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Chen-Yost HI, Hao W, Hamilton J, Dahl J, Jin X, Pantanowitz L. Second opinion for pulmonary and pleural cytology is valuable for patient care. J Am Soc Cytopathol 2024:S2213-2945(24)00042-5. [PMID: 38789337 DOI: 10.1016/j.jasc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Thoracic cytology can be challenging due to limited procured material or overlapping morphology between benign and malignant entities. In such cases, expert consultation might be sought. This study aimed to characterize all pulmonary and pleural cytology consult cases submitted to our practice and provide recommendations on approaching difficult cases. MATERIALS AND METHODS All thoracic (pulmonary and pleural) cytology cases submitted for expert consultation to the University of Michigan (MLabs) from 2013 to mid-2022 were reviewed. Cases where cytology was only part of a hematopathology or surgical pathology consult were excluded. Patient demographics, specimen location, procedure performed, referring diagnosis, and our diagnoses were recorded for each case. Diagnoses were categorized according to the Papanicolaou Society of Cytopathology recommendations for pulmonary and effusion cytology. Discordant diagnoses were stratified as major or minor. Data was analyzed using chi-square analysis and logistic models. RESULTS We received 784 thoracic cytology consult cases, including 530 exfoliative samples and 307 fine-needle aspirations. The most common anatomic locations sampled were the bronchial wall (n = 194, 23%), lung nodule (n = 322, 38%), and pleura (n = 296, 35%). 413 cases had a diagnostic discrepancy (48.3%), with 274 (66%) minor and 139 (34%) major discrepancies. By location, pleural effusion specimens had the highest probability of a discrepant diagnosis (P = 0.003). By specimen type, fine-needle aspiration samples were significantly more likely to have a discrepant diagnosis (P = 0.06). CONCLUSION Nearly half of the thoracic cytology cases submitted for expert second opinion had diagnostic discrepancies. Consequently, consulting a tertiary medical care center with cytopathology expertise for challenging thoracic cytology diagnoses is beneficial.
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Affiliation(s)
| | - Wei Hao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - John Hamilton
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Julia Dahl
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Xiaobing Jin
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Hui H, Ma GL, Yin HT, Zhou Y, Xie XM, Gao YG. Computed tomography-guided cutting needle biopsy for lung nodules: when the biopsy-based benign results are real benign. World J Surg Oncol 2022; 20:180. [PMID: 35659681 PMCID: PMC9166573 DOI: 10.1186/s12957-022-02647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Computed tomography (CT)-guided cutting needle biopsy (CNB) is an effective diagnostic method for lung nodules (LNs). The false-negative rate of CT-guided lung biopsy is reported to be up to 16%. This study aimed to determine the predictors of true-negative results in LNs with CNB-based benign results. Methods From January 2011 to December 2015, 96 patients with CNB-based nonspecific benign results were included in this study as the training group to detect predictors of true-negative results. From January 2016 to December 2018, an additional 57 patients were included as a validation group to test the reliability of the predictors. Results In the training group, a total of 96 patients underwent CT-guided CNB for 96 LNs. The CNB-based results were true negatives for 82 LNs and false negatives for 14 LNs. The negative predictive value of the CNB-based benign results was 85.4% (82/96). Univariate and multivariate logistic regression analyses revealed that CNB-based granulomatous inflammation (P = 0.013, hazard ratio = 0.110, 95% confidential interval = 0.019–0.625) was the independent predictor of true-negative results. The area under the receiver operator characteristic (ROC) curve was 0.697 (P = 0.019). In the validation group, biopsy results for 47 patients were true negative, and 10 were false negative. When the predictor was used on the validation group, the area under the ROC curve was 0.759 (P = 0.011). Conclusions Most of the CNB-based benign results were true negatives, and CNB-based granulomatous inflammation could be considered a predictor of true-negative results.
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Affiliation(s)
- Hui Hui
- Department of Radiation Oncology, Xuzhou Central Hospital, 199 Jiefang Road, Jiangsu, Xuzhou, China
| | - Gao-Lei Ma
- Department of Radiation Treatment, Xuzhou First People's Hospital, 269 Daxue Road, Xuzhou, Jiangsu, China
| | - Hai-Tao Yin
- Department of Radiation Oncology, Xuzhou Central Hospital, 199 Jiefang Road, Jiangsu, Xuzhou, China
| | - Yun Zhou
- Department of Radiation Oncology, Xuzhou Central Hospital, 199 Jiefang Road, Jiangsu, Xuzhou, China
| | - Xiao-Mei Xie
- Department of Radiation Oncology, Xuzhou Central Hospital, 199 Jiefang Road, Jiangsu, Xuzhou, China
| | - Yong-Guang Gao
- Radiology Department, Xuzhou Central Hospital, Xuzhou, China.
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Boggio F, Del Gobbo A, Croci G, Barella M, Ferrero S. Early stage lung cancer: pathologist's perspective. J Thorac Dis 2020; 12:3343-3348. [PMID: 32642258 PMCID: PMC7330767 DOI: 10.21037/jtd.2019.12.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Francesca Boggio
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Del Gobbo
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Croci
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Barella
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Rekhtman N. "Napoleon Hat" Sign: A Distinctive Cytologic Clue to Reactive Pneumocytes. Arch Pathol Lab Med 2020; 144:443-445. [PMID: 31971464 DOI: 10.5858/arpa.2019-0615-sa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Various types of acute and subacute lung injury can cause severe reactive pneumocyte atypia, which may mimic malignant proliferations and present a major diagnostic pitfall. This particularly applies to cytologic preparations and frozen sections, where background inflammatory injury may be subtle or not apparent. Although several distinguishing morphologic features of reactive pneumocytes have been suggested, there is significant overlap with neoplastic proliferations. In this article, a highly distinctive but underrecognized feature of reactive pneumocytes is highlighted that can serve as a useful diagnostic clue. The feature refers to the distinctive pinched shape of reactive pneumocytes, for which the author has coined the term "Napoleon hat" sign to draw the analogy with the iconic headwear. The analogy vividly captures the distinctive shape of reactive pneumocytes, and can serve as a useful diagnostic and teaching tool in the interpretation of pulmonary specimens.
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Affiliation(s)
- Natasha Rekhtman
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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Atypical cells in pathology of endobronchial ultrasound-guided transbronchial biopsy of peripheral pulmonary lesions: incidence and clinical significance. Surg Endosc 2018; 33:1783-1788. [PMID: 30203208 DOI: 10.1007/s00464-018-6452-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 09/06/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Atypical cells may occasionally be the only pathologic finding in radial-probe endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) of peripheral pulmonary lesions (PPLs); however, it is uncertain how often we encounter such a situation and what clinical features can be used to identify these ambiguous PPLs, which are more likely to be malignant. METHODS From 2009 to 2016, consecutive patients referred for EBUS-guided TBB of PPLs and with pathology reports indicating atypical cells alone were included. Medical records were reviewed to extract patient demographics, clinical characteristics, procedural details and complications. The primary outcome was the final diagnosis of the PPLs on subsequent investigation. Multivariate logistic regression analysis was used to identify independent factors associated with a final malignant diagnosis. RESULTS One hundred sixty-five (7.2%) of 2291 patients had non-diagnostic TBB showing atypical cells. Benign and malignant diagnoses were subsequently obtained in 45 (27%) and 120 (73%) patients, respectively. The leading malignancy was lung adenocarcinoma; of note, a variety of benign lesions revealed cellular atypia on pathology, in particular, chronic inflammation, tuberculosis and pneumonia. Multivariate analysis indicated lesion appearance [solid vs. others; odds ratio (OR) 7.93; 95% confidence interval (CI) 2.94-21.40; P < 0.001] and probe position (adjacent to vs. within; OR 3.36; 95% CI 1.11-10.15; P = 0.032) were two significant factors predictive of a final diagnosis of malignancy. CONCLUSIONS One out of 14 EBUS-guided TBB procedures for PPLs exhibited atypical cells on pathology. Meticulous management strategies should be formulated to deal with these instances after taking into consideration lesion appearance, probe position and patient preferences.
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Rui Y, Han M, Zhou W, He Q, Li H, Li P, Zhang F, Shi Y, Su X. Non-malignant pathological results on transthoracic CT guided core-needle biopsy: when is benign really benign? Clin Radiol 2018; 73:757.e1-757.e7. [PMID: 29884525 DOI: 10.1016/j.crad.2018.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 03/12/2018] [Indexed: 12/21/2022]
Abstract
AIM To determine true negatives and characterise the variables associated with false-negative results when interpreting non-malignant results of computed tomography (CT)-guided lung biopsy. MATERIALS AND METHODS Nine hundred and fifty patients with initial non-malignant findings on their first transthoracic CT-guided core-needle biopsy (TTNB) were included in the study. Initial biopsy results were compared to definitive diagnoses established later. RESULTS The negative predictive value (NPV) of non-malignant diseases upon initial TTNB was 83.6%. When the biopsy results indicated specific infection or benign tumour (n=225, 26.1%), they all were confirmed true negative for malignancy later. Only one inconclusive "granuloma" diagnosis was false negative. All 141 patients (141/861, 16.4%) who were false negative for malignancy were from the "infection not otherwise specified (NOS)", "inflammatory diseases", or "inconclusive" groups. Age (p=0.002), cancer history (p<0.001), target size (p=0.003), and pneumothorax during lung biopsy (p=0.003) were found to be significant predictors of false-negative results; 47.6% (410/861) of patients underwent additional invasive examinations to reach a final diagnosis. Ultimately, 52.7% (216/410) were successfully diagnosed. CONCLUSION Specific infection, benign tumour, and granulomatous inflammation of first TTNBs were mostly true negative. Older age, history of cancer, larger target size, and pneumothorax were highly predictive of false-negative results for malignancies. In such cases, additional invasive examinations were frequently necessary to obtain final diagnoses.
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Affiliation(s)
- Y Rui
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - M Han
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - W Zhou
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Q He
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - H Li
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Guangzhou, 510515, China
| | - P Li
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - F Zhang
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Y Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - X Su
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Guangzhou, 510515, China.
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Non-specific benign pathological results on transthoracic core-needle biopsy: how to differentiate false-negatives? Eur Radiol 2017; 27:3888-3895. [PMID: 28188426 DOI: 10.1007/s00330-017-4766-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/26/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the negative predictive value (NPV) of non-specific benign results from cone-beam CT (CBCT)-guided transthoracic core-needle biopsy (TTNB) and identify predicting factors for false-negative for malignancies. METHODS From January 2009-December 2011, 1,108 consecutive patients with 1,116 lung lesions underwent CBCT-guided TTNB using an 18-gauge coaxial cutting needle. Among them, 226 patients with 226 TTNBs, initially diagnosed as non-specific benign, were included in this study. The medical charts, radiological or pathological follow-ups were reviewed to classify false-negative and true-negative results and to identify which variables were associated with false-negatives. RESULTS Of 226 lesions, 24 (10.6%) were finally confirmed as malignancies and 202 (89.4%) as benign, of which the NPV was 89.4% (202/226). Multivariate analysis revealed that part-solid nodule (PSN) (odds ratio (OR), 3.95; P = 0.022), a biopsy result of 'granulomatous inflammation' (OR, 0.04; P = 0.022), and exact location of needle tip within targets (OR, 0.37; P = 0.045) were significantly associated with false-negatives among initial non-specific benign biopsy results. CONCLUSION The NPV of the non-specific benign biopsy was 89.4%. PSN was a significant positive indicator, but a biopsy result of 'granulomatous inflammation' and exact location of needle tip within targets were significant negative indicators for false-negatives. KEY POINTS • The negative predictive value of the non-specific benign biopsy was 89.4%. • A part-solid nodule is a significant predictor for false-negative biopsy (OR = 3.95). • Pathological diagnosis of granulomatous inflammation is a robust indicator for 'true-negatives'. • Identifying needle tip within target lesions is a significant predictor for 'true-negatives'.
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Rosa M. Cytologic Features of Subacute Granulomatous Thyroiditis Can Mimic Malignancy in Liquid-Based Preparations. Diagn Cytopathol 2016; 44:682-4. [PMID: 27167165 DOI: 10.1002/dc.23495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 04/05/2016] [Accepted: 04/18/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Marilin Rosa
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Frisch NK, Nathan R, Ahmed YK, Shidham VB. Authors attain comparable or slightly higher rates of citation publishing in an open access journal (CytoJournal) compared to traditional cytopathology journals - A five year (2007-2011) experience. Cytojournal 2014; 11:10. [PMID: 24987441 PMCID: PMC4058908 DOI: 10.4103/1742-6413.131739] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/31/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The era of Open Access (OA) publication, a platform which serves to better disseminate scientific knowledge, is upon us, as more OA journals are in existence than ever before. The idea that peer-reviewed OA publication leads to higher rates of citation has been put forth and shown to be true in several publications. This is a significant benefit to authors and is in addition to another relatively less obvious but highly critical component of the OA charter, i.e. retention of the copyright by the authors in the public domain. In this study, we analyzed the citation rates of OA and traditional non-OA publications specifically for authors in the field of cytopathology. DESIGN We compared the citation patterns for authors who had published in both OA and traditional non-OA peer-reviewed, scientific, cytopathology journals. Citations in an OA publication (CytoJournal) were analyzed comparatively with traditional non-OA cytopathology journals (Acta Cytologica, Cancer Cytopathology, Cytopathology, and Diagnostic Cytopathology) using the data from web of science citation analysis site (based on which the impact factors (IF) are calculated). After comparing citations per publication, as well as a time adjusted citation quotient (which takes into account the time since publication), we also analyzed the statistics after excluding the data for meeting abstracts. RESULTS Total 28 authors published 314 publications as articles and meeting abstracts (25 authors after excluding the abstracts). The rate of citation and time adjusted citation quotient were higher for OA in the group where abstracts were included (P < 0.05 for both). The rates were also slightly higher for OA than non-OA when the meeting abstracts were excluded, but the difference was statistically insignificant (P = 0.57 and P = 0.45). CONCLUSION We observed that for the same author, the publications in the OA journal attained a higher rate of citation than the publications in the traditional non-OA journals in the field of cytopathology over a 5 year period (2007-2011). However, this increase was statistically insignificant if the meeting abstracts were excluded from the analysis. Overall, the rates of citation for OA and non-OA were slightly higher to comparable.
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Affiliation(s)
- Nora K. Frisch
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
| | - Romil Nathan
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
| | - Yasin K. Ahmed
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
| | - Vinod B. Shidham
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Old Hutzel Hospital, Detroit, MI 48201, USA
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Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, Ishikawa Y, Wistuba I, Flieder DB, Franklin W, Gazdar A, Hasleton PS, Henderson DW, Kerr KM, Petersen I, Roggli V, Thunnissen E, Tsao M. Diagnosis of lung cancer in small biopsies and cytology: implications of the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Arch Pathol Lab Med 2012; 137:668-84. [PMID: 22970842 DOI: 10.5858/arpa.2012-0263-ra] [Citation(s) in RCA: 283] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society lung adenocarcinoma classification provides, for the first time, standardized terminology for lung cancer diagnosis in small biopsies and cytology; this was not primarily addressed by previous World Health Organization classifications. Until recently there have been no therapeutic implications to further classification of NSCLC, so little attention has been given to the distinction of adenocarcinoma and squamous cell carcinoma in small tissue samples. This situation has changed dramatically in recent years with the discovery of several therapeutic options that are available only to patients with adenocarcinoma or NSCLC, not otherwise specified, rather than squamous cell carcinoma. This includes recommendation for use of special stains as an aid to diagnosis, particularly in the setting of poorly differentiated tumors that do not show clear differentiation by routine light microscopy. A limited diagnostic workup is recommended to preserve as much tissue for molecular testing as possible. Most tumors can be classified using a single adenocarcinoma marker (eg, thyroid transcription factor 1 or mucin) and a single squamous marker (eg, p40 or p63). Carcinomas lacking clear differentiation by morphology and special stains are classified as NSCLC, not otherwise specified. Not otherwise specified carcinomas that stain with adenocarcinoma markers are classified as NSCLC, favor adenocarcinoma, and tumors that stain only with squamous markers are classified as NSCLC, favor squamous cell carcinoma. The need for every institution to develop a multidisciplinary tissue management strategy to obtain these small specimens and process them, not only for diagnosis but also for molecular testing and evaluation of markers of resistance to therapy, is emphasized.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
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Campainha S, Gonçalves M, Tavares V, Castelões P, Marinho A, Neves S. Granulomatosis with polyangiitis initially misdiagnosed as lung cancer. REVISTA PORTUGUESA DE PNEUMOLOGIA 2012; 19:45-8. [PMID: 22748944 DOI: 10.1016/j.rppneu.2012.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/12/2012] [Indexed: 10/28/2022] Open
Abstract
Granulomatosis with Polyangiitis (GPA), which was formerly named Wegener's Granulomatosis (WG) is a systemic disease characterized by necrotizing granulomatous inflammation and vasculitis that primarily involves upper and lower respiratory tract, as well as kidneys. Diagnosing GPA on the basis of transthoracic fine needle aspiration (TFNA) may be problematic, as it can be misdiagnosed as cancer. We describe a patient with a probable GPA which was originally diagnosed as malignancy, but who responded to lung cancer chemotherapy.
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Affiliation(s)
- S Campainha
- Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal.
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