Clinical, radiological, and laboratory features of HIV-negative pulmonary cryptococcosis with regard to serum lateral flow assay.

Introduction: Cryptococcosis is the second most common invasive yeast infection in China. Pulmonary cryptococcosis (PC) is difficult to diagnose due to the lack of specific clinical features and the limitation of diagnostic techniques. Although lateral flow assay was very useful in diagnosing cryptococcal infection, quite a few patients with PC presented negative serum lateral flow assay (sLFA). Methods: We conducted a retrospective study of HIV-negative patients who were diagnosed with PC in our hospital over the past decade to explore the potential relationship between the clinical profiles and sLFA in PC. Results: In total, 112 patients with sLFA tested were enrolled in this study, of which 58.93% were male. The positivity rate of sLFA for PC was 91.07%. The extent of pulmonary lesions was positively correlated with sLFA grade (Spearman r = 0.268, p < 0.01). Solitary nodule (SN) and pneumonia were the most common imaging findings in PC with negative and positive sLFA respectively. Among 65 symptomatic PC patients, 14 presented with fever and had higher hypersensitive C-reactive protein (hsCRP) level and more extensive pulmonary involvement (Mann-Whitney U test, p < 0.05) than those without fever. Symptomatic PC patients were more likely to have positive results of sLFA (Mann-Whitney U test, p = 0.05) compared against asymptomatic ones. Discussion: In conclusion, negative sLFA cannot exclude PC in patients with a solitary nodule in lung. Positive sLFA is more reliable in diagnosing PC in symptomatic patients with diffused lesions in lung who generally experience a more severe systemic inflammatory reaction.

Pulmonary sarcoidosis presenting as a solitary nodule mimicking lung cancer.

Nodular sarcoidosis is a rare form of sarcoidosis. It is difficult to differentiate from malignancy based on radiological findings. Histological examination is important, and sarcoidosis should be considered as differential diagnosis of solitary lung nodule.

Primary cutaneous anaplastic large-cell lymphoma of the eyelid: report of two cases and review of the literature.

PURPOSE: Two new cases of primary cutaneous CD30+ anaplastic large-cell lymphoma (cALCL) of the eyelid are reported; these are analysed alongside existing cases to identify challenges relating to the diagnosis and management of such rare lesions. MATERIAL AND METHODS: A review of existing literature on the PubMed database is conducted using the keywords: 'eyelid lymphoid proliferations', 'lymphoma of the eyelid', and 'primary cutaneous CD30+, ALK-anaplastic large-cell lymphoma of the eyelid'. Two new cases of cALCL are reported. Cases where patients present solely with a nodular periocular lesion are analysed for recurrence and survival rate. RESULTS: Two new patients with a painless ulcerated nodule on the upper eyelid receive a confirmed diagnosis of cALCL after undergoing an excisional biopsy. The first, elderly patient has spontaneous remission; the second patient, with a concomitant chronic infection of hepatitis C virus (HCV), presents a more diffuse disease at the onset and requires radiotherapy. Together with 13 patients a primary cALCL identified from 11 previous studies, this constitutes a cohort of 15 patients. Of these, 10 present with an exclusively nodular lesion of the eyelid and four experience disease recurrence; no deaths from cALCL are reported. CONCLUSION: Differential diagnosis between primary cALCL and lymphomatoid papulosis is essential and requires careful consideration of clinical and pathologic features. Radiologic staging examination is crucial in order to exclude systemic ALCL, particularly for patients with comorbidity. Though cALCL has the pathological features of a malignant lesion, the prognosis seems favourable for patients; a relatively high percentage even experience spontaneous resolution.

High Rates of Underlying Thyroid Cancer in Patients Undergoing Thyroidectomy for Hyperthyroidism.

BACKGROUND: The rate of thyroid cancer in patients with hyperthyroidism is reported to be rare, and patients with toxic thyroid nodules do not routinely undergo fine-needle aspiration (FNA) to evaluate for malignancy. However, higher rates of malignancy in hyperthyroid patients may exist than previously reported. This study examines the rate of malignancy in patients with hyperthyroidism who have undergone thyroidectomy. METHODS: A retrospective review of prospectively collected data of 138 patients with hyperthyroidism who underwent thyroidectomy at a single institution was performed. Patients were divided into three groups: Graves' disease (n = 80), toxic multinodular goiter (n = 46), and toxic solitary nodule (n = 12). Patients with previous thyroid surgery were excluded from the study. All patients had biochemical confirmation of hyperthyroidism with thyroid-stimulating hormone <0.1 mIU/L and clinical diagnosis by a referring physician. RESULTS: Of 138 patients, 22% (31/138) were found to have malignancy on final pathology. The breakdown of malignancy by hyperthyroid condition was as follows: 16% in Graves' disease, 24% in toxic multinodular goiter patients, and 50% in toxic solitary nodule patients. CONCLUSIONS: There is a clinically significant rate of malignancy seen in patients who undergo thyroidectomy for hyperthyroidism. Patients with distinct thyroid nodules in the presence of hyperthyroidism may have the highest rates of malignancy and should undergo appropriate workup with ultrasound and FNA to exclude underlying malignancy. In cases with suspicious ultrasound features and/or FNA cytopathology, surgical treatment should be considered as initial management.

Trauma-induced Focal Nodular Mucinoses: A Rare Entity.

Cutaneous mucinoses refer to disorders with abnormal accumulation of mucin in the skin. Mucin is an amorphous material that is a part of the extracellular matrix in dermis. Cutaneous mucinoses could be primary or secondary. The latter is associated with systemic disorders such as autoimmune diseases, diabetes mellitus, paraproteinemia, or altered thyroid function. Here, we report an adult female patient with trauma-induced cutaneous focal nodular mucinoses on left-sided scapular region. Histology showed replacement of collagen bundles by mucinous deposits in superficial and mid-dermis. Mucinous substance was present in peri-eccrine location on Alcian blue staining.

Predictors of a follicular nodule (Thy3) outcome of thyroid fine needle aspiration cytology among Saudi patients.

OBJECTIVE: A retrospective study was performed to evaluate predictors of thyroid fine needle aspiration cytology (FNAC) outcomes among Saudis with a thyroid nodule. Socio-demographic data, thyroid function status, thyroid parameters, ultrasound and cytology results were collected from 269 files of patients with thyroid nodules. RESULT: The patients' age was 40 ± 1.4 years (mean ± SD), and the mean body mass index (BMI) was 30.3 ± 1.2 kg/m2. The thyroid statuses were euthyroid (85.5%), hypothyroidism (7.4%) and hyperthyroidism (7.1%). Young age, an absence of irradiation history, and multinodular goitre were protective against Thy3 [(OR = 0.05, CI = 003-0.6, P = 0.024), (OR = 0.4, CI = 0.2-0.8, P = 0.012) and (OR = 2.5, CI = 1.2-5.3, P = 0.016), respectively]; a lower FT3 was protective against Thy4 (OR = 0.4, CI = 0.2-0.99, P = 0.046), the absence of cervical lymphadenopathy was associated with Thy2 (OR = 2.7, CI = 1.4-5, P = 0.001), and a solid nodule was associated with Thy2 and Thy3 [(OR = 1.2, CI = 0.3-0.97, P = 0.040) and (OR = 2.2, CI = 1-4.8, P = 0.039), respectively]. In a multivariate analysis, younger age, multinodular goitre, an absence of irradiation history and cervical lymphadenopathy were protective against Thy3 [(OR = 0.04, 95% CI = 0.002-0.96, P = 0.047), (OR = 2.4, 95% CI = 1.0-5.60, P = 0.039), (OR = 0.4, 95% CI = 0.16-0.94, P = 0.036) and (O R = 0.39, 95% CI = 1-5.6, P = 0.039), respectively]. In summary, younger age, multinodular goitre, the absence of an irradiation history and cervical lymphadenopathy were protective against Thy3 in a thyroid nodule.

Ground-glass opacities and a solitary nodule on chest in intravascular large B-cell lymphoma.

A 74-year-old woman presented with dyspnea on exertion and nocturnal cough. Chest computed tomography (CT) revealed scattered bilateral ground-glass opacities without a zonal dominance. Bronchoalveolar lavage elicited increased lymphocytes, but transbronchial lung biopsies were not performed because of hypoxemia during the examination. She received steroid therapy because of her subsequent worsening respiratory condition, but her condition continued to deteriorate. The ground-glass opacities partially consolidated with the appearance of new ground-glass opacities and a nodular shadow. Hepatosplenomegaly was observed on CT while soluble interleukin-2 receptor was elevated. A biopsy of a Campbell de Morgan spot of the trunk yielded a diagnosis of intravascular large B-cell lymphoma. There was marked clearing of the pulmonary infiltrates and significant symptomatic improvement in response to systemic chemotherapy.

Characteristics of pulmonary Mycobacterium avium complex disease diagnosed later in follow-up after negative mycobacterial study including bronchoscopy.

BACKGROUND: We occasionally experience cases suspected of pulmonary Mycobacterium avium complex (MAC) disease without positive bacterial cultures. OBJECTIVE: To evaluate features of pulmonary MAC cases diagnosed later in the follow-up after negative intensive investigation. METHODS: We defined and compared three groups; the first study negative (FSN) group, the first study positive (FSP) group, and MAC negative group. The FSN group consisted of patients negative for MAC isolation by bronchial washing performed between 2007 and 2011, but positive later. Patients with positive MAC cultures in the first study were incorporated into the FSP group. MAC negative group consisted of MAC suspects without MAC isolation in the follow-up. RESULTS: Twenty-four patients were classified as FSN group, 61 as MAC negative group and 265 as FSP group. FSN group exhibited more solitary nodule pattern (n = 7 in FSN, n = 6 in FSP; p < 0.001) and less nodular/bronchiectatic (NB) diseases (n = 17 in FSN, n = 245 in FSP; p < 0.001). When limited to NB type, the FSP group had more cavitations (6% in FSN, 32% in FSP; p = 0.028). Patients with more than three lung lobes involved were more frequent in the FSN group compared with FSP group with negative sputum cultures (65% vs 34%; p = 0.014) and with MAC negative group (65% vs 28%; p = 0.009). CONCLUSIONS: Patients diagnosed as pulmonary MAC disease in the follow-up duration tend to show solitary nodular pattern or NB pattern without cavitation. In FSN patients with NB pattern, more lung lobes were involved in the first study, suggesting subsequent MAC infection onto the underlying ectatic bronchi.

A case report on bronchoalveolar carcinoma presenting as non-resolving consolidation.

Bronchoalveolar carcinoma presenting as non-resolving consolidation is an uncommon presentation. The typical presentation of bronchoalveolar carcinoma is asymptomatic (solitary nodule) and remains without symptoms even as disease disseminates. We report a case of bronchoalveolar carcinoma presenting as non-resolving consolidation in a young male with productive cough, exertional breathlessness and physical examination revealing the features of right lower consolidation on x-ray chest, with subsequent CT of the chest and bronchoscopic examination revealed bronchoalveolar carcinoma. Patient had a good score and was managed conservatively.

A Case of Bronchiolitis Obliterans Organizing Pneumonia with a Solitary Pulmonary Nodule in a Child / 소아알레르기및호흡기학회지

Bronchiolitis obliterans organizing pneumonia (BOOP) is a pulmonary disorder that exhibits various radiographic findings. It often shows bilateral, patched, or ground glass interstitial infiltrate, but a solitary nodular pattern rarely appears. We report a case of an 8-year-old boy suffering from BOOP that showed a single nodular pattern of the lung in the chest radiography. We conclude that when there is a solitary nodule discovered in the lungs of children or adolescence, the differential diagnosis must include BOOP.

Solitary Drain-Site Recurrence after Lumpectomy for Breast Cancer

Locoregional recurrence after breast conservative surgery is not a rare event. However, a metastatic nodule solely at the surgical drain site seems to be extremely unusual. In this report, we present a patient who received a lumpectomy for breast cancer but a metastatic nodule developed at the drain site more than two years after her surgery.

Toxic adenoma of the thyroid gland and Wolff-Parkinson-White syndrome.

We report the case of a 17-year-old girl with toxic adenoma scheduled for surgery right lobectomy and isthmectomy of thyroid gland. During the examination before surgery, patient was diagnosed for the first time as having with Wolff-Parkinson-White (WPW) syndrome. In the operating room, after the induction of anesthesia, the electrocardiogram showed wide QRS complex tachycardia with a rate of 180 beats/min, which was diagnosed as paroxysmal supraventricular tachycardia. The patient was treated immediately with antiarrhythmic drugs: adenosine iv three times (at doses of 6 mg, 12 mg, 12 mg bolus) and esmolol iv twice (at doses 28.5 mg). This approach resulted in disappearance of the delta wave and tachycardia for the whole surgery period. In this case report we discuss the role of induction of anesthesia and presence of toxic adenoma in a patient with WPW.

A Case of Nodular Condyloma Lata on the Lip Mucosa / 대한피부과학회지

Condyloma lata is a common manifestation of secondary syphilis, but involvement of the lip mucosa is rare. Nodular lesions, especially solitary nodules, are uncommon manifestations of secondary syphilis, and only a few cases have been described. Failure to recognize condyloma lata of the lip mucosa may delay diagnosis and treatment. A 20-year-old man presented with a 4-month history of a solitary nodule on his upper lip mucosa. A diagnosis of condyloma lata was made on the basis of serologic tests for syphilis and pathological findings. We report an interesting case of condyloma lata on the upper lip mucosa that showed an unusual clinical manifestation of secondary syphilis.

Langerhans Cell Histiocytosis Presenting as a Solitary Nodule / 대한피부과학회지

Langerhans cell histiocytosis, previously called histocytosis X, is a disease of unknown cause characterized by the proliferation of a distinct cell type that is S-100 and CD1a positive and contains cytoplasmic langerhans granules. We report a case of langerhans cell histiocytosis, which a 10-year-old girl presented as a solitary nodule without systemic involvement. Histologic examination of the nodule showed a dense dermal infiltrate of histiocytic cells with bean-shaped nuclei. These cells reacted with antibodies to S-100 and CD1a. Ultrastructural analysis showed Birbeck granules in the cytoplasm of the histiocytic cells. We confirmed langerhans cell histicytosis presenting as a solitary nodule by above findings.

Langerhans Cell Histiocytosis Presenting as a Solitary Nodule / 대한피부과학회지

Langerhans cell histiocytosis, previously called histocytosis X, is a disease of unknown cause characterized by the proliferation of a distinct cell type that is S-100 and CD1a positive and contains cytoplasmic langerhans granules. We report a case of langerhans cell histiocytosis, which a 10-year-old girl presented as a solitary nodule without systemic involvement. Histologic examination of the nodule showed a dense dermal infiltrate of histiocytic cells with bean-shaped nuclei. These cells reacted with antibodies to S-100 and CD1a. Ultrastructural analysis showed Birbeck granules in the cytoplasm of the histiocytic cells. We confirmed langerhans cell histicytosis presenting as a solitary nodule by above findings.

Effectiveness of Percutaneous Ethanol Injection in Benign Cold Thyroid Nodules: Five Years' Experience / 대한내분비학회지

BACKGROUND: Percutaneous ethanol injection therapy (PEI) which is performed with the guidance of ultrasonography has recently been used in patient who had benign cold thyroid nodules. We performed this study to analyze the long-term effects of PEI on benign cold thyroid nodules. METHOD: From September 1995 to September 2000, we treated 198 outpatients (12 men and 186 women, who had a mean age of 40.8 years, with a range of 15-71) who had benign cold thyroid nodules at the Asan Medical Center. The PEI was performed on 141 patients who had solitary nodules (SN) and on 57 patients who had prominent nodules or Questionable or typing error? multiple nodules (MN). All patients had fine needle aspirations (FNAs) at least twice which resulted in a diagnosis of the presence of a colloid nodule. Thyroid hormone was given to all patients along with TSH measurements. The thyroid hormone dose was titrated to correspond to TSH level of a low normal range. These patients were followed up for mean period of 37.6 months (range 18-60). Patients who were treated with PEI were classified into three groups according to their volume reduction: a complete response (CR, which was above 90% in volume reduction), a partial response (PR, which was a 50-89%) reduction and No Response (which was below 50% or an increased size) groups. RESULTS: The overall pre-treatment volumes of the nodules were 15.7+/-19.8 mL. The overall post-treatment volumes were 2.4+/-2.6 mL and consisted of volume reductions of 70.1+/-17.1%. The results of PEI for all of the patients were: a complete reduction (CR) in 34 cases (17.2%), a partial reduction (PR) in 142 cases (71.7%) and No Response in 22 patients (11.1%). In 141 patients in the SN group, in which there was a mean follow-up duration of 36.7+/-11.2 months, the volume reductions were 68.3+/-18.8%. CR was observed in 20 patients (14.2%), PR in 103 (73.0%) and No Response in 18 (12.8%). In twenty-two of the SN patients (22/141, 15.6%) we were able to discontinue the thyroid hormone suppressive therapy because those nodules had markedly decreased in volume after PEI without any further increase of nodule size during the follow-up period. In 57 patients in the MN group, over a mean follow-up durations of 37.1+/-11.4 months, the volume reductions were 74.3+/-12.1%. CR was observed in 14 patients (24.6%), PR in 39 (68.4%) and No Response occurred in 4 (7.0%). During the follow-up period after PEI, further volume reductions were observed for 36 months after thyroid hormone suppressive therapy in the Response Group. Differences in volume reductions between the SN and MN groups were not statistically significant but the volume reductions in patients who had a pre-treatment volume larger than 15 mL were higher than those in the smaller group (p<0.001). In the cases of the SN and MN groups, volume reductions did not correlate with either the amount of injected ethanol or the pre-treatment volumes, but the pre-treatment volumes correlated with post-treatment volumes in the patients who had SN (p<0.001, r=0.411) and MN (p<0.001, r=0.729). We observed mild, but transient complications in 32 patients (16.2%) during PEI which included a transient neck pain (n=27, 13.6%), a transient unilateral vocal cord palsy (n=4, 2.0%), and an abscess formation (n=1, 0.5%) which was cured. CONCLUSION: These results suggest that PEI is a feasible adjunctive therapy to use in thyroid hormone suppressive therapy for benign cold thyroid nodules

Solitary Pulmonary Nodule:Dynamic Spiral CT Scan of Thin Collimation with Pathology Study / 实用放射学杂志

Objective To evaluate the diagnosis and differentiation of solitary pulmonary nodule (SPN) using dynamic spiral CT scan of thin collimation.Methods The thin collimation no-enhanced CT scan and contrast enhanced scan in 30 seconds,1 minute,1 minutes,2 minutes,5 minutes,10 minutes,and 15 minutes after administration of media 100 ml were performed in 38 cases. Results The mean enhanced CT numbers of lung cancer and inflammatory pseudotumor were much higher than that of tuberculosis(TB) and hamartoma and statistically significant in different time of enhancement;20 HU was the threshold for a positive test,the sensitivity was 100% and the specificity was 96%.In time-attenuation curve analysis,lung cancer reached peak enhancement about 2 minutes,inflammatory pseudotumor in 5 minutes and keep longer enhanced time than that of lung cancer.No marked enhancement in SPN of TB and harmatoma,but ring-shaped enhancement can be seen in some of TB.More valuable imaging signs were found with thin collimation scan and more accurate to measure the CT numbers than traditional scan.Conclusion Dynamic spiral CT scan of thin collimation is a very valuable method for diagnosis and differentiation of SPN.

Clinical Observations of the Solitary Pulmonary Nodules / 영남의대학술지

The authors conducted a clinical observation of 55 cases of solitary pulmonary nodules at Yeungnam University Hospital from June 1986 to October 1990, and the following results were obtained: 1. The age distribution was ranged from 18 to 77 years, and the male-to female ratio was 1.8:1. 2. Among 55 cases of nodules, 28 cases were benign and 27 cases were malignant nodules, and of malignant nodules, the primary lung cancer was 23 cases and of benign nodules, 18 cases were tuberculoma. 3. 23 cases (41.8%) was asymptomatic and the other 32 cases were symptomatic; chest pain 12 cases, hemoptysis; 8 cases, cough; 8 cases and dyspnea; 4 cases. 4. The non-smoker-to-smoker ratio was 1:1.04, but among 23 smoker over 20 pack years, 14 cases were malignant nodules. 5. According to nodular size, there is no striking differences between benign and malignant nodules except 3-4 cm sized nodules. 6. The lobar distribution of nodules, 35 cases were in the right lung (upper lobe; 14 cases, middle lobe; 11 cases, and lower lobe; 10 cases) and 23 cases were in the left lung (upper lobe; 9 cases, lower lobe; 11 cases), and the malignant nodules were most commonly observed in the right upper lung.