Childhood primary pulmonary neoplasms.

Nine children (6 boys, 3 girls) were diagnosed with a primary endobronchial or pulmonary parenchymal neoplasm. The average age at diagnosis was 9 years. Presenting complaints included cough (7), fever (5), pulmonary infection (3), respiratory distress (3), weight loss (2), pain (2), and hemoptysis (1). Pulmonary x-rays showed persistent atelectasis, pneumonic infiltrates or mass lesions. A computed tomography scan was performed in 8. Five of six endobronchial tumors were diagnosed with bronchoscopy and biopsy. Treatment consisted of thoracotomy and pulmonary resection in 7 cases and laser resection in 2. The pathologic diagnoses were bronchial carcinoid (3), bronchial mucoepidermoid carcinoma (1), inflammatory pseudotumor (plasma cell granuloma) of the bronchus (2) and of the lung parenchyma (1), fibrosarcoma (1), and rhabdomyosarcoma (1). Postoperative chemotherapy was given only to the patient with pulmonary rhabdomyosarcoma; this child died. One child has developed a local recurrence while 7 children are alive and free of disease at an average of 2.4 years postresection. Pulmonary neoplasms are unusual in the pediatric age group and represent a wide spectrum of pathology. Including the present series, 383 tumors have been described. Seventy-six percent were malignant. Early investigation and surgical intervention are essential in children with persistent pulmonary symptoms or x-ray abnormalities. In most cases, the prognosis is excellent with complete surgical resection; however, malignancies other than bronchial adenoma are associated with significantly mortality.

Endobronchial inflammatory pseudotumor of the lung.

Inflammatory pseudotumor (also called plasma cell granuloma, histiocytoma and x-anthofibroma) is a benign, slow growing lesion which may present with cough, dyspnea, hemoptysis and unresolving pneumonia or can be discovered radiographically as a localised lesion. It has been reported in individuals up to 70 years old, but approximately two-thirds have developed in individuals under 30 years of age. The sex incidence is approximately equal. Inflammatory pseudotumors of the lung are usually peripheral lesions but may occasionally be endobronchial. We report the case of an endobronchial inflammatory pseudotumor in a 17-year-old girl who presented with unresolving right-sided pneumonia. Appropriate radiological, bronchoscopic and histopathological investigations lead to accurate pre-operative diagnosis and early complete surgical resection through a limited right main bronchus incision (bronchotomy). The patient made good postoperative recovery and an excellent prognosis is anticipated.

Mycobacterial spindle cell pseudotumor of the lung.

Mycobacterial spindle cell pseudotumor (MSP) is a rare benign lesion characterized by local proliferation of spindle-shaped histiocytes containing acid-fast mycobacteria. Most reported cases of MSP occur in the lymph nodes, skin, spleen, and brain in patients who are immunocompromised, particularly following solid organ transplant and in those with AIDS. This is a case report of a patient with AIDS who presented with cough, generalized weakness, and fatigue, who was found to have multilobar lung masses that were MSP, which to our knowledge has not yet been reported in the literature.

[Computed tomography in endobronchial mucus accumulation]. / La tomografia computerizzata nella malattia da accumulo endobronchiale di muco.

To investigate the value of CT in depicting endobronchial mucoid collections, the authors retrospectively reviewed the CT scans of 22 patients, 14 with mucous plugs, 7 with mucoid pseudotumors, and one with a bronchocele due to bronchial atresia. Atelectasis could be seen in 11 of 14 patients with mucous plugs. In 12 of 14 patients with mucous plugs CT showed the involved bronchi filled by fluid representing abnormal mucus accumulation. In the patients with atelectasis CT showed mucus-filled bronchi as low-attenuation branching structures (mucoid bronchogram). All the mucoid pseudotumors appeared as low-attenuation (< 20 HU) polypoid wall lesions with no involvement of the bronchial walls. In a patient with bronchial atresia CT showed a solitary pulmonary nodule (representing the obstructed and dilated bronchus filled by mucus) surrounded by peripheral pulmonary hyperinflation. Characteristically, the endobronchial mucoid collections never enhanced after bolus contrast medium. Endobronchial mucoid collections had to be differentiated from endobronchial neoplasms. In some cases bronchoscopy was necessary to make the differential diagnosis. In conclusion, CT is a valuable tool with good sensitivity and specificity in diagnosing endobronchial mucoid collections.