Facial granulomatous papules are important to recognise, as some of them are associated with significant systemic association, particularly sarcoidosis and certain infectious conditions. Lupus miliaris disseminatus faciei (LMDF) is a benign granulomatous disorder of unknown aetiology characterised by symmetrical, monomorphic, reddish-brown papules on the face. It is not associated with any underlying systemic involvement. We report a case of LMDF in a middle-aged man who presented to us with multiple asymptomatic and monomorphic reddish papules on the face for 3 months. Skin biopsy showed well-formed perifollicular epithelioid cell granulomas with focus of necrosis suggestive of LMDF. The lesions significantly responded to oral steroids.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the primary modality for mediastinal lymph node staging in lung carcinoma. We aimed to evaluate its utility in extra-pulmonary malignancies (EPM). EBUS-TBNA aspirations (2013 done in patients with known/suspected EPMs and mediastinal lymphadenopathy/masses was performed. All archived cytology/histology material was reviewed and categorised as positive, negative and unsatisfactory. Methods: Database search of Results:The selected 139 patients included 100 patients with known EPMs, 11 patients with known lymphoma, and 28 patients with suspected EPM of unknown primary. EBUS-TBNA was adequate in 110 patients (79%), including 21 patients who yielded only reactive lymphoid tissue. Satisfactory blood clot cores were obtained in 34 patients and contributed significantly to diagnosis and ancillary testing. Metastasis was detected in 45 patients with known EPM, predominantly originating from a known primary in the breast in females (56%) and squamous cell carcinomas of head and neck in males (60%). Granulomatous lymphadenopathy was identified in 16 patients with known EPM (16%). Lymphoma relapse and granulomatous lymphadenopathy were identified in three and four patients with known lymphoma, respectively. In patients with suspected EPM of unknown primary site, malignancy was confirmed in 21 patients, predominantly representing metastatic adenocarcinomas (n = 5) and neuroendocrine neoplasms (n = 5). Immunocytochemistry was performed in 16 of these cases and aided in characterisation of primary site/type of tumour in 12 cases.Conclusion: EBUS-TBNA is efficient for screening mediastinal lymph nodes/masses for malignancy in EPMs. Procuring sufficient material for ancillary testing would improve diagnostic accuracy and reduce need for resampling. K E Y W O R D Sblood clot cores, endobronchial ultrasound-guided transbronchial needle aspiration, extrapulmonary malignancy, lymphoma, mediastinal lymphadenopathy, metastases Aruna Nambirajan and Moanaro Longchar contributed equally and should be considered co-first authors.

No abstract

Background: The Dumon silicone Y-stent (Novatech SA, La Ciotat, France) is useful for releasing tracheobronchial stenosis but requires sufficient predilation because of the weak expansion force of silicone Y-stents. We have performed mechanical expansion (debulking or coreout) by rigid bronchoscopy, microwave coagulation, and balloon expansion (Fogarty catheter). In recent years, however, we have used a respiratory dilatation balloon (CRE Pulmonary Balloon Dilator; Boston Scientific, Marlborough, MA). We investigated the feasibility, efficacy, and safety of stenting using a silicone Y-stent or additional self-expanding metallic stent (SEMS), focusing especially on the usefulness of a pulmonary balloon dilator, in patients with malignant tracheobronchial stenosis. Method: From May 2012 to November 2017, 75 patients (54 male, 21 female; mean age, 64 years; range, 30e91 years) who underwent Dumon silicone Y-stent placement for malignant tracheobronchial stenosis in our department were retrospectively examined. Forty-six patients had lung cancer, 20 had esophageal cancer, 5 had tracheal carcinoma, and 4 had other carcinomas. All procedures were performed in the operating room under general anesthesia, and the stents were implanted via rigid bronchoscopy. The patients were divided into three groups according to the method of predilatation before stenting: no use of balloon expansion (Group N, n¼36), use of a Fogarty catheter (Group F, n¼22), and use of a respiratory dilatation balloon (Group B, n¼17). Result: Stents were implanted and symptoms were resolved in all patients. No operative death occurred. The types of indwelling stents were only a Y-stent in 46 patients and a Y-stent with additional SEMS in 29. Although the mean number of additional SEMS was significantly higher in Group B (0.7 stents/patient) than in Groups N and F (0.3 stents/patient, respectively), there was no difference in the median (range) operation time among Groups N, F, and B: 55 (32e115), 59 (29e110), and 49 (17e102) minutes, respectively. In the 46 patients who underwent placement of only a Y-stent without a SEMS, the operation time was significantly shorter in Group B [n¼6, 39 (17e64) minutes] than in Groups N [n¼25, 53 (32e115) minutes] and F [n¼15, 59 (29e106) minutes] (p¼0.028). There were no differences in the amount of bleeding, postoperative performance status, or hospitalization days. Conclusion: A respiratory dilatation balloon is useful for predilatation in patients with tracheobronchial stenosis requiring a silicone Y-stent. Such balloons also contribute to a shorter operation time and more efficient procedure for severe stenosis requiring additional stenting.Background: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently emerged as a minimally invasive and safe modality for the evaluation of mediastinal lymphadenopathy, particularly in staging of lung carcinoma patients. Our aim was to evaluate its utility in patients with non-pulmonary malignancies presenting with mediastinal lymphadenopath...