1,721,049 research outputs found
May sarcoidal reaction and malignant features coexist in regional lymph nodes of non-small cell lung cancer patients?
No full textIn the study of Steinfort et al., as well as in previous studies, no cases of co-involvement of malignant features and sarcoidal reactions were seen in non-small cell lung cancer patients undergoing mediastinal staging, leading the authors to state that non-necrotizing granulomas revealed by EBUS-TBNA should serve to indicate the absence of lymph node metastases. We report on a case of stage IIIA pulmonary adenocarcinoma in which TBNA of a subcarinal node showed the presence of both neoplastic cells and non-necrotizing granulomas. (C) 2009 Published by Elsevier Ireland Ltd
Bronchiolitis obliterans organizing pneumonia associated with lower respiratory tract infection by respiratory syncytial virus in an immunocompetent adult
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Endometriosis-related pneumothorax: clinicopathologic observations from a newly diagnosed case
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Thoracic endometriosis: current knowledge
No full textThoracic endometriosis syndrome includes four well-recognized clinical entities, namely catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis and lung nodules, as well as some exceptional presentations. The etiological mechanisms of this syndrome are not well understood, and different theories have been proposed. Controversies exist about optimal management, as experience has been drawn from case reports and small clinical series. Surgery, hormonal treatments and combined approaches have all been proposed, with variable results in terms of short and long term outcome
Hemoptysis and progressive dyspnea in a 39-year-old woman with previous sinonasal lymphoma
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Interobserver agreement of PD-L1 (SP263) assessment in advanced NSCLC on cytological smears and histological samples
No full textBackground: The PD-L1 assessment is mandatory for the selection of patients affected by advanced non-small-cell lung cancer (NSCLC) who can benefit from the PD-1/PD-L1 checkpoint inhibitors therapy. Previous studies tested PD-L1 on cytological smears to evaluate this sample as an alternative to formalin-fixed paraffin-embedded (FFPE) ones, but several critical issues needed to be clarified.Aim: We evaluated the cyto-histological agreement (CHA) and the PD-L1 interobserver agreement (IrOA) among three different pathologists (Path1, Path2, Path3) on 160 paired cytological smears and histological samples of advanced NSCLC.Results: With the cut-off of < 50%/> 50%, CHA resulted good for Path1 (Cohen's k: 0.702) and Path3 (Cohen's k: 0.731), moderate for Path2 (Cohen's k: 0.576) adopting the same cut-off, the IrOA was moderate (ICC 0.72 [95% CI: 0.63-0.78]) for smears and good for histological samples (ICC 0.85 [95% CI: 0.80-0.85]).Conclusion: With a cut-off system of < 50%/> 50%, PD-L1 assessment shows moderate to good CHA and exhibited moderate IrOA on smears and good IrOA on FFPE. As result, PD-L1 assessment should be improved on cytological smears as well as could be a suitable alternative for patients without FFPE samples and not eligible for pembrolizumab, adopting a cut-off of < 50%/> 50%; presumably, an appropriate pathologist training could further improve the reproducibility
A Very Unusual Cause of Pulmonary Consolidation Diagnosed by Transbronchial Needle Aspiration
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The value of flexible transbronchial needle aspiration in the diagnosis of stage I sarcoidosis
No full textStudy objectives: Transbronchial lung biopsy (TBLB) during flexible bronchoscopy (FB) is the recommended procedure for diagnosing sarcoidosis in most cases, although its yield in stage I disease is reported to be not as high as when parenchymal involvement is radiologically evident. We undertook this study to assess the diagnostic value of transbronchial needle aspiration (TBNA) in sarcoidosis presenting with hilar and/or mediastinal lymphadenopathy (stage 1).Design: Retrospective review of bronchoscopy procedures performed over a 6-year period for the diagnostic workup of hilar and/or mediastinal lymphadenopathy, as detected by chest radiographs.Setting: Urban academic hospital. Patients: Fifty-five patients with hilar and/or mediastinal lymphadenopathy without pulmonary abnorinalities were included in the analysis. Interventions: After chest CT and physical examinations, all patients underwent FB with TBNA. Patients thought to have clinicoradiologic findings highly consistent with sarcoidosis, as assessed by the bronchoscopists performing the procedures, underwent combined TBNA and TBLB.Results: A diagnosis of sarcoidosis was established in 32 patients. In the remaining 23 patients, other diseases were pathologically diagnosed. Overall, TBNA was diagnostic in 23 of 32 patients with sarcoidosis (72%) by showing nonnecrotizing granulomas in 28 of 39 lymph node stations sampled (72%). Among the 15 patients who were submitted to both TBNA and TBLB, TBNA exclusively established the diagnosis in 7 of 15 patients (47% increase in the diagnostic rate) and its yield exceeded that of TBLB (11 of 15 patients [73%] vs 6 of 15 patients [40%], respectively). The association of TBNA and TBLB increased the diagnostic yield to 87%.Conclusions: TBNA may be of great value in the diagnostic evaluation of patients with suspected stage I sarcoidosis, and its use in association with TBLB should be strongly encouraged. TBNA may also preclude the need for further surgical diagnostic procedures in several patients with hilar and/or mediastinal adenopathy due to causes other than sarcoidosis
Sarcoidal granulomas in cytological specimens from intrathoracic adenopathy: morphologic characteristics and radiographic correlations
No full textBackground: Clinical experience and literature data suggest that the ability of pathologists to identify granulomas in cytological specimens from intrathoracic lymphadenopathy varies considerably and may negatively influence the yield of transbronchial needle aspiration (TBNA), both conventional and ultrasound-guided (EBUS-TBNA). Objectives: To describe the cytomorphology of sarcoidal granulomas on TBNA cytology specimens and to analyze the presence of associations between the cytological characteristics of granulomas and the radiographic stage of sarcoidosis. Methods: TBNA cytological specimens from 123 sarcoidosis patients and 14 tuberculosis patients (control population) were reviewed independently by two pathologists blinded to the clinical-radiological details. Results: Sarcoidal granulomas were small [median (IQR) largest diameter: 0.478 (0.318-0.701) mm] and well-formed, round or elliptical in shape, and almost invariably had a regular contour. Background elements lacked necrotic debris or exudate. The density [median (IQR) number of granulomas per slide: 6.85 (3.66-11) vs. 5.25 (2.5-8), p = 0.073] and size [median (IQR) largest diameter: 0.51 (0.319-0.733) vs. 0.398 (0.318-0.522), p = 0.071] tended to be larger in stage I than in stage II sarcoidosis. A necrotic background was common in the tuberculosis cohort studied (79 vs. 0%, p < 0.0001). Conclusions: Granulomas can be reliably identified on TBNA cytological material once their characteristic cytomorphology is delineated. A higher density of granulomas in lymphadenopathy of stage I sarcoidosis patients could partly explain the higher success rate constantly obtained by TBNA and EBUS-TBNA in this stage of the disease. A necrotic background suggests a tubercular etiology of the granulomas over a sarcoidal one, in the appropriate clinical setting. Copyright (C) 2012 S. Karger AG, Base
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