[A clinicopathological analysis of pulmonary lymphangioleiomyomatosis].

BACKGROUND AND OBJECTIVE: Pulmonary lymphangioleiomyomatosis (PLAM) is a rare tumor with unique clinicopathological features. The aim of this study is to investigate the clinicopathological features, the diagnosis and differential diagnosis of pulmonary lymphangioleiomyomatosis. METHODS: Three cases of PLAM were analyzed by light microscopy, immunohistochemistry and their clinical data, and the relative literatures were reviewed. RESULTS: Three cases of patients suffered from PLAM were the women in their reproductive aged, from 27 years to 45 years (mean 37.7 years), two cases of the HRCT showed bilateral diffuse cystic airspaces changed, and one case was the pneumothorax. The histopathological examination revealed the tumor was composed of the variably sized cystic spaces are lined by plaque-like or nodular aggregates of endothelial cells and the hyperplasia, smooth-muscle-like spindle cells which was along with the bronchi and the vessels. The immunohistochemistry showed that Des, Caldes, SMA, MSA, HMB-45, CD63, Vim, ER and PR were positive in the hyperplasia spindle cells, and there was no expression of MRAT-1. The FVIII, CD34 were positive in the capillary endothelial cells, and the D2-40 was positive in the lymphatic vessels. All the patients were alive without the recrudescence of the PLAM since the diagnosis, about 3 months to 25 months, and there was no LAM in their other systems. CONCLUSIONS: The most significant histopathological feature of pulmonary lymphangioleiomyomatosis was the progressive invasion of smooth muscle cells into the lymphatic vessels, and the blood vessels. The majority of the cases occur in the lungs of the women in the predominantly premenopausal and middle-age. It is a poor prognosis due to the progressive respiratory failure.

Modified cavoatrial anastomosis in Warden procedure.

The Warden procedure was introduced for surgical repair of partial anomalous pulmonary venous connection to the higher portion of the superior vena cava in an attempt to decrease the incidence of postoperative sinoatrial node dysfunction and pulmonary venous obstruction. However, postoperative cavoatrial channel stenosis and obstruction up to 20% and 10%, respectively, requiring catheter intervention has been reported. In this article, we describe a modified cavoatrial anastomotic technique to avoid postprocedural superior vena cava stenosis.

[Contrast-enhanced multislice CT features and predominant anatomic distribution of mediastinal malignant lymphoma].

The objective of this study was to investigate the specific contrast-enhanced MSCT features and predominant anatomic distribution of mediastinal malignant lymphoma. Contrast-enhanced MSCT in 31 cases of mediastinal malignant lymphomas were retrospectively evaluated by analyzing the features of size, morphology, attenuation and anatomic distribution in accordance to the ATS classification of intrathoracic lymph nodes. Nine cases of Hodgkin Disease (HD) and 22 cases of Non-Hodgkin Disease (NHL) were included. The enlarged nodes were found to be homogeneous (HD 72.7%, NHL 88.9%) and partly homogeneous with necrosis (HD 27.3%, NHL 11.1%). HD involved predominantly the lymph nodes in the areas of 2R (77.8%), 3 (55.6%), 4R (88.9%), 4L (55.6%), 5 (66.7%), 6 (55.6%), 7 (66.7%) and 10R (55.6%), while NHL often involved the areas of 2R (68.2%), 3 (54.5%) 4R (59.1%), 4L (50%), 5 (54.5%), 6 (54.5%), 7 (54.5%) and 8 (50%). The following extranodal organs were involved: pericardium (19.4%), pleura (19.4%), great vessels (6.4%), lung (6.4%), chest wall (3.2%) and breast (3.2%). Mediastinal malignant lymphoma had some characteristic manifestations and predominant anatomic distribution shown on contrast-enhanced MSCT, which can provide imaging evidences for diagnosis and for determining the tumor stage.

[CT and MRI features of diseases involving masticator spaces].

OBJECTIVE: This is a study on the CT and MRI features of diseases involving the masticator spaces; the purpose is to improve the diagnostic accuracy. METHODS: Fifty-seven cases involving the masticator spaces were collected, among which, 11 cases were originated from the masticator space, another 46 cases were secondary invasion from the adjacent structures, including 18 cases from the buccal mucosa, 10 from the nasopharynx, 5 from the gingiva, 3 from the parotid gland, 6 from the maxillary sinus, 1 from the intracranial location, 2 from the palate and 1 from the orbit. The CT and MRI features of the masticator space involvement were analysed. RESULTS: Masticator space involvement is visualized on CT and MRI as effacement of the fat plane, swelling of the masticatory muscles, and erosion of the mandibular ramus. Disease from surrounding structures can invade the masticator space via the pterygopalatine fossa, the buccal space immediately anterior to the ramus, the foramen ovale, or by way of direct invasion. CONCLUSION: Masticator space involvement is not uncommon in the maxillofacial diseases, which must be noticed in the imaging diagnosis.

[CT and MRI findings of cancerous invasion of the main pulmonary artery in lung cancer: the correlation with pathologic features and the value in making surgical plan].

BACKGROUND: To study the correlation between CT/MRI features and surgical and pathological findings of cancerous invasion of the main pulmonary artery (CIMPA) in lung cancer and to evaluate the role of CT and MRI in making surgical plan. METHODS: CT findings in 15 cases and MRI findings in 13 cases were observed and blindly compared with surgical and pathological findings in this prospective study of 23 cases of central type lung cancer. RESULTS: The CT and MRI features showed as follows: the wall thickening sign in 73.7% of CT and 84.6% of MRI; lumen narrowing sign in 55.3% of CT and 69.2% of MRI; peri-vascular fat sign in 100.0% of both CT and MRI. Two types of CIMPA were visualized: contacted type (10 cases in CT and 7 cases in MRI) and encased type (5 cases in CT and 6 cases in MRI). Surgically, contacted type was found in 10 cases who all underwent lobectomy with sleeve-angioplasty. Encased type was found in 13 cases, among whom unresectable in 2, pneumonectomy in 7, and lobectomy with angioplasty in 4. Of the 21 resected specimen, the cancerous infiltration was demonstrated 100.0% (21/21) in adventitia, 66.7% (14/21) in media and 4.8% (1/21) in intima. There was no significant difference in the deepness of the cancer infiltration between the two types (P>0.05). Acute or chronic inflammatory infiltration which enhanced the thickening of the wall were shown on all specimens. CT and MRI findings were well corresponding to surgical and pathological appearance (Kappa value = 0.61 in CT and 0.84 in MRI). CONCLUSIONS: In our study of CIMPA, CT and MRI features characterized by wall thickening and lumen narrowing without occlusion are closely correlated with pathological findings that cancerous invasion prominently limited adventitia and media with remarkable proliferation of connective tissue, and classifying two types is valuable in making surgical plan.

[CT features and anatomic distribution of pleural dissemination in lung cancer].

BACKGROUND: To study the CT appearance of lung cancer combined with pleural dissemination and its anatomic characteristics. METHODS: CT findings of 32 cases of lung cancer with pleural dissemination proved by surgery and pathology were analyzed. RESULTS: The main CT manifestations were pleural effusion (24 cases), visceral pleural dissemination with nodules (10 cases), parietal pleural dissemination with nodules (16 cases), and pleural thickening (31 cases). Out of the cases with visceral pleural disseminations, nodules distributed on the lung surface in 9 sites, while on the interlobular pleura in 10 sites. Parietal pleural dissemination with nodules were found in 45 sites which located on the diaphragmatic pleura, the costal pleura, the mediastinal pleura, and the pulmonary ligament. The diameters of the small nodules ranged from 2 to 5 mm, and the large nodules from 5 to 10 mm. There were direct invasion with tumor induced pleural thickening in 10 cases, while indirect invasion in 21 cases. In the later cases, 9 cases had parietal pleural thickening less than 10 mm, 4 circumferential pleural thickening, 5 mediastinal pleural involvement thickening, and 3 pulmonary ligament thickening. CONCLUSIONS: Pleural effusion is the main manifestation of lung cancer combined with pleural dissemination. The CT features of lung cancer with pleural dissemination are the parietal and visceral pleural nodules, as well as the pleural thickening. The nodules are likely to distribute on parietal pleura of the diaphragmatic and the costal pleura, and they may transfer to the pulmonary ligament.The early small disseminating nodules are miliary in size, and only can be detected on the pulmonary window of chest CT scan.