Endobronchial ultrasound convex probe for lymphoma, sarcoidosis, lung cancer and other thoracic entities. A case series Paul Zarogoulidis, Haidong Huang,

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Presentation transcript:

Endobronchial ultrasound convex probe for lymphoma, sarcoidosis, lung cancer and other thoracic entities. A case series Paul Zarogoulidis, Haidong Huang, Chong Bai, Christoforos Kosmidis, Georgia Trakada, Lemonia Veletza, Theodora Tsiouda, Nikolaos Barbetakis, Dimitrios Paliouras, Evangelia Athanasiou, Dimitris Hatzibougias, Anastasios Kallianos, Nikolaos Panagiotopoulos, Liana Papaemmanouil, Wolfgang Hohenforst-Schmidt Respiratory Medicine Case Reports Volume 22, Pages 187-196 (January 2017) DOI: 10.1016/j.rmcr.2017.08.016 Copyright © 2017 The Authors Terms and Conditions

Fig. 1 On the left side: after the biopsy, cleaning the 22G needle, on the right side: a tissue core from the lesion (Figures by Paul Zarogoulidis). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 2 On the left side: the equipment of Pentax, an EPK-1000 and EUB-6500HV, on the right side: a EB-1970UK EBUS endoscope (Figures by Paul Zarogoulidis equipment in the Private Hospital “Saint Luke'’). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 3 CT of the thorax with an enlarged station 4R. Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 4 The previously demonstrated in Fig. 3 station 4R during biopsy. Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 5 Subcarinal lymph node aspiration and cell block preparation. a) Haematoxylin/Eosin (H/E) stain in cell block of lymph node material contained numerous lymphoid aggregates (magnification x 40). b) in high power view (magnification x 400) the lymphoid cells were small in size with convoluted or “gyroid” nucleus and abundant clear cytoplasm. c,d) after conventional cytological preparation (Papanikolaou stain) the lymphoid cells were uniform with basophilic dark nucleus (magnification x 200, x 400). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 6 Immunostain for CD20. The neoplastic lymphoid cells were almost totally positive for CD20 (magnification x 400). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 7 Enlarged 11Linferior lymph node. Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 8 Lung adenocarcinoma. a)Haematoxylin/Eosin (H/E) stain in cell block preparation of the lung tumor, revealed aggregations of large neoplastic cells (magnification x 100). b) Their cytoplasm varied in size and enclosed polymorphous nucleus. The cytoplasm was amphophilic (magnification x 100). c) Papanikolaou stain in lymph node aspiration with neoplastic cells similar of those in lung tumor. The nucleus was enlarged with conspicuous nucleoli (magnification x 400). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 9 Immunostains in lung adenocarcinoma. a) Strong cytoplasmic positivity for CK7 immunostain of neoplastic cells in cell block preparation (magnification x 100). b) atypical adenoid structures were positive for CK 7 (magnification x 100). c, d) the majority of neoplastic cells performed nuclear positivity for TTF-1 (magnification x 200). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 10 Subcarinal lymph node 22mm. Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 11 Subcarina lymph node aspiration and cell block preparation. a) Haematoxylin/Eosin (H/E) stain in cell block of lymph node material contained numerous lymphoid aggregates (magnification x 40). b) in high power view (magnification x 400) the lymphoid cells were small in size with convoluted or “gyroid” nucleus and abundant clear cytoplasm. c,d) after conventional cytological preparation (Papanikolaou stain) the lymphoid cells were uniform with basophilic dark nucleus (magnification x 200, x 400). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 12 Immunohistochemistry for CD3, CD20 in cell block material. a)The majority of lymphoid cells were of T-cell origin and strongly positive for CD3, b) while CD20 positive lymphocytes (B cells) were practically absent (magnification x 200). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 13 Immunohistochemistry for CD56, synaptophysin and CK7 in cell block material a)Immunostain for CD56, b) synaptophysin and c) CK7 were negative (magnification x 200). Upper right sided inserts are external positive controls for the above markers. Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 14 Large mass surrounding the trachea. Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 15 Paratranchea tumor. a, b) Cell block contained abundant stroma, haemorages areas, inflammatory cells and follicular structures in variable size and configuration (magnification x 100). c) the epithelial cells were uniform in size, cuboidal with amphophilic cytoplasm and lumens contained an eosinophilic amorfous material resembling colloid (magnification x 400) which was also exaggerated in the surrounding matrix (d) (magnification x 100). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 16 Cytological aspiration and immunohistochemistry. a) Well formed follicular structures were also found in cytological aspiration (PAP stain, magnification x 100), b) as well as numerous macrophages with abundant haemosidinin granules in their cytoplasm (arrows, magnification x 100). In serial sections of the cell block tissue, the same follicular structures were both positive for (c) anti-thyreosphairin protein and (d) TTF-1 (magnification x 100). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 17 CT of the thorax with a large mass ≥10cm. Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 18 Thymoma. a) Cell block section of EBUS guided aspiration of a paratrachea lump, revealed matrix-riched and haemorragic background with small-medium sized neoplastic cells in substance organoid formations (magnification x 400, b) the neoplastic groups bordered with thick tissue septae (magnification x 100) and (c) constituted of cells with medium sized cytoplasm and epithelial-like features with small lymphocytes between them (magnification x 600), d) these epithelial-like cells were thymocytes and exhibited positivity for CD 117 and e) CKAE1/AE3 (magnification x 600). Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 19 On the left lymph node station number 7 and on the right, PET-CT with lymphadenopathy of the mesothorax (lymph nodes ≤3cm. Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions

Fig. 20 Non-necrotizing granulomas. Respiratory Medicine Case Reports 2017 22, 187-196DOI: (10.1016/j.rmcr.2017.08.016) Copyright © 2017 The Authors Terms and Conditions