Paulo Marcos Valiante

Influenza A (H1N1) virus-associated pneumonia: High-resolution computed tomography–pathologic correlation

OBJECTIVE The purpose of this study was to describe the high-resolution computed tomography (HRCT) features of fatal cases of Influenza A (H1N1) virus-associated pneumonia and to correlate them with pathologic findings. METHODS The study included six adult patients who died following Influenza A (H1N1) virus-associated pneumonia. All patients had undergone HRCT, and the images were retrospectively analyzed by two chest radiologists, who reached decisions by consensus. Two experienced lung pathologists reviewed all pathological specimens. The HRCT findings were correlated with the histopathologic data. RESULTS The predominant HRCT findings included areas of airspace consolidation (n=6) and ground-glass opacities (n=3). The main pathological features consisted of diffuse alveolar damage with hyaline membrane formation (n=5), associated with various degrees of pulmonary congestion, edema, hemorrhage, inflammatory infiltration and bronchiolitis. A patient who survived longer showed findings of organizing pneumonia. CONCLUSION Fatal cases of Influenza A (H1N1) virus-associated pneumonia can present as areas of consolidation on CT, with or without ground-glass opacities. These abnormalities can be pathologically correlated with diffuse alveolar damage. Patients with longer survival may present with findings of organizing pneumonia.

Paracoccidioidomycosis: High-resolution computed tomography–pathologic correlation

OBJECTIVE The purpose of this study was to describe the high-resolution computed tomography (HRCT) features of pulmonary paracoccidioidomycosis and to correlate them with pathologic findings. METHODS The study included 23 adult patients with pulmonary paracoccidioidomycosis. All patients had undergone HRCT, and the images were retrospectively analyzed by two chest radiologists, who reached decisions by consensus. An experienced lung pathologist reviewed all pathological specimens. The HRCT findings were correlated with histopathologic data. RESULTS The predominant HRCT findings included areas of ground-glass opacities, nodules, interlobular septal thickening, airspace consolidation, cavitation, and fibrosis. The main pathological features consisted of alveolar and interlobular septal inflammatory infiltration, granulomas, alveolar exudate, cavitation secondary to necrosis, and fibrosis. CONCLUSION Paracoccidioidomycosis can present different tomography patterns, which can involve both the interstitium and the airspace. These abnormalities can be pathologically correlated with inflammatory infiltration, granulomatous reaction, and fibrosis.

Necrotizing Sarcoid Granulomatosis in a Family of Patients with Sarcoidosis Reinforces the Association between Both Entities

Necrotizing sarcoid granulomatosis (NSG) is a rare entity mainly characterized by a prominent granulomatous vasculitis affecting middle-aged or old individuals and with a favorable prognosis. Although many believe it is a variant of sarcoidosis, the proper classification is still a matter of debate as some of its features are found in sarcoidosis but also in Churg-Strauss syndrome, Wegener’s disease and hypersensitivity pneumonitis. In this paper, we described for the first time a case of NSG in a family with several cases of sarcoidosis, reinforcing the relationship between NSG and sarcoidosis. Additional interesting findings were the young age of the patient (15 years old), the symptoms limited to the respiratory tract (uncommon when NSG affects youngsters) and the increase in serologic markers of autoimmune disease. Though complete criteria for autoimmune disease were not present, systemic lupus erythematosus and Sjögren’s syndrome are possible candidates. As sarcoidosis is described to be associated with several autoimmune diseases, this finding is an additional suggestion of the relationship between both entities.

LINFOMAS PULMONARES: CORRELAÇÃO DA TOMOGRAFIA COMPUTADORIZADA DE ALTA RESOLUÇÃO COM A ANATOMOPATOLOGIA

This paper describes the high-resolution computed tomography and anatomopathological findings of pulmonary lymphomas. We studied the chest high-resolution computed tomographies and histopathological data of 10 patients with biopsy-proven non-Hodgkins or Hodgkins disease. The most common radiologic findings in this series were areas of consolidation with air-bronchogram (n = 8). Other findings included multiple pulmonary nodules (n = 4), thickening of bronchovascular bundles (n = 3) and foci of ground-glass attenuation (n = 2). The present series results are consistent with the current available literature on radiographic appearance of the disease. The pathological correspondence of the areas of airspace consolidation was alveolar filling by neoplastic cells, the thickening of bronchovascular bundles was secondary to lymphomatous cells infiltrates, and the areas of ground-glass attenuation corresponded to alveolar septal infiltration by these cells.

Lung and Chest-Wall Metastasis of Liposarcoma

A 57-year-old woman was admitted to our institution with a painful mass on the right thigh. Biopsy revealed dedifferentiated liposarcoma (LS). The lesion was surgically resected, and the patient underwent 4 months of radiotherapy. 1 year later, she developed a growing mass in the posterior chest wall associated with pain and paraplegia. The mass was fixed to the left paraspinal region and measured approximately 8 cm. Chest computed tomography (CT; Fig. 1) showed a large mass with heterogeneous contrast enhancement containing low-density components, suggesting the presence of fat in the left paravertebral region and invading adjacent structures. Parenchymal lung nodules with fat density were also seen in the right inferior lobe. Magnetic resonance imaging (MRI; Fig. 2) confirmed the CT findings and demonstrated invasion of the spinal canal with cord compression and vertebral metastasis. A biopsy of the thoracic mass confirmed the diagnosis of dedifferentiated LS metastasis (Fig. 3). The patient underwent palliative chemotherapy and radiotherapy and died 4 months later from sepsis.

Intrapulmonary Mature Teratoma Mimicking a Fungus Ball

A 22-year-old woman presented with history of cough and hemoptysis. Chest computed tomography (CT) revealed a heterogeneous cavitated mass in the left upper lobe, with solid intracavitary content, mimicking a fungus ball (Fig. 1). Patient was subjected to upper left upper lobectomy. The cut section revealed a solid-cystic mass (Fig. 2). The tumor was composed of skin, sebaceous glands, hair follicles, apocrine glands, smooth muscle, cartilage, fat, and respiratory epithelium (Fig. 3). Given the presence of unaffected pulmonary parenchymal areas adjacent to the mediastinal pleura, the final diagnosis was primary mature pulmonary teratoma. The patient’s postoperative course was uneventful.

Heparanase expression and localization in different types of human lung cancer.

BACKGROUND Heparanase is the only known mammalian glycosidase capable of cleaving heparan sulfate chains. The expression of this enzyme has been associated with tumor development because of its ability to degrade extracellular matrix and promote cell invasion. METHODS We analyzed heparanase expression in lung cancer samples to understand lung tumor progression and malignancy. Of the samples from 37 patients, there were 14 adenocarcinomas, 13 squamous cell carcinomas, 5 large cell carcinomas, and 5 small cell carcinomas. Immunohistochemistry was performed to ascertain the expression and localization of heparanase. RESULTS All of the tumor types expressed heparanase, which was predominantly localized within the cytoplasm and nucleus. Significant enzyme expression was also observed in cells within the tumor microenvironment, such as fibroblasts, epithelial cells, and inflammatory cells. Adenocarcinomas exhibited the strongest heparanase staining intensity and the most widespread heparanase distribution. Squamous cell carcinomas, large cell carcinomas, and small cell carcinomas had a similar subcellular distribution of heparanase to adenocarcinomas but the distribution was less widespread. Heparanase expression tended to correlate with tumor node metastasis (TNM) staging in non-small cell lung carcinoma. CONCLUSION In this study, we showed that heparanase was localized to the cytoplasm and nucleus of tumor cells and to cells within the microenvironment in different types of lung cancer. This enzyme exhibited a differential distribution based on the type of lung tumor. General significance Elucidating the heparanase expression patterns in different types of lung cancer increased our understanding of the crucial role of heparanase in lung cancer biology. This article is part of a Special Issue entitled Matrix-mediated cell behaviour and properties.

High-frequency ultrasound associated with dermoscopy in pre-operative evaluation of basal cell carcinoma

The recent development of high-frequency ultrasound, associated with the improved sensitivity in color Doppler, enabled the identification of various skin structures and layers. In basal cell carcinoma, the 22 MHz frequency ultrasound permits the delimitation of tumor margins, while color Doppler, determines its vascularization. We present two cases in which the association of both exams allowed an in vivo analysis of the tumors morphology, size, thickness and vascularization, thus contributing to a better pre-operative evaluation.

Nódulos com sinal do halo na aspergilose pulmonar angioinvasiva: correlação da tomografia computadorizada de alta resolução com a anatomopatologia

The aim of this study was to correlate the early findings observed on high-resolution computed tomography with anatomopathology results of patients with angioinvasive aspergillosis. The authors studied two patients with leukemia. The nodules seen on high-resolution computed tomography corresponded to areas of hemorrhagic infarction, necrotic coagulation and fungal hyphae infiltration whereas ground glass halo corresponded to intraalveolar hemorrhage. Nodules with halo sign were closely correlated with anatomopathology findings. We concluded that the anatomopathology findings can clearly explain the image features of the lesions observed on high-resolution computed tomography.

Pneumonia intersticial linfocítica: correlação da tomografia computadorizada de alta resolução com a anatomopatologia

The purpose of this study is to report the main high-resolution computed tomography findings of two patients with lymphocytic interstitial pneumonia. High-resolution computed tomography findings were correlated with pathology findings of material obtained from open biopsies. One patient had diffuse ground glass opacities seen on high-resolution computed tomography whereas the other patient had peribroncovascular thickening. Anatomopathology studies showed that the main pattern was polyclonal lymphocyte interstitial infiltration, particularly along alveolar septa. The current study demonstrated a close correlation between high-resolution computed tomography and anatomopathology findings.