Apical Mass Research Articles

A CASE OF SCHWANNOMA OF THE BRACHIAL PLEXUS WITH INTRATHORACIC EXTENSION CAUSING FRACTURE OF THE RIB

A case of Schwannoma of the left brachial plexus that extended into the thoracic cavity and caused fracture of the left first rib is presented. A 33-year-old woman suffered from a sudden onset of left shoulder pain at coughing. Chest X-ray film revealed fracture of the left first rib and a left apical mass. The tumor was subcapsularly resected with thoracoscopic surgery. The resected tumor was Schwannoma arisen from the brachial plexus of nerve trunk. After the operation, the patient developed a mild motor inpairment of the muscles controlled by median and ulnar nerve. This postoperative neurological problem was improved in 6 months. It should be kept in mind that tumors arising in the brachial plexus are a probable differential diagnosis for tumors at the pulmonary apex, even if no neurological symptoms are seen in the upper extremities.

Syndrome de Pancoast-Tobias révélant un lymphome non hodgkinien pulmonaire primitif

Pancoast's syndrome is generally due to superior sulcus tumors, generally bronchial cancer. In rare cases, other causes are found, but these are potentially curable. A 78-year old woman with a long history of tobacco intake presented with Pancoast's syndrome in the form of a locally invasive left apical lung mass. Despite her advanced age and the diagnosis of the high probability of lung cancer, a transparietal biopsy procedure was nevertheless performed, with the subsequent diagnosis of primary malignant pulmonary lymphoma. The patient was satisfactorily treated by combined chemotherapy. The present study has shown that malignant non-Hodgkin lymphomas should be considered in the etiology of the disease, and as a rare but potentially treatable cause of Pancoast's syndrome.

Síndrome de Pancoast secundario a metástasis cervical con radiografía de tórax normal

Pancoast's syndrome is characterized by pain in the shoulders and upper extremities, Horner's syndrome, bone loss and hand muscle atrophy. Bronchogenic carcinoma is the most common cause, although other neoplasms or lung infection are occasionally responsible. An apical mass on the chest film can be seen in over 90% of cases, although apical pleural thickening is sometimes the only radiographic finding. We describe a patient whose clinical picture was highly suggestive of Pancoast's syndrome but whose chest film was normal. Magnetic resonance imaging disclosed a cervical mass adjacent to the brachial plexus that proved to be cervical metastasis from an unknown primary tumor. We emphasize the need to consider the possibility of a metastatic cervical tumor compromising the brachial plexus in patients with a normal chest X-ray but clinical signs highly suggestive of Pancoast's syndrome.

Apical pleural mass developing following talc pleurodesis

Apical pleural mass developing following talc pleurodesis

Anomalously placed papillary muscle masquerading as a left ventricular apical mass

A 63-year-old man was seen with a history of nonfluent dysphasia and headaches. His blood tested positive for anticardiolipin antibodies. Transthoracic echocardiography showed a mass in the left ventricular apex. The transgastric five-chamber view identified this mass as an anomalously placed papillary muscle. In the presence of an apical mass, if the transthoracic echocardiogram is equivocal, a transesophageal echocardiogram, using the transgastric five-chamber view may be helpful in making the correct diagnosis. (J Am Soc Echocardiogr 1997;10:228–30.)

Reply to "Comment on 'Observation of a possible oxygen isotope effect on the effective mass of carriers in YBa2Cu3O6.94' "

In our recent paper [Zhao and Morris, Phys. Rev. B 51, 16 487 (1995)], we reported experiments which showed that there is a substantial oxygen isotope effect on the effective mass of supercarriers ${m}^{*}$, but negligible effect on the supercarrier density ${n}_{s}$ in the optimally doped Y${\mathrm{Ba}}_{2}$${\mathrm{Cu}}_{3}$${\mathrm{O}}_{6.94}$. This is in contradiction with a model for the isotope effect proposed by Kresin and Wolf [Phys. Rev. B 49, 2652 (1994)], in which ${n}_{s}$ (and thereby the penetration depth) would depend on the apical oxygen mass. In any event, their model has been ruled out by our subsequent measurements of the site-selective oxygen isotope effect in the underdoped ${\mathrm{Y}}_{0.7}{\mathrm{Pr}}_{0.3}{\mathrm{Ba}}_{2}{\mathrm{Cu}}_{3}{\mathrm{O}}_{7\ensuremath{-}y}$ [Guo-meng Zhao et al., Phys. Rev. B 54, 14 982 (1996)], which showed that the large isotope shift is caused by Cu${\mathrm{O}}_{2}$ plane oxygen mass and is independent of apical oxygen mass. Further evidence also comes from our recent observation of a large Cu isotope effect in oxygen-depleted (underdoped) Y${\mathrm{Ba}}_{2}$${\mathrm{Cu}}_{3}$${\mathrm{O}}_{6.6}$ [Guo-meng Zhao et al., Phys. Rev. B 54, 14 956 (1996)].

Microanatomy of secretory granule release from guinea pig tracheal goblet cells.

The microanatomy of mucin granule release from epithelial goblet cells has been investigated in guinea pig tracheae. Using a tannic acid arrest procedure, granule release under basal conditions and after high K+ or acetylcholine (ACh) application was arrested and a variety of granule fusion sites were identified in ultrathin sections and freeze-fracture replicas. Rather than there being subclasses of secretory cells containing either electron-lucent granules (indicative of mucin) or smaller electron-dense (serous) granules, the majority of secretory cells in both control and treated groups contained granules with an electrondense core surrounded by an electron-lucent region. Granule release sites were of three principal types: (1) simple exocytosis, where the membranes of single granules fused directly with the plasma membrane to give an "omega" profile; (2) compound exocytosis, where granule membranes, fused together intracellularly, were found in continuity with the plasma membrane; and (3) apocrine-like secretion, which involved the loss of the central apical mass of granules together with elements of the cell cytoplasm. In treated preparations, there was an increase in the number of cells exhibiting fusion sites; the percentage showing simple fusions fell from 82% to 59% (with ACh) and 57% (with KCl), whereas the percentage of cells exhibiting compound and apocrine-like secretion increased. Dense cores were frequently retained at the sites of fusion and, despite the expansive decondensation of mucin known to occur, there was also evidence of some retention of the electron-lucent material.

Cardiac fibroma mimicking apical hypertrophic cardiomyopathy: A case report and differential diagnosis

A 55-year-old man was seen with palpitations, dyspnea, syncope, and a large apical left ventricular mass. A diagnosis of apical hypertrophic cardiomyopathy had been made by cardiac catheterization 10 years previously. Transthoracic echocardiography performed during the current evaluation, however, was suggestive of a primary cardiac tumor. At operation, a large fibroma was excised. Knowledge of the echocardiographic appearance of apical left ventricular abnormalities can be helpful in determining the most appropriate choice of therapy.

Root Rot of Melon Caused by Nodulisporium melonis in Japan. 2. Idintification.

Nodulisporium melonis sp. nov., the causal fungus of root rot of melon in Japan is described and illustrated. Colonies of this fungus on PDA are white and homogeneous, subhyaline, cream to pale brown in reverse. The conidiophores are erect, hyaline, simple or branched verticillately or irregularly, 45-280×1.2-2.3μm, bearing single conidia or apical spore masses, 2-9 conidia per head on apical fertile portions, denticulate after detachment of conidia, often proliferated from conidia on conidiophores. Conidia are single, in short chains or aggregated, sympodulosporous, acropleurogenous, hyaline, 1-celled, obovoid, cylindrical, elliptical or irregular in shape, 2.5-13.8×1.2-3.0μm (5.9×2.5μm) with basal frill or cylindrical appendix, 3.0-10.0×0.4-1.0μm.

The PsB glycoprotein complex is secreted as a preassembled precursor of the spore coat in Dictyostelium discoideum

The PsB glycoprotein in Dictyostelium discoideum is one of a diverse group of developmentally regulated, prespore-cell-specific proteins, that contain a common O-linked oligosaccharide. This post-translational modification is dependent on the wild-type modB allele. The PsB protein exists as part of a multiprotein complex of six different proteins, which have different post-translational modifications and are held together by both covalent and non-covalent interactions (Watson et al. (1993). J. Biol. Chem. 268, 22634-22641). In this study we have used microscopic and biochemical analyses to examine the cellular localization and function of the PsB complex during development. We found that the PsB complex first accumulates in prespore vesicles in slug cells and is secreted later during culmination and becomes localized to both the extracellular matrix of the apical spore mass of mature fruiting bodies and to the inner layer of the spore coat. The PsB associated with the spore coat is covalently bound by disulfide bridges. The PsB protein always exists in a multiprotein complex, but the composition of the PsB complex changes during secretion and spore maturation. Some of the PsB complex proteins have been identified as spore coat proteins. These data demonstrate that some of the proteins that form the spore coat exist as a preassembled precursor complex. The PsB complex is secreted in a developmentally regulated manner during the process of spore differentiation, at which time proteins of the complex, as well as additional spore coat proteins, become covalently associated in at least two forms of extracellular matrix: the interspore matrix and the spore coat. These and other studies show that proteins with modB dependent O-linked oligosaccharides are involved in a wide variety of processes underlying morphogenesis in this organism. These developmental processes are the direct result of cellular mechanisms regulating protein targeting, assembly and secretion, and the assembly of specific extracellular matrices.

Myositis Ossificans Masquerading as a Recurrent Spindle Cell Lipoma of the Orbit

A spindle cell lipoma developed in the right orbit of a 43-year-old woman whose medical history was only significant for chronic asthma. Sixteen months after nearly complete excision of the tumor, the patient presented with eyelid swelling, orbital pain, and a calcified apical mass as demonstrated by computerized tomography (CT). Recurrent tumor or a second neoplasm was suspected. Histologic examination revealed myositis ossificans. To our knowledge, this is the first reported case of myositis ossificans in the orbit.

From Swirling to a Mobile, Pedunculated Mass—The Evolution of Left Ventricular Thrombus Despite Full Anticoagulation: Echocardiographic Demonstration

We describe the unusual evolution of a left ventricular thrombus following acute anterior myocardial infarction despite adequate anticoagulation. Serial echocardiographic examinations demonstrated the evolution from swirling in the left ventricle through a solid apical mass gradually dislodging into a mobile, pedunculated mass that was removed surgically to prevent embolization. This report emphasizes the need to follow echocardiographically left ventricular thrombi during treatment with anticoagulants, and to identify morphologic changes that may predict embolization. This case suggests that left ventricular thrombectomy should be considered in selected patients in whom a very high-risk thrombus morphology is detected.

Schwannoma of the brachial plexus mimicking an apical lung tumor

Primary tumors of the brachial plexus are unusual. We describe a patient with a large schwannoma of the lower trunk of the brachial plexus that had the radiologic appearance of an apical lung mass. Use of a posterior subscapular approach as well as intraoperative nerve action potential recording permitted resection with spared function.

Cytoskeleton of intestinal goblet cells: role of microtubules in baseline secretion

To determine the involvement of microtubules (MTs) in granule translocation, autoradiographic analysis of maximal granule movement in the absence or presence of MT inhibitors was performed. Rabbit colonic mucosal explants were pulse-labeled with [3H]glucosamine for 30 min in organ culture, then maintained on nonradioactive medium for 1-6 h. Radio-labeled mucin granules appear in the apical granule mass in 1-2 h, then they migrate to the apical plasma membrane, with a total transit time of 4-6 h. Mucosal explants were treated with either nocodazole or taxol for 30 min, pulse-labeled for 30 min, then maintained in organ culture with the same drug for up to 6 h. Nocodazole binds tubulin, preventing polymerization. In response, granule movement out of the supranuclear region and along the apical granule mass is significantly impeded. Taxol stabilizes MTs, preventing depolymerization. In response, supranuclear MTs are misoriented, but thecal MTs maintain normal orientation. Taxol treatment impedes granule migration out of the supranuclear region of the cell but not migration along the theca. These data suggest that the organization of MTs dictate the spatial organization of the baseline secretory pathway. Microtubules are necessary for granule translocation by providing directed tracks for granule movement, but microtubule dynamics are not the motile mechanism transporting mucin granules to the apical plasma membrane for secretion.

Optic Nerve Hemangioblastoma

A solitary hemangioblastoma of the optic nerve was found in a 36-year-old male with a distinct family history of intracranial hemangioblastoma. The patient was admitted with complaints of visual loss and exophthalmos of the right eye. X-rays showed enlargement of the right optic canal. Right carotid angiography revealed a hypervascular tumor in the orbital apex, supplied by the ophthalmic artery. Computed tomography disclosed a pear-shaped, isodense mass with moderate contrast enhancement in the orbital apex. The right optic nerve was enlarged along its entire course and was involved with the apical mass. Surgery via the right frontal extradural approach disclosed a solid, vascular tumor involving the optic nerve at the apex of the orbit. Histological examination showed the tumor to be a characteristic hemangioblastoma. Over 90% of intracranial hemangioblastomas are located in the posterior fossa. Supratentorial hemangioblastomas, especially those arising in the optic nerve, are extremely rare. In addition, optic nerve hemangioblastomas are frequently familial and are associated with infratentorial hemangioblastomas, angiomatosis retinae, and cysts of the abdominal viscera.

Clinical manifestations of intrathoracic cutaneous T-cell lymphoma.

Intrathoracic involvement with cutaneous T-cell lymphoma (CTCL) was documented in eight patients with mycosis fungoides and two patients with Sĕzary syndrome. The radiographic findings consisted of multiple bilateral parenchymal nodular densities (five patients), patchy areas of consolidation (two patients), diffuse reticulonodular or interstitial infiltration (two patients), and pleural effusion without underlying parenchymal disease (one patient). Dyspnea on exertion and nonproductive cough were the most frequent presenting symptoms, and physical examination of the lungs was usually normal. In one patient a partial Pancoast's syndrome developed from a pulmonary apical mass. Results of blood gas studies and pulmonary function tests indicated an alveolar-capillary block in gas diffusion. Although the antemortem diagnosis was often suggested on cytopathologic preparations or on tissue obtained by transbronchial or percutaneous needle aspiration biopsy, a definitive diagnosis of CTCL usually required an open-lung biopsy. The response of pulmonary infiltrates to various systemic chemotherapeutic agents was variable, and the mean survival after initiation of drug therapy was 9.5 months. The findings suggest that combined modality therapy should be considered for patients with extracutaneous CTCL.

Left ventricular apical masses: Noninvasive differentiation of rare from common ones

Left ventricular apical masses: Noninvasive differentiation of rare from common ones

Dynamic approach to transurethral resection of large prostate adenoma

Since it is not how much tissue is removed but rather how much is left behind that attests to the quality of a TURP, an explanation of four common complications is offered hoping that with this increased understanding the resectionist will be more comfortable with the procedure and undertake careful resection of larger prostate glands. The following guidelines are offered: (1) allow time after the initial resection of easily reached adenoma for the delivery by the contracting capsule of the peripheral adenoma and the apical masses. One can always return to these areas for further rapid resection. (2) Do not resect within 0.5 or 1.0 cm of the bladder neck until the very end of the procedure. This will minimize the undermining of the vesical neck and the “climbing” of the trigone. It will also allow for the preservation of vesicle mucosa up to or over the bladder neck thus lessening the chance of later contracture at this site. (3) Do not resect the juxta capsular adenoma in the “levator ani area” until near the end of the procedure.

Cytoskeleton of intestinal goblet cells in rabbit and monkey: The theca

The infrastructure and function of the cytoskeleton in intestinal goblet cells was investigated in colonic mucosa from rabbits and monkeys. This exocrine cell is unusual in that its secretory granules are stored as a compact apical mass limited by a dense, cup-shaped layer of cytoplasm called the “theca”. Ultrastructural analysis of this cytoplasmic layer in rabbit goblet cells permeabilized with Triton X-100, treated with S4 fragments of heavy meromyosin, and fixed in the presense of tannic acid revealed that it contains an orderly arrangement of microtubules and intermediate filaments, but no detectable actin filaments. Microtubules are arranged vertically, like barrel staves, along the inner aspect of the theca. Intermediate filaments are arranged in two contiguous layers: an inner, basketlike network and an outer series of circumferential bundles resembling the hoops of a barrel. Autoradiography of [3H]glucosamine-labeled human and rabbit cells maintained in organ culture without secretagogues had provided preliminary data suggesting that labeled secretory granules migrate preferentially along the periphery of the apical granule mass, adjacent to the theca, toward the luminal cell surface. In this study, we confirm this observation and show that colchicine inhibits this movement. Cholinergic secretagogues induce rapid release of mucin by compound exocytosis of the granules stored in the theca. This secretory activity is not inhibited by colchicine, presumably because it does not require granule movement. The cuplike shape of the theca is unaltered during rapid release of stored granules. Because the shape is unaltered after 6 h of colchicine treatment, it appears to be maintained by the intermediate filament layers.

Computed-tomographic-guided biopsy of small apical and peripheral upper-lobe lung masses.

After undergoing unsuccessful bronchoscopic and fluoroscopic biopsy attempts, 15 patients with small, peripheral upper-lobe and apical lung masses underwent computed-tomographic-guided biopsy. Malignant tissue was obtained in all cases. No complications resulted.