Lung cancer associated with punctate calcification: CT and histological correlation.

The etiology of punctate calcifications in lung cancer was evaluated on the basis of CT and histological correlations. Seven cases of lung cancer with punctate calcifications were demonstrated on CT. The patients had undergone surgical resection (five men and two women, 60-70 years old; six adenocarcinomas and one squamous cell carcinoma), and each case was evaluated for its CT appearance and histological findings. The number of calcifications observed on CT varied from one to six. Most were eccentric, but some calcifications in four cases were within the more central portion of the nodules. Overall, in six of seven cases the calcifications were histologically estimated to be due to preexisting old granulomatous fibrotic changes or fragments of bronchial cartilage incorporated within the growing tumors. In only one case were the calcifications psammoma bodies within the tumor. We conclude that punctate calcifications in lung cancers correspond mostly to preexisting calcified granuloma or degenerated bronchial cartilage.

CT of pulmonary metastases with pathological correlation.

CT, including high-resolution CT, has become an essential means of imaging to evaluate pulmonary metastases. The underlying pathological processes of pulmonary metastases can be observed well on CT images, but they are not always specific. Several important CT features correlate with histopathological findings: (1) margin of nodule; (2) hemorrhage accompanying a metastatic nodule; (3) calcification; (4) cavitation; (5) sterilized metastasis; (6) small metastatic nodules in the lobules; (7) lymphangitic carcinomatosis; (8) tumor emboli; and (9) pleural metastases. For reasonable use of CT in pulmonary metastases, these various CT manifestations and their limitations must be understood.

Mild emphysema: a novel method using formalin-fixed lungs for computed tomography and pathological analyses.

We evaluated a novel method of computed tomography (CT) analysis using formalin-fixed lungs of autopsy cases with mild emphysema. Eight formalin-inflated lungs (FILs) obtained at autopsy were examined using CT after draining off the formalin and air inflation with an air pump, and subjected to pathological study including pathological scoring of emphysema and microscopic image analysis (MIA). Satisfactory CT examination was carried out within 5 h of lung fixation. The mean alveolar area determined by MIA correlated highly with the lung volume (r = 0.845) and CT score (r = 0.722). This method is simple compared with conventional polyethylene glycol fixation for CT and enables CT examination of resected lungs without anxiety about biohazards, Mild emphysema can be detected by MIA.

CT and MRI manifestations of primary pulmonary plasmacytoma.

Primary pulmonary plasmacytoma (PPP) is rare and its radiographic appearances have been seldom described. We report on a patient with PPP presenting with a hilar mass on chest radiograph. The diagnosis was confirmed by immunohistochemical study of the resected specimen. The computed tomographic and magnetic resonance imaging findings are presented.

[Combined radiotherapy and hyperthermia for Pancoast tumor].

Thirteen patients with Pancoast tumor were treated with combined radiotherapy and hyperthermia from April 1987 to December 1992. Radiotherapy was performed using 10 MV X-rays, and all patients received a total dosage of 40-118 Gy with conventional fractionation. Hyperthermia was performed once or twice a week within 30 minutes after each irradiation, using 8 MHz RF capacitive heating equipment (Thermotron RF-8). Partial response, defined as 50% or more regression of the tumor, was observed in 7/13 (54%) patients, and the median survival time was 25.2 months. Results of 14 patients treated with irradiation alone from July 1980 to December 1992 were also evaluated, and were used as a historical control. The partial response was 4/14 (29%) and the median survival time was 7.3 months. Radiotherapy combined with hyperthermia is an effective modality for treating Pancoast tumors.

Appearance of pulmonary metastases on high-resolution CT scans: comparison with histopathologic findings from autopsy specimens.

OBJECTIVE: The purpose of this study was to compare the appearance of pulmonary metastases on high-resolution CT scans with the histopathologic findings in lung specimens obtained at autopsy. The factors considered were the appearance of the margins of pulmonary metastases, the location of relatively small nodules in relation to the secondary pulmonary lobules, and the detectability of lymphangitic spread of tumors and intravascular tumor emboli on high-resolution CT scans. MATERIALS AND METHODS: We studied 14 lungs obtained at autopsy that contained metastatic lesions. We used both microscopy and high-resolution CT to evaluate 87 metastatic nodules 5-20 mm in diameter for the appearance of their margins and to determine the location of 43 nodules that were less than 5 mm in diameter relative to the secondary pulmonary lobules. The detection of histologically confirmed intravascular tumor emboli and lymphangitic spread by high-resolution CT also was evaluated. RESULTS: On high-resolution CT scans, 38% of the nodules had well-defined, smooth margins, 16% had well-defined, irregular margins, 16% had poorly defined, smooth margins, and 30% had poorly defined, irregular margins. The well-defined, smooth margins on high-resolution CT scans corresponded histologically to an expanding type and to an alveolar space-filling type; the poorly defined margins, to an alveolar cell type; and the irregular margins, to an interstitial proliferative type. Some correlation was found between the histologic type of primary tumor and the CT appearance of the lesion's margins. As for small nodules, 12% were connected with the central bronchovascular bundle, 28% were on the perilobular structures, and 60% were apparently not in contact with these structures. Only two of the 11 lungs with histopathologically confirmed lymphangitic tumor spread and none of the tumor emboli were detected on high-resolution CT scans. CONCLUSION: The characteristics of the margins of metastatic pulmonary nodules noted on histopathologic examination correlated well with their high-resolution CT findings. Microscopic intravascular tumor emboli and lymphangitic tumor spread were difficult to detect on high-resolution CT scans, indicating a limitation of high-resolution CT in the diagnosis of pulmonary metastatic disease.

[Pathologic-HRCT correlation of pneumoconiosis--a study on inflation-fixed lungs].

High resolution computed tomography (HRCT) findings were correlated with pathologic features of 14 inflation-fixed postmortem lungs with pneumoconiosis to evaluate the ability of HRCT to depict pneumoconiotic changes. The results are as follows: 1) Irregular peribronchiolar and interlobular fibrosis was the most constant pathologic feature in all lungs. This pathologic finding corresponded to an area of hazy increased density or reticular density on HRCT. The reticular density on HRCT became coarser with the progression of fibrosis. Mild fibrosis, confirmed by histologic procedures, could not be detected with HRCT. 2) Subpleural curvilinear line seen on HRCT in 5 lungs corresponded to band-like zone of fibrosis containing bronchioles or zone of collapsed alveoli with fibrotic thickening on histologic sections. A subpleural band-like zone of organized pneumonia was recognized in 2 cases. Subpleural patchy density was seen on HRCT in 8 cases. Five of them were histologically a focus of fibrosis and the other 3 were localized pulmonary edema, organized pneumonia, or atelectasis without fibrosis. 3) Pneumoconiotic nodules were located at centrilobular portion or along interlobular septa on histologic sections. These location were correspond to HRCT findings. They were round with irregular borders and were surrounded by a zone of enlarged air space. Overall 71% (182/256) of pathologically proved nodules were seen on HRCT, but 63% (52/83) of small "p" type nodules (smaller than 1.5 mm) could not be detected. Enlarged air space at the periphery of the nodules was seen on HRCT in 78% (122/156) of those pathologically proved. 4) A total of 12 lesions of progressive massive fibrosis was found in 5 lungs. An irregular border, seen on HRCT in all lesions, was pathologically based on the fibrosis extending into the surrounding alveoli and partially confluencing pneumoconiotic micronodules. Pleural indentation was seen in 8 lesions. Patent residual bronchi, spared from destructive fibrotic change, were seen as strand-like air density on HRCT in 4 of 6 lesions. 5) Focal emphysema was found pathologically in 9 of the 14 lungs. They appeared as non-peripheral, small low-attenuation area with a central dot on HRCT. The dot histologically corresponded to fibrosis around centriacinar bronchovascular bundle. The limit of visibility of this form of emphysema on HRCT was 2.0 mm in size. When emphysema was complicated by pneumonia, some showed honeycomb appearance on HRCT. 6) It is concluded that HRCT can detect and quantify the various pneumoconiotic changes of the lung and the HRCT-pathological correlation data presented here will be useful for the interpretation of the findings in clinical cases of pneumoconiosis.

[Computed tomography of Pancoast tumor].

Computed tomography (CT) and chest radiography of 14 patients with Pancoast tumor were reviewed. The cross-sectional format and superior contrast resolution of CT demonstrated the relationship of the tumor to significant adjacent structures (ribs, vertebral bodies, root of spinal nerves, mediastinum and brachial plexus) better than conventional chest radiographies. CT provided additional information to the latter technique in all patients studied. An accurate assessment of the local extent of tumor was also provided by CT. Our study suggests that the obliteration of the fat plane between scalene muscles on CT indicates the tumor invasion of the brachial plexus. CT is useful in the evaluation of the patient with Pancoast tumor.

Primary malignant lymphoma of the rectum.

A rare case of a primary malignant lymphoma of the rectum in a 7 year old girl is presented. Although rectal polyps in children are usually benign juvenile polyps, a rare possibility of malignancy should be kept in mind. An adequate histological examination is essential.