[A case of atypical pulmonary carcinoid accompanying skin metastasis].

A 73-year-old woman underwent cranial surgery in 1999 after receiving a diagnosis of suspected malignant meningioma. She began complaining of headache 2 years postoperatively, and around the same time, she noticed a painful skin tumor. She was then transferred to our hospital for further evaluation. The skin tumor was diagnosed by skin biopsy as an atypical metastatic carcinoid tumor. Systemic examination demonstrated a primary lesion in the left lung. Pulmonary, skin and bone biopsy samples exhibited the same pathological findings as those of the atypical pulmonary carcinoid tumor. She did not show any carcinoid symptoms. EP therapy (etoposide + carboplatin) and CAV therapy (cyclophosphamide + doxorubicin + vincristin) were administered, but there was no clinical response. The patient is currently doing well without chemotherapy and is being followed by the Outpatient Department.

Time-dependent effect of pneumonectomy on alveolar epithelial fluid clearance in rat lungs.

OBJECTIVE: Because pneumonectomy initiates compensatory growth of the remaining lung, we determined the time-dependent effects of pneumonectomy on alveolar fluid clearance capacity. METHODS: Alveolar fluid clearance capacity with the Evans blue-labeled albumin concentration was measured in rats 3 hours, 2 days, 7 days, 14 days, and 28 days after left pneumonectomy. The mechanisms responsible for the increase in alveolar fluid clearance were explored. RESULTS: Alveolar fluid clearance in the remaining lung was normal through 7 days and then increased 14 and 28 days after pneumonectomy. The increase in alveolar fluid clearance at 28 days after pneumonectomy was accounted primarily by an increase in amiloride-sensitive transport. The expression of epithelial sodium channel messenger RNA was increased in the remaining lung and in type II alveolar epithelial cells isolated from rats 28 days after pneumonectomy. The number of isolated type II cells was larger in pneumonectomized rats than in control rats. Also, beta-adrenergic agonist therapy increased the rate of alveolar fluid clearance at the 3-hour and 28-day time points. CONCLUSIONS: The capacity to remove alveolar fluid in the remaining lung is maintained at a normal level for up to 7 days after pneumonectomy in a rat, and then there is a marked increase in amiloride-sensitive alveolar fluid transport capacity that might depend, at least in part, on increased expression of epithelial sodium channels in type II cells and in part on the increased number of type II cells.

[An intra-pulmonary lymphnode resembling typical pulmonary primary adenocarcinoma on high-resolution computed tomographic (HR-CT) chest images].

A 40-year-old man was admitted to our hospital for further evaluation of a pulmonary nodule in chest radiographs. The 8-mm nodular lesion was located in the right anterior basal lobe on a plain chest radiograph, and showed 1) spiculation, 2) pleural indentation and 3) a converging vessel formation in high-resolution computed tomography of the chest. The radiographic findings were highly suggestive of primary pulmonary adenocarcinoma and the patient underwent video-assisted thoracoscopic surgery (VATS) to obtain a precise diagnosis. The nodule was diagnosed histopathologically as an intrapulmonary lymph node. In cases with such radiographic findings, careful attention should be paid in the differential diagnosis to distinguish intrapulmonary lymph nodes from primary pulmonary adenocarcinoma.