Pulmoner karsinosarkom nadir bir tümör olup tüm pulmoner maligniteler içerisinde yaklaþýk 0,2 ile 0,4 arasýnda görülmektedir. Pulmoner karsinosarkom Dünya Saðlýk Örgütü sýnýflamasýnda “sarkom benzeri element veya sarkomatöz komponent içeren az differansiye küçük hücreli dýþý akciðer kanseri” olarak tanýmlanmýþtýr. Ýleri evre primer pulmoner karsinosarkom saptanan 46 yaþýndaki erkek olguyu sunuyoruz.

Pulmonary carcinosarcoma (PCS) is a rare tumor, that comprises approximately 0.2% to 0.4% of all pulmonary neoplasms.
PCS was defined in the World Health Organization classification as "poorly differentiated non-small cell lung carcinomas containing a sarcoma-like element or sarcomatous component". Presently, described is case of a 46-year-old male who presented with advanced primary PCS.

Rekküren respiratuar papillomatozis Human Papilloma Virus'ün neden olduðu nadir bir hastalýktýr. Hastalýk solunum yollarýnda siðil benzeri squamoz lezyonlarla karakterizedir. Sunduðumuz olgu 24 yaþýnda kafkas ýrkýndan bir erkek olup rekküren trakeobronþial papillomatozis saptanmýþtýr. Olguya 1,5 yaþýnda iken laringoskopi yapýlmýþ ve lezyon eksize edilerek taný konulmuþtur. Biyopsi materyali squamoz hücreli papilloma olarak raporlanmýþtýr. Olgu daha önce interferon α-2a ve inhaler interferon tedavisi almýþ fakat semptomlarda duraklama veya gerileme olmamasý nedeniyle sonlandýrýlmýþtý. Hastaya 3 yýldýr her 3 ile 4 ayda bir papilloma eksizyonu yapýlmaktadýr.

Recurrent respiratory papillomatosis is a rare respiratory condition associated with human papillomavirus. It is characterized by exophytic, wart-like, squamous lesions within the respiratory tract. Presently described is case of a 24-year-old Caucasian male who presented with recurrent laryngotracheal papillomatosis. Laryngoscopy and excisional biopsy had been performed at approximately 1½ years of age. Biopsy specimen was determined to be squamous cell papilloma. The patient received interferon alpha-2a and inhaled interferon, but treatment was discontinued due to lack of regression or delay in reappearance of symptoms. Rigid bronchoscopy has been performed for recurrent papilloma excision approximately every 3 to 4 months for 3 years.

Tüberküloz tüm Dünya’da önemli bir mortalite nedeni olmaya devam etmektedir. Antitüberküloz tedavi sýrasýnda kullanýlan ilaçlarla, allerjik veya non-allerjik reaksiyonlar þeklinde yan etkiler ortaya çýkmaktadýr. Ciddi reaksiyonlar nadir görülmekle beraber, ilaca baðlý cilt reaksiyonlarý antitüberküloz ilaçlarýn en sýk görülen yan etkileridir. Burada, ilk seçenek antitüberküloz ilaçlarýn tümüne karþý fiks ilaç döküntüsü olan akciðer tüberkülozlu 34 yaþýndaki erkek olguyu sunuyoruz. Antitüberküloz ilaçlarýn alýmýndan sonra hastanýn tüm vücudunda çok sayýda erozyon ve kabarcýklar oluþtu. Cilt biyopsisi yapýldý ve sonucu epidermal ve sub-epidermal büller olarak tanýmlandý. Hastanýn durumu aðýr hiposemi nedeniyle kötüleþmeye baþladý. Ne yazýk ki, fiks ilaç döküntüsü tedavisi sýrasýnda hasta vefat etti.

Tuberculosis (TB) is still one of the leading causes of mortality worldwide. Treatment with anti-TB drugs sometimes results in side effects for patients, including drug reactions, both allergic and non-allergic. Cutaneous adverse drug reaction is the most common side effect of anti-TB drugs, but severe reaction is rare. Here, we report rare case of a 34-year-old male who presented with pulmonary TB and fixed drug eruption to all first-line anti-TB therapies. After ingesting anti-TB regimen, multiple skin erosions and blisters occurred. Skin biopsy was performed and result was epidermis with subepidermal bullous. The patient’s condition deteriorated, he developed severe hypoxemia, and unfortunately, he died during fixed drug eruption treatment.

Sarkoidoz ve tüberküloz farklý etyoloji ve tedaviye sahip ancak klinik ve histolojik olarak birbiri ile sýkça karýþan hastalýklardýr. Tüberküloz ve sarkoidoz birlikteliði nadirdir. Burada mikrobiyolojik ve histopatolojik olarak kanýtlanmýþ tüberküloz ve sarkoidoz birlikteliði olan olgu sunulmaktadýr.

Tuberculosis (TB) and sarcoidosis are granulomatous diseases with different etiologies and management; however, they have similar clinical and histological characteristics. Coexistence of TB and sarcoidosis is extremely rare. Presently described is a case of coexistence of pulmonary tuberculosis and sarcoidosis confirmed microbiologically and histopathologically.

Granülomatöz hastalýklar ülkemizde oldukça sýk görülmektedir. Tüberküloz ve sarkoidoz bu hastalýklar içerisinde en baþta gelenlerdir. Tüberküloz sýklýkla akciðerleri tutmasýna raðmen bazý olgularda mediastinal lenf tutulumu þeklinde de ortaya çýkmaktadýr. Sarkoidoz ise sýklýkla mediastinal ve hiler lenfadenopatiler þeklinde karþýmýza çýkmaktadýr. Bu makalede PET-BT incelemelerinde mediastinal maligniteyi taklit eden, yüksek düzeyde F-18 FDG tutulumu olan granülamatöz lenfadenit olgularýný sunmayý amaçladýk. Kliniðimize PET-BT görüntülerinde patolojik FDG tutulumu olan mediastinal LAP nedeniyle üç hasta baþvurdu. Hastalarýn ikisinde öksürük ve nefes darlýðý þikayeti, birisi meme kanseri, uterus kanseri ve tiroit kanserinden ameliyat edilmiþti. Ýki olgunun videomediastinoskopik lenf nodu biyopsi sonucu kazeifiye granülomatöz iltihabi olay olarak rapor edildi. Nefes darlýðý nedeniyle tetkik edilen hastanýn PET-BT'de subkarinal lenf nodu ve sol interlober lenf nodlarýnda patolojik FDG tutulumu izlendi. Bu olgunun videomediastinoskopik lenf nodu biyopsi sonucu non-kazeifiye granülomatöz iltihabi olay olarak rapor edildi. Ülkemizde tüberküloz ve sarkoidoz gibi granülamatöz hastalýklar yanlýþ pozitif FDG PET nedenleri arasýnda en sýk görülenlerdir. Olgularýmýzdaki gibi yüksek FDG tutulumu olanlarda maligniteyi ekarte edebilmek için doku biyopsisi gereklidir.

Granulomatous diseases are quite common in our country; tuberculosis (TB) and sarcoidosis are the most common. TB mostly involves the lungs; however, in some cases, it may involve the mediastinal lymph nodes. Sarcoidosis, on the other hand, often reveals itself as mediastinal or hilar lymphadenopathy (LAP). Presently described are cases of granulomatous lymphadenitis that mimicked mediastinal malignancy in positron emission tomography-computed tomography (PET-CT) scanning and had high fludeoxyglucose (FDG) uptake. Three patients whose PET-CT scans revealed pathological FDG uptake due to mediastinal LAP were admitted to our clinic. Two had cough and dyspnea, and third had operated breast cancer, uterine cancer, and thyroid cancer. Videomediastinoscopic biopsies of 2 patients were reported as caseating granulomatous inflammation. In patient who was examined for dyspnea, PET-CT revealed pathological FDG uptake in subcarinal lymph nodes and the left interlobar lymph nodes. Videomediastinoscopic lymph node biopsy of this patient was reported as non-caseating granulomatous inflammation. Granulomatous diseases, such as TB and sarcoidosis, are the most common cause of false-positive FDG PET scans in our country. In cases with high FDG uptake, tissue biopsy can exclude malignancy.

Pulmoner sekestrasyonlar (PS) nadir görülen konjenital malformasyonlar olup çocuklarda fetal ultrason ve eriþkinlerde bilgisayarlý tomografi ile tipik olarak taný almaktadýrlar. PS’nin potansiyel komplikasyonlarý tekrarlayan solunum yolu infeksiyonlarý, hemoraji, kalp yetmezliði ve solunumsal yetmezliklerdir. Önerilen tedavi cerrahi rezeksiyondur. Bu makalede intralober PS tanýsý konmuþ 20 yaþýnda erkek olgu tartýþýldý.

Pulmonary sequestration (PS) is rare congenital lung malformation typically diagnosed with fetal ultrasound or computed tomography scans. Potential complications of PS include recurrent respiratory infections, hemorrhage, heart failure, and respiratory distress. Recommended treatment is surgical resection. Presently described is case of a 20-year-old male diagnosed with intralobar PS.

Kedi týrmýðý hastalýðý, baðýþýklýk sistemi normal kiþilerde, giriþ yerinin drene olduðu lenf düðümlerinde kronik inflamasyonla seyreden bir infeksiyondur. Baðýþýklýk sistem baskýlanmýþ olan hastalarda ensefalit, nöroretinit, granülomatöz konjunktivit, hepatosplenik tutulum, pnömoni ve trombositopenik purpura gibi klinik tablolar þeklinde de ortaya çýkabilir. Elli yaþýnda kadýn hasta öksürük, ateþ, eklem aðrýsý nedeni ile deðerlendirildi. Özgeçmiþinde dört yýl önce karaciðer kist hidatiði nedeni ile operasyon ve romatoid artrit nedeni ile bir yýldýr deltakortil kullanýmý mevcuttu. Toraks tomografisinde sað alt lob superiyor ve üst lobta nodul saptandý. Laboratuvar incelemesinde lökositoz dýþýnda anormallik saptanmadý. Balgam aerob kültür ve ARB incelemesi negatif olarak saptandý. Hastaya tanýsal VATS uygulandý. Patoloji sonucu granülomlar içinde polimorf nüveli lokositler, tbc ve sarkoidoz dýþý granülomatöz hastalýk ön planda kedi týrmýðý hastalýðý olarak raporlandý.

Cat-scratch disease (CSD) is an infectious disease, presenting with chronic inflammation of lymph nodes that drain the portal of entry of the causative organism in immunocompetent persons. It may also manifest as encephalitis, neuroretinitis, granulomatous conjunctivitis, hepatosplenic involvement, or pneumonia and thrombocytopenic purpura in immunocompromised patients. A 50-year-old, previously healthy woman was evaluated for symptoms of cough, fever, and arthralgia. She had history of surgery for hydatid cyst (liver) 4 years earlier and 1 year of Deltacortril use for rheumatoid arthritis. Nodular formations were observed in the right anterior upper lobe, right middle lobe, and right inferior posterobasal lobe on chest tomography image. Laboratory analysis revealed no abnormal findings except leukocytosis. Aerobic culture and EZN staining of sputum were negative. The patient underwent diagnostic video-assisted thoracoscopic surgery. Pathological results were reported as granulomatous disease, excluding tuberculosis and sarcoidosis, and indicating likely CSD, presenting with polymorphonuclear leukocytes in the granulomas.

Kist hidatik (KH), dünya çapýnda tahminen 1,2 milyon insaný etkileyen sestod Echinococcus granulosus'un neden olduðu kronik, kompleks ve ihmal edilen zoonotik bir enfeksiyondur. Vertebral tutulum endemik bölgelerde bile tüm KH hastalarýn %1’den daha azýný etkileyen nadir bir durumdur. Taný ve tedavisi oldukça zordur. Bu nedenle “Beyaz kanser” olarak adlandýrýlmýþtýr. Bütün cerrahi ve medikal tedavilere raðmen rekürrens oraný %40–100 arasýnda ve ortalama süreside 30 aydýr. Bölgenin anatomik ve fizyolojik özelliklerinden kaynaklanan güçlüklerde eklenince hastalarýn tedavileri daha da zorlaþmaktadýr. Klinisyen tedavi ve hastalýk arasýnda kýsýr bir döngünün içine girmektedir. Hem cerrahi hem de medikal açýdan rekürrensi engelleyecek; kýsýr döngüyü kýracak yeni yöntemler ve özellikle santral sinir sistemine daha iyi penetre olan ilaçlara ihtiyaç duyulmaktadýr. Burada spinal kanala uzaným gösteren Vertebral KH olgusunu sunduk.

Hydatid disease (HD), or echinococcosis, is a complex, chronic, neglected zoonotic disease caused by cestodes of the genus Echinococcus. The infection is found worldwide affects an estimated 1.2 million people. Vertebral involvement is rare, affecting less than 1% of all HD patients, even in endemic regions. Diagnosis and treatment of osseous HD is quite challenging; it is also called “white cancer.” Despite surgical and medical treatment, recurrence ratio for HD is 40% to 100% within average of 30 months. Challenges arising from anatomical and physiological features in cycle of treatment and recurrence can be frustrating for clinicians. New methods, particularly medications that can better penetrate the central nervous system, are needed to prevent recurrence. Presently described is a case of vertebral HD penetrating the spinal canal.

Elli altý yaþýnda kadýn hasta üç yýldýr devam eden göðüs aðrýsý, nefes darlýðý ve göðsünün sað tarafýnda þiþlik yakýnmalarý ile baþvurdu. Akciðer grafisinde ve bilgisayarlý toraks tomografisinde sað akciðerde 16X13X12 cm ebadýnda kitle lezyonu görüldü. Hastaya sað torakotomi uygulandý. Kitle mediastinal plevradan kaynaklanýyordu. Tümör parçalanarak çýkarýldý. Makroskopik olarak tümör sert, düzensiz yüzeyli, beyaz-sarý renkte bir kitle idi. Histolojik olarak olarak belirgin hücresel nekroz ve mitotik aktivitesi olmayan düz kas liflerinden oluþuyordu. Amacýmýz çok nadir görülen plevral kaynaklý leimiyomanýn malignite potansiyelinden dolayý çýkarýlmasý gerektiðini vurgulamaktýr.

A 56-year-old female patient presented with chest pain and shortness of breath ongoing for 3 years. Chest X-ray and computed tomography of the thorax revealed mass 16 x 13 x 12 cm in size in the right middle and lower lobes. Right posterolateral thoracotomy was performed. According to frozen biopsy, mass was determined to be degenerative leiomyoma. Histopathologically, tumor consisted of packets and bundles of smooth muscle fibers without significant cellular necrosis or mitotic activity. Macroscopic appearance of the tumor was white-yellow color and texture was very hard. Due to size and location, tumor was removed with 2 incisions. Aim of this report was to emphasize the need for removal of leiomyoma due to malignant potential of pleural origin.

Kombine pulmoner fibrozis ve amfizem sendromu (KPFA), kendine özgü klinik bulgularý olan ve radyolojik olarak üst lob amfizemi ve alt lob fibrozisi ile karakterize yeni tanýmlanan bir sendromdur. Hastalýk iyi bilinmediði için yeterince taný konulamamaktadýr. Progresif nefes darlýðý þikayetiyle baþvuran, 60 paket/yýl sigara öyküsü olan erkek hastanýn çekilen toraks tomografisinde KPFA sendromuna özgü üst loblarda amfizem ve alt loblarda fibrozis izlendi. Hastalýðýn bir diðer önemli özeliði olarak FEV1 kýsmen korunmuþ, DLCO ise oldukça düþük bulundu. hastada pulmoner hipertansiyon saptandý. Tüm bulgularýyla KPFA sendromu tanýsý konulan olgu, bu sendromuna dikkat çekmek için literatür eþliðinde sunuldu.

Combined pulmonary fibrosis and emphysema syndrome (CPFE) is a newly defined syndrome with unique clinical findings, characterized by presence of emphysema and pulmonary fibrosis seen radiologically. Since awareness of the syndrome is insufficient, CPFE is under-recognized. Male patient presented with progressive dyspnea and history of smoking 60 packs per year. Upper lobe emphysema and lower lobe fibrosis, which are specific for CPFE syndrome, were observed in chest computed tomography scans. Forced expiratory volume 1 was relatively well preserved, but diffusing capacity of the lungs for carbon monoxide was very low, and is an important feature of the disease. Pulmonary hypertension has also been determined to be characteristic finding of the syndrome. Patient was diagnosed as CPFE syndrome based on presence of all characteristic features and case is presented with review of the literature to draw attention to this disease.

Akciðerler, küçük hücreli dýþý akciðer kanserlerin sýklýkla metastaz yaptýðý organlardýr. Akciðer metastazlarý görüntüleme bulgularý, pulmoner nodül, plevral effüzyon ve lenf nodu geniþlemesi þeklinde olabilir. Ancak akciðer kanserlerinin miliyer daðýlýmý çok nadirdir. Erlotinib'e iyi yanýt veren miliyer daðýlým ile seyreden bir adenokarsinom olgusu sunuldu.

The lungs are frequently metastatic organs for non-small cell lung cancer, and lung metastasis may present with several different patterns on chest radiography, including multiple pulmonary nodules, pleural effusion, and hilar or mediastinal adenopathy. However, lung cancer with miliary intrapulmonary carcinomatosis is an uncommon phenomenon. Presently described is a case of miliary intrapulmonary carcinoma that responded well to erlotinib treatment.

Paraquat, tarýmda yaygýn kullanýlan ve akciðerlerde birikimi sonucu ilerleyici pulmoner fibrozise neden olan toksik özelliði yüksek bir herbisiddir. Paraquat intoksikasyonunda birkaç gün içinde çoklu organ yetmezliði veya birkaç hafta içinde pulmoner fibrozise baðlý solunum yetmezliði sonucu ölüm geliþebilir. Veno-venöz ekstrakorporeal membran oksijenasyonu(V-V ECMO) günümüzde akut solunum sýkýntýsý sendromunda(ARDS) yaygýn olarak uygulanan bir tedavi stratejisidir. Bu yazýda ARDS tanýsý ile yatýrýlan ve tedavi sürecinde V-V ECMO kullanýlan bir olguyu sunduk. ECMO desteðine raðmen yeterli oksijenasyona ulaþýlamayan ve ECMO’ya baðlý hipoksi nedenleri dýþlanan olguda, tekrar sorgulanan týbbi öyküsü sonucu üç hafta önce paraquata maruziyet olduðu saptandý. V-V ECMO desteðine raðmen hipoksi devam eden olgu, yoðun bakýma yatýþýnýn 6. günü kaybedildi. Bu olgu aracýlýðý ile V-V ECMO sýrasýnda dirençli hipoksinin nedenlerini gözden geçirmeyi amaçladýk.

Paraquat is a highly toxic herbicide used in agriculture worldwide that causes progressive pulmonary fibrosis (PF) due to selective accumulation in the lungs. Paraquat intoxication can result in death due to multi-organ failure within a few days or respiratory failure due to PF within a few weeks. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is currently a widely used therapeutic strategy for acute respiratory distress syndrome (ARDS). Presently described is case of a 46-year-old man who was hospitalized with ARDS and treated with V-V ECMO. Expected oxygenation levels could not be attained despite ECMO support. When excluding causes for hypoxia in this patient on ECMO, detailed medical history revealed exposure to paraquat 3 weeks previously. Severe hypoxemia persisted during V-V ECMO and the patient died on sixth day after admission. The aim of this study was to examine probable causes of persistent hypoxemia during V-V ECMO observed in this case.

Sarkoidoz idiyopatik multisistemik granülomatöz bir hastalýktýr. En sýk akciðerleri tutar. Biz nadir ve genellikle asemptomatik karaciðer tutulumu olmayan nodüler splenik sarkoidozlu bir olguyu sunduk. Otuz bir yaþýndaki erkek hasta; öksürük, balgam ve nefes darlýðý þikâyetleriyle kliniðimize baþvurdu. Sarkoidozun yaygýn sistemik bulgularýndan hiçbirine rastlanýlmadý. Toraks ve batýn BT incelenmesinde çok sayýda hipodens mediastinal lenf nodlarý ve dalak tutulumu vardý. Baþka intra-abdominal patoloji veya periferik lenfadenopati saptanmadý. Mediastinoskopi yapýldý. Tanýsý histopatolojik olarak doðrulandý. Týbbi tedaviden sonra þikâyetleri azaldý. Nodüler splenik tutulumu nadirdir. Sarkoidozun; multiple karaciðer ve splenik tutulumu olan otuz dokuz olgu rapor edilmesine raðmen, sadece üç izole nodüler splenik tutulum literatürde bildirilmiþtir. Nadirliði nedeniyle ekstrapulmoner sarkoidoz önemli morbidite ve mortaliteye neden olabilir. Bu nedenle, karaciðer tutulumu olmayan nodüler splenik sarkoidozun, belirtileri, tanýsý ve klinik seyrine dikkat çekmek amacýyla bu olguyu sunduk.

Sarcoidosis is an idiopathic, multi-systemic, granulomatous disease. It most commonly involves the lungs. Herein, we present a rare and usually asymptomatic case with splenic sarcoidosis without liver involvement. A 31-year-old male patient was admitted to our clinic with cough, sputum, and shortness of breath. He reported no common systemic complaints of sarcoidosis. Thoracic and abdominal computed tomography showed multiple hypodense mediastinal lymph nodes with splenic involvement. No other intra-abdominal pathology or peripheral lymphadenopathy was detected. Mediastinoscopy was performed. Diagnosis was made histopathologically. Following the treatment, his complaints regressed. Nodular splenic involvements are uncommon. Although there have been reported thirty-nine cases of sarcoidosis with multiple nodular hepatic and splenic lesions, only three isolated splenic cases have been reported in the literature to date. Despite its rarity, extra-pulmonary sarcoidosis may cause significant morbidity and mortality. Therefore, we discuss this case to draw attention to splenic sarcoidosis without liver involvement and its manifestations, diagnosis, and clinical course.

Fotodinamik tedavi (FTD), illüminasyon için kullanýlan diyot lazer ile aktive edilen fotosensitizör ilacýn hastaya verildiði bir tedavi yöntemidir. Erken evre ve endobronþiyal kritik darlýðý olmayan ileri akciðer kanserlerinin tedavisinde kullanýlmaktadýr. FDT uygulamasý, etkinliði, komplikasyonlarý ve endikasyonlarý kýsaca anlatýlmýþtýr.

Photodynamic therapy (PDT) is a method of treatment in which photosensitizer drug is administered to the patient and activated by diode laser used for illumination. It is used for treatment of advanced lung cancer without endobronchial critical stenosis and for early stage lung cancer. PDT application, efficacy, complications, and indications are briefly explained.