Hilar pulmonary granular cell tumor: a case report and review of the literature.

We present a case of pulmonary granular cell tumor (GCT). A 35-year-old man underwent pulmonary resection for metastatic testicular mixed germ cell tumor when two interlobar lymph nodes were found to be enlarged and abnormal. Intraoperative frozen section examination showed their involvement by GCT. Histologic examination of the lobectomy specimen showed a benign, predominantly hilar GCT as well as metastatic germ cell tumor. This location, with no endobronchial component and with extension into regional hilar lymph nodes, is unusual. The differential diagnosis and the association with the metastatic testicular cancer are discussed and the literature on pulmonary GCT is reviewed.

Bronchocentric granulomatosis: computed tomographic findings in five patients.

AIM: The aim of this study was to assess the CT manifestations of bronchocentric granulomatosis. SUBJECTS AND METHODS: The CT results of five patients with bronchocentric granulomatosis were retrospectively analysed. The patients ranged from 20 to 72 years of age and included three men and two women. The diagnosis of bronchocentric granulomatosis was made at lobectomy (n = 2), open lung biopsy (n = 2), and transbronchial biopsy (n = 1). Only one of the five patients had asthma. RESULTS: The main findings consisted of a spiculated mass lesion (n = 3) or lobar consolidation with associated mild volume loss (n = 2). One of the two patients with consolidation had extensive mucoid impaction. The abnormalities involved predominantly an upper lobe in four patients and a lower lobe in one patient. In the four resected specimens, the macroscopic pathological appearance was consolidation (n = 2) and mass lesion (n = 2). Microscopically, the typical histology of airway-centred necrotizing granulomata was present in all cases. Aspergillus hyphae were identified in two cases. Nocardia sp. was cultured from the biopsy specimen in one case. CONCLUSION: The CT manifestations of bronchocentric granulomatosis consist of a focal mass or lobar consolidation with atelectasis. These reflect the presence of granuloma formation with or without associated bronchial obstruction.

Follicular bronchiolitis: thin-section CT and histologic findings.

PURPOSE: To evaluate the thin-section computed tomographic (CT) findings of follicular bronchiolitis and compare them with the histologic findings. MATERIALS AND METHODS: Thin-section CT scans obtained in 12 patients (age range, 24-77 years; mean age, 47 years) with follicular bronchiolitis proved at open lung biopsy were reviewed by two observers. Underlying conditions included rheumatoid arthritis (n = 8), mixed collagen vascular disorders (n = 2), autoimmune disorder (n = 1), and acquired immunodeficiency syndrome (n = 1). All patients had thin-section CT scans (1.0-1.5-mm collimation, 11 patients; 3.0-mm collimation, one patient; high-spatial-frequency reconstruction algorithm) obtained at 10-mm intervals through the chest. RESULTS: The main CT findings included bilateral centrilobular (n = 12) and peribronchial (n = 5) nodules. All 12 patients had nodules smaller than 3 mm in diameter; six patients also had nodules 3-12 mm in diameter. Areas of ground-glass opacity were present in nine (75%) patients. Histologically, all patients had lymphoid hyperplasia along the bronchioles; eight had peribronchiolar lymphocytic infiltration. CONCLUSION: The cardinal CT feature of follicular bronchiolitis consists of small centrilobular nodules variably associated with peribronchial nodules and areas of ground-glass opacity.

Epstein-Barr-virus-associated lymphoproliferative disease of the lung: CT and histologic findings.

PURPOSE: To assess the computed tomographic (CT) and histologic findings of intrathoracic lymphoproliferative disease (LPD) associated with the Epstein-Barr virus (EBV). MATERIALS AND METHODS: The authors retrospectively reviewed the CT scans of the chest and the pathologic specimens obtained in 24 patients with histologically proved intrathoracic LPD and with positive serologic findings or immunohistochemical staining for EBV. Five patients had acquired immunodeficiency syndrome (AIDS); one had common variable immune deficiency; and 18 were receiving immunosuppressive therapy for heart, lung, or heart-lung (n =15) or bone marrow (n = 2) transplantation and vasculitis (n = 1). RESULTS: Final diagnoses included malignant lymphoma (n = 15), polyclonal LPD (n = 8), and hyperplasia of bronchus-associated lymphoid tissue (n = 1). CT findings included multiple nodules (n = 21), lymphadenopathy (n = 9), areas of groundglass opacification (n = 8), septal thickening (n = 7), consolidation (n = 5), pleural effusion (n = 4), and solitary endobronchial lesion (n = 2). The nodules were 2-4 cm in diameter, involved mainly the middle and lower lung zones, and frequently had a predominantly peribronchovascular (n = 15) or subpleural (n = 14) distribution. CONCLUSION: EBV-associated LPD may range from benign lymphoid hyperplasia to high-grade lymphoma. The most common CT manifestation consists of multiple nodules, frequently in a predominantly peribronchovascular or subpleural distribution.

Invasive aspergillosis in the immunocompromised host: utility of computed tomography and bronchoalveolar lavage.

OBJECTIVE: Bronchoalveolar lavage is performed almost routinely in immunocompromised patients with suspected pneumonia, but it has a low yield in the diagnosis of pulmonary aspergillosis. The aim of this study was to determine whether computed tomography (CT) is helpful in determining the likelihood of a positive bronchoalveolar lavage by allowing distinction of patients with angioinvasive aspergillosis from those with Aspergillus bronchopneumonia. METHODS AND RESULTS: A retrospective study was performed including consecutive immunocompromised patients with suspected pneumonia who underwent CT scanning of the chest and bronchoalveolar lavage and who had definite diagnosis of pulmonary aspergillosis. The CT scans were reviewed by two chest radiologists and classified as showing features consistent with angioinvasive or airway invasive aspergillosis. Twenty-one patients met the inclusion criteria. Bronchoalveolar lavage was positive for fungi in two of 11 patients with CT findings consistent with angioinvasive aspergillosis and eight of 10 patients with CT scans consistent with Aspergillus bronchopneumonia (P < 0.01, chi-squared test). CT findings of angioinvasive aspergillosis included nodules measuring 1-3.5 cm in diameter in six, segmental consolidation in three, and both nodules and segmental consolidation in two patients. CT findings of Aspergillus bronchopneumonia including peribronchial consolidation in five, small centrilobular micronodules in one, and both in four patients. CONCLUSIONS: Chest CT is helpful in determining the likelihood of successful diagnosis of pulmonary aspergillosis by bronchoalveolar lavage.

Obscure gastrointestinal bleeding from an ampullary tumour in a patient with a remote history of renal cell carcinoma: a diagnostic conundrum.

Metastasis of renal cell carcinoma to the ampulla of Vater is a rare occurrence. The outlined case, which presented as an upper gastrointestinal bleed, is only the eighth such reported case in the English-language literature. This case is the longest reported time interval between surgical nephrectomy to presentation with ampullary metastasis at 17.5 years. The ampullary source of bleeding in this case was initially obscure and missed by conventional gastroscopy. Diagnosis was made with a side-viewing endoscope, emphasizing the usefulness of this instrument in the investigation of active bleeding from a small bowel source.

Chronic pulmonary coccidioidomycosis: computed tomographic and pathologic findings in 18 patients.

OBJECTIVE: To review the computed tomographic (CT) findings in pathologically proven chronic pulmonary coccidioidomycosis. PATIENTS AND METHOD: The study included 19 pulmonary lesions caused by mycologically and pathologically proven chronic coccidioidomycosis in 18 immunocompetent patients (aged 22 to 75 years, mean 57 years) who had a chest CT scan. Thirteen patients were Canadians who had travelled to an endemic area, and 5 were inhabitants of an endemic area in southern California and Arizona. The CT findings were assessed to determine the type, size, margin, internal architecture and location of parenchymal abnormalities. RESULTS: The CT findings included solitary nodules of 1.0 to 2.0 cm (mean 1.7 cm) in diameter in 17 patients, a focal area of ground-glass attenuation in 1 patient, and focal consolidation in 1 patient. Ten of the nodules had homogeneous attenuation on CT, 2 had central areas of low attenuation, 2 showed cavitation, 2 had foci of calcifications and 1 had bubble lucency. The nodules were located peripherally (in 14 patients) and centrally (in 3 patients). The predominant histologic finding in these nodules was a necrotizing granuloma. Three nodules were surrounded by halos of ground-glass attenuation, which were shown on histologic examination to represent granulomatous inflammation (in 2 cases) and pulmonary hemorrhage due to a pulmonary artery-bronchial fistula (in 1 case). Two nodules had adjacent consolidation, which was due to granulomatous inflammation surrounding a necrotizing granuloma. CONCLUSION: Necrotizing granulomas in chronic coccidioidomycosis appear as a well-defined nodule on CT, while granulomatous inflammation may appear as areas of ground-glass attenuation or consolidation.

Pulmonary complications after bone marrow transplantation: high-resolution CT and pathologic findings.

A wide variety of pulmonary complications occur in bone marrow transplant (BMT) recipients and are a major cause of morbidity and death. High-resolution computed tomography (CT) is excellent in the detection of pulmonary abnormalities, but these findings are generally nonspecific. However, the different complications, which reflect the immunologic status of the patients, occur in three phases. This pattern can be used to interpret CT scans. The neutropenic phase (up to 3 weeks after BMT) is characterized by fungal infections, notably angioinvasive aspergillosis, alveolar hemorrhage, pulmonary edema, and drug reactions. At CT, angioinvasive aspergillosis appears as a nodule surrounded by a halo of ground-glass attenuation; alveolar hemorrhage and drug reactions, as bilateral areas of ground-glass attenuation or consolidation; and pulmonary edema, as prominent pulmonary vessels, interlobar septal thickening, ground-glass attenuation, and pleural effusions. The second phase (3 weeks to 100 days after BMT) is dominated by cytomegalovirus pneumonia, which appears as multiple small nodules with associated areas of consolidation or ground-glass attenuation, and Pneumocystis carinii pneumonia, which appears predominantly as ground-glass attenuation. The late phase (more than 100 days after BMT) is characterized by bronchiolitis obliterans, bronchiolitis obliterans with organizing pneumonia (BOOP), and chronic graft-versus-host disease. In bronchiolitis obliterans, CT reveals bronchial dilatation and a mosaic pattern of attenuation; in BOOP, CT findings usually consist of patchy consolidation or ground-glass attenuation. If CT findings are considered in relation to the time elapsed after BMT, diagnostic options can be narrowed sufficiently to enable accurate diagnosis.

Pulmonary carcinosarcoma: radiologic and pathologic findings in three patients.

OBJECTIVE: The purpose of this study was to describe the radiologic and pathologic features of pulmonary carcinosarcoma in three patients. CONCLUSION: The tumors measured 9-14 cm in diameter, had inhomogeneous contrast enhancement, and in two cases had invaded the mediastinum or chest wall extensively. Carcinosarcomas are rare tumors that tend to be large, necrotic, enhancing, and locally invasive.

Calcium overload during reperfusion is accelerated in isolated hypertrophied rat hearts.

In this study, calcium overload during reperfusion and the severity of morphologically evident ischemic myocardial injury were compared in hypertrophied and normal hearts. Hypertrophied hearts isolated from rats where a clip had been placed on the proximal thoracic aorta for 6 weeks were compared to those from sham-operated rats in an isolated state perfused with Krebs-Henseleit buffer containing 3% albumin, 1.2 mM palmitate and 11 mM glucose. The isolated hearts were exposed to global, no-flow, normothermic ischemia following potassium arrest and were reperfused. Following ischemia and reperfusion, left ventricular end diastolic pressure was increased (39 +/- 7 v 13 +/- 2 mmHg, P < 0.05), and percentage recovery of left ventricular systolic function was decreased (34.4 +/- 8.9 v 77.1 +/- 6.3% P < 0.05), in hypertrophied hearts compared to control hearts. Calcium overload during reperfusion was two and one-half times greater in the hypertrophied hearts than in the control hearts and showed significant relationships with recovery of left ventricular systolic function (r = -0.86, P < 0.001) and left ventricular end diastolic pressure (r = 0.78, P < 0.005). Myocardial energy charge did not differ between the two groups at the end of reperfusion. Ischemic myocardial injury was quantitated morphologically by point counting techniques in a comparable series of control and hypertrophied hearts. After ischemia, hearts were either exposed to a monoclonal antimyosin antibody to identify and measure irreversibly injured myocardium by light microscopy or fixed by perfusion with 2.5% glutaraldehyde to quantitate the morphologic changes ultrastructurally. Control and hypertrophied hearts were not significantly different in severity of myocardial injury due to ischemia as assessed morphologically. Thus, the data suggest that calcium overload during reperfusion plays a significant role in post-ischemic left ventricular dysfunction of the hypertrophied heart. The accelerated calcium overload that occurs in the hypertrophied rat heart during reperfusion cannot be explained by differences in severity of myocardial injury during ischemia which indicates that other mechanisms are responsible.