Multifocal Consolidation Research Articles

Atypical Pulmonary Lymphangitic Metastasis Manifesting as Air-space Lesions: A Case Report

Pulmonary lymphangitic carcinomatosis is a common secondary neoplasm of the lung that may result from hematogenous dissemination to small pulmonary arteries and arterioles followed by invasion of the interstitial space and lymphatics, or from the retrograde spread of tumors from mediastinal or hilar lymph nodes. Radiologically, irregular interlobular septal thickening, bronchovascular interstitial thickening and/or lymph node enlargement are observed. In this report, we describe an atypical radiological manifestation of lymphan-gitic metastasis of stomach cancer in a 37-year-old woman admitted for dyspnea on exertion and a cough which had been present for one month. HRCT scanning revealed bilateral multifocal ground glass opacity or consolidation, mild diffuse axial interstitial thickening, and slight pleural effusion. These findings were thought to indicate the existence of an air-space disease rather than metastasis. Open lung and endoscopic biopsy, however, demonstrated the presence of lymphangitic metastasis from stomach cancer.

High-resolution computed tomographic appearance of MALToma of the lung

MALToma of the lung is rare and advances in molecular techniques have only recently allowed accurate diagnostic classification of the previously termed "pseudolymphomas" by demonstrating that many are monoclonal B-cell proliferations of MALT tissue and therefore true low-grade lymphomas. No significant previous contribution was found in the literature regarding the high-resolution CT appearance (HRCT) of these tumours. We describe the high-resolution CT appearances in five cases presenting to our institution from 1994 to 1997. The HRCT scans (1-mm sections at 10- to 15-mm intervals) were performed as the opacities seen radiographically were thought to be part of a diffuse lung process. In one patient a spiral sequence was performed through the main airway. Multifocal, ill-defined nodules containing air bronchograms were seen in four cases and focal lobar consolidation in one case. Interlobular septal thickening, centrilobular micronodules and bronchial wall thickening were seen in two cases. Mediastinal lymphadenopathy and pleural reaction do not appear to be characteristic features. The appearance of multifocal consolidation is similar to that seen in bronchoalveolar cell carcinoma and cryptogenic organising pneumonia.

Comparison of the Pathogenicity of Two US Porcine Reproductive and Respiratory Syndrome Virus Isolates with that of the Lelystad Virus

The Lelystad virus or one of two US isolates (VR2385, VR2431) of porcine reproductive and respiratory syndrome virus were given intranasally to 25 4-week-old cesarian-derived colostrum-deprived pigs. Pigs from these groups were necropsied at 1, 2, 3, 5, 7, 10, 15, 21, or 28 days postinoculation. The Lelystad virus and VR2431 induced mild transient pyrexia, dyspnea, and tachypnea. VR2385 induced labored and rapid abdominal respiration, pyrexia, lethargy, anorexia, and patchy dermal cyanosis. All three isolates induced multifocal tan-mottled consolidation involving 6.8% (n = 9; SEM = 3.4) of the lung for Lelystad, 9.7% (n = 9, SEM = 2.7) of the lung for VR2431, and 54.2% (n = 9, SEM = 4.4) of the lung for VR2385 at 10 days postinoculation. Characteristic microscopic lung lesions consisted of type 2 pneumocyte hypertrophy and hyperplasia, necrotic debris and increased mixed inflammatory cells in alveolar spaces, and alveolar septal infiltration with mononuclear cells. Lymphadenopathy with follicular hypertrophy, hyperplasia, and necrosis was consistently seen. Similar follicular lesions were also seen in Peyer's patches and tonsils. Lymphohistiocytic myocarditis and encephalitis were reproduced with all three isolates. Clinical respiratory disease and gross and microscopic lung lesion scores were considerably and significantly more severe in the VR2385-inoculated pigs. All three viruses were readily isolated from sera, lungs, and tonsils throughout the 28 days of the study. The lymphoid and respiratory systems have the most remarkable lesions and appear to be the major site of replication of these viruses. This work demonstrated a marked difference in pathogenicity of porcine reproductive and respiratory syndrome isolates.

The radiology and terminology of cryptogenic organizing pneumonia.

The clinical features, radiographic and computed tomographic findings of nine patients with histological proof of cryptogenic organizing pneumonia were analysed. Patients present with cough, dyspnoea and malaise and commonly have bilateral multifocal consolidation on chest radiography, which may show resolution or relapse with or without steroid treatment. A good response to steroids is the rule, usually with complete radiological resolution or minimal residual scarring. The relative merits of the terms cryptogenic organizing pneumonia and bronchiolitis obliterans organizing pneumonia, both currently used to describe this entity, are discussed.

Bronchiolitis obliterans organizing pneumonia: The clinical and radiological features of seven cases and a review of the literature

The clinical and radiological features of seven cases of bronchiolitis obliterans organizing pneumonia (BOOP) are presented and the literature is reviewed. Six of these cases were idiopathic, one patient had rheumatoid arthritis. Detailed respiratory function tests were available in four cases and showed a restrictive defect with impaired gas transfer. The majority of chest radiographs showed consolidation with no zonal preponderance. One case with unilobar consolidation was mistaken for malignancy. Another case with interstitial shadowing was thought to have cryptogenic fibrosing alveolitis. In those cases with consolidation, it was mainly peripheral. Six of the cases showed good response to oral steroid therapy. Open lung biopsy was the principal means by which tissue was obtained for diagnosis. BOOP should be included in the differential diagnosis of multifocal consolidation. The condition is usually responsive to steroid therapy, so it is important to confirm the diagnosis histologically.

Clinicopathologic and Immunohistochemical Characteristics of Goblet Cell Type Adenocarcinoma of the Lung

Twenty-two resected goblet cell type adenocarcinomas of the lung were examined clinicopathologically and immunohistochemically. The stage and survival curve of goblet cell type adenocarcinomas were compared with those of 44 cases of pure or mixed Clara cell and bronchial surface epithelial cell (Clara and BSE) type adenocarcinomas. Each case of goblet cell type was matched with two cases of Clara and BSE type as to sex, age and date of surgery. In goblet cell type adenocarcinomas, lymph node metastasis was less frequently and intrapulmonary metastasis was more frequently detected than in other types of adenocarcinomas (p less than 0.001 and p less than 0.05, respectively). Goblet cell type adenocarcinomas showed better prognoses than Clara and BSE type adenocarcinomas. However, the estimated survival curves of those two groups become similar after adjustment of the TNM condition using Cox's proportional-hazard general linear model. This result indicated that the longer survival of goblet cell type adenocarcinoma was due to the characteristic distribution of TNM conditions, that is, unique local growth and low incidence of lymph node metastasis. When goblet cell type adenocarcinoma was macroscopically classified into two types, i.e. solitary peripheral nodule type (nodular type) and multifocal nodular type or consolidation of all or part of a lobe (diffuse type), the nodular type had better prognosis than the diffuse type (p less than 0.05). Immunohistochemically, 83%, 11%, and 0% of goblet cell type adenocarcinomas were positive for NCC-CO-450, carcinoembryonic antigen (CEA), and surfactant apoprotein, respectively. Most Clara and BSE type adenocarcinomas were negative for NCC-CO-450, but positive for CEA and surfactant apoprotein.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal pneumonia associated with medium-chain triglyceride feeding supplement

The appearance of a similar pattern of multifocal pulmonary consolidation in four neonates receiving undiluted medium-chain triglyceride oil suggested a cause-and-effect relationship. This was supported by the demonstration in rabbits that the transtracheal injection of MCTO caused severe pneumonia. It is suggested that MCTO be mixed with formula before it is given to neonates.