Hideo Sakuma

Immunoglobulin G4-related inflammatory pseudotumor of the lung.

An 82-year-old man presented with a nodule in the right S2a of the lung as seen by chest computed tomography (CT). He had undergone treatment for chronic obstructive lung disease. He had a 53-year history of smoking 20 cigarettes a day. Subsequent to the appearance of the nodule in the right S2a, the CT images revealed consolidations in the right S2b, right S3, and left S5. The nodule in the right S2a was diagnosed as squamous cell carcinoma after performing video-assisted thoracoscopic wedge resection of the lung. After 4 months, the size of the consolidation in the right S2b increased. Recurrence of lung cancer was suspected. Using transbronchial lung biopsy, the consolidation in the left S5 was diagnosed as organizing pneumonia; therefore, right upper lobectomy was performed. The consolidations in the right S2b and right S3 were diagnosed as inflammatory pseudotumors with infiltrations of immunoglobulin G4-positive plasma cells.

Bronchoscopic Investigation of Atypical Drug-induced Hypersensitivity Syndrome Showing Viral Lung Involvement.

We herein report a case of atypical drug-induced hypersensitivity syndrome (DIHS) involving serological reactivation of cytomegalovirus induced by carbamazepine with pulmonary and skin manifestations. These lesions were not present on admission, but developed on virus reactivation as indicated by the presence of inclusion bodies and multinucleated giant cells in alveolar cells with CD8(+) T lymphocyte infiltration on a transbronchial lung biopsy. Although the precise mechanism of DIHS remains unknown, this case suggests the crucial role of viral reactivation in pulmonary lesions in DIHS.

Solitary fibrous tumors of the pleura presenting satellite tumors

A 29-year-old man presented with a mass in the left lower lung field on a chest radiograph obtained during a medical checkup. Computed tomography revealed a tumor adjacent to the diaphragm. A sessile tumor measuring 10.5 × 8.5 × 4.5 cm arising from the parietal pleura was resected. The tumor was accompanied by several little tumors on the nearby diaphragm. Pathologically, the major tumor consisted of typical spindle-shaped cells with myxoid degeneration. There was no increased cellularity, cellular pleomorphism, or a high mitotic count. In immunohistochemical studies, the spindle cells showed positive staining for CD34 and were negative for bcl-2. The smaller tumors also consisted of myxoid degeneration. We diagnosed benign solitary fibrous tumor of the pleura with satellite tumors. We must be aware of the possibility of satellite tumors when we treat patients with a benign solitary fibrous tumor.

Hyperplasia of Lymphoid Follicles and Lymphangiectasia in the Parietal Pleura in Bucillamine-induced Yellow Nail Syndrome

Yellow nail syndrome (YNS) pleurisy is often difficult to control, and pathological examinations have rarely been reported. We herein report a case of bucillamine-induced YNS in which histopathology of the parietal pleura revealed hyperplasia of the lymphoid follicles and lymphangiectasia. Even after the discontinuation of bucillamine, the pleurisy and lymphedema showed no change. Based on the histopathological findings showing similarity to rheumatoid pleurisy, we administered corticosteroid treatments, and both the pleurisy and lymphedema improved. The findings in the present case suggest that, in bucillamine-induced YNS, pleurisy may be related to inflammation caused by rheumatoid arthritis in addition to abnormalities in lymphatic vessels.

Pirfenidone-induced Eosinophilic Pleurisy

The patient was a 69-year-old man with idiopathic pulmonary fibrosis who was taking pirfenidone. After 7 weeks of treatment, he suffered from left-sided eosinophilic pleurisy. Medical thoracoscopy was performed and the histopathological examination of the parietal pleura revealed the massive infiltration of eosinophils and lymphoid follicles. After stopping pirfenidone therapy, the patients pleural effusion disappeared without additional treatment, and never recurred. This is the first case report of pirfenidone-induced pleurisy.

Myopathy in Autoimmune Diseases - Primary Sjögren's Syndrome and Dermatomyositis

Myopathy, which clinically shows muscular pain (myalgia), weakness, cramps, stiffness and spasm, is one of neuromuscular disorders due to inflammation and/or dysfunction of muscle fibers. “Myositis”, which is a general term for inflammation of the muscle, is pathologically an inflammatory myopathy seen seen mainly in autoimmune disorders including dermatomyositis (DM). The myopathy is classified by National Institute of Neurological Disorders and Stroke (NINDS) as indicated in Table 1 (1). We here focus myopathy on primary Sjogren’s syndrome (pSjS) associated with myalgia “mimicking DM”, as previously reported (2), and the inflammatory myopathy of DM (Table 2). Most of SjS is a secondary disorder to systemic autoimmune diseases including systemic lupus erythematosus (SLE), systemic sclerosis, DM, and so on. However, SjS, which is not associated with other autoimmune diseases, is considered to be an idiopathic primary disorder characterized by sicca symptoms. It is known that pSjS may be associated with fever, fatigue, myalgia, arthralgia, cutaneous vasculitis, etc. in addition to sicca symptoms (4-8).