A safe high-yield technique for cutting needle biopsy of the lung in patients with diffuse lung disease

Occult pulmonary lymphangitic carcinomatosis presenting as 'chronic cough' with a normal HRCT chest

A diagnosis of ‘chronic cough’ (CC) requires the exclusion of sinister pulmonary pathology, including infection and malignancy. We present a patient with a 3 month history of CC who had an extensive workup including a normal high resolution computed tomography of the chest (HRCT) 6 weeks prior to consultation at our center. He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation. A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC) from a colon primary. Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution. PLC is a very rare cause of ‘chronic cough’ and incipient/occult PLC presenting with chronic cough and a normal initial HRCT chest has not been previously reported.

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Asthma, GERD and postnasal drip are the 3 most common causes of chronic cough.

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Constitutional symptoms (weight loss etc.) never occur in chronic cough.

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Pulmonary lymphangitic carcinomatosis can rarely present with chronic cough.

Tumor-like pulmonary sarcoidosis diagnosed by CT-guided transthoracic lung biopsy

Introduction

Most patients referred for lung biopsy have a focal lesion that is likely to be a carcinoma and fine needle aspiration (FNA) is usually sufficient to confirm diagnosis. Percutaneous cutting needle biopsy (CNB) is an important and potential diagnostic technique when non carcinomatous disease is suspected or when the pulmonary disease is unclear, so tissue architecture is very important.

Case presentation

We present a case of a 24 year old male arrived at our hospital with dyspnea and unusual computed tomography (CT) findings of sarcoidosis. Chest X-ray and CT scan revealed multiple masses in both lungs suggesting lung metastasis. Bronchoscopy and bronchoalveolar lavage did not reveal any malignant cells. None of the laboratory examinations revealed any primary extrapulmonary tumor. The patient underwent CT-guided core needle biopsy. Histopathological examination confirmed the diagnosis of sarcoidosis.

Conclusion

CT-guided core needle biopsy is a very helpful diagnostic tool in order to determine the benign or malignant nature of a thoracic lesion.

A comparison of biopsy and post-mortem findings in the lungs of healthy cows

Lung biopsy in cattle for the diagnosis of lung diseases is rarely used or described. The clinical effects and the gross findings in lung and pleura after ultrasonic-guided percutaneous lung biopsy in the upright animal of healthy cattle were reported previously (Braun et al., 1999). This report describes the yield of attained lung tissue and the local tissue reaction in 60 healthy adult cows slaughtered 24 h (50 animals) and 10 days (10 animals) after invasion. The yield of lung tissue in the biopsies was high (85.5%) in 90 histologically examined biopsy specimens and judged 'good to excellent'. The local tissue reaction and the extent of haemorrhage in the lung parenchyma, both 24 h and 10 days after the biopsy, were minimal. In the latter group, the scar tissue had approximately the same dimensions as the tissue cylinders punched 10 days before. There were no local adhesions between the pleural surfaces. Previously published data concerning clinical reactions and complications, macroscopically examined local tissue bleeding and the histologically evaluated minimal local inflammatory reaction, following lung biopsy of cattle, indicate that this procedure is safe and satisfactory for sampling of accurate lung material. The results of this study concur and indicate that local complications in the animal were minimal to absent.

Cutting needle biopsy in the diagnosis of clinically suspected non-carcinomatous disease of the lung

Most patients referred for lung biopsy have a focal lesion that is likely to be a carcinoma, and fine needle aspiration is usually sufficient to confirm the diagnosis. When non-carcinomatous disease is suspected, tissue architecture is important and potential diagnostic techniques include percutaneous cutting needle biopsy (CNB). We retrospectively reviewed 37 CNBs performed for clinically suspected non-carcinomatous disease; recording the biopsy result, final diagnosis, radiological nature of the pulmonary abnormality, distance from the pleura of the lesion biopsied and biopsy complications. 9 patients had a single pulmonary nodule/mass; 13 had multiple nodules/masses; 8 had a lobar consolidation/mass; and 7 had multifocal consolidation. The lesion abutted the pleura in 31 cases, lying within 1 cm in the other 6 cases. The minor complication rate was 14%, with no major complications. Specific malignant diagnoses were made in 9 patients, and specific benign in 23, in all of whom clinicoradiological follow-up was concordant. CNB did not yield a specific diagnosis in five patients, including two lymphomas and one case of unsuspected tuberculosis in which the sample was not cultured. The overall accuracy of CNB was 32/37 (86%). CNB is a safe and accurate means of achieving a tissue diagnosis for patients with peripheral pulmonary parenchymal disease thought not to represent carcinoma.