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Alghanim F, Li KZ, An M, Verceles AC, Grier WR, Abbas H, Deepak J. Exploring the effects of racial and socioeconomic factors on timeliness of lung cancer diagnosis and treatment in Baltimore Veterans. Semin Oncol 2022; 49:S0093-7754(22)00055-0. [PMID: 35927100 DOI: 10.1053/j.seminoncol.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To characterize the effect of racial and socioeconomic factors on the timeliness of lung cancer diagnosis and treatment in a single-center Veterans Affair Medical Center (VAMC) pulmonary nodule clinic. METHODS We conducted a single-center retrospective review of all patients seen at the Baltimore VAMC pulmonary nodule clinic between 2013 and 2019 to identify key demographic factors, measures of neighborhood socioeconomic disadvantage, cancer staging and histopathologic information, and time elapsed between diagnosis and treatment. We excluded patients with pulmonary nodules undergoing active surveillance, prior history of lung cancer, metastases of a different primary origin, insufficient followup, or who had received care outside the VHA system. RESULTS Median times to diagnosis and treatment of lung cancer were 28 and 73 days. There were no statistically significant differences in overall timeliness of diagnosis and treatment when stratified by race or measures of neighborhood socioeconomic disadvantage. CONCLUSIONS The authors found no differences in timeliness of lung cancer care by race and socioeconomic status within the system. Despite general adherence to national standards in timeliness of care, there continues to be a need for improvements in the operational workflows to reduce time to diagnosis and treatment for all Veterans.
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Affiliation(s)
- Fahid Alghanim
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kevin Z Li
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Max An
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Avelino C Verceles
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William R Grier
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hatoon Abbas
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Janaki Deepak
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Kamona A, Al Lawati F, Kamona A, Al Busaidi N, Al Mahrooqi Y, Al-Tai S, Al Lawati N, Al-Umairi RS. Pulmonary Hyalinising Granuloma: A report of two cases. Sultan Qaboos Univ Med J 2019; 19:e157-e160. [PMID: 31538016 PMCID: PMC6736260 DOI: 10.18295/squmj.2019.19.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/25/2019] [Accepted: 04/18/2019] [Indexed: 12/01/2022] Open
Abstract
Pulmonary hyalinising granuloma (PHG) is a rare fibrosclerosing inflammatory lung condition of unknown aetiology. It is characterised by solitary or multiple pulmonary nodules that are usually found incidentally while imaging the chest for other reasons. We report two cases of histologically proven PHG diagnosed at the Royal Hospital, Muscat, Oman. The first case was a 71-year-old male patient who presented in 2010 with a dry cough, weight loss and bilateral pulmonary nodules. The second case was a 58-year-old male patient who presented in 2012 and was found to have incidental bilateral pulmonary nodules on chest X-ray. Both patients were started on prednisolone and on follow-up the PHG nodules remained stable. Although there is no definitive treatment, PHG generally has an excellent prognosis.
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Affiliation(s)
- Ameen Kamona
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Atheel Kamona
- Department of Radiology, Royal Hospital, Muscat, Oman
| | | | | | - Saqar Al-Tai
- Department of Radiology, Royal Hospital, Muscat, Oman
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Miller AR, Jackson D, Hui C, Deshpande S, Kuo E, Hamilton GS, Lau KK. Lung nodules are reliably detectable on ultra-low-dose CT utilising model-based iterative reconstruction with radiation equivalent to plain radiography. Clin Radiol 2019; 74:409.e17-409.e22. [PMID: 30832990 DOI: 10.1016/j.crad.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/06/2019] [Indexed: 12/21/2022]
Abstract
AIM To determine if ultra-low-dose (ULD) computed tomography (CT) utilising model-based iterative reconstruction (MBIR) with radiation equivalent to plain radiography allows the detection of lung nodules. MATERIALS AND METHODS Ninety-nine individuals undergoing surveillance of solid pulmonary nodules undertook a low-dose (LD) and ULD CT during the same sitting. Image pairs were read blinded, in random order, and independently by two experienced thoracic radiologists. With LD-CT as the reference standard, the number, size, and location of nodules was compared, and inter-rater agreement was established. RESULTS There was very good inter-rater agreement with regards nodules ≥4mm for both the LD- (k=0.931) and ULD-CT (k=0.869). One hundred and ninety-nine nodules were reported on the LD-CT by both radiologists and 196 reported on the ULD-CT, with no nodules reported only on the ULD-CT. This gives a sensitivity of 98.5% and specificity of 100% for ULD-CT with MBIR. The effective dose of radiation was significantly different between the two scans (p<0.0001), 1.67 mSv for the LD-CT and 0.13 mSv for the ULD-CT. CONCLUSION ULD-CT utilising MBIR and delivering radiation equivalent to plain radiography, allows detection of lung nodules with high sensitivity. The attendant 10-fold reduction in radiation may allow for dramatic reductions in cumulative radiation exposure.
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Affiliation(s)
- A R Miller
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia; Monash University, Clayton, Victoria, Australia; General Medicine, Monash Health, Clayton, Victoria, Australia.
| | - D Jackson
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - C Hui
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - S Deshpande
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
| | - E Kuo
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
| | - G S Hamilton
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia; Monash University, Clayton, Victoria, Australia
| | - K K Lau
- General Medicine, Monash Health, Clayton, Victoria, Australia; Monash Imaging, Monash Health, Clayton, Victoria, Australia
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Al-Umairi RS, Al-Lawati F, Al-Busaidi FM. Nodular Pulmonary Amyloidosis Mimicking Metastatic Pulmonary Nodules: A case report and review of the literature. Sultan Qaboos Univ Med J 2018; 18:e393-e396. [PMID: 30607286 DOI: 10.18295/squmj.2018.18.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 02/19/2018] [Accepted: 04/26/2018] [Indexed: 12/13/2022] Open
Abstract
Amyloidosis is a disorder characterised by the extracellular deposition of amyloid, a fibrillary protein, in various organs such as the lungs. Pulmonary nodular amyloidosis can mimic other lung conditions that present with pulmonary nodules, such as metastasis, sarcoidosis and hyalinising granuloma. We report a 60-year-old man who presented to the Royal Hospital, Muscat, Oman, in 2017 with a history of shortness of breath upon exertion, orthopnoea and bilateral lower limb swelling. A chest X-ray showed bilateral nodular opacities. Enhanced chest computed tomography revealed bilateral pulmonary nodules with a predominantly perilymphatic and subpleural distribution, giving the impression of a neoplastic nodule. A histopathological examination of biopsied lung tissue confirmed a diagnosis of nodular pulmonary amyloidosis.
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5
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den Harder AM, Bangert F, van Hamersvelt RW, Leiner T, Milles J, Schilham AMR, Willemink MJ, de Jong PA. The Effects of Iodine Attenuation on Pulmonary Nodule Volumetry using Novel Dual-Layer Computed Tomography Reconstructions. Eur Radiol 2017; 27:5244-5251. [PMID: 28677062 PMCID: PMC5674131 DOI: 10.1007/s00330-017-4938-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the effect of iodine attenuation on pulmonary nodule volumetry using virtual non-contrast (VNC) and mono-energetic reconstructions. METHODS A consecutive series of patients who underwent a contrast-enhanced chest CT scan were included. Images were acquired on a novel dual-layer spectral CT system. Conventional reconstructions as well as VNC and mono-energetic images at different keV levels were used for nodule volumetry. RESULTS Twenty-four patients with a total of 63 nodules were included. Conventional reconstructions showed a median (interquartile range) volume and diameter of 174 (87 - 253) mm3 and 6.9 (5.4 - 9.9) mm, respectively. VNC reconstructions resulted in a significant volume reduction of 5.5% (2.6 - 11.2%; p<0.001). Mono-energetic reconstructions showed a correlation between nodule attenuation and nodule volume (Spearman correlation 0.77, (0.49 - 0.94)). Lowering the keV resulted in increased volumes while higher keV levels resulted in decreased pulmonary nodule volumes compared to conventional CT. CONCLUSIONS Novel dual-layer spectral CT offers the possibility to reconstruct VNC and mono-energetic images. Those reconstructions show that higher pulmonary nodule attenuation results in larger nodule volumes. This may explain the reported underestimation in nodule volume on non-contrast enhanced compared to contrast-enhanced acquisitions. KEY POINTS • Pulmonary nodule volumes were measured on virtual non-contrast and mono-energetic reconstructions • Mono-energetic reconstructions showed that higher attenuation results in larger volumes • This may explain the reported nodule volume underestimation on non-contrast enhanced CT • Mostly metastatic pulmonary nodules were evaluated, results might differ for benign nodules.
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Affiliation(s)
- A M den Harder
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands.
| | - F Bangert
- Department of Radiology, Sint Antonius Ziekenhuis, P.O. Box 2500, 3430EM, Nieuwegein, The Netherlands
| | - R W van Hamersvelt
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands
| | | | - A M R Schilham
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands
| | - M J Willemink
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands
| | - P A de Jong
- Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, E01.132, 3508 GA, Utrecht, The Netherlands
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Jafari M, Farrokh D, Mohammadpanah N. Multiple bilateral pulmonary nodules masquerading as pulmonary metastasis; a case of nodular sarcoidosis. Electron Physician 2016; 8:2802-2806. [PMID: 27757192 PMCID: PMC5053463 DOI: 10.19082/2802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/30/2016] [Indexed: 11/20/2022] Open
Abstract
Sarcoidosis is a multi-system inflammatory disorder of unknown etiology that is manifested by the presence of non-caseating granulomas. Multiple pulmonary nodules are rare presentations of sarcoidosis. We report a case of nodular sarcoidosis in a young male of Middle-East origin who had initially presented with bilateral painful ankle edema. His chest X-ray showed multiple bilateral pulmonary nodules. A high resolution computed tomography scan of the chest demonstrated multiple pulmonary nodular lesions and also mediastinal and hilar lymphadenopathy. Subsequent biopsies revealed non-necrotizing granuloma with multi-nucleated giant cells indicative of sarcoidosis. An appropriate work-up was done to confirm the true nature of the nodules and facilitate treatment.
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Affiliation(s)
- Mostafa Jafari
- MD, Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Donya Farrokh
- MD, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najmeh Mohammadpanah
- MD, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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7
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Bitton RC, Ramos REO, Siqueira S, Feher O. Pulmonary nodules: a challenging diagnosis during the follow up of cancer patients. Autops Case Rep 2015; 5:39-42. [PMID: 26484323 PMCID: PMC4608167 DOI: 10.4322/acr.2014.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/21/2014] [Indexed: 11/23/2022] Open
Abstract
Pulmonary nodules (PN), frequently found on imaging studies, represent a diagnostic challenge during the follow up of cancer patients. However, published data about investigation of PNs incidentally found on chest imaging is scarce. The PN may be present at the time of cancer diagnosis, or arise during the treatment or follow-up periods. In the context of the oncologic patient these lesions are quite invariably considered as metastases, what impacts directly on patients´ treatment and prognosis. The present study reports 2 cases of pulmonary nodules found in two patients already diagnosed with cancer. Case 1 referred to a woman with squamous cell carcinoma and two pulmonary nodules, and in case 2 the patient was diagnosed with duodenal adenocarcinoma. Both patients were submitted to pulmonary biopsies before the oncologic treatment. In both cases the nodules were of infectious origin, what changed significantly the neoplasia staging and the oncologic treatment intention. The authors performed a literature review as well as a discussion about the management of PN in cancer patients.
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Affiliation(s)
- Rafael Caparica Bitton
- Department of Clinical Oncology - Instituto do Câncer do Estado de São Paulo, São Paulo/SP - Brazil
| | | | - Sheila Siqueira
- Department of Pathology - Hospital das Clínicas da Universidade de São Paulo, São Paulo/SP - Brazil
| | - Olavo Feher
- Department of Clinical Oncology - Instituto do Câncer do Estado de São Paulo, São Paulo/SP - Brazil
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Koo GW, Chung SJ, Kwak JH, Oh CK, Park DW, Kwak HJ, Moon JY, Kim SH, Sohn JW, Yoon HJ, Shin DH, Park SS, Oh YH, Pyo JY, Kim TH. Intrathoracic Desmoid Tumor Presenting as Multiple Lung Nodules 13 Years after Previous Resection of Abdominal Wall Desmoid Tumor. Tuberc Respir Dis (Seoul) 2015; 78:267-71. [PMID: 26175783 PMCID: PMC4499597 DOI: 10.4046/trd.2015.78.3.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 01/30/2015] [Accepted: 02/23/2015] [Indexed: 12/04/2022] Open
Abstract
Desmoid tumors are rare soft tissue tumors considered to have locally infiltrative features without distant metastasis until now. Although they are most commonly intraabdominal, very few cases have extra-abdominal locations. The origin of intrathoracic desmoid tumors is predominantly the chest wall with occasional involvement of pleura. True intrathoracic primary desmoid tumors with no involvement of the chest wall or pleura are extremely rare. We recently experienced a case of true intrathoracic desmoid tumor presenting as multiple lung nodules at 13 years after resection of a previous intraabdominal desmoid tumor.
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Affiliation(s)
- Gun Woo Koo
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Jun Chung
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Joo Hee Kwak
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Kyo Oh
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyeon Jung Kwak
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jang Won Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Ho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Soo Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young-Ha Oh
- Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
| | - Ju Yeon Pyo
- Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Kołaczyk K, Chamier-Ciemińska K, Walecka A, Chosia M, Szydłowska I, Starczewski A, Grodzki T, Smereczyński A, Sawicki M. Pulmonary benign metastasizing leiomyoma from the uterine leiomyoma: a case report. Pol J Radiol 2015; 80:107-10. [PMID: 25774240 PMCID: PMC4345854 DOI: 10.12659/pjr.892733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 10/23/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Benign metastasizing leiomyoma (BML) is a rare condition described as multiple well-differentiated leiomyomas at sites distant from the uterus. Apart from lungs it has also been reported in lymph nodes, heart, brain, bone, skin, eye and spinal cord. We present a case of pulmonary benign metastasizing leiomyoma in a female patient admitted to our hospital with suspicion of left adnexal tumor. CASE REPORT A 45-year-old woman was referred to our hospital with suspicion of left adnexal tumor. The control transvaginal ultrasound examination performed at admission to the Gynecological Department excluded adnexal neoplasm. However, a large amount of fluid within the Douglas pouch raised the oncological concern. The patient underwent myomectomy in 2005. In the same year she was diagnosed with multiple lung nodules and underwent pulmonary wedge resection with the diagnosis of pulmonary benign metastasizing leiomyoma being stated. The decision of reevaluation of the specimen, control CT and puncture of the Douglas pouch fluid was made. Computed tomography performed at the Department of Diagnostic Imaging and Interventional Radiology of the Pomeranian Medical University Hospital revealed multiple, bilateral nodules. The microscopic examination of the samples confirmed the initial diagnosis of benign metastasizing leiomyoma with no evidence of neoplastic cells within the fluid. CONCLUSIONS Pulmonary benign metastasizing leiomyoma is a rare entity. However, it should be always taken into consideration in women with a previous or coincident history of uterine leiomyoma, especially when no evidence of other malignancy is present.
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Affiliation(s)
- Katarzyna Kołaczyk
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Chamier-Ciemińska
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Anna Walecka
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Maria Chosia
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Iwona Szydłowska
- Clinic of Gynaecology and Urogynaecology, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Starczewski
- Clinic of Gynaecology and Urogynaecology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Grodzki
- Department of Thoracic Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Smereczyński
- Self-Educational Ultrasonographic Section of Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Sawicki
- Self-Educational Ultrasonographic Section of Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
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Lalueza A, Alcalá-Galiano A. Only acute dyspnea? High-grade osteosarcoma. Eur J Intern Med 2014; 25:e85-6. [PMID: 24907920 DOI: 10.1016/j.ejim.2014.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 05/13/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Antonio Lalueza
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain; Department of Medicine, Faculty of Medicine, Universidad Complutense, Madrid, Spain.
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11
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Kang DO, Choi SI, Oh JY, Sim JK, Choi JH, Choo JY, Hwang JW, Lee SH, Lee JH, Lee KY, Shin C, Kim JH. Endometrial stromal sarcoma presented as an incidental lung mass with multiple pulmonary nodules. Tuberc Respir Dis (Seoul) 2014; 76:131-5. [PMID: 24734101 PMCID: PMC3982240 DOI: 10.4046/trd.2014.76.3.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/15/2013] [Accepted: 10/22/2013] [Indexed: 11/24/2022] Open
Abstract
Low-grade endometrial stromal sarcoma (ESS) is an uncommon gynecologic malignancy of mesodermal origin. Pulmonary metastasis of low-grade ESS can occur years and decades after the treatment of the primary disease. Low-grade ESS is frequently mistaken as benign uterine neoplasm like uterine leiomyoma, which can potentially lead to a misdiagnosis. We present a case of a 42-year-old woman with low-grade ESS, that initially presented as an incidental lung mass with multiple pulmonary nodules, seven years after an uterine myomectomy. A 6.9×5.8 cm-sized intrapelvic mass suspected of uterine origin was discovered while searching for potential extrathoracic primary origin. A pelviscopy and simultaneous thoracoscopic lung biopsy were conducted for pathologic diagnosis. Finally, the diagnosis was confirmed as low-grade ESS with lung metastasis based on the histopathologic examination with immunohistochemical stain, which was showed positive for CD10 and hormone receptor markers (estrogen and progesterone receptors) in both pelvic and lung specimens.
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Affiliation(s)
- Dong Oh Kang
- Division of Pulmonology, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sue In Choi
- Division of Pulmonology, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jee Youn Oh
- Division of Pulmonology, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Kyeom Sim
- Division of Pulmonology, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jong Hyun Choi
- Division of Pulmonology, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ji Yung Choo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jin Wook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Heon Lee
- Division of Pulmonology, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ju-Han Lee
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ki Yeol Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Chol Shin
- Division of Pulmonology, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Je Hyeong Kim
- Division of Pulmonology, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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12
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Kim YS, Lee IH, Kim HS, Jin SS, Lee JH, Kim SK, Song SH, Yoo J, Kim CH, Kwon SS. Pulmonary cryptococcosis mimicking primary lung cancer with multiple lung metastases. Tuberc Respir Dis (Seoul) 2012; 73:182-6. [PMID: 23166553 PMCID: PMC3492405 DOI: 10.4046/trd.2012.73.3.182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 08/06/2012] [Accepted: 08/30/2012] [Indexed: 12/11/2022] Open
Abstract
Cryptococcosis is an invasive fungal infection, which is more common in immunocompromised patients. However, pulmonary cryptococcosis can occur in immunocompetent patients and should be considered on a differential diagnosis for nodular or mass-like lesions in chest radiograph. Recently, we experienced a patient with pulmonary cryptococcosis, successfully treated with oral fluconazole therapy. A 74-year-old female patient was referred for an evaluation of abnormal images, a large consolidative mass with multiple nodular consolidations and small nodules that mimics primary lung cancer with multiple lung to lung metastases. Computed tomography-guided lung biopsy confirmed the diagnosis of pulmonary cryptococcosis. The follow-up image taken after 4 months with oral fluconazole treatment showed marked improvement.
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Affiliation(s)
- Yu Seung Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Kim SH, Kim TH, Sohn JW, Yoon HJ, Shin DH, Kim IS, Park SS. Primary pulmonary plasmacytoma presenting as multiple lung nodules. Korean J Intern Med 2012; 27:111-3. [PMID: 22403510 PMCID: PMC3295978 DOI: 10.3904/kjim.2012.27.1.111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/01/2009] [Accepted: 05/06/2009] [Indexed: 12/21/2022] Open
Affiliation(s)
- Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jang Won Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Ho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - In Soon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Soo Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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