[Trans-bronchial lung biopsy and video-assisted thoracoscopic surgery for diffuse lung diseases].
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Biopsy↗
Biomedical subjects
Yoichiro Kobashi
Publications and source records attributed to Yoichiro Kobashi.
[A case of small cell lung cancer with an initial symptom of breast metastasis].
We report a case of small cell lung cancer with an initial symptom of breast metastasis. A 55-year-old woman was admitted complaining of multiple breast masses. Chest computed tomography (CT) and magnetic resonance imaging (MRI) showed a left hilar mass. Specimens obtained from a breast mass and transbronchial biopsy revealed neoplastic cells suggesting small cell carcinoma Small cell lung cancer with breast metastasis was diagnosed. Systemic chemotherapy resulted in partial remission of the primary lesion and breast metastases.
Breast Neoplasms↗
[A case of cryptogenic organizing pneumonia after postoperative irradiation for breast cancer].
The patient was a 69-year-old woman who had undergone breast-conserving surgery of the right breast, followed by tangential irradiation of 50 Gy to the remaining breast. Her subsequent progress was monitored by endocrine therapy with toremifene. Symptoms consisting of cough and slight fever developed 5 months after completion of radiation therapy. A chest X-ray image revealed an infiltrating shadow in the right middle and lower pulmonary fields, and the patient visited our hospital. BOOP was diagnosed by thoracoscopic biopsy. Spontaneous remission was observed during monitoring of the patient's progress. A shadow subsequently reappeared, for which a steroid was administered. Improvement was rapid. This case suggests that when tangential irradiation with or without endocrine therapy is provided, subsequent to breast-conserving treatment, patients should be monitored for the occurrence of BOOP.
Aged↗
[A case of cryptogenic organizing pneumonia accompanied by large bullae].
A 66-year-old man complaining of fever was given intravenous antibiotic therapy, but he did not improve. After subsequent admission, chest X-ray film and computed tomography scans showed large bullae and consolidation in the right lung field. A transbronchial lung biopsy specimen revealed infiltration of mononuclear cells in alveolar septa and organizing lesions in alveolar ducts. We considered this case to be cryptogenic organizing pneumonia (COP) from its clinical course and pathological findings. Treatment with corticosteroid resulted in disappearance of the large bullae and consolidations. COP accompanied by large bullae is very rare. The large bullae may have been caused by check-valve mechanism.
Aged↗
[Clinical evaluation of bird related hypersensitivity pneumonitis].
We retrospectively evaluated 8 cases of bird related hypersensitivity pneumonitis in Tenri hospital, all of whom underwent surgical lung biopsy. They had a history of contacting with birds and had serological studies using lymphocyte stimulation test to pigeon serum or antibody in serum and bronchoalveolar lavage fluid to pigeon dropping extracts yielded positive results. Computed tomography revealed a radiographic pattern unlike typical UIP. The result of pathological diagnosis of surgical lung biopsy was 'others' or NSIP pattern. Only one case had pathological findings of granuloma. Four cases had an improved or stable course only offer segregation from bird antigens. The other four cases needed corticosteroids and immunosuppressants, and two of the four cases had a progressive course and died of respiratory failure.
Aged↗
[A case of myelodysplastic syndrome complicated with organizing pneumonia].
A 74-year-old man had been given a diagnosis of myelodysplastic syndrome (MDS), and had been treated with granulocyte-colony stimulating factor (G-CSF). 1 year later, he suffered from fever and his chest X-ray lung biopsy did not provide a diagnosis, video-assisted thoracoscopic lung biopsy was performed, which yielded a histological diagnosis of organizing pneumonia. His pulmonary disease was diagnosed as secondary organizing pneumonia due to MDS, and was treated successfully with steroids. Vigorous efforts to establish a histological diagnosis is needed for the antibiotics-resistant pneumonia in the case of MDS.
Aged↗
Promoter analysis and aberrant expression of the MUC5B gene in diffuse panbronchiolitis.
Diffuse panbronchiolitis (DPB) is a chronic inflammatory airway disease predominantly affecting Asian populations. DPB is considered to be a complex genetic disease. Considering the mucous hypersecretion of the disease, we hypothesized that the transcriptional activity of mucin genes may be altered in DPB. We analyzed nucleotide sequences of regulatory region of six mucin genes--MUC1, MUC2, MUC4, MUC5AC, MUC5B, and MUC7--and detected their promoter polymorphisms. Among them, the insertion/deletion polymorphism identified in the MUC5B gene was significantly associated with the disease (p = 0.0001). Transcriptional activity observed in the three major promoter haplotypes corresponded to the strength of the disease association in which these haplotypes are involved. Immunohistochemistry of the lung tissues of DPB revealed that MUC5B was abundantly expressed not only in bronchial glands but also in increased numbers of goblet cells on the bronchial surface, where MUC5AC is predominant and MUC5B expression is generally scarce in the normal lung. Marked mucous hypersecretion observed in DPB may be partly explained by increased and aberrant expression of MUC5B. The possible involvement of MUC5B gene in DPB was demonstrated. A further role of the MUC5B polymorphism in its pathogenesis should be studied in the future.
Aged↗
Infective endocarditis developing as uremia.
A 49-year-old man presented with fever and uremic symptoms such as general malaise, leg edema and decreased urine output. He was diagnosed as having infective endocarditis (IE) accompanied by renal failure. Although he had been receiving hemodialysis for a long time, renal function dramatically improved after heart valve replacement. This case suggests that uremia can develop as an initial manifestation of IE and removal of an infected heart valve can improve renal function despite persistent renal failure. From the perspective of recovery of renal function, early surgery should be considered in patients with renal failure following IE.
Anuria↗
[Histopathologic findings in idiopathic interstitial pneumonias].
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Humans↗
[A case of MPO-ANCA-related vasculitis after asbestos exposure with progression of a renal lesion after improvement of interstitial pneumonia].
A 72-year-old woman was admitted complaining of productive cough. She had worked for an asbestos factory for twenty years. She was positive for MPO-ANCA. The chest HRCT showed interstitial pneumonia without any UIP pattern. A specimen obtained by video-assisted thoracoscopic lung biopsy revealed chronic interstitial pneumonia associated with an asbestos body. Although the interstitial pneumonia improved after the administration of a corticosteroid and an immunosuppressive agent, hematuria and renal dysfunction developed about nine months later. The serum MPO-ANCA titer was elevated and the renal biopsy specimen revealed the presence of vasculitis. As the interstitial pneumonia improved after this treatment, the correct diagnosis may have been, not asbestosis, but MPO-ANCA-related interstitial pneumonia.
Aged↗
[A case of intramedullary spinal cord metastasis due to small cell lung cancer].
A 69-year-old woman was diagnosed with limited stage, small cell lung cancer in February 2001. Systemic chemotherapy and radiotherapy were performed resulting in complete remission of the disease. In October 2001, she complained of pain and numbness of her left arm. Magnetic resonance imaging (MRI) of the neck showed an intramedullary enhanced mass at the C4-5 level. Specimen obtained by tumor biopsy showed pathological diagnosis of metastasis from small cell lung cancer. Neurological symptoms improved after radiochemotherapy. Intramedullary metastasis of lung cancer is very rare, and early diagnosis and multidisciplinary treatment may improve quality of life.
Aged↗
Sustained interleukin-6 signalling leads to the development of lymphoid organ-like structures in the lung.
A variety of pathological changes are seen in lymphoproliferative disorders of the lung but the histogenesis of these abnormalities is not yet fully understood. We previously showed that adenovirus vector-mediated transient expression of both the human interleukin-6 (IL-6) and IL-6 receptor (IL-6R) genes, but not the IL-6 gene alone, in the rat lung induced lymphocytic alveolitis. In the present study, we explored the lung pathology of human IL-6 and IL-6R double transgenic mice to elucidate the effects of prolonged IL-6 signalling on the lung. The transgenic animals developed mononuclear cell accumulation in peribronchovascular regions, but little infiltration into alveolar spaces. Immunohistochemical analysis revealed that the cellular accumulations contained not only mixtures of inflammatory cells but also lymphoid tissue-like structures. As the expression of CXCL13/BLC, the indispensable chemokine for lymphoid organogenesis, was recognized in the B cell follicles of the pulmonary lesions, we speculate that this chemokine plays an inductive role in the development of the lymphoid tissue-like structures. These structures were distinguished from bronchus-associated lymphoid tissues (BALTs) by their location and by the lack of lymphoepithelium, which is a characteristic of BALT. These findings imply that IL-6 signalling may play a role in the pathogenesis of lymphoproliferative disorders of the lung.
Animals↗
Clinicopathological features of pancreatic intraepithelial neoplasias and their relationship to intraductal papillary-mucinous tumors.
Pancreatic intraepithelial neoplasia (PanIN) is a recently proposed nomenclature for putative precursor lesions of pancreatic cancer, which are designated as PanIN-1 through -3 according to their increasing grade of dysplasia. A stepwise progression model of PanINs has been proposed, and multistep genetic alterations in PanINs are being investigated. PanIN-1A and PanIN-1B may remain unchanged for a long period. PanIN-3 potentially progresses toward invasive ductal carcinoma (IDC), and there are several case reports suggesting such progression. In these reported patients, PanIN-3 was found in specimens from partial pancreatectomies, and IDC manifested in the pancreatic remnant 17 months to 29 years after the surgery. We describe herein a patient with PanIN-3, in whom IDC manifested in the distal remnant pancreas 69 months after segmental pancreatectomy. Of the reported cases, including the present one, four of the patients were male and three were female, and the age at the first operation ranged from 46 to 70 years. Intraductal papillary-mucinous tumor (IPMT) is an entity that is distinct from PanIN. However, IPMTs of small size resemble PanINs morphologically. Loss of Dpc4 expression has been reported in the invasive component of IPMT, as well as in PanIN-3 and IDC. Analysis of mucin expression patterns has been reported, suggesting that, in practice, MUC1-positive MUC2-negative IPMTs may not be distinguishable from PanINs. There may be overlapping lesions between PanINs and IPMTs. Should the paradigm of the ductal origin of IDC be accepted, PanINs and a fraction of IPMTs would represent precursors of IDC.
Aged↗
An autopsy case of acute pulmonary toxicity associated with gemcitabine.
Acute respiratory distress syndrome (ARDS) developed following intravenous gemcitabine monotherapy in a 75-year-old man with non-small cell lung cancer. The total dose of gemcitabine was 1,500 mg, and the latent period from starting gemcitabine to pulmonary toxicity was three days. The chest radiographs and high resolution computed tomographic scan revealed bilateral ground-glass opacity. He died on the fourteenth post-chemotherapeutic day due to respiratory failure. Postmortem examination of the lung revealed mixed exudative and fibrotic stages of diffuse alveolar damage. Pulmonary toxicity from gemcitabine can be acute and fatal.
Aged↗
[Saprophytic mycosis appearing as a necrotic bronchial tumor and masking lung cancer].
We describe four cases of saprophytic mycosis superficially covering lung cancer to form a bronchial necrotic tumor. Although the first biopsy in each case disclosed mycosis with necrosis, repeated transbronchial biopsy revealed malignant cells. In two of the four cases, we started treatments for lung cancer based on the clinical diagnosis preceding histological diagnosis. Although no treatment to eliminate fungi was performed, all cases showed an uneventful clinical course. It is important not to misdiagnose cancer as a fungal disease on the basis only of a transbronchial biopsy, and to bear in mind this type of saprophytic mycosis.
Aged↗
[A giant pulmonary aspergilloma managed surgically in an elderly man].
We describe a case of giant pulmonary aspergilloma in a 79-year old man. He had undergone an operation for pulmonary tuberculosis of the right lung at the age of 49 years. His chest ragiograph showed a large fungus ball in the right upper lung field. Taking his age and pulmonary condition into consideration, we performed a cavernostomy and fungus ball resection to prevent life-threatening hemoptysis. The postoperative course was satisfactory and without complication. Cavernostomy may be an alternative choice in high-risk aspergilloma patients.
Aged↗
Proton two-dimensional chemical shift imaging for evaluation of prostate cancer: external surface coil vs. endorectal surface coil.
PURPOSE: To compare the diagnostic ability of proton magnetic resonance spectroscopy (MRS) using an external surface coil with that using an endorectal surface coil in patients with prostate cancer. MATERIALS AND METHODS: MR imaging (MRI) and two-dimensional chemical shift imaging (2D CSI) were performed in 5 healthy volunteers and in 35 patients with prostate cancer. The receiver coil was the anterior lower part of a phased-array coil or an endorectal surface coil. RESULTS: Receiver-operating characteristic analysis for diagnosing prostate cancer showed no significant difference (P = 0.784) between the area under the curve of phased-array coil CSI and that of endorectal surface coil CSI. CONCLUSION: The phased-array coil CSI could provide comparable detection accuracy to endorectal surface coil CSI. In patients with rectal diseases or patients who could not tolerate the discomfort with insertion of an endorectal surface coil, we recommend the phased-array coil CSI.
Adult↗
[Chronic eosinophilic pneumonia--a follow-up study of 12 cases].
In this study, twelve cases of CEP were followed for a mean period of 10.9 years (range 9.3-12.9 years) at National Himeji Hospital. Of the five women and seven men examined, two patients possessed preexisting asthma and one developed asthma during the course of CEP disease. None of the patients exhibited any symptoms of allergic rhinitis. All had dramatic responses to corticosteroid therapy without developing extrathoracic manifestations. During the course of CEP, one patient died from acute myocardial infarction. Relapses, which occurred in six patients, responded as well to the treatment as in the original episode. One patient continued long-term oral corticosteroids (5 mg/day) and steroid inhalants (800 micrograms/day) as treatment for asthma. Another was administered steroid inhalants (800 micrograms/day) to treat both asthma and relapsing CEP; two additional patients received 800-600 micrograms/day to prevent relapse. These data indicate that, with proper treatment, the long-term prognosis for patients with CEP is excellent.
Adrenal Cortex Hormones↗