Transthoracic aspiration cytology for the diagnosis of thoracic infection.

The article describes the use and results of transthoracic aspiration cytology for diagnosis of thoracic infection in a Thai referral chest center. We reviewed 60 cytologic samples, initially diagnosed as thoracic infection or inflammation among a total of 532 percutaneous transthoracic needle aspirations obtained from patients with clinical suspicion of malignancy in a period of 6 years. Follow-up clinical data were collected and correlated with cytologic diagnosis. We found specific microorganisms in 8 samples (13.33%). These included 4 cases of actinomycosis, 3 cases of cryptococcosis and a case of aspergillosis. Granulomatous inflammation was found in 12 samples (20.00%). Among these patients, 10 cases were verified as having tuberculosis. The remaining 40 samples (66.67%) revealed acute inflammatory exudate with no specific microorganism. Follow-up clinical data confirmed or assumed infection in 27 cases. Therefore, in patients with thoracic infection who presented with clinical suspicion of malignancy, from our experience, aspiration cytology revealed adequate morphology for accurate diagnosis which resulted in prompt specific treatment and better prognosis.

Fine needle aspiration cytology of thymoma.

Thymoma is the 2nd most common mediastinal tumor found in Thai people. Cytologically it has a characteristic biphasic cell pattern and can be differentiated from other mediastinal lesions. We reviewed 14 aspirated samples, initially diagnosed as thymoma among a total of 80 mediastinal aspirations, obtained during a period of 6 years. Revised cytologic diagnosis was made and compared with histopathology from needle biopsy, surgical biopsy and surgical removal in each case. All cytologic samples revealed a mixture of epithelial cells and lymphocytes in varying proportions. Histopathologic samples were available in 13 patients and showed 12 thymomas and 1 immature teratoma. While all thymomas revealed characteristic cytologic features, a case of mediastinal immature teratoma with unsatisfactory aspirated sample revealed resembling features and it was very difficult to differentiate such a tumor from thymoma.

Pulmonary actinomycosis: a study of 16 cases from Central Chest Hospital.

Actinomycosis is a relatively rare infection. This is a report of 16 patients with pulmonary actinomycosis diagnosed from 1990 to 1997 at the Central Chest Hospital, Thailand. Twelve patients were male and 4 were female, with a mean age of 59 years and a mean duration of symptoms of 9 months. Common symptoms were cough and hemoptysis. Mass-like shadowing was the most common radiographic finding (37%). The diagnosis, based on findings of typical sulfur granules, was reached by bronchoscopy (10 cases), surgery (5 cases) and fine needle aspiration (1 case). Endobronchial mass with luminal occlusion was the most frequent bronchoscopic finding (56%). Coexistent bronchial carcinoma was present in one specimen. Penicillin was given in 10 patients, 2 of whom (20%) were cured, 5 (50%) are currently on treatment and have achieved clinical response, whereas, the other 2 patients (20%) did not respond. Surgical resection was performed in 8 patients, all of whom recovered. An awareness of the full spectrum of actinomycosis manifestations will expedite diagnosis and optimize treatment.

Percutaneous transthoracic needle aspiration biopsy of localized lung lesions under fluoroscopic or ultrasound guidance.

Diagnostic percutaneous transthoracic needle aspiration biopsy (TNAB) under fluoroscopic or ultrasound guidance was performed in 195 patients with peripheral lung lesions. Final diagnosis was confirmed in 178 cases. These consisted of 150 cases of malignant and 28 cases of non-malignant lung lesions. Most cases of the latter belonged to the infectious group. Sensitivity of TNAB in the diagnosis of malignancy and lung infections were 92.0 per cent and 62.5 per cent respectively. Needles with different sizes were used and the needle number 18G was found to obtain both cytological and histological samples and showed the highest sensitivity. Among cases that TNAB provided both types of samples, histology alone showed higher sensitivity in diagnosis than cytology alone. However, by cytological examination, malignant tumors could be interpreted for definite cell type in more cases than by histology. To reach the highest diagnostic yield, the results of both samples should be combined. We also found that the aspirated samples with solid or semisolid features were more diagnostic than those with other features. Pneumothorax, the most common complication of the TNAB procedure, was found in only 2.0 per cent of our series.

Histologic types, staging, resectability, and smoking among Thai patients with lung cancer.

AIM: To examine the prevalence of cigarette smoking, histological types, staging at presentation and resectability among Thai patients with lung cancer. SETTING: A 500-bed referral cardiothoracic centre. METHOD: Prospective study with pre-defined outcome data, from January to December 1996. RESULTS: A total of 349 patients were histologically proved to have lung cancer. The mean age was 60 years (SD 12.5). There were 264 males and 85 females. 269 patients (77%) were smokers. Percentage of histopathologic types were 39 per cent adenocarcinoma, 30 per cent squamous cell carcinoma, 20 per cent undifferentiated cell carcinoma, and 11 per cent small cell carcinoma. The association with smoking is stronger in squamous cell carcinoma and small cell carcinoma and weaker in adenocarcinoma. Most patients (82%) were in advanced stages, stage 3B and 4.18 per cent of the patients were in stages eligible for surgery, i.e. stage 1, 2 and 3A. However, only 9.7 per cent of the patients were operable and 9.1 per cent were resectable. CONCLUSIONS: On reaching the diagnosis, most patients with lung cancer were in advanced stages of the disease, rendering a low resectability. The results emphasise the need for early diagnostic intervention in patients presenting with lung mass. Furthermore, preventive measures including a campaign against cigarette smoking, research into other possible aetiological factors should be more encouraged.

Mucinous cystadenocarcinoma of the lung.

One case of primary mucinous cystadenocarcinoma of the lung is recorded. The patient was a 67-year-old male with a peripheral mass of the right lung, treated by pneumonectomy. The tumor was made up of fibrous-walled cyst containing abundant mucinous material. Microscopically, it revealed the same morphology as its counterparts arising in other common sites: ovary, appendix and pancreas. The transitional change of the cystic lining from benign features resembling reactive respiratory epithelium to frank malignancy indicated that the tumor had the origin from the lung. This is a very rare intrapulmonary neoplasm that should be differentiated from metastatic lesion and mucinous bronchioloalvolar carcinoma due to different clinical courses and prognoses.