Transthoracic aspiration cytology for the diagnosis of thoracic infection

The article describes the use and results of transthoracic aspiration cytology for diagnosis of thoracic infection in a Thai referral chest center. We reviewed 60 cytologic samples, initially diagnosed as thoracic infection or inflammation among a total of 532 percutaneous transthoracic needle aspirations obtained from patients with clinical suspicion of malignancy in a period of 6 years. Follow-up clinical data were collected and correlated with cytologic diagnosis. We found specific microorganisms in 8 samples (13.33%). These included 4 cases of actinomycosis, 3 cases of cryptococcosis and a case of aspergillosis. Granulomatous inflammation was found in 12 samples (20.00%). Among these patients, 10 cases were verified as having tuberculosis. The remaining 40 samples (66.67%) revealed acute inflammatory exudate with no specific microorganism. Follow-up clinical data confirmed or assumed infection in 27 cases. Therefore, in patients with thoracic infection who presented with clinical suspicion of malignancy, from our experience, aspiration cytology revealed adequate morphology for accurate diagnosis which resulted in prompt specific treatment and better prognosis.

Surgical correction of congenital vascular anomaly of left lung, anomalous systemic arterial supply to normal basal segments of left lower lobe (PALLADA): a report of eight cases

Eight cases of PALLADA were found. Preoperative diagnosis and hemodynamic confirmation were made in all cases except the first case. Surgical correction by anastomosing the abnormal artery to the existing pulmonary is recommended. Lobectomy or division of anomalous shunt is also a choice of treatment in some cases. No operative complications occurred.

Human immunodeficiency virus-related tuberculosis and primary drug resistance in Bangkok, Thailand

SETTING

Central Chest Hospital, a 500-bed referral hospital near Bangkok with a large out-patient department.

OBJECTIVES

To determine human immunodeficiency virus (HIV) seroprevalence among patients with pulmonary tuberculosis (TB), and compare HIV-positive and HIV-negative TB patients.

DESIGN

From July 1995 through June 1996, a cross-sectional study was conducted of newly registered adults (> or =16 years old) with suspected pulmonary TB.

RESULTS

Of 2587 newly registered patients with suspected pulmonary TB, 2019 (78%) received HIV pretest counseling and 1816 (90%) consented to testing. Of these, 364 (20%) were HIV-seropositive. Among 1091 patients with bacteriologically confirmed TB, HIV seroprevalence was 22%. HIV-positive patients were more likely to be young, unemployed, single men and to have a history of injection drug use. HIV-positive patients with first-episode TB were more likely to have Mycobacterium tuberculosis strains resistant to isoniazid (10.9% vs 3.5%; P < 0.001), rifampicin (9.4% vs 2.9%; P < 0.001), and at least isoniazid and rifampicin (multidrug-resistant TB [MDR-TB]; 5.2% vs 0.4%; P < 0.001).

CONCLUSIONS

HIV prevalence is high among TB patients at this Bangkok hospital and is associated with drug resistance, including a 12 times higher risk of MDR-TB. These findings underscore the urgent need to assure adherence to complete, effective TB treatment regimens for all patients, including persons who are potentially difficult to manage such as injection drug users.

Fine needle aspiration cytology of thymoma

Thymoma is the 2nd most common mediastinal tumor found in Thai people. Cytologically it has a characteristic biphasic cell pattern and can be differentiated from other mediastinal lesions. We reviewed 14 aspirated samples, initially diagnosed as thymoma among a total of 80 mediastinal aspirations, obtained during a period of 6 years. Revised cytologic diagnosis was made and compared with histopathology from needle biopsy, surgical biopsy and surgical removal in each case. All cytologic samples revealed a mixture of epithelial cells and lymphocytes in varying proportions. Histopathologic samples were available in 13 patients and showed 12 thymomas and 1 immature teratoma. While all thymomas revealed characteristic cytologic features, a case of mediastinal immature teratoma with unsatisfactory aspirated sample revealed resembling features and it was very difficult to differentiate such a tumor from thymoma.

Hughes-Stovin syndrome: a case report and review of the literature

A young man presented with prolonged pyrexia, recurrent optic neuritis, thrombophlebitis and bilateral pulmonary artery aneurysms with thrombus formation. The life-threatening hemoptysis necessitated mechanical ventilatory support and emergency left lower lobectomy. Systemic corticosteroids conferred clinical improvement and reduction of the remaining right pulmonary artery aneurysm. The patient eventually succumbed to sudden massive hemoptysis. This report underscores the unpredictable nature of this syndrome and emphasises the need for aggressive surgical intervention of pulmonary artery aneurysms in Hughes-Stovin syndrome.

Percutaneous transthoracic needle aspiration biopsy of localized lung lesions under fluoroscopic or ultrasound guidance

Diagnostic percutaneous transthoracic needle aspiration biopsy (TNAB) under fluoroscopic or ultrasound guidance was performed in 195 patients with peripheral lung lesions. Final diagnosis was confirmed in 178 cases. These consisted of 150 cases of malignant and 28 cases of non-malignant lung lesions. Most cases of the latter belonged to the infectious group. Sensitivity of TNAB in the diagnosis of malignancy and lung infections were 92.0 per cent and 62.5 per cent respectively. Needles with different sizes were used and the needle number 18G was found to obtain both cytological and histological samples and showed the highest sensitivity. Among cases that TNAB provided both types of samples, histology alone showed higher sensitivity in diagnosis than cytology alone. However, by cytological examination, malignant tumors could be interpreted for definite cell type in more cases than by histology. To reach the highest diagnostic yield, the results of both samples should be combined. We also found that the aspirated samples with solid or semisolid features were more diagnostic than those with other features. Pneumothorax, the most common complication of the TNAB procedure, was found in only 2.0 per cent of our series.

Histologic types, staging, resectability, and smoking among Thai patients with lung cancer

AIM

To examine the prevalence of cigarette smoking, histological types, staging at presentation and resectability among Thai patients with lung cancer.

SETTING

A 500-bed referral cardiothoracic centre.

METHOD

Prospective study with pre-defined outcome data, from January to December 1996.

RESULTS

A total of 349 patients were histologically proved to have lung cancer. The mean age was 60 years (SD 12.5). There were 264 males and 85 females. 269 patients (77%) were smokers. Percentage of histopathologic types were 39 per cent adenocarcinoma, 30 per cent squamous cell carcinoma, 20 per cent undifferentiated cell carcinoma, and 11 per cent small cell carcinoma. The association with smoking is stronger in squamous cell carcinoma and small cell carcinoma and weaker in adenocarcinoma. Most patients (82%) were in advanced stages, stage 3B and 4.18 per cent of the patients were in stages eligible for surgery, i.e. stage 1, 2 and 3A. However, only 9.7 per cent of the patients were operable and 9.1 per cent were resectable.

CONCLUSIONS

On reaching the diagnosis, most patients with lung cancer were in advanced stages of the disease, rendering a low resectability. The results emphasise the need for early diagnostic intervention in patients presenting with lung mass. Furthermore, preventive measures including a campaign against cigarette smoking, research into other possible aetiological factors should be more encouraged.

Intrapulmonary teratoma: a report of three cases

Three cases of intrapulmonary teratoma are described. A specific symptom of trichoptysis occurred in two patients. The other presented with only recurrent hemoptysis. All were treated by lobectomy of the affected lung. Pathologic examination in each specimen showed that the tumor had a cystic portion which was connected to the bronchial system and contained sebaceous material and pieces of hair. The solid portion consisted of tissues representing all three germ cell layers. The pathologic findings correlated well with the clinical symptoms and radiologic findings in the patients.

Solitary fibrous tumor arising from hyperplastic thymus

One case of a solitary fibrous tumor arising from the hyperplastic thymus is recorded. The patient was a 37-year-old female who presented with an anterior mediastinal mass. Thoracotomy was performed and revealed that the tumor arose on a pedicle from the posteroinferior surface of the enlarged thymus. The pathologic findings were characteristic of a solitary fibrous tumor. This is a very rare neoplasm that occurred in the mediastinum and had evidence of thymus gland in origin.

Bilateral chylothorax complicating massive osteolysis (Gorham's syndrome)

Chylothorax may rarely occur in osteolysis. A fatal case of bilateral chylothorax complicating massive osteolysis is described and the pathogenesis and management are discussed.

Salmonella lung abscess and bacteraemia in an AIDS patient

This report describes a 28-year-old, HIV-infected man presenting with subacute onset of pyrexia, cough, dyspnoea and pleuritic pain. Chest radiograph showed bilateral multiple cavitary lesions. The diagnosis of salmonellosis was secured by isolation of salmonella typhimurium in blood, as well as in sputum. Therapy with sequential ceftriaxone/ciprofloxacin led to satisfactory improvement symptomatically and radiologically. The present report serves to heighten the awareness of AIDS-associated salmonella bacteremia and lung abscesses.

Pleomorphic lipoma in the middle mediastinum

Mediastinal pleomorphic lipoma was found in a 63-year-old Thai male who presented with problems of chronic cough, dyspnea and dysphagia for 1 year. CT and MRI studies revealed a well-circumscribed mass in the middle mediastinum. Thoracotomy was performed and excision of the tumor was done completely. The pathological features of the tumor were typical of pleomorphic lipoma. While lipomas are common tumors in the mediastinum, liposarcomas are rare and there has been no reported case of mediastinal pleomorphic lipoma before. Differential diagnosis of liposarcoma was very important in this case due to different clinical courses and prognoses.

Clinical aspects and treatment outcome in HIV-associated pulmonary tuberculosis: an experience from a Thai referral centre

This case-control study examined the impact of HIV infection on clinical presentation, response to treatment, and outcome of pulmonary tuberculosis. Symptoms, radiographic pattern, sputum direct smear, drug susceptibility, treatment outcome and adverse reactions of 88 HIV-infected patients with newly-diagnosed, culture-proved, untreated pulmonary tuberculosis were compared with those of age and gender-matched HIV-seronegative patients. No differences in the frequency of pyrexia, dyspnoea, cough or haemoptysis were evident. Cavitary lesions and upper zone infiltrates were observed significantly less often in the HIV-infected group (p = 0.02 and 0.01, respectively). Direct smear positivity was comparable in the 2 groups. The resistance rates to antituberculous drugs were not different except for Streptomycin which was higher among the HIV-infected patients (p = 0.01). Cutaneous hypersensitivity reactions and drug-induced hepatitis occurred more often in the HIV-seropositive group, albeit not reaching statistical significance. Default was much higher in the HIV-infected patients (33%); however, the culture conversion rate was satisfactory among those completed treatment. Twelve HIV-infected patients died during the course of treatment, four of whom as a result of tuberculosis. Based on these observations, physicians should maintain a high index of suspicion for tuberculosis among HIV-seropositive patients for short-course chemotherapy to be promptly instituted.