1
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Asbah M, Shrateh ON, Musleh A, Abbadi K, Amro W, Shaltaf A. Huge mesenteric inflammatory myofibroblastic tumor as a rare cause of intussusception with recurrence after 10 months: Case report and literature review. Int J Surg Case Rep 2023; 111:108871. [PMID: 37757735 PMCID: PMC10539857 DOI: 10.1016/j.ijscr.2023.108871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Inflammatory myofibroblastic tumor (IMT) is an infrequent, generally non-cancerous mesenchymal growth. IMT can affect individuals across various age groups, with a higher prevalence in children and adolescents. While it can emerge in any bodily region, it has a tendency to develop more often in the lungs and mesentery. IMT occurrence in the small bowel is exceptionally uncommon. It's a rare cause of intussusception and has unpredictable recurrence rate. CASE PRESENTATION This report highlights a unique clinical presentation involving a mesenteric IMT, which presented as small intestine intussusception in a 2-year-old child. Additionally, the patient was found to have an asymptomatic mass in the right upper quadrant, later identified as a recurrent IMT 10 months after surgical intervention for intussusception caused by the same tumor. CLINICAL DISCUSSION IMTs originate from mesenchymal tissues and encompass a blend of fibroinflammatory conditions. They exhibit a diverse combination of inflammatory and spindle cells. Diagnosing IMTs prior to surgery is intricate, as they can mimic malignant growths. Histopathology following surgery is usually needed for confirmation. Complete removal with a clear margin is the favored treatment approach. CONCLUSION Intestinal IMT is an infrequent and often overlooked condition, but it should be taken into account when diagnosing small bowel intussusception. The best chance of preventing recurrence in cases of intestinal IMT is through complete surgical removal with a negative margin. Nonetheless, the most effective approach for managing local recurrence and metastasis is still uncertain and necessitates ongoing long-term observation.
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Affiliation(s)
- Malvina Asbah
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Asil Musleh
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Khaled Abbadi
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine.
| | - Wael Amro
- Department of Pediatric Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Ahmad Shaltaf
- Department of Pediatric Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
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2
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Nodular Lymphoid Hyperplasia as Incidental Finding of Suspect Pulmonary Mass. Case Rep Med 2022; 2022:2242418. [PMID: 35607351 PMCID: PMC9124141 DOI: 10.1155/2022/2242418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Nodular lymphoid hyperplasia of the lung is a rare disease of polyclonal lymphoid proliferation. The incidental finding of a solid nodular lesion with irregular margins adjacent to the visceral pleura in the reported case was highly suggestive of malignancy. The present report underscores the typical immunohistochemical findings and the benign course of nodular lymphoid hyperplasia. The current knowledge about disease aetiology and the value of different diagnostic tools to distinguish nodular lymphoid hyperplasia from other pulmonary lymphoid lesions are summarized by a review of the literature. Surgical resection is not only diagnostic but also curative with no evidence so far that NLH can regress without operation. The present case shows the spontaneous regression of NLH after CT-guided biopsy indicating that an alternative, less invasive diagnostic approach has curative potential.
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3
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Savić Vuković A, Kukuljan M, Dinter M, Jurinović K, Jonjić N. The diagnostic challenge of adenocarcinoma in pulmonary nodular lymphoid hyperplasia. SAGE Open Med Case Rep 2021; 9:2050313X211039371. [PMID: 34721874 PMCID: PMC8552398 DOI: 10.1177/2050313x211039371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Pulmonary nodular lymphoid hyperplasia is a rare, nonneoplastic lymphoproliferative disorder mostly manifesting as one or more nodules or localized lung infiltrates. The lesion comprises reactive germinal centers with well-preserved mantle zones and sheets of interfollicular mature plasma cells, lymphocytes, histiocytes, and neutrophils. The radiological finding is not specific, and the diagnosis of pulmonary nodular lymphoid hyperplasia relies generally on pathohistological and immunohistochemical analyses. The most important differential diagnoses are extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and immunoglobulin G4–related sclerosing disease. Nonetheless, we present a case of pulmonary nodular lymphoid hyperplasia in a 69-year-old woman with the diagnostic challenge of cytological atypia in alveolar spaces inside the lymphoid tissue, coexisting with the diagnosis of adenocarcinoma of the lepidic pattern. Therefore, this case highlights the importance of identifying these rare benign and reactive lymphoproliferative diseases given the risk of developing not only lymphoma but also carcinoma.
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Affiliation(s)
| | - Melita Kukuljan
- Clinical Hospital Center Rijeka, KBC Rijeka, Rijeka, Croatia
| | - Morana Dinter
- Department of Cytology, Clinical Hospital Center Rijeka, KBC Rijeka, Rijeka, Croatia
| | | | - Nives Jonjić
- Clinical Hospital Center Rijeka, KBC Rijeka, Rijeka, Croatia.,Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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4
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Nelson BE, Hong A, Okereke I, Markowitz A, Willis M, Muthukumarana PV, Nawgiri R. Non-neoplastic inflammatory pseudotumor of the lung after immunotherapy for melanoma: A diagnostic pitfall on fine needle aspiration biopsy of lung. Diagn Cytopathol 2021; 49:1150-1154. [PMID: 34331523 DOI: 10.1002/dc.24846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/25/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
Nivolumab is commonly used as monotherapy or in combination therapy for management of locally advanced or metastatic melanoma; however, it is also associated with immunotherapy-related adverse events concerning for disease progression or tumor flare reaction. This report presents a case of a non-neoplastic pseudotumor of the lung initially mistaken for malignancy that occurred in a patient receiving adjuvant nivolumab therapy following complete resection of stage IIIB melanoma. The diagnosis was made by lung biopsy and confirmed by a wedge resection, with findings consistent with organizing pneumonia type of pulmonary inflammatory pseudotumor rather than malignancy.
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Affiliation(s)
| | - Angelina Hong
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ike Okereke
- Department of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Avi Markowitz
- Department of Hematology & Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Maurice Willis
- Department of Hematology & Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Ranjana Nawgiri
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
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5
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Val-Bernal JF, Mayorga MM, García-Gutierrez FJ. Abdominal elastotic lesions. A clinicopathologic study of 23 cases. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:841-851. [PMID: 33817725 PMCID: PMC8112749 DOI: 10.47162/rjme.61.3.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abdominal elastotic deposits are uncommon lesions that often presents as polyps. They show three histological patterns: fibroelastosis, angioelastosis, and elastofibroma. We describe 23 cases including rare locations, such as mesentery, greater omentum, hernia sac, spleen, peripancreatic fat, and hypodermal fat. The age of the patients ranged from 49 to 93 years (mean, 76.8 years). Most lesions were discovered incidentally in the microscopic study. The most frequent locations were peritoneal subserosa (43.5%) and mesentery/mesocolon/greater omentum (39.1%). The most common pattern was fibroelastosis (69.6%) followed by angioelastosis (26.1%). We observed one case of omental elastofibroma. A review of the 14 abdominal elastofibromas described including our case revealed that the age of the patients ranged from 45 to 88 years (mean, 68.5 years). Female predominance is striking (M:F, 1:12). The most common site was the stomach (50%). The greater omentum (14.3%), small intestine (7.1%), and pancreas (7.1%) are very rare sites for this lesion. Only one case before ours has been published in the greater omentum. The size of the lesions ranged from 0.7 cm to 8 cm (mean 3.2 cm). In 36.4% of the cases located in the digestive tract, the mucosa did not show alterations. Ulcerations (36.4%) or polypoid excrescences (18.2%) were mostly observed. Six (42.9%) cases were asymptomatic and six (42.9%) cases simulated a neoplasm. Two cases were associated with elastofibromas in other locations. Differential diagnosis includes amyloidoma, elastofibrolipoma, mesenteric elastic vascular sclerosis in neuroendocrine tumors, diverticular disease elastosis, pseudoxanthoma elasticum, pulse granuloma, and digestive lesions in patients treated with D-Penicillamine.
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6
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Nigam N, Hashim Z, Neyaz Z, Gupta M, Nath A. Inflammatory pseudotumor of the lung with complete resolution. Lung India 2021; 38:90-91. [PMID: 33402647 PMCID: PMC8066923 DOI: 10.4103/lungindia.lungindia_71_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Neha Nigam
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Zia Hashim
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Zafar Neyaz
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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7
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Alabbas Z, Issa M, Omran A, Issa R. Mesenteric inflammatory myofibroblastic tumor as a rare cause of small intestinal intussusception. J Surg Case Rep 2020; 2020:rjaa322. [PMID: 32994915 PMCID: PMC7509889 DOI: 10.1093/jscr/rjaa322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/18/2020] [Accepted: 07/24/2020] [Indexed: 02/03/2023] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is an uncommon, usually benign, mesenchymal tumor. IMT affects people of all ages, but it more commonly occurs in children and adolescents. Also, it has the potential to arise in any part of the body, though, it frequently develops in the lungs and mesentery. In this report, we discuss a rare clinical manifestation of mesenteric IMT presented as intussusception of the small intestine in a 7-year-old child.
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Affiliation(s)
- Zeina Alabbas
- Correspondence address. Department of Pathology, Tishreen University, Lattakia, Syria. E-mail:
| | - Mohsen Issa
- Al Andalus Private University, Tartus, Syria
| | - Ammar Omran
- Department of Pediatric Surgery, Tishreen University, Lattakia, Syria
| | - Rana Issa
- Department of Pathology, Tishreen University, Lattakia, Syria
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8
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Govender D, Jackson C, Chetty D. Syphilitic Pulmonary Inflammatory Pseudotumor: A Diagnostic Challenge. Int J Surg Pathol 2020; 29:90-96. [PMID: 32486870 DOI: 10.1177/1066896920928584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 46-year-old man presented with nonproductive cough and lower limb swelling. Chest radiograph showed a left lower lobe lung mass and multiple subpleural nodules. Other investigations revealed that he had nephrotic syndrome. Core biopsies of the left lower lobe lung mass showed features of inflammatory pseudotumor with endarteritis obliterans and a lymphoplasmacytic infiltrate. Immunohistochemical stain for Treponema pallidum was positive. Resolution of the lung mass and nephrotic syndrome was achieved after treatment with intramuscular benzathine benzylpenicillin. The differential diagnosis of pulmonary inflammatory pseudotumor, manifestations of pulmonary syphilis, and a literature review of secondary syphilis of the lung are discussed.
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Affiliation(s)
- Dhirendra Govender
- University of Cape Town, Cape Town, South Africa.,PathCare, Claremont, Cape Town, South Africa
| | - Christopher Jackson
- University of Cape Town, Cape Town, South Africa.,NHLS-Groote Schuur Hospital, Cape Town, South Africa
| | - Dharshnee Chetty
- University of Cape Town, Cape Town, South Africa.,NHLS-Groote Schuur Hospital, Cape Town, South Africa
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9
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Occam's Razor versus Hickam's Dictum. Ann Am Thorac Soc 2019; 14:1709-1713. [PMID: 29090995 DOI: 10.1513/annalsats.201701-087cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Panagopoulos N, Leivaditis V, Kraniotis P, Ravazoula P, Koletsis E, Dougenis D. Sclerosing Mediastinitis Causing Unilateral Pulmonary Edema Due to Left Atrial and Pulmonary Venous Compression. A Case Report and Literature Review. Braz J Cardiovasc Surg 2019; 34:85-92. [PMID: 30810679 PMCID: PMC6385839 DOI: 10.21470/1678-9741-2018-0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/08/2018] [Indexed: 12/01/2022] Open
Abstract
Sclerosing mediastinitis (SM), previously named chronic fibrosing mediastinitis,
is an inflammatory process that in its end-stage results to sclerosis around the
mediastinal structures. SM is quite rare and has been correlated with
inflammatory and autoimmune diseases, as well as malignancy. SM may either
present in a mild form, with minor symptoms and a benign course or in a more
aggressive form with severe pulmonary hypertension and subsequent higher
morbidity and mortality. The diagnosis of SM may be difficult and quite
challenging, as symptoms depend on the mediastinal structure that is mainly
involved; quite often the superior vena cava. However, practically any
mediastinal structure may be involved by the fibrotic process, such as the
central airways, as well as the pulmonary arteries and veins, leading to
obstruction or total occlusion. The latter may be impossible to undergo proper
surgical excision of the lesion, and is considered to be a real challenge to the
surgeon. We herein report a case of SM that presented with arterial and venous
compression. The imaging appearance was that of unilateral pulmonary edema,
associated with lung collapse. The case is supplemented by a non-systematic
review of the relevant literature.
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Affiliation(s)
| | - Vasileios Leivaditis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece.,Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
| | | | | | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
| | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
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11
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Abstract
Pulmonary nodular lymphoid hyperplasia is an uncommon reactive lymphoproliferative disorder that presents as an asymptomatic lung mass. The histopathologic diagnosis of pulmonary nodular lymphoid hyperplasia may be challenging because of its morphologic overlap with other diseases, such as extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and immunoglobulin G4-related sclerosing disease. Despite the similarities, there are distinctive morphologic and phenotypic features that allow for the correct diagnosis in the majority of cases. This review aims to discuss the clinicopathologic features of pulmonary nodular lymphoid hyperplasia and contrast them with its histopathologic mimickers.
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Affiliation(s)
- Maggie Yell
- From the Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown (Dr Yell); and the Department of Pathology, University of Texas Southwestern Biocenter, Dallas (Dr Rosado)
| | - Flavia G Rosado
- From the Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown (Dr Yell); and the Department of Pathology, University of Texas Southwestern Biocenter, Dallas (Dr Rosado)
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12
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Yi ES, Sekiguchi H, Peikert T, Ryu JH, Colby TV. Reprint of: Pathologic manifestations of Immunoglobulin(Ig)G4-related lung disease. Semin Diagn Pathol 2018; 35:347-351. [PMID: 30249368 DOI: 10.1053/j.semdp.2018.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immunoglobulin(Ig)G4-related disease (IgG4-RD) is a fibroinflammatory condition that can affect virtually any organ and usually presents as tumefactive lesions involving multiple sites. Characteristic histopathology of IgG4-RD consists of dense lymphoplasmacytic infiltrate, fibrosis (often in storiform pattern), and obliterative phlebitis, accompanied by tissue infiltration of IgG4-positive plasma cells with or without elevation of serum IgG4 level. Despite a general similarity in the morphologic manifestations of IgG4-RD, site-specific unique morphologic features have been described in some organs including the lung. Compared with other sites, pulmonary involvement by IgG4-RD has been recognized more recently, and lung biopsy interpretation for this condition is often challenging, as both a relative paucity of pathognomonic features and a plethora of overlapping findings with other fibroinflammatory processes of the lung. This review is focused on the morphologic spectrum of IgG4-related lung disease documented in the current literature and on the pertinent issues in the differential diagnoses with other conditions encountered in the lung.
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Affiliation(s)
- Eunhee S Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
| | - Hiroshi Sekiguchi
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas V Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
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13
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Sim J, Koh HH, Choi S, Chu J, Kim TS, Kim H, Han J. Pulmonary Nodular Lymphoid Hyperplasia with Mass-Formation: Clinicopathologic Characteristics of Nine Cases and Review of the Literature. J Pathol Transl Med 2018; 52:211-218. [PMID: 29902913 PMCID: PMC6056364 DOI: 10.4132/jptm.2018.04.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/27/2018] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary nodular lymphoid hyperplasia (PNLH) is a non-neoplastic pulmonary lymphoid disorder that can be mistaken for malignancy on radiography. Herein, we present nine cases of PNLH, emphasizing clinicoradiological findings and histological features. Methods We analyzed radiological and clinicopathological features from the electronic medical records of nine patients (eight females and one male) diagnosed with PNLH. IgG and IgG4 immunohistochemical staining was performed in three patients. Results Two of the nine patients had experienced tuberculosis 40 and 30 years prior, respectively. Interestingly, none were current smokers, although two were ex-smokers. Three patients complaining of persistent cough underwent computed tomography of the chest. PNLH was incidentally discovered in five patients during examination for other reasons. The remaining patient was diagnosed with the disease following treatment for pneumonia. Imaging studies revealed consolidation or a mass-like lesion in eight patients. First impressions included invasive adenocarcinoma and mucosal-associated lymphoid tissue‒type lymphoma. Aspergillosis was suspected in the remaining patient based on radiological images. Resection was performed in all patients. Microscopically, the lesions consisted of nodular proliferation of reactive germinal centers accompanied by infiltration of neutrophils and macrophages in various degrees and surrounding fibrosis. Ultimately, all nine patients were diagnosed with PNLH and showed no evidence of recurrence on follow-up. Conclusions PNLH is an uncommon but distinct entity with a benign nature, and understanding the radiological and clinicopathological characteristics of PNLH is important.
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Affiliation(s)
- Jongmin Sim
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hee Koh
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangjoon Choi
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinah Chu
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Kim
- Department of Radiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology and Translational Genomics, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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14
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Masunaga A, Ishibashi F, Koh E, Oide T, Sekine Y, Hiroshima K. Possible relationship between fibrosis of IgG4-related thymitis and the profibrotic cytokines, transforming growth factor beta 1, interleukin 1 beta and interferon gamma: a case report. Diagn Pathol 2018; 13:6. [PMID: 29439708 PMCID: PMC5811959 DOI: 10.1186/s13000-018-0684-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/09/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND IgG4-related disease often forms a mass and the affected lesion is clinically removed because the mass cannot be differentiated from a neoplasm. Affected lesions commonly occur in the pancreas, hepatobiliary tract, kidney, and retroperitoneum. However, the lesion rarely occurs in the thymus. A histological worldwide consensus of IgG4-related disease proposed that pathological diagnosis of IgG4-related disease should meet more than two of three major features: 1) dense lymphoplasmacytic infiltration with greater than 40% IgG4+/IgG+ plasma cells, 2) storiform fibrosis; and 3) obliterative phlebitis. Currently, fibrosis of IgG4-related disease is thought to be induced by profibrotic cytokines such as transforming growth factor beta 1 (TGFB1), interleukin 1 beta (IL1B) and interferon gamma (IFNG), which are secreted by regulatory T cells (Tregs) and CD4-positive cytotoxic T cells. However, it is unclear whether profibrotic cytokines are associated with the fibrosis seen in IgG4-related thymitis. Here we examined whether cytokines in the mass were increased compared with those in the surrounding thymus, and whether Tregs were present in the mass, using reverse transcription absolute quantitative polymerase chain reaction (RT-ab-qPCR) and immunohistochemistry. CASE PRESENTATION A 70-year-old Japanese man contracted IgG4-letated thymitis. Histological and immunohistochemical analyses demonstrated his mass had massive fibrosis with a focally storiform pattern and lymphoplasmacytic infiltration with 40% IgG4+/IgG+ plasma cells, but not obliterative phlebitis. The mass was surrounded by atrophic thymus. We diagnosed the mass as IgG4-related thymitis. Immunohistochemically, Tregs were scattered throughout the mass. RT-ab-qPCR showed that messenger RNA expressions of TGFB1, IL1B and IFNG in the mass were 270-, 158- and 5.5- fold higher than in the surrounding thymus. His serum IgG4 level after surgery was within the normal range (83.4 mg/dl soon after surgery, 89.3 mg/dl 2 weeks after surgery). CONCLUSIONS Our results suggested the profibrotic cytokines TGFB1, IL1B and IFNG induce fibrosis and that Tregs might produce some of these cytokines in IgG4-related thymitis as well as in the other affected lesions of IgG4-related disease.
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Affiliation(s)
- Atsuko Masunaga
- Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524 Japan
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa Japan
| | - Fumihiro Ishibashi
- Division of Thoracic Surgery, Department of Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan
| | - Eitetsu Koh
- Division of Thoracic Surgery, Department of Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan
| | - Takashi Oide
- Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524 Japan
| | - Yasuo Sekine
- Division of Thoracic Surgery, Department of Surgery, Tokyo Women’s Medical University Yachiyo Medical Center, Yachiyo, Chiba, Japan
| | - Kenzo Hiroshima
- Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo, Chiba, 276-8524 Japan
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15
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Bharadwaj R, Madakshira MG, Bharadwaj P, Sidhu HS. Sclerosing Mediastinitis Presenting as Complete Heart Block. J Clin Diagn Res 2017; 11:ED12-ED14. [PMID: 28658779 DOI: 10.7860/jcdr/2017/26349.9786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/23/2017] [Indexed: 12/24/2022]
Abstract
Sclerosing Mediastinitis (SM) is a rare condition which is characterized by the presence of dense fibrosis which infiltrates and encroaches upon various structures in the mediastinal cavity. Depending on the extent and the predominant organ of involvement, the patient presents with symptomatology of dysphagia, superior vena cava compression syndrome or dyspnoea. However, the involvement of the heart is rarely seen. Aetiologies of SM are several, with infections being the most common. We discuss a case of SM involving the oesophagus, descending aorta, hilum of lungs and the heart secondary to mucormycosis in an immunocompetent male.
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Affiliation(s)
- Reena Bharadwaj
- Professor and Head, Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Manoj Gopal Madakshira
- Assistant Professor, Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Prashant Bharadwaj
- Professor and Head, Department of Cardiology, Military Hospital, Cardio Thoraic Center, Pune, Maharashtra, India
| | - Hardeep Singh Sidhu
- Classified Specialist, Department of Pathology, Military Hospital, Cardio Thoraic Center, Pune, Maharashtra, India
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16
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Nodular or Round Pneumonia With Highly Elevated Rheumatoid Factors. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Rubenstein JN, Beatty C, Kinkade Z, Bryan C, Hogg JP, Gibson LF, Vos JA. Extranodal Marginal Zone Lymphoma of the Lung: Evolution from an Underlying Reactive Lymphoproliferative Disorder. ACTA ACUST UNITED AC 2015; 5. [PMID: 26457231 DOI: 10.4172/2161-0681.1000208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Extranodal Marginal Zone Lymphoma (ENMZL) of Mucosa-Associated Lymphoid Tissue (MALT) is a problematic and sometimes controversial diagnosis. While commonly seen in the stomach in the setting of chronic Helicobacter pylori infection, other extranodal sites, such as the lung, may also present with disease. ENMZL is clinically and morphologically heterogeneous; however, regardless of presentation, the etiology lies in the accumulation of lymphoid tissue in non-traditional sites. This phenomenon is typically secondary to an underlying inflammatory stimulus such as chronic infection or autoimmune states. The current case report details the clinical history of a patient with Sjögren syndrome over a four year period who eventually developed ENMZL. The patient initially presented with an atypical, but polyclonal, lymphoproliferative process diagnosed as lymphocytic interstitial pneumonia. Over time, the patient showed evolution to a monoclonal process with associated radiologic progression of disease. This evolution manifested as a dense lymphoid infiltrate with prominent plasmacytic differentiation and the development of a lung mass radiologically. This case contributes to the growing body of knowledge that suggests ENMZL lies along a biological spectrum of lymphoproliferative disorders whereby a benign, reactive process may eventually undergo malignant transformation. This evolution likely represents the acquisition of genetic abnormalities that allow autonomous proliferation in the absence of the initial immune stimulus. In practice, determining when this event occurs and, thus, distinguishing between reactive and neoplastic disorders within this spectrum may be difficult as no single clinicopathologic feature may be present to establish the diagnosis. This case further illustrates the importance of correlating the clinical, radiologic and pathologic data to evaluate patients with atypical pulmonary lymphoproliferative disorders and to allow the optimal management of their disease.
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Affiliation(s)
| | - Colleen Beatty
- Department of Pathology, West Virginia University School of Medicine, USA
| | - Zoe Kinkade
- Department of Pathology, West Virginia University School of Medicine, USA
| | - Cara Bryan
- Department of Radiology, West Virginia University School of Medicine, USA
| | - Jeffery Paul Hogg
- Department of Radiology, West Virginia University School of Medicine, USA
| | - Laura F Gibson
- Professor of Microbiology, Immunology and Cell Biology, Mary Babb Randolph Cancer Center at West Virginia University School of Medicine
| | - Jeffrey A Vos
- Department of Pathology, West Virginia University School of Medicine, USA
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Abstract
Inflammatory pseudotumors are rare solid, non-neoplastic masses that can mimic pulmonary malignancy. It occurs most commonly in children and young adults and is usually found incidentally. There are many reports of the existence of this tumor in various organs in the human body. The occurrence of this tumor exclusively in the pleura has not been described before. We present a case of inflammatory pseudotumor of the pleura and its successful management.
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Karnatovskaia LV, Khoor A, Johnson MM, Kaplan J. A 60-year-old woman with PET scan-avid lung nodules and a history of a ruptured silicone breast implant. Chest 2014; 146:e138-e142. [PMID: 25288007 DOI: 10.1378/chest.14-0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 60-year-old woman was referred to the pulmonary clinic for evaluation of lung nodules. Her medical history was notable for hypothyroidism, anxiety, and a ruptured breast implant for which incomplete surgical resection and evacuation had been performed 10 years previously. She was a lifelong nonsmoker and worked as a gym instructor. The patient denied occupational exposures and had not traveled recently. Medications included levothyroxine and alprazolam. Except for a 1-month history of occasional dry cough, the review of systems was negative. The patient's physician queried whether the previously ruptured silicone breast implant may have played a role in the genesis of the nodules and referred the patient to our institution for further management. The lack of systemic symptoms relative to the degree of lung involvement provided an early diagnostic clue.
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Affiliation(s)
| | - Andras Khoor
- Department of Pathology, Mayo Clinic Florida, Jacksonville, FL
| | - Margaret M Johnson
- Departments of Pulmonary and Critical Care Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Joseph Kaplan
- Departments of Pulmonary and Critical Care Medicine, Mayo Clinic Florida, Jacksonville, FL
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20
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Upponi S, Butler AJ, Watson CJE, Shaw AS. Encapsulating peritoneal sclerosis--correlation of radiological findings at CT with underlying pathogenesis. Clin Radiol 2013; 69:103-9. [PMID: 24209872 DOI: 10.1016/j.crad.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 12/11/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare entity most commonly associated with peritoneal dialysis (PD). Several imaging features at computed tomography (CT) are common to many diseases; however, appreciation of the features unique to this condition interpreted with the appropriate clinical findings is crucial to diagnosis.
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Affiliation(s)
- S Upponi
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - A J Butler
- Academic Department of Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - C J E Watson
- Academic Department of Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - A S Shaw
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
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21
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Diagnostic and therapeutic challenges of a large pleural inflammatory myofibroblastic tumor. Case Rep Pulmonol 2012; 2012:102196. [PMID: 23346443 PMCID: PMC3549377 DOI: 10.1155/2012/102196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 12/16/2012] [Indexed: 12/20/2022] Open
Abstract
We report a 48-year-old woman with a pleural pseudoneoplasm requiring different diagnostic and therapeutic strategies. After initial presentation with increasing dyspnoea, temperature, dry cough, and interscapular pain diagnostic processing showed a large mediastinal mass with marked pleural effusion and high metabolic activity in the 18F-FDG-PET/CT. Extensive CT-guided biopsy of the tumor reaching from the visceral pleura into the right upper lobe revealed no malignancy, but a marked inflammatory tissue reaction containing foam cells. Initial empiric antibiotic therapy was temporarily successful. However, in the further course the mass relapsed and was resistant to antibiotics and a corticosteroid trial. With the working hypothesis of an inflammatory myofibroblastic tumor the patient underwent surgical tumor resection, finally confirming the suspected diagnosis. Due to residual disease intravenous immunoglobulins were administered leading to sustained response. This case with a pleural localisation of a large inflammatory pseudotumor with responsiveness to immunomodulation after incomplete resection extends the reported spectrum of thoracopulmonary manifestations of this rare entity.
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Yi ES, Sekiguchi H, Peikert T, Ryu JH, Colby TV. Pathologic manifestations of Immunoglobulin(Ig)G4-related lung disease. Semin Diagn Pathol 2012; 29:219-25. [PMID: 23068301 DOI: 10.1053/j.semdp.2012.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Immunoglobulin(Ig)G4-related disease (IgG4-RD) is a fibroinflammatory condition that can affect virtually any organ and usually presents as tumefactive lesions involving multiple sites. Characteristic histopathology of IgG4-RD consists of dense lymphoplasmacytic infiltrate, fibrosis (often in storiform pattern), and obliterative phlebitis, accompanied by tissue infiltration of IgG4-positive plasma cells with or without elevation of serum IgG4 level. Despite a general similarity in the morphologic manifestations of IgG4-RD, site-specific unique morphologic features have been described in some organs including the lung. Compared with other sites, pulmonary involvement by IgG4-RD has been recognized more recently, and lung biopsy interpretation for this condition is often challenging, as both a relative paucity of pathognomonic features and a plethora of overlapping findings with other fibroinflammatory processes of the lung. This review is focused on the morphologic spectrum of IgG4-related lung disease documented in the current literature and on the pertinent issues in the differential diagnoses with other conditions encountered in the lung.
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Affiliation(s)
- Eunhee S Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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23
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Gravdahl DJ, Gardetto JS, Hurley JR, Tazelaar HD, Koontz PW, Leslie KO. Pulmonary histoplasmosis producing a spindle cell "pseudotumor". Am J Clin Pathol 2011; 136:410-5. [PMID: 21846916 DOI: 10.1309/ajcp13kzddjcicat] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Pulmonary spindle cell proliferations have been reported in association with a limited group of infectious agents. These lesions are rare and identified most often in the setting of immunosuppression. Because their appearance can simulate a spindle cell neoplasm, they are diagnostically treacherous, sometimes delaying antimicrobial therapy or resulting in unnecessary surgery. We report a case of a spindle pseudotumor of the lung resulting from Histoplasma capsulatum infection, a previously unreported cause of a spindle cell lesion in the lung. The patient was a 67-year-old woman in whom positron emission tomography-positive nodules developed in the left lung and left mediastinum. The patient had undergone renal transplantation and was receiving immunosuppressive therapy with mycophenolate, tacrolimus, and low-dose prednisone. Infection with H capsulatum was confirmed by culture of pleural effusion fluid, DNA probe analysis of the pleural fluid culture isolate, urinary Histoplasma antigen detection, and Grocott methenamine silver stains of tissue sections. To our knowledge, this is the first case of a spindle cell "pseudotumor" of the lung resulting from histoplasmosis. It highlights the importance of performing special stains for organisms when evaluating pulmonary spindle cell lesions in an immunocompromised host.
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Affiliation(s)
- Daniel J. Gravdahl
- Department of Pathology, St Joseph’s Hospital and Medical Center, Phoenix, AZ
| | | | | | - Henry D. Tazelaar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | - Paul W. Koontz
- Department of Pathology, Skaggs Community Hospital, Branson, MO
| | - Kevin O. Leslie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
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Tetikkurt C, Tetikkurt S, Ozdemir I, Bayar N. Round atelectasis in sarcoidosis. Multidiscip Respir Med 2011; 6:180-2. [PMID: 22958304 PMCID: PMC3463071 DOI: 10.1186/2049-6958-6-3-180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 02/08/2011] [Indexed: 11/10/2022] Open
Abstract
Round atelectasis is a benign inflammatory condition most frequently observed in patients with asbestos exposure but it can also result from a variety of chronic pleural diseases like infection. It has not previously been described in sarcoidosis. We report the occurrence of round atelectasis in four previously diagnosed sarcoidosis patients who were under follow up at our outpatient clinic. Three patients had symptoms consisting of thoracic pain, dry cough and sensation of fullness at the posterior thorax, respectively. Chest roentgenogram showed subpleural or pleural based opacity with diameters ranging from 2 to 3 cm in each of the patients. Chest computerized tomography (CT) revealed features of round atelectasis. Fiberoptic bronchoscopy with transbronchial lung biopsy was performed. Diagnosis was confirmed by the histopathologic examination of the biopsy samples. The mechanical influence of a prior pleural effusion due to sarcoidosis may be the predominant mechanism underlying the onset of round atelectasis in these patients. Clinicians should bear in mind the possibility of sarcoidosis as an etiologic factor for round atelectasis.
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Affiliation(s)
- Cuneyt Tetikkurt
- Pulmonary Diseases Department, Cerrahpasa Medical Faculty, Istanbul University, Turkey.
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