Self-learning experience in transbronchial needle aspiration in diagnosis of intrathoracic lymphadenopathy.

BACKGROUND: Lack of a training program and experience result in underutilized transbronchial needle aspiration (TBNA). Pulmonologists who are not graduated from Europe or the United States might have little chance to learn and gain experience in this procedure. OBJECTIVE: To determine the authors' diagnostic yield from self-learning TBNA in diagnosis of intrathoracic lymphadenopathy. MATERIAL AND METHOD: After reviewing a videotape recorded TBNA procedure repetitively and receiving training in tracheobronchial lung model, the authors performed TBNA according to standard techniques using 21-guage cytology needles connected to a flexible bronchoscope in diagnosis of intrathoracic lymphadenopathy and performed data collection on all TBNA procedures at Ramathibodi Hospital, a tertiary university hospital in Bangkok, Thailand between January 1, 2006 and December 31, 2007. RESULTS: Thirty-eight consecutive patients were examined Twenty-seven nodes (71.1%) were malignancies and II nodes (28.9%) were benign diseases. During the first 6-month, the authors' diagnostic yield and frequency of adequate specimens were low. With some modification of the TBNA technique and learning experience, the frequency of inadequate specimens significant decreased from 36.4% to 0% (p = 0.03). Although the diagnostic yield increased from 45.5% to 84.6%, it did not reach statistical significance (p = 0.09). No complication, in either the patients or the bronchoscopes, was found. CONCLUSION: TBNA is a safe procedure that can be self-mastered by pulmonologists with interest, intent, and who exert themselves. TBNA performance will be improved over time with practice.

The Sarcocystis-cyst containing beef and pork as the sources of natural intestinal sarcocystosis in Thai people.

BACKGROUND: Human intestinal sarcocystosis is a zoonotic disease caused by two coccidians, i.e. Sarcocystis fusiformis (syn. S. bovihominis, S. hominis) due to consumption of raw infected beef and Sarcocystis meischeriana (syn. S. suihominis) due to consumption of infected raw pork. In 1987, survey of the macroscopic S. fusiformis cysts in market beef mainly from old water buffalos aged more than 15 years were commonly observed in Bangkok. In 2005, the macroscopic cyst was no longer seen in beef of cattle and water buffalo aged less than three years. OBJECTIVE: The epidemiological investigation of Sarcocystis spp. infected meat in Bangkok and Lampang. MATERIAL AND METHOD: Samples for each of the tongue and beef of cattle and water buffalo, pork from Bangkok markets and pork of domestic swine from some remote villages in various subprovinces (Ampurs) in Lampang were obtained for microscopic examination by H and E and selectively by PAS staining. RESULTS: The microscopic S. fusiformis cysts were seen in all five specimens of tongues and ten specimens of muscles of cattle and water buffalo obtained from fresh-food markets in Bangkok. Ten samples of pork from Bangkok markets revealed no coccidian infection. The microscopic S. meischeriana cysts were seen in three specimens of swine muscles collected from two subprovinces in Lampang. CONCLUSION: The present merozoites in coccidian cysts retrieved from beef and pork are similar to those previously observed in human intestine. This may histologically indicate an invasive sarcocystosis by both species leading to a condition presently known as chronic inflammation of undetermined etiology in man.

Giant cell reparative granuloma concurrent with squamous cell carcinoma of the temporal bone: a case report and review of the literature.

A case of giant cell reparative granuloma concurrent with squamous cell carcinoma of the right temporal bone in a 44-year-old man with clinically presenting otorrhea from the mass of the right acoustic canal with hearing loss is reported. The histopathological examination of the lesion characterizes by multinucleated giant cells with in a fibroblastic stroma and area of keratinizing squamous cell carcinoma. GCRG may have been a local reaction provoked by the squamous cell carcinoma. Clinical and pathological features with briefly reviewed relevant literatures of temporal GCRG describing 24 cases are discussed. The patients have the mean age of 34.8 years. The ages of the patients ranged from 4 months to 72 years old. Temporal bone GCRG shows a male predilection of approximately 3:1. The frequently presenting symptoms of temporal bone GCRG are hearing loss, mass, tinnitus, otalgia, otorrhea, vertigo, headache, facial weakness, and diplopia. This is the first reported description in the literature of temporal bone GCRG concurrent with squamous cell carcinoma.

Epstein-Barr virus associated lymphoepithelial carcinoma of the parotid gland; a clinicopathological report of three cases.

Lymphoepithelial carcinoma is a relatively uncommon malignant tumor of the salivary gland demonstrating malignant epithelial cells with dense lymphoid stroma. The authors report three cases of lymphoepithelial carcinoma associated with Epstein-Barr virus of the right parotid gland with clinically presenting as painless, gradual enlargement of the preauricular mass. The histopathologic examination of the parotid gland is characterized by malignant epithelial cells with dense lymphoid stroma. Immunohistochemical stains show positive reactivity to cytokeratin and p53 in malignant epithelial cells. In situ hybridization of the Epstein-Barr virus-encoded Ribonucleic acid shows positivity in malignant epithelial cells. Clinical and pathologic features with relevant literatures are discussed. These are the first reported cases of primary parotid lymphoepithelial carcinoma associated with Epstein-Barr virus infection in Thailand and Southeast Asia.

Bilateral Kuttner tumor of submandibular glands; a case report and review of the literature.

Kuttner tumor is a relatively uncommon disease of the salivary gland. It is also known as chronic sclerosing sialadenitis or cirrhosis of the submandibular gland. The examination of the submandibular gland characterizes clinically by a firm swelling of the gland, and histologically by progressive periductal sclerosis, dense lymphocytic infiltration with lymphoid follicle formation, reduction of the secretory gland parenchyma and fibrosis. Clinical, cytologic, histopathologic and immunohistopathologic features with briefly reviewed relevant literature describing 231 cases are discussed. The patients with the mean age of 44 years (range 13-81 years) had submandibular masses known to be present for 1 week to 55 years (mean 23.2 years). There is a slight predilection for occurrence in men. This is the first reported description of bilateral Kuttner tumor of submandibular glands in Thailand. It was initially diagnosed as a primary submandibular gland neoplasm that fine needle aspiration revealed to be chronic sialadenitis.