In order to examine the feasibility and safety of undertaking a larger prospective study to compare the diagnostic yield from concurrent open lung biopsy (OLB) and bronchoalveolar lavage (BAL) in febrile neutropenic patients with pulmonary infiltrates and the impact of such knowledge on clinical outcome, a pilot exploratory study was performed. 13 immunocompromised patients (mainly with haematological malignancy or bone marrow transplantation recipients) were investigated. At least one diagnostic finding in 12 of 13 patients was provided by OLB compared to 4 of 13 patients by BAL. BAL provided 7 specific diagnoses (pneumocystis 1, fungal infection 3, bacterial pneumonia 1, pulmonary haemorrhage 2) whilst OLB provided 12 specific diagnosis (CMV 2, pneumocystis 3, fungal infection 1, bacterial pneumonia 1, pulmonary haemorrhage 4, pulmonary embolism 1). Five patients with nonspecific interstitial/alveolar inflammation were diagnosed only by OLB. The concordance that the exact same specific diagnoses present in the OLB were found in the BAL was zero. There were 2 minor complications (1 wound infection by OLB, 1 moderate haemorrhage by BAL). Mortality at 28 days was 8 of 13 patients which in no case was related to either procedure. We suggest that OLB is a safe procedure in such patients, provides superior and more complete diagnostic information compared to BAL and a larger controlled study to investigate the impact of early OLB on the outcome of these patients appears to be justified.
Nodular skin lesions on the lateral aspects of the legs of a female child were first noticed at the age of 6 days. A biopsy of the lesions was done at the age of 6 months when the child had also developed cervical and inguinal lymphadenopathy and angiomatous lesions on the face. The diagnosis of Rosai-Dorfman disease (RDD; also known as sinus histiocytosis with massive lymphadenopathy, SHML) was made. Increasing respiratory obstruction by lymphoid tissue prompted a 2-week trial with oral prednisolone. A dramatic response occurred, with complete resolution of all clinical findings within 5 days, but with recurrence of lymphadenopathy 6 weeks after stopping with medication. Further observations over the next 3 years established a consistent response to prednisolone and a pattern of steroid dependence.
Solitary fibrous tumour was first described as a pleural tumour. It has been reported in a number of extrapleural sites including the head and neck. We present the first case of solitary fibrous tumour of the infratemporal fossa described in the English literature. Complete excision was achieved using the orbitozygomatic infratemporal craniotomy approach.
Five cases of Ki-1-positive anaplastic large-cell lymphoma diagnosed by fine-needle aspiration biopsy are reviewed, and cytologic, histologic, and ultrastructural findings in these cases are correlated. In all cases, the diagnosis of anaplastic large-cell lymphoma was suggested on the basis of the morphological appearance in aspiration smears. This diagnosis was confirmed by immunohistochemistry, which revealed strong positivity of most of the cells by Ki-1 antibody. Two of the lymphomas were T-cell type, one was B-cell type, and the remaining 2 were composed of null cells. In 2 cases, intracytoplasmic inclusions were seen in some of the tumor cells in aspiration smears. These were ultrastructurally correlated with large lysosomal bodies of variable morphology. Fine-needle aspiration combined with immunohistochemistry may be an effective technique for diagnosing this neoplasm.
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