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Primary chondrosarcoma of the left inferior lobar bronchus.

A primary chondrosarcoma arising in the left inferior lobar bronchus is described in a 67-year-old man. The symptoms upon admittance were dyspena, cough with purulent sputum and weight loss. The tumor was removed by pneumonectomy. Eight months later the patient died of massive mediastinal lymph node involvement. While tracheobronchially located primary pulmonary chondrosarcoma tends to remain localized, the peripheral variety tends toward mediastinal lymph node involvement and thoracic metastasis. The treatment of choice is resection in a radical manner, whenever possible.

Aged↗

Hollow bone in the bronchus or the danger of chicken soup.

A 6-month-old infant arrived at the emergency room with severe respiratory distress after being spoon-fed chicken soup. Air entry was normal, chest X-rays were normal, and bronchoscopy revealed a hollow chicken bone lining the whole left main bronchus.

Animals↗

A study on delayed hypersensitivity aspects of immune response in patients with carcinoma of bronchus in relation to radiotherapy.

Results of a preliminary study on the delayed hypersensitivity aspects of immune response in 45 patients with carcinoma of bronchus revealed by sequential skin testing are presented. Short-term prognosis and the immune reactivity thus studied appear to be well correlated. Anergy before treatment and allergy changing to anergy following radiotherapy tend to be associated with grave prognosis and conversely persistently allergic patients fare better at least on short-term prognosis. Contrary to the usual impression that radiations are immunodepressant, this study reveals increased skin tests reactivity following radiotherapy in 7 out of 17 immunocompetent patients. Recent literature on human and animal studies appear to support this phenomenon of increased immune reactivity in certain situations following radiotherapy and chemotherapy. The few publications are reviewed. A much more elaborate controlled in vivo and in vitro study is now underway to reveal the immune profile of patients with cancer particularly in relation to radiotherapy.

Adult↗

Is the solitary papilloma of the bronchus always a benign tumor?

99 pulmonary resections for benign tumors were performed during the period 1967-1978. 4 patients showed bronchial papilloma. Solitary papilloma of the bronchus is one of the rarest benign tumors; the differences of multiple papillomatosis and inflammatory polyp are stressed. Malignant change was observed in 3 of the 4 cases. The 4 patients presented a 2- to 5-year history of hemoptysis episodes and radiographic aspects characterized by intermittent atelectasis. Radical surgery is the only satisfactory therapy; endoscopic removal of the neoplasm is often incomplete and unsatisfactory.

Aged↗

Defective bronchus-associated lymphoid tissue in long-term surviving rat lung allografts.

In a previous study we found that a local immune response did not develop in the bronchus-associated lymphoid tissue (BALT) of infected rat allografts. We hypothesized that the BALT in rat lung allografts was damaged after allotransplantation. Therefore, we investigated three prerequisites for a normal function of the BALT, i.e., its structure, the uptake of antigens, and the lymphocyte migration to the BALT in three groups of rats (n = 10 each): (1) Brown Norway(BN)-to-Lewis (LEW) allografts; (2) LEW-to-LEW isografts; and (3) normal LEW rats. All rats were immunosuppressed with CsA (injected on days 2 and 3). Six mo after transplantation the structure of the BALT and the uptake of intrabronchially injected carbon particles in the BALT were determined histologically; the migration of intravenously injected, fluoroscein-isothiocyanate labeled lymphocytes to the BALT was determined immunohistochemically. In the allografts the BALT was defective in all three investigated aspects. It was reduced in size and lymphocyte density and was largely replaced by fibrous tissue. Twenty-four h after administration no carbon particles and only a few labeled lymphocytes were found in the BALT. In contrast, in the syngeneically transplanted and nontransplanted lungs the BALT consisted of a large and dense collection of lymphocytes. In these BALTs large numbers of carbon particles and labeled lymphocytes were found. In conclusion, after allogeneic transplantation the BALT in the lung becomes defective in structure and function. The BALT is most likely damaged by rejection, since the BALT is syngeneic lung transplants was perfectly normal.

Animals↗

Cellular distribution of bronchus-associated lymphoid tissue in rheumatoid arthritis.

Bronchus-associated Lymphoid tissue (BALT) has been reported to be present in the lungs of patients with rheumatoid arthritis (RA). However, little is known about the structure and cellular distribution of BALT in this disease, so we investigated these points using immunohistochemical methods. The subjects were eight RA patients with BALT in biopsy specimens and a histologic diagnosis of follicular bronchiolitis. Seven patients had cough and purulent sputum, and four patients had positive sputum cultures. BALT was histologically composed of four distinct regions, which were the lymphoepithelium, the dome area, the follicular area, and the parafollicular area. Surface IgM+ B cells were predominant in the follicular area, whereas IgA+ cells were scattered in the dome and parafollicular areas. T cells were mainly found in the parafollicular area (CD4+ > CD8+), and most of them expressed the T Cell receptor alpha beta (alpha beta TCR). These findings were similar to those described previously for BALT in diffuse panbronchiolitis, which manifests as a chronic respiratory infection. The present study indicated that extrinsic stimulation as well as alterations of the immune response are involved in the development of BALT in RA, although the exact mechanism requires further clarification.

Adult↗

Trypsin-induced, neurokinin-mediated contraction of guinea pig bronchus.

Proteases may act as cell signaling molecules via protease-activated receptors (PARs). PAR1, PAR3, and PAR4, but not PAR2, are activated by thrombin, whereas trypsin can activate PAR2 and PAR4. In this study, trypsin (3-100 nM) evoked concentration-dependent contractions of guinea pig isolated bronchus, however, thrombin (3-300 nM) was a weak spasmogen. Neither the PAR2-activating peptide SLIGRL (100 microM) nor mast cell tryptase (100 nM), a trypsin-like protease known to activate PAR2, evoked contraction. A role for neurokinins in trypsin-induced contraction is suggested by our observation that contractions to trypsin were markedly attenuated in the presence of neurokinin receptor antagonists. Depletion of neurokinins in sensory nerves with capsaicin also markedly reduced the ability of trypsin to evoke contraction. In electrophysiological studies, trypsin did not evoke action potentials in C-fiber afferents whose receptive fields were located in the trachea or main bronchi. The results from this study support the hypothesis that trypsin activates a mechanism allowing for local release of sensory neurokinins from afferent C-fibers and that this release occurs independently of the sensory function of these nerves.

Animals↗

Study of bronchus-associated lymphoid tissue in patients with diffuse panbronchiolitis.

Bronchus-associated lymphoid tissue (BALT) is thought to affect local immunologic defense mechanisms. Studies of BALT, however, have mainly been focused on animals, and information detailing the BALT structure and functions in humans is scanty. Therefore, the purpose of this study is to clarify BALT morphology and immunologic findings in patients with diffuse panbronchiolitis (DPB) and compare them with BALT findings in animals. Thus, in 17 patients diagnosed with DPB, open-lung biopsy specimens were reviewed, and lymphoid follicles with a lymphoepithelium that was determined as BALT were identified in 12 patients. BALT was found mostly at bifurcations from nonrespiratory bronchioles to respiratory bronchioles. This lymphoepithelium was devoid of cilia and was diffusely infiltrated with CD4-positive (helper/inducer) T cells. The majority of T cells were confined to the parafollicular area with a predominance of helper T cells. Also, a few high endothelial venules were recognized in the parafollicular area. Further, in a follicular area situated in the center of the BALT, a number of sigM-positive cells were found to be heavily distributed, suggesting that this follicular area has the characteristics of a B cell zone equivalent to a germinal center of the peripheral lymph nodes. These observations are comparable with BALT findings in animals and suggest that BALT is at least partially related to the local immune response.

Adult↗

Pharmacologic and neurochemical evidence for the activation of capsaicin-sensitive sensory nerves by lipoxin A4 in guinea pig bronchus.

Exogenous administration of lipoxin A4 (LXA4) to guinea pig isolated bronchus produced contractile effects in a concentration-dependent manner (1, 3, and 6 microM). These responses were potentiated when preparations were previously incubated with thiorphan (10 microM), an inhibitor of tachykinin breakdown, but were significantly depressed when sensory nerves were previously desensitized in vitro by capsaicin (10 microM for 15 min) challenge. Ruthenium red (10 microM for 20 min), a blocker of the cationic channel coupled to the capsaicin receptor, also produced, although in a weaker manner, a reduction in bronchomotor responses elicited by LXA4. On the other hand, preexposure to omega-conotoxin (0.1 microM for 45 min), a blocker of neuronal voltage-dependent Ca2+ channels, did not modify the LXA4 contractile effects. Furthermore, LXA4 (6 microM) superfusion of guinea pig bronchial tissue elicited a significant calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) release that was reduced by capsaicin (10 microM, 30 min) desensitization. Finally, LXA4 (10 microM) was unable to displace [3H]resiniferatoxin binding in dorsal root ganglion of rat and guinea pig. These findings support (1) a role for LXA4 in activating motor sensory function of capsaicin-sensitive nerves; (2) this activation mechanism is marginally ruthenium red-sensitive and omega-conotoxin-resistant; and (3) the interaction does not involve the recognized binding site on the vanilloid receptor. As a whole this study presents LXA4 as an endogenous mediator activating sensory nerves potentially involved in basic mechanisms of airway diseases.

Animals↗

Quantitation of T-lymphocyte subsets in human bronchus mucosa.

Cells were isolated from human bronchus mucosa, and characterized according to a surface marker for sheep erythrocytes (T cells), to the presence of membrane associated immunoglobulin (B cells), and to the capacity to phagocytose latex particles (macrophages). The T lymphocytes were further characterized according to their capacity to bind to the Fc fragment of IgG, IgM, and IgA (T gamma, T mu, and T alpha cells, respectively). Less t alpha cells were found in acutely inflamed mucosa than in mucosa obtained from patients with chronic inflammatory, or neoplastic disease (p = less than 0.001).

Antibodies, Monoclonal↗

Lectin cytochemistry reveals differences between hamster trachea and bronchus in the composition of epithelial surface glycoconjugates and in the response of secretory cells to neutrophil elastase.

Hamsters exposed to an intratracheal instillation of human neutrophil elastase (HNE) accumulate an abnormally high number of secretory granules in bronchial but not tracheal epithelial cells. We employed lectin cytochemistry to investigate possible differences in the epithelial cell surface glycoconjugate layer in trachea compared to bronchus which might explain the regional dissimilarity in response to HNE. Portions of glutaraldehyde-fixed trachea and bronchi were incubated in one of several ferritin-labeled lectins prior to embedding for transmission electron microscopy. Lectins from Ricinus communis, Helix pomatia, and Triticum vulgaris bound to the surface of tracheal secretory cells in moderate to profuse amounts, while most bronchial secretory cells showed little or no label with these lectins. Gold-labeled Helix pomatia agglutinin (HPA), a lectin specific for secretory cells, showed a decrease in surface binding to all tracheal secretory cell types within 2 h of HNE instillation, compared to saline controls. In contrast, the majority of bronchial secretory cells showed an HNE-induced increase in surface label from extremely low levels in saline controls. The low levels of lectin binding to bronchial cells, in contrast to the trachea, may indicate the lack of a protective surface glycoconjugate coat, thus explaining the vulnerability of these cells to HNE. The rise in number of accessible HPA binding sites on the surface of bronchial secretory cells exposed to HNE may represent an important event in the pathologic accumulation of secretory granules by these cells.

Animals↗

Is the bronchus-associated lymphoid tissue (BALT) an integral structure of the lung in normal mammals, including humans?

In the respiratory tract, lymphoid aggregates with a specialized epithelium have been called bronchus-associated lymphoid tissue (BALT) and compared to the organized lymphoid tissue of the gut (GALT), e.g., Peyer's patches. BALT might play a central role in antigen uptake, initiating immune responses and disseminating primed lymphoid cells in the respiratory tract. In the present study, lungs of mice, rats, guinea pigs, rabbits, pigs, cats, and humans have been studied with respect to the presence and number of BALT and the dependence of BALT on age and microbial stimulation. BALT is not a constitutive structure in all these species. Its frequency varies widely, from 100% in rabbits and rats, 50% in guinea pigs, 33% in pigs, to its absence in cats and all normal human lungs. BALT seems to be a lymphoid structure which is not present in all the species studied but can develop in the lung after stimulation. This is in contrast to lymphoid organs, such as lymph nodes or Peyer's patches, which can always be found. These species differences are of major importance in interpreting the clinical relevance of experiments in animal models on the lung immune system, e.g., antigen uptake, immunostimulation, or lung transplantation.

Aging↗

Inducible bronchus-associated lymphoid tissue (iBALT) in patients with pulmonary complications of rheumatoid arthritis.

Bronchus-associated lymphoid tissue (BALT) was originally described as a mucosal lymphoid organ in the lungs of some species. However, while the lungs of naive mice and humans typically lack BALT, pulmonary infection in mice leads to the development of inducible BALT (iBALT), which is located in peribronchial, perivascular, and interstitial areas throughout the lung. Here we investigated whether iBALT forms in patients with a variety of interstitial lung diseases. We show that while iBALT can be found in the lungs of patients suffering from multiple diseases, well-developed iBALT is most prevalent in patients with pulmonary complications of RA and Sjögren syndrome. In these patients, iBALT consisted of numerous B cell follicles containing germinal centers and follicular dendritic cells. A loosely defined T cell area surrounded the B cell follicles while lymphatics and high endothelial venules were found at the B cell/T cell interface. Increased expression of lymphoid-organizing chemokines, such as CXCL13 and CCL21, as well as molecules involved in the immunopathology of RA, such as B cell-activating factor of the TNF family (BAFF), ICOS ligand, and lymphotoxin, correlated with more well-developed iBALT. Finally, the presence of iBALT correlated with tissue damage in the lungs of RA patients, suggesting that iBALT participates in local RA pathogenesis.

Adult↗

Spent bullet in the bronchus.

Penetrating tracheal trauma, although infrequent, varies from minor to life-threatening injuries. Serious injury often results from airway compromise or significant associated esophageal or vascular trauma. Tracheal injuries resulting in a retained ballistic fragment in the airway have been infrequently reported. We report the successful treatment of a patient with a gunshot wound to the anterior cervical trachea resulting in a spent bullet lodged in the left lower lobe bronchus.

Bronchi↗

Carcinoid and mucoepidermoid carcinoma of bronchus in children.

Four patients with bronchial carcinoid and two patients with mucoepidermoid carcinoma of the bronchus are presented. Presenting symptoms of these rare childhood tumors are chronic cough, hemoptysis, repeated bouts of pulmonary infection, and chest pain. Bronchoscopic examination should be considered in patients with these symptoms and is highly reliable in diagnosing these tumors Surgical resection is the treatment of choice. Bronchial carcinoid and mucoepidermoid carcinoma have an excellent prognosis following conservative surgical resection.

Adolescent↗

Body space measurements in the hyponatraemia of carcinoma of the bronchus: evidence for the chronic 'sick cell' syndrome?

Body space measurements using simultaneous multiple isotope dilution techniques were made in both hyponatraemic and normonatraemic patients with carcinoma of the bronchus and wasting, and compared with those in a group of normal volunteers. Both groups of patients showed osmolal loss from cells. The significance of these findings in relation to the development of hyponatraemia is discussed.

Adult↗

Treatment of small cell carcinoma of the bronchus by combined chemotherapy--clinicopathological correlation with response.

Thirty-seven consecutive patients, referred to a respiratory unit with a histological diagnosis of small cell carcinoma of the bronchus, were treated with a combined chemotherapy regime of adriamycin, vincristine and cyclophosphamide. Palliative radiotherapy was given for the control of symptoms. Thirty of 37 patients responded to treatment, 11/37 having a complete and 19/37 a partial response. The median survival of those patients with a complete response was 55 weeks, significantly higher (P less than 0.01) than either those with partial or no response to treatment. Those patients with limited disease survived longer. A high proportion of patients relapsed at the primary site of the tumour in the lungs. The relationship between the therapeutic response and the histological subtype of small cell carcinoma suffered from the limitations of the available pathological material. However, more of the patients with a complete response were of the lymphocytic-like pattern of small cell carcinoma. Useful survival in these patients with inoperable small cell carcinoma was achieved using this regime of chemotherapy, even in those patients with extensive disease, five of whom had survived for over one year.

Adult↗

Fulminant cardiac tamponade: an exceedingly rare presentation of squamous carcinoma of the bronchus in a male patient.

A 49 year old man presented with near-fatal, fulminant, haemorrhagic cardiac tamponade. He responded well to emergency pericardiocentesis and subsequent investigation revealed the cause to be an unknown squamous carcinoma of the bronchus with pericardial involvement. He died 13 weeks later. Such a dramatic presentation of this type of tumour in a male patient has not been previously described.

Bronchial Neoplasms↗