Rajesh Thomas

Clinico-pathologic study of pulmonary carcinoid tumours – A retrospective analysis and review of literature

OBJECTIVE To determine the characteristic clinico-pathologic features of pulmonary carcinoid tumours in India. METHODS Retrospective analysis of the clinico-pathologic and radiologic data of patients with pulmonary carcinoid tumours from the department of Pulmonary Medicine of the Christian Medical College, a tertiary care teaching hospital in Southern India, over a study period of 3 years (2001-2004). RESULTS There were 25 cases of pulmonary carcinoid tumours: typical 22 (88%) and atypical 3 (12%). The ratio of female to male was 0.8:1. There were 3 smokers (all of whom were males) in the typical carcinoid group and none in the atypical carcinoid group. Haemoptysis and cough were the commonest presenting symptoms. The common radiologic findings were post-obstructive pneumonitis or atelectasis, and mass lesion. Carcinoid syndrome was not present in any patient. Most of the tumours were central (n=23; 92%) and in the main bronchi (n=13; 52%). The most common site was the right main bronchus (n=9; 36%). Diagnosis was made by flexible bronchoscopy and bronchial biopsy in 23 patients (92%). The tumour bled significantly following biopsy in most patients; however, there was no mortality, and only 1 patient required blood transfusion. Surgical option was offered to most; 13 patients (52%) had pneumonectomy and 4 patients (16%) had lobectomy. A review of large series from the literature is also presented. CONCLUSION The clinico-pathologic and radiologic features of pulmonary carcinoid tumours are presented. We report the first series of pulmonary carcinoid tumours from India.

Cerebral air embolism complicating CT-guided trans-thoracic needle biopsy of the lung.

Background and Aims:  Systemic air embolism is recognized as a rare but potentially fatal complication of trans‐thoracic needle biopsy of the lung.

Endogenous excess cortisol production and diabetes mellitus as predisposing factors for pulmonary cryptococcosis: A case report and literature review

Pulmonary cryptococcosis usually occurs as an opportunistic infection in immunocompromised patients. Endogenous Cushings syndrome is associated with cortisol excess and can predispose to development of cryptococcal infections. We report a case of diabetic patient with ACTH secreting pituitary tumour who developed a cavitating lung mass. Computed tomography-guided biopsy of the lesion revealed mucicarminophilic budding forms of cryptococcus. Broncheoalveolar lavage culture grew Cryptococcus neoformans. There was radiological response to treatment with liposomal Amphotericin, but patient ultimately succumbed to septicemia and multiorgan failure. Opportunistic infections with organisms like Cryptococcus neoformans, should be considered in patients with endogenous Cushings syndrome and a pulmonary infiltrate.