Multiple calcified pulmonary nodules in an elderly man.
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Adenocarcinoma↗
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Results for “Multiple Pulmonary Nodules”
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Tumor growth and regression rates relative to tumor size: a clinical study of metastatic pulmonary nodules.
Patients with multiple discrete metastatic pulmonary nodules were serially monitored and tumor growth and regression rates were determined for selected measurable lesions. Tumor volume doubling time (TDT) in growing tumors or tumor volume halving time (THT) in regressing tumors was measured for multiple lesions. The objective of the study was to correlate tumor growth and/or regression rates with initial tumor size. A total of eight patients with 29 nodules of varying sizes was studied over observation periods the nodules regressed in response to specific chemotherapy. This study suggests that metastatic pulmonary nodules grow or regress at a relatively constant rate that is independent of pretreatment size. Growth and regression rates do not generally fluctuate, although tumor nodules may remain stationary or arrested for variable time periods. The study of tumor kinetics by clinical techniques is relevant to understanding tumor biology and to developing approaches to therapy.
Antineoplastic Agents↗
The radiology of lymphomatoid granulomatosis in the lung.
This paper describes the salient clinical and radiological features of two patients with lymphomatoid granulomatosis of the lungs. We have, in addition, reviewed the previously documented 22 cases in which radiographs were published along with their case histories. The commonest radiographic appearance, that of bilateral multiple pulmonary nodules, should not be mistaken for multiple metastases.
Aged↗
[Differential diagnosis of multiple pulmonary coin lesions--pulmonary hyaline granuloma].
In addition to metastases, the differential diagnosis of pulmonary nodules also includes tuberculosis, sarcoidosis, and silicosis. Rarer diseases such as amyloid tumors, rheumatic nodules, and plasma-cell granulomas can, depending on the clinical situation, be the cause of this finding. For the example of the clinical picture of pulmonary hyalinizing granuloma, the differential diagnosis of multiple pulmonary nodules is illustrated under consideration of the pathognomonic, morphologic observations.
Adult↗
Pulmonary metastases from benign-appearing smooth muscle tumors of the uterus.
A 42-year-old woman was found to have multiple pulmonary nodules 7 years after hysterectomy for leiomyoma. Thoracotomy revealed multiple well differentiated smooth muscle masses containing epithelial inclusions. This patient is similar to others previously reported as examples of "multiple pulmonary fibroleiomyomatous hamartoma" on the basis of slow-growth, benign-appearing histology, and the presence of epithelial elements. Evidence is presented which suggests that these cases represent metastasis from well differentiated leiomyosarcomas. There is a frequent association with uterine smooth-muscle tumor, cases with equally benign-appearing histology have shown lymph node metastasis, the nonmesenchymal elements have been shown to represent engulphed bits of adjacent pulmonary tissue, and the histologic di-ferentiation of benign from malignant mesenchymal tumors is known to be unreliable in some cases. Unlike more anaplastic leiomyosarcomas, this condition may be associated with few symptoms and prolonged survival despite widespread disease.
Adult↗
Pulmonary nodules due to Corynebacterium ulcerans.
A 53 year old male with symptoms of coughing for 6 months presented with bilateral multiple pulmonary nodules suggestive of metastatic disease. By surgical resection 4 out of 6 nodules were removed. Histopathological examination showed granulomatous necrotizing inflammation with growth of Corynebacterium ulcerans, which did not produce diphtheria toxin. The patient was treated with penicillin for 1 week. Follow-up for 2 yrs showed no sign of recurrence.
Corynebacterium Infections↗
Metastatic pulmonary epithelioid hemangioendothelioma with peculiar radiographic features.
We report a case of a pulmonary epithelioid hemangioendothelioma presenting as a solitary pulmonary nodule with subsequent systemic spread, including histologically documented gingival metastasis. Chest radiography and computed tomography at initial evaluation showed a solitary 2 cm pulmonary nodule, associated with pleural indentation and vascular convergence. The tumor later spread systemically, including multiple pulmonary nodules, bilateral pleural effusions, and gingival swelling and erosion. A biopsy of the gingival lesion showed histologic features identical to that of the lung biopsy.
Fatal Outcome↗
Pulmonary nodules secondary to total parenteral alimentation.
A seven-year-old male, who had a retro-peritoneal alveolar rhabdomyosarcoma and was on total parenteral alimentation (TPN) developed multiple pulmonary nodules, indistinguishable from metastases. These proved to be multiple lipid emboli on open biopsy.
Child↗
Carcinoid tumorlets simulate pulmonary metastases in women with breast cancer.
A pulmonary carcinoid tumorlet (PCT) is a nodular proliferation of neuroendocrine cells smaller than 0.5 cm. On computed tomographic (CT) imaging, these nodules are nonspecific in appearance and can mimic metastatic disease. Cases of multiple PCTs diagnosed between 1992 and 2003 in patients with history of breast cancer were identified through a search of the pathology files. The clinical information was abstracted from the medical records. We identified 12 women with a history of breast cancer and biopsy-proven PCTs, who were treated at our institution in a period of 12 years. Only 3 women were smokers. The mean age at diagnosis of the breast cancer was 62.8 years. The breast cancer was invasive carcinoma in 10 cases (9 ductal and 1 lobular) and ductal carcinoma in situ and malignant phyllodes tumor in 1 case each. Six women received radiotherapy; 5, chemotherapy; and 4, hormonal treatment, alone or in combination. Pulmonary carcinoid tumorlets were identified within 5 months from diagnosis of the breast malignancy in 7 patients and at follow-up (range, 57-162 months) in the remaining 5. In all cases, the PCTs consisted of multiple pulmonary nodules that were radiologically interpreted as suspicious for pulmonary metastases. Misdiagnosis of metastatic carcinoma was rendered intraoperatively by frozen section analysis in 3 cases. None of the patients had known metastatic disease at the time of diagnosis of PCTs. Three patients subsequently developed recurrent disease, including 2 with extramammary spread. Pulmonary carcinoid tumorlets are radiologic and histologic mimickers of pulmonary metastases in patients with a history of breast cancer. Consideration should be given to the possibility of PCTs in patients with breast cancer with pulmonary nodules, even if multiple.
Adult↗
Amyloid-like pulmonary nodules, including localized light-chain deposition: clinicopathologic analysis of three cases.
Amyloid-like pulmonary nodules have been described in patients with systemic light-chain deposition disease, but their significance in other clinical contexts is unknown. We examined biopsy specimens of amyloid-like pulmonary nodules from 3 women without systemic light-chain deposition disease. Patient 1 (aged 62 years) had multiple pulmonary nodules and underwent 2 separate lung biopsies, the first showing nodules composed of kappa light-chain deposits accompanied by low-grade lymphoplasmacytic lymphoma limited to the lung and the second, obtained after chemotherapy 9 months later, showing only residual nodules without persistent lymphoma. Patients 2 (aged 65 years) and 3 (aged 69 years) had asymptomatic solitary pulmonary nodules. In all cases, electron microscopic examination showed dense granular extracellular deposits without the fibrillary characteristics of amyloid. Amyloid-like nodules should be distinguished from nodular amyloidosis and, in some patients, might represent a localized form of light-chain deposition.
Aged↗
Cytomegalovirus pneumonitis. An unusual cause of pulmonary nodules in a patient with AIDS.
A patient with AIDS and a history of non-Hodgkin's lymphoma developed a generalized illness associated with the appearance of multiple pulmonary nodules on a chest radiograph. Cytomegalovirus infection was demonstrated by needle aspiration cytology. The patient's symptoms and radiographic abnormalities resolved completely on ganciclovir therapy. This unusual case (1) broadens the differential diagnosis of nodular pulmonary disease in patients with AIDS and (2) suggests that cytomegalovirus can cause clinically significant lung disease which may respond to standard antiviral therapy in patients with AIDS.
AIDS-Related Opportunistic Infections↗
Pulmonary adenocarcinomas associated with rheumatoid nodules: a case report and review of the literature.
Necrobiotic lung nodules and primary lung carcinoma both occur with some frequency in patients with rheumatoid arthritis; however, few reports exist of a primary lung carcinoma occurring within a rheumatoid nodule. We report a case of a 62-year-old woman with multiple pulmonary nodules discovered incidentally by computed tomography. Although 2 of the lesions were composed solely of necrotizing granulomas, 2 additional lesions contained malignant glands at the periphery of necrobiotic nodules. Immunohistochemical staining supported the diagnosis of both tumors as primary lung carcinomas. Our literature search revealed only 2 other reported cases of adenocarcinoma occurring in association with a rheumatoid nodule; these cases, as well as the association between rheumatoid disease and malignancy, are briefly reviewed.
Adenocarcinoma↗
Sarcoid-like hilar and mediastinal lymphadenopathy in a patient with metastatic testicular cancer.
Previous reports indicate that enlarged hilar and mediastinal lymph nodes due to sarcoid-like reactions may develop after curative resection of testicular cancer, and their presence does not necessarily denote neoplastic recurrence. Reports further suggest that coexisting pulmonary nodules in this setting may be related to nodular sarcoidosis. A patient developed progressive hilar and mediastinal adenopathy associated with multiple pulmonary nodules after apparent curative resection of a testicular embryonal cell cancer. Biopsy specimens from the mediastinal lymph nodes demonstrated granulomas, suggesting the diagnosis of nodular sarcoidosis. Needle aspiration of the pulmonary nodules, however, revealed metastatic testis cancer. Sarcoid-like mediastinal reactions occur after resection of testis cancer, but biopsies should be performed on coexisting pulmonary nodules to exclude pulmonary metastases.
Adult↗
Role of videoendoscopy in pulmonary surgery: present experience.
Videothoracoscopic techniques were utilized in managing 88 consecutive patients. The series was composed of 36 patients with pneumothorax, 44 cases of single and 9 of multiple pulmonary nodules and 1 patient with diffuse lung disease. In 14 cases (15.9%) conversion to open thoracotomy was necessary while in the remaining 74 patients the procedure (30 blebectomies, 2 bullectomies, 37 wedge resections, 6 lobectomies and one multiple biopsies) were carried out as planned. In each lobectomy and in six wedge resections an accessory small incision was necessary; we consider only this video-assisted thoracic surgery (VATS). Benign disease, aside from the blebs and bullae, was found in 12 cases of solitary pulmonary nodules and in 1 case of multiple lesions, while malignant lesions were detected in 31 patients. Primary carcinoma was diagnosed in nine cases after a wedge resection had been performed on a suspicious solitary nodule. In two of these wedge resection had to suffice because of poor lung function, while in the remaining seven cases, a lobectomy was carried out through an open thoracotomy in two patients, and in five cases VATS was attempted successfully in four, while in one case a formal thoracotomy was necessary due to bleeding. Solitary metastases were found in 14 patients and were managed by 12 wedge resections and 2 lobectomies. Seventy-one patients (97.3%) had an uneventful postoperative course while 2 (2.7%) had only minor complications. No recurrences were observed, however follow-up is limited. Videothoracoscopy techniques are very useful and are good alternatives to conventional thoracotomy in managing cases of pneumothorax, benign pulmonary lesions and in taking biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Imaging of Wegener's granulomatosis: changes by serial chest CT].
We reviewed the chest radiographs and serial CT scans of two patients with pathologically confirmed Wegener's granulomatosis. The radiographs revealed multiple nodules or masses with and without cavitation, as well as consolidations. Lung lesions on CT included multiple pulmonary nodules and masses of varying size, cavities, consolidations with air bronchogram. Bronchovascular bundle thickening and lymph node swelling were also seen on CT. Some lung nodules or masses demonstrated feeding vessels or wedge-shaped lesions, or both, abutting the pleura. Follow-up CT before treatment showed that the multiple nodules had increased in size, resulting in masses and consolidations with air bronchogram. After treatment, almost all nodules disappeared without scarring, while the masses and consolidation resolved with residual scarring, and the cavity was transformed to a cystic lesion by follow-up CT. The bronchovascular bundle thickening and lymph node swelling showed improvement.
Granulomatosis with Polyangiitis↗
Hereditary hemorrhagic telangiectasia mimicking metastases in a patient with gastric carcinoma.
Hereditary hemorrhagic telangiectasia (HHT) is associated with arteriovenous malformation in multiple organs. The association of HHT with primary malignancy has rarely been reported. We describe the case of a 68-year-old man with gastric carcinoma who presented with abdominal fullness and cramping pain. Radiographic examination showed multiple pulmonary nodules and an osteolytic cervical spine lesion. The initial diagnosis of gastric cancer with multiple metastases was revised after meticulous imaging studies revealed these lesions to be vascular malformations in the lungs and vertebra. This case demonstrates that HHT may coexist with a primary malignancy and mimic multiple metastases.
Aged↗
Cavernous hemangiomas of lungs and liver in an asymptomatic girl.
We describe a 15-year-old asymptomatic girl with multiple pulmonary nodules which turned out to be cavernous hemangiomas. The radiological findings of other organs revealed no abnormalities, excluding the liver, where multiple low-density areas were located. Thoracoscopy and laparoscopy revealed cavernous hemangiomas of the lung and liver. While liver cavernous hemangiomas are common, pulmonary hemangiomas are fairly rare. Although cavernous hemangiomas are classified as malformations, some of these lesions have been reported to grow. In pulmonary hemangiomas, some cases have an inexorable clinical course with hemoptysis, respiratory distress, and heart failure. In our case, the lesions have not remarkably progressed under observation for more than 2 years.
Adolescent↗
CT of posttransplantation lymphoproliferative disorder in pediatric recipients of lung allograft.
OBJECTIVE: The purpose of this study was to determine the CT and clinical findings of posttransplantation lymphoproliferative disorder in pediatric lung allograft recipients. MATERIALS AND METHODS: We reviewed the medical records and CT examinations of 260 lung transplantations in pediatric patients and found 26 recipients who had 29 episodes of histologically proven posttransplantation lymphoproliferative disorder. The clinical and CT features of the disease, the time to diagnosis, and the outcomes were assessed. RESULTS: The clinical presentation of posttransplantation lymphoproliferative disorder varied from asymptomatic pulmonary nodules (14/29 [48%]) detected on chest CT to specific (organ-related) and nonspecific symptoms (15/29 [52%]). Intrathoracic posttransplantation lymphoproliferative disorder occurred in 20 (69%) of 29 cases and manifested as multiple pulmonary nodules (n = 17), alveolar infiltrates (n = 2), and combined nodules and infiltrates (n = 1). In eight (28%) of 29 cases, there was extraparenchymal disease, including adenopathy, pleural effusion, and esophageal thickening and erosions. Extrathoracic posttransplantation lymphoproliferative disorder occurred in 13 cases and involved the abdomen (n = 10), paranasal sinuses (n = 2), and brain (n = 1). In the abdomen, extranodal disease was more common than nodal disease and presented as bowel wall thickening, focal mass lesions, and splenomegaly. In 18 of 29 episodes of posttransplantation lymphoproliferative disorder, the histologic diagnosis was lymphoma. The median time to diagnosis after transplantation for the 29 episodes of posttransplantation lymphoproliferative disorder was 10 months. Thirteen of the 26 patients died. The median time of survival after the diagnosis of posttransplantation lymphoproliferative disorder was 17 months. CONCLUSION: Posttransplantation lymphoproliferative disorder in pediatric lung transplant recipients occurs with relatively high frequency in both the chest and abdomen, tends to have lymphomatous features, and results in substantial mortality rates.
Adolescent↗