Progressive intraparenchymal lung nodules dissemination in a heavy smoker and seropositive rheumatoid arthritis suspected of tuberculosis relapse

Vol. 54 No. 3 Suppl., 2013
This supplement was not sponsored by Outside Organizations.

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Oana Cristina Arghir, Mimi Nitu, Mihaela Trenchea, Camelia Ciobotaru

Anthony Caplan first described rheumatoid lung nodules associated with pneumoconiosis in coal-miners (Caplan, 1953). Intraparenchymal lung nodules were later described in rheumatoid arthritis (RA) patients who were never exposed to coal dust and/or without pneumoconiosis. Rheumatoid lung nodules are usually detected in unselected patients: 0.2% in chest radiography and 4% in high-resolution computed tomography (Nannini et al., 2008). Patients could be reluctant to perform surgical lung biopsy for an accurate histopathological diagnosis. We present a peculiar association between a seropositive RA and a presumptive active tuberculosis (TB) disease in a 59-year-old male patient, ex-smoker with a previously healed pulmonary TB disease. The purpose of this report is to describe an unusual case of a presumptive relapse of the nodular TB disease, which progressed to an extensive nodular bilateral dissemination under anti-tuberculosis therapy, mimicking a metastatic carcinoma. The diagnosis of rheumatoid necrobiotic lung nodules was confirmed after open biopsy left pulmonary was performed. Formalin-fixed paraffin-embedded pulmonary rheumatoid nodules were processed for histology and stained with Masson's trichrome. Central structure of the removed pulmonary nodules is typical of a rheumatoid nodule with central necrosis surrounded by a palisade of macrophages. The accumulation of anthracotic pigment was noticed inside the pulmonary nodules in a RA patient without professional exposure to coal or mineral dust. This rare entity is an appearance of the rheumatoid nodules lung syndrome and anthracosis in a heavy tobacco former smoker.

Corresponding author: Mimi Nitu, Assistant Professor, MD, PhD; e-mail: dr_nitumimi@yahoo.com

Download PDF

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

V. Budu, I. Bulescu, Carmen Aurelia Mogoanta

Juvenile nasopharyngeal angiofibromas (JNA) are rare, benign, highly vascular tumors which appear in proximity to the sphenopalatine foramen. The tumor arises most commonly in adolescent males suggesting that in could be hormonally responsive. Although it is histologically benign, it has a high destructive potential and a high grade of recurrence. It is a fibrous vascular tumor with vascular sources from branches of the external or internal carotid arteries. Modern treatment of JNA includes surgery and also radiotherapy, chemotherapy and hormone therapy. This paper presents two cases from the eight of our clinic's experience, with morphological features which made their treatment challenging.

Corresponding author: Vlad Budu, MD, PhD; e-mail: vladbudu@yahoo.com

Download PDF
Download cover
Download contents

Journal archive