Sjoerd S. Wagenaar

Mesenchymoma of the lung (so called hamartoma): a review of 154 parenchymal and endobronchial cases.

In a series of 154 patients (116 male and 38 female) with so called pulmonary hamartoma the peak incidence was in the sixth decade, with only three patients less than 20 years of age. Sequential radiographs showed that in 55 patients the tumour first appeared in adult life and that in 53 it progressively increased in size. The age incidence and progressive growth leads to the conclusion that the tumour is a benign neoplasm rather than a hamartoma, consisting of various connective tissues intersected by clefts lined by respiratory epithelium. The epithelial elements are regarded as entrapped non-neoplastic inclusions and the tumour as a purely mesenchymal neoplasm: the name mesenchymoma therefore seems the most appropriate. There were two recurrences after simple enucleation, 10 and 12 years later. A total of 142 tumours were parenchymal, and only 12 were endobronchial. All lobes were affected but there was a slight preponderance in the left upper lobe. Four patients had two (synchronous) mesenchymomas. There was an associated bronchial carcinoma in 11 patients, synchronous in six and metachronous in five.

Primary sarcoma of the lung: A clinical study with long-term follow-up

Primary pulmonary sarcoma is an extremely rare tumor. In more than 30 years, only 22 patients with PPS were seen in our hospital; 18 patients (82%) underwent operation. Radical resection is the only curative treatment in patients with primary pulmonary sarcoma. All 4 patients (18%) who did not undergo operation died within 17 months. All 7 patients (32%) in whom no radical resection could be performed died between 10 months and 16 years after operation. Total resection of the tumor could be performed in 11 patients (50%). Of these, 7 are still alive (64%), and 1 patient died of an unrelated cause after 25 years (mean follow-up, 13.5 years). Histologic diagnosis in these patients was leiomyosarcoma in 4, malignant schwannoma in 2, and fibrosarcoma and undifferentiated sarcoma in 1 each. Median survival for all patients was 24 months. Actuarial 5-year survival was 44% for all patients. Small tumor diameter and low-grade malignancy are statistically significant favorable prognostic factors. No patient with grade 1 tumor died; the median survival was 60 months for grade 2 sarcomas, and 17 months for grade 3 sarcomas. No patient with a completely resected small primary pulmonary sarcoma had recurrence or metastasis.

Relationship between cells obtained by bronchoalveolar lavage and survival in idiopathic pulmonary fibrosis.

BACKGROUND--The relationship between cell types in bronchoalveolar lavage (BAL) fluid and the clinical course of patients with idiopathic pulmonary fibrosis (IPF) has been the subject of several studies. However, the results of these studies are not conclusive. The aim of this study was to investigate the relationship between the absolute and relative cell numbers in BAL fluid from patients with IPF and their survival. METHODS--Results obtained from the initial BAL fluid analyses of all histologically proven cases of IPF (n = 49) were selected retrospectively. Coxs proportional hazards survival analysis was used for estimating the relationship between absolute and relative cell numbers and survival. RESULTS--A negative relationship was found between both the absolute numbers and percentages of eosinophils in BAL fluid samples and survival. No such relationship was demonstrated for the absolute numbers or the percentages of any other cell type. CONCLUSIONS--Although this study has restrictions, these findings suggest a negative relationship between the absolute numbers and percentages of eosinophils in BAL fluid samples and survival in patients with IPF.

Bilateral cardiac myxomas and peripheral myxomas in a patient with recent myocardial infarction

Coronary arteriography, performed for recent anterior wall myocardial infarction in a 29 year old man, showed multiple aneurysms of the distal branches of the left coronary artery without evidence of obstructions in the major branches, and two clusters of abnormal vessels, supplying tumors in the right ventricle and the left atrium. At operation and histologic examination both tumors appeared to be myxomas. In addition, two myxomas, located elswhere in the body, could be proven histologically.

Relationship between plasma cell levels and profile of bronchoalveolar lavage fluid in patients with subacute extrinsic allergic alveolitis.

BACKGROUND--Plasma cells are usually absent in bronchoalveolar lavage (BAL) fluid. Extrinsic allergic alveolitis is associated with increased numbers of T and B lymphocytes in BAL fluid, as well as the presence of a few plasma cells. The aim of this study was to investigate whether there is a relationship between the presence of plasma cells and other cells, and immunoglobulin levels in BAL fluid of patients with extrinsic allergic alveolitis. METHODS--Thirty non-smoking patients with extrinsic allergic alveolitis who had a bronchoalveolar lavage 2-7 days after their last exposure to the causative antigen were selected, retrospectively. RESULTS--Patients suffering from extrinsic allergic alveolitis with plasma cells in the BAL fluid (n = 18) had increased absolute numbers of lymphocytes, eosinophils and mast cells, a decreased percentage of alveolar macrophages and lower CD4/CD8 ratio, as well as higher immunoglobulin levels, when compared with patients with extrinsic allergic alveolitis having no plasma cells in the BAL fluid (n = 12). CONCLUSIONS--The results suggest a relationship between the presence of plasma cells and the other constituents in BAL fluid and a more intense alveolitis. In addition there was a positive relationship between the number of plasma cells in BAL fluid and immunoglobulin levels. These data support the concept of local production of immunoglobulins by plasma cells in the lung following antigen exposure in susceptible individuals.

Diagnosis of Pneumocystis carinii Pneumonia in HIV-Positive Patients

OBJECTIVE To evaluate the contribution of bronchoalveolar lavage (BAL) and bronchial brushing (BB) and the use of different tinctorial stains in the detection of Pneumocystis carinii (PC) in human immunodeficiency virus (HIV)-positive patients. STUDY DESIGN In a retrospective study, 195 HIV-positive patients suspected of a pulmonary infection underwent bronchoscopy with BAL. In 143 cases subsequent BB was performed. On 135 BAL fluid cytocentrifuge preparations four staining techniques were applied simultaneously: May-Grünwald-Giemsa (MGG), toluidine blue-O (TOL), Papani-colaou (PAP) and Grocott methenamine silver (GRO). RESULTS PC was recovered in 79 (40.5%) cases. The yields of MGG and TOL were identical (33.3%). PAP and GRO showed lower results, 31.1% and 29.6%, respectively. These differences were not statistically significant. The combination of BAL and BB revealed 64 cases of PC infection. BAL was positive in the vast majority of cases (63, 44.1%). BB was positive in 54 (37.8%). The combination of positive BB with negative BAL was present in one case. However, 10 cases of PC were found with the use of BAL and not detected by BB (P < .01). CONCLUSION The results of this study indicate that to confirm a PC infection in HIV-positive patients, the use of bronchoalveolar lavage with a single staining technique is appropriate. Bronchial brushing seems to be of limited additional value.

Asthma, eosinophilic pleuropneumonia, and pericarditis without vasculitis.

PATIENT I A 43 year old man had had bronchial asthma with blood eosinophilia, but without evidence of allergy, since 1976 and was treated with oral theophylline and salbutamol and later with inhalations of sodium cromoglycate and beclomethasone. The powdered cromoglycate was replaced by an aqueous solution because of coughing. In 1983 he visited our hospital because of thoracic pain, weight loss, general weakness, and night sweats. Physical examination revealed basal crackles, a pericardial rub, and a temperature of 40°C. Sputum, stool, urine, and blood examinations for viruses, mycobacteria, bacteria, fungi, and parasites gave negative results. Chest radiography showed progressive bilateral infiltration in the axillary and apical fields and evidence of pericardial effusion. Laboratory investigations gave the following results: white blood cell count 19.7 x 109/l with 10.3 x 109/l eosinophils; platelet count 824 x 109/l; erythrocyte sedimentation rate (ESR) 86mm in one hour; serum IgE 1.600kU/I; rheumatoid arthritis latex test positive; rheumatoid arthritis haemagglutinating antibody titre 1/640. There were circulating immune complexes and cryoglobulins. Other serological tests gave negative or normal results. Open lung biopsy showed hyperplasia of the muscularis mucosae and thickening of the basal membrane of bronchi and bronchioles, with a modest inflammatory reaction containing many eosinophils, but no evidence of obliterative bronchiolitis. The alveoli were found to contain many eosinophils and macrophages. Type 1I pneumocytes covered the alveolar walls; lymphocytes, plasma cells, and eosinophils were found in the interstitium. No features of vasculitis were seen. The pleural stroma contained locally accumulated plasma cells, lymphocytes, and many eosinophils. The pericardial biopsy showed fibrous thickening with local inflammatory centres of eosinophils and lymphocytes. Similar inflammatory cells were found in pericardial fluid. There were no deposits of immunoglobulins or complement in the vessel walls or along alveolar walls.

Metastatic meningioma of the lung.

A difficult diagnostic problem may be caused by the presence of multiple pulmonary nodules on a chest radiograph. The differential diagnosis includes infection, primary or metastatic tumour (benign or malignant), and the expression of systemic disease such as rheumatoid arthritis and sarcoidosis. This case report describes a patient with multiple lung tumours considered to be due to metastatic meningioma.