Internal Nodule Research Articles

A Schizophyllum commune fungus ball in a lung cancer cavity: a case report

BackgroundSchizophyllum commune is a basidiomycete that lives in the environment and can cause infections, mainly those of the respiratory system. Although S. commune is increasingly reported as a cause of allergic bronchopulmonary mycosis and sinusitis, cases of fungal ball formation are extremely uncommon. Identification of S. commune is difficult using routine mycological diagnostic methods, and in clinically suspicious cases, internal transcribed spacer sequencing should be used for diagnosis. Here, we report a first case of lung cancer with a fungal ball formation of S. commune, confirmed by analyzing the internal transcribed spacer.Case presentationA 76-year-old man with diabetes and hypertension was admitted to the hospital with a chief complaint of hemosputum, which he had for about 19 months. A computed tomography image of the patient’s chest showed a cavity and internal nodule in the left upper lobe of his lung. A left upper lobectomy was performed, and histopathological examination revealed squamous cell carcinoma of the lung and a fungal ball. The isolate from the surgical specimen was identified as S. commune by analyzing the internal transcribed spacer. The patient had no recurrence of the infection during 5 months of follow-up.ConclusionsOnly three cases of lung fungal balls caused by S. commune have been previously reported, and this is the first case of lung cancer cavity with a fungal ball formation. In cases of fungal ball formation in the lung, S. commune should be considered a possible causative microorganism.

A Pilot Study to Estimate the Impact of High Matrix Image Reconstruction on Chest Computed Tomography

Objectives:The objectives of the study were to estimate the impact of high matrix image reconstruction on chest computed tomography (CT) compared to standard image reconstruction.Material and Methods:This retrospective study included patients with interstitial or parenchymal lung disease, airway disease, and pulmonary nodules who underwent chest CT. Chest CT images were reconstructed using high matrix (1024 × 1024) or standard matrix (512 × 512), with all other parameters matched. Two radiologists, blinded to reconstruction technique, independently examined each lung, viewing image sets side by side and rating the conspicuity of imaging findings using a 5-point relative conspicuity scale. The presence of pulmonary nodules and confidence in classification of internal attenuation was also graded. Overall image quality and subjective noise/artifacts were assessed.Results:Thirty-four patients with 68 lungs were evaluated. Relative conspicuity scores were significantly higher using high matrix image reconstruction for all imaging findings indicative of idiopathic lung fibrosis (peripheral airway visualization, interlobular septal thickening, intralobular reticular opacity, and end-stage fibrotic change; P ≤ 0.001) along with emphysema, mosaic attenuation, and fourth order bronchi for both readers (P ≤ 0.001). High matrix reconstruction did not improve confidence in the presence or classification of internal nodule attenuation for either reader. Overall image quality was increased but not subjective noise/artifacts with high matrix image reconstruction for both readers (P < 0.001).Conclusion:High matrix image reconstruction significantly improves the conspicuity of imaging findings reflecting interstitial lung disease and may be useful for diagnosis or treatment response assessment.

Novel digital assessment technique used to describe peanut nodulation life history

Biological nitrogen fixation (BNF) in legume root nodules is an important source of N globally. Typically, the quantification of BNF is an estimate of N fixation through techniques such as an acetylene reduction assay or isotopic signatures. However, these methods have large logistical limitations, and do not allow for assessments of the nodule morphology or the nodulation process itself, knowledge that is important to fully understand the BNF process. To provide an updated method of nodulation assessments, peanut (Arachis hypogaea L.) nodules were sampled from a two-year field trial and quantified using scanned images of excised nodules, allowing digital assessment of nodule number and size. Further, a digital color analysis method was developed to assess internal nodule color (a known proxy for nodule BNF activity and senescence). To apply and evaluate the new method, peanut nodulation trait data was used for an exploration of the relationship between nodulation traits, plant physiological processes, and nitrogen status in the plant, followed by a nodulation life history analysis. The nodulation assessment method was confirmed by strong correlation with measures of peanut tissue N, biomass, photosynthetic function, and yield. Nodulation life history data suggest novel findings regarding differences in the development of nodules between taproots and lateral roots, contrary to the previous understanding of peanut nodulation life history. This new nodulation assessment method can provide further insight into the BNF process by allowing the collection of detailed data in a relatively simplified manner in field conditions.

Ultrasonic Characteristics of Medullary Thyroid Carcinoma: Differential From Papillary Thyroid Carcinoma and Benign Thyroid Nodule.

The aim of this study was to evaluate the differences in ultrasonic features of patients with medullary thyroid carcinoma (MTC), papillary thyroid carcinoma (PTC), and benign thyroid nodules. This study included 53 cases of MTC, 151 cases of PTC, and 200 cases of benign thyroid nodule which were pathologically confirmed. There were no significant differences in sex and thyroid gland involvement among the MTC, PTC, and benign thyroid nodule groups. The age among the 3 groups was statistically different (P = 0.002). The TNM stage of MTC was significantly higher than that of PTC (P < 0.001). Compared with PTC, the lesion size, shape, margin, echogenicity, internal nodule component, and blood flow were significantly different in MTC (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P = 0.045, P < 0.001). However, there were no differences in the form of calcification and cervical lymph node involvement between the 2 groups (P = 0.671, P = 0.128). Except for the lesion size and shape (P = 0.068, P = 0.444), MTC group have significant differences in the grade of Thyroid Imaging Reporting and Data System, lesion margin, echogenicity, internal nodule component, calcification, cervical lymph node, and blood flow compared with benign thyroid nodule group (P < 0.001, P = 0.014, P = 0.032, P < 0.001, P < 0.001, P < 0.001). Our data indicate that ultrasound have important value in preoperative diagnosis of MTC. The ultrasonic features of MTC include relatively large nodules, aspect ratio less than 1, smooth edge, solid hypoechoic, microcalcification, and rich blood flow. It is necessary to combine multiple ultrasonic features for the differential diagnosis of MTC, PTC, and benign thyroid nodules.

Analysis of breast nodule vascularity as a predictive factor for malignancy

Introduction: Ultrasound is considered the main complementary diagnostic method to mammography in screening malignant breast nodules. The fifth edition of the BI-RADS® classification suggests analyzing nodule vascularity and the resistance index (RI) during the ultrasound. However, they are still not considered a decisive factor for the final classification. Objectives: To evaluate if the vascularity of breast nodules is a predictive factor for malignancy, and identify the RI value of the vessel most associated with malignant results. Methodology: This retrospective cross-sectional study assessed 750 ultrasound-guided breast biopsies performed at the Mastology Outpatient Clinic of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) from August 2015 to May 2017. The variables analyzed included examination date, ultrasound BI-RADS® category, internal nodule vascularity, RI value, and biopsy result. Exams from patients with no breast nodule were excluded. The statistical analysis was performed using Pearson's X² test. Results: The presence of vessels inside the nodule was highly associated with malignancy (OR=7.2, p&lt;0.0001) and also with BI-RADS® categories of greater risk (p&lt;0.0001). The median RI was 0.7 (interquartile range – IQR=0.23) in benign nodules with vessel and 0.86 (IQR=0.23) in malignant ones, with statistical significance (p&lt;0.0001). The RI cut-off point to predict malignancy was 0.71 with 83.8% accuracy, 91.9% sensitivity, and 57% specificity (according to the Receiver Operating Characteristic – ROC – curve). Nodules initially classified as 4A but with internal vascularity and high resistance (RI&gt;0.71) proved to be malignant in the biopsy in 35.7% of cases, that is, much higher than expected for the category (2% to 10%). Similarly, 72% of nodules initially classified as 4B but with internal vascularity and high resistance were malignant. On the other hand, 18.4% of nodules classified as 4C but without internal vascularity had malignancy confirmed by biopsy, far below the expected for the category (50% to 95%). Conclusion: The presence of internal vascularity and the RI were important factors for differentiating benign nodules from malignant ones on ultrasound, and in images classified as BI-RADS® 4, this information can be essential when dividing these nodules into subcategories (4A, 4B, and 4C).

Three new species of Fallacia from intertidal sediments in Japan

Three new species of Fallacia, F. miyajimensis sp. nov., F. nodulifera sp. nov., and F. similigemmifera sp. nov. are described from intertidal sediments in Japan. Their morphologies are studied with light, scanning and transmission electron microscopy. Fallacia miyajimensis differs from congeners in the presence of an apical pore, a finely porous conopeum possessing finger-shaped extensions with uniseriate rows of pores and a thick layer adjacent to the raphe with isolated depressions with small pores inside. Fallacia nodulifera differs from congeners in the presence of a unique asymmetric internal central nodule. It can also be distinguished by the combination of stria density, conopeum with short extensions, and centrally convex lateral sterna. Fallacia similigemmifera differs from congeners by its lanceolate valve outline, more or less straight, distinct lateral areas and the presence of a rectelevatum on internal central nodule. We suggest that the structural combination of the structure of the conopeum and the lateral sterna is a stable feature in species discrimination and could be used to define species groups. The cingulum of F. similigemmifera comprises a wide open valvocopula and two linear bands with different ligulae. This type of cingulum structure is also present in F. tenera, F. hodgeana, and probably in F. litoricola and F. fracta as well, and likely occurs commonly in Fallacia.

The symbiotic role of the actin filament cytoskeleton.

This article is a Commentary on Zhang et al., 221: 1049–1059.

Clear Cell Hidradenoma: Characteristic Imaging Features on Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging.

The purpose of this study was to evaluate the imaging features of clear cell hidradenoma on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The radiologic and pathologic databases at 2 medical institutions were searched retrospectively from 2004 to 2016 to identify patients with a diagnosis of clear cell hidradenoma. Ultrasonographic, CT, and MRI features were described, and pathologic specimens were reviewed. There were 5 female and 4 male patients. The mean patient age was 48.9 years (range, 28-70 years). Five patients underwent only US; 2 patients underwent only CT; 1 patient underwent both US and CT; and 1 patient underwent US and MRI. Most of the tumors were located primarily in the subcutaneous fat layer. The mean tumor size was 18.4 mm. On US, 6 masses had a heterogeneous echo texture, including an anechoic portion with protruding echogenic portions. Two masses had multiple septa in the anechoic portion. On color Doppler US, blood flow was both central and peripheral in 5 patients. All 3 cases seen on CT presented as a low-attenuation mass with an enhanced solid internal nodule. On MRI, the mass showed heterogeneous signal intensity on T2-weighted images and enhancement of the peripheral wall and internal solid component on contrast-enhanced T1-weighted images. Clear cell hidradenoma is usually located in the subcutaneous fat layer, has a well-defined margin, appears as a cystic mass with an internal solid nodule, and occasionally has multiple septa on US, CT, and MRI.

Pancreatic cystic tumors evaluated by endoscopic ultrasound: Is it multifocal disease?

Background and Objectives:Pancreatic cystic tumors are detected with increasing frequency globally. One large cross-sectional imaging study showed a prevalence of 25.5% for multifocal cystic tumors. A surgical series showed that single cysts within multifocal disease exhibit independent behavior in molecular and histological analyses. Our study describes the endoscopic ultrasound (EUS) appearance and prevalence of cystic tumors in multifocal disease, which has not previously been studied.Methods:We report a retrospective analysis of 545 consecutive patients with pancreatic cystic lesions who underwent EUS from January 2010 to July 2015. The patient demographics were 63% females and 37% males, mean age of 67 years, range 21–94.Results:On initial EUS, 315 (58%) of 545 patients had single lesions. 100 (32%) of 315 patients with single lesions had EUS follow-up, and the 11 patients who later developed multifocal disease were not included in our analyses. 230 (42%) of 545 had multiple cystic lesions on initial EUS and comprised our primary analysis. These patients (mean age 71.3) were significantly older (P < 0.05) than patients with single lesions (mean age 64.3). Of the 230 patients with multiple cystic tumors on initial EUS, 145 (63%) were women and 85 (37%) were men. Before EUS, computed tomography (CT) imaging only detected multiple cystic lesions in 16 (7%) of these patients in whom multiple lesions were later diagnosed on EUS. 83 (36%) of patients with multifocal disease had both simple and multilobulated cysts. 154 (67%) of patients with multifocal disease had cysts scattered throughout both the proximal region (uncinate, head, and neck) as well as in the distal region (body/tail) of the pancreas. 34 (15%) of patients with multifocal disease had solid internal nodules.Conclusion:Multifocal disease was seen in 42% of patients with cystic tumors evaluated by EUS, due to the increased sensitivity of EUS compared to CT. As cystic tumors are more common in females, multiple cystic tumors are also more common in female patients. The cystic lesions were both complex and simple in appearance on EUS in these patients, with 15% having a solid internal nodule, which has a predisposition for malignancy. As the majority of these patients had cystic lesions scattered throughout the pancreas, we recommend a complete pancreatic examination when performing EUS for pancreatic cysts detected on CT.

Legume nodules from nutrient-poor soils exhibit high plasticity of cellular phosphorus recycling and conservation during variable phosphorus supply

Nitrogen fixing legumes rely on phosphorus for nodule formation, nodule function and the energy costs of fixation. Phosphorus is however very limited in soils, especially in ancient sandstone-derived soils such as those in the Cape Floristic Region of South Africa. Plants growing in such areas have evolved the ability to tolerate phosphorus stress by eliciting an array of physiological and biochemical responses. In this study we investigated the effects of phosphorus limitation on N2 fixation and phosphorus recycling in the nodules of Virgilia divaricata (Adamson), a legume native to the Cape Floristic Region. In particular, we focused on nutrient acquisition efficiencies, phosphorus fractions and the exudation and accumulation of phosphatases. Our finding indicate that during low phosphorus supply, V. divaricata internally recycles phosphorus and has a lower uptake rate of phosphorus, as well as lower levels adenylates but greater levels of phosphohydrolase exudation suggesting it engages in recycling internal nodule phosphorus pools and making use of alternate bypass routes in order to conserve phosphorus.

Eccrine Acrospiroma of Inguinal Area

Eccrine acrospiroma is a tumor originating from the sweat glands. The computed tomography findings of eccrine acrospiroma in the right inguinal area are presented. In our case, the tumor was seen as a well-defined and ovoid-shaped cystic mass with an internal enhancing solid portion and containing calcifications. Eccrine acrospiroma should be considered in the differential diagnosis of a subcutaneous cystic mass with an internal solid nodule.

Analysis of a new combined stretch and pressure sensor for internal nodule palpation

In clinical practice doctors routinely palpate the patient's body with the fingers and palm to determine the condition of the parts beneath the skin surface. Detection of indwelling lumps and smaller nodules is an important consequence of such examination by touch. However, clinical palpation is frequently unable to detect the presence of nodules with sufficient clarity. Thus, there is a need for a sensor that can transduce the perception of a nodule with enhanced sensitivity. Deformable force-stretch array (DFSA) is a new sensor form proposed for indwelling nodule detection. The DFSA sensor combines an array of linearly deforming tactels with length change transducing stretch elements connecting the tactel tips. Biomechanical analysis of a human body palpation model comprising of the DFSA pressed upon a homogenous elastic slab containing a hard nodule has been performed. Body elasticity independent parameters strain index (SI) and bulge index (BI) have been formulated. From the SI and BI values, which are obtained from the measured values of tactel strain and stretch element length change, and a nomogram the nodule size and depth are derived. The results show that the sensor enables the identification of relatively small and deep-seated nodules. A variable elasticity body simulator has been used for experimental validation of the theoretical results.

Effect of Increases in Oxygen Concentration during the Argon-Induced Decline in Nitrogenase Activity in Root Nodules of Soybean

When intact nodulated roots of soybean (Glycine max L. Merr. nodulated with Bradyrhizobium japonicum strain USDA 16) were exposed to an atmosphere lacking N(2) gas (Ar:O(2) 80:20), total nitrogenase activity (measured as H(2) evolution) and respiration (CO(2) evolution) declined with time of exposure. In Ar-inhibited nodules, when the O(2) concentration in the rhizosphere was increased in a linear ;ramp' of 2.7% per minute, 93% of the original H(2) evolution and 99% of the CO(2) evolution could be recovered. The internal nodule O(2) concentration (estimated from leghemoglobin oxygenation) declined to 56% of its initial value after 60 minutes of Ar:O(2) exposure and could be partially recovered by the linear increases in O(2) concentration. Nodule gas permeability, as estimated from the lag in ethylene production following exposure of nodules to acetylene, decreased to 26% of its initial value during the Ar-induced decline. Collectively, the results provide direct evidence that the Ar-induced decline results from decreased nodule gas permeability and indicate that the decline in permeability, rather than being immediate, occurs gradually over the period of Ar:O(2) exposure.

Carbonate Nodule Growth on Florida's Outer Shelf and Its Implications for Fossil Interpretations

The use of carbonate nodules as paleoenvironmental indicators is generally based on examples of modern nodule growth. Although nodules are found in both shallowand deep-water environments, research on their composition, formation, and depositional setting has been limited almost exclusively to shallow depths. The lack of deep-water studies results primarily from the logistical difficulties associated with research below 20-30 m. Consequently, interpretation offossil deposits containing carbonate nodules may be biased by our lack of knowledge regarding nodule formation in relatively deep-water habitats. Recent observations of carbonate nodule growth on Florida's outer shelf reveal the processes by which carbonate nodules may form in a relatively deep (35-65 m), quiet-water setting. Observations in situ and examinations of internal nodule structure indicate that encrusting organisms-primarily the foraminifera, Gypsina vesicularis, and various coralline algae genera-grow on a nodule's upper as well as lower surfaces. Nodule formation may therefore be facilitated by slight repositioning rather than complete overturning. On Florida's outer shelf, repositioning of nodules occurs (1) frequently as a result of intense biologic activity at the sea floor, and (2) infrequently as a consequence of physical transport during hurricane-strength storms or periodic surge events. These findings suggest that in addition to the traditional association with shallow-water habitats and physical turbulence, fossil carbonate nodules may be indicative of a relatively deep, quiet-water setting characterized by persistent bioturbation and occasional near-bottom flow.