RESUMEN
BACKGROUND: Bronchioloalveolar carcinoma is a distinctive subtype of typical adenocarcinoma of the lung that tends to metastasize widely throughout the lungs but less commonly elsewhere. Because conventional therapies for intrapulmonary metastatic bronchioloalveolar carcinoma are generally ineffective, we treated seven patients who had intrapulmonary metastatic bronchioloalveolar carcinoma with lung transplantation. METHODS: Seven patients with biopsy-proved bronchioloalveolar carcinoma and no evidence of extrapulmonary disease received transplants of either one or two cadaveric lungs. At transplantation, all native lung tissue was removed and replaced with a donor lung or lungs. The patients received the usual post-transplantation care given at the institution. RESULTS: Four of the seven patients had recurrent bronchioloalveolar carcinoma within the donor lungs; the recurrences appeared from 10 to 48 months after transplantation. All recurrences were limited to the donor lungs. Histologic and molecular analyses showed that the recurrent tumors in three patients originated from the recipients of the transplants. CONCLUSIONS: Lung transplantation for bronchioloalveolar carcinoma is technically feasible, but recurrence of the original tumor within the donor lungs up to four years after transplantation was common.
Asunto(s)
Adenocarcinoma Bronquioloalveolar/cirugía , Neoplasias Pulmonares/cirugía , Trasplante de Pulmón , Recurrencia Local de Neoplasia , Adenocarcinoma Bronquioloalveolar/patología , Adulto , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Resultado del TratamientoRESUMEN
Continuous intravenous infusion of epoprostenol sodium in selected patients with primary pulmonary hypertension improves symptoms and survival. This report describes two patients with primary pulmonary hypertension treated with epoprostenol in whom intrapulmonary shunting and severe hypoxemia occurred. Intrapulmonary shunting was confirmed by contrast echocardiography showing delayed appearance of bubbles in the left cardiac chambers after peripheral venous injection of agitated saline solution.
Asunto(s)
Antihipertensivos/uso terapéutico , Epoprostenol/uso terapéutico , Hipertensión Pulmonar/fisiopatología , Circulación Pulmonar/fisiología , Antihipertensivos/administración & dosificación , Medios de Contraste/administración & dosificación , Ecocardiografía , Epoprostenol/administración & dosificación , Hemangioma Capilar/patología , Humanos , Hipertensión Pulmonar/tratamiento farmacológico , Hipoxia/etiología , Infusiones Intravenosas , Inyecciones Intravenosas , Neoplasias Pulmonares/patología , Trasplante de Pulmón , Masculino , Persona de Mediana Edad , Circulación Pulmonar/efectos de los fármacos , Fibrosis Pulmonar/patología , Cloruro de Sodio/administración & dosificaciónRESUMEN
PURPOSE: Our goal was to describe the radiologic features of calcifying fibrous pseudotumor (CEPT) of pleura. METHOD: Chest radiographs and CT images of three patients, aged 23-34 years, with pathologically proven CFPT of pleura were reviewed with regard to lesion size, location, and appearance. RESULTS: Chest radiographs showed well marginated, noncalcified pleural masses in all cases. Two patients had solitary masses and one had multifocal ipsilateral masses. All masses were located in the inferior aspect of the chest and measured 3-12 cm. All masses were calcified on CT. The calcifications were thick and band-like in two cases and punctate in one. There was no chest wall invasion, pleural effusion, or parenchymal disease. CONCLUSION: CFPTs of pleura are rare lesions that manifest as calcified pleural masses in young adults.
Asunto(s)
Enfermedades Pleurales/diagnóstico por imagen , Adulto , Calcinosis/diagnóstico por imagen , Femenino , Fibrosis , Humanos , Masculino , Pleura/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
A newly recognized distinctive fibrous soft tissue lesion called "calcifying fibrous pseudotumor" (CFPT) was recently described in the soft tissues of the extremities, trunk, scrotum, groin, neck, or axilla. To date, CFPT has not been described in the pleura. The authors reviewed the clinical, radiologic, and pathologic features of three cases. A 23-year old woman and 34-year old man who presented with chest pain, and a 28-year old woman without chest symptoms were found to have a pleural mass on chest radiographs. Computed tomography (CT) scans of each patient revealed pleural-based nodular masses with central areas of increased attenuation due to calcifications. Each lesions consisted of circumscribed, but unencapsulated masses of hyalinized collagenous fibrotic tissue interspersed with lymphoplasmacytic infiltrates and calcifications, many of which had psammomatous features. The lesions were limited to the pleura and did not involve the underlying lung parenchyma. Electron microscopy in one case showed fibroblasts scattered in dense collagenous tissue. Calcifying fibrous pseudotumor is distinct from other pleural lesions such as fibrous tumor of pleura, calcified granulomas, calcified pleural plaques, and chronic fibrous pleuritis as well as intrapulmonary lesions such as hyalinizing granuloma, inflammatory pseudotumor, and amyloid. As in the soft tissues, local excision appears adequate therapy for CFPT of the pleura. If these lesions behave in a similar fashion to CFPT of soft tissues, one might expect a low frequency of local recurrence.
Asunto(s)
Calcinosis/patología , Pleura/patología , Enfermedades Pleurales/patología , Adulto , Diagnóstico Diferencial , Femenino , Fibrosis/patología , Humanos , Masculino , Enfermedades Pleurales/diagnóstico , Enfermedades Pleurales/diagnóstico por imagen , Neoplasias Pleurales/patología , Pleuresia/patología , Tomografía Computarizada por Rayos XAsunto(s)
Adenocarcinoma Bronquioloalveolar/complicaciones , Hipertensión Pulmonar/etiología , Neoplasias Pulmonares/complicaciones , Adenocarcinoma Bronquioloalveolar/diagnóstico por imagen , Adenocarcinoma Bronquioloalveolar/patología , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A 59-year-old male heart transplant recipient experienced progressive visual loss following routine cataract surgery with intraocular lens implantation. Cranial magnetic resonance (MR) imaging suggested and brain biopsy confirmed the cause to be progressive multifocal leukoencephalopathy (PML). The patient died 2 months following cataract surgery. This case illustrates that visual failure may be the initial manifestation of PML, and the ophthalmologist should be aware of this central demyelinating disorder when dealing with immunocompromised patients.