Allergic bronchopulmonary aspergillosis due to Aspergillus niger without bronchial asthma.

A 65-year-old woman was admitted to our hospital with a dry cough and pulmonary infiltrates. Chest radiograph and CT revealed mucoid impaction and consolidations. Peripheral blood eosinophilia and elevated serum IgE were observed. Aspergillus niger was cultured repeatedly from her sputum, but A. fumigatus was not detected. Immediate skin test and specific IgE (RAST) to Aspergillus antigen were positive. Precipitating antibodies were confirmed against A. niger antigen, but not against A. fumigatus antigen. She had no asthmatic symptoms, and showed no bronchial hyperreactivity to methacholine. Thus, this case was diagnosed as allergic bronchopulmonary aspergillosis (ABPA) without bronchial asthma due to A. niger, an organism rarely found in ABPA. The administration of prednisone improved the symptoms and corrected the abnormal laboratory findings.

Tumor angiogenesis and vascular endothelial growth factor expression in stage I lung adenocarcinoma.

Vascular endothelial growth factor (VEGF) is one of the most important factors for angiogenesis in various malignant tumors. However, the biological significance of VEGF in lung adenocarcinoma remains unclear. We stained intratumoral microvessels immunohistochemically using anti-CD34 antibody and analyzed VEGF expression using anti-VEGF antibody in 44 cases of stage I lung adenocarcinoma. Of the 44 patients studied, 14 patients had a postoperative relapse, and 30 patients did not. The mean microvessel count (MVC) in stage I lung adenocarcinoma was 79.5 +/- 26.9 per x200 microscopic field. Immunohistochemical expression of VEGF was found in 27 of 44 cases of stage I lung adenocarcinoma. The mean MVC in cases of VEGF-positive lung adenocarcinoma (86.4 +/- 28.2) was significantly higher than that in cases of VEGF-negative lung adenocarcinoma (68.6 +/- 21.4; P < 0.05). The high-MVC group patients (MVC > 80) had significantly worse survival rates than those in the low-MVC group (MVC < or = 80; P < 0.01), and patients with VEGF-negative tumors had significantly better survival rates than those with VEGF-positive tumors (P < 0.05). We conclude that angiogenesis, as assessed by intratumoral MVCs, is a significant prognostic factor in stage I lung adenocarcinoma, and that VEGF is an important angiogenic factor in stage I lung adenocarcinoma.

Parathyroid-hormone-related-protein-producing thymic carcinoma presenting as a giant extrathoracic mass.

A 53-year-old female with a 9-month history of chest pain presented with a giant anterior chest wall mass. Radiologic examination showed an anterior mediastinal tumor invading the chest wall. Serum calcium and parathyroid hormone-related protein (PTHrP) levels were extremely elevated. Biopsy specimens disclosed a squamous cell carcinoma with Hassall's corpuscle-like keratotic pearls, and an immunohistological study showed a positive staining with PTHrP. The tumor and serum PTHrP concentration markedly decreased following cisplatin-based chemotherapy and radiation. This is the first case of PTHrP producing a thymic carcinoma with the unusual presentation of a large extrathoracic mass.

Diagnosis of pulmonary lymphangioleiomyomatosis by HMB45 in surgically treated spontaneous pneumothorax.

Pulmonary lymphangioleiomyomatosis (PLAM) is a rare disease with poor prognosis, characterized by an abnormal proliferation of smooth muscle. The patients are females and recurrent pneumothorax is a frequent complication. HMB45 is a monoclonal antibody with specific immunoreactivity for malignant melanoma. Recently, it was reported that some of the smooth muscle cells in PLAM had reactivity for HMB45. The aim of this study was to assess the sensitivity and specificity of HMB45 for the diagnosis of PLAM in cystic pulmonary diseases that cause recurrent pneumothorax. We compared immunoreactivity of the specimens obtained by open lung biopsy at surgical resection of bullae in 72 patients. The specimens of five females with PLAM, one female with suspected PLAM, 49 patients with primary spontaneous pneumothorax (19 females and 30 males), four with pulmonary eosinophilic granuloma (2 females and 2 males), seven with pulmonary emphysema (7 males), and six with idiopathic pulmonary fibrosis with apical bullous change (2 females and 4 males) were stained with HMB45 and anti-smooth muscle actin. All PLAM cases had HMB45 positive cells, which also stained with anti-smooth muscle actin. The biopsy specimens of a PLAM suspected case also stained with HMB45. None of the specimens from other diseases reacted with HMB45. HMB45 appears to provide a highly specific and highly sensitive diagnosis for PLAM in females. It may also be useful in patients with subtle smooth muscle proliferation. where the diagnosis of PLAM is difficult to confirm by conventional histological examination.

[Sarcoidosis with pulmonary cavitation and calcification].

A 38-year-old man was seen at another hospital because of bilateral reticulo-nodular shadows on a chest X-ray film at the time of a regular health check-up. Pulmonary tuberculosis was diagnosed, and the patient was treated with antituberculous chemotherapy. The shadow did not improve, and the patient was transferred to our hospital. Bacteriological studies for pyogenic bacteria, mycobacteria, and fungi were all negative. Serum levels of angiotensin-converting enzyme and lysozyme were abnormally high. Examination of a specimen obtained by transbronchial lung biopsy revealed noncaseating epithelioid-cell granuloma associated with severe hyalinization. Sarcoidosis was diagnosed. Chest CT showed multiple nodular opacities, some of which were calcified. Oral steroids were given because the lesion was progressing rapidly. Cavitary lesions appeared during tapering of steroid therapy. Bacteriological and fungal studies were negative and transbronchial lung biopsy showed noncaseating epithelioid-cell granuloma. Therefore, the cavitation within the granuloma with hyalinization may have developed because of steroid therapy, and the calcification may have been caused by postorganizing dystrophy.

[A case of malignant lymphoma arising from chronic pyothorax; usefulness of magnetic resonance imaging (MRI) for diagnosis].

A 79-year-old man had a history of pneumothorax induced to treat pulmonary tuberculosis when he was 40 years old, and of chronic pyothorax when he was 60 years old. He was admitted to our hospital because of chest pain and swelling of the right lateral chest wall. Soft tissues of the chest wall and rib had been destroyed, and a fistula had formed at the skin. The diagnosis was confirmed by examination of a biopsy specimen from the chest wall tumor. The tumor was successfully treated by radiation therapy. 67Ga scintigraphy, CT, and MRI were useful for diagnosis and follow up. Pyothorax and the tumor could be distinguished only with MRI.

[A case of influenza B viral bronchopneumonia followed by CT].

A 69-year-old male with bronchial asthma was admitted to a hospital with fever, dyspnea, and productive cough. Arterial blood gas analysis revealed sever hypoxemia (PaO2 54.8 torr, PaCO2 28.8 torr). Chest roentgenogram showed diffuse reticulonodular shadows predominantly in the upper filed and a small amount of bilateral pleural effusion. CT image of the lung showed nodular opacities at the peripheral branches of the pulmonary arteries and bronchi, some of which had become confluent. The bronchoarterial bundle had become thicker compared with a CT taken 18 months before this admission. Three days treatment with antibiotics and gamma globulin did not change the symptoms or radiologic findings. After commencing methylprednisolone therapy, the pneumonia showed rapid improvement. Based upon the significant elevation of serum influenza B (B/Singapore/79) virus antibody titer, the patient was diagnosed as having influenza B viral bronchopneumonia. Twenty-three days after initiation of steroid therapy, slight nodular opacities were observed on CT. This finding suggests that bronchiolitis has a relatively prolonged course in influenza viral bronchopneumonia.