III, malignant lymphoma, carcinomatosis, undifferentiated carcinoma, bronchioloalveolar carcinoma, squamous carcinoma, adenocarcinoma. There were 5 cases (6%) of small pneumothorax with spontaneous resorption and 11 cases with small bleeding (5-10 ml) who stopped spontaneously or at local administration of xilometasolin or oximetasolin. No other incidents were registered. CONCLUSIONS: TLB is a good alternative of surgical biopsy. The international guidelines request that the TLB has to be made before the thoracoscopy or the thoracotomy; because of the small size of prelevated fragments the diagnosis sensibility is variable. Our results for the 78 cases are comparable with the international data from literature both from the point of view of the diagnosis and the complications.