Round Nodules Research Articles

Interstitial pneumonia combined with nocardia cyriacigeorgica infection: A case report

BACKGROUND Nocardia infection is a relatively uncommon disease, with no reports among patients with interstitial pneumonia. Due to its atypical clinical symptoms and chest computed tomography (CT) findings and the frequent yielding of negative results by conventional cultures, it poses challenges for timely diagnosis and treatment. CASE SUMMARY A 63-year-old female patient presented to our hospital in July 2022 with a 3-mo history of intermittent cough and poor appetite, accompanied by a 2-wk long duration of headaches. She had a previous medical history of interstitial pneumonia and was on oral prednisone and cyclosporine. Chest CT revealed the presence of newly developed round nodules. The diagnosis of Nocardia cyriacigeorgica infection was confirmed through metagenomic next-generation sequencing (mNGS) performed on bronchoalveolar lavage fluid. Targeted anti-infection therapy was initiated, resulting in symptom improvement and radiological resolution, further validating the mNGS results. CONCLUSION Nocardia cyriacigeorgica infection is a clinically rare condition that is primarily observed in immunocompromised patients. Its clinical and radiological manifestations lack specificity, but mNGS can aid in rapidly obtaining pathogenic information. Early initiation of targeted antimicrobial therapy based on mNGS results can improve patient prognosis.

THU661 Marine-Lenhart Syndrome: An Unusual Presentation Of Hyperthyroid Disease

Abstract Disclosure: B. Ji: None. O. Adeniran: None. L. Soni: None. Background: Marine-Lenhart syndrome, also known as nodular Graves’ disease, is defined as the coexistence of functioning thyroid nodules and Graves’ disease. It is a rare syndrome, with a prevalence of approximately 0.8-2.7%. The two diseases may coexist or present at different times [1]. Treatment options include high doses of antithyroid medications or radioactive iodine and thyroidectomy in selected cases [2]. Clinical Case: A 72-year-old female with a medical history of right-sided breast cancer treated with lumpectomy and radiation therapy in 2012 on anastrozole was referred for multinodular goiter (MNG) evaluation in 2018. She was clinically and biochemically euthyroid. Her thyroid ultrasound demonstrated two isoechoic right lobe nodules measuring 2.1cm and 1.3cm, respectively. An isoechoic rounded isthmus nodule measures 2.1cm. Three isoechoic nodules in the left lobe measuring 2.6cm, 2.2cm, and 1.7cm. She underwent fine needle aspiration (FNA) of two nodules in 2019, and both demonstrated benign follicular nodules with Bethesda II classification. At a follow-up visit in 2021, she reported unintentional weight loss but denied any other symptoms of hyperthyroidism, including heat intolerance, palpitation, tremor, or diarrhea. Physical examination was significant for exophthalmos, lid retraction, and diffusely enlarged thyroid with non-tenderness to palpation. Thyroid function tests revealed subclinical hyperthyroidism with TSH of <0.01uIU/mL (0.27-4.2uIU/ml) and FT4 of 1.5ng/dL(0.9-1.8ng/mL). Thyroid stimulating immunoglobulin (TSI) was 3.98IU/L (0.00-0.55IU/L), and TSH receptor antibody was 7.64 IU/L (0.00-1.75 IU/L). She was started on low-dose methimazole therapy. Thyroid uptake scan showed markedly elevated radioactive iodine uptake with 63.46% in 24 hours and focal nodular regions of increased uptake of the bilateral thyroid lobes compatible with toxic multinodular goiter. Repeated thyroid ultrasound in 2022 revealed stable-sized nodules with at least two new sub-centimeter nodules in both lobes. The patient was also seen by ophthalmology and plans to start teprotumumab treatment. At her most recent follow-up visit in January 2023, she has been continued on methimazole 2.5mg daily. Conclusion: The criteria for diagnosing Marine-Lenhart syndrome have not been well established. The possibility of Marine-Lenhart syndrome should be considered in hyperthyroid patients with positive antibodies and nodular goiter. In this case, she was initially asymptomatic with an enlarged multinodular goiter; three years later, she developed subclinical hyperthyroidism due to Graves’ disease and toxic multinodular goiter. Her symptom and thyroid function are well-controlled with low-dose methimazole. Presentation: Thursday, June 15, 2023

Enlarging 18 F-FDG-Avid Solitary Pulmonary Nodule: A Distinctly Unusual Presentation of Cytomegalovirus Infection in a Patient Receiving Chemotherapy.

Rapidly growing lung lesions, particularly in immunocompromised patients, invoke consideration of an infectious etiology. Aspergillomas, for example, can appear as round nodules with soft tissue attenuation, often associated with cavitation, and are variably 18 F-FDG avid. In contrast, cytomegalovirus, which may also evidence 18 F-FDG uptake, typically manifests as ground-glass opacities, symmetrically distributed small pulmonary nodules, or confluent consolidations, with lower lobe predilection. We describe a patient treated for lymphoma presenting with a solitary enlarging FDG-avid lung nodule, which was determined on resection to be focal cytomegalovirus infection, a distinctly uncommon presentation of this pathogen, more typical of fungal or mycobacterial disease.

Surgical treatment for chronic pulmonary coccidioidomycosis: a retrospective study from a single institution.

Coccidioidomycosis, caused by the Coccidioides species, is a well-known disease in the Southwestern United States and North Mexico, with scattered reports in Latin America countries. While this disease is still rare in Japan and other Asian countries, its incidence has been increasing over the last two decades. Coccidioides species are highly infectious and require caution when encountered. This study presents a case series of chronic pulmonary coccidioidomycosis surgically treated at a single institution. We conducted a retrospective chart review of six patients who underwent lung resection for pulmonary coccidioidomycosis at Chiba University Hospital between January 2007 and December 2021. All six patients had travelled to the Southwestern United States. Preoperative serology was negative for the anti-Coccidioides antibody in four patients and positive in two. Chest computed tomography revealed a single, well-defined round nodule in all patients. Preoperative biopsy taken from three patients failed to obtain a definitive diagnosis. Histopathological examination of the resected pulmonary nodules revealed granulomas that contained numerous spherules with many endospores, thereby confirming the diagnosis of pulmonary coccidioidomycosis. Pulmonary coccidioidomycosis should be suspected based on travel history and radiological findings. Meticulous care should be taken during specimen processing to prevent cross infection.

Insights on the Formation Conditions of Manganese Oxides from Crimora, VA (USA)

Many regions of the United States contain manganese deposits economically valuable in New England, Appalachian, and Piedmont regions in the Eastern United States, in Northern Arkansas, and, to a small extent, in Central–Western California. Mn oxide/hydroxide (commonly referred to as Mn oxide minerals) are found in a wide variety of geological settings and occur as fine-grained aggregates, veins, marine and freshwater nodules and concretions, crusts, dendrites, and coatings on rock surfaces (e.g., desert varnish). How manganese oxides form and what mechanisms determine which oxides are likely to form are limited and still debated. This paper focuses on Mn oxides collected at the southern bound of the abandoned open-pit site called Crimora Mine (Augusta County, Virginia). This study uses mineralogical and chemical features to shed light on the origin of manganese deposits in Crimora along the western foot of the Blue Ridge in South–West Virginia. We report the first detailed study on the genesis of the Crimora manganese deposit conducted since the mine was closed in the 1950s. Crimora Mine sample is dark black fine- to medium-grained round and oblong nodules coated with a fine-grained intermix of yellowish earthy limonite, clays, and quartz. Scanning electron microscopy (SEM) revealed that the Crimora Mn-oxides exhibit concentric layering, breccia-like matrices, and veins. X-ray powder diffraction (XRPD) identified the set of Mn minerals as hollandite and birnessite. The concentration and range of dissolved chemical species in freshwater, seawater, and hydrothermal depositional fluids impart a geochemical signature to the Mn-oxides, providing a diagnostic tool to shed light on their genetic origin. Inductively coupled plasma optical emission spectroscopy (ICP-OES) analysis of the Crimora manganese oxides shows Mn, Fe, and Ti, as well as trace elements such as Co, Ba, Y, Zn, Cr, Ni, Tl, La, V, and Li. A bivariate analysis based on the geochemical correlation of Mn and other common substituting cations (e.g., Fe, Co, Ti) shows a mixed genesis in different environments with varying biological and sedimentary supergene (freshwater and marine) conditions. These data suggest that the Mn-rich deposit in Crimora, VA, was formed in a continental margin environment of surficial deposits and reprecipitated in mixed biogenic and supergene conditions.

August 2023 Medical Image of the Month: Cannonball Metastases from Metastatic Melanoma

No abstract available. Article truncated after 150 words. A 48-year-old man with a significant smoking history presented with progressive dyspnea, a mildly productive cough with brown-tinged sputum, headache, weight loss, and progressive back pain over a period of 8 weeks. The patient had no known history of lung conditions. As part of their initial evaluation, the patient received a frontal CXR and was found to have innumerable rounded pulmonary nodules throughout the lungs, which were consistent with a “cannonball” pattern of pulmonary metastatic disease (Figure 1A). A subsequent CT confirmed innumerable pulmonary metastases (Figure 1B). An MRI of the brain and spine revealed hemorrhagic brain metastases (Figure 2), spinal metastases, and bone metastases. A biopsy of a lesion in the left iliac bone confirmed the diagnosis of metastatic melanoma. This case highlights the so-called “cannonball” pattern of pulmonary metastatic disease with innumerable round nodules throughout the lungs with a slight lower lung predilection, consistent with a hematogenous spread …

Multi-organ metastases of primary chondrosarcoma of the mammary gland of a spayed Toy Poodle

We report the clinical and histopathological findings associated with multi-organ metastases of primary mammary chondrosarcoma in a 12-year-old spayed female Toy Poodle. At post-mortem examination, multifocal, sharply demarcated, grey–white to bright brown, round nodules of variable size were randomly distributed in the lungs, myocardium, liver, pancreas, spleen, intestinal tract and kidneys. Histologically, immature cartilage structures and primitive mesenchymal cells were seen in these organs. Neoplastic cells located in the cartilaginous basophilic extracellular matrix had cytoplasmic vacuolation and round vesicular nuclei and were stained with Safranin O and Alcian blue. To the best of our knowledge, this is the first report of a multi-organ metastatic chondrosarcoma that originated in the mammary gland of a dog.

Atypical Radiology Imaging of Squamous Cell Lung Carcinoma: A Case Report and Narrative Review

Introduction: Multiple well-circumscribed round nodules, also known as “Cannonball” appearance in the lungs, are typically associated with specific pulmonary metastases. However, limited reports denote the finding, especially if correlated with primary squamous cell lung carcinoma in the younger population. This is the first case report in Indonesia of a 19-year-old male with primary squamous cell carcinoma in the lung and chest radiograph image mimicking a “Cannonball” appearance Case Presentation: A 19-year-old male was presented with a history of progressing hemoptysis for two weeks with no other abnormal respiratory symptoms but a reduction of vocal fremitus. The subject is an occasional smoker and had a history of lung tuberculosis in 2009 and a suprarenal or adrenal mass. X-ray imaging revealed multiple bilateral pulmonary nodules, mimicking the “Cannonball” appearance. A fine needle aspiration (FNA) biopsy of a nodule was done and interpreted to be primary squamous cell carcinoma. Symptomatic treatment was given and the subject was discharged on the fifth day. Conclusions: A “Cannonball” appearance or its mimic is not always typical to certain carcinoma based on what this case report finds. In the case of a tumor, radiograph findings should also be correlated with other supporting tests such as biopsy and clinical presentation.

Placental Chorangiocarcinoma a Specific Histological Pattern of Uncertain Incidence and Clinical Impact: Systematic Review of the Literature.

Chorangiocarcinoma is a very rare and misdiagnosed placental neoplasm. The unique morphologic features of the lesion distinguish it from other trophoblastic tumors and vascular abnormalities. We present a systematic review of the literature to provide clarity on chorangiocarcinoma entity and biology. A literature search was carried out in December 2022 using the keywords "Placental chorangiocarcinoma", "Chorangioma", "Placenta", and "Throphoblast proliferation". Articles published from 1988 to 2022 were obtained from Scopus, Google Scholar, and PUBMED. In our review, we examined maternal age, gestational age at the time of delivery, parity, type of pregnancy, placental weight, ultrasound features of the placenta, macroscopic examination and tumor size, microscopic examination, immunostaining, maternal beta-human chorionic gonadotropin, fetal and maternal outcome. Eight manuscripts were detected. They are all case reports. The macroscopic characteristics of the lesions were represented by the presence of a grey-yellow-white color well-demarcated round nodule. Microscopically, all the authors described typical aspects of malignancy as a high rate of mitosis, nuclear atypia and necrotic areas. In some cases, the presence of AE1/AE3 cytoplasmic positivity, p63 nuclear staining, and beta-human chorionic gonadotropin (BHCG) were reported. A good fetal outcome was reported in all cases of newborns with normal birth weight, except one with fetal growth restriction. Maternal outcome was good in all cases except one with maternal lung metastasis three months after delivery. The clinical course has probably underestimated the real incidence of the pathology. Only greater knowledge of its histology and its clinical course will allow us to evaluate the real prevalence of the disease.

Vitamin A deficiency in peafowl with secondary visceral urate deposition

Clinical History: In a flock of approximately 180 peafowl, several were showing signs of a possible upper respiratory infection and had mouth gaping per the owner. They were also reported to be lethargic, to have excessive phlegm or mucus in the mouths, had trouble swallowing, and were losing weight. They were being treated with Baytril and Metronidazole with no improvement. Approximately eight had died. Five peafowl were submitted for necropsy and diagnostic work-up, including three peahens and two peacocks. Gross Findings: In all five peafowl, the oral cavity contained excess mucus. The oral, crop, and esophageal mucosa had disseminated, smooth, raised, round nodules with a central pore. The proximal esophagus was the most severely affected site. The nodules measured on average ~2 mm in diameter. Upon squeezing some of these nodules, pale tan, caseous material could be expressed. In all five peafowl, the heart was diffusely coated by abundant white, chalky, urate material. Similar though lesser amounts of urates partially coated the surface of the liver and other coelomic membranes. In one peahen, the ureters were multifocally distended and contained consolidated accumulations of tan to pale yellow, caseous material. The kidneys in this bird were pale.

Imaging of ring-shaped lateral ventricular nodules (RSLVNs).

Ring-shaped lateral ventricular nodules (RSLVN) are small and round nodules attached on the ependyma of lateral ventricles with unknown nature. They are considered "leave me alone lesions" and differential diagnosis includes subependymal grey matter heterotopia, subependymomas, subependymal hamartomas, and subependymal giant cell astrocytomas. In this short article, we report imaging findings of RSLNVs discovered in five patients, underlining the pivotal role of neuroimaging in the diagnostic path.

Radiological and clinical features of multinodular and vacuolating neuronal tumor (MVNT)

BackgroundTo investigate the imaging findings and clinical features of multinodular and vacuolating neuronal tumor (MVNT).MethodsWe retrospectively sought for cases that have suspicious imaging findings for MVNT through the hospital information system. The patients’ demographics and clinical symptoms were extracted. All available images were re-examined.ResultsHeadache was the most common complaint (n = 7). Other complaints included seizure, stroke-like symptoms and numbness. Conventional MRI revealed that all lesions consisted of tiny, sharply marginated, round or ovoid nodules following the gyral contour. These nodules were hyperintense on T2 and FLAIR WI, hypointense on T1 WI. All lesions were characterized by a lack of enhancement and diffusion restriction. Mass effect and peripheral edema were not observed. MVNT presented as an incidental finding in one case who complained gynecomastia and had pituitary adenoma on pituitary MRI. All lesions were supratentorial—mostly on the right side (10/11)—and located in subcortical white matter. Follow-up MRI was available for 11 patients with a mean of 14.8 months (3–40 months). No change in lesion size and morphology was observed in these follow-up images.ConclusionsRadiological and clinical follow-up data suggest MVNT may exhibit indolent behavior. If asymptomatic, patients can be followed by imaging alone. Surgery should be considered for symptomatic patients.

Lung to Lung Cannon Ball Metastases: A Case Series on Primary Lung Malignancy

Cannon ball metastases refer to large, well circumscribed, round pulmonary nodules like cannon balls that are scattered over both lungs, being a classical presentation of haematogenous tumour spread.Cannon ball pulmonary metastases are typically seen in the patients with choriocarcinoma or renal cell carcinoma. Rarely, pulmonary metastases with the same appearance may be secondary from prostate cancer, synovial sarcoma, endometrial carcinoma or haepatocellular carcinoma.The present case series is about six patients diagnosed with cannon ball metastases which occurred from primary lung carcinoma. Out of these six cases, three were of small cell carcinoma, two of squamous cell carcinoma and one of adenocarcinoma.The histopathology of all the cases was established by biopsy from the tumour site and appropriate treatment was started in the form of chemotherapy and radiotherapy as needed. Clinicians must investigate thoroughly for primary origin of cannon ball metastasis, though rare but lung cancer can present as this kind of metastasis.

TAIL GUT CYST- A RARE FINDING- CASE REPORT AND REVIEW OF LITERATURE

Introduction: Tailgut cysts are rare congenital entity that arises from the embryological hindgut and usually located in presacral space. Here we report a case of tail gut cyst which is an infrequent condition. Case report: Here, we report a nineteen year old male with lower abdominal pain. The relevant investigations were performed. The CT abdomen revealed a well-dened cystic lesion in the pelvis in lower presacral region and posterior to rectum with small calcied foci suggestive of tail gut cyst with scalloping of sacrum. MRI pelvis suggested large well dened unilocular cystic lesion in the retro-rectal and pre-sacral region extending from S2 to mid coccygeal level showing thin imperceptible walls few tiny projections and small rounded non enhancing nodule along its posterior wall with thin focal calcication seen in its wall with no evidence of malignancy and no signs of osseous destruction. The patient was explored and intraoperatively ndings revealed a cyst of size 8 cm * 5 cm behind the rectum and in front of sacrum which was densely adhered to the posterior wall of rectum but free from sacrum. The mass was resected as a whole and sent for histopathological exam which was suggestive of tailgut cyst. Tailgut cysts is infrequent condition which manifests as chronic lower abdominal pai Conclusion: n. It is crucial that such entity be diagnosed and surgically excised early in its presentation. It is important to rule out malignancy in the post operative biopsy

Клинический случай иридоциклита, мимикрирующий под меланому радужки по типу зерен саго («тапиоки»)

Iris melanoma by the type of sago grains («tapioca») is a rare form of malignant neoplasm that develops from melanocytes of the iris stroma. Early diagnosis of this disease is extremely important for the life and ability to work of patients. In a patient with chronic recurrent iridocyclitis, deposits of small calcifications were found on the cornea, long-standing opacities at the stroma level in the lower parts perilimbally, epitheliopathy in the form of small-point defects; multiple rounded nodules (neoplasms) of pale brown color on the iris OU. Diagnostic methods: ultrasound, gonioscopy, UBM, OST of the cornea, OST of the iris. Diagnosis: secondary calcifying ribbon keratopathy OS. Suspected iris melanoma of the type of sago grains («tapioca»), immature cataract, chronic iridocyclitis without exacerbation. Due to conservative treatment, including the use of glucocorticosteroids, the changes in the iris completely disappeared after 1.5 months. A clinical case demonstrates the possibility of developing one disease with manifestations of clinical symptoms of another nosological group disease. This implies a thorough differential diagnosis with the possible use of test therapy. Keywords: melanoma, chronic recurrent iridocyclitis, calcifications.

Benign Metastasizing Leiomyoma of The Lung: A Case Report

Introduction: Benign metastasizing leiomyoma of the lung which is categorized by the growth of uterine leiomyoma in the lung is an extremely exceptional disease.
 Case presentation: We report a 39-year-old woman who had a previous history of uterine leiomyoma. Chest computed tomography (CT) scan exhibited round nodules well-defined margins in both lungs. Thoracoscopic partial resection of the lung was done. Pathological and immunohistochemical examination showed that neoplastic tissue composed of spindle-shaped smooth muscle cells, compatible with uterine leiomyoma. Thus, these tumors can be reflected to be lung metastases from a uterine leiomyoma (benign metastasizing leiomyoma).
 Conclusion: It is an uncommon condition but it would be careful in women of reproductive age with a past medical history of uterine leiomyoma, who existing with pulmonary nodules.

AN UNUSUAL CASE OF ORAL FOCAL MUCINOSIS

Focal oral mucinosis (OFM) is a rare lesion of unknown etiology that exhibits tumor growth. OFM has a predilection for keratinized tissues, such as the gingiva or hard palate. The occurrence of OFM in nonadherent oral mucosa is rare. Here we present the case of a 47-year-old woman, nonsmoker, nonalcoholic, with no history of facial trauma. On extrabuccal examination, no changes were observed. On intraoral examination, a 10 × 10 mm yellow submucosal rounded nodule was observed in the lower midline fornix region, fibrous on palpation, covered by thin and normal mucosa. On occlusal radiography, no bone destruction was observed. Excisional biopsy was performed. Histomorphologic analysis showed myxoid connective tissue with abundant mucinous material with delicate collagen fibrils. The diagnosis of OFM was established by staining with Alcian blue, period acid-Schiff stain, and immunohistochemistry for protein S-100. In 1 year of follow-up, there was no recurrence.

Possible Alterations of Imaging Patterns in Computed Tomography for Delta-VOC of SARS-CoV-2.

So far, typical findings for COVID-19 in computed tomography (CT) have been described as bilateral, multifocal ground glass opacities (GGOs) and consolidations, as well as intralobular and interlobular septal thickening. On the contrary, round consolidations with the halo sign are considered uncommon and are typically found in fungal infections, such as invasive pulmonary aspergillosis. The authors recently observed several patients with COVID-19 pneumonia presenting with round, multifocal consolidations accompanied by a halo sign. As this may indicate alterations of CT morphology based on the virus variant, the aim of this study was to investigate this matter in more detail. 161 CT scans of patients with confirmed SARS-CoV-2 infection (RT-PCR within 2 days of CT) examined between January 2021 and September 15, 2021 were included. Follow-up examinations, patients with invasive ventilation at the time of CT, and patients with insufficient virus typing for variants of concern (VOC) were excluded. CT scans were assessed for vertical and axial distribution of pulmonary patterns, degree of involvement, uni- vs. bilaterality, reticulations, and other common findings. The mean density of representative lesions was assessed in Hounsfield units. Results were compared using Mann-Whitney U-tests, Student's t-rests, descriptive statistics, and Fisher's exact tests. 75 patients did not meet the inclusion criteria. Therefore, 86/161 CT scans of unique patients were analyzed. PCR VOC testing confirmed manifestation of the Delta-VOC SARS-CoV-2 in 22 patients, 39 patients with Alpha-VOC and the remaining 25 patients with Non-VOC SARS-CoV-2 infections. Three patients with the Delta-VOC demonstrated multiple pulmonary masses or nodules with surrounding halo sign, whereas no patients with either Alpha-VOC (p = 0.043) or non-VOC (p = 0.095) demonstrated these findings. All three patients were admitted to normal wards and had no suspicion of a pulmonary co-infection. Patients with Delta-VOC were less likely to have ground glass opacities compared to Alpha-VOC (7/22 or 31.8 % vs. 4/39 or 10.3 %; p < 0.001), whereas a significant difference has not been observed between Delta-VOC and non-VOC (5/25 or 20 %; p = 0.348). The mean representative density of lesions did not show significant differences between the studied cohorts. In this study 3 out of 22 patients (13.6 %) with Delta-VOC presented with bilateral round pulmonary masses or nodules with surrounding halo signs, which has not been established as a notable imaging pattern in COVID-19 pneumonia yet. Compared to the other cohorts, a lesser percentage of patients with Delta-VOC presented with ground glass opacities. Based on these results Delta-VOC might cause a divergence in CT-morphologic phenotype. · Until recently, CT-morphologic signs of COVID-19 pneumonia have been presumed to be uncontroversially understood. Yet, recently the authors observed diverging pulmonary alterations in patients infected with Delta-VOC.. · These imaging alterations included round pulmonary masses or nodules with surrounding halo sign.. · These imaging alterations have not yet been established as typical for COVID-19 pneumonia, yet.. · Based on these results, Delta-VOC could impose a divergence of CT-morphologic phenotype.. · Yüksel C, Sähn M, Kleines M et al. Possible Alterations of Imaging Patterns in Computed Tomography for Delta-VOC of SARS-CoV-2 . Fortschr Röntgenstr 2022; 194: 1229 - 1241.

Dental manifestations of hereditary hemorrhagic telangiectasia: a clinical case

A rare disorder that changes the blood vessels of many organs and causes bleeding. The disease affects the lungs, liver, central nervous system, gastrointestinal tract, skin and mucous membranes. The degree of incidence of Randu-Weber-Osler disease is not high and ranges from 1 detected case per 50 thousand – per 100 thousand population. The scientific article presents a clinical case with dental manifestations of Randu-Weber-Osler disease and indicates the important role of the dentist in monitoring such patients. The red border of the lips is dry, pale, with pronounced multiple punctate telangiectasias of red-violet color. In the area of the lower lip, brightly colored round nodules with a diameter of about 5 mm are found, protruding above the surface, painless on palpation. On the dorsal and lateral surfaces, there are papular formations of a red-violet color, with a diameter of 5 to 7 mm, protruding above the surface. The gums are hyperemic, edematous, loose, bleeds on probing, periodontal pockets with exudative contents. On examination, attention was drawn to an insufficient amount of saliva, which was located mainly in the retromolar region; it was frothy. The salivation rate is reduced (0.1 ml per minute). It is assumed that before and during invasive dental procedures, antibiotic therapy is necessary, especially when working in infected areas (500 mg of amoxicillin) every 8 hours starting 12 hours before the procedure for 7 days. Given that hypoxia and cerebral embolism are frequent complications, the dental chair should be in an upright position throughout the patient's appointment. Treatment of this disorder is only supportive in nature, its goals are to relieve symptoms, treat complications and prevent progression of the disease. Early definition of the manifestations of this disease and careful observation of the patient gives a favorable prognosis of the course and prevents the development of severe complications. Keywords: hereditary hemorrhagic telangiectasia, periodontitis, xerostomia.

CASE REPORT: PULMONARY HAMARTOMA IN PATIENT WITH BREAST CANCER

TYPE: Case Report TOPIC: Cardiothoracic Surgery INTRODUCTION: Pulmonary hamartoma accounts 77% of benign lung tumors and 4% of solitary pulmonary nodules. It is more common in male adults. It is rare benign lung tumors and are composed of an abnormal mixture of epithelial and mesenchymal elements. It usually presents as single, round nodules with distinct boundaries and mostly asymptomatic. Metastasis was differential diagnosis. Enclulation was done through mini-thoracotomy. Histopathological examination confirmed the diagnosis. CASE PRESENTATION: 47-years female referred from Oncology Department with two pulmonary nodules. She had bilateral mastectomy 3-years ago. The patient had a history of hormonal therapy and chemotherapy, as well as of adjuvant radiotherapy. Chest CT revealed two pulmonary nodules (3 × 2.5 cm). Pulmonary metastasis was differential diagnosis and biopsy indicated for confirmation. Enucleation was performed through mini-thoracotomy. The excised nodules were firm, and non-capsulated. The patient recovered well and discharged on 3rd POD. DISCUSSION: The incidence of pulmonary hamartoma was 0.25%. It is more common in adult males,and discovered accidentally . [4] It is the third most common cause of SPN. [5] Surgical resection is a definitive diagnosis, and with low morbidity and mortality rate. [1] Conservative lung sparing surgery is indicted. [4] Pulmonary nodules in breast cancer patients should be treated after pathological confirmation. The most common “symptoms” is fear, as these tumors can similar to cancer when found, especially on imaging. [5] CONCLUSIONS: Pulmonary hamartomas present as PSN. Sparing lung surgery is recommended for accurate diagnosis and treatment. DISCLOSURE: Nothing to declare. KEYWORD: Hamartoma, Solitary Pulmonary Nodule, Lung Cancer, Breast Cancer, Metastasis.