Peribronchial Nodes Research Articles

Analysis of Influencing Factors and Construction of Predictive Model for Persistent Cough After Lung Cancer Resection Under Thoracoscopy.

This study aims to explore the influencing factors of cough after pulmonary resection (CAP) after thoracoscopic lung resection in lung cancer patients and to develop a predictive model. A total of 374 lung cancer patients who underwent lung resection in our hospital from March 2020 to October 2023 were randomly divided into a modeling group (n=262) and a validation group (n=112). Based on the occurrence of CAP in the modeling group, the patients were divided into a CAP group (n=85) and a non-CAP group (n=177). Multivariate Logistic regression analysis was used to identify the influencing factors of CAP in lung cancer patients. A nomogram model for predicting the risk of CAP was constructed using R4.3.1. The consistency of the model's predictions was evaluated, and a clinical decision curve (DCA) was drawn to assess the clinical utility of the nomogram. The predictive performance of the model was evaluated using ROC curves and the Hosmer-Lemeshow test. Multivariate Logistic regression analysis showed that smoking history (OR=6.285, 95% CI: 3.031-13.036), preoperative respiratory function training (OR=20.293, 95% CI: 7.518-54.779), surgical scope (OR=20.667, 95% CI: 7.734-55.228), and peribronchial lymph node dissection (OR=5.883, 95% CI: 2.829-12.235) were significant influencing factors of CAP in lung cancer patients (P<0.05). ROC curves indicated good discriminatory power of the model, and the Hosmer-Lemeshow test showed a high degree of agreement between predicted and actual probabilities. The DCA curve revealed that the nomogram model had high clinical value when the high-risk threshold was between 0.08 and 0.98. The nomogram model based on smoking history, preoperative respiratory function training, surgical scope, and peribronchial lymph node dissection has high predictive performance for CAP in lung cancer patients. It is useful for clinical prediction, guiding preoperative preparation, and postoperative care.

Stage I and II nonsmall cell lung cancer treatment options.

Chest radiography, computed tomography (CT) and positron emission tomography (PET)-CT are required for staging nonsmall cell lung cancers. Stage I cancers may be up to 4 cm in maximal diameter, with stage IA tumours being up to 3 cm and stage IB up to 4 cm. A lung cancer becomes stage II if the tumour is between 4 and ≤5 cm (stage IIA), or it spreads to ipsilateral peribronchial or hilar lymph nodes (stage IIB). Stage IA tumours should be surgically resected, ideally using minimally invasive methods. Lobectomy is usually performed, although some studies have shown good outcomes for sublobar resections. If surgery is not possible, stereotactic body radiotherapy is a good alternative. This involves delivering a few high-dose radiation treatments at very high precision. For stage IB to IIB disease, combinations of surgery, chemotherapy or immunotherapy and radiotherapy are used. There is evidence that neoadjuvant treatment (immunotherapy with nivolumab and chemotherapy for stage IB and II) optimises outcomes. Adjuvant chemotherapy with a platinum-based doublet (typically cisplatin+vinorelbine) should be offered for resected stage IIB tumours and considered for resected IIA tumours. Adjuvant pembrolizumab is used for stage IB-IIIA following resection and adjuvant platinum-based chemotherapy. Osimertinib may be used for resected stage IB to IIIA cancers which have relevant mutations (epidermal growth factor receptor exon 19 deletions or exon 21 (L858R) substitution). There are no fixed guidelines for follow-up, but most centres recommend 6-monthly CT scanning for the first 2-3 years after definitive treatment, followed by annual scans.

Serous endometrial carcinoma with cardiac metastasis (a case report)

Cardiac metastasis from endometrial cancer is a very rare finding. The article presents a case of death, demonstrating the aggressive clinical course of endometrial serous carcinoma. In this clinical example the disease was accompanied by generalized metastasizing through a lymphogenous route to unexpected distant organs (peribronchial lymph nodes, pleura, pericardium).

Visualizing intratumoral injections in lung tumors by endobronchial ultrasound.

Real-time endobronchial ultrasound images are crucial for the accurate placement of the needle in peribronchial lung tumors and lymph nodes for diagnostic sampling. Beyond its role as a diagnostic tool, ultrasound-guided bronchoscopy can also aid the delivery of anti-cancer agents intratumorally, enabling diagnosis, staging, and treatment to occur within the same anesthesia, reducing the patient's burden. However, determining drug retention and distribution in situ remains challenging, albeit pivotal in assessing the success or failure of the therapeutic intervention. We hypothesized that ultrasound images acquired by the bronchoscope during the injection can provide qualitative and quantitative real-time information about drug transport. As a proof-of-concept, we retrospectively analyzed 13 videos of intratumoral cisplatin injections in advanced non-small cell lung cancers. We identified the injection and performed quantitative analysis through image processing and segmentation algorithms and mathematical models in 5 of them. We were able to infer the unlikeliness of a laminar flow through interstitial pores in favor of the emergence of tissue fractures. These data imply that the structural integrity of the tumor is a critical determinant of the ultimate distribution of an intratumorally delivered agent.

Unexpected High-Grade Neuroendocrine Carcinoma in Lung Explant

<h3>Introduction</h3> Rarely, malignancies are incidentally detected in lung transplant (LT) explants. These can remain unidentified before LT due to significant architectural distortion of the lung parenchyma, despite appropriate radiographic surveillance. <h3>Case Report</h3> We present the case of a 74-year-old man with history of bilateral LT (03/2021), complicated by grade 2 primary graft dysfunction, for fibrotic hypersensitivity pneumonitis after which a high-grade neuroendocrine carcinoma was unexpectedly found in the right explanted lung. The tumor was 2.1 cm and 3/11 peribronchial lymph nodes were positive for metastatic carcinoma. The left lung explant was negative for malignancy. The tumor was strongly positive for TTF-1 and synaptophysin (<b>Figure 1</b>) with dot-like positivity of the pancytokeratin (AE1/AE3) and CAM 5.2 stains. Tumor cells were negative for CD45, PHH3 demonstrated >50 mitoses/10 high-power fields, and MIB-1 highlighted approximately 60% of tumor nuclei. Whole-body imaging was negative for other masses or acute processes. Maintenance immunosuppression was decreased, and the patient was discharged after LT in stable condition with need for outpatient oncology follow-up. Given the aggressive nature of the explant tumor, the patient decided to pursue adjuvant chemotherapy after recovery from the early post-LT period. The patient received 2 cycles of carboplatin/etoposide, but further treatment was stopped due to severe pancytopenia and need for blood products including platelets. At 6 months post-LT, allograft function is stable - FEV₁ at 2.56 L (88%) - with no evidence of acute cellular rejection or antibody-mediated rejection. There is no evidence of cancer recurrence. <h3>Summary</h3> This is a rare case of high-grade neuroendocrine carcinoma in a lung explant after LT. Recommended etoposide/platinum-based chemotherapy may be limited by adverse effects. Prognosis and feasibility of adjuvant chemotherapy after LT is insufficiently understood.

Морфологическая оценка сосудистого микроокружения плоскоклеточных карцином легкого

Introduction. Non-small cell lung cancer (NSCLC), including squamous cell carcinoma, accounts for 80% of all lung cancers. Anti-angiogenic drugs are currently available for NSCLC treatment. However, there are no predictive biomarkers for selecting patients who could benefit from this therapy. The aim of the study was to assess the correlation between the density of the tumor vascular microenvironment and the tumor size, as well as between the density of tumor lymphatic vessels and the presence or absence of metastases in the ipsilateral peribronchial lymph nodes. Materials and methods. Patients with a morphologically verified diagnosis of squamous cell lung carcinoma were divided into 2 groups depending on the stage of cancer: group 1 (stage I, n=15) and group 2 (stage II, n=15). We performed a morphometric study of histological slides stained with hematoxylin and eosin and antibodies to CD34 and Podoplanin (specific and sensitive markers to blood and lymphatic vessels, re-spectively) with immunohistochemical methods. Vascular density was assessed according to the Chalkley method. We quantitatively evaluated the density of blood vessels in absolute numbers on a 0.73-mm² area with a magnification of ×200 (three fields of view were evaluated with subsequent calculation of the mean blood vessels density). Results. The median of vascular density of the microvasculature was 9.67 (8.67; 10.33) and 10.33 (9.67; 11.67) in the intratumoral zone in group 1 and group 2, respectively. In the peritumoral zone, it was 12 (11.33; 12.67) for group 1 and 16.33 (15.67; 19.67) for group 2. The median density of lymphatic vessels in group 1 and group 2 in the intratumoral zone amounted to 1.5 (1; 2) and 2 (1.67; 3.75), respectively; whereas in the peritumoral zone, this parameter was 2 (1.92; 2.75) and 3.33 (2.67; 4) for groups 1 and 2, respectively. We found a correlation between tumor size and vascular density of the microvasculature in the peritumoral zone (p&lt;0.05) and between the density of lymphatic vessels in the peritumoral zone and the presence of metastases in the peribronchial lymph nodes (p&lt;0.05). Conclusion. Features of the vascular microenvironment of the tumor contribute to the progression of squa-mous cell carcinoma of the lung. Keywords: squamous cell lung cancer, tumor vascular microenvironment, tumor vascular density

Influence of COVID-19 on the morphofunctional state of (peribronchial) lymph nodes of the lungs

Influence of COVID-19 on the morphofunctional state of (peribronchial) lymph nodes of the lungs

An Infectious Cause of Esophagobronchial Fistula

An infected cause of esophagobronchial fistula between left bronchus and esophagus is mentioned who is a 32 year old male with a history of smoking and I/V drug abuse. The scientific reasons for suspecting an esophagogastric-bronchial fistula in an adult are discussed, as well as a description of the different etiologies of this condition. Intra thoracic malignancy, injuries, and infections are the most frequent causes of esophageal-bronchial fistula. These fistulas are caused by the rupturing of caseous peribronchial lymph nodes into adjacent structures such as the esophagus and bronchi. It's difficult to determine what the right course of action is. Such cases are surgically treated, while others can only be treated conservatively. Diagnosing bronchoesophageal fisula is usually challenging and often delayed, since there have not been many cases found. Any patient who presents with cough after deglutition should be suspected of having an esophagobronchial fistula, and tubercular origin should also be considered, particularly in an endemic region, since early diagnosis and treatment with anti-tubercular therapy typically results in resolution.

Conventional transbronchial needle aspiration cytology as a diagnostic tool in patients with suspected lung cancer - Our experience at a tertiary care center.

Background: Conventional transbronchial needle aspiration (c-TBNA) is a minimally invasive bronchoscopic technique used to obtain cytological samples from peribronchial lesions and mediastinal lymph nodes. However, the concern about its efficacy and the advent of newer techniques have led to the underutilization of this time tested and cost-effective modality. Objective: The present study was aimed to assess the diagnostic yield of c-TBNA in suspected cases of lung cancer. Method: c-TBNA smears received from January 2017 to February 2020, with clinical-radiological suspicion of lung malignancy were retrospectively analyzed. Result: A total of 22 cases were reviewed. The mean age of the study population was 57.54 years, with a male-female ratio of ~2:1. The adequate aspirate was obtained in 19/22 (86%) cases. The overall diagnostic yield of c-TBNA was 82%. 14/19 (74%) cases were positive for malignancy, non-small cell lung carcinoma being the most common malignancy diagnosed (11 cases). 4/19 (21%) cases were diagnosed with granulomatous pathology, while smears in 1 case were non-diagnostic. Conclusion: Conventional transbronchial needle aspiration cytology is an efficacious method used for the diagnosis of lung carcinoma. Especially in resource-limited settings, it remains irreplaceable as a diagnostic tool and should be routinely utilized.

Abstract B70: Differential expression of regulatory T cells and Th17 cells are indicative of tumor recurrence in pN0 stage I lung cancer patients

Abstract Background: Up to 30% of lung cancer (Stage I) with the most favorable outcome recur within 5 years after surgery. Predicting relapse in patients treated curatively with surgical resection for stage I non-small cell lung cancer (NSCLC) remains difficult. The sentinel lymph nodes (SLNs) are the first lymph nodes reached by metastatic cancer cells from a primary tumor. In a recent immunologic study, immunologic changes were detected in these lymph nodes prior to pathologic invasion. This study evaluated the pattern of failure after surgical resection in pN0 lung cancers and determines whether regulatory T (Treg) cells and Th17 cells were prognostic indicator for recurrence. Methods: Patients over 18 years of age who were clinically diagnosed with stage I lung cancer were enrolled. Patients receiving prior lung cancer treatment or thoracic radiation were excluded from enrollment. During surgery, the sentinel lymph nodes were isolated using a handheld gamma probe, followed by the dissection of the visible mediastinal, hilar, and peribronchial lymph nodes. Samples from normal lung tissue, the tumor mass, and all dissected lymph nodes were sectioned and conventionally examined using H&amp;E staining and immunohistochemistry. In addition, the forkhead transcription factor3 (Foxp3) and transcription factor retinoic acid-related orphan receptor (ROR)-γ, recently described to be essential for differentiation of Tregs and Th17 cells, were evaluated by real time RT-PCR. Results: Between October 2009 and October 2010, 27 patients with clinical stage I NSCLC were enrolled consecutively. Among them, twenty patients (thirteen men, seven women, mean age 67.6 years) pathologically staged as N0 were analyzed. Eight patients had squamous cell carcinoma and twelve patients had adenocarcinoma. The expression of Foxp3 in the tumor mass was increased in adenocarcinoma compared to squamous cell carcinoma (P=0.05). The Foxp3 expression and Treg cells in the tumor mass were not significantly associated with recurrence. However, Foxp3 expression and Treg cells’ presence in SLNs were significantly increased in patients with recurring disease compared to nonrecurring disease (P=0.03 and P=0.01, respectively). The number of Th17 cells in tumor mass was decreased in patients with recurring pN0 disease compared to those with non-recurring disease (P=0.04). ROR-γ expression and Th17 cells presence in SLNs were not related with recurrence. Conclusion: The results of this study suggest that the increased number of Treg cells in SLNs and decreased number of Th17 cells in tumor mass might be a promising indicator of recurrence. Citation Format: Chan Kwon Park, Seung Joon Kim. Differential expression of regulatory T cells and Th17 cells are indicative of tumor recurrence in pN0 stage I lung cancer patients [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr B70.

Resolvin E3 attenuates allergic airway inflammation via the interleukin-23-interleukin-17A pathway.

We investigated the effects of resolvin E (RvE) 1, RvE2, and RvE3 on IL-4- and IL-33-stimulated bone marrow-derived dendritic cells (BMDCs) from house dust mite (HDM)-sensitized mice. We also investigated the role of RvE3 in a murine model of HDM-induced airway inflammation. In vitro, BMDCs from HDM-sensitized mice were stimulated with IL-4 and IL-33 and then treated with RvE1, RvE2, RvE3, or vehicle. RvE1, RvE2, and RvE3 suppressed IL-23 release from BMDCs. In vivo, RvE3 administrated to HDM-sensitized and challenged mice in the resolution phase promoted a decline in total numbers of inflammatory cells and eosinophils, reduced levels of IL-23 and IL-17 in lavage fluid, and suppressed IL-23 and IL-17A mRNA expression in lung and peribronchial lymph nodes. RvE3 also reduced resistance in the lungs of HDM-sensitized mice. A NanoBiT β-arrestin recruitment assay using human embryonic kidney 293 cells revealed that pretreatment with RvE3 suppressed the leukotriene B4 (LTB4)-induced β-arrestin 2 binding to LTB4 receptor 1 (BLT1R), indicating that RvE3 antagonistically interacts with BLT1R. Collectively, these findings indicate that RvE3 facilitates the resolution of allergic airway inflammation, partly by regulating BLT1R activity and selective cytokine release by dendritic cells. Our results accordingly identify RvE3 as a potential therapeutic target for the management of asthma.-Sato, M., Aoki-Saito, H., Fukuda, H., Ikeda, H., Koga, Y., Yatomi, M., Tsurumaki, H., Maeno, T., Saito, T., Nakakura, T., Mori, T., Yanagawa, M., Abe, M., Sako, Y., Dobashi, K., Ishizuka, T., Yamada, M., Shuto, S., Hisada, T. Resolvin E3 attenuates allergic airway inflammation via the interleukin-23-interleukin-17A pathway.

Concentration of titanium in respiratory tissue obtained from autopsies in Mexico city residents

To quantify the levels of titanium (Ti) in respiratory tissue obtained by autopsy in people who resided in Mexico City. An exploratory study was conducted in which 216 samples of respiratory tissue from pulmonary lobes and peribronchial lymph nodes were obtained from legal medical autopsies of 36 corpses with a minimum of two years of residence in Mexico City. Histopathological analyses of the samples were performed and the Ti existing in them was quantified by induction plasma coupled to atomic absorption spectrophotometry. The amount of Ti in respiratory tissue was distributed between 0 micrograms of Ti in dry tissue (µg Ti/g ts) and 39.7 µg Ti/g ts; the presence of Ti was identified as distributed in up to six times a higher quantity in the lymph nodes than in pulmonary lobes. Cluster analysis showed that the sample consisted of four groups of individuals grouped according to the amount and distribution of Ti in the lower respiratory tract, age, body mass index, place and time of residence in Mexico City. . Due to the distribution pattern observed, Ti found in respiratory tissue samples may come from urban air; the amount of Ti in conjunction with other elements may be the cause of respiratory pathologies.

Black lungs in the general population: a new look at an old dispute.

Almost from the time that autopsies were first routinely carried out, darkening of lungs with increasing age was described. Different explanations for the origin of the accumulating black pigment arose and by the early nineteenth century three hypotheses had emerged: 1) soot inhaled into the lungs from the air; 2) carbon accumulating in the lungs from abnormal pulmonary carbon dioxide metabolism; and, 3) pigment derived from the blood. In 1813 the English physician and chemist George Pearson published a paper in which he described the recovery of the black pigment from lungs and its chemical analysis. Pearson declared the black pigment to be airborne carbon/soot from the burning of coal and wood. He described these particles depositing in 'black spots' in the terminal airways and accumulating in the peribronchial lymph nodes, forming 'black glands'. Despite Pearson's prescient account, debate continued and the true explanation, given in that paper, was not fully accepted until the late nineteenth century.

Subxiphoid robotic-assisted right pneumonectomy.

A 70-year-old lady, an ex-smoker, was referred with a 3-month history of a non-productive cough. Her past medical history included hypertension, type II diabetes mellitus and marginal zone lymphoma of the skin in 2015. The computed tomography (CT) thorax reported a nodule posterior to the right bronchus intermedius measuring 28 mm with prominent sub carinal lymph nodes. Positron emission tomography (PET) scan showed the nodule to be FDG avid with no other sites of local or distant disease identified. Her lung function tests were satisfactory. The biopsy of the right peribronchial lymph node taken via endobronchial ultrasound (EBUS) showed no carcinoma but low-grade lymphoma was not excluded.

Competence in endosonographic techniques.

Endobronchial ultrasound (EBUS) has revolutionized the field of bronchoscopy because it allows to observe peribronchial structures and distal peripheral lung lesions. The use of EBUS was first described by Hurte and Hanrath in 1992. EBUS technology exists in two forms: radial and convex transducer probes. The radial EBUS probe has a 20-MHZ (12-30 MHz available) rotating transducer that can be inserted together with or without a guide sheath through the working channel (2.0-2.8 mm) of a standard flexible bronchoscope. The transducer rotates and produces a 360-degree circular image around the central position of the probe. There are two types of radial EBUS probes: "peripheral" probes, used to identify parenchymal lung lesions, and "central" probes, with balloon sheaths, used for the assessment of airway walls and peribronchial lymph nodes.

From one incision to one port: The surgical technique and the evolution of segmentectomy in patients with pulmonary tuberculosis.

ObjectivesWe retrospectively reviewed the evolution of segmentectomy for pulmonary tuberculosis (TB) and the feasibility of multi- and single-incision video-assisted thoracoscopic segmentectomy.MethodsOf 348 patients undergoing surgery for TB, the medical records of 121 patients undergoing segmentectomy between January 1996 and November 2015 were reviewed. Clinical information and computed tomography (CT) image characteristics were investigated and analyzed.ResultsEighteen patients underwent direct or intended thoracotomy. Sixty-four underwent video-assisted thoracoscopic segmentectomy (VATS), including 53 multi-incision thoracoscopic segmentectomy (MITS), and 11 single-incision thoracoscopic segmentectomy (SITS). Thirty-nine were converted to thoracotomy. The intended thoracotomy group had more operative blood loss (p = 0.005) and hospital stay (p = 0.001) than the VATS group although the VATS group had higher grade of cavity (p = 0.007). The intended thoracotomy group did not differ from converted thoracotomy in operative time, blood loss, or hospital stay, and the grade of pleural thickening was higher in the converted thoracotomy group (p = 0.001). The converted thoracotomy group had more operative blood loss, hospital stay, and complication rate than the MITS group (p = 0.001, p<0.001, and p = 0.009, respectively). The MITS group had lower pleural thickening, peribronchial lymph node calcification, cavity, and tuberculoma grading than the converted thoracotomy group (p<0.001, p = 0.001, 0.001, and 0.017, respectively). The SITS group had lower grading in pleural thickening, peribronchial lymph node calcification, and aspergilloma grading than the converted thoracotomy group (p = 0.002, 0.010, and 0.031, respectively). Four patients in the intended thoracotomy group and seven in the converted thoracotomy group had complications compared with three patients in the MITS and two in the SITS group. Risk factors of conversion were pleural thickening and peribronchial lymph node calcification.ConclusionAlthough segmentectomy is technically challenging in patients with pulmonary TB, it could be safely performed using MITS or SITS and should be attempted in selected patients. Its efficacy for medical treatment failure needs investigation.

Predictors of conversion to thoracotomy during video-assisted thoracoscopic surgery lobectomy in lung cancer: additional predictive value of FDG-PET/CT in a tuberculosis endemic region.

To evaluate the added clinical value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans to chest CT imaging in predicting the conversion to thoracotomy during video-assisted thoracoscopic surgery (VATS) lobectomy in patients with lung cancer. This is a retrospective study of 235 consecutive patients who underwent planned VATS lobectomy for primary lung cancer between 2011 and 2015. CT images were interpreted in terms of the presence and the attenuation of peribronchial lymph nodes (PLN) and peribronchial cuffs of soft (PCS) tissue, pleural calcification, and parenchymal calcified nodule. On FDG PET/CT images, anthracofibrotic lymph node was considered present when high FDG uptake (SUVmax >3.5) was observed on PET/CT images corresponded to PLN or PCS on chest CT. Among the 235 patients undergoing attempted VATS lobectomy, 55 (23.4%) underwent conversion to thoracotomy. Multivariate logistic regression analysis revealed that the attenuation of PLN or PCS on chest CT (OR, 2.57; 95% CI, 1.328-4.380, 0.005) was an only independent predictor of conversion. The ROC curve showed that combined FDG PET/CT and chest CT reading [areas under curve (AUC), 0.847 (95% CI, 0.795-0.891)] was significantly better than that of chest CT scans alone [AUC, 0.655 (95% CI, 0.50-0.751)] in predicting conversion (P=0.024). The addition of FDG PET/CT scanning to chest CT imaging provides better performance for predicting conversion to thoracotomy during VATS lobectomy in lung cancer patients. Therefore, in lung cancer patients undergoing surgical resection, FDG PET/CT can provide additional reliable information in selecting the appropriate surgical approach for a lobectomy.

Sequestrum in a Lymph Node in Contagious Bovine Pleuropneumonia (CBPP) Infection without Lung Lesions: A Case Report

Contagious bovine pleuropneumonia (CBPP) is a highly contagious disease of ruminants caused by Mycoplasma mycoides subsp. mycoides (Mmm), with a major impact on livestock production and a potential for rapid spread. It is manifested by anorexia, fever and respiratory signs such as dyspnoea, polypnoea, cough and nasal discharges in cattle. Lesions of CBPP are generally confined to the organs of the thoracic cavity except in young calves where inflammation of the limb joints (usually the carpal and tarsal joints), sometimes seen with increased fluid. The characteristic type of lesions seen in the organs generally include; pleuritis, hypertrophy of the lymph nodes, unilateral marbling of the lungs in acute disease and sequestra formation in subacute to chronic cases. This case study report describes the presence of a well-developed sequestrum in a peri-bronchial lymph node at the trachea bifurcation in an animal artificially infected with Mmm causing CBPP. The epidemiological role such lesions play in the transmission of the disease in the field is not known. This requires further investigation to ascertain whethersuch lesions are implicated in the transmission and perpetuation of disease. In addition such lesions would be missed at post-mortem in an outbreak as they are small and in unexpected organs leading to misdiagnosis of the disease.

Infections Leading to Broncholithiasis

Abstract Broncholithiasis is a condition where there is a presence of broncholiths or calcified masses in the airways. The broncholiths commonly are calcified peribronchial lymph nodes that are formed in response to chronic granulomatous infections. The calcified masses either compress the bronchi or erode through the walls into the lumen. They then may be aspirated or expectorated (lithoptysis). Infections with bacteria and fungi have been associated with the development of broncholiths. We present a case of histoplasma infection leading to the formation of broncholiths that were surgically resected along with a literature review of other infectious and noninfectious causes of broncholiths.

Sclerosing Pneumocytoma with Lymph Node Metastasis

A 33-year-old woman with a family history of multiple cancers had been undergoing surveillance scans. Magnetic resonance imaging revealed cysts in the kidney and pancreas, multiple hemangiomas in the liver, and a lesion in the left lower lobe (LLL) of the lung. Repeat positron emission tomogram/computed tomography demonstrated a 1.8 1.6-cm nodule (Fig. 1) within the LLL. The patient underwent endobronchial ultrasound– guided fine needle aspiration biopsy of the LLL nodule, which showed hypercellular smears containing uniform, cuboidal, round, and oval medium-sized cells. They were diffusely positive for thyroid transcription factor-1, and negative for neuroendocrine cell markers. The diagnosis was well-differentiated lung adenocarcinoma. The patient underwent video-assisted thoracoscopic LLL lobectomy, which showed a well-circumscribed 2.5-cm yellow-tan nodule composed of mostly monomorphic, cuboidal surface cells and round cells with pink to clear cytoplasm and well-defined cell borders in papillary, solid, and sclerotic growth patterns. Occasional hemorrhagic foci were also present. A focal area of mild cytologic atypia was noted. A focus of metastatic tumor deposit containing solid sheets of cells was identified in one of the peribronchial lymph nodes. The results of staining for thyroid transcription factor-1 and epithelial membrane antigen were positive in both surface and round cells, but cytokeratin 7 and cytokeratin AE1/AE3 stained only surface cells (Fig. 2). The cytomorphologic examination findings and immunoprofile were consistent with sclerosing pneumocytoma (SP) with a lymph node metastasis. SP (previously called sclerosing hemangioma) is a rare tumor of the lung that is thought to arise from primitive respiratory epithelium. This tumor usually occurs in middle-aged adults with a male-to-female ratio of 1:5. 1 Surgical resection is curative without a need for additional treatment. Although SP is considered a benign tumor, we found a lymph node (LN)