Neslihan Mutluay

Fibrosing mediastinitis mimicking bronchogenic carcinoma

Fibrosing mediastinitis is a rare but benign disorder characterized by an excessive fibrotic reaction in the mediastinum which can result in compromise of airways, great vessels, and other mediastinal structures. In this paper we presented a patient with fibrosing mediastinitis mimicking bronchogenic carcinoma. The patient was a 32-year-old diabetic male admitting with cough and hemoptysis. There was a right hilar mass and multiple mediastinal conglomerated lymph nodes on chest computed tomography. Positron emission tomography with computed tomography (PET/CT) scan demonstrated increased fluorodeoxyglucose (FDG) uptake at the right hilar mass lesion and mediastinal lymph nodes. Fiberoptic bronchoscopy showed mucosal distortion of right upper lobe. Pathologic examination of the mucosal biopsy revealed inflammation. Endobronchial ultrasound guided transbronchial needle and cervical mediastinoscopic lymph node biopsies were undiagnostic. Diagnostic thoracotomy confirmed the diagnosis fibrosing mediastinitis. Administration of six months of systemic corticosteroid and antituberculous therapy was not beneficial. In conclusion, despite being a rare clinical entity, fibrosing mediastinitis should be kept in mind in the differential diagnosis of mediastinal mass lesions of unknown etiology. The diagnosis is exceptionally difficult in the presence of atypical radiological findings. The treatment is particularly challenging without any proven effective therapy.

The cell block method increases the diagnostic yield in exudative pleural effusions accompanying lung cancer.

Abstract Objective: Thoracentesis is the first investigation to be performed in a patient with lung cancer and pleural effusion. The diagnostic yield of conventional smear studies varies in the first thoracentesis. In this study, we aimed to investigate if the cell block method increases the diagnostic yield in exudative pleural effusions accompanying lung cancer. Material and Method: Forty patients with lung cancer and exudative pleural effusions were included. Ten mililiters of fresh pleural fluid was obtained by thoracentesis from all patients in the initial evaluation. The pleural fluid sample was divided into two equal parts. One part was subjected to conventional smear and the other to the cell block method. Conventional smears were stained with May-Grünwald-Giemsa and Hematoxylin-Eosin. Cell block sections were stained with Hematoxylin-Eosin and mucicarmine. Conventional smear findings were grouped as “benign cytology” or “malignant cytology”. The cell block sections were evaluated for the presence of single tumor cells, acinary or papillary pattern, solid islands and staining with mucicarmine. Results: There were 20 patients each in the benign and malignant conventional smear group. In the benign group, adding the cell block method to conventional smear provided a diagnosis of malignancy in 4 more patients and the diagnosis of malignant effusion was increased by a ratio of 10% (4/40). In the malignant group, adding the cell block technique provided the subtyping of lung cancer as adenocarcinoma in 7 patients (7/20, 35%). Conclusion: Our study confirms that the cell block method combined with conventional smear increases the diagnostic yield in exudative pleural effusions accompanying lung cancer Öz Amaç: Torasentez, plevra sıvısı olan akciğer kanserli bir hastada yapılması gereken ilk incelemedir. İlk torasentezde yapılan konvensiyonel sitolojik incelemelerin tanı başarısı değişkendir. Bu çalışmada, eksudatif plevra sıvısı olan akciğer kanserli hastalarda, hücre bloğu yönteminin tanıyı artırıp artırmağını araştırmayı amaçladık. Gereç ve Yöntem: Eksudatif plevral sıvısı olan 40 akciğer kanserli hasta çalışmaya alındı. Tanı aşamasında her hastadan torasentezle 10 ml plevra sıvısı alındı. Sıvı iki eşit parçaya ayrıldı. Bir kısım konvansiyonel sitoloji için kullanılırken diğer kısımdan hücre bloğu yapıldı. Konvansiyonel yaymalar May-Grünwald-Giemsa ve Hematoksilen- Eosin ile boyandı. Hücre bloğu kesitleri Hematoksilen-Eosin ve musikarmin ile boyandı. Konvansiyonel sitoloji bulguları “benign sitoloji” ve “malign sitoloji” olarak gruplandı. Sitoblok kesitleri tek tümör hücresi, asiner, papiller patern, solid ada varlığı, musikarmin ile boyanma açısından değerlendirildi. Bulgular: Benign ve malign konvansiyonel sitoloji grubunun her birinde 20’şer hasta vardı. Benign konvansiyonel sitoloji grubunda, konvensiyonel sitolojiye ek olarak sitoloblok yapılması 4 hastaya daha malignite tanısı konmasını sağlayarak, malign sıvı tanısını (4/40) %10 oranında artırdı. Konvansiyonel sitolojisi malign olan grupta, sitoblok yönteminin beraber kullanılması, 7 hastada (7/20, %35) adenokarsinom tanısı koydurarak, akciğer kanserinin subtiplendirmesine olanak sağladı. Sonuç: Çalışmamız, akciğer kanserine eşlik eden eksudatif plevra sıvısı olan hastalarda, konvansiyonel sitoloji ile birlikte sitoblok yönteminin kullanılmasının tanı değerini artırdığını kanıtlamıştır

Diffuse pulmonary amyloidosis due to Familial Mediterranean Fever, a rare presentation

To the Editor, Familial Mediterranean Fever (FMF) is a hereditary disease characterized by sporadic, paroxysmal attacks of fever and serosal inflammation described primarily in several ethnic groups originating from Mediterranean region. The most serious complication of FMF is chronic renal failure (CRF) developing due to secondary amyloidosis (1). Clinically evident lung involvement due to FMF associated amyloidosis is extremely rare and occurs in severe cases (2). On the other hand very fine amyloid deposits can be recognized in the peripheral alveolar septa in autopsies of FMF patients (1). Herein we present a case of diffuse pulmonary amyloidosis due to FMF in an asymptomatic patient referred to our clinic with a preliminary diagnosis of miliary tuberculosis. (Published: 29 May 2012) Citation: Libyan J Med 2012, 7 : 18482 - http://dx.doi.org/10.3402/ljm.v7i0.18482