ABSTRACT
BACKGROUND: Our previous study revealed that intraoperative frozen section (FS) analysis could differentiate invasive lung adenocarcinoma (LUAD) accurately from preinvasive lesions. However, few articles have analyzed the clinical impact of FS errors such as underestimation of invasive adenocarcinomas (IACs), and whether complementary therapy is needed remains controversial. RESEARCH QUESTION: What is the prognosis of patients undergoing limited resection for invasive LUAD misdiagnosed as atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), or minimally invasive adenocarcinoma (MIA) by intraoperative FS analysis? STUDY DESIGN AND METHODS: From 2012 through 2018, data on 3031 patients undergoing sublobar resection of AAH, AIS, or MIA diagnosed by FS analysis were collected. The concordance rate between FS analysis and final pathologic results was evaluated. To assess the clinical significance of a discrepancy between FS and final pathologic results, patients with final pathologic results of IAC were identified for prognostic evaluation. RESULTS: When AAH, AIS, and MIA were classified together as a group, the overall concordance rate between FS and final pathologic results was 93.7%, and 192 patients (6.3%) received an upgraded diagnosis from the final pathologic results. Misdiagnosed IACs consisted of 94 patients (48.9%) with lepidic-predominant adenocarcinoma, 77 patients (40.1%) with acinar predominant adenocarcinoma, 19 patients (9.9%) with papillary predominant adenocarcinoma, one patient with solid predominant adenocarcinoma, and one patient with invasive mucinous adenocarcinoma. Among these patients, no positive N1 or N2 lymph node findings were observed. Moreover, the 5-year recurrence-free survival was still 100%, although the final pathologic results turned out to be IAC. INTERPRETATION: Patients undergoing limited resection of invasive LUAD misdiagnosed as AAH, AIS, or MIA by FS analysis showed excellent prognoses. Sublobar resection guided by FS diagnosis would be adequate for these underestimated cases of invasive LUAD.
Subject(s)
Adenocarcinoma of Lung , Frozen Sections/methods , Intraoperative Care/methods , Lung Neoplasms , Pneumonectomy , Precancerous Conditions/diagnosis , Adenocarcinoma in Situ/diagnosis , Adenocarcinoma of Lung/diagnosis , Adenocarcinoma of Lung/pathology , Adenocarcinoma of Lung/surgery , Adenomatosis, Pulmonary/diagnosis , China/epidemiology , Diagnostic Errors/statistics & numerical data , Female , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Invasiveness , Pneumonectomy/methods , Pneumonectomy/statistics & numerical data , Prognosis , Tomography, X-Ray Computed/methodsABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Anesthetics, Local/adverse effects , Horner Syndrome/diagnosis , Pain, Postoperative/drug therapy , Adenomatosis, Pulmonary/diagnosis , Diarrhea/etiology , Hematoma/diagnosis , Neurocirculatory Asthenia/etiology , Thoracotomy/adverse effectsABSTRACT
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Subject(s)
Infant, Newborn , Humans , Cystic Adenomatoid Malformation of Lung, Congenital/diagnosis , Cystic Adenomatoid Malformation of Lung, Congenital/pathology , Magnetic Resonance Spectroscopy , Genetic Diseases, Inborn/diagnosis , Genetic Diseases, Inborn/physiopathology , Adenomatosis, Pulmonary/diagnosis , Adenomatosis, Pulmonary/surgery , Cystic Adenomatoid Malformation of Lung, Congenital , Genetic Diseases, Inborn/metabolism , Anesthesia, Epidural/methods , Anesthesia, Epidural , Adenomatosis, Pulmonary/etiologyABSTRACT
Visceral leishmaniasis is not unusual in patients with acquired immunodeficiency syndrome (AIDS), but lung infiltration is uncommon. Leishmaniasis involving the lung often manifests as interstitial pneumonitis. We report a case in which the discovery of amastigotes in the transbronchial biopsy led to a diagnosis of leishmaniasis. However, the findings from x-rays and study of the bronchoalveolar lavage fluid were consistent with bronchiolitis obliterans, possibly caused by the AIDS virus. In addition, the transbronchial biopsy findings were consistent with a diagnosis of bronchioloalveolar adenoma with radiographic evidence of multiple nodules.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Adenomatosis, Pulmonary/diagnosis , Bronchiolitis Obliterans/diagnosis , Leishmaniasis/diagnosis , Lung Diseases, Parasitic/diagnosis , Adenomatosis, Pulmonary/complications , Adult , Bronchiolitis Obliterans/complications , Humans , Leishmaniasis/complications , Lung Diseases, Parasitic/complications , MaleABSTRACT
La leishmaniasis visceral no es inusual en pacientes con síndrome de inmunodeficiencia adquirida (sida), pero su afectación pulmonar es infrecuente. La leishmaniasis pulmonar a menudo se presenta como neumonitis intersticial. Describimos un caso en el cual el hallazgo de amastigotes en la biopsia transbronquial permitió el diagnóstico de leishmaniasis pulmonar. Sin embargo, los hallazgos radiológicos y del lavado broncoalveolar eran compatibles con una bronquiolitis obliterante que podría deberse al virus del sida. Además, la biopsia transbronquial permitió diagnosticar un adenoma bronquioloalveolar con la presencia radiológica de múltiples nódulos
Visceral leishmaniasis is not unusual in patients with acquired immunodeficiency syndrome (AIDS), but lung infiltration is uncommon. Leishmaniasis involving the lung often manifests as interstitial pneumonitis. We report a case in which the discovery of amastigotes in the transbronchial biopsy led to a diagnosis of leishmaniasis. However, the findings from x-rays and study of the bronchoalveolar lavage fluid were consistent with bronchiolitis obliterans, possibly caused by the AIDS virus. In addition, the transbronchial biopsy findings were consistent with a diagnosis of bronchioloalveolar adenoma with radiographic evidence of multiple nodules
Subject(s)
Male , Humans , Acquired Immunodeficiency Syndrome/complications , Adenomatosis, Pulmonary/diagnosis , Bronchiolitis Obliterans/diagnosis , Leishmaniasis/diagnosis , Lung Diseases, Parasitic/diagnosis , Adenomatosis, Pulmonary/complications , Bronchiolitis Obliterans/complications , Leishmaniasis/complications , Lung Diseases, Parasitic/complicationsABSTRACT
BACKGROUND: The association of pregnancy and cancer is a rare event, occurring in less than 1 case per 5,000 pregnancies, and is a cause of maternal mortality in about 5% of cases. CASE: A 33-year-old, Japanese woman presented at the end of pregnancy with clinical manifestations of pneumonia and developed fatal disseminated intravascular coagulation in the postpartum period. The pathologic findings suggested the existence of a primary cancer in the gastrointestinal tract with pulmonary and placental metastases. CONCLUSION: The biologic course of malignancies in pregnancy is complex. In gastrointestinal cancer, normal pregnancy symptoms can mask and delay the diagnosis. As in this patient, very rare presentations are possible.
Subject(s)
Adenomatosis, Pulmonary/diagnosis , Disseminated Intravascular Coagulation/complications , Gastrointestinal Neoplasms/diagnosis , Lung Neoplasms/diagnosis , Pregnancy Complications, Neoplastic/diagnosis , Acute Disease , Adenomatosis, Pulmonary/complications , Adenomatosis, Pulmonary/secondary , Adult , Fatal Outcome , Female , Gastrointestinal Neoplasms/complications , Gastrointestinal Neoplasms/pathology , Humans , Infant, Newborn , Lung Neoplasms/complications , Lung Neoplasms/secondary , Male , Postpartum Period , Pregnancy , Pregnancy Complications, Neoplastic/pathology , Pregnancy Trimester, ThirdABSTRACT
La adenomatosis quística pulmonar es una rara malformación congénita que consiste en un hamartoma torácico generado por un trastorno embrionario que acontece entre la quinta y sexta semana de gestación debido a un cese en la maduración bronquiolar con un excesivo crecimiento del mesénquima pulmonar y cuyo diagnóstico prenatal es hoy día posible debido a las técnicas ultrasonográficas de las que se dispone (AU)
Subject(s)
Adult , Female , Humans , Adenomatosis, Pulmonary/complications , Adenomatosis, Pulmonary/diagnosis , Pregnancy Complications/diagnosis , Pregnancy Complications , Fetus/abnormalities , Congenital Abnormalities/classification , Congenital Abnormalities/diagnosis , Prenatal Diagnosis/methods , Ultrasonography, Prenatal/classification , Ultrasonography, Prenatal/methods , PrognosisABSTRACT
Descreve-se, no Rio Grande do Sul, o primeiro caso de adenomatose pulmonar ("jaagsiekte") em um ovino da raça Karakul, fëmea de 2 anos, filha de pais importados da Alemanha. O ovino morreu de acidose lática por sobrecarga alimentar e as lesöes pulmonares representaram achados incidentais. Macroscopicamente encontraram-se duas áreas esbranquiçadas nodulares com aproximadamente 4 e 6cm de diâmetro respectivamente, com bordos irregulares que, microscopicamente, correspondiam a tumoraçäo epitelial bem diferenciada, formando projeçöes papilares para o interior do lúmem alveolar e bronquiolar. Näo foram encontrados indícios de associaçäo com Maedi/Visna através dos achados sorológicos e histopatológicos. O diagnóstico de adenomatose pulmonar, baseou-se na histopatologia.
Subject(s)
Animals , Female , Adenomatosis, Pulmonary/diagnosis , Adenomatosis, Pulmonary/history , Adenomatosis, Pulmonary/veterinary , Sheep Diseases , Retroviridae , SheepABSTRACT
Presentamos un caso clínico de diagnóstico antenatal de malformación adenomatosa quística del pulmón. Se realiza una revisión de la literatura y se discute el manejo perinatal
