We describe a case in which the rapid diagnosis of tuberculous pericarditis was made using the Mycobacterium tuberculosis (MTB)-specific enzyme-linked immunospot (ELISPOT) assay on pericardial ...effusion mononuclear cells (PEMCs). The analysis of MTB-specific T-cells in PEMCs by ELISPOT may be useful for rapid decision-making in anti-tuberculous treatment.
A 68-year-old man was admitted to our hospital because of continuous cough of three months duration and for investigation of a thin-wall cavitary lesion (> 3 cm) in the right upper lung field. ...Thin-wall cavity (40 x 35 mm) with notch and spiculation was observed in the right S2 on chest CT. A histological diagnosis of pulmonary adenocarcinoma was obtained by bronchoscopic examination, and he was transferred to the Department of Thoracic Surgery where a right upper lobectomy was performed. Subsequently, cavity formation (45 x 40 x 35 mm) was disclosed in the right S2. Most of the surrounding cavity consisted of the components of a well differentiated squamous cell carcinoma with keratinization and slightly different components of a poorly differentiated adenocarcinoma with mucous production. The final diagnosis was pulmonary adenosquamous cell carcinoma and the postoperative histological classification was T2N2M0 (Stage 3A) because of metastasis to the lymph nodes (#4 and #11). A communicating bronchus was histologically identified and we presumed that the thin-wall cavity developed by a check valve mechanism. Although squamous cell carcinoma has been reported to be the histological type, tending to form thin-wall cavities among patients with lung cancer reported to be squamous cell carcinoma, recently an increasing number of such cavities have been reported among patients with pulmonary adenocarcinoma. Herein, we have reported a rare case of histological diagnosis of pulmonary adenosquamous cell carcinoma with cavity formation.
A 79-year-old man, who had an occupational history of handling rushes (which were treated with pigmented earth containing 25% silica) for 30 years and a past history, eight years earlier, of primary ...pulmonary adenocarcinoma in the left lower lung (T2N2M0), was admitted to our hospital for the investigation of two nodular shadows in the right upper S3 which showed a double lesion detected on chest CT. A histological diagnosis of pulmonary adenocarcinoma was obtained by bronchoscopic examination, and so he was transferred to the Department of Thoracic Surgery and video-assisted thoracoscopic surgery (VATS) was performed. Subsequently, the large part of the tumor, in the central region, was diagnosed as a pulmonary adenocarcinoma, and the smaller part of the tumor, in the peripheral region, was found to consist of an adhesion of small nodules composed of pneumoconiosis due to the rushes. Multiple small nodules consisting of rush pneumoconiosis were histologically recognized surrounding this smaller part of the tumor. Although, at admission, we first suspected the presence of multicentric, metastatic lung cancer and an inflammatory tumor, the patient's occupational history also proved to be important, and we could not decide on the appropriate diagnosis before VATS because multiple small nodules consisting of rush pneumoconiosis overlapped the tumor.
We report a peculiar case of multifocal micronodular pneumocyte hyperplasia (MMPH) in a 54-year-old woman with tuberous sclerosis complex (TSC) diagnosed during antituberculous treatment. Findings ...were initially detected by chest computed tomography (CT) to check for complication of pulmonary tuberculosis. Chest CT demonstrated multiple small nodules with ground-glass opacity, measuring up to 5 mm diameter, presenting in the bilateral lung fields, without cystic change. Because the differentiation from multiple atypical adenomatous hyperplasia (AAH) was necessary, we finally performed a diagnosis of MMPH based on specimens obtained by video-assisted thoracoscopic surgery. Histologically, type II pneumocytes without nuclear atypia lined the thickened alveolar septa and proliferated papillary structures. There was no proliferation of immature smooth muscle cells suggestive of lymphangioleiomyomatosis. Although immunohistochemical stains for cytokeratin and surfactant apoprotein A and B were positive for alveolar lining cells in each MMPH lesion, those for HMB-45, alpha-smooth muscle actin, p53 and carcinoembryonic antigen were negative. We must consider MMPH as part of the differential diagnosis along with multiple AAH when multiple small nodules with ground-glass opacity were observed on chest CT in patients with TSC.
When heat-killed Propionibacterium acnes is intravenously injected into tuberculin-sensitized guinea pigs, the sensitized lyuphocytes are infiltrated in the liver tissue. By further injecting ...specific antigen, purified protein derivatives (PPD), the cholestatic factor is produced and intrahepatic cholestasis is immunologically induced in vivo. In order to examine the mechanism by which intrahepatic cholestasis is induced, we studied the bile excretion of 14C-sucrose and 32P-orthophosphate, which are known to excrete into the bile through the tight junction (paracellular pathway) rather than through the liver cells. However, in the guinea pigs in which intrahepatic cholestasis was immunologically induced, there was no change in the excretion of 14C-sucrose and 32P-orthophosphate into the bile.
PDF
