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The cells have abundant rough endoplasmic reticulum and cytoplasmic vesicles, and small numbers of mitochondria. Radioisotope studies show an uneven distribution of perfusion and ventilation, and confirm the presence of segmental and/or diffuse pulmonary functional defects. Destruction of the pulmonary vascular bed leads to secondary pulmonary hypertension. Immunohistochemically, adenosquamous carcinoma expresses pancytokeratins and cytokeratin 7, but not cytokeratin 20. Pulmonary cavitary sarcoidosis: clinico-radiologic characteristics and natural history of a rare form of sarcoidosis. Once established, however, arterial hypertension itself comes to act as a stress factor on the vasculature, causing shear stress. Typically a region of necrosis is surrounded by a rim of foamy macrophages and inflammatory cells. Extent of pulmonary pigmentation as an indicator of particulate environmental air pollution. Histopathologic and immunohistochemical features of fatal influenza virus infection in children during the 2003:2004 season. Macrophage production of basic fibroblast growth factor in the fibroproliferative disorder of alveolar fibrosis after lung injury. Respiratory symptoms, weight loss, anemia, extensive lymphangitic, interstitial, intravascular or endobronchial spread of tumor, pleural effusion, hilar metastases, liver metastases, peripheral lymphadenopathy and spindle cell histology have been reported to be indicators of a worse prognosis. The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992:2000. They can sporadically arise in the lung, with fewer than 30 cases reported as primary pulmonary tumors in the literature. Primary pulmonary adenocarcinoma with enteric differentiation resembling metastatic colorectal carcinoma: a report of the second case negative for cytokeratin 7. Firstly, the pool of lungs available for transplant has remained stagnant over the last two decades despite the increasing number of potential candidates for transplant in North America and Europe. The symptomatic chronic form may not occur for years or even decades after initial infection. When a focal lung lesion is involved, these changes may be beneficial, since they probably divert the blood flow to normal or less affected parts of the lung. The age range of affected patients is 2:86 years, the peak incidence being in the forties. As discussed in Chapters 27 and 28, adenocarcinomas and squamous cell carcinomas are sensitive to different chemotherapeutic agents. By contrast, septic emboli, which are larger and more variable in size, are sieved out in the dichotomous pulmonary arteries anywhere from the main pulmonary artery to the small pulmonary arteries at the level of the terminal bronchioles. Although this probably results from parenteral nutrition lipid administration,472,473 some argue that lipid infusion is not a prerequisite. Histopathological findings were summarized as arborizing intraluminal tufts of immature fibroblastic tissue ("bronchiolitis obliterans"), often in combination with organizing alveolar pneumonia but less dominant than the interstitial component; interstitial fibrosis distant from the bronchiolar disease; architectural "simplification" with some degree of honeycomb change; chronic interstitial inflammation; and occasional peribronchiolar metaplasia. When its expression is experimentally re-established in renal tumor cell lines, this has a suppressive influence on the tumor, including colony formation in vitro and slower establishment of tumors in mouse xenografts. Removing the pigment with picric acid is helpful in determining whether these are parasites and not pigment in the red cells. Some cases feature mostly primitive blastema-like cells, while others a predominance of fibroblastic cells. Because Babesia parasites infect and destroy red blood cells, babesiosis can cause hemolytic anemia, leading to jaundice and dark urine. Clinicopathological patterns of respiratory involvement can broadly be grouped into upper airway disease, small airways disease and parenchymal disease (Table 14). Sporotrichosis with widespread cutaneous lesions: report of 24 cases related to transmission by domestic cats in Rio de Janeiro, Brazil.

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This probably represents a region of post-inflammatory scarring and atelectasis with subtotal involvement of the lobule. As such, "recruitment" of congested/collapsed alveoli is fundamental to mechanical ventilation strategies aiming to improve ventilation-perfusion matching. Primary pulmonary ganglioneuroblastoma: a clinicopathologic and immunohistochemical study of two cases. Certain unusual radiological appearances in the chest of coal-miners suffering from rheumatoid arthritis. Primary pulmonary glomus tumor: a clinicopathologic and immunohistochemical study of two cases. Pulmonary venoocclusive disease: involvement of pulmonary arteries and review of the literature. The most intense exposures, causing pneumoconiosis, have been reported in kaolin miners and processing plant workers. Expression of kidney-specific cadherin distinguishes chromophobe renal cell carcinoma from renal oncocytoma. This infection can present as a pulmonary coin lesion or characteristic comma-shaped shadow on imaging. More complex procedures, such as chest wall or pericardial resections, may be indicated. Mechanisms and experimental models of chronic obstructive pulmonary disease exacerbations. They have a single elastic lamina, so they are indistinguishable from normal pulmonary arterioles. Ring-shaped opacities of contiguous cavities giving the characteristic appearance of a bunch of grapes are highly suggestive of pulmonary paragonimiasis. A genotypic study failed to confirm a relationship between pulmonary meningothelial nodules and central nervous system meningiomas. The exclusion of bacterial or fungal infection is important in the early postoperative period and in patients with chronic airway rejection. Thyroid transcription factor-1 expression during normal human lung development and in patients with congenital diaphragmatic hernia. These structures are often scanty and the electron microscopic features of these tumors are more variable. The highest T category and stage of disease should be assigned and the multiplicity or the number of tumors should be indicated in parenthesis. Marijuana abusers may develop paraseptal bullae, in contrast to centrilobular emphysema seen more commonly in exclusively tobacco smokers. Cavitation is seen in up to 25% of cases and may also represent "cavitary sarcoidosis" in the clinical literature. Peribronchial metaplasia associated with mild peribronchial interstitial fibrosis. Lymphogranulomatosis benigna in the light of prolonged clinical observations and autopsy findings. Infection As mentioned previously the lung allograft is at risk from a variety of infectious complications on account of immunological, mechanical and functional issues related to the donor, the recipient, the procedure and post-transplant management. This is particularly the case with adenocarcinomas with a predominant lepidic component. Increase of cytokine production by pulmonary artery endothelial cells induced by supernatants from monocytes stimulated with autoantibodies against U1ribonucleoprotein. Additional histochemical stains, immunohistochemistry and molecular techniques are advocated on a case-by-case basis. Pancoast tumors: improved survival with preoperative and postoperative radiotherapy. In susceptible hosts, it produces a hypersensitivity reaction in the lung involving inflammation, stereotypically granulomatous, of the small airways (bronchiolitis), the alveolar parenchyma and airspaces. Large pleural effusions, while unusual, may occur with adenovirus and parainfluenza pneumonias. Effect of a gonadotrophin-releasing hormone analogue on lung function in lymphangioleiomyomatosis.

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At most levels, transverse sections through the female worm contain paired uterine tubes filled with eggs, developing into microfilaria. Lymph node and distant metastases are noted and almost half of all patients reportedly die of the carcinoma. The presence of, in some instances, molecular changes associated with the more usual forms of lung cancer supports this hypothesis. The diagnosis is most often based on isolation of the organism from blood taken through the catheter. Longitudinal studies of human subjects who are at known risk of developing bronchogenic carcinoma (smoking history, other known exposures, history of previous lung or head and neck cancer, etc. The severity of each type is related to the residual acid -galactosidase enzyme activity. A reevaluation of the clinical significance of histological subtyping of non: small-cell lung carcinoma: diagnostic algorithms in the era of personalized treatments. Retrospective diagnosis of hantavirus pulmonary syndrome, 1978:1993: implications for emerging infectious diseases. As a reminder, the presence of small cell carcinoma removes the neoplasm from this category. Each fragment is remarkably similar in size and with regard to amount of epithelial proliferation. They may be found in soil, food, water or surfaces that have been contaminated with the feces from infected humans or animals. Since the ectopic endometrium cycles according to systemic hormone levels, fluid shifts during the cycle and tissue breakdown during menstruation cause both hemorrhage and tissue protusion into airways. Lung carcinoma is the third commonest cancer amongst Chinese women in Singapore and constitutes almost 10% of all cancers in this group. Role of open lung biopsy for diagnosis in lung transplant recipients: ten-year experience. Enzyme replacement therapy stabilizes obstructive pulmonary Fabry disease associated with respiratory globotriaosylceramide storage. The former allows easy identification of small veins, while the latter tissue allows examination of arteries and veins of both small and large caliber. When they present at advanced stages, it is primarily due to direct invasion to the surrounding structures or intrapulmonary metastases. The pathogenesis and treatment of acid sphingomyelinasedeficient Niemann-Pick disease. Others, such as intravascular lymphoma and lymphomatoid granulomatosis, are not necessarily confined to the lungs at presentation. Catheter-associated Malassezia fungemia is a sporadic illness in immunocompromised children and adults. By this route, eggs can directly reach the pulmonary vascular bed, again causing vascular damage. There are intraluminal plugs of loose fibromyxoid connective tissue ("Masson bodies") within alveoli and alveolar ducts. This modality reduces the risk of downward spread of virus, noted in bronchoscopy patients. The major features and images of the common and uncommon bacteria that cause pneumonia are presented in Table 2, while additional characteristics are presented in the following section. The epithelial component is considered entrapped bronchiolar or alveolar epithelium and in no way resembles fetal glandular tissue. Bronchial arteries are accompanied by bronchial veins that reach the right atrium, via the azygos vein on the right, and the highest left intercostal or the accessory hemiazygos vein on the left. The important distinction from marginal zone lymphoma is discussed in detail below. As a transcription factor, there is a large body of publications elucidating its biological role. This polysaccharide circulates in the blood of patients with invasive mycoses, including candidiasis and aspergillosis, but not cryptococcosis or mucormycosis. In some instances, such as asbestos mining, the causative agent is apparent, while in others, such as painting and welding, an excessive risk is noted, but the causative agents are not known. When uncertain, however, a definitive diagnosis should be deferred since an erroneous interpretation of typical carcinoid tumor will lead to an unnecessary lobectomy and lymphadenectomy.

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In an attempt to accommodate the more protean aspects of the disease, more recent interpretations suggest "acute progressive", "acute intermittent non-progressive" and "recurrent non-acute disease" patterns (Table 1). However, not all patients have clear-cut stepwise progression as up 732 Chapter 19: Pulmonary vasculitis and pulmonary hemorrhage syndromes Table 10 Churg-Strauss syndrome: main clinical features Asthma Eosinophilia > 10% Sinusitis Lung involvement Peripheral neuropathy Skin involvement Heart involvement Gastrointestinal tract involvement Renal involvement Central nervous system involvement to 20% may have overlapping manifestations from the different phases. Cytological samples may show atypical bronchioloalveolar cells but their origin cannot be ascertained. Electron micrograph of pneumocytes in a patient with Hermansky-Pudlak syndrome: there are numerous giant lamellar bodies. In addition to morphological findings, the procured tissue can be examined for infectious agents. The latest classification17,18 (Table 1) differs fundamentally and conceptually from its predecessors. The 2004 classification also added a mixed subtype category of adenocarcinoma, as an acknowledgement that most adenocarcinomas feature at least two if not more morphological patterns. Multiorgan involvement is most prominent in the diffuse variant, with vascular and connective tissue fibrosis affecting the skin, gastrointestinal tract, lungs and kidneys. Dietary folate intake and lung cancer risk in former smokers: a case-control analysis. The presence of IgM antibody or four-fold rise in the IgG antibody is usually indicative of acute infection while stable IgG antibody levels suggest prior infection. The measurement of adenosine deaminase in body fluids has been shown to be useful in diagnosis in some reports. Subdiaphragmatic bronchogenic cyst with communication to the stomach: a case report. This has recently been confirmed by the reduction in elderly pneumococcal bacteremias, resulting from vaccination of young children with conjugate pneumococcal vaccine. This is due to silicainduced injury to alveolar macrophages, as well as a reduction in cell-mediated immunity, caused by silica exposure. Recurrence of idiopathic pulmonary hemosiderosis in a young adult patient after bilateral single-lung transplantation. Expression, function, and clinical implications of the estrogen receptor beta in human lung cancers. Especially in endemic areas, this can be complicated further by a chest wall abscess, which in half the cases can involve the ribs. There is a heterogeneous pattern of disease with relatively normal lung anteriorly (black arrow), dense air-space opacification in the most dependent areas (double arrow) and ground-glass changes in the intervening lung (white arrow). Not all the features for a particular grade will be present in every lesion and this is a biologically continuous evolution of disease. These features may be also observed in any of the diffuse pulmonary fibrosing pneumonitides. Eosinophils along with lymphocytes, neutrophils, histocytes and even multinucleated giant cells infiltrate small vessel walls. Lung cancer associated with chloromethyl methyl ether manufacture: an investigation at two factories in the United Kingdom. Prospective study of transbronchial biopsies in the management of heart-lung and single lung transplant patients. Malignant mesenchymomas may exhibit malignant osteoid, but they also have other sarcomatous components. Chronic cadmium exposure is associated in epidemiological studies with emphysema and interstitial fibrosis. Sarcomatoid mesothelioma may have areas of desmoplastic diffuse malignant mesothelioma, which are not found in monophasic synovial sarcoma (see Chapter 36). The disease usually recurs many times over many years, becomes widespread and extends into the bronchial tree in up to 5% of patients. The glandular cells feature little differentiation toward mucous or ciliated cells; mucin-secreting granules are inconspicuous and peculiar round bodies with beaded borders may represent rudimentary intracellular components of primitive developing cilia. Viral and mycoplasmal pneumonias: reviewing 202 Chapter 5: Pulmonary viral infections 37.

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The mineral finds utility as loose-fill thermal insulation and fire production, aggregate in cement, wallboards and plasters, as well as a soil additive and bulking agent in animal feeds. Cells are large and variably preserved with marked anisonucleosis, noticeable nucleoli and irregular, coarsely stippled chromatin. Silicon carbide pneumoconiosis Silicon carbide (carborundum) is a very hard synthetic abrasive. The appearance of a purulent fluid of a chocolate-like color (often described as anchovy paste) following the puncture of an abscess, discharge or through vomiting is highly suggestive of amebiasis. Occasional (sporadic) cases of babesiosis caused by other Babesia species are reported. Chronic summer-type hypersensitivity pneumonitis: clinical similarities to idiopathic pulmonary fibrosis. Calcifications in the hilar nodes can eventually erode into the lumina of the adjacent bronchi and result in broncholithiasis (see Chapter 17). Man becomes infected usually only in situations where warm water first of all becomes stagnant, allowing the organism to multiply and then secondly aerosolized, so the organism can be inhaled. Treatment of exacerbations usually involves both anti-inflammation therapy and airflow-augmenting agents, and may also include antibiotics. Immunohistochemical localization of pulmonary surfactant apoproteins in various lung tumors. Angiomyolipomas are indicator lesions for sporadic lymphangioleiomyomatosis in women. Spindle cell pseudotumors in the lungs due to Mycobacterium tuberculosis in a transplant patient. Expression of carcinoembryonic antigen and related genes in lung and gastrointestinal cancers. The alveolar capillaries are typically described as showing increased numbers of marginated neutrophils, although this is not a universal finding, and there is interstitial edema. Adventitial cell proliferation, Histopathological patterns of hypertensive pulmonary vascular disease Introduction the role of biopsy pathology in the diagnosis and clinical management of pulmonary hypertension is limited to those cases where clinical presentation and hemodynamic parameters do not provide an unequivocal diagnosis. Nucleotide excision repair genes and risk of lung cancer among San Francisco Bay Area Latinos and African Americans. Sarcomatoid mesothelioma with chondrosarcomatous foci might be confused with primary pulmonary chondrosarcoma. A disintegrin and metalloprotease 33 and chronic obstructive pulmonary disease pathophysiology. Lower plasma protein C is associated with worse clinical outcomes in patients with acute lung injury. Special clinical features Patients with primary pulmonary angiosarcoma usually present with cough and dyspnea, and may have chest pain and hemoptysis. Giant cell formation in sarcoidosis: cell fusion or proliferation with nondivision With particular reference to the small ovoid body and a note on the finding of dolomite. In fact, an "angiogenic switch" might be crucial at this stage of disease evolution. Birefringent foreign material and large interstitial fibrotic masses containing foreign particles surrounded by multinucleated giant cells and granulomas are often seen. Luminal cuboidal cells with eosinophilic cytoplasm are surrounded by myoepithelial cells with focally clear cytoplasm. The calcified lymph nodes are usually the result of either granulomatous lymphadenitis. Mixed connective tissue disease with pulmonary hypertension: a clinical and pathological study. A longitudinally sectioned bronchiole is seen along the top of the photomicrograph. Before birth these arteries are constricted, so the media is thick in comparison to the vascular diameter. In other instances, the converse is true and tumor cells occlude the vessels but a thrombotic reaction is absent. Mucormycosis is the second most frequent mold infection in immunocompromised individuals. This exceptionally rare carcinoma features a poorly defined raised tan infiltrate. Markers of cell proliferation and expression of melanosomal antigen in lymphangioleiomyomatosis.

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Proliferative-phase endometrial glands feature larger cells than adjacent bronchiolar epithelium (arrowheads). It is satisfying for pathologists to note that the European League Against Rheumatism recommends that histology should be obtained in all cases to assist in diagnosis. A case of well differentiated fetal adenocarcinoma with a mutation of the b-cateinin gene (in Japanese). Accidental laboratory infections have been recorded, and great care should be exercised in handling culture samples. The following sections describe the recognized histological patterns of pulmonary hypertensive vascular disease. The final paper section is compared to a grading standard to produce an overall severity estimation. Respiratory involvement is not a feature of Krabbe disease, although recurrent aspiration secondary to neurological impairment might be anticipated. De novo production of K-alpha1 tubulin-specific antibodies: role in chronic lung allograft rejection. Incidence rates vary from 2 to 10 per million persons across Europe and less than 1 per million in the United States. Clinical features the lung is the probable portal of entry for blastomycosis, even in those cases where disease only manifests in other organs. The residue can be collected on a membrane filter, which is analyzed by various techniques. Pulmonary veins and venules also show a slight increase in smooth muscle content but not artertialization, as identified in congestive vasculopathy (see below). Diagnostic value of immunohistochemically detected surfactant: apoprotein-A in malignant tumors located in the lungs: report of two cases. Other occupations associated with exposure to talc include the leather, rubber, paper and textile industries; manufacture of ceramics, cosmetics, paints, pharmaceuticals, soaps, toiletries, and refractory and roofing materials; plate casting in which molds are dusted with talc before pouring; and dusting of life rafts with talc. Isolated pulmonary capillaritis and diffuse alveolar hemorrhage in rheumatoid arthritis and mixed connective tissue disease. In such cases the proliferation is modest and often apparent only after immunolabelling. Using too great a force may also result in overexpansion of lobules or interlobular septa. It can be associated with less severe levels of immunosuppression, including splenectomy,155 crescentic glomerulonephritis,156 cirrhosis,157 necrotizing fasciitis,158 Mycobacterium tuberculosis159 and even pregnancy. This probably represents in situ conversion of iron oxide to iron hydroxide (hemosiderin). A minority of patients may have systemic symptoms, such as fever, weight loss and anemia. Secretory phospholipase A2 concentrations, which increase in response to inflammation and are known to be very high in acute chest syndrome, further increase expression of adhesion molecules in the pulmonary vasculature, causing more vasoocclusion. Immunohistochemical and ultrastructural markers suggest different origins for cuboidal and polygonal cells in pulmonary sclerosing hemangioma. Adjacent lung parenchyma distal to the tumor shows dilated bronchi with inspissated mucus and obstructive pneumonia. It may progress to a necrotizing phase with or without vasculitis,79 but this is not a common occurrence. The yield of endoscopic ultrasound-guided fine needle aspiration for histological diagnosis in patients suspected of stage I sarcoidosis. Mortality from Smoking in Developed Countries 1950:2000: Indirect Estimates from National Vital Statistics. Clonal origin of multiple lung cancers: K-ras and p53 mutations determined by nonradioisotopic single-strand conformation polymorphism analysis. Primary intrapulmonary spindle cell thymoma with marked granulomatous reaction: report of a case with review of literature.

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They may be multiple, arranged in a miliary pattern, often near an interlobular septum. Primary pulmonary osteosarcoma: a report of 4 cases and a review of the literature. In most cases, however, the presence of pulmonary consolidation on physical examination or infiltrates on chest radiographs accurately separates tracheobronchitis from pneumonia. While pulmonary arteries in this case showed some mural thickening, no concentric intimal fibroplasia was identified. Association between a 15q25 gene variant, smoking quantity and tobaccorelated cancers among 17 000 individuals. As molecular mechanisms are clarified, prevention rather than treatment becomes the goal. Array-based comparative genomic hybridization analysis of high-grade neuroendocrine tumors of the lung. Once ingested, the bacteria-containing phagosome is immunologically activated by interferon-g, leading to fusion with a lysosome. Cholesterol granuloma Pulmonary cholesterol granulomas may be identified in patients with endogenous lipoid pneumonia, pulmonary alveolar proteinosis or lysinuric protein intolerance, as an incidental finding at autopsy. Status asthmaticus is epidemiologically associated with ascariasis, suggesting it is an occult environmental cause of asthma. Sputum is usually mucoid, but may be bloodstained, and frank hemoptysis can occur. Macroscopically, there are multiple small abscesses filled with yellow pus and hemorrhagic borders. Both the cough and stridor are signs of inflammation, while edema of the larynx and trachea is primarily localized at the subglottic level. A case of pneumocytoma (so-called sclerosing hemangioma) with lymph node metastasis. This precipitates HbS polymerization and vaso-occlusion, causing further hypoxia and inflammation. This finding distinguishes emphysematous lung from honeycomb lung, which has fibrotic walls. These represent a dynamic, continuous process rather than discrete, pathological steps. Evidence for a multiclonal origin of multicentric advanced lesions of Kaposi sarcoma. Neonatal lung neutrophils and elastase/proteinase 136 Chapter 3: Congenital abnormalities and pediatric lung diseases, including neoplasms inhibitor imbalance Am Rev Respir Dis 1984;130:817:21. The homogeneous low- attenuation centers of the nodules on contrast enhancement correlate with the necrosis seen on histopathology. In the second stage, the fibrinoid necrosis is more widespread, and involves the entire arterial wall. Interestingly, no difference in the prevalence of chronic cough, sputum production or wheezing was noted in marijuana or tobacco smoking cohorts. Gene expression patterns in the lungs of patients with primary pulmonary hypertension: a gene microarray analysis. Reference values for adventitial thickness in humans are not available, so this feature has limited diagnostic utility. Aside from the papillary subtype, invasive adenocarcinomas elicit stromal desmoplasia, and varying degrees of host inflammation, including neutrophils, eosinophils, lymphocytes and plasma cells. The inflammatory cell infiltrate is usually mixed and includes lymphocytes, macrophages, small numbers of plasma cells and prominent collections of eosinophils. Adult thyroid-like low-grade nasopharyngeal papillary adenocarcinoma with thyroid transcription factor-1 expression. Lung lesions consist of nodules and cavities containing necrotic material and the worms. Nonspecific interstitial pneumonitis as the sole histologic expression of hypersensitivity pneumonitis. This constitutes a diagnostic challenge, particularly in adults, since the changes on biopsy are frequently nonspecific and a diagnosis of metabolic lung disease may not be considered. These minerals, along with silica and alumina, may be important sources of reactive oxygen species.

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Loss of reactivity of the pulmonary vascular bed in primary pulmonary hypertension. Organism Malaria parasites infect successively two types of hosts: humans and female Anopheles mosquitoes. Rhabdoid tumour of the lung is a dedifferentiated phenotype of pulmonary adenocarcinoma. As such, the pulmonary hypertension is less a complication of the meconium aspiration but 112 Chapter 3: Congenital abnormalities and pediatric lung diseases, including neoplasms both conditions share a common etiology of chronic intrauterine stress and hypoxia. Findings vary from interstitial reticulonodular infiltrates to pulmonary fibrosis or a ground-glass appearance. Skin biopsies show dense dermal neutrophilic inflammation, accompanied by variable amounts of leukocytoclasis. Severe brain coinfection with Cryptococcus neoformans and Mycobacterium tuberculosis in a young, otherwise healthy student recently immigrated from China. A slight female predominance is noted and virtually all individuals are asymptomatic. Clinical-pathologic analysis of 40 patients with large cell neuroendocrine carcinoma of the lung. Pathophysiology Bronchiectasis probably evolves through a variety of different mechanisms. The intima may be ridged, with a "tree bark" appearance, a feature common to many aortitides. Second-line treatment is rarely an option due to patient performance status and rapidly progressive disease. Takeda M, Ito W, Kobayashi N, et al Co-existence of Mycobacterium tuberculosis and Mycobacterium intracellulare in one sputum sample. Distinguishing Gram-positive from Gram-negative bacteria is not always straightforward. The pulmonary circulation is derived from the pulmonary arterial trunk, while the bronchial arteries originate from the thoracic aorta. Other important systemic mycoses reported from India include aspergillosis, cryptococcosis, candidiasis and mucormycosis. Risk factors and independent predictors of survival in patients with pulmonary epithelioid haemangioendothelioma. Fatal illness associated with pulmonary hypertension in a neonate caused by intrauterine echovirus 11 infection. Interestingly, these "dilatation lesions" may be solitary or may cluster together as angiomatoid lesions. Fibrosis as in Grade 2 lesions, plus fibrotic thickening of the septa of all alveoli between at least two adjacent bronchioles. Diffuse alveolar damage: uncommon manifestation of pulmonary involvement in patients with connective tissue diseases. Congenital bronchopulmonary vascular malformations: clinical application of a simple anatomical approach in 25 cases. Accurate diagnosis is particularly important for environmental mycobacterial infection. Relationship between lung cancer and human papillomavirus in north of Iran, Mazandaran province. There is loss of basophilic staining of the cartilage matrix with indistinct borders with adjacent connective tissue. If there is a distinct zonation within the aberrant epithelium, different areas showing markedly different patterns of squamous carcinoma, the disease is more likely to be invasive. Preoperative diagnosis of clear cell "sugar" tumor of the lung by computed tomography-guided fine-needle biopsy and core-needle biopsy. In addition, a number of drugs have been associated with drug-induced lupus-associated pleuritis.

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In this case the upper lobe is almost entirely replaced with cysts while parenchymal disease including bronchiectasis affects remaining lung. Basophilic cytoplasm may be finely or coarsely vacuolated and nuclei are often eccentric and may be indented by the mucin vacuoles. Lymphoid follicles may also have a lymphangitic distribution, along the interlobular septa and beneath the pleura, a pattern sometimes referred to as lymphoid hyperplasia. Persisting cavities may lead to later aspergillus colonization or environmental mycobacterial infection. Clinical course of hospitalized children infected with human metapneumovirus and respiratory syncytial virus. A less common way of becoming infected is by having a transfusion from a blood donor with a silent Babesia infection. If one cannot apply the diagnostic criteria in full, a more pragmatic approach is required. They may occur either singly or multiply and are distributed preferentially in a subpleural location or along interlobular septa. During the first couple of weeks, Histoplasma yeasts multiply inside alveolar macrophages and spread throughout the reticuloendothelial system. Endoluminal stenosis of proximal bronchi in sarcoidosis: bronchoscopy, function, and evolution. Chemopreventive effect of a novel nutrient mixture on lung tumorigenesis induced by urethane in male A/J mice. Gram-negative bacteria, Staphylococcus aureus and Acinetobacter are the most frequent causes. Expression of a mutant human fibrillin allele upon a normal human or murine genetic background recapitulates a Marfan cellular phenotype. Natural history and prognosis Traditionally, patients have been treated with corticosteroids. Strong chromogranin and synaptophysin staining are also seen in typical carcinoid tumors but not in sclerosing hemangiomas. The factors responsible for the clearance of the immature organizing exudative process are poorly understood. Diagnostic value of hepatocyte paraffin 1 antibody to discriminate hepatocellular carcinoma from metastatic carcinoma in fine-needle aspiration biopsies of the liver. From 86 to 89% of patients suffer either irreversible vasculitis or therapy-related problems. However, these changes were also present in cigarette smokers, with smoking acting as an additive factor in asthmatics. If early in life, development is affected and the lung is smaller than the uninvolved lung. Reported pulmonary toxicities include clinical descriptions of "interstitial pneumonitis" and "interstitial fibrosis" as well as alveolar hemorrhage and respiratory failure. Clinicopathological correlation It is important to differentiate normal adipose tissue or other normal structures removed at biopsy from a primary pulmonary lipoma, and clinicopathological correlation is necessary. An overview of the North American residential radon and lung cancer casecontrol studies. Complicated silicosis has an increased risk of tuberculosis, which in the past has been reported in as many as 40:60% of cases. These patients are very ill with multi-organ failure, and unless the diagnosis is suspected and treated promptly, mortality is high. Pulmonary blastoma: an ultrastructural and immunohistochemical study with special reference to nuclear filament aggregation. Mitotic figures are commonly observed, particularly in areas of densely packed blastema-like cells. Spindle cell carcinoid tumor and primary pulmonary teratoma with a prominent thymic component are other rare considerations. Tissue Gram, silver and Dieterle stains demonstrate the Gram-positive pleomorphic rods. Meconiuminduced umbilical cord vascular necrosis and ulceration: a potential link between the placenta and poor pregnancy outcome.

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Immunohistochemical and flow cytometric characteristics of two new cases and a review of the literature. Transition from squamous cell carcinoma to adenocarcinoma in adenosquamous carcinoma of the lung. Overexpression of cyclins D1 and E is frequent in bronchial preneoplasia and precedes squamous cell carcinoma development. Such exposes the organism to a low pH and antibacterial substances (principally reactive oxygen and nitrogen molecules). As mentioned above, mitral valve insufficiency in particular has been identified as a risk factor for pulmonary infarcts, probably due to venous stasis. Human histoplasmosis can take five main clinical forms: (1) acute primary, (2) latent, (3) chronic cavitary pulmonary, (4) disseminated and (5) cicatricial. No animal reservoir has been identified, but the disease has been reported in armadillos. Morphologic and immunocytochemical studies of bronchioloalveolar carcinoma at Duke University Medical Center, 1968:1986. Niemann-Pick type A runs a rapidly neurodegenrative course, which causes death by 3 years of age. In the early stages hyaline membranes may be relatively focal but as the injury develops they may be more widespread. Beta-adrenergic agonist stimulated alveolar fluid clearance in ex-vivo human and rat lungs. Pulmonary eosinophilia syndromes Local and systemic eosinophil reactions are classic immunological T-cell-mediated responses to many parasitic infections, particularly worms. Cutaneous sarcoidosis in a patient with Philadelphia-positive chronic myelogenous leukemia treated with interferon-alpha. Differential diagnosis the distinction from other forms of interstitial pneumonia depends on the degree and extent of the lymphoid infiltrate 1320 Chapter 34: Pulmonary lymphoproliferative diseases Pulmonary nodular lymphoid hyperplasia Pulmonary nodular lymphoid hyperplasia was a term first suggested by Kradin and Mark as more appropriate than pseudolymphoma, a term no longer used. Radon is a natural gas present in the soil in many areas and also identified in concrete. Also, only poorly differentiated carcinomas demonstrate bizarre shapes or abnormal nucleoli. Dirofilariasis Introduction the Dirofilaria genus is an animal infection (zoonosis) and paratenic, so man is infected accidentally. In contrast to Coccidioides, the adiaspores are much larger, have a thicker wall and do not contain endospores. Occasionally, the ductal structures may be nearly lost among the numerous clear myoepithelial cells. Changes in the bronchial epithelium in relation to smoking and cancer of the lung. Anti-glomerular basement membrane antibodies in the diagnosis of Goodpasture syndrome: a comparison of different assays. The diagnosis is most readily made by demonstrating the budding yeast forms in sputum or lavage. Diffuse alveolar hemorrhage with underlying isolated, pauciimmune pulmonary capillaritis. Positivity is uncommon in extra-pulmonary neuroendocrine tumors not of small cell morphology (see Table 13). Some have argued that epidemiological studies favor asbestosis as the precursor to asbestos-induced lung cancer. Immunohistochemical staining for thyroid transcription factor-1: a helpful aid in discerning primary site of tumor origin in patients with brain metastases. Individual particles have also been detected in situ by means of laser microprobe, ion microprobe mass spectrometry or electron energy-loss spectrometry. Table 1 World Health Organization classification of pulmonary squamous cell carcinomas Squamous cell carcinoma Variants Papillary Clear cell Small cell Basaloid Squamous cell carcinoma arises from bronchial epithelium.


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