| Case Series |
Three different CT and FDG PET/CT findings of pulmonary involvement in methotrexate-associated lymphoproliferative disease
Sachi Matsubayashi, Manabu Suzuki, Keita Sakamoto, Shinyu Izumi, Masayuki Hojo, Haruhito Sugiyama DOI: 10.1002/rcr2.520
Methotrexate (MTX) is one of the key drugs for treating rheumatoid arthritis (RA) and other autoimmune arthritis. Lymphoproliferative disease (LPD) is a complication of low-dose MTX therapy. We describe three cases of MTX-LPD where we conducted chest computed tomography (CT) and 18F-fluorodeoxyglucose (FDG)/positron emission tomography (PET)/CT. This report focuses on the radiological findings of MTX-LPD, including FDG PET/CT, based on these cases. FDG PET/CT might be a useful diagnostic tool as it may reflect disease progression and help identify separate lesions. |
| Case Reports |
Isolated unilateral pulmonary artery agenesis presenting with massive hemoptysis
Min Kyun Kang, Do Kyun Kang, Youn-Ho Hwang DOI: 10.1002/rcr2.511
A 21-year-old man presented with recurrent and persistent haemoptysis. Chest computed tomography showed a right-sided pulmonary artery agenesis and associated hypertrophic change of right-sided bronchial arteries. Thoracic aortogram revealed abnormal collateral arteries supplying the right lung. Minor haemoptysis continued despite endovascular embolization of collateral vessels. Thus, right pneumonectomy was performed and the patient was treated successfully. Physicians should be aware that unilateral pulmonary artery agenesis could be a source of haemoptysis and pneumonectomy may be the best treatment. |
Interstitial pneumonia with autoimmune features that met the proposed diagnostic criteria for IgG4-related respiratory disease
Nobuhito Arakawa, Hideaki Yamasawa, Tamiko Takemura, Shinya Okada, Takafumi Taki, Shigemi Ishikawa DOI: 10.1002/rcr2.512
We held a multidisciplinary discussion on a case of interstitial lung disease without extrathoracic lesions that met the classification criteria for interstitial pneumonia with autoimmune features (IPAF) and the proposed diagnostic criteria for immunoglobulin G4 (IgG4)-related respiratory disease (IgG4-RRD). We concluded that the present case was IPAF that met the proposed diagnostic criteria for IgG4-RRD. |
The first case of micropapillary adenocarcinoma associated with cystic airspace in a non-smoking man
Saeko Takahashi, Saori Murata, Reishi Seki, Shoji Kuriyama, Masahiro Kaji, Morio Nakamura DOI: 10.1002/rcr2.513
Lung cancers associated with cystic airspaces are typically adenocarcinoma with lepidic, papillary, and/or acinar patterns and are usually found in smokers. To date, there has been no report of those cancers revealing micropapillary patterns. Here, we describe the first case of pulmonary micropapillary adenocarcinoma associated with cystic airspaces in 79-year-old non-smoking man. |
Effectiveness of mepolizumab for eosinophilic pneumonia following bronchial thermoplasty
Ryota Otoshi, Tomohisa Baba, Shigeru Komatsu, Masato Asaoka, Eri Hagiwara, Takashi Ogura DOI: 10.1002/rcr2.514
Bronchial thermoplasty (BT) is a bronchoscopic procedure for treating severe asthma using thermal energy to reduce airway smooth muscle. There are some reports of complications such as bronchitis and atelectasis due to transient inflammation and oedema, but, to the best of our knowledge, no studies have reported eosinophilic pneumonia (EP) due to BT. Mepolizumab is an anti-interleukin-5 monoclonal antibody that is reportedly effective against eosinophilic inflammation such as bronchial asthma; however, only few studies have reported its use in treating EP. Here, we report the effectiveness of mepolizumab in treating EP following BT. |
Zosteriform cutaneous metastases: an unusual presentation of metastatic lung carcinoma
Kirsty J L Wark, Melani Mahendran, Artiene Tatian, Amandeep Singh, Jane Woods, Ananthakrishnapuram Aravindan DOI: 10.1002/rcr2.515
Zosteriform cutaneous metastases are a rare morphological variant. We present a case of metastatic adenocarcinoma of the lung in a 78-year-old presenting as zosteriform cutaneous metastases around a vascular catheter site. |
Primary squamous cell carcinoma of the pleura treated with nivolumab
Ioanna Sigala, Nektarios Alevizopoulos, Konstantinos Elefteriou, Niki Gianniou, Ioannis Kalomenidis DOI: 10.1002/rcr2.516
We report the case of a 48-year-old man who presented with persistent right-sided thoracic pain with chest computed tomography scan demonstrating a right-sided pleural effusion and pleural mass invading the ribs. Ultrasound-guided biopsy revealed a primary squamous cell carcinoma of the pleura. Positron emission tomography staging demonstrated metastatic lung and lymph node involvement precluding surgical therapy. Immunotherapy with nivolumab resulted in prolongation of survival with good quality of life. |
Endoscopic ultrasound-guided pleural biopsy in the hands of the pulmonologist
Rana Bibi, Uffe Bodtger, Rafi Nessar, Henrik K Jensen, Ida Skovgaard Christiansen, Paul F Clementsen DOI: 10.1002/rcr2.517
Endoscopic ultrasound (EUS) via the oesophagus can be performed either with the use of a conventional gastrointestinal endoscope (EUS-fine needle aspiration (FNA)) or by using the endobronchial ultrasound (EBUS) endoscope in the oesophagus (EUS-B-FNA). The use of EUS-B for the diagnosis and staging of thoracic malignancy is quickly gaining ground. We here present two cases demonstrating that EUS-B-guided FNA (EUS-B-FNA) of pleural lesions is possible. |
Omalizumab as add-on therapy in a patient with severe asthma and OSA
Giulia Scioscia, Enrico Buonamico, Maria Pia Foschino Barbaro, Donato Lacedonia, Roberto Sabato, Giovanna Elisiana Carpagnano DOI: 10.1002/rcr2.518
We report the case of a 61-year-old severe allergic asthmatic woman (body mass index (BMI): 38) who was followed up by our outpatient clinic for one year. She started treatment with omalizumab and underwent polysomnography showing a severe obstructive sleep apnoea (OSA) pattern (apnoea/hypopnoea index (AHI): 72.7). After six months, she showed functional improvement and good asthma symptoms control and underwent a new polygraphy for the persistence of the night symptoms which showed an ameliorated, despite still severe, OSA pattern (AHI: 31.9). The patient obtained complete polygraphic normalization after adequate positive airway pressure (PAP) titration. This is the first documented case report that demonstrates a possible role of omalizumab in improving the OSA pattern in a patient affected by severe asthma and OSA. |
Squamous cell transformation as a mechanism of acquired resistance to tyrosine kinase inhibitor in EGFR-mutated lung adenocarcinoma: a report of two cases
Hironori Uruga, Takeshi Fujii, Nobuyuki Nakamura, Shuhei Moriguchi, Kazuma Kishi, Hisashi Takaya DOI: 10.1002/rcr2.521
Pathological transformation to squamous cell carcinoma after epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) treatment has been reported, but details of the transformation remain unclear. Here, we report two cases with transformation to squamous cell carcinoma after treatment with EGFR-TKIs. Both patients had PTEN genomic alterations and the PI3K/AKT/mTOR (mammalian target of rapamycin) pathway might play an important role in squamous cell transformation. |
Antibiotic-induced reduction of abnormal lung shadow in pulmonary nodular lymphoid hyperplasia
Akari Tanino, Yukari Tsubata, Shunichi Hamaguchi, Akihisa Sutani, Mamiko Nagase, Takeshi Isobe DOI: 10.1002/rcr2.522
A case of pulmonary nodular lymphoid hyperplasia (PNLH) that was difficult to diagnosis because of an abnormal shadow that was reduced due to antibiotics use was described. Histopathological examination indicated a diagnosis of PNLH and the pathological evidence of bacteria suggested an infective aetiology for PNLH. |
Subacute invasive pulmonary aspergillosis after chemoradiotherapy for lung cancer
Hirofumi Watanabe, Toshihiro Shirai, Mika Saigusa, Kazuhiro Asada, Kazumori Arai DOI: 10.1002/rcr2.523
Subacute invasive pulmonary aspergillosis (SIPA), a rapidly progressive fungal infection of less than three months arising from pre-existing lung lesions, generally afflicts moderately immunocompromised patients. We herein report the case of a 69-year-old man who developed SIPA following chemoradiotherapy for lung cancer and treated with multiple antifungal therapy. |
Pembrolizumab-related pancreatitis with elevation of pancreatic tumour markers
Tamaki Kakuwa, Masao Hashimoto, Atsuko Izumi, Go Naka, Yuichiro Takeda, Haruhito Sugiyama DOI: 10.1002/rcr2.525
We report a case of pembrolizumab-induced immune-related pancreatitis with the elevation of pancreatic tumour markers in a patient with squamous cell lung cancer. |
Difficult intubation in an asymptomatic patient with tracheobronchopathia osteochondroplastica
Dona Kafili, Timothy Sampson, Sean Tolhurst DOI: 10.1002/rcr2.526
Tracheobronchopathia osteochondroplastica (TO) is a rare, benign, slowly progressive disease of unknown aetiology. It is characterized by numerous sessile, cartilaginous, or osseous submucosal nodules distributed throughout the anterolateral walls of the trachea and projecting into the laryngotracheobronchial lumen. The diagnosis is usually incidental with distinct bronchoscopic or computed tomography (CT) scan findings. We present a case of asymptomatic TO identified through fibreoptic bronchoscopy and biopsy after having a difficult intubation for elective prostate surgery. |
Bronchial artery embolization for haemothorax and haemoptysis caused by primary lung cancer
Shota Yamamoto, Shunsuke Kamei, Yusuke Kondo, Shinichiro Hiraiwa, Terumitsu Hasebe, Fumio Sakamaki DOI: 10.1002/rcr2.529
This is the first report of primary lung cancer causing a massive haemothorax and haemoptysis simultaneously. We believe it is also the first such case in which haemostasis was secured using bronchial artery embolization. |
Pulmonary artery intimal sarcoma: a case report and literature review
Ding-Yu Chang, Kun-Chang Lin, Jun-Yen Pan, Hung-Wei Liu, Shu-Hung Kuo, Lin Lee DOI: 10.1002/rcr2.530
Pulmonary artery intimal sarcoma is a rare disorder arising from the intimal wall of the pulmonary artery. As the tumour decreases the lumen of the pulmonary artery, patients usually present with symptoms and signs of right ventricular failure, and it has often been misdiagnosed as pulmonary thromboembolism. In this report, we present the case of a patient in whom the diagnosis of pulmonary artery sarcoma was made promptly and surgery was performed soon after. |
Left ventricular dysfunction in an idiopathic pulmonary fibrosis patient on nintedanib
Ryosuke Imai, Yutaka Tomishima DOI: 10.1002/rcr2.533
We report a case of left ventricular dysfunction in a patient with idiopathic pulmonary fibrosis treated with nintedanib, which recovered after cessation of nintedanib. Nintedanib may induce left ventricular dysfunction, and early recognition is important since this condition is potentially reversible. |
Primary resistance to osimertinib despite acquired T790M
Ling-Kai Chang, Yih-Leong Chang, Jin-Yuan Shih DOI: 10.1002/rcr2.532
Liquid biopsy to diagnose T790M presence in non-small cell lung carcinoma (NSCLC) patients resistant to epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) might miss other possible resistance mechanisms. Tissue biopsy should be considered to exclude the presence of small cell lung carcinoma (SCLC) transformation. |
| Clinical Image |
Restrictive ventilatory impairment and thrombosis due to a giant liver cyst
Keitaro Nakamoto, Chika Miyaoka, Aya Hirata, Yasuhiro Nakamura, Tetsuya Nakazato, Hajime Takizawa DOI: 10.1002/rcr2.524
A small number of patients with liver cysts present with symptoms. Percutaneous needle aspiration with injection of a sclerosing agent can be an effective non-surgical treatment for patients with symptomatic cysts, and to our knowledge, this is the first case to show improvement of restrictive ventilatory impairment. |
Indwelling pleural catheter tract metastasis from renal cell carcinoma
See-Wei Low, Kenneth K Sakata DOI: 10.1002/rcr2.527
The importance of recognizing new nodules or subcutaneous mass in patients who has had indwelling pleural catheter (IPC) or overlying the IPC site is highlighted. This report describes the first case of catheter tract metastasis (CTM) due to renal cell carcinoma (RCC) and the second case of CTM post-IPC removal. |
