Sarcoidosis is multisystem disease that has been amusing physicians since its discovery in 1989 by Caesar Boeck. More than 10,000 articles have been published in the literature by far, and each time it affects a new organ. Involvement of bone has been recently discovered and because it is still a rare entity, it is important to focus on the presenting systems and also to be able to differentiate it from other closely related diseases including but not limited to tumor and other infectious processes. We describe two cases of osseous sarcoma in two relatively young but surprisingly asymptomatic patients.

Dikshya Sharma

Naureen Narula

Bindu Mudduluru

Bino Joseph

Dany Elsayegh

Osseous Sarcoma: Is Sarcoma the New Emperor of Maladies? Case-Series with Brief Review of the Literature

Malignant melanoma is a nonepithelial neoplasm of melanocytes. It is tremendously rare for this condition to primarily involve the respiratory tract, accounting only for 0.01&#x25; of the lung malignancies. It often presents as a solitary nodule provoking mass effect and/or obstructive symptom. It most commonly affects patients 50 years old and older, with no gender predilection. Complete surgical excision is the treatment of choice; nevertheless, chemotherapy or radiation might be necessary depending on tumor location and/or metastasis status. Recently, biochemotherapy and immunotherapy have emerged as promising treatment modalities. We present a case of Primary Pulmonary Malignant Melanoma (PPMM) in a 76-year-old male with no previous personal or family history of cancer who presented with new onset nonproductive cough. We also present an analysis with high yield points summarizing clinical features, diagnostic workup, and management of PPMM. Finally, we post a table summarizing all the cases ever reported in English literature.

Fernando Figueroa Rodriguez

Ahsan Uddin

Justine Nasr

Primary Pulmonary Malignant Melanoma Found While Evaluating New Onset Cough: A Case Presentation and Literature Review

Pulmonary malignancies carry a significant morbidity and mortality and are one of the leading causes of cancer-related deaths worldwide. Primary pulmonary lymphoma is a rare malignancy which should be considered in the differential of solitary pulmonary nodule or lung mass especially in a low-risk patient presenting with constitutional symptoms. Here, we describe a case of an elderly male who presented to our clinic with incidental pulmonary nodules and subsequent workup revealed low grade B cell non-Hodgkin&#x27;s lymphoma consistent with diagnosis of primary pulmonary marginal zone lymphoma.

Saad Ullah

Mirza Ali

Mingchen Song

Rare Primary Pulmonary Marginal Zone Lymphoma Presenting with Incidental Pulmonary Nodules

We herein report the case of a 37-year-old immunocompetent man who died from Pneumocystis jirovecii pneumonia (PCP). He was initially treated for an acute exacerbation of interstitial pneumonia; however, the elevation of the patient&#x2019;s serum (1-3) &#x3b2;-D glucan (BG) level suggested the possibility of PCP and sulfamethoxazole trimethoprim was added. A postmortem pathological examination and retrospective Grocott&#x27;s methenamine silver (GMS) staining of the bronchoalveolar lavage fluid (BALF), which was obtained on the day of admission, revealed PCP. The present case suggests that it is essential to perform a BG assay and GMS staining of BALF specimens when patients show diffuse ground-glass opacity on chest computed tomography, regardless of their immune status.

Hiromi Ide

Yoshikazu Yamaji

Kazunori Tobino

Masanobu Okahisa

Kojin Murakami

Yuki Goto

Takuto Sueyasu

Saori Nishizawa

Kohei Yoshimine

Miyuki Munechika

Masafumi Oya

Yuka Hiraki

Pneumocystis jirovecii Pneumonia in an Immunocompetent Japanese Man: A Case Report and Literature Review

Eosinophilic lung disease is a heterogeneous group of disorders that reveal eosinophil involved lung tissue often in patients with asthma or atopy. Classification and diagnostic criteria of eosinophilic lung disease are not well-established; however, peripheral ground-glass opacity is typical on chest computed tomography. Another etiology of this same radiographic finding reported in the literature is silicone embolism syndrome. Here, we present a 43-year-old female with poorly controlled severe persistent asthma presenting with difficulty breathing. Computed tomography showed peripherally dominant ground-glass opacity. Peripheral blood, bronchoalveolar lavage fluid analysis, and transbronchial biopsy did not find eosinophilia. Serial bronchoalveolar lavage of the demonstrated increasingly blood-tinged fluid. The patient required mechanical ventilation upon admission. After further questioning the patient revealed that she had frequently received injectable cosmetics at non-licensed establishments. Initially, due to past medical history, presentation, and radiographic findings, eosinophilic pneumonia was suspected. However, after a review of the patient&#x2019;s social history and risk factors, silicone embolisms syndrome became a likely diagnosis. The patient had good clinical response to high dose steroid therapy.

Chia-Yu Chiu

Michael David

Aya Musa

Mohmed Gora

Manmeet Kaur Gujral

A Woman with Asthma and Peripheral Ground-Glass Opacities

Subcostal access is a novel approach for anatomical lung resection. To perform surgery via this access, specially designed long instruments are required. Subcostal access provides excellent visualization of the mediastinum and anterior lung hilum. We exhibit here a subcostal middle lobectomy with systematic en-block mediastinal lymphadenectomy in an obese 52-year-old male patient with body mass index (BMI=37.7) performed via this single incision. The operation was completed efficiently within 30 minutes with negligible postoperative pain.

Samer Al Sawalhi

Deping Zhao

Haomin Cai

Yuxing Jin

Uniportal Subcostal Video-Assisted Thoracoscopic Surgery: A Feasible Approach for a Challenging Middle Lobectomy in an Obese Patient

Background. Simultaneous bilateral primary spontaneous pneumothorax (SBPSP) is an extremely rare and potentially fatal condition. Patients usually have no relevant medical conditions. Some cases, however, may have certain risk factors such as smoking, being young, and male gender. We reported a case of a healthy young male who presented with BPSP. Case Presentation. A 21-year-old man with a past medical history of well-controlled intermittent asthma presented with acute worsening shortness of breath overnight. Chest X-ray performed showed bilateral large pneumothorax with significantly compressed mediastinum. Chest tubes were placed bilaterally with immediate clinical improvement. However, the chest tubes continued to have an air leak without full lungs expansion. Computed tomography scan without contrast of the chest revealed subpleural blebs in both upper lobes. The patient underwent bilateral video-assisted thoracoscopic surgery (VATS) with apical bleb resection, bilateral pleurectomy, and bilateral doxycycline pleurodesis. Biopsy of the apical blebs and parietal pleura of both lungs were negative for any atypical cells suspicious for malignancy or Langerhans cell histiocytosis. The patient had been doing well six months following surgery with no recurrence of pneumothorax. Conclusion. SBPSP is a rare and urgent condition that requires prompt intervention. In a young patient without any underlying disease, surgical intervention, such as VATS, is relatively safe and can be considered early.

Jakrin Kewcharoen

Paul Morris

Chanavuth Kanitsoraphan

Hanh La

Narin Sriratanaviriyakul

Simultaneous Bilateral Primary Spontaneous Pneumothorax: A Case Report and a Review of the Literature

Lymphomatoid granulomatosis (LG) is an EBV-associated angiodestructive lymphoproliferative disease with multiorgan involvement that predominantly affects the lungs. We present a case of a 72-year-old man with a history of chronic lymphocytic leukemia who presented with upper respiratory symptoms and multiple erythematous skin papules. Chest CT showed ill-defined, irregular solid pulmonary nodules with peripheral ground-glass opacities in a peribronchovascular distribution. The differential for this pattern of lung disease is vast which includes but is not limited to infection, vasculitis, sarcoidosis, lymphoma, and Kaposi sarcoma. Subsequent PET/CT showed rapid progression of lung opacities and marked FDG uptake of pulmonary opacities and skin nodules, which raised the question of Richter syndrome. Wedge biopsy under video-assisted thoracoscopic surgery was performed. Pathology showed an extensive lymphoid infiltrate involving lymphatic and bronchovascular bundles and consisting of a mixture of large lymphocytes and inflammatory cells. Special stains showed that the large lymphocytes expressed B-cell markers and EBV virus. Overall, the findings were consistent with LG.

Shahab Rezvani

Marie Tominna

Sayf Al-Katib

Marc D. Smith

Craig Cousineau

Ayad Al-Katib

Lymphomatoid Granulomatosis in a Patient with Chronic Lymphocytic Leukemia and Rapidly Progressing Peribronchovascular Pulmonary Infiltrates

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Case Reports in Pulmonology publishes case reports and case series in all areas of pulmonology, prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.

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Case Reports in Pulmonology - Table of contents 2019

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Case Reports in Pulmonology publishes case reports and case series in all areas of pulmonology, prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.

Case Reports in Pulmonology