Mapping of succinate dehydrogenase losses in 2258 epithelial neoplasms.

Losses in the succinate dehydrogenase (SDH) complex characterize 20% to 30% of extra-adrenal paragangliomas and 7% to 8% of gastric GISTs, and rare renal cell carcinomas. This loss is reflected as lack of the normally ubiquitous immunohistochemical expression of the SDH subunit B (SDHB). In paragangliomas, SDHB loss correlates with homozygous loss of any of the SDH subunits, typically by loss-of-function mutations. The occurrence of SDHB losses in other epithelial malignancies is unknown. In this study, we immunohistochemically examined 2258 epithelial, mostly malignant neoplasms including common carcinomas of all sites. Among renal cell carcinomas, SDHB loss was observed in 4 of 711 cases (0.6%), including a patient with an SDHB-deficient GIST. Histologically, the SDHB-negative renal carcinomas varied. There was 1 clear cell carcinoma with a high nuclear grade, 1 papillary carcinoma type 2, 1 unclassified carcinoma with a glandular pattern, and 1 oncocytoid low-grade carcinoma as previously described for SDHB-negative renal carcinoma. None of these patients was known to have paragangliomas or had loss of SDHA expression in the tumor. Three of these patients had metastases at presentation (2 in the adrenal, 1 in the retroperitoneal lymph nodes). There were no cases with SDHB loss among 64 renal oncocytomas. SDHB losses were not seen in other carcinomas, except in 1 prostatic adenocarcinoma (1/57), 1 lymphoepithelial carcinoma of the stomach, and 1 (1/40) seminoma. On the basis of this study, SDHB losses occur in 0.6% of renal cell carcinomas and extremely rarely in other carcinomas. Some of these renal carcinomas may be clinically aggressive. The clinical significance and molecular genetics of these SDHB-negative tumors requires further study

Difficulties in recognizing granulomatosis with polyangiitis (GPA) in elderly patients undergoing diagnostic thoracotomy twice — a report of two cases

Granulomatosis with polyangiitis (GPA) is defined as a necrotizing granulomatous inflammation usually involving the upper and lower respiratory tract with necrotizing vasculitis affecting predominantly small to medium vessels. Because of non-specific symptoms, its radiological presentation, and the diversity of its clinical expression, it is not uncommon to for it to be misdiagnosed, especially in the elderly. Although biopsy and histological examination seem to be essential for GPA diagnosis, their results are sometimes ambiguous and not helpful in making a decision. In this report, we present difficulties in the recognition of GPA in two elderly patients in whom, despite twice performing a diagnostic thoracotomy, GPA was recognized almost 4 and 6 years after the first symptoms

Benign pulmonary metastasizing leiomyoma uteri. Case report and review of literature

Benign metastasizing leiomyoma (BML) is a rare condition in middle-aged women with a history of uterine leiomyomata. It is characterized by the proliferation of, usually multiple, smooth muscle nodules. Approximately 100 cases have been reported in the literature, and the lungs were the most common site of metastases. We report a case of 52-year-old obese woman (BMI 31), hospital worker, smoker, admitted to the hospital with exertional dyspnoea, night sweats, loss of weight, and productive cough. Hysterectomy for a uterine leiomyoma was performed 9 years earlier. In addition, a history of two episodes of superficial vein thrombosis 3 and 2 years before admission was noted. Chest X-ray and subsequently CT chest examinations revealed multiple, non-calcified nodules within the middle and lower parts of both lungs. Specimens obtained by transbronchial biopsy (TBLB) and from open lung biopsy displayed benign muscle cell proliferation compatible with BML. The levels of sex hormones were characteristic for the menopause; therefore, observation was advised. Additionally, Streptococcus pneumoniae was cultured from bronchial washing, and bronchitis was diagnosed. Antibiotics, bronchodilators, and mucolytics were administered, and dyspnoea and cough with expectoration were diminished. Two years later pulmonary lesions have been stable; however, she has put on weight. Subsequently the patient has developed deep vein thrombosis with pulmonary embolism. Anticoagulant treatment was introduced, with some improvement

Recommendation concerning the microscopic classification of lung adenocarcinoma presented by International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society

In February 2011 ample recommendations concerning the new classification of primary lung adenocarcinoma and the diagnostic evaluation of small biopsies and cytology specimens were published [...

Pulmonary pathology in patients with ulcerative colitis treated with mesalazine — a challenging and complex diagnostic problem. Case series and literature review

Pulmonary involvement in the course of inflammatory bowel disease has been a subject of interest to clinicians for long time, but despite this, its epidemiology and potential pathomechanisms remain obscured. Equally unclear is the role of medications used for bowel disease treatment in lung disease development. We present three patients with ulcerative colitis, all treated with mesalazine, in whom unexplained lung disease developed. Due to different clinical and radiological presentation, different conditions were initially placed on the top of the differential list in each of them. The outcome was favourable in all patients despite differences in management. We compared our patients with similar cases from literature. We show the level of difficulty and complexity in the issue of lung disease in patients with inflammatory bowel disease.Zagadnienie zajęcia płuc w przebiegu nieswoistych zapaleń jelit pozostaje przedmiotem zainteresowania klinicystów od dawna. Pomimo to epidemiologia tego zjawiska ani potencjalne patomechanizmy nie są znane. Niewyjaśniona jest także rola leków stosowanych w zapaleniach jelit w rozwoju patologii płucnej. W pracy przedstawiono troje pacjentów z wrzodziejącym zapaleniem jelita grubego leczonych mesalazyną, u których rozwinęła się choroba płuc. Z powodu różnej prezentacji klinicznej i radiologicznej, wstępna diagnostyka u każdego z nich ukierunkowana była na inne jednostki chorobowe. Zastosowane postępowanie u każdego z nich również było inne. Dokonaliśmy porównania naszych pacjentów do podobnych przypadków opisanych w literaturze. Opisani przez nas pacjenci dobrze obrazują, jak trudne i złożone jest zagadnienie chorób płuc rozwijających się u pacjentów z nieswoistymi zapaleniami jelit

Leflunomide-induced acute interstitial pneumonia in a patient treated for rheumatoid arthritis

Leflunomid należy do leków przeciwreumatycznych modyfikujących przebieg choroby. Jest on stosowany u chorych z reumatoidalnym zapaleniem stawów, u których leczenie pierwszej linii było nieskuteczne. Leczenie leflunomidem może być jednak związane z istotnymi powikłaniami płucnymi, zwłaszcza u osób predysponowanych. Autorzy przedstawiają opis przypadku chorego na reumatoidalne zapalenie stawów leczonego leflunomidem, u ktorego wystąpiły powikłania ze strony układu oddechowego. Omówiono czynniki ryzyka wystąpienia uszkodzenia płuc w przebiegu leczenia tym preparatem oraz sposób postępowania w przypadku ich wystąpienia.Leflunomide is a disease-modifying anti-rheumatic drug that is used in patients with rheumatoid arthritis (RA), who do not respond well to standard RA treatment. Leflunomide therapy may, however, be related with significant pulmonary complications in predisposed individuals. We present a patient with RA treated with leflunomide, in whom leflunomide lung injury had a fatal outcome. Potential risk factors for pulmonary complications of leflunomide treatment and the management of patients with leflunomide lung injury are discussed