Pulmonary Mass Lesions Research Articles

Anti-GM-CSF autoantibodies predict outcome of cryptococcal meningitis in patients not infected with HIV: A cohort study

ObjectivesTo explore the seroprevalence of anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies in non-HIV cryptococcal meningitis (CM) and assess its predictive value for survival. MethodsThis is a retrospective study of 12 years of non-HIV CM. We detected serum anti-GM-CSF autoantibodies, and evaluated the clinical features and outcomes, together with the exploration of prognostic factors for 2-week and 1-year survival. ResultsA total of 584 non-HIV CM cases were included. 301 of 584 patients (51.5%) were phenotypically healthy. 264 Cryptococcus isolates were obtained from cerebrospinal fluid (CSF) culture, of which 251 were identified as C. neoformans species complex and 13 as C. gattii species complex. Thirty-seven of 455 patients (8.1%) tested positive for serum anti-GM-CSF autoantibodies. Patients with anti-GM-CSF autoantibodies were more susceptible to C. gattii species complex infection (66.7% vs. 6.3%; p < 0.001) and more likely to develop pulmonary mass lesions with a diameter >3 centimetres (42.9% vs. 6.5%; p 0.001). Of 584 patients 16 (2.7%) died within 2 weeks, 77 of 563 patients (13.7%) died at 1 year, and 93 of 486 patients (19.1%) lived with disabilities at 1 year. Univariant Cox regression analysis found that anti-GM-CSF autoantibodies were associated with lower 1-year survival (HR, 2.66; 95% CI, 1.34–5.27; p 0.005). Multivariable Cox proportional hazards modelling revealed that CSF cryptococcal antigen titres ≥1:1280 were associated with both, reduced 2-week and 1-year survival rates (HR, 5.44; 95% CI, 1.23–24.10; p 0.026 and HR, 5.09; 95% CI, 1.95–13.26; p 0.001). DiscussionPresence of serum anti-GM-CSF autoantibodies is predictive of poor outcomes, regardless of host immune status and the causative Cryptococcus species complex.

Utility of needle biopsy in centrally located lung cancer for genome analysis: a retrospective cohort study

BackgroundIt is essential to collect a sufficient amount of tumor tissue for successful next-generation sequencing (NGS) analysis. In this study, we investigated the clinical risk factors for avoiding re-biopsy for NGS analysis (re-genome biopsy) in cases where a sufficient amount of tumor tissue could not be collected by bronchoscopy.MethodsWe investigated the association between clinical factors and the risk of re-genome biopsy in patients who underwent transbronchial biopsy (TBB) or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and required re-genome biopsy in cases enrolled in LC-SCRUM Asia, a prospective nationwide genome screening project in Japan. We also examined whether the frequency of re-genome biopsy decreased between the first and second halves of the enrolment period.ResultsOf the 572 eligible patients, 236 underwent TBB, and 134 underwent EBUS-TBNA. Twenty-four TBBs required re-genome biopsy, and multivariate analysis showed that the risk of re-genome biopsy was significantly increased in lesions where the tumor lesion was centrally located. In these cases, EBUS-TBNA should be utilized even if the lesion is a pulmonary lesion. However, it should be noted that even with EBUS-TBNA, lung field lesions are at a higher risk of re-canalization than mediastinal lymph node lesions. It was also found that even when tumor cells were detected in rapid on-site evaluation, a sufficient amount of tumor tissue was not always collected.ConclusionsFor centrally located pulmonary mass lesions, EBUS-TBNA, rather than TBB, can be used to obtain tumor tissues that can be analyzed by NGS.

Urgent intraoperative cytological diagnosis of spherical mass lesions in the lungs

Differential diagnosis of pulmonary mass lesions is one of the most difficult tasks not only in pulmonology but also in phthisiology, because clinical manifestations, data from visual and laboratory examinations are undifferentiated in the early stages. In the case of an unclear diagnosis, morphological verification of the process played a crucial role. Urgent intraoperative examination is the most difficult option for morphologic verification of lung lesions, which requires a quick, detailed, and accurate answer.The aim of this study was to evaluate the clinical significance and efficacy of urgent intraoperative cytologic examination in the differential diagnosis between granulomatous (tuberculosis, sarcoidosis), tumor and tumor-like lesions of the lung.Methods. The results of urgent intraoperative cytologic examination of 173 tissue specimens from lung masses were retrospectively analyzed. Cytologic specimens were stained by the May – Grunwald – Giemse and Ziehl – Neelsen methods and then visualized on a Zeiss Lab A1 microscope (Carl Zeiss, Germany). The obtained data are compared with the results of histological examination. To evaluate the effectiveness of intraoperative cytologic examination, the accuracy, sensitivity, and specificity were calculated.Results. Analysis of the results of urgent cytological examinations (n = 173) shows that granulomatosis (tuberculosis/sarcoidosis) was established in 64.7% of cases, malignancy – in 31 cases (cancer – 9.2%, carcinoid tumor – 2.9%, malignant neoplasm of unclear etiology – 4%, suspected malignant lesion – 1.7%); benign process – in 9.2% of cases (hamartoma + chondroma – 5.2%, chronic inflammation – 4%). 1.2% of the cases had no diagnostic material. When comparing the obtained results, there was a discrepancy between the histological picture (2.9% of cases) and the primary clinical diagnosis (5.7% of cases). Sensitivity, specificity, and accuracy of cytologic examination of intraoperative material amounted to 95.9, 71, and 98%, respectively.Conclusion. The high sensitivity and accuracy (&gt; 90%) of urgent cytologic diagnosis of pathologic processes in the lung under intraoperative conditions were demonstrated by the correct assessment of morphologic signs of a given lesion and by their comparison with the clinical picture and the results of additional examinations. Analysis of cytological specimens showed that urgent cytological examination significantly complements the morphological picture of lung lesions and can be considered as the first stage of phenotypic diagnosis.

LUNG LESIONS: CORRELATION OF ITS HISTOPATHOLOGY WITH IMMUNOHISTOCHEMISTRY

Background The anatomical and histological features oblige the Lungs to be most susceptible to invasions. Lung lesions are common due to exposure to various risk factors. A few of them are pollution, smoking, human immunodeciency virus (HIV), infections, tuberculosis, and malnutrition. An increasing trend in cases of lung cancer is being seen in India. Lung biopsy is a simple, relatively safe, rapid and reliable technique for the diagnosis of pulmonary mass lesions, particularly with the aid of computed tomography (CT) scan. We wanted to study the histopathological pattern of lung lesions along with its distribution with regard to age, sex, and site. Methods This is an observational study conducted at the Department of Pathology, ESIC Medical College, Kalaburagi from January 2020 to December 2022. Material for the study consisted of all the biopsies submitted for histopathological and immunohistochemical study. Results 164 cases were included in the study, out of which 104 cases (63.41%) were malignant, 10 cases (6.10%) were of inammatory origin and 50 cases (30.49%) showed no evidence of malignancy. Male to Female ratio was 3:1. Most common age group was 51 to 60 years (31.71%). Most common histological type of malignancy was adenocarcinoma (36.54%), followed by squamous cell carcinoma (30.77%). Conclusions Lung biopsy is reliable with high accuracy for diagnosis and subtyping of lung lesions. Immunohistochemistry is an important complimentary tool for routine diagnosis of lung cancers.

Melioidosis

Melioidosis is a disorder caused by Gram-negative bacillus Berkholderia pseudomallei. The condition is endemic in Far East Southeastern Asia Northern Australia and India. It presents with recurrent or prolonged febrile illness. There may be a variety of manifestations in the form of septicemia acute localized suppuration acute pulmonary infection chronic suppuration or as a pulmonary mass lesion. It is associated with high mortality. It is treated with third generation cephalosporins.

Fibreoptic Bronchoscopy-its Role in Pulmonary Medicine-Current Trends in Intensive Care Unit

Fibreoptic Bronchoscopy is an endoscopic procedure to visualize the tracheobronchial tree and also to obtain bronchial washings, biopsies, brush smears, transbronchial biopsies to arrive at an etiological diagnosis of the underlying disease process responsible for the nonresolving shadows in the lung, these can facilitate therapeutic decision. Utilization of bronchoscopy in the intensive care unit (ICU) has made the diagnosis and treatment of many diseases presenting as acute respiratory illness, more possible to interventional pulmonologists and intensivists although challenging in the critical ill cases, specially in ventilator support. We report our one year experience with the use of flexible fiberoptic bronchoscopy. A total 205 cases were undergone this procedure during Aug 2022 till July 2023 out of which 169 cases were taken up from the wards and rest 36 cases were taken up from the intensive care units. Pre-bronchoscopy screening was done. Of 205 patients, there were 124 Male patients and 81 Female patients. Mean age of the patients was 50.1 years. Among 169 cases in the ward were mainly non-resolving consolidation in 99 (58%) cases followed by pulmonary mass lesion in 31(18.3%) cases, Cavitary lesion in 22 (13%) cases, collapse with bronchiectasis-18(10.6%) and in 16 cases with hemoptysis with Normal X-ray. The diagnostic yield were Pulmonary infection - Non TB- 46 %, Tuberculosis-8%, Malignancy 17% – Squamous cell carcinoma-2 cases (18%), Adenocarcinoma 4 cases, Small Cell carcinoma -5 cases Bronchoscopy has ultimately lead to change in therapy in 70% cases, Bronchoscopy among 36 (17.5%)cases in ICU were mainly related to non-resolving consolidation 12(33%), hemoptysis 8(22.4%), for tracheal intubation-3(8.3%). Therapeutic bronchoscopy was performed in collapse due to retained secretion in 13(36%) cases. Complications were minimal indicating its safety in expert hands.

Bilateral Large Pulmonary Hydatid Cyst: A Rare Presentation in a Young Child from Ethiopia

Hydatidosis is a parasitic disease caused by Echinococcus granulosus, which is endemic in many parts of the world. Hydatid cysts can occur in any organ of the human body and the lung is the most common site in children, primarily related to higher lung tissue elasticity. Bilateral pulmonary hydatid cyst is a rare clinical phenomenon in young children. Here, we report on a 3-year-old boy diagnosed with bilateral pulmonary hydatid cyst after he came with four months history of dry cough and progressive worsening of shortness of breath. Computed tomography of the chest revealed large bilateral thick-walled pulmonary cystic mass lesions, with bilateral perihilar extension and pressure effect on the diaphragm with surrounding atelectatic changes. The patient underwent left posterolateral thoracotomy and cyst excision was done for the left hydatid cyst. Two months after the first surgical cyst excision, right posterolateral thoracotomy and cystectomy was done for the right lung hydatid cyst. He recovered well post-operatively.

Primary Pulmonary Undifferentiated Pleomorphic Sarcoma: A Rare Malignant Lung Tumor

We report a case of a 56-year-old man with persistent right upper lobe cavitary mass. A chest computed tomography scan showed about 4-cm-sized mass with internal low attenuation and peripheral enhancement in right upper lobe apical segment. The lesion size increased over 1 month. Right upper lobectomy was performed with the intention to treat the lesion. Pathological examination showed primary pulmonary undifferentiated pleomorphic sarcoma. We describe this rare lung disease to remind that primary pulmonary undifferentiated pleomorphic sarcoma could be the differential diagnosis of pulmonary cavitary mass lesions.

Full core technology versus notch sampling technology: evaluation of the diagnostic accuracy and the risk of a pneumothorax after transthoracic needle biopsy of suspicious lung lesions.

Percutaneous needle biopsy of the lung (PCBL) under image guidance has become a safe and effective minimal invasive method to obtain a specimen related histological diagnosis of pulmonary lesions. To evaluate the diagnostic yield and safety of two different coaxial biopsy technologies: full core and notch sampling technology. The former allowing the removal of full punch cylinders and the latter using a cutting-edge mechanism. A retrospective analysis of 48 consecutive PCBL procedures has been carried out for this prognostic study, involving patients with a documented pulmonary nodule or mass lesion on previous computed tomography (CT) scans. The study population included 38 men and 10 women (mean age = 67 years). Of these 48 patients who underwent a procedure with a co-axial cutting system, 24 have been performed with notch sampling technology and 24 with full core technology. Out of the 48 biopsy procedures, 46 yielded specimens were adequate for histopathological evaluation, consistent with a technical success rate of 96%. The most common induced image-guided biopsy complication was a pneumothorax, occurring in 14 patients (35%). Seven patients with a pneumothorax were attributed to the full core technology and seven to the notch sampling technology (odds ratio = 1, 95% confidence interval = 0.28-3.51, P = 1). In the setting of full core versus notch sampling percutaneous CT-guided coaxial needle biopsy of the lung, no significant difference in the diagnostic accuracy and the incidence of pneumothoraces could be shown, while both technologies have an excellent diagnostic performance.

Pathological variations of lung masses

Introduction: Lung is a common place for the spread of tumors from within or other parts of the body. Lung shadows with a diameter less than or larger than 3 cm are termed lung nodule or mass respectively. Aims: To study the histopathological spectrum of lung masses and efficacy of computerized tomography guided FNAC/biopsy in diagnosis of lung masses. Materials and Methods: Forty (40) cases picked up as lung masses on conventional screening & CT scan were subjected to CT guided FNAC/Biopsy and their pathological variations were studied. Results: A total of 40 cases were studied. The mean age of the patients was 60.57 years with 25 (62.5%) males and 15 (37.5%) females. 65% of lesions were in right lung. Malignant lesions were more common and accounted for 27 (67.5 %) cases and benign in 8 (20%) cases. Amongst the malignant lesions, adenocarcinoma was seen in 16 (59.25%), squamous cell carcinoma in 10 (37.03%) and small cell carcinoma in 1 (3.70%) case. Conclusion: FNAC is a simple, relatively safe, rapid, reliable technique for the diagnosis of pulmonary mass lesions, particularly with the aid of computed tomography (CT) scan. FNAC not only distinguishes between benign and malignant lesions but also helps in tumor typing of lung cancer. Keywords: Lung mass, Computed tomography, Needle biopsy.

Role of image-guided fine needle aspiration cytology of lung lesions in diagnosis and primary care of patients: Experience in a Government Medical College of Eastern India.

Context:Lung cancer is the most common cancer affecting males worldwide. Its incidence in females is also on an increasing trend. Other conditions affecting lung-like tuberculosis are on a rise in middle-east countries due to overcrowding and poor living conditions. In developing countries, image-guided fine-needle aspiration cytology (FNAC) of lung lesions is a cost-effective method for early detection and apt treatment of patients by physicians.Aim:The main aim of this study is to identify the importance of computed tomography (CT)guided FNAC as an accurate and cost-effective tool in early diagnosis of lung lesions.Settings and Design:It was prospective and retrospective study done in a government medical college of West Bengal, India.Material and Methods:Over a period of two years, 42 cases were included in the study. These were further subjected to evaluation of pulmonary mass lesions by CT guided transthoracic fine needle aspiration cytology.Results:Out of these 42 cases majority were males with cough being most common clinical presentation. On CT guided FNAC of pulmonary lesions 69% of cases were malignant. Cytoradiological correlation in this study was 90.4%.Conclusion:CT guided FNAC of lung lesions is an accurate, cost effective and quick technique for early diagnosis, referral and appropriate treatment of patients in developing countries.

Pulmonary Amyloidosis in a Patient With Newly Diagnosed Rheumatoid Arthritis

SESSION TITLE: Pulmonary Manifestations of Systemic Disease 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Amyloidosis is a term used to describe a group of protein folding disorders. One form of systemic amyloidosis is amyloid A-type (AA). It is known to occur in chronic inflammatory conditions, including rheumatoid arthritis (RA). The prevalence of secondary amyloidosis in patients with RA ranges from 5-78% with only a small portion of cases with biopsy proven pulmonary amyloidosis.1,2 Here we present a patient with newly diagnosed RA found to have pulmonary amyloidosis. CASE PRESENTATION: Patient is a 76 year old woman with a past medical history of asthma, hypertension, hypothyroidism, and recurrent sinusitis who presented with complaints of swelling and joint pain bilaterally in her hands, shoulders, hips, and knees of 3-4 weeks duration. She reported difficulty rising from a chair as well as lifting her arms above shoulder level. Additionally, the patient complained of a minimally productive cough with clear sputum of 2-3 weeks duration. Review of systems was positive for fatigue, weakness, dry eyes, dry mouth, and joint pain. Physical exam was notable for pain on passive ROM and decreased ROM of bilateral upper extremities; there was no tenderness to palpation over her hands. Lab work up demonstrated positive rheumatoid factor, ANA, Smith, RNP, CCP, and SSA/RO. An x-ray of the hands demonstrated normal joint spaces bilaterally and no evidence of erosive changes. A chest x-ray demonstrated multiple pulmonary nodules in both lungs. Chest CT with IV contrast demonstrated diffuse pulmonary mass lesions without cavitations. Biopsy of a peripheral lung nodule demonstrated eosinophilic material consistent with amyloid. Congo red stain confirmed the presence of amyloid. A work up for amyloidosis showed normal urine protein, normal kappa/lambda ratio, and SPEP with no monoclonal spike. The patient was started on hydroxychloroquine 200 mg BID and prednisone 20mg daily with significant improvement in swelling and joint pain. DISCUSSION: Secondary amyloidosis occurs after several years in an inflammatory state. Deposition of the precursor protein, serum amyloid A, most commonly occurs in the kidneys and gastrointestinal tract.3 Pulmonary amyloidosis is an exceedingly rare finding in RA. CONCLUSIONS: Although AA amyloidosis has become less common due to advances in the treatment of RA, clinicians should include pulmonary amyloidosis in the differential when patients with RA present with pulmonary nodules. Reference #1: Barile L, Ariza R, Muci H, et al. Tru-cut needle biopsy of subcutaneous fat in the diagnosis of secondary amyloidosis in rheumatoid arthritis. Archives of Medical Research. 1993; 189-192. Reference #2: Kobayashi H, Tada S, Fuchigami T, et al. Secondary amyloidosis in patients with rheumatoid arthritis: diagnostic and prognostic value of gastroduodenal biopsy. British Journal of Rheumatology. 1996; 44-49. Reference #3: Lachmann HJ, Goodman HJB, Gilbertson JA, et al. Natural History and Outcome in Systemic AA Amyloidosis. New England Journal of Medicine. 2007: 2361-2371. DISCLOSURE: The following authors have nothing to disclose: Hooman Saberinia, Richa Bhardwaj, Justin Goralnik, Prashant Grover No Product/Research Disclosure Information

A Study on Distribution of Various Morphological Pulmonary Mass Lesions Using Computed Tomography Guided Fine Needle Aspiration Cytology

Background: CT guided Fine Needle Aspiration Cytology (FNAC) isthe first investigation of choice for intra thoracic mass lesions. It is very easy, safe, and provides real time visual access for aspiration of deeper tissues even though few millimeters in size. Objective: Present study was to evaluate the various spectrums of morphological mass lesions in the lung and determine effectiveness of CT guided FNAC.Materials and methods: This was a descriptive, cross sectional study on 50 patients, over a period of 1 year from April 2015 to March 2016, who underwent CT guided aspirationand their diagnoses were confirmed by appropriate methods.The results were analyzed and interpreted statistically.The study was approved by the Institutional Ethics Committee. Results:Out of 50 cases, 76 %( n=38) were males while rest of were females 24 %( n=12). For interpretation of specific diagnosis material was obtained 84 %( n=42) of cases. Most of thelung lesions were malignant 76 %( n=38) with in this squamous cell carcinoma56% (n=28)is most common, followed by adenocarcinoma 12% (n=6) and inflammatory granulomatous 8% (n=4) lesions.Conclusions: CT image guided Fine needle aspiration cytology provide more accurate, a noninvasive technique and extremely valuable in diagnosis of pulmonary mass lesions with minimal post aspiration complications.

Pulmonary Mass Lesions: CT Scan Diagnostic-Impressions and FNAC Diagnoses – A Correlative Study

Introduction: Bronchogenic carcinoma, the commonest pulmonary mass lesion, is the leading cause of cancer related death globally. Computed tomography (CT) scan is often used for evaluation of pulmonary mass lesions to have an initial diagnostic impression for deciding on next course of actions in clinical management. So, it becomes highly imperative to study the correlation of CT scan-diagnoses with pathological diagnoses. Till date such correlative studies are very meagre from north-eastern part of India. This study was designed to address this deficiency. Aim: To correlate CT scan-diagnoses of pulmonary mass lesions with the pathological diagnoses made on fine needle aspiration cytology (FNAC). Materials and Methods: Ninety subjects with pulmonary mass lesions were included. CT scan evaluation and CT-guided FNAC were performed. Important clinical profiles, radiological diagnostic impressions on nature of the lesions (malignant/benign) and cytological diagnoses were recorded. Finally, a radio-cytological correlation of diagnoses was done. Results: Out of 90 cases, CT scans diagnosed 81 cases as malignant and nine as benign. On FNAC, there were 73 malignant and nine benign lesions and in eight cases aspirates were unsatisfactory. An overall radio-cytological correlation of 92.6% was observed. The sensitivity and specificity of CT scan for detecting malignancy in pulmonary mass lesions were found to be 94.5% and 55.5% respectively with an overall diagnostic accuracy of 89%. Conclusion: CT scan study is a very useful non-invasive diagnostic modality in the clinical evaluation of lung masses. CT-guided FNAC is a simple, rapid and safe procedure with high yielding rate of pathological diagnoses.

Pulmonary infections in immunocompromised patients: the role of image-guided fine needle aspiration cytology.

To evaluate the role of fine needle aspiration cytology (FNAC) in the diagnosis of pulmonary infections in immunocompromised patients and to identify the imaging pattern of infections on computed tomography (CT). This was a retrospective study of 42 immunocompromised patients who underwent FNAC under image guidance owing to a clinical pulmonary infection. Each patient was evaluated for an underlying immunocompromised condition, cytological diagnosis, CT findings and complications. The most common predisposing condition was diabetes mellitus (n = 11), renal transplant status (n = 11) followed by connective tissue disorders (n = 6) and malignancy (n = 5). There were four patients with renal disease and three had a human immunodeficiency virus (HIV) infection. The most common cytological diagnosis was mucormycosis (n = 13) followed by nocardiosis (n = 8) and necrotising inflammation (n = 7), tuberculosis (n = 6), cryptococcosis (n = 2), aspergillosis(n = 2), histoplasmosis(n = 1) and atypical mycobacterial infection (n = 1). Mucormycosis presented as a pulmonary nodule (n = 7), mass lesion (n = 5) or consolidation (n = 4). The patients with nocardiosis had lung nodules with associated consolidation and cavitation. None of the patients had any major complication. FNA is a relatively reliable, safe and quick method of diagnosing pulmonary infection in immunocompromised patients. Cytomorphological features, when aided by special stains, can accurately detect the specific infection which is potentially treatable. Specific infections may be suggested based on specific imaging patterns.

Fine Needle Aspiration Cytology of Lung Masses, benefits, precautions and complications.

Background: Pulmonary masses represent a great challenge for diagnosis. Fine Needle Aspiration Cytology (FNAC) is one of the diagnostic methods which was used since long time.Objectives: To concern on Fine Needle Aspiration Cytology of pulmonary masses regarding benefits, precautions and patient’s preparation to avoid possible complications.Patients and Methods: A prospective study is carried out from December 2008 to July 2015 on 45 patients presented with pulmonary masses to the Department of the thoracic and vascular surgery at Al-Yarmook teaching hospital and from the private sector. A Fine Needle Aspiration Cytology was done for them under local anesthesia as an outpatient procedure.Results: 40 patients (88.9%) got accurate results of diagnosis as different types of malignancies. Five patients (11.1%) got inconclusive results. No mortality reported. Complications like Pneumothorax was occurred in three patients (6.7 %), Haemoptysis in 14 patients (31%) and mild chest pain in 13 patients (29%).Conclusion: FNAC is relatively safe and valuable method to diagnose pulmonary mass lesions and to categorize them for better subsequent management either surgical or by chemotherapy but the patients must be prepared well and the doctor who intend to do FNAC either being trained to deal with possible complications or backed up with a thoracic unit.

Pulmonary malignant melanoma with distant metastasis assessed by positron emission tomography-computed tomography.

Melanoma is a cutaneous malignant neoplasm of melanocytes. Primary malignant melanoma (MM) of the lung is very rare. Although previous reports have described the radiologic features of pulmonary MM, its rarity means that many factors are unknown. Thus, radiologic diagnosis is very difficult. Furthermore, there is little information regarding diagnostic application and/or the usefulness of [18F]‐fluorine‐2‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography‐computed tomography (FDG‐PET‐CT) for primary pulmonary MM. A 69‐year‐old patient with a productive cough lasting three weeks was admitted to our hospital. Chest CT showed a large single mass with a multi‐lobulated margin and homogeneous enhancement in the right upper lobe, which was subsequently diagnosed as a primary pulmonary MM with multiple metastases. On PET‐CT images, the pulmonary mass and multiple bone lesions showed very increased uptakes of FDG. Considering that pulmonary metastasis from a mucocutaneous melanoma is the main differential diagnosis of primary pulmonary MM, systemic assessment of the whole body is more important than for other types of lung malignancies. This report introduces PET‐CT as a useful diagnostic modality for pulmonary MM, especially in cases of distant multiple metastases.

A Rare Case Report - Primary Pulmonary Artery Sarcoma

The primary pulmonary artery sarcomas are rarely seen, can imitate pulmonary thromboembolism. The prognosis of patients with pulmonary artery sarcomas is dependent on its early and accurate diagnosis. Placed below is a description of a case of a 51-year-old man presented with dry cough and breathlessness was initially thought to have a Koch's lesion. AKT was given but the patient did not improve. Then on CT pulmonary angiography patient was suspected of having pulmonary embolus or hypo attenuating mass lesion and was given anticoagulation with unfractionated heparin, which was ineffective. CT guided biopsy of an enlarged right hilar nodal mass led to the diagnosis of primary pulmonary artery sarcoma.

The diagnostic accuracy of integrated positron emission tomography/computed tomography in the evaluation of pulmonary mass lesions in a tuberculosis-endemic area.

Integrated positron emission tomography/computed tomography (PET-CT) is a well-validated modality for assessing pulmonary mass lesions and specifically for estimating risk of malignancy. Tuberculosis (TB) is known to cause false-positive PET-CT findings. To investigate the utility of PET-CT in the evaluation of pulmonary mass lesions and nodules in a high TB prevalence setting. All patients referred for the evaluation of a solitary pulmonary nodule or mass and who underwent PET-CT scanning over a 3-year period were included. The PET-CT findings, including maximum standardised uptake value (SUVmax), were compared with the gold standard (tissue or microbiological diagnosis). The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy for malignant disease were calculated according to the SUVmax cut-off of 2.5 and a proposed cut-off obtained from a receiver operating characteristic (ROC) curve. Forty-nine patients (mean (standard deviation) age 60.1 (10.2) years; 29 males) were included, of whom 30 had malignancy. Using an SUVmax cut-off of 2.5, PET-CT had a sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for malignancy of 93.3%, 36.8%, 70.0%, 77.8% and 71.4%, respectively. After a ROC curve analysis, a suggested SUVmax cut-off of 5.0 improved the specificity to 78.9% and the diagnostic accuracy to 86.7%, with a small reduction in sensitivity to 90.0%. The diagnostic accuracy of PET-CT in the evaluation of pulmonary mass lesions using the conventional SUVmax cut-off of 2.5 was reduced in a TB-endemic area. An SUVmax cut-off of 5.0 has a higher specificity and diagnostic accuracy for malignancy, with a comparable sensitivity.

Uptake Difference by Somatostatin Receptors in a Patient with Neuroendocrine Tumor: 99mTc-Octreotide Uptake in the Lung without Uptake in Liver Lesions.

The diagnostic value of somatostatin receptor scintigraphy (SRS) in detecting tumors has been assessed in a number of studies. We present a 30-year-old female with a history of eight months cough and left shoulder pain. Radiologic evaluation showed pulmonary mass and hepatic lesions, which were pathologically diagnosed as neuroendocrine carcinoma. 99mTc-octreotide scan demonstrated that the pulmonary lesion was positive for somatostatin receptor (SSTR), while the liver metastases were SSTR negative. The present case highlights the significance of a differential uptake pattern by somatostatin receptors in SRS in patients with neuroendocrine tumors.