Clinical usefulness of fluoro-2-deoxy-D-glucose PET in a case with multiple bone metastases of carcinoid tumor after ten years

We report a peculiar case in an 80-year-old man with multiple bone metastases due to the recurrence of thymic carcinoid tumor after surgical resection and radiation therapy ten years earlier. He was admitted to our hospital with a complaint of lumbago. Fluoro-2-deoxy-D-glucose (FDG) PET was useful for recognition of multiple bone metastases due to the recurrence of thymic carcinoid tumor, while (201)Tl-whole body scintigraphy and by (99)mTc-methylene diphosphonate ((99)mTc-MDP) bone scintigraphy did not reveal the metastases. Finally, we performed a CT-guided bone biopsy from lumbar vertebra and could obtain the diagnosis of metastases of carcinoid tumor histologically. As evident in this case, it is important to consider the recurrence of carcinoid tumor even if a long time has passed after the surgical resection and radiation therapy; also FDG-PET may be a useful diagnostic imaging modality to detect metastases from thymic carcinoid tumor to other organs.

Clinicopathological analysis of multifocal micronodular pneumocyte hyperplasia associated with tuberous sclerosis in Japan

BACKGROUND AND OBJECTIVE

This study investigated the clinical and pathological findings of lung disease in tuberous sclerosis complex (TSC) as previously reported in Japan.

METHODS

The clinical and pathological findings in 15 patients diagnosed as having multifocal micronodular pneumocyte hyperplasia (MMPH) with TSC were analysed.

RESULTS

The majority of patients (80%) were women and the mean age was 37 years. Three patients had a family history of TSC. The radiological findings were small multiple nodular shadows with ground-glass opacity randomly distributed in the bilateral whole-lung fields in most patients. Differentiation from multiple atypical adenomatous hyperplasia or metastatic lung cancer was necessary in most patients. In 11 patients, the diagnostic method used to identify pulmonary lesions of MMPH with TSC was VAT. Among the complications of MMPH with TSC, lymphangioleiomyomatosis was recognized in 53% of patients. The prognosis was comparatively good because only one patient died of respiratory failure. The histological findings were papillary or tubular proliferation of type II pneumocytes without nuclear atypia lining the thickened alveolar septa and lymphocyte infiltration. Immunohistochemical staining for cytokeratin, and surfactant proteins A and B was positive in alveolar lining cells of all MMPH lesions. However, staining for HMB-45, alpha-smooth muscle actin, p53, carcinoembryonic antigen and hormonal receptor was negative in most patients.

CONCLUSIONS

Surgical investigation and immunohistochemical staining for pathological markers are useful for diagnosing MMPH when the radiological findings indicate multiple micronodules with ground-glass opacity in patients with TSC.

Multifocal micronodular pneumocyte hyperplasia associated with tuberous sclerosis: differentiation from multiple atypical adenomatous hyperplasia

We report a peculiar case of multifocal micronodular pneumocyte hyperplasia (MMPH) in a 54-year-old woman with tuberous sclerosis complex (TSC) diagnosed during antituberculous treatment. Findings were initially detected by chest computed tomography (CT) to check for complication of pulmonary tuberculosis. Chest CT demonstrated multiple small nodules with ground-glass opacity, measuring up to 5 mm diameter, presenting in the bilateral lung fields, without cystic change. Because the differentiation from multiple atypical adenomatous hyperplasia (AAH) was necessary, we finally performed a diagnosis of MMPH based on specimens obtained by video-assisted thoracoscopic surgery. Histologically, type II pneumocytes without nuclear atypia lined the thickened alveolar septa and proliferated papillary structures. There was no proliferation of immature smooth muscle cells suggestive of lymphangioleiomyomatosis. Although immunohistochemical stains for cytokeratin and surfactant apoprotein A and B were positive for alveolar lining cells in each MMPH lesion, those for HMB-45, alpha-smooth muscle actin, p53 and carcinoembryonic antigen were negative. We must consider MMPH as part of the differential diagnosis along with multiple AAH when multiple small nodules with ground-glass opacity were observed on chest CT in patients with TSC.

Evidence of immune tolerance to blood group antigens in a case of ABO-incompatible pediatric liver transplantation

In a 12-year-old patient with blood group O, who had received a partial liver graft 10 years ago from his father with blood group A, the levels of anti-A-specific antibodies (Abs) were persistently undetectable after the transplantation, while the levels of anti-B-specific Abs gradually increased and attained a plateau. Peripheral blood mononuclear cells (PBMCs) from this patient were engrafted into NOD/SCID mouse in order to investigate the immune response to donor-type blood group antigens. Even after sensitization with blood group-A erythrocytes, no anti-A Abs were detected in the serum samples of the mouse that received PBMCs from the blood group-O recipient of group-A liver allograft, however, immunoglobulins specific for antigens other than the A antigens were produced. Thus, we provide a possible evidence of immune tolerance to blood group antigens in this ABO-incompatible pediatric liver transplantation.

Inflammatory pseudotumor of the lung: clinicopathological analysis in seven adult patients

BACKGROUND

As the origin and pathology of inflammatory pseudotumor is not clearly understood, there has recently been some confusion regarding the diagnosis of inflammatory pseudotumor.

METHODS

We performed clinicopathological analyses in seven patients with inflammatory pseudotumors of the lung histologically diagnosed after surgical resection. The seven patients, selected from patients admitted to Kawasaki Medical School Hospital between April 1989 and December 2005, consisted of four men and three women (average age, 60.4 years). The detection method was from clinical symptoms in two patients and from health examinations in five patients.

RESULTS

Five patients had a solitary nodular shadow on chest radiographs and the other two patients had multiple shadows. Because it was difficult to distinguish pseudotumor from lung cancer by chest computed tomography in the five patients showing a solitary nodular shadow, the final diagnosis was obtained by surgical resection. In the other two patients, with multiple shadows, one of whom had nodular shadows with cavitary lesions, surgical resection was performed to distinguish the pseudotumor from metastatic lung cancer. The histological types according to the criteria of Matsubara were fibrous histiocytic in five patients, organizing pneumonia in one, and lymphoplasmocytic in one. The histological types according to the World Health Organization criteria were compact spindle-cell pattern in six patients and hypocellular fibrous pattern in one.

CONCLUSION

Because it is difficult to make a preoperative diagnosis of inflammatory pseudotumor by radiological findings or histological findings using specimens obtained by transbronchial lung biopsy, surgical resection, such as video-assisted thoracic surgery or open lung biopsy, is required to differentiate inflammatory pseudotumors from primary or metastatic lung cancers.

Near-infrared spectroscopic analysis of hemodynamics and mitochondrial redox in right lobe grafts in living-donor liver transplantation

Near-infrared spectroscopy (NIRS), which enables non-destructive evaluation of hemoglobin (Hb) oxygenation and the redox state of cytochromeoxidase (Cyt.aa3) in living tissues, has been employed during surgery to detect possible impairment of hemodynamics and mitochondrial respiration in the anterior segment of a right lobe liver graft in living-donor liver transplantation (LDLT). Thirty-six patients undergoing LDLT using a right lobe graft without the middle hepatic vein (MHV) were enrolled in this study. During the course of harvesting and implantation, NIRS measurements were performed on the anterior segments of the liver grafts. In two recipients of liver grafts with Hb residue over 70% in the anterior segment after ex vivo flushing, the MHV tributary was reconstructed, while it was not reconstructed in the other 34 recipients. Of those 34 recipients, 16 recipients of liver graft with 40-70% Hb residue showed transient increase of transaminase levels after LDLT. Of those 16 recipients, six recipients who showed reduction in oxidized Cyt.aa3 in the anterior segment suffered from persistent hyperbilirubinemia after LDLT. In patients showing impairment of mitochondrial redox associated with congestion caused by deprivation of the MHV tributaries, reconstruction of the MHV tributaries might have a beneficial effect.

Clinicopathological analysis of lung cancer resembling malignant pleural mesothelioma

OBJECTIVE

The aim of this study was to evaluate the clinicopathological features of lung cancer resembling malignant pleural mesothelioma.

METHODOLOGY

The seven patients studied had tumours showing an extensive pleural growth pattern, and were chosen from 1516 lung cancer patients diagnosed at two affiliated hospitals over a 17-year period.

RESULTS

Histologically, five of these lung cancers were adenocarcinomas, one was a small cell carcinoma, and one a large cell carcinoma. Tumour markers such as carcinoembryonic antigen (CEA) were elevated in six patients at admission. However, a clinical diagnosis was difficult and these cancers could only be distinguished from malignant pleural mesothelioma by thoracentesis in two cases, pleural biopsy in two, thoracotomy in two, and in case 7 at autopsy. Treatment consisted of chemotherapy or radiation therapy in four patients, but with little clinical effect. The mean survival time was 6.7 months, which is much less than for true malignant pleural mesothelioma.

CONCLUSIONS

Lung cancer resembling malignant pleural mesothelioma is most frequently observed in patients with adenocarcinoma, which is suspected to occur peripherally. To distinguish pseudomesotheliomatous carcinoma from malignant pleural mesothelioma in patients with diffuse pleural thickening and effusion, requires adequate tissue sampling by thoracotomy or video-assisted thoracoscopic surgery and a panel of immunohistochemical stains.