Morphologic changes leading to bronchiolitis obliterans in a patient with delayed non-infectious lung disease after allogeneic bone marrow transplantation.

A 37-year-old man developed delayed non-infectious lung disease after undergoing bone marrow transplantation (BMT) for acute myeloid leukaemia. Over a 15-month period, the progression of morphologic changes from cellular interstitial pneumonia to bronchiolitis obliterans organizing pneumonia and cicatricial bronchiolitis obliterans was documented. Pulmonary function tests, high-resolution CT, bronchoalveolar lavage, lung biopsy and extensive microbiological studies were used as diagnostic tools either at onset and during the follow-up. This represents the first reported case in which a model--supported by longitudinal biopsy results--for the evolution of histologic lesions toward bronchiolitis obliterans after BMT is suggested; therapeutic implications are discussed.

Human pulmonary dirofilariasis: report of a new European case.

We report a new European case of pulmonary dirofilariasis occurring in an Italian patient. The paper emphasizes the peculiar pathological features of Pulmonary Dirofilariasis, that, on clinical and radiological grounds, closely imitates primary or secondary neoplasms. The disease characteristically presents itself as a solitary subpleural coin-like lesion, histologically corresponding to a well demarcated, roughly spherical infarct, centered by a medium-sized thrombosed artery whose lumen contains the parasite, i.e. a Dirofilaria nematode.

Primary angiosarcoma of the chest wall.

We report the case of a 15-year-old boy with primary high grade angiosarcoma of the 6th rib. The patient underwent chest wall resection (3 ribs) and reconstruction by using a sandwich of Marlex mesh with strips of methyl methacrylate. No adjuvant treatment was administered. A favourable outcome was observed, with no recurrence at 6-year follow-up. Functional results were excellent as well, with complete return of the patient to normal activities.

Surgical treatment of stage I lung cancer. Results and prognostic factors.

BACKGROUND: The aims of the present study were: 1) to study the type and extent of resection in patients with pathological stage I lung cancer; 2) to evaluate the results of surgical treatment; 3) to assess prognostic factors. SETTING: a tertiary referral general hospital. METHODS: Retrospective review of clinical records of 296 patients operated on for pathologic stage I lung cancer between 1989 and 1998. Mean follow-up period was 33.1+/-28.1 months. Survivals were calculated by the actuarial method and compared by the long-rank test. Age, sex, tumor size, type and extent of resection and histologic type were evaluated by univariate and multivariate analisis. RESULTS: Two hundred and forty-five lobectomies, 39 pneumonectomies, 5 segmental resections and 7 wedge resections were performed. Overall actuarial 5- and 10-year survivals were 62 and 49%, respectively. Stage Ia patients showed significantly better 5- and 10-year survivals (76 and 54%, respectively) as compared to Stage Ib patients (57 and 46%, p=0.007). Univariate analysis showed no significant difference in survival according to the age, the sex or the extent of resection. The histological type influenced the outcome (p=0.05): 5-year survival rate were 57, 67, 75% in squamous cell carcinoma, adenocarcinoma and bronchoalveolar carcinoma, respectively. At multivariate analysis stage and histology were identified as independent prognostic factors. CONCLUSIONS: Satisfactory results in terms of suvival can be achieved following surgery for stage I lung cancer. The T status and the histologic type significantly influence survival.

Rupture of the azygos vein in blunt chest trauma.

Isolated traumatic laceration of the azygos vein is a rare condition that is mainly associated with violent deceleration traumas. Diagnosis is crucially based on radiologic evidence of massive right pleural bleeding and hemorrhagic shock. Surgical exploration needs to be early and concomitant with resuscitation, prognosis largely depending on timely intervention. Median sternotomy provides the most advantageous access because it can be quickly performed and allows for surgical exploration.

Epithelioid haemangioendothelioma of the lung imitating clinical features of pulmonary histiocytosis X.

A young male who was a heavy smoker presented with spontaneous right pneumothorax. A high resolution computed tomography scan showed disseminated nodules up to 1 cm in diameter; the greatest majority of which were sited in the centrilobular zone, though some abutted on the pleural surface. Surgical lung biopsies allowed a diagnosis of epithelioid haemangioendothelioma. The neoplastic tissue infiltrated the wall of bronchioles, partially obliterating them and the visceral pleura. These two histological aspects could be considered as concomitant mechanisms for the appearance of spontaneous pneumothorax. Epithelioid haemangioendothelioma should be added to the list of lung diseases in young heavy smokers that can begin with a spontaneous pneumothorax.

[Treatment of pathological obesity biliopancreatic bypass operations: one-year follow-up of 10 cases (author's transl)]. / Traitement de l'obésité pathologique avec by-pass biliopancréatique. A propos de 10 sujets un an après l'intervention.

A biliopancreatic bypass operation has been used to treat obese patients since June 1978, and 10 women have been followed-up for over a year. Biliopancreatic shunts reduce food absorption by eliminating enzymatic and biliary secretion activity in the intestinal lumen. Bodyweight loss was satisfactory, was proportional to excess weight, and was evaluated as being a mean of 33.1 kg. The constant and sometimes dramatic diarrhea provoked by conventional jejuno-ileal bypass operations was not observed. Hepatic steatosis, frequently present to varying degrees, was never made worse : in one case it even disappeared completely, while in another case biological tests conducted one year after operation showed considerable regression. Neither severe complications nor mortality were reported in this series.

Needle biopsy of endothoracic neoformations: a five-year experience.

We dwell upon the importance of percutaneous biopsy in the diagnosis of endothoracic masses, comparing the results of the cutting needles to those of the fine needle aspiration biopsy. We began utilizing the Vim-Silverman needle with good results (73.7% diagnoses) and a small number of complications, only 1 of which needed treatment, but in the light of the severe and lethal complications described in the literature, we came to prefer the use of the fine needle aspiration technique, which provided good results, too, (74% diagnoses) and enlarged the diagnostic range of the percutaneous biopsy of the lung in cases of deep, or mediastinal masses. We also hold that the use of cutting needles should not be given up: in fact when a technically good smear from an aspiration biopsy does not allow a diagnosis, we usually repeat the biopsy using a cutting needle, if there is no contraindication.

[Spontaneous mediastinal hematoma during therapy with oral anticoagulants]. / Ematoma mediastinico spontaneo in corso di terapia anticoagulante orale.

Mediastinal haematoma as a complication of anticoagulant therapy has rarely been described in the literature. A case is reported of an anterior mediastinal haematoma which developed in a patient with mitral valve disease while on oral anticoagulant therapy. This occurred in spite of well-controlled anticoagulation therapy and the clinico-radiological features did not directly recall the hemorrhagic complication. Computerized tomographic scan of the chest, even if not conclusive, was essential for the clinical strategy. A definite diagnosis was obtained by percutaneous needle aspiration followed by iodinate contrast medium injection. This procedure also led to the resolution of the haematoma, thus avoiding hazardous surgical therapy.

Acute interstitial pneumonia: report of a series.

Four cases of acute interstitial pneumonia (AIP) are described with special emphasis on clinical background, lung imaging and bronchoalveolar lavage findings. A retrospective chart review of four patients with histologically-proven AIP, diagnosed between 1998 and 2000, was carried out. Clinical data, bronchoalveolar lavage (BAL) findings, high-resolution computed tomography (HRCT) and histological features were analysed. Three patients died and only one is in follow-up. HRCT showed areas of ground glass attenuation and alveolar consolidation in all patients. Histology, documented by open lung biopsy or autopsy specimens, was consistent with the organising form of diffuse alveolar damage pattern. BAL findings were characteristic, with a huge neutrophilia associated with scattered atypical type II pneumocytes collected in clusters with extracellular amorphous material (fragments of hyaline membranes) observed in two out of three cases. In this paper, four cases of acute interstitial pneumonia are reported in detail. The poor prognosis associated with this entity has been confirmed and the possible diagnostic role of the bronchoalveolar lavage is emphasised.

Invasive inflammatory pseudo-tumor involving the lung and the mediastinum.

Inflammatory pseudotumor is a rare clinical entity. We report here the case of a 14-year-old boy who underwent lung resection en bloc with the lower esophagus, the mediastinal pleura and the diaphragm for an inflammatory pseudotumor of the left lower lobe. Postoperative radiotherapy was administered. The patient is well at 9-year follow-up. Inflammatory pseudotumor may present a particularly aggressive behavior. Multimodality approach, including extensive surgical resection, may be necessary in dealing with this disease.

Core needle biopsy is effective in the initial diagnosis of mediastinal lymphoma.

BACKGROUND AND OBJECTIVE: With the development and refinement of guidance modalities for percutaneous biopsies, many investigators have reported studies supporting the role of guided core needle biopsy in the diagnosis of mediastinal lymphoma. The aims of this report are to evaluate the efficacy of findings at core needle biopsy of mediastinal masses on patient care and define the key determinants of clinical success. DESIGN AND METHODS: Fluoroscopy-guided (in 75 patients) and computed tomography-guided (in 8 patients) core needle biopsies were performed in 83 patients with mediastinal lymphoma: all but one of the patients were at first diagnosis. All the biopsies were performed using a Menghini needle (from 1.2 mm to 1.8 mm). In the vast majority of cases the 1.8 mm gauge was employed. RESULTS: The overall sensitivity for the diagnosis of lymphoma was 81% (67/83 cases). In the remaining 16 patients the lymphoma diagnosis was reached either by mediastinoscopy (11 cases) or anterior mediastinotomy (3 cases) or core needle biopsy of the lung (1 case); one patient was treated directly after the needle biopsy had been unsuccessful because he needed rapid therapy. In 77/82 (93%) patients it was possible to assess the specific histotype. There was no operative mortality; all the biopsies were performed on an outpatient basis. INTERPRETATION AND CONCLUSIONS: Our data indicate that core needle biopsy should be considered as an effective and safe procedure in the diagnosis of patients with mediastinal lymphoma with the possibility of determining the tumor subtype and subsequent specific treatment.