[Fulminant hepatic failure related to immunosuppressive therapy in an asymptomatic HBsAg carrier with idiopathic interstitial pneumonia].

A 72-year-old woman who was an asymptomatic HBsAg carrier was admitted because of productive cough and dyspnea on exertion. After close examination, she was given a diagnosis of idiopathic interstitial pneumonia (IIP), and treated with glucocorticoids and cyclophosphamide. However, fulminant hepatitis type B developed and the patient died of respiratory complications stemming from the acute exacerbation of IIP. To avoid such outcomes, extra caution should be taken when planning immunosuppressive therapy for HBsAg carriers.

[Peripheral carcinoid tumor of the lung presenting as a solitary mass shadow on a chest roentgenogram and diagnosed by CT-guided percutaneous needle biopsy].

A 59-year-old woman was referred to our clinic because a solitary mass shadow (2.5 cm in diameter was seen in the left lower lung field on a chest roentgenogram. Transbronchial biopsy via a fiberoptic bronchoscope did not yield a definitive diagnosis. Examination of a specimen obtained by CT-guided percutaneous needle biopsy revealed that the tumor consisted of small cells proliferating in a solid, tubular, pseudoglandular, and follicular pattern, which suggested the diagnosis of carcinoid. A left lower lobectomy was performed, and several hilar and mediastinal lymph nodes were also removed. The tumor cells did not show pleomorphism of nuclei, mitotic activity, or necrosis. Grimelius and immunohistochemical stains for chromogranin. A, neuron-specific-enorase, synaptophysin, and serotonin were positive. These findings confirmed the diagnosis of carcinoid CT-guided percutaneous needle biopsy can be useful for the diagnosis of peripheral carcinoid and other peripheral lung tumors.

Role of superoxide anions in airway hyperresponsiveness induced by cigarette smoke in conscious guinea pigs.

To investigate the involvement of superoxide in airway hyperresponsiveness and bronchoconstriction induced by cigarette smoke (CS), we evaluated the effects of superoxide dismutase (SOD), a scavenger of superoxide anion, and apocynin, an inhibitor of superoxide anion-generating NADPH oxidase in phagocytes, on the airway responses induced by CS in conscious guinea pigs. Airway responsiveness was assessed by PC200Mch, the concentration required to produce a doubling in the baseline specific airway resistance (sRaw) to an inhaled methacholine aerosol, in nonanesthetized spontaneously breathing animals. Before being exposed to ten puffs of CS, animals inhaled either SOD (5,000 units/ml or 25,000 units/ml) or vehicle. Although SOD did not affect PC200Mch in the air control group, this agent significantly reduced the CS-induced airway hyperresponsiveness. Repeated administration of apocynin (12 mg/kg for 4 days) did not affect PC200Mch after exposure to CS. These data suggest that the superoxide from CS was involved in the airway hyperresponsiveness induced by CS, whereas phagocytic reactive oxygen species were not. The data also suggest a potential therapeutic role for antioxidants in airway hyperresponsiveness.

Superoxide mediates cigarette smoke-induced infiltration of neutrophils into the airways through nuclear factor-kappaB activation and IL-8 mRNA expression in guinea pigs in vivo.

We examined the hypothesis that superoxide mediates infiltration of neutrophils to the airways through nuclear factor (NF)-kappaB and interleukin-8 (IL-8) after acute exposure to cigarette smoke (CS) in vivo. Male Hartley strain guinea pigs were exposed to air or 20 puffs of CS and killed 5 h after the exposure. The differential cell count of bronchoalveolar lavage fluid and specific myeloperoxidase enzyme assay demonstrated that acute exposure to CS caused neutrophil accumulation to the airways and parenchyma, respectively. Acute exposure to CS increased DNA-binding activity of NF-kappaB in the lung. Acute exposure to CS also increased IL-8 messenger RNA (mRNA) expression in the lung. Pretreatment of guinea pigs with recombinant human superoxide dismutase (rhSOD) aerosols reduced the CS-induced neutrophil accumulation to the airways. Both activation of NF-kappaB and increased IL-8 mRNA expression were also inhibited by the pretreatment of rhSOD aerosols. Strong immunoreactivities for p65 and p50 were detected in the nuclei of alveolar macrophages after acute exposure to CS. The signal for IL-8 mRNA expression was demonstrated in the alveolar space after acute exposure to CS. Neither significant immunoreactivities for p65 and p50 nor IL-8 mRNA signals were observed in airway epithelium. These observations suggest that acute exposure to CS initiates superoxide-dependent mechanism that, through NF-kappaB activation and IL-8 mRNA expression, produces infiltration of neutrophils to the airways in vivo. It was also suggested that the alveolar macrophage is one potential source of NF-kappaB activation and IL-8 mRNA expression after acute exposure to CS.

[Adenocarcinoma of the lung associated with acute promyelocytic leukemia and miliary tuberculosis].

A 44-year-old man was admitted to the hospital because of acute promyelocytic leukemia. A nodular shadow (2.5 cm in diameter) was seen in the right upper lung field on a chest roentgenogram. During the administration of combination chemotherapy for the leukemia, diffuse granular shadow appeared in all lung fields. Transbronchial lung biopsy findings indicated tuberculosis. The patient was given streptomycin, isoniazid, rifampicin and ethambutol, but the nodular show enlarged and a pleural effusion appeared on the right side. Cytologic examination of the pleural effusion revealed adenocarcinoma. Similar findings were obtained from a second transbronchial lung biopsy. The frequency of association of lung cancer and other malignancy is about 4%. The incidences of primary lung cancer found during the course of active tuberculosis, active pulmonary tuberculosis found during the course of primary lung cancer, and tuberculosis found during the course of acute leukemia are 0.9 to 1.4%, 0.4 to 4.3%, and 2.4 to 4.5%, respectively. To our knowledge, this is the first case in Japan in which adenocarcinoma of the lung was associated with acute promyelocytic leukemia and tuberculosis.

Large cell carcinoma of the lung metastatic to nuchal muscle.

Clinically apparent hematogenous skeletal muscle metastases from lung cancer are extremely rare. We present a 72-year-old man with a large cell lung carcinoma metastatic to nuchal muscle. Cervical computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a well-defined mass in the left splenius capitis muscle. A percutaneous needle biopsy was performed to establish a diagnosis. Localized skeletal muscle swelling may rarely prove to be metastases in patients with lung cancer, but should be investigated in the case of muscle swelling.