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Perivascular epithelioid cell tumors (PEComas) are very rare mesenchymal neoplasms, composed of histologically and immunohistochemically distinctive cells that form a sheetlike appearance around vessel lumens. Although most are benign, a malignant subset does exist, complicating clinical diagnostic efforts. Proper evaluation and management are thus essential for long-term patient survival. Herein, we present a rare case of a benign pulmonary PEComa that was diagnosed postoperatively in a 45-year-old woman.

Abstract Objectives Lung carcinoids and atypical hamartomas may be difficult to differentiate but require different treatment. The aim was to differentiate these tumors using contrast-enhanced CT semantic and radiomics criteria. Methods Between November 2009 and June 2020, consecutives patient operated for hamartomas or carcinoids with contrast-enhanced chest-CT were retrospectively reviewed. Semantic criteria were recorded and radiomics features were extracted from 3D segmentations using Pyradiomics. Reproducible and non-redundant radiomics features were used to training a random forest algorithm with cross-validation. A validation-set from another institution was used to evaluate of the radiomics signature, the 3D ‘median’ attenuation feature (3D-median) alone and the mean value from 2D-ROIs. Results Seventy-three patients (median 58 years [43‒70]) were analyzed (16 hamartomas; 57 carcinoids). The radiomics signature predicted hamartomas vs carcinoids on the external dataset (22 hamartomas; 32 carcinoids) with an AUC = 0.76. The 3D-median was the most important in the model. Density thresholds 60 HU to predict carcinoids were chosen for their high specificity > 0.90. On the external dataset, sensitivity and specificity of the 3D-median and 2D-ROIs were, respectively, 0.23, 1.00 and 0.13, 1.00 60 HU. The 3D-median was more reproducible than 2D-ROIs (ICC = 0.97 95% CI [0.95‒0.99]; bias: 3 ± 7 HU limits of agreement (LoA) [− 10‒16] vs. ICC = 0.90 95% CI [0.85‒0.94]; bias: − 0.7 ± 21 HU LoA [− 4‒40], respectively). Conclusions A radiomics signature can distinguish hamartomas from carcinoids with an AUC = 0.76. Median density 60 HU on 3D or 2D-ROIs may be useful in clinical practice to diagnose these tumors with confidence, but 3D is more reproducible. Critical relevance statement Radiomic features help to identify the most discriminating imaging signs using random forest. ‘Median’ attenuation value (Hounsfield units), extracted from 3D-segmentations on contrast-enhanced chest-CTs, could distinguish carcinoids from atypical hamartomas (AUC = 0.85), was reproducible (ICC = 0.97), and generalized to an external dataset. Key points • 3D-‘Median’ was the best feature to differentiate carcinoids from atypical hamartomas (AUC = 0.85). • 3D-‘Median’ feature is reproducible (ICC = 0.97) and was generalized to an external dataset. • Radiomics signature from 3D-segmentations differentiated carcinoids from atypical hamartomas with an AUC = 0.76. • 2D-ROI value reached similar performance to 3D-‘median’ but was less reproducible (ICC = 0.90). Graphical Abstract

Objectives: Lung carcinoids and atypical hamartomas may be difficult to differentiate but require different treatment. The aim was to differentiate these tumors using contrast-enhanced CT semantic and radiomics criteria. Methods: Between November 2009 and June 2020, consecutives patient operated for hamartomas or carcinoids with contrast-enhanced chest-CT were retrospectively reviewed. Semantic criteria were recorded and radiomics features were extracted from 3D segmentations using Pyradiomics. Reproducible and non-redundant radiomics features were used to training a random forest algorithm with cross-validation. A validation-set from another institution was used to evaluate of the radiomics signature, the 3D 'median' attenuation feature (3D-median) alone and the mean value from 2D-ROIs. Results: Seventy-three patients (median 58 years [43‒70]) were analyzed (16 hamartomas; 57 carcinoids). The radiomics signature predicted hamartomas vs carcinoids on the external dataset (22 hamartomas; 32 carcinoids) with an AUC = 0.76. The 3D-median was the most important in the model. Density thresholds < 10 HU to predict hamartoma and > 60 HU to predict carcinoids were chosen for their high specificity > 0.90. On the external dataset, sensitivity and specificity of the 3D-median and 2D-ROIs were, respectively, 0.23, 1.00 and 0.13, 1.00 < 10 HU; 0.63, 0.95 and 0.69, 0.91 > 60 HU. The 3D-median was more reproducible than 2D-ROIs (ICC = 0.97 95% CI [0.95‒0.99]; bias: 3 ± 7 HU limits of agreement (LoA) [− 10‒16] vs. ICC = 0.90 95% CI [0.85‒0.94]; bias: − 0.7 ± 21 HU LoA [− 4‒40], respectively). Conclusions: A radiomics signature can distinguish hamartomas from carcinoids with an AUC = 0.76. Median density < 10 HU and > 60 HU on 3D or 2D-ROIs may be useful in clinical practice to diagnose these tumors with confidence, but 3D is more reproducible. Critical relevance statement: Radiomic features help to identify the most discriminating imaging signs using random forest. 'Median' attenuation value (Hounsfield units), extracted from 3D-segmentations on contrast-enhanced chest-CTs, could distinguish carcinoids from atypical hamartomas (AUC = 0.85), was reproducible (ICC = 0.97), and generalized to an external dataset. Key points: • 3D-'Median' was the best feature to differentiate carcinoids from atypical hamartomas (AUC = 0.85). • 3D-'Median' feature is reproducible (ICC = 0.97) and was generalized to an external dataset. • Radiomics signature from 3D-segmentations differentiated carcinoids from atypical hamartomas with an AUC = 0.76. • 2D-ROI value reached similar performance to 3D-'median' but was less reproducible (ICC = 0.90). [ABSTRACT FROM AUTHOR]

Pulmonary malakoplakia is a rare lung lesion more frequently found in immunocompromised patients than in immunocompetent individuals. In this study, we report the challenging case of a young immunocompetent patient with an irregular pulmonary nodule with peripheral cysts who, after undergoing surgery, was diagnosed with malakoplakia. Due to the rarity of the disease and the similarity of this condition to malignant neoplasms, cytopathological or histopathological examinations are necessary for the correct diagnosis. A description of pulmonary malakoplakia with peripheral cysts has not been previously published in the literature.

Thermal ablation is a minimally invasive technology used to treat many types of tumors, including lung cancer. Specifically, lung ablation has been increasingly performed for unsurgical fit patients with both early-stage primitive lung cancer and pulmonary metastases. Image-guided available techniques include radiofrequency ablation, microwave ablation, cryoablation, laser ablation and irreversible electroporation. Aim of this review is to illustrate the major thermal ablation modalities, their indications and contraindications, complications, outcomes and notably the possible future challenges. [ABSTRACT FROM AUTHOR]

Abstract Background Extramedullary plasmacytoma is a rare monoclonal plasma cell neoplasm that originates from tissues other than the bone marrow and constitutes only 3%–5% of all plasma cell neoplasms. Most cases involve the upper respiratory tract. Extramedullary plasmacytoma involving the lung is extremely rare. Primary pulmonary plasmacytoma is a rare type of extramedullary plasmacytoma, usually presenting with a nodule or mass in hilar region. Literature search has shown very few cases of immunohistochemically confirmed cases of pulmonary plasmacytoma. Diffuse pulmonary infiltration is an unusual presentation. Case presentation We report the case of a 56 year old lady with history of cough and breathlessness since one month. Computed Tomography revealed diffusely scattered multiple cavitating nodules and consolidation in both lungs. Computed Tomography guided biopsy of one of the lung nodules was done. Histopathologic examination and immunohistochemistry showed features of pulmonary plasmacytoma .This is an unique case of primary pulmonary plasmacytoma with the rare presentation as diffusely scattered multiple cavitating nodules and consolidation. According to our literature search, primary pulmonary plasmacytoma manifesting as cavitating nodules is being reported for the first time. Conclusions Primary pulmonary plasmacytoma should be also be considered in the differential diagnosis of multiple diffusely scattered cavitating lung nodules.

Lung cancer is the leading cause of cancer-related mortality worldwide. Early diagnosis of lung cancer is hampered by the absence of specific symptoms and the lack of a widely recognised cost-effective screening programme. Acquisition of a tumour tissue sample for morphological and molecular genetic examination is of paramount importance for cancer diagnosis. We describe diagnostic challenges for early-stage lung cancer and their possible current solutions. Liquid biopsy is a relatively new technology that was developed for evaluation of tumour-related circulating genetic material. Recent achievements in data processing provide more opportunities for wider implementation of Next Generation Sequencing (NGS) in clinical practice. This article summarises available data on the current and future role of liquid biopsy in the management of lung cancer. We also present an ongoing Latvian lung cancer study that focuses on integration of liquid biopsy with comprehensive clinical data utilising advantages of information technologies. [ABSTRACT FROM AUTHOR]

Pulmonary sarcomatoid carcinoma is a very rare primary tumor of the lung. Although usually aggressive, these tumors have not been described previously to invade through the diaphragm into the liver. We present a patient with a pulmonary sarcomatoid carcinoma with transdiaphragmatic spread into the dome of the liver. An 82-year-old female with a lifetime non-smoking history presented with generalized fatigue, fever, night sweats, cough, and pleuritic chest pain. She had recently traveled to the western United States. Additionally, she had recently undergone periodontal deep cleaning with no peri-procedural antibiotics. Laboratory testing was significant for a leukocytosis of 13.5 white blood cells per microliter and a negative viral panel. Computed tomography and magnetic resonance imaging revealed a large heterogeneous mass extending from the right pulmonary hilum through the diaphragm. Although initial radiology reports suggested hepatic abscess, percutaneous fine needle aspiration was performed. Biopsy revealed pulmonary sarcomatoid carcinoma. She was begun on systemic treatment. Pulmonary sarcomatoid carcinoma can exhibit transdiaphragmatic invasion into the liver. This clinical situation can easily be confused with a hepatic abscess, but suspicion should remain for abscess. Clinical suspicion for neoplasm should warrant biopsy when technically possible. Although hepatic abscesses can exhibit transdiaphragmatic spread into the chest, pulmonary sarcomatoid carcinoma can also invade the abdomen. Biopsy should be performed during the evaluation and workup of the patient. • Pulmonary sarcomatoid carcinoma is a very rare tumor with a typical aggressive course. • Most cases of pulmonary sarcomatoid carcinoma present with metastatic disease. • This case is the first to describe pulmonary sarcomatoid carcinoma with transdiaphragmatic spread into the liver. • Although easily confused for hepatic abscess, biopsy should be obtained if technically possible. [ABSTRACT FROM AUTHOR]

Carcinoid tumors are generally indolent neoplasms. Brain metastases are rare and when present, yield a poor prognosis. We present the case of a 76-year old female surgically treated for an atypical bronchial carcinoid, staged as T2aN0M0G2. Without further adjuvant treatment she remained stable for four years, when she presented with headaches and gait imbalance. Brain MRI revealed a midline, intra-axial infratentorial lesion that was completely removal, of which histolology confirmed a carcinoid metastasis. At 14 months of follow-up, the patient showed no signs of systemic disease or brain recurrence, and thus no adjuvant radiotherapy was prescribed. [ABSTRACT FROM AUTHOR]

INTRODUCTION: the incidence lung cancer has risen 25% in recent years with 10% survival at 5 years. Response to treatment needs to be evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST) and conventional measuring methods. PURPOSE: stage response to treatment with the RECIST, comparing such measurements with the conventional radiological method. MATERIAL AND METHOD: we studied 51 patients in the period January 2012 to September 2015 with histological diagnosis of lung carcinoma. RESULTS: statistically significant difference in the RECIST group was observed in the baseline and follow-up studies compared with conventional methods. There was no significant difference between the three measuring methods in baseline and follow-up studies in evaluation of target lesions; we propose that the three measuring methods can be used in evaluating target lesions. Because the T test showed statistically significant difference between baseline and follow-up evaluations of the one-dimensional method, we recommend using it in global evaluation of response to treatment. CONCLUSION: the RECIST are superior to conventional methods because they include non-target lesions, new lesions to assign global response, where the latter was changed to include the aforementioned lesions, altering the classification of response to treatment. [ABSTRACT FROM AUTHOR]

We describe a rare case of pedunculated endobronchial hemangioma observed in a 60 years old patient complaining of chronic productive cough and accessional dyspnea which had been progressively worsening over 20 years. The lesion was first noticed at fiberoptic bronchoscopy; then computed tomography scan was performed and integrated with tridimensional reconstruction techniques. Pathology showed the picture of a vascular neoplasm, compatible with capillary hemangioma. The lesion was submitted to laser-assisted endoscopic removal in order to relieve the obstruction, leading to remission of symptoms.

This paper describes the tomographic appearance of pulmonary lymphomas. We studied the thoracic computed tomographies of ten patients with biopsy-proven diagnoses non-Hodgkin's and Hodgkin's disease. The most common radiologic findings in this series are the alveolar opacities with air bronchograms (n=8). Other manifestations include multiple pulmonary nodules (n=4), thickening of broncho-vascular bundles (n=3) and foci of ground-glass attenuation (n=2). The present series confirms the results published in available literature about the radiographic appearance of the disease.

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Background: The incidence of non-microcytic lung cancer has increased 25% in recent years; with 10% survival at 5 years, we need to evaluate response to treatment using the Response Evaluation Criteria In Solid Tumors (RECIST), three-dimensional measurement methods, or both. Objective: Stage response to treatment with RECIST and compare such measurements with those of the three- dimensional and volume radiological methods. Material and method: We studied 11 patients with histological diagnosis of pulmonary carcinoma (except small cell carcinoma) in the period January to September 2013. Results: We observed only one case of concordance between conventional three-dimensional radiological measurements and RECIST criteria; in the rest of the population studied there was a 5 to 43% range of difference between the two measurements. Discussion: In the patients studied we found: in 5 progression of disease, in 3 stability, in 2 partial response, and in only 1 complete response based on RECIST criteria and the three-dimensional method. This shows that uniform protocol is needed to monitor patients with lung cancer, using evaluation by three-dimensional measurements, RECIST, or both. Conclusion: Use of RECIST to classify response in all patients with pulmonary tumors should be considered, regardless of histological subtype and stage of disease, to standardize monitoring and evaluation not only of the target lesion or lesions but of all lesions present (metastasis) for optimum control of treatment. [ABSTRACT FROM AUTHOR]

Introduction: This article is an integrative review of the literature, which aims to identify the status of the issue of stigma perceived by patients with lung cancer and the instruments used for this evaluation. Methods: The sample consisted of 11 items found through database analysis of the medical literature and online retrieval: Medline, Cumulative Index to Nursing and significance level (CINAHL), PsycINFO and Scopus, using combinations of descriptors: stigma AND (lung neoplasm OR lung cancer).The search was conducted between September and October 2013. Results: The country with the highest number of publications was the United States (72.7%), and there was no Brazilian study. The publications were produced between 2004 and 2013, especially in 2013 (45.4%), indicating the importance of the topic. Four instruments to assess stigma were used, with the Cataldo Lung Cancer Stigma Scale (CLCSS) the only specific to lung cancer. The most significant findings were: patients with lung cancer feel stigmatized, regardless of being a smoker or not, they feel more guilty, ashamed and anxious than other patients with other cancers and there is a strong association between stigma and depression and impaired quality of life. Conclusion: The studies in this field are recent, few and no study in a Brazilian sample. [ABSTRACT FROM AUTHOR]

Copyright of Der Pathologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Immunohistochemistry (IHC), as such, can be used in routine pathology in order to make correct diagnosis of lung carcinomas. Consequently, more detailed analyses are needed in this field in order to make a wide spectrum of unique combinations for such pulmonary neoplasms. Our aim was to apply an antibody panel, and examine and confirm its utility in the differential diagnosis of lung cancer. Twenty-one cases (both bioptic and surgical material) of diagnosed lung cancer were investigated. An immunohistochemical analysis -- (RTU FLEX Immunoperoxidase system) was made using Dako monoclonal antibodies (Cytokeratin 7, CK7; Cytokeratin 20, CK20; Neuron specific enolase, NSE, Thyroid transcription factor-1, TTF1 and Leucocyte common antigen, LCA). LCA expression was not expressed in any of our cases. Most adenocarcinoma were CK7(+) -- 83.3% and TTF1(±) -- 50%. The CK20(+) expression showed a metastatic pulmonary deposit of adenocarci- noma in the lung. TTF1(+) -- 100%, NSE(+) -- 100% and CK7(-) -- 66.66% expression was found in most cases of SCLC. NSE(+) --100% had the highest expression in carcionoid tumour, while TTF1(+) expression was highest in SCLC. For squamous cell carcinoma (SqCC), immunostaining was negative for this antibody panel, except focal and weak expression of NSE -- 60%, so we did some extra IHC using CKHMW antibody, which showed the highest expression. The essential antibody panel that we have confirmed and suggest for routine basic differential diagnosis of pulmonary neoplasms is: TTF1, CK7, CK20 and NSE. Due to the high number of co-occurrunces IHC should not be performed alone, but integrated in conjunction with morphological diagnosis. [ABSTRACT FROM AUTHOR]

INTRODUCTION Cancer has historically been a main cause of death in Cuba, with lung cancer the number one cause of cancer death in both sexes. Cancer morbidity and mortality rates are the basic measures of cancer impact in the community. Cancer mortality has been one of the major applications of geographic analysis and has made important progress in recent decades thanks to access to mortality statistics and to development and availability of geographic information systems. Cuba does not have a strong tradition of etiologic research using spatial analysis. High levels of lung cancer morbidity and mortality in Villa Clara and growing interest in spatial analysis as an epidemiologic tool motivated this study. OBJECTIVE To identify spatial and/or spatiotemporal clusters of lung cancer morbidity and case fatality in the province of Villa Clara, and to demonstrate the value of cluster analysis as an epidemiologic tool. METHODS Descriptive observational study based on administrative data, using the technique of space-time scan statistics. The study focused on new cases diagnosed in 2004 and case-fatality for those cases through 2009. Variables used were: cases diagnosed, deaths, date of diagnosis, date of death, municipality and Cartesian geocoding for each municipality. RESULTS The study identified significant spatial and spatiotemporal clusters of greater than expected lung cancer incidence (municipalities of Encrucijada, Camajuaní, Cifuentes, Sagua la Grande, Caibarién and Santa Clara) and case fatality (Encrucijada, Camajuaní, Cifuentes, Sagua la Grande, Caibarién, Santa Clara, Placetas and Manicaragua). CONCLUSIONS Although the results are not explanatory, the spatial and spatiotemporal patterns of excess lung cancer risk and case-fatality can support hypothesis generation for research and eventual interventions for targeted prevention and management. [ABSTRACT FROM AUTHOR]

Objective: The present study is based on the cytologic evaluation of bronchial brushings for the diagnosis of non neoplastic and neoplastic bronchopulmonary lesions and relation of the cytologic findings with clinical diagnosis and histopathologic examination wherever possible. Material and Method: 35 symptomatic patients were selected on whom bronchoscopy was done. Bronchial brushing was performed using straight brushes and bronchial washing specimens were collected after brushing samples. Smears were stained by PAP, H&E, and Giemsa in all the cases while PAS and Ziehl Neelsen stainings were done in selected cases. Endobronchial biopsy was performed using a flexible long biopsy forceps. Results: The age of the patients varied from 18 to 88 years, and the male:female ratio was 3.3:1. Carcinoma was diagnosed in 21 (60%) out of total 35 cases on bronchial biopsy and the remaining 14 cases (40%) showed inflammatory, tuberculous or no significant pathology. Bronchial washing showed 10 true positive, 10 true negative, 4 false positive and 11 false negative cases whereas bronchial brushing showed 17 true positive, 12 true negative, 2 false positive and 4 false negative cases as confirmed on biopsy. Bronchial brushing showed good sensitivity (80.9%) and specificity (85.7%) compared to bronchial washing which had sensitivity of 47.6% and specificity of 71.4%. Conclusion: These findings attempted to confirm the concept that pulmonary cytology has improved to the point that its sensitivity is high enough to justify its use as a definitive diagnostic tool in those cases in which tissue diagnosis is not possible. [ABSTRACT FROM AUTHOR]

Background Bricklayers may be at increased risk of lung cancer, although a firm association has not been established. We examined this association within the EAGLE (Environment And Genetics in Lung cancer Etiology) study, a population-based case-control study conducted in Italy between 2002 and 2005. Methods For men in selected occupations in the construction sector we calculated smoking-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). For bricklayers we estimated the population attributable fraction (PAF) and the attributable community risk (ACR). Results We found increased lung cancer risk for bricklayers (OR 1.57, 95% CI 1.12-2.21; 147 cases, 81 controls). The PAF was 3.9% (95% CI 0.7-7.0), corresponding to an ACR of 4.1 cases annually per 100,000 men (95% CI 0.7-7.3) in the whole community. Among bricklayers, there were increased risks for squamous cell (OR 2.03, 95% CI 1.32-3.13, 56 exposed cases) and small cell carcinomas (OR 2.29, 95% CI 1.29-4.07, 21 exposed cases), while no excess (OR 1.06, 95% CI 0.68-1.65, 41 exposed cases) was found for adenocarcinoma. Conclusions Our findings provide additional evidence of increased lung cancer risk in Italian bricklayers. The association is plausible because they are exposed to several carcinogens, notably crystalline silica. Am. J. Ind. Med. 55:423-428, 2012. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of our study was to retrospectively determine the diagnostic yield of CT fluoroscopy-guided cutting needle biopsy of focal pure ground-glass opacity lung lesions. Materials and methods: Biopsies were performed using 20-G coaxial cutting needles for 83 focal pure ground-glass opacity lung lesions (mean lesion size, 12.1mm). After excluding the lesions for which biopsy specimens were unobtainable and final diagnoses were undetermined, the diagnostic yield, including sensitivity and specificity for a diagnosis of malignancy and accuracy, was calculated. The lesions were then divided into 2 groups: the diagnostic failure group, comprising lesions with false-negative results and for which a biopsy specimen was unobtainable; and the diagnostic success group, comprising lesions with true-negative results and true-positive results. Various variables were compared between the 2 groups by univariate analysis. Results: Biopsy specimens were obtained from 82 lesions, while specimens could not be obtained from 1 lesion. Final diagnosis was undetermined in 16 lesions. The sensitivity and specificity for a diagnosis of malignancy were 95% (58/61) and 100% (5/5), respectively. Diagnostic accuracy was 95% (63/66). The 4 lesions in diagnostic failure group were smaller, deeper, and more likely to be located in the lower lobe and further, for those lesions, number of specimens obtained was smaller, compared with 63 lesions in diagnostic success group. However, none of the differences were statistically significant. Conclusion: CT fluoroscopy-guided cutting needle biopsy provided high diagnostic yield for focal pure ground-glass opacity lung lesions. [Copyright &y& Elsevier]

Primary pulmonary neoplasms are uncommon in children and represent a wide spectrum of pathology from benign to malignant. They are quite different in their histopathologic distribution from that of adults. This study was done to analyze the histopathologic spectrum of primary lung tumors in children. All the resected specimens of lung in children over a period of 5 years were studied and only the cases of primary pulmonary neoplasms were further analyzed. There were two cases of inflammatory myofibroblastic tumor. The patients were boys aged 10 and 12 years, respectively. One case of bronchial carcinoid was diagnosed in a boy of 12 years. There were one case each of pleuropulmonary blastoma (PPB) in a girl of 9 years and pulmonary blastoma (PB) in a girl of 2 years of age. In our study, the two cases of inflammatory myofibroblastic tumor had excellent prognosis. However, the cases of PPB and PB were both associated with poor clinical outcome, whereas the case of bronchial carcinoid has been doing well on follow-up. [ABSTRACT FROM AUTHOR]

The current carcinogenicity study with female rats focused on the toxicity and carcinogenicity of intratracheally instilled fine and ultrafine granular dusts. The positive control, crystalline silica, elicited the greatest magnitude and progression of pulmonary inflammatory reactions, fibrosis and the highest incidence of primary lung tumors (39.6%). Addition of poly-2-vinylpyridine-N-oxide decreased inflammatory responses, fibrosis, and the incidence of pulmonary tumors induced by crystalline quartz to 21.4%. After repeated instillation of soluble, ultrafine amorphous silica (15 mg) a statistically significant tumor response (9.4%) was observed, although, the inflammatory response in the lung was not as persistently severe as in rats treated with carbon black. Instillation of ultrafine carbon black (5 mg) caused a lung tumor incidence of 15%. In contrast to a preceding study using a dose of 66 mg coal dust, lung tumors were not detected after exposure to the same coal dust at a dose of 10 mg in this study. Pulmonary inflammatory responses to coal dust were very low indicating a mechanistic threshold for the development of lung tumors connected with particle related chronic inflammation. The animals treated with ultrafine carbon black and ultrafine amorphous silica showed significantly more severe lesions in non-cancerous endpoints when compared to animals treated with fine coal dust. Furthermore, carbon black treated rats showed more severe non-cancerous lung lesions than amorphous silica treated rats. Our data show a relationship between tumor frequencies and increasing scores when using a qualitative scoring system for specific non-cancerous endpoints such as inflammation, fibrosis, epithelial hyperplasia, and squamous metaplasia. [ABSTRACT FROM AUTHOR]

Se presenta el caso de un paciente de 18 años de edad, raza blanca y sexo masculino, con manifestaciones respiratorias de tos, expectoración, dolor torácico y rayos X de tórax con una masa de lóbulo superior izquierdo. Después de pleurotomía mínima y biopsia se le diagnosticó un blastoma pulmonar. Se le relizó neumectomía y posteriormente, se le administró poliquimioterapia.The case of a 18-year old, white, male patient presenting with respiratory manifestations of cough, expectoration, thoracic pain, and a chest radiography showing a mass of the left upper lobe, is reported. After performing a minimal pleurotomy and a biopsy, a pulmonary blastoma was diagnosed. The patient underwent a pneumonectomy and subsequently he received polychemotherapy.

An intrathoracic mass was discovered on magnetic resonance imaging (MRI) of the spine in a 37-year-old Caucasian man with a 1 year history of progressively severe upper back pain. A subsequent chest CT scan indicated a 4 cm left hilar mass, extending to the apex and encasing a portion of the left bronchus and pulmonary artery. Initial bronchoscopic and transthoracic biopsies failed to obtain diagnostic material. The patient underwent thoracotomy and was found to have a locally advanced, surgically unresectable lung tumor, involving the pleura, pericardium and diaphragm. The patient failed to respond to radiochemotherapy, and died 11 months following the diagnosis with tamponade and metastasis to the skin of the thoracoabdominal wall. Histologically the tumor had an epithelioid and spindled appearance, without high-grade histological features, and was initially thought to represent biphasic diffuse malignant mesothelioma. Positive immunohistochemistry for vascular markers (CD31, CD34, and FLI-1) disclosed the vascular nature of the tumor. Mesothelioma markers were universally negative and cytokeratin was focally reactive only in some epithelioid cells. Epithelioid hemangioendothelioma is a rare tumor in the lung that can mimic other more common pathological entities, and should be included in the differential diagnosis of unusual pulmonary neoplasms with epithelioid or biphasic morphology. [ABSTRACT FROM AUTHOR]

Abstract: The data presented in this paper have been derived from a carcinogenicity experiment with rats as part of a comprehensive research project focused on experimental studies on the toxicity and carcinogenicity of intratracheally instilled granular dusts [Ernst H, Rittinghausen S, Bartsch W, Creutzenberg O, Dasenbrock C, Görlitz B-D et al. Pulmonary inflammation in rats after intratracheal instillation of quartz, amorphous SiO2, carbon black, and coal dust and the influence of poly-2-vinylpyridine-N-oxide (PVNO). Exp Toxicol Pathol 2002; 54: 109–26; Ernst H, Kolling A, Bellmann B, Rittinghausen S, Heinrich U, Pott F. Pathogenetische und immunbiologische Untersuchungen zur Frage: Ist die Extrapolation der Staubkanzerogenität von der Ratte auf den Menschen gerechtfertigt? Teil II: Histologie. Abschlussbericht. Umweltforschungsplan des Bundesministeriums für Umwelt, Naturschutz und Reaktorsicherheit. November 2005. http://www.umweltdaten.de/publikationen/fpdf-l/3033.pdf]. The results of the standard approach to histological sampling in rodent carcinogenicity inhalation studies were compared to those obtained after supplemental evaluation of step sections at intervals of 250μm through the entire lung. Seven lung tissue specimens (six sections) each of 251 rats (55 rats of the control group, 53 rats of the group treated with quartz DQ 12, 56 rats of the group treated with quartz DQ 12 and PVNO (poly-2-vinylpyridine-N-oxide), 53 rats of the group treated with amorphous SiO2, and 17 rats each of the groups treated with coal dust and carbon black) were evaluated by light microscopy. At least 60 hematoxylin and eosin (H&E)-stained sections per lung were evaluated of 99 female rats (30 rats of the control group, 7 rats each of the groups treated with quartz, quartz and PVNO, and carbon black, 31 rats of the group treated with amorphous SiO2, and 17 rats treated with coal dust). For the neoplastic and pre-neoplastic lesions detected in the serial slides an approximate value of the whole tumor volume was calculated. The detection of tumors with a diameter of 0.25mm was possible. Based on the size distribution of 75 tumor volumes, the probability of detecting a tumor was 86% when using 12 sections. The addition of step sections enhanced the tumor detection rate from 17 to a total number of 44 lung tumors in the quartz-treated rats, from 6 to 10 in the quartz- and PVNO-treated rats, from 4 to 11 in the amorphous SiO2-treated rats, and from 4 to 10 in the carbon black-treated rats. Both the tumor multiplicity and the number of rats with pre-neoplastic lesions increased. These additional data corroborated the initial findings in all experimental groups and provided statistically significant results confirming the equivocal evidence of carcinogenic activity of amorphous SiO2 in female Wistar rats. This technique offered accurate information on the incidence, histological type, size, and location of proliferative lesions in the entire lung, but the benefit must be balanced against the extra financial effort. [Copyright &y& Elsevier]

The purpose of this retrospective study was to evaluate the impact of energy subtraction (ES) chest radiography on the detection of pulmonary nodules and masses in daily routine. Seventy-seven patients and 25 healthy subjects were examined with a single exposure digital radiography system. Five blinded readers evaluated first the non-subtracted PA and lateral chest radiographs alone and then together with the subtracted PA soft tissue images. The size, location and number of lung nodules or masses were registered with the confidence level. CT was used as standard of reference. For the 200 total lesions, a sensitivity of 33.5–52.5% was found at non-subtracted and a sensitivity of 43.5–58.5% at energy-subtracted radiography, corresponding to a significant improvement in four of five readers (p < 0.05). However, in three of five readers the rate of false positives was higher with ES. With ES, sensitivity, but not the area under the alternative free-response receiver operating characteristics (AFROC) curve, showed a good correlation with reader experience (R = 0.90, p = 0.026). In four of five readers, the diagnostic confidence improved with ES (p = 0.0036). We conclude that single-exposure digital ES chest radiography improves detection of most pulmonary nodules and masses, but identification of nodules <1 cm and false-positive findings remain a problem. [ABSTRACT FROM AUTHOR]