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Tooth in right bronchus in a 60-year-old man who presented with recurrent episodes of chest infection, dyspnoea and haemoptysis is a rare clinical entity. The patient was cured after successful bronchoscopic removal of the tooth.
A case of successfully treated chronic traumatic thoracic aneurysm is reported. A 43-year-old man was admitted suffering from severe respiratory distress. He had a history of a blunt chest trauma in a traffic accident twenty-three years ago. A plain chest film, bronchofiberscopy, chest CT, MRI and angiography revealed a calcified aneurysm with compression of left main bronchus at the isthmus. He was successfully treated by replacement with woven Dacron graft under partial left heart bypass by means of a centrifugal pump. His postoperative course was uneventful. The literature states operative cases demonstrate a significantly higher survival rate compared to the nonoperative cases. Surgical treatment should be strongly considered for potential aortic rupture.
1) Aggregates of eosinophils closely related to the enlarged endothelial cells in the capillary vessels were recognized in 64% of 28 cases in biopsied specimens of the major bronchus of patients with sarcoidosis. 2) Electron microscopy revealed the vacuolated central cores or matrix in the specific granules of the eosinophils adjacent to the swollen vascular endothelial cells, frequent findings with attachment of the blood platelets to the damaged plasma membrane of the endothelial cells eventually becoming occluded in the lumen with platelet thrombosis, and multilayer formation of the basement membrane of the capillary vessels. 3) Sarcoidosis is suggested to be a pathological process producing both granuloma formation in each organ and vascular endothelial cell changes in the capillary vessels accompanied by aggregation of eosinophils in some periods of the disease process due to unidentified etiological factors.
Nonadrenergic, noncholinergic contractile responses of guinea pig hilar bronchi to transmural electrical stimulation (TES) have been suggested to be due to release of endogenous tachykinins from capsaicin-sensitive neurons (C-fibers). Thiorphan and phosphoramidon, inhibitors of neutral endopeptidase (NEP, the major enzyme responsible for degrading tachykinins), were found to potentiate contractile responses of this isolated airway segment to TES and exogenously applied capsaicin, substance P and neurokinin A. However, the magnitude of potentiation by either inhibitor was smaller for TES and capsaicin (less than 10-fold leftward shift) than for the substrate agonists (about 100-fold leftward shift). This quantitative difference in potentiation by NEP inhibitors does not appear to be due to an influence of vasoactive intestinal peptide or calcitonin gene-related peptide, two endogenous peptides that might be released concomitantly by TES. Neither peptide caused marked effects on contractile responses to TES or tachykinins when applied to the isolated tissues. Addition of inhibitors of serine proteases, aminopeptidases, acetylcholinesterase and angiotensin-converting enzyme failed to further potentiate responses to TES in the presence of thiorphan. Therefore, the contractile response does not appear to be further modified by the activity of these peptidases. Neuropeptide gamma, but not neuropeptide K, was potentiated by thiorphan. The data suggest that peptides that are not substrates for NEP (for example, neuropeptide K) may also be released by TES from capsaicin-sensitive neurons to cause contraction. This may, at least in part, explain the quantitative difference in potentiation by NEP inhibitors of contractile responses to TES and to exogenously applied NEP-sensitive tachykinins in the guinea pig hilar bronchus.
A case of bronchial atresia of additive anomalous bronchus in right middle lobe was reported. A mass and emphysematous lung were found on the chest roentgenogram. CT, and MRI, and it is not difficult to diagnose.
Lung tumors of various types, fixed in 4% formaldehyde-1% glutaraldehyde, were stained for keratin proteins. The results were compared with previous ultrastructural evidence of intermediate filament bundles (IFBs), presumed to be keratin. Electron and light microscopic methods were largely complimentary and the results were in agreement in 79% of cases. Light microscopy was superior for demonstrating keratinizing foci containing numerous well-developed IFBs, whereas electron microscopy was superior when keratin filaments were sparsely distributed in cells throughout a tumor. Fetal and adult bronchial specimens were also studied. Normal adult bronchus, fixed in aldehydes, was unreactive but keratin was observed in similarly fixed bronchi that showed epidermoid metaplasia and/or intraepithelial carcinoma. Keratin was demonstrated in normal adult bronchi fixed in ethanol. Keratin was not observed in fetal lung until the 14th week of gestation, when it appeared in basal cells and a few columnar cells of the larger bronchi. Thereafter, keratin progressively appeared in the more distal branches. As specimens from gestations of less than 14 weeks were fixed in aldehydes, the apparent lack of immunoreactivity may have been artifactual. Nevertheless, keratin was demonstrable in aldehyde-fixed fetal bronchi at 16 and 23 weeks' gestation.
Twelve cases of adenoid cystic carcinoma of the trachea and main-stem bronchus were histologically analyzed, and the results were examined with reference to the growth pattern of the tumor and the prognosis. The tumors were histologically classified into tubular, cribriform, and solid subtypes. Three histologic grades were established: grade I, tumors with tubular and cribriform subtypes but without solid subtype; grade II, tumors with tubular and cribriform subtypes in which the solid subtype comprised less than 20% of the area; grade III, tumors in which the solid subtype comprised more than 20% of the area. Three gross infiltrating types were established: type I, entirely intraluminal; type II, predominantly intraluminal; type III, predominantly extraluminal. In most cases histologic grade correlated with gross tumor type; that is, grades, I, II, and III were grossly types I, II, and III, respectively. The tumors infiltrating along the tracheobronchial wall were of the tubular or cribriform subtype, but not of the solid subtype. In two patients who died of distant metastasis, the histologic studies revealed the solid subtype. Immunohistochemical analysis demonstrated that the tubular subtype was the most differentiated form and the solid subtype, the most undifferentiated form. The histologic subtype of adenoid cystic carcinoma of the tracheobronchial tree was an important factor in the growth pattern of the tumor and the prognosis.
We investigated the metastatic process to the lungs from subcutaneous transplants of R3327-MatLyLu tumor, a rat model for anaplastic prostatic carcinoma. Considerable metastasis of tumor cells to bronchus associated lymphoid tissue (BALT) was observed with time. Immunocytochemistry clearly showed the presence of the epithelial type of intermediate filaments (cytokeratin) in these cells, confirming their carcinomatous origin. No positive staining for cytokeratin could be observed in the BALT in controls. Localization of tumor cells within the BALT was mainly confined to the region near the adjacent artery. After intravenous injection of monodispersed tumor cells, an influx of tumor cells was observed within minutes in this same region of the BALT. These observations suggest that BALT is involved in the metastatic process of tumor cells to the lungs. Its role in controlling metastasis and in tumor cell kill, if any, remains to be elucidated.
Small cell lung cancer is distinguished from other lung cancer histologic types by possessing a variety of neuroendocrine properties. Anti-Leu-7 is a monoclonal antibody that recognizes a 110,000-dalton molecular weight glycoprotein initially described on natural killer cells and subsequently reported on a variety of normal and malignant neural and neuroendocrine cell types. We have found intense anti-Leu-7 binding to a large number of small cell lung cancers, while other lung cancer types were negative or showed only weak and focal binding. Other antigens expressed by natural killer cells, lymphocytes, and monocytes were never or less often expressed on small cell lung cancer cells. In addition, we report for the first time anti-Leu-7 binding by carcinoids, carotid body tumors, pheochromocytomas, endocrine cells of the fetal bronchus and the adult intestine, and select pancreatic islet cells. Anti-Leu-7 binding by small cell lung cancer is consistent with a derivation from pulmonary precursor cells, and anti-Leu-7 staining is clinically useful for the identification of human neuroendocrine tumors of the amine precursor uptake and decarboxylation ("APUD") type.
A case of a bronchus rupture with delayed diagnosis is reported. The symptoms of tracheobronchial lesions are discussed. With this case report the authors wish to bring attention to a rare but increasingly common injury in patients with multiple trauma.
This article deals with the ontogeny, morphology, and function of bronchus-associated lymphoid tissue (BALT). The surface epithelium of the respiratory tract, including the lymphoepithelium of BALT, is described, with emphasis on infiltrated nonepithelial cells (lymphocytes, macrophages). Special attention is given to antigen handling by the lymphoepithelium and the interaction with BALT and lung macrophages. The structure and function of the diverse types of BALT nonlymphoid cells are discussed. The local immune responses (cellular and humoral reactions), the relationships between local and systemic immune reactions, and the role of BALT in the common mucosal immune system are reviewed. The BALT is compared with Peyer's patches in terms of antigen processing, local immune responses, cell populations, and migration of lymphoid and nonlymphoid cells.
A case of squamous cell carcinoma of the mid-thoracic esophagus invading the left main bronchus, and synchronous gastric cancer was successfully treated with subtotal esophagectomy, left pneumonectomy, total gastrectomy and reconstruction using the right colon. The indications of this procedure are discussed.
Alveolar proteinosis (AP) and postobstructive or endogenous lipid pneumonia (ELP) are two distinct morphologic types of phospholipid accumulation in the lung. In ELP, ultrastructurally amorphous fat accumulates in the cytoplasm of alveolar macrophages. In AP, lamellar surfactant bodies with an electron microscopic complex structure are stored within alveolar lumina. In contrast to ELP, AP has not been associated with bronchial obstruction. One case of postobstructive AP occurred distal to a central carcinoid tumor, and two cases of combined AP and ELP occurred next to a squamous cell carcinoma that obstructed a lobar bronchus. Results of histologic and ultrastructural studies were determined with regard to new insights into the physiology and biochemistry of pulmonary lipids. It was concluded that the morphology of accumulated fat in obstructed lung tissue may depend on local oxygen and carbon dioxide tensions.
The patient was a 63-days-old boy who was admitted to our hospital because of moderate cyanosis and tachypnea. After admission, severe respiratory distress and emphysematous change of the right lung on the chest X-ray developed progressively. Echocardiogram and angiocardiogram demonstrated that a tetralogy of Fallot associated with right aortic arch and absence of pulmonary valve, and revealed remarkably dilated ascending aorta which compressed the right pulmonary artery and bronchus. Therefore, the emergency operation in that the ascending aorta was suspended to the 2nd rib was performed through a right thoracotomy. After surgery, his respiratory distress and emphysema of the right lung completely disappeared. To our knowledge, this is the 2nd reported case in which suspension of ascending aorta was successfully performed for pulmonary complication in congenital cardiovascular anomalies as this patient.
The effect of glucocorticoid on the immunological response in the delayed type hypersensitivity reaction of granulomatous disorders was investigated in order to elucidate the mechanism of glucocorticoid on the suppressive course of the reaction. Experimental pulmonary granuloma model in rats was induced by an intravenous injection of heat killed BCG, and the effects of methylprednisolone (MPSL) on the granulomatous lung tissue, bronchus associated lymphoid tissue (BALT) and the population of cells from bronchoalveolar lavage fluid (BALF) and peripheral blood were examined by the cytological and immunohistochemical methods. The pulmonary granulomatous reaction was reduced effectively by the administration of MPSL. A remarkable reduction of the number of Ia antigen positive alveolar macrophages (Ia+ A.M phi) and T lymphocytes in the granulomatous lung tissue and BALF was observed. T helper cells to non-helper cells (TH/TNH) ratio in BALF decreased remarkably. Furthermore, a reduction of Ia antigen positive macrophages (Ia+ M phi) and T cells was noted in the parafollicular area of BALT. These findings suggest that glucocorticoid may suppress the immunological activity of M phi and T cell through its inhibitory effect on the differentiation of Ia+ M phi and activated T cells, which result in the diminishment of pulmonary granulomatous reaction through the disorder of M phi - T cell interaction. On the other hand, lymphocytopenia with decreased TH/TNH ratios in peripheral blood was observed simultaneously with the reduction of the pulmonary granulomatous reaction. Thus, the mechanism of reduced pulmonary granulomatous reaction after MPSL administration may be not only due to local immunosuppression, but also to impaired systemic immune response. In addition, the disappearance of the germinal center and the reduction of surface IgM-positive cells in the follicular area of BALT occurred with the reduction of pulmonary granulomatous reaction. These results suggest that glucocorticoid also suppress the humoral immune responses in BALT during the course of delayed type hypersensitivity reaction.
A relatively unknown existence of a tracheal bronchus in three, approximately 2-3 years old ponies, is reported and the possible genesis of this anomaly is discussed.
Biopsy specimens of the major bronchus of sixty-nine patients with sarcoidosis were investigated electronmicroscopically. 22 patients (12 males, 10 females), 32% of the cases, showed concentric lamellar or similar kinds of dense bodies in the bronchial wall. Typically, the concentric lamellar bodies were observed in various numbers, scattered in the collagen-increased tunica propria or superficial submucosal layer, where adjacent or deeply located blood capillary vessels were mostly obliterated. They were generally of 0.2 to 1.8 micron in size, but occasionally smaller ones were observed. We also found large swollen and irregular lamellated bodies greater than 2 microns in the cell cytoplasm. Six cases with particularly large numbers of these bodies in the bronchial wall showed "capped" figures, in which the concentric lamellar bodies were partly attached to other demilunar dense bodies. These figures were assumed to be the very early stage of formation of conchoidal bodies at the LM level, so-called Schaumann bodies. Two cases (5%) (chronic bronchitis, lung cancer) among 40 control patients with other diseases disclosed the same small lamellated bodies in the bronchial wall. We were unable to resolve the problem of the origin of these deposited in them, but assume that they will initially occur in the cell cytoplasm in some patients with sarcoidosis and eventually develop into typical concentric lamellar bodies.
Two case reports of solitary bronchial papillomas are presented. The histologic features of the lesions are those of squamous papillomas exhibiting prominent condylomatous changes. Immunoperoxidase stains revealed the presence of human papillomavirus antigens in the koilocytotic cells. Ultrastructural studies demonstrated possible intranuclear viral-size particles. Solitary condylomatous papillomas of the bronchus should be distinguished from solitary bronchial squamous papillomas that do not have condylomatous features. The rationale for this separation is the likelihood of a viral origin for these condylomatous papillomas and their potential for malignant change.