Pulmonary lymphangitic sarcomatosis and a review of the literature.

Intrapulmonary spread of a sarcoma via lymphatics is a rare cause of death in a young adult. A 31-year old man was admitted to our hospital complaining of dyspnea and malaise of 2 months' duration. A chest radiography revealed bilateral hilar enlargement, and reticulonodular infiltrations. Thoracic CT-scans demonstrated mediastinal lymphadenopathy, thickening of interlobular septa, polygonal lines, and thickening of bronchovascular bundles. The diagnosis was made by open-lung biopsy. The patient died within 3 months after diagnosis. Pulmonary lymphangitic sarcomatosis is a rare but important manifestation of an angiosarcoma. Optimal treatment of these patients is not well defined, but a trial of chemotherapy may be warranted.

[Sternal tuberculosis]. / Sternum tüberkülozu.

Isolated involvement of the sternum is rare, representing less than 1% of tuberculous osteomyelitis. In this report, a 51-years-old woman who was admitted to the hospital with a localized solid mass in the sternum has been presented. A soft, painful mass measuring 3 cm in diameter in the lower sternum was detected during physical examination. Radiological investigation revealed presternal soft tissue and bone expansion in the posterior side of lower sternum. The patient was treated with non-specific antibiotics for a suspected diagnosis of osteomyelitis but the lesion did not show any regression. Since the microbiological analysis of fine needle aspiration fluid demonstrated acid-fast bacilli in direct microscopy and Mycobacterium tuberculosis was isolated from the culture, anti-tuberculous therapy consisting of isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and ethambutol (ETM) was started. Sputum and urine cultures of the patient yielded negative results in terms of tuberculosis. After the first month of the therapy, her skin lesion was completely healed. Since the strain was found to be resistant to isoniazid, the maintenance therapy has been applied as INH + RIF + PZA for nine months. The history of the patient indicated that one of her relatives had skin tuberculosis on the face. As a result the patient has been successfully treated with anti-tuberculosis combination therapy together with surgical debridement.

Benign metastasizing leiomyoma.

A 41-year-old woman presented with chest pain and a cough. There was a solitary pulmonary nodule in the upper-left lobe. The patient had no history of neoplasm except a hysterectomy for uterine leiomyoma five years before. Six months after the first presentation, the tumor showed a gradual increase in size; an explorative thoracotomy was performed. The histopathologic examination showed a tumor consisting of well-differentiated spindle-shaped cells with intervening collagen. She was readmitted 8 months after the operation because of right-sided spontaneous pneumothorax. Multiple pulmonary nodules appeared when the lung was re-expanded by chest tube drainage. In conclusion, uterine leiomyomas can metastasize to various organs, such as lungs, despite having a benign pathologic appearance.