Alveolar lymphocytosis in patients with chronic uveitis: relationship to sarcoidosis.

Bronchoalveolar lavage (BAL) is frequently performed in patients with suspected ocular sarcoidosis. This study describes the immunogenetical, immunological, radiological, and functional features of a subclinical alveolar lymphocytosis unrelated to sarcoidosis in patients with chronic uveitis. Two hundred and ten patients with chronic uveitis of unknown origin, who underwent fiber-optic bronchoscopy with BAL as part of a prospective protocol over a three-year period, were evaluable for retrospective analysis. Sixty-five patients had alveolar lymphocytosis: Sarcoidosis was diagnosed in 13 (6%) patients, whereas alveolar lymphocytosis was considered unrelated to sarcoidosis in 52 (25%). Alveolar lymphocytosis unrelated to sarcoidosis was not associated with radiologically detectable interstitial lung disease or pulmonary function impairment. CD4/CD8 lymphocyte ratio was 3.7 +/- 3.0. Total cell count, total lymphocyte, and CD4 lymphocyte percentage were significantly lower when compared with sarcoidosis-related alveolitis (129,000 +/- 80,000 vs. 218,000 +/- 117,000, p <0.05; 33.1% +/- 13.2 vs. 39.7% +/- 13.2, p <0.05; and 54.3% +/- 18.2 vs. 65.4% +/- 10.1, p <0.05, respectively). Patients with alveolar lymphocytosis unrelated to sarcoidosis were older (47.8 +/- 17.7 years vs. 42.7 +/- 14.2 years, p <0.05) and more likely to carry the HLA-B51 allele (19.7% vs. 7.1%, p <0.01) than patients with chronic uveitis without alveolar lymphocytosis. They did not appear to be at risk of developing clinically apparent interstitial lung disease on followup. We conclude that alveolar lymphocytosis is frequently observed in patients with chronic uveitis. It is generally unrelated to sarcoidosis and may then be associated with a distinctive immunogenetic phenotype.

[Cystic pulmonary metastasis simulating a diagnosis of histiocytosis X]. / Métastases pulmonaires kystiques simulant le diagnostic d'une histiocytose X.

A case of cystic pulmonary metastases from a renal origin simulating lung histiocytosis on high-resolution CT is presented. This diagnosis was suggested because of the presence of cystic lung lesions, micronodules and recurrent pneumothoraces in a male smoker. The diagnosis was reviewed after lung biopsy and demonstration of a renal mass.

Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle.

PURPOSE: To evaluate a lung biopsy technique in which a detachable, 18-gauge, coaxial guide around a central notched stylet is used as a cutting needle. MATERIALS AND METHODS: The records of 89 consecutive patients (41 women, 48 men; aged 21-86 years) who underwent coaxial percutaneous core biopsy of 91 lung lesions that required needle passage through normal lung tissue (mean lesion size, 33.6 mm; range, 9-80 mm) were studied. Detachable, 18-gauge, coaxial automated cutting needles were used. RESULTS: The mean number of needle passes was 2.5 (range, 1-4). All biopsies yielded sufficient tissue for histopathologic (n = 91) and, if necessary, bacteriologic (n = 12) evaluation (mean core length, 5 mm; range, 1-15 mm). Eighty-nine lesions had definitive diagnoses. Seventy-five lesions were proved to be malignant; seventy (93%) could be accurately diagnosed with coaxial percutaneous core biopsy samples. Fourteen lesions were proved to be benign; 10 (71%) were specifically diagnosed with biopsy samples. Among the 91 biopsies, the overall diagnostic accuracy was 88% (80 of 91 lesions). A pneumothorax occurred in 31 cases (34%), three (3%) of which necessitated placement of a chest tube. Postbiopsy hemoptysis occurred and resolved spontaneously in nine cases (10%). CONCLUSION: This technique provides a core biopsy specimen without the need for an on-site cytopathologist during the procedure. It has a high diagnostic accuracy and an acceptable rate of complications.

Nonpalpable breast tumors: diagnosis with contrast-enhanced subtraction dynamic MR imaging.

PURPOSE: To determine the accuracy of contrast material-enhanced subtraction dynamic magnetic resonance (MR) imaging in the diagnosis of nonpalpable breast tumors. MATERIALS AND METHODS: One hundred forty-three patients underwent surgical biopsy of a nonpalpable breast lesion. Their mammograms showed microcalcifications (n = 80), opacity (n = 52), architectural distortion (n = 10), or asymmetric density (n = 1). All patients underwent a preoperative gadolinium tetraazacyclododecanetetraacetic acid-enhanced subtraction dynamic study. Any early contrast enhancement in the breast parenchyma was considered pathologic. RESULTS: At histologic analysis, 27 intraductal carcinomas, 37 invasive carcinomas, and 79 benign lesions were found. Dynamic MR studies showed early contrast enhancement in 61 of 64 breast cancers (sensitivity, 95%) and in 37 of 79 benign lesions (specificity, 53%). Two invasive lobular carcinomas and one tubular carcinoma showed no early contrast enhancement. CONCLUSION: Subtraction dynamic MR imaging may be helpful to rule out malignancy in nonpalpable breast tumors.

Epstein-Barr virus latent and replicative gene expression in post-transplant lymphoproliferative disorders and AIDS-related non-Hodgkin's lymphomas. French Study Group of Pathology for HIV-associated Tumors.

In acquired immunodeficiency, B-cell proliferation is usually associated with Epstein-Barr virus (EBV), implying the impairment of the normal control of EBV and EBV-infected cells. It has been assumed that EBV infection is latent in lymphoproliferative disorders. In order to determine the type of latency and to investigate whether any lymphoproliferative disorders enter into the lytic cycle, we analyzed the expression of latent and replicative EBV genes in 9 post-transplant lymphoproliferative disorders (PTLD) and in 23 EBV-positive AIDS-related non-Hodgkin's lymphomas (AR-NHL). The PTLD cases were categorized into polyclonal or monoclonal polymorphic tumors and monoclonal monomorphic tumors. The AR-NHL cases included large-cell/immunoblastic (LC/IB) and Burkitt's lymphoma (BL) groups. We demonstrated that varying patterns of latent-viral-gene expression are exhibited showing the 3 forms of latency. Polymorphic PTLD and LC/IB AR-NHL frequently expressed type II or III latency, whereas monomorphic tumors and BL AR-NHL showed type I latency. It is noteworthy that 3 cases of BL AR-NHL expressed latency II form. Induction of lytic cycle highlighted by the expression of BZLF1 occurred in 55.5% of PTLD, 36% of LC/IB and 22% of BL AR-NHL. In contrast, late viral proteins indicating productive cycle were present in 22% of PTLD, 14% of LC/IB, and were absent in BL cases. These data suggest that the impairment of EBV control permits disruption of latency, but the initiation of the lytic cycle may not always lead to viral production.

Histologic aspects of pulmonary barotrauma in critically ill patients with acute respiratory failure.

OBJECTIVE: To describe histologically pulmonary barotrauma in mechanically ventilated patients with severe acute respiratory failure. DESIGN: Assessment of histologic pulmonary barotrauma. SETTING: A 14-bed surgical intensive care unit (SICU) PATIENTS: The lungs of 30 young critically ill patients (mean age 34 +/- 10 years) were histologically examined in the immediate post-mortem period. None of them were suspected of pre-existing emphysema. MEASUREMENTS AND RESULTS: Clinical events and ventilatory settings used during mechanical ventilation were compared with lung histology. Airspace enlargement, defined as the presence of either alveolar overdistension in aerated lung areas or intraparenchymal pseudocysts in nonaerated lung areas, was found in 26 of the 30 lungs examined (86%). Patients with severe airspace enlargement (2.6-40 mm internal diameter) had a significantly greater incidence of pneumothorax (8 versus 2, p < 0.05), were ventilated using higher peak airway pressures (56 +/- 18 cmH2O versus 44 +/- 10 cmH2O, p < 0.05) and tidal volumes (12 +/- 3 ml/kg versus 9 +/- 2 ml/kg, p < 0.05), were exposed significantly longer to toxic levels of oxygen (8.6 +/- 9.4 days versus 1.9 +/- 2 days at FIO2 > 0.6, p < 0.05) and lost more weight (6.3 +/- 9.2 kg versus 0.75 +/- 5.8 kg, p < 0.05) than patients with mild airspace enlargement (1-2.5 mm internal diameter). CONCLUSION: Underlying histologic lesions responsible for clinical lung barotrauma consist of pleural cysts, bronchiolar dilatation, alveolar overdistension and intraprenchymal pseudocysts. Mechanical ventilation appears to be an aggravating factor, particularly when high peak airway pressures and large tidal volumes are delivered by the ventilator.

[Histopathology and ultrastructure of opportunistic infections of the digestive tract in acquired immunodeficiency syndrome]. / Histopathologie et ultrastructure des infections opportunistes du tube digestif au cours du syndrome d'immunodéficience acquis.

Light and electron microscopy studies of digestive tract biopsy specimens from AIDS patients are very useful for the detection of opportunistic pathogens which may be located in: the lumen (bacteria, Candida albicans, Giardia lamblia), enterocyte brush border (Cryptosporidium sp), enterocyte cytoplasm (Enterocytozoon bieneusi), enterocyte nuclei (cytomegalovirus), or cytoplasm of lamina propria macrophages (Mycobacterium avium intracellulare). These studies may also be useful to detect combinations of morbid conditions and to evaluate the effectiveness (if any) of therapeutic agents.

[Heart-lung transplantation. A necropsy study of thirty-seven patients]. / Transplantation coeur-poumons. Etude nécropsique de trente-sept patients.

Between 1987 and 1992, thirty-seven heart-lung transplant recipients had a postmortem examination at the Pitié-Salpêtrière Teaching Hospital in Paris, France. Except for three patients who survived 2 months, 4 months and 16 months after transplantation, respectively, most patients died in the early postoperative period (mean survival time = 34.6 days). Autopsy disclosed minor acute heart rejection in four patients and minor acute lung rejection in three patients. Five patients had obliterating bronchiolitis that was the cause of death in two cases. Main causes of death included perioperative pleural bleeding, respiratory infection with or without septicemia, diffuse alveolar lesions (adult respiratory distress syndrome and/or pulmonary edema undergoing organization) and multiple organ failure. Hemodynamic and respiratory complications responsible for multiple organ failure in the perioperative period, as well as pre-existing morbid conditions such as cirrhosis of the liver induced by heart failure, may have a major bearing on the outcome of heart-lung transplantations.

Perianal ulcer: an unusual presentation of Wegener's granulomatosis. Report of a case.

A 46-year-old man, without remarkable past medical history, had a perianal ulcer that appeared spontaneously two months before presentation. At admission, the ulcer was painless, measuring 4 to 5 cm in diameter and showing detachment and a slightly papillomatous aspect at the edge but without induration of the base. Microscopic examination revealed cutaneous ulceration with a well-developed inflammatory response, a few small vessels with intraluminal thrombosis or necrotizing walls, and isolated microscopic granulomata. No infectious disease was detected. The diagnosis of Wegener's granulomatosis was made six months later, when the disease was clinically evident in three principal sites: upper airways, lung, and kidney. At that time, serum antineutrophil cytoplasmic autoantibodies were detected with indirect immunofluorescence microscopy. There has been an excellent response to immunosuppressive therapy. Review of the literature revealed no similar reports.