Endobronchial lipoma with tracheobronchial aspergillosis: A case report.

INTRODUCTION: Benign neoplasm of the endobronchial tree is quite rare, while endobronchial lipoma is extremely rare. Tracheobronchial aspergillosis is a relatively uncommon but severe form of invasive aspergillosis involving the tracheobronchial tree. PATIENT CONCERNS: A 54-year-old male presented to our hospital for investigation and treatment of a cough and hemoptysis. DIAGNOSIS: The diagnosis was confirmed as endobronchial lipoma with tracheobronchial aspergillosis. INTERVENTIONS: The patient received pneumonectomy and voriconazole treatment. OUTCOMES: The patient's postoperative course was uneventful, and he was discharged 10 days after surgery. The patient had no evidence of the fungal infection and recurrence during 1 year of follow-up. CONCLUSION: Endobronchial lipoma is a rare benign lung tumor, and this is the first report of endobronchial lipoma with tracheobronchial aspergillosis. In patients with suspected endobronchial lipoma, especially those who present with hemoptysis as the initial symptom, it is advisable to exclude coexistent aspergillosis.

Mycobacterium avium-intracellulare presenting as an endobronchial tumour due to immune reconstitution inflammatory syndrome.

Mycobacterium avium-intracellulare (MAI) infection in an HIV-positive patient can present shortly after starting antiretroviral therapy, as a result of immune reconstitution inflammatory syndrome (IRIS). We report a case of a 33-year-old woman where MAI presented as an endobronchial tumour due to IRIS. She responded well to standard anti-MAI treatment (rifamycins, macrolide and ethambutol).

Bronchus-associated lymphoid tissue lymphoma arising in a patient with bronchiectasis and chronic Mycobacterium avium infection.

We describe a 67-year-old woman with bronchiectasis and Mycobacterium avium complex infection who underwent wedge resection of her pulmonary infiltrates because they were progressing despite antibiotic therapy. In addition to the expected granulomatous changes, she was found to have a B-cell lymphoma of bronchus associated lymphoid tissue (BALT). Despite normal bone marrow morphology, marrow involvement was demonstrated by flow cytometry. Her lymphoma remains suppressed with antimycobacterial therapy 6 months after resection of bulk disease.

Disseminated Mycobacterium intracellulare infection in an HIV-negative, nonimmunosuppressed patient with multiple endobronchial polyps.

Endobronchial lesions caused by nontuberculous mycobacterial disease are extremely rare, but we recently encountered a case of disseminated disease due to Mycobacterium intracellulare presenting as multiple endobronchial polypoid lesions in an HIV-negative host. The patient was a 45-year-old Japanese female with fever, loss of body weight and cervical lymphadenopathy. Chest X-rays demonstrated a left hilar mass, and bronchoscopy revealed multiple polypoid lesions in the left main bronchus and bronchus of the left upper lobe. The infection later progressed, involving generalized lymphadenopathy, liver splenic and cutaneous abscesses, pulmonary infiltration, pleural effusion, and costal fracture. Finally, in two separate cutaneous abscesses M. intracellulare was identified by a DNA probe method. Antimycobacterial drugs were given, and the endobronchial lesions along with other symptoms and signs greatly improved.

Oral yeast carriage in patients with advanced cancer.

The aim of this study was to investigate oral yeast carriage amongst patients with advanced cancer. Oral rinse samples were obtained from 120 subjects. Yeasts were isolated using Sabouraud's dextrose agar and CHROMagar Candida, and were identified using a combination of the API 20 C AUX yeast identification system, species-specific PCR and 26S rDNA gene sequencing. Oral yeast carriage was present in 66% of subjects. The frequency of isolation of individual species was: Candida albicans, 46%; Candida glabrata, 18%; Candida dubliniensis, 5%; others, < 5%. The increasing isolation of non-Candida albicans species is clinically important, since these species are often more resistant to antifungal drugs. Oral yeast carriage was associated with denture wearing (P = 0.006), and low stimulated whole salivary flow rate (P = 0.009). Identification of these risk factors offers new strategies for the prevention of oral candidosis in this group of patients.

Prognostic importance of human papilloma virus typing in squamous cell papilloma of the bronchus: comparison of in situ hybridization and the polymerase chain reaction.

Thirty-one solitary bronchial squamous cell papillomas (SCPs) with variable degrees of dysplasia, one combined with larynx papilloma and small cell carcinoma in the contralateral lung, and 12 papillomas combined with invasive squamous cell carcinomas (SCCs) were investigated for the presence of human papilloma virus (HPV) DNA by in situ hybridization (ISH) and the polymerase chain reaction (PCR). Benign SCPs showed an association with HPV type 11 and rarely with type 6, whereas type 16 or 18, sometimes in combination with type 31/33/35, was found in SCPs associated with SCCs. In one patient HPV type 18- and 31/33/35-positive benign SCP preceded the recurrence of HPV 18-positive SCP (this time combined with carcinoma) by 2 years. Patients with SCP exhibiting HPV 16 or 18 positivity are at high risk for the development of SCC. Virus typing seems to be a better prognostic indicator than grading of dysplasia or age relationship. Virus typing by the PCR is more sensitive compared with ISH, but positive cells cannot be determined; ISH is less sensitive than the PCR but permits a definite designation of the cell types that have integrated HPV sequences into their DNA. Our data suggest that HPV typing should be performed in every bronchial SCP.

Tracheobronchial involvement of laryngeal papillomatosis at onset.

A case of adult onset laryngeal papillomas with tracheal and bronchial involvement present at onset is presented. The presence of human papilloma virus (HPV) DNA type 6/11 is demonstrated by in situ hybridization.

The predictive value of human papilloma virus (HPV) typing in the prognosis of bronchial squamous cell papillomas.

Five solitary squamous papillomas of bronchus with variable degrees of dysplasia, one combined with a laryngeal papilloma and with a neuroendocrine carcinoma in the contralateral lung, and five papillomas combined with invasive squamous cell carcinomas were investigated for their expression of human papilloma virus DNA by in situ hybridization. Benign squamous cell papillomas showed an association with papilloma virus type 11 and rarely type 6, whereas types 16 or 18, sometimes in combination with types 31/33/35 were found in papillomas associated with carcinomas. In one patient a benign papilloma containing human papilloma virus type 18 and 31/33/35-positive preceded a recurrence combined with carcinoma by 2 years; this recurrent papilloma and the carcinoma were also positive for human papilloma virus 18 DNA. We suggest that human papilloma virus typing should be performed in every squamous cell papilloma of bronchus. Patients with papillomas exhibiting human papilloma virus 16 or 18 positivity are at high risk for the development of squamous cell carcinoma. Furthermore, virus typing may be of prognostic importance in relation to the development of squamous carcinoma.

An investigation into the role of human papillomavirus in endobronchial papillary squamous tumours.

Tissue specimens from 15 patients with endobronchial papillary squamous tumours were probed for the presence of human papillomavirus DNA using the technique of in situ hybridization with probes to human papillomavirus genotypes 4, 5, 6b, 8, 11, 16 and 18. Despite the histological similarity of these lesions to known human papillomavirus-associated tumours no evidence of hybridization was detected in any of the cases analysed. It is thus unlikely that human papillomavirus has a significant role in the genesis of these tumours.

Human papilloma virus type 11 in a fatal case of esophageal and bronchial papillomatosis.

We report a case of an apparently healthy 27-year-old man with a fatal course of papillomatosis, originating in the distal part of the esophagus and spreading into the main and intermediate bronchus. Human papillomavirus type 11, usually associated with juvenile laryngeal papillomatosis and genital condyloma acuminatum, was detected in the papillomas. In spite of treatment with CO2-laser evaporation of the papillomas, and with systemic as well as topical interferon, VP-16 and bleomycin, the papillomatosis progressed relentlessly during almost 2 years, and finally caused the death of the patient. We have no explanation for the malignant course of wart virus infection in this young man.

Solitary condylomatous papilloma of the bronchus.

Two case reports of solitary bronchial papillomas are presented. The histologic features of the lesions are those of squamous papillomas exhibiting prominent condylomatous changes. Immunoperoxidase stains revealed the presence of human papillomavirus antigens in the koilocytotic cells. Ultrastructural studies demonstrated possible intranuclear viral-size particles. Solitary condylomatous papillomas of the bronchus should be distinguished from solitary bronchial squamous papillomas that do not have condylomatous features. The rationale for this separation is the likelihood of a viral origin for these condylomatous papillomas and their potential for malignant change.

Epstein-Barr virus specific IgA serum antibodies in nasopharyngeal and other respiratory carcinomas.

In order to better understand the relationship between IgA and IgG antibodies to Epstein-Barr virus (EBV) in nasopharyngeal carcinoma (NPC), we analyzed 230 NPC sera but also a series of sera from patients with other carcinomas selected for their high EBV/IgG antibody titres. We were surprised to find that 21 out of 46 sera from bronchopulmonary carcinomas (BPC) and 6 out of 7 carcinomas of nasal fossae were IgA anti-VCA positive, and 9 BPC sera and 5 nasal fossae sera were also positive for IgA and anti-EA. Bronchial undifferentiated small-cell carcinomas may represent a particular group associated with high EBV profile.

Mycobacterium resembling Mycobacterium fortuitum that produces brown pigment.

Two cultures of acid-fast bacilli with characteristics most closely resembling those of Mycobacterium fortuitum were recovered as casual isolates from sputa of a patient with an apparent brochogenic tumor. One of the cultures was consistenly cream colored to rosy buff. The other, however, changed from buff to rust to dark brown and had the gross appearance of a fungus culture.