Pulmonary Lymphoma Misdiagnosed as Pneumonia.
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ABSTRACT:
SUBMITTER: Lee J
PROVIDER: S-EPMC5074981 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe lung is one of the most common target organs for malignant tumor metastasis. The existence of lung metastasis may have a decisive effect on the choice of treatment regimen. Minute pulmonary meningothelial-like nodules (MPMNs) usually present as ground-glass opacity or solid nodules, mimicking the imaging findings of malignant pulmonary nodules. This study summarizes the clinical, radiological, and pathological features of MPMNs to distinguish them from malignant pulmonary nodules.MethodsThe Guangdong Lung Cancer Institute Pathology Information System was searched using the key words "minute meningothelioid nodules" and "lung." Patients who underwent pulmonary resection from 23 February 2009 to 31 May 2017 were included in the study. The 11th edition of Rosai and Ackerman's Surgical Pathology was used to confirm the diagnosis. The clinical, imaging, and pathological characteristics of MPMNs were recorded.ResultsTwelve patients had MPMNs. MPMNs were associated with cancerous or precancerous lesions (10/12), female gender (11/12), and non-smokers (11/12). Four patients were misdiagnosed with malignant pulmonary nodules before surgery. Positron emission tomography-computed tomography revealed an increased maximum standardized uptake value in one patient. Immunohistochemistry identified eight specimens positive for vimentin, EMA, and PR and negative for TTF-1 and CK.ConclusionsMPMNs tend to coexist with malignant tumors, mimicking the imaging findings of malignant pulmonary nodules, thus resulting in misdiagnosis. Dynamic monitoring or an invasive examination may help to distinguish MPMNs from malignant lesions.
| S-EPMC6501004 | biostudies-literature
Project description:BackgroundExtranodal NK/T-cell lymphoma (ENKTL) is an aggressive non-Hodgkin lymphoma that typically develops in the upper aerodigestive tract.Case presentationWe encountered an ENKTL patient who presented with purpura-like rashes and foot drops as initial symptoms and later developed other peripheral nerve involvement. The nerve conduction study of both the motor nerve and the sensory nerve showed axonal damage resembling mononeuropathy multiplex. Although the initial response to steroids was encouraging, the patient's symptoms reappeared and aggravated. A biopsy of the abdominal subcutaneous fat tissue with additional immunohistochemistry revealed neoplastic NK/T lymphocytes.ConclusionWe reported the first case presented as mononeuropathy multiplex as the initial clinical manifestation in ENKTL patients. Lymphoma should be considered in the diagnosis of atypical mononeuropathy in multiplex patients.
| S-EPMC10702496 | biostudies-literature
Project description:We report the case of a 25-year-old woman with a pulmonary artery sling who was misdiagnosed as having childhood-onset refractory asthma for approximately 20 years. The use of computed tomography may be useful for diagnosing this rare condition.
| S-EPMC5458045 | biostudies-other
Project description:A 36-year-old woman, unresponsive to pneumonia antibiotherapy followed by antituberculosis treatment, was referred to our clinic. Thorax computed tomography (CT) and positron emission tomography CT showed cystic mass and mediastinal lymph node with suspicion of malignancy. Fine needle aspiration biopsy and mediastinoscopy showed no malignancy, so the patient underwent an exploratory thoracotomy. A frozen section of wedge-resected mass was reported as adenocarcinoma, leading to right lower lobectomy with mediastinal lymph node dissection. Besides cutting-edge diagnostic techniques, exploratory thoracotomy for cavitary lung lesions can still be necessary, as the last-line choice. The probability of malignancy must always be considered, despite a patient's age or symptoms.
| S-EPMC5553461 | biostudies-other
Project description:ObjectivesDuring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, dramatic endothelial cell damage with pulmonary microvascular thrombosis have been was hypothesized to occur. The aim was to assess whether pulmonary vascular thrombosis (PVT) is due to recurrent thromboembolism from peripheral deep vein thrombosis or to local inflammatory endothelial damage, with a superimposed thrombotic late complication.DesignObservational study.SettingMedical and intensive care unit wards of a teaching hospital.ParticipantsThe authors report a subset of patients included in a prospective institutional study (CovidBiob study) with clinical suspicion of pulmonary vascular thromboembolism.InterventionsComputed tomography pulmonary angiography and evaluation of laboratory markers and coagulation profile.Measurements and main resultsTwenty-eight of 55 (50.9%) patients showed PVT, with a median time interval from symptom onset of 17.5 days. Simultaneous multiple PVTs were identified in 22 patients, with bilateral involvement in 16, mostly affecting segmental/subsegmental pulmonary artery branches (67.8% and 96.4%). Patients with PVT had significantly higher ground glass opacity areas (31.7% [22.9-41] v 17.8% [10.8-22.1], p < 0.001) compared with those without PVT. Remarkably, in all 28 patients, ground glass opacities areas and PVT had an almost perfect spatial overlap. D-dimer level at hospital admission was predictive of PVT.ConclusionsThe findings identified a specific radiologic pattern of coronavirus disease 2019 (COVID-19) pneumonia with a unique spatial distribution of PVT overlapping areas of ground-glass opacities. These findings supported the hypothesis of a pathogenetic relationship between COVID-19 lung inflammation and PVT and challenged the previous definition of pulmonary embolism associated with COVID-19 pneumonia.
| S-EPMC7836419 | biostudies-literature
Project description:PurposeTo investigate pulmonary vascular abnormalities at CT pulmonary angiography (CT-PE) in patients with coronavirus disease 2019 (COVID-19) pneumonia.Materials and methodsIn this retrospective study, 48 patients with reverse-transcription polymerase chain reaction-confirmed COVID-19 infection who had undergone CT-PE between March 23 and April 6, 2020, in a large urban health care system were included. Patient demographics and clinical data were collected through the electronic medical record system. Twenty-five patients underwent dual-energy CT (DECT) as part of the standard CT-PE protocol at a subset of the hospitals. Two thoracic radiologists independently assessed all studies. Disagreement in assessment was resolved by consensus discussion with a third thoracic radiologist.ResultsOf the 48 patients, 45 patients required admission, with 18 admitted to the intensive care unit, and 13 requiring intubation. Seven patients (15%) were found to have pulmonary emboli. Dilated vessels were seen in 41 cases (85%), with 38 (78%) and 27 (55%) cases demonstrating vessel enlargement within and outside of lung opacities, respectively. Dilated distal vessels extending to the pleura and fissures were seen in 40 cases (82%) and 30 cases (61%), respectively. At DECT, mosaic perfusion pattern was observed in 24 cases (96%), regional hyperemia overlapping with areas of pulmonary opacities or immediately surrounding the opacities were seen in 13 cases (52%), opacities associated with corresponding oligemia were seen in 24 cases (96%), and hyperemic halo was seen in 9 cases (36%).ConclusionPulmonary vascular abnormalities such as vessel enlargement and regional mosaic perfusion patterns are common in COVID-19 pneumonia. Perfusion abnormalities are also frequently observed at DECT in COVID-19 pneumonia and may suggest an underlying vascular process.Supplemental material is available for this article.© RSNA, 2020.
| S-EPMC7307217 | biostudies-literature
Project description:Community-acquired pneumonia remains a major contributor to global communicable disease-mediated mortality. Neutrophils play a leading role in trying to contain bacterial lung infection, but they also drive detrimental pulmonary inflammation, when dysregulated. Here we aimed at understanding the role of microRNA-223 in orchestrating pulmonary inflammation during pneumococcal pneumonia. Serum microRNA-223 was measured in patients with pneumococcal pneumonia and in healthy subjects. Pulmonary inflammation in wild-type and microRNA-223-knockout mice was assessed in terms of disease course, histopathology, cellular recruitment and evaluation of inflammatory protein and gene signatures following pneumococcal infection. Low levels of serum microRNA-223 correlated with increased disease severity in pneumococcal pneumonia patients. Prolonged neutrophilic influx into the lungs and alveolar spaces was detected in pneumococci-infected microRNA-223-knockout mice, possibly accounting for aggravated histopathology and acute lung injury. Expression of microRNA-223 in wild-type mice was induced by pneumococcal infection in a time-dependent manner in whole lungs and lung neutrophils. Single-cell transcriptome analyses of murine lungs revealed a unique profile of antimicrobial and cellular maturation genes that are dysregulated in neutrophils lacking microRNA-223. Taken together, low levels of microRNA-223 in human pneumonia patient serum were associated with increased disease severity, whilst its absence provoked dysregulation of the neutrophil transcriptome in murine pneumococcal pneumonia.
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Project description:Chronic pulmonary blastomycosis is often misdiagnosed and treated as tuberculosis in disease-endemic and non-disease-endemic areas. We report the case of a 32-year-old man who after visiting Chicago, Illinois, USA, returned to India and received treatment for tuberculosis for 12 months before receiving the correct diagnosis of blastomycosis.
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Project description:This case highlights the importance of coordinating with cardiopediatricians or congenitalists in the evaluation and treatment of ASD.
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