Endobronchial metastasis: an epidemiologic and clinicopathologic study of 174 consecutive cases

PURPOSE: Endobronchial metastases from extrapulmonary solid tumors are a rare event and currently available epidemiological and clinico-pathological data mainly derive from anecdotal case reports. METHODS: A series of 174 consecutive cases of endobronchial metastases from extrathoracic solid tumors were collected over a period of 18 years. Immunohistochemistry was performed in 115 cases. Complete imaging features were available in 81 patients, and analysis of the latency period between primitive tumor diagnosis and occurrence of endobronchial metastasis was obtained. RESULTS: Among all bronchoscopic examinations performed in the same period for malignancy, a mean of 5.6 cases per year consisted of endobronchial metastases (range 2-17 cases), with a statistically significant increase when comparing the periods 1992-2000 (65 cases, 37%) and 2001-2009 (109 cases, 63%) (p = 0.05). Overall, 4% of endobronchial biopsies for suspected malignancy disclosed an endobronchial metastasis from extrapulmonary tumor. Breast (52 cases, 30%), colorectal (42 cases, 24%), renal (14%), gastric (6%) and prostate (4.5%) cancers and melanoma (4.5%) were the most common metastatic neoplasms presenting as endobronchial mass. One-hundred fifty-four cases were identified after the primitive tumor diagnosis (metachronous cases, 89%), 11 cases were simultaneously evidenced in extrapulmonary and endobronchial sites (synchronous cases, 6%), while 9 occult metastatic cases (5%) first presented as endobronchial mass (anachronous cases). Overall, mean latency from extrapulmonary tumor diagnosis and endobronchial metastasis was 136 months (range, 1-300 months). The most frequent symptoms were dyspnea (23%), cough (15%) and haemoptysis (12%), while 26% of patients were totally asymptomatic. At radiology, 53% presented as multiple pulmonary nodules, while other cases presented as hilar and mediastinal mass, single peripheral nodule, atelectasis or pleural effusion. CONCLUSIONS: Endobronchial metastases from extrapulmonary tumors account for about 4% of all bronchoscopic biopsies performed for suspected malignancy and in 5% of the cases the metastasis is the first manifestation of the neoplasm

Emergency Laser Treatment of a Tracheobronchial Carcinoid during ECMO

Early diagnosis of endobronchial carcinoids is challenging, as they often mimic other common acute respiratory conditions at first presentation. Increasing consensus favours surgical resection over endoscopic management of bronchial carcinoids whenever possible. ECMO has been reported to be an effective supportive strategy in many cases of elective and urgent surgical or endoscopic airway procedures. However, it has never been described as a supportive technique for the emergency endoscopic management of an endobronchial carcinoid. Herein we report the case of a 17 year-old girl presenting with spontaneous pneumomediastinum and an almost complete endotracheal obstruction at the level of the main carina, due to a typical carcinoid that was treated successfully by endoscopic laser disruption under veno-venous extracorporeal circulation in an emergency scenario

Herpes simplex virus (HSV) pneumonia in the non-ventilated immunocompromised host: Burden and predictors

Objectives: To evaluate burden and predictors of HSV pneumonia among immunocompromised patients not undergoing invasive mechanical ventilation according to a tailored diagnostic algorithm. Methods: This prospective, observational study included immunocompromised adults with pneumonia non-responding to empirical antibiotic therapy. Bronchoalveolar lavage (BAL) specimens were cultured for bacteria, mycobacteria and fungi. Real-time PCR for Herpesviruses and other microorganisms were performed on BAL and other specimens. Cytological examination of BAL samples was carried out for identification of intranuclear inclusion bodies and immunohistochemical staining for HSV. Results: We enrolled 45 patients (mean age 64.6 years) from January 2015 to June 2016. Nineteen (42.2%) cases tested positive for HSV-1 PCR on BAL. According to our definitions, 11 (24.4%) patients had HSV- 1 pneumonia with viral loads ranging between 10 3 copies/mL and 10 7 copies/mL. HSV-1 positive throat swab (OR 85.2, 95% CI 5.83\u20131245.1, P < 0.001) and solid organ transplant (SOT) (OR 53.3, 95% CI 1.37\u20132072.8, P < 0.03) as underlying condition were found to be independently associated with HSV pneumonia by multivariable analysis. Conclusions: HSV pneumonia turned out to be relatively common and should be investigated especially in individuals with HSV positive throat swab and SOT. Interventional studies are needed to assess the real clinical impact of HSV pneumonia in immunocompromised patients

Iron Overload in Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation: Quantification of Iron Burden by a Superconducting Quantum Interference Device (SQUID) and Therapeutic Effectiveness of Phlebotomy

n/

Histological verification of positive positron emission tomography findings in the follow-up of patients with mediastinal lymphoma.

Background and Objectives Follow-ups of patients with mediastinal lymphoma are not accurate if they rely on computed tomography (CT). Positron emission tomography (PET) has been suggested to be useful in several lymphoma settings, such as initial staging, evaluation of residual masses after therapy, and assessment of response early in the course of treatment. The aim of this retrospective study was to verify the reliability of positive PET scans of the mediastinum in following up patients wirh mediastinal lymphoma, using histological findings as a comparison. Design and Methods From January 2002 to July 2005, 151 patients with mediastinal lymphoma (57 with Hodgkin's disease [HD] and 94 with aggressive non-Hodgkin's lymphoma [NHL]) were followed-up after the end of front-line treatment. Patients with a positive PET scan of the mediastinum underwent CT scanning and surgical biopsy. Results In 30 (21 HD and 9 NHL) out of 151 patients (20%) a suspicion of lymphoma relapse was raised based on positive mediastinal PET scanning. Histology confirmed this suspicion in 17 (10 HD and 7 NHL) out of 30 patients (57%), whereas either benign (9 fibrosis, 3 sarcoid-like granulomatosis) or unrelated neoplastic conditions (1 thymoma) were demonstrated in the remaining 13 patients (43%). SUVmax was significantly higher among patients who had signs of relapse (17 true positive cases) than among those who stayed in remission (13 false positive cases), the median values being 5.95 (range, 3.5–26.9) and 2.90 (range, 1.4–3.3), respectively ( p =0.01). Interpretation and Conclusions We suggest that a positive PET scan of the mediastinum of a patient being followed-up for a mediastinal lymphoma should not be considered sufficient for diagnostic purposes in view of its lack of discrimination. Histological confirmation can safely be carried out with various biopsy techniques, the choice of which should be made on the basis of the findings of the clinical and imaging studies of the individual case

Annealing effect on electromechanical behaviour of polyanilines organic acids-doped

This work presents an extensive experimental qualification of an innovative polyaniline synthesized by a more sustainable approach as sensing element. The electromechanical properties of polyanilines prepared by two different approaches (PANI1 from a traditional method and PANI2 from a more environmentally friendly route) are investigated in order to verify the applicability of these materials for the development of force and pressure transducers. The two PANI were chemically characterised and investigated through several mechanical tests. The variation of their resistance was continuously monitored during loading/unloading cycles up to 40 kN after heat treatment in order to evaluate the modification of the electromechanical properties at different temperatures. It was observed that both the polyanilines exhibit a strong change of their resistance value as function of the compression load acting on the samples. Moreover, PANI2 shows a high resistance which is a good property for insert the element into any measurement circuit avoiding problems of impedance losses due to cables or other circuit elements. The results will also show that both PANIs have steady behaviour at high temperatures up to 85°–100 °C

High-Resolution Computed Tomography: Lights and Shadows in Improving Care for SSc-ILD Patients

The diagnosis and classification of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is essential to improve the prognosis of systemic sclerosis (SSc) patients. The risk-stratification of disease severity and follow-up requires a multidisciplinary approach, integrating highresolution computed tomography (HRTC) of the lung, pulmonary function tests (PFT), along with clinical and symptomatic evaluations. The use of HRCT in detecting SSc-ILD is not so much based on a definitive validation, but rather reflects the widespread clinician recognition of dissatisfaction with other modalities. However, due to the heterogeneity of SSc-ILD and the potential absence of symptoms in early or mild disease, it is prudent to consider as many parameters as possible in the assessment and monitoring of newly diagnosed patients. An early diagnosis meets the primary goal, i.e., the prevention of disease progression. The current first line treatment regimens are mainly centered on immunosuppressive therapy. This review assesses the role HRCT plays in optimizing care and improving clinical outcomes in SSc-ILD patients

Limited role for bronchoalveolar lavage to exclude Covid-19 after negative upper respiratory tract swabs: a multicenter study

Given the strong agreement between negative upper respiratory swabs and BAL, we suggest that BAL has a limited role in the diagnosis of Covid-19 if thoracic imaging and upper respiratory swabs are concordantly negative