• Tuberculosis and Respiratory Diseases
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• v.68 no.4
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• pp.231-235
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• 2010

Lymphadenopathy in the thoracic cavity is frequently caused by inflammatory diseases. In very rare cases, the node-bronchial fistula has been reported to be the cause of complications of pulmonary tuberculosis. A male patient with necrotizing pneumonia and mediastinal lymph node enlargements identified by chest computed tomography was also found to have a node-bronchial fistula caused by lung cancer. The patient was treated for tuberculosis with pneumonia for one week before a definitive diagnosis was made. A further investigation revealed him to have non-small cell lung cancer (NSCLC, adenocarcinoma) and multiple mediastinal lymphadenopathies accompanied with the node-bronchial fistula. We report this specific case that had been previously treated for tuberculosis but was later revealed to be NSCLC accompanied with a node-bronchial fistula.

• Korean Journal of Bronchoesophagology
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• v.6 no.2
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• pp.196-200
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• 2000

Nasopharyngeal tuberculosis is a rare pathological condition. It is most often associated with lymph node and pulmonary lesions, but it may be an isolated lesion. The clinical manifestation may resemble a malignant tumor of the nasopharynx and the nasopharyngeal tuberculosis is occurred occasionally primary infection but more frequently secondary infection to pulmonary tuberculosis. The nasal endoscopic evaluation of nasopharynx is necessary in patient with possible pulmonary or extrapulmonary tuberculosis. The author reports two cases of nasopharyngeal tuberculosis in a 45-years old and 34-years old woman with a review of the literature.

• Tuberculosis and Respiratory Diseases
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• v.38 no.4
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• pp.347-356
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• 1991

Endobronchial tuberculosis is a serious disase because it frequently leaves airway obstruction as the complication, and the treatment of airway obstruction is generally troublesome. In the tumorous type of endobonchial tuberculosis, the bronchial patency is partially or completely compromised with lymph node contents when the necrotic focus of the lymph node ruptures into the bronchial lumen to form a bronchoglandular fistula. To investigate the transition of endobronchial lesion and to evaluate the therapeutic role of bronchoscopic electrocautery in the tumorous type of endobronchial tuberculosis, we performed electrocautery in addition to the combination chemotherapy with steroid and anti-tuberculous drugs in two cases which had airway obstruction proximal to lobar bronchus with the impairment of pulmonary function. We also treated another two cases only with chemotherapy and we have followed up four cases over a 36-month period. In cases that bronchoscopic electrocautery was done, the bronchial patency was completely restored and the impairment of pulmonary function disappeared just after cautery and these effects have remained for 12 months or more. But in cases of medical treatment only, bronchial stenosis was inevitable as the tumorous type of endobronchial tuberculosis changed to the stenotic type with fibrosis. It can be concluded that bronchoscopic electrocautery can nip the occurence of bronchial stenosis in the bud when it is applied in addition to combination chemotherapy with steroid and antituberculous drugs in the tumorous type of endobronchial tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.879-883
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• 1999

The lymphoid system of the lung represents a complex network of lymphoid tissue and lymphatic vessels. Lymph nodes are normally located in the hila, adjacent to the lobar bronchi and within the lung to the level of the fourth-order bronchi. Clinically apparent intrapulmonary lymph nodes are rare. Although of intrapulmonary lymph node histogenesis is uncertain, They are probably hyperplastic lymphoid nodules related to inhalation of irritant dusts and attendant distortion of local lymphatic vessels. Intrapulmonary lymph nodes are detected as solitary or multiple pulmonary nodules. These nodules are difficult to differentiate from intrapulmonary metastasis by radiologic finding. We experienced a case of intrapulmonary lymph nodes presenting multiple nodules in a 46 years old man, which was confirmed by thoracoscopic biopsy.

• Tuberculosis and Respiratory Diseases
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• v.46 no.4
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• pp.542-547
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• 1999

Background: Decision in mediastinal lymph node involvement of lung cancer by CT scan is very important and valuable for the treatment planning and prognosis prediction. In general, long diameter of mediastinal lymph node more than 15mm is used as criterion of lung cancer involvement. Adenocarci-noma has a tendency of early distant metastasis and micrometastasis, so adenocarcinoma may involve lymph node earlier and cannot be detected before lymph nodes are enlarged enough. The authors tried to determine the difference between two size criteria(15mm, 10mm) in adenocarcinoma for the detection of cancer involvement. Methods: Numbers of sample are 60 cases(male 46, female 14, median age: 61.5 years). According to pathology, squamous cancer 41, large cell cancer 2, adenocarcinoma 17. According to TNM stage, I 23, III 24, IIIA 13. Results : Mean long diameter of lymph node involvement is 16.0($\pm8.0$) mm in non-adenocarcinoma group, and that of adenocarcinoma group is 12.0($\pm3.2$) mm(p<0.05). If long diameter of lymph node larger than 15mm as involvement criterion is applied, sensitivity, specificity, positive predictive index, negative predictive index, accuracy of nonadenocarcinoma group are 54%, 100%, 100%, 83%, 86%, and those of adenocarcinoma group are 43%, 90%, 75%, 69%, 71%. If long diameter of lymph node larger than 10mm as involvement criterion is applied, sensitivity, specificity, positive predictive index. negative predictive index. accuracy of nonadenocarcinoma group are 65%, 77%, 61%, 92%, 79%, and those of adenocarcinoma group are 100%, 80%, 78%, 100%, 88%. Conclusion: Long diameter of lymph node larger than 10mm is more valuable criterion as lymph node involvement in adenocarcinoma of lungs.

• Tuberculosis and Respiratory Diseases
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• v.44 no.3
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• pp.669-676
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• 1997

Castleman's disease is uncommon lymphoproliferative disorder as giant lymph node hyperplasia and angiofollicular lymph node hyperplasia. Multicentric variant of Castleman's disease, plasma cell type has been described that has more generalized lymph node involvement as well as involvement of other organ systems than localized type. Multicentric plasma cell type is frequently accompanied by systemic manifestations, such as weight loss, lowgrade fever and weakness. But the reported cases of pulmonary parenchymal involvement are rare and have almost consisted of hyalinized granuloma adjacent to a bronchus. We report a patient with Castleman's disease of the lung, pathologically proven interstitial pulmonary involvement.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.742-755
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• 1997

Background : Endobronchial tuberculosis(ET) is still relatively common disease in Korea. We intended to evaluate the length of endobronchial lesion, peribronchial thickness, luminal irregularity and associated mediastinal lymph node enlargement with Chest CT to get information for such aggressive treatment as electrocautery, laser therapy and so on of bronchial stricture in ET, and also to compare the change of Chest CT finding with that of bronchoscopic finding after one month of anti-tuberculosis treatment. Method : We performed CT in 26 patients who were diagnosed as ET by bronchoscopy at Boramae Hospital from November 1991 to March 1996. After classifying ET into seven subtypes according to bronchoscopic finding, we analyzed the CT finding of each subtype. And we followed up the bronchoscopy, CT, and PIT after one month of anti-tuberculosis treatment, and compared the change of CT findings with those of bronchoscopic findings in nine patients. Results : Age of the patients was from 17 to 73 years old, and the ratio of male to female was 1 : 25 with absolute female predominance. The site(s) of bronchial involvement by tuberculosis is one in 14 cases, two in nine cases and three in one case, respectively, and the left main bronchus was the most frequently involved site (13 cases for multiple involvements and 7 cases for single involvement among 26 cases). The length of bronchial involvement by tuberculosis which was measured by CT was from 10 to 55 mm, and there was a tendency that the length of involved lesion in fibrostenotic type was shorter than that of actively caseating type. Bronchial stricture on CT was noticed in 25 (96%) cases and the range of severity was from total occlusion to near-normal and also showed wide variation even though the subtype of ET was same. The increase of peribronchial thickness which was measured by CT, was noticed in 21 cases (91%) among 23 cases (in which the measurement was possible), and there was no improvement of peribronchial thickness in those cases which showed little improvement in bronchial stricture despite anti-tuberculosis treatment. There was no difference in the luminal irregularity of involved bronchi on CT in relation to bronchoscopic subtypes. The mediastinal lymph node enlargement, defined as the diameter of lymph node was larger than 1cm on CT, was detected in 20 cases (77%), and right side was more frequently involved (L : R = 1 : 5.2). The CT finding usually showed extrinsic bronchial compression but showed direct invasion in two cases which were bronchoscopically classified as tumorous type. When follow-up bronchoscopy and CT was performed after one month of anti-tuberculosis treatment in nine patients, CT showed significant improvement in peribronchial thickness and mediastinal lymph node enlargement. Bronchial stricture was also improved in 6 cases but aggravated in 3 cases despite anti-tuberculosis therapy. In two cases which were classified as fibrostenotic type by bronchoscopy, CT showed significant improvement in bronchial stricture, interestingly. Conclusion : We concluded that the role of Chest CT was complimentary to bronchoscopy in ET, since CT was useful in evaluating the length of bronchial involvement, peribronchial thickness, and mediastinal lymph node enlargement.

• Tuberculosis and Respiratory Diseases
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• v.75 no.3
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• pp.116-119
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• 2013

Sarcoidosis, a systemic granulomatous disease of unknown etiology. The presentation of sarcoidal granuloma in neck nodes without typical manifestations of systemic sarcoidosis is difficult to diagnose. We describe the case of a 37-year-old woman with an increasing mass on the right side of neck. The excisional biopsy from the neck mass showed noncaseating epithelioid cell granuloma of the lymph nodes. No evidence of mycobacterial or fungal infection was noted. Thoracic evaluations did not show enlargement of mediastinal lymph nodes or parenchymal abnormalities. Immunohistochemistry showed abundant expression of tumor necrosis factor-${\alpha}$ in the granuloma. However, transforming growth factor-${\beta}$ was not expressed, although interleukin-$1{\beta}$ was focally expressed. These immunohistochemical findings supported characterization of the granuloma and the diagnosis of sarcoidosis. Sarcoidosis can present with cervical lymph node enlargement without mediastinal or lung abnormality. Immunohistochemistry may support the diagnosis of sarcoidosis and characterization of granuloma.

• Tuberculosis and Respiratory Diseases
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• v.60 no.6
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• pp.684-689
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• 2006

Uterine cervical cancer is the $5^{th}$ most common malignancy in Korean women. With the development of new diagnostic and therapeutic modalities, earlier stage cancers are being diagnosed with longer survival rates being anticipated. Accordingly, recurrent cancers are being encountered more often in clinical practice. Most recurrent uterine cervical cancer patients, have intra-pelvic lesions and adjacent lymph node involvement, while a distant metastasis alone is extremely rare. A mediastinal recurrence of uterine cervical cancer is not common with most manifesting as small lymph node enlargements. We report a case of a 46-year-old woman with recurrent uterine cervical cancer presenting only as a huge mediastinal mass without a local recurrence.

• Tuberculosis and Respiratory Diseases
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• v.57 no.4
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• pp.345-350
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• 2004

Background : To evaluate the frequency and clinical significance of lymph node micrometastasis in patients of non-small-cell lung cancer pathologically staged to be T1-2,N0. Method : From consecutive 29 patients of non-small-cell lung cancer who received curative operation and routine systemic nodal dissection, we immunohistochemically examined 806 lymph nodes from mediastinal, hilar and peribronchial lesion. All slides were stained with hematoxylin and eosin staining for one section and with cytokeratin AE1/AE3 antibody for another consecutive section of same lymph node to find out micrometastasis. Results : In 806 lymph nodes examined, no tumor cell was seen on hematoxylin and eosin staining and micrometastic foci were shown to be on 0.37%(3) of 806 lymph nodes, in which were upper paratracheal, interlobar and peribronchial lymph node. These three positive stains constitute 10.3%(3) of the 29 patients with non-small-cell lung cancer. Nine patients died from disease progression(4), postoperative complication(3) and concomitant diseases(2). The four patients with disease progression did not show evidence of micrometastasis on their lymph node examination. Conclusion : The frequency of lymph node micrometastasis was in 0.37% of 806 lymph nodes examined. The study results might suggested that routine analysis of micrometastasis on the lymph node didn't give any clinical implication on patients with non-small-cell lung cancer.