8 mm biopsy forceps www.selleckchem.com/products/DAPT-GSI-IX.html included in the K-203 Guide Sheath Kit (Olympus). We underscore the importance of using this biopsy forceps, particularly for pure GGO, to preserve the structural integrity of the tissues. We suppose that doing so would facilitate a more comprehensive histopathologic examination of the ground glass tissue sample, especially for identifying AIS or MIA, which often exhibit weak cellular atypia.
Most physicians commonly use small guide sheath kit (K-201) when approaching peripheral lesions but from our experience it often fails to provide adequate amount of tissues. A usual 1.8 mm biopsy forceps with large guide sheath (K-203) is favored in obtaining the desired quality of specimens compared to the small one. In conclusion, Blizzard Sign on EBUS was found to be useful for detecting GGO, especially the pure type, during bronchoscopy even if the lesion was not visualized by fluoroscopy. This study was approved by the hospital’s Institutional Review Board and Ethics Committee; informed consent was sought from the patients. We thank Koji Tsuta and Yukio Watanabe for pathological examinations. This work was supported by The National Cancer Center Research and Development Fund (25-A-12). “
“A 50 year-old immunosuppressed Caucasian female presented to her primary care physician’s office
with a dry cough. Her past medical history was significant for simultaneous kidney and pancreas transplant
in May 2010 for type I diabetes selleck chemical mellitus and end-stage renal disease on hemodialysis. She was placed on tacrolimus, prednisone, and mycophenolate mofetil for immunosuppression. Her post-transplant course was unremarkable except for an episode of acute calculous cholecystitis in October 2010 which was treated with intravenous antibiotics for 6 weeks and to then a laparoscoptic cholecystectomy. She developed a nonproductive cough in late March 2011 and was treated with amoxicillin-clavulanate 875 mg twice a day, for a total of 14 days. She denied any fever, chills or hemoptysis. Her cough resolved at day 4 of treatment. A follow-up chest X-ray (CXR) revealed a 3 cm rounded mass in the right upper lobe medially which was new when compared to a prior from October 2010. A computed tomography (CT) of the chest from April 5th showed a 2.6 by 1.5 cm irregularly shaped, medially located mass in the right upper lobe (RUL) medially which corresponded to the abnormality on the CXR. (Picture 1) The CT scan of the chest also showed a noncalcified 10 mm by 6 mm nodule in the right lower lobe along with multiple calcified nodules in both lungs along with calcified adenopathy. Due to the high probability of an infectious etiology and the central location of the mass, it was decided to obtain the sample via bronchoscopy.