1/39. pituitary apoplexy following metastasis of bronchogenic adenocarcinoma to a prolactinoma.A 42-year-old house wife presented with worsening headaches over 6 months in the absence of visual symptoms or symptoms suggestive of focal neurology. She was a life-long smoker. Systems review was unremarkable apart from secondary amenorrhoea and galactorrhoea of 6 months duration. Her serum prolactin was found to be 620 mU/l (60-400), FT4 12.6 nmol/l (9.8-23.1), TSH 1.38 mU/l (0.35-5.5), oestradiol < 73 pmol/l, LH and FSH of 4.4 and 12.6 mIU/l, respectively. She was on bromocriptine. A presumptive diagnosis of pneumonia, based on pyrexia and CXR findings, was made and she was started on IV antibiotics. Two days later she developed meningism and deterioration of conscious level. (Lumbar puncture results: no organisms, 312 neutrophils and 164 lymphocytes). CT scan revealed a 2.5-cm pituitary adenoma, with suprasellar extension. A repeat hormonal profile revealed FSH 1.4, LH < 0.3 mU/l, oestradiol < 73 pmol/l, prolactin 488 mU/l (60-400), and low random cortisol at 29 nmol/l. T1-weighted MRI revealed a large pituitary mass with evidence of haemorrhage. The patient subsequently underwent a transsphenoidal exploration with resection of the pituitary lesion. Whilst awaiting the histopathology results, CT of chest revealed a 1. 5-cm diameter rounded well defined density in the right lower lobe associated with hilar, pre- and right para-tracheal lymphadenopathy. The histopathology of the pituitary lesion, obtained piecemeal, revealed fragments of fibrous tissue infiltrated by sheets of acidophilic prolactin-positive cells, in keeping with a prolactinoma. In addition, other fragments with blood clot included highly atypical epithelial cells with mitotic figures. These were negative for prolactin but showed HMFG-and CEA-positivity, excluding them from a pituitary lineage. Transbronchial biopsy revealed moderately differentiated adenocarcinoma, with evidence of lymphatic spread. The overall conclusion was of bronchogenic adenocarcinoma, metastasizing to a prolactinoma and complicated by apoplexy.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/39. Primary small cell bronchogenic carcinoma in a 14-year-old boy.A 14-year-old Korean boy was admitted with cough, hemoptysis, and fever. A chest X-ray showed a solitary pulmonary mass and pneumonitis. Bronchial biopsy by fiberoptic bronchoscopy revealed a poorly differentiated small cell carcinoma. All of the staging information indicated that the patient had limited disease. During the 7 months following diagnosis, he received adjuvant chemotherapy in conjunction with radiotherapy. The size of the lesion was reduced by almost 50%. Small cell bronchogenic carcinoma has not been reported previously in childhood.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
3/39. Bronchocentric granulomatosis with mucus impaction due to bronchogenic carcinoma. An association with clinical relevance.OBJECTIVE: To describe an unexpected inflammatory process associated with malignancy in the lung and to postulate a new mode of pathogenesis. DESIGN: Retrospective review of surgical pathologic findings. SETTING: Academic hospital pathology department. patients: Four patients, 2 men and 2 women, ranging in age from 45 to 74 years, each of whom had a solitary mass on chest radiographs. INTERVENTIONS: Pulmonary lobectomy. MAIN OUTCOME MEASURE: Histopathologic identification of bronchocentric granulomatosis. RESULTS: Accompanying a bronchogenic carcinoma in each case was a necrotizing chronic granulomatous reaction centered around bronchioles that were plugged with mucus, necrotic detritus from the tumor, lipid, or a combination of these substances. eosinophils were present in small numbers in one case. The pathologic findings characterize bronchocentric granulomatosis. CONCLUSIONS: The presence of bronchocentric granulomatosis in the biopsy of a mass does not exclude the presence of an accompanying bronchogenic carcinoma associated with obstruction of bronchioles. Bronchocentric granulomatosis in some cases may represent an immunologic response to tumor detritus or lipid, as well as to mucus impaction.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/39. Malignant hyperinflation of the nondependent lung during chest surgery.Unilateral malignant hyperinflation of the lungs during positive pressure mechanical ventilation was described during aggressive respiratory therapy of unilateral lung disease or in situations of significant difference in compliance between the two lungs. We report a case of malignant hyperinflation of the nondependent lung during chest surgery. The differential diagnosis and treatment with differential lung ventilation are described.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
5/39. Isolated bilateral trochlear nerve palsy as the first clinical sign of a metastatic [correction of metastasic] bronchial carcinoma.PURPOSE: To report a case with isolated, nontraumatic bilateral fourth nerve palsy as the first clinical sign of a metastatic lung carcinoma. methods: Case report. A 56-year-old man presented with isolated, nontraumatic bilateral fourth nerve palsy. magnetic resonance imaging (MRI) of the brain and orbits and, subsequently, chest x-ray and a computer tomographic (CT)-scan of the thorax, the abdomen, and the pelvis were performed. RESULTS: magnetic resonance imaging confirmed the presence of a midline brain stem lesion in the region of decussation of the trochlear nerves. Computed tomographic scan of the chest revealed that the lesion was caused by a metastatic lung carcinoma. CONCLUSION: The findings of isolated bilateral fourth nerve palsy in the absence of trauma should alert the clinician to the possibility of a posterior fossa lesion in the region of the trochlear nerves. Besides urgent scanning of the dorsal midbrain, investigations should be directed to search for the primary tumor.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
6/39. Metastases to the products of conception from a maternal bronchial carcinoma. A case report and review of literature.The association of mother's malignancy with metastases to the products of conception is rarely reported. We present 8th case reported in the literature of oat-cell lung carcinoma complicated by an aggressive clinical course and documented placental metastases. review of all published cases of lung cancer metastasizing to the placenta is also presented. A 44-year-old white pregnant woman at an estimated gestational age of 30 weeks presented with cervical incompetence symptoms and multiple tumors of 2-4 cm in diameter located in the subcutaneous tissue of the chest, including both breasts. The biopsy revealed a metastatic oat-cell carcinoma. cesarean section was performed immediately. During the procedure, micronodular metastatic infiltration of the liver was noted. Microscopic examination of placenta showed clusters of oat-cell carcinoma calls within the intervillous spaces; no infiltration of villi themselves was noted. The malignant cells were morphologically identical as those of the subcutaneous metastases. The woman succumbed to cancer and died on the 16th postoperative day. lung cancer metastasizing to the placenta is relatively rarely reported. In all cases only placental metastases were found; the fetus in all cases was spared. Only in one out of 8 reported cases outcome of mother was not fatal. It should be emphasized that not in all cases of maternal malignancy the histological examination of the placental was made Therefore it is possible that the incidence of placental involvement is more often than it is reported.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
7/39. Pneumomediastinum, pneumothorax and subcutaneous emphysema during radiotherapy in primary cavitating bronchogenic carcinoma.An extremely rare case of cavitating large cell carcinoma lung is reported in a middle aged man who developed pneumomediastinum, pneumothorax and subcutaneous emphysema on thirteenth day of his tele cobalt radiotherapy to chest. Possible mechanisms of such complications during radiotherapy are also discussed.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
8/39. Colonic metastasis from bronchogenic carcinoma presenting as pancolitis.The colonic metastases from bronchogenic carcinoma are rare. We present a 73-year-old man presented with features suggestive of pan colitis after metastasis from undifferentiated large cell carcinoma of the lung. The plain radiograph and computed tomography scan of the chest had revealed a mass lesion in the right lower lobe of lung. He had no evidence of significant lesions elsewhere. Considering the advanced stage and poor differentiation of the tumour, no active therapy was undertaken and he survived for three months.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/39. Pulmonary aspergilloma simulating bronchogenic carcinoma.When a pre-existing lung cavity is colonized by Aspergilius fumigatus, it forms a fungal ball (pulmonary aspergilloma) and the presenting symptom is usually haemoptysis that may be massive and often-times life threatening. The radiological finding is that of a ball-like structure within a lung cavitation and the typical air crescent around the ball both on plain radiography and CT scan of the chest. The present case is of a 50-year-old male who had a 25-year history of heavy smoking (40 cigarettes per day) and haemoptysis. Although the cavitating lesion, ball-like structure and the crescenteric rim of air were present on the radiographs, the possibility of bronchogenic carcinoma was held high in view. Flexible fibreoptic and transbronchial biopsies were negative for malignancy. sputum and bronchoalveolar lavage examinations showed neither malignant cells nor fungal elements. Right thoracotomy, cavernostomy, removal of the fungal ball and obliteration of the cavity by suturing (capitonnage) were done with an uneventful postoperative period.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
10/39. Unilateral diaphragmatic paralysis: a matter for concern.A dilemma often faces the clinician who is asked to evaluate unilateral elevation of a hemidiaphragm that is identified on routine chest roentgenogram. The possibilities include neoplasm, infection, neuromuscular disease, trauma, or benign etiologies. We present an asymptomatic patient with this finding to provide some guidelines for the nature and extent of further investigation of unilateral diaphragmatic paralysis.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
| | Next -> |