A combination of intravenous immunoglobulin and pulse methylprednisolone extended survival in pulmonary alveolar proteinosis with chronic interstitial pneumonitis: a case report.

Pulmonary alveolar proteinosis (PAP) is characterized by intra-alveolar accumulation of lipoproteinaceous material. The severe chronic pulmonary disease and susceptibility to pulmonary infection is a prominent feature of the disease. We reported a case of postnatal-onset PAP and chronic interstitial pneumonitis in a girl with chronic respiratory distress since she was 5 months of age. A lung biopsy confirmed the diagnosis. The therapeutic bronchoalveolar lavages, a short trial of granulocyte colony-stimulation factor (G-CSF) and a combination of low dose methylprednisolone and hydroxychloroquine were used at different times without noting satisfactory improvement. Intravenous immunoglobulin (IVIG) and pulse methylprednisolone were given monthly with gradual recovery. She did not require oxygen supplement after 21 months of this combination. Our report suggested that IVIG and pulse methylprednisolone might have a potential role in the treatment of PAP with chronic interstitial pneumonitis.

Optimal level of sections for definite diagnosis in transbronchial biopsy and pleural biopsy specimens.

Objective: To determine optimal level of serial section in transbronchial and pleural biopsy that yield maximal definite diagnosis. Methods: A cross sectional study of 118 transbronchial biopsy and pleural biopsy specimens submitted with serial sectioning in 3 levels were performed. Specimens of 1 mm. in diameter were serially cut and slides at levels I, II, III (120, 240 and 360 µm.) from initial exposure of tissue in paraffin blocks were studied, and specimens of 2-3 mm. in diameter were cut at levels I, II, III (0, 120 and 240 µm.) after tissues in paraffin blocks were trimmed to expose maximal diameter. Comparisons of diagnoses of each level were done. Results: The percentages of definite diagnoses were 89, 95.8 and 93.2 in sections of level I, II and III, respectively. Chronic granulomatous lesions were found in section level II more than other levels, but there was no statistical significance. (P value 0.131, Chi-Square test) Conclusion: Transbronchial and pleural biopsy specimens should be cut deep to level II, one slide for hematoxylin-eosin staining and 3 unstained slides for further investigation.

Pulmonary sarcoidosis: Classic radiographic finding.

We present the classic image findings of pulmonary sarcoidosis which is a rare disease in our country. A 31-year-old woman presents with an abnormal annual check up chest radiograph, which showed bilateral, symmetrical hilar nodes and a right paratracheal node enlargement without abnormal lung parenchyma. The physical examination, complete blood count, and blood chemistry, were unremarkable. Although many diseases can present with this abnormal image finding, but the combination of the nodal group involvement, the presence of intranodal calcification and nodal enhancement pattern, along with other pertinent positive findings on the chest CT scan, the diagnosis could be made.

Benign clear cell tumor of the lung: A case report.

A case of benign clear cell tumor of the lung in Thai male patient 22 years of age is presented. It is rare tumor with uncertain histogenesis. The perivascular epithelioid cells are proposed to be the proliferating cell type in the group of clear cell tumor, angiomyolipoma and lymphangio-leiomyomatosis. Most of clear cell tumor of the lung is benign and cured by tumor resection.

Radiopathological Conference: Differences in CT findings of mediastinal lymphadenopathy between metastasis and tuberculosis not always applicable.

A case report of male patient with a right neck mass is discussed .The initial diagnosis was tuberculosis. The plain film chest and CT chest also demonstrated mediastinal lymphadenopathy. The autopsy and pathology findings indicated adenocarcinoma of lung.

Pulmonary leiomyoma in an HIV-infected child: A case report.

Smooth muscle tumors, benign or malignant, are rare in childhood. However, a higher incidence is found in HIV infected children with a reported association with Epstein-Barr Virus. We report a case of a 6-year-old HIV-infected girl who presented with a right upper lung mass and pulmonary tuberculosis. Histopathology of the resected mass showed a bronchiolar leiomyoma with adjacent noncaseous granulomas. Staining for AFB was negative. Polymerase chain reaction amplification for Mycobacterium tuberculosis complex was weakly positive. PCR amplification for EBV yielded a negative result.

Bronchioloalveolar carcinoma presenting with obstructive jaundice: A case report.

An unusual case of bronchioloalveolar carcinoma of the lung presented with chronic cough and obstructive jaundice in an adult Thai male, who subsequently died after having undergone palliative treatment with percutaneous transhepatic biliary drainage (PTBD). Autopsy finding included typical bronchioloalveolar carcinoma diffusely distributed in both lungs and its metastatic tumors at paratracheal nodes, both adrenal glands, spleen, liver and soft tissue around common bile duct that caused obstruction of biliary tract mimicking hepato-biliary cancer, clinically. In addition to histopathologic evaluation, the ultrastructural finding of dense bodies reminiscent of lamella bodies, and the identical DNA index of near diploid aneuploid cell cycle of the tumors in the lung and liver, confirmed the bronchioloalveolar carcinoma of the lung as the primary tumor that had a widespread metastasis.

Endobronchial hamartoma treated by laser resection.

A 42 years old male was transferred to the hospital for the treatment of endobronchial mass. He had a history of cough with initial hemoptysis. The endoscopic finding showed endobronchial mass totally occluded left upper lobe bronchus. The initial biopsy revealed chronic inflammation. The patient was scheduled for bronchoscopic laser photoresection and the mass was removed with the stump left at superior segment of lingular lobe. Endobronchial hamartoma was diagnosis from pathological section. The case is reported and the review of endobronchial hamartoma is presented.