1/46. Giant hamartoma of the lung.In the following case of giant pulmonary hamartoma, a 62-year-old woman exhibited a huge tumor shadow in the right lung field, whilst remaining asymptomatic. A thoracotomy revealed a solid intrapulmonary mass histologically diagnosed as a cartilaginous hamartoma with no evidence of malignancy. The tumor was resected by enucleation and there has been no recurrence for 40 months since surgery. Parenchyma-saving enucleation or excision is a safe and sufficient procedure for peripheral hamartomas of any size.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/46. Development of a giant bulla after lung volume reduction surgery.lung volume reduction surgery (LVRS) is being evaluated in the treatment of emphysema. The proposed mechanisms of improvement are increased elastic recoil of the lung and improved mechanical efficiency of the muscles of respiration. We report a unique patient with emphysema who developed a giant bulla 3 years subsequent to LVRS. The patient underwent extensive evaluation, including measurements of lung mechanics. Bullectomy was performed, but it was unsuccessful. Although the mechanisms behind the development of giant bullous disease remain speculative, heterogeneous improvement in elastic recoil following LVRS may be one of the responsible mechanisms.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
3/46. Giant pulmonary bulla.The present report describes a case of a giant pulmonary bulla in a 32-year-old man that progressed to occupy almost the entire left hemithorax. This report is unique in documenting the natural history of progression of this condition. Bullectomy was performed using the video-assisted thoracoscopic surgery approach.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/46. Spontaneous resolution of a giant pulmonary bulla.Giant bullae occur most often in individuals who chronically inhale tobacco smoke. The natural history of these bullae is unpredictable, although the majority of them increase gradually in size and cause worsening respiratory function. Complete spontaneous resolution of a giant bulla is a rare occurrence, with only eight cases reported in English literature. Most of the cases of spontaneous resolution of giant bullae are thought to have resulted from an infectious process leading to closure of the communication between the airways and the bulla. However, resolution of a bulla has been associated with adenocarcinoma of the lung.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
5/46. Angiocentric immunoproliferative lesions of the lung associated with diffuse renal involvement.A 62-year-old Japanese man presented with high fever, cough, and sputa. Computed tomography (CT) scan of the chest revealed lung infiltrates with air bronchogram of the right middle lobe and mediastinal lymphadenopathy. Bronchoscopic examination was performed, and mycobacterium avium complex was detected from bronchoalveolar lavage fluid. Although the administration of clarithromycin and levofloxacin improved the patient's symptoms, the lung infiltrates on chest CT scan gradually worsened. lung biopsy of segments 4 and 8 by video-assisted thorachoscopy revealed angiocentric and angiodestructive massive lymphoplasmocytic infiltrations with multinucleated giant cells, which were compatible with grade II angiocentric immunoproliferative lesions. The patient was found to have deterioration of renal function, and glomerular filtration rate was 32.6 mL/min. His kidneys were enlarged and showed prominent and diffuse uptake of gallium-67 citrate. Percutaneous renal biopsy revealed massive infiltration of CD4 mononuclear cells, plasma cells, and eosinophils in the interstitium and destruction of normal structure of tubules. blood vessels were destroyed and replaced by inflammatory cells. The combination chemotherapy achieved a remission, and the patient has remained free of disease at 2 years after onset of the illness. We recommend the imaging of kidneys for diagnosis and following renal biopsy to evaluate the renal involvement of angiocentric immunoproliferative lesions.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
6/46. Embolized crospovidone (poly[N-vinyl-2-pyrrolidone]) in the lungs of intravenous drug users.Crospovidone is an insoluble polymer of N-vinyl-2-pyrrolidone that is used as a disintegrant in pharmaceutical tablets. It can potentially embolize to the lung when aqueous tablet suspensions are injected intravenously. In this report, we identified embolized crospovidone in autopsy-derived lung tissue from three adult IV drug users, 1 man and 2 women, whose ages respectively were 27, 38, and 40 years. Suspected crospovidone was compared with pharmaceutical-grade crospovidone by means of histochemical stains, transmission electron microscopy, and infrared spectroscopy. Similar particles were also observed by light microscopy in a 4-mg tablet of hydromorphone, a preparation prescribed to two of the patients. Two patients had sickle cell disease and were taking methadone and/or hydromorphone for pain management; the third was receiving parenteral hyperalimentation after small bowel resection. Crospovidone appeared as deeply basophilic, coral-like particles within pulmonary arteries and in extravascular foreign-body granulomas. Intrapulmonary crospovidone stained similarly to the pure substance, including intense staining with mucicarmine, congo red, and Masson trichrome. With Movat pentachrome stain, both intravascular and purified crospovidone appeared orange-yellow, whereas most interstitial particles associated with giant cells stained blue-green. alcian blue failed to stain intravascular or purified crospovidone but strongly decorated some phagocytized particles. Ultrastructurally, both purified powder and tissue deposits of crospovidone appeared as irregular, electron dense, laminated, and finely granular material. Intrapulmonary crospovidone was associated with inflammatory cells and exhibited degenerative changes. By infrared spectroscopy, crospovidone in tissue had the same spectral characteristics as pharmaceutical grade crospovidone and the library reference, polyvinylpyrrolidone (PVP). We conclude that crospovidone contributes to pulmonary vascular injury in some persons who illicitly inject pharmaceutical tablets. It is readily identifiable histologically and distinguishable from other tablet constituents, such as cornstarch, talc, and microcrystalline cellulose. The variable staining with alcian blue and Movat suggests that crospovidone is altered in vivo by the inflammatory response.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/46. Giant cell granuloma of the lung.In a 50-year-old man without bronchopulmonary symptoms a round mass lesion close to the hilum of the right lung was detected in a routine chest x-ray and confirmed by computed tomography. Histological examination of two biopsy specimens did not result in a definitive diagnosis. Therefore thoracotomy with enucleation of the focus was performed. The histological picture of the lesion is characterized by connective tissue proliferation, multinucleated giant cells, ossification, localised hemorrhage, deposits of hemosiderin and foci of foam cells. The findings are interpreted as a giant cell granuloma of the lung.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
8/46. Idiopathic granulomatous bronchitis. An unusual form of known granulomatous lung diseases or an unknown disease?We describe two patients demonstrating a granulomatous inflammation of bronchial mucosa characterized clinically by a persistent dry cough, lack of manifestations of bronchial asthma, normal level of serum IgE and serum ACE, inflamed bronchial mucosal appearance consisting of edema, erythema, bleeding and narrowing and recovering without specific treatment. Histopathological findings of the bronchial inflammation of our patients were characterized by noncaseating granuloma formation consisting of epithelioid cells and multinucleated giant cells with infiltration of lymphocytes, plasma cells and eosinophils. The bronchial granulomatous inflammation of our patients was thought to differ from that of diseases which have been known, to our knowledge, as diseases demonstrating a granulomatous inflammation of bronchial mucosa. Although the pathogenesis of the disease could not be clarified by a careful search of special staining and culturing for the infective agent, it was most suggestive of non-specific inflammation with a granulomatous response to some sort of inhaled agents.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/46. A living case of pulmonary ossification associated with osteoclast formation from alveolar macrophage in the presence of T-cell cytokines.A 61-year-old woman had been coughing up blood-tinged sputum since May 1998. Chest radiography and computed tomography (CT) scans revealed a solitary mass (3 cm in greatest dimension) in the right lower field, accompanied by a surrounding area of ground glass and reticular appearance. Surgical lung biopsy was performed to the surrounding area. The pathological diagnosis was pulmonary ossification of the dendriform type. Alveolar macrophages obtained from her lung differentiated into tartrate-resistant acid phosphatase (TRAP)-positive multinucleated giant cells (MGCs) in the presence of autologous T cells or of macrophage colony stimulating factor (M-CSF) and interleukin-4 (IL-4). This results suggest the possibility that monocytes/macrophages may have the ability to form osteoclasts in the presence of cytokines that may be involved in the development of pulmonary ossification.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/46. Multicentric reticulohistiocytosis with pulmonary involvement.Multicentric reticulohistiocytosis (MRH) is a rare and possibly devastating systemic disorder characterized by tissue infiltration by histiocytes and multinucleated giant cells. The disease commonly involves the skin, joints, and mucous membranes, with the rare involvement of other organ systems. We describe a patient with MRH presenting with papules and nodules on both hands and a rapidly progressive arthritis who may have had pulmonary involvement of the disease.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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