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A 27-year-old man, in good health but a moderate smoker, suddenly had two episodes of haemoptysis. Routine clinical examination was unremarkable. Erythrocyte sedimentation rate was increased to 34 mm/h. The chest radiography showed ill-defined, contrast-poor infiltrations bilaterally, as well as left hilar enlargement. Lung scintigraphy and pulmonary arteriogram suggested pulmonary embolism, possible from a "pelvic vein spur", i.e. an intimal proliferation due to crossing of the common iliac artery over the pelvic vein. He was placed on oral anticoagulants. Three months later he had another severe haemoptysis, providing the indication for an exploratory thoracotomy. This revealed the left pulmonary artery wall to have inflammatory changes with aneurysmal dilatation. The aneurysm was plicated. Histological examination demonstrated chronic vasculitis as seen in Behcet's syndrome, a diagnosis confirmed by the findings of ulcers of the oral mucosa and the presence of HLA B5 allo-antigens. Immunosuppressive treatment was given with prednisone (1 mg/kg), azathioprine (2.5 mg/kg) and ciclosporin (5 mg/kg). Over the next 12 months there has been only one further haemoptysis.

OBJECTIVE: To analyze the sensitivity, specificity, positive and negative predictive values and the efficacy of fine needle aspiration (FNA) in our material, to investigate the influence of the histologic type and stage of carcinoma on the quality of the aspirates and on the detection rates of mammary carcinoma, and to investigate diagnosis in the rate of inadequate samples and the accuracy of cytologic diagnoses, with an emphasis on the rate offalse positive diagnoses in benign mammary lesions. STUDY DESIGN: The results of 1,472 FNAs of the breast obtained over three years were subjected to a retrospective analysis. RESULTS: The cytologic diagnoses were benign in 1,003 cases (68.1%), suspicious in 49 (3.3%) and malignant in 181 (12.3%); 239 (16.2%) of the aspirates were inadequate. In 393 (26.6%) of the cases and in 85% of cytologically malignant smears, the aspirate was compared with histologic examination. The rate of false negative FNAs was 9.0%. The proportion of inadequate cases was clearly related to stage (pT): it was 9.5% in pT1, 5.0% in pT2 and 0% in pT3. Among invasive carcinomas the sensitivity was 89.9%, specificity 99.3 % and overall accuracy 88.5%. Among the cases diagnosed cytologically as benign, 182 were compared with biopsies. Of these, 79.9% were true negative, 0.5% (1 case) was false positive, and 15.4% had insufficient cells for evaluation. CONCLUSION: FNA cytology has improved decision making and the selection of patients for biopsy of mammary lesions and has contributed to saving time in the clinical management of breast lumps. In no case did FNA lead to inadequate clinical measures or other disadvantages to patients. Thus, FNA cytology is an indispensible diagnostic tool in the management of breast lesions.

Mesothelioma are primary malignant neoplasms of the serous membranes. They usually involve the pleura and rarely the pericardium, the peritoneum and the tunica vaginalis testis. About 90% are associated with exposure to asbestos. The exposure is generally occupational, an environmental inhalation of asbestos and asbestiform fibers in areas in Turkey has been observed and presents a major health problem. This report of a patient from Anatolia with peritoneal mesothelioma after environmental exposure outlines the importance of considering this pathology in the differential diagnosis of a Turkish patient presenting with ascites.

The accuracy of different histological and cytological methods were analysed in 240 patients with primary lung cancer. The diagnosis had been confirmed by either biopsy, surgery or autopsy. Using multiple diagnostic procedures a positive pre-operative diagnosis was obtained in 86.5%. Where the tumour was endoscopically visible and accessible to direct biopsy the correct diagnosis was made in 97.5%. In case of more peripheral tumour localisation positive results were obtained by cytological tests in 76.5%. The most accurate method of diagnosis was direct forceps biopsy of visible tumours (91% positive). Bronchial washing was positive in 64%, post-bronchoscopic sputum analysis in 60%, pre-bronchoscopic sputum in 55% and bronchial brushing in 30%.

A rare case of desquamating interstitial pneumonia, in a 15-year-old boy, is reported. Symptoms consisted of dry cough, progressive dyspnoea and chest pain. The chest X-ray revealed bilateral basal opacities. There were hypoxaemia and restrictive ventilatory changes. Bacteriological, virological and serological tests were all negative. An open lung biopsy established the diagnosis and corticosteroids were given as the drug of first choice. Other drugs, such as cytostatic ones, should only be given if steroids are ineffective. Arterial blood gases proved to be the most sensitive indicator of improvement, while the chest X-ray remained abnormal for several months.

One hundred and nineteen cases of mesothelioma of the pleura were studied. A striking concentration was found about a large asbestos processing factory. In 55 cases, occupational exposure could be ascertained by retrospective study of case histories. In 21 cases, anamnestic data could no longer be obtained. The desirability, and difficulty, of undertaking prospective investigations is reviewed.

It is not clear which morphological alterations cause changes of functional parameters in obstructive airway disease; therefore, samples from bronchi of 29 deceased patients who underwent lung functio

This study reports on a first case of granulomatous Pneumocystis carinii pneumonia (PCP) in a human immunodeficiency virus-negative patient with antineutrophil cytoplasmic antibody-positive Wegener's granulomatosis whilst receiving immunosuppressive treatment. The patient presented with diffuse alveolar haemorrhage, pauci-immune rapid progressive glomerulonephritis and leukocytoclastic vasculitis of the skin. Granulomatous Pneumocystis carinii pneumonia developed under immunosuppressive treatment with cyclophosphamide and prednisone. At the time Pneumocystis carinii pneumonia developed, there was a marked lymphopenia with a very low CD8+ cell count in the blood. Grocott staining in bronchoalveolar lavage fluid revealed no Pneumocystis carinii. The diagnosis was made via a video-assisted thoracoscopic lung biopsy which showed granulomas containing high numbers of Pneumocystis carinii cysts.