Diagnostic criteria and research progress on lung allograft pathology / 器官移植

In recent years, the quantity of lung transplantation has been gradually increased in China along with the accumulation of surgical techniques and postoperative management experience of lung transplantation. Multiple lung allograft complications may occur after lung transplantation, mainly including primary graft dysfunction (PGD) caused by ischemia-reperfusion injury (IRI) of the lung allograft, acute and chronic rejection, opportunistic infection or lymphoproliferative disorder of lymphoid tissues induced by the decrease of host immunity due to postoperative use of immunosuppressants, etc. The diagnosis of complications after lung transplantation mainly relies on biopsy of the lung allograft. In this article, the brief history of lung allograft pathology, main approaches and pathological processing techniques of lung allograft biopsy, major complications after lung transplantation and pathological diagnostic criteria were elucidated, aiming to provide reference for targeted management of these complications in clinical practice.

Value of non-real-time radial probe endobronchial ultrasound guided transbronchial lung biopsy in the diagnosis of peripheral lung cancer and analysis of false negative results / 中国内镜杂志

Objective To explore the diagnostic value of non-real-time radial probe endobronchial ultrasound (RP-EBUS) guided transbronchial lung biopsy (TBLB) for peripheral lung cancer and analysis of false negative results. Methods A retrospective analysis of the clinical and imaging data of 256 patients with peripheral lung cancer between March 2013 and December 2016, all the cases underwent non-real-time RP-EBUS guided TBLB, then evaluate its significance in the diagnosis of peripheral lung cancer and analyze the reasons of false negative results. Result In 256 patients who received non-real-time RP-EBUS examinations, 73.83% (189/256) of peripheral lung cancer were detected by RP-EBUS and the positive rate of RP-EBUS guided TBLB was 61.33% (157/256). The positive rate of non-real-time RP-EBUS guided TBLB was correlated with lesions >2 cm in diameter, lesions close to visceral pleura, ultrasonic image characteristics and the RP-EBUS probe surrounding by lesion (P < 0.05). The positive rate of non-real-time RP-EBUS guided TBLB was not correlated with RP-EBUS probe passed through lesions and times of biopsy (P > 0.05). Complications including bleeding, chest pain and pneumothorax recovered spontaneously. Conclusion Non-real-time RP-EBUS guided TBLB was a practical technology for diagnosis of peripheral lung cancer with high diagnostic rate and good safety. Lesion size, connection to visceral pleura, ultrasonic image characteristics and the RP-EBUS probe surrounding by lesion influenced the diagnostic yield. Improvement of operative skills can reduce false negative results.

Aproximación diagnóstica a las enfermedades pulmonares difusas / Diagnostic approach to diffuse pulmonary diseases

Las enfermedades pulmonares difusas representan un grupo de enfermedades que comparten un mismo criterio radiológico, existiendo más de 200 entidades que se presentan como tal. La clínica es fundamental para aproximar el diagnóstico etiológico que muchas veces resulta complejo. Tos y disnea progresiva son los síntomas clínicos característicos de estas enfermedades y se acompañan de la radiografía de tórax con opacidades difusas como método radiológico inicial. El estudio en general es multi- disciplinario incluyendo patrones radiológicos de la tomografía axial de tórax, estudio de función pulmonar, lavado bronquioal- veolar y biopsia pulmonar en algunos casos.

The diffuse lung diseases are a group of conditions that share common radiological criteria. There are over 200 causes. The clinic skill is essential to approximate the etiologic diagnosis, often complicated. Cough and progressive dyspnea are the clinical features of these diseases and are accompanied by chest radiography with diffuse opacities as the initial radiological method. The study is generally multidisciplinary and including radiological patterns in computer tomography of the chest, lung function study, bronchoalveolar lavage and lung biopsy in some cases.

Role of fiberoptic bronchoscopy and utility of bronchial washings and brushings in the diagnosis of lung diseases.

Transbronchial lung biopsy via fiberoptic bronchoscope is an extremely useful technique by which bronchial as well as lung biopsies along with brushings and washings can be easily and safely taken.1 Fiberoptic bronchoscopy (FOB) was performed and biopsies were done in 250 patients. In addition, bronchial brushings and washings were also taken in 140 and 115 cases, respectively. Adequate material was obtained in 242 cases. The cases were broadly classified into neoplastic and nonneoplastic categories. Malignancies and specific granulomatous diseases, tuberculosis and sarcoidosis were the main diseases diagnosed. Brushings showed a sensitivity of 88.2% and a specificity of 98.9% for the diagnosis of neoplasms. On the other hand, washings had only a 34.9% sensitivity and a 98.6% specificity in diagnosing neoplastic disorders. We concluded that FOB is a safe and effective tool in the diagnostic work-up of suspected malignancies and neoplastic lung diseases.

Sarcoidosis in north indian population: A retrospective study.

Background. Sarcoidosis is a systemic granulomatous disease of unknown origin most commonly involving the lungs. Sarcoidosis is frequently misdiagnosed due to its clinico-radiological resemblance to tuberculosis (TB). Hence, the present study was undertaken with the aim of studying the clinico-radiological profile of sarcoidosis in the Indian context. Methods. We retrospectively studied 146 patients diagnosed to have sarcoidosis during the period 2001-2010 at one of the respiratory units at Vallabhbhai Patel Chest Institute. Results. Majority of them (70%) were more than 40 years of age; females comprised 58.2% of the patients. Before coming to our clinic, 30% patients had been misdiagnosed to have TB. Cough (89.7%) was the most common presenting symptom; joint symptoms (28.8%) and end inspiratory crepitations at lung bases (49.3%) were other salient manifestations. Cutaneous involvement and digital clubbing were rarely seen. Pulmonary function testing showed restriction with impaired diffusion in 72.7% patients. The most common radiological feature was bilaterally symmetrical hilar lymphadenopathy. Transbronchial lung biopsy (TBLB) had a very high diagnostic yield (90.8%). Conclusions. Sarcoidosis is often misdiagnosed as TB in India. Transbronchial lung biopsy has high diagnostic yield in sarcoidosis.

A case of pulmonary siderosis confirmed by bronchoalveolar lavage and transbronchial lung biopsy / 결핵및호흡기질환

Pulmonary siderosis is one kind of pneumoconiosis, occurs from chronic inhalation of iron or iron oxide. Inhaled iron dust is deposited in the intra-alveolar spaces, which leads to radiological changes and respiratory symptoms. It is diagnosed by iron exposure history, radiological changes, and the evidence of intra-alveolar iron deposit. We have experienced a case of pulmonary siderosis which was confirmed by bronchoalveolar lavage and transbronchial lung biopsy, so report it with a review of literature.

Diagnostic value of transbronchial lung biopsy combined with immunohistochemistry in pulmonary interstitial fibrosis and the clinical significance / 第三军医大学学报

Objective To evaluate the diagnostic value in pulmonary interstitial fibrosis by transbronchial lung biopsy(TBLB) and immunohistochemistry. Methods The lung tissue samples were obtained from 20 cases of pulmonary fibrosis due to different causes, including 9 cases of idiopathic pulmonary fibrosis(IPF) and 11 cases of pulmonary fibrosis caused by chronic obstructive pulmonary disease (PF COPD), by means of transbronchial lung biopsy. Hematoxylin and eosin staining, Masson trichrome staining and immunostaining with anti type Ⅲ collagen and anti type I collagen multiclonal antibodies were performed. Differences in clinical characteristics, pathological manifestations, levels, types and distribution of proliferation of collagen fibers between IPF and PF COPD were compared. Results The proliferation of collageneous fibers was significantly higher in IPF than in PF COPD( P

Diagnosis of 101 Cases of Unknown Lung Mass / 中国医师杂志

Objective To explore the diagnostic value of transbronchial lung biopsy(TBLB), CT-guided percutaneous lung biopsy and sputum cytology for unknown lung mass. Methods The clinical data of 101 inpatients with unknown lung mass were retrospectively analyzed. Results Among the 101 cases, 73 cases underwent fibrous bronchoscopic examination, 18 cases underwent CT-guided percutaneous lung biopsy, and 10 cases underwent both of them.The diagnostic coincident rate of the two methods was 70%. 54 cases were diagnosed lung carcinoma by pathology. The sensitivity and specificity of TBLB for diagnosing central type of tumor were 88% and 100%, respectiely, and those for diagnosing peripheral type of tumor were 43% and 100%, respectively. The sensitivity of CT-guided percutaneous lung biopsy was 80%,while the specificity was 100%. Complication frequency in the CT-guided percutaneous lung biopsy was 22%, and much higher than that (12%) in the TBLB. Only 30% cases underwent sputum cytology examination, and the positive rat was 6%. Conclusion Sputum cytologic examination is a convenient and cheap method, but its diagnostic rate is relatively low. TBLB was the first choice for examining central type of lung mass. For the peripheral type of lung mass, examination method was selected based on the location and size of the mass.

A Case of Chemical Pneumonitis Induced by Ingestion of Hydrocarbon / 결핵

A 33-year-old woman was presented with dyspnea and chest discomfort after indigesting approximately 500ml of oil paint brush washing fluid. Hypoxic symptoms and radiographic infiltrates rapidly progressed. The patient was intubated and received mechanical ventilation. Bronchoalveolar lavage and transbronchial lung biopsies were performed. The CT scan of the lung showed bilateral extensive pneumonitis with necrosis and the lung tissue pathologic findings showed diffuse alveolar damage with extensive necrosis and numerous lipidladen macrophages. After intensive medical care with mechanical ventilation, her symptoms and radiological findings improved.

A Case of lymphangitic carcinomatosis of lung presented as rapidly exacerbating reticulonodular infiltrates / 결핵

A 52-year-old woman was presented with 2-week history of increasing dyspnea and dry cough. The chest radiograph revealed bilateral reticular infiltrates. Radiographic infiltrates were rapidly progressed and symptoms from hypoxemia were aggravated. The patient was intubated and bronchoscopy with transbronchial lung biopsies was performed. Biopsies revealed lymphatic vessels plugged by nests of metastatic adenocarcinoma. She died 11 days after admission despite of intensive ventilatory support. We had difficulties in the diagnosis of lymphangitic lung carcinomatosis at initial presentation of her illness because the progression was unusually rapid. Lymphangitic lung carcinomatosis should be included in the differential diagnosis of patients showing rapidly progressive interstitial radiographic findings. Also, transbronchial lung biopsy may be a useful tool to confirm the diagnosis.

Diagnostic Value of Transbronchial Lung Biopsy: Including Diagnostic Yield According to Tumor-bronchus Relationship / 결핵

BACKGROUND: Transbronchial lung biopsy (TBLB) is a relatively simple and convenient procedure to obtain lung tissue in from a patient, with with diffuse or localized lesion on chest radiographs, whose disease cannot be diagnosed through routine tests. The authors tried to evaluate the diagnostic value of TBLB, especially, the concordance between CT scan and TBLB with respect to the location of the lesion, and and diagnostic yield according to tumor-bronchus relationship. METHOD: We reviewed the medical records, plain chest films, and chest CT scans of 278 patients who underwent TBLB at Kyungpook National University Hospital between January 1996 and June 1998. RESULTS: One hundred and sixteen (41.7 %) patients were diagnosed by TBLB. Diagnostic yield of TBLB in of malignant tumor tumors tended to be higher than that of benign disease diseases (64.7 % versus 53.9 %, p=0.09). Of primary lung cancers, TBLB was more diagnostic in adenocarcinoma and small-cell carcinoma than the rest other cell types (p<0.01) and, of benign diseases, more diagnostic in tuberculosis than in non-tuberculous diseases (p<0.05). According to the location of tumor, there was There was no significant difference in the diagnostic rate according to the location of the tumor. The diagnostic rate tended to increase with the size of tumor (p=0.06). In benign disease, there There was no difference in the The diagnostic rate of TBLB did not differ according to the pattern of lesion in benign diseases(.) but in malignant disease, However, in malignant diseases TBLB was more diagnostic in diffuse/multiple nodular lesion lesions than in localized lesion lesions (p<0.05). According to the tumor-bronchus relationship, TBLB was more diagnostic in type I/II groups than the rest in other types. CT scan and TBLB showed a strong correlation with respect to the localization of the lesion (gamma=0.994, p<0.01). CONCLUSION: The above results showed show that TBLB is useful in the diagnosis of lung disease. CT scan and TBLB showed a strong correlation in deciding in determining the location of the lesion. Diagnostic yield of TBLB is higher in the lesion lesions with 'bronchus sign' (type I and II). It is anticipated that (delete) TBLB and other diagnostic methods such as transthoracic needle aspiration have complementary role in diagnosing lung disease. are expected to complement one another in the diagnosis of lung diseases.

A Case of Pulmonary Cryptococcosis diagnosed by Transbronchial Lung Biopsy / 대한내과학회지

Cryptococcosis has been considered as an opportunistic mycosis associated with depressed immune function of the host. However, it may develop in healthy individuals without any underlying disease. Recently, we experienced a case of pulmonary cryptococcosis in healthy person. The patient had experienced hemoptysis and dry cough persisted for a month. The chest X-ray and CT showed multifocal pneumonic consolidation containing small cavities in RLL, LUL and LLL. Fiberoptic bronchoscopy didn't revealed endobronchial lesion in both lungs. Transbronchial lung biopsy(TBLB) was done, and we could diagnose pulmonary cryptococcosis by means of histopathologic examination. Clinical evaluations did not reveal immune deficiency or evidence of other specific disease. The patient was treated with fluconazole and resulted in clinical and radiological improvement. Cryptococcosis has well known for its meningeal involvement. Although primary pulmonary cryptococcosis is rare, we must think of it when meet mass or nodular lesion on the chest radiology.

A Case of Acute Eosinophilic Pneumonia / 결핵

Most cases of eosinophilic pneumonia reported previously have followed a chronic course. The case presented here was acute in onset, suggesting a acute eosinophilic pneumonia. A model of criteria for acute and chronic eosinophilic pneumonia was made by Umeki in 1992. A previously healthy young man presented with cough, sputum, fever, and multiple small nodules on the chest radiograph. We confirmed eosinophilic pneumonia with bronchoalveolar lavage analysis and transbronchial lung biopsy. This case examplifies the recently descrived acute eosinophilic pneumonia.

Sensitivity and Specificity of Transbronchial Lung Biopsy (TBLB)

Twenty-five patients underwent flexible fiberoptic bronchoscopic examination under fluoroscopic guidance. All patients had an endoscopically invisible pulmonary lesion suggestive of malignancy. A diagnostic specimen was obtained in 23 of the 25 patients (92%). A pathological finding of lung cancer was obtained in 14 patient (56%) through the transbronchial lung biopsy (12 cases) and by washing cytology (2 cases). Remaining 11 patients who were undiagnosed for pulmonary malignancy were followed by clinically had roentgenographically over 6 months. We evaluated the sensitivity and specificity of the TBLB procedures including brushing cytology and noted an 82.4% in sensitivity and 100% in specificity.