Search

The author presents a quick review of the pulmonary lesions due to ARC, mainly the pulmonary lymphoid hyperplasias. The most frequent pulmonary complications of the disease are summarised (opportunistic infections and Kaposi sarcoma) the practical conditions of their pathological diagnosis are illustrated.

3 cases of hairy cell leukaemia were studied with ultrastructural immunocytochemical methods using an anti human Ig HRPO-Fab fragment. Ig were detected on the cell surface, in the perinuclear cisterna and endoplasmic reticulum of hairy cells. Evidence of Ig in these sites demonstrates a B-lymphoid differentiation of the leukaemic cells.

To study indicators of disease activity in sarcoidosis, bronchoalveolar lavage (BAL) and serum angiotensin-converting enzyme (SACE) measurement were performed in 39 patients with active sarcoidosis and in 13 patients with inactive sarcoidosis. All patients were non-smokers. Results were compared to those from 9 non-smoking controls and 20 patients with non-granulomatous interstitial lung disease. Lymphocyte counts, IgG concentrations and the IgG/K ratio were high in BAL fluid specimens from patients with active sarcoidosis, indicating a relationship between cellular and humoral immunity. Conversely, specimens from inactive sarcoidosis patients showed supranormal lymphocyte counts with IgG levels and a IgG/K ratio that did not differ significantly from those in controls or patients with interstitial lung disease (p greater than 0,05). Patients with active sarcoidosis that abated after 6 to 12 months had an initial lymphocytosis of 28.7% and a IgG/K ratio under 170 mg/mmol. We conclude that IgG concentrations and the IgG/K ratio are better discriminators between active and non-active or nearly resolved disease than lymphocyte counts. SACE assay is not sufficiently discriminative.

A 24-year-old man presented clinically confirmed Behcet's disease. He developed thoracic pain accompanied by hemoptyses as a result of thromboses and aneurysm formation in the pulmonary artery. The presence of these aneurysms was suggested by perihilar images on standard radiography, and confirmed by pulmonary arteriography findings and results of histological examination of the operative specimen. Radiological and anatomical evidence of the presence of bronchial endarteritis lesions was also obtained.

Advances in the therapy of tumors or for the maintenance of grafts have improved survival in a large number of patients, but at the price of repeated complications due to the induced immunodeficiency state. Pulmonary infections are a frequent occurrence, and while some are easily recognized and treated, others must be precisely diagnosed, as only early specific treatment can avoid the often fatal outcome. Various techniques have therefore been developed to obtain specimens for microorganism isolation before having ultimate recourse to a surgical lung biopsy. It is in this field that the most marked progress is currently being made. The different microorganisms responsible for these affections are reviewed, the majority being common to the immunodeficiency state, while others are encountered more frequently as a function of the underlying disorder and of the ecological conditions in each centre.

Amyloidosis of the lower respiratory tract is a rare condition. We report three new cases and we review the literature. Tracheobronchial amyloidosis is the most frequent form. The diagnostic is made by fiberoscopy and biopsies with a risk of bleeding. Our patients were usually treated with intermittent bronchoscopic resections. In one of the three cases reported, desobstruction of the large airway was performed with laser. Nodular pulmonary amyloidosis is usually asymptomatic, and surgical resection results in cure in all cases. Diffuse pulmonary amyloidosis is very unusual and fatal.

Data yielded by bronchial and transbronchial biopsy specimens removed during fiberoptic bronchoscopy in 53 patients with sarcoïdosis (24 stage I, 27 stage II, and 2 stage III) was analyzed. Bronchial biopsies (3 to 5 specimens) were positive in 49% of patients (41,6% stage I, 55,5% stage II, 1/2 stage III). Transbronchial biopsies removing bronchiolar and alveolar specimens yielded 88,6% positive results (91.6% stage I, 85,1% stage II, 2/2 stage III). Lymphocyte counts bronchioalveolar washings exceeded normal values by 15% in all 42 patients studied. We conclude : 1) that transbronchial lung biopsies yield significantly more information than proximal bronchial biopsies ; 2) that results of bronchioloalveolar washings reflect granulomatous immunologic changes in the lung and do not allow unequivocal diagnosis.

A case of Pneumocystis carinii pneumonia is presented. Following presentation a chronic alveolitis was uncovered, which was due to ultimately repeated and prolonged inhalation of sweets containing gum arabic. The diagnosis was confirmed by a trans-bronchial biopsy and by chemical analysis of centrifugation of the alveolar lavage deposit. After cessation of the inhalation the progress was satisfactory both in terms of clinical status and lung function measurement.

Diffuse pulmonary hemorrhages may occur in pulmonary vasculites, including Wegener disease, systemic lupus erythematosus, Behçet disease, and other systemic vasculites. The pulmonary bleeding is often the first manifestation of the disease and frequently denotes a severe form. The etiologic diagnosis can be established only by performing a surgical lung biopsy, which is often a difficult decision. Leukoclastic capillaritis of the alveolar septa is the common features shared by all the vasculites responsible for pulmonary hemorrhage.

The clinical and pathological features of three unusual soft tissue tumors are presented. They occurred in the groin of elderly patients in the subcutaneous tissue. In Case 1, the inguino-crural tumor coexisted with a second mass in the pelvis. The tumors had a tendency to recur locally and to invade the regional lymph nodes. Metastatic dissemination of the disease resulted in the death of the patient in Case 3. Histologically, the tumors appeared composed of small round cells with scanty cytoplasms, arranged in diffuse, poorly cohesive or solid sheets. In places, a trabecular pattern was noted. Mitotic figures were numerous. Some cells exhibited argyrophil granules. The ultrastructural study revealed compact whorls of intermediate filaments and neurosecretory granules. All three cases displayed a paranuclear dot-like positive reaction with antibodies to cytokeratins and neurofilaments. A diffuse cytoplasmic immunostaining for neuron-specific enolase was present in Cases 1 and 2. Protein S-100, vimentin and leucocyte common antigen could not be demonstrated. All these characteristics, except for the subcutaneous location, are shared with neuroendocrine (Merkel cell) tumors of the skin.

We observed a patient with Lennert's lymphoma. Immunocytochemical study of paraffin sections by the immunoperoxidase technique and immunologic study of viable cell suspension by monoclonal antibodies confirmed the T-cell nature of the neoplastic lymphoid cells. Subtyping showed a predominance of helper T lymphocytes. The histiocytic nature of the epithelioid-cell component of Lennert's lymphoma was also shown by immunostaining.

A case report is presented of a patient with a pleural effusion subsequently shown to have a localised immunoblastic lymphoma of the bronchus of non-Hodgkin's type. The development of this lymphoma in a patient with mycosis fungoides underlines the potential for the transformation of a T cell epidermoid lymphoma of low grade malignancy to a lymphoma of high grade malignancy.

The authors present the results of a histopathological study on the lymph-nodes taken from 45 subjects suffering from either an AIDS or from a chronic adenopathy corresponding to the definition of AIDS related complex (ARC). The various aspects observed were classed as type I to type IV. The lymph-node modifications observed in the 29 patients with an ARC could be divided into three principle groups: an extensive follicular hyperplasia associated with other elementary lesions or type IA (25 lymph-nodes from 23 patients); changes resembling a multicentric Castleman syndrome or type IB (1 case); angioimmunoblastic-like (AIL) lesions or type II (2 cases) and an association of lesions of type II (7 lymph-nodes from 6 patients). During AIDS, the adenopathy usually disappears, and the small lymph-nodes removed, especially on autopsy, show an extensive lymphoid depletion (type III) with systematic sclerosis (15 lymph-nodes from 14 patients). When adenopathy persists, it is due to infections complications (tuberculosis, cryptococcosis, avian mycobacteriosis and Whipple's disease like lesions). Of the 10 patients in whom a Kaposi's sarcoma was observed, only 6 showed lymph-node involvement, or type IV. The different histopathological lesions seem to appear according to an evolving succession, proven by certain association of lesions and by successive biopsies. In our series, 17% of subjects with an ARC evolved to AIDS. Lymph-node biopsy allows a possible ARC to be implicated on the association of the following simple lesions: follicular hyperplasia with partial or total destruction of the perifollicular lymphocytic cisterna, infiltration of the germinative centres by streams of small lymphocytes, evolving to an aspect of a "burst" germinative centre and various sinusal reactions with, in particular, the presence of neutrophilic polynuclear cells. The biopsy also allows the forms with bad prognosis to be recognized: those with AIL-like aspect or multicentric Castleman-like syndrome, which seems to represent a particular evolutive form. Finally, it also detects, in certain cases, the localization of a Kaposi syndrome, signalling the passage to AIDS. The immunopathological studies present a double interest. Firstly, they offer arguments in favour of the diagnosis: increase in the number of T8 lymphocytes in the germinative centres with the formation of small clusters and disruption of the network of dendritic reticular cells, and the inversion of the T4/T8 ratio in the extra-follicular cortical regions, by either a decrease in T4 lymphocytes or by an increase in T8 lymphocytes.(ABSTRACT TRUNCATED AT 400 WORDS)

A case of severe diffuse interstitial pneumonia is reported in a 69 year old after 5 weeks treatment with gold salts. Regression of symptoms on withdrawal of gold salts and under steroid therapy, the similarity with previously published cases, the absence of another cause lead us to incriminate the gold salts. The case is documented with optical and electronic microscopic studies of transbronchial biopsy and repeated examination of bronchoalveolar lavage fluid. A general review of the literature is included with a critical discussion of the physiopathogenic mechanisms. The results of the examination of the bronchoalveolar lavage fluid are further evidence in favour of cell-mediated hypersensitivity reaction.

The authors report the case of a malignant hemangioendothelioma of the choroid occurred in a 62 years old man. Clinically the lesion simulated a malignant melanoma but the histological examination showed an unpigmented tumour consisting of nests of large, pleomorphic cells proliferating inside reticular sheaths. The immunohistochemical identification of Factor VIII Related Antigen by the peroxidase-antiperoxidase method of Sternberger permitted the identification of their endothelial nature. This case which seems to be the first described in the literature, is distinguished from benign hemangioendothelioma and from neoplastic angioendotheliomatosis.

Kartagener syndrome, identified 40 years ago, is an obstructive bronchopulmonary condition of early onset which rapidly becomes chronic and linked to immobility of the bronchial cilia. This clinical entity is based upon a kinetic problem secondary to ultrastructural abnormalities of the cilia. Current techniques for the study of ciliary movement and electron microscopy in particular are sufficiently accurate to be able to link certain ciliary abnormalities to particular clinical manifestations. Although it is a frequent neonatal condition, Kartagener syndrome may be compatible with prolonged survival. The authors report a case in an adult, with a favorable course, and give an updated review of the condition.

A case of lymphomatoid granulomatosis arising in a patient with a long history of dysimmunity is reported. The autopsy reviewed the final evolution into a high grade malignant lymphoma with IgM K immunoglobulin production and discovered in deep lymph nodes modifications similar to angio-immunoblastic lymphadenopathy.

Histological examination of the various specimens taken during an exploratory laparotomy for Hodgkin's disease revealed the presence of epithelioid cells in 56 cases out of a total of 235 patients (i.e. 23.8 p. 100). These cells were disseminated throughout the lymphoid tissue or grouped in clumps, in plaques or, more rarely, as true follicles. They were found either in contact with Hodgkin's lesions or at a distance in organs free of disease. They were found in Lukes-Rye histological types 1, 2 and, above all, 3. Their significance remains unknown. The most likely hypotheses would appear to be those of a response to the accumulation of substances to be eliminated (tumour antigens?) or those of a disorder in cellular immunity.

Epidermolysis bullosa acquisita (EBA) is a rare non hereditary bullous disease. One case is described with a morphological, and immunocytochemical ultrastructural study. The plain ultrastructural morphology showed a dense amorphous deposit in the superficial dermis, under the basal lamina. Immunofluorescence showed IgG and C3 deposits. The ultrastructural study (direct immunoperoxidase technique using Fab) showed a dense labelling associating : dark dots spaced under the basal lamina and fogging less dense labelling in the clarified superficial dermis. Using the patient's antibodies an indirect reaction on normal human skin performed : the same dotted sub laminal labelling was found but with no dermal diffuse reaction product. The study shows the site and the aspect of the Ig deposit in EBA and indicates that the antibodies demonstrated in some patients are reactive with a constituent of the normal superficial dermis.

Fine needle transthoracic aspiration (FNTA) of pulmonary opacities under guidance of computerized tomography (CT) is a simple procedure yielding conclusive results in many patients with malignant lung tumours. The small caliber of the needles utilized and the CT control make this increasingly popular procedure both accurate and safe. Yet a number of complications have occurred; most of them were benign (e.g. pneumothorax) but some were potentially dangerous (e.g. pulmonary haemorrhage), so that the pros and cons of the procedure must carefully be weighed. We report the case of a patient in whom FNTA was complicated by copious haemoptysis and a pulmonary haematoma clearly visible at CT. The literature concerning the potential complications of transthoracic puncture is reviewed.

The cytology of samples from broncho-alveolar lavage was studied in 18 patients with stage I or II sarcoidosis, three of whom were smokers (stage II). Cell content was 213 +/- 111.10(3)/ml with 30.8 +/- 15.7 p. cent of lymphocytes for stage I, and 338 +/- 98.10(3)/ml with 34.1 +/- 8.7 p. cent of lymphocytes for stage II patients who were non smokers. In the three patients in stage II who smoked, cell content was 206 +/- 107.10(3)/ml with 15.3 +/- 9.4 p. cent of lymphocytes. Measuring angiotensin conversion enzyme in 12 cases demonstrated elevated (7 cases) or normal (5 cases) levels unrelated to the radiological stage or the lymphocytosis. Diagnosis was confirmed by the presence of characteristic epithelioid granulomas in all cases, in 14 patients after trans-bronchial pulmonary biopsy. In comparison, cell content in 3 cases of extrinsic allergic alveolitis associated with histologically confirmed granulomas was 690 +/- 120.10(3)/ml with 50.3 +/- 10.7 p. cent of lymphocytes, and in 9 cases of different types of intestinal affections was 327 +/- 157.10(3)/ml with 6.33 +/- 7 p. cent of lymphocytes. Constantly elevated lymphocytosis in sarcoidosis constitutes a diagnostic aid; perhaps it can be used during follow-up examinations as a means of assessing progression of the disease. No correlation with the conversion enzyme was noted.

Eighteen dogs were studied to determine the presence, extent and evolution of tissue lesions related to extracorporeal lithotripsy of the gallbladder under conditions similar to those encountered in clinical practice (electrohydraulic generator, ultrasonographic localization, prone positioning and 2,500 shocks delivered per session). Twelve dogs underwent lithotripsy 14 days after implantation of a 9 to 14 millimeter human stone in the gallbladder. The dogs were sacrificed one, 14 and 28 days after lithotripsy (four dogs at each date). Two dogs underwent implantation of stone but not lithotripsy and were sacrificed 14 days later. The last four dogs received only shock wave therapy and were sacrificed one (two dogs) and 14 (two dogs) days later. All calculi were completely fragmented into pieces less than 5 millimeters. Increases in leukocyte count (11 +/- 3.7 10(9) per liter) and alanine and aspartate aminotransferase levels (206 +/- 139 and 156 +/- 164 international units per deciliter, respectively) were seen after lithotripsy (p less than 0.05), but returned to normal during the next four weeks. Macroscopic hemorrhages were noted only in the dogs having undergone lithotripsy and were exclusively located in the organs lying in the path of the shock wave. Macroscopic hemorrhages were found in all six dogs sacrificed the day after lithotripsy and in two of the six dogs sacrificed 14 days later; one dog of the four sacrificed 28 days after lithotripsy still showed a large hemorrhage in the wall of the gallbladder. Microscopic abnormalities included congestion and hemorrhage of the same organs; although more discrete, congestion and hemorrhage were still present one month after shock wave therapy. Early and localized pulmonary fibrosis at the hypercellular stage was noted in two of the four dogs sacrificed at 28 days. The clinical implications for biliary lithotripsy upon humans include the necessity for intact coagulation parameters, strict avoidance of the bases of the lungs in targeting the stone and performing an ultrasonographic assessment of the wall of the gallbladder before repeating lithotripsy sessions, month apart.

Computed tomography was used to evaluate mediastinal lymph nodes in 97 patients with nonsmall cell lung cancer. All patients had thorough surgical-pathological determination of mediastinal node status. Twenty-three patients were found to have metastatic lymph nodes. The usual lymphatic pathways of tumor spread into the mediastinum were defined using the node mapping scheme suggested by the American Thoracic Society. We considered mediastinal nodes abnormal when the short axis of the largest mediastinal node in the lymphatic drainage territory of the cancer was greater than or equal to 10 mm and the difference between this node and the largest node in the other territories is greater than 5 mm. The sensitivity was 78%, the specificity 99%, the positive predictive value 95%, the negative predictive value 94%, and the accuracy 94%. Comparing our method to those that used the size criterion alone, the number of false positives was reduced.

Three hundred and four cases of small cell lung cancer diagnosed histologically were included in a randomised multi-centre trial (23 centres) from 1st January 1983 to the 30 September 1985, with no clinical criteria for exclusion. The clinical and laboratory data were taken from the initial assessment of the patients in the trial, and were compared with those in the literature. The sex ratio was 10:1, only 27 were women (9%) and all were less than 70. The mean aged was 60 +/- 10 (extremes 33 to 84 years) and 80% of the population was from 40 to 70 years. Tobacco consumption was virtually constant, only 7 were non-smokers and 7% of patients smoked less than 20 packs/year; indeed consumption was very heavy with a mean of 44 +/- 23 packs/years. 14% of cases were discovered on systematic radiological examination, but 39% of these asymptomatic patients already had disseminated disease. For the 304 patients overall, despite a very variable degree of dissemination from one patient and one centre to another, 163 (54%) had disseminated disease at the outset and 141 (46%) were apparently localised. The initial metastases were often multiple: extra-thoracic nodes (21%), hepatic (23%), osseous (20%), bone marrow (23%), cerebral (9%), and others (9%); these frequencies are underestimated in view of the fact that the investigations were not over-extensive. The serum carcino embryonic antigen levels were abnormal in 32% of cases. Fibroscopy remains the main diagnostic method to provide the histological proof for 90% of patients, but 4% had thoracotomies (of whom 3% were diagnostic thoracotomies).(ABSTRACT TRUNCATED AT 250 WORDS)

On the basis of a critical analysis of the literature, the authors review the various respiratory lesions imputed to the inhalation of hair lacquers. Pulmonary thesaurismosis is alleged to result from accumulation in the pulmonary parenchyma of non-biodegradable macro-molecules, such as PVP. Only isolated cases have been published and the true existence of this disease remains to be confirmed, in the absence of convincing epidemiological data as well as the lack of experimental reproducibility. Chronic inhalation of hair lacquers may, however, be responsible for bronchial irritative manifestations and obstruction of the small airways, in particular in hairdressers. Increase in the relative risk of bronchopulmonary carcinoma has not been proven.

A case of generalised scleroderma is reported in a dental technician exposed to the risk of silicosis. A study of the occupational toxic risks in this patient showed pulmonary overload with silica and metallic particles composed of chromium, cobalt and tungsten. The job also involved the handling of vinyl chloride and its stable polymer. This chemical is known to give rise to scleroderma-type skin disease. The relationship between these occupational factors leads to a difficult physio-pathological problem and justifies preventative measures, even though they may be costly and demanding.

5 cases of angiolymphoid hyperplasia with eosinophilia of the skin are reported. This rare condition was initially described in 1969 by Wells and Whimster. The microscopical pattern is characterised by an atypical vascular proliferation associated with an eosinophilic and lymphoplasmocytic granuloma. In our series, immunohistological study demonstrated the polyclonality of the plasmacytoid component. Electron microscopy performed in one case shows endothelial features even in cells forming clusters without well-defined lumen. These results support the endothelial origin of angiolymphoid hyperplasia with eosinophilia.

This study concerns 37 cases of Pneumocystis carinii pneumonia in AIDS patients. The time elapsed between human immunodeficiency virus (HIV) seropositivity and the onset of pneumocystosis has been established. Three clinical types are individualized. In cases with normal X-ray films of the chest, measurement of carbon dioxide transfer capacity, always reduced, has led to a bronchoalveolar lavage which provided an early diagnosis. In spite of good response to treatment, the prognosis of pneumocystosis is poor owing to the frequency of associated diseases.

An immunoelectronmicroscopic method using Fab fragment of anti human IgG (H + L) has been employed to study the localization of cytoplasmic immunoglobulins in the tumoral cells of 12 B non Hodgkin's malignant lymphomas (B-M.L.). A comparison with normal homologous B lymphoid cells was performed on 10 non tumoral reactive lymph nodes. Immunostaining was observed in PNC, RER and Golgi complex. The criterions of differentiation were discussed in the different B-M.L.. Because of a granular hyaloplasmic immunostaining in normal and tumoral centroblasts and immunoblasts, monospecific antibodies against gamma, mu, alpha heavy chains were used to rule out a non specific uptake. Presence of mu heavy chain was discussed as an argument for immunoglobulin free ribosomal synthesis.

Actinomycosis of the lung is rare and difficult to diagnose. Its good prognosis after medical treatment contrasts with the high frequency of surgical excision, due to the fact that pre-operative diagnosis is exceptional. Following a review of the recent bacteriological, radiological and therapeutic data available in the literature, 4 personal cases are presented. In all 4 cases actinomycosis was diagnosed post-operatively on the presence of yellow grains in the histological specimens. In 2 cases surgical excision proved impossible, but an almost complete radiological recovery could be obtained after prolonged treatment with co-trimoxazole. This shows how important it is to be aware of the disease, to improve its diagnostic approach and to remember its sensitivity to antibacterial agents, even in well organized forms.