A Case of Papillary Adenocarcinoma Presenting with Multiple Cysts / 결핵및호흡기질환

A 23-year old woman was admitted to our hospital with hemoptysis. The chest X-ray showed reticulonodular opacity and multiple cysts throughout the entire lung field. The chest CT scan revealed numerous bilateral cysts with various sizes, some of them with thickened walls. An open lung wedge resection was performed. The resected specimen showed scattered small nodules, 0.3 to 0.6 cm in size. Microscopically, each nodule was composed of atypical glands with an occasional papillary architecture spreading to the alveolar septa, which were morphologically consistent with a papillary adenocarcinoma with a bronchioloalveolar carcinoma growth pattern. Immunochemically, the tumor cells were negative for the S-100 protein. The patient was diagnosed with an adenocarcinoma of the lung. A variety of diseases can produce or mimic multiple, thin-walled cysts in the lung. Lung cancer with multiple cysts is quite rare. Nevertheless, adenocarcinoma should be a diagnostic consideration. We report a case of a multiple cystic adenocarcinoma of the lung.

The Effect of Particulate Matter 10 from Asian Dust on the Production of Reactive Oxygen Species, TGF-beta, NF-kappaB, PDGF-alpha and Fibronectin in MRC-5 Fibroblast Cells / 결핵및호흡기질환

BACKGROUND: Dust clouds blown by the wind from the arid deserts of Mongolia and Northeast China are known as Asian dust storms. Ambient particulate matter with a diameter <10 micrometer (PM(10)) is associated with the exacerbation of respiratory diseases and increased mortality of heart and lung disease patients. The fibrotic effects of PM(10) of Asian dust to pulmonary fibroblast cells are unknown. This study examined the production of reactive oxygen species (ROS), TGF-beta, NF-kappaB, PDGF-alpha and Fibronectin in fibroblasts exposed to Asian dust particles. METHODS: Air samples were collected using a high volume air sampler (Sibata model HV500F) with an air flow of 500 L/min for at least 6 hours. The MRC-5 cells were exposed to 0, 50 and 100 microgram/mL of PM(10) for 24 hours. ROS was detected by measuring the level of oxidized DCF using FACS. TGF-beta, NF-kappaB, PDGF-alpha and fibronectin were detected by western blotting. RESULTS: There was no increase in the ROS, TGF-beta and PDGF-alpha levels in the MRC-5 cells exposed to PM(10). The NF-kappaB level was higher in the MRC-5 cells exposed to 50 and 100 microgram/mL of PM(10) for 24 hours. The fibronectin level in the MRC-5 cells after 24 hours incubation with 50 microgram/mL PM(10) was significantly higher than the control group (PM(10) 50 microgram/mL 113.27+/-8.65 of control, p=0.005). CONCLUSION: PM(10) from Asian dust increases the activation of NF-kappaB and fibronectin expression in MRC-5 fibroblast cells.

A Case of Pulmonary Langerhans' Cell Histiocytosis Mimicking Hematogenous Pulmonary Metastases

A 31-year-old man presented with a dry cough and exertional dyspnea. The chest X-ray showed multiple nodular opacities throughout the entire lung field. Chest computed tomography (CT) revealed variable-sized nodules with a peribronchiolar or centrilobular distribution, some of which revealed thick-walled cavitary change. Based on the chest CT findings, it was initially assumed that metastatic lung nodules with hematogenous spread were present; therefore, we performed an open lung biopsy. On microscopic examination, several compact cellular interstitial infiltrates composed of Langerhans' cells, eosinophils, and lymphocytes were observed. Immunochemically, the Langerhans' cells showed strong cytoplasmic staining for S-100 protein. Based on these findings, the patient was diagnosed with Langerhans' cell histiocytosis of the lung. High-resolution CT of the chest is a useful, sensitive tool in the diagnosis of pulmonary Langerhans' cell histiocytosis (PLCH). A typical radiologic finding of PLCH is irregularly shaped cysts. The radiological finding in this case of nodular opacities throughout the lung fields only without cysts is rare in PLCH. We report a case of PLCH with atypical multiple nodules mimicking hematogenous metastatic lung nodules.